Americans are increasingly using complementary and integrative medicine for pain and other health problems, according to national surveys. Researchers at Kaiser Permanente Washington Health Research Institute (KPWHRI) are using rigorous scientific methods to evaluate the effectiveness — including cost-effectiveness — of complementary and integrative therapies delivered in real-world practice.
Several 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 6 complementary and integrative approaches: 4 of them — acupuncture, massage, mindfulness, and yoga — on the strength of Kaiser Permanente research.
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. This has led to a 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 Associate Investigator Clarissa Hsu, PhD, has led these efforts for multiple projects.
Projects embedded in the delivery system are also a focus at KPWHRI. Large, multisite projects have included complementary and integrative health components. For example, a 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.
Birch S, Sherman K. Zhong Yi acupuncture and low-back pain: traditional Chinese medical acupuncture differential diagnoses and treatments for chronic lumbar pain. J Altern Complement Med. 1999;5(5):415-25; discussion 427-8. PubMed
van Tulder MW, Cherkin DC, Berman B, Lao L, Koes BW. The effectiveness of acupuncture in the management of acute and chronic low back pain. A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine. 1999;24(11):1113-23. PubMed
Cherkin D, Street J. Alternative medicine--the case of herbal remedies. N Engl J Med. 1999;340(7):565; author reply 566. PubMed
Cherkin DC, Street J. Response to "Alternative medicine- the risks of untested and unregulated remedies." N Engl J Med. 1999;340:565.
Cherkin D. Why patients use alternative medicine. JAMA. 1998;280(19):1660; discussion 1661. PubMed
![]() Andrea J. Cook, PhDSenior Biostatistics Investigator |
![]() Clarissa Hsu, PhDAssociate Investigator |
![]() Robert D. Wellman, MSSenior Collaborative Biostatistician |
![]() Lorella Palazzo, PhDCollaborative Scientist |
![]() Marlaine Gray, PhDAssistant Investigator |
![]() Laurel Hansell, MA, MPHCollaborative Scientist |
![]() Kimberly Arthur, MPHCollaborative Scientist |
Susan D. Reed, MD, MPH
Harborview Medical Center; University of Washington (UW) Department of Obstetrics and Gynecology