COMPLEMENTARY
AND ALTERNATIVE MEDICINE
GOALS
Course
Description
“Complementary and Alternative Medicine” is a home study
continuing education course for rehabilitation professionals. This course presents updated information
about Complementary and Alternative Medicine (
Course
Rationale
The
purpose of this course is to present current information about Complementary
and Alternative Medicine. Both
therapists and therapy assistants will find this information pertinent and
useful when providing care for individuals who receive, or may benefit from,
non-traditional health care.
Course
Goals and Objectives
Upon completion of this course, the therapist or assistant will be
able to
1.
recognize current statistical
demographic trends of
2.
differentiate
between the various categories of
3.
identify and differentiate the practices that
are categorized as alternative medicine systems.
4.
identify and differentiate the practices that
are categorized as mind body medicine.
5.
identify and differentiate the practices that
are categorized as biologically based practices.
6.
identify and differentiate the practices that
are categorized as energy therapies.
7.
identify and differentiate the practices that
are categorized as manipulative and body based practices.
8.
locate and review current research data and
information specific to each of the various
9.
recognize
consumer issues relating to
Course
Instructor
Michael Niss, DPT
Target Audience
Physical
therapists, physical therapist assistants, occupational therapists, and occupational
therapist assistants
Course Educational
Level
This
course is applicable for introductory learners.
Course Prerequisites
None
Criteria for issuance of Continuing Education
Credits
A documented score of 70% or greater on the written
post-test.
Continuing
Education Credits
Four
(4) hours of continuing education credit (4 NBCOT PDUs/4 contact hours)
AOTA - .4 AOTA CEU, Category 1: Domain of OT – Client Factors, Context
Determination
of Continuing Education Contact Hours
“Complementary and Alternative Medicine” has been established to
be a 4 hour continuing education program.
This determination is based on an accepted standard for home-based
self-study courses of 10-12 pages of text (12 pt font) per hour. The complete instructional text for this
course is 49 pages (excluding Post-Test).
COMPLEMENTARY
COURSE OUTLINE
Page(s)
Course
Goals and Objectives 1 start hour 1
Course
Outline 2
Introduction 3
Use of
Alternative
Medical Systems 10-16
Traditional Chinese Medicine 10-11
Acupuncture 11-12
Materia Medica 12-13
Ayurvedic Medicine 13 end hour 1
Naturopathy 13-14 start hour 2
Homeopathy 14-16
Mind
Body Medicine 17-20
Definition 17
Background 17-18
Interventions and Disease Outcomes 18-19
Influences on Immunity 19
Meditation and Imaging 19
Physiology of Expectancy 19-20
Stress and Wound Healing 20
Surgical Preparation 20
Biologically
Based Practices 21-29
Definition 21-22
History and Use 22-23 end hour 2
Research 23-26 start hour 3
Summary of Evidence 26-29
Energy
Therapies 29-35
Veritable Energy Medicine 30-33
Putative Energy Fields 33-35
Manipulative
and Body Based Practices 36-42
Introduction 36
Definitions 36-37 end hour 3
Chiropractic 37 start hour 4
Research 38-41
Risks 41
Utilization 41
Cost 41-42
Patient Satisfaction 42
Consumer
Issues 42-44
References 44-48
Alternative Medical Systems 44
Mind Body Medicine 45
Biologically Based Practices 45-47
Energy Therapies 47-48
Manipulative and Body Based
Practices 48-49
Post-Test 50-51 end hour 4
Introduction
Complementary
and alternative medicine (
While some scientific evidence exists
regarding some
The Use of Complementary
and Alternative Medicine in the
The most comprehensive and reliable findings
to date on Americans' use of
The survey
included questions on various types of
CAM Therapies Included in the
Survey
Acupuncture
Ayurveda
Biofeedback
Chelation therapy
Chiropractic care
Deep breathing exercises
Diet-based therapies
Vegetarian
diet
Macrobiotic diet
Atkins diet
Pritikin diet
Ornish diet
Zone diet
Energy
healing therapy
Folk medicine
Guided imagery
Homeopathic treatment
Hypnosis
Massage
Meditation
Megavitamin therapy
Natural products
(nonvitamin and nonmineral, such as herbs and other products
from plants, enzymes, etc.)
Naturopathy
Prayer for health reasons
Prayed
for own health
Others ever prayed for your health
Participate in prayer group
Healing ritual for self
Progressive
relaxation
Qi gong
Reiki
Tai chi
Yoga
How Many People Use CAM
In the
Who
Uses CAM Most
Women
than men
People
with higher educational levels
People
who have been hospitalized in the past year
Former
smokers, compared with current smokers or those who have never smoked
This survey
was the first to yield substantial information on
CAM Domains Used the Most
When prayer
is included in the definition of
Prayer
specifically for health reasons was the most commonly used
Use
of Natural Products
As shown in
figure 4, about 19% (or one-fifth) of the people surveyed used natural
products. See figure 5 for the most commonly used natural products and for the
percentages of natural product users who took those products.
Health
Conditions Prompting CAM Use
People
use
Reasons
for Using CAM
The survey
asked people to select from five reasons to describe why they used
Conventional medical treatments would
not help: 28%
A conventional medical professional
suggested trying
Conventional medical treatments are
too expensive: 13%
The survey
found that most people use
Spending on CAM
The NHIS did
not include questions on spending on health care, but the report authors cited
spending figures from national surveys. Those surveys found the following:
The
Of this amount, between $12 billion
and $20 billion was paid out-of-pocket for the services of professional
These fees represented more than the
public paid out-of-pocket for all hospitalizations and about half of what it
paid for all out-of-pocket physician services.
$5
billion of out-of-pocket spending was on herbal products.
Categories of
NCCAM classifies
1. Alternative Medical Systems
Alternative medical systems are built upon
complete systems of theory and practice. Often, these systems have evolved
apart from and earlier than the conventional medical approach used in the
2. Mind-Body Interventions
Mind-body medicine uses a variety of techniques
designed to enhance the mind's capacity to affect bodily function and symptoms.
Some techniques that were considered
3. Biologically Based Therapies
Biologically based therapies in
4. Energy Therapies
Energy therapies involve the use of energy
fields. They are of two types:
Biofield
therapies are
intended to affect energy fields that purportedly surround and penetrate the
human body. The existence of such fields has not yet been scientifically
proven. Some forms of energy therapy manipulate biofields by applying pressure
and/or manipulating the body by placing the hands in, or through, these fields.
Examples include qi gong, Reiki, and Therapeutic Touch.
Bioelectromagnetic-based
therapies involve the
unconventional use of electromagnetic fields, such as pulsed fields, magnetic
fields, or alternating-current or direct-current fields.
5. Manipulative and Body-Based Methods
Manipulative and body-based methods in
Alternative Medical
Systems
Introduction
Alternative
medical systems involve complete systems of theory and practice that have
evolved independently from or parallel to allopathic (conventional) medicine.
Many are traditional systems of medicine that are practiced by individual
cultures throughout the world. Major Eastern whole medical systems include
traditional Chinese medicine (TCM) and Ayurvedic medicine, one of
Traditional
Chinese Medicine
TCM is a
complete system of healing that dates back to 200 B.C. in written form.
Treatments
in TCM are typically tailored to the subtle patterns of disharmony in each
patient and are based on an individualized diagnosis. The diagnostic tools
differ from those of conventional medicine. There are three main therapeutic
modalities:
- Acupuncture and moxibustion (moxibustion is the
application of heat from the burning of the herb moxa at the acupuncture
point)
- Chinese Materia Medica (the catalogue of natural
products used in TCM)
- Massage and manipulation
Although TCM proposes that natural products
catalogued in Chinese Materia Medica or acupuncture can be used alone to treat
virtually any illness, quite often they are used together and sometimes in
combination with other modalities (e.g., massage, moxibustion, diet changes, or
exercise).
Acupuncture
Acupuncture is one of the oldest, most
commonly used medical procedures in the world. Originating in
The term
acupuncture describes a family of procedures involving stimulation of
anatomical points on the body by a variety of techniques. American practices of
acupuncture incorporate medical traditions from
Acupuncture
needles are metallic, solid, and hair-thin. People experience acupuncture
differently, but most feel no or minimal pain as the needles
are inserted. Some people are energized by treatment, while others feel
relaxed. Improper needle placement, movement of the patient, or a defect in the
needle can cause soreness and pain during treatment. This is why it is
important to seek treatment from a qualified acupuncture practitioner.
The U.S.
Food and Drug Administration (FDA) approved acupuncture needles for use by
licensed practitioners in 1996. The FDA requires that sterile, nontoxic needles
be used and that they be labeled for single use by qualified practitioners
only.
Relatively
few complications from the use of acupuncture have been reported to the FDA in
light of the millions of people treated each year and the number of acupuncture
needles used. Still, complications have resulted from inadequate sterilization
of needles and from improper delivery of treatments. Practitioners should use a
new set of disposable needles taken from a sealed package for each patient and
should swab treatment sites with alcohol or another disinfectant before
inserting needles. When not delivered properly, acupuncture can cause serious
adverse effects, including infections and punctured organs.
The report
from a Consensus Development Conference on Acupuncture held at the National Institutes
of Health (NIH) states that acupuncture is being "widely" practiced--by
thousands of acupuncturists, physicians, dentists, and other practitioners--for
relief or prevention of pain and for various other health conditions.(NIH
Consensus Panel; 2004) In terms of the evidence at that time, acupuncture was
considered to have potential clinical value for nausea/vomiting and dental
pain, and limited evidence suggested its potential in the treatment of other
pain disorders, paralysis and numbness, movement disorders, depression,
insomnia, breathlessness, and asthma.
Preclinical
studies have documented acupuncture's effects, but they have not been able to
fully explain how acupuncture works within the framework of the Western system
of medicine.
It is
proposed that acupuncture produces its effects by the conduction of electromagnetic
signals at a greater-than-normal rate, thus aiding the activity of pain-killing
biochemicals, such as endorphins and immune system cells at specific sites in
the body. In addition, acupuncture may alter brain chemistry by changing the
release of neurotransmitters and neurohormones and affecting the parts of the
central nervous system related to sensation and involuntary body functions,
such as immune reactions and processes whereby a person's blood pressure, blood
flow, and body temperature are regulated.
Chinese Materia
Medica
Chinese Materia Medica is a standard reference book of information on medicinal
substances that are used in Chinese herbal medicine. Herbs or botanicals
usually contain dozens of bioactive compounds. Many factors--such as geographic
location, harvest season, post-harvest processing, and storage--could have a
significant impact on the concentration of bioactive compounds. In many cases,
it is not clear which of these compounds underlie an herb's medical use.
Moreover, multiple herbs are usually used in combinations called formulas in
TCM, which makes the standardization of herbal preparations very difficult.
Further complicating research on TCM herbs, herbal compositions and the
quantity of individual herbs in a classic formula are usually adjusted in TCM
practice according to individualized diagnoses.
In the past
decades, major efforts have been made to study the effects and effectiveness of
single herbs and of combinations of herbs used in classic TCM formulas. The
following are examples of such work:
Artemisia annua. Ancient Chinese physicians
identified that this herb controls fevers. In the 1970s, scientists extracted
the chemical artemisinin from Artemisia annua. Artemisinin is the
starting material for the semi-synthetic artemisinins that are proven to treat
malaria and are widely used. (Klayman dL; 1985)
Tripterygium wilfordii Hook F (Chinese
Thunder God vine).
Thunder God vine has been used in TCM for the treatment of autoimmune and
inflammatory diseases. The first small randomized, placebo-controlled trial of
a Thunder God vine extract in the
Ayurvedic Medicine
Ayurveda,
which literally means "the science of life," is a natural healing
system developed in
Naturopathy
Naturopathy
is a system of healing, originating from
- The healing power of nature
- Identification and treatment of the cause of disease
- The concept of "first do no harm"
- The doctor as teacher
- Treatment of the whole person
- Prevention
The core
modalities supporting these principles include diet modification and
nutritional supplements, herbal medicine, acupuncture and Chinese medicine,
hydrotherapy, massage and joint manipulation, and lifestyle counseling.
Treatment protocols combine what the practitioner deems to be the most suitable
therapies for the individual patient.
As of this writing, virtually no
research studies on naturopathy as a complete system of medicine have been
published. A limited number of studies on botanicals in the context of use as
naturopathic treatments have been published. For example, in a study of 524
children, echinacea did not prove effective in treating colds. (Taylor JA, et
al; 2003) In contrast, a smaller, double-blind trial of an herbal extract
solution containing echinacea, propolis (a resinous product collected from
beehives), and vitamin C for ear pain in 171 children concluded that the
extract may be beneficial for ear pain associated with acute otitis media.
(Sarrell EM; 2003) A naturopathic
extract known as Otikon Otic Solution (containing Allium sativum, Verbascum thapsus flores , and Hypericum
perforatum in olive oil) was found as effective as anesthetic ear drops and
was proven appropriate for the management of acute otitis media-associated ear
pain. (Sarrell EM; 2001) Another study looked at the clinical
effectiveness and cost-effectiveness of naturopathic cranberry tablets--versus
cranberry juice and versus a placebo--as prophylaxis against urinary tract
infections (UTIs). Compared with the placebo, both cranberry juice and
cranberry tablets decreased the number of UTIs. Cranberry tablets proved to be
the most cost-effective prevention for UTIs. (Strothers L; 2002)
Homeopathy
In the late
1700s, Samuel Hahnemann, a physician, chemist, and linguist in
Hahnemann
was interested in developing a less-threatening approach to medicine. The first
major step reportedly was when he was translating an herbal text and read about
a treatment (cinchona bark) used to cure malaria. He took some cinchona bark
and observed that, as a healthy person, he developed symptoms that were very
similar to malaria symptoms. This led Hahnemann to consider that a substance
may create symptoms that it can also relieve. This concept is called the
"similia principle" or "like cures like." The similia
principle had a prior history in medicine, from Hippocrates in Ancient
Greece--who noted, for example, that recurrent vomiting could be treated with
an emetic (such as ipecacuanha) that would be expected to make it worse--to
folk medicine. Another way to
view "like cures like" is that symptoms are part of the body's
attempt to heal itself--for example, a fever can develop as a result of an
immune response to an infection, and a cough may help to eliminate mucus--and
medication may be given to support this self-healing response.
Hahnemann
tested single, pure substances on himself and, in more
dilute forms, on healthy volunteers. He kept meticulous records of his
experiments and participants' responses, and he combined these observations
with information from clinical practice, the known uses of herbs and other
medicinal substances, and toxicology, eventually treating the sick and
developing homeopathic clinical practice.
Hahnemann
added two additional elements to homeopathy:
A concept that became
"potentization," which holds that systematically diluting a
substance, with vigorous shaking at each step of dilution, makes the remedy
more, not less, effective by extracting the vital essence of the substance. If
dilution continues to a point where the substance's molecules are gone,
homeopathy holds that the "memory" of them--that is, the effects they
exerted on the surrounding water molecules--may still be therapeutic.
A concept that treatment should be
selected based upon a total picture of an individual and his symptoms, not
solely upon symptoms of a disease. Homeopaths evaluate not only a person's
physical symptoms but her emotions, mental states, lifestyle, nutrition, and
other aspects. In homeopathy, different people with the same symptoms may
receive different homeopathic remedies.
Hans Burch
Gram, a Boston-born doctor, studied homeopathy in
In the late
19th and early 20th centuries, numerous medical advances were made, such as the
recognition of the mechanisms of disease; Pasteur's germ theory; the
development of antiseptic techniques; and the discovery of ether anesthesia. In
addition, a report (the so-called "Flexner Report") was released that
triggered major changes in American medical education. Homeopathy was among the
disciplines negatively affected by these developments. Most homeopathic medical
schools closed down, and by the 1930s others had converted to conventional
medical schools.
In the
1960s, homeopathy's popularity began to revive in the
Persons
using homeopathy do so to address a range of health concerns, from wellness and
prevention to treatment of injuries, diseases, and conditions. Studies have
found that many people who seek homeopathic care seek it for help with a
chronic medical condition. Many users of homeopathy treat themselves with
homeopathic products and do not consult a professional.
Since
homeopathy is administered in minute or potentially nonexistent material
dosages, there is a skepticism in the scientific
community about its efficacy. Nonetheless, the medical literature provides
evidence of ongoing research in the field. Studies of homeopathy's effectiveness
involve three areas of research:
- Comparisons of homeopathic remedies and placebos
- Studies of homeopathy's effectiveness for particular
clinical conditions
- Studies of the biological effects of potencies,
especially ultra-high dilutions
Several systematic
reviews and meta-analyses evaluated clinical trials of the effectiveness of
homeopathic remedies as compared with placebo. The reviews found that, overall, the quality of clinical research in homeopathy is
low. But when high-quality studies were selected for analysis, a surprising
number showed positive results. (Jonas WB; 2003, Mathie RT; 2003, Cucherat M,
et al; 2000)
Overall,
clinical trial results are contradictory, and systematic reviews and
meta-analyses have not found homeopathy to be a definitively proven treatment
for any medical condition.
Summary
While whole medical systems differ in
their philosophical approaches to the prevention and treatment of disease, they
share a number of common elements. These systems are based on the belief that
one's body has the power to heal itself. Healing often involves marshalling
multiple techniques that involve the mind, body, and spirit. Treatment is often
individualized and dependent on the presenting symptoms. To date, NCCAM's
research efforts have focused on individual therapies with adequate
experimental rationale and not on evaluating whole systems of medicine as they
are commonly practiced. (NCCAM; 2004)
Mind-Body Medicine
Introduction
Mind-body medicine focuses on the
interactions among the brain, mind, body, and behavior, and the powerful ways
in which emotional, mental, social, spiritual, and behavioral factors can
directly affect health. It regards as fundamental an approach that respects and
enhances each person's capacity for self-knowledge and self-care, and it
emphasizes techniques that are grounded in this approach.
Definition
Mind-body medicine typically focuses on
intervention strategies that are thought to promote health, such as relaxation,
hypnosis, visual imagery, meditation, yoga, biofeedback, tai chi, qi gong,
cognitive-behavioral therapies, group support, autogenic training,
spirituality, and prayer. The field views illness as an opportunity for
personal growth and transformation, and health care providers as catalysts and
guides in this process.
Mind-body interventions constitute a major
portion of the overall use of
Background
The concept that the mind is important in the
treatment of illness is integral to the healing approaches of traditional
Chinese and Ayurvedic medicine, dating back more than 2,000 years. It was also
noted by Hippocrates, who recognized the moral and spiritual aspects of
healing, and believed that treatment could occur only with consideration of
attitude, environmental influences, and natural remedies (ca. 400 B.C.). While
this integrated approach was maintained in traditional healing systems in the
East, developments in the Western world by the 16th and 17th centuries led to a
separation of human spiritual or emotional dimensions from the physical body.
This separation began with the redirection of science, during the Renaissance
and Enlightenment eras, to the purpose of enhancing humankind's control over
nature. Technological advances (e.g., microscopy, the stethoscope, the blood
pressure cuff, and refined surgical techniques) demonstrated a cellular world
that seemed far apart from the world of belief and emotion. The discovery of
bacteria and, later, antibiotics further dispelled the notion of belief
influencing health. Fixing or curing an illness became a matter of science
(i.e., technology) and took precedence over, not a place beside,
healing of the soul. As medicine separated the mind and the body, scientists of
the mind formulated concepts, such as the unconscious, emotional impulses, and
cognitive delusions, that solidified the perception that diseases of the mind
were not "real," that is, not based in physiology and biochemistry.
In the
1920s, Walter Cannon's work revealed the direct relationship between stress and
neuroendocrine responses in animals. Coining the phrase "fight or
flight," Cannon described the primitive reflexes of sympathetic and
adrenal activation in response to perceived danger and other environmental
pressures (e.g., cold, heat). Hans Selye further defined the deleterious effects
of stress and distress on health. At the same time,
technological advances in medicine that could identify specific pathological
changes, and new discoveries in pharmaceuticals, were occurring at a very rapid
pace. The disease-based model, the search for a specific pathology, and the
identification of external cures were paramount, even in psychiatry.
During World
War II, the importance of belief reentered the web of health care. On the
beaches of
Since the
1960s, mind-body interactions have become an extensively researched field. The
evidence for benefits for certain indications from biofeedback,
cognitive-behavioral interventions, and hypnosis is quite good, while there is
emerging evidence regarding their physiological effects. Less research supports
the use of other, more clearly
Mind-Body Interventions
and Disease Outcomes
Over the
past 20 years, mind-body medicine has provided considerable evidence that
psychological factors can play a substantive role in the development and
progression of coronary artery disease. There is evidence that mind-body
interventions can be effective in the treatment of coronary artery disease,
enhancing the effect of standard cardiac rehabilitation in reducing all-cause
mortality and cardiac event recurrences for up to 2 years. (Rutledge JC, et al;
1999)
Mind-body
interventions have also been applied to various types of pain. Clinical trials
indicate that these interventions may be a particularly effective adjunct in
the management of arthritis, with reductions in pain maintained for up to 4
years and reductions in the number of physician visits. (Luskin FA, et al;
2000) When applied to more general acute and chronic
pain management, headache, and low-back pain, mind-body interventions show some
evidence of effects, although results vary based on the patient population and
type of intervention studied.(Astin JA; 2003)
Evidence
from multiple studies with various types of cancer patients suggests that
mind-body interventions can improve mood, quality of life, and coping, as well
as ameliorate disease- and treatment-related symptoms, such as
chemotherapy-induced nausea, vomiting, and pain. (Mundy EA, et al; 2003) Some studies have
suggested that mind-body interventions can alter various immune parameters, but
it is unclear whether these alterations are of sufficient magnitude to have an
impact on disease progression or prognosis. (Irwin MR, et al; 2003)
Mind-Body Influences on Immunity
There is
considerable evidence that emotional traits, both
negative and positive, influence people's susceptibility to infection.
Following systematic exposure to a respiratory virus in the laboratory,
individuals who report higher levels of stress or negative moods have been
shown to develop more severe illness than those who report less stress or more
positive moods. (Cohen S, et al; 2003) Recent studies
suggest that the tendency to report positive, as opposed to negative, emotions
may be associated with greater resistance to objectively verified colds. These
laboratory studies are supported by longitudinal studies pointing to
associations between psychological or emotional traits and the incidence of
respiratory infections. (Smith A; 2001)
Meditation and Imaging
Meditation,
one of the most common mind-body interventions, is a conscious mental process
that induces a set of integrated physiological changes termed the relaxation
response. Functional magnetic resonance imaging (fMRI) has been used to
identify and characterize the brain regions that are active during meditation.
This research suggests that various parts of the brain known to be involved in
attention and in the control of the autonomic nervous system are activated,
providing a neurochemical and anatomical basis for the effects of meditation on
various physiological activities. (Lazr SW, et al; 2000) Recent studies involving imaging are advancing
the understanding of mind-body mechanisms. For example, meditation has been
shown in one study to produce significant increases in left- sided anterior
brain activity, which is associated with positive emotional states. Moreover,
in this same study, meditation was associated with increases in antibody titers
to influenza vaccine, suggesting potential linkages among meditation, positive
emotional states, localized brain responses, and improved immune function.
(Davidson RJ, et al; 2003)
Physiology of Expectancy (Placebo Response)
Placebo
effects are believed to be mediated by both cognitive and conditioning
mechanisms. Until recently, little was known about the role of these mechanisms
in different circumstances. Now, research has shown that placebo responses are
mediated by conditioning when unconscious physiological functions such as
hormonal secretion are involved, whereas they are mediated by expectation when
conscious physiological processes such as pain and motor performance come into
play, even though a conditioning procedure is carried out.
Positron
emission tomography (PET) scanning of the brain is providing evidence of the
release of the endogenous neurotransmitter dopamine in the brain of Parkinson's
disease patients in response to placebo. (Fuente-Fernandez R, et al; 2002) Evidence indicates that the placebo effect in
these patients is powerful and is mediated through activation of the
nigrostriatal dopamine system, the system that is damaged in Parkinson's
disease. This result suggests that the placebo response involves the secretion
of dopamine, which is known to be important in a number of other reinforcing
and rewarding conditions, and that there may be mind-body strategies that could
be used in patients with Parkinson's disease in lieu of or in addition to
treatment with dopamine-releasing drugs.
Stress and Wound Healing
Individual
differences in wound healing have long been recognized. Clinical observation
has suggested that negative mood or stress is associated with slow wound
healing. Basic mind-body research is now confirming this observation. Matrix
metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases
(TIMPs), whose expression can be controlled by cytokines, play a role in wound
healing. Using a blister chamber wound model on human
forearm skin exposed to ultraviolet light, researchers have demonstrated that
stress or a change in mood is sufficient to modulate MMP and TIMP expression
and, presumably, wound healing. (Yang EV, et al; 2002) Activation
of the hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal medullary (
Surgical
Preparation
Mind-body
interventions are being tested to determine whether they can help prepare
patients for the stress associated with surgery. Initial randomized controlled
trials--in which some patients received audiotapes with mind-body techniques
(guided imagery, music, and instructions for improved outcomes) and some
patients received control tapes--found that subjects receiving the mind-body
intervention recovered more quickly and spent fewer days in the hospital.
(Tusek DL, et al; 1997)
Behavioral interventions have been shown to
be an efficient means of reducing discomfort and adverse effects during
percutaneous vascular and renal procedures. Pain increased linearly with
procedure time in a control group and in a group practicing structured
attention, but remained flat in a group practicing a self-hypnosis technique.
The self-administration of analgesic drugs was significantly higher in the
control group than in the attention and hypnosis groups. Hypnosis also improved
hemodynamic stability. (Lang EV, et al; 2000)
Conclusion
Evidence from randomized controlled trials
and, in many cases, systematic reviews of the literature, suggest
that:
Mechanisms
may exist by which the brain and central nervous system influence immune,
endocrine, and autonomic functioning, which is known to have an impact on
health.
Multicomponent
mind-body interventions that include some combination of stress management,
coping skills training, cognitive-behavioral interventions, and relaxation
therapy may be appropriate adjunctive treatments for coronary artery disease
and certain pain-related disorders, such as arthritis.
Multimodal
mind-body approaches, such as cognitive-behavioral therapy, particularly when
combined with an educational/informational component, can be effective adjuncts
in the management of a variety of chronic conditions.
An
array of mind-body therapies (e.g., imagery, hypnosis, relaxation), when
employed presurgically, may improve recovery time and reduce pain following
surgical procedures.
Neurochemical
and anatomical bases may exist for some of the effects of mind-body approaches.
Mind-body
approaches have potential benefits and advantages. In particular, the physical
and emotional risks of using these interventions are minimal. Moreover, once
tested and standardized, most mind-body interventions can be taught easily.
Finally, future research focusing on basic mind-body mechanisms and individual
differences in responses is likely to yield new insights that may enhance the
effectiveness and individual tailoring of mind-body interventions. In the
meantime, there is considerable evidence that mind-body interventions, even as
they are being studied today, have positive effects on psychological
functioning and quality of life, and may be particularly helpful for patients
coping with chronic illness and in need of palliative care.
Biologically Based
Practices
Definition
The
Dietary
supplements are a subset of this
The Food and
Drug Administration (FDA) regulates dietary supplements differently than drug
products (either prescription or over-the-counter).
First, drugs
are required to follow defined good manufacturing practices (GMPs). The FDA is
developing GMPs for dietary supplements. However, until they are issued,
companies must follow existing manufacturing requirements for foods.
Second, drug
products must be approved by the FDA as safe and effective prior to marketing.
In contrast, manufacturers of dietary supplements are responsible only for
ensuring that their products are safe. While the FDA monitors adverse effects
after dietary supplement products are on the market, newly marketed dietary
supplements are not subject to pre-market approval or a specific post-market
surveillance period.
Third, while
DSHEA requires companies to substantiate claims of benefit, citation of
existing literature is considered sufficient to validate such claims.
Manufacturers are not required, as they are for drugs, to submit such
substantiation data to the FDA; instead, it is the Federal Trade Commission
that has primary responsibility for monitoring dietary supplements for truth in
advertising. An Institute of Medicine (
History and
Demographic Use
Dietary supplements reflect some of humankind's first attempts to improve the
human condition. The personal effects of the mummified prehistoric "Ice
Man" found in the Italian Alps in 1991 included medicinal herbs. By the Middle Ages, thousands of botanical products had been
inventoried for their medicinal effects. Many of these, including digitalis and
quinine, form the basis of modern drugs.
Interest in
and use of dietary supplements have grown considerably
in the past two decades. Consumers state that their primary reason for using
herbal supplements is to promote overall health and wellness, but they also
report using supplements to improve performance and energy, to treat and
prevent illnesses (e.g., colds and flu), and to alleviate depression. According
to a national survey on Americans' use of
Supplement
use differs by ethnicity and across income strata. On average, users tend to be
women, older, better educated, live in one- or
two-person households, have slightly higher incomes, and live in metropolitan
areas.
Use of
vitamin and mineral supplements, a subset of dietary supplements, by the
Sales of
dietary supplements are an estimated $18.7 billion per year, with
herbs/botanical supplements accounting for an estimated $4.3 billion in sales.
Consumers consider the proposed benefits of herbal supplements less believable
than those of vitamins and minerals. Recently sales of herbs have experienced
negative growth. This is attributed to consumers' withering confidence and
confusion. Within the herbal category, however, formulas led single herbs in
sales; products became increasingly condition-specific; and sales of women's
products actually increased by approximately 25 percent.
In contrast
to dietary supplements, functional foods are components of the usual diet that
may have biologically active components (e.g., polyphenols, phytoestrogens,
fish oils, carotenoids) that may provide health benefits beyond basic
nutrition. Examples of functional foods include soy, nuts, chocolate, and
cranberries. These foods' bioactive constituents are appearing with increasing
frequency as ingredients in dietary supplements. Functional foods are marketed
directly to consumers. Sales are now over $16.2 billion annually. Unlike
dietary supplements, functional foods may claim specific health benefits. The
Nutrition Labeling and Education Act (NLEA) of 1990 delineates
the permissible labeling of these foods for health claims. Whole diet therapy has become an accepted
practice for some health conditions. However, the popularity of unproven diets,
especially for the treatment of obesity, has risen to a new level as the
prevalence of obesity and metabolic syndrome among Americans has increased and
traditional exercise and diet "prescriptions" have failed. Popular
diets today include the Atkins, Zone, and Ornish diets, Sugar Busters, and others.
The range of macronutrient distributions of these popular diets is very wide.
The proliferation of diet books is phenomenal. Recently, food producers and
restaurants have been targeting their marketing messages to reflect
commercially successful low-carbohydrate diets.
Public need
for information about dietary supplements, functional foods, and selected
strict dietary regimens has driven research on the effectiveness and safety of
these interventions and the dissemination of research findings.
Research
Research on dietary supplements spans the spectrum of basic to clinical
research and includes ethnobotanical investigations, analytical research, and
method development/validation, as well as bioavailability, pharmacokinetic, and
pharmacodynamic studies. However, the basic and preclinical research is better
delineated for supplements composed of single chemical constituents (e.g.,
vitamins and minerals) than for the more complex products (e.g., botanical
extracts). There is an abundance of clinical research for all types of dietary
supplements. Most of this research involves small phase II studies.
The
literature on functional foods is vast and growing; it includes clinical
trials, animal studies, experimental in
vitro laboratory studies, and epidemiological studies. Much of the current evidence for functional
foods is preliminary or not based on well-designed trials. However, the
foundational evidence gained through other types of investigations is
significant for some functional foods and their "health-promoting"
constituents.
An important
gap in knowledge concerns the role of diet composition in energy balance.
Popular diets low in carbohydrates have been purported to enhance weight loss.
Shorter-term clinical studies show equivocal results. In addition, mechanisms
by which popular diets affect energy balance, if at all, are not well
understood. Although numerous animal studies assessing the impact of diet
composition on appetite and body weight have been conducted, these studies have
been limited by availability and use of well-defined and standardized diets.
The research on weight loss is more abundant than that on weight maintenance.
Primary Challenges
Many clinical studies of dietary supplements are flawed because of inadequate sample
size, poor design, limited preliminary dosing data, lack of blinding even when
feasible, and/or failure to incorporate objective or standardized outcome
instruments. In addition, the lack of reliable data on the absorption,
disposition, metabolism, and excretion of these entities in living systems has
complicated the selection of products to be used in clinical trials. This is more
problematic for complex preparations (e.g., botanicals) than for products
composed of single chemicals.
The lack of
consistent and reliable botanical products represents a formidable challenge
both in clinical trials and in basic research. Most have not been sufficiently
characterized or standardized for the conduct of clinical trials capable of
adequately demonstrating safety or efficacy, or predicting that similarly
prepared products would also be safe and effective in wider public use.
Consequently, obtaining sufficient quantities of well-characterized products
for evaluation in clinical trials would be advantageous. Several issues
regarding the choice of clinical trial material require special attention, for
example:
Influences of climate and soil
Use of different parts of the plants
Use of different cultivars and species
Optimal growing, harvesting, and
storage conditions
Use of the whole extract or a specific
fraction
Method of extraction
Chemical standardization of the
product
Bioavailability of the formulation
Dose and length of administration
Some
nonbotanical dietary supplements, such as vitamins, carnitine, glucosamine, and
melatonin, are single chemical entities. Botanicals, however, are complex
mixtures. Their specific active ingredients may be identified, but are rarely
known for certain. Usually, there is more than one of these ingredients, often
dozens. When active compounds are unknown, it is necessary to identify marker
or reference compounds, even though they may be unrelated to biological
effects.
Qualitative
and quantitative determinations of the active and marker compounds, as well as
the presence of product contaminants, can be assessed by capillary
electrophoresis, gas chromatography, liquid chromatography-mass spectrometry,
gas chromatography-mass spectrometry, high-performance liquid chromatography,
and liquid chromatography-multidimensional nuclear magnetic resonance.
Fingerprinting techniques can map out the spectrum of compounds in a plant
extract.
New
applications of older techniques and new analytical methods continue to be
developed and validated. However, there remains a
limited number of analytical tools that are precise, accurate, specific, and
robust. Steps are currently being taken to apply molecular tools, such as DNA
fingerprinting, to verify species in products, while transient expression
systems, and microarray and proteomic analyses, are beginning to be used to
define the cellular and biological activities of dietary supplements.
Particular
attention should be paid to the issues of complex botanicals and clinical
dosing. Quality control of complex botanicals is difficult, but must be
accomplished, because it is not ethical to administer an unknown product to
patients. The use of a suboptimal dose that is safe but ineffective does not
serve the larger goals of research community, or public health. Although the
trial would indicate only that the tested dose of the intervention was
ineffective, the public might conclude that all doses of the intervention are
ineffective, and patients would be denied a possible benefit from the
intervention. Overdosing, on the other hand, might produce unnecessary adverse
effects. Phase I/II studies should be conducted first
to determine the safety of various doses, and the optimal dose should then be
tested in a phase III trial. As a result, maximum benefit would be seen in the
trial; also, any negative result would be definitive.
To a great
extent, the difference between a dietary supplement and a drug lies in the use
of the agent, not in the nature of the agent itself. If an herb, vitamin,
mineral, or amino acid is used to resolve a nutritional deficiency or to
improve or sustain the structure or function of the body, the agent is
considered a dietary supplement. If the agent is used to diagnose, prevent,
treat, or cure a disease, the agent is considered a drug. This distinction is key when the FDA determines whether proposed research on a
product requires an investigational new drug (
Similarly,
little attention has been paid to the quality of probiotics. Quality issues for
probiotic supplements may include:
Viability of bacteria in the product
Types and titer of bacteria in the
product
Stability of different strains under
different storage conditions and in different product formats
Enteric protection of the product
Therefore,
for optimal studies, documentation of the type of bacteria (genus and species),
potency (number of viable bacteria per dose), purity (presence of contaminating
or ineffective microorganisms), and disintegration properties must be provided
for any strain to be considered for use as a probiotic product. Speciation of
the bacteria must be established by means of the most current, valid
methodology.
Many of the
challenges identified for research on dietary supplements, including issues of
composition and characterization, are applicable to research on functional
foods and whole diets. In addition, challenges of popular diet research include
adherence to the protocol for longer-term studies, inability to blind
participants to intervention assignment, and efficacy versus effectiveness.
Summary of Evidence
Over the past
few decades, thousands of studies of various dietary supplements have been
performed. To date, however, no single supplement has been proven effective in
a compelling way. Nevertheless, there are several supplements for which early
studies yielded positive, or at least encouraging, data.
For a few
dietary supplements, data have been deemed sufficient to warrant large-scale
trials. For example, multicenter trials have concluded or are in progress on
ginkgo (Ginkgo biloba) for prevention of dementia, glucosamine
hydrochloride and chondroitin sulfate for osteoarthritis of the knee, saw
palmetto (Serenoa repens)/African plum (Prunus africana) for
benign prostatic hypertrophy, vitamin E/selenium for prevention of prostate
cancer, shark cartilage for lung cancer, and St. John's wort (Hypericum
perforatum) for major and minor depression. The results of one of the
depression studies showed that
The Agency
for Healthcare Research and Quality has produced a number of evidence-based
reviews of dietary supplements, including garlic, antioxidants, milk thistle,
omega-3 fatty acids, ephedra, and S-adenosyl-L-methionine (SAMe). The following
are examples of findings from some of these reviews:
Analysis of the
literature shows generally disappointing results for the efficacy of
antioxidant supplementation (vitamins C and E, and coenzyme Q10) to prevent or
treat cancer. Because this finding contrasts with the benefits reported from
observational studies, additional research is needed to understand why these
two sources of evidence disagree. (AHRQ 04-E002;
2004)
Similarly, the literature on the roles
of the antioxidants vitamins C and E and coenzyme Q10 for cardiovascular
disease also shows discordance between observational and experimental data.
Therefore, the thrust of new research into antioxidants and cardiovascular
disease should be randomized trials. (AHRQ 03-E043; 2003)
The clinical efficacy of milk thistle
to improve liver function is not clearly established. Interpretation of the
evidence is hampered by poor study methods or poor quality of reporting in
publications. Possible benefit has been shown most frequently, but not
consistently, for improvement in aminotransferase levels. Liver function tests
are overwhelmingly the most common outcome measure studied. Available evidence
is not sufficient to suggest whether milk thistle is more effective for some
liver diseases than others. Available evidence does suggest that milk thistle
is associated with few, and generally minor, adverse effects. Despite
substantial in vitro and animal research, the mechanism of action of
milk thistle is not well defined and may be multifactorial. (AHRQ 01-E025;
2001)
The review of SAMe
for the treatment of depression, osteoarthritis, and liver disease identified a
number of promising areas for future research. For example, it would be helpful
to conduct
(1) additional review studies, studies
elucidating the pharmacology of SAMe, and clinical trials;
(2) studies that would lead to a
better understanding of the risk-benefit ratio of SAMe compared to that of conventional
therapy;
(3) good dose-escalation studies using
the oral formulation of SAMe for depression, osteoarthritis, or liver disease;
and
(4) larger clinical trials once the
efficacy of the most effective oral dose of SAMe has been demonstrated.(AHRQ 02-E034;
2002)
Two high-quality randomized controlled
trials provide good evidence that cranberry juice may decrease the number of
symptomatic urinary tract infections in women over a 12-month period. It is not
clear if it is effective in other groups. The fact that a large number of women
dropped out of these studies indicates that cranberry juice may not be
acceptable over long periods of time. Finally, the optimal dosage or method of
administration of cranberry products (e.g., juice or tablets) is not clear.(Jepson RG, et al; 2004)
There has
been some study of other popular dietary supplements. For example, valerian is
an herb often consumed as a tea for improved sleep, and melatonin is a pineal
hormone touted for the same purpose.(Kunz D, et al; 2004) Small studies suggest that these two
supplements may relieve insomnia, and there may be little harm in a trial
course of either one. Echinacea has long been taken to treat or prevent colds;
other supplements currently used for colds include zinc lozenges and high doses
of vitamin C. As yet, only moderate-sized studies have been conducted with
echinacea or zinc, and their outcomes have been conflicting. (Marshall I; 2004,
Melchart D, et al; 2003) Large
trials of high doses of oral vitamin C showed little, if any, benefit in
preventing or treating the common cold.(Douglas RM; 2004)
Because of
widespread use, often for centuries, and because the products are
"natural," many people assume dietary supplements to be inert or at
least innocuous. Yet, studies show clearly that interactions between these
products and drugs do occur. For example, the active ingredients in ginkgo
extract are reported to have antioxidant properties and to inhibit platelet
aggregation. (Foster S; 1996) Several cases have been reported of increased
bleeding associated with ginkgo's use with drugs that have anticoagulant or
antiplatelet effects.
Other
dietary supplements shown to potentiate or interfere with prescription drugs
include garlic, glucosamine, ginseng (Panax), saw palmetto, soy,
valerian, and yohimbe. (De Smet PA; 2002)
In addition
to interacting with other agents, some herbal supplements can be toxic.
Misidentification, contamination, and adulteration may contribute to some of
the toxicities. But other toxicities may result from the products themselves.
For example, in 2001, extracts of kava were associated with fulminant liver
failure. More recently, the FDA banned the sale of ephedra after it was shown
to be associated with an increased risk of adverse events.
Given the
large number of dietary supplement ingredients; that dietary supplements are
assumed to be safe in general; and that the FDA is unlikely to have the
resources to evaluate each ingredient uniformly, the
All federally supported research on
dietary supplements conducted to assess efficacy should be required to include
the collection and reporting of all data on the safety of the ingredient under
study.
The
development of effective working relationships and partnerships between the FDA
and NIH should continue.
The
FDA and NIH should establish clear guidelines for cooperative efforts on
high-priority safety issues related to the use of dietary supplements.
Energy Therapies
Introduction
Energy
medicine is a domain in
Veritable, which can be measured
Putative, which have yet to be
measured
The veritable
energies employ mechanical vibrations (such as sound) and electromagnetic
forces, including visible light, magnetism, monochromatic radiation (such as
laser beams), and rays from other parts of the electromagnetic spectrum. They
involve the use of specific, measurable wavelengths and frequencies to treat
patients.
In contrast,
putative energy fields (also called biofields) have defied measurement
to date by reproducible methods. Therapies involving putative energy fields are
based on the concept that human beings are infused with a subtle form of
energy. This vital energy or life force is known under different names in
different cultures, such as qi in traditional Chinese medicine (TCM), ki in the
Japanese Kampo system, doshas in Ayurvedic medicine, and elsewhere as prana,
etheric energy, fohat, orgone, odic force, mana, and homeopathic resonance.
Vital energy is believed to flow throughout the material human body, but it has
not been unequivocally measured by means of conventional instrumentation.
Nonetheless, therapists claim that they can work with this subtle energy, see
it with their own eyes, and use it to effect changes in the physical body and
influence health.
Practitioners
of energy medicine believe that illness results from disturbances of these
subtle energies (the biofield). For example, more than 2,000 years ago, Asian
practitioners postulated that the flow and balance of life energies are
necessary for maintaining health and described tools to restore them. Herbal
medicine, acupuncture, acupressure, moxibustion, and cupping, for example, are
all believed to act by correcting imbalances in the internal biofield, such as
by restoring the flow of qi through meridians to reinstate health. Some
therapists are believed to emit or transmit the vital energy (external qi) to a
recipient to restore health.
Examples of
practices involving putative energy fields include:
Reiki and Johrei, both of Japanese
origin
Qi gong, a Chinese practice
Healing touch, in which the therapist
is purported to identify imbalances and correct a client's energy by passing
his or her hands over the patient
Prayer specifically for health
purposes--such as intercessory prayer, in which a person intercedes through
prayer on behalf of another
In the
aggregate, these approaches are among the most controversial of
Veritable Energy
Medicine
There are many well-established uses for the
application of measurable energy fields to diagnose or treat diseases:
electromagnetic fields in magnetic resonance imaging, cardiac pacemakers,
radiation therapy, ultraviolet light for psoriasis, laser keratoplasty, and
more. There are many other claimed uses as well. The ability to deliver
quantifiable amounts of energies across the electromagnetic spectrum is an
advantage to studies of their mechanisms and clinical effects. For example,
both static and pulsating electromagnetic therapies have been employed.
Magnetic Therapy
Magnets have been used for many centuries in attempts to treat pain. By various
accounts, this use began when people first noticed the presence of naturally
magnetized stones, also called lodestones. Other accounts trace the beginning
to a shepherd noticing that the nails in his sandals were pulled out by some
stones. By the third century A.D., Greek physicians were using rings made of
magnetized metal to treat arthritis and pills made of magnetized amber to stop
bleeding. In the Middle Ages, doctors used magnets to treat gout, arthritis,
poisoning, and baldness; to probe and clean wounds; and to retrieve arrowheads
and other iron-containing objects from the body.
In the
Static
magnets have been used for centuries in efforts to relieve pain or to obtain
other alleged benefits (e.g., increased energy). They are usually made from
iron, steel, rare-earth elements, or alloys. Typically, the magnets are placed
directly on the skin or placed inside clothing or other materials that come
into close contact with the body. Static magnets can be unipolar (one pole of
the magnet faces or touches the skin) or bipolar (both poles face or touch the
skin, sometimes in repeating patterns). Some magnet manufacturers make claims
about the poles of magnets--for example, that a unipolar design is better than
a bipolar design, or that the north pole gives a
different effect from the south pole. These claims have not been scientifically
proven. Numerous anecdotal
reports have indicated that individuals have experienced significant, and at
times dramatic, relief of pain after the application of static magnets over a
painful area.
Although the
literature on the biological effects of magnetic fields is growing, there is a
limited amount of data from well-structured, clinically sound studies. However,
there is growing evidence that magnetic fields can influence physiological
processes. It has recently been shown that static magnetic fields affect the
microvasculature of skeletal muscle. (Morris CE; 2003) Microvessels that are initially dilated
respond to a magnetic field by constricting, and microvessels that are
initially constricted respond by dilating. These results suggest that static
magnetic fields may have a beneficial role in treating edema or ischemic
conditions, but there is no proof that they do.
Electromagnets
were approved by the FDA in 1979 to treat bone fractures that have not healed
well. Researchers have been
studying electromagnets for painful conditions, such as knee pain from
osteoarthritis, chronic pelvic pain, problems in bones and muscles, and
migraine headaches. However,
these uses of electromagnets are still considered experimental by the FDA and
have not been approved. Currently, electromagnets to treat pain are being used
mainly under the supervision of a health care provider and/or in clinical
trials.
An
electromagnetic therapy called TMS (transcranial magnetic stimulation) is also
being studied by researchers. In TMS, an insulated coil is placed against the
head, near the area of the brain to be examined or treated, and an electrical
current generates a magnetic field into the brain. Currently, TMS is most often
used as a diagnostic tool, but research is also under way to see whether it is
effective in relieving pain. A type of TMS called rTMS (repetitive TMS) is
believed by some to produce longer lasting effects and is being explored for
its usefulness in treating chronic pain, facial pain, headache, and
fibromyalgia pain. A related form of electromagnetic therapy is rMS (repetitive
magnetic stimulation). It is similar to rTMS except that the magnetic coil is
placed on or near a painful area of the body other than the head. This therapy
is being studied as a treatment for musculoskeletal pain.
Pulsating
electromagnetic therapy has also been used for treating osteoarthritis,
migraine headaches, multiple sclerosis, and sleep disorders. Some animal and cell culture studies have been
conducted to elucidate the basic mechanism of the pulsating electromagnetic
therapy effect, such as cell proliferation and cell-surface binding for growth
factors. However, detailed data on the mechanisms of action are still lacking.
The kinds of
magnets marketed to consumers are generally considered to be safe when applied
to the skin. Reports of side
effects or complications have been rare. One study reported that a small
percentage of participants had bruising or redness on their skin where a magnet
was worn.
Manufacturers
often recommend that static magnets not be used by the following people:
Pregnant women, because the possible
effects of magnets on the fetus are not known.
People who use a medical device such
as a pacemaker, defibrillator, or insulin pump, because magnets may affect the
magnetically controlled features of such devices.
People who use a patch that delivers
medication through the skin, in case magnets cause dilation of blood vessels,
which could affect the delivery of the medicine. This caution also applies to
people with an acute sprain, inflammation, infection, or wound.
There have
been rare cases of problems reported from the use of electromagnets. Because at
present these are being used mainly under the supervision of a health care
provider and/or in clinical trials, readers are advised to consult their
provider about any questions.
Millimeter Wave
Therapy
Low-power millimeter wave (MW) irradiation elicits biological effects, and
clinicians in Russia and other parts of Eastern Europe have used it in past
decades to treat a variety of conditions, ranging from skin diseases and wound
healing to various types of cancer, gastrointestinal and cardiovascular
diseases, and psychiatric illnesses. In spite of an increasing number of in vivo and in vitro studies, the nature of MW action is not well
understood. It has been shown, for example, that MW irradiation can augment
T-cell mediated immunity in vitro. (Logani MK, et al; 2004) However, the mechanisms by which MW
irradiation enhances T-cell functions are not known. Some studies indicate that
pretreating mice with naloxone may block the hypoalgesic and antipruritic
effects of MW irradiation, suggesting that endogenous opioids are involved in
MW therapy-induced hypoalgesia. Theoretical and experimental data show that
nearly all the MW energy is absorbed in the superficial layers of skin, but it
is not clear how the energy absorbed by keratinocytes, the main constituents of
epidermis, is transmitted to elicit the therapeutic effect. (Szabo I, et al;
2003) It is also unclear
whether MW yields clinical effects beyond a placebo response.
Sound Energy
Therapy
Sound energy therapy, sometimes referred to as
vibrational or frequency therapy, includes music therapy as well as wind chime
and tuning fork therapy. The presumptive basis of its effect is that specific
sound frequencies resonate with specific organs of the body to heal and support
the body. Music therapy has been the most studied among these interventions,
with studies dating back to the 1920s, when it was reported that music affected
blood pressure.11 Other studies have suggested that music can help
reduce pain and anxiety. Music and imagery, alone and in combination, have been
used to entrain mood states, reduce acute or chronic pain, and alter certain
biochemicals, such as plasma beta-endorphin levels.12 These uses of energy fields truly overlap with the domain of
mind-body medicine.
Light Therapy
Light therapy is the use of natural or artificial light to treat various
ailments, but unproven uses of light extend to lasers, colors, and
monochromatic lights. High-intensity light therapy has been documented to be
useful for seasonal affective disorder, with less evidence for its usefulness
in the treatment of more general forms of depression and sleep disorders. Hormonal changes have been detected after
treatment. Although low-level laser therapy is claimed to be useful for
relieving pain, reducing inflammation, and helping to heal wounds, strong
scientific proof of these effects is still needed.
Putative Energy
Fields
The concept that sickness and disease arise
from imbalances in the vital energy field of the body has led to many forms of
therapy. In traditional Chinese medicine, a series of approaches are taken to
rectify the flow of qi, such as herbal medicine, acupuncture (and its various
versions), qi gong, diet, and behavior changes.
Therapeutic Touch and Related Practices
Numerous other practices have evolved over
the years to promote or maintain the balance of vital energy fields in the
body. Examples of these modalities include Therapeutic Touch, healing touch,
Reiki, Johrei, vortex healing, and polarity therapy. All these modalities involve movement of the
practitioner's hands over the patient's body to become attuned to the condition
of the patient, with the idea that by so doing, the practitioner is able to
strengthen and reorient the patient's energies.
Many small
studies of Therapeutic Touch have suggested its effectiveness in a wide variety
of conditions, including wound healing, osteoarthritis, migraine headaches, and
anxiety in burn patients. In one meta-analysis of 11 controlled Therapeutic
Touch studies, 7 controlled studies had positive outcomes, and 3 showed no
effect; in one study, the control group healed faster than the Therapeutic
Touch group.(Winstead-Fry P; 1999) Similarly, Reiki and Johrei practitioners
claim that the therapies boost the body's immune system, enhance the body's
ability to heal itself, and are beneficial for a wide range of problems, such
as stress-related conditions, allergies, heart conditions, high blood pressure,
and chronic pain. (Gallob R; 2003) However, there has been little rigorous
scientific research. Overall, these therapies have impressive anecdotal
evidence, but none has been proven scientifically to be effective.
Distant Healing
Proponents of energy field therapies also
claim that some of these therapies can act across long distances. For example,
the long-distance effects of external qi gong have been studied in
Another form of distant healing is
intercessory prayer, in which a person prays for the healing of another person
who is a great distance away, with or without that person's knowledge. Review
of eight nonrandomized and nine randomized clinical trials published between
2000 and 2002 showed that the majority of the more rigorous trials do not
support the hypothesis that distant intercessory prayer has specific
therapeutic effects. (Ernst E; 2003)
Physical Properties of Putative Energy Fields
There has always been an interest in
detecting and describing the physical properties of putative energy fields.
Kirlian photography, aura imaging, and gas discharge visualization are
approaches for which dramatic and unique differences before and after therapeutic
energy attunements or treatments have been claimed. However, it is not clear what is being
detected or photographed. Early results demonstrated that gamma radiation
levels markedly decreased during therapy sessions in 100 percent of subjects
and at every body site tested, regardless of which therapist performed the
treatment. Recently replicated studies identified statistically significant
decreases in gamma rays emitted from patients during alternative healing
sessions with trained practitioners.
It has been
hypothesized that the body's primary gamma emitter, potassium-40 (K40),
represents a "self-regulation" of energy within the body and the
surrounding electromagnetic field. The body's energy adjustment may result, in
part, from the increased electromagnetic fields surrounding the hands of the
healers. Furthermore, an extremely sensitive magnetometer called a
superconducting quantum interference device (SQUID) has been claimed to measure
large frequency-pulsing biomagnetic fields emanating from the hands of
Therapeutic Touch practitioners during therapy.
In one
study, a simple magnetometer measured and quantified similar frequency-pulsing
biomagnetic fields from the hands of meditators and practitioners of yoga and
qi gong. These fields were 1,000 times greater than the strongest human
biomagnetic field and were in the same frequency range as those being tested in
medical research laboratories for use in speeding the healing process of
certain biological tissues. (Sisken BF; 1995) This range is low energy and extremely low
frequency, spanning from 2 Hz to 50 Hz. However, there are considerable
technical problems in such research. For example, SQUID measurement must be
conducted under a special shielded environment, and the connection between electromagnetic
field increases and observed healing benefits reported in the current
literature is missing.
Other
studies of putative energies suggested that energy fields from one person can
overlap and interact with energy fields of other people. For example, when
individuals touch, one person's electrocardiographic signal is registered in
the other person's electroencephalogram (EEG) and elsewhere on the other
person's body. (Russek L; 1996) In addition, one individual's cardiac signal
can be registered in another's EEG recording when two people sit quietly
opposite one another.
Additional Theories
Thus far, electromagnetic energy has been
demonstrated and postulated to be the energy between bioenergy healers and
patients. However, the exact nature of this energy is not clear. Among the
range of ideas emerging in this field is the theory of a Russian researcher who
hypothesized that "torsion fields" exist and that they can be
propagated through space at no less than 109 times the speed of
light in vacuum; that they convey information without transmitting energy; and
that they are not required to obey the superposition principle. (Panov V; 1997)
There are
other extraordinary claims and observations recorded in the literature. For
example, one report claimed that accomplished meditators were able to imprint
their intentions on electrical devices (IIED), which when placed in a room for
3 months, would elicit these intentions, such as changes in pH and temperature,
in the room even when the IIED was removed from the room. (Tiller WA; 2004)
Another claim is that water will
crystallize into different forms and appearances under the influence of written
intentions or types of music. (Emoto M; 2004)
For research, questions remain about which of
the above theories and approaches can be and should be addressed using existing
technologies, and how.
Manipulative and Body-Based
Practices
Introduction
Under the umbrella of manipulative and
body-based practices is a heterogeneous group of
Manipulative
and body-based practices focus primarily on the structures and systems of the
body, including the bones and joints, the soft tissues, and the circulatory and
lymphatic systems. Some practices were derived from traditional systems of
medicine, such as those from
Definitions
Alexander
technique:
Patient education/guidance in ways to improve posture and movement, and to use
muscles efficiently.
Bowen
technique:
Gentle massage of muscles and tendons over acupuncture and reflex points.
Chiropractic
manipulation:
Adjustments of the joints of the spine, as well as other joints and
muscles.
Craniosacral
therapy:
Form of massage using gentle pressure on the plates of the patient's skull.
Feldenkrais
method:
Group classes and hands-on lessons designed to improve the coordination of the
whole person in comfortable, effective, and intelligent movement.
Massage
therapy:
Assortment of techniques involving manipulation of the soft tissues of the body
through pressure and movement.
Osteopathic
manipulation:
Manipulation of the joints combined with physical therapy and instruction in
proper posture.
Reflexology: Method of foot (and
sometimes hand) massage in which pressure is applied to "reflex"
zones mapped out on the feet (or hands).
Rolfing: Deep tissue massage
(also called structural integration).
Trager
bodywork:
Slight rocking and shaking of the patient's trunk and limbs in a rhythmic
fashion.
Tui
Na:
Application of pressure with the fingers and thumb, and manipulation of
specific points on the body (acupoints).
Chiropractic
Chiropractic is a form of spinal
manipulation, which is one of the oldest healing practices. Spinal manipulation
was described by Hippocrates in ancient
Some chiropractors continue to view
subluxation as central to chiropractic health care. However, other
chiropractors no longer view the subluxation theory as a unifying theme in
health and illness or as a basis for their practice.
Patients may
or may not experience side effects from chiropractic treatment. Effects may
include temporary discomfort in parts of the body that were treated, headache,
or tiredness. These effects tend to be minor and to resolve within 1 to 2 days.
The majority of research on manipulative and body-based practices has been
clinical in nature, encompassing case reports, mechanistic studies, biomechanical
studies, and clinical trials. A cursory search in PubMed for research published
in the last 10 years identified 537 clinical trials, of which 422 were
randomized and controlled. Similarly, 526 trials were identified in the
Cochrane database of clinical trials. PubMed also contains 314 case reports or
series, 122 biomechanical studies, 26 health services studies, and 248 listings
for all other types of clinical research published in the last 10 years. On the
other hand, for this same time period, there have been only 33 published
articles of research involving in
vitro assays or employing animal models.
Primary Challenges
Different challenges face investigators studying mechanisms of action than
those studying efficacy and safety. The primary challenges that have impeded
research on the underlying biology of manual therapies include the following:
Lack of appropriate animal models
Lack of cross-disciplinary
collaborations
Lack of research tradition and
infrastructure at schools that teach manual therapies
Inadequate use of state-of-the-art
scientific technologies
Clinical
trials of
Identifying an appropriate,
reproducible intervention, including dose and frequency. This may be more
difficult than in standard drug trials, given the variability in practice
patterns and training of practitioners.
Identifying an appropriate control
group(s). In this regard, the development of valid sham manipulation techniques
has proven difficult.
Randomizing subjects to treatment
groups in an unbiased manner. Randomization may prove more difficult than in a
drug trial, because manual therapies are already available to the public; thus,
it is more likely that participants will have a preexisting preference for a
given therapy.
Maintaining investigator and subject
compliance to the protocol. Group contamination (which occurs when patients in
a clinical study seek additional treatments outside the study, usually without
telling the investigators; this will affect the accuracy of the study results)
may be more problematic than in standard drug trials, because subjects have
easy access to manual therapy providers.
Reducing bias by blinding subjects and
investigators to group assignment. Blinding of subjects and investigators may
prove difficult or impossible for certain types of manual therapies. However,
the person collecting the outcome data should always be blinded.
Identifying and employing appropriate
validated, standardized outcome measures.
Employing appropriate analyses,
including the intent-to-treat paradigm.
Preclinical Studies
The most abundant data regarding the possible mechanisms underlying
chiropractic manipulation have been derived from studies in animals, especially
studies on the ways in which manipulation may affect the nervous system. For example, it has been shown, by means of
standard neurophysiological techniques, that spinal manipulation evokes changes
in the activity of proprioceptive primary afferent neurons in paraspinal
tissues. Sensory input from these tissues has the capacity to reflexively alter
the neural outflow to the autonomic nervous system. Studies are under way to
determine whether input from the paraspinal tissue also alters pain processing
in the spinal cord.
Animal
models have also been used to study the mechanisms of massage-like stimulation.
(
Although
animal models of chiropractic manipulation and massage have been established,
no such models exist for other body-based practices. Such models could be
critical if researchers are to evaluate the underlying anatomical and
physiological changes accompanying these therapies.
Clinical Studies: Mechanisms
Biomechanical studies have characterized the force applied by a practitioner
during chiropractic manipulation, as well as the force transferred to the
vertebral column, both in cadavers and in normal volunteers. (Swenson R; 2003)
In most cases, however, a single practitioner provided the manipulation,
limiting generalizability. Additional work is required to examine
interpractitioner variability, patient characteristics, and their relation to
clinical outcomes.
Studies
using magnetic resonance imaging (MRI) have suggested that spinal manipulation
has a direct effect on the structure of spinal joints; it remains to be seen if
this structural change relates to clinical efficacy.
Clinical
studies of selected physiological parameters suggest that massage therapy can
alter various neurochemical, hormonal, and immune markers, such as substance P
in patients who have chronic pain, serotonin levels in women who have breast
cancer, cortisol levels in patients who have rheumatoid arthritis, and natural
killer (NK) cell numbers and CD4+ T-cell counts in patients who are
HIV-positive. (Field T; 2002) However, most of these studies have come from
one research group, so replication at independent sites is necessary. It is
also important to determine the mechanisms by which these changes are elicited.
Despite
these many interesting experimental observations, the underlying mechanisms of
manipulative and body-based practices are poorly understood. Little is known
from a quantitative perspective. Important gaps in the field, as revealed by a
review of the relevant scientific literature, include the following:
Lack of biomechanical characterization
from both practitioner and participant perspectives
Little use of state-of-the-art imaging
techniques
Few data on the physiological,
anatomical, and biomechanical changes that occur with treatment
Inadequate data on the effects of
these therapies at the biochemical and cellular levels
Only preliminary data on the
physiological mediators involved with the clinical outcomes
Clinical Studies: Trials
Numerous clinical trials have been conducted on the use of spinal manipulation
for low-back pain, and there are abundant systematic reviews and meta-analyses
of the efficacy of spinal manipulation for both acute and chronic low-back
pain. (Assendelft WJ; 2003) These trials employed a variety of manipulative
techniques. Overall, manipulation studies of varying quality show minimal to
moderate evidence of short-term relief of back pain. Information on
cost-effectiveness, dosing, and long-term benefit is scant. Although clinical
trials have found no evidence that spinal manipulation is an effective
treatment for asthma, (Hondras MA; 2004) hypertension (Goertz CH, et al; 2002),
or dysmenorrhea, (Proctor ML, et al; 2004) spinal manipulation may be as
effective as some medications for both migraine and tension headaches (Astin
JA; 2002) and may offer short-term benefits to those suffering from neck pain.
(Hurwitz DL; 2002) Studies have not compared the relative effectiveness of
different manipulative techniques.
Although
there have been numerous published reports of clinical trials evaluating the
effects of various types of massage for a variety of medical conditions (most
with positive results), these trials were almost all small, poorly designed,
inadequately controlled, or lacking adequate statistical analyses. For example,
many trials included co-interventions that made it impossible to evaluate the
specific effects of massage, while others evaluated massage delivered by
individuals who were not fully trained massage therapists or followed treatment
protocols that did not reflect common (or adequate) massage practice.
There have
been very few well-designed controlled clinical trials evaluating the
effectiveness of massage for any condition, and only three randomized
controlled trials have specifically evaluated massage for the condition most
frequently treated with massage--back pain.(Cherkin DC, et al; 2003) All three
trials found massage to be effective, but two of these trials were very small.
More evidence is needed.
Risks
There are some risks associated with manipulation of the spine, but most
reported side effects have been mild and of short duration. Although rare,
incidents of stroke and vertebral artery dissection have been reported
following manipulation of the cervical spine. Despite the fact that some forms
of massage involve substantial force, massage is generally considered to have
few adverse effects. Contraindications for massage include deep vein
thrombosis, burns, skin infections, eczema, open wounds, bone fractures, and advanced
osteoporosis.
Utilization
In the United States, manipulative therapy is practiced primarily by doctors of
chiropractic, some osteopathic physicians, physical therapists, and
physiatrists. Doctors of chiropractic perform more than 90 percent of the spinal
manipulations in the
Individual
provider experience, traditional use, or arbitrary payer capitation decisions--rather
than the results of controlled clinical trials--determine many patient care
decisions involving spinal manipulation. More than 75 percent of private payers
and 50 percent of managed care organizations provide at least some
reimbursement for chiropractic care. Congress has mandated that the Department of
Defense (DOD) and the Department of Veterans Affairs provide chiropractic
services to their beneficiaries, and there are DOD medical clinics offering
manipulative services by osteopathic physicians and physical therapists. The
State of
Although the
numbers of Americans using chiropractic and massage are similar, massage
therapists are licensed in fewer than 40 states, and massage is much less
likely than chiropractic to be covered by health insurance. Like spinal manipulation, massage is most
commonly used for musculoskeletal problems. However, a significant fraction of
patients seek massage care for relaxation and stress relief.
Cost
A number of observational studies have looked at the
costs associated with chiropractic spinal manipulation in comparison with the
costs of conventional medical care, with conflicting results. Smith and Stano
found that overall health care expenditures were lower for patients who received
chiropractic treatment than for those who received medical care in a
fee-for-service environment. (Smith M; 1997) Carey and colleagues found chiropractic spinal
manipulation to be more expensive than primary medical care, but less expensive
than specialty medical care. (Carey TS, et al; 1995) Two randomized trials
comparing the costs of chiropractic care with the costs of physical therapy
failed to find evidence of cost savings through chiropractic treatment. ( Cherkin DC, et al; 1998, Skargren EI, et al; 1998) The
only study of massage that measured costs found that the costs for subsequent
back care following massage were 40 percent lower than those following
acupuncture or self care, but these differences were not statistically
significant. (
Patient Satisfaction
Although there are no studies of patient satisfaction
with manipulation in general, numerous investigators have looked at patient
satisfaction with chiropractic care. Patients report very high levels of
satisfaction with chiropractic care. Satisfaction with massage treatment has
also been found to be very high.
Consumer Issues
Safety
of
Each
treatment needs to be considered on its own. However, here are some issues to
think about when considering a
Many consumers believe that
"natural" means the same thing as "safe." This is not
necessarily true. For example, think of mushrooms that grow in the wild: some
are safe to eat, while others are poisonous.
Individuals
respond differently to treatments. How a person might respond to a
For a
The
components or ingredients that make up the product.
Where
the components or ingredients come from.
The
quality of the manufacturing process (for example, how well the manufacturer is
able to avoid contamination).
The
manufacturer of a dietary supplement is responsible for ensuring the safety and
effectiveness of the product before it is sold. The U.S. Food and Drug
Administration (FDA) cannot require testing of dietary supplements prior to
marketing. However, while manufacturers are prohibited from selling dangerous
products, the FDA can remove a product from the marketplace if the product is
dangerous to the health of Americans. Furthermore, if in the labeling or
marketing of a dietary supplement a claim is made that the product can
diagnose, treat, cure, or prevent disease, such as "cures cancer,"
the product is said to be an unapproved new drug and is, therefore, being sold
illegally. Such claims must have scientific proof.
For
Efficacy
of
Statements
that manufacturers and providers of
1. Is there scientific evidence (not
just personal stories) to back up the statements? Ask the manufacturer or the
practitioner for scientific articles or the results of studies. They should be
willing to share this information, if it exists.
2. Does the Federal Government have
anything to report about the therapy?
Visit the FDA online at www.fda.gov to
see if there is any information available about the product or practice.
Information specifically about dietary supplements can be found on FDA's Center
for Food Safety and Applied Nutrition Web site at www.cfsan.fda.gov. Or visit
the FDA's Web page on recalls and safety alerts at www.fda.gov/opacom/7alerts.html.
Check with the Federal Trade
Commission (FTC) at www.ftc.gov to see if there are any fraudulent claims or
consumer alerts regarding the therapy. Visit the Diet, Health, and Fitness
Consumer Information Web site at www.ftc.gov/bcp/menu-health.htm.
3. How does the provider or manufacturer
describe the treatment? The FDA advises that certain types of language may
sound impressive but actually disguise a lack of science. Be wary of
terminology such as "innovation," "quick cure,"
"miracle cure," "exclusive product," "new
discovery," or "magical discovery." Watch out for claims of a
"secret formula." If a therapy were a cure for a disease, it would be
widely reported and prescribed or recommended. Legitimate scientists want to
share their knowledge so that their peers can review their data. Be suspicious
of phrases like "suppressed by Government" or claims that the medical
profession or research scientists have conspired to prevent a therapy from
reaching the public. Finally, be wary of claims that something cures a wide
range of unrelated diseases (for example, cancer, diabetes, and AIDS). No
product can treat every disease and condition.
References
Agency for
Healthcare Research and Quality. Effect of the Supplemental Use of Antioxidants Vitamin C,
Vitamin E, and Coenzyme Q10 for the Prevention and Treatment of Cancer.
Evidence Report/Technology Assessment no. 75.
Agency for Healthcare Research and Quality. Effect of Supplemental Antioxidants
Vitamin C, Vitamin E, and Coenzyme Q10 for the Prevention and Treatment of
Cardiovascular Disease. Evidence Report/Technology
Assessment no. 83.
Agency for Healthcare Research and Quality. Milk Thistle: Effects on Liver Disease and
Cirrhosis and Clinical Adverse Effects. Evidence
Report/Technology Assessment no. 21.
Agency for Healthcare Research and Quality. S-Adenosyl-L-Methionine (SAMe) for Depression,
Osteoarthritis, and Liver Disease . Evidence Report/Technology
Assessment no. 64.
Apel-Neu A. Zettl
Assendelft
WJ, Morton SC, Yu EI, et al. Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies.
Annals of Internal Medicine. 2003;138(11):871-881
Astin
JA, Shapiro SL, Eisenberg DM, et al. Mind-body medicine: state of the science,
implications for practice. Journal of the American Board
of Family Practice. 2003;16(2):131-147.
Astin
JA, Ernst E. The effectiveness of spinal manipulation for the treatment of
headache disorders: a systematic review of randomized clinical trials. Cephalalgia. 2002;22(8):617-623.
Barnes
P, Powell-Griner E, McFann K, Nahin R. Complementary and alternative medicine
use among adults: United States, 2002. CDC Advance Data Report #343.
2004.
Ben-Arye E. Frenkel M. Referring to complementary and alternative
medicine--a possible tool for implementation. Complementary
Therapies in Medicine. 16(6):325-30, 2008 Dec.
Carey TS, Garrett J, Jackman A, et al. The outcomes and costs of care for acute low back pain
among patients seen by primary care practitioners, chiropractors, and
orthopedic surgeons. The
Cherkin
DC, MacCornack FA. Patient evaluations of low back pain care from family
physicians and chiropractors. Western Journal of Medicine.
1989;150(3):351-355.
Cohen
S, Doyle WJ, Turner RB, et al. Emotional style and susceptibility to the common
cold. Psychosomatic Medicine. 2003;65(4):652-657.
Cucherat
M, Haugh MC, Gooch M, et al. Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG.
Homeopathic Medicines Research Advisory Group. European Journal of Clinical Pharmacology. 2000;56(1):27-33.
Davidson
RJ, Kabat-Zinn J, Schumacher J, et al. Alterations in brain and immune function
produced by mindfulness meditation. Psychosomatic Medicine.
2003;65(4):564-570.
De
Smet PA. Herbal remedies.
Douglas RM, Chalker EB, Treacy B. Vitamin C for
preventing and treating the common cold. Cochrane Database of Systematic Reviews. 2004;(3):CD000980. Accessed at
www.cochrane.org on
Edirne T. Ugurluer G. Keskin S. Kusaslan D. Baloglu M. Praying as complementary and alternative medicine. Journal of Alternative &
Complementary Medicine. 14(3):225-6,
2008 Apr.
Emoto M. Healing with water. Journal of Alternative and
Complementary Medicine. 2004;10(1):19-21.
Ernst E. Distant healing--an "update" of a
systematic review. Wiener Klinische Wochenschrift. 2003;115(7-8):241-245.
Foster
S. Herbal medicine: an introduction for pharmacists. Part II. Categories of herbal medicine. National
Association of Retail Druggists Journal. 1996;(10):127-144.
Fuente-Fernandez
R, Phillips AG, Zamburlini M, et al. Dopamine release in human ventral striatum
and expectation of reward. Behavioural Brain Research.
2002;136(2):359-363.
Gallob
R. Reiki: a supportive therapy in nursing practice and self-care for nurses.
Journal of the
Goertz
CH, Grimm RH, Svendsen K, et al. Treatment of Hypertension with Alternative
Therapies (THAT) Study: a randomized clinical trial. Journal
of Hypertension. 2002;20(10):2063-2068.
Grimaldi D. Integration of
complementary and alternative medicine into mainstream health care. Journal of Psychosocial Nursing & Mental Health
Services. 46(10):8-9, 2008 Oct.
Haltiwanger E. Stein F. Occupational therapy and complementary and alternative medicine. Occupational
Therapy International. 16(1):1-5, 2009.
Hardy
ML. Research in Ayurveda: where do we go from here? Alternative
Therapies in Health and Medicine. 2001;7(2):34-35.
Hondras
MA, Linde K, Jones AP. Manual therapy for asthma. Cochrane
Database of Systematic Reviews. 2004;(2):CD001002.
Accessed at www.cochrane.org on
Hurwitz
EL, Aker PD, Adams AH, et al. Manipulation and mobilization of the cervical
spine. A systematic review of the literature. Spine. 1996;21(15):1746-1759.
Irwin
MR, Pike JL, Cole JC, et al. Effects of a behavioral intervention, Tai Chi
Chih, on varicella-zoster virus specific immunity and health functioning in
older adults. Psychosomatic Medicine. 2003;65(5):824-830.
Jepson
RG, Mihaljevic L, Craig J. Cranberries for preventing urinary tract infections.
Cochrane Database of Systematic Reviews. 2004;(2):CD001321. Accessed at
www.cochrane.org on
Jindal V. Ge A. Mansky PJ. Safety and
efficacy of acupuncture in children: a review of the evidence. Journal of Pediatric Hematology/Oncology. 30(6):431-42, 2008 Jun.
Jonas
WB, Kaptchuk TJ, Linde K. A critical overview of homeopathy.
Annals of Internal Medicine. 2003;138(5):393-399.
Kelley BJ. Knopman DS. Alternative medicine and Alzheimer disease. Neurologist. 14(5):299-306, 2008 Sep.
Kemper KJ. Vohra S. Walls R. American
Kim SR. Lee TY. Kim MS. Lee MC. Chung SJ. Use of complementary and alternative medicine by
Korean patients with Parkinson's disease. Clinical
Neurology & Neurosurgery.
111(2):156-60, 2009 Feb.
Klayman
DL. Qinghaosu (artemisinin): an antimalarial drug from
Knupp HM. Esmail S. Warren S. The use of complementary and alternative medicine (
Kunz
D, Mahlberg R, Muller C, et al. Melatonin in patients
with reduced
la Cour P. Rheumatic disease and
complementary-alternative treatments: a qualitative study of patient's
experiences. JCR: Journal of Clinical
Rheumatology. 14(6):332-7, 2008 Dec.
Lang
EV, Benotsch EG, Fick LJ, et al. Adjunctive non-pharmacological analgesia for
invasive medical procedures: a randomised trial. Lancet.
2000;355(9214):1486-1490.
Lazar SW, Bush G, Gollub RL, et al. Functional brain
mapping of the relaxation response and meditation. Neuroreport. 2000;11(7):1581-1585.
Linde K, Clausius N, Ramirez G, et al. Are the clinical effects of homeopathy placebo
effects? A meta-analysis of placebo-controlled trials.
Lancet. 1997;350(9081):834-843.
Logani
MK, Bhanushali A, Anga A, et al. Combined millimeter wave and cyclophosphamide
therapy of an experimental murine melanoma. Bioelectromagnetics.
2004;25(7):516.
Lu Z. Scientific Qigong Exploration.
Luskin FM, Newell KA,
Marshall I. Zinc for the common cold. Cochrane Database of Systematic
Reviews. 2004;(3):CD001364. Accessed
at www.cochrane.org on
Mathie
RT. The research evidence base for homeopathy: a fresh assessment of the
literature. Homeopathy. 2003;92(2):84-91.
Melchart D, Linde K, Fischer P, et al. Echinacea for
preventing and treating the common cold. Cochrane Database of Systematic Reviews. 2003;(3):CD000530. Accessed at www.cochrane.org
on
Mundy EA, DuHamel KN,
Nahas R. Complementary and alternative medicine approaches
to blood pressure reduction: An evidence-based review. Canadian Family Physician. 54(11):1529-33, 2008 Nov.
National Institutes of Health Consensus Panel. Acupuncture: National Institutes of Health
Consensus Development Statement.
NCCAM Publication No. D236 October 2004
Ni
H, Simile C, Hardy AM. Utilization of complementary and alternative medicine by
Panov
V, Kichigin V, Khaldeev G, et al. Torsion fields and experiments. Journal of New Energy. 1997;
Pittler MH. Ernst E. Complementary
therapies for neuropathic and neuralgic pain: systematic review. Clinical Journal of Pain. 24(8):731-3, 2008 Oct.
Proctor
ML, Hing W, Johnson TC, et al. Spinal manipulation for
primary and secondary dysmenorrhoea. Cochrane Database of
Systematic Reviews. 2004;(2):CD002119.
Radimer
K, Bindewald B, Hughes J, et al. Dietary supplement use by US adults: data from
the National Health and Nutrition Examination Survey, 1999-2000. American Journal of Epidemiology. 2004;160(4):339-349.
Rossi P. Torelli P. Di Lorenzo C. Sances G. Manzoni GC.
Tassorelli C. Nappi G. Use of complementary and alternative medicine by
patients with cluster headache: results of a multi-centre headache clinic
survey. Complementary
Therapies in Medicine. 16(4):220-7,
2008 Aug.
Russek
L, Schwartz G. Energy cardiology: a dynamical energy systems approach for
integrating conventional and alternative medicine. Advances: The Journal of
Mind-Body Health. 1996;12(4):4-24.
Rutledge
JC, Hyson DA, Garduno D, et al. Lifestyle modification program in management of
patients with coronary artery disease: the clinical experience in a tertiary
care hospital. Journal of Cardiopulmonary Rehabilitation.
1999;19(4):226-234.
Sampson HA. Role
of complementary and alternative medicine in the field of
allergy and clinical immunology. Journal of
Allergy & Clinical Immunology. 123(2):317-8,
2009 Feb.
Sarrell EM, Cohen HA, Kahan E. Naturopathic treatment
for ear pain in children. Pediatrics. 2003;111(5):e574-e579.
Sarrell EM, Mandelberg A, Cohen HA. Efficacy of naturopathic extracts in the management of
ear pain associated with acute otitis media. Archives of
Pediatric & Adolescent Medicine. 2001;155(7):796-799.
Sisken
BF, Walder J. Therapeutic aspects of electromagnetic fields for soft tissue
healing. In: Blank M, ed. Electromagnetic Fields: Biological Interactions
and Mechanisms.
Skargren
EI, Carlsson PG, Oberg BE. One-year follow-up comparison of
the cost and effectiveness of chiropractic and physiotherapy as primary
management for back pain. Subgroup analysis, recurrence, and additional
health care utilization. Spine. 1998;23(17):1875-1883.
Smith
A, Nicholson K. Psychosocial factors, respiratory viruses and exacerbation of
asthma. Psychoneuroendocrinology. 2001;26(4):411-420.
Smith BW. Dalen J. Wiggins KT. Christopher PJ. Bernard JF.
Shelley BM. Who is willing to use complementary and alternative medicine? Explore: The Journal of Science & Healing. 4(6):359-67,
2008 Nov-Dec.
Smith GD. The
practice and research of complementary and alternative medicine in
nursing. Journal of Clinical Nursing. 17(19):2521-3, 2008 Oct.
Smith
M, Stano M. Costs and recurrences of chiropractic and medical episodes of
low-back care. Journal of Manipulative and Physiological
Therapeutics. 1997;20(1):5-12.
Smith
MJ,
Smith N. Shin DB. Brauer JA. Mao J. Gelfand JM. Use of complementary and alternative medicine among
adults with skin disease: results from a national survey. Journal of the
Stothers
L. A randomized trial to evaluate effectiveness and cost
effectiveness of naturopathic cranberry products as prophylaxis against urinary
tract infection in women. Canadian Journal of
Urology. 2002;9(3):1558-1562.
Swenson
R, Haldeman S. Spinal manipulative therapy for low back pain. Journal of the
Szabo
I, Manning MR, Radzievsky AA, et al. Low power millimeter wave irradiation
exerts no harmful effect on human
Tao
X, Younger J, Fan FZ, et al. Benefit of an extract of Tripterygium Wilfordii
Hook F in patients with rheumatoid arthritis: a double-blind,
placebo-controlled study. Arthritis and Rheumatism.
2002;46(7):1735-1743.
Taylor
JA, Weber W, Standish L, et al. Efficacy and safety of echinacea in treating
upper respiratory tract infections in children: a randomized controlled trial. Journal of the American Medical Association. 2003;290(21):2824-2830.
Teixeira ME. Meditation
as an intervention for chronic pain: an integrative review. Holistic Nursing Practice. 22(4):225-34, 2008 Jul-Aug.
Tusek
DL, Church JM, Strong SA, et al. Guided imagery: a significant advance in the
care of patients undergoing elective colorectal surgery. Diseases
of the
Willson
TM, Kliewer SA.
Winstead-Fry
P, Kijek J. An integrative review and meta-analysis of therapeutic touch
research. Alternative Therapies in Health and Medicine.
1999;5(6):58-67.
Wolsko PM, Eisenberg DM, Davis RB, et al. Use of
mind-body medical therapies. Journal of General Internal Medicine. 2004;19(1):43-50.
Yang EV, Bane CM, MacCallum RC, et al. Stress-related
modulation of matrix metalloproteinase expression. Journal of Neuroimmunology.
2002;133(1-2):144-150.
COMPLEMENTARY
AND ALTERNATIVE MEDICINE
POST-TEST
- According to the National Health
Interview Survey (NHIS), what percentage of Americans
seek care from a licensed
A. 5
B. 12
C. 18
D. 23
- Ayurveda is included in Which CAM
category?
A. Alternative Medicine System
B. Mind Body Intervention
C. Biologically Based Therapy
D. Manipulative and Body Based Method
- Traditional Chinese Medicine
teaches that there are _____ main meridians in the human body.
A. 8
B. 12
C. 200
D. 2000
- Which of the following is NOT one
of the principles of Naturopathy?
A. The healing power of nature
B. Treatment of the whole person
C. The doctor as student
D. Prevention
- The systematic diluting and
vigorous shaking of a substance to extract its vital essence is known as
___________.
A. extraction
B. potentization
C. minimalization
D. homeopathes
- Research by Henry Beecher showed
that up to 35% of a therapeutic response to any medical treatment could be
as a result of
A. immunological suppression
B. hemolytic integration
C. neurological transference
D. placebo effect
- Which of the following is TRUE?
A. The FDA currently requires dietary
supplements to follow defined good manufacturing practices.
B. Manufacturers of dietary supplements
must ensure that their products are safe and effective.
C. Newly marketed dietary supplements are
subject to FDA pre-market approval.
D. None of the above
- Any substance that claims to
diagnose, prevent, treat, or cure a disease is classified by the FDA as a
A. dietary supplement
B. drug
C. probiotic
D. functional food
- Which of the following is NOT a
putative energy practice?
A. Magnetism
B. Johrei
C. Qi Gong
D. Healing Touch
- Which of the following is a
manipulative body based practice that includes slight rocking and shaking
of the patient’s trunk and limbs in a rhythmic fashion?
A. Alexander Technique
B. Bowen Technique
C. Trager Bodywork
D. Tui Na