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Complementary and Integrative Modalities

Complementary and integrative medicine, briefly CIM, is a common term for healthcare treatments that have historically been excluded from conventional medicine. As proven efficacy and safety accumulate, complementary and alternative therapies are increasingly integrated with conventional treatments (Mayo Clinic, 2020). Consequently, by lowering exhaustion, pain, and anxiety, CIM can assist patients with cancer, chronic pain, chronic fatigue, arthritis, and many other illnesses better manage their symptoms and enhance patients’ quality of life. According to Chen and Michalsen (2017), CIM is a novel integrated strategy for treating several clinical disorders that incorporate Western-style medicine and alternative health treatments. Moreover, chronic pain is the most common reason for using CIM because, despite breakthroughs in chronic pain medications, many patients continue to have poor pain control. Addiction, kidney problems, and gastrointestinal bleeding are among the side effects and issues of analgesic medicines that restrict their usage (Chen & Mechalsen, 2017). Thus, CIM is a multimodality therapeutic method that can address the multifaceted character of pain while causing few or no significant side effects.

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Essentially, patients frequently turn to CIM to reduce chronic pain. Despite advancements in medicine, numerous patients will continue to experience symptoms that are not adequately treated by the best treatments that traditional medicine can deliver (Bauer et al., 2016). Complementary and integrative therapies are indicated to assist people in managing chronic pain. Morse et al. (2020) acknowledge that CIM relieves acute pain while decreasing dependency on opioid prescribing in urgent care. Bauer et al. (2016) inform that CIM modalities include acupuncture, meditation, herbs, and massage, among others. Scientific and governmental organizations are also beginning to engage CIM modalities guidelines into chronic pain care (Bauer et al., 2016). Chen and Michalsen (2017) suggest that CIM includes a variety of practices, which can be divided into four major categories as listed in Table 1. Hence, the CIM categories include whole medical systems and traditional medicine, mind-body interventions, manipulative and body-based methods, and natural products, and biologically-based therapies.

Table 1: Categories of complementary and integrative therapy 

Category Modalities
Whole medical systems and traditional medicine
  • Naturopathy
  • Traditional Chinese medicine (herbs, acupuncture, etc.)
  • Traditional Indian (Ayurvedic), European, Korean, Arabian, and Kampo medicine
  • Anthroposophical medicine
  • Homeopathy
Mind-body interventions
  • Yoga, tai chi, qigong, meditation, cognitive-behavioral therapy, relaxation, biofeedback, art therapy, music therapy, dance therapy
Manipulative and body-based methods
  • Chiropractic manipulation, osteopathic manipulation, massage
Natural products and biologically-based therapies
  • Nutritional interventions and dietary supplements, herbal products, natural products

The five modalities were selected within the complementary and integrative traditions, such as massage, acupuncture, herbs and dietary supplements, yoga, and meditation. Consequently, the analysis will include a concise summary of the primary principle for each modality, including significant strengths and limitations. The evidence to support the use of the particular modality for chronic pain, the type and length of treatment, and other relevant facts will be demonstrated.


Manipulative and body-based methods include massage as one of the modalities. Massage refers to rubbing, stretching, and touching the skin, muscles, tendons, and joints of a patient. The therapy is usually conducted by professional therapists who concentrate on the muscles and tissues with multiple methods, such as pressing, deep, circular movements, vibrations, and strokes (Bauer et al., 2016). Additionally, therapists typically use their hands and fingers, but they may also utilize their elbows, forearms, and feet. According to the theory, massage prevents pain sensations from accessing the central nervous system by activating larger nerve fibers (Bauer et al., 2016). Essentially, this modality may also work to lessen pain perception through impacts on patient’s tension and stress.

Moreover, massage has shown a positive effect on chronic pain. Bauer et al. (2016) demonstrate numerous research studies that emphasize the benefits of this therapy. For instance, massage treatment has been shown to help with fibromyalgia discomfort. The massage was shown to be beneficial in the great majority of reports for the pain condition investigated (Bauer et al., 2016). According to Chen and Michalsen (2017), external Ayurvedic therapies using classic massage techniques and medicated oils were compared to routine local thermal therapy in a clinical study of sixty-four individuals with persistent low back pain. Notably, ayurvedic therapy significantly decreased pain severity and discomfort after two and four weeks compared to control treatment. When performed by a qualified and competent massage therapist, Bauer et al. (2016) state that massage therapy is generally regarded as a low-risk therapy because the documented adverse effects are mainly minor, such as muscle soreness. Significantly, massage may benefit the overall therapy plan for people suffering from chronic pain.


The whole medical systems and traditional medicine category involves acupuncture. Chen and Michalsen (2017) claim that acupuncture has been a vital part of Asia’s healthcare system for over three thousand years. Consequently, acupuncture has grown in popularity in several Western countries during the last few decades. The low incidence of side effects compared to numerous medications and medical procedures is a primary reason people choose acupuncture treatment (Chen & Michalsen, 2017). Chen and Michalsen (2017) mention that their research results suggest that both “the central and peripheral neural systems are engaged in the process, including neurotransmitters and neuromodulators like endorphins, neurohumoral factors, and other chemical mediators” (p. 2). Vickers et al. (2018) acknowledge that acupuncture theory traditionally involves non-anatomical structures such as meridians and non-physiological activities such as qi energy flow. Vickers et al. (2018) argue that many modern practitioners do not depend on such beliefs. Nonetheless, there is research on how the insertion of needles at particular spots on the body might result in long-term pain reduction.

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Much study has been conducted to identify the scientific foundation of acupuncture’s benefits. Vickers et al. (2018) added seven years of data to an individual patient data meta-analysis of high-quality acupuncture studies for chronic pain. Important to mention that thirty-nine studies and 20,827 patients were included in the analysis (Vicker et al., 2018). Significantly, the findings support and reinforce previous crucial findings that acupuncture has a clinically significant impact when compared to a no-acupuncture control group.

Herbs and Dietary Supplements

Natural products and biologically-based therapies concentrate on herbs and dietary supplements. According to Bauer (2016), the dietary supplement includes “one or more of the following dietary ingredients: a vitamin; a mineral; a herb or other botanical; an amino acid; a dietary substance for use” (p. 406). Despite widespread media coverage, dietary supplements are rarely used as a stand-alone therapy for chronic pain (Bauer, 2016). Thus, they may be a valuable supplement to a complete treatment program occasionally. Nonetheless, their usage requires supervision by a practitioner educated about their correct prescription, including the prevention of drug-herb interactions or other contraindications.


Yoga incorporates meditative breathing, relaxation, stretching, and various positions to reduce pain and discomfort. Bauer et al. (2016) demonstrate two meta-analyses of eight and ten clinical studies, respectively, looked at the effectiveness of yoga for persistent back pain. Consequently, yoga had a medium to substantial impact on chronic back pain and functional impairment in the first research, benefiting from maintaining follow-up evaluations. The second trial found significant evidence of pain, specific impairment from back pain, and overall improvement.


Meditation fosters removing distracting or unpleasant ideas from the mind, providing calmness and concentration. Bauer et al. (2016) acknowledge that the research on meditation and mindfulness is conflicting. For instance, three of the five high-quality studies evaluated eleven trials involving 1,209 individuals, found good impacts on pain outcomes. In another meta-analysis of mindfulness-based therapies for chronic pain, “11 studies were included addressing various chronic pain conditions including fibromyalgia, rheumatoid arthritis, chronic musculoskeletal pain, failed back surgery syndrome ” (Bauer et al., 2016, p. 407). Important to note that the outcomes of the second meta-analysis were not encouraging. Nonetheless, mind-body therapies assist in reducing stress and anxiety. To conclude, yoga and meditation are among the safest integrative treatments offered nowadays.


Bauer, B. A., Tilburt, J. C., Sood, A., Li, G., & Wang, S. (2016). Complementary and alternative medicine therapies for chronic pain. Chinese Journal of Integrative Medicine, 22(6), 403–411. Web.

Chen, L., & Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ, 357, j1284. Web.

Mayo Clinic (2020). Integrative medicine. Web.

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Morse, E. F., Ross, C., Clemensen, S., Babbar, S., Wisneski, L. A., Clune, H., de Picciotto, M., Xu, S., & Binswanger, I. (2020). Exploring the use of complementary and integrative health modalities in urgent care for acute pain. The Journal of Alternative and Complementary Medicine, 26(7), 537-540. Web.

Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., Irnich, D., Witt, C. M. & Linde, K. (2018). Acupuncture for chronic pain: Update of an individual patient data meta-analysis. The Journal of Pain, 19(5), 455–474. Web.

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