Use Of Complementary Alternative Medicine Research Articles

Prevalence of Use and the Risk of Adverse Effects Associated with Complementary and Alternative Medicine in a Cohort of Patients Receiving Warfarin

The use of complementary and alternative medicine (CAM), including orally administered herbals, botanicals, vitamins, and supplements, may pose a risk to patients on warfarin therapy. To estimate the prevalence of CAM use among patients taking warfarin and evaluate the impact of CAM exposure on the risk of warfarin-related adverse effects. A survey was administered to hospital inpatients and clinic outpatients on drug exposure (including CAM) over the previous month, self-reported bleeding events, use of alcohol and vitamin K-rich foods, and medical conditions. Prescription medication use was verified, and laboratory records were checked for out-of-range international normalized ratios (INRs) (defined as INR >4 or <2). The use of CAM, including products with reported or theoretical interactions with warfarin, was compared between patients with and without self-reported bleeding or out-of-range INR. Among the 314 patients who completed the survey, 44.3% reported using CAM at least weekly. Potentially interacting CAM was used by 34.1% of all patients, or 18.2% if vitamin E was excluded as an interacting CAM. Vitamin E was used by 24.2% of all patients and 71.0% of those who used potentially interacting CAM. There was no significant difference in CAM use or consumption of vitamin K-rich foods between patients with and without INRs greater than 4 or for patients with and without INRs less than 2. The use of potentially interacting CAM in this cohort was higher than the use previously reported among patients on warfarin therapy. However, exposure to CAM was not associated with an increase in the risk of self-reported bleeding or out-of-range INR.

Complementary Alternative Medicine for Children with Autism: A Physician Survey

Previous studies suggest over half of children with autism are using complementary alternative medicine (CAM). In this study, physicians responded (n = 539, 19% response rate) to a survey regarding CAM use in children with autism. Physicians encouraged multi-vitamins (49%), essential fatty acids (25%), melatonin (25%) and probiotics (19%) and discouraged withholding immunizations (76%), chelation (61%), anti-infectives (57%), delaying immunizations (55%) and secretin (43%). Physicians encouraging CAM were more likely to desire CAM training, inquire about CAM use, be female, be younger, and report greater autism visits, autism education and CAM knowledge. Physicians were more likely to desire CAM training, inquire about CAM and view CAM as a challenge for children with autism compared to children with other neurodevelopmental and chronic/complex conditions.

Use of Complementary and Alternative Medicine in Children

In 2007, for the first time, the National Health Interview Survey (NHIS) included questions to assess use of complementary and alternative medicine

Complementary or Alternative--Does It Matter In Your Questionnaire?

In this study the impact of the use of the terms complementary medicine and alternative medicine on participants’ responses to surveys about the use of, and beliefs about, these therapies was explored. Two identical surveys were prepared, one of which referred to alternative medicines and the other which referred to complementary medicine. A telephone survey was used to gather responses from a random sample of individuals living in 3 geographically close metropolitan cities in Australia. Respondents were those aged over 18 years who consented to participate in the study. Forty five percent of respondents indicated using complementary medicines while 34% used alternative medicine; similarly 40% had visited a complementary medicine practitioner while 29% had visited an alternative medicine practitioner. However neither of these comparisons was statistically significant. Questions related to beliefs about these therapies, sources of information and benefits for specific conditions showed few, if any, differences between the two groups. While the results of this study do not demonstrate that there are significant differences in responses to questionnaires depending on whether the terms complementary medicine or alternative medicine are used, the data does suggest that this is an area that requires more exploration.

Rheumatic Disease and Complementary-Alternative Treatments

Complementary-alternative medicine (CAM) has been widely used by rheumatic patients for many years, but doctors are often unaware of the actual use. This study aimed at patients' experience and perceptions of CAM as a way for long-term coping with illness. Fifteen in-depth interviews were conducted with patients sampled by contact with voluntary patient-driven rheumatic disease societies, outside of any treatment settings. Strategically, the sampling included a variety of rheumatic diseases and CAM-treatments, but strived otherwise to be typical of CAM-users. Interviews were taped and fully transcribed; coding and analysis of themes were assisted by computer software. Rheumatic disease patients expressed use of CAM as methods of regulation of discomforts, the feeling of the body, and self-empowerment, not for unrealistic healing of their rheumatic disease. They experienced a variety of effects, most often expressed in terms of mind-body interrelated experiences, such as "lightness of the body" rather than relief in specific symptoms. They expressed the feeling of "have been helped" when leaving a CAM-session and appreciated to have more than 1 way to understand their disease and symptoms. They were usually not naive, but were critical consumers. The patients typically believed in the alternative viewpoints of "natural is best" and in "energy meridians," but they were otherwise not believers in any alternative, "new age"-type worldview. These findings suggest that clinical practice may be enriched by listening to or asking rheumatic disease patients' CAM-experiences in a nonpatronizing way.

The successful resolution of chronic constipation in three pediatric patients following chiropractic spinal manipulative therapy

Chronic constipation is a common condition in the very young and the very old. This is reflected in approximately $800 million spent on laxatives in the United States each year. The elimination of food waste from the body is a common and simple daily occurrence for most individuals. Constipation is such a common problem in the pediatric population that it is the second most referred problem to the pediatric gastroenterologist and accounts for 25% of all visits. Between 5% and 28% of all children experience great difficulty with elimination of food waste, which is often accompanied with pain, fear, and avoidance. The symptoms of constipation are defined as infrequent or difficult evacuation of the feces. The ever-increasing use of complementary and alternative medicine (CAM) in adults is also reflected in CAM use by children. In fact, adult CAM users are three times as likely to use CAM for their children compared to non-CAM users. Chiropractic stands as the most popular type of CAM therapy for children. Given the many anecdotes and testimonials within the chiropractic profession on the successful care of pediatric patients with various pediatric conditions, we describe through a case series presentation the successful outcome of chiropractic care in pediatric patients with chronic constipation. All three patients were under the age of 2 years with bowel movements ranging from once per week to every 3–4 days. Previous unsuccessful care involved medical advice with dietary changes and the use of cod liver or mineral oil. Following a trial of chiropractic care using a combination of high-velocity, low-amplitude thrusts and a manually assisted, hand-held instrument to sites of spinal segmental dysfunction, the patients’ constipation resolved as demonstrated by an increased frequency in bowel movements at once to every 1–2 days with accompanying soft stool without straining and pain.

Potential health risks of complementary alternative medicines in HIV patients

To determine the prevalence and purpose of complementary alternative medicines (CAMs) use in people receiving treatment for HIV infection. To identify and quantify potential health risks of CAM use in this population and to explore options for improved pharmacovigilance. Cross-sectional questionnaire survey of 293 patients receiving antiretroviral (ARV) therapy at three specialist HIV out-patient clinics in central London, UK. The use of herbal medicines and supplements was explored, and potentially adverse side effects or significant drug interactions with conventional therapies were identified. Of the 293 patients included, 61% (n=179) were taking herbal remedies or supplements and 35% (n=103) were using physical treatments. Twenty-seven per cent (n=80) used a combination of both. Twenty per cent (n=59) potentially compromised their HIV management through using CAM therapy. Ten per cent (n=29) were advised to stop their CAMs and 15% (n=43) were made aware of potential drug interactions and adverse effects and were advised to monitor their care. There are potentially significant health risks posed by the concomitant use of CAMs in patients taking ARV therapy. Medical practitioners need to be able to identify CAM use in HIV-positive patients and recognize potential health risks. Patients should be encouraged to disclose CAM use to their clinicians and other healthcare professionals.

Radiation Therapists' Experiences with Complementary Alternative Medicine Use by their Patients: A Preliminary Study

Complementary and alternative medicine (CAM) is increasingly popular among patients receiving radiation therapy. However, there is little empirical evidence relating to the interactions of radiation therapists and their patients regarding the use of CAM during treatment. The study objectives were to quantify how often the issue of CAM use arises in the therapists' daily practice, to explore radiation therapists' knowledge and attitudes about CAM use by their patients, and to identify areas for future education and development for therapists. This article describes a two-centre survey conducted at the Vancouver Cancer Centre in British Columbia and Princess Margaret Hospital in Ontario. The survey used an email survey instrument, “SurveyMonkey,” which was emailed to all therapists working at both centres (n = 230). The survey had a 5-point Likert scale ranging from “strongly disagree” to “strongly agree.” There were also associated open-ended questions to allow for individual comments. The total response rate from the two centres was 49%. Results indicated that the topic of CAM does arise, although the frequency of interaction between patient and therapist varies between centres. Therapists reported feeling comfortable with their knowledge of 3 from a list of 27 common CAM therapies. They would recommend/support their patients' use of 11 CAM therapies in total. Therapists and patients use a variety of information sources about CAM, but would welcome more information/education in this area. Overall, therapists felt that the radiation oncologist was the most appropriate person to discuss the use of CAM with patients. Radiation therapists need more information about CAM in the form of continuing education to meet the needs of their patients. Further research is warranted, as this is a very preliminary look at a large and somewhat controversial topic.

The Use of Complementary Alternative Medicine (CAM) in 1 001 German Adults: Results of a Population-Based Telephone Survey

The objective of this study was to evaluate the patterns of use of complementary alternative medicine (CAM) in a representative adult population in Germany. A population-based telephone survey was conducted in Lübeck, Germany. We performed computer-assisted telephone interviews (CATI) in order to obtain information on demographics, health status, prevalence of CAM usage, motivation for using CAM, type of CAM and health problems for which CAM were used. 1,001 adults (median age 48 years) participated in the study (response 46.8%). 79.6% of the interviewed subjects reported health problems. The most frequently named problems were chronic pain (45.3%), circulation problems (32.9%) and colds with fever (27.8%). Non-users of CAM had a lower incidence (76.6%) of overall illness than users (83.5%) (OR 0.65, 0.47-0.89). 42.3% of the participants had used CAM. The CAM user group consisted of significantly more females (72.8 vs. 55.5%) (OR 2.32, 1.74-3.08) and involved better educated subjects (school education >12 years, 36.6 vs. 27.9%, OR 3.25, 1.35-7.81) than the non-user group. The main health problems for which CAM was used were chronic pain (36.3%), some cases of uncomplicated colds (16.9%) and for improving general health (14.7%). Three procedures accounted for the majority of usage: Acupuncture (34.5%), homeopathy (27.3%) and herbal medicine (9.7%). A large number of participants reported as the main reason for using CAM the wish to avoid drugs as much as possible (31.7%). 26.7% reported opting for CAM due to the recommendation of their physician. 23.9% gave unsatisfactory results of conventional medicine as reason for CAM usage. CAM is used widely for different complaints by the general population. This frequent use of CAM has implications for the health-care system and health policy.

Adult vaccination coverage levels among users of complementary/alternative medicine – results from the 2002 National Health Interview Survey (NHIS)

BackgroundWhile many Complementary/Alternative Medicine (CAM) practitioners do not object to immunization, some discourage or even actively oppose vaccination among their patients. However, previous studies in this area have focused on childhood immunizations, and it is unknown whether and to what extent CAM practitioners may influence the vaccination behavior of their adult patients. The purpose of this study was to describe vaccination coverage levels of adults aged ≥ 18 years according to their CAM use status and determine if there is an association between CAM use and adult vaccination coverage.MethodsData from the 2002 National Health Interview Survey, limited to 30,617 adults that provided at least one valid answer to the CAM supplement, were analyzed. Receipt of influenza vaccine during the past 12 months, pneumococcal vaccine (ever), and ≥ 1 dose of hepatitis B vaccine was self-reported. Coverage levels for each vaccine by CAM use status were determined for adults who were considered high priority for vaccination because of the presence of a high risk condition and for non-priority adults. Multivariable analyses were conducted to evaluate the association between CAM users and vaccination status, adjusting for demographic and healthcare utilization characteristics.ResultsOverall, 36% were recent CAM users. Among priority adults, adjusted vaccination coverage levels were significantly different between recent and non-CAM users for influenza (44% vs 38%; p-value < 0.001) and pneumococcal (40% vs 33%; p-value < 0.001) vaccines but were not significantly different for hepatitis B (60% vs 56%; p-value = 0.36). Among non-priority adults, recent CAM users had significantly higher unadjusted and adjusted vaccination coverage levels compared to non-CAM users for all three vaccines (p-values < 0.001).ConclusionVaccination coverage levels among recent CAM users were found to be higher than non-CAM users. Because CAM use has been increasing over time in the U.S., it is important to continue monitoring CAM use and its possible influence on receipt of immunizations among adults. Since adult vaccination coverage levels remain below Healthy People 2010 goals, it may be beneficial to work with CAM practitioners to promote adult vaccines as preventive services in keeping with their commitment to maintaining good health.

Exploring adolescent complementary/alternative medicine (CAM) use in Canada

A qualitative study using a grounded theory approach investigated adolescents' perceptions about complementary/alternative medicine (CAM) use. Adolescents, attending a clinic at the Canadian College of Naturopathic Medicine, were interviewed after receiving ethics approval. Data were collected using semi-structured interviews. The decision of adolescents to use CAM was based within the context of their world and how it shaped influencing factors. Factors that influenced adolescents' decision to use CAM were identified as certain personality traits, culture, media, social contacts and the ability of CAM providers to develop therapeutic relationships. The barriers and benefits of CAM use influenced evaluation of choices. The importance of barriers in limiting freedom of choice in health care decisions should be investigated by practitioners as they provide care to adolescents. Health care planning for integrative models of care requires determining the “right” blend of expertise by knowing interprofessional boundaries, determining mixed skill sets to provide the essential services and ensuring appropriate regulation that allows practitioners to use their full scope of practice.

Use of complementary alternative medicine for low back pain consulting in general practice: a cohort study

BackgroundAlthough back pain is considered one of the most frequent reasons why patients seek complementary and alternative medical (CAM) therapies little is known on the extent patients are actually using CAM for back pain.MethodsThis is a post hoc analysis of a longitudinal prospective cohort study embedded in a RCT. General practitioners (GPs) recruited consecutively adult patients presenting with LBP. Data on physical function, on subjective mood, and on utilization of health services was collected at the first consultation and at follow-up telephone interviews for a period of twelve monthsResultsA total of 691 (51%) respectively 928 (69%) out of 1,342 patients received one form of CAM depending on the definition. Local heat, massage, and spinal manipulation were the forms of CAM most commonly offered. Using CAM was associated with specialist care, chronic LBP and treatment in a rehabilitation facility. Receiving spinal manipulation, acupuncture or TENS was associated with consulting a GP providing these services. Apart from chronicity disease related factors like functional capacity or pain only showed weak or no association with receiving CAM.ConclusionThe frequent use of CAM for LBP demonstrates that CAM is popular in patients and doctors alike. The observed association with a treatment in a rehabilitation facility or with specialist consultations rather reflects professional preferences of the physicians than a clear medical indication. The observed dependence on providers and provider related services, as well as a significant proportion receiving CAM that did not meet the so far established selection criteria suggests some arbitrary use of CAM.

The use of alcohol and medicines among Australian adults

To collect Australian population-based data on concurrent use of conventional medicines, complementary/alternative medicines (CAM), and alcohol. National survey administered in December 2005 to 816 Australian adults. 71% of respondents reported recent (last 24 hour) use of conventional medicine or CAM. 24% had recently consumed alcohol and conventional medicine, 17% alcohol and CAM and 13% alcohol and both types of medicines. Use of blood pressure and arthritis medicines was significantly more likely among daily drinkers than less than daily drinkers and non-drinkers. Concurrent use of medicines and alcohol is common, particularly among older people. Use of alcohol may have an impact on the stability of chronic illness managed by medicines or other types of interactions with medicines, such as sedation. Health care professionals should routinely inquire about such use to be able to incorporate appropriate safety strategies into clinical management.

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Medicinal Plants of Brazil.Medicinal Plants of India.Medicinal Plants of Indonesia.

Pediatricians' attitudes, experience and referral patterns regarding Complementary/Alternative Medicine: a national survey.

BackgroundTo assess pediatricians' attitudes toward & practice of Complementary/Alternative Medicine (CAM) including their knowledge, experience, & referral patterns for CAM therapies.MethodsAn anonymous, self-report, 27-item questionnaire was mailed nationally to fellows of the American Academy of Pediatrics in July 2004.648 of 3500 pediatricians' surveyed responded (18%).ResultsThe median age ranged from 46–59 yrs; 52% female, 81% Caucasian, 71% generalists, & 85% trained in the US. Over 96% of pediatricians' responding believed their patients were using CAM. Discussions of CAM use were initiated by the family (70%) & only 37% of pediatricians asked about CAM use as part of routine medical history. Majority (84%) said more CME courses should be offered on CAM and 71% said they would consider referring patients to CAM practitioners. Medical conditions referred for CAM included; chronic problems (headaches, pain management, asthma, backaches) (86%), diseases with no known cure (55.5%) or failure of conventional therapies (56%), behavioral problems (49%), & psychiatric disorders (47%). American born, US medical school graduates, general pediatricians, & pediatricians who ask/talk about CAM were most likely to believe their patients used CAM (P < 0.01).ConclusionPediatricians' have a positive attitude towards CAM. Majority believe that their patients are using CAM, that asking about CAM should be part of routine medical history, would consider referring to a CAM practitioner and want more education on CAM.

Complementary/alternative medicine use in a pediatric oncology unit in Turkey

Important in the cancer therapy is the increasingly use of complementary/alternative medicine (CAM). The current study aims to establish the extent of use, the types of therapies employed, factors influencing, the reasons for choosing and the cost of CAM used in pediatric cancer patients in our clinic in Ankara, Turkey. A detailed questionnaire regarding demographic data and information about the use of CAM was completed by 95 patients who have attended the clinic between 1999 and 2000. Forty-nine patients (51.6%) had used one or more than one type of CAM. The most frequent (71.4%) was herbal medicine and biologic intake (stinging nettle, plant essence, honey of Anzer). The second one was religious therapy (40.8%). No correlation could be found between the use of CAM and parents education status, the level of income, number of siblings, the prognosis of the disease, the rate of satisfaction with the level of information given by the doctor at the time of diagnosis or the belief in the information given by the doctor about the prognosis (P > 0.05). All patients used CAM in addition to conventional therapy. More than half of the patients used CAM, with stinging nettle being the most common agent. Our patients place a high level of trust in their physicians and the conventional therapies offered by them; however, they also believe that the complementary therapies are harmless and, therefore, worth trying.

Complementary Alternative Medicine Use Among Chinese Americans: Findings From a Community Mental Health Service Population

Complementary alternative medicine use among Asian Americans is widespread, yet poorly understood. This study explored its use among Chinese Americans reporting mental health symptoms. A cross-sectional survey determined the prevalence and correlates of complementary alternative medicine use in an urban sample seen at a community mental health service. Out of 153 Chinese-American patients, 126 (82%) reported current use of complementary therapies (megavitamin therapy, 46%; herbal medicine, 43%; massage, acupuncture, and spiritual healing, about 25% each). Compared with nonusers, users were older, female, employed, less well functioning physically, and less acculturated. Growing immigrant populations and increasing mental health services consumption by members of ethnic-racial groups in the United States call for more attention to complementary alternative medicine use and its potential to aid conventional medical and mental services delivery.

Complementary Alternative Medicine Use Among Chinese Americans: Findings From a Community Mental Health Service Population

Complementary Alternative Medicine Use Among Chinese Americans: Findings From a Community Mental Health Service Population

CAM Use in Pediatric Oncology

For many families of pediatric cancer patients the use of complementary/alternative medicine (CAM) is an accepted adjunct to conventional therapy, even if data regarding effects and risks are scarce. This report provides information about the prevalence of CAM use and reasons for CAM use among pediatric cancer patients. We report the studies available in the literature concerning pediatric oncology and summarise what is known about beneficial effects and risks that could be attributed to certain complementary and alternative methods. Frequently used CAM like mind-body medicine, nutrition (incl. diets and vitamins), homeopathy, anthroposophic medicine, phytotherapy, and acupuncture are highlighted, as were CAM with a lesser percentage of users, bearing special risks (e.g. interactions with chemotherapy) and/or are costly for their users. Physicians should be aware that a substantial percentage of their patients may use CAM without telling them. Physicians need to be open-minded and should discuss CAM with parents, because parents often think that CAM is natural and, therefore, safe. On the other hand, physicians often lack basic knowledge concerning CAM leading to an avoidance of talking about CAM with parents. A professional differentiation between potentially useful and potentially dangerous CAM is necessary to aim at minimising the risks for CAM users.

The Use of Complementary and Alternative Medicine By Cancer Patients Undergoing Radiation Therapy

Use of complementary alternative medicine (CAM) is widespread among patients with chronic diseases including cancer. The purpose of our study was to examine the pattern of alternative medicine use in patients undergoing radiation treatment of cancer. A cross-sectional study was conducted among cancer patients treated with radiation therapy from July 2003 through July 2005 at the University of Cincinnati. We defined CAM as the use of dietary supplements, massage therapy, prayer, acupuncture, chiropractic, and other novel therapies undertaken after their diagnosis with cancer. There were 152 patients that participated in the study. Their median age was 59 (range, 21-85), 82 (54%) were males, 108 (69%) were Caucasian. Out of 152 patients, 104 (68%) patients were users of CAM. The most common CAM modality reported was prayer 85 (82%) and use of dietary supplements 84 (80%). The majority of users were female and well-educated. Among CAM users 60 (58%) had discussed its use with their physician. Level of education, employment status and income showed a significant correlation with the use of CAM. This study demonstrates that the use of complementary alternative medicine among cancer patients receiving radiation therapy is frequent. Given the potential risks with some CAM therapies, physicians should actively ask patients whether they use CAM and provide appropriate counseling.