Chronic Pain and Complementary Therapies: The Challenge of Measuring Patient Benefit

Rationale Chronic pain remains a major challenge in healthcare despite advances in pharmaceutical management. Growing recognition of the biopsychosocial complexity of chronic pain has highlighted the need for approaches that reflect this multidimensional experience. Complementary therapies, used alongside mainstream treatments, are increasingly popular, yet evidence supporting their efficacy is limited. Randomised controlled trials (RCTs) have not generated findings sufficient to influence policy or practice, potentially because their outcome measures fail to capture what matters most to patients. Methods A keyword search of Ovid Medline, PubMed, the Cochrane Collaboration, and National Institute for Health and Care Excellence (NICE) guidance from 2010 onwards identified contemporary chronic primary pain guidelines and systematic reviews. Results Our narrative synthesis examines current approaches to chronic pain management, the prevalence of complementary therapy use, and the evidence underpinning efficacy. We critically consider whether RCT designs and reductionist outcome measures are appropriate for evaluating holistic interventions. Conclusions We argue that the unique components of complementary therapies must be understood as potential mediators of change. Shifting focus from narrow efficacy testing towards evaluating meaning, patient responses, and perceived utility may provide more relevant insights. Developing programme theories and logic models can clarify how complementary therapies work and guide the selection of suitable outcome measures for future research.