Osteoarthritis

Acupuncture got a top score of 5 in this category, followed by tai chi with 4. Both ratings indicate high levels of efficacy for dealing with the degenerative joint disease.

Fibromyalgia

Massage received 5 and acupuncture 4 in this analysis, based on results of 50 trials that looked at 17 therapies in more than 3,000 patients with fibromyalgia. Tai chi and relaxation therapy both got 3, which indicates there is promising evidence that they may help.

Low back pain

This category had the most studies – 75 in all, featuring more than 11,000 patients testing 14 therapies. Acupuncture and massage each received 5, yoga scored 4 and relaxation therapy, osteopathy and the Alexander technique scored 3. The Alexander technique teaches people to move, sit and stand with less strain and more ease.

Only chiropractic and osteopathy received an “amber” rating for safety. These treatments, which involve spinal manipulation designed to relieve pain or discomfort and increase mobility, were found to have minor side effects such as headache, tiredness, dizziness, nausea and pain.

Jones says it’s important to evaluate these CAM therapies in populations with musculoskeletal conditions, as they likely use the treatments more than others. “People do spend their money on these things, and there’s a need to advise them where the evidence fits so they can make these choices wisely,” he says. CAM therapies are used by approximately 38 percent of American adults, according to the 2007 National Health Interview Survey.

The evidence is especially clear in favor of acupuncture for OA, fibromyalgia and low back pain. In fact, Jones says its benefits are so well-documented that it raises the question of whether acupuncture should continue to be viewed as a CAM therapy. “There’s an argument that maybe this should be part of conventional medicine. When something works, when there is good evidence something works, is it right that it is still a complementary therapy? Probably not,” Jones says, adding that he’d like to see future studies about why CAM therapies work.

Dr. Clauw says he hopes for more high-quality studies comparing the effectiveness of CAM therapies. But he says this is more data than patients have ever had before, which is helpful since CAM therapies often aren’t covered by insurance.

Jones agrees. “Until this came out and synthesized data, there was no guidance. Now there is some. That would be a good place for someone to start if they want to pursue CAM therapies,” Jones says. “Start with the ones that are on the list, but it doesn’t mean that something not on the list won’t work.”

Before you try a CAM therapy, make sure your doctor is supportive, Dr. Clauw says. “The main thing I can help you with is to evaluate if it’s safe,” he explains. “And then it comes down to patient preference. Are they willing to pay out of pocket for a treatment that may or may not work?”

He also recommends trying only one CAM therapy at a time. “Give it a month or two, retain what works and discard what doesn’t,” Dr. Clauw suggests. “If it’s not working after a month or a couple treatments a week, it’s probably best for the patient to check the box saying, ‘This didn’t work,’ and move on.”