Specific Complementary And Alternative Medicine Research Articles

Treat or Treatment: A Qualitative Study Analyzing Patients’ Use of Complementary and Alternative Medicine

We analyzed how patients use complementary and alternative medicine (CAM) and examined how patients' perspectives relate to existing, expert-led taxonomies. We conducted semistructured interviews with 46 people who used CAM in southern England, then performed a qualitative thematic analysis of the interviews. CAM appeared to be used in 4 different ways: as treats, and as alternative, complementary, or conventional treatments. Treats were portrayed as personal luxuries, not directed at an identified health need. Systematic differences in the context, anticipated benefits, and implications for financial justification were revealed when nonmedical therapies were viewed and used as alternative, complementary, or conventional treatments. Specific CAM practices were viewed and used in different ways by different participants. Some participants used CAM practices as a personal luxury, not as a health care technology. This is incongruent with existing expert-led taxonomies. Physicians and researchers need to be aware that patients' views of what constitutes CAM can differ radically from their own. They should choose their terminology carefully to initiate meaningful dialogue with their patients and research participants.

Evidence-based Complementary and Alternative Medicine for Cancer Prevention

Cancer prevention with complementary and alternative medicine (CAM), especially based upon biologically-based practices, is a major concern among physicians, health care providers, and general population. Biologically-based practices include diet-based therapies, botanicals and herbs, vitamins and minerals, animal-derived extracts, and amino acids. We searched databases since the late 1990s and reviewed what have been done in the area of cancer prevention with specific CAM therapies to provide the most recent and updated materials and to be able to serve as a reference for physicians. Scottish Intercollegiate Guidelines Network (SIGN) and National Institute for Clinical Excellence (NICE) methodologies were adopted to classify the study design, study quality assessment, and determination of the evidence level. Some have more or less protective effects but there are conflicting evidences regarding the effectiveness of certain CAM therapies for the prevention of cancer, and most of them are epidemiologic studies, whereas clinical trials are relatively rare in the context of evidence-based medicine (EBM). More researches are mandatory to assess the effectiveness for the prevention of cancer by specific CAM therapies that allow the clinicians and health care providers to give EBM based advice to the patients and inspire them to study CAM therapies for cancer prevention.

Use of complementary medicinal therapies in West Pomerania: a population-based study

Objectives Prior studies suggested a high prevalence of complementary and alternative medicine (CAM) in Germany. The objectives of this study were (1) to describe in more detail the utilization of CAM, (2) to compare characteristics between CAM users and non-users, and (3) to delineate information on source of prescription and insurance coverage of 14 specific CAM therapies.Methods We extracted information derived from a computer-aided personal interview on the use of CAM, medical history, behavioral, and sociodemographic characteristics, all of which were generated by the Study of Health in Pomerania (formerly part of East Germany), a cross-sectional population-based survey. We analyzed data from 4291 individuals aged 20–79 years.Results Use of any CAM within the previous year was reported by 6.0% of the population. The modality used most widely among CAM users was active and passive exercise therapy (including various massage therapies). CAM users, when compared to non-users, were more likely to be female, experienced more years of education, were more physically active, less often overweight, reported a lower self-rated physical health status, and were more likely to visit an outpatient facility during the last year. There were higher proportions of several chronic diseases in CAM users than non-users. The results of this survey suggest that CAM therapies were most often utilized to alleviate pain. Most CAM therapies were prescribed by a physician. Reimbursement schemes were complex and differed according to therapy.Conclusions The low estimate of CAM use might be explained by specific characteristics of the study region, including changes after the German reunification. CAM users and non-users differ with respect to several behavioral, sociodemographic and medical characteristics.

The use and perceived benefit of complementary and alternative medicine among Californians with cancer

Population-based data on complementary and alternative medicine (CAM) use among cancer sufferers is lacking. In a telephone survey representative of California households (response rate = 68.9%, N = 1845) those who reported a diagnosis of cancer (excluding non-melanoma skin cancers) were asked about CAM use. CAM use is substantial, although with few exceptions, it is approximately that found among those with non-malignant chronic conditions. Those with cancer are more likely to report praying for their health, using support groups, and taking multiple dietary supplements. They are less apt to use CAM providers or special diets. Socio-demographic factors associated with CAM use vary by specific CAM modality. Site of the cancer was not associated with any particular CAM modality. The use of CAM therapies specifically promoted as cancer therapies was not common, especially among those diagnosed recently. The use of CAM providers and mind-body techniques specifically for the purpose of treating cancer is unusual (<10%), while special diets are more frequently employed for the purpose of treatment and/or prevention of the cancer itself. A clear majority of those who do use CAM for treating cancer report at least some benefit from the treatment, and are likely to inform their physicians of such use.

The use of complementary and alternative therapies for fibromyalgia

This paper reviews fibromyalgia syndrome (FMS), and examines the evidence for non-pharmacological interventions for the management of the condition. This follows from a previous systematic review carried out by the authors by focusing on the use of complementary and alternative therapies and their integration within clinical practice. The strength of evidence for the effectiveness of complementary and alternative medicine (CAM) interventions for FMS is presented. Best evidence was found to exist for a combined management programme incorporating exercise, education and aspects of CAM therapies. In terms of specific CAM therapies, results were found to be inconclusive due to methodological difficulties, though moderate evidence was found to exist for balneotherapy and acupuncture and some evidence was found for the effectiveness of massage, holistic movement therapies and chiropractic. Implications for service users and practitioners are discussed.

Pattern and frequency of use of complementary and alternative medicine among patients with epilepsy in the midwestern United States

Complementary and alternative medicine (CAM) is recognized to be commonly used by patients, yet there have been few studies regarding the scope of CAM use by patients with epilepsy. This study assessed usage and perceptions of CAM by patients with epilepsy in the midwest of the United States. A 25-item survey was administered to adult patients with epilepsy, and data were collected from 228 patients. The survey collected demographics, specific CAM usage, adverse effects of CAM therapy, and perceptions of the effectiveness of CAM. Thirty-nine percent reported using CAM; 25% reported using CAM specifically for their epilepsy. Prayer/spirituality was the most commonly used form of CAM (46%), followed by “mega” vitamins (25%), chiropractic care (24%), and stress management (16%). CAM use is common among midwestern patients with epilepsy, although the pattern of use may be slightly different than in other regions of the United States and elsewhere.

A Critical Review of Complementary Therapies for Cancer-Related Fatigue

To review the available literature on the use of complementary and alternative medicine (CAM) treatments for cancer-related fatigue with an aim to develop directions for future research. PubMed, EMBASE, CINAHL, PsycINFO, and SPORTDiscus were searched for relevant studies. Original clinical trials reporting on the use of CAM treatments for cancer-related fatigue were abstracted and critically reviewed. CAM interventions tested for cancer-related fatigue include acupuncture, aromatherapy, adenosine triphosphate infusions, energy conservation and activity management, healing touch, hypnosis, lectin-standardized mistletoe extract, levocarnitine, massage, mindfulness-based stress reduction, polarity therapy, relaxation, sleep promotion, support group, and Tibetan yoga. Several of these interventions seem promising in initial studies. Currently, insufficient data exist to recommend any specific CAM modality for cancer-related fatigue. Therefore, potentially effective CAM interventions ready for further study in large, randomized clinical trials (eg, acupuncture, massage, levocarnitine, and the use of mistletoe) should be pursued. Other interventions should be tested in well-designed feasibility and phase II trials.

Complementary and alternative medicine: The challenges of ethical justification

With the prevalence of complementary and alternative medicine (CAM) increasing in western societies, questions of the ethical justification of these alternative health care approaches and practices have to be addressed. In order to evaluate philosophical reasoning on this subject, it is of paramount importance to identify and analyse possible arguments for the ethical justification of CAM considering contemporary biomedical ethics as well as more fundamental philosophical aspects. Moreover, it is vital to provide adequate analytical instruments for this task, such as separating 'CAM as belief system' and 'CAM as practice'. Findings show that beneficence and non-maleficence are central issues for an ethical justification of CAM as practice, while freedom of thought and religion are central to CAM as belief system. Many justification strategies have limitations and qualifications that have to be taken into account. Singularly descriptive premises in an argument often prove to be more problematic than universal ethical principles. Thus, non-ethical issues related to a general philosophical underpinning--e.g. epistemology, semantics, and ontology--are highly relevant for determining a justification strategy, especially when strong metaphysical assumptions are involved. Even if some values are shared with traditional biomedicine, axiological differences have to be considered as well. Further research should be done about specific CAM positions. These could be combined with applied qualitative social research methods.

Lessons learned from complementary and integrative medicine curriculum change in a medical school

This paper describes a pilot study that examined lessons learned from the introduction of complementary and alternative medicine (CAM) elements into a medical school curriculum. A qualitative approach was selected as a first step in evaluating the phenomenological experience of introducing the CAM Educational Project in 2000-05. In 2005, semi-structured interviews were conducted with faculty staff and graduating students who had participated in all 4 years of the CAM Project. Qualitative content was analysed focusing on linguistic data and contextual meaning. The overall response to the integration of CAM curricular elements into the medical school curriculum was positive among all faculty and graduating medical students. Participant experiences were often dependent on the perceived rigour of alternative approaches to a presenting patient problem, along with the importance attributed to openness to patient perspectives as part of evidence-based practices. There was an appreciation of the importance of developing increased awareness and utilisation of CAM in medical practice, as well as a recognition of resistance by some medical school faculty to CAM approaches. This evaluation of a specific CAM educational project suggests potentially transferable findings to other medical schools. Integrating CAM into the medical school curriculum requires a dedicated team if it is to result in a significant change. This change requires that CAM practices are visible to both students and faculty, that there is a co-operative climate, accessible resources, and institutional support, and that CAM content is embedded into the existing curriculum. All these factors combined can lead to sustainable integration of CAM content issues into the medical school curriculum.

Use of Complementary and Alternative Medicine Therapies to Control Symptoms in Women Living With Lung Cancer

Complementary and alternative medicine (CAM) use by cancer patients, especially women, is increasing. However, CAM use among patients with lung cancer, who have been reported to have the highest symptom burden, is poorly documented. This study describes types and frequencies of specific CAM therapies used by women with lung cancer to manage symptoms, and examines differences in demographic and clinical characteristics between CAM users and non-CAM users. Participants included 189 women with non-small cell lung cancer and > or =1 of 8 symptoms. Six CAM therapies, used to control symptoms, were assessed, including herbs, tea, acupuncture, massage, meditation, and prayer. Forty-four percent (84 women) used CAM therapies, including prayer (34.9%), meditation (11.6%), tea (11.6%), herbs (9.0%), massage (6.9%), and acupuncture (2.6%). Complementary and alternative medicine use was greatest for difficulty breathing and pain (54.8% each), with prayer the most commonly used CAM for all symptoms. Significant differences (P < .05) were found for age (t = 2.24), symptom frequency (t = -3.02), and geographic location (chi = 7.51). Women who were younger, experienced more symptoms, and lived on the West Coast or South (vs Northeast) were more likely to use CAM. We found that CAM use is variable by symptom and may be an indicator of symptom burden. Our results provide important initial data regarding CAM use for managing symptoms by women with lung cancer.

Complementary And Alternative Medicine Use among American Women: Findings from The National Health Interview Survey, 2002

The prevalence of use of complementary and alternative medicine (CAM) among Americans is high, especially among women, but a national profile of women CAM users has yet to be characterized. This study identified sociodemographic, health, and lifestyle factors associated with use of various types of CAM among women in the United States and examined health conditions and reasons for use. Data from the 2002 National Health Interview Survey (NHIS), a nationally representative sample of U.S. adults, were analyzed (n = 17,295 women). Any recent use of CAM as well as specific types of CAM (e.g., biologically based therapies) use were analyzed; prayer was considered separately. Prevalence estimates and logistic regression results were weighted, and variance estimates were adjusted for complex sample design. About 40% of women reported any recent CAM use. Biologically based therapies (23.8%) were the most frequently reported CAM type, followed by mind-body therapies (20.9%). User characteristics were generally similar across specific CAM types; there were some differences between women who used CAM and women who prayed for health. Women frequently reported using CAM in conjunction with conventional medicine and to treat chronic pain conditions. This study provides a comprehensive profile of recent CAM use among a national sample of American women, including user characteristics and reasons and conditions for use. Widespread CAM use reflects a social phenomenon of healthcare-seeking practices that can potentially inform public health strategies for health promotion and disease prevention.

CAM Use Among Older Adults Age 65 or Older with Hypertension in the United States: General Use and Disease Treatment

Hypertension (HT) is a common condition among older adults that greatly increases morbidity and mortality risk. Although a number of antihypertensive therapies are currently available, adherence and control are low. The purpose of this study was to assess the use of complementary and alternative medicine (CAM) among older adults with HT. Using a nationally representative cross-sectional survey, the authors examined the prevalence of CAM use among older adults with and without diagnosed HT and the degree to which CAM is used specifically for HT treatment. Subjects were 5821 adults age > or = 65 who participated in the 2002 National Health Interview Survey (NHIS), including the Alternative Health supplement. HT status was assessed by self-report. CAM use was classified as any CAM use, use of four CAM modalities, and specific CAM therapies. Any CAM use was higher for persons with HT compared to those without diagnosed HT (69.5% versus 65.6%). Only 7.8% of CAM users reported using CAM to treat HT. Homeopathic treatment (16.7%), healing ritual (14.5%), and diet-based therapies (13.0%) were the most common HT therapies. Frequency of use of specific types of CAM therapies did not differ by HT status other than for biologically based therapies, which were used less often by those with HT. CAM use is high among older adults with HT, but the vast majority of CAM is used for treating or preventing other conditions. Healthcare providers treating patients with HT should be aware of CAM among their patients.

The Complementarity and Substitution between Unconventional and Mainstream Medicine among Racial and Ethnic Groups in the United States

To describe racial and ethnic differences in the utilization patterns of 12 common types of complementary and alternative medicine (CAM) and mainstream medicine (MSM) and to test whether a specific CAM type is a substitute for or a complement to MSM among five racial and ethnic groups in the United States. The Medical Expenditure Panel Survey in 1996 and 1998 were used. The sample of 46,673 respondents was stratified into non-Hispanic whites (NHW), Hispanics, blacks, Asians, and other races. Twelve types of CAM visits and visits to office-based and outpatient physicians were used to describe the pattern of CAM and MSM use. Utilization patterns among each racial and ethnic group were established and compared. Multivariate analyses were conducted to test whether each type of CAM and MSM were complements or substitutes within a racial and ethnic group, controlling for respondents' sociodemographics and health. Significant intergroup differences in the prevalence rates of using various types of CAM were found. In particular, for some racial and ethnic groups, CAM can be either a substitute for or a complement to MSM visits, depending on the CAM type. More complementary relationships between CAM and physician visits were found in NHW and Asians than in other groups. All significant relationships between CAM types and physician visits among Hispanics and other races (predominantly Native American Indians) were substitution. Complementarity and substitution of CAM and MSM varied by racial and ethnic groups and by type of CAM. Culturally sensitive approaches are needed in successful integration of CAM in treatment management.

An analysis of sickness absence in chronically ill patients receiving Complementary and Alternative Medicine: A longterm prospective intermittent study

BackgroundThe popularity of complementary and alternative medicine (CAM) has led to a growing amount of research in this area. All the same little is known about the effects of these special treatments in every-day practice of primary care, delivered by general practitioners within the health insurance system. From 1994 to 2000 more than 20 German Company health insurances initiated the first model project on CAM according to the German social law. Aim of this contribution is to investigate the effectiveness of multi-modal CAM on chronic diseases within primary health care.MethodsA long-term prospective intermittent study was conducted including 44 CAM practitioners and 1221 self-selected chronically ill patients (64% women) of whom 441 were employed. Main outcome measure is sick-leave, controlled for secular trends and regression-to-the mean and self-perceived health status.ResultsSick-leave per year of 441 patients at work increased from 22 (SD ± 45.2) to 31 (± 61.0) days within three years prior to intervention, and decreased to 24 (± 55.6) in the second year of treatment, sustaining at this level in the following two years. Detailed statistical analysis show that this development exceeds secular trends and the regression-toward-the-mean effect. Sick-leave reduction was corroborated by data on self-reported improvement of patients' health status.ConclusionResults of this longterm observational study show a reduction of sick leave in chronically ill patients after a complex multimodal CAM intervention. However, as this is an uncontrolled observational study efficacy of any specific CAM treatment can not be proven. The results might indicate an general effectiveness of CAM in primary care, worthwhile further investigations. Future studies should identify the most suitable patients for CAM practices, the most appropriate and safe treatments, provide information on the magnitude of the effects to facilitate subsequent definitive randomised controlled studies that will help to position complementary and alternative medicine in health care.

Use of Complementary and Alternative Medicine by Older Adults: An Exploratory Study

Determinants of complementary and alternative medicine (CAM) use and characteristics of users are examined using a sample of 848 adults aged 50 and older from the 2000 Health and Retirement Survey. Logistic regression is used to identify the factors associated with the likelihood of using CAM. Nearly 70% of the respondents use at least one CAM modality, with 44% reporting use of curative CAM and 58% reporting use of preventive/curative CAM. Whites, relative to Blacks, were more likely to use curative and less likely to use preventive/curative CAM. Widowed older adults were more likely to use preventive/curative CAM. Number of limitations in activities of daily living was positively associated with use of both types of CAM. Recommendations are made for improving research on alternative health care utilization, for educating CAM users, and for qualitative studies to gain further insight into factors affecting the use of specific CAM modalities.

Complementary and Alternative Medicine: Oncology Nurses' Experiences, Educational Interests, and Resources

To describe oncology nurses' experiences with patients communicating interest in or use of complementary and alternative medicine (CAM) therapies along with oncology nurses' CAM resources and educational interests. National mailed survey. A national medical center and research institute. A random sample of 850 Oncology Nursing Society (ONS) members who are RNs involved in direct patient care. Respondents completed a demographic questionnaire and the Nurse Complementary and Alternative Medicine Knowledge and Attitude Survey. Initial analysis compared the demographics of the sample to the ONS membership. Descriptive analysis was used to further describe nurses' experiences with patients communicating interest in or use of CAM, nurses' interest in CAM education, and nurses' use of CAM resources. Experiences, resources, interests, and CAM therapies. Oncology nurses reported their experiences with patients who communicated interest in or use of CAM therapies. Respondents demonstrated considerable interest in learning more about specific CAM therapies and used a variety of resources to find information on CAM therapies. Assessing oncology nurses' experiences, resources used, and interest in learning about CAM therapies is the first step in determining the learning needs of oncology nurses in the direct patient care environment. The next step is to obtain baseline information on oncology nurses' CAM knowledge and attitudes for developing and providing appropriate education. CAM education will provide nurses with knowledge to support and advocate for their patients. Oncology nurses are the bridge to help patients safely integrate evidence-based CAM therapies into conventional treatment.

Physicians′ Attitudes Toward Complementary and Alternative Medicine and Their Knowledge of Specific Therapies: A Survey at an Academic Medical Center

The purpose of this study was to evaluate the attitudes of physicians at an academic medical center toward complementary and alternative medicine (CAM) therapies and the physicians' knowledge base regarding common CAM therapies. A link to a Web-based survey was e-mailed to 660 internists at Mayo Clinic in Rochester, MN, USA. Physicians were asked about their attitudes toward CAM in general and their knowledge regarding specific CAM therapies. The level of evidence a physician would require before incorporating such therapies into clinical care was also assessed. Of the 233 physicians responding to the survey, 76% had never referred a patient to a CAM practitioner. However, 44% stated that they would refer a patient if a CAM practitioner were available at their institution. Fifty-seven percent of physicians thought that incorporating CAM therapies would have a positive effect on patient satisfaction, and 48% believed that offering CAM would attract more patients. Most physicians agreed that some CAM therapies hold promise for the treatment of symptoms or diseases, but most of them were not comfortable in counseling their patients about most CAM treatments. Prospective, randomized controlled trials were considered the level of evidence required for most physicians to consider incorporating a CAM therapy into their practice. The results of this survey provide insight into the attitudes of physicians toward CAM at an academic medical center. This study highlights the need for educational interventions and the importance of providing physicians ready access to evidence-based information regarding CAM.

Pain and Use of Complementary and Alternative Medicine in a National Sample of Persons Living with HIV

The current study investigated the relationship of pain to use of complementary and alternative medicine (CAM) in a U.S. nationally representative sample of 2466 persons with human immunodeficiency virus (HIV), using data from the HIV Cost and Services Utilization Study. Pain was conceptualized as a need characteristic within the context of predisposing, enabling, and need (PEN) characteristics following Andersen's Behavioral Model of Health Services Use. Multivariate analyses were used to examine the association of baseline PEN characteristics with CAM use by follow-up (approximately 6 months later), including use of five specific CAM domains. Change in pain from baseline to follow-up was also examined in relation to CAM use. Baseline pain was a strong predictor of CAM use, and increased pain over time was associated with use of unlicensed or underground drugs with potential for harm. These results highlight the importance of medical efforts to control pain in persons living with HIV.

Mainstreaming Complementary Therapies: New Directions In Health Care

Within the past decade, complementary and alternative medicine (CAM) has penetrated mainstream U.S. health care. Major medical journals are publishing research on the efficacy of specific CAM therapies, physicians are attending oversubscribed continuing medical education courses on CAM, and hospitals are offering CAM services, sometimes through outpatient integrative medicine clinics. This paper presents factors behind the growth of CAM, analyzes its relationship with conventional medicine, and suggests how the integration of CAM and conventional medicine can be more effectively guided.

Is complementary and alternative medicine (CAM) cost-effective? a systematic review

BackgroundOut-of-pocket expenditures of over $34 billion per year in the US are an apparent testament to a widely held belief that complementary and alternative medicine (CAM) therapies have benefits that outweigh their costs. However, regardless of public opinion, there is often little more than anecdotal evidence on the health and economic implications of CAM therapies. The objectives of this study are to present an overview of economic evaluation and to expand upon a previous review to examine the current scope and quality of CAM economic evaluations.MethodsThe data sources used were Medline, AMED, Alt-HealthWatch, and the Complementary and Alternative Medicine Citation Index; January 1999 to October 2004. Papers that reported original data on specific CAM therapies from any form of standard economic analysis were included. Full economic evaluations were subjected to two types of quality review. The first was a 35-item checklist for reporting quality, and the second was a set of four criteria for study quality (randomization, prospective collection of economic data, comparison to usual care, and no blinding).ResultsA total of 56 economic evaluations (39 full evaluations) of CAM were found covering a range of therapies applied to a variety of conditions. The reporting quality of the full evaluations was poor for certain items, but was comparable to the quality found by systematic reviews of economic evaluations in conventional medicine. Regarding study quality, 14 (36%) studies were found to meet all four criteria. These exemplary studies indicate CAM therapies that may be considered cost-effective compared to usual care for various conditions: acupuncture for migraine, manual therapy for neck pain, spa therapy for Parkinson's, self-administered stress management for cancer patients undergoing chemotherapy, pre- and post-operative oral nutritional supplementation for lower gastrointestinal tract surgery, biofeedback for patients with "functional" disorders (eg, irritable bowel syndrome), and guided imagery, relaxation therapy, and potassium-rich diet for cardiac patients.ConclusionWhereas the number and quality of economic evaluations of CAM have increased in recent years and more CAM therapies have been shown to be of good value, the majority of CAM therapies still remain to be evaluated.