Complementary and Alternative Therapies Chapter 32 Complementary and Alternative Therapies Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Lesson 32.1 Complementary Medicine Overview Theory Discuss the use of complementary and alternative medicine (CAM) in integrative medicine. Consider each therapy that is considered a part of CAM. Examine five commonly used complementary and alternative therapies. Contrast four mind-body therapies. Clinical Practice Assist patients in using relaxation and imagery. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Complementary and Alternative Medicine Complementary therapies—used in conjunction with other medical treatments Alternative therapies—used in place of mainstream medicine Example: macrobiotic diet therapy used to treat cancer instead of having surgery, radiation, or chemotherapy Discuss why complementary and alternative therapies are becoming more and more popular. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Complementary and Alternative Medicine (cont’d) Many of the alternatives can be expensive and frequently are not covered by insurance. National Institute of Health’s National Center for Complementary and Integrative Health (NCCIH) was established to undertake evidence-based research regarding the efficacy of the various complementary and integrative health therapies, and to provide information for the public Integrative medicine focuses on combining conventional and complementary interventions in a collaborated way Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Complementary and Alternative Medicine (cont’d) NCCIH classifies complementary therapies into two main categories: Mind and Body Interventions Natural Products Other Complementary Interventions: therapies do not fit in either of the two groups. These therapies include traditional healers, Ayurvedic medicine, traditional Chinese medicine, homeopathy, and naturopathy. Mind and Body Interventions: A variety of techniques designed to enhance the mind’s capacity to affect bodily functions and symptoms. Natural Products: This group contains several different products, such as herbs, vitamins and minerals, and probiotics. These are often referred to as dietary supplements. These substances are commonly found in nature. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Mind and Body Interventions: Acupuncture A branch of Chinese medicine in which needles are used to stimulate certain points on the body (called meridians to stimulate or disperse the flow of energy) Can be an effective method to control pain Also used to increase immunity Acupuncture is an ancient Chinese medical therapy that works to encourage the body to heal itself. What precautions should be taken for acupuncture? Needles should be clean and sterile to prevent infection and transmission of HIV and hepatitis. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Mind-Body Interventions: Yoga A spiritual practice that combines exercise, controlled breathing, posture, and mental focus to bring about positive effects on the body and mind Effects Regulating blood pressure and heart rate Increasing circulation Aiding digestion Healing chronic back pain Helping with other disorders It began as part of the Hindu healing science Ayurveda. The word yoga comes from a Sanskrit root “yuj,” which means “to join.” In its spiritual sense, the identity and the Supreme Soul is realized by the yogi. The human soul is brought into conscious communion with the Divine Reality. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Figure 32-2: Yoga Yoga can be useful for many different health care problems. Figure 32-2 from the textbook Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Mind and Body Interventions: Chiropractic Uses manipulation of the spine for symptomatic relief and improved functioning Brings the spinal components back into correct alignment, thereby decreasing or eliminating pain Exercise, ice, heat, electrical stimulation, and massage may be used in conjunction with spinal manipulation What are the positive effects of proper body alignment? Chiropractic uses manipulation of the spine for symptomatic relief and improved body functioning by bringing the spinal components back into correct alignment, thereby decreasing or eliminating pain Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Mind and Body Interventions: Massage therapy Uses soft tissue manipulation to improve health Stroking, kneading, friction, and vibration used to relieve muscle pain and promote comfort Several varieties of massage, with each using specialized ways of manipulating the soft tissue Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Mind and Body Interventions: Relaxation Therapy Used to ease stress and is helpful for a variety of chronic illnesses Relaxation induces a light state of altered consciousness through refocusing, conscious breathing, and body awareness Relaxation techniques help patients to reduce stimulation and ease discomfort. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Mind and Body Interventions: Imagery Uses a visual stimulus to produce a particular physiologic change that can decrease stress or promote healing Useful in decreasing pain, and can be particularly helpful to patients undergoing painful procedures May produce a physiologic effect on all of the major systems of the body. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Mind and Body Interventions: Meditation Involves focusing attention on a single repetitive stimulus, thereby decreasing all other stimuli Alters consciousness and can bring a beneficial mind-body response Induces a restful state and lowers heart and respiratory rates; may reduce anxiety It has been helpful for people with asthma, hypertension, diabetes, and other disorders. Meditation can improve productivity and mood and reduce irritability. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Mind and Body Interventions: Biofeedback Technique that trains patient to lessen symptoms Learn to control particular internal physiologic processes that normally occur involuntarily, such as heart rate or blood pressure With practice, a person can use this information to gain control over the “involuntary” activity Specialists in many different fields use biofeedback to help their patients cope with pain. Biofeedback is used effectively for many conditions, but is particularly successful in treating tension or migraine headaches and chronic pain. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Biofield Therapies Qi Gong A form of exercise (stimulation therapy) Improves health by redirecting mental focus, controlling breathing, improving coordination, and promoting relaxation Activates the natural currents that flow along the body’s meridians to rebalance the body’s own healing ability Ask students have they ever used any biofield therapies. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Biofield Therapies (con’t) Reiki A practitioner acts as a conduit for healing energy that is directed into the patient’s energy field or body Channels energy to the patient, and the patient’s body does the healing Therapeutic touch Alters body energy fields to restore natural healing powers The hands of the practitioner are passed over the patient to ascertain where tensions or excessive energies exist Touch may be used to redirect energies and reestablish energy balance Biofield therapies are supposed to affect energy fields that surround and penetrate the human body. Bioelectromagnetic-based therapies are based on the use of electromagnetic fields. A therapy may use pulsed fields, magnetic fields, or alternating or direct current. The use of magnets on a body part to relieve pain is an example of a bioelectromagnetic therapy. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Mind and Body Interventions: Hypnotherapy Used to alter behavior, retrieve memories, and induce anesthesia A hypnotic state is created in which suggestions are implanted that remain during the posthypnotic period Hypnotherapy has had moderate success in helping people to quit smoking and to lose weight. Can all people be hypnotized? It does not work on all people. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Mind and Body Interventions: Music, Art, and Dance Therapy Art therapy helpful when the person has difficulty expressing feelings verbally Music therapy beneficial for expressing feelings, reducing stress and anxiety, enhancing relaxation; also a distraction to aid in pain management Dance therapy promotes recognition of feelings and awareness of the body An artistic medium is used to help the individual neutralize conflict or work through a problem. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Mind and Body Interventions: Humor Proven very helpful as complementary treatment Can speed the course of healing and decrease pain Generally will raise spirits and help to bring about a more positive outlook Watching movies or comedy sketches or reading humorous literature is distracting, and laughter seems to have a positive effect on the body. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Mind and Body Interventions: Prayer Helps reduce stress, promotes healing, and may arrest disease May be practiced individually or in groups as intercessory prayer Prayer chains Different people pray for a set time for an individual’s recovery over a period of hours or days; considered beneficial by many people Research has shown that prayer can be effective in healing. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Question 1 Sara’s patient is nervous about a painful procedure tomorrow. Her patient is using a visual stimulus to produce a particular physiologic change that can decrease stress or pain. Her patient is using which relaxing therapy? Imagery Meditation Biofeedback Hypnotherapy Answer: 1 Rationale: Imagery uses a visual stimulus to produce a physiologic change to decrease stress or promote healing. It may produce an effect on all the major systems. Meditation involves focusing attention on a single repetitive stimulus. Biofeedback is a technique that trains the patient to lessen symptoms by learning to control a particular internal physiologic process. Hypnotherapy is used to heal a behavior and retrieve memories. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Lesson 32.2 Overview of Alternative Therapies Theory Direct patients to information needed to make a decision on whether to use an herbal preparation. Describe the desired outcome of spinal manipulation during chiropractic treatment. Clinical Practice Assess the use of complementary and alternative therapies by assigned patients. Direct patients to information about complementary and alternative therapies. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Natural Products: Herbal Therapy/Aromatherapy Used by more than 70% of the world’s population Medicines contain plants as their active ingredient Used to treat a wide variety of conditions Many herbs interact with prescription drugs Aromatherapy Oils from plants absorbed through the skin or inhaled Thought to act on the brain to evoke pleasant feelings related to past experiences and emotions Aromatherapy may be combined with a body-based therapy. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Herbs Determined to Be Safe by Non-U.S. Authorities Aloe Astragalus Bilberry Cat’s claw Chamomile Dong quai Echinacea Feverfew Garlic Ginger Ginkgo biloba Ginseng Goldenseal Hawthorn Milk thistle St. John’s wort Saw palmetto Valerian What medical conditions are known to be improved by these herbal preparations? Refer to Table 32-1 Should these herbs be used in combination with traditional medications? Herbs may interact with various prescription drugs. Contraindications to taking an herb should be checked with the primary care provider and pharmacist before using it. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Other Complementary Interventions: Homeopathic Medicine Teaches that symptoms are signs of the body’s effort to get rid of disease Disease can be cured by giving small doses of substances that produce symptoms of the disease Stimulates a person’s natural defenses, alleviating the problem Three principles: Like cures like The greater the dilution of the remedy, the greater its potency Illness is specific to the individual Homeopathic medicine: stimulates the patient’s natural defenses to alleviate the problem caused by a disease or disorder. focuses on the belief that energy or a “vital force” exists in plants, minerals, and other natural substances. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Other Complementary Interventions: Naturopathic Medicine A philosophy directed at the prevention of disease Use of natural means to promote health Lifestyle management, natural foods, massage, used with regular exercise to maintain the body at a high level of wellness through use of the body’s inherent healing ability What lifestyle management tools can be used in naturopathic medicine? Answers will vary. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Other Complementary Interventions: Traditional Chinese Medicine Based on opposition of polarities (yin/yang); the elements of wood, fire, earth, metal, and water; and the flow of energy (chi) in the body Focuses on looking for underlying causes of imbalance and patterns of disharmony in the body Uses medicinal plants, acupuncture, massage, Tai Chi, and Qi Gong for therapy Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Other Complementary Interventions: Ayurveda The traditional Hindu system of medicine Uses combinations of herbs, minerals, purgatives, massage, meditation, special diets Focuses on restoring and strengthening the body, mind, and spirit Healing focus is on maintenance of balance and wholeness to prevent illness The practice is holistic, aiming to treat imbalances of mind, body, and spirit to promote health and combat illness. Used in India along with orthodox medicine. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Other Complementary Interventions: Shamanism The shaman uses techniques to achieve a nonordinary reality, or a “shamanic” state of consciousness May perform various ceremonies including burning particular plants and herbs to bring about the rebalancing of the individual with nature The shamanic journey is the most common practice of the traditions. The journey is usually induced by rhythmic drumming or other percussive sounds. Involves the acquisition of power through interaction with spirits.  The shaman maintains a relationship with “spiritual helpers” to receive instruction and information to help patients. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Other Complementary Interventions: Folk Medicine A holistic approach to healing practiced throughout Latin America Illness is seen as an imbalance Hot and cold Patient and the environment Parts of the body Patient and the spiritual realm Biologic compounds, foods, and herbs are used to treat the physical components of the illness A curandero treats the supernatural components Curanderismo uses natural ingredients like herbs as remedies. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Other Complementary Interventions: Native American Medicine Healing herbs and ceremonies combined with a spiritual emphasis are used to treat ailing patients Therapies based on the belief that spirit, mind, and emotions all interact with the environment Patient’s disease or disorder is believed to be caused by a disharmony in the patient’s connection to nature and the spirit world Therapeutic approach combines spirituality, herbalism, and magic. Used to treat a wide range of physical and emotional ailments, from the common cold to depression. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Question 2 Which type of complementary therapy is a form of Chinese exercise-stimulation therapy that is supposed to improve health by redirecting mental focus, controlling breathing, improving coordination, and promoting relaxation? Acupuncture Qi Gong Ayurveda Shamanism Answer: 2 Rationale: Qi Gong is a form of Chinese exercise-stimulation therapy that is supposed to improve health by redirecting mental focus. It has been effective for many years for the management of chronic diseases. Acupuncture is the use of needles to stimulate certain points on the body. Ayurveda uses the combination of herbs, minerals, and special diets. Shamanism uses techniques to achieve a nonordinary reality. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Question 3 Peggy has a patient who verbalizes that she prefers to approach her illness in a holistic way. Which type of medicine uses this approach? Homeopathic Naturopathic Chinese Folk Answer: 4 Rationale: Folk medicine is a holistic approach to illness. Illness is thought to be an imbalance between hot and cold in the body. Naturopathic medicine is directed at the prevention of disease and healing of the body. Chinese medicine is a comprehensive system based on the opposition of polarities (yin and yang). Homeopathic medicine is based on the belief that symptoms are signs of the body’s effort to get rid of disease; treatment is based on the person as a whole. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Question 4 Chloe’s patient states, “I often use herbs when I am nauseated.” Which herb would Chloe’s patient use? Echinacea Ginseng Ginger St. John’s wort Answer: 3 Rationale: Ginger is an antiemetic. It would be helpful for a patient who is nauseated. Echinacea stimulates the immune system. Ginseng increases physical endurance, and St. John’s wort helps with depression. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Question 5 Jim’s patient asks if there are any herbs to shrink the prostate gland. Which of the following helps shrink the prostate gland?   Hawthorn Milk thistle Saw palmetto Valerian Answer: 3 Rationale: Saw palmetto helps with benign prostatic hyperplasia. It also helps with urinary problems. Hawthorn increases oxygen utilization by the heart. Milk thistle stimulates production of new liver cells. Valerian is a minor tranquilizer. Copyright © 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.