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Understanding Complementary and Alternative Medicine

Publié le 1 mars, 2009 | Pas de commentaires
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An increasing trend towards non-traditional health practices is emerging internationally. This presents promising healthcare options, yet some basic issues remain unclear. In an effort to provide a broader understanding of this emerging issue, various types of complementary and alternative medicines are explored, and the reasons for increased use briefly examined. Understanding complementary and alternative medicine allows individuals to contemplate a range of health care options beyond the traditional pharmaceutical ones.

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Worldwide healthcare has long been a central topic of debate. Core topics range from the lack of services in developing nations, the pitfalls of the private system of the United States, or the difficulties with public healthcare, such as in Canada. There are few countries, if any, that can boast of absolute satisfaction with their healthcare solution. It is this dissatisfaction that may have contributed to what is now being recognized as a widespread increase in complementary and alternative medicine (CAM).

What is CAM?

CAM includes diverse practices, products, and treatments that are not considered to be part of conventional medicine. Complementary medicines are used in conjunction with conventional approaches, while alternative practices are used alone, to substitute traditional treatment.

Traditionally, the concept of CAM evoked images of “new-aged” or “naturalistic” treatments. However, in today’s global playground, people are increasingly aware, and accepting, of different approaches to healthcare. Chiropractic care is an excellent example of a treatment “going mainstream”. The American Medical Association regarded chiropractic care as an unscientific cult, and an unethical approach to healthcare, until 1980 (1). Today, chiropractic care is one the most widely used alternative practices. Another poignant example is acupuncture. Rooted in traditional Eastern medicine, with a history that extends back thousands of years, acupuncture began gaining a foothold in North America approximately 30 years ago. Acupuncture is now a common and widely used complementary approach.

The field of CAM can be categorized into four domains: mind-body medicine, biologically- and body-based practices, and energy therapies. Mind-body medicine includes meditation, mental healing, art, dance, or music therapy, and patient support groups. The goal of mind-body medicine is to use the mind to influence symptoms and bodily functions. A biologically-based approach attempts to provide relief through natural substances such as herbal teas, vitamins, and specific foods. A body-based practice manipulates the body, such as in massage, or chiropractic medicine. Finally, energy therapies are based on the theory that the body is surrounded by energy, and can therefore be altered by therapeutic touch or magnetic fields.

Although some of those techniques have been integrated into mainstream medicine, others remain largely isolated. Chiropractic care, acupuncture, hypnosis, and massage therapy remain among the most widely employed methods, recognized to varying degrees under healthcare and private insurance. By contrast, a great deal of controversy surrounds the use of therapeutic touch or energy fields, practices that have yet to be empirically validated.

Prevalent forms of CAM

Among the most mainstream forms of CAM are hypnotherapy, chiropractic care, massage therapy, and acupuncture. Hypnotherapy, a mind-body practice, has been found to be an effective analgesic for children as well as adults, and several scientific journals are dedicated to empirical research on the use and practice of hypnotherapy. As children are generally more hypnotizable than adults, the use of pediatric hypnosis has been widely researched. Used as an adjunct treatment, hypnosis has been shown to effectively reduce pain associated with medical procedures (specifically lumbar puncture and bone marrow aspiration in pediatric cancer patients), as well as postoperative pain and chronic headache (2). Additional disorders responsive to pediatric hypnosis include anxiety, phobias, bedwetting, diabetes, and juvenile rheumatoid arthritis, among others. As for adults, a recent study on chronic pain in individuals with disabilities showed that hypnotic analgesia led to significant decreases in reported pain intensity over a 12 month period with 20 % of patients reporting clinically significant, long-lasting reductions in daily pain (3). In addition, hypnosis has also been effective in obstetrics (specifically labor and delivery). Criticisms of hypnosis mainly focus on the lack of studies comparing hypnosis to a credible placebo or current effective treatments. Without this research, it is difficult to ascertain overall efficacy of hypnosis as a pain reliever.

Back pain affects approximately 60-80 % of individuals at some point in their lives, and chiropractic care has emerged as an efficient, non-pharmacological solution. Chiropractic care, a body-based practice, is potentially the most widely used and accepted form of CAM. Chiropractic, like medicine, dentistry, or psychology, is a self-governing profession, adhering to strict licensing programs, regulations, and disciplinary action. These stringent regulations reflect the seriousness of the practice itself. Chiropractic often involves spinal manipulation with potentially severe complications such as stroke, neurological impairments, soreness, and tightness in the manipulated area. The risks of severe complications with spinal manipulations are extremely rare, and estimated at 0.5 to 2 incidents per million treatments resulting in stroke. Of these, one third will recover fully within a short period. However one third will be fatal, resulting in approximately 12 deaths per year in the US (4). In addition, relatively mild negative reactions to chiropractic are estimated to occur in 30 to 61 % of patients (5). Nonetheless, recent decision analyses examining the best non-surgical neck-pain treatment concluded little benefit or risk discrepancy between the pharmacological approach of nonsteroidal anti-inflammatory drugs (NSAIDs), chiropractic manual therapy, and prescribed exercise (6). In summary, chiropractic is a regulated practice with clear risks and benefits associated with treatment, but despite controversy, associated risks do not appear to be more severe than those of substitute treatment options.

Acupuncture, the process of inserting fine filiform needles into strategic body points, is part of traditional Chinese medicine and pain relief. However, a review of research on acupuncture and pain treatment was unable to conclude that acupuncture was more effective than a placebo, and provided only limited evidence that acupuncture was better than no treatment (7). There is some evidence in support of acupuncture, and National Institute of Health remarked that the potential deleterious side effects associated with acupuncture may be significantly less than pharmacological options (8). Regardless, the contradictions in the research and ambiguity surrounding the effectiveness of acupuncture highlight the need for additional research with strong methodologies to clarify the issue of efficacy.

Who uses CAM?

Recent numbers indicate 35 % of adults in the United States use some form of CAM (9). In Europe, the Forum for Complementary and Alternative Medicine was created in 2004 to address the increasing percentage of individuals using CAM and the lack of uniformity in regulations throughout the European Union (10). This rising interest worldwide certainly represents a movement towards a holistic approach to healthcare, and perhaps dissatisfaction with the current healthcare options.

In North America, health coverage legislation differs between states, influencing the distribution of CAM usage. However, recent policy shifts addressing private health coverage and health insurance for senior citizens reveals a trend towards non-pharmaceutical approaches gaining legal ground. Internationally, similar policy changes are being evaluated to contend with the increased demand for complementary and alternative medicine.

Why CAM?

The National Center for Complementary and Alternative Medicine surveyed users with the goal of examining reasons for the recent increase in interest. The statement “CAM would improve health when used in combination with conventional medical treatments” was endorsed by 55 % of those surveyed. Half indicated that they thought CAM would be interesting to try. Approximately 25 % of the sample reported that they turned to CAM when conventional medical treatments were inefficient, or when suggested by their medical professional. Finally, the statement that “conventional medical treatments are too expensive” was endorsed by 13 % of the sample (11). In general, these results identify improving personal health and curiosity about unique approaches as the main reasons for use.

General dissatisfaction with global healthcare systems is a reality. A universal shortage of qualified doctors and a similar nursing shortage is affecting healthcare worldwide. In most industrialized nations, emergency wait times are often excessive, and quality of care suffers. Additionally, there is a growing awareness of the potentially deleterious side effects of pharmacological approaches, and growing interest in alternative options. These factors are among those contributing to the increased prevalence of complementary and alternative medicine.

Future directions in CAM research

Given the variations in CAM coverage and use worldwide, increased efforts should be taken to ensure empirically supported non-pharmaceutical treatment options are uniformly available. This requires further research to differentiate between the useful and ineffective, or potentially harmful forms of complementary and alternative medicine. As a field, non-pharmaceutical medicine requires updated government legislation regulating and financially covering non-traditional practices that are empirically demonstrated to be as effective as their pharmacological counterparts, giving the individual greater freedom in their medical decision making. However, given the wide discrepancies between treatment efficacies, consulting with a health care professional prior to beginning any novel treatment is prudent.

References

(1) Cherkin, Dan. AMA policy on chiropractic. American Journal of Public Health, 79.11 (1989): 1569-1570.
(2) Neron, Sylvain, and Randolph Stephenson. “Effectiveness of Hypnotherapy with Cancer Patients’ Trajectory: Emesis, Acute Pain, and Analgesia and Anxiolysis in Procedures”. International Journal of Clinical and Experimental Hypnosis 55.3 (2007): 336-354.
(3) Jensen, Mark P., Joseph Barber, Marisol A. Hanley, Joyce E. Engel, Joan M. Romano, Diana D. Cardenas, George H. Kraft, Amy J.Hoffman, and David R. Patterson “Long-Term Outcome of Hypnotic-Analgesia Treatment for Chronic Pain in Persons with Disabilities”. International Journal of Clinical and Experimental Hypnosis, 56.2 (2008):156–169.
(4) What are the Risk of Chiropractic Neck Treatments? William J. Lauretti. September 17, 2008. <http://www.chiro.org/chimages/chiropage/cva-1.html>.
(5) Ernst, Edzard. “Adverse effects of spinal manipulation: a systematic review”. Journal of the Royal Society of Medicine, 100.7 (2007):330-338.
(6) Van der Velde, Gabrielle, Sheilah Hogg-Johnson, Ahmed M. Bayoumi, David J. Cassidy, Pierre Côte, Eleanor Boyle, Hilary Llewellyn-Thomas, Stella Chan, Peter Subrata, Jan L. Hoving, Eric Hurwitz, Claire Bombardier, and Murray Krahn. “Identifying the Best Treatment Among Common Nonsurgical Neck Pain Treatments: A Decision Analysis”. European Spine Journal, 17.1 (2008): 184-191.
(7) Ezzo, Jeanette, Brian Berman, Victoria A. Hadhazy, Alejandro R. Jadad, Lixing Lao, and Betsy B. Singh. “Is acupuncture effective for the treatment of chronic pain? A systematic review”. Pain, 86.3, (2000): 217-225.
(8) Sham Acupuncture. E Not Alone. 23 October 2008 <http://www.enotalone.com/article/9160.html>.
(9) Tindle, Hilary A., Roger B. Davis, Russell S. Phillips, and David M. Eisenberg. “Trends in use of complementary and alternative medicine by US adults: 1997-2002”. Alternative Therapies in Health and Medicine 11.1 (2005): 42-49.
(10) Declaration of the European Platform/Forum for CAM/NCM. European Forum for Complementary and Alternative Medicine. 17 August 2008 < http://cam.epha.org/>.
(11) The Use of Complementary and Alternative Medicine in the United States. National Center for Complementary and Alternative Medicine. 4 December 2008. <http://nccam.nih.gov/news/camsurvey_fs1.htm#reason>

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