Integrative medicine, emphasizing communication and education, is a patient-driven approach to lifestyle changes and overall improvement of well-being. An integrative approach to pain management and rehabilitation across neurologic and musculoskeletal disorders may drive enhanced outcomes.
Integrative Medicine (eSlide 18.1)
Complementary and integrative medicine (CIM) is a holistic, interdisciplinary approach to health, designed to treat the person and not just the disease. CIM combines conventional medicine with complementary and alternative medicine (CAM) when there is strong evidence of safety and effectiveness of the CAM. It encompasses Eastern and Western philosophies, as well as the individual and family. The goal is to concurrently treat the mind, body, and spirit.
Complementary and Alternative Medicine (eSlide 18.2)
The National Center for Complementary and Alternative Medicine (NCCAM) uses the term “complementary health approaches” and defines two specific subgroups of CAM: natural products (i.e., herbs and supplements, such as vitamins) and mind–body practices (including acupuncture, massage, meditation, mindfulness, movement therapies, relaxation techniques, spinal manipulation, yoga, and traditional Chinese medicine such as tai chi and qigong). Complementary medicine involves nonmainstream treatments that are often used in conjunction with conventional medicine. Alternative medicine, in contrast, involves the use of CAM instead of conventional medicine. According to the 2007 National Health Interview Survey, back pain (17.1%), neck pain (5.9%), and joint pain (5.2%) were the most common conditions that prompted CAM use.
Complementary and Alternative Medicine Practices (eSlide 18.3)
Whole Medical Systems
Traditional Chinese medicine uses specific diagnostic evaluations, such as pulse and tongue assessment, and treatments such as herbal prescriptions and acupuncture.
Ayurveda from India is based on the theory of the three doshas (Tridoshas; the elements of life force or energy), which must be at equilibrium for good health. Yoga and herbal medicines are also components of Ayurvedic medicine.
Homeopathy focuses on two theories: “like cures like” (i.e., the disease can be treated or cured by a substance that produces similar symptoms in healthy people) and “law of minimum dose” (i.e., the principle of dilution: the effect is greater at the lowest dose of the medication).
Mind–Body Medicine
Research has identified interactions between the brain and immune system, suggesting the existence of a mind–body connection. Yoga, tai chi, qigong, mindfulness-based (MB) cognitive therapy, and MB stress reduction programs are a few common MB interventions. These approaches are being used in psychotherapy and for the management of pain.
Manipulative and Body-Based Practices
Osteopathy
Osteopathic medicine, including manual manipulation of the spine, appears to play a role in the management of various types of pain, such as low back pain.
Massage
Massage is a general term for pressing, rubbing, and manipulating the skin, muscles, tendons, and ligaments to aid in relaxation and recovery from injury.
Movement Therapies
Common forms of movement therapy include tai chi, qigong, and yoga.
Acupuncture (eSlide 18.4)
Acupuncture is a form of energy medicine. The traditional Chinese explanation is that life energy (Qi) flows through the body and over its surface to nourish the tissues through channels called meridians. Pain and illness are considered to occur when the flow of Qi becomes blocked or unbalanced. Acupuncture can unblock the obstructions and reestablish the flow of Qi through needle placement at points along the meridians, thus allowing the return of homeostasis. The modern scientific explanation is that acupuncture stimulates the nervous system to release chemicals in the muscles, spinal cord, and brain. These chemicals will either change the experience of pain or trigger the release of other chemicals and hormones, influencing the body’s internal regulating systems. Acupuncture has been clinically demonstrated to be effective for low back pain, lateral epicondylitis, headaches, nausea, and vomiting.
Supplements (eSlide 18.5)
S-Adenosylmethionine (SAM-E), a substance produced and used in the liver, has been shown to be as effective as nabumetone and celecoxib in the treatment of knee osteoarthritis (OA). The efficacy of glucosamine and chondroitin sulfate for treating arthritis has been controversial. Other supplements include vitamin D, N-acetylcysteine (NAC), methylsulfonylmethane (MSM), alpha-lipoic acid (ALA), magnesium, strontium, and fish oil.
Qigong (eSlide 18.6)
Qigong is a “moving” mindfulness practice that uses slow graceful movements with coordinated breathing to promote the circulation of Qi within the body, thereby enhancing overall health, relaxation, and mental focus. A literature review concluded that evidence of health benefits from tai chi or qigong is strongest for bone health, cardiopulmonary fitness, balance, and factors associated with preventing falls and improving the quality of life and self-efficacy. Qigong may also reduce pain and improve sleep and mood status in patients with fibromyalgia or cancer.
Tai Chi (eSlide 18.7)
Tai chi, often referred to as “meditation in motion,” involves performing a series of movements in a slow and graceful manner. It can enhance cardiovascular fitness, muscular strength, balance, physical function, quality of life, and performance of activities of daily living and reduce stress, anxiety, and depression. Tai chi can be safely recommended for patients with OA, rheumatoid arthritis, fibromyalgia, and Parkinson disease.
Yoga (eSlide 18.8)
Many styles of yoga exist. Yoga has been shown to significantly improve standing balance and performance on the sit-to-stand and 4-m walk tests, as well as reduce sympathetic activity and/or increase vagal modulation. Studies support the use of yoga as a feasible intervention for patients who have had a stroke or traumatic brain injury.
Meditation/Mindfulness (eSlide 18.9)
There are numerous types of meditation, such as guided imagery, mindfulness meditation, and prayer. By focusing attention, meditation has long been used for relaxation and stress reduction. Studies have also shown that it can help reduce pain and improve mood.
Economics of Complementary and Integrative Medicine (eSlide 18.10)
Research supports the use of CIM as a cost-effective option. CIM practices that include chiropractic manipulation, acupuncture, massage, reflexology (foot massage), music therapy, relaxation response stress reduction, and guided imagery may reduce pain, decrease medication use, and lower health care expenditures.
Conclusion
Integrative medicine includes all health and wellness practices that best serve each individual. Future research may continue to explore the mechanisms of these approaches and the effectiveness of their application for diverse conditions (eSlide 18.11) .
- 1.
Spinal manipulation, most often provided by chiropractors, is beneficial for low back pain. Its contraindications include severe osteoporosis, spinal epidural infection, and spinal metastasis. The most common side effect is local discomfort. The risk of death or permanent neurologic sequelae from stroke after cervical spine manipulation is 1 in 1,000,000 (eSlide 18.12) .
- 2.
Reiki involves the manipulation of energy fields using specific hand positions. It can be performed at a distance and does not require focused attention by the patient.
- 3.
The Dietary Supplement Health and Education Act of 1994 exempts manufacturers from having to prove the safety or efficacy of their herbal products.
- 4.
Studies have suggested the following indications for complementary and alternative medicine in integrative rehabilitation:
- 1)
Pain management: osteopathy, acupuncture (needle shock typically occurs during the first treatment), massage, qigong, tai chi, yoga, meditation, reflexology (based on the principle of microsystem), vitamin D, NAC, and fish oil
- 2)
Arthritis: acupuncture, tai chi, SAM-E, glucosamine and chondroitin (full effects can take up to 2 to 4 months), MSM, strontium ranelate, fish oil, cat’s claw, devil’s claw
- 3)
Cardiorespiratory fitness enhancement, balance improvement, and fall prevention: movement therapies
- 4)
Relaxation or stress reduction: massage, meditation, qigong, tai chi, yoga
- 1)
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