Complementary and Alternative Medicines

Written by staff | 18 July 2011

Complementary and Alternative Medicines (CAM) consist of systems, practices and products that are an alternative to the “standard of care” as defined by conventional medical practice in the US^{1, 3}. Broken down further, “alternative” refers to the replacement of conventional medicine with non-conventional medicine, while “complementary” and “integrative” refers to the use of non-conventional medicine in conjunction with conventional medicine^{2, 3}.

According to a 2007 national health survey, an estimated 38% of adults use some type of CAM³. CAM therapies can be loosely classified into several categories³:

• Natural/herbal supplements including vitamins, minerals, pro-biotics (live organisms) and more
• Manipulations focusing on bones, joints, soft tissues and circulation; these include chiropractic/osteopathic manipulation, massage therapy and more
• Mind-body medicine which focuses on using the mind to affect the body; this category includes meditation, yoga, deep breathing exercises and more. Prayer is sometimes considered a CAM as well⁴
• Energy therapy including magnetic therapy, light therapy and others

CAM is most frequently used to treat musculoskeletal conditions including back, neck and joint pain. The most common CAM therapies include supplements, deep breathing exercises, meditation, chiropractic/osteopathic manipulation, massage and yoga⁵. CAM has been touted as beneficial for many conditions, however evidence is often mixed; many treatments require further investigation⁷. In particular, studies have found no evidence supporting CAM for conditions such as cancer and rheumatoid arthritis^7,8. There have been many reported disadvantages to CAM as well^{1, 2, 3}:

• The benefits and safety of CAM are not well understood due to a lack of scientific evidence and clinical trials. However, in recent years the amount and quality of research into CAM has dramatically increased
• Without objective scientific research, success rates for CAM therapies can be difficult to determine and are ultimately based on subjective, anecdotal evidence
• Dietary supplements are not as tightly regulated by the FDA as other conventional medications. Also dosage recommendations may be inconsistent or non-existent
• Credentialing of CAM providers isn’t as tightly regulated as with more conventional medical professionals. Further, different CAM practitioners may provide contradictory information
• CAM therapies can be expensive, particularly supplements. In a recent report, however, certain therapies have actually been found to be cost effective; notably acupuncture for chronic low back pain when integrated with conventional medicine, St. John’s Wort for mild to moderate depression, and fish oils for coronary heart disease⁶

With time, scientific evidence will grow as CAM practices become widely accepted and incorporated into the standard of care, it is important for patients to be informed and to minimize risk before using CAM therapy by^{2, 3}:

• Selecting practitioners with care based on proper training and experience
• Being aware of interactions between supplements and other medications, as well as side effects
• Notifying primary care physicians when undergoing CAM therapy
• Researching CAM; how it works, effectiveness, dosage and cost

With careful care and consideration, CAM therapies may prove an effective means for managing pain and other specific medical conditions.

References

1. MedlinePlus. (2010) Complementary and Alternative Medicine. Retrieved from: www.nlm.nih.gov/medlineplus/complementaryandalternativemedicine. Accessed July 14, 2011.
2. Kernich, C. (2001) Alternative and Complementary Medicine. The Neurologist. Vol. 7 (6) 369-370.
3. National Center for Complementary and Alternative Medicine. (2010) What is Complementary and Alternative Medicine?. Retrieved from: nccam.nih.gov/health/whatiscam. Accessed July 14, 2011.
4. Barnes, P.; et al. (2004) Complementary and alternative medicine use among adults: United States, 2002. Seminars in Integrative Medicine. Vol. 2 (2) 54-71.
5. Barnes, P.; Bloom, B. (2008) Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007. Retrieved from: [PDF]suporior-surrogacy.com/nchs/data/nhsr/nhsr012.pdf. Accessed July 14, 2011.
6. Access Economics for the National Institute of Complementary Medicine. (2010) Cost effectiveness of complementary medicines. Retrieved from: www.nicm.edu.au.libproxy.boisestate.edu/cost_effectiveness_cm_ae_2010.pdf. Accessed July 14, 2011.
7. Macfarlane, G.; et al. (2011) Evidence for the efficacy of complementary and alternative medicines in the management of rheumatoid arthritis: a systematic review. Rheumatology. Vol. 50 (8) 1-12.
8. Ernst, E. (2011). Complementary and alternative therapies for cancer. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.