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Transcript of Complimentary and Alternative Medicine Michelle Nissen Angela Robinson Teresa Siefke.
Complimentary and Alternative MedicineMichelle NissenAngela RobinsonTeresa Siefke
Complementary and Alternative Medicine (CAM)
Objectives
• Define Complimentary and Alternative therapies
• Discuss the prevalence of CAM in society today
• Identify common therapies used in CAM
• Identify the risks of using CAM• Provide credible resources for the use
of CAM
Definition • Complimentary Medicine–medicines used that are not
mainstream but are used together with conventional medicine
• Alternative Medicine– non-mainstream medicines
used in place of conventional therapies
(US Department of Health and Human Services, 2013)
Categories of CAM
(Frass et al., 2012, p. 47)
Prevalence
Approximately 32.2% of the population uses some form of CAM - not including prayer
1997- 12.2 billion out of pocket2007 – 34 billion out of pocket
(Frass et al., 2012)
Prevalence Most used therapies
• Homeopathic• Acupuncture• Chiropractic Manipulation• Phytotherapy/Herbal Medicine• Massage
Five medical conditions that use CAM • Back pain• Depression• Insomnia• Severe headaches • Stomach ailments
(Frass et all., 2012)
Iridology
http://www.iridologyphg.com/
Analyze color, pigment distribution, and lacunae are believed to allow diagnosis of abnormalities and believe that these changes are “seen” before clinical manifestations are detected(Munstedt, et al., 2005)
Iridology• Analyze the iris to detect
certain diseases• 110 subjects to identify
cancer– Only three cases were
correctly identified– Yielded sensitivity of only
0.04
• Despite its popularity, iridology has shown no real benefit(Munstedt, et al., 2005)
Diet• Low fat (LF) vs low carbohydrate
(LC)– One year randomized clinical trial
• woman 25-50 years old• BMI 27-40 kg/m² • non-diabetic • generally healthy
• Total plasma insulin to determine the IR and IS individuals– IR >10.6 μIU/ml – IS <6.9 μIU/ml– Intermediate levels were excluded
(McClain, Otten, & Gardner, 2013)
Insulin Resistant
• LF diet– less likely to adhere and lose
weight when compared to IS
• LC diet–more success with weight loss
• Improved insulin levels compared to other groups – Degree of weight loss
correlated with improved insulin
(McClain, Otten, & Gardner, 2013)
Twelve-month change in diet by insulin
resistance status in diet groups
(McClain, Otten, & Gardner, 2013, p. 89)
Mediterranean• MedDiet consists mainly of– Fruits, vegetables, cereals, whole
grain breads, beans, nuts, seeds– Locally grown fresh and seasonal
foods– Sugars and honey only a few
times per week– Fat mainly from olive oil, low
amount of cheese, yogurt– Low red meat, high fish– Moderate red wine
(Hartley, Clarke, Hooper, Thorogood, & Stranges, 2013)
MedDiet & CVD• Survey of 11 RCTs– None could positively link
MedDiet to outcomes–Most showed reduction in
individual CVD risk factors• Small reductions in cholesterol,
LDL-C, triglycerides, and lowered blood pressure• No significant increase in HDL
or reduction in diabetes risk
(Hartley, Clarke, Hooper, Thorogood, & Stranges, 2013)
Metabolic Syndrome
(MetS)• Increased risk of CVD• Pro-inflammatory state
with elevated levels of inflammatory markers– C-reactive protein (CRP)– Interleukin-6 (IL-6)– Interleukin-8 (IL-8)– Tumor necrosis factor-α (TNF-
α)
(Richard, Couture, Desroches, & Lamarche, 2013)
MedDiet & MetS
• Four phase study– 5-week: control-feeding diet
(isocaloric/weight maintain)-to minimize inter-individual variations attributed to individual diet
– 5-week: controlled feeding MedDiet (isocaloric, no weight loss)-evaluate impact on inflammation before weight loss
– 20-week: free-living feeding for weight loss (-500kcal/day) with dietician assistance to reach a minimum of 5% body weight reduction
– 5-week: MedDiet after weight loss (isocaloric feeding/weight maintain)
(Richard, Couture, Desroches, & Lamarche, 2013)
Four Phase Study Design
(Richard, Couture, Desroches, & Lamarche, 2013, p. 53)
Results
• Even without clinically significant weight loss, a significant decrease in plasma CRP was found.
• Without clinically significant weight loss, little impact on IL-6, IL-18, and TNF-α were seen• these are adipose tissue-derived
cytokines(Richard, Couture, Desroches, & Lamarche, 2013, p. 54)
Issues• Traditional Remedies account for
35% of Acute Kidney Injury• The mortality rate is from 24% to
75% • Factors contributing to
nephrotoxicity– Incorrect use– Incorrect route of administration– Co-existing Illness– Interactions with other medications– Poor Storage
(Luycks, 2012)
Issues• alfalfa, and black cohash – transplant rejection• CKLS -a liver and spleen purifier –acute interstitial
nephritis• Cone flower (part of echinacia) used for fever or
prevention of colds- renal tubular acidosis and hypokalemai
• Creatinine- used for body building- acute interstitial nephritis
• Hydralazine sulfate- for cancer- hepatorenal syndrome• Ma- huang (contains euphedra) nephrolithiasis• Licorice- weight loss- ATN due to rhabdomyolysis • Pennyroyal- to induce abortion- ATN hepatorenal
syndrome• Spanish fly blister beetle- sexual stimulant, wart
removal- ATN, glomerular injury protein urea• St johns wort- depression- transplant rejection• Vitamin C- infection, cancer, fatigue, viral infections-
tubular calcium oxalate crystal deposition• Wormwood oil- stimulates digestion- rhabdomyolysis
(Luycks, 2012)
Chelation• Chelators bind to metal ions and are
then excreted via urine or feces– Have been used for treatment of heavy
metal accumulation and toxic poisoning, e.g. lead (Pb)
• Established for the treatment of mylodysplastic syndromes (MDS) and transfusional iron overload
• MDS is characterized by ineffective hemopoiesis, may progress to acute myeloid leukemia and approximately 90% are anemic
(Gattermann, 2008)
Guidelines• WHO classification of MDS 2002
– Refractory anemia– Refractory anemia with ringed
sideroblasts– Refractory anemia with excess blasts– Cytopenia with multilineage dysplasia– Refractory cytopenia with
multilineage dysplasia– Ringed sideroblasts– Unclassified meylodysplastic
syndrome– 5q-syndrome (separate subtype)
(Gattermann, 2008)
Supportive Therapy
• RBC transfusion, no agreed upon Hb threshold– Asian-Pacific 6-9 g/dL– Latin America 7-10 g/dL– Italian Society of Hematology
>8 g/dL– Hb >10g/dL is rare
• Case-by-case basis, symptoms, and co-morbid processes such as cardiac function, oxygenation, and quality of life
(Gattermann, 2008)
Iron Overload• Chronic transfusions result in
iron overload from catabolism of erythrocytes– iron levels exceeding binding
capacity of transferrin
• Monitor iron overload by serum ferritin is useful– not as accurate as
superconducting quantum interference device (SQUID) or hepatic MRI
(Gattermann, 2008)
Chelation Therapy
• Recommended to treat iron overload
• Initiation of therapy –When serum ferritin is ≥1000
μg/L – Patient has received two
units of RBC per month for one year
(Gattermann, 2008; NCCN task force report, 2009)
Medications
(NCCN task force report, 2009, p. S6)
Alzheimer’s Disease
• Metal ions accumulate in the brain in neurodegenerative diseases like Alzheimer’s Disease (AD)– copper (Cu)– iron (Fe)– zinc (Zn) – aluminum (Al)
(Hegde, et al., 2009)
Alzheimer’s cont.
• AD can have high levels compared to a normal brain– Cu 400 μM-vs-70 μM– Zn 1 mM-vs-350 μM
• Clioquinol (CQ)-specific Cu-Zn chelator • CQ has been banned in the US since
1971• PBT2, another hydroxyquinoline
ligand is in Phase IIa double blind trials in mouse model for AD
(Hegde, et al., 2009)
Natural Chelators
• Polyphenols– have antioxidant, anti-
inflammatory, and metal chelating properties
• Flavanoids are the largest group– include anthocyanins and
anthoxanthins– anthoxanthins further divided
• flavones, isoflavones, flavanols, and flavans
(Hegde, et al., 2009)
Curcumin• Curcumin also has
anti-inflammatory properties that are believed to reduce the swelling within neuronal cells
• Curcumin can bind with several metals, reducing their toxicity– include binding with
redox-active metals such as Cu and Fe
http://www.google.com/imgres?imgurl=http://www.curcuminresearch.org/Images/inhibits.jpg&imgrefurl=http://www.curcuminresearch.org/cancer.html&h=175&w=288&tbnid=Nmy4m16OGm3LFM:&zoom=1&tbnh=91&tbnw=151&usg=__UUko_UwOs-UQqeX7FObhgIK4BAQ=&docid=ZPZDFzVCDWUexM&itg=1&sa=X&ei=Nl6bU_eNHM6XyASsmoG4DQ&ved=0CO4BEPwdMAo(Hegde, et al., 2009)
EGCG• Polyphenols
– Epigallocatechin-3-gallate (EGCG), a polyphenolic, is the major component of green tea
– Green tea polyphenols are potent metal chelators, including Fe and Cu, which are associated with the pathogenesis in AD
http://www.google.com/imgres?imgurl=http://www.bjjee.com/wp-content/uploads/2013/01/keep-calm-and-drink-green-tea-39.png&imgrefurl=http://www.bjjee.com/nutrition/the-benefits-of-green-tea-lemon-for-bjj-players/&h=240&w=210&tbnid=yVwi9XLVMcKpvM:&zoom=1&tbnh=104&tbnw=91&usg=__wwTgHDzZAANB8dRtzhz5ux6r1Tk=&docid=PhqQxgie_v5ZvM&itg=1&sa=X&ei=oV6bU43zHta0yAT8zIDICQ&ved=0CMQBEPwdMAo
(Hegde, et al., 2009)
Anthroposophy Medicine
• Anthroposophical medicine was developed/inspired by Rudolf Steiner; Austrian philosopher and scientist (1861-1925)
• Anthropos = human; Sophia = wisdom
• Focused on the entire human being
• Extension to conventional medicine
• Anthroposophical doctors are fully licensed, board certified
http://www.rudolfsteineraudio.com/
Anthroposophic Medicine and Therapies in America, 2014)
Anthroposophical Medicine
• Rudolph Steiner joined a Dutch physician, Dr. Ita Wegmen to open first Anthroposophical medical clinic in Arleshim, Switzerland
• Dr. Wegmen developed a cancer treatment using extract from mistletoe, called Iscar, later developed into Iscador
• Iscador approved in Germany and a number of countries, clinical trials in U.S.A.
Anthroposophic Medicine and Therapies in America, 2014
https://www.google.com/
Countries practicing AM
http://www.ivaa.info/anthroposophic-medicine/facts-and-figures-am-worldwide/therapists-in-anthroposophic-medicine/
Mind-Body Therapies
Mind-body medicine concentrates on:• The interactions among the
mind, brain, body, and behavior• The ways in which emotional,
mental, social, spiritual, experimental, and behavior influences can affect one’s health
National Institute of Health, 2010
Tai Chi• Originated in ancient China, began as a
martial arts meaning “self-defense”• Consists of slow, relaxed, graceful movements
concentrating on body and mind• Referred to as “Meditation in motion” • Tai Chi safely promotes improvement with
balance, flexibility, and cardiovascular in aging adults with chronic conditions
• RCT compare the effectiveness of stroke survivor patients with Tai Chi, silver sneakers, and usual care on physical function, fall rate, and quality of life during a 12 week intervention
• Tai Chi led to improved aerobic endurance and reduced fall rates
Taylor-Piliae et al., 2014
Qigong • Similar to Tai Chi, most researcher
combine the two• Focus on physical movement, mental
focus, and deep breathing• Most effective with strengthening
bones, cardiovascular fitness, balance, and quality of life
• Researchers of Institute of Integral Qigong and Tai Chi analyzed 77 articles and 66 RCT’s, n=6410, strong evidence with positive health benefits of Tai Chi and Qigong
Qigong & Tai Chi
Alexander Technique
• Improves mobility posture performance and alertness
• Relieves chronic stiffness, tension and stress• In Asthma
– Improved• Forced expiratory flow 9%• Maximal inspiratory pressure 12%• Maximum Voluntary Ventilation 6%
(Cates, 2012)
• In Low back pain– Improved
• Number of day in pain from 27 of 28 to 3 of 28 (Woodman and Moore, 2012)
https://www.youtube.com/watch?v=-u8Py3GCYf4
(American Society for the Alexander Technique, 2014)
Feldenkrais Method
Two Techniques• Functional Integration
• Uses skilled manipulation and passive movements
• Awareness Through Movement• Uses guided attention and
purposeful movement
(The Feldenkrais Institute, 2013)
Feldinkrais Method
• Improves balance, mobility and balance confidence
• Shown to decrease a patients fear of falling (Ullmann, Willians, Hussey, Durstine, McClenaghan , 2010)
• Found significant improvement in physical and emotional well being and pain
• Increased ability to focus on positive aspects of recovery and decrease in dwelling on pain (Conners, Pile, Nichols, 2011)
Massage• Massage therapy uses the hands to
press, rub, and manipulate soft tissue
• One of the fastest growing aspects of CAM
– 31% of Americans received a massage in the last 5 years
– 15% of Americans discussed massage with their physicians in the past year
– 59% of patients would like to see massage covered by insurance
(American Massage Therapy Association, 2012; National Center for Complimentary and Alternative Medicine, 2014)
Massage
(Adams, White and Beckett, 2010, p. 8 )
MassageCHF
• Improved blood pressure, heart rate, respiratory rate and oxygen saturation
• Reported a reduction in anxiety(Chen et al., 2013)
Oncology• Included in the Evidence Based
Practice Guidelines for Integrative Oncology– Found that massage significantly
reduced pain and improved mood (Deng et al., 2009)
Reflexology• Certain pressure points on the
hands, feet and ears correspond with different body organs
• Applying pressure to different areas will improve function in the organ associated with this area.
• Found to be beneficial in pain associated with cancer and diabetic neuropathy
(Dalal, Maran, Pandey, & Tripathi, 2014, p. 6)
Rolfing• Based on the concept that
our connective tissue connects all parts of the body including muscles, bones, nerves and organs
• Very similar to massage but described as almost painful- works to balance the length and tone of all of the soft tissues in the body
(The Rolf Institute of Structural Integration, 2014)
ChiropracticManipulation
• The process of applying controlled force to the spine or joint to restore mobility, relieve pain and muscle tightness
• Based on the theory that tissues undergo chemical and physical changes that cause inflammation and pain
• Manipulation of these tissues restores mobility and alleviates pain
(The American Chiropractic Association, 2014)
Chiropractic Manipulation
• Spinal Manipulation is included in the Guidelines for control of low back pain by the American College of Physicians and the American Pain Society
• The Agency for Research and Quality also recommends the use of spinal manipulation for low back pain
• Use of the guidelines as part of the hospital based standardized care pathway resulted in a 95% satisfactory rating and a 68% reduction in pain
(National Center for Complimentary and Alternative Medicine, 2014)
Chiropractic Manipulation
Patients evaluated for low back pain received standardized or chiropractic treatment
Top graph does not show a significant reduction in pain the participants reported, however many fewer pain days with chiropractic therapy and no narcotic use
(Bishop, Quon, Fisher, & Dvorak, 2010, p. 1061)
Osteopathic Manipulation
• Very similar to Chiropractic Manipulation however is performed by a doctor osteopathic medicine
• This therapy has also been shown to reduce the need for analgesics when used for relief of back pain
(Seffinger et al., 2010)
Magnetic Therapy
• Ionizing electromagnetic fields energy decreases calcium transport alterations in human lymphocytes, supports natural killer cells to fight cancer and viruses, modulates traumatic brain injury, and reduces post-op infections
(Ross & Harrison, 2013)
Music Therapy• Classical Music– anxiety, depression, cardiovascular
disturbances, pain, stress, and sleep disorders
• Popular Music– eye opener
• Meditation Music– sedative effects
• Music from the Patients Youth– help with motivation, concentration
and improved mood
(Trappe, 2012)
Music TherapyCardiac Disease
• Reduces pain and respiratory rate• Reduces anxiety• Reduces systolic blood pressure and
heart rate• Improves sleep following cardiac
procedures or surgery• Reduces level of cortisol • Increases levels of oxytocin and PA02• Led to lower levels of anxiety
compared to subjects given midalozam
(Dileo, 2013; Trappe, 2010)
Light Therapy• Light therapy involves
exposure to blue light for a certain amount of time each day
• This exposure results in: – Increased sleep time of 18%– Increases in total sleep time – Decreases in awakenings – Improvement in daytime
fatigue(Tamrat, Huyn-Le, & Goyal ,2013, Chong, Tan, Tay, Wong, & Ancoli-Isreal, 2013, DPsych, Ponsford, Taffe, Lockley, &Rajaratnam ,2014)
Acupuncture• One of the oldest healing
practices in the world• Developed in ancient China• Stimulates parts of the
body to regulate flow of Qi along pathways called Meridians
• Done with very thin needles or cups or mugwart (National Center for Complimentary and Alternative
Medicine, 2014)
AcupunctureChinese Acupuncture Treatment based on extensive questioning and
observation
Japanese Acupuncture Uses the least amount of stimulation possible to affect the greatest amount of change
Korean Hand Acupuncture Hands are seen as microcosms of the body and needles are inserted into specific parts of the hand
Auricular Acupuncture The ears are the microcosms of the body and needles, seeds, and tacks are placed in and around the ear. Used for substance abuse
Scalp Acupuncture The scalp is seen as the microcosm. Used a lot for motor impairment and spinal conditions
Non-Insertion Acupuncture Uses blunt needles made of silver or platinum to touch the skin at specific points
Cupping Influences the flow of Qi and blood. The suction stimulates blood flow to the area
Moxibustion Burning mugwart to warm specific acupuncture sights and promote Qi
(Solleivo, 2012)
Acupuncture
(Acar, Cuvas, Ceyham, & Dikman, 2013, p. 421)
Anxiety and Surgery
Acupuncture
• Cerebral Aneurysm Rupture– Reduced angiographic
vasospasm– Reduced delayed ischemic
neurologic deficit
(Ko et al., 2013)
AromatherapyLaparoscopic intra-abdominal
surgery (LABG) chosen for:– Similar postoperative
requirements due to uniformity of surgery technique
– Visceral pain does not typically respond well to opioids
– Reducing opioid adverse effects in morbidly obese patients
(Kim, et al., 2001)
Post-operative pain
Use of Lavender oil decreased amount of morphine use
• Lavender (n=26) 2.38 mg • Placebo (n=27) 4.26 mg
(P<.04)
There was no statistical significance in the need for antiemetics or antihypertensives
(Kim, et al., 2001)
Work StressSeven categories:
• Environment, structure, changes
• Non-optimal work arrangements
• Patient care demands• Collaboration with others• Workload• Role conflict and
ambiguity• Personality factors; Type A
behavior patterns and locus of control
(Davis, Cooke, Holzhauser, Jones, & Finucane, 2005)
http://jeffreysterlingmd.files.wordpress.com/2014/01/stress-management-checklist-to-survive-and-thrive.jpg
Study• 15 minute seated massage– 16 per week for 12 weeks– Participants chosen at random
with subsequent consent to participate
– Massages per participant averaged 2.7 per person
• Music via earphones• Aromatherapy spray mist– One of four scents, chosen by
participant
(Davis, Cooke, Holzhauser, Jones, & Finucane, 2005)
ED Nurses• Data collection of
Perceived Occupational Stress Scale (POSS) and consisted of 46 questions
• Pretest and posttest response of 48% was achieved
• 86% improvement in anxiety after massage
(Davis, Cooke, Holzhauser, Jones, & Finucane, 2005)
Relaxation Techniques
• Autogenic training• Biofeedback• Deep-breathing exercises• Guided Imagery• Meditation• Self Hypnosis• Prayer
Autogenic Training • Autogenic training was developed
by, German neurologist Johannes Schultz, about a 100 years ago
• Autogenic = self-generating; you are in control
• AT is composed of six mental exercises aimed at reducing anger, tension, and stress
• AT main goal is to achieve a relaxed state of main and decrease stress
(National Center for Complementary and Alternative Medicine, 2014)
Autogenic Training
• Concentrates on reducing anxiety, depression, stress, and GI disturbances
• 59 patients, randomized chose to participant in a study with standardized care or autogenic training
• The results; baseline standard deviation at two and five months, BP & HR baseline and at five months
AnxietyState
BaselineSD
2 Month
5 Month
BP 5 Month
HR 5 Month
Experimental group
10.3 9.8 8.8 17.9 7.3 14.3 9.3
Control group 11.3 14.5 15.5 15 22.3 12.2 11.6
(Kanji, N., White, A., & Ernest, E.,2004)
Autogenic Training & Tension Headaches
• Seven clinical control trials included• Different methods of CAM methods
were chosen to evaluate headaches • Hypnosis, biofeedback, autogenetic
training, and control groups• The results: inconclusive, the
presence of evidence is insufficient• Self-Hypnosis did show a small
improvement• Biofeedback is more effective than
AT & the preferred treatment
(Kanji, N., White, A. R., & Ernest, E., 2006)
Biofeedback• Developed in the 1960’s to train experimental
research subjects to alter brain activity, BP, HR, and other functions not controlled voluntarily
• Use electronic devices to teach a person how to consciously produce relaxation state
• Physical therapist use biofeedback in stroke patients to help regain movement in paralyzed muscles
• Psychologists use it in anxious or tense patients to produce a calming affect
• Specialists incorporate with patients experiencing pain
• Can assist in reducing migraines or tension headaches, digestive disorders, hypertension, cardiac arrhythmias, Raynaud's disease, epilepsy, and some movement disorders(Andrasik, 2010)
Biofeedback & Headaches• Techniques: biofeedback-assisted relaxation
response or more specialized approaches• Biofeedback-assisted relaxation response for
headaches has bend evaluated for decades via comprehensive reviews by expert panels and meta-analytic statistical analysis
• Relaxation training, thermal biofeedback combined with relaxation training, electromyographic biofeedback, and cognitive-behavioral therapy may be considered as treatment options for prevention of migraine (Grade A evidence)
• Behavioral therapy(biofeedback, relaxation) may be combined with preventive drug therapy to achieve additional clinical improvement for migraine relief (Grade B evidence)
• Evidenced-based recommendations are not yet possible on the use of hypnosis, acupuncture, TENS, cervical manipulation, or hyperbaric oxygen as preventative or acute therapy for migraine (Grade C evidence)
(Andrasik, 2010)
Biofeedback Statistics of
Migraine Patients
(Andrasik, 2010, p. 75)
Guided Imagery/
Self-Hypnosis
Self-Hypnosis
Meditation• Meditation refers to a group of techniques:
mantra meditation, relaxation response, and mindfulness meditation
• Developed in the Eastern religious or spiritual traditions
• Meditation is practiced globally for health and well-being, outside of the traditional development
• Meditation teaches a person how to focus, concentrating on mindful thoughts, feelings, and sensations while observing in nonjudgmental way
• Most used for anxiety, pain, depression, stress, insomnia, and overall wellness
MeditationMood, BP, & Heart rate reduction
•Mindfulness meditation is used to reduce negativity, depression, tension, fatigue, anxiety and lower heart rate•A study conducted identified a significant drop in negative mood, 88%
Lower Acute Respiratory Infections•Comparison of a control, exercise, and mindfulness meditation group underwent monitoring of ARI’s and the outcomes monitoring incidence, duration, and global severity.•The results conducted a significant reduction of ARI’s with meditation (incidence, duration, and global severity) when compared to the control group• Incidence 33%, duration 43%, and global severity 60% lower if a person practiced mindfulness meditation when compared to the control group
(Zeidan, Johnson, Gordon, & Goolkasian, 2010; Barrett et al., 2010)
Yoga- Historical origins in ancient
Indian philosophy- Incorporates mind and body- Combines physical posture,
breathing techniques, meditation, and distinct philosophy
- Different types of Yoga - Yoga is sixth common used
CAM National Institute of Health, 2014
Benefits of Yoga
• Decrease low back pain• Reduce anxiety and stress• Enhance quality of life• Improve overall fitness and
well-being• Improve mood/ depression
Yoga and Chronic Back
Pain• A RCT n= 228 adults; enrolled in yoga, stretching exercises, or issued a self-care book to examine the best reduction in back pain
• After 12 weeks of therapy yoga group were superior to the self-care group for function, -2.5[95% CI, -3.7 TO -1.3]; P<.001 & mean difference symptoms, -1.1 [95% CI, -1.7 TO -0.4]; P<.001.
• 26 Weeks mean difference yoga superior, -1.8 [95% CI, -3.1 TO -0.5]; P<.001
• Yoga was not superior to stretching
Yoga and Smoking Cessation
• A study of 55 women, randomized to examine yoga and smoking cessation compared to general health and wellness group
• At end of eight weeks yoga demonstrated 24hour smoking cessation vs wellness condition, (46.9% vs 17.4%; odds ratio 4.19; 95% CI, 1.2-15.1; P=0.029
• Yoga more likely to have attained 7-day point prevalence abstinence (7PPA) vs wellness condition; (40.6% vs 13% odd ratio; 4.56; 95%CI, 1.1-18.6; P=0.034
Yoga & Anxiety
Bock et al., p.245 2012
Issues• Yoga low-impact• Low side effects• Recommend guidance of
well-trained instructor• Stroke and nerve pain, rare
possibilities• Pregnant women with certain
medical history should avoid some types of yoga
National Center of Complementary Alternative Medicine, 2014
Hypnosis• Also known as hypnotherapy• Evolved in the 1700’s accidentally by
somnambulism (sleepwalking).• Focused relaxation state of awareness to
alter desired medical conditions • Facilitate communication between bilateral
sides of the brain • Person is always in control, but fully relaxed• Three aspects to hypnosis: absorption,
dissociation, and suggestibility • Commonly used to treat anxiety, chronic
pain, depression, GI disturbances, HTN, insomnia, and hot flashes cancer or postmenopausal women
National Center for Complementary Alternative Medicine, 2014
Hypnosis Studies
• Multiple meta-analyses support hypnosis for management of symptoms associated with chemotherapy, surgical & invasive procedures
• Results identified a reduction in symptomology; N/V, pain, anxiety, and distress
• Emotional distress improved 82% undergoing invasive procedures
• Post-operative anxiety reduced with hypnosis
Lew, Kravits, Garberoglio, & Williams, 2011
Guided Imagery
• Focuses on pleasant images or visualizations to replace negative or stressful occurrences
• Promotes relaxation• Most commonly used to promote
sleep, calm emotions, reduce anxiety, depression, and decrease pain
Group Therapy & Cognitive Behavior
Therapy• Similar in nature, focus on cognitive
(thoughts) and behavior (actions) to change an underlying concern
• A RCT comparing multidimensional family therapy and cognitive behavior or a drug addiction
• Data gathered at baseline, termination, six, and twelve months, n=224
• Results determined both interventions are promising treatments
Liddle, Dakof, Turner, Henderson, & Greenbaum, 2008
Homeopathic
Pet Therapy• Animal-assisted therapy is a complementary
intervention, primarily dogs• Evidence supporting therapeutic animal
visits for medical and surgical patients with pervasive developmental disorders; cerebral palsy, speech disorders, cardiovascular disease, Alzheimer's disease, schizophrenia, cancer, spinal cord injuries, and extended rehabilitation facilities
• A literature review provided Class IIa-IIb evidence, recommending animal-assisted therapy to optimize healing environments
Pet Therapy Studies
Prayer