Complementary and alternative therapies
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Complementary And Alternative Therapies. Dinesh Sirisena.

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Complementary And Alternative Therapies

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Complementary and alternative therapies

Complementary And Alternative Therapies

Dinesh Sirisena


Complementary and alternative therapies

“Complementary and alternative medicine (CAM) is a broad domain of healing resources encompassing all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period.”

“All practices and ideas defined by their users as preventing or treating illness or promoting health and well-being are included.”

“Boundaries within CAM and between the CAM domain and that of the dominant system are not always well defined.”

(Cochrane)


Complementary and alternative therapies

Complementary - together with conventional medicine

Alternative - in place of conventional medicine

Some providers practice both


Topics

Topics?

  • Why do people use them?

  • Who uses them?

  • Frequency of use?

  • Types?

  • Costs?

  • Evidence?

  • Problems?


Complementary and alternative therapies

Why?


Complementary and alternative therapies

Positive motives

Perceived effectiveness or safety

Spiritual

Holism

All things natural

Active role

Control over treatment

Pleasant therapeutic experience

Good patient/therapist relationship

Fewer time restraints (£)

On equal terms (£)

Empathy (£)

Non-invasive

Accessibility (£)

Affluence (£)

Why?


Complementary and alternative therapies

Negative motives

Dissatisfaction with conventional health care

Ineffective

Adverse effects

Doctor-patient relationship

insufficient time

waiting lists

Reject science and technology

Reject “the establishment”

Desperation

Why?


Complementary and alternative therapies

Why?

  • Other Motives

    • Not an alternative

    • What is available for their health care


Complementary and alternative therapies

Women>Men

Well educated + affluent

Middle aged

Ethnic population

Afro-Caribbean>Asian>Caucasian

Chronic Ill Health

Cancer

AIDS

Long term conditions

Worried well

Myalgic Encephalopathy

33% use CAM

Who?


Frequency

Frequency?

  • 46% UK population will try at some point

  • 1999

    • 50,000 CAM practitioners (UK)

    • 5 million patients consulted a CAM practitioner in one year

  • More uptake in Europe

    • France & Germany

  • USA

    • 629 million visits in one year alone (?%pop)


Frequency1

Frequency?

  • Use of CAM in the United Kingdom 1999 (%)

    • Herbal medicine (34)

    • Aromatherapy (21)

    • Homeopathy (17)

    • Acupuncture / acupressure (14)

    • Massage (6)

    • Reflexology (6)

    • Osteopathy (4)

    • Chiropractic (3)


Costs

Costs?


Costs1

Costs?

  • Not necessarily actual cost

  • Cost effectiveness

  • Royal Pharmaceutical Society (1999)

    • £231.8 million was spent on non-prescription medicine

  • Aromatherapy session (£40-60+)

  • Acupuncture (£40-60+)

  • Massage (£30-40+)


How many types

How Many Types?


Types

Types?

  • Biologically based practices

    • supplementing a person's normal diet

  • Manipulative and body-based therapies

    • focus on the body's various systems and structures

  • Mind-body interventions

    • use the connection between a person's mind, body, and spirit to enhance total well being

  • Energy therapies

    • are meant to restore disturbances in the body's natural energy


Types common

Acupuncture

Alexander Technique

Allergy testing

Aromatherapy

Art Therapy

Autogenic Training

Auricular Acupuncture

Ayuveda

Bodywork

Bowen

Biofeedback

Chiropractic

Chinese Herbal Medicine

Counselling

Craniosacral Therapy

Crystal Therapy

Dowsing Flower Therapy

Healing Herbalism

Homeopathy

Types? (Common)


Types common1

Hydrotherapy

Hypnotherapy

Indian Head Massage

Iridology

Kinesiology

Music Therapy

Naturopathy

Nutrition

Osteopathy

Physiotherapy

Radionics

Reflexology

Reiki

Shiatsu

Tai Chi

TENS therapy

Traditional Chinese Medicine

Thought Field Therapy

Yoga Therapy

Types? (Common)


Types rarer

Auricular Acupuncture

Australian Flower Essences Therapy

Bach Flower remedies

Bee Venom Therapy

Chelation Therapy

Colonic Hydrotherapy

Colour Therapy

Dream Therapy

Eye Movement Desensitization and Reprogramming

Exercise Healing

Health Clubs

Health Screening

Juice Therapy

Light Therapy

Light Touch Therapy

Magnotherapy

Marma Therapy

Meta-Aromatherapy

Microwave Resonanace Therapy

Naturotherapy

Oxygen Therapy

Panchakama Therapy

PIP scans

Raw Vegetable Juice Therapy

Rolfing

Spiritual Counselling

Stress Management

Swimming Therapy

Transdecendal Meditation

Tragerwork

Vegetable Juice Therapy

Types? (Rarer)


Specific types

Specific Types?

  • Aromatherapy

    • Used since Egyptian times

    • Distilled plant extracts

      • 400 Oils

      • Varying quality (RCT)

    • Improve well-being

      • Peppermint – digestive effects

      • Tea Tree Oil – antibacterial

    • Massage, Baths, Inhalation


Specific types1

Specific Types?

  • Bee Venom Therapy

    • Contain sulphur

    • Stimulates cortisol release

    • Applied to surface

    • Chronic inflammatory conditions

    • RA, Myositis

    • Applied for 5days with 2-3day interval

    • Normally haemorrhagic


Evidence

Evidence?

  • Circumstantial

  • Past attempts at investigations

  • Little research

    • Difficulty with RCT

    • Outcomes dependant on social, cultural and spiritual beliefs


Evidence1

Evidence?

  • Evidence Based Complementary and Alternative Medicine (eCAM)

    • Yoga

      • Improve risk in adults with DM 2

      • Prevention and management of cardiovascular complications

      • May be useful in the management of stress (post tsunami victims)

    • Massage

      • Benefits in chronic pain conditions

    • Sanfujiu (herbal ointments into pressure points)

      • moderately effective in treating allergic symptoms


Evidence2

Evidence?

  • eCAM

    • Green Tea

      • Regular intake (>3 cups per day) may reduce the lung cancer in smokers

    • Gentle Touch Therapy

      • (strong) circumstantial evidence

      • Improved psychological well-being

      • Self-reported psychological problems


Evidence3

Evidence?

  • eCAM

    • Electro-acupuncture

      • Relieving labour pain

      • Synergism of the CNS with a direct impact on the uterus through release of ß-EP and 5-HT into the blood

    • Tai Chi

      • 15 week course

      • effective in reducing headache symptoms and perception of physical and mental health

    • Music Therapy

      • Benefited patients in hospice and palliative care


Evidence4

Evidence?

  • (2007) NHS trial in Belfast

    • £200,000 for GP to use alternative therapies

    • Was it a success?

    • Reduced use of conventional therapy

    • Effective?


Problems

Problems?


Problems1

Problems?

  • Safety risk

    • Especially during pregnancy

    • Ayurvedic treatments

      • Heavy metals (Lead, Mercury, Arsenic)

    • Unknown purities

    • Reactions are not routinely monitored

    • Dietary supplements can interact with prescribed medications

  • Difficulty establishing reliability/efficacy


Problems2

Problems?

  • Significant lack of evidence/research

    • Speculative

    • Small trials

    • Often biased

  • Financial motivations

  • Lack of regulation

    • Some with registered Osteopaths (GOsC) and Chiropractors (GCC)

    • Remaining registration is voluntary


Problems3

Problems?


Topics1

Topics?

  • Why do people use them?

  • Who uses them?

  • Frequency of use?

  • Types?

  • Costs?

  • Evidence?

  • Problems?


Useful links

Useful Links?

  • http://www.bcma.co.uk/

  • http://www.cancerbackup.org.uk/Treatments/Complementarytherapies/Generalinformation/Complementaryalternativetherapies

  • http://www.therapiesguide.co.uk/

  • http://www.holisticpages.co.uk/

  • http://www.dh.gov.uk/en/Publichealth/Healthimprovement/Complementaryandalternativemedicine/index.htm

  • http://www.medicine.ox.ac.uk/bandolier/booth/booths/altmed.html

  • http://www.nlm.nih.gov/medlineplus/complementaryandalternativetherapies.html

  • http://www.cancer.org/docroot/ETO/ETO_5.asp

  • http://www.nhsdirectory.org/

  • http://nccam.nih.gov/


Useful links1

Useful Links?

  • http://www.library.nhs.uk/cam/

  • http://www.internethealthlibrary.com/Prime-pages/A-ZDirAltTherapies.htm

  • http://www.arc.org.uk/arthinfo/patpubs/6007/6007.asp

  • http://diabetes.niddk.nih.gov/dm/pubs/alternativetherapies/

  • http://www.publications.parliament.uk/pa/ld199900/ldselect/ldsctech/123/12301.htm

  • http://homeopathy4health.wordpress.com/

  • http://ecam.oxfordjournals.org/

  • http://www.bmj.com/cgi/content/full/319/7211/693

  • http://www.cancerhelp.org.uk/help/default.asp?page=216

  • http://www.medicalnewstoday.com/sections/complementary_medicine/


The three oils

The Three Oils

  • A = Lavender

    • calming effect, aiding relaxation and anxiety

  • B = Lemon Grass

    • antiseptic, bactericidal, deodorant and antifungal

  • C = Sandalwood

    • Stress and anxiety, itching and skin inflammation, aphrodisiac


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