title: Reductions in pain medication use associated with traditional Chinese medicine for chronic pain.
abstract: BACKGROUND
  Participants in a randomized trial of traditional Chinese medicine (TCM) for temporomandibular joint dysfunction (TMD) had a linear decline in pain over 16 TCM visits.
  
  
  OBJECTIVE
  To investigate whether reductions in pain among participants receiving TCM can be explained by increased use of pain medications, or whether use of pain medications also declined in this group.
  
  
  METHODS
  One hundred sixty-eight participants with TMD were treated with TCM or enhanced self-care according to a stepped-care design. Those for whom self-care failed were sequentially randomized to further self-care or TCM. This report includes 111 participants during their first 16 TCM visits. The initial 8 visits occurred more than once a week; participants and practitioners determined the frequency of subsequent visits.
  
  
  METHODS
  Average pain (visual analog scale, range 0-10) and morphine and aspirin dose equivalents.
  
  
  RESULTS
  The sample was 87% women and the average age was 44 ± 13 years. Average pain of narcotics users (n = 21) improved by 2.73 units over 16 visits (p < 0.001). Overall narcotics use trended downward until visit 11 (-3.27 doses/week, p = 0.156), and then trended upward until week 16 (+4.29 doses/week, p = 0.264). Among those using narcotics, use of nonsteroidal anti-inflammatory drugs (NSAIDs) declined linearly over visits 1-16 (-1.94 doses/week, p = 0.002).Among the top quartile of NSAID-only users (n = 22), average pain decreased linearly over 16 visits (-1.52 units, p = 0.036). Overall NSAID doses/week declined between visits 1 and 7 (-9.95 doses/week, p < 0.001) and then remained stable through 16 visits. NSAID use also declined among the third quartile (n = 23) and remained low and stable among the lower half (sorted by total intake) of NSAID users.
  
  
  CONCLUSIONS
  Among the heaviest NSAID users, we observed a short-term reduction in NSAID use that was sustained as TCM visits became less frequent. There was no indication that pain reduction during TCM treatment was influenced by drug use.
authors.affiliation: Center for Health Research, Portland, OR, USA. charles.elder@kpchr.org
authors.forename: Charles
authors.initials: C
authors.lastname: Elder
authors.forename: Cheryl
authors.initials: C
authors.lastname: Ritenbaugh
authors.forename: Mikel
authors.initials: M
authors.lastname: Aickin
authors.forename: Richard
authors.initials: R
authors.lastname: Hammerschlag
authors.forename: Samuel
authors.initials: S
authors.lastname: Dworkin
authors.forename: Scott
authors.initials: S
authors.lastname: Mist
authors.forename: Richard E
authors.initials: RE
authors.lastname: Harris
mesh_terms: D015670:Acupuncture Therapy; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000627:therapeutic use; D018771:Arthralgia / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D059350:Chronic Pain / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008405:Massage; D008516:Medicine, Chinese Traditional; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage* / Q000627:therapeutic use; D009819:Office Visits; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D008517:Phytotherapy; D012648:Self Care; D012720:Severity of Illness Index; D013704:Temporomandibular Joint
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D009294:Narcotics