Hassan S, Zheng Q, Rizzolo E, et al. Does Integrative Medicine Reduce Prescribed Opioid Use for Chronic Pain? A Systematic Literature Review. Pain Med. 2019 Nov 22. pii: 5637803. doi: 10.1093/pm/pnz291. (Systematic review)

BACKGROUND: Chronic pain (CP) is a major public health problem. Many patients with CP are increasingly prescribed opioids, which has led to an opioid crisis. Integrative medicine (IM), which combines pharmacological and complementary and alternative medicine (CAM), has been proposed as an opioid alternative for CP treatment. Nevertheless, the role of CAM therapies in reducing opioid use remains unclear.

OBJECTIVES: To explore the effectiveness of the IM approach or any of the CAM therapies to reduce or cease opioid use in CP patients.

METHODS: An online search of MEDLINE and Embase, CINAHL, PubMed supp., and Allied and Complementary Medicine Database (AMED) for studies published in English from inception until February 15, 2018, was conducted. The Mixed Methods Appraisal Tool (MMAT) was used to critically appraise selected studies.

RESULTS: The electronic search yielded 5,200 citations. Twenty-three studies were selected. Eight studies were randomized controlled trials, seven were retrospective studies, four studies were prospective observational, three were cross-sectional, and one was quasi-experimental. The majority of the studies showed that opioid use was reduced significantly after using IM. Cannabinoids were among the most commonly investigated approaches in reducing opioid use, followed by multidisciplinary approaches, cognitive-behavioral therapy, and acupuncture. The majority of the studies had limitations related to sample size, duration, and study design.

CONCLUSIONS: There is a small but defined body of literature demonstrating positive preliminary evidence that the IM approach including CAM therapies can help in reducing opioid use. As the opioid crisis continues to grow, it is vital that clinicians and patients be adequately informed regarding the evidence and opportunities for IM/CAM therapies for CP.

Discipline Area Score
Psychologist 7 / 7
Physician 5 / 7
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Comments from MORE raters

Physician rater

Although the article tries to clarify newer approaches to manage chronic pain without use of opioids, I think information on this is still preliminary and more specific recommendations would help change practice and avoid opioid use.

Physician rater

The authors conclude that this review offers preliminary evidence for the effect of integrative medicine(IM) or any of the complementary alternative medicine (CAM) therapies to reduce the opioid use and abuse among these 50% of the chronic pain (CP) patients that seek relief from a variety of these drugs. There is an imbalance between the type of interventions/therapies reviewed. The medical cannabis and multidiscipinary interventions represent 31% and 26 % respectively, among a plethora of alternative therapies. Furthermore, as the authors comment, there is no clear evidence for the association (either beneficial or harmful) between cannabis use and reduction in opioid use.

Physician rater

The systematic review of highly heterogenous studies of highly variable quality leaves one with the impression that almost any intervention to reduce opiate use in chronic pain patients may be worth an attempt. It is very preliminary but provides enough information to proceed with further, better designed research.

Physician rater

This is a good review. The use of systematic ways in searching and appraising the evidence is the strength of this study. The review come from a study that has limitations related to sample size, duration, and study design. This review showed that there is a small but defined body of literature demonstrating positive preliminary evidence that the IM approach including CAM therapies can help in reducing opioid use. Further studies are warranted.

Psychologist rater

Promising results. There need to be more well-designed studies and more studies comparing different forms of Canabinoids and CAM modalities to develop evidence-based guidelines for treatment.

Psychologist rater

Timely and excellent review of substantive data in a field that is rife with confusion, uncertainty and a great deal of misinformation. My compliments to the authors.
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