MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Opioid over-use has become a huge problem, particularly in the US. Proponents of complementary and alternative medicine (CAM) – or so-called alternative medicine (SCAM) as I prefer to call it these days – have been keen to suggest that they have a solution to this problem. But is this really true? So far, the evidence was slim, to say the least.

This systematic review evaluated the effectiveness of the integrative medicine (IM) approach or any of the CAM therapies to reduce or cease opioid use in CP patients.

The electronic searches yielded 5,200 citations. Twenty-three studies were selected. Eight studies were randomized controlled trials, 7 were retrospective studies, 4 studies were prospective observational, 3 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-behavioural therapy (CBT), and acupuncture. The majority of the studies had limitations related to sample size, duration, and study design.

The authors concluded 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. 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.

The authors who are from the Canadian College of Naturopathic Medicine in Ontario, Canada (and who claim to have no conflict of interest) seem to have forgotten to discuss some not so unimportant details and questions:

  • Why did they include studies with extremely weak designs in their review (such studies are likely to produce false positive findings)?
  • Why did they consider treatments such as CBT as CAM (most experts would characterise them as conventional psychological therapies)?
  • Why did they not conduct a separate analysis of the RCT-evidence (is it because that would not have generated the result they wanted?)?

My reading of the RCTs – the only type of study that might give a reliable answer to the question posed- is that they do not show a opioid-sparing effect of CAM use, particularly if we eliminate those studies that tested treatments which are not truly CAM. In any case, as I have said several times before, the way to avoid over-prescribing opioid is not through using more therapies of doubtful effectiveness but through prescribing less opioids. And to achieve that, doctors should just do what they learnt in medical school (at least I did all those years ago).

5 Responses to Does Integrative Medicine Reduce Prescribed Opioid Use for Chronic Pain?

  • Hear, hear!

    “In any case, as I have said several times before, the way to avoid over-prescribing opioid is not through using more therapies of doubtful effectiveness but through prescribing less opioids.”

  • The opioid crisis in the USA is something which will have RG screaming about evil Big Pharma and the compliant physicians who have blithely prescribed their addictive wares.

    And I think that RG is absolutely right.

    How this situation has been allowed to come about is truly headshaking.

    • I always find it odd that in the UK, Big Pharma are so impotent and useless that they can’t even get the ban on advertising prescription medicines to the public lifted…

    • @Lenny

      Healthcare in the USA is a business, one of the biggest and the most profitable. After viewing and experiencing the reality of for profit healthcare, I’ll admit that I would welcome a better system.
      Not that a free market system is completely incapable of working in theory, the problem is that the “free market system” in the USA is not really a free market. It is a strange mixture of insurance + medical care. Most patients don’t even know what they end up paying for their healthcare in the long run…. including me. So we are not truly free to choose our physician, nor our pharma source, nor the price that will be paid for services rendered.

      Just like other sectors of our free market capitalism, it’s been corrupted. Crony Capitalism is what we now have, or what I call Corporatism. Corporatism isn’t working for the middle class as did true Capitalism. Is it no surprise that Capitalism is coming under attack, and Socialism is getting a second look.

      As for a true free market medical system, we would need to go back in time many many decades to see it in practice…. probably the early part of the 20th century.

      I could welcome a single payer system, the difficulty is getting there from where we are now.

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