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Managing Pain with Alternative Therapies

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About 126 million adults report having pain in the past three months. Annually, nearly 62 million Americans fill at least one prescription for opioids, and approximately 12 million individuals misuse prescription pain relievers. Alternative and integrative therapies, such as acupuncture, mindfulness (meditation), and Tai Chi, may help some individuals manage pain.

Understanding the effectiveness of these therapies can be a challenge. RAND researchers studied hundreds of reviews of the evidence on the effect of these three therapies on different types of pain.

The chart below compiles information from these studies on the effectiveness of acupuncture, mindfulness, and Tai Chi for the types of pain listed below. Each symbol represents both the likelihood of being effective (for example, color-filled circles represent therapies likely to have a positive effect) and the number of studies on the effect of a particular therapy. Areas of the chart without circles indicate insufficient evaluation of certain combinations of pain type and therapy.

Individuals can use this chart to understand which therapies may be promising to help manage their pain. This chart is not meant to provide medical advice; patients should consult their health care providers before pursuing therapeutic treatment.

Therapies Reviewed

  • Acupuncture
  • Mindfulness
  • Tai Chi

Whole-body pain

Whole-body pain

Therapies Acupuncture Mindfulness Tai Chi
Chronic 20 or more studies with positive effect 20 or more studies with positive effect No studies
General Between 10 and 19 studies with potentially positive effect No studies Between 10 and 19 studies with potentially positive effect
Fibromyalgia Between 10 and 19 studies with unclear effect Less than 10 studies with unclear effect Less than 10 studies with unclear effect
Cancer Between 10 and 19 studies with unclear effect No studies No studies
Surgical or postoperative Between 10 and 19 studies with unclear effect No studies No studies
Rheumatoid arthritis Less than 10 studies with unclear effect No studies Less than 10 studies with unclear effect
Neuropathic Less than 10 studies with unclear effect No studies No studies
Pain intensity No studies Less than 10 studies with unclear effect No studies

Upper-body pain

Therapies Acupuncture Mindfulness Tai Chi
Headache or migraine 20 or more studies with positive effect No studies No studies
Jaw Less than 10 studies with potentially positive effect No studies No studies
Neck 20 or more studies with unclear effect No studies No studies

Midsection pain

Therapies Acupuncture Mindfulness Tai Chi
Labor Between 10 and 19 studies with positive effect No studies No studies
Back 20 or more studies with unclear effect Less than 10 studies with positive effect No studies
Pregnancy Less than 10 studies with potentially positive effect No studies No studies
Prostatitis Less than 10 studies with potentially positive effect No studies No studies
Menstrual 20 or more studies with unclear effect No studies No studies
Carpal tunnel or shoulder Less than 10 studies with unclear effect No studies No studies

Lower-body pain

Therapies Acupuncture Mindfulness Tai Chi
Osteoarthritis 20 or more studies with positive effect No studies Less than 10 studies with potentially positive effect
Plantar heel Less than 10 studies with potentially positive effect No studies No studies
Ankle sprain Between 10 and 19 studies with unclear effect No studies No studies

About the Research

This graphic is based on evidence maps for mindfulness (July 2017), Tai Chi (February 2014, updated March 2018), and acupuncture (March 2013, updated March 2018). The evidence maps represent on overview of the evidence found in systematic reviews that identify, extract, synthesize, and appraise information from published research. The methodology is described in detail in the published reports cited below.

  • Hempel S., and S. Baxi, “Alternative Pain Approaches—Based on 3 Evidence Maps,” Santa Monica, Calif.: RAND Corporation, unpublished researched, 2008, available upon request from Susanne Hempel.
  • Hempel, S., S. L. Taylor, N. J. Marshall, I. M. Miake-Lye, J. Beroes, R. Shanman, M. R. Solloway, and P.G. Shekelle, Evidence Map of Mindfulness, Washington, D.C.: U.S. Department of Veterans Affairs, VA Evidence-Based Synthesis Program Reports, VA-ESP Project 05-226. October 2014. As of August 9, 2018: https://www.rand.org/pubs/external_publications/EP50729.html
  • Hempel, S., S. L. Taylor, M. R. Solloway, I. M. Miake-Lye, J. M. Beroes, R. Shanman, M. J. Booth, A. M. Siroka, and P. G. Shekelle, Evidence Map of Acupuncture, Washington, D.C.: U.S. Department of Veterans Affairs, VA Evidence-Based Synthesis Program Reports, VA-ESP Project 05-226, January 2014. As of August 9, 2018: https://www.rand.org/pubs/external_publications/EP50723.html
  • Hempel, S., S. L. Taylor, M. R. Solloway, I. M. Miake-Lye, J. M. Beroes, R. Shanman, and P. G. Shekelle, Evidence Map of Tai Chi, Washington, D.C.: U.S. Department of Veterans Affairs, VA Evidence-Based Synthesis Program Reports, VA-ESP Project 05-226, September 2014. As of August 9, 2018: https://www.rand.org/pubs/external_publications/EP50728.html
  • Hilton, L., N. Marshall, A. Motala, S. Taylor, I. M. Miake-Lye, S. Baxi, R. Shanman, M. R. Solloway, J. Beroes, and S. Hempel, “Mindfulness Meditation for Workplace Wellness: An Evidence Map,” WORK: A Journal of Prevention, Assessment and Rehabilitation, in press.
  • Solloway, M. R., S. L. Taylor, P. Shekelle, I. M. Miake-Lye, J. M. Beroes, R. Shanman, and S. Hempel, “An Evidence Map of the Effect of Tai Chi on Health Outcomes,” Systematic Reviews, Vol. 5, No. 1, 2016. As of August 9, 2018: https://www.rand.org/pubs/external_publications/EP66587.html

Individual References

  • Vickers, A. J., E. A. Vertosick, G. Lewith, H. MacPherson, N. E. Foster, K. J. Sherman, D. Irnich, C. M. Witt, and K. Linde, Acupuncture Trialists’ Collaboration, “Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis,” Journal of Pain, Vol. 19, No. 5, May 2018, pp. 455–474. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/29198932
  • Hilton, L., S. Hempel, B. A. Ewing, E. Apaydin, L. Xenakis, S. Newberry, B. Colaiaco, A. R. Maher, R. M. Shanman, M. E. Sorbero, and M.A. Maglione, “Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-Analysis,” Annals of Behavioral Medicine, Vol. 51, No. 2, April 2017, pp. 199–213. As of August 10, 2018: https://www.rand.org/pubs/external_publications/EP66661.html Back to table ⤴
  • Madsen, M. V., P. C. Goetzsche, and A. Hrobjartsson, “Acupuncture Treatment for Pain: Systematic Review of Randomized Clinical Trials with Acupuncture, Placebo Acupuncture, and No Acupuncture Groups,” BMJ, Vol. 338, No. a3115, January 27, 2009. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/19174438
  • Hall, A., B. Copsey, H. Richmond, J. Thompson, M. Ferreira, J. Latimer, and C. G. Maher, “Effectiveness of Tai Chi for Chronic Musculoskeletal Pain Conditions: Updated Systematic Review and Meta-Analysis,” Physical Therapy, Vol. 97, No. 2, February 1, 2017, pp. 227–238. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/27634919 Back to table ⤴
  • Deare, J. C., Z. Zheng, C. C. Xue, J. P. Liu, J. Shang, S. W. Scott, and G. Littlejohn, “Acupuncture for Treating Fibromyalgia,” Cochrane Database of Systematic Reviews, Vol. 5, May 31, 2013. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/23728665
  • Theadom, A., M. Cropley, H. E. Smith, V. L. Feigin, and K. McPherson, “Mind and Body Therapy for Fibromyalgia,” Cochrane Database of Systematic Reviews, Vol. 4, April 9, 2015. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/25856658
  • Mist, S. D., K. A. Firestone, and K. D. Jones, “Complementary and Alternative Exercise for Fibromyalgia: A Meta-Analysis,” Journal of Pain Research, Vol. 6, 2013, pp. 247–260. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/23569397 Back to table ⤴
  • Paley, C. A., M. I. Johnson, O. A. Tashani, and A. M. Bagnall, “Acupuncture for Cancer Pain in Adults,” Cochrane Database of Systematic Reviews, Vol. 10, October 15, 2015. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/26468973 Back to table ⤴
  • Lee, H., and E. Ernst, “Acupuncture Analgesia During Surgery: A Systematic Review,” Pain, Vol. 114, No. 3, April 2005, pp. 511–517. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/15777876
  • Sun, Y., T. J. Gan, J. W. Dubose, and A. S. Habib, “Acupuncture and Related Techniques for Postoperative Pain: A Systematic Review of Randomized Controlled Trials,” British Journal of Anaesthesia, Vol. 101, No. 2, August 2008, pp. 151–160. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/18522936 Back to table ⤴
  • Wang, C., P. de Pablo, X. Chen, C. Schmid, and T. McAlindon, “Acupuncture for Pain Relief in Patients with Rheumatoid Arthritis: A Systematic Review,” Arthritis and Rheumatism, Vol. 59, No. 9, September 15, 2008, pp. 1249–1256. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/18759255
  • Han, A., V. Robinson, M. Judd, W. Taixiang, G. Wells, and P. Tugwell, “Tai Chi for Treating Rheumatoid Arthritis,” Cochrane Database of Systematic Reviews, Vol. 3, 2004. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/15266544 Back to table ⤴
  • Ju, Z. Y., K. Wang, H. S. Cui, Y. Yao, S. M. Liu, J. Zhou, T. Y. Chen, and J. Xia, “Acupuncture for Neuropathic Pain in Adults,” Cochrane Database of Systematic Reviews, Vol. 12, December 2, 2017. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/29197180 Back to table ⤴
  • Reiner, K., L. Tibi, and J. D. Lipsitz, “Do Mindfulness-Based Interventions Reduce Pain Intensity? A Critical Review of the Literature,” Pain Medicine, Vol. 14, No. 2, February 2013, pp. 230–242. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/23240921 Back to table ⤴
  • Linde, K., G. Allais, B. Brinkhaus, Y. Fei, M. Mehring, E. A. Vertosick, A. Vickers, and A. R. White, “Acupuncture for the Prevention of Episodic Migraine,” Cochrane Database of Systematic Reviews, Vol. 6, June 28, 2016. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/27351677
  • Linde, K., G. Allais, B. Brinkhaus, Y. Fei, M. Mehring, B. C. Shin, A. Vickers, and A. R. White, “Acupuncture for the Prevention of Tension-Type Headache,” Cochrane Database of Systematic Reviews, Vol. 4, April 19, 2016. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/27092807 Back to table ⤴
  • Jung, A., B. C. Shin, M. S. Lee, H. Sim, and E. Ernst, “Acupuncture for Treating Temporomandibular Joint Disorders: A Systematic Review and Meta-Analysis of Randomized, Sham-Controlled Trials,” Journal of Dentistry, Vol. 39, No. 5, May 2011, pp. 341–350. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/21354460 Back to table ⤴
  • Trinh, K., N. Graham, D. Irnich, I. D. Cameron, and M. Forget, “Acupuncture for Neck Disorders,” Cochrane Database of Systematic Reviews, Vol. 5, May 4, 2016. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/27145001 Back to table ⤴
  • Smith, C. A., C. T. Collins, C. A. Crowther, and K. M. Levett, “Acupuncture or Acupressure for Pain Management in Labour,” Cochrane Database of Systematic Reviews, Vol. 7, July 6, 2011. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/21735441 Back to table ⤴
  • Furlan, A. D., F. Yazki, A. Tsertsvadze, A. Gross, M. Van Tulder, L. Santaguida, J. Gagnier, C. Ammendolia, T. Dryden, S. Doucette, B. Skidmore, R. Daniel, T. Ostermann, and S. Tsouros, “A Systematic Review and Meta-Analysis of Efficacy, Cost-Effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-Back Pain,” Evidence-Based Complementary and Alternative Medicine, 2012. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/22203884
  • Chou, R., R. Deyo, J. Friedly, A. Skelly, R. Hashimoto, M. Weimer, R. Fu, T. Dana, P. Kraegel, J. Griffin, S. Grusing, and E. D. Brodt, “Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline,” Annals of Internal Medicine, Vol. 166, No. 7, April 4, 2017, pp. 493–505. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/28192793 Back to table ⤴
  • Ee, C. C., E. Manheimer, M. V. Pirotta, and A. R. White, “Acupuncture for Pelvic and Back Pain in Pregnancy: A Systematic Review,” American Journal of Obstetrics and Gynecology, Vol. 198, No. 3, March 2008, pp. 254–259. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/18313444 Back to table ⤴
  • Posadzki, P., J. Zhang, M. S. Lee, and E. Ernst, “Acupuncture for Chronic Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome: A Systematic Review,” Journal of Andrology, Vol. 33, No. 1, January–February 2012, pp. 15–21. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/21436307 Back to table ⤴
  • Smith, C. A., M. Armour, X. Zhu, X. Li, Z. Y. Lu, and J. Song, “Acupuncture for Dysmenorrhoea,” Cochrane Database of Systematic Reviews, Vol. 4, April 18, 2016. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/27087494 Back to table ⤴
  • Sim, H., B. C. Shin, M. S. Lee, A. Jung, H. Lee, and E. Ernst, “Acupuncture for Carpal Tunnel Syndrome: A Systematic Review of Randomized Controlled Trials,” Journal of Pain, Vol. 12, No. 3, March 2011, pp. 307–314. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/21093382
  • Green, S., R. Buchbinder, and S. Hetrick, “Acupuncture for Shoulder Pain,” Cochrane Database of Systematic Reviews, Vol. 2, April 18, 2005. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/15846753 Back to table ⤴
  • Corbett, M. S., S. J. Rice, V. Madurasinghe, R. Slack, D. A. Fayter, M. Harden, A. J. Sutton, H. Macpherson, and N. F. Woolacott, “Acupuncture and Other Physical Treatments for the Relief of Pain Due to Osteoarthritic of the Knee: Network Meta-Analysis,” Osteoarthritis and Cartilage, Vol. 21, No. 9, September 2013, pp. 1290–1298. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/23973143
  • Escalante, Y., J. M. Saavedra, A. Garcia-Hermoso, A. J. Silva, and T. M. Barbosa, “Physical Exercise and Reduction of Pain in Adults with Lower Limb Osteoarthritis: A Systematic Review,” Journal of Back and Musculoskeletal Rehabilitation, Vol. 23, No. 4, 2010, pp. 175–186. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/21079296 Back to table ⤴
  • Clark, R. J., and M. Tighe, “The Effectiveness of Acupuncture for Plantar Heel Pain: A Systematic Review,” Acupuncture in Medicine, Vol. 30, No. 4, December 2012, pp. 298–306. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/23099290 Back to table ⤴
  • Kim, T. H., M. S. Lee, K. H. Kim, J. W. Kang, T. Y. Choi, and E. Ernst, “Acupuncture for Treating Acute Ankle Sprains in Adults,” Cochrane Database of Systematic Reviews, Vol. 6, June 23, 2014. As of August 10, 2018: https://www.ncbi.nlm.nih.gov/pubmed/24953665 Back to table ⤴

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