Complementary & Integrative Health

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.

Affiliate researcher

Susan D. Reed, MD, MPH

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