Evidence-based integrative pain medicine

Integrative medicine is already, consciously or unconsciously, widely practised in pain medicine. However, a large part of practised pain medicine is not evidence-based. In this article, the evidence for different forms of conventional pain therapy (pharmacological, psychological, physical and interventional) as well as CAM for the pain conditions cancer pain, neuropathic pain, low back pain, and fibromyalgia syndrome is reviewed. The literature search comprised only randomised controlled trials (RCTs) and systematic reviews or guideline publications in which the quality of the included studies is analysed according to predefined criteria. Except for cancer pain, evidence is lacking for both conventional and alternative therapies, and conventional therapy is often not sufficiently efficacious. A multimodal/multidisciplinary approach seems appropriate and integration of CAM in this approach is facilitated by the similarity of the bio-psycho-social model of chronic pain with the mind-body models of many forms of CAM. In addition, placebo-controlled studies may not be always necessary due to the fact that the placebo effect is also therapeutic in pain therapy ("therabo"). Instead, different forms of therapy may be directly compared in RCTs, accompanied by cost-effectiveness and cost-utility studies. However, pain therapy is still a long way from having an evidence-based therapy option for every patient. (C) 2010 Elsevier GmbH. All rights reserved.