Proeftuin Integrative Medicine

The use of Complementary and Alternative Medicine (CAM) among patients with chronic musculoskeletal pain has become increasingly popular in different countries. During the past two years in the Netherlands, 71% of the patients with chronic musculoskeletal pain visited a CAM practitioner. Manual therapists, acupuncturists and homeopaths were most frequently visited. CAM practitioners work mostly outside the world of conventional medicine. The majority of patients do not disclose these CAM visits to their General Physician (GP). However, previous studies have shown that the majority of patients would like to discuss CAM use and prefer a GP that refers them to CAM. To meet needs of patients, primary care disease management may thus benefit from an active involvement of GPs concerning CAM communication/referral. In the current study we would like to investigate the outcome of such an integrative primary care approach, in which the GP can refer patients to additional CAM therapies. The goal of this prospective study is to compare the outcome of an integrative primary care (IPC) approach with standard primary care (SPC) management of patients with chronic musculoskeletal pain. A randomized intervention study is conducted to assess comparative effectiveness among patients of 18 year and older with chronic musculoskeletal pain for the duration of > 3 months who are visiting a GP. The primary outcome measure will be the change in quality of life. In addition, we anticipate to gain more insights in other factors related to chronic musculoskeletal pain such as pain, fatigue and general well-being.

An integrative primary care approach, including communicating about and referring to CAM, may enhance quality of life of chronically ill patients

Individual duration:

12 months in total under the study

• T=0: Inclusion, baseline measurements

• T=3: Three months observation

• T=6: Six months observation

• T=12: Twelve months observation, study end point




Total duration of the study:

2,5 year: One year for inclusion of all patients, one year follow/up and half a year for including data analysis and reporting.

Standard Primary Care Management (SPC): SPC will be according to the NHG guidelines and depends on the diagnosis and severity of complaints. SPC can include: Rest, physical exercise, physiotherapy, behavioural therapy and pharmacological treatment such as NSAID’s, systemic corticosteroids, DMARD’s such as methotrexaat, cyclosporine, hydroxychloroquine, sulfasalazine and azathioprine.
Integrative Primary Care Approach (IPC): In IPC, GPs can refer patients to five CAM therapies: Acupuncture, Tai-Chi, Osteopathy, Homeopathy and Naturopathy. Referral to a CAM therapy is in addition to SPC. The GP and the patient together will make the selection which CAM therapy is most suitable for the patient and his/her specific complaints.