There is growing acceptance for combining complementary and integrative health (CIH) therapies with standard rehabilitative care (SRC) for chronic pain management, yet little evidence on the best sequence of therapies. We investigated whether starting with CIH therapies or SRC is more effective in reducing pain impact. Participants were 280 service members with predominantly (88%) musculoskeletal chronic pain referred to an interdisciplinary pain management center who were randomized to a twice weekly program of either CIH therapies (n = 140) or SRC (n = 140) for the 3-week first stage of treatment. The composition of a second 3-week treatment stage depended upon response to the first stage. The primary outcome measure was the impact score (range 8-50) from the NIH Task Force on Research Standards for Chronic Low-Back Pain. Outcomes were measured after 3 and 6 weeks of treatment and at 3- and 6-month follow-ups. Most participants were men (76.8%) and mean age was 34.7 years (SD 8.0). At end of stage 1, pain impact decreased significantly more in the CIH group (29.8 points [SD 7.2] at baseline to 26.3 points [SD 7.9], change of -3.3 points [95% confidence interval, -4.2 to -2.5]) than in the SRC group (30.8 [SD 7.6] to 29.4 [SD 7.8], change of -0.9 points [95% confidence interval, -1.8 to -0.1]; P < 0.001). No significant between-group differences were observed after 6 weeks of treatment nor at 3- or 6-month follow-ups. Complementary and integrative health therapies may provide earlier improvement in pain impact than SRC, but this difference is not sustained.

中文翻译：

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慢性肌肉骨骼疼痛军人的补充、综合和标准康复疗法：一项采用 SMART 设计的实用临床试验。


人们越来越接受将补充和综合健康 （CIH） 疗法与标准康复护理 （SRC） 相结合进行慢性疼痛管理，但几乎没有关于最佳治疗顺序的证据。我们研究了从 CIH 疗法或 SRC 开始是否能更有效地减少疼痛影响。参与者是 280 名主要 （88%） 患有肌肉骨骼慢性疼痛的服役人员，他们被转诊到跨学科疼痛管理中心，他们被随机分配到每周两次的 CIH 疗法 （n = 140） 或 SRC （n = 140） 计划，进行为期 3 周的第一阶段治疗。第二个 3 周治疗阶段的组成取决于对第一阶段的反应。主要结局指标是 NIH 慢性腰痛研究标准工作组的影响评分 （范围 8-50）。在治疗 3 周和 6 周后以及 3 个月和 6 个月的随访中测量结局。大多数参与者是男性 （76.8%），平均年龄为 34.7 岁 （SD 8.0）。在第 1 阶段结束时，CIH 组（基线时 29.8 分 [SD 7.2] 至 26.3 分 [SD 7.9]，变化 -3.3 分 [95% 置信区间，-4.2 至 -2.5]）比 SRC 组（30.8 [SD 7.6] 至 29.4 [SD 7.8]，变化 -0.9 分 [95% 置信区间，-1.8 至 -0.1];P < 0.001）。治疗 6 周后以及 3 个月或 6 个月的随访中未观察到显著的组间差异。与 SRC 相比，补充和综合健康疗法可能更早地改善疼痛影响，但这种差异并不持续。