1. Dietary Ingredients as an Alternative Approach for Mitigating Chronic Musculoskeletal Pain: Evidence-Based Recommendations for Practice and Research in the Military
- Author
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Courtney Boyd, Kevin Berry, Karin Meissner, Cindy Lentino, Patricia A. Deuster, Lynn Teo, Cindy Crawford, and Charmagne F. Paat
- Subjects
medicine.medical_specialty ,Evidence-based practice ,media_common.quotation_subject ,Review Article ,Dietary Ingredients ,Scientific evidence ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,030202 anesthesiology ,law ,Musculoskeletal Pain ,medicine ,Humans ,Quality (business) ,Military Medicine ,media_common ,Randomized Controlled Trials as Topic ,Evidence-Based Medicine ,business.industry ,Chronic pain ,General Medicine ,medicine.disease ,INTEGRATIVE MEDICINE SECTION ,Military personnel ,Meta-analysis ,Anesthesiology and Pain Medicine ,Systematic review ,Military Personnel ,Family medicine ,Dietary Supplements ,Practice Guidelines as Topic ,Neurology (clinical) ,Systematic Review ,Chronic Pain ,business ,030217 neurology & neurosurgery ,Phytotherapy - Abstract
Objective Approximately 55–76% of Service members use dietary supplements for various reasons, including pain and related outcomes. This work evaluates current research on dietary ingredients for chronic musculoskeletal pain to inform decisions for practice and self-care, specifically for Special Operations Forces personnel. Methods A steering committee convened to develop research questions and factors required for decision-making. Key databases were searched through August 2016. Eligible systematic reviews and randomized controlled trials were assessed for methodological quality. Meta-analysis was applied where feasible. GRADE was used to determine confidence in the effect estimates. The committee made evidence-informed judgments and recommendations for practice and self-care use. Results Nineteen eligible dietary ingredients were assessed for quality, efficacy, and safety. Avocado soybean unsaponifiables, capsaicin, curcuma, ginger (as a food source), glucosamine, melatonin, polyunsaturated fatty acids, and vitamin D were conditionally recommended as their benefits outweighed risks, but there was still some uncertainty about the trade-offs. No recommendations were made for boswellia, ginger (as a dietary supplement), rose hip, or s-adenosyl-L-methionine. Recommendations were made against the use of collagen, creatine, devil’s claw, l-carnitine, methylsulfonylmethane, pycnogenol, willow bark extract, and vitamin E. Research priorities were developed to address gaps precluding stronger recommendations. Conclusions Currently the scientific evidence is insufficiently robust to establish definitive clinical practice guidelines, but processes could be established to track the impact of these ingredients. Until then, providers have the evidence needed to make informed decisions about the safe use of these dietary ingredients, and future research can address existing gaps.
- Published
- 2019