Práticas integrativas e complementares (PICS) para o manejo da dor crônica em pacientes com osteoartrite no sistema único de saúde (SUS) : evidências, percurso assistencial e desenvolvimento de tecnologia digital.

Abstract

Traditional, Complementary, and Integrative Medicine (TCIM) utilize natural and holistic methods to treat the individual in a comprehensive way. They view illness as a state of disharmony requiring balance and address both treatment and prevention. This thesis aims to develop evidence-based strategies to enhance the use of TCIM in managing chronic pain among osteoarthritis patients within the Brazilian Unified Health System (SUS) by creating a care pathway, management support tools, and a digital self-care technology. A scoping review identified acupuncture and phytotherapy as the most effective practices. Acupuncture was found to produce a significant reduction in pain with lasting effects, while phytotherapy stood out for the efficacy of Curcuma longa and Miconia albicans, comparable to conventional anti-inflammatory drugs but with a superior safety profile. Given the serious socioeconomic impact of chronic pain as a public health problem, a Clinical Pathway Protocol (CPP) was developed to integrate TCIM into treatment and prevention, establishing a multimodal, evidence-based pathway that promotes shared decision-making between professionals and patients, combines conventional treatments with complementary non-pharmacological therapies, optimizes health resources, and provides holistic care from primary prevention through to the treatment of established pain. To enable the practical application of this evidence, a mobile application for self-management of pain in osteoarthritis patients was developed using the Design Science Research (DSR) methodology, addressing a critical gap identified by the absence of Brazilian digital solutions that integrate TCIM specifically for this condition. The application includes scientific and educational modules, a pain diary, guided TCIM sessions, a reminder system, progress reports, and an accessible interface for elderly users. The research represents an innovative convergence of scientifically validated traditional knowledge, SUS public policies, and digital technology, transforming the passive care model into collaborative self-management and patient empowerment. Nevertheless, the need for greater methodological standardization and scientific validation of TCIM for its broad implementation in SUS clinical protocols is acknowledged. In summary, this thesis contributes to the strengthening of public health policies by demonstrating the applicability of TCIM as effective and sustainable tools in primary care, fostering a paradigm shift in chronic pain management, with a focus on comprehensiveness, co-responsibility, and technological innovation in health.