Editorial: Rehabilitation and Alternative Medicine in the Healthcare for Chronic Rheumatic Pain Disorders

Provisionally accepted

Chronic rheumatic pain disorders, including rheumatoid arthritis (1), osteoarthritis (2), fibromyalgia (3), and gout (4), represent a substantial burden on patients and healthcare systems due to their persistent nature, high prevalence, and impact on functional mobility (5). While conventional pharmacotherapy, such as disease-modifying antirheumatic drugs (DMARDs), corticosteroids, and biologic agents, remains a cornerstone of treatment, limitations in efficacy, long-term safety concerns, and potential adverse effects necessitate the exploration of adjunctive therapies (6). Consequently, there has been an increasing emphasis on rehabilitation and alternative medicine modalities (7), including evidence-based physical therapy interventions (8,9), acupuncture (10), mind-body approaches (11) such as mindfulness-based stress reduction, and integrative medicine (12)(13)(14)(15) strategies that combine conventional and complementary methodologies.To provide a structured perspective on the various studies included in thisResearch Topic, we have categorized them into three major domains: Physical Therapy and Manual Techniques, Traditional and Complementary Medicine, and Epidemiological and Research Trends. Each of these categories encapsulates a distinct approach to managing chronic rheumatic pain disorders, offering insights into evidence-based rehabilitation, integrative therapies, and research trends that shape future clinical applications.Research trends in physical therapy for knee osteoarthritis (KOA) from 2013 to 2022 identified key thematic clusters and influential contributors, with Harvard University leading contributions in the field (16). Aerobic exercise and lower limb strengthening were found to be effective, emphasizing the need for personalized exercise dosing and digital interventions to promote self-management. Future studies should incorporate rigorous trials to validate these approaches. A cross-sectional study in Poland examined occupational risk factors for nonspecific neck pain among healthcare workers, identifying prolonged static postures, ergonomic deficiencies, and psychological stress as key contributors (17). These findings highlight the need for ergonomic and rehabilitative interventions to mitigate occupational risks. Another bibliometric analysis assessed global trends in dry needling from 2004 to 2024, highlighting increasing academic interest but a lack of large-scale, high-quality trials validating its efficacy (18). A review on KOA management emphasized pharmacologic and nonpharmacologic approaches, including platelet-rich plasma (PRP), stem cell therapy, exercise, and multimodal pain management, advocating for integrative strategies to optimize patient outcomes (19). An umbrella review evaluated PRP efficacy for KOA using nine meta-analyses encompassing 46 datasets, with mixed findings regarding its effectiveness in pain relief and mobility improvement (20).Variability in PRP preparation and patient selection contributed to these inconsistencies, emphasizing the need for standardized methodologies and long-term outcome assessments. Sartori et al conducted a randomized controlled pilot trial to evaluate ultrasound-guided percutaneous peripheral nerve stimulation (pPNS) targeting the gluteal nerves in individuals with chronic knee pain. The intervention improved hip extension power, suggesting potential benefits for knee function and pain management. Further research is needed to confirm these findings (21).While promising, larger studies are needed to confirm its clinical applicability. A retrospective study assessed Pridinol Mesylate combined with rehabilitation in elderly patients with spondyloarthritis-related low back pain, showing superior pain reduction and functional improvement compared to monotherapy with either intervention alone (22). Further trials are necessary to confirm long-term efficacy. A randomized trial compared the efficacy of Extracorporeal ShockWave Therapy (ESWT) and mesotherapy for myofascial pain syndrome, concluded that ESWT provided greater pain relief and improved mobility (23). Another study evaluated high-frequency laser therapy (HFLT) for cervical disk herniation, demonstrating comparable efficacy to physiotherapy, suggesting it as a noninvasive alternative (24).These studies underscore the growing significance of evidence-based rehabilitation techniques in managing chronic pain conditions. By incorporating regenerative medicine, neuromodulatory interventions, high-frequency laser therapy, and ESWT, these approaches contribute to a comprehensive, multimodal treatment framework aimed at enhancing pain relief, restoring function, and improving overall patient well-being. The findings further highlight the necessity of rigorous clinical validation and interdisciplinary collaboration to refine and optimize rehabilitation methodologies for musculoskeletal and rheumatic disorders, ensuring their effective integration into mainstream clinical practice.A randomized trial investigated the effects of Yijinjing, a traditional Chinese exercise, on rheumatoid arthritis (RA)-related hand dysfunction, reporting significant improvements in hand mobility, grip strength, and quality of life (25). Although promising, further research is required to establish long-term efficacy and determine optimal exercise regimens. A case report explored the application of traditional Chinese manual therapy in a 10-year-old patient with adolescent idiopathic scoliosis, showing improvements in spinal alignment and pain reduction over 18 months (26).Larger studies are needed to confirm its efficacy as a conservative treatment option. A case series examined acupuncture for linezolid-induced peripheral neuropathy in multidrug-resistant tuberculosis, documenting pain relief and functional recovery (27). However, larger controlled trials are required to validate these findings. A case report integrated graded exercise with motion-style acupuncture therapy for a patient with failed back surgery syndrome and major depressive disorder. This intervention demonstrated physical and psychological improvements (28) suggesting future studies should explore if this intervention has broader applicability. A meta-analysis reviewed osteopathic craniosacral therapy (CST) for chronic pain and mobility disorders, and it demonstrated some benefits in chronic somatic pain but raising concerns about methodological rigor and placebo effects (29).These studies highlight the integration of traditional therapeutic modalities with modern rehabilitative techniques, demonstrating their potential for neuromuscular reconditioning, pain modulation, and functional improvement. By incorporating acupuncture, structured therapeutic exercise, craniosacral therapy, and manual interventions, these complementary approaches provide holistic, patient-centered treatment options for managing chronic pain and musculoskeletal disorders. While preliminary findings suggest promising benefits, further rigorous, high-quality research is essential to establish standardized protocols, validate long-term efficacy, and optimize their integration into contemporary clinical practice.As rehabilitation and alternative medicine therapies evolve, future research should focus on optimizing evidence-based integrative treatment strategies for chronic rheumatic pain disorders. Key areas for advancement include standardizing physical therapy protocols, enhancing neuromodulatory techniques, and refining traditional therapeutic modalities such as acupuncture and osteopathic manipulation. Multidisciplinary collaboration among rheumatologists, physiotherapists, and integrative medicine practitioners will be key to advancing effective and sustainable chronic pain management.and alternative medicine in the management of chronic rheumatic pain disorders. The included studies demonstrate the therapeutic potential of physical therapy, manual interventions, acupuncture, neuromodulatory approaches, and osteopathic techniques in improving pain relief, functional mobility, and quality of life. While these findings emphasize the value of multimodal, patient-centered treatment strategies, further high-quality clinical trials and interdisciplinary collaborations are necessary to establish standardized, evidence-based protocols for broader clinical application.Moving forward, an integrative, personalized approach that combines conventional and complementary therapies will be essential in addressing the complex challenges of chronic pain management, ultimately leading to more effective, holistic, and sustainable healthcare solutions.