Complementary and Alternative Medicine

Complementary and Alternative Medicine

Gina Kearney

C. Ronald MacKenzie


Complementary and alternative medicine (CAM) refers to a diverse group of medical and health care systems, practices, and products, which are not currently considered to be a part of conventional medicine, or medicine as practiced by physicians (MD or DO) and other traditionally trained allied health professionals. Therefore, until recently, CAM therapies and holistic philosophy in general were practiced outside the domain of traditional medicine. They were not part of US medical school curricula and were even less prominent in U.S. hospitals. These divisions, however, are gradually disappearing as the prevalence and use of CAM has risen steadily over the last decade. Use of at least one of the 16 alternative therapies by the general public increased from 33.8% in 1990 to 42.1% in 1997. During the same 7-year period, CAM expenditures increased 45.2% and have been estimated at $27 billion.

It is clear that the upward trend in the use of CAM is continuing, spurred on mainly by the use of CAM therapy initiated by the patient. Results from the National Health Interview Survey (NHIS) in 2000 revealed that 62% of those surveyed used some form of CAM therapy during the 12 months preceding the survey, generally for conditions such as back pain, head/chest colds, neck pain, joint pain or stiffness, and anxiety or depression. The primary reason for the use of CAM is its “perceived efficacy”, with 55% of those surveyed in the NHIS reporting they believed that CAM would improve health when used in combination with conventional medical treatments.


When describing various modalities, complementary therapies generally refer to those therapies that are used with conventional medicine, and alternative medicine/therapies are those that are used in place of conventional medicine. The term integrative is being used
more often to better illustrate the “complementary” nature of care; however, most people are more familiar with CAM. Although some scientific evidence exists regarding some select modalities of CAM, for most modalities there are questions that are yet to be answered through well-designed scientific studies. Safety and efficacy are at the core of most debates because these issues will shape the future of CAM research.


Conventional medicine usually offers symptomatic relief for patients with rheumatic disease, but for a significant number of those affected, cure is not a reasonable goal that can be hoped for or an expected clinical outcome. Because of this constrained expectation, it is not surprising that many individuals with rheumatic disease have incorporated CAM into their health care regimen. Estimates of CAM use among this population are generally higher than among patients with other conditions. Studies have reported the use of CAM by patients with rheumatic disease to be ranging from 63% to as much as 94% among those surveyed. Severe pain, arthritis (both rheumatoid arthritis and osteoarthritis), and fibromyalgia are among the rheumatologic conditions particularly amenable to CAM intervention, with exercise, over-the-counter products (topical remedies), spiritual aids (prayer, meditation, and relaxation), and dietary recommendations (vitamins, herbs, and supplements) being the most commonly selected CAM modalities.

Although most conventional practitioners are not adequately trained to provide CAM therapies for their patients directly, there exists a responsibility, at a minimum, to be prepared to discuss and guide patients to appropriate resources and/or to refer them to qualified CAM practitioners. Of the numerous CAM therapies, the following represents an overview of select CAM modalities that may be of interest (and potential benefit) for the patient with rheumatism.


Alternative medical systems are built upon complete systems of theory and practice. As stated by the National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (NIH), alternative medical systems may be unfamiliar to many; however, many of these systems have evolved separately from and earlier than the large number of conventional approaches commonly utilized. Listed in the subsequent text are some examples.

I. Ayurveda

Ayurveda is Sanskrit for the science of life and is a form of medicine that has been practiced in India for thousands of years. Ayurvedic medicine places equal emphasis on the body, mind, and spirit and uses herbs, yoga, diet, meditation, massage, exposure to the sun, and breathing exercises to restore natural harmony and balance to the body. An ayurvedic doctor identifies an individual’s “constitution” or overall health profile by determining his or her metabolic body type (Vata, Pitta, or Kapha) through an assessment of personal history. The individual’s “constitution” then becomes the foundation for a specific plan of treatment designed to guide the individual back into balance with the environment.

II. Traditional Chinese Medicine

The roots of Chinese medicine, on which acupuncture, massage, and herbal therapy are based, date back as far as to the Shang dynasty (1000 B.C.). One of the major underpinnings of traditional Chinese medicine (TCM) is the belief that there are patterns of energy flow (Qi or chi) present in all living things, which are essential for health and well-being. When these patterns of energy flow become disrupted or blocked, illness and/or disease results. Within the system of energy pathways, or meridians, there are over 1,000 acupoints that can be stimulated through the insertion of needles. Hence, the practice of acupuncture is believed to help correct and rebalance the flow of energy and restore health. Acupuncture is frequently used to treat both acute conditions and chronic pain, and has shown promise in treating arthritis, fibromyalgia, lupus, chronic fatigue syndrome, and low-back pain.

III. Homeopathy

This system of medical practice is based on the Law of Similars, or the theory that any substance that can produce symptoms of disease or illness in a healthy individual can cure those symptoms in a sick individual. Administered in diluted form, homeopathic remedies are derived from plant, animal, and mineral sources. Numbering in the thousands, these over-the-counter natural remedies have been used to treat a variety of ailments including allergies, asthma, influenza, headaches, and indigestion. Homeopathy offers a low-risk, affordable approach to many acute and chronic conditions. Although individuals have used homeopathy for self-care/healing for many years, the optimal effect is realized only when the “proper” remedy is selected. Homeopathic remedies are now widely available in drug stores and health food stores, but are often marketed as standard drugs, meaning, a specific remedy or combination of remedies is indicated for each condition. However, the classic prescribing of homeopathic remedies is based on the personal characteristics and symptoms of the particular individual rather than the specific condition, which is extremely important in treating serious health conditions. Although not harmful, selection of an incorrect remedy will simply have no effect, often resulting in the dismissal of this treatment approach prematurely. For this reason, it is best to consult a well-trained and experienced homeopath for the best results. Keeping this in mind, a listing of some of the homeopathic remedies commonly recommended for specific rheumatic conditions are given here (dosages are indicated by letters and numbers, such as “12 C”).

  • Ankylosing spondylitis. Tuberculinum nosode, 12 C (only in the early stages of the disease).

  • Fibromyalgia. Cimicifuga racemosa, 9 C.

  • Rheumatoid arthritis (RA). Streptococcin nosode, 12 C (only in the early stages of the disease).

  • Rheumatic joints. Apis mellifica, 9 C (for painless swelling) and Bryonia alba, 9 C (for painful swelling).

IV. Naturopathy

This broad system of medicine is based on the theory that the body is a self-regulating mechanism with the natural ability to maintain a state of health and wellness. Emphasis is placed on employing healthy practices (prevention) and self-healing. Practitioners of naturopathy generally elect to avoid invasive procedures and the use of synthetic drugs, and try to cure illness and disease by harnessing the body’s natural healing powers. This is accomplished by the use of a combination of modalities from practices such as herbal medicine, homeopathic treatment, massage, dietary supplements, and other physical therapies. Causes of the illness, or root causes as they are sometimes referred to, are identified and treated using a holistic approach. The doctor assumes the role of an educator and a motivator to enable individuals to take responsibility for their own health. The relationship between the physician and patient, in essence, becomes part of the therapy.


I. Chiropractic

The third largest independent health profession in the United States, this treatment modality involves adjustment of the spine and joints to influence the body’s nervous system and natural defense mechanisms to alleviate pain and improve general health. Chiropractors make their diagnosis based on physical examination, history, palpation of the spine, and often x-rays. An assumption of chiropractic is that health is a state of balance, particularly of the nervous and musculoskeletal systems. When the spine is fully aligned, nerve energy flows freely to every cell and organ in the body. This free flow of energy nurtures the innate ability of the body to work optimally and coordinate normal body functions. There are three primary treatment goals: (a) to reduce or eliminate pain; (b) to correct the subluxation (or misalignment) of the spine; and (c) to offer preventive maintenance so that the problem does not recur. For the patient with rheumatism, chiropractic can be an effective adjunctive therapy for the back, neck, and shoulder syndromes, sciatica, muscle spasms, headaches, and arthritic conditions.

II. Massage and Bodywork

Therapeutic massage is a means of manipulating muscles and other soft tissues by rubbing, kneading, rolling, pressing, and tapping movements, causing them to relax and lengthen, thereby allowing for pain-relieving oxygen and blood to flow to the affected area(s). Benefits of massage can be experienced on physical, mental, and emotional levels. Massage relieves muscle tension and stiffness, reduces muscle spasm, speeds recovery from exertion, improves joint flexibility and motion, increases ease and efficiency of movement, improves posture, improves local circulation, induces a relaxed state of alertness, reduces anxiety, increases the feeling of well-being, and raises awareness of the mind-body connection. There are four major categories of massage and bodywork (with over 75 different methods).

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Jul 29, 2016 | Posted by in RHEUMATOLOGY | Comments Off on Complementary and Alternative Medicine

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