Reductions in pain medication use associated with traditional Chinese medicine for chronic pain

Abstract

Context: 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.

Design: 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.

Outcome measures: 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.

Trial registration: ClinicalTrials.gov NCT00856167.

Figures

Figure 1

Consort diagram. NSAID = nonsteroidal anti-inflammatory drugs; TCM = traditional Chinese medicine.

Figure 2

Changes in pain (upper line) and narcotics dosages (lower line) per week among participants ever using narcotics (n = 21).

Figure 3

Changes in pain (upper line) and NSAID dosages (lower line) per week among participants ever using narcotics (n = 21). NSAID = nonsteroidal anti-inflammatory drugs.

Figure 4

Changes in pain (upper line) and NSAID dosages (lower line) per week among participants in the highest quartile of NSAID use (n = 22). NSAID = nonsteroidal anti-inflammatory drugs.

Figure 5

Changes in pain (upper line) and NSAIDs dosages (lower line) per week among participants in the 3rd quartile of NSAID use (n = 23). NSAID = nonsteroidal anti-inflammatory drugs.