Is a study on alternative therapies, including Acupuncture, Tai Chi, Osteopathic Manipulative Medicine (OMM), and Chiropractic Care, for managing Chronic Pain biased?

From the Guidelines

The current evidence suggests that studies on alternative therapies, including Acupuncture, Tai Chi, Osteopathic Manipulative Medicine (OMM), and Chiropractic Care, for managing Chronic Pain may have biases and limitations, and their effectiveness varies, as indicated by the 2017 study published in the Annals of Internal Medicine 1. When evaluating the effectiveness of these alternative therapies, it's essential to consider the strength of evidence, which ranges from low to moderate, as reported in the 2017 study 1. Some key points to consider when evaluating these therapies include:

• The magnitude of pain benefits is generally small to moderate and short-term, as noted in the 2017 study 1.
• The effects on function are generally smaller than the effects on pain, as reported in the 2017 study 1.
• There is limited evidence on the effectiveness of these therapies for acute low back pain, as stated in the 2017 study 1.
• The evidence is based on qualitative synthesis of new trials with prior meta-analyses, restricted to English-language studies, and has limitations such as heterogeneity in treatment techniques and inability to exclude placebo effects, as mentioned in the 2017 study 1. In terms of specific recommendations, the 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV recommends considering a trial of acupuncture for chronic pain, but with a weak recommendation and moderate quality of evidence 1. It's crucial to approach these alternative therapies with caution and consult with a primary care physician before starting any new treatment, as they can help integrate these approaches safely into the overall pain management plan, ensuring they complement rather than replace proven medical treatments. Some evidence-based approaches to consider for managing chronic pain include:
• Cognitive behavioral therapy (CBT), which is recommended for chronic pain management with strong, moderate evidence, as stated in the 2017 HIVMA of IDSA clinical practice guideline 1.
• Yoga, which is recommended for the treatment of chronic neck/back pain, headache, rheumatoid arthritis, and general musculoskeletal pain with strong, moderate evidence, as reported in the 2017 HIVMA of IDSA clinical practice guideline 1.
• Physical and occupational therapy, which are recommended for chronic pain with strong, low evidence, as mentioned in the 2017 HIVMA of IDSA clinical practice guideline 1.
• Hypnosis, which is recommended for neuropathic pain with strong, low evidence, as stated in the 2017 HIVMA of IDSA clinical practice guideline 1.

From the Research

Study Bias

The question of whether a study on alternative therapies, including Acupuncture, Tai Chi, Osteopathic Manipulative Medicine (OMM), and Chiropractic Care, for managing Chronic Pain is biased can be examined through various studies.

• The study by 2 provides an evidence-based evaluation of complementary health approaches for pain management, which includes the mentioned alternative therapies.
• However, the study by 3 highlights the ongoing barriers to chronic pain management in primary care, which may indicate a gap in the evidence-practice gap, rather than a bias in the study itself.
• The study by 4 discusses psychotherapeutic interventions for chronic pain, which may not be directly related to the alternative therapies in question, but does provide evidence for non-pharmacological treatments.
• The studies by 5 and 6 provide evidence for mindfulness-based interventions and nonpharmacologic strategies for comprehensive pain care, respectively, which include some of the alternative therapies mentioned.

Evidence for Alternative Therapies

The evidence for the alternative therapies mentioned includes:

• Acupuncture: 2, 6 provide evidence for the efficacy of acupuncture in managing chronic pain.
• Tai Chi: 2, 6 provide evidence for the efficacy of Tai Chi in managing chronic pain.
• Osteopathic Manipulative Medicine (OMM): 6 provides evidence for the efficacy of OMM in managing chronic pain.
• Chiropractic Care: 6 provides evidence for the efficacy of chiropractic care in managing chronic pain.

Limitations and Gaps

The studies mentioned have some limitations and gaps, including:

• The study by 3 highlights the ongoing barriers to chronic pain management in primary care, which may indicate a need for further research.
• The study by 4 discusses psychotherapeutic interventions, which may not be directly related to the alternative therapies in question.
• The studies by 5 and 6 provide evidence for mindfulness-based interventions and nonpharmacologic strategies, but may not be comprehensive in their evaluation of all alternative therapies.