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Introduction
Modern medicine has few good answers to the perplexing problem of chronic pain and, as a result, people with chronic pain often turn to complementary medicine. In most cases, people concurrently use complementary and conventional medicine, hoping perhaps to find the "magic bullet" cure but also realising they need to find other ways to cope and to improve their quality of life. A recent study published in JAMA has shown that people often turn to complementary therapies out of a desire to find approaches that are more congruent with a mind-body-spirit philosophy (not merely treating symptoms) and because they want to play an active part in their own healing. 1
Nevertheless, the medical profession is often ambivalent about the role of complementary approaches, partly from a lack of knowledge but also from a feeling that good practice should be based on solid scientific evidence of effectiveness and safety, which has been lacking in complementary medicine. As commendable as the scientific approach is, clinicians may be missing the boat by resting their case on the evidence argument and summarily dismissing complementary medicine. Patients are becoming increasingly well informed and want to be treated as partners in their health care but, finding or anticipating ambivalence among their primary care providers, they tend not to divulge their concurrent use of complementary medicine. 2 This has important implications for the legacy of the doctor-patient relationship, which should embody mutual trust and shared decision making, and holding back is obviously not in the best interest of either patient or doctor.
Safety is perhaps the most obvious concern about lack of disclosure (for instance, the potential for negative drug and herb interactions such as between warfarin and ginkgo biloba). However, we should also look at the potential of complementary therapies to give people more ways to help themselves-to reduce or cope with not only pain but also other aspects of chronic conditions such as anxiety and stress, or to change to more healthy lifestyles.
Mind-body therapies
The most obvious self help approaches are mind-body therapies. Many approaches, usually cognitive behavioural methods, are already incorporated into multidisciplinary pain programmes, but others-such as hypnosis, Qi Gong, and meditation-are less well accepted. In 1996 the US National Institutes of Health held a technology...