National Health Statistics Reports
 

Number 98  October 12, 2016 

Use of Complementary Health Approaches for 


Musculoskeletal Pain Disorders Among Adults:
 

United States, 2012 


by Tainya C. Clarke, M.P.H., Ph.D., National Center for Health Statistics; Richard L. Nahin, M.P.H., Ph.D., 

National Institutes of Health; Patricia M. Barnes, M.A., National Center for Health Statistics; and 

Barbara J. Stussman, National Institutes of Health 

Abstract 

Objective—This report examines the use of complementary health approaches 

among U.S. adults aged 18 and over who had a musculoskeletal pain disorder. 

Prevalence of use among this population subgroup is compared with use by persons 

without a musculoskeletal disorder. Use for any reason, as well as specifically to treat 

musculoskeletal pain disorders, is examined. 

Methods—Using the 2012 National Health Interview Survey, estimates of the 

use of complementary health approaches for any reason, as well as use to treat 

musculoskeletal pain disorders, are presented. Statistical tests were performed to 

assess the significance of differences between groups of complementary health 

approaches used among persons with specific musculoskeletal pain disorders. 

Musculoskeletal pain disorders included lower back pain, sciatica, neck pain, joint 

pain or related conditions, arthritic conditions, and other musculoskeletal pain 

disorders not included in any of the previous categories. Respondents could report 

having more than one disorder. 

Results—In 2012, 54.5% of U.S. adults had a musculoskeletal pain disorder. 

The use of any complementary health approach for any reason among persons with 

a musculoskeletal pain disorder (41.6%) was significantly higher than use among 

persons without a musculoskeletal pain disorder (24.1%). Among adults with any 

musculoskeletal pain disorder, the use of natural products for any reason (24.7%) was 

significantly higher than the use of mind and body approaches (15.3%), practitionerbased approaches (18.2%), or whole medical system approaches (5.3%). The pattern 

of use of the above-mentioned groups of complementary health approaches was 

similar for persons without a musculoskeletal disorder. However, prevalence of 

use among these persons was significantly lower compared with persons with a 

musculoskeletal disorder. 

For treatment, the use of practitioner-based approaches among persons with any 

musculoskeletal pain disorder (9.7%) was more than three times as high as the use of 

any other group of approaches (0.7%–3.1%). The patterns of use of specific groups of 

complementary health approaches also differed among specific musculoskeletal pain 

disorders. 

Keywords: arthritis • back pain • sciatica • National Health Interview Survey 

Introduction 

Pain is a leading cause of disability 

and a major contributor to health care 

utilization (1). Pain is often associated 

with a wide range of injury and disease. 

It is also costly to the United States, not 

just in terms of health care expenses 

and disability compensation, but 

also with respect to lost productivity 

and employment, reduced incomes, 

lost school days, and decreased 

quality of life (2). The focus of this 

report is on somatic pain affecting 

the body’s musculoskeletal tissues 

(musculoskeletal pain disorders) and the 

use of different types of complementary 

health approaches by persons who are 

affected. In order to better understand 

differences in use among this population 

subgroup, this report compares the use 

of complementary health approaches 

among those with a musculoskeletal 

disorder with use among those without a 

musculoskeletal disorder. 

Musculoskeletal pain disorders 

include a wide range of acute and chronic 

injuries or inflammatory conditions 

that cause pain in the body’s joints; 

ligaments; muscles; nerves; tendons; 

and structures that support the limbs, 

neck, and back (3). These disorders can 

impair daily functioning and are some of 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
 

Centers for Disease Control and Prevention
 

National Center for Health Statistics
 
Page 2 National Health Statistics Reports  Number 98  October 12, 2016 

the leading causes of physical disability 

in the United States (4). Conventional 

medical treatment for chronic 

musculoskeletal pain (e.g., nonsteroidal 

anti-inflammatory drugs and surgery) 

and use of opioids often lack long-term 

benefit or subject patients to other risks 

(5–7). Consequently, some persons with 

these conditions may seek alternative 

treatment options. Alternative health 

care interventions (e.g., chiropractic and 

osteopathic medicine), products (e.g., 

herbs and natural products), or practices 

(e.g., massage therapy and yoga) not 

generally considered part of conventional 

medicine may collectively be referred to 

as complementary health approaches. 

There is increasing clinical trial 

evidence for the efficacy of some 

complementary health approaches in 

treating specific musculoskeletal pain 

disorders (7). However, there have been 

inconsistencies in the experimental 

designs and diagnostic criteria used 

in patient selection for many of these 

clinical trials (7,8). As a result, there is 

some discord among the clinical research 

community regarding the efficacy of 

some of these approaches for various 

musculoskeletal pain disorders (5,7–10). 

Despite this, examining which groups 

of approaches are being used by persons 

with individual musculoskeletal pain 

disorders may better inform physicianpatient dialogue and priority-setting 

efforts for clinical researchers. 

Data from population-based 

surveys on the use of complementary 

health approaches in the United States 

now span 20 years (11–13). The 2002 

National Health Interview Survey 

(NHIS) provided the first nationally 

representative estimates of adult use 

of complementary health approaches 

based on data collected from in-person 

interviews (14). Since then data on the 

use of complementary health approaches 

in the general U.S. population, collected 

periodically by NHIS, have been used 

by numerous researchers (11,15–17). To 

better understand the patterns of use of 

complementary health approaches among 

U.S. adults with musculoskeletal pain 

disorders, this report presents estimates 

of the use of complementary health 

approaches for any reason, as well as 

estimates for the subset of these adults 

who used these approaches specifically 

for treatment of their musculoskeletal 

pain disorders. Comparisons are 

also made for persons with specific 

musculoskeletal pain disorders. 

Methods 

Data source 

Data from the 2012 NHIS were 

used for this analysis. NHIS is a 

nationally representative, cross-sectional 

household interview survey that is 

fielded continuously by the National 

Center for Health Statistics and produces 

annual estimates of the health of the 

U.S. civilian noninstitutionalized 

population. Interviews are conducted in 

respondents’ homes, but follow-ups to 

complete interviews may be conducted 

over the telephone. A detailed description 

of the 2012 NHIS sample design and 

the survey questionnaire is available 

elsewhere (18). The Household and 

Family Core of NHIS collect health and 

sociodemographic information on each 

member of all families residing within a 

sampled household. Within each family, 

additional information is collected from 

one randomly selected adult (the “sample 

adult”) aged 18 and over through the 

Sample Adult Core. The most recent 

Adult Alternative Medicine (ALT) 

supplement was administered to sample 

adult respondents in 2012. The ALT 

supplement, sponsored by the National 

Institutes of Health’s National Center for 

Complementary and Integrative Health 

(NCCIH), was implemented in order 

to provide a national data source on 

complementary medicine use. 

Information on the use of 

complementary health approaches in 

the past 12 months was collected from 

a sample of 34,525 adults aged 18 

and over who participated in the ALT 

supplement, while the information on 

musculoskeletal pain disorders was 

obtained from the Sample Adult Core. 

In 2012, the sample adult response 

rate was 79.7%, with 34,525 adults 

completing the NHIS interviews. 

The ALT supplement questions are 

embedded in the NHIS sample adult 

module and are administered to all 

sample adults. The processes used to 

field the ALT supplement have been 

previously described (19). The study 

sample included 19,236 adults who 

reported having one or more individual 

musculoskeletal pain disorders in the past 

3 months. Respondents were asked not 

to report aches and pains that are fleeting 

or minor. Only persons with pain that 

lasted a whole day or more were included 

in these analyses. Questions about the 

individual musculoskeletal pain disorders 

discussed in this report are located in the 

“Definition of terms” section at the end of 

this report. 

Complementary Health 

Approaches 

Survey respondents were asked 

about their use of up to 23 named 

approaches in the past 12 months. Use 

of complementary health approaches for 

any reason was determined by a positive 

response to having used or having seen a 

practitioner for a complementary health 

approach during the past 12 months, 

regardless of reason for use. For the three 

most frequently used approaches for each 

individual, persons were then asked if, 

during the past 12 months, they used the 

specific named approach “for one or more 

specific health problems, symptoms, or 

conditions.” Those who responded yes 

were asked “for what health problems, 

symptoms, or conditions did you see a 

practitioner” or use the specific named 

approach. There was no predetermined 

list of conditions for this question, so 

interviewers recorded the conditions 

as reported by respondents. This report 

only includes responses to whether the 

three most frequently named approaches 

were used for treatment of individual 

musculoskeletal pain disorders. Use for 

treatment of nonmusculoskeletal pain 

disorders was not analyzed separately. 

Use of complementary health approaches 

for any reason includes use for treatment 

of a musculoskeletal pain disorder. 

For this report, the use of any 

complementary approach includes the 

use of one or more of the following 

during the past 12 months: acupuncture; 

Alexander technique; Ayurveda; 

biofeedback; chelation therapy; 

chiropractic or osteopathic manipulation; 

energy healing therapy; Feldenkrais; 

guided imagery; homeopathic treatment; 
National Health Statistics Reports  Number 98  October 12, 2016 Page 3 

hypnosis; naturopathy; nonvitamin, 

nonmineral dietary supplements; massage 

therapy; meditation; Pilates; progressive 

relaxation; traditional healers; Trager 

psychophysical integration; qi gong; tai 

chi; or yoga. 

Approaches were further grouped 

by similar mode of practice or 

administration for analyses: natural 

products (nonvitamin, nonmineral 

dietary supplements and special diets); 

practitioner-based (Alexander technique, 

chiropractic or osteopathic manipulation, 

Feldenkrais, massage therapy, and 

Trager psychophysical integration); 

mind and body approaches (biofeedback, 

energy healing therapy, guided imagery, 

hypnosis, meditation, progressive 

relaxation, Pilates, tai chi, qi gong, 

and yoga); and whole medical systems 

(Ayurveda, acupuncture, homeopathy, 

naturopathy, and traditional healers). 

Information on use of each type of 

approach was collected on an individual 

basis. More information about specific 

health approaches is available from 

NCCIH at: https://nccih.nih.gov/health/ 

integrative-health. 

Musculoskeletal Pain 

Disorders 

Musculoskeletal pain disorders were 

examined as a collective group (any 

musculoskeletal pain disorder), as well 

as individually. The musculoskeletal 

pain disorders examined in this report 

include lower back pain without sciatica 

(this will be referred to as lower back 

pain), sciatica with back pain (referred 

to as sciatica), neck pain, non-arthritic 

joint pain or related conditions, arthritic 

conditions, and other musculoskeletal 

pain disorders not included in any of the 

previous categories. Arthritic conditions 

include several forms of arthritis: 

rheumatoid arthritis (an autoimmune 

disorder that first targets the lining of 

joints [synovium]); gout (an abnormal 

metabolism of uric acid, resulting in an 

excess of uric acid in the tissues and 

blood causing swollen joints); lupus 

(a chronic autoimmune disease that 

can damage any part of the body [skin, 

joints, or organs inside the body]); or 

fibromyalgia (a syndrome of common 

and chronic disorders characterized by 

widespread pain, diffuse tenderness, and 

a number of other symptoms which result 

in pain in the muscles, ligaments, and 

tendons). Persons who responded “no” 

to having arthritis and “yes” to having 

joint pain or related conditions were 

categorized as having non-arthritic joint 

pain or related conditions. 

Sciatica typically refers to pain that 

radiates along the path of the sciatic 

nerve, which branches from the lower 

back through the hips and buttocks and 

down each leg. In NHIS, sciatica was 

identified by a “yes” response to the 

question, “During the past 3 months, 

did you have low back pain?” and “Did 

this pain spread down either leg to areas 

below the knees?” Only respondents who 

answered “yes” to both questions were 

defined as having sciatica. Back pain 

was defined by a response to the initial 

question only. Other musculoskeletal 

problems include muscle or bone pain, 

sprain or strain, and jaw pain. Persons 

could report having more than one 

musculoskeletal pain disorder. 

Statistical Analyses 

The sample of persons with any 

musculoskeletal pain disorder included 

all adults aged 18 and over who 

responded “yes” to having one or more 

named musculoskeletal pain disorders 

surveyed on the NHIS sample adult 

module. The number of people with 

a positive response to having one or 

more of these musculoskeletal pain 

disorders (19,236) was the denominator 

for all questions pertaining to use of 

complementary health approaches among 

persons with any musculoskeletal pain 

disorder. The denominator for the use 

of complementary health approaches 

among persons with a specific 

musculoskeletal pain disorder was those 

who responded “yes” to having that 

specific disorder. Persons who reported 

using a complementary health approach 

to treat a musculoskeletal pain disorder 

in the ALT supplement had to respond 

“yes” to having the condition in the past 

3 months in the sample adult module 

to be included in the numerator of 

analyses. Respondents could respond 

“yes” to having more than one specific 

musculoskeletal pain disorder. As such, 

the specific disorder subgroups are not 

mutually exclusive. However, treatment 

is specific to each disorder. Persons who 

responded “no” to having any of the 

musculoskeletal pain disorders mentioned 

were used for comparison of the use of 

complementary health approaches among 

persons with a musculoskeletal pain 

disorder. 

Groups of complementary health 

approaches (natural products, mind and 

body approaches, practitioner-based 

approaches, and whole medicine systems) 

are mutually exclusive. However, an 

individual could use multiple approaches 

and could be counted in more than one 

group of approaches. These persons 

were counted only once for use of any 

complementary health approach. 

Analyses were conducted using 

SAS-callable SUDAAN version 11.0.0 

(20), which accounts for the complex 

sample design of NHIS. All estimates 

for adults were weighted using the 

annual sample weights for adults and, 

so, are representative of the U.S. civilian 

noninstitutionalized population of 

adults aged 18 and over. Data weighting 

procedures are described in more 

detail elsewhere (21). Calculations of 

estimates excluded persons with missing 

information for musculoskeletal pain 

disorders or use of complementary 

health approaches. The Taylor series 

linearization method was chosen for 

estimation of standard errors. Estimates 

were considered reliable if the relative 

standard error (RSE) was less than 

30%. Statistical tests performed to 

assess the significance of differences 

between estimates were two-tailed tests 

with no adjustments made for multiple 

comparisons. 

Strengths and 

Limitations of the Data 

A major strength of these analyses 

is that the data are from a nationally 

representative sample of U.S. adults, 

allowing for population estimates. The 

large sample size allows for estimation 

of the use of complementary health 

approaches among subgroups of U.S. 

adults with self-reported musculoskeletal 

pain disorders, both of which are 

collected in NHIS. 
Page 4 National Health Statistics Reports  Number 98  October 12, 2016 

The data in this report also have 

some limitations. NHIS does not collect 

information on the specific dates of use of 

complementary health approaches or of 

the incidence date for the musculoskeletal 

pain disorders, so it is not possible to 

determine if use occurred prior to having 

a musculoskeletal pain disorder. NHIS 

also does not collect information on 

simultaneous treatment of these disorders 

with mainstream or conventional 

medicine. Responses are dependent on 

participants’ recall of complementary 

health approaches that they used in 

the past 12 months, as well as their 

willingness to report their use accurately. 

Results 

More than 50% of U.S. adults 

(125 million) had a musculoskeletal 

pain disorder in 2012 (Figure 1). Just 

over 20% of U.S. adults had arthritic 

conditions (22.1%) or lower back pain 

(20.3%). A smaller percentage of persons 

reported having non-arthritic joint pains 

or other joint conditions (17.5%) and 

neck pain or problems (14.3%), and an 

even smaller percentage had sciatica 

(9.8%). A significant proportion of the 

population reported having at least one 

other musculoskeletal problem that was 

not examined independently (28.1%). 

The proportion of persons with each 

musculoskeletal pain disorder illustrated 

in Figure 1 are the subpopulations for 

subsequent analyses shown in Figures 2–6. 

More than 40% of adults with a 

musculoskeletal pain disorder used a 

complementary health approach for 

any reason in 2012 (Figure 2). This was 

significantly higher than use among 

persons without a musculoskeletal pain 

disorder (24.1%). Use of complementary 

health approaches for any reason among 

persons with neck pain or problems was 

more than twice as high as use among 

persons without these problems. Among 

adults with a musculoskeletal pain 

disorder, use of any complementary health 

approach was highest among those with 

neck pain or problems (50.6%), followed 

by persons with other musculoskeletal 

problems (46.2%). The use of any 

complementary health approach was 

significantly lower among adults with 

sciatica (41.9%), arthritic conditions 

(40.9%), and lower back pain (43.0%). 

Figure 1. Prevalence of musculoskeletal pain disorders among adults in the past 12 months: 

United States, 2012 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 2. Use of any complementary health approach in the past 12 months for any reason 

and for treatment among adults: United States, 2012 
National Health Statistics Reports  Number 98  October 12, 2016 Page 5 

Among adults with a musculoskeletal 

pain disorder, almost 14% used a 

complementary health approach for 

treatment. Persons with neck pain or 

problems (9.2%), lower back pain 

(10.3%), and sciatica (11.2%) were more 

likely to use a complementary health 

approach to treat their disorder compared 

with those with non-arthritic joint 

pain or other joint conditions (6.4%), 

arthritic conditions (6.6%), and other 

musculoskeletal problems (4.1%). 

In 2012, almost 25% of persons with 

any musculoskeletal pain disorder used 

natural products (nonvitamin, nonmineral 

dietary supplements and special diets) 

(Figure 3). This was almost twice as 

high as use among persons without a 

musculoskeletal pain disorder (13.4%). 

Use of complementary health approaches 

for any reason was more than twice as 

high among persons with non-arthritic 

joint pain and other joint conditions 

(27.7%), neck pain or problems (27.7%), 

and other musculoskeletal problems 

(28.2%) compared with those without a 

musculoskeletal pain disorder. 

There was no significant difference 

in the use of natural products among 

persons with sciatica (24.1%) and those 

with lower back pain (23.2%). Use of 

natural products was significantly lower 

among persons with lower back pain 

when compared with persons with all 

other individual musculoskeletal pain 

disorders examined, except sciatica. 

However, few complementary health 

users used these approaches specifically 

for treatment of their musculoskeletal 

pain disorder. Approximately 3% of 

adults with any musculoskeletal pain 

disorders used natural products to treat 

one or more of these disorders. Adults 

with arthritic conditions (3.3%) and 

non-arthritic joint pain and other joint 

conditions (2.9%) were significantly 

more likely to use natural products 

for treatment of these conditions than 

individuals with other musculoskeletal 

pain disorders and other musculoskeletal 

problems (0.5%). 

In 2012, more than 15% of persons 

with any musculoskeletal pain disorder 

used a mind and body approach such 

as biofeedback, meditation, or yoga 

for any reason (Figure 4). This was 

almost one-third higher than use among 

persons without a musculoskeletal 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 3. Use of natural products in the past 12 months for any reason and for treatment 

among adults: United States, 2012 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 4. Use of mind and body approaches in the past 12 months for any reason and for 

treatment among adults with specific musculoskeletal pain disorders: United States, 2012 
Page 6 National Health Statistics Reports  Number 98  October 12, 2016 

pain disorder (10.2%). Use of mind 

and body approaches among persons 

without a musculoskeletal pain disorder 

was also lower than use among persons 

with individual musculoskeletal pain 

disorders. 

Use of mind and body approaches 

for any reason varied among persons 

with individual musculoskeletal pain 

disorders. Use by persons with neck pain 

or problems (18.9%), non-arthritic joint 

pain or other joint conditions (18.0%), 

and other musculoskeletal problems 

(17.3%) was significantly higher than use 

among persons with arthritic conditions 

(12.5%) or sciatica (14.2%). 

Less than 2% of adults with a 

musculoskeletal pain disorder used 

mind and body approaches specifically 

for treatment. Use of mind and body 

approaches for treatment of these 

conditions was twice as high among 

persons with sciatica (1.6%) compared 

with persons with other musculoskeletal 

problems (0.8%). 

In 2012, more than 18% of persons 

with any musculoskeletal pain disorder 

used a practitioner-based approach 

for any reason (Figure 5). Use of 

practitioner-based approaches for any 

reason was almost twice as high among 

persons with any musculoskeletal pain 

disorders compared with persons without 

a musculoskeletal pain disorder. Persons 

with individual disorders were also 

more likely to use a practitioner-based 

approach for any reason compared with 

those with no musculoskeletal pain 

disorder. 

Almost 30% of persons with neck 

pain or problems used a practitionerbased approach such as Alexander 

technique or chiropractic or osteopathic 

manipulation in the past 12 months. 

This was significantly higher than use 

among persons with all other types of 

musculoskeletal pain disorders. Persons 

with sciatica (19.8%), lower back pain 

(21.7%), and other musculoskeletal 

problems (20.8%) were significantly 

more likely to use practitioner-based 

approaches in the past 12 months 

compared with persons with arthritic 

conditions (17.4%) and non-arthritic joint 

pains or other joint conditions (16.8%). 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 5. Use of practitioner-based approaches in the past 12 months for any reason and for 

treatment among adults: United States, 2012 

Just under 10% of adults with a 

musculoskeletal pain disorder used a 

practitioner-based approach specifically 

for treatment of that disorder. Persons 

with sciatica (8.9%), lower back pain 

(8.9%), and neck pain or problems (7.9%) 

were more likely to use practitionerbased approaches for treatment of these 

conditions than persons with arthritic 

conditions (2.7%), non-arthritic joint 

pains or other joint conditions (2.9%), 

and other musculoskeletal problems 

(3.1%). 

In 2012, 5.3% of persons with any 

musculoskeletal pain disorder used whole 

medical systems for any reason 

(Figure 6). This was more than twice as 

high as persons without a musculoskeletal 

pain disorder. Persons with sciatica 

(6.8%) and neck pain or problems 

(8.0%) were most likely to use whole 

medical systems such as acupuncture and 

naturopathy in the past 12 months. There 

was no significant difference in use of 

whole medical systems among persons 

with arthritic conditions (5.1%), lower 

back pain (5.3%), non-arthritic joint pains 

and other joint conditions (6.0%), and 

other musculoskeletal problems (6.2%). 

Overall, less than 1% of persons with 

any musculoskeletal pain disorder used 

whole medical systems specifically for 

treatment. Comparatively, persons with 

sciatica (1.4%) were more likely to use 

whole medical systems for treatment than 

persons with lower back pain (0.6%) and 

neck pain or problems (0.8%). 

Discussion 

More than 50% of U.S. adults, 

that is, approximately 125 million 

Americans, suffer from one or more 

musculoskeletal pain disorders. The 

goal of pain management is usually to 

achieve maximum reduction in pain 

intensity as quickly as possible, to restore 

an individual’s daily functioning, to 

help the patient cope with residual pain, 

and to assess for side effects of therapy 

(5,22). Complementary approaches 

are increasingly being integrated into 

conventional treatment plans for some 

health conditions. More than 50% of 

medical schools offer some instruction in 

complementary health approaches (23), 

and a growing body of scientific evidence 

suggests that several of these approaches, 
National Health Statistics Reports  Number 98  October 12, 2016	 Page 7 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 6. Use of whole medical systems in the past 12 months for any reason and for 

treatment among adults: United States, 2012 

including chiropractic manipulation, 

acupuncture, massage, and yoga, may 

help to manage some painful conditions 

(24–31). 

In 2012, 41.6% of adults with a 

musculoskeletal pain disorder used one or 

more complementary health approaches. 

This is significantly higher than the use 

among adults without a musculoskeletal 

pain disorder (24.1%). An even higher 

prevalence of use was seen among 

persons who had neck pain and problems 

(50.6%) and other musculoskeletal 

problems (46.2%). 

Natural products were the most 

common complementary health approach 

used among U.S. adults with one or 

more musculoskeletal pain disorders; 

24.7% of adults with musculoskeletal 

pain disorders used natural products. 

This was almost twice the use among 

persons without a musculoskeletal pain 

disorder (13.4%). However, use of 

natural products specifically for treatment 

among adults with musculoskeletal pain 

disorders was less than 4%. 

The use of practitioner-based 

approaches for any reason among 

persons with any musculoskeletal pain 

disorder (18.2%) was almost three times 

as high as among persons without a 

musculoskeletal pain disorder (6.9%). 

Regarding treatment of musculoskeletal 

pain disorders, the prevalence of use of 

practitioner-based approaches (9.7%) 

was more than three times that of use 

of other types of complementary health 

approaches among persons with any 

musculoskeletal pain disorder. Use 

of practitioner-based approaches was 

more than five times the use of other 

approaches among persons with neck 

pain or problems, lower back pain, 

sciatica, and other musculoskeletal 

problems. 

The use of the selected 

complementary health approaches 

examined varied among persons with 

arthritis and non-arthritic joint pain and 

other conditions. However, these persons 

were consistently more likely to treat 

their conditions with natural products and 

practitioner-based approaches than with 

mind and body approaches. 

Whole medical systems involve 

complete systems of theory and practice 

that have evolved independently from, 

or parallel to, conventional medicine 

(32). However, although whole medical 

systems share a number of common 

elements with conventional medicine, 

use of these approaches for any reason 

or for treatment of musculoskeletal pain 

disorders was less popular than other 

types of approaches. 

This report adds to evidence 

regarding the use of complementary 

approaches to treat or manage pain in 

the U.S. population. The high level of 

use of practitioner-based approaches 

identified in this report adds to previous 

research that has shown that some 

U.S. adults use complementary health 

approaches for treatment despite a lack 

of health insurance coverage for their 

complementary health practitioner visits 

(33). As such, the information in this 

report may be useful to clinicians and 

researchers interested in the types of 

complementary health approaches most 

frequently used for musculoskeletal 

pain management, and in implementing 

the 2016 National Pain Strategy, which 

lays out a plan for better addressing pain 

issues in the United States (5). 

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National Health Statistics Reports  Number 98  October 12, 2016 Page 9 

Technical Notes 

Definition of terms 

Arthritic conditions—Based on a 

positive response to “Have you ever 

been told by a doctor or other health 

professional that you have some form of 

arthritis, rheumatoid arthritis, gout, lupus, 

or fibromyalgia?” 

Lower back pain without sciatica— 

Based on a positive response to “During 

the past 3 months, did you have low 

back pain?” However, persons who 

subsequently responded “yes” to a 

question about lower back pain spreading 

down to the legs and areas below the 

knees were excluded from this subgroup. 

Mind and body approaches— 

Includes biofeedback, energy healing 

therapy, guided imagery, hypnosis, 

meditation, progressive relaxation, 

Pilates, tai chi, qi gong, and yoga. 

Natural products—Includes 

nonvitamin, nonmineral dietary 

supplements and special diets. 

Neck pain—Based on a positive 

response to “During the past 3 months, 

did you have neck pain?” Respondents 

were instructed to refer to pain that lasted 

a whole day or more, and not report aches 

and pains that were fleeting or minor. 

Neuropathic pain—Pain caused by 

injury or malfunction to the spinal cord 

and peripheral nerves. 

Non-arthritic joint pain or other 

joint conditions—Based on a positive 

response to “During the past 30 days, 

have you had any symptoms of pain, 

aching, or stiffness in or around a joint?” 

Respondents were instructed to exclude 

back or neck pain. Persons with a positive 

response who subsequently responded 

“yes” to ever being told by a doctor 

or other health professional that they 

have some form of arthritis, rheumatoid 

arthritis, gout, lupus, or fibromyalgia 

were excluded from this subgroup. 

Other musculoskeletal conditions— 

Includes a positive response to “During 

the past 3 months, did you have facial 

ache or pain in the jaw muscles or the 

joint in front of the ear?,” “During the 

past 12 months, have you had any severe 

sprains or strains?,” and “During the past 

12 months, have you had other muscle or 

bone pain?” 

Practitioner-based approaches— 

Includes Alexander technique, 

chiropractic or osteopathic manipulation, 

Feldenkrais, massage therapy, and Trager 

psychophysical integration. 

Sciatica with back pain—Based on 

a positive response to “During the past 

3 months, did you have low back pain?” 

and “Did this pain spread down either 

leg to areas below the knees?” Only 

respondents who answered “yes” to both 

questions were defined as having sciatica. 

Persons with sciatica were distinct from 

those with lower back pain without 

sciatica. 

Somatic pain—Pain caused by the 

activation of pain receptors in either the 

body surface or musculoskeletal tissues. 

Visceral pain—The pain felt when 

internal organs are damaged or injured. 

Visceral pain is caused by the activation 

of pain receptors in the chest, abdomen, 

or pelvic areas. 

Whole medical systems—Includes 

Ayurveda, acupuncture, homeopathy, 

naturopathy, and traditional healers. 


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Suggested citation 

Clarke TC, Nahin RL, Barnes PM, Stussman 

BJ. Use of complementary health approaches 

for musculoskeletal pain disorders among 

adults: United States, 2012. National health 

statistics reports; no 98. Hyattsville, MD: 

National Center for Health Statistics. 2016. 

Copyright information 

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated. 

National Center for Health Statistics 

Charles J. Rothwell, M.S., M.B.A., Director
 

Jennifer H. Madans, Ph.D., Associate 


Director for Science
 

Division of Health Interview Statistics 

Marcie L. Cynamon, Director 

Stephen J. Blumberg, Ph.D., Associate 

Director for Science