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5 Alternative Therapies for Pain

What the research says about whether yoga, chiropractic, massage and other types of integrative care can provide relief

Closeup to Acupuncture for the treatment of the lower back
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As you age, you may notice that aches and pain — a sore knee, a bum hip — become all too frequent. More than 50 million adults in the United States live with chronic pain, according to the National Institutes of Health. Unfortunately, pain becomes more common as we age: Over a quarter of people between the ages of 45 and 84 report that they currently experience it, according to the Centers for Disease Control and Prevention. Looking for relief, many older adults have tried an alternative therapy. About two-thirds of participants in a new University of Michigan National Poll on Healthy Aging, which was supported by AARP, report that they’ve used an integrative medicine strategy such as acupuncture, chiropractic, massage, meditation or yoga. More than 90 percent said that they found these types of treatments helpful. The poll report is based on findings from an online and phone survey of 2,277 adults ages 50 to 80 conducted in January and February 2022.

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“Anecdotally, my patients tell me that they benefit from them,” says Rachael Maciasz, M.D., a general internal medicine physician at Michigan Medicine who worked on the report. “It gives them another tool in their toolbox to deal with issues such as chronic pain.” This is especially important as about a third of adults in their 60s and 70s take at least five different prescription drugs and research shows that pain medications are the most frequently prescribed. “These have side effects, especially among older adults,” Maciasz adds. “If we can empower patients to utilize nonpharmacological approaches to their health when it’s appropriate, it’s often safer, and we can cut back on their out-of-pocket costs too.”

But many older adults are paying for their own alternative therapies, the poll found. Only 15 percent of those surveyed said that insurance covered some or all of the cost. So it’s important to research any treatment you’re considering and to talk to your doctor beforehand to make sure it’s right for you, stresses Maciasz. And according to the new survey, that isn’t a common conversation; less than 20 percent of people in the survey said they’d spoken about an integrative health strategy with their primary care provider.

Experts say more quality research needs to be done into alternative, complementary and integrative therapies. The National Center for Complementary and Integrative Health funds such scientific research and chronic pain is one of the areas of study. Just keep in mind that it doesn’t replace traditional medicine, and you always should talk to your doctor before trying any complementary therapy. Here’s a look at five common integrative health treatments used by survey participants: what they are, what the research shows, and whether part — or all — of the cost may be covered by insurance.

1. Acupuncture for pain

What it is: a technique in which a trained practitioner stimulates specific points on your body by inserting needles through your skin. Traditional Chinese medicine believes that the needles open blocked energy channels so that they can flow properly, which encourages healing, says Gary Soffer, M.D., director of the integrative medicine program at the Yale School of Medicine in New Haven, Connecticut. “From a scientific standpoint, there’s less understanding, but we think that your body’s own opiates get released when the needles are placed, which helps to reduce pain,” he explains. Sixteen percent of poll respondents said they’d tried it, according to the AARP survey.

Research shows: It’s effective in treating many different forms of chronic pain, including back, neck and osteoarthritis-related pain such as knee pain, according to the National Institutes of Health. One 2019 review published in the journal Acupuncture in Medicine, for example, analyzed 14 trials of over 2,100 patients with acute or chronic low-back pain and found that those who used acupuncture had significant reductions in discomfort immediately after treatment compared with those who didn’t, or who used sham acupuncture (where needles that look and feel like real acupuncture needles are used but not inserted into the skin.) “Acupuncture can be hard to study, because there’s some evidence that sham acupuncture can help with pain too,” Soffer says.

Is it covered by insurance? Medicare covers up to 12 acupuncture treatments by a licensed acupuncturist over a 90-day period only for chronic low-back pain (defined as pain that lasts for 12 weeks or longer), and an additional eight sessions if you show improvement. You can’t have more than 20 acupuncture treatments during a 12-month period. If you have private insurance, contact the company. Even if it’s not covered, you can use your health savings account or flexible spending account to pay for treatment if it’s recommended by a health care professional for a medical condition.

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2. Chiropractic care for pain

What it is: a treatment that involves manual therapy such as stretching and spinal manipulation to improve joint movement and function. It’s performed by a chiropractor, who has to earn a doctor of chiropractic (D.C.) degree, pass a national exam and have a state license. The AARP survey found that chiropractic care is one of the top integrative health practices used, with more than 40 percent of respondents saying they’d tried it to help relieve physical symptoms.

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Research shows: It’s effective in treating chronic back pain, neck pain and headache. The American College of Physicians recommends it as one of several first-line options to treat acute or chronic low-back pain. A 2019 study published in the American Journal of Managed Care found that older adults who had access to chiropractic care spent about $40 less a year on diagnostic tests and imaging for spine conditions. But while it can be helpful, older adults should be especially cautious, notes Medhat Mikhael, M.D., medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in Fountain Valley, California. “Sometimes chiropractors who aren’t experienced enough manipulate the spine aggressively, which can worsen disc bulges and cause bone fractures,” he says. It can also cause a major injury in an older adult who has spinal stenosis and/or bone spurs in their spine, he said.

Is it covered by insurance? About 30 percent of poll respondents who used chiropractic said their physician suggested it. But original Medicare will only pay for chiropractic if you are diagnosed with a vertebral subluxation, which is a condition where at least one of your spinal vertebrae becomes misaligned. Some Medicare Advantage and commercial insurance plans have a supplemental benefit that allows you to see a chiropractor for chronic pain, says Douglas Metz, M.D., chief health services officer at American Specialty Health, a national health and wellness organization that provides specialty network management for integrative therapies such as chiropractic.

3. Massage therapy for pain

What it is: a therapy where a practitioner manipulates the soft tissues of the body. It can be helpful, not just to relieve muscle spasms but to invoke the “relaxation response,” a state where your heart and breathing rate slow, your blood pressure decreases and stress hormones go down, Mikhael says. This can also help reduce chronic pain. It was one of the top integrative therapies used by AARP survey participants, with over 40 percent saying they’ve tried it to relax and/or address physical symptoms.

Research shows: Although numerous studies have found massage therapy can help with short-term pain relief, there’s only weak evidence that it can help with long-term relief of low-back pain, according to the NIH. A 2015 review of 25 studies, for example, found that it provided short-term improvement, but the quality of the research was low. “We don’t really have strong evidence that it can provide a long-term benefit,” says Benjamin Kligler, M.D., executive director of the office of patient centered care and cultural transformation at the Veterans Health Administration. Many experts agree, however, that more research should be done to follow up on some promising studies.

Is it covered by insurance? Massage therapy is much less likely to be covered than other therapies such as acupuncture, points out Kligler, which may make it financially impractical for some. It’s not covered at all by traditional Medicare. If you have a Medicare Advantage plan or private insurance, you’ll need to call your company and ask them. If they say they do provide coverage, your best bet is to get a prescription or referral from your doctor, says Adria Gross, CEO of MedWise Insurance Advocacy in Monroe, New York. Ask your doctor to prescribe massage for the most general diagnosis possible — for example, muscle pain. This allows your therapist to adjust your treatment as needed. Also check to see if your plan has limitations as to the number of visits, or the length of time for each visit.

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4. Meditation and mindfulness for pain

What they are: Meditation refers to practices that calm the mind, usually by maintaining mental focus on a certain sensation such as breathing or on a mantra. It’s often combined with mindfulness, which involves staying attentive and aware in the moment. There are different forms, such as mindfulness-based stress reduction, which combines mindful meditation with discussions, or mindfulness-based cognitive therapy, which combines mindfulness with cognitive behavior therapy. Over a quarter of all adults in the AARP survey had tried these practices, mainly for relaxation and stress management.

Find out more

The National Center for Complementary and Integrative Health provides a list of dozens of therapies — from acupuncture to tai chi to yoga — and summarizes the scientific evidence of benefits for each one. Explore the research here.

Research shows: It’s effective for back pain that’s of less than six months’ duration, and has also been shown to help with both acute and chronic pain, according to the National Institutes of Health. “These practices can be helpful for people who feel intermittent pain, because they allow them to be present in the moment, rather than waiting around for pain to show up,” Soffer says. A 2019 study published in the journal Mindfulness found that people who were taught to accept their pain — meaning they were taught to continue tasks or activities even while acknowledging their discomfort — were able to increase their pain endurance and tolerance compared with those who didn’t use this method.

Is it covered by insurance? Medicare will cover meditation and mindfulness if they are part of an intensive cardiac rehabilitation program. You may qualify for this if you had a heart attack or heart surgery in the previous 12 months or have heart failure. Otherwise, most private health insurance and Medicare Advantage plans won’t cover it, unless you’re doing mindfulness-based cognitive therapy with a therapist who’s in your plan network, says Kligler. You may be able to pay for a meditation or mindfulness-based class or program from a flexible spending account or health savings account if you get a note from your physician that it’s medically necessary, he adds.

5. Yoga for pain

What it is: mind and body practice that combines physical postures, breathing exercises and meditation. There are many different kinds. “It helps with chronic pain in many ways: It reduces inflammation, increases flexibility and helps to reduce stress and muscle tension in the body,” Mikhael says. About a quarter of AARP survey respondents say they’ve used it, mainly for relaxation and to improve physical symptoms.

Research shows: There’s evidence that yoga helps with chronic low-back pain, neck pain, headache and knee osteoarthritis. A 2020 report by the Agency for Healthcare Research and Quality, for example, reviewed 10 studies of yoga for low-back pain and found that it was as effective as exercise in terms of improving pain and function. Another 2020 review found that yoga helped reduce the frequency, duration and intensity of tension-type headache, but not migraine. A 2019 review of nine studies found that yoga improved pain, function and stiffness in knee osteoarthritis. “There’s also evidence now that online yoga is as effective as in-person instruction, which opens the door to a lot of people who might not go otherwise,” Kligler says.

Is it covered by insurance? No, but if you have a Medicare Advantage or Medigap plan, it may offer a gym membership that offers yoga classes as part of its coverage package, says Metz.

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