Crawford C, Boyd C, Berry K, et al. Dietary Ingredients Requiring Further Research Before Evidence-Based Recommendations Can Be Made for Their Use as an Approach to Mitigating Pain. Pain Med. 2019 Apr 15. pii: 5464928. doi: 10.1093/pm/pnz050. (Evidence-based guideline)

OBJECTIVE: Approximately 55-76% of Service members use dietary supplements for various reasons; although such use has become popular, decisions are often driven by information that is not evidence-based. This work evaluates whether current research on dietary ingredients for chronic musculoskeletal pain provides sufficient evidence to inform decisions for practice and self-care, specifically for Special Operations Forces personnel.

METHODS: A steering committee convened to develop research questions and factors required for decision-making. Key databases were searched through August 2016. Eligible systematic reviews and randomized controlled trials were assessed for methodological quality. Meta-analysis was applied where feasible. Grading of Recommendations, Assessment, Development and Evaluation was used to determine confidence in the effect estimates. The committee used a decision table to make evidence-informed judgments across decision-making factors and recommendations for practice and self-care use.

RESULTS: Nineteen dietary ingredients were assessed. No recommendations were given for boswellia, ginger, rose hip, or s-adenosyl-L-methionine (SAMe); specifically, although ginger can be obtained via food, no recommendation is provided for use as a supplement due to unclear research. Further, there were insufficient strong research on boswellia and SAMe and possible compliance issues (i.e., high number of capsules required daily) associated with rose hip.

CONCLUSIONS: No recommendations were made when the evidence was low quality or trade-offs were so closely balanced that any recommendation would be too speculative. Research recommendations are provided to enhance the quality and body of evidence for the most promising ingredients. Clinicians and those with chronic pain can rely on evidence-based recommendations to inform their decisions.

Discipline Area Score
Physician 5 / 7
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Comments from MORE raters

Physician rater

This article is one of three related papers. It is of good quality, but can only be read together with the other two. Table 1 is useful to give quick review of the situation.

Physician rater

This study looked at the evidence to support use of dietary supplements in the management of musculoskeletal pain with the specific patient group being special operations sources personnel in USA. A steering committee looked at eligible systematic reviews and randomised controlled trials and were unable to make any positive recommendations for boswellia, ginger, rose hip or s-adenosyl-L-methionine. Clearly the claims made by the supplements industry are not backed up by evidence and better regulation of this industry and the claims they make is required.
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