Complementary and Alternative Medicine

Complementary and Alternative Medicine
Suzanne K. Powell
This chapter is a revised version of what was previously published in the first edition of CMSA Core Curriculum for Case Management. The contributor wishes to acknowledge Janice E. Benjamin, as some of the timeless material was retained from the previous version.
LEARNING OBJECTIVES
Upon completion of this chapter, the reader will be able to:
  • Define concepts and terms relative to complementary and alternative medicine (CAM), including brief descriptions of CAM modalities, along with their indications and contraindications.
  • Identify CAM systems, and the modalities within those systems, that case managers will likely encounter.
  • Describe the current impact of CAM on the health care industry and its potential to change the delivery of health care, including the challenges of CAM integration into the current medical model.
  • Discuss the differences between CAM and allopathic medicine, as well as the areas in which they complement each other.
  • Identify barriers to third-party reimbursement and HMO benefits for CAM, and the CAM modalities most often considered for inclusion.
  • Discuss issues and challenges related to research into CAM modalities.
  • Identify ways in which case management can integrate CAM into treatment plans, and the challenges and opportunities it presents.
IMPORTANT TERMS AND CONCEPTS
  • Acupuncture
  • Alexander Technique
  • Allopathic Medicine
  • Aromatherapy
  • Auric Field
  • Autogenic Training
  • Ayurvedic Medicine
  • Bioelectric
  • Bioelectromagnetic-based therapies
  • Biomedical model
  • Bioenergy
  • Bioenergy Therapies
  • Biofeedback
  • Complementary and Alternative Medicine (CAM)
  • Chiropractic Manipulation
  • Craniosacral Therapy
  • Creative Visualization
  • Doshas (Vata, Pitta, Kapha)
  • Feldenkrais Therapy
  • Flower Essences
  • Guided Imagery
  • Hatha Yoga
  • Herbal Medicine/Herbology
  • Homeopathy
  • Hydrotherapy
  • Hypnosis
  • Law of Similars
  • Magnetic Therapy
  • Meditation
  • Mind-Body Medicine
  • Musculoskeletal Therapies
  • National Institutes of Health (NIH)
  • Naturopathic Medicine
  • Neurolinguistic Programming (NLP)
  • Nutritional Supplementation
  • Polarity Therapy
  • Preventive Medicine
  • Qi
  • Quantum Healing
  • Reflexology
  • Reiki
  • Relaxation Response
  • Rolfing
  • Sound Healing
  • Structural Integration
  • Therapeutic Touch
  • Traditional Chinese Medicine
  • Yin/Yang
▪ INTRODUCTION
A. Definitions (see Table 24-1)
  • Conventional medicine—Medicine practiced in quality-controlled health care, based on evidenced-based practice.
  • Complementary and alternative medicine (CAM)—Any therapeutic intervention not based on conventional, Western, allopathic treatment protocols.
  • Integrative medicine—The incorporation of CAM techniques into the conventional health care delivery system.
  • Complementary medicine and alternative medicine are different (NCCAM, 2006):
    • Complementary medicine is used together with conventional medicine. An example of a complementary therapy is using aromatherapy to help lessen a patient’s discomfort following surgery.
    • Alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a conventional doctor.
TABLE 24-1 Definitions and Foci of Medical Modalities

Type of MedicineModality

Definition

Focus/Intent

Healing Methods/Techniques

Conventional medicine

Medicine practiced in quality-controlled health care, based on evidenced-based practice

Illness model that seeks to reverse or halt the progression of a disease or traumatic state

Uses technological and pharmaceutical interventions that have been determined to halt or reverse the condition

Complementary and alternative medicine (CAM)*

Any therapeutic intervention not based on conventional, Western, allopathic treatment protocols

Wellness model based on the balance and integration of the mind, body, and spirit

After a holistic assessment, practitioner chooses the healing modalities based on the premise that the body has an innate ability to heal itself

Integrative medicine

The incorporation of CAM techniques into the conventional health care delivery system

Integrates and uses techniques of both medicine modalities to enhance the effectiveness of therapy

Uses both evidenced-based technological and pharmaceutical interventions, supported by CAM modalities decided on by the practitioner and patient

* NOTE: Complementary medicine and alternative medicine are different (NCCAM, 2006): Complementary medicine is used together with conventional medicine. An example of a complementary therapy is using aromatherapy to help lessen a patient’s discomfort following surgery.

Alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a conventional doctor.

B. Brief history of CAM in the United States and the impact of consumer use in bringing CAM into the mainstream of health care delivery
  • In 1992, as billions of consumer dollars were spent on alternative medicine, the Office of Alternative Medicine’s budget increased the CAM budget to $2.0 million and Congress established the Office of Alternative Medicine. Over the next several years, subsequent budget increases occurred (NCCAM, 2005).
    • Fiscal Year (FY) 1993—$2.0 million
    • FY 1994—$3.4 million
    • FY 1995—$5.4 million
    • FY 1996—$7.7 million
    • FY 1997—$12.0 million
    • FY 1998—$19.5 million
  • In 1999, the National Center for Complementary and Alternative Medicine (NCCAM) became one of the 27 institutes and centers that make up the National Institutes of Health (NIH) and the FY 1999 budget was $50.0 million. Subsequent budgets increased (NCCAM, 2006).
    • FY 2000—$68.7 million
    • FY 2001—$89.2 million
    • FY 2002—$104.6 million
    • FY 2003—$114.1 million
    • FY 2004—$117.7 million
    • FY 2005—$123.1 million
  • 2006—NCCAM is well-known for research into complementary and alternative healing practices, training CAM researchers, and disseminating authoritative information to the public and professionals.
C. Eisenberg’s 1990 and 1993 surveys on consumer use of CAM impacted the health care industry when it clearly determined consumer interest in and use of CAM; subsequent surveys/studies showed the trend in consumer use of CAM rising.
D. Current efforts are being made toward creating integrative medicine and incorporating CAM into the health care delivery system. Training requirements and potential for insurance reimbursement varies from state to state.
E. Theoretical contrasts between CAM and allopathic medicine include:
  • The biomedical model of cellular pathology as the root of disease compared with the model of a disruption of bioenergetic pathways as the root of disease
  • Prevention and wellness interventions as the model for treatment compared with acute care interventions and symptom management as the model for treatment
  • Treatment focused on building the body’s own immunity and reparative systems compared with treatment focused on disease processes
F. Broad categories of CAM modalities available in the United States include:
  • Whole health care systems, which have theoretical foundations, diagnostic guidelines, and treatment protocols for addressing the full range of health care conditions
  • Mind-body medicine therapies, which effect health through accessing and strengthening the relationship between the mind and body
  • Musculoskeletal therapies, which work by restoring and maintaining the functions of the body’s skeletal and muscular systems
  • Bioenergy therapies, which work on the bioelectrical and biomagnetic fields of the body
  • Herbal medicine, which uses whole plants to treat disease and maintain health
  • Nutritional supplementation, which prescribes megadoses of vitamins and minerals to treat disease and maintain health
▪ KEY DEFINITIONS
A. Acupuncture—Acupuncture is a treatment modality based on the concepts of traditional Chinese medicine that involves the placement of very thin, stainless steel needles into specific points on the body with the intention of maintaining or restoring the smooth flow of energy, or Qi, along specific pathways, or meridians, that travel along the surface of the body and enter deep into the body to connect with all the organs. Qi is considered a vital energy necessary for the body to function.
B. Alexander technique—Focuses on restoring a balanced, dynamic posture, or coordination of the head and the spine, by reprogramming neuromotor patterns through repetitive musculoskeletal movements or postures.
C. Aromatherapy—Involves the use of essential oils (extracts or essences) from flowers, herbs, and trees to promote health and well-being (NCCAM, 2006).
D. Auric field—A person’s energy body.
E. Ayurvedic medicine—A 5,000-year-old philosophy and system of practice that teaches people how to live in harmony with all aspects of life by caring for themselves on a day-to-day basis. Ayurvedic medicine is deeply rooted in the ancient culture and religion of the Indian continent, and addresses the whole person as body-mind-spirit. The World Health Organization (WHO) supports the use of Ayurvedic medicine and its integration with modern medicine.
F. Bioacoustics—A cross between music therapy and biofeedback. Similar to sound therapy, bioacoustics uses low-based frequency sounds to elicit biological and emotional responses.
G. Bioelectric—Involving the electric phenomena that occur in living tissues (eg, muscles and nerves) www.spotutah.com/glossary.asp
H. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternatingcurrent or direct-current fields. http://nccam.nih.gov/health/whatiscam (2) the magnetic field emanating from living organisms http://www.biomagnetic.org/magnetic%20vocabulary.html
I. Biomedical model—(1) Treats disease as a pathology that occurs within the person. The limitation of this model is that it excludes any psychological, social or ecological factors. www.uwic.ac.uk/shss/dom/newweb/General/Glossary.htm (2) The viewpoint that illness can be explained on the basis of aberrant somatic processes and that psychological and social processes are largely independent of the disease process; the dominant model in medical practice until recently highered.mcgraw-hill.com/sites/0072412976/student view0/chapterl/glossary.html (3) The biomedical model of medicine, has been around for centuries as the predominant model used by physicians in the diagnosis of disease. The term is used by practitioners of Natural Health, a form of alternative medicine, in contrast to the biopsychosocial model, which incorporates psychological and social factors en.wikipedia.org/wiki/Biomedical_model
J. Bioenergy—Energy generated from renewable biomass, i.e. living plants and plant components english.forestindustries.fi/glossary/B.html
K. Bioenergy therapies—Treatment modalities that work on balancing the patient’s energy body, sometimes called the auric field, and include polarity therapy and therapeutic touch.
L. Biofeedback—Uses technology to provide feedback to patients training to gain conscious control over physiological functions of the body, such as regulation of the heart rate.
M. Chinese medicine—See traditional Chinese medicine.
N. Chiropractic manipulations—Concerned with the relationship of the spinal column and musculoskeletal structures of the body to the nervous system. It is believed that when the spinal column is out of alignment, it interferes with the flow of nerve impulses or messages from the central nervous system. Thus, misalignment can have an impact on every part of the body.
O. Complementary and alternative medicine (CAM)—As defined by NCCAM, a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. While some scientific evidence exists regarding some CAM therapies, for most key questions remain that are yet to be answered through well-designed scientific studies—questions such as whether these therapies are safe and whether they work for the diseases or medical conditions for which they are used. The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge (NCCAM, 2006).
P. Conventional medicine—Medicine practiced in quality-controlled health care, based on evidenced-based practice.
Q. Craniosacral therapy—This technique manipulates the bones of the skull to treat a range of conditions, from headache and ear infection to stroke, spinal cord injury, and cerebral palsy. Just as the human body has a rhythm associated with the heart beat and breathing, there is also a rhythm to the ebb and flow of fluid within the cranium and spinal cord generated by subtle pressure changes as fluid enters and exits these spaces.
R. Creative visualization—See guided imagery.
S. Doshas (Vata, Pitta, and Kapha)—The doshas govern psychobiological changes in the body and physiopathological changes.
T. Feldenkrais therapy—This system combines stretching, exercise, and yoga to improve awareness of movement patterns and encourage proper body movement.
U. Flower essences—Flower essences are considered to be a form of “vibrational” medicine. Much like homeopathy, flower essences contain the energetic pattern of a flower, rather than its molecular structure.
V. Guided imagery—Also known as visualization, the thought process that invokes an inner mental picture usually using all the senses, which include vision as well as hearing, smell, touch, taste, position, and movement.
W. Hatha Yoga—The yoga of movement and coordinated breath.
X. Health—The WHO’s definition of health is a state of complete physical, mental and spiritual well-being, not merely the absence of disease.
Y. Herbology/herbal medicine—The use of whole plants, or parts thereof, for the treatment of disease and the maintenance of good health. It is the oldest form of medicine known and has been practiced for thousands of years.
Z. Homeopathic medicine—A healing technique based on three principles: the Law of Similars, the Law of Infinitesimal Dose, and the Laws of Holism.
AA. Hydrotherapy—Therapies using water for healing.
BB. Hypnosis—An artificially induced state characterized by a heightened receptivity to suggestion; a form of guided imagery.
CC. Integrative medicine—Integrative medicine, as defined by NCCAM, combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness (NCCAM, 2006).
DD. Magnetic therapy—A therapy where magnets or magnetic devices are placed on the skin; thought to prevent or treat symptoms of disease, especially pain.
EE. Meditation—An ancient spiritual practice for achieving spiritual awakening, which works by quieting the incessant, random flow of thoughts through the mind.
FF. Mind-body medicine—The ability of a belief or image held in the mind to directly effect a change in the body on a physical, cellular level is now called mind-body medicine, and includes such practices as meditation, hypnosis, biofeedback, creative visualization, the relaxation response, and autogenic training.
GG. Mindfulness meditation—A form of meditation developed in the traditions of Buddhism and designed to allow the individual to be at peace in any experience in which they find themselves. It requires much focused attention and a nonjudgmental attitude.
HH. Musculoskeletal therapies—Treatment modalities that bring the patient’s awareness to body posture and movement, and manipulate the physical body in order to facilitate the flow of blood and energy through the muscles, fascia, and skeletal structures. Therapies include the Alexander technique, the Feldenkrais technique, craniosacral therapy, rolfing, chiropractic manipulation, yoga, massage, and reflexology.
II. Naturopathic medicine—The underlying goal of naturopathic medicine is to strengthen the body’s immune system so that it can heal itself. Treatment modalities include the use of western herbs, high dose vitamins, homeopathic remedies, hydrotherapy, counseling, minor surgery, diet and lifestyle changes, detoxification regimens, and physical medicine modalities such as massage.
JJ. Polarity therapy—Promotes the smooth flow of energy along electromagnetic paths around the body by releasing blockages of energy.
KK. Prana—Life force, or energy that occurs throughout the body.
LL. Preventive care—The concept designed to prevent disease, or to detect and treat it early, or to manage its course most effectively. Examples of traditional preventive care include immunizations, Pap smears, mammograms, and cholesterol screening. Alternative therapies such as herbal remedies and various CAM modalities are important forms of preventive care.
MM. Qi—The vital force that runs throughout the body, animating and supporting the function of different organ systems.
NN. Quantum healing—“Quantum healing is healing the bodymind from a quantum level. That means from a level which is not manifest at a sensory level. Our bodies ultimately are fields of information, intelligence and energy. Quantum healing involves a shift in the fields of energy information, so as to bring about a correction in an idea that has gone wrong. So quantum healing involves healing one mode of consciousness, mind, to bring about changes in another mode of consciousness, body” (Chopra, 2006).
OO. Reflexology—Also called zone therapy, reflexology is based on the notion that each body part is represented on the hands and feet, where there are believed to be reflex points that can stimulate the glands and organs in the body.
PP. Reiki—A Japanese technique using “laying on hands” for stress reduction, relaxation, and healing promotion. It is based on the idea that an unseen “life force energy” flows through us and is what causes us to be alive. If one’s “life force energy” is low, then we are more likely to get sick or feel stress, and if it is high, we are more capable of being happy and healthy.
QQ. Relaxation response—Achieved through mental imagery in a meditative state and activates the body’s parasympathetic nervous system; can restore homeostasis and allow the body to heal from the physiological changes that can occur as the result of chronic stress.
RR. Rolfing—A form of deep tissue massage. Rolfers manipulate and stretch the body’s fascial tissue in order to release adhesions and relieve restricted muscles and joints.
SS. Sound healing/therapy—Uses vibrational tones to elicit biological and emotional responses to promote healing.
TT. Therapeutic massage—The use of touch to manipulate the soft tissues of the body for the purpose of relieving muscle tension and promoting blood circulation. There are more than 100 styles of massage categorized according to the type of strokes or manipulations used, the depth of the massage, the incorporation of movements with the massage, the body part worked on, and the overall goal of the session.
UU. Therapeutic touch—A form of hands-on healing, although often the practitioner’s hands are two to six inches from the patient.
VV. Traditional Chinese medicine (TCM)—A philosophy and practice of medicine based on the theory that health exists when the forces of Yin and Yang are balanced within the body-mind-spirit.
WW. Yin/Yang—The forces that maintain homeostasis in the body-mind-spirit, a balance between catabolism and anabolism, rest and activity, and heat and cold. Yang represents the functional aspect of the body-mind-spirit, and Yin represents the substance of the body-mind-spirit. Examples of Yang energy are heat, agitation, rapid movement, and the daytime. Examples of Yin energy are cold, rest, slow movement, and the nighttime.
XX. Yoga (classical)—Yoga that is organized into eight “limbs” that provide a complete system of physical, mental, and spiritual health. Some of the yogas focus on developing the mind, some on developing the body, and some on developing the deeper inner life of the spirit.
▪ ALTERNATIVE WHOLE HEALTH CARE SYSTEMS
A. Four classifications
  • Traditional Chinese medicine
  • Ayurvedic medicine
  • Naturopathic medicine
  • Homeopathic medicine
B. Traditional Chinese medicine (TCM)
  • TCM definition of health is a philosophy and practice of medicine based on the theory that health exists when the forces of Yin and Yang are balanced within the body-mind-spirit.
  • Historical foundation of TCM in the Chinese culture’s relationship with nature
    • The view of humans as the place where Heaven (Yang) and Earth (Yin) come together, so that health is the balance of these forces in the body-mind-spirit
    • The importance of the patient’s relationship to the environment and the seasons, and living in harmony with the changes in nature
  • Theoretical concepts on which clinical practice is based upon include:
    • Qi (chi) as bioenergy flow through defined meridians, or pathways, in the body
    • Yin/Yang and their interrelationships and interplay within the body
    • The six organ systems (lung, kidney, liver, heart, pericardium, spleen) and their interrelated functions
  • Modalities used in treatment include acupuncture, herbal medicine, diet therapy, heat, cupping, and massage.
  • Conditions that can be treated and research supporting the effectiveness of TCM include the National Institutes of Health (NIH) consensus conference outcomes and the recommendations of the WHO.
C. Ayurvedic medicine
  • A CAM alternative medical system that has been practiced primarily in the Indian subcontinent for 5,000 years. Ayurveda includes diet and herbal remedies and emphasizes the use of body, mind, and spirit in disease prevention and treatment (NCCAM, 2006).
  • Identifying the patient’s constitutional type, or dosha, is the basis for maintaining health and designing treatment during illness.
    • Vata represents the aspects of thinness, dryness, cold, activity, imagination, and the respiratory and circulatory systems.
    • Pitta represents the aspects of heat, a medium build, strong appetite, emotionality, and the digestive system.
    • Kapha represents the aspects of heaviness, slow movement, sweet and salty tastes, good memory, and the physical structures of the body.
  • Modalities for clinical treatment include diet, massage, herbs, meditation, yoga, detoxification, and breathing exercises.
  • Considerations for case managers if they are considering use of Ayurveda—have the client/patient:
    • Tell their health care provider that they are considering or using Ayurveda
    • Make sure that any diagnosis of a disease or condition has been made by a provider who has substantial conventional medical training and experience with managing that disease or condition.
    • It is better to use Ayurvedic remedies under the supervision of an Ayurvedic medicine practitioner than to try to treat oneself.
    • Ask about the practitioner’s training and experience.
    • Find out whether any rigorous scientific studies have been done on the therapies the client/patient is interested in.1
D. Naturopathic medicine
  • Six principles of practice that define naturopathic medicine include:
    • The body has the ability to heal itself, and treatment is designed to support the innate wisdom of the body.
    • Treat the underlying cause, rather than just suppress the symptoms.
    • Do no harm; thus, use only natural means and substances.
    • Treat the whole person—body, mind, and spirit.
    • The physician is a teacher to empower the patient.
    • Prevention is the best medicine.
  • Naturopathic philosophy of disease cause and progression includes the importance of not suppressing natural body processes such as fever, by which the body attempts to restore homeostasis.
  • Modalities used in treatment include diet, vitamin/mineral therapy, herbal medicine, hydrotherapy, spinal manipulation, homeopathy, and massage.
E. Homeopathic medicine
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Jul 14, 2016 | Posted by in PEDIATRICS | Comments Off on Complementary and Alternative Medicine

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