Use of complementary and alternative medicine (CAM) by patients with chronic non-malignant pain: comparison between primary headache and rheumatic disease

Complementary and alternative medicine (CAM) is frequently used by patients with chronic non-malignant pain. However, little is known about the use of CAM according to the kind and origin of the pain. Our aim was to compare the rate, pattern, and motivation of complementary and alternative medicine (CAM) use between two clinical populations: primary headache and rheumatic disease patients. Method: we studied 307 primary headache patients (F: 81%; M: 19%; mean age±SD: 38.9±9.0 years; migraine: 90%; tension-type headache: 7%; cluster headache: 3%) and 303 rheumatic disease patients (F: 79%, M: 21%; mean age±SD: 52.0±13.6 years; disorders of connective tissue: 61%; rheumatoid arthritis: 25%; fibromyalgia: 14%) consecutively attending the out-patients services respectively of the Headache Centre and of the Rheumatology Clinic of the University Hospital of Modena for a follow-up visit from October 2008 to March 2009. The investigation was carried out by a standardized physician-administered questionnaire. The data collected were inserted into a specially prepared data base. A descriptive analysis of the frequencies of all parameters collected was made, as well as a comparison between primary headache and rheumatic disease patients. Statistical differences were analysed by Fisher’s exact test to compare percentages and by Student’s t test for unpaired data to compare mean values between groups. A “P” lower than 0.05 was chosen as significant for all the tests. Results: the majority of the patients in both groups had never used CAM. The headache patients’ group had used at least one kind of CAM significantly more (n=138, 45%) than the rheumatic disease group (n=104, 34%) (P= 0.008, Fisher’s exact test). The first three kinds of most used CAM were the same in the two groups: homeopathy, phytotherapy and acupuncture. However, a significantly larger number of headache patients (n=57, 41%) than of rheumatic disease patients (n=22, 21%) had used acupuncture (P= 0.000; Fisher’s exact test). The most common source of recommendation of CAM was a friend or a relative in both groups (headache patients: 70%; rheumatic disease patients: 55%). The chemist had been a source of advice significantly more for headache (n=32, 23%) than for rheumatic patients (n=4, 4%) (P= 0.000; Fisher’s exact test). Most patients, without any differences between the two groups (headache patients: 67%; rheumatic disease patients: 71%), had informed their general practitioner that they were using CAM. The first reason for the use of CAM was different in the two groups: lack of efficacy of traditional drugs in the case of headache patients (49% vs rheumatic disease group: 6%; P= 0.000; Fisher’s exact test) and idea of using a more natural treatment, less dangerous than traditional drugs, in the case of rheumatic disease patients (59% vs headache patients: 33%; P= 0.000; Fisher’s exact test). Most rheumatic patients had only used one kind of CAM (52% vs headache patients: 37%; P= 0.026; Fisher’s exact test). A higher percentage of headache patients (20%) than of rheumatic patients (5%) had used three or more kinds of CAM (P= 0.000; Fisher’s exact test). Less headache patients (45%) than rheumatic patients (61%) reported to have improved thanks to the use of CAM (P= 0.019; Fisher’s exact test). However, only a minority (5-7%) in both groups thought that CAM treatments were more effective than traditional pharmacological treatments. In spite of this, most patients (headache patients: 74%; rheumatic disease patients: 68%) considered the use of CAM a positive experience and thought that CAM therapy should be chargeable to the National Health Service (headache patients: 82%; rheumatic disease patients: 73%). Conclusion: the use of CAM suggests an active behaviour and seems to answer chronic non-malignant pain patients’ fully justified needs, considering the limitations of the drugs presently available for their treatment. A large number of patients suffering from primary headache are not satisfied with their pharmacological treatments, first of all because of their limited efficacy. Rheumatic patients would also like to be treated with less risky drugs. Furthermore, even if most patients who used CAM considered it a positive experience, this did not make them discontinue the treatments offered by specialised clinics. On the whole, patients were prudent in assessing the efficacy of CAM and had openly informed their general practitioner that they were using it. Specialists should therefore have a better knowledge of complementary and alternative medicine, in order to be able to discuss with patients about them and to properly integrate these therapies with traditional drugs, thus optimising the treatment of each patient