Americans Are Using More Alternative Pain Therapies

By Pat Anson, PNN Editor

It’s fair to say that almost every person living with chronic pain has been told by a doctor, loved one, friend or even strangers that they should try a “complimentary health approach” to pain management. Also known as a “multimodal” or “comprehensive” care, the idea is to get pain patients to reduce or stop using opioids and other medications by utilizing alternative health therapies such as massage, meditation and acupuncture.

A new study shows that there has been surge in the use of those therapies by Americans over the last two decades, with chronic pain sufferers leading the way.   

Researchers at the National Institutes of Health looked at data from the 2002, 2012, and 2022 National Health Interview Survey (NHIS) to evaluate the use of seven alternative therapies: yoga, meditation, massage, chiropractic care, acupuncture, naturopathy, and guided imagery/progressive muscle relaxation.

Their findings, published in JAMA Network Open, show significant increases in the use of all seven therapies. The most widely used alternative therapy was meditation, which rose from 7.5% of respondents in 2002 to 17.3% in 2022.The largest increase in utilization was for yoga, which rose from 5% of respondents in 2002 to 15.8% in 2022.

Complimentary Health Approaches Used by U.S. Adults

NATIONAL INSTITUTES OF HEALTH

By 2022, over a third of respondents (36.7%) reported using at least one complimentary health approach (CHA), up from 19.2% in 2002. Nearly half said they used a CHA for pain management.

The CHAs most widely used for pain in 2022 were chiropractic care (85.7%) and acupuncture (72.8%). Researchers think that expanded insurance coverage for those treatments may have contributed to their growing use. Significant reductions in opioid prescribing over the last decade may have also driven people to try other treatments.  

Complimentary Health Approaches Used for Pain

NATIONAL INSTITUTES OF HEALTH

“Between 2002 and 2022, US adults increasingly used CHAs, including for pain management. This shift in utilization coincides with increased pain prevalence nationally and may be attributable to several factors, including randomized clinical trials suggesting that some CHAs provide low to moderate levels of pain management, incorporation of CHAs into best practice pain management guidelines, and the need to mitigate unnecessary use of potentially harmful opioids through use of nonopioid interventions,” wrote lead author Richard Nahin, PhD, lead epidemiologist at the National Center for Complementary and Integrative Health.

As with many of these data mining studies, the NIH researchers did not document what kind of pain conditions the respondents had, how often they used an alternative therapy, or even whether the treatment worked.  

According to one estimate, 55 million U.S. adults spent $28.3 billion on CHAs in 2012, about 9% of total out-of-pocket health care expenses that year.

Only 1 in 7 Chronic Pain Patients Use Opioids

By Pat Anson, PNN Editor

Have you tried physical therapy? What about yoga or Tai Chi? Did massage help you feel better?

Just about everyone in chronic pain has been asked that by family members, friends, doctors and sometimes even complete strangers.  The questions are innocent enough and usually well-meaning, but they often imply that a pain sufferer hasn’t looked beyond opioids for pain relief.

A new study shows that most people with chronic pain make extensive use of non-opioids and other “alternative” pain treatments – and that it’s relatively rare for a patient to only use opioids for pain relief.

The findings, published in JAMA Network Open, are based on answers to the 2019 National Health Survey by nearly 32,000 U.S. adults with chronic pain. The 2019 survey was the first to ask people about their use of 11 pain management techniques during the previous three months.

It turns out most people with chronic pain (54.7%) only used non-opioid pain management. And nearly a third (30.2%) used no pain therapy whatsoever. The rest either used opioids alone (4.4%) or a combination of opioids with one or more alternative treatments (10.7%).

That means only about 1 in every 7 adults with chronic pain even use opioids – a startling number when you consider the constant harping from anti-opioid activists and public health officials about how opioids are “overprescribed” in the U.S.   

“This study found that adults with chronic pain in the US use a variety of pain management techniques, including opioids,” wrote lead author Cornelius Groenewald, MB, a pediatric anesthesiologist and associate professor at the University of Washington School of Medicine. “Nonpharmacologic and nonopioid pharmacologic therapies are preferred treatments for chronic pain, and it is encouraging to note that most adults with chronic pain use a combination of various nonopioid modalities for treatment.”

Alternative Chronic Pain Therapies Used in 2019

• 18.8% Physical Therapy

• 17.6% Massage

• 15.6% Meditation or Relaxation Techniques

• 11.6% Spinal Manipulation or Chiropractic Care

• 8.5% Yoga or Tai Chi

• 5.1% Pain Self-Management Workshops

•  3.8% Psychological or CBT Therapy

• 1.8% Peer Support Group      

Nearly 40% of chronic pain sufferers reported using other therapies that were not listed in the survey. That may include treatments such as cannabis, kratom, medical devices, acupuncture or even ice packs. It would be good to include more of those options in future surveys.

Groenewald and his colleagues were disappointed that so few people used psychological techniques such as cognitive behavioral therapy (CBT), which was the only alternative pain therapy that they said was “underused.”   

The researchers found that complementary, psychological or psychotherapeutic therapies were more likely to be used by younger adults, females and people with more education. Adults using physical, occupational or rehabilitative therapies were more likely to be older, female, highly educated and have medical insurance.

Missouri Finds Managing Pain Without Opioids Isn’t Easy

By Lauren Weber, Kaiser Health News

Missouri began offering chiropractic care, acupuncture, physical therapy and cognitive-behavioral therapy for Medicaid patients in April, the latest state to try an alternative to opioids for those battling chronic pain.

Yet only about 500 of the state’s roughly 330,000 adult Medicaid users accessed the program through December, at a cost of $190,000, according to Josh Moore, the Missouri Medicaid pharmacy director. While the numbers may reflect an undercount because of lags in submitting claims, the jointly funded federal-state program known in the state as MO HealthNet is hitting just a fraction of possible patients so far.

Meanwhile, according to the state, opioids were still being doled out: 109,610 Missouri Medicaid patients of all age groups received opioid prescriptions last year.

The going has been slow, health experts said, because of a slew of barriers. Such treatments are more time-consuming and involved than simply getting a prescription.

A limited number of providers offer alternative treatment options, especially to Medicaid patients. And perhaps the biggest problem? These therapies don’t seem to work for everyone.

The slow rollout highlights the overall challenges in implementing programs aimed at righting the ship on opioid abuse in Missouri — and nationwide. To be sure, from 2012 to 2019, the number of Missouri Medicaid patients prescribed opioid drugs fell by more than a third — and the quantity of opioids dispensed by Medicaid dropped by more than half.

Still, overdoses linked to legal and illicit opioids killed an estimated 1,132 Missourians in 2018 and 46,802 Americans nationally, according to the latest data available. Progress to change that can be frustratingly slow.

“The opioids crisis we got into wasn’t born in a year,” Moore said. “To expect we’d get perfect results after a year would be incredibly optimistic.”

Despite limited data on the efficacy of alternative pain management plans, such efforts have become more accepted, especially following a summer report of pain management best practices from the U.S. Department of Health and Human Services. States such as Ohio and Oregon see them as one part of a menu of options aimed at curbing the opioid crisis.

St. Louis chiropractor Ross Mattox, an assistant professor at chiropractic school Logan University, sees both uninsured patients and those on Medicaid at the CareSTL clinic. He cheered Missouri’s decision to expand access, despite how long it took to get here.

“One of the most common things I heard from providers,” he said, “is ‘I want to send my patient to a chiropractor, but they don’t have the insurance. I don’t want to prescribe an opioid — I’d rather go a more conservative route — but that’s the only option I have.’”

And that can lead to the same tragic story: Someone gets addicted to opioids, runs out of a prescription and turns to the street before becoming another sad statistic.

“It all starts quite simply with back pain,” Mattox said.

Practical Barriers

While Missouri health care providers now have another tool besides prescribing opioids to patients with Medicaid, the multistep approaches required by alternative treatments create many more hoops than a pharmacy visit.

The physicians who recommend such treatments must support the option, and patients must agree. Then the patient must be able to find a provider who accepts Medicaid, get to the provider’s office even if far away and then undergo multiple, time-consuming therapies.

The effort and cost that go into coordinating a care plan with multiple alternative pain therapies is another barrier.

“Covering a course of cheap opioid pills is different than trying to create a multidisciplinary individualized plan that may or may not work,” said Leo Beletsky, a professor of law and health sciences at Northeastern University in Boston, noting that the scientific evidence of the efficacy of such treatments is mixed.

And then there’s the reimbursement issue for the providers. Corry Meyers, an acupuncturist in suburban St. Louis, does not accept insurance in his practice. But he said other acupuncturists in Missouri debate whether to take advantage of the new Medicaid program, concerned the payment rates to providers will be too low to be worthwhile.

“It runs the gamut, as everyone agrees that these patients need it,” Meyers stressed. But he said many acupuncturists wonder: “Am I going to be able to stay open if I take Medicaid?”

Structural Issues 

While helpful, plans like Missouri’s don’t address the structural problems at the root of the opioid crisis, Beletsky said.

“Opioid overutilization or overprescribing is not just a crisis in and of itself; it’s a symptom of broader structural problems in the U.S. health care system,” he said. “Prescribers reached for opioids in larger and larger numbers not just because they were being fooled into doing so by these pharmaceutical companies, but because they work really well for a broad variety of ailments for which we’re not doing enough in terms of prevention and treatment.”

Fixing some of the core problems leading to opioid dependence — rural health care “deserts” and the impact of manual labor and obesity on chronic pain — requires much more than a treatment alternative, Beletsky said.

And no matter how many alternatives are offered, he said, opioids will remain a crucial medicine for some patients.

Furthermore, while alternative pain management therapies may lessen opioid prescriptions, they do not address exploding methamphetamine addiction or other addiction crises leading to overdoses nationwide — even as a flood of funds pours in from the national and state level to fight these crises.

“Prescribers reached for opioids in larger and larger numbers not just because they were being fooled into doing so by these pharmaceutical companies, but because they work really well for a broad variety of ailments.”

— Dr. Leo Beletsky, Northeastern University

The Show-Me State’s refusal to expand Medicaid coverage to more people under the Affordable Care Act also hampers overall progress, said Dr. Fred Rottnek, a family and addiction doctor who sits on the St. Louis Regional Health Commission as chair of the Provider Services Advisory Board.

“The problem is we relatively cover so few people in Missouri with Medicaid,” he said. “The denominator is so small that it doesn’t affect the numbers a whole lot.”

But providers like Mattox are happy that such alternative treatments are now an option, even if they’re available only for a limited audience.

He just wishes it had been done sooner.

“A lot of it has to do with politics and the slow gears of government,” he said. “Unfortunately, it’s taken people dying — it’s taken enough of a crisis for people to open their eyes and say, ‘Maybe there’s a better way to do this.’”

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

Many Alternative Therapies for Back Pain Not Covered

By Pat Anson, PNN Editor

A new study by the Johns Hopkins Bloomberg School of Public Health has confirmed what many back pain sufferers already know: Public and private health insurance plans often do not cover non-drug alternative pain therapies.

Bloomberg researchers looked at dozens of Medicaid, Medicare and commercial insurance coverage policies for chronic lower back pain and found that while most plans covered physical therapy and chiropractic care, there was little or no coverage for acupuncture, massage or counseling.

"This study reveals an important opportunity for insurers to broaden and standardize their coverage of non-drug pain treatments to encourage their use as safer alternatives to opioids," says senior author Caleb Alexander, MD, a professor of epidemiology at the Bloomberg School.  

Alexander and his colleagues examined 15 Medicaid, 15 Medicare Advantage and 15 major commercial insurer plans that were available in 16 states in 2017.

Most payers covered physical therapy (98%), occupational therapy (96%), and chiropractic care (89%), but coverage was inconsistent for many of the other therapies.

Acupuncture was covered by only five of the 45 insurance plans and only one plan covered therapeutic massage.

Nine of the Medicaid plans covered steroid injections, but only three covered psychological counseling.

"We were perplexed by the absence of coverage language on psychological interventions," Alexander says. "It's hard to imagine that insurers wouldn't cover that."  

Even for physical therapy, a well-established method for relieving lower back pain, insurance coverage was inconsistent.

"Some plans covered two visits, some six, some 12; some allowed you to refer yourself for treatment, while others required referral by a doctor," Alexander says. "That variation indicates a lack of consensus among insurers regarding what model coverage should be, or a lack of willingness to pay for it.”  

The Bloomberg study is being published online in the journal JAMA Network Open.  It was funded by the U.S. Department of Health and Human Services, National Institutes of Health and the Centers for Disease Control and Prevention.  

Lower back pain is the world’s leading cause of disability, but there is surprisingly little consensus on the best way to treat it. A recent series of reviews by an international team of experts in The Lancet medical journal found that low back pain is usually treated with bad advice, inappropriate tests, risky surgeries and painkillers.

“The majority of cases of low back pain respond to simple physical and psychological therapies that keep people active and enable them to stay at work,” said lead author Rachelle Buchbinder, PhD, a professor at Monash University in Australia. “Often, however, it is more aggressive treatments of dubious benefit that are promoted and reimbursed.”

The authors recommend counseling, exercise and cognitive behavioral therapy as first-line treatments for short-term low back pain, followed by spinal manipulation, massage, acupuncture, meditation and yoga as second line treatments. They found limited evidence to support the use of opioids for low back pain, and epidural steroid injections and acetaminophen (paracetamol) are not recommended at all.

5 DIY Tips to Reduce Lower Back Pain

By Mark El-Hayek, Guest Columnist

Lower back pain is the world's leading cause of disability. Almost all of us will at some point in our lives have to deal with it.

Lower back pain is any form of pain or discomfort in the lower part of the spine, which is known as the lumbar spine. It can be brought about by things like muscle tension, stress, improper diet, lack of exercise, poor posture, excess body weight and pregnancy.

We put together five simple do-it-yourself tips to help reduce lower back pain.

1) Correct Posture

Poor posture is one of the leading causes of lower back pain. Good posture involves sitting, walking, standing and sleeping in ways that do not weaken or over activate your supporting muscles. There are several things you can do to improve posture.

When sitting, avoid sitting on the edge of a chair as this puts a lot of strain on your back. Sit with your back straight and shoulders back.

The same is true for walking. Avoid bending or slouching over while walking. This strains your back and causes lower back pain.

When lying down, get into a position that is comfortable and one that does not compromise the curve in your back.

2) Ice and Heat

For many people, putting ice or something cold on an injured area provides relief from pain. Heat also works well in reducing lower back pain, but the two techniques work very differently.

When you put something cold on your lower back, the cold makes the blood vessels constrict, which reduces the pain caused by inflammation. Heat, on the other hand, relaxes blood vessels and increases blood flow, which helps heal the affected area.

It is advisable that when using ice and heat together, you start by doing the cold compress first and then the hot compress. You can use ice packs or frozen peas for the cold compress. For the hot compress, you can use a hot water bottle or a towel soaked in warm water.

Alternate between the cold and hot compresses for a few minutes and you will notice that your lower back pain has reduced.

3) Exercise

Regular exercise is a good way to prevent lower back pain. Make a point of exercising as often as you can. If you have a job that has you sitting for long hours, integrate exercises and movement into your everyday routine.

Walk to the bathroom or the water cooler a couple of times a day to keep your joints moving and lower back pain at bay. Take the stairs instead of the elevator or escalator to help stay fit.

4) Rest

Lower back pain is often caused by stress. The moment you start feeling back pain, take a couple of hours off to rest. You can start by taking a hot shower to help you relax. The shower will help your blood vessels relax and make oxygen flow freely to your lower back. After the hot shower, rest for a couple of hours and you will probably feel better.

5) Do not stay in bed too long

While resting is important, make sure you do not stay in bed too long. Lying down for an extended period of time, especially when your posture is poor or you do not have a good mattress, could increase your lower back pain. Instead of lying down, go for a slow walk to allow your joints and muscles to move and reduce inflammation.

Mark El-Hayek graduated from Macquarie University in Sydney, Australia with a Masters of Chiropractic and a Bachelor of Medical Science.  He is the head chiropractor and owner of Spine and Posture Care in Sydney.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

The Four C’s That Can Help Lower Pain Levels

By Barby Ingle, Columnist

I hear more than ever from others living with chronic pain that they “have tried everything” and nothing helps. But there are always new pain therapies being developed or improved; some real, some placebo, and some researched more than others. 

I personally don’t believe that there is any one treatment that cures or fixes anyone, but there are many that can help take the edge off the pain we are feeling. I also recognize that some options are not right for some people or contraindicated for certain conditions. There is no one-size-fits-all treatment for chronic pain.

Last month we looked at four alternative therapies that start with the letter “A” (acupressure, acupuncture, aromatherapy and art therapy). This month the spotlight is on four therapies that start with “C” – Calmare, Chinese medicine, chiropractic, and craniosacral therapy. 

Calmare Therapy

Calmare is a relatively new treatment that is becoming more popular. I have tried it myself, and while it was not a long-term useful tool for me, I do know others who have received major benefit and relief from it.

Calmare Therapy, also known as scrambler therapy, is a non-invasive, drug-free solution for neuropathy and other conditions that cause nerve damage. I think of it as TENS unit on steroids. 

Duringtreatment, small electrodes are placed on the skin, which are connected by wires to a box-like device. Electrical pulses are transmitted to the body, like little electric shocks. This can help block pain signals in some people with certain types of chronic pain.

The provider I hear about the most having success with this form of treatment is Dr. Michael Cooney, a chiropractor practicing in New Jersey who sees patients from all over country.

Cooney wrote a guest column about Calmare for PNN a few months ago, where you can learn more about the treatment and how it works.

Chinese Medicine

When people think about Chinese Medicine (CM), many just think of acupuncture, but CM is more than just one modality. It involves a broad range of traditional medicine practices which were developed in China over 2,000 years ago, including various forms of herbal medicine, massage, exercise and dietary therapy.

One of the basic tenets of CM is that the body's vital energy (chi or qi) circulates through channels called meridians, which have branches connected to bodily organs and functions.

CM is being used more and more in American pain treatment as an alternative to Western medical practices. Only six states (Alabama, Kansas, North Dakota, South Dakota, Oklahoma, and Wyoming) do not have legislation regulating the professional practice of CM. 

Be sure to tell all your healthcare providers about any complementary health approaches you use, as it is important to give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care, which is important with more than a million Americans using forms of CM. 

The prices of traditional CM vary, depending on the practitioner and the region. Usually an initial herbal consultation ranges from $30 to $60, and follow-up consultation costs around $30. A month's supply of herbs may cost $30 to $50, but it’s a good value if it helps lower your pain levels, stress and helps regulate your neuro-inflammation.

Chiropractic

Chiropractic care is a harder subject for me. I have had positives and negatives with this treatment and with different practitioners. For the most part, my insurance has covered this type of care, but for many insurance policies it is not covered at all or it only pays for a few appointments a year. 

Chirporactic sessions can range from $34 to $106, depending on where you live, how many areas of the spine the chiropractor services, and whether more extensive exams are required.

This form of alternative care typically treats mechanical disorders of the musculoskeletal system with an emphasis on the spine, although I have had chiropractors adjust my hips, feet and shoulders. 

Chiropractic care is somewhat controversial with mainstream practitioners, including some who believe it is sustained by pseudo-scientific ideas such as subluxation and "innate intelligence" that are not based on sound research. In my own reviews of studies on chiropractic manipulation, I have not found evidence that it is effective long term for chronic pain, except for treatment of back pain.

However, chiropractic care is well established in the U.S. and Canada as a form of alternative treatment. It is often combined with other manual-therapy professions, including massage therapy, osteopathy and physical therapy.

Craniosacral Therapy

Craniosacral therapy (CST) takes a whole-person approach to healing, and the inter-connections of the mind, body and spirit. Practitioners say it is an effective form of treatment for a wide range of illnesses, and encourages vitality and a sense of well-being. Because it is non-invasive, it is suitable for people of all ages, including babies, children and the elderly. 

The intent of CST treatment is to enhance the body's own self-healing and self-regulating capabilities. This is done as the practitioner gently touches areas around the brain and spinal cord, which helps improve respiration and the functioning of the central nervous system. 

CST practitioners say it can help temporarily relieve a vast number of issues, including migraines and headaches, chronic neck and back pain, stress and tension-related disorders, brain and spinal cord injuries, chronic fatigue, fibromyalgia, TMJ syndrome, scoliosis, central nervous system disorders, post-traumatic stress, orthopedic problems, depression, anxiety and grief. 

Treatment costs range between $100 and $200 per session, and patients typically attend multiple times when chronic pain issues are being addressed. Some health insurance policies will cover CST.

Do I believe that CST will take pain away? No. But do I think it is a mindfulness tool that can help temporarily. Did it work for me? No, but it was worth a try since it is non-invasive. 

Again, I am spotlighting alternative therapy ideas that can help lower or reduce chronic pain.. Typical pain patients, including myself, find that it takes a variety of treatments to get pain levels low enough to consider it significant relief. The fact that they are treatments and lifestyle changes – and not cures -- is important to remember. 

I'd like to know if you've tried these methods and if they worked or didn’t work. The more we share our ideas and experiences, the better off others in pain will be in understanding different treatment options. 

Over the next few months I will spotlight more than 70 alternative treatments. Please only try what you are comfortable with and don’t put down others who are willing to try what they are interested in. 

Barby Ingle lives with reflex sympathetic dystrophy (RSD), migralepsy and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain Foundation. She is also a motivational speaker and best-selling author on pain topics. More information about Barby can be found at her website. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Chiropractic Therapy Gives ‘Modest’ Relief to Back Pain

By Pat Anson, Editor

When it comes to treating short-term back pain, spinal manipulation may not be all it’s cracked up to be.

In a review published in JAMA of over two dozen clinical trials involving over 1,700 patients, researchers said chiropractic adjustments provided only “modest” relief for acute low back pain – pain that lasts no more than 6 weeks.

The improvement in pain and function were considered “statistically significant,” but researchers said it was about the same as taking over-the-counter pain relievers. Over half of the patients also experienced side effects from having their spines manipulated, including increased pain, muscle stiffness and headache.

Although the study findings are mixed on the benefits of chiropractic treatment, the American Chiropractic Association (ACA) said it “adds to a growing body of recent research supporting the use of spinal manipulative therapy.”

“As the nation struggles to overcome the opioid crisis, research supporting non-drug treatments for pain should give patients and health care providers confidence that there are options that help avoid the risks and dependency associated with prescription medications,” said ACA President David Herd, DC.

Last month the ACA approved a resolution supporting new guidelines by the American College of Physicians (ACP), which recommend spinal manipulation, massage, heating pads and other non-drug therapies as first line treatments for chronic low back pain.

“By identifying and adopting guidelines that ACA believes reflect best practices based on the best available scientific evidence on low back pain, we hope not only to enhance outcomes but also to create greater consensus regarding patient care among chiropractors, other health care providers, payers and policy makers,” said Herd.

But the ACP guidelines are hardly a ringing endorsement of spinal manipulation. The overall evidence was considered low quality that chiropractic adjustments can “have a small effect on function” and that they provide “no difference in pain relief.”

In fact, the best treatment for acute low back pain may be none at all.

"Physicians should reassure their patients that acute and subacute low back pain usually improves over time regardless of treatment," said ACP President Nitin Damle, MD.

One in four adults will experience low back pain in the next three months, making it one of the most common reasons for Americans to visit a doctor. According to a 2016 Gallup survey, more than 35 million people visit a chiropractor annually.

Most Pain Patients Use Alternative Therapy (Video)

By Pat Anson, Editor

A large new study of chronic pain patients found that over half were using chiropractic care or acupuncture for pain relief, but many didn’t discuss their use of alternative therapy with their primary care providers.

Researchers surveyed over 6,000 patients in Oregon and Washington State who were Kaiser Permanente members and had three or more outpatient visits for chronic pain in 18 months.

The study, published in the American Journal of Managed Care, found that 58 percent of the patients had used chiropractic care, acupuncture, or both.

Over a third (35%) of the pain patients who had acupuncture never told their doctor, while 42% who had chiropractic care didn't talk to their providers about it. Almost all of the patients said they would be happy to share this information if their doctor had asked.

"Our study confirms that most of our patients with chronic pain are seeking complementary treatments to supplement the care we provide in the primary care setting," said Charles Elder, MD, lead author of the study and affiliate investigator at the Kaiser Permanente Center for Health Research. "The problem is that too often, doctors don't ask about this treatment, and patients don't volunteer the information.

"We want our patients to get better, so we need to ask them about the alternative and complementary approaches they are using. If we know what's working and what's not working, we can do a better job advising patients, and we may be able to recommend an approach they haven't tried,” said Elder, who is the lead physician for Kaiser Permanente's complementary and alternative medicine program.

The majority of the patients in the study (71 percent) were women, and the mean age was 61. Most suffered from back pain, joint pain, arthritis, neck and muscle pain, or headache.

The study was funded by a grant from the National Center for Complementary and Integrative Health.

A video report on the study that was produced by Kaiser Permanente can be seen here:

One-hundred million Americans suffer from chronic pain every year, and many of them turn to alternative therapies for relief. In fact, a new study shows that more than half of patients with chronic pain enrolled in a managed care setting use chiropractic care or acupuncture.