Intended for healthcare professionals

Dealing With Pain

Integrative approaches to pain management: how to get the best of both worlds

BMJ 2003; 326 doi: (Published 12 June 2003) Cite this as: BMJ 2003;326:1320
  1. Brian M Berman (, director1
  1. 1 Center for Integrative Medicine, University of Maryland School of Medicine, James L Kernan Hospital, 2200 Kernan Drive, Baltimore, MD 21207, USA


    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 …

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