Integrative medicine for chronic pain management: a narrative review.

Complementary and Integrative Therapies in Psychiatry

BackgroundImmigration is rapidly increasing in Iceland with 13.6% of the population holding foreign citizenship in 2020. Earlier findings identified inequities in childbirth care for some women in Iceland. To gain insight into the quality of intrapartum midwifery care, migrant women's use of pain management methods during birth in Iceland was explored.MethodsA population‐based cohort study including all women with a singleton birth in Iceland between 2007 and 2018, in total 48 173 births. Logistic regression analyses with odds ratios (ORs) and 95% confidence intervals (CIs) were used to investigate the relationship between migrant backgrounds defined as holding foreign citizenship and the use of pain management during birth. The main outcome measures were use of nonpharmacological and pharmacological pain management methods.ResultsData from 6097 migrant women were included. Migrant women had higher adjusted OR (aORs) for no use of pain management (aOR = 1.23 95% CI [1.12, 1.34]), when compared to Icelandic women. Migrant women also had lower aORs for the use of acupuncture (0.73 [0.64, 0.83]), transcutaneous electrical nerve stimulation (TENS) (0.92 [0.01, 0.67]), shower/bath (0.73 [0.66, 0.82]), aromatherapy (0.59 [0.44, 0.78]), and nitrous oxide inhalation (0.89 [0.83, 0.96]). Human Development Index (HDI) scores of countries of citizenship <0.900 were associated with lower aORs for the use of various pain management methods.ConclusionsOur results suggest that being a migrant in Iceland is an important factor that limits the use of nonpharmacological pain management, especially for migrant women with citizenship from countries with HDI score <0.900.

A Clinical Hypnosis Handbook for Pain Management and Palliative Care

BACKGROUND: Integrative medicine such as acupuncture, meditation, yoga and massage are highly desired by breast cancer survivors. Breast medical oncology professionals including physicians, advanced nurse practitioners and physician assistants are often the first clinicians that patients would expect to discuss the use of integrative medicine. Many distressing symptoms, such as hot flashes, insomnia, anxiety, and pain, are common and remain challenging to manage with limited pharmacological intervention available and potential toxicities. Evidence-based integrative medicine approaches, including acupuncture, meditation, yoga, and massage, may help reduce this symptom burden and improve quality of life. However, many breast medical oncology professions are not familiar with current evidence and knowledge in integrative medicine. Therefore, there is an urgent need to educate them on the fundamentals of evidence-based integrative medicine interventions that could improve quality of life for breast cancer survivors. METHODS: We designed the Integrative Oncology training Program for breast medicine professionals at our institution. The program faculty are composed of five breast medical oncologists, five integrative medicine faculty, and one education coordinator. RESULTS: We developed an online, interdisciplinary five-hour course on evidence-based integrative oncology with essential knowledge on integrative medicine approaches for breast cancer survivors. We determined the topic of interest based on feedback from the program faculty. The integrative medicine approaches in management of hot flashes, arthralgia, insomnia, are cannabis uses are some examples that were highly in-demand. The program summarizes high-quality evidence in herbal supplements, acupuncture, meditation, and yoga, pertinent to the audience, as well as the referral flow to our Integrative Medicine Service. CONCLUSIONS: Integrative medicine education programs for oncological professionals are needed to disseminate integrative medicine knowledge and to prepare them to guide our patients on integrative and complementary approaches during and after anticancer treatments. Citation Format: W. Iris Zhi, Rui Wanq, Ting Bao. Implementation of Integrative Medicine Program for Breast Medical Oncology Professionals in an Academic Cancer Center [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-08-02.

Despite high rates of women's use of intrapartum pain management techniques, little is known about the factors that influence such use. Examine the determinants associated with women's use of labour pain management. Cross-sectional survey of a substudy of women from the 'young' cohort of the Australian Longitudinal Study of Women's Health (ALSWH). Women aged 31-35 years who identified as being pregnant or recently given birth in the 2009 ALSWH survey (n = 2445) were recruited for the substudy. The substudy survey was completed by 1835 women (RR = 79.2%). Determinants examined included pregnancy health and maternity care [including complementary and alternative medicine (CAM)] for their most recent pregnancy and any previous pregnancies. Participants' attitudes and beliefs related to both CAM and maternity care were also included in the analysis. The outcome measures examined were the use of both pharmacological and non-pharmacological pain management techniques (NPMT). Differences were seen in the effects of demographics, health service utilization, health status, use of CAM, and attitudes and beliefs upon use of intrapartum pain management techniques across all categories. The only variable that was identified as a determinant for use of all types of pain management techniques was a previous caesarean section (CS). The effect of key determinants on women's use of pain management techniques differs significantly, and, other than CS, no one determinant is clearly influential in the use of all pain management options.

TheMyrnaBrindCenter of Integrative Medicine at Jefferson University Hospitals, Thomas Jefferson University, Philadelphia, Pennsylvania, has combined its expertise, experience, and advanced diagnostics to serve as a leader in the field of integrative medicine and provide state-of-the-art care for people desiring an integrative medicine approach to their health. Now, the recent awarding of a $14 million grant by the Marcus Foundation, Inc., has allowed for the establishment of a new center, the Brind-Marcus Center of Integrative Medicine, in Villanova, Pennsylvania, which opened its doors in December 2015. The new Center has enabled expansion of both clinical and research endeavors as well as cutting-edge technology, including the addition of a unique positron emission tomography–magnetic resonance imaging (PET-MRI) scanner. Daniel A. Monti, MD, MBA, senior vice president and the director of both centers, commented on the evolution of success of integrative medicine at Thomas Jefferson University:

BackgroundAs more integrative medicine educational content is integrated into conventional family medicine teaching, the need for effective evaluation strategies grows. Through the Integrative Family Medicine program, a six site pilot program of a four year residency training model combining integrative medicine and family medicine training, we have developed and tested a set of competency-based evaluation tools to assess residents' skills in integrative medicine history-taking and treatment planning. This paper presents the results from the implementation of direct observation and treatment plan evaluation tools, as well as the results of two Objective Structured Clinical Examinations (OSCEs) developed for the program.MethodsThe direct observation (DO) and treatment plan (TP) evaluation tools developed for the IFM program were implemented by faculty at each of the six sites during the PGY-4 year (n = 11 on DO and n = 8 on TP). The OSCE I was implemented first in 2005 (n = 6), revised and then implemented with a second class of IFM participants in 2006 (n = 7). OSCE II was implemented in fall 2005 with only one class of IFM participants (n = 6).Data from the initial implementation of these tools are described using descriptive statistics.ResultsResults from the implementation of these tools at the IFM sites suggest that we need more emphasis in our curriculum on incorporating spirituality into history-taking and treatment planning, and more training for IFM residents on effective assessment of readiness for change and strategies for delivering integrative medicine treatment recommendations. Focusing our OSCE assessment more narrowly on integrative medicine history-taking skills was much more effective in delineating strengths and weaknesses in our residents' performance than using the OSCE for both integrative and more basic communication competencies.ConclusionAs these tools are refined further they will be of value both in improving our teaching in the IFM program and as competency-based evaluation resources for the expanding number of family medicine residency programs incorporating integrative medicine into their curriculum. The next stages of work on these instruments will involve establishing inter-rater reliability and defining more clearly the specific behaviors which we believe establish competency in the integrative medicine skills defined for the program.

Complementary medicine therapies are frequently used to treat pain conditions such as headaches and neck, back, and joint pain. Chronic pain, described as pain lasting longer than 3-6 months, can be a debilitating condition that has a significant socioeconomic impact. Pharmacologic approaches are often used for alleviating chronic pain, but recently there has been a reluctance to prescribe opioids for chronic noncancer pain because of concerns about tolerance, dependence, and addiction. As a result, there has been increased interest in integrative medicine strategies to help manage pain and to reduce reliance on prescription opioids to manage pain. This article offers a brief critical review of integrative medical therapies used to treat chronic pain, including nutritional supplements, yoga, relaxation, tai chi, massage, spinal manipulation, and acupuncture. The goal of this article is to identify those treatments that show evidence of efficacy and to identify gaps in the literature where additional studies and controlled trials are needed. An electronic search of the databases of PubMed, The Cochrane Library, EMBASE, PsycINFO, and Science Citation Index Expanded was conducted. Overall, weak positive evidence was found for yoga, relaxation, tai chi, massage, and manipulation. Strong evidence for acupuncture as a complementary treatment for chronic pain that has been shown to decrease the usage of opioids was found. Few studies were found in which integrative medicine approaches were used to address opioid misuse and abuse among chronic pain patients. Additional controlled trials to address the use of integrative medicine approaches in pain management are needed.

Objectives: According to the National Cancer Institute, the integrative medicine (IM) approach to medical care combines standard medicine with complementary and alternative medicine practices that have proved safe and effective.Methods: We describe the clinical cases of four patients with malignant pleural mesothelioma (MPM), diffuse malignant peritoneal mesothelioma (DMPM), intrahepatic cholangiocarcinoma, and breast cancer (BC) who received supportive treatment (ST) according to an IM approach after the failure of standard cancer treatments or the appearance of serious adverse events caused by antiblastic chemotherapy. The critical role of complementary drugs in reducing the side effects of cancer treatments and normalizing the white cell count is especially apparent in the case of the patient with metastatic BC, who experienced prolonged neutropenia.Results: The IM approach was well-tolerated and had no adverse side effects. It improved the quality of life (QoL) of all patients and in two cases extended overall survival.Conclusion: The extended clinical and instrumental response to IM of the patients with malignant mesothelioma and the improved health-related QoL and good tolerance of the ST demonstrated in all cases support the value of this approach in patients whose cancer therapies have failed but who show a good performance status. Our data require confirmation in a well-designed prospective clinical trial.

Doctors who use biomedicine with complementary and alternative medicine (CAM) in a carefully integrated way offer benefits from both systems to chronic patients without compromising on safety. The Institute of Applied Dermatology, Kasaragod has successfully developed a model of integrative medicine (IM) and effectively managed lymphoedema patients. This article describes the process of developing IM treatment adopting 'standard protocol items and recommendations for interventional trials'. All patients were examined by a team of doctors, biomedical and CAM, and nurses, thus enabling each patient's condition to be understood from these different perspectives, and diagnosis and management through an IM approach. A minimum of 30 min counselling is essential for every patient before informed consent is gained. The 'systems-based' conclusive process follows the standard guidelines in each therapeutic discipline. IM management is achieved following 'bedside discussion'. The minimum requirements for a clinical setting to conduct IM studies, documentation, patient selection and follow-up are described, utilizing biomedical outcome measures to demonstrate the effectiveness of IM. Components of the IM case record algorithm are described here. The process of clinical examination for Ayurveda is described along with comparative biomedical explanation. Biomedical confirmatory study, maintaining records of primary outcome measures, transcription of IM discussions and follow-up entries of patients under IM are also explained. Improving IM protocols for patient care has involved input from global experts together with feedback from patients who have received IM treatment. The IM treatment protocol should evolve as a patient-oriented approach. The protocol discussed here focuses on biomedical systems and structures to measure its effectiveness. This article provides a method for conducting evidence-based clinical studies to develop new IM therapies for chronic skin diseases.

Cancer is a major cause of morbidity and mortality, with the number of new global cases estimated to reach 21.4 million in 2030. The increase in cancer incidence is due not only to aging populations and increased life expectancies but also to unhealthy lifestyle practices, environmental exposures, and a lack of effective and accessible prevention programs. Knowledge of evidenced-based cancer prevention strategies is crucial for healthcare providers and patients. This chapter describes both conventional medical and integrative medicine approaches to primary cancer prevention. Integrative medicine is an emerging field within cancer prevention and control. This chapter describes what is and is not known about the effectiveness of integrative medicine approaches to cancer prevention. An optimal preventive healthcare approach should include cancer prevention programs that integrate all evidence-based conventional and integrative medicine treatment approaches and options.

Pain Management in Patients with Heart Failure: A Survey of Nurses’ Perception

Integrated (or integrative) medicine has become a popular concept, at least amongst proponents of alternative therapies. It has been defined as ‘medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence and makes use of all appropriate therapeutic approaches, health care professionals and disciplines (conventional and complementary) to achieve optimal health and healing’ [1]. This and other definitions [2] are sound promising, but they do not tell us what modalities might be included under this umbrella. To find out, we have several options. We can, for instance, search the internet, where we find any manner of unproven treatments, even outright quackery, associated with integrated medicine [3]. But it might be unfair to judge this field by its associations in a commercial environment. Perhaps, it is more objective to define integrative medicine through an analysis of the contents of recently published books on this subject. Table 1 lists the therapies which were discussed in detail in six recent books on the subject [4-9]. Based on these data, integrated medicine covers a wide range of therapies. Unanimous agreement amongst the authors of these books seems to exist that it includes the following modalities: acupuncture, herbal medicine, homeopathy, massage and osteopathy. Most of the books would furthermore include biofeedback, chiropractic, hypnotherapy, meditation and naturopathy. For all other treatments, no clear consensus emerges. With the exceptions of counselling, exercise, massage (in European countries), nutritional therapies, psychotherapy, spinal cord stimulation and vitamins, the listed therapies are all nonorthodox (Table 1). For most of them, the evidence base is less than solid [10]. Prime examples of unproven or disproven treatments include homeopathy [11], prayer [12], reflexology [13] and spiritual healing [14]. Another option to describe the nature of integrated medicine might be to evaluate the abstracts of an academic conference on this topic. The third ‘European Congress of Integrated Medicine’ took place on 3–4 December 2010 in Berlin. I categorized its 222 abstracts[15] according to subject areas, whenever possible, attributing one therapeutic technique to each abstract. There were several general abstracts, e.g., surveys (such as ‘Complementary medicine use in XY’) and abstracts with disease-specific topics (e.g. ‘Integrative medicine approach for neuropathic pain’). None of them were linked to a specific intervention. Acupuncture (n = 21), homeopathy (n = 20), anthroposophic medicine (n = 14) and herbal medicine (n = 14) stood out as the most frequent therapies. They were followed by Traditional Chinese Medicine (n = 8), mind–body therapies (n = 5), Ayurveda (n = 5), placebo (n = 5), massage (n = 4), diet (n = 3) and spiritual interventions (n = 3). Two abstracts each related to art therapy, hypnotherapy, kinesiology and nonherbal supplements. One abstract each related to aromatherapy, Bach flower remedies, the Balint approach, bioresonance, chiropractic, cupping, dance therapy, electrotherapy, fasting, honey, leeches, music therapy, naturotherapy, osteopathy, reflexology, thermotherapy, Tibetan medicine, water immersion and yoga. Both analyses confirm that integrated medicine embraces a wide range of unproven or disproven alternative therapies with little consensus amongst experts which modalities are at the core of this area. They also show that mainstream modalities are largely excluded. It is thus fair to suspect that integrated medicine is alternative medicine by another name, nothing other than a cloak of respectability disguising alternative medicine. The term ‘integrative’ seems to disclose the ‘bait and switch’ tactic of charlatans. At best, integrative medicine is well meaning but naïve[1]; at worst, it represents muddled or even fraudulent concepts [2, 3, 16] with little potential to serve the needs of patients. No conflicts of interest to declare.

Pain Management in Patients with Heart Failure: A Survey of Nurses’ Perception

PurposeDespite patients’ widespread use and acceptance of complementary and integrative medicine (IM), few data are available regarding health-care professionals’ current implementation of it in clinical routine. A national survey was conducted to assess gynecologists’ attitudes to and implementation of complementary and integrative treatment approaches.MethodsThe Working Group on Integrative Medicine of the German Society of Gynecological Oncology conducted an online survey in collaboration with the German Society of Gynecology and Obstetrics (DGGG) in July 2019. A 29-item survey was sent to all DGGG members by email.ResultsQuestionnaires from 180 gynecologists were analyzed, of whom 61 were working office-based in private practice and 95 were employed in hospitals. Seventy percent stated that IM concepts are implemented in their routine clinical work. Most physicians reported using IM methods in gynecological oncology. The main indications for IM therapies were fatigue (n = 98), nausea and vomiting (n = 89), climacteric symptoms (n = 87), and sleep disturbances (n = 86). The most commonly recommended methods were exercise therapy (n = 86), mistletoe therapy (n = 78), and phytotherapy (n = 74). Gynecologists offering IM were more often female (P = 0.001), more often had qualifications in anthroposophic medicine (P = 0.005) or naturopathy (P = 0.019), and were more often based in large cities (P = 0.016).ConclusionsThere is strong interest in IM among gynecologists. The availability of evidence-based training in IM is increasing. Integrative therapy approaches are being implemented in clinical routine more and more, and integrative counseling services are present all over Germany. Efforts should focus on extending evidence-based knowledge of IM in both gynecology and gynecological oncology.