By Ben Kligler, MD 1-16-2018
For people who use and practice complementary and integrative medicine, 2017 was a watershed year—and 2018 promises to be even more so. For many years, the demand from patients (and some clinicians!) for more effective joining of some of the nontraditional approaches to healing—like acupuncture, meditation, yoga, and tai chi—with their regular conventional medical care has led to progress and a slow opening of our mainstream medical institutions to the use of these approaches. But now that opening has widened dramatically because of some of the developments over the past year:
In April 2017, the American College of Physicians—one of the most respected mainstream medical professional organizations—issued a new set of evidence-based guidelines for the treatment of low back pain, which is the most common cause of chronic pain in the U.S.. Based on an exhaustive review of everything published in the medical literature, those guidelines recommend that non-pharmacologic approaches be the first option for pain—and that acupuncture, mindfulness meditation, tai chi, yoga, massage, and spinal manipulation should all be considered as possible first-line treatments for patients with chronic back pain.[1]
Continuing awareness of the pain and suffering being caused by the overuse of opioid medications, with the increased risk of overdose and addiction that comes with their use, is continuing to create a spotlight from the public, the media, the healthcare industry, and from Congress on the need for safe and effective alternative options for pain treatment. Complementary and integrative approaches are now being seen as an important part of filling that gap.
As of January 2018, The Joint Commission (TJC)—the national group responsible for certifying and accrediting hospitals and healthcare institutions, which has tremendous influence over practice standards and quality—is requiring that hospitals specifically offer non-pharmacologic options for pain. Although TJC does not specifically require any particular therapy like acupuncture or meditation, they always advocate for evidence-based strategies—so the fact that the most influential mainstream practice guidelines now recommend a number of complementary and integrative approaches means that more and more hospitals will begin to offer these as a way to meet the TJC requirement.
These are great developments for the 100 million Americans suffering from chronic pain, for healthcare providers who have always believed that a bigger toolbox and a more open-minded approach was needed to provide the best medicine, and for our healthcare system in general.
More to come in 2018!!
Citation:
[1] Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166:514–530. doi: 10.7326/M16-2367
Dr. Kligler is National Director of the Integrative Health Coordinating Center for the Veterans Health Administration and Research Director for the Center Institute for Research and Education in Integrative Medicine. He is Co-Director of the Beth Israel Fellowship Program in Integrative Medicine, and teaches in the Beth Israel Residency Program in Urban Family Practice. Dr. Kligler is the author of Curriculum in Complementary Therapies: A Guide for the Medical Educator, and co-editor of Integrative Medicine: Principles for Practice, a textbook published by McGraw-Hill. He is also Co-Editor-in-Chief of the peer-reviewed journal Explore: The Journal of Science and Healing.