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

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. The characteristics of older adults with debilitating musculoskeletal pain who report SCAM use is also examined. For this purpose, the cross-sectional European Social Survey Round 7 from 21 countries was employed. It examined participants aged 55 years and older, who reported musculoskeletal pain that hampered daily activities in the past 12 months.

Of the 4950 older adult participants, 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.

The most commonly used SCAMs were:

  • manual body-based therapies (MBBTs) including massage therapy (17.9%),
  • osteopathy (7.0%),
  • homeopathy (6.5%)
  • herbal treatments (5.3%).

SCAM use was positively associated with:

  • younger age,
  • physiotherapy use,
  • female gender,
  • higher levels of education,
  • being in employment,
  • living in West Europe,
  • multiple health problems.

(Many years ago, I have summarized the most consistent determinants of SCAM use with the acronym ‘FAME‘ [female, affluent, middle-aged, educated])

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.

I often mutter about the plethora of SCAM surveys that report nothing meaningful. This one is better than most. Yet, much of what it shows has been demonstrated before.

I think what this survey confirms foremost is the fact that the popularity of a particular SCAM and the evidence that it is effective are two factors that are largely unrelated. In my view, this means that more, much more, needs to be done to inform the public responsibly. This would entail making it much clearer:

  • which forms of SCAM are effective for which condition or symptom,
  • which are not effective,
  • which are dangerous,
  • and which treatment (SCAM or conventional) has the best risk/benefit balance.

Such information could help prevent unnecessary suffering (the use of ineffective SCAMs must inevitably lead to fewer symptoms being optimally treated) as well as reduce the evidently huge waste of money spent on useless SCAMs.

12 Responses to Use of so-called alternative medicine among older adults with musculoskeletal pain

  • Reports should also include the use of medications which can cause such pain. Example:

    https://www.rxsaver.com/blog/muscle-pain-side-effect-medications

    • I think the following list of reasons that can contribute to musculoskeletal pain should be included in the report as well:
      1. manual therapy sessions (chiropractic, PT, osteopathic etc.)
      2. getting hit by a truck
      3. falling off a ladder
      4. running a marathon
      5. rock climbing etc.

      The list is too long to post here, but you get the point.

  • Right.

    “Results: In 2017, 36.1% of older Australians were affected by continuous polypharmacy, or an estimated 935 240 people. Rates of polypharmacy were higher among women than men (36.6% v 35.4%) and were highest among those aged 80–84 years (43.9%) or 85–89 years (46.0%). The prevalence of polypharmacy among PBS concessional beneficiaries aged 70 or more increased by 9% during 2006–2017 (from 33.2% to 36.2%), but the number of people affected increased by 52% (from 543 950 to 828 950).” https://www.mja.com.au/journal/2019/211/2/polypharmacy-among-older-australians-2006-2017-population-based-study

    In the general population (but common use in the elderly)

    “Australians continue to use statins more than any other prescription drug, with the two most common cholesterol-lowering medicines being prescribed more than 24 million times in 12 months.” https://amp.abc.net.au/article/12936626

    Of the more common side effects of statins:

    Headache
    Muscle aches, tenderness, or weakness (myalgia) https://www.webmd.com/cholesterol-management/side-effects-of-statin-drugs#091e9c5e8025c4f7-2-4

    But sure, let’s include granny running a marathon and grandpa out rock climbing.

    • Whataboutism (also known as Whataboutery especially in the UK) is a deflection or red herring version of the classic tu quoque logical fallacy — sometimes implementing the balance fallacy as well — which is employed as a propaganda technique. It is used as a diversionary tactic to shift the focus off of an issue and avoid having to directly address it.”
      https://rationalwiki.org/wiki/Whataboutism

      Balance fallacy
      “There’s a kind of notion that everyone’s opinion is equally valid. My arse! A bloke who’s been a professor of dentistry for 40 years doesn’t have a debate with some eejit who removes his teeth with string and a door!”
      — Dara Ó Briain

      • actually my response doesn’t fall under those fallacies. If care seeking is due to side effects of pharmaceuticals in the elderly that is valuable information in such studies.

        • Your formal fallacy is: confusion of necessity and sufficiency.

          Now, let’s examine your rhetoric “actually my response doesn’t fall under those fallacies. If care seeking is due to side effects of pharmaceuticals in the elderly that is valuable information in such studies.” using logic.

          Start with the conclusion, which is a core tenet of the pseudoscientific method: (actually my response doesn’t fall under those fallacies).

          To support the conclusion, ‘DC’ deploys the formal fallacy affirming the consequent in the following sentence:

          If antecedent (care seeking is due to side effects of pharmaceuticals in the elderly) is true then consequent (that is valuable information in such studies) is true.

          Well done!

          It may be helpful to state that there is no such thing as chiropractic quackery. Instead, it is quackery by a chiropractor.

    • But sure, let’s include granny running a marathon and grandpa out rock climbing.

      Are you sure grandpas and grandmas are NOT rock climbing and running marathons?

      https://www.runtri.com/2010/10/marine-corps-marathon-2010-race-results.html
      https://www.climbing.com/people/climbing-into-old-age-7-senior-climbers-share-their-experience-and-advice/

      Don’t be an ageist.

      • sigh, I didn’t say some elderly don’t do those activities. However in a research setting one should always query on the most likely explanations of MSK pain. In the case of elderly that would certainly include pharmaceutical side effects and falls (which are often a side effect of, wait for it, some pharmaceuticals). Less common causes, like whatever, can be of interest but have lesser extrapolation.

        Thus, if a significant portion of these elderly people are seeking CAM for the side effect of pharmaceuticals (which may or may not affect the outcome of conservative care) well, that is important information to record. If you disagree, or are just arguing for the sake of arguing, so be it.

        • Thus, if a significant portion of these elderly people are seeking CAM for the side effect of pharmaceuticals (which may or may not affect the outcome of conservative care) well, that is important information to record. If you disagree, or are just arguing for the sake of arguing, so be it.

          I never disagreed with what you are saying. Indeed, that is important information to record. So are non-pharmaceutical factors I listed above. You wouldn’t get the whole picture unless you record all potential factors contributing to MSK pain in elderly who are seeking CAM remedies. A CAM service provider like yourself may be biased against conventional medicine and may claim that pharmaceutical factors are the major contributors to MSK pain in elderly. However, others may want to look at the whole picture with supporting data. How would one go about doing that? By recording both pharmaceutical and non-pharmaceutical factors.

          We can certainly discuss the root cause of MSK pain, but the study showcased in the above post tries to answer the question as to what CAM remedies people are seeking to deal with MSK pain. Do you have any thoughts on that? As a Chiropractor I bet you have a different perspective than most when it comes to the topic of this blog post.

          • yes, the two items that I find of interest is that the percentage of those with back/neck pain and with headaches tends to decrease with age. I have seen this trend in other research.

  • Many years ago, I have summarized the most consistent determinants of SCAM use with the acronym ‘FAME‘ [female, affluent, middle-aged, educated]

    A lot of these are likely characteristics of people who are more likely to seek healthcare in general.
    For example, women are more likely to visit a doctor.

    Even excluding pregnancy-related visits, women were 33 percent more likely than men to visit a doctor, although this difference decreased with age. The rate of doctor visits for such reasons as annual examinations and preventive services was 100 percent higher for women than for men.

    So women using alt-med more often doesn’t mean that women are more likely than men to see an alt-med provider if they are seeking healthcare.

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