1 What Is Complementary Alternative Medicine?… medical and health care practices and products outside the realm of conventional medicine, which are yet to be validated using scientific methods Complementary: together with conventional practices ( aroma therapy for surgery patients) Alternative: in place of conventional practices. Relies on certain stimuli for body’s natural healing
2 Types of Therapies Homeopathy- “like cures like” Small amounts of substances can cure while larger amounts can cause symptoms (ex- allergy shots) Herbal therapy- most popular but not covered by law or tested by FDA Acupuncture - manipulation of energy flow by inserting needles into the meridians of this flow Naturopathic medicines- assists body’s natural healing; includes diet, massage, exercise, acupuncture Prayer
3 The Big “Seven” Chinese herbal medicine Western herbalism AcupunctureChiropractic care Massage Homeopathy Diet and nutrition therapy
4 CAM Practices Now in Mainstream MedicineCodeine for pain Digitalis for heart failure Ipecac for poisoning Quinine for malaria Aspirin for fever Behavioral therapy for headache Hypnosis for smoking cessation Low fat, low cholesterol diets Exercise for diabetes Support groups for breast cancer
5 The CAM Domains
6 The Appeal of CAM Patient empowermentFocus on spiritual and emotional well-being Therapist providing “touch, talk, time” Feeling of “natural” treatment Tradition
7 CAM Use in the United StatesPhone poll- 62% of adults 18+ used CAM in the past year Verified Current Version (JT)
8 Who Is the Practitioner?Medical doctors CAM practitioners Traditional healers
9 CAM Economics Americans spend more out-of-pocket for CAM than for all other health care needs CAM is big business 56% of Americans believe their health plans should cover CAM
10 Who uses CAM? More educated More affluentPossess a holistic orientation to health Had a ‘transformational experience’ Identification with environmentalism, feminism, spirituality Report chronic anxiety, pain, UTI, back problems (Astin et al. JAMA ,1998)
11 Communication Many mainstream doctors do not approve of CAM therapiesMost patients do not report alternative therapies to their doctors Communication is key to prevent further damage especially with alternative meds
12 The Research Portfolio: NCCAM’s Ongoing Phase III TrialsTherapy Condition Status Co-Sponsors Glucosamine-Chondroitin Osteoarthritis Fully recruited; ongoing NIAMS, VA Ginkgo Biloba Dementia NIA, NHLBI, NINDS Vitamin E-Selenium Prostate Cancer NCI Shark Cartilage Lung Cancer Recruiting EDTA Chelation Therapy Coronary Artery Disease NHLBI St. John’s Wort Minor Depression NIMH, ODS Vitamin E Down Syndrome NICHD, NIA Phytoestrogens Atherosclerosis ODS, ORWH SAMe Depression Acupuncture Low back pain Updated 1/19/05 ct w/ J Berman data
13 Dietary Supplements: DSHEA DefinitionProduct intended to supplement the diet Contains one or more of the following: Vitamin Mineral Herb or other botanical (not tobacco) Amino acid Any other dietary substance For oral intake as a concentrate, metabolite, extract, constituent, or combination
14 Patterns of Supplement Use: The Slone Survey2590 participants 18 years + Telephone survey, random sample Feb Dec 1999 In the preceding week: 14% of population used herbals and/or supplements 16% of prescription drug users used herbals and/or supplements JAMA, 2002
15 Patterns of Supplement Use:Ten Most Commonly Used Herbals / Supplements Ginseng Ginkgo biloba Allium sativum Glucosamine St. John’s wort Echinacea Lecithin Chondroitin Creatine Serenoa repens
16 Patterns of Supplement UseTen Most Common Reasons for taking herbs / supplements General health/good for you (16%) Arthritis (7%) Memory improvement (6%) Energy (5%) Immune booster (5%) Joints (4%) Supplement diet (4%) Sleep aid (3%) Prostate (3%) No reason (2%) All other reasons (45%) JAMA, 2002
17 Challenges of Herbal MedicinesSafety is assumed, not proven Lack of product standardization Contamination with drugs, heavy metals Allergic reactions Inherent toxicity Interactions with drugs Replacing proven therapies
18 Herbal Therapy and Surgery
19 Ephedra: Safety ConcernsMa huang (Ephedra sineca) – Short-term treatment for asthma, decongestion Contains L-ephedrine, pseudoephedrine Major current use in U.S. in combination with caffeine for weight loss, athletic performance Dozens of reports of severe and life-threatening adverse events in young people
20 Echinacea Used as cold and flu remedySome studies show it increasing phagocytosis and release of interferon Some studies have shown it to reduce duration of colds Problem- only anecdotal evidence and no consistency in dosage of product
21 Lack of regulation of CAMMany alternative medications lack studies to verify their efficacies FDA approval not required so standards for dosage is not set Some dosages vary as much as 10X other dosages Alt meds cannot make claims or promoted as curing or preventing disease
22 Acupuncture- What exactly is Chi?Chi is an energy that, according to ancient Chinese beliefs, permeates all things Chi must be able to flow freely throughout the body in order for a person to maintain overall health Chi flows along the meridians of the body
23 Where do yin and yang fit in?Acupuncture needles are inserted in an attempt to balance the opposing forces of yin and yang Yin and yang are balanced when a person is healthy and chi is therefore able to flow freely Injury or illness cause yin and yang to become distressed and unbalanced
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26 What is acupuncture used to treat?Depression Arthritis Kidney problems Flu Fatigue Chronic pain Migraines Paralysis Hypertension Tendonitis Vision problems Sexual Dysfunction And many others… What is acupuncture used to treat?
27 Possible medical explanationsStimulation of natural painkilling chemicals such as endorphins Needles block the transmission of pain impulses to the CNS Possible medical explanations
28 But there are risks… Bladder or lung punctureAllergic reaction to needles Infection from unsterilized needles Fainting Convulsions Nerve Damage Putting off treatments that are known to be effective But there are risks…
29 History of ChiropracticChiropractic- means “done by hand”, referring to manipulation of the spine. Greek words cheir (hand) and praxis (action) Chiropractic is a form of spinal manipulation, one of the oldest healing practices. Spinal manipulation was described by Hippocrates in ancient Greece.
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31 The Founder of the Modern Profession of ChiropracticDaniel David Palmer Healing philosophies Spiritualism Magnetic therapy Background in osteopathic training
32 Basic Concepts of ChiropracticThe body has a powerful self- healing ability. The body’s structure (primarily the spine) and its function are closely related, and this relationship affects health. Chiropractic therapy is given with the goals to normalize the relationship between structure and function and assisting the body as it heals. Basic Concepts of Chiropractic
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34 Conditions Commonly Treated by ChiropractorsBack pain including low-back pain Neck pain Headaches including migraines Sports Injuries Repetitive strains Others Asthma, Arthritis, Bursitis, Cerebral Palsy, Flu symptoms, DM, Infertility, etc
35 Controversies and CriticismEffectiveness of treatments Non-manual treatments heat and ice, magnetic therapy, nutrition counseling and dietary supplements Potential risks Presumed to be safe from what is known Potential Osteoporosis compared to healthier bone
36 History of Massage Natural reaction to when the body hurts is to rub it Dates back to at least the ancient Olympics Massage is derived from 2 sources Arabic verb mass “to touch” Greek word massein “to knead” Egyptians, Romans, Japanese& Chinese were known to practice massage
37 What is Massage Therapy?Used to manipulate the body’s tissue Effective in promoting local & systemic relaxation, increasing local blood flow, encouraging venous return Act of rubbing, kneading, or stroking the superficial parts of the body with the hand or an instrument for the purpose of modifying nutrition, restoring power of movement
38 Treatment Considerations & GuidelinesNeed to know underlying pathology Need to know basic massage Avoid constant hyperextension or hyperflexion of any joints Must obtain correct positioning that will allow for relaxation, prevent fatigue & permit free movement of arms, hands, & body.
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41 Physiological Effects of Massage TherapyDepending on the amount of pressure applied & the speed of the stroke Light, slow stroking – evokes systemic relaxation Fast, deep strokes increase blood flow to the area Cardiovascular changes – deep friction or vigorous massage was thought to produce vascular changes Massage can produce decreased heart rate, breathing rate, & blood pressure if the purpose is for inducing system relaxation
42 Acupressure- history 5000 year old healing artFirst originated in China Used in preventative care, immune boosting and stress relief 12 Meridians of healing energy pathways Blockages occur with illness or injury both physical and/or mental
44 Benefits of AcupressureIncreases circulation Reduces pain Releases stress Balance body energy Beauty treatments (improves muscle tone and skin circulation)
45 Homeopathy Homeopathy is a system of medicine based on three principles: Like cures like For example, if the symptoms of your cold are similar to poisoning by mercury, then mercury would be your homeopathic remedy. Minimal Dose The remedy is taken in an extremely dilute form; normally one part of the remedy to around 1,000,000,000,000 parts of water. The Single Remedy No matter how many symptoms are experienced, only one remedy is taken, and that remedy will be aimed at all those symptoms.
46 Homeopathic treatment- an exampleThe symptoms between a bee sting and a rash are similar. A bee sting swells and itches. Hives, a rash or even another insect bite itch the homeopathic medicine is made from a tiny amount of a bee. Instead of masking symptoms, the medicine sends the body a signal to help it rebalance and heal.
47 Another example Your eyes burn, itch and water when you peel an onion. You might have a runny nose too You have a runny nose and begin to sneeze during a cold or allergy attack, A homeopathic micro-dose of the remedy Allium cepa (red onion) would help your body heal itself.
48 Homeopathic vs HerbalogyNot to be confused with herbalogy Homeopathic remedies are very dilute doses of natural ingredients including plants or minerals Herbal remedies are made solely from plants.
49 The Controversy Remedies are so diluted, they are rendered useless for treatment Even in dilute cases, some treatments are made of toxic chemicals
50 Nutrition Therapy Treatment of medical conditions with diet and nutrition Usually based on whole food diet with supplements Many feel diseases worsen by an improper diet
51 History of Nutrition TherapyRelatively recent practice Dietetic Association began in the 1900s Began as treatment for surgery patients Now healthy patients seek diet therapy to remain healthy or even reverse aging effects
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55 Cupping Gua sha Ideas for next time