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Study: Uses of Complementary health approaches overall and also for pain management in US adults for 2002, 2012, and 2022

Research Letter

The January 25, 2024, JAMA Research Letter compared the use of Complementary Health Approaches (CHA) Overall and for Pain Management by US adults during 2002, 2012, and 2022.


Millions of US adults use complementary health approaches (CHAs) each year; in 2012, 55 million adults spent $28.3 billion on CHAs, comparable to 9% of total out-of-pocket health care expenditures.1 Previously, the safety and efficacy of many of these approaches lacked rigorous clinical trials.2 Over the past 2 decades, increasing evidence has supported the safety and efficacy of selected approaches for pain management.3,4 We examined trends in CHA use among US adults at 3 time points: 2002, 2012, and 2022.


Methods

We used data from the 2002, 2012, and 2022 National Health Interview Survey (NHIS), an annual, nationally representative, cross-sectional household interview survey conducted in-person and by telephone. Response rates were 74.3% in 2002, 61.2% in 2012, and 49.6% in 2022. Increasingly sophisticated approaches to produce sample weights were used to account for nonresponse. The NHIS was approved by the National Center for Health Statistics Research Ethics Review Board, with verbal informed consent obtained.

The following approaches were consistently captured in all 3 years: acupuncture, guided imagery and/or progressive muscle relaxation, massage, naturopathy, and yoga. Questions on chiropractic care and meditation were consistently captured in 2002 and 2022. However, the questionnaire wording was substantially different in 2012, preventing comparisons with the 2002 or 2022 data. Further details on the surveys and the questions used in the present study are given in the eAppendix and eTable in Supplement 1.


Outcomes were the changes over time in use of any of the 7 CHAs and each CHA individually both for any reason and for pain management. Analyses were conducted using PROC SURVEYFREQ in SAS, version 9.4 (SAS Institute Inc). All data were age-standardized using the 2010 US Census population to allow comparisons across the survey years. We used the Cochran-Mantel-Haenszel test for linear trend to assess the significance of changes over time. Statistical significance was set at α<.05 (2-sided), with 95% CIs presented for all prevalence estimates.


Results

There were 31 044, 34 525, and 27 651 NHIS participants in 2002, 2012, and 2020, respectively. Adults reporting use of any of the 7 approaches increased significantly between 2002 and 2022 from 19.2% (95% CI, 18.7%-19.7%) to 36.7% (95% CI, 36.0%-37.5%) (P < .001). Trends for all individual modalities were significant (Figure 1). The largest increase in utilization was seen for yoga: 5.0% (95% CI, 4.7%-5.2%) in 2002, 9.0% (95% CI, 8.6%-9.4%) in 2012, and 15.8% (95% CI, 15.2%-16.3%) in 2022. The CHA with the highest prevalence was meditation, used by 17.3% (95% CI, 16.7%-17.9%) of individuals in 2022. Use of acupuncture, which was increasingly covered by insurance, increased from 1.0% (95% CI, 0.9%-1.2%) in 2002 to 1.5% (95% CI, 1.3%-1.6%) in 2012 and 2.2% (95% CI, 2.0%-2.4%) in 2022.


Among participants reporting use of any of the 7 approaches, the percentage reporting use for pain management increased significantly from 42.3% (95% CI, 40.8%-43.8%) in 2002 to 49.2% (95% CI, 48.0%-50.3%) in 2022. Trends for use of all individual CHAs for pain management were statistically significant. Of the 7 approaches, adults practicing yoga reported the largest increase in use for pain management, from 11.4% (95% CI, 9.3%-13.6%) in 2002 to 22.8% (95% CI, 20.4%-25.1%) in 2012 and 28.8% (95% CI, 27.3%-30.4%) in 2022. The CHA with the highest use for pain management was chiropractic care (85.7% [95% CI, 84.2%-87.2%] in 2022) (Figure 2).


Discussion

Between 2002 and 2022, US adults increasingly used CHAs, including for pain management. This shift in utilization coincides with increased pain prevalence nationally5 and may be attributable to several factors, including randomized clinical trials suggesting that some CHAs provide low to moderate levels of pain management,3 incorporation of CHAs into best practice pain management guidelines,4 and the need to mitigate unnecessary use of potentially harmful opioids through use of nonopioid interventions. Insurance coverage for acupuncture also increased during this period, expanding patient access.6 Study limitations include decreasing NHIS response rates over time, possible recall bias, use of cross-sectional data, and differences in how CHAs and their use for pain management were queried across survey years.


JAMA. Published online January 25, 2024. doi:10.1001/jama.2023.26775


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