Post on 19-Dec-2015
Complementary And Alternative Therapies
Dinesh Sirisena
“Complementary and alternative medicine (CAM) is a broad domain of healing resources encompassing all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period.”
“All practices and ideas defined by their users as preventing or treating illness or promoting health and well-being are included.”
“Boundaries within CAM and between the CAM domain and that of the dominant system are not always well defined.”
(Cochrane)
Complementary - together with conventional medicine
Alternative - in place of conventional medicine
Some providers practice both
Topics?
• Why do people use them?
• Who uses them?
• Frequency of use?
• Types?
• Costs?
• Evidence?
• Problems?
Why?
Why?
• Positive motives– Perceived
effectiveness or safety– Spiritual– Holism– All things natural– Active role– Control over treatment– Pleasant therapeutic
experience
– Good patient/therapist relationship
• Fewer time restraints (£)• On equal terms (£)• Empathy (£)
– Non-invasive– Accessibility (£)– Affluence (£)
Why?
• Negative motives– Dissatisfaction with
conventional health care
• Ineffective • Adverse effects
– Doctor-patient relationship
• insufficient time • waiting lists
– Reject science and technology
– Reject “the establishment”
– Desperation
Why?
• Other Motives– Not an alternative – What is available for their health care
Who?
• Women>Men• Well educated +
affluent• Middle aged• Ethnic population
– Afro-Caribbean>Asian>Caucasian
• Chronic Ill Health– Cancer– AIDS– Long term conditions
• Worried well• Myalgic
Encephalopathy – 33% use CAM
Frequency?
• 46% UK population will try at some point• 1999
– 50,000 CAM practitioners (UK)– 5 million patients consulted a CAM
practitioner in one year
• More uptake in Europe– France & Germany
• USA– 629 million visits in one year alone (?%pop)
Frequency?
• Use of CAM in the United Kingdom 1999 (%)– Herbal medicine (34)– Aromatherapy (21)– Homeopathy (17)– Acupuncture / acupressure (14)– Massage (6)– Reflexology (6)– Osteopathy (4)– Chiropractic (3)
Costs?
Costs?
• Not necessarily actual cost
• Cost effectiveness
• Royal Pharmaceutical Society (1999)– £231.8 million was spent on non-prescription
medicine
• Aromatherapy session (£40-60+)
• Acupuncture (£40-60+)
• Massage (£30-40+)
How Many Types?
Types?
• Biologically based practices – supplementing a person's normal diet
• Manipulative and body-based therapies – focus on the body's various systems and structures
• Mind-body interventions – use the connection between a person's mind, body,
and spirit to enhance total well being
• Energy therapies – are meant to restore disturbances in the body's
natural energy
Types? (Common)
• Acupuncture• Alexander Technique• Allergy testing• Aromatherapy • Art Therapy• Autogenic Training• Auricular Acupuncture• Ayuveda • Bodywork
• Bowen• Biofeedback• Chiropractic • Chinese Herbal Medicine• Counselling • Craniosacral Therapy• Crystal Therapy• Dowsing Flower Therapy• Healing Herbalism• Homeopathy
Types? (Common)
• Hydrotherapy • Hypnotherapy• Indian Head Massage• Iridology• Kinesiology• Music Therapy• Naturopathy• Nutrition• Osteopathy
• Physiotherapy• Radionics• Reflexology• Reiki• Shiatsu• Tai Chi• TENS therapy• Traditional Chinese
Medicine• Thought Field Therapy• Yoga Therapy
Types? (Rarer)• Auricular Acupuncture• Australian Flower Essences Therapy• Bach Flower remedies• Bee Venom Therapy• Chelation Therapy • Colonic Hydrotherapy • Colour Therapy • Dream Therapy • Eye Movement Desensitization and
Reprogramming • Exercise Healing • Health Clubs • Health Screening • Juice Therapy • Light Therapy
• Light Touch Therapy • Magnotherapy • Marma Therapy• Meta-Aromatherapy• Microwave Resonanace Therapy• Naturotherapy• Oxygen Therapy• Panchakama Therapy• PIP scans• Raw Vegetable Juice Therapy• Rolfing• Spiritual Counselling• Stress Management• Swimming Therapy• Transdecendal Meditation• Tragerwork• Vegetable Juice Therapy
Specific Types?
• Aromatherapy– Used since Egyptian times– Distilled plant extracts
• 400 Oils• Varying quality (RCT)
– Improve well-being• Peppermint – digestive effects• Tea Tree Oil – antibacterial
– Massage, Baths, Inhalation
Specific Types?
• Bee Venom Therapy– Contain sulphur – Stimulates cortisol release – Applied to surface– Chronic inflammatory conditions– RA, Myositis– Applied for 5days with 2-3day interval– Normally haemorrhagic
Evidence?
• Circumstantial
• Past attempts at investigations
• Little research – Difficulty with RCT– Outcomes dependant on social, cultural and
spiritual beliefs
Evidence?
• Evidence Based Complementary and Alternative Medicine (eCAM)– Yoga
• Improve risk in adults with DM 2• Prevention and management of cardiovascular complications• May be useful in the management of stress (post tsunami
victims)
– Massage• Benefits in chronic pain conditions
– Sanfujiu (herbal ointments into pressure points) • moderately effective in treating allergic symptoms
Evidence?
• eCAM– Green Tea
• Regular intake (>3 cups per day) may reduce the lung cancer in smokers
– Gentle Touch Therapy• (strong) circumstantial evidence • Improved psychological well-being • Self-reported psychological problems
Evidence?
• eCAM– Electro-acupuncture
• Relieving labour pain• Synergism of the CNS with a direct impact on the uterus
through release of ß-EP and 5-HT into the blood
– Tai Chi• 15 week course • effective in reducing headache symptoms and perception of
physical and mental health
– Music Therapy • Benefited patients in hospice and palliative care
Evidence?
• (2007) NHS trial in Belfast– £200,000 for GP to use alternative therapies– Was it a success?– Reduced use of conventional therapy– Effective?
Problems?
Problems?
• Safety risk – Especially during pregnancy– Ayurvedic treatments
• Heavy metals (Lead, Mercury, Arsenic)
– Unknown purities– Reactions are not routinely monitored – Dietary supplements can interact with prescribed
medications
• Difficulty establishing reliability/efficacy
Problems?
• Significant lack of evidence/research– Speculative– Small trials– Often biased
• Financial motivations
• Lack of regulation– Some with registered Osteopaths (GOsC) and
Chiropractors (GCC)– Remaining registration is voluntary
Problems?
Topics?
• Why do people use them?
• Who uses them?
• Frequency of use?
• Types?
• Costs?
• Evidence?
• Problems?
Useful Links?• http://www.bcma.co.uk/• http://www.cancerbackup.org.uk/Treatments/
Complementarytherapies/Generalinformation/Complementaryalternativetherapies
• http://www.therapiesguide.co.uk/• http://www.holisticpages.co.uk/• http://www.dh.gov.uk/en/Publichealth/Healthimprovement/
Complementaryandalternativemedicine/index.htm• http://www.medicine.ox.ac.uk/bandolier/booth/booths/altmed.html• http://www.nlm.nih.gov/medlineplus/
complementaryandalternativetherapies.html• http://www.cancer.org/docroot/ETO/ETO_5.asp• http://www.nhsdirectory.org/• http://nccam.nih.gov/
Useful Links?• http://www.library.nhs.uk/cam/• http://www.internethealthlibrary.com/Prime-pages/A-
ZDirAltTherapies.htm• http://www.arc.org.uk/arthinfo/patpubs/6007/6007.asp• http://diabetes.niddk.nih.gov/dm/pubs/alternativetherapies/• http://www.publications.parliament.uk/pa/ld199900/ldselect/
ldsctech/123/12301.htm• http://homeopathy4health.wordpress.com/• http://ecam.oxfordjournals.org/• http://www.bmj.com/cgi/content/full/319/7211/693• http://www.cancerhelp.org.uk/help/default.asp?page=216• http://www.medicalnewstoday.com/sections/
complementary_medicine/
• A = Lavender– calming effect, aiding relaxation and anxiety
• B = Lemon Grass– antiseptic, bactericidal, deodorant and
antifungal
• C = Sandalwood– Stress and anxiety, itching and skin
inflammation, aphrodisiac
The Three Oils