A Scoping Review on the Efficacy/Effectiveness and Utilization of Complementary and Integrative Health for Pain in the Military Health System.

Abstract

Introduction: This scoping review evaluated the efficacy/effectiveness and utilization of complementary and integrative health (CIH) therapies for pain management within the Military Health System (MHS). Specifically, it aimed to assess evidence-based modalities such as acupuncture, biofeedback, hypnosis, massage therapy, meditation, guided imagery, Tai Chi/Qi Gong, and yoga, which are part of the Veterans Administration's (VA) Whole Health program. The goal was to determine their effectiveness in military service members and understand their utilization in the MHS, as well as explore CIH research in the MHS to identify gaps. Methods: A comprehensive search of PubMed, Embase, and Ovid All EBM Reviews databases was conducted for studies published from January 1, 2014 to March 22, 2024. The search focused on CIH therapies related to pain management in military populations, yielding 433 studies. After screening for eligibility, 53 studies were included for detailed review. Studies included randomized controlled trials, case studies, large database analyses, and retrospective chart reviews. Exclusion criteria eliminated nonpeer-reviewed articles, not pain-related, not related to one of the prespecified CIH modalities (acupuncture, biofeedback, hypnosis, massage therapy, meditation, guided imagery, Tai Chi/Qi Gong, and yoga), and those not specific to the MHS. The review did not address bias due to the heterogeneity of study designs included. Results: The review identified significant evidence supporting the use of CIH modalities for pain management. Acupuncture, particularly Battlefield Acupuncture, showed immediate reduction in pain score for both acute and chronic pain. Studies of massage therapy and biofeedback demonstrated efficacy/effectiveness in reducing pain and improving functional outcomes in various musculoskeletal and stress-related disorders. Meditation and yoga were shown to be effective for chronic pain, stress management, and enhancing overall well-being. Utilization data indicated a steady increase in CIH therapy use across military facilities. Discussion: CIH therapies, particularly acupuncture, massage therapy, and yoga, appear to be effective nonpharmacologic interventions for pain management in military populations. Their growing utilization reflects the recognition of their benefits in managing chronic pain and improving quality of life among service members. Further research is needed to standardize practices and optimize utilization across the MHS. Registration of Protocol: PROSPERO 2024 CRD4202453685, 29 April 2024, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024536853.