Chapter 10
Complementary and alternative medicine
In your quest to find relief from your pain, chances are you’ve tried or considered some form of complementary or alternative medicine. Maybe you’ve had a massage, practiced meditation or yoga, or thought about acupuncture.
And you probably have a lot of questions. Do these methods really work? Are they safe? Exactly what is complementary and alternative medicine? This chapter helps answer these questions.
The National Center for Complementary and Alternative Medicine (NCCAM), a division of the National Institutes of Health, defines complementary and alternative medicine as a group of diverse medical and health care practices and products that are generally not considered part of conventional medicine.
Complementary medicine refers to therapies used in addition to conventional treatments. An example would be practicing meditation in addition to taking prescription drugs to manage anxiety. In contrast, alternative medicine includes treatments used in place of traditional medicine. This might include seeing a homeopath or naturopath instead of your regular doctor.
Among the general public, however, this distinction isn’t as clear. Many people use the term alternative medicine as a catchall phrase to refer to both — those therapies used in addition to conventional care and those used in place of it.
Integrative medicine, meanwhile, is a fairly new term that describes a growing movement taking place in many health care institutions — integrating complementary and alternative therapies with conventional medicine. The goal of integrative medicine is to treat the whole person — mind, body and spirit — not just the disease. This is done by combining the best of today’s high-tech medicine with the best of nontraditional practices — treatments that have some high-quality evidence to support their use.
Complementary and alternative therapies aren’t new. Some have been practiced for thousands of years. But their use has become more popular as people seek greater control of their own health.
Two of the most common conditions for which people use complementary and alternative medicine are anxiety and pain. Studies sponsored by NCCAM have shown that certain therapies, such as acupuncture, biofeedback, meditation and relaxed breathing, can be useful in treating chronic pain. For others, the evidence isn’t as supportive.
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Too good to be true?
The Food and Drug Administration and the National Council Against Health Fraud recommend that you watch for the following claims or practices to protect yourself against potentially fraudulent treatments:
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5 smart strategies
Complementary and alternative medicine can play a role in better health. But it’s important to remember that there are some important differences between conventional medicine and complementary and alternative therapies and practices.
If you decide to use complementary and alternative treatments, protecting your health — and your wallet — requires you to do two things. First, find out how various treatments work and what benefits they may provide. Second, take responsibility for your own well-being. Before selecting a specific treatment, do your homework.
While complementary and alternative therapies can help you maintain good health and relieve some symptoms, it’s important that you continue to rely on conventional medicine to diagnose a problem and treat your condition. Make sure to tell your health care team about all of the treatments you’re using — both conventional and unconventional.
Remember that there’s no substitute for a healthy lifestyle. Nutrition, exercise, stress management and adequate rest are key to better health and pain relief.
Herbs and other supplements
As anyone who’s walked through a health food store can attest, the pro-fusion of herbal remedies and other dietary supplements is almost overwhelming. Following are some products heavily marketed for pain relief — especially arthritic pain.
Devil’s claw
The herb devil’s claw originates from the Kalahari desert region of southern Africa. It’s used to relieve pain and inflammation in joints and to treat headache and back pain. The manner in which it works is unknown. Research suggests devil’s claw may be effective for short-term treatment of osteoarthritic pain, and it may also help alleviate low back pain. But the studies have been small, and more information is needed before any recommendations can be made regarding its use.
Glucosamine and chondroitin
Glucosamine and chondroitin are natural compounds found in cartilage — the tough tissue that cushions joints. They’re used to treat osteo-arthritis, a painful condition caused by the inflammation, breakdown and loss of cartilage. Glucosamine supplements are made from the skeletons of shellfish (chitin). Chondroitin supplements are made from shark, cow or plant products, as well as from other sources.
Glucosamine and chondroitin have become an extremely popular treatment for osteoarthritis. They appear to be safe and produce fewer adverse side effects than do medications such as nonsteroidal anti-inflammatory drugs (NSAIDs). The question is, are they effective at treating arthritis?
While many older studies gave very promising results, the results of a large study sponsored by the National Institutes of Health (NIH) raised some questions. In that study, only individuals with very severe symptoms appeared to receive some benefit. The NIH study, however, was faced with a lot of challenges, and many questions still remain. But while the studies may be conflicting, side effects from the supplements are few and far between.
So far, no other treatments have shown promise at increasing cartilage. It’s possible — though certainly not guaranteed — glucosamine and chondroitin may help.
SAMe
S-adenosyl-L-methionine (SAMe) is a compound that occurs naturally in the human body. Among other functions, it helps produce and regulate hormones and maintain cell membranes. Trials indicate that SAMe can relieve pain from osteoarthritis as effectively as NSAIDs, with fewer side effects.
But the long-term benefits and risks of SAMe are still unknown. As with any supplement, it’s best to consult your doctor before trying SAMe. One drawback of SAMe is that it can interact with antidepressant medications. That is why, with any supplement that you take, it is important to talk with your doctor first.
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Evaluating herbal remedies
Unlike medications you receive from your doctor, dietary and herbal products aren’t regulated by the Food and Drug Administration for effectiveness. Regulations regarding the safety of these products also are different.
With prescription drugs, the manufacturer must prove that the benefits of the drug outweigh any safety concerns before the drug is approved for sale. Dietary and herbal supplements, however, are assumed to be safe until proved otherwise. Only when a supplement is found unsafe is it removed from the market. Because these products don’t follow the same safety procedures, they can contain toxic substances that may not be listed on the label. In addition, the amount of active ingredient may vary greatly between different brands.
You might consider herbal products to be natural and, therefore, harmless. However, they can have active chemicals that may not safely mix with other medications you’re taking. The best advice is to talk with your doctor before taking any dietary supplement or herbal product.
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Hands-on therapies
This group includes some of the most commonly used complementary treatments. Hands-on therapies are used to treat musculoskeletal conditions such as back pain, headache and arthritis.
Aromatherapy
This ancient form of healing involves the use of essential oils that are derived from plant extracts and resins and used to induce relaxation and promote both health and healing. Practitioners believe these oils can help treat various symptoms and conditions — including pain — when massaged into your skin or inhaled.
There are about 150 different essential oils used in aromatherapy. The oils are categorized according to their effects on the mind and body and on specific diseases. More study is needed to determine whether these oils provide any health benefit, and for which conditions they may be the most beneficial. Aromatherapy is often used in conjunction with massage therapy.
Chiropractic
Chiropractic therapy is perhaps the most common complementary therapy in the United States. It’s based on the concept that restricted movement in the spine may lead to pain and reduced function. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease back pain.
Studies have found spinal manipulation to be an effective treatment for uncomplicated low back pain, especially if the pain has been present less than four weeks. Studies also suggest spinal manipulation may be effective for headache and other spine-related conditions, such as neck pain. There’s no evidence, though, to support the belief that spinal manipulation can cure whatever ails you.
As with any medical specialist, select a chiropractor who’s willing to work with the other members of your health care team. Make sure you’re comfortable with the recommendations, including how many sessions you’ll need. Be questionable of chiropractors who ask to extend your treatment indefinitely.
When limited to the low back, chiropractic treatment has few risks. How-ever, manipulation of the neck has been associated with injury to blood vessels supplying the brain. Rarely, neck manipulation may cause a stroke.
Massage
Massage therapy involves the use of different manipulative techniques to move your body’s muscles and soft tissues. Massage therapists primarily use their hands to manipulate muscles and tissues, but sometimes they may use their forearms, elbows or feet.
There are many theories as to how massage therapy promotes good health. One popular theory follows the belief that when muscles are overworked, waste products can accumulate in the muscle, causing soreness and stiffness. The aim of massage therapy is to improve circulation in the muscle, increasing the flow of nutrients and oxygen and eliminating waste products. Massage therapy also induces the body’s relaxation response, another route to healing and improved health.
Massage therapists claim the treatment can help relieve stress and anxiety, relax your muscles, reduce headaches, lower blood pressure, improve range of motion in your joints, and increase the body’s production of natural painkillers.
A growing body of literature is beginning to validate many of the benefits of massage therapy. Studies suggest it can decrease headache pain and pain associated with fibromyalgia. It may also help relieve back pain. Although massage is generally safe, avoid it if you have open sores, acute inflammation or circulatory problems. A massage should feel good. If it doesn’t, speak up.
Movement therapies
Several nontraditional therapies, such as the Feldenkrais and Trager methods, center around the philosophy that, over time, people start moving and holding their bodies in dysfunctional ways. Weaker muscles end up doing the work of stronger muscles, causing stress and tension.
With these therapies, an instructor takes you through a series of specific movements designed to teach you to use your muscles and joints more comfortably and efficiently. The movements are also designed to help you find greater ease with your body.
Practitioners claim these therapies can help control pain and promote an overall sense of well-being. Although they appear to be safe, studies documenting their benefits are fairly limited.
Prolotherapy
Prolotherapy — also known as sclerotherapy or proliferant therapy — is a procedure done by a trained professional that involves injecting sterile solutions containing dextrose, a specific type of sugar, into painful ligaments and tendons. The solutions are intended to stimulate the production of connective tissue.
Proponents of prolotherapy believe the treatments help restore strength and stability to ligaments and joints, which in turn helps relieve pain. Prolotherapy has been used to treat a number of painful musculoskeletal conditions, such as osteoarthritis and chronic back pain.
Studies of prolotherapy have produced conflicting evidence regarding its effectiveness in treating chronic pain. Some have suggested a possible benefit, while others have indicated none. At this point, more research is needed to determine what role, if any, prolotherapy may play in the treatment of chronic pain.
Rolfing
Rolfing is a form of deep-tissue massage. It’s based on the theory that tissues surrounding your muscles become thickened and stiff as you get older. This affects your posture and how well you’re able to move. The purpose of Rolfing is to align your body so that all of its components are positioned correctly.
Practitioners of Rolfing believe that injury or stress causes tissues to adhere in unhealthy ways, interfering with your body’s natural movement and producing symptoms such as pain. To restore natural alignment, deep pressure is applied to stretch the tissues and help reposition muscles and joints.
Few scientific studies support Rolfing’s benefits. Its deep massage may help reduce stress and tension. However, some people find the procedure painful, and it may worsen your pain.
Energy therapies
Energy therapies are based on the belief that the body contains natural energy fields and that good health results when this energy can flow freely without interruption.
Acupressure and acupuncture
These therapies stem from the Chinese belief that within the human body there are multiple invisible pathways, called meridians. Through these pathways flows qi (pronounced chee), the Chinese word for “life force” or “life energy.” When the flow of qi is obstructed, illness or pain results.
During acupressure, a practitioner applies pressure with his or her fingers to specific points on your body in an attempt to restore the free flow of qi and relieve symptoms such as pain and stress. People who feel they’re helped by the procedure find the therapy to be relaxing and comforting. However, more research is needed to document the effectiveness of this treatment.
During a typical acupuncture session, an acupuncturist inserts anywhere from one to 20 hair-thin needles into your skin for 10 to 30 minutes. The acupuncturist may also manipulate the needles or apply electrical stimulation or heat to the needles.
Acupuncture is one of the most studied nontraditional medical practices, and it continues to gain acceptance within modern medicine for treatment of certain conditions.
A number of studies have shown that acupuncture is effective in treating postoperative dental pain, pain related to endoscopic procedures, low back pain related to pregnancy and some forms of chronic pain, including fibromyalgic pain.
Acupuncture has also been effective in reducing pain related to tennis elbow, but it’s had mixed results when used to treat osteoarthritis of the knee, hip and back. Some studies suggest it may provide considerable pain relief, while other studies show no benefit from the treatment.
Adverse side effects from acupuncture are rare, but they can occur. Make sure your acupuncturist is trained and certified or licensed and follows good hygiene practices, including use of disposable needles.
Magnet therapy
Most claims regarding the healing power of magnets are from manufacturers of products that contain magnets. These products include arm and leg wraps, belts, mattress pads and shoe inserts. Manufacturers often claim the products can relieve various health problems, including chronic pain, by stimulating your body’s natural electrical field.
To date, there’s no scientific evidence that magnets used in this manner provide any health benefits. And some experts believe inappropriate use of magnets could possibly lead to health problems.
A few medical researchers are exploring the use of different, more powerful magnets — not the common refrigerator magnets — as a therapy for some forms of chronic pain. More study is needed before any conclusions can be drawn.
Mind-body therapies
A simple definition of mind-body medicine reads like this: “positively influencing the mind to improve the health of the individual.” The belief that mind and body are intricately connected goes back centuries. Mind-body practices have two core components. The first is to restore the mind to a state of peaceful neutrality. The second is to use this “ready” mind to improve your health.
Biofeedback
Biofeedback uses technology to teach you how to develop certain body responses that may help reduce your pain. During a biofeedback session, a trained therapist applies electrodes and other sensors to various parts of your body. The electrodes are attached to devices that monitor and give you feedback on body functions, including muscle tension, brain wave activity, respiration, heart rate, blood pressure and temperature.
Once the electrodes are in place, the therapist uses relaxation techniques to calm you, reducing muscle tension and slowing your heart rate and breathing. You then learn how to produce these changes yourself. The goal of biofeedback is to help you enter a relaxed state in which you can better cope with your pain. Sometimes, specific muscle groups are monitored to help you learn how to position yourself in order to reduce muscle strain.
Biofeedback is, for the most part, widely used and accepted. It has the potential to improve symptoms associated with many medical conditions. It has relatively few risks, and it’s practiced in many medical centers.
Studies indicate biofeedback has the potential to improve symptoms of headache, anxiety, stress, irritable bowel syndrome and high blood pressure, in addition to improving symptoms of other conditions, such as asthma, nausea and vomiting associated with chemotherapy and incontinence. Research is ongoing.
Hypnosis
People have been using hypnosis to promote healing since ancient times. Hypnosis produces an induced state of relaxation in which your mind stays narrowly focused and open to suggestion. It’s not known how hypnosis works, but experts believe it alters your brain wave patterns in much the same way as other relaxation techniques.
For treatment of chronic pain, you receive suggestions designed to help you decrease your perception of the pain and increase your ability to cope with it. Unlike situations sometimes portrayed in movies and on TV, you can’t be forced under hypnosis to do something you normally wouldn’t want to do.
The success of hypnosis depends on your understanding of the procedure and your willingness to try it. You need to be strongly motivated to change. About 80 percent of adults can be hypnotized by a trained professional. People who don’t want to feel out of control often can’t be hypnotized.
The National Institutes of Health cites evidence that supports the effectiveness of hypnotherapy in the treatment of chronic pain associated with cancer, irritable bowel syndrome, temporal mandibular joint (TMJ) problems and some types of headache. Studies also show that hypnosis may reduce anxiety. Particularly, hypnosis has been shown to lower anxiety before some medical and dental procedures.
Meditation
The term meditation refers to a group of techniques, many of which have their roots in religious or spiritual traditions. Today, many people use meditation for health and wellness purposes.
In meditation, a person focuses attention on his or her breathing or on repeating a word, phrase or sound in order to suspend the stream of thoughts that normally occupies the conscious mind. Meditation is believed to lead to a state of physical relaxation, mental calmness, alertness and psychological balance. Practicing meditation can change how you respond to your brain’s constant flow of emotions and thoughts, and it may help control how you react to a challenging situation.
Meditation may be practiced on its own or as a part of another mind-body therapy, such as yoga or tai chi. Like these other therapies, once you learn how, you can meditate by yourself.
Meditation may be used to treat a number of problems, including anxiety, pain, depression, stress and insomnia. It can be the perfect complement to the rush of a busy, complicated life. As evidence supporting the use of meditation grows, adding it to your daily schedule may be just the antidote you need to deal with a hectic routine. In addition, if meditation helps lower your blood pressure and reduce stress, so much the better. The long-term benefits of meditation continue to be studied.
Music therapy
Practitioners of music therapy claim that it can lower stress, reduce symptoms of depression and promote pain relief. With this treatment, a trained music therapist uses music and all of its facets — physical, emotional, mental, social and spiritual — to help individuals improve or maintain their health. Performing or listening to music, with guidance from a music therapist, can help relieve muscle tension and slow your breathing.
Music therapy hasn’t been extensively researched. However, it poses virtually no risk and is an inexpensive form of therapy. Several organizations promote the use of music for health and healing.
Tai chi
Tai chi, a form of martial arts developed in China, is a popular method for strengthening muscles, improving joint flexibility and reducing stress.
Tai chi involves gentle, deliberate circular movements, combined with deep breathing. As you concentrate on the motions of your body, you develop a feeling of tranquility. For this reason, tai chi is sometimes described as a form of moving meditation. Similar to other forms of Chinese medicine, it’s designed to foster the free flow of qi necessary for health.
If you’re trying to improve your general health, you may find tai chi helpful as part of your program. It is generally safe for people of all ages and levels of fitness. Studies show that for older adults it can improve balance and reduce the risk of falls.
Because the movements are low impact and they put minimal stress on your muscles and joints, tai chi is appealing to many. For these same reasons, if you have a condition such as arthritis or you’re recovering from an injury, you may find tai chi useful. It may help you reduce your level of stress and manage conditions such as high blood pressure and depression.
Yoga
People practice yoga for many reasons. For some, it’s a spiritual path. For others, it’s a way to promote physical flexibility, strength and endurance. In either case, you may find that yoga can help you relax and manage stress.
The ultimate goal of yoga is to reach complete peacefulness of body and mind by way of breathing, meditation and posture. Traditional yoga philosophy also requires that practitioners adhere to ethical behavior and dietary practices. However, chances are you may not be looking for a complete change in lifestyle but rather a tool to help increase flexibility, promote relaxation or relieve stress.
According to the National Institutes of Health, yoga can help reduce stress, slow breathing, lower blood pressure and alter brain waves. Its precise, quiet movements focus your mind less on your busy day and more on the moment at hand, as you move your body through poses that require balance and concentration.