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

Selfe TK, Wen S, Sherman K, Klatt M, Innes KE. Acceptability and feasibility of a 12-week yoga vs. educational film program for the management of restless legs syndrome (RLS): study protocol for a randomized controlled trial. Trials. 2019;20(1):134. doi: 10.1186/s13063-019-3217-7. PubMed

Kligler B, Bair MJ, Banerjea R, DeBar L, Ezeji-Okoye S, Lisi A, Murphy JL, Sandbrink F, Cherkin DC. Clinical policy recommendations from the VHA state-of-the-art conference on non-pharmacological approaches to chronic musculoskeletal pain. J Gen Intern Med. 2018 Apr 9. pii: 10.1007/s11606-018-4323-z. doi: 10.1007/s11606-018-4323-z. [Epub ahead of print]. PubMed

Becker WC, DeBar LL, Heapy AA, Higgins D, Krein SL, Lisi A, Makris UE, Allen KD. A research agenda for advancing non-pharmacological management of chronic musculoskeletal pain: findings from a VHA state-of-the-art conference. J Gen Intern Med. 2018 Apr 9. pii: 10.1007/s11606-018-4345-6. doi: 10.1007/s11606-018-4345-6. [Epub ahead of print]. PubMed

Suri P, Delaney K, Rundell SD, Cherkin DC. Predictive validity of the STarTback tool for risk of persistent disabling back pain in a United States primary care setting. Arch Phys Med Rehabil. 2018 Apr 3. pii: S0003-9993(18)30204-1. doi: 10.1016/j.apmr.2018.02.016. [Epub ahead of print]. PubMed

Saper RB, Lemaster C, Delitto A, Sherman KJ, Herman PM, Sadikova E, Stevans J, Keosaian JE, Cerrada CJ, Fernia AL, Roseen EJ, Gardiner P, Gergen-Barnett K, Faulkner C, Weinberg J. Yoga, physical therapy, or education for chronic low back pain: a randomized noninferiority trial. Ann Intern Med. 2017 Jun 20. doi: 10.7326/M16-2579. [Epub ahead of print]. 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

Curriculum vitae (CV)

Lynn DeBar, PhD

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

Curriculum vitae (CV)

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)

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)
 

Affiliate researcher

Susan D. Reed, MD, MPH

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