Complementary & Integrative Health

“Our studies have helped establish the evidence base for many ‘complementary therapies’ that Americans often use to treat chronic pain and other conditions. This helps ensure treatments are truly patient-centered.”

Karen J. Sherman, PhD, MPH
Senior Investigator, Kaiser Permanente Washington Health Research Institute

Research overview

Americans are increasingly using complementary and integrative medicine for pain and other health problems, according to national surveys. Kaiser Permanente Washington Health Research Institute (KPWHRI) has one of the nation's leading teams researching these approaches to healing. Team members use rigorous scientific methods to evaluate the effectiveness—including cost-effectiveness—of complementary and integrative therapies delivered in real-world practice.

Many KPWHRI studies concern musculoskeletal conditions such as back pain, which accounts for a large portion of visits to alternative providers. National guidelines for treating back pain now include six complementary and integrative approaches: four of them—acupuncture, massage, mindfulness, and yoga—on the strength of Kaiser Permanente research.

"Our research has shown that massage, yoga, acupuncture, mindfulness-based stress reduction, and to a lesser extent spinal manipulation help relieve chronic low back pain," says KPWHRI Senior Investigator Emeritus Dan Cherkin, PhD. "But the reasons why these treatments are helpful remain unclear."

The stress-reducing aspects of some treatments may be more important than the physical ones. Also, complementary and integrative practitioners often approach their patients with optimism, offer suggestions for ways they can achieve more balance in their lives, and coach them on becoming more involved in their own healing and self-care. “We’re very interested in self-care: things that people can do for themselves,” says Senior Investigator Karen Sherman, PhD. This has led to a new project in implementation science in which KPWHRI researchers are learning to optimize mindfulness training to work for a greater number of patients. Qualitative research is an important component of this research and Assistant Investigator Clarissa Hsu, PhD, has led these efforts for multiple projects.

"We are understanding better how the mind and body are intricately connected, with both important for healing to occur," Dr. Sherman says. "In primary care, we hope to harness the mind-body connection to enhance healing for various health problems that don't respond well to conventional treatments."

Projects embedded in the delivery system are also receiving increasing attention. Senior investigator Lynn DeBar, PhD, MPH, has led large, multisite projects that have included complementary and integrative health components. A recently completed pragmatic trial carried out in Kaiser Permanente clinics in Georgia, Hawaii, Oregon, and Washington tested a primary care-based integrated behavioral health intervention that included a yoga-based adaptive movement component. A current Patient-Centered Outcomes Research Institute-funded project is evaluating the impact of an Oregon policy designed in part to lower barriers for Medicaid-insured patients with back or neck pain to access a range of complementary and integrative health treatments including acupuncture, chiropractic care, massage, and yoga, as well as other nonpharmacotherapy services.

Recent publications on Complementary and Integrative Health

Johnson ES, Dickerson JF, Vollmer WM, Rowley AM, Ritenbaugh C, Deyo RA, DeBar L. The feasibility of matching on a propensity score for acupuncture in a prospective cohort study of patients with chronic pain. BMC Med Res Methodol. 2017 Mar 16;17(1):42. doi: 10.1186/s12874-017-0318-4. PubMed

Cherkin DC, Anderson ML, Sherman KJ, Balderson BH, Cook AJ, Hansen KE, Turner JA. Two-year follow-up of a randomized clinical trial of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care for chronic low back pain. JAMA. 2017;317(6):642-644. doi: 10.1001/jama.2016.17814. PubMed

Sawyer T, Fu B, Gray M, Umoren R. Medical improvisation training to enhance the antenatal counseling skills of neonatologists and neonatal fellows: a pilot study. J Matern Fetal Neonatal Med. 2017;30(15):1865-1869. doi: 10.1080/14767058.2016.1228059. Epub 2016 Sep 5. PubMed

Cherkin DC, Sherman KJ, Balderson BH, Cook AJ, Anderson ML, Hawkes RJ, Hansen KE, Turner JA. Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: a randomized clinical trial. JAMA. 2016 Mar 22-29;315(12):1240-9. doi: 10.1001/jama.2016.2323. PubMed

Keosaian JE, Lemaster CM, Dresner D, Godersky ME, Paris R, Sherman KJ, Saper RB. "We're all in this together": A qualitative study of predominantly low income minority participants in a yoga trial for chronic low back pain. Complement Ther Med. 2016 Feb;24:34-9. doi: 10.1016/j.ctim.2015.11.007. Epub 2015 Dec 2. PubMed

Researchers in Complementary and Integrative Health

Daniel C. Cherkin, PhD

Senior Investigator (Emeritus)
206-287-2875
Dan.C.Cherkin@kp.org

Curriculum vitae (CV)

Karen J. Sherman, PhD

Senior Investigator
206-287-2426
Karen.J.Sherman@kp.org

Katherine M. Newton, PhD

Senior Investigator (Emeritus)
206-287-2973
Katherine.M.Newton@kp.org

Curriculum vitae (CV)

Andrea J. Cook, PhD

Senior Investigator
206-287-4257
Andrea.J.Cook@kp.org

Curriculum vitae (CV)

Clarissa Hsu, PhD

Assistant Investigator
206-287-4276
Clarissa.W.Hsu@kp.org

Curriculum vitae (CV)

Ben Balderson, PhD

Research Associate
206-287-2803
Benjamin.H.Balderson@kp.org

Curriculum vitae (CV)

Eric Johnson, MS

Biostatistician
206-287-2105
Eric.Johnson@kp.org

Curriculum vitae (CV)

Robert D. Wellman, MS

Biostatistician
206-287-2557
Robert.D.Wellman@kp.org

Curriculum vitae (CV)

Lorella Palazzo, PhD

Research Associate
206-287-2173
Lorella.G.Palazzo@kp.org

Curriculum vitae (CV)

Marlaine Gray, PhD

Assistant Investigator
206-287-2620
Marlaine.S.Figueroagray@kp.org

Curriculum vitae (CV)

Lynn DeBar, PhD

Senior Investigator
(206) 287-2942
Lynn.Debar@kp.org

Curriculum vitae (CV)
 

Affiliate researcher

Susan D. Reed, MD, MPH

Harborview Medical Center; University of Washington (UW) Department of Obstetrics and Gynecology