Alternative Medical Therapies Research Articles

A systematic review of medical therapy for anal fissure.

This is a meta-analysis of randomized, controlled trials to assess the efficacy and morbidity of medical therapies for anal fissure. Medline and the Cochrane Controlled Trials Register and the Cochrane Colorectal Cancer Review Groups Controlled Trials Register were searched using the terms "anal fissure randomized" from 1966 to 2002. Studies in which participants were randomized to a nonsurgical therapy for anal fissure were the focus of this review. Comparison groups included an operative procedure, an alternate medical therapy, or placebo. Chronic fissure, acute fissure, and fissure in children were included in the review, however, atypical fissure associated with inflammatory bowel disease, cancer, or anal infection were excluded. Data were abstracted from published reports and meeting abstracts, assessing method of randomization, blinding, "intention to treat" and dropouts, therapies, supportive measures, dosing and frequency, and crossovers. Outcome measures included nonhealing of the fissure and adverse events. Twenty one different comparisons of medical therapies to heal anal fissure have been reported in 31 trials, including 9 agents-glyceryl trinitrate, isosorbide dinitrate, botulinum toxin, diltiazem, nifedipine, hydrocortisone, lidocaine, bran, placebo-as well as anal dilators and surgical sphincterotomy. Glyceryl trinitrate was favored in the analysis over placebo (odds ratio = 0.55, 95 percent confidence interval, 0.41-0.74). After excluding two studies from analysis because of placebo response rates >2 standard deviations below the mean for all studies, the advantage of glyceryl trinitrate over placebo was no longer statistically significant (odds ratio = 0.78; 95 percent confidence interval, 0.56-1.08). Nifedipine and diltiazem did not differ from glyceryl trinitrate in their ability to cure fissure (0.66; 0.22-2.01). Botulinum toxin compared with placebo showed no significant efficacy (0.75; 0.32-1.77), and was also no better than glyceryl trinitrate (0.48; 0.21-1.10). Surgery was more effective than medical therapy in curing fissure (0.12; 0.07-0.22). Medical therapy for chronic anal fissure, acute fissure, and fissure in children may be applied with a chance of cure that is only marginally better than placebo, and for chronic fissure, far less effective than surgery.

The use of herbs and complementary and alternative medicine in pediatric preoperative patients

Study objective To determine the use of herbs and complementary and alternative medicine among a pediatric preoperative population. Design Prospective, consecutive clinical study and survey questionnaire. Setting Children's Hospital pediatric preoperative clinic. Measurements and main results A total of 1,100 surveys were distributed to pediatric patients under the age of 18 years during their preoperative visit over an 8-month period. The survey consisted of a questionnaire about the use of herbs and complementary and alternative therapies within 1 year before the anticipated surgery. The patient or legal guardian was asked whether the patient had tried any of the complementary and alternative medical therapies within 1 year before the scheduled surgical procedure. Of 1,021 completed surveys received, 29.5% of these patients indicated they had tried one or more complementary and alternative therapies in the past year before the surgery, and 12.8% of the pediatric patients used herbal remedies before the surgery. Conclusions Herbs and complementary and alternative medical therapies are frequently used in pediatric populations. Anesthesiologists need to be aware the usage of various herbal supplements in pediatric patients. It is important then to determine the potential of drug and anesthetic interactions in the perioperative period.

Interview with John A. Astin, PhD

Dr. John A. Astin received his PhD in health psychology from the University of California, Irvine. He has been a research fellow in the Complementary and Alternative Medicine Program at the Stanford University School of Medicine and director of mind-body research at the Complementary Medicine Program, University of Maryland School of Medicine. In 2002, he joined California Pacific Medical Center in San Francisco as a research scientist. His research and clinical work has focused on several related areas: the use of mind-body therapies, particularly mindfulness meditation, to treat various health-related problems; psychosocial factors associated with use of complementary and alternative medical therapies; the psychological construct of control and its relationship to mental and physical health; and the role of spirituality in healthcare. His research has appeared in such journals as Archives of Internal Medicine, JAMA, and the Annals of Internal Medicine. He is coauthor (with Deane Shapiro) of the book, Control Therapy: An Integrated Approach to Psychotherapy, Health, and Healing. Along with his scholarly pursuits, Dr. Astin is an accomplished singer, songwriter, and recording artist and has produced five albums of original music that are distributed worldwide.

Characteristics of patients with no underlying toxicologic syndrome evaluated in a toxicology clinic.

A significant number of patients seek medical evaluation for chronic subjective symptoms they presume to be associated with a single toxic trigger. This report describes our clinic experience with these patients. Twenty patients (of a total of 261 patients) with a mean age of 41 years (median age 42 years; range: 4 to 65 years) were evaluated over an 8 month period. All describe a single past toxic exposure triggering their nonspecific (usually vaguely neurologic) symptoms. Zero of 20 (0%) describe other chemical sensitivities; 2/20 (10%) report ongoing exposure, 18/20 (90%) had a limited exposure dating 1 month to 6 yrs prior to toxicology clinic evaluation; 9/20 (45%) are currently employed; 6/20 (30%) sought alternative medical therapy prior to toxicologist evaluation; 6/20/(30%) have attempted litigation. Despite repeatedly normal toxicologic and medical evaluations, all data refuting an underlying toxic cause are not accepted by this series of patients, and their search for a diagnostic linkage persists. Specific toxin identification or treatment for these patients is unlikely to occur.

Regulation, religious experience, and epilepsy: a lens on complementary therapies

Complementary and alternative medical (CAM) therapies include chiropractic, acupuncture and traditional Oriental medicine, massage therapy, and herbal remedies; mind–body therapies (such as meditative practices and visualization); and folk practices and religious healing. Of these, modalities based on spiritual healing create a number of conundrums for the clinician, including legal, regulatory, and ethical issues. Further, the historic relationship between the study of epilepsy and religious experience suggests particular, potential associations between CAM therapies (and especially spiritual healing) and care for epileptic patients. There are at least two dimensions to this exploration: first, the widespread use of spiritual healing for treatment of epilepsy; and second, the hypothesized connection between epileptic seizures and mystical states. A number of legal rules help address potential abuse of authority by health care professionals, and include: (1) medical licensure; (2) scope of practice; (3) professional discipline; (4) malpractice; and (5) fraud. This article offers a preliminary resource for clinicians interested in these topics.

Animal health in organic agriculture: new guidelines and perspectives for food animal practitioners

In the last decade, the organic agriculture in Switzerland has been substantially increased due to the interest of consumer and financial incentives of the federation. Ruminants take directly or indirectly the largest part from grassland used within the organic managed surfaces. As the contacts between veterinary practice and organic agriculture has increased, the potential for veterinary activity in this area has developed considerably. The organic agriculture guidelines stipulate that all the preventive measures should be taken in feeding, keeping and breeding to insure animal health safety. This requires veterinary services for herd management. The organic status of a farm affects veterinary practice also in the form of alternative therapy/drugs administration and measures like dehorning and tail-docking. An important point in organic managed herds requests that treatment of animals should depend on alternative medical preparations or procedures based on veterinarian's experience and also on the therapeutic effect on the animal species concerned as well as on the disease. However, there are no restrictions on the veterinarian to use registered drugs as long as no alternative therapy, according to experience and possible success, is available to treat the animals. The prophylactic administration of allopathic veterinary drugs is not permissible. Further features in organic farms regarding the use of drugs are the keeping of withholding/withdrawal time, the documentation and the treatment frequency tolerated by organic marketing. Despite the above measures, the animal health has a priority regardless of its organic status. Although management of organic farms represent a unique responsibility, there are still obvious deficits in the education of veterinary practitioners for this new situation. However, in the future the extension of veterinary activity to include the alternative medical therapy should be regarded for the practitioner as a challenge and an opportunity at the same time.

Non surgical therapy for anal fissure.

Because of the disability associated with surgery for anal fissure and the risk of incontinence, medical alternatives for surgery have been sought. Most recently, pharmacologic methods that relax the anal smooth muscle, to accomplish reversibly what occurs in surgery, have been used to obtain fissure healing. To assess the efficacy and morbidity of various medical therapies for anal fissure. Search terms include "anal fissure randomized". Studies in which participants were randomized to a non-surgical therapy for anal fissure. Comparison groups may include an operative procedure, an alternate medical therapy or placebo. Chronic fissure, acute fissure and fissure in children are included in the review. Atypical fissures associated with inflammatory bowel disease or cancer or anal infection are excluded. Data were abstracted from published reports and meeting abstracts, assessing method of randomization, blinding, "intention to treat" and drop-outs, therapies, supportive measures (applied to both groups), dosing and frequency and cross-overs. Dichotomous outcome measures included Non-healing of the fissure (a combination of persistence and recurrence), and Adverse events (including incontinence, headache, infection, anaphylaxis). Continuous outcome measures included measures of pain relief and anorectal manometry. 21 different comparisons of the ability of medical therapies to heal anal fissure have been reported in 31 RCTs. Nine agents were used (nitroglycerin ointment (GTN), isosorbide dinitrate, Botulinum toxin (Botox), diltiazem, nifedipine (Calcium channel blockers or Cachablos), hydrocortisone, lignocaine, bran, placebo) as well as anal dilators and surgical sphincterotomy. When two studies are excluded from analysis due to quality concerns, the significance disappears in the three main analyses: GTN vs. placebo group (0.78; 0.56-1.08), in children (0.96; 0.48-1.92) and adults (0.73; 0.50-1.07). That is, GTN was, in this modified analysis, not significantly better than placebo in curing anal fissure. Cachablos were not tested against placebo, but in a comparison to GTN, Cachablo was equivalent in its ability to cure fissure (odds ratio 0.66; 0.22-2.01). Botox, in a meta-analysis of two studies compared to placebo, showed no significant advantage in efficacy (0.75; 0.32-1.77), and in a comparison to GTN analyzing two studies, was also not significantly better than GTN (0.48; 0.21-1.10). Medical therapy for chronic anal fissure, acute fissure and fissure in children may be applied with a chance of cure that is only marginally better than placebo, and, for chronic fissure in adults, far less effective than surgery.

Correction: Advising Patients Who Seek Complementary and Alternative Medical Therapies for Cancer

Correction: Advising Patients Who Seek Complementary and Alternative Medical Therapies for Cancer

Complementary and alternative medical practices: training, experience, and attitudes of a primary care medical school faculty.

Interest in alternative and complementary medical practices has grown considerably in recent years. Previous surveys have examined attitudes of the general public and practicing physicians. This study examined the training, experience, and attitudes of medical school faculty, who have the primary responsibility for the education of future family physicians. A 24-item, self-administered questionnaire was distributed to all 200 faculty at a medical school with a mission of training primary care physicians. Of 30 therapies listed, 5 were considered legitimate medical practices by more than 70% of the faculty. Eighty-five percent of the respondents reported some training in alternative medical therapies, and 62% were interested in additional training. Eighty-three percent of the faculty reported personal experience with alternative therapies and most rated these as effective. Eighty-five percent of the respondents indicated that their general attitude toward alternative medicine is positive. The results indicate that respondents have had substantial exposure to complementary therapies, are interested in learning more about these therapies, and have generally positive attitudes toward alternative medical practices and their use. Because of the role of these therapies in prevention, the positive attitudes might reflect the mission of this medical school to train primary care physicians.

Use of complementary and alternative medical therapies in patients with cardiovascular disease

BackgroundComplementary and alternative medical (CAM) therapies are becoming increasingly popular, yet little information is available about the prevalence and patterns of CAM therapy use by patients with cardiovascular disease (CVD). MethodsInterviewers administered telephone questionnaires to 107 patients randomly selected from a stratified cohort of 2487 eligible patients participating in a registry of patients with CVD. ResultsThe current use of CAM therapies was reported by 64% of the patients surveyed. Nutritional supplements (40%) and megadose vitamins (35%) were the most frequently used preparations. Most CAM therapy users (65%) cited their underlying cardiac condition as the reason for taking such therapy. The most common sources of information about CAM were a friend or relative (43%) or the respondent’s usual physician. However, although 80% of respondents claimed that they had discussed their use of CAM therapies with their physician, 58% of respondents taking a potentially toxic cardiovascular medication (digoxin, warfarin, sotalol, or amiodarone) were simultaneously taking an oral supplement. ConclusionThe use of CAM therapies was high in the cohort of patients surveyed. Physicians caring for patients with CVD need to inquire about CAM therapy use. Further scientific study should be performed to evaluate the potential benefits and risks of CAM therapies in this patient population.

Complementary and alternative medical therapies: implications for medical education.

Increased use of complementary and alternative medicine (CAM) has made it imperative that these topics be included in medical education from the preclinical years through residency and beyond. There has been progress in this direction in recent years, with a steady increase in the number of medical schools that include CAM therapies in their curricula. There remains, however, a lack of clear goals and concrete suggestions for implementing these changes. This article examines the questions that arise when medical educators consider how to incorporate CAM therapies as an integral part of the medical curriculum. It offers practical suggestions for finding time in an already packed curriculum, getting started, including faculty and students in the process, and sustaining the initiative with the necessary administrative and institutional support.

Use of complementary and alternative therapies by patients with human immunodeficiency virus disease in the era of highly active antiretroviral therapy.

Complementary and alternative medical therapies (CAM) are popular with patients who are human immunodeficiency virus (HIV) seropositive, despite effective drug treatments, potential drug interactions, and overlapping toxicities. To determine rates and correlates of ingested and noningested CAM use, and to examine temporal changes in the rates of ingested CAM use during the introduction of highly active antiretroviral therapy (HAART). Cross-sectional analysis with repeated measures from a cohort study, with the study visit as the unit of analysis. Eastern Massachusetts and Rhode Island. Adults who are HIV seropositive followed semiannually (n = 642) in Nutrition for Healthy Living (NFHL) study. Rates of ingested and noningested CAM use were assessed by interview every 6 months between 1995 and 1999. Ingested CAM use was reported at 60% of visits. Between 1995 and 1999, HAART use increased from 0% to 70%, and ingested CAM use decreased from 71% to 52%. In multivariate analyses, users of ingested complementary therapies were more likely to be gay men (prevalence ratio [PR] 1.40, 95% confidence interval [CI] 1.23-1.58; p < 0.0001), at least high school educated (PR 1.37, 95% CI 1.12-1.68, p = 0.002), and with secure housing (PR 0.75, 95% CI 0.61-0.92; p = 0.007). Even in the lowest risk group (less educated, nongay males with insecure housing), CAM use rates were 27% (95% CI 21%-34%). There was no association between HAART and CAM use. CAM therapies complement, rather than replace, HAART. Even among poorly educated, nongay male patients with insecure housing, rates of ingested CAM use were substantial. Physicians should routinely ask about ingested CAM therapy use and become knowledgeable about potential hazards.

A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain.

Few treatments for back pain are supported by strong scientific evidence. Conventional treatments, although widely used, have had limited success. Dissatisfied patients have, therefore, turned to complementary and alternative medical therapies and providers for care for back pain. To provide a rigorous and balanced summary of the best available evidence about the effectiveness, safety, and costs of the most popular complementary and alternative medical therapies used to treat back pain. MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. Systematic reviews of randomized, controlled trials (RCTs) that were published since 1995 and that evaluated acupuncture, massage therapy, or spinal manipulation for nonspecific back pain and RCTs published since the reviews were conducted. Two authors independently extracted data from the reviews (including number of RCTs, type of back pain, quality assessment, and conclusions) and original articles (including type of pain, comparison treatments, sample size, outcomes, follow-up intervals, loss to follow-up, and authors' conclusions). Because the quality of the 20 RCTs that evaluated acupuncture was generally poor, the effectiveness of acupuncture for treating acute or chronic back pain is unclear. The three RCTs that evaluated massage reported that this therapy is effective for subacute and chronic back pain. A meta-regression analysis of the results of 26 RCTs evaluating spinal manipulation for acute and chronic back pain reported that spinal manipulation was superior to sham therapies and therapies judged to have no evidence of a benefit but was not superior to effective conventional treatments. Initial studies have found massage to be effective for persistent back pain. Spinal manipulation has small clinical benefits that are equivalent to those of other commonly used therapies. The effectiveness of acupuncture remains unclear. All of these treatments seem to be relatively safe. Preliminary evidence suggests that massage, but not acupuncture or spinal manipulation, may reduce the costs of care after an initial course of therapy.

El dolor de espalda en la población catalana. Prevalencia, características y conducta terapéutica

BackgroundBack pain is a common symptom of health assistance in Western countries. The goal of the present survey was to establish the prevalence of back pain in the general population in Catalonia, as well as to establish its characteristics, its relationship to sociodemographic variables, the therapeutic behavior followed by those affected and the associated-impairment and disabilities for the sufferers. MethodsThe survey was a descriptive study including a sample of 1,964 people, obtained from the census (1991) and representative of the population older than 18 years. The study was done in 1994 and data were obtained by means of a telephone interview. The prevalence of pain in the last six months was determined. Among those suffering back pain, additional information was obtained concerning its characteristics, the relationship with socio-demographic variables, the therapeutic behaviors used by patients, and the personal, social and work impairment and disabilities. ResultsBack pain was highly prevalent (50.9%), appeared in all ages (mean age of 47.6 years), was the highest in women (60.7%), in manual workers (54.9%) and in those less educated (71.1%). Back pain was long lasting (69.2% more than 3 years), frequent (49.7% more than the half of the days), and highly painful (severe-unbearable in 51.4%). The therapeutic behaviors most commonly used were the visit to the physician (71.9%), the use of alternative medical treatments (24.7%), physical therapy (22.7%, physical exercises and electrotherapy) and self-medication (14.6%, being acetylsalicylic acid the most employed). In general, the duration and degree of improvement was variable. Back pain limited the daily activities (36.7%) and forced to bed rest (22.7%). It was also a significant reason for time off work (17%) and disability pension (6.5%). ConclusionsBack pain has a very high prevalence in the Catalonian population and is an important reason to seek medical attention. It greatly limits the daily personal and professional activities.

Credentialing complementary and alternative medical providers.

Since the late 19th century, state legislatures and professional medical organizations have developed mechanisms to license physicians and other conventional nonphysician providers, establish standards of practice, and protect health care consumers by establishing standardized credentials as markers of competence. The popularity of complementary and alternative medical (CAM) therapies presents new challenges. This article describes the current status of, and central issues in, efforts to create models for health care credentialing of chiropractors, acupuncturists, naturopaths, massage therapists, and other CAM practitioners. It also suggests a strategy of CAM provider credentialing for use by physicians, health care administrators, insurance companies, and national professional organizations. The credentialing debate reflects fundamental questions about who determines which providers and therapies will be accepted as safe, effective, appropriate, and reimbursable. More nationally uniform credentialing mechanisms are necessary to ensure high standards of care and more generalizable clinical research. However, the result of more uniform licensure and credentialing may be excessive standardization and a decrease in individualization of services. Thus, increased standardization of credentialing for CAM practitioners may alter CAM practice substantially. Furthermore, even credentialed providers can deliver ineffective therapy. The suggested framework balances the desire to protect the public from dangerous practices against the wish to grant patients access to reasonably safe and effective therapies.

Advising patients who seek complementary and alternative medical therapies for cancer.

Many patients with cancer use complementary and alternative medical (CAM) therapies. Physicians need authoritative information on CAM therapies to responsibly advise patients who seek these interventions. This article summarizes current evidence on the efficacy and safety of selected CAM therapies that are commonly used by patients with cancer. The following major categories of interventions are covered: dietary modification and supplementation, herbal products and other biological agents, acupuncture, massage, exercise, and psychological and mind-body therapies. Two categories of evidence on efficacy are considered: possible effects on disease progression and survival and possible palliative effects. In evaluating evidence on safety, two types of risk are considered: the risk for direct adverse effects and the risk for interactions with conventional treatments. For each therapy, the current balance of evidence on efficacy and safety points to whether the therapy may be reasonably recommended, accepted (for example, dietary fat reduction in well-nourished patients with breast or prostate cancer), or discouraged (for example, high-dose vitamin A supplementation). This strategy allows the development of an approach for providing responsible, evidence-based, patient-centered advice to persons with cancer who seek CAM therapies.

Effect of “Ionized” Wrist Bracelets on Musculoskeletal Pain: A Randomized, Double-Blind, Placebo-Controlled Trial

To assess objectively the perceived benefits of wearing an "ionized" wrist bracelet to treat muscle or joint pain. This study was performed at the Mayo Clinic in Jacksonville, Fla, in 2000 and 2001. In a randomized, double-blind design, 305 participants wore an ionized bracelet and 305 wore a placebo bracelet for 4 weeks. For each location where pain was present at baseline, participants rated the intensity of pain. Follow-up ratings were made after 1, 3, 7, 14, 21, and 28 days of wearing the bracelet. Two primary end points were defined for evaluating efficacy. The first was the change at 4-week follow-up (day 28) in the pain score at the location with the highest baseline value (maximum pain score). The second was the change at 4-week follow-up in the sum of the pain scores for all locations. Analysis of the data showed significant improvement in pain scores in both groups, but no differences were observed between the group wearing the placebo bracelet and the group wearing the ionized bracelet. The finding that subjective improvement in pain scores was equivalent with ionized and placebo bracelet use questions the benefit of using an ionized bracelet. New treatments in alternative medical therapy must be shown to be effective through vigorous, unbiased, objective testing before physicians acknowledge potential benefits or recommend these treatments to patients.

Complementary therapies for pharmacists

I must admit that it was with some trepidation that I undertook to review this book being a sceptic when it comes to many of the complementary and alternative medical (CAM) therapies. However, regardless of one's personal position there is no denying the enormous increase in the public's demand for CAM treatments. Consequently, healthcare practitioners and in this case pharmacists are being increasingly expected to have a working knowledge of CAM and its interface with orthodox medicine. Despite the author's background in homeopathy he reviews both the positive and negative trial results of this complementary approach and admits ‘a great deal more work is necessary to prove the efficacy of homeopathy to the satisfaction of sceptical colleagues’. Indeed, this book was not written with a view to providing irrefutable evidence for CAM but to provide a balanced overview for the practicing pharmacist, and to this end it is a great success. The book is divided into four parts: General aspects of CAM. This section deals with the classification of CAM, the approach to healing, the demand for CAM, research into CAM and integrating CAM into the UK healthcare system. This section sets the scene for more detailed consideration of the individual therapies. Therapies most appropriate to pharmacy with guidance on how they can be integrated into practice including homeopathy and anthroposophy, medical herbalism, aromatherapy and flower remedy therapy. Ethnic traditional therapies including Chinese and Ayurvedic medicines. One of the least attractive treatment regimens described in this section is an ayurvedic treatment regimen known as pancha karma and involves therapeutic vomiting, purgation, enemas, nasal aspiration of herbs and therapeutic release of toxic blood. Other CAM therapies about which pharmacists may be asked. For example, naturopathy, diagnostic therapies (iridology, kinesiology), manual therapies (chiropractic, massage, osteopathy and reflexology) and mind and body therapies (colour, crystal and music). Each complementary approach is defined, followed by sections on its history, theory, practice, evidence of effectiveness and safety. The adverse effects of each therapy are described and where applicable drug interactions highlighted. Whilst the drug interactions of some herbal preparations such as St John's Wort are well known, potential interactions involving other CAM therapies are less well defined, e.g. aromatherapy oils and warfarin. These obviously warrant further study. Overall, this book is well researched, written in a very readable style and presented in a logical sequence. Each chapter is well referenced. Whilst being written for the practising pharmacist this book provides a useful guide for anyone with an interest in CAM therapies. Like myself, on reading this book you may still be unconvinced regarding the effectiveness of many of the complementary treatments described but you will have a good overview of the subject.

Survey on the use of complementary and alternative medicine among patients with headache syndromes.

The objective was to determine headache patients' knowledge, prevalence of use and perceived effectiveness of complementary and alternative medicine. Seventy-three patients with headache syndromes attending a head and neck pain clinic were interviewed using a standardized questionnaire. Alternative medical therapies were used by 85% of surveyed patients for the relief of their head pain. In 60%, the therapies were perceived to have a benefit. Almost 100% of the patients were familiar with one or more of the presented alternative treatments. Eighty-eight per cent perceived at least one of the complementary treatments to be an effective remedy for headache pain. Exposure to and interest in alternative treatments are common among patients with headache syndromes, despite the lack of scientific evidence of benefit and assessments of risks for many of the treatments. Neurologists and general physicians should be aware of the increasing role of alternative medicine in the healthcare system. There is still an urgent need for objective, integrative and critical research with regard to complementary and alternative medicine.

Attitudes of patients undergoing surgery toward alternative medical treatment.

There has been an increased interest in complementary and alternative medical (CAM) therapies in the scientific literature and the popular press for the last decade. We undertook a survey study to assess the prevalence of CAM therapies in a surgical patient population as well as their interests toward CAM therapies during the preoperative period. A total of 1000 questionnaires were administrated to the patients in the presurgical holding area of Yale-New Haven Hospital. A total of 857 surveys were returned (85.7%). Two hundred and seventy-five (275) patients undergoing surgery (32%) reported having used CAM therapies. The most common CAM therapies in patients undergoing surgery were reported to be massage therapy (15.2%), followed by herb therapy (9.7%), relaxation (8.3%), and acupuncture (6.6%). A significant proportion of patients (42%) indicated their willingness to use acupuncture as a treatment modality for anxiety during the preoperative period. Those surgical patients who expressed an interest in using acupuncture as a preoperative anxiety treatment modality are younger than those who have no interest (47 +/- 16 vs. 53 +/- 19, p = 0.0001). In addition, those patients who used CAM therapies had a significant interest in using acupuncture as a preoperative anxiety treatment modality as compared to individuals who had no experience in CAM therapies (66.3% vs. 29.9%, p = 0.0001). A logistic regression model that included various demographics as predictors demonstrated that age and education level were significant factors that determined the use of CAM therapies in our surgical patients population. In our survey, however, gender does not play a significant role in the usage of CAM therapies. Alternative medicine use is reported to be a common phenomenon prior to surgery. A significant number of patients are willing to accept acupuncture as treatment for anxiety during the preoperative period.