Integrative Medicine Approach Research Articles

A systematic review of integrative medicine for opioid withdrawal

IntroductionThe United States has been battling an opioid epidemic for decades. As substance use disorders have grown, so too has investigation into treatment options, including integrative medicine approaches, for managing opioid withdrawal symptoms (OWS). ObjectivesThis systematic review sought to assess the use of integrative medicine approaches for the alleviation of OWS in patients dependent on opioids and to summarize the available data. MethodsThe authors searched using synonyms for opioids, substance use disorder, and integrative medicine and standardized searches in Embase, PubMed, and Cochrane Library. We also hand searched references for systematic reviews. This review did not include articles that could not be obtained as full-text publications via interlibrary loan. The review also excluded studies with interventions involving acupuncture because multiple systematic reviews on this approach already exist. In addition, we also excluded studies of therapy for opioid maintenance. We evaluated studies for inclusion based on the Jadad criteria. We compared opioid withdrawal outcomes of the studies to determine the efficacy of integrative medicine approaches. ResultsThe authors identified a total of 382 unique publications initially for possible inclusion through systematic searches. After applying inclusion and exclusion criteria, five studies met Jadad criteria. The authors identified an additional two studies for inclusion via hand searching. A total of seven studies included interventions consisting of passionflower, weinicom, fu-yuan pellet, jinniu capsules, tai-kang-ning, dynorphin, and l-tetrahydropalmatine. Analyzing the articles was difficult given the varied scoring methods they used to quantify opioid withdrawal symptoms and the small sample sizes in the trials. Most showed evidence that supported integrative medicine approaches for OWS, although the strength of evidence was limited because of sample sizes. ConclusionsThis review found evidence of multiple integrative medicine approaches for opioid withdrawal symptoms. Well-designed randomized controlled trials should assess the efficacy of integrative medicine for improvement in OWS.

Gynecologists\u2019 attitudes toward and use of complementary and integrative medicine approaches: results of a national survey in Germany

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.

Mind-body-spirit model for the medical management of female sexual well-being.

Although healthcare providers are increasingly interested in addressing their female patient's sexual wellbeing in a holistic fashion, most do not receive training in how to conceptualize the complex interactions between mind, body and spirit that drive health and wellness, let alone how to apply empirical data in any of these dimensions to their individual patients. Here, we present a simple mind-body-spirit model, grounded in an integrative medicine approach, to help translate research on sexual functioning and satisfaction into a shared decision-making plan for the management and enhancement of women's sexual wellness. In considering the dimensions of physical and behavioral health, spirituality and sensuality, physicians can help women orient to the ways in which their sexual healthcare can address their core values and connection to others, which in turn can improve sexual satisfaction. The application of the model is outlined in a case study. Too often female sexual wellbeing is not discussed in the medical setting and this mind-body-spirit model is a tool that health care providers could use address this important aspect of well-being.

Implicações sobre o uso do ozônio (O3) no tratamento coadjuvante do COVID-19

Recentemente, a doença de coronavírus 2019 (COVID-19) causou uma grande pandemia global e representa sérias ameaças à saúde pública. Consequentemente, há uma demanda mundial por encontrar novos tratamentos para controlar a nova pandemia do coronavírus. Na ausência de antivirais e vacinas para o COVID-19, há uma necessidade urgente de buscar alternativas terapêuticas capaz de mitigar os danos causados pelo vírus SARS-CoV-2. Assim, busca-se com este estudo, através da revisão narrativa, fornecer uma compreensão das evidências atuais disponíveis a respeito da importância do terapia de ozônio (ozonioterapia) e sua possível aplicabilidade no tratamento do COVID-19. Utilizou-se as bases de dados bibliográficas do MEDLINE/PubMed, SciELO e LILACS. As evidências mostram que o ozônio (O3) é capaz de inativar vírus através da oxidação direta de seus componentes estruturais e bloquear a replicação viral. Ainda, devido sua ação de modulação do processo inflamatório, o aumento do sistema antioxidante e imunológico celular e humoral, pode atenuar doenças pulmonares e distúrbios respiratórios semelhantes às complicações do novo surto de coronavírus. Dessa forma, as evidências encontradas neste estudo direcionam que o ozônio poderia ser proposto como um suporte para a terapia medicamentosa no tratamento contra infecções virais em geral e particularmente contra o novo coronavírus (SARS-CoV2), dentro de uma abordagem de medicina integrativa, justificado devido seu mecanismo de ação e à patogênese do COVID-19. Entretanto, faz-se necessário ensaios clínicos controlados e randomizados para endossar sua eficácia na prevenção, controle e tratamento contra o novo surto de coronavírus.

The role of Korean Medicine in the post-COVID-19 era: an online panel discussion part 1 – clinical research

BackgroundAs it is predicted that large-scale viral diseases will occur more frequently in the future, there are voices that Korean Medicine (KM) community need to discuss the role of KM and what to prepare to play a significant part of national disease control system in the post-Coronavirus Disease 2019 (COVID-19) era. MethodsThis paper summarizes the edited highlights of an online video meeting by Google meet on 23 April 2020, organized by the Korean Medicine Convergence Research Information Center. Six speakers who are experts in respiratory medicine, cardiology and neurology, gastroenterology, and neuropsychiatry presented what KM community should prepare for the future acute infectious disease outbreaks by learning from experiences of KM teleconsultation center for COVID-19. ResultsUnlike in the past infectious disease outbreaks, KM community has played a bigger part in COVID-19 pandemic in spite of regulatory challenges via activities of KM teleconsultation centers. Telemedicine in pandemic could be more actively utilized in light of the present KM teleconsultation center’s achievements. Data from KM teleconsultation centers would be useful to establish an evidence-base for effectiveness and safety of KM treatments if they are properly collected and analyzed. It might be beneficial to adopt an integrative medicine approach in response to acute viral infectious diseases in the future but the inclusion of KM in the national disease control system is required. ConclusionThe present online discussion suggested possible directions of clinical research in KM for the post-COVID-19 era.

American Academy of Pediatrics Concussion Guidance Clinical Report (December 2018): An Integrative Medicine Approach

American Academy of Pediatrics Concussion Guidance Clinical Report (December 2018): An Integrative Medicine Approach

American Academy of Pediatrics Concussion Guidance Clinical Report (December 2018): An Integrative Medicine Approach

Introduction: Sports related concussion (SRC) is a widespread concern in young athletes, and AAP published clinical guidance in December 2018. While symptoms typically resolve with a return-to-sports program, some athletes may have prolonged symptoms greater than four weeks. Objective: To describe a novel integrative medicine approach to evaluate and treat patients with concussion symptoms. Method: A case study of a patient at our Integrative Medicine Center illustrates risk factors, evaluation, and treatment of patients with concussion symptoms. RT, a 12 …

Non-Pharmacologic Approaches to Treating Chronic Pain: A Case Study of Myofascial Pain in An Adolescent Dancer

Introduction: The American Academy of Orthopedic Surgeons Annual Meeting (March 2019) reported back pain in 33.7% of children and adolescents in the previous year, with 79% participating in sports or physical activity, and those performing at the highest level reporting the most pain. Studies estimate that up to 38% of youth suffer from chronic pain, and large proportions of adolescents are commonly prescribed opiods for pain management of headaches and sports injuries. Objective: To describe a novel integrative medicine approach to evaluate and treat patients with …

National workshop on Scope of Integrative Medical Treatment in Clinical practice (SIMTI-2020): A brief report

Integrative medicine is an approach to integrated health care that focuses mainly on the patient with the range of physical, mental, emotional, social, and spiritual health of the person, which can help people with cancer, persistent pain, chronic fatigue, fibromyalgia, and many other conditions better manage their symptoms and improve their quality of life by reducing fatigue, pain, and anxiety. It is also a personal strategy that adheres to the uniqueness of the person, their need and their circumstances. Siddha medicine is claimed to revitalize and rejuvenate dysfunctional organs that cause the disease. Kayakarpam, a special combination of medicine and lifestyle, Varmam therapy, Vaasi (Pranayamam), and Muppu the universal salt are the specialties of Siddha system of medicine. Thus, this system connects both spiritual and physical and treats the person, i.e., it concentrates the physical, psychological, social, and spiritual well-being of an individual, also reveals the same hypothesis to the medical systems. Implementation of the integration of both Western and AYUSH can probably be a comprehensive treatment for the global challengeable diseases. The integrative medicine (IM) approach recently reemerged with the hope of providing an affordable and practical solution to the global healthcare crisis. To propagate integration in treatment strategies, a workshop was organized by Siddha Clinical Research Unit, Tirupati, and the events and the feedback are narrated briefly in this article.

Aging in the Perspective of Integrative Medicine, Psychoneuroendocrineimmunology and Hormesis.

Aging has been considered a progressive decrease of a living organism's homeodynamics, which indicates a reduction of psycho-biological resilience. This narrative review provides an overview of the available literature related to the holistic approach of integrative medicine, Psychoneuroendocrineimmunology (PNEI) and hormesis in the aging process. On the basis of Pathophysiology of cell senescence and of chronic degenerative diseases, possible preventive/therapeutic pathways have been examined. Chronic low grade cellular inflammation and chronic stress have been shown as the general interlinked factors inducing aging, on the basis of complex biochemical, cell and multi-organ derangements. The main cell degenerative processes which have been related to aging are: altered mitochondria DNA/metabolism, excessive oxidative stress, glycation, alteration of autophagy and proteasome, and genome alterations. Literature about longevity-targeting interventions, beyond conventional medicine, describes a spectrum of possible measures to improve psycho-biological resilience, based on the PNEI paradigm, on hormesis and upon mitochondriatargeted interventions. Calorie restriction, exercising, fasting, nutraceuticals, sleep regulation, specific breathing, meditation and psychotherapy are discussed, among others.

Does Integrative Medicine Reduce Prescribed Opioid Use for Chronic Pain? A Systematic Literature Review.

Chronic pain (CP) is a major public health problem. Many patients with CP are increasingly prescribed opioids, which has led to an opioid crisis. Integrative medicine (IM), which combines pharmacological and complementary and alternative medicine (CAM), has been proposed as an opioid alternative for CP treatment. Nevertheless, the role of CAM therapies in reducing opioid use remains unclear. To explore the effectiveness of the IM approach or any of the CAM therapies to reduce or cease opioid use in CP patients. An online search of MEDLINE and Embase, CINAHL, PubMed supp., and Allied and Complementary Medicine Database (AMED) for studies published in English from inception until February 15, 2018, was conducted. The Mixed Methods Appraisal Tool (MMAT) was used to critically appraise selected studies. The electronic search yielded 5,200 citations. Twenty-three studies were selected. Eight studies were randomized controlled trials, seven were retrospective studies, four studies were prospective observational, three were cross-sectional, and one was quasi-experimental. The majority of the studies showed that opioid use was reduced significantly after using IM. Cannabinoids were among the most commonly investigated approaches in reducing opioid use, followed by multidisciplinary approaches, cognitive-behavioral therapy, and acupuncture. The majority of the studies had limitations related to sample size, duration, and study design. There is a small but defined body of literature demonstrating positive preliminary evidence that the IM approach including CAM therapies can help in reducing opioid use. As the opioid crisis continues to grow, it is vital that clinicians and patients be adequately informed regarding the evidence and opportunities for IM/CAM therapies for CP.

Complementary and Integrative Therapies for Childhood Atopic Dermatitis.

Background: Childhood atopic dermatitis is a chronic inflammatory skin condition that causes significant psychological and financial costs to the individual and society. Treatment regimens may require long-term medication adherence and can be associated with poor patient satisfaction. There is considerable interest in complementary and integrative medicine (CIM) approaches for childhood atopic dermatitis. Objective: To assess the effects of CIM approaches on childhood atopic dermatitis outcomes as defined by randomized, controlled clinical trials. Methods: A PubMed review of CIM-related treatments for pediatric atopic dermatitis was performed, and data related to age, study population, efficacy, treatment regimen, length of treatment, and sample size were included. Results: The search yielded 20 trials related to probiotic/prebiotic treatments for atopic dermatitis, three on the effects of vitamins on children with atopic dermatitis, and two on the effects of Chinese herbal treatments for atopic dermatitis in children and adolescents. The strongest evidence was for supplementation with the probiotics L. fermentum and L. plantarum. Conclusions: Certain strains of probiotics, specifically L. plantarum and L. fermentum, may improve clinical severity scores in children with atopic dermatitis. However, additional trials are needed to more thoroughly delineate the effects of additional integrative therapies on childhood atopic dermatitis.

Multidimensional integrative medicine applied to outpatient cancer treatment in southern Brazil: Preliminary cost-effectiveness analysis.

5 Background: Cost-effective analysis as part of cancer treatment decision-making. Methods: We reviewed deaths of 52 metastatic cancer patients treated with multidimensional integrative medicine (MIM) approach. Patients received standard oncologic treatment plus a MIM predefined program of emotional, cognitive and social support. The method included empathy improvement, changes on physician attitude and office environment, modulation of staff behavior supporting patient’s needs and rights, promotion of belongingness, increasing on patient’s protagonism using multimedia interactive narrative and shared decision-making. Patients were categorised according to the tumor site, pathologic, molecular and IHC characteristics, clinical stage and treatment. Observed survival was defined as the time elapsed between the detection of first metastasis and death. The observed survival for each patient was compared with the median expected survival previously reported on prospective randomised trials which had accrued patients with similar prognostic factors based on a best fit model. Treatment monthly cost for each patient was converted in American dollars (USD) on a daily exchange basis. Cost of the treatment periods were compared with those analysed in four large USA commercial managed care plans. Results: Treatment of metastatic cancer patients using MIM showed a 44% increase in median survival and a 48% decrease in cost. The estimated ICER/QALY was of 32304 USD, which represented 2.0 of Brazilian PPP. Conclusions: Despite methodological limitations, this is the first study to indicate a cost-effective survival increase in metastatic cancer patients using a MIM-behavioral modulation model. [Table: see text]

Perspectives on the use of aromatherapy from clinicians attending an integrative medicine continuing education event

BackgroundThe use of essential oils is growing in the United States, but clinician attitudes, experience, and beliefs regarding their use have not previously been studied.MethodsOne hundred five of 106 clinician attendees (99.1%) of an integrative medicine continuing education conference were surveyed using an audience response system to obtain baseline information. Response frequencies of each item were reported. Nonparametric correlations were assessed comparing the statement “In the last 12 months, I have used essential oils for myself and/or my family” with the other agree/disagree statements using Spearman’s rho.ResultsA majority of participants personally used integrative medicine approaches other than aromatherapy (92.6%) and recommended them clinically (96.8%). Most had personally used essential oils (61%) and wished to offer essential oil recommendations or therapies to their patients (74.0%). Only 21.9% felt confident in their ability to counsel patients on safe use. Personal use of essential oils was highly correlated with confidence in the ability to counsel patients on safe use (Spearman coefficient 0.376, P = 0.000).ConclusionsThis study indicates that clinicians interested in integrative medicine desire to provide aromatherapy recommendations, but do not feel confident in their ability to do so.

The effectiveness and safety of mindfulness-based interventions for posttraumatic stress disorder - a systematic review and meta-analysis

Following the British Medical Research Council recommendations for pilot trials, this study aims to increase experience with a complex integrative medicine (IM) intervention in a randomized controlled design to assess the feasibility for studying this intervention in a larger trial. Specific objectives are to: 1) assess the feasibility of implementing this IM approach to improve dysfunction from tinnitus in a large clinical trial; 2) evaluate patient satisfaction with this complex intervention; and 3) obtain preliminary clinical efficacy data using the planned procedures and measures.This NIDCD-funded pilot study targets retention of 40 participants with significant tinnitus-related dysfunction, recruited from a conventional otolaryngology clinic. To maximize experience with the intervention, enrolled participants are randomized in a 3:1 ratio to IM + a commonly applied sound-based and educational therapy (SBE) or to SBE alone. The 6-month IM treatment includes the same SBE, modeled after the Veteran’s Affairs Progressive Tinnitus Management approach, as well as 3 cognitive behavioral psychotherapy sessions, an 8-week Mindfulness Based Stress Reduction course, 5 acupuncture sessions, and 9 telephonic health coaching sessions. Enrollment, retention, patient satisfaction and lessons learned by the trial team will determine the feasibility of using this complex IM intervention in a large trial. Baseline, post-treatment, and 3-months follow-up measures and trial procedures planned for the larger trial are also piloted, with change in tinnitus-dysfunction over the intervention slated to provide preliminary clinical efficacy data.This pilot protocol will inform decisions regarding the feasibility of using this complex IM intervention in a large clinical trial. The larger trial would potentially offer patients an IM treatment to amplify conventional SBE for those who are unable to habituate to tinnitus.

Integrative medicine for significant dysfunction from tinnitus: Treatment rationale and protocol for a randomized clinical pilot trial

ObjectivesFollowing the British Medical Research Council recommendations for pilot trials, this study aims to increase experience with a complex integrative medicine (IM) intervention in a randomized controlled design to assess the feasibility for studying this intervention in a larger trial. Specific objectives are to: 1) assess the feasibility of implementing this IM approach to improve dysfunction from tinnitus in a large clinical trial; 2) evaluate patient satisfaction with this complex intervention; and 3) obtain preliminary clinical efficacy data using the planned procedures and measures. Design & methodsThis NIDCD-funded pilot study targets retention of 40 participants with significant tinnitus-related dysfunction, recruited from a conventional otolaryngology clinic. To maximize experience with the intervention, enrolled participants are randomized in a 3:1 ratio to IM + a commonly applied sound-based and educational therapy (SBE) or to SBE alone. The 6-month IM treatment includes the same SBE, modeled after the Veteran’s Affairs Progressive Tinnitus Management approach, as well as 3 cognitive behavioral psychotherapy sessions, an 8-week Mindfulness Based Stress Reduction course, 5 acupuncture sessions, and 9 telephonic health coaching sessions. Enrollment, retention, patient satisfaction and lessons learned by the trial team will determine the feasibility of using this complex IM intervention in a large trial. Baseline, post-treatment, and 3-months follow-up measures and trial procedures planned for the larger trial are also piloted, with change in tinnitus-dysfunction over the intervention slated to provide preliminary clinical efficacy data. DiscussionThis pilot protocol will inform decisions regarding the feasibility of using this complex IM intervention in a large clinical trial. The larger trial would potentially offer patients an IM treatment to amplify conventional SBE for those who are unable to habituate to tinnitus.

Yoga: Can it be integrated with treatment of neuropathic pain?

Neuropathic pain (NP) is a debilitating condition that may result from spinal cord injury (SCI). Nearly 75% of all SCI results in NP affecting 17,000 new individuals in the United States every year, and an estimated 7-10% of people worldwide. It is caused by damaged or dysfunctional nerve fibers sending aberrant signals to pain centers in the central nervous system causing severe pain that affects daily life and routine. The mechanisms underlying NP are not fully understood, making treatment difficult. Identification of specific molecular pathways that are involved in pain syndromes and finding effective treatments has become a major priority in current SCI research. Yoga has therapeutic applications may prove beneficial in treating subjects suffering chronically with SCI induced NP, chronic back and associated pains if necessary experimental data is generated. This review aims to discuss the implications of various mechanistic approaches of yoga which can be tested by new study designs around various nociceptive molecules including matrix metalloproteinases (MMPs), cation-dependent chloride transporter (NKCC1) etc in SCI induced NP patients. Thus, yogic practices could be used in managing SCI induced NP pain by regulating the action of various mechanisms and its associated molecules. Modern prescriptive treatment strategies combined with alternative approaches like yoga should be used in rehabilitation centers and clinics in order to ameliorate chronic NP. We recommend practical considerations of careful yoga practice as part of an integrative medicine approach for NP associated with SCI.

Cost-Effectiveness of a Team-Based Integrative Medicine Approach to the Treatment of Back Pain.

To report the results of health economic analyses comparing two treatment approaches for chronic low back pain (CLBP). Observational prospective cohort study comparing effectiveness and cost-effectiveness of CLBP care provided at an integrative care clinic with that provided in other clinics within the same hospital. CLBP-related medical utilization, function, quality of life, and days of work incapacity were self-reported at baseline, 3, 6, and 12 months. Osher Clinical Center (OCC) based at a tertiary academic hospital (Brigham and Women's Hospital [BWH]) and other clinics at BWH. CLBP patients seeking care at OCC or non-OCC BWH clinics. Integrative or conventional care for CLBP as prescribed by the treating clinician(s). Quality-adjusted life years (QALYs) were estimated per treatment approach based on the SF-12. Cost per QALY gained was evaluated using an incremental cost-effectiveness ratio (ICER). ICERs based on CLBP-specific effectiveness measures (Roland Disability Questionnaire [RDQ] and bothersomeness of pain [BOP]) were exploratory outcomes. Total adjusted annual CLBP-related costs per patient were greater in the OCC versus non-OCC group ($11,526.73 vs. $6,810.63). Between group differences in QALYs were small and ICER estimate of cost per QALY gained was high ($436,676). However, unadjusted mean direct costs per patient decreased over time in the OCC group. Savings in direct costs of $391 (95% confidence interval: -1,078 to 1,861) were observed in the OCC group for the 6- to 12-month period, driven primarily by reduced medication usage. ICERs based on adjusted RDQ and BOP group differences showed cost of $2,073 and $4,203 for a one-point reduction per respective scale. When adjusted for baseline differences, self-reported costs were higher in the OCC group with only small effects on QALYs. However, trends toward decreased direct expenditures and medication usage over time warrant further investigation. Future studies evaluating potential benefits of integrative care models for the management of CLBP should employ randomized designs, longer observational periods, and explore multiple metrics of cost-effectiveness.

Nutraceutical-based Integrative Medicine: Adopting a Mediterranean Diet Pyramid for Attaining Healthy Ageing in Veterans with Disabilities.

Veterans with disability represent a big burden worldwide and often require long-term rehabilitation. Unhealthy dietary and lifestyle habits, including smoke and alcohol abuse, are common in veterans. In the context of integrative medicine approaches, the "complementary and alternative medicine" has been suggested for the management of chronic diseases. However, the potential risk of interaction between herbal products, dietary supplements and drugs must be considered in veterans. The Mediterranean diet has been suggested as a natural, non-pharmacological nutraceutical for healthy ageing. Although there is a broad consensus on the positive effect of plant foods consumption, the presence of glucosinolates, flavonoids and furanocoumarins in some plant foods and beverages must be taken into consideration owing to their potential interfering with drugs metabolism and bioavailability. Albeit seasonality could ensure the maintenance of the single dose of phytochemical below that at which adverse effects in some individuals genetically predisposed or unpleasant drug interactions in diseased subjects can occur, a personalized nutrition is recommended in veterans who are under treatment for comorbidities. Furthermore, sports practice can lead veterans with motor disabilities and mental impairments to excel in some disciplines, giving rise to the phenomenon of the Paralympics and the development of "recreational therapy". Moreover, outdoor lifestyle, through vitamin D synthesis, and conviviality, improving socialization, could account for the Mediterranean lifestyle health benefits. In this work, we propose for veterans a Mediterranean Pyramid, which could be the basis for integrative medicine for veterans with disabilities, patient-centered approaches and interprofessional (including physical medicine and rehabilitation clinicians, pharmacists and nutritionists) interventions.

An Integrative Medicine Approach to the Utilization of Cannabis and Cannabinoids for Palliation in Advanced Cancer Patients: Canadian/US Perspectives and Practical Recommendations (SA527)

•Describe current and future examples of research on medical cannabis for palliation in advanced cancer patients.•Understand the various challenges to providing access and monitoring to medical cannabis in community-based, tertiary care and long-term care residences.•Review key practical recommendations on the integration of cannabinoids for symptom management in palliative care patients. Integration of cannabinoids into palliative care has been delayed by many obstacles, such as paucity of clinical research data, poor clinical knowledge on how to initiate and monitor cannabinoid treatments and conflicting or unsupportive regulatory frameworks. Cancer patients, on the other hand, are known to have high rates of cannabis use and desire but are not receiving information about cannabis from oncology providers. This session proposes to illustrate the different clinical settings where the use of the traditional plant botanical cannabis and its derivatives could be considered, as well as provide an overview regarding their appropriate use from an integrative medicine perspective --cannabinoid integrative medicine. The discussion will primarily be focused on the palliative care needs of patients with advanced cancer. The group of authors include both US and Canadian-based clinician-scientist/scholars who have developed a practical approach for the integration of cannabis into oncologic palliative care, including guidance on choice of chemovars (strains), titration and monitoring as well as development of clinical pearls based on their clinical experience and the published literature. Areas covered include symptom management, palliation of existential distress, and experimental use of cannabinoids in disease modification.