Complementary And Alternative Therapies Dinesh Sirisena.

Complementary And Alternative Therapies

Dinesh Sirisena

“Complementary and alternative medicine (CAM) is a broad domain of healing resources encompassing all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period.”

“All practices and ideas defined by their users as preventing or treating illness or promoting health and well-being are included.”

“Boundaries within CAM and between the CAM domain and that of the dominant system are not always well defined.”

(Cochrane)

Complementary - together with conventional medicine

Alternative - in place of conventional medicine

Some providers practice both

Topics?

• Why do people use them?

• Who uses them?

• Frequency of use?

• Types?

• Costs?

• Evidence?

• Problems?

Why?

Why?

• Positive motives– Perceived

effectiveness or safety– Spiritual– Holism– All things natural– Active role– Control over treatment– Pleasant therapeutic

experience

– Good patient/therapist relationship

• Fewer time restraints (£)• On equal terms (£)• Empathy (£)

– Non-invasive– Accessibility (£)– Affluence (£)

Why?

• Negative motives– Dissatisfaction with

conventional health care

• Ineffective • Adverse effects

– Doctor-patient relationship

• insufficient time • waiting lists

– Reject science and technology

– Reject “the establishment”

– Desperation

Why?

• Other Motives– Not an alternative – What is available for their health care

Who?

• Women>Men• Well educated +

affluent• Middle aged• Ethnic population

– Afro-Caribbean>Asian>Caucasian

• Chronic Ill Health– Cancer– AIDS– Long term conditions

• Worried well• Myalgic

Encephalopathy – 33% use CAM

Frequency?

• 46% UK population will try at some point• 1999

– 50,000 CAM practitioners (UK)– 5 million patients consulted a CAM

practitioner in one year

• More uptake in Europe– France & Germany

• USA– 629 million visits in one year alone (?%pop)

Frequency?

• Use of CAM in the United Kingdom 1999 (%)– Herbal medicine (34)– Aromatherapy (21)– Homeopathy (17)– Acupuncture / acupressure (14)– Massage (6)– Reflexology (6)– Osteopathy (4)– Chiropractic (3)

Costs?

Costs?

• Not necessarily actual cost

• Cost effectiveness

• Royal Pharmaceutical Society (1999)– £231.8 million was spent on non-prescription

medicine

• Aromatherapy session (£40-60+)

• Acupuncture (£40-60+)

• Massage (£30-40+)

How Many Types?

Types?

• Biologically based practices – supplementing a person's normal diet

• Manipulative and body-based therapies – focus on the body's various systems and structures

• Mind-body interventions – use the connection between a person's mind, body,

and spirit to enhance total well being

• Energy therapies – are meant to restore disturbances in the body's

natural energy

Types? (Common)

• Acupuncture• Alexander Technique• Allergy testing• Aromatherapy • Art Therapy• Autogenic Training• Auricular Acupuncture• Ayuveda • Bodywork

• Bowen• Biofeedback• Chiropractic • Chinese Herbal Medicine• Counselling • Craniosacral Therapy• Crystal Therapy• Dowsing Flower Therapy• Healing Herbalism• Homeopathy

Types? (Common)

• Hydrotherapy • Hypnotherapy• Indian Head Massage• Iridology• Kinesiology• Music Therapy• Naturopathy• Nutrition• Osteopathy

• Physiotherapy• Radionics• Reflexology• Reiki• Shiatsu• Tai Chi• TENS therapy• Traditional Chinese

Medicine• Thought Field Therapy• Yoga Therapy

Types? (Rarer)• Auricular Acupuncture• Australian Flower Essences Therapy• Bach Flower remedies• Bee Venom Therapy• Chelation Therapy • Colonic Hydrotherapy • Colour Therapy • Dream Therapy • Eye Movement Desensitization and

Reprogramming • Exercise Healing • Health Clubs • Health Screening • Juice Therapy • Light Therapy

• Light Touch Therapy • Magnotherapy • Marma Therapy• Meta-Aromatherapy• Microwave Resonanace Therapy• Naturotherapy• Oxygen Therapy• Panchakama Therapy• PIP scans• Raw Vegetable Juice Therapy• Rolfing• Spiritual Counselling• Stress Management• Swimming Therapy• Transdecendal Meditation• Tragerwork• Vegetable Juice Therapy

Specific Types?

• Aromatherapy– Used since Egyptian times– Distilled plant extracts

• 400 Oils• Varying quality (RCT)

– Improve well-being• Peppermint – digestive effects• Tea Tree Oil – antibacterial

– Massage, Baths, Inhalation

Specific Types?

• Bee Venom Therapy– Contain sulphur – Stimulates cortisol release – Applied to surface– Chronic inflammatory conditions– RA, Myositis– Applied for 5days with 2-3day interval– Normally haemorrhagic

Evidence?

• Circumstantial

• Past attempts at investigations

• Little research – Difficulty with RCT– Outcomes dependant on social, cultural and

spiritual beliefs

Evidence?

• Evidence Based Complementary and Alternative Medicine (eCAM)– Yoga

• Improve risk in adults with DM 2• Prevention and management of cardiovascular complications• May be useful in the management of stress (post tsunami

victims)

– Massage• Benefits in chronic pain conditions

– Sanfujiu (herbal ointments into pressure points) • moderately effective in treating allergic symptoms

Evidence?

• eCAM– Green Tea

• Regular intake (>3 cups per day) may reduce the lung cancer in smokers

– Gentle Touch Therapy• (strong) circumstantial evidence • Improved psychological well-being • Self-reported psychological problems

Evidence?

• eCAM– Electro-acupuncture

• Relieving labour pain• Synergism of the CNS with a direct impact on the uterus

through release of ß-EP and 5-HT into the blood

– Tai Chi• 15 week course • effective in reducing headache symptoms and perception of

physical and mental health

– Music Therapy • Benefited patients in hospice and palliative care

Evidence?

• (2007) NHS trial in Belfast– £200,000 for GP to use alternative therapies– Was it a success?– Reduced use of conventional therapy– Effective?

Problems?

Problems?

• Safety risk – Especially during pregnancy– Ayurvedic treatments

• Heavy metals (Lead, Mercury, Arsenic)

– Unknown purities– Reactions are not routinely monitored – Dietary supplements can interact with prescribed

medications

• Difficulty establishing reliability/efficacy

Problems?

• Significant lack of evidence/research– Speculative– Small trials– Often biased

• Financial motivations

• Lack of regulation– Some with registered Osteopaths (GOsC) and

Chiropractors (GCC)– Remaining registration is voluntary

Problems?

Topics?

• Why do people use them?

• Who uses them?

• Frequency of use?

• Types?

• Costs?

• Evidence?

• Problems?

Useful Links?• http://www.bcma.co.uk/• http://www.cancerbackup.org.uk/Treatments/

Complementarytherapies/Generalinformation/Complementaryalternativetherapies

• http://www.therapiesguide.co.uk/• http://www.holisticpages.co.uk/• http://www.dh.gov.uk/en/Publichealth/Healthimprovement/

Complementaryandalternativemedicine/index.htm• http://www.medicine.ox.ac.uk/bandolier/booth/booths/altmed.html• http://www.nlm.nih.gov/medlineplus/

complementaryandalternativetherapies.html• http://www.cancer.org/docroot/ETO/ETO_5.asp• http://www.nhsdirectory.org/• http://nccam.nih.gov/

Useful Links?• http://www.library.nhs.uk/cam/• http://www.internethealthlibrary.com/Prime-pages/A-

ZDirAltTherapies.htm• http://www.arc.org.uk/arthinfo/patpubs/6007/6007.asp• http://diabetes.niddk.nih.gov/dm/pubs/alternativetherapies/• http://www.publications.parliament.uk/pa/ld199900/ldselect/

ldsctech/123/12301.htm• http://homeopathy4health.wordpress.com/• http://ecam.oxfordjournals.org/• http://www.bmj.com/cgi/content/full/319/7211/693• http://www.cancerhelp.org.uk/help/default.asp?page=216• http://www.medicalnewstoday.com/sections/

complementary_medicine/

• A = Lavender– calming effect, aiding relaxation and anxiety

• B = Lemon Grass– antiseptic, bactericidal, deodorant and

antifungal

• C = Sandalwood– Stress and anxiety, itching and skin

inflammation, aphrodisiac

The Three Oils