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ARRA Investments in PAIN CONDITIONS—CHRONIC

Public Health Burden

Millions of Americans suffer from chronic pain. Although the human costs of chronic pain are incalculable, its annual economic cost—including health care expenses, lost income, and lost productivity—is estimated to be $100 billion. Surveys show that people who use complementary and alternative medicine (CAM) therapies most often do so because they are seeking relief from pain. Learning about the safety and effectiveness of these therapies helps to address a major public health burden.

Using Existing Medical Records To Study CAM Effectiveness for Treating Painful Conditions

Comparative effectiveness research, which uses data from real-world settings to compare strengths and weaknesses of various medical interventions, holds great promise for evaluating CAM therapies and determining how they might best be combined with conventional care. An ARRA-funded grant is developing a comparative effectiveness research method and applying it to chronic pain conditions.

  • Using a patient database from a clinic that offers both conventional and CAM therapies, researchers are designing a model for use in evaluating and comparing conventional medical care and integrative/CAM approaches for specific conditions. Their goal is to enable patient-centered, evidence-based recommendations that can be applied to patients in treatment settings. The researchers will use the model to study several chronic pain conditions, including irritable bowel syndrome, fibromyalgia, and back pain.1

CAM for Common Types of Chronic Pain: Low-Back Pain, Osteoarthritis, and Carpal Tunnel Syndrome

Two of the most common forms of chronic pain are low-back pain and the joint pain associated with osteoarthritis. Another painful condition, carpal tunnel syndrome, is a common cause of employee absenteeism. ARRA-funded grants are exploring potential CAM options for treating these conditions.

  • Neuroimaging studies suggest that carpal tunnel syndrome (CTS) involves not only nerve damage at the wrist, but also faulty sensory processing in the brain. Although acupuncture has shown potential as a conservative treatment option for CTS, its mechanisms of action are not known. An ARRA-funded grant will assess changes in brain activity that accompany CTS dysfunction in the wrist, as well as how acupuncture might benefit wrist nerve health and modify brain function to help treat CTS patients.2
  • Building on findings from earlier laboratory studies, another ARRA grant is testing pomegranate extract in an animal model (rabbits) of knee osteoarthritis. The study will determine whether the extract slows cartilage deterioration and disease progression, and will also provide information on the biomechanisms involved. The findings may lead to another treatment option.3
  • Another grant is looking at Swedish massage therapy for relieving pain from osteoarthritis of the knee. The researchers will investigate doses, safety considerations, and clinical effects. Their findings will provide evidence about a possible treatment option for people who suffer from this common condition but do not respond well to drug therapies.4
  • Scientific evidence indicates that spinal manipulation may provide mild-to-moderate relief from low-back pain. One ARRA grant is combining technologies from the fields of acoustics and MRI imaging to study the mechanisms involved in spinal manipulative therapy—specifically, the relationship between “cavitation” (an audible release that occurs during therapy) and “gapping” of the zygapophysial (Z) joints between vertebrae after therapy. Understanding this relationship is important for ensuring that this form of therapy is used appropriately for people with low-back pain.5




References

  1. 3 R01 AT005715-01—CER Collaboration: University of Arizona and Marino Center for Integrative Health. Aickin, Mikel G. (AZ and MA)
  2. 3 R01 AT004714-02S1—Brain Plasticity in Carpal Tunnel Syndrome and Its Response to Acupuncture. Napadow, Vitaly. (MA)
  3. 1 R21 AT004026-01A2—Chondroprotective Activity of Pomegranate Extract. Haqqi, Tariq M. (SC)
  4. 1 R01 AT004623-01—Multisite RCT Investigating the Efficacy of Massage in Osteoarthritis. Perlman, Adam. (NJ)
  5. 3 R01 AT0000123-06S2—Z Joint Changes in Low Back Pain Following Adjusting. Cramer, Gregory D. (IL)