A pragmatic clinical trial utilizing a Sequential Multiple Assignment Randomized Trial (SMART) design has revealed promising results for Complementary and Integrative Health (CIH) therapies in managing chronic musculoskeletal pain among active-duty military personnel. The study, presented at a recent Grand Rounds, compared the effectiveness of initiating treatment with CIH therapies versus Standard Rehabilitative Care (SRC).
The research, led by Ardith Z. Doorenbos, PhD, RN, and Diane M. Flynn, MD, MPH, addressed the need for optimized strategies in combining SRC (physical and occupational therapies) with CIH therapies (acupuncture, chiropractic, yoga, and massage) for chronic pain management. The primary outcome measured was the Pain Impact Scores of active-duty service members.
Study Design and Results
The SMART design randomized participants to either CIH or SRC for three weeks. Those showing improvement continued on their assigned treatment, while non-improving participants were randomized to the other treatment arm or a combination of both. The study found that both groups experienced significant improvement in pain levels up to six months compared to baseline. Notably, after three weeks, the CIH group showed greater improvement than the SRC group. However, by the end of the six-week mark, as well as at three- and six-month follow-ups, there was no significant difference in average improvement between the groups.
Key Considerations and Future Directions
The study team acknowledged limitations regarding treatment duration, as participants had the option to continue therapy for up to six weeks. This variability could have influenced follow-up assessments. Furthermore, the actual treatment hours were only slightly higher in the CIH arm than the SRT arm due to lower-than-intended participation.
One theory proposed by the researchers is that the initial positive response to CIH therapies may be due to the reduced movement involved, addressing issues of allostatic stress and kinesiophobia prevalent in the study population. Future research may explore the underlying biological or neurological mechanisms driving the impact of these interventions.
Implications for Clinical Practice
The findings suggest that clinicians can confidently recommend initiating treatment with CIH therapies, particularly if it aligns with patient preferences. This approach could potentially offer earlier benefits in pain management for active-duty service members experiencing chronic musculoskeletal pain. The study supports expanding access to CIH approaches within military healthcare systems.
