G. Dobos

Ten years ago, when I started to work at a hospital where leeches had been routinely used for years in the treatment of painful osteoarthritis of the knee I was skeptical. I had spent the past 12 years training in internal medicine at Freiburg University Hospital and had spent two years doing research in the United States. I could not seriously see myself approaching my former colleagues as a proponent of leech therapy for gonarthrosis, especially as there was not a single study on the efficacy of leeching in that indication.

At first I tried to close my eyes to leeching as a treatment option. However, the numbers of patients who spontaneously reported how leeching had dramatically reduced their pain could not be ignored. In most of our patients, osteoarthritis was a secondary diagnosis. It was evident that leech therapy had achieved a significant reduction of pain intensity or, in many cases, had completely eliminated the pain. After leeching, patients were able to climb stairs again without any problems and gross swelling in the knee region was no longer detectable.

I found a way out of the dilemma after I was appointed Chief of Staff of the Model Clinic for Complementary and Integrative Medicine at Kliniken Essen-Mitte, an academic teaching hospital at the University of Duisburg-Essen. I called for the systematic study and inclusion of leech therapy in our therapeutic program. Dr. Andreas Michalsen, Assistant Medical Director of our department, applied the medicinal “magical creatures” with great care, enthusiasm, and scientific curiosity. Through our efforts over many years, together with the bio logical expertise of Dr. Manfred Roth and the practical experience of Dr. Ulrich Storck and Petra Flecken, leeching developed into a dynamic field of medicine.

Impressive treatment successes in the fields of plastic and reconstructive surgery had earlier marked the beginning of an international renaissance of leech therapy. In alternative medicine, leeches are mainly used for treatment of symptomatic joint diseases and local pain syndromes. Over 1500 leech treatments have been administered for these problems at Kliniken Essen-Mitte in recent years. However, not a single severe adverse event has been observed. The most frequent side effects are itching at the bite site, which generally disappears within a few days, and prolonged bleeding from the leech bite. As mentioned elsewhere in book, leeching is contraindicated in certain cases, for example, in patients with coagulation disorders, those taking anticoagulant drugs, and immunosuppressed patients.

All in all, it seems to me that leech therapy is a good candidate for the currently developing concept of Integrative Medicine, an approach that integrates established conventional medicine with natural healing techniques, Complementary Medicine, and Mind–Body medicine. The term “Integrative Medicine” should be taken metaphorically. We interpret it as the ability to “speak different languages.” Proponents of Integrative Medicine use a practical combination of different proved techniques of conventional medicine (we avoid the term “allopathic medicine” because of the historically negative connotations attached to it), applied naturopathy, and Mind–Body medicine. In addition, they utilize active behavioral adaptation strategies to overcome disease. The integrative therapist approaches the individual case without prejudice. The decision regarding which treatment modality to implement is based on a thorough assessment of the available scientific evidence regarding the treatment method in question (external evidence) and the therapist’s own experience (internal evidence).