title: Complementary and alternative approaches to the treatment of persistent musculoskeletal pain.
abstract: OBJECTIVE
  To review common complementary and alternative treatment modalities for the treatment of persistent musculoskeletal pain in older adults.
  
  
  METHODS
  A critical review of the literature on acupuncture and related modalities, herbal therapies, homeopathy, and spinal manipulation was carried out. Review included 678 cases within 21 randomized trials and 2 systematic reviews of herbal therapies: 798 cases within 2 systematic reviews of homeopathy; 1,059 cases within 1 systematic review of spinal manipulation for low back pain, and 419 cases within 4 randomized controlled trials for neck pain. The review of acupuncture and related modalities was based upon a paucity of well-controlled studies combined with our clinical experience.
  
  
  RESULTS
  Insufficient experimental evidence exists to recommend the use of traditional Chinese acupuncture over other modalities for older adults with persistent musculoskeletal pain. Promising preliminary evidence exists to support the use of percutaneous electrical nerve stimulation for persistent low back pain. While some herbals appear to have modest analgesic benefits, insufficient evidence exists to definitively recommend their use. Drug-herb interactions must also be considered. Some evidence exists to support the superiority of homeopathic remedies over placebo for treating osteoarthritis and rheumatoid arthritis. The benefits of spinal manipulation for persistent low back and neck pain have not been convincingly shown to outweigh its risks.
  
  
  CONCLUSIONS
  While the use of complementary and alternative modalities for the treatment of persistent musculoskeletal pain continues to increase, rigorous clinical trials examining their efficacy are needed before definitive recommendations regarding the application of these modalities can be made.
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213-3313, USA. dweiner@pitt.edu
authors.forename: Debra K
authors.initials: DK
authors.lastname: Weiner
authors.forename: Edzard
authors.initials: E
authors.lastname: Ernst
mesh_terms: D026881:Acupuncture; D002986:Clinical Trials as Topic; D000529:Complementary Therapies / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D009140:Musculoskeletal Diseases / Q000150:complications / Q000628:therapy*; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010166:Palliative Care; D026741:Physical Therapy Modalities; D008517:Phytotherapy; D016896:Treatment Outcome