Pain Patients

Ying Cao et al. (2025) · QJM : monthly journal of the Association of Physicians

This randomized trial with 84 emergency department patients explored whether acupuncture started right away, before a diagnosis is confirmed, eases the pain of suspected renal colic, the sudden, severe cramping pain in the back or abdomen that usually comes from a kidney or urinary stone. Imaging to confirm a stone takes time while patients are in extreme pain, and the authors note that the usual painkillers have drawbacks: anti-inflammatory drugs can raise heart risk with higher doses and longer use, and opioids cause side effects including nausea, drowsiness and dependence concerns. Acupuncture, a traditional Chinese medicine technique that places thin needles at specific body points, had already been reported by this group to reduce pain in confirmed cases. Adults aged 18 to 80 with one-sided colicky pain and tenderness over the kidney area, and pain of at least 4 on a 0 to 10 scale, were treated at a Beijing hospital emergency department. Half received needles in the back of both hands at Yaotongdian, a point the authors use for lumbar pain, with the needles lifted and rotated until a soreness or heaviness sensation appeared and then left in for 30 minutes. The other half had very shallow needling with tiny short needles at spots that are not acupuncture points, with no manipulation. Ten minutes after needling, 64.3% of the acupuncture group (27 of 42) had at least halved their pain, versus 16.7% of the sham group (7 of 42), a 47.6 percentage point gap (P < 0.01, so chance is very unlikely to explain it). By 30 minutes the figures were 85.7% versus 31.0%. Average pain scores at 10 minutes were 3.38 versus 6.00. Fewer acupuncture patients needed an analgesic injection by 30 minutes (33.3% vs 59.5%; P = 0.03) and satisfaction scores were higher (4.69 vs 3.69). Patients, outcome assessors and statisticians did not know the group, and patients guessed their group at similar rates, so the blinding held. Surgery and return visits did not differ between groups, and each group had one adverse event (bleeding with acupuncture; nausea and vomiting with sham). The authors suggest that early acupuncture is a safe option for pain relief while a diagnosis is awaited and that it did not appear to interfere with later care. The authors also note that a single acupuncture point may give limited improvement in critically ill patients. They state plainly that the study was done at one center with experienced acupuncturists, included only 3 acupuncture-group patients who turned out not to have a urinary stone, and did not analyze results by stone size. They call for multicenter confirmation.

Jian-Feng Tu et al. (2022) · JAMA network open

This randomized trial with 80 emergency department patients explored whether adding acupuncture to a standard painkiller injection brings faster relief from renal colic, the severe cramping flank pain that occurs when a kidney stone blocks or moves through the urinary tract. Renal colic is described by the authors as one of the worst types of pain, and the guideline first-choice drugs, nonsteroidal anti-inflammatory medicines such as diclofenac, take time to work: in an earlier study, 37.5% of patients still had moderate or severe pain 15 minutes after an injection. Acupuncture, a traditional Chinese medicine technique that inserts thin needles at specific body points, had shown quick pain reduction in other settings. Adults aged 18 to 75 with stone-related renal colic and pain of at least 4 out of 10 on a visual analog scale (a line on which patients mark their pain) were treated at a Beijing hospital emergency department in 2020. Everyone received a 50 mg diclofenac injection into the muscle. Half then had 30 minutes of needling at Yaotongdian, a point on the back of each hand, with the needles twisted and lifted until a soreness or heaviness sensation (called De qi) appeared. The other half had shallow needle pricks at forearm spots that are not acupuncture points. Ten minutes after needling, 77.5% of the acupuncture group (31 of 40) had at least halved their pain score, compared with 10.0% of the sham group (4 of 40), a gap of 67.5 percentage points (P < .001, so chance is very unlikely to explain it). Average pain fell to 3.0 versus 5.9 out of 10. Acupuncture also led at 0, 5, 15, 20 and 30 minutes (97.5% vs 80.0% at 30 minutes; P = .03). Patients, assessors and the statistician did not know the group, and patients guessed their group about equally often in both arms (P = .48). The advantage faded as the injection took effect: by 45 and 60 minutes both groups had about 92% to 98% responding (P = .62), and only 1 patient needed stronger rescue medication. No adverse events were recorded. The authors suggest acupuncture may serve as an optional add-on for faster relief, since it uses a single point and needs no individual diagnosis. They attribute the absence of a rescue-medication difference to a possible ceiling effect from the diclofenac. They note limitations plainly: one hospital, treatment given after diagnostic imaging, experienced acupuncturists who could not be blinded, and no follow-up of pain beyond 60 minutes or analysis by stone size. They plan to study acupuncture before imaging.

Hazel J Jenkins et al. (2026) · Chiropractic & manual therapies

This pilot randomised trial with 20 patients and 11 chiropractors explored whether it is practical to run a large study asking a simple question: does taking spinal x-rays change outcomes for people receiving chiropractic care for back or neck pain? In medical settings, trials have found routine imaging does not improve non-specific low back pain, yet chiropractors use x-rays at widely varying rates (8% to 84%), partly to screen for reasons spinal manipulation might be unsuitable. No randomised trial had tested imaging where manipulation is also part of care, so the authors first tested whether such a trial could work. Chiropractors in Sydney, Australia, invited adults with a new episode of spinal pain, where the chiropractor was unsure whether an x-ray was needed. A computer randomly assigned each consenting patient to get spinal radiographs or not, and everything else, including manipulation, was decided between chiropractor and patient. Pain, disability (Roland Morris Disability Questionnaire for the back, Neck Disability Index), satisfaction and side effects were collected at 2, 6 and 12 weeks, and chiropractors were interviewed about the experience. Recruitment was the main difficulty: 135 patients were screened, 33 (24%) were eligible and 20 took part, short of the 50 planned. Three of 10 patients assigned to imaging did not get it, and 2 of 10 assigned to no imaging did, always after a clinical change. Follow-up fell from 90% of patients at 2 weeks to 75% at 12 weeks. Pain and disability fell in both groups, but differences between groups were small and the trial was too small to compare them. Mild, short-lived side effects such as muscle soreness affected 4 of 20 participants (1 imaging, 3 no imaging). The authors judged that most criteria for a larger trial were met but recruitment and cross-over would need strategies, since COVID-19, time pressure and discomfort explaining diagnostic uncertainty to patients limited enrolment. Limitations include a self-selected group of chiropractors, probably non-consecutive recruitment and mostly young, low-disability participants.

Rita Chiaramonte et al. (2026) · The Journal of manual & manipulative therapy

This systematic review of 18 randomized controlled trials explored whether hands-on treatment eases pain and improves jaw movement in adults with temporomandibular disorders (TMD). TMD is a group of conditions affecting the jaw joint, the chewing muscles and nearby tissues, and it is estimated to affect about 31% of adults. Its subtypes include muscle pain (myalgia), disc displacement (the cushioning disc slips out of position, sometimes locking the jaw) and joint pain. Manual therapy covers thrust manipulation, soft-tissue release, massage and intra-oral techniques, delivered by physiotherapists, chiropractors, osteopaths, dentists and physicians. The review asked which techniques help most and whether results differ by profession. Researchers searched four databases through March 2025 and screened 561 records, keeping 18 trials of adults with a clinical TMD diagnosis. Trials compared manual therapy with sham treatment, no treatment, splints, medication, exercise or education. Pain was rated on the visual analogue or numeric rating scale (0 to 10), and maximum mouth opening was measured in millimetres. Risk of bias was checked with the Cochrane tool and certainty with GRADE. Because the trials differed so widely in technique, dose, comparator and follow-up, results were summarized in words rather than pooled statistically. Most trials reported short-term pain reduction and wider mouth opening, but certainty was low to moderate for pain and low for mouth opening. High-velocity low-amplitude (HVLA) thrusts made up 56% of interventions and fascial manipulation with myofascial release made up 37.5%. Dry needling plus upper neck HVLA beat splint therapy, diclofenac and joint mobilization at three months (p < 0.001), and intra-oral therapy kept benefits for one year in chronic jaw-muscle pain. Upper thoracic HVLA showed no significant effect (p > 0.05), and jog manipulation gained only 6.86 mm of mouth opening at first visit with no later group difference. Massage and fascial manipulation by physiotherapists were linked to relief of jaw-muscle symptoms, while chiropractic, osteopathic and dental trials also reported gains. Physiotherapy trials were the most numerous, which the authors attribute to publication volume rather than superior effectiveness. The authors describe manual therapy as associated with short-term benefit and treat professional comparisons as descriptive, since profession was tangled with setting, technique and country. Limitations include small samples, short follow-up, mixed diagnoses, English-only searching and no meta-analysis. Safety findings were not reported in pooled form, and the evidence mostly covers weeks to months rather than years. The authors call for larger trials with longer follow-up and standardized protocols, and they state that manual therapy is best delivered by trained, licensed professionals.

Salma Bouqartacha et al. (2026) · Chiropractic & manual therapies

This randomized mechanistic cross-over trial with 89 adults explored how two hands-on neck treatments differ right after they are delivered. Chronic neck pain, defined here as pain lasting at least 12 weeks, is one of the leading causes of disability worldwide. Spinal manipulation (SM) is a single quick, shallow thrust applied to a joint, and spinal mobilization (Smob) is a slower, repeated rocking pressure on the same area. Both are recommended in clinical guidelines, but they are often lumped together, so little was known about how their effects on pain, movement and muscle activity compare. Participants were aged 18 to 65, with an average of 35 years, and 65% were women. They were recruited in Zurich, Switzerland, and Trois-Rivieres, Canada. Each person attended two sessions three days apart, receiving SM in one and Smob in the other in random order. SM was one thrust to the most painful neck joint while lying face up, and Smob was 30 seconds of repeated pressure on the same level while lying face down. Pain was rated from 0 to 10, and neck movement, tenderness to pressure, grip strength and muscle electrical activity were measured before and after. Pain dropped by 0.79 points after SM and 0.37 points after Smob, a gap of 0.41 points (p = 0.002), which stayed below the 1.3 points considered clinically meaningful. Neck movement improved after both treatments, by about 4.6 degrees after SM and 3.7 degrees after Smob in bending forward and back, with no difference between them. Neck muscles responded more strongly during SM, with activity in the sternocleidomastoid about six times higher (0.144 versus 0.023). Tenderness and grip strength changed inconsistently, and the grip decrease of 1.13 kg was far under the 6 kg detectable change. Participants' own global impression of change favored SM (p < 0.001) but also stayed below the clinical threshold. Upper trapezius activity was likewise higher during SM (0.083 versus 0.024). No serious adverse events were reported. The authors state that statistically significant differences did not reach clinical significance, so the trial cannot support conclusions about which treatment works better in practice. Only immediate effects after one session were measured, many outcomes were tested, participants could tell the treatments apart, and baseline disability was mostly mild to moderate. Clinician training also differed between sites. The authors propose that future trials examine several sessions of each treatment, since a multi-session or combined approach may reach clinical relevance.

Ilse N Ganzevoort et al. (2026) · The British journal of general practice : the journal of the Royal College of General Practitioners

This randomised controlled trial with 152 Dutch children explored whether home-based guided hypnotherapy, added to usual care from a general practitioner (GP), helps children with functional abdominal pain (recurring stomach pain with no underlying disease found) or irritable bowel syndrome (IBS, abdominal pain linked to bowel habit changes). Both conditions are disorders of gut-brain interaction, meaning the gut and the nervous system influence one another, and in children they are linked with anxiety, school absence and lower quality of life. Hypnotherapy is a state of focused attention in which therapeutic suggestions are used to influence sensation, emotion and thought. It is already available in secondary care, but its effect in primary care had not been tested. Children aged 7 to 17 with a GP diagnosis were randomly assigned to usual care alone (education, reassurance and symptom monitoring) or usual care plus hypnotherapy. Of the 152 children, 46 came through GPs and 106 through social media; median age was 9.4 years. The hypnotherapy group listened to five audio exercises on a website, one for breathing and relaxation and four visualisation exercises, for 15 to 20 minutes on at least five days a week for three months. The main outcome was adequate relief of abdominal pain at 12 months; pain severity was rated from 0 to 10. At 12 months the main result was not statistically significant: 79.5% of the hypnotherapy group reported adequate relief versus 74.3% of the usual care group (adjusted odds ratio 1.47, 90% confidence interval 0.74 to 2.93; the interval includes no difference). Earlier, differences were larger. At 3 months 73.2% versus 56.8% reported relief (odds ratio 2.74, meaning higher odds of relief), and at 6 months 77.6% versus 58.6% (odds ratio 4.26). Pain severity scores were lower in the hypnotherapy group by 1.38 points at 6 months and 0.89 points at 12 months, but not significantly at 3 months. Pain threat beliefs were lower and more children fell asleep within 20 minutes. Anxiety, depression, quality of life and school absence were similar between groups. No adverse events were spontaneously reported, but children were not asked about them directly. The authors suggest that hypnotherapy added to usual care may bring earlier relief and lower pain at low cost, and note that relief at 12 months was high in both groups. The trial had limits: it recruited fewer children than planned, so the significance threshold was relaxed to 10%, which raises the chance of false positives. Participants and clinicians knew who received hypnotherapy, and most families preferred it, so placebo effects are possible. More than 40% of pain diary data were missing. The authors call for research on which children benefit most and on possible adverse effects.

Meng-Si Peng et al. (2022) · JAMA network open

This assessor-blinded randomized clinical trial with 113 adults explored whether exercising in water (therapeutic aquatic exercise) works better over the long term than common physical therapy modalities for chronic low back pain, meaning pain lasting at least 3 months. The modalities were transcutaneous electrical nerve stimulation (mild electrical pulses applied through the skin) and infrared ray thermal therapy (heat delivered by infrared light). Aquatic exercise meant guided, active exercise in a pool, where buoyancy and water resistance change how the body carries load. The authors note that low back pain is common and costly, and that no earlier trial had compared these two approaches or followed participants for a full year. Participants were 18 to 65 years old (average 31 years; 59 women, 54 men) and were randomly placed into an aquatic exercise group (56 people) or a modalities group (57 people). Both groups attended 60-minute sessions twice a week for 12 weeks. The aquatic group did a 10-minute warm-up, 40 minutes of water exercise at moderate effort (about 13 on the Borg scale) and a 10-minute cool-down; the modalities group received 30 minutes of nerve stimulation and 30 minutes of infrared heat. Measurements at baseline, 3, 6 and 12 months used the Roland-Morris Disability Questionnaire (24 yes/no items on daily activities limited by back pain) and a 0-to-10 pain rating scale. The aquatic group had lower disability scores than the modalities group at every check: 1.77 points lower at 3 months (P = .006), 2.42 lower at 6 months (P = .006) and 3.61 lower at 12 months (P = .001), so the gap widened over time. At 12 months, 46.43% of the aquatic group improved by at least 5 disability points (a change the authors treat as clinically meaningful) versus 7.02% of the modalities group. Most-severe pain was 0.79, 1.34 and 2.04 points lower in the aquatic group at 3, 6 and 12 months. Sleep quality, fear of movement and overall quality of life (SF-36) also improved more with aquatic exercise (P = .02, P < .001 and P = .003 for the overall group-by-time effect). Not every measure separated the groups: overall SF-36 scores were nearly identical at 3 months (P = .92), and work-related fear-avoidance scores did not differ. Treatment-related pain was uncommon in both groups (3.6% versus 7.0%). The authors suggest that water-based exercise may offer longer-lasting benefit than passive modalities for chronic low back pain, in part because it is active exercise. They state clear limits: participants were mostly young with fairly low pain, no one could be blinded, the comparison group did not exercise so the water itself cannot be credited alone, and costs were not examined. The authors call for trials that add a land-exercise group, combine both approaches, and include older people with more severe pain.

Jonathan Greenberg et al. (2025) · JAMA network open

This feasibility randomized clinical trial with 92 sedentary adults experiencing chronic musculoskeletal pain explored whether a mind-body walking program could be delivered successfully across three geographically and racially diverse U.S. academic medical centers, compared with a health education program. The mind-body walking program combined quota-based pacing — increasing step-count goals gradually based on what participants could sustain, rather than tying goals to whether pain was present — with mind-body skills such as breathing exercises and body scans, and cognitive skills aimed at identifying and reframing unhelpful pain-related thoughts. The trial measured physical function in three complementary ways (self-reported, performance-based, and step-count-based), addressing a gap identified in pain-trial reporting guidelines. Participants were randomized 1:1 to the 10-week, 60-minute weekly group mind-body walking program (47 participants) or a matched health-education control (45 participants), recruited between April 2023 and January 2024. The mind-body group received a Fitbit Inspire 3 tracker with individualized weekly step goals. Physical function was measured with the 6-Minute Walk Test, a wrist-worn accelerometer worn for one week, and the World Health Organization Disability Assessment Schedule. Pain, mood, and psychological mechanisms — pain catastrophizing, fear of movement, adaptive coping, and mindfulness — were measured with validated questionnaires before and after the program. Both programs met most feasibility benchmarks, including attendance (95.7% mind-body walking vs 82.2% health education), delivery fidelity, and participant retention (93.6% vs 86.7%). Racial and ethnic diversity exceeded its target (54.3% of participants from minority groups, against a 38% benchmark), though overall recruitment fell short (69.7% of eligible patients enrolled, against an 80% target). Within the mind-body walking group, participants showed large pre-to-post improvements in walking distance (48.6 meters over six minutes, P<.001), self-reported physical function (P<.001), and pain catastrophizing (P<.001), plus medium improvements in pain intensity (P=.002) and fear of movement (P<.001), and smaller but significant improvements in adaptive coping and mindfulness (both P<.05). The health education group improved only on walking distance and pain intensity. Because the trial was not statistically powered to compare the two programs against each other, these within-group changes describe what happened in each arm rather than a demonstrated advantage of one program over the other. The trial establishes that a mind-body walking program can be delivered with strong attendance and participant satisfaction across diverse academic medical centers, supporting a future, fully powered efficacy trial. The findings do not establish that the mind-body walking program produces greater benefit than health education, since the study was designed to test feasibility rather than comparative outcomes. The gap between eligible and enrolled participants (69.7% versus an 80% target) points to recruitment timing as an area for refinement in future trial designs.

Daniel C Cherkin et al. · JAMA

This randomized clinical trial with 342 adults explored whether an eight-week mindfulness-based stress reduction (MBSR) program — training in meditation, body awareness, and yoga — could ease chronic low back pain as effectively as cognitive behavioral therapy (CBT), a well-established talk-therapy approach that helps people change pain-related thoughts and behaviors. Both interventions govern how the nervous system processes and responds to persistent pain signals, but through different mechanisms: MBSR through non-judgmental present-moment awareness, CBT through restructuring unhelpful thought patterns. Participants had lived with low back pain for an average of over seven years. Adults aged 20 to 70 (mean 49, two-thirds women) with pain lasting at least three months were randomly assigned to MBSR, CBT, or usual care. Both active groups met weekly for eight two-hour sessions — MBSR practiced body scans, sitting and walking meditation, and gentle yoga, while CBT focused on identifying unhelpful thoughts, relaxation training, and pacing daily activities. Improvement was measured with the Roland Disability Questionnaire (a 23-item scale of pain-related function) and a 0-10 pain-bothersomeness rating, checked by blinded interviewers at 8, 26, and 52 weeks. At the six-month mark, 61% of the MBSR group and 58% of the CBT group showed clinically meaningful improvement in function, compared with 44% of the usual-care group (a statistically significant difference, p=0.04, meaning the pattern was unlikely to occur by chance). Pain bothersomeness improved meaningfully for 44% of MBSR participants and 45% of CBT participants, versus 27% on usual care (p=0.01). MBSR was about 1.4 times more likely than usual care to produce meaningful functional improvement, and both active treatments held their advantage a full year later. On mood measures, CBT edged out MBSR at some points, though both beat usual care through six months. Roughly 3 in 10 MBSR participants and 1 in 10 CBT participants reported a temporary increase in discomfort — most often stiffness or soreness from yoga or relaxation exercises — with no serious safety concerns in either group. The trial suggests MBSR works about as well as CBT for chronic low back pain, giving people a second evidence-based option beyond conventional pain therapies. Only about half of participants attended six or more of the eight sessions, hinting the benefits may not require full completion. The study was conducted at a single US healthcare system among a fairly well-educated population, so how the findings translate to other settings, or to CBT delivered one-on-one rather than in groups, is not yet known. The authors call for further work on cost-effectiveness and long-term durability beyond one year.

Bowen Xu et al. (2026) · Frontiers in endocrinology

This open-label randomized trial at Shanghai East Hospital compared two approaches to primary dysmenorrhea (menstrual cramping without an underlying pelvic disease) in 80 women aged 15 to 46: a Traditional Chinese Medicine protocol called Cai's Gynecology Cyclical Therapy, paired with a specific formula called the Stasis-Clearing and Meridian-Warming Method, versus standard ibuprofen. The TCM approach is built on a century-old idea from a Shanghai medical lineage: that treatment should change across the four phases of the menstrual cycle rather than staying the same throughout. Forty women received ibuprofen (a common anti-inflammatory pain reliever) for two days during each period, while the other forty received herbal decoctions -- different formulas depending on the cycle phase -- for three full menstrual cycles. Researchers tracked pain on a 0-to-10 visual pain scale and a symptom-severity score, and checked whether pain returned in the month after treatment ended. People collecting the follow-up data did not know which treatment each woman had received. Both treatments worked well overall (97.5% of women improved in each group), but the pattern of improvement differed. Ibuprofen relieved pain faster in the first month, as expected for a direct pain reliever. The herbal treatment started more slowly but kept improving month after month, and by the third month the two treatments were statistically equivalent on both pain and symptom scores. The most striking difference came after treatment stopped: only about 13% of the herbal-treatment group had their pain return the following month, compared to about 90% of the ibuprofen group. No side effects were reported in either group throughout the study. The researchers suggest this gap in relapse rates may reflect a real difference in how the two approaches work -- ibuprofen blocks pain-causing chemicals only while it is being taken, whereas the herbal protocol may produce a more lasting change. However, because patients and treating doctors could not be kept unaware of which treatment they were giving or receiving (an inherent challenge when comparing herbal decoctions to a standard pill), and because the study involved one hospital and a single follow-up cycle, the authors call for larger, multi-site studies with longer follow-up to confirm these findings.

Jihye Seo et al. (2020) · Medicine

This systematic review and meta-analysis pooled 14 randomized controlled trials (1,215 women, mostly from China with one from Japan) exploring whether Dangguijagyag-san (DJS) - a traditional East Asian herbal formula also called Danggui Shaoyao San - helps primary dysmenorrhea (PD), the cramping menstrual pain that occurs without an underlying pelvic disease. PD is common, estimated to affect 16-91% of women of reproductive age, and is driven by elevated uterine prostaglandins causing muscle spasm; standard NSAID and hormonal treatments carry gastrointestinal and other side-effect risks, which is part of why researchers keep examining herbal alternatives. The review followed a pre-registered protocol and searched eight medical databases through April 2019. The included trials compared DJS - most often prepared as a decoction (a boiled herbal liquid), given over roughly three menstrual cycles - against NSAIDs (5 trials), a placebo (1 trial), other herbal formulas (6 trials), or NSAIDs with moxibustion added to DJS (2 trials). The main outcome tracked was the total effective rate, a practitioner-judged measure of symptom improvement, alongside pain scores on a visual analogue scale in some trials. Pooled results favored DJS across every comparison. Against NSAIDs, DJS produced a higher effective rate (relative risk 1.16, meaning about 16% more improvement events, 95% confidence interval 1.08-1.24, with no meaningful variation between trials). Against placebo, DJS reduced pain scores and cut how often women needed rescue pain medication during their period. Against other herbal formulas, DJS again showed a higher effective rate (RR 1.24), an advantage that held up most consistently when DJS was prepared as a decoction rather than a granule or capsule. Adding moxibustion (heated-herb therapy at acupuncture points) to DJS outperformed NSAIDs alone (RR 1.47). Side effects were reported in only a handful of trials and were mostly mild digestive complaints, less frequent in the DJS groups than the NSAID groups. The review's authors rated the overall certainty of this evidence as moderate to low: most trials did not clearly describe how they randomized or concealed group assignment, could not blind participants to which herbal or drug treatment they were taking, and were often small (many under 100 participants), all conducted in East Asia. The findings do not establish how DJS performs in other populations or over longer treatment periods, and the authors call for larger, more rigorously designed trials to confirm the effect.

Nicolas Vaillancourt et al. (2026) · Pain management

This two-arm randomized controlled trial with 36 adults compared 10 weeks of aquatic (pool-based) exercise therapy against a standard land-based care program for chronic low back pain (CLBP) — pain lasting more than three months without a clear structural cause. Beyond the usual measures of pain and disability, the study also tracked psychological factors that keep chronic pain going: pain catastrophizing (dwelling on and magnifying pain), kinesiophobia (fear of movement or reinjury), anxiety, depression, and sleep disturbance — factors most exercise trials for back pain don't examine. Participants, aged 18 to 65, trained twice a week for 60 minutes over 10 weeks, one-on-one with a certified athletic therapist. The aquatic group did dynamic lumbar-stabilization, core, hip and aerobic circuit exercises in a therapeutic pool, where water's buoyancy takes weight off the spine and its resistance still builds strength. The standard-care group received an individualized land-based mix of hands-on manual therapy (spinal mobilization, myofascial release) and progressive stabilization and strength exercise — reflecting the real-world care most people with CLBP actually receive. Thirty-four people completed the study; both groups attended more than 85% of sessions, and no one had an adverse event. Both programs worked: pain, disability, physical and overall quality of life, pain catastrophizing, and anxiety/depression all improved significantly in both groups by 10 weeks, with disability improvements (18-point and 13-point drops) comfortably clearing the threshold considered clinically meaningful, and neither group pulling statistically ahead of the other on any of these. The one place aquatic therapy stood out on its own was kinesiophobia and sleep: only the aquatic group's improvement in fear-of-movement scores and sleep-disturbance scores reached statistical significance, likely because moving safely and painlessly in water helps people rebuild confidence that movement won't hurt them. That said, the aquatic group wasn't statistically better than standard care on these two measures either — it simply crossed the bar for significance within its own group while standard care came close but didn't. These results support aquatic therapy as a genuinely comparable — and possibly, on fear of movement and sleep, slightly favorable — alternative to standard hands-on and land-exercise care for chronic low back pain. The study is small (34 completers), was originally powered to detect a different outcome in its parent trial, and its therapists weren't blinded to which treatment they were giving, so these encouraging psychological findings need confirmation in larger, purpose-built trials before they can be treated as settled.

Pamela M Rist et al. (2020) · Cephalalgia : an international journal of headache

This pilot randomized controlled trial with 61 adult women explored whether adding multimodal chiropractic care to enhanced usual care could feasibly be delivered to people with episodic migraine, and whether it might reduce how often migraines occurred. Multimodal chiropractic care combines several hands-on techniques — spinal manipulation (adjusting joint movement in the spine), joint mobilization, soft-tissue release, and posture correction — rather than spinal manipulation alone, the approach most prior migraine trials tested. Enhanced usual care meant continuing regular medical treatment plus migraine education materials and regular phone check-ins, giving both groups comparable attention from the study team. Participants were women ages 21 to 55 (average 36) having 4 to 13 migraine days a month, randomly assigned to receive up to 10 individualized chiropractic sessions over 14 weeks (29 women) or enhanced usual care alone (32 women). Chiropractors tailored treatment to each person's diagnosis — myofascial pain, spinal misalignment, or jaw dysfunction — drawing from a fixed menu of techniques. Migraine frequency, severity, and disability were tracked through daily logs and standardized questionnaires: the Migraine Disability Assessment (MIDAS), the Headache Impact Test (HIT-6), and a migraine-specific quality-of-life scale, completed at 14 and 18 weeks. Recruitment and safety looked encouraging: of 422 people screened, 61 enrolled over 20 months, 93% completed migraine logs, and no serious side effects occurred, though only 83% of chiropractic-group participants attended enough sessions to meet the study's own adherence goal (versus a target of 85%), so feasibility criteria were narrowly missed. Migraine days dropped substantially more with chiropractic care added, a difference of about 2 fewer migraine days per month than usual care alone (95% confidence interval -3.46 to -0.37, meaning the true benefit is likely real but its exact size is uncertain), and this advantage held up a month after treatment ended. Disability and headache-impact scores (MIDAS and HIT-6) improved significantly more with chiropractic care too. However, migraine severity, duration, medication use, and quality-of-life scores did not differ significantly between groups, and musculoskeletal stiffness was reported more often by the chiropractic group (21% versus 6%). For migraine sufferers seeking non-drug options, these results are promising but preliminary: the size of the migraine-day reduction was similar to what topiramate, propranolol, and erenumab achieve against placebo in prior research. Because participants and chiropractors knew who was receiving treatment, and the chiropractic group received more attention overall, some of the benefit could reflect that extra contact rather than the techniques themselves. The sample was small, all female, and drawn from one clinic, so a larger, multi-site trial is needed before multimodal chiropractic care can be recommended as proven migraine therapy.

Taewoo Kang et al. (2022) · Medicine

This single-blind randomized controlled trial with 41 adults explored two ways of treating chronic neck pain (CNP) -- pain lasting more than three months, often traced to a forward head posture that overloads the cervical spine. The researchers focused on the scapulothoracic region, the muscles connecting the shoulder blade to the rib cage and spine, because weakness in the middle and lower trapezius combined with tightness in the upper trapezius creates a muscle imbalance that drives neck pain and reduced neck mobility. One group performed a resistance exercise program targeting the weakened muscles directly; the other received trapezius massage targeting the tight ones, and both were compared head-to-head over four weeks. Adults aged 29 to 66 (mean 47.9, 22 men, 19 women) with confirmed chronic neck pain were split into a resistance-exercise group (21 people) and a massage group (20 people) at a South Korean clinic, training five days a week for four weeks. The exercise group used elastic bands for eight movements -- chin tucks, rows, and scapular retraction among them -- building from 10-15 up to 15-20 repetitions per set. The massage group received a standardized 20-minute trapezius massage combining myofascial release, trigger-point work, and friction techniques. Pain, neck motion, muscle tone, disability, and quality of life were all measured. Both approaches worked: pain, disability, and quality-of-life scores improved significantly within each group (p<.05 throughout). But head-to-head, resistance exercise pulled ahead on several measures. Pain dropped further with exercise (VAS change 2.67 vs. 2.30 points, p=.02), and disability scores on the Neck Disability Index fell more as well (p=.04). Quality of life improved more on both the physical (p=.04) and mental (p<.001) subscales. Muscle tone and stiffness in the upper trapezius -- the very muscle massage directly targets -- actually decreased more in the exercise group (p=.01 to .03), suggesting that strengthening the weakened muscles around it relieved tension more effectively than massaging the tight muscle itself. Cervical rotation, often the most functionally limited movement in this condition, also improved more with exercise (p<.001 to .02). Flexion, extension, and side-bending improved to a similar degree in both groups, with no meaningful difference in muscle elasticity. For people managing chronic neck pain, a structured resistance program targeting the shoulder-blade stabilizers may offer more relief than massage alone, particularly for pain, disability, quality of life, and neck rotation -- and it requires only elastic bands, making home practice feasible. The trial did not track adverse events or follow participants beyond the 4-week program, so how long the gains last is unknown. It also did not directly measure whether the weakened muscles actually got stronger, so the exact mechanism behind the improvement is inferred rather than proven. Larger studies with longer follow-up periods are needed.

Ángel Rodríguez-Ruiz et al. (2024) · Medicina (Kaunas, Lithuania)

This randomized controlled trial with 44 women explored whether a four-week "HAMMAM" program -- combining hydrotherapy (therapeutic water bathing at varying temperatures) and Swedish massage (a full-body technique using kneading, stroking, and tapping to relax muscle tissue and improve circulation) -- could ease pain in women with endometriosis-related chronic pelvic pain that had not improved with standard medical treatment. Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, commonly causing pain during menstruation (dysmenorrhea, governing cyclical cramping) and intercourse (dyspareunia) that standard analgesics and hormonal therapy fail to relieve in roughly a third to half of patients. Women aged 20-50 with confirmed endometriosis and pelvic pain rated at least 4 out of 10 were randomly assigned to the HAMMAM group (21 women) or a control group continuing usual care (23 women) at a hospital in Granada, Spain. The HAMMAM group attended three 90-minute sessions over four weeks at a bathhouse: a 60-75 minute circuit of warm, hot, and cold water baths plus a steam room, then a 15-minute Swedish massage with essential oils; the last session added a traditional exfoliating scrub. Pain was measured on a 0-10 scale, and pressure sensitivity with a handheld algometer. The HAMMAM group reported significantly less menstrual pain (p = 0.035, a large effect) and pain during intercourse (p = 0.020, a moderate-to-large effect) after the program compared with the control group. Pain interfering with sleep also dropped notably (p = 0.018), and pressure pain thresholds in the pelvic region rose (p = 0.029, meaning the area became less sensitive to pressure -- a sign of reduced pain sensitization), with the strongest change at the left groin ligament (p = 0.006). Everyone attended all sessions (100% adherence) and rated satisfaction at 9.71 out of 10, with no adverse events. However, overall pelvic pain ratings, catastrophic thinking about pain, general subjective well-being, and endometriosis-specific quality of life did not change significantly, showing the benefits were concentrated in specific pain measures rather than global wellness. For women whose endometriosis pain persists despite conventional treatment, this suggests a short, low-intensity spa-style program combining water therapy and massage may meaningfully ease menstrual and intercourse pain and pain-disrupted sleep, with high satisfaction and no safety concerns. Because hydrotherapy and massage were only tested together, it is not yet known which component -- or their combination -- drives the benefit, and the small, single-site sample limits how broadly these results apply. Larger trials testing each therapy alone are needed before firm clinical recommendations can be made.

Gert Bronfort et al. (2022) · Chiropractic & manual therapies

Low back pain touches an estimated 40-80% of adults at some point, and when it becomes chronic, it is a major driver of disability, missed work, and long-term opioid use. Guidelines recommend combining conventional care with complementary approaches like spinal manipulation, exercise, and acupuncture, but most back pain treatment in practice still relies on a single approach. This year-long randomized trial in Minneapolis compared standard chiropractic care against a coordinated team approach -- chiropractors, acupuncturists, massage therapists, psychologists, exercise therapists, and a physician working together -- to see whether combining disciplines beats chiropractic care alone for people with ongoing low back pain. 201 adults with long-standing back pain (on average, pain for 8 to 9 years) were randomly assigned to 12 weeks of either chiropractic-only care or the multidisciplinary team approach, with a case manager coordinating each patient's individualized plan. Both groups showed strong participation -- over 90% attended their recommended visits. Researchers tracked back pain intensity as the main outcome, alongside disability, quality of life, and patient satisfaction, checking in at 4, 12, 26, and 52 weeks after the study began. Over the full year, the team-based approach edged out chiropractic-only care on pain intensity, with the clearest advantage showing up at the one-year mark. The team approach also showed a meaningful, statistically significant advantage for disability, overall improvement, satisfaction with care, and how often people experienced back symptoms -- though pain relief itself, while favoring the team approach throughout, only reached statistical significance at certain checkpoints (mainly week 52). Things like quality of life, medication use, and fear of movement did not differ meaningfully between the two approaches. Both approaches were very safe: only five serious health events occurred over the year (mostly unrelated conditions like pneumonia or a fractured foot), and about half of participants in both groups reported mild, temporary side effects like increased soreness -- at nearly identical rates whichever approach they received. In people with chronic low back pain, this trial found that a coordinated team of practitioners — rather than chiropractic care alone — gave a modest edge, mainly on disability and overall satisfaction, without added safety risk. That said, the study's participants were not very racially or economically diverse, and the exact process used to decide each patient's treatment plan had not itself been formally validated, so the results may not translate perfectly to every clinic. Still, the findings support integrated, team-based care as a reasonable option on the evidence here.

Dilara Onan et al. (2025) · Journal of oral & facial pain and headache

Chronic tension-type headache (CTTH) -- headaches on 15 or more days a month for at least three months -- is thought to involve tight, tender muscles in the head, neck, and face, though scientists are not fully certain why it happens. This systematic review and meta-analysis pulled together randomized trials testing physiotherapy-style treatments -- things like massage, exercise, acupuncture, and relaxation training -- to see whether they actually ease CTTH symptoms. The researchers followed a pre-registered research plan and searched two major databases through mid-2024, aiming to answer a focused question: do these hands-on and movement-based approaches beat sham treatment, no treatment, or medication alone? Two physiotherapist researchers with PhD degrees independently screened 237 studies and settled on nine randomized trials -- ranging from 25 to 169 patients each, mostly women, treated for 3 to 12 weeks. The approaches tested included trigger point massage, electroacupuncture, relaxation with muscle-tension biofeedback, yoga, and neck-and-shoulder strengthening exercises, among others. Seven of the nine trials had comparable enough data to combine mathematically (meta-analysis), and each study's methodological rigor was scored using a standard 11-item checklist. When the researchers pooled the numbers, physiotherapy approaches meaningfully reduced headache intensity compared to control (a large, statistically significant effect), cut the number of headache days per month by more than one day on average, and shortened how long headaches lasted -- all statistically significant improvements. A fourth measure, day-to-day headache impact on daily life, trended in favor of physiotherapy but did not reach statistical significance. Looking at individual studies: electroacupuncture beat sham treatment for headache intensity; combining a hands-on release technique with ibuprofen worked better than ibuprofen alone; and yoga added to standard medical care outperformed medical care by itself on several measures. Importantly, though, the researchers rated their overall confidence in these pooled results as low to very low -- the studies were small, methods varied a lot between them, and most carried some risk of bias. No serious side effects were reported in any trial. The takeaway is cautiously encouraging: physiotherapy-based approaches -- especially those combining exercise, hands-on techniques, or relaxation training with standard care -- show a real signal for easing CTTH symptoms, and they appear safe. But because the underlying evidence is still thin and inconsistent, these findings should not be read as proof that any one specific technique is the best choice. The authors call for larger, more consistently designed trials before physiotherapy can be confidently recommended as a primary CTTH treatment, though the current evidence supports trying it as a reasonable, low-risk complement to standard care.

Filip Gedin et al. (2025) · BMC musculoskeletal disorders

This Swedish trial asked whether a chiropractor, a physiotherapist, or advice to stay active works best for low back pain lasting months — and the honest answer is that it could not tell the three apart. Eighty-eight people at ten primary care clinics around Stockholm were randomly assigned to one of four things: advice only, physiotherapy, chiropractic care, or both together. Six months later, everyone was better. Disability scores dropped in every group — most in the chiropractic group, least in the physiotherapy group — but the gaps between groups were well within what chance alone would produce. Pain scores and quality of life told the same story: improvement everywhere, no clear winner. Where the groups did differ was cost. The advice-only group ended up costing the health system about three times more than the others — around SEK 11,000 per person versus roughly SEK 3,000 — mostly because those patients went on to see doctors more, and one of them had spine surgery. Getting hands-on treatment early appeared to head off more expensive care later, though with numbers this small a single surgery moves the whole average. Combining chiropractic care with physiotherapy came out best on the economics: slightly more quality-adjusted life years for slightly less money. But "slightly" is doing a lot of work — the difference across all four groups was eight thousandths of a QALY, which is roughly three days of perfect health. The researchers are unusually candid about the limits. They wanted far more participants than they got, nearly half the people dropped out before six months, and the four groups were not well matched at the start. They present this as a lesson for whoever runs the definitive trial next, not as a result to act on. What it does support, gently: for chronic low back pain, staying active matters, and both chiropractic care and physiotherapy are reasonable, comparably effective options — with some signal that getting treatment rather than advice alone may save money downstream.

Zhiyong Long et al. (2023) · Frontiers in immunology

Whether the plant compounds often discussed for rheumatoid arthritis — turmeric, green tea, pomegranate, garlic — actually do anything is the question this meta-analysis set out to answer. This review gathered every randomized trial it could find on the question: 47 trials, nearly 3,900 people, fifteen different plant polyphenols, from Iran, China, Korea, Egypt, Japan, Brazil, India and the United States. The clearest picture came from two of them. The first is total glucosides of paeony, an extract of Chinese peony root that is a licensed prescription medicine in China. Twenty-three trials tested it — always added to standard RA drugs like methotrexate, never instead of them. Disease activity scores came down, and so did CRP, ESR and rheumatoid factor, the blood markers doctors track. The most interesting result: people taking it reported *fewer* side effects than people on the standard drugs alone. That fits how it is used clinically — it appears to soften the toll the conventional drugs take on the liver and stomach. The second is curcumin, the yellow compound in turmeric. Five trials, and the same direction: lower disease activity, lower inflammatory markers, no extra side effects. Green tea polyphenols looked promising across two trials. Saffron did not show a clear effect. Everything else — pomegranate, garlic, resveratrol, sesame, cinnamon, ginger, kudzu, cranberry, olive oil, quercetin — rests on one or two small trials apiece, which is encouraging but not yet evidence that bears weight. The honest caveat, which the authors state plainly themselves: the trials disagreed with each other a great deal, most were small, and when the researchers sliced the data by dose and duration some of the headline benefits faded. Nearly all of these were add-on studies. Nobody tested a polyphenol against methotrexate, so the evidence says nothing about replacing a prescribed medication. What it does support is turmeric and peony extract as the best-evidenced candidates, studied as additions to existing treatment rather than replacements for it.

Ziqing Soh et al. (2025) · Journal of food and drug analysis

This double-blind, randomized, placebo-controlled trial with 30 young Malaysian women explored whether a beverage combining chamomile and l-theanine could ease primary dysmenorrhea - menstrual cramping that occurs without any underlying pelvic disease. Chamomile (Matricaria recutita) is a flowering herb long used as a calming remedy; the study intervention used a standardized flower extract of it. L-theanine is a non-protein amino acid concentrated in tea leaves (Camellia sinensis), used in supplements to support relaxation. The trial paired both in a functional beverage (CTT) and tested it against a chamomile-flavored placebo (non-CTT) to see whether the combination eased pain, mood, and sleep during menstruation. Thirty women aged 18-30 with primary dysmenorrhea (pain rated at least 4 of 10 on a visual scale across three cycles) were randomly split into a CTT group (480 mg chamomile extract plus 200 mg l-theanine daily) or a non-CTT control group, drinking two 240 mL packs daily - one on waking, one before bed - for five days spanning two days before their period through its third day. Pain was tracked with two 0-10 scales, symptoms with the 18-item Cox Menstrual Symptom Scale, sleep with the Pittsburgh Sleep Quality Index, and mood with the Profile of Mood States. Compared to their own baseline, women drinking CTT saw pain scores drop by roughly 57% on both pain scales (p<0.001), a large reduction over five days. Eight menstrual symptoms also eased significantly, including lower abdominal pain (down 53%), back pain (down 56%), and irritability (down 45%, all p<0.05). Mood shifted too: depression scores fell 12% and vigor (energy and alertness) rose 62% (p<0.05). On sleep, only "daytime dysfunction" - grogginess, poor concentration, and low energy during the day - improved (down 32%, p<0.05); overall sleep quality, how long it took to fall asleep, and total sleep time did not change significantly. Hemoglobin levels, checked with a finger-prick test, were unaffected in either group, likely because red blood cells take weeks to months to regenerate, too slow to show up in five days. Interestingly, the placebo group also felt calmer on a few measures, which the researchers link to the shared chamomile scent and flavor rather than to any active ingredient. For young women managing primary dysmenorrhea without relying on NSAIDs, a short course of this chamomile-l-theanine beverage appears to meaningfully ease pain and several physical and emotional symptoms, with no reported side effects. Because chamomile and l-theanine were only tested together, it is not yet clear how much each contributes individually, and the tiny sample (15 per group) and single five-day cycle mean the results are preliminary. Longer trials spanning multiple cycles, larger and more diverse groups, and a scent-neutral placebo are needed before firmer conclusions can be drawn.