This study describes the use of so-called alternative medicine (SCAM) among older adults who report being hampered in daily activities due to musculoskeletal pain. Cross-sectional European Social Survey (EES) Round 7 (2014) data from 21 countries were examined for participants aged 55 years and older, who reported musculoskeletal pain that hampered daily activities in the past 12months. From a total of 35,063 individuals who took part in the ESS study, 13,016 (37%) were aged 55 or older; of which 8183 (63%) reported the presence of pain, with a further 4950 (38%) reporting that this pain hampered their daily activities in any way.
Of the 4950 older adult participants reporting musculoskeletal pain that hampered daily activities, the majority (63.5%) were from the West of Europe, reported secondary education or less (78.2%), and reported at least one other health-related problem (74.6%). In total, 1657 (33.5%) reported using at least one SCAM treatment in the previous year. Manual body-based therapies (MBBTs) were most used, including massage therapy (17.9%) and osteopathy (7.0%). Alternative medicinal systems (AMSs) were also popular with 6.5% using homeopathy and 5.3% reporting herbal treatments. A general trend of higher SCAM use in younger participants was noted.
SCAM usage was associated with
- physiotherapy use,
- female gender,
- higher levels of education,
- being in employment,
- living in West Europe
- having multiple health problems.
The authors concluded that a third of older Europeans with musculoskeletal pain report SCAM use in the previous
12 months. Certain subgroups with higher rates of SCAM use could be identified. Clinicians should comprehensively and routinely assess SCAM use among older adults with musculoskeletal pain.
Such studies have the advantage of large sample sizes, and therefore one is inclined to consider their findings to be reliable and informative. Yet, they resemble big fishing operations where all sorts of important and unimportant stuff is caught in the net. When studying such papers, it is wise to remember that associations do not necessarily reveal causal relationships!
Having said this, I find very little information in these already outdated results (they originate from 2014!) that I would not have expected. Perhaps the most interesting aspect is the nature of the most popular SCAMs used for musculoskeletal problems. The relatively high usage of MBBTs had to be expected; in most of the surveyed countries, massage therapy is considered to be not SCAM but mainstream. The fact that 6.5% used homeopathy to ease their musculoskeletal pain is, however, quite remarkable. I know of no good evidence to show that homeopathy is effective for such problems (in case some homeopathy fans disagree, please show me the evidence).
In my view, this indicates that, in 2014, much needed to be done in terms of informing the public about homeopathy. Many consumers mistook homeopathy for herbal medicine (which btw may well have some potential for musculoskeletal pain), and many consumers had been misguided into believing that homeopathy works. They had little inkling that homeopathy is pure placebo therapy. This means they mistreated their conditions, continued to suffer needlessly, and caused an unnecessary financial burden to themselves and/or to society.
Since 2014, much has happened (as discussed in uncounted posts on this blog), and I would therefore assume that the 6.5% figure has come down significantly … but, as you know:
I am an optimist.
I believe in progress.
Part of the problem is the poor understanding of pain and its science amongst clinicians and thus the general public. Pain management has been watered down on NHS , patients are offered lityle but a one-size – fits all approach, often with an accompanying message ‘of its all in your head ‘ . Natural progression is having to compete with all the nonsense of homeopathy ( and chiropractic etc. ). Until we get decent, consistent, pain education and fully supported pain management programmes we are all vulnerable to the SCAM nonsense.
burdle- you may well be correct in your desire for better education of clinicians and public but there is no shortage of information regards musculo skeletal origins and treatment of pain. I have here at home many texts on the subject that started with books by Mennell and Cyriax of St Thomases Hospital and the late Gregory Grieve. Physical medicine has a long history.
… but a long history tells us nothing about its effectiveness nor safety.
Prof Edzard- surely a long history of any medical intervention will have something to useful say about effectiveness or otherwise. ‘Nothing’ is an overstatement. You have learned a great deal about the ineffectiveness of homeopathy or the risk /benefit of say the polio vaccine. The examples could be endless. That long history which you wish to ‘belittle’ is replete with issues of effectiveness and safety, limitations of research, road maps to research still needed, limitations of what we know and don’t know and much more. Physical medicine, particularly manipulations certainly has not the evidence base such as is available for chemotherapies but that doesn’t leave it as valueless- just a lot less dependable and often with an irrational scientific theoretical basis. Peruse ‘Common Vertebral Joint Problems’ 2edit. by Gregory P. Grieve and you will understand why you are in no position to throw out the baby with the bathwater
“surely a long history of any medical intervention will have something to useful say about effectiveness or otherwise”
you mean like blood letting, mercury treatments, enemas, etc.?
btw: you can call me edzard or prof ernst, but prof edzard only displays a lack of research about me.
Prof Ernst- forgive my ignorance in research of yourself. You have many impressive medical credentials. Do you have personal experience of undiagnosed, joint pain, particularly spinal? Do you have any personal experience of this pain being relieved by a skillful manipulative therapist or have seen them personally in action on others? Do you have any intention of referring to the one book I recommend? The history of medicine is replete with examples such as you refer to but does not address my points about the value of certain physical treatments for painful musculoskeletal problems.
Prof. Ernst. Considering that Paracetemol is considered no better than a placebo in the treatment of low back pain, (Lancet March 2018), and it is one of the most used medications for low back pain, I am wondering why you wasted your time and bothered to do this post. Be consistent with your argument please.
I agree that pain management isn’t well taught, and in my experience few doctors outside oncology and palliative care even know how to prescribe opiods safely and effectively.
My uncle (a former GP, sadly no longer with us) was taught by Cyriax at St. Thomas’s and spoke very highly of him.
A long history of usage is no guarantee of anything in medicine. I have seen many standard treatments fail the scrutiny of clinical trials over the course of my career, and in particular it worries me that so many surgeons feel that trials are unnecessary for established surgical interventions. Clinicians are prone to putting too much faith in received wisdom and personal experience as opposed to robust data, and although musculoskeletal pain is not my area of expertise I would be surprised if it is an exception here.
Dr Julian- you make my point for me about the history of most medical issues. Within that history , if well written, should be the failures as well as successes of any interventions, and where there is doubt then further areas of research needed should be indicated. Before Cyriax at St Thomases was Mennell and I believe the late Gregory P Grieve was a worthy follower in their footsteps and his book is monumental. There are numerous brilliant texts on the subject of pain management and treatment for all manner of medical conditions. The knowledge is available. Treatment of musculoskeletal conditions are prone to the biases you mention but as I said previously don’t throw out the baby with the bathwater. There is much of therapeutic value in physical treatments of painful MS conditions which includes manipulation in it’s various approaches, when applied by knowledgeable expert practitioners. I know full well of the charlatans and scammers in the ‘field’ and the outdated, erroneous hypotheses about some of the wider’ benefits’ of manipulative therapy.
74.5% have other medical issues so the they are most likely using some or many CON-Med (conventional big-con medicine) suppressive treatments with lots of side effects. One big impetus to use homeopathy.
There is your evidence that it is effective: 6.5% are using homeopathy.
Roger-your description of conventional medical treatment is a travesty. If a credulous 6.5% are using homeopathy then the benefits are placebo in nature and have no direct basis in altering any pathological/physiological processes except maybe occasionally via some mental process that could affect the physical ‘matter’- you know , ‘mind over matter’.
Interesting explanation. Then scroll down to user comments.
Surgery: the Ultimate Placebo. https://www.youtube.com/watch?v=IzueFu1cq5U