Chronic Pain and CAM: At a Glance

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Pain is one of the most common conditions for which adults use 

complementary and alternative therapies. Because chronic (longterm) pain can be resistant to many medical treatments and can 

cause serious problems, people who suffer from chronic pain often 

turn to complementary and alternative medicine (CAM) for relief. 

This fact sheet provides basic information on chronic pain and 

“what the science says” about the effectiveness of CAM therapies. If 

you are considering a CAM therapy for chronic pain, talk with your 

health care provider first.

About Chronic Pain 

Millions of Americans suffer from pain that is chronic, severe, and 

not easily managed. Pain from arthritis, back problems, other 

musculoskeletal conditions, and headache costs U.S. businesses 

more than $61 billion a year in lost worker productivity.

Chronic pain is often defined as any pain lasting more than 12 

weeks. Whereas acute pain is a normal sensation, chronic pain is 

very different. Chronic pain persists—often for months or even 

longer. (In a national survey, 26 percent of adults—an estimated 76.5 

million Americans—reported experiencing pain that lasted more 

than 24 hours; of those reporting pain, 42 percent said it lasted more 

than a year.) Chronic pain may arise from an initial injury such as a 

back sprain, or there may be an ongoing cause such as a disease, or 

there may be no evident cause. Other health problems—such as 

fatigue, sleep disturbance, mood changes, and mobility limitations—

may also be associated with chronic pain.

Common chronic pain conditions include low-back pain, headache, 

arthritis pain, pain from nerve damage (e.g., diabetic neuropathy), 

cancer pain, and other conditions, such as fibromyalgia, in which 

pain is a prominent factor.

A person may have two or more co-existing chronic pain conditions. 

Such conditions can include chronic fatigue syndrome, 

endometriosis, fibromyalgia, interstitial cystitis (painful bladder 
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syndrome), irritable bowel syndrome, temporomandibular joint dysfunction, and vulvodynia 

(chronic vulvar pain). It is not known whether these disorders share a common cause.

People who suffer from chronic pain take various prescription and nonprescription 

medications; often, these do not provide adequate relief and have unwanted side effects. Other 

approaches to pain management, such as cognitive behavioral therapy (which emphasizes the 

role of thought patterns), physical therapy, exercise, and various CAM therapies, are also 

widely used.

CAM Use for Chronic Pain 

In the 2007 National Health Interview Survey, back pain was by far the most common 

condition cited as a reason for using CAM, followed by neck pain, joint pain/stiffness, and 

arthritis; other musculoskeletal pain and severe headache also ranked among the top 10 

reasons. Another survey of more than 400 patients at a chronic pain clinic found that almost 

40 percent used at least one form of CAM.

People seeking relief from chronic pain use a variety of CAM therapies. Examples include 

dietary supplements, such as glucosamine, chondroitin, and various herbs, and mind and body 

approaches, such as acupuncture, guided imagery, hypnotherapy, massage, meditation, 

relaxation therapy, spinal manipulation, tai chi, and yoga.

What the Science Says About CAM and Chronic Pain 

In spite of the widespread use of CAM therapies for chronic pain, scientific evidence on 

whether the therapies help the conditions for which they are used and, if so, how—is, for the 

most part, limited. However, the evidence base is growing, especially for CAM therapies that 

many people use for common kinds of pain.

About Scientific Evidence on CAM Therapies

Scientific evidence on CAM therapies includes results from laboratory research (e.g., animal 

studies) as well as clinical trials (studies in people). It encompasses both “positive” findings 

(evidence that a therapy may work) and “negative” findings (evidence that it probably does not 

work or that it may be unsafe). Scientific journals publish study results, as well as review 

articles that evaluate the evidence as it accumulates; fact sheets from the National Center for 

Complementary and Alternative Medicine (NCCAM)—like this one—base information about 

CAM research primarily on the most rigorous review articles, known as systematic reviews and 

meta-analyses. Authors of such reviews often conclude that more research and/or better 

designed studies are needed.

A comprehensive description of scientific research on all the CAM therapies that people use 

for chronic pain is beyond the scope of this fact sheet. The rest of this section highlights the 

research status of some of the therapies used for common kinds of pain.
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• Low-back pain. Reviews of 

research on acupuncture, 

massage, and spinal manipulation

for chronic low-back pain have 

found evidence that these 

therapies may be beneficial. 

Clinical practice guidelines issued 

by the American College of 

Physicians/American Pain Society 

in 2007 recommend these 

therapies and five other 

nonpharmacologic (nondrug) 

approaches for patients with back 

pain who do not improve with 

medication, education, and selfcare (the other recommended 

approaches are cognitivebehavioral therapy, exercise 

therapy, progressive relaxation,

intensive interdisciplinary 

rehabilitation, and yoga). Reviews 

of research on other CAM 

therapies that people sometimes 

use for chronic low-back pain, 

such as various herbal remedies

and prolotherapy injections,

generally have found limited or 

no evidence to support their use for this purpose, or the evidence is mixed.

• Arthritis. Among CAM approaches that have been studied for pain relief in osteoarthritis 

are acupuncture, glucosamine/chondroitin, herbal remedies, mineral baths (balneotherapy),

and tai chi. Many of these approaches have also been studied for rheumatoid arthritis. 

Overall, although some studies of CAM practices for arthritis have had promising results, 

the evidence generally is limited or mixed. A systematic review article on acupuncture for 

osteoarthritis concluded that acupuncture may lead to small improvements in pain and 

function. However, in a large clinical study, known as GAIT (Glucosamine/chondroitin 

Arthritis Intervention Trial), the popular dietary supplements glucosamine and chondroitin 

sulfate alone or in combination did not significantly relieve knee osteoarthritis pain among 

all participants, although the combination did help a subgroup who had moderate-tosevere pain. Reviews have found evidence that gamma linolenic acid (GLA, from evening 

primrose and certain other plant oils) may relieve rheumatoid arthritis pain, although 

further research is needed. Reviews have also noted evidence that dietary supplements 

known as ASUs (avocado-soybean unsaponifiables) and devil’s claw may provide relief from 

osteoarthritis pain.

Scientific Evidence on

CAM for Pain

Promising 

Evidence of 

Potential 

Benefit

Limited, 

Mixed, or No 

Evidence To 

Support Use

Low-Back Pain

Acupuncture 

Massage 

Spinal Manipulation 

Progressive Relaxation 

Yoga 

Prolotherapy 

Herbal Remedies 

Arthritis

Acupuncture 

Glucosamine/Chondroitin 

Gamma Linolenic Acid (GLA) 

Herbal Remedies 

Balneotherapy (Mineral Baths) 

Tai Chi 

Headache

Acupuncture 

Spinal Manipulation 

Feverfew 

Neck Pain

Acupuncture 

Spinal Manipulation 
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• Headache. Reviews of research on acupuncture for reducing the frequency and intensity of 

migraine and tension-type headaches conclude that patients may benefit from 

acupuncture therapy. One review found evidence that spinal manipulation may help 

patients suffering from chronic tension-type or cervicogenic (neck-related) headaches. 

Some research suggests that the herb feverfew may prevent migraine attacks, but results 

from clinical trials are mixed, and additional research is needed.

• Neck pain. Reviews of research on manual therapies (primarily manipulation or 

mobilization) and acupuncture for chronic neck pain have found mixed evidence regarding 

potential benefits and have emphasized the need for additional research. One review noted 

that clinical guidelines often endorse the use of manual therapies for neck pain, although 

there is no overall consensus on the status of these therapies.

• Other types of pain. Various CAM approaches have also been studied for other types of 

chronic pain, such as facial pain, including from temporomandibular joint (jaw) disorder;

nerve pain associated with diabetes and other conditions; cancer pain; and pain experienced 

by people with fibromyalgia. For example, a small study found that people with fibromyalgia 

may benefit from practicing tai chi. In general, research reviews have found some promising 

evidence of effectiveness for some CAM therapies but often emphasize that additional 

research is needed before treatment recommendations can be made.

• Other CAM approaches. People suffering from various types of chronic pain sometimes 

turn to other CAM practices, such as hypnotherapy, meditation, or qi gong. Again, reviews of 

the research on these therapies have found some evidence of effectiveness but note the 

need for further studies. Although static magnets are widely marketed for pain control, a 

review of the related research concludes that the evidence does not support this practice.

Several NCCAM fact sheets present additional information on pain-related CAM research and 

include reference lists citing relevant studies and reviews; examples include Acupuncture for 

Pain, Spinal Manipulation for Low-Back Pain, Fibromyalgia and CAM: At a Glance, Massage Therapy: 

An Introduction, and Yoga for Health: An Introduction.

NCCAM-Funded Research

NCCAM is part of the National Institutes of Health (NIH) Pain Consortium, which coordinates 

pain research at NIH. NCCAM-supported studies are helping to build an evidence base on the 

efficacy and safety of CAM modalities for treating chronic pain. Recent NCCAM-supported 

studies have been investigating:

• CAM therapies for chronic low-back pain, including acupuncture, massage, spinal 

manipulation, and yoga

• CAM therapies for osteoarthritis pain, including prolotherapy, tai chi, and yoga

• Massage for chronic neck pain

• Acupuncture and spinal manipulation for chronic headaches

• Acupuncture and tai chi for fibromyalgia pain.
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In addition, NCCAM is supporting a year-long, Internet-based survey of people with chronic 

pain and other chronic conditions to study CAM effectiveness as well as interactions among 

stress and coping, pain, and treatment outcomes. The survey is called PROCAIM—PatientReported Outcomes from Complementary, Alternative, and Integrative Medicine. NCCAM is also 

supporting an analysis of results from clinical trials on acupuncture for chronic pain. Another 

NCCAM initiative is assessing the effectiveness of CAM interventions for chronic back pain.

Chronic Pain: CAM Research Challenges and Opportunities

In light of the human and economic costs of chronic pain, as well as evidence that many 

people who suffer from chronic pain turn to CAM for relief, NCCAM places a high priority on 

pain-related research. Researchers in this area face unique challenges, in that much remains 

to be understood about the nature of chronic pain and about the best approaches to studying 

its many different causes, people’s different responses, and the value of various treatment 

approaches—CAM and conventional. The ultimate goal of research on chronic pain is to build 

an evidence base that can guide pain management decisions tailored to individuals. These 

decisions often involve combining treatment approaches in cost-effective ways that do the 

best possible job of helping people with chronic pain minimize pain, maximize function, and 

improve quality of life.

While building an evidence base to help people with chronic pain and their health care 

providers make decisions about specific therapies, CAM research is also helping to close gaps 

in our basic understanding of pain mechanisms. For example, researchers are using state-ofthe-art imaging technology to see how acupuncture affects brain activity. One study’s finding 

that changes in brain activity during acupuncture are different for people with chronic pain 

compared with healthy people is important for understanding not only how acupuncture 

might work but also pain processes in general.

If You Are Considering CAM for Chronic Pain 

• Do not use a CAM therapy as a replacement for conventional care or to postpone seeing a 

doctor about chronic pain or any other medical problem.

• Learn about the therapy you are considering, especially the scientific evidence on its safety 

and whether it works.

• Talk with the health care providers you see for chronic pain. Tell them about the therapy 

you are considering and ask any questions you may have. They may know about the 

therapy and be able to advise you on its safety, use, and likely effectiveness.

• If you are considering a practitioner-provided CAM therapy such as chiropractic 

manipulation, massage, or acupuncture, ask a trusted source (such as your doctor or a 

nearby hospital) to recommend a practitioner. Find out about the training and experience 

of any practitioner you are considering. Ask whether the practitioner has experience 

working with your pain condition. To learn more, see the NCCAM fact sheet, Selecting a 

CAM Practitioner.
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• If you are considering dietary supplements, keep in mind that they can act in the same 

way as medications. They can cause medical problems if not used correctly, and some may 

interact with prescription or nonprescription medications or other dietary supplements 

you take. Your health care provider can advise you. If you are pregnant or nursing a child, 

or if you are considering giving a child a dietary supplement, it is especially important to 

consult your health care provider. To learn more, see the NCCAM fact sheet, Using Dietary 

Supplements Wisely.

• Tell all your health care providers about any complementary and alternative practices you 

use. Give them a full picture of what you do to manage your health. This will help ensure 

coordinated and safe care. For tips about talking with your health care providers about 

CAM, see NCCAM’s Time to Talk campaign at nccam.nih.gov/timetotalk/. 

Selected References 

Abeles M, Solitar BM, Pillinger MH, et al. Update on fibromyalgia therapy. American Journal of Medicine. 2008;121(7):555-561.

Assendelft WJJ, Morton SC, Yu EI, et al. Spinal manipulative therapy for low-back pain. Cochrane Database of Systematic

Reviews. 2004;(1):CD000447. Accessed at http://www.cochrane.org on June 22, 2010.

Bardia A, Barton DL, Prokop LJ. Efficacy of complementary and alternative medicine therapies in relieving cancer pain:

a systematic review. Journal of Clinical Oncology. 2006;24(34):5457-5464.

Barnes PM, Bloom B, Nahin R. Complementary and alternative medicine use among adults and children: United States,

2007. CDC National Health Statistics Report #12. 2008.

Berman BM, Lao L, Langenberg P, et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee:

a randomized, controlled trial. Annals of Internal Medicine. 2004;141(12):901-911.

Bronfort G, Nilsson N, Haas M, et al. Non-invasive physical treatments for chronic/recurrent headaches. Cochrane

Database of Systematic Reviews. 2004;(3):CD001878. Accessed at http://www.cochrane.org on June 22, 2010.

Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an

American Pain Society/American College of Physicians clinical practice guideline. Annals of Internal Medicine.

2007;147(7):492-504.

Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low-back pain: a joint clinical practice guideline from the

American College of Physicians and the American Pain Society. Annals of Internal Medicine. 2007;147(7):478-491.

Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee

osteoarthritis. New England Journal of Medicine. 2006;354(8):795-808.

Dagenais S, Yelland MJ, Del Mar C, et al. Prolotherapy injections for chronic low-back pain. Cochrane Database of

Systematic Reviews. 2007;(2):CD004059. Accessed at http://www.cochrane.org on June 22, 2010.

Elkins G, Jensen MP, Patterson DR. Hypnotherapy for the management of chronic pain. International Journal of Clinical

and Experimental Hypnosis. 2007;55(3):275-287.

Furlan AD, Imamura M, Dryden T, et al. Massage for low-back pain. Cochrane Database of Systematic Reviews. 2008;(4):

CD001929. Accessed at http://www.cochrane.org on June 22, 2010.

Furlan AD, van Tulder MW, Cherkin D, et al. Acupuncture and dry-needling for low back pain. Cochrane Database of

Systematic Reviews. 2005;(1):CD001351. Accessed at http://www.cochrane.org on June 22, 2010.
7 

Gagnier JJ, van Tulder MW, Berman BM, et al. Herbal medicine for low back pain. Cochrane Database of Systematic 

Reviews. 2006;(2): CD004504. Accessed at http://www.cochrane.org on June 22, 2010.

Haldeman D, Dagenais S, eds. Evidence-informed management of chronic low back pain. Spine Journal. 2008;8(1):1-278.

Hall A, Maher C, Latimer J, et al. The effectiveness of tai chi for chronic musculoskeletal pain conditions: a systematic

review and meta-analysis. Arthritis and Rheumatism. 2009;61(6):717-724.

Hurwitz EL, Carragee EJ, van der Velde G, et al. Treatment of neck pain: noninvasive interventions. Results of the Bone

and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008;33(4S):S123-S132.

Konvicka JJ, Meyer TA, McDavid AJ, et al. Complementary/alternative medicine use among chronic pain clinic patients. 

Journal of Perianesthesia Nursing. 2008;23(1):17-23.

Lawrence DJ, Meeker W, Branson R, et al. Chiropractic management of low back pain and low back-related leg

complaints: a literature synthesis. Journal of Manipulative and Physiological Therapeutics. 2008;31(9):659-674.

Lee MS, Pittler MH, Ernst E. External quigong for pain conditions: a systematic review of randomized clinical trials.

Journal of Pain. 2007;8(11):827-831.

Lee MS, Pittler MH, Ernst E. Tai chi for osteoarthritis: a systematic review. Clinical Rheumatology. 2008;27(2):211-218.

Lee MS, Pittler MH, Ernst E. Tai chi for rheumatoid arthritis: a systematic review. Rheumatology. 2007;46(11):1648-1651.

Linde K, Allais G, Brinkhaus B, et al. Acupuncture for migraine prophylaxis. Cochrane Database of Systematic Reviews.

2009;(1):CD001218. Accessed at http://www.cochrane.org on June 22, 2010.

Linde K, Allais G, Brinkhaus B, et al. Acupuncture for tension-type headache. Cochrane Database of Systematic Reviews.

2009;(1):CD007587. Accessed at http://www.cochrane.org on June 22, 2010.

Manchikanti L, Singh V, Datta S, et al. Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain

Physician. 2009;12(4):E35-70.

Manheimer E, Cheng K, Linde K, et al. Acupuncture for peripheral joint osteoarthritis. Cochrane Database of Systematic

Reviews. 2010;(1):CD001977. Accessed at http://www.cochrane.org on August 31, 2010.

Manheimer E, Linde K, Lao L, et al. Meta-analysis: acupuncture for osteoarthritis of the knee. Annals of Internal Medicine.

2007;146(12):868-877.

Manheimer E, White A, Berman B, et al. Meta-analysis: acupuncture for low back pain. Annals of Internal Medicine.

2005;142(8):651-663.

Morone NE, Greco CM. Mind-body interventions for chronic pain in older adults: a structured review. Pain Medicine.

2007;8(4):359-375.

Myers CD. Complementary and alternative medicine for persistent facial pain. Dental Clinics of North America.

2007;51(1):263-274.

National Center for Health Statistics. Health, United States, 2006, With Chartbook on Trends in the Health of Americans.

Special feature: pain. Hyattsville MD, National Center for Health Statistics; 2006:68-87.

National Institute of Neurological Disorders and Stroke. Chronic Pain Information Page. National Institute of

Neurological Disorders and Stroke Web site. Accessed at

http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm on June 23, 2010.
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Pittler MH, Brown EM, Ernst E. Static magnets for reducing pain: systematic review and meta-analysis of randomized

trials. Canadian Medical Association Journal. 2007;177(7):736-742.

Pittler MH, Ernst E. Complementary therapies for neuropathic and neuralgic pain: systematic review. Clinical Journal of

Pain. 2008;24(8):731-733.

Pittler MH, Ernst E. Feverfew for preventing migraine. Cochrane Database of Systematic Reviews. 2004;(1):CD002286.

Accessed at http://www.cochrane.org on June 22, 2010.

Santaguida PL, Gross A, Busse J, et al. Complementary and Alternative Medicine in Back Pain Utilization Report. Evidence

Report/Technology Assessment no. 177. Rockville, MD: Agency for Health Care Policy and Research; 2009. AHRQ 

publication no. 09-E006.

Sawitzke AD, Shi H, Finco MF, et al. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their

combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT. Annals of the 

Rheumatic Diseases. 2010;69(8):1459-1464.

Selfe TK, Taylor AG. Acupuncture and osteoarthritis of the knee: a review of randomized, controlled trials. Family and

Community Health. 2008;31(3):247-254.

Soeken KL. Selected CAM therapies for arthritis-related pain: the evidence from systematic reviews. Clinical Journal of

Pain. 2004;20(1):13-18.

Stewart WF, Ricci JA, Chee E, et al. Lost productive time and cost due to common pain conditions in the U.S. workforce.

Journal of the American Medical Association. 2003;290(18):2443-2454.

Teixeira ME. Meditation as an intervention for chronic pain: an integrative review. Holistic Nursing Practice.

2008;22(4):225-234.

Trinh K, Graham N, Gross A. Acupuncture for neck disorders. Cochrane Database of Systematic Reviews.

2006;(3):CD004870. Accessed at http://www.cochrane.org on June 22, 2010.

Turk DC, Swanson KS, Tunks ER. Psychological approaches in the treatment of chronic pain patients—when pills,

scalpels, and needles are not enough. Canadian Journal of Psychiatry. 2008;53(4):213-223.

Verhagen AP, Bierma-Zeinstra SMA, Boers M, et al. Balneotherapy for osteoarthritis. Cochrane Database of Systematic

Reviews. 2007;(4):CD006864. Accessed at http://www.cochrane.org on June 22, 2010.

Verhagen AP, Bierma-Zeinstra SMA, Boers M, et al. Balneotherapy for rheumatoid arthritis. Cochrane Database of

Systematic Reviews. 2004;(1):CD000518. Accessed at http://www.cochrane.org on June 22, 2010.

Vernon H, Humphreys BK. Manual therapy for neck pain: an overview of randomized clinical trials and systematic

reviews. Europa Medicophysica. 2007;43(1):91-118.

Wang C, Schmid CH, Rones R, et al. A randomized trial of tai chi for fibromyalgia. New England Journal of Medicine.

2010;363(8):743-754.

Yuan J, Pureppong N, Kerr DP, et al. Effectiveness of acupuncture for low back pain: a systematic review. Spine.

2008;33(23):E887-900.

Zareba G. Phytotherapy for pain relief. Drugs of Today. 2009;45(6):445-467.
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For More Information

NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications 

and searches of Federal databases of scientific and medical literature. The Clearinghouse does 

not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226

TTY (for deaf and hard-of-hearing callers): 1-866-464-3615

Web site: nccam.nih.gov

E-mail: info@nccam.nih.gov

National Institute of Neurological Disorders and Stroke (NINDS)

The mission of NINDS is to reduce the burden of neurological diseases—a burden borne by every 

age group, every segment of society, and people all over the world. To accomplish this goal 

NINDS supports and conducts research, both basic and clinical, on the normal and diseased 

nervous system, fosters the training of investigators in the basic and clinical neurosciences, and 

seeks better understanding, diagnosis, treatment, and prevention of neurological disorders.

Web site: www.ninds.nih.gov/

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

The mission of NIAMS is to support research into the causes, treatment, and prevention of 

arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists 

to carry out this research; and the dissemination of information on research progress in 

these diseases.

Web site: www.niams.nih.gov

PubMed®

A service of the National Library of Medicine (NLM), PubMed contains publication information 

and (in most cases) brief summaries of articles from scientific and medical journals.

Web site: www.ncbi.nlm.nih.gov/sites/entrez

The Cochrane Database of Systematic Reviews

The Cochrane Database of Systematic Reviews is a collection of evidence-based reviews 

produced by the Cochrane Library, an international nonprofit organization. The reviews 

summarize the results of clinical trials on health care interventions. Summaries are free; fulltext reviews are by subscription only.

Web site: www.thecochranelibrary.com/view/0/index.html
ClinicalTrials.gov

ClinicalTrials.gov is a database of information on federally and privately supported clinical 

trials (research studies in people) for a wide range of diseases and conditions. It is sponsored 

by NIH and the U.S. Food and Drug Administration.

Web site: www.clinicaltrials.gov

NIH National Library of Medicine’s MedlinePlus

To provide resources that help answer health questions, MedlinePlus brings together authoritative 

information from NIH as well as other Government agencies and health-related organizations.

Web site: www.medlineplus.gov

Acknowledgments 

NCCAM thanks the following individuals for their technical expertise and review of this 

publication: Micke Brown, B.S.N, R.N., American Pain Foundation; Daniel Cherkin, Ph.D., 

Center for Health Studies, Group Health Cooperative, Seattle; Scott Haldeman, D.C., M.D., 

Ph.D., Department of Neurology, University of California, Irvine; John W. Kusiak, Ph.D., 

National Institute of Dental and Craniofacial Research; John Glowa, Ph.D., NCCAM; and 

Partap Khalsa, D.C., Ph.D., NCCAM.

This publication is not copyrighted and is in the public domain.

Duplication is encouraged.

NCCAM has provided this material for your information. It is not intended to substitute for the 

medical expertise and advice of your primary health care provider. We encourage you to 

discuss any decisions about treatment or care with your health care provider. The mention of 

any product, service, or therapy is not an endorsement by NCCAM.

National Institutes of Health

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U.S. Department of Health and Human Services

D456

Created September 2010

Updated September 2011