CHAPTER 47 COMPLEMENTARY AND ALTERNATIVE MEDICINE Robert A. Duarte, MD, Charles E. Argoff, MD 1. What is the definition of complementary and alternative medicine? There is no one prototype definition of complementary and alternative medicine (CAM), because the therapies keep changing, as well as moving from alternative to mainstream. At present, the term applies to a number of modalities that are not routinely taught in medical schools and are not generally part of conventional medicine. Presumably, as some of these modalities are shown to be useful, they will enter mainstream teaching and no longer be “alternative,” much as use of nitroglycerine and digitalis did. Chiropractic, osteopathy, and biofeedback have already entered the mainstream and are no longer considered strictly alternative. However, the general philosophy of complementary and alternative medicine is that your body has the ability to heal itself and that prevention of disease, above all, is most important. 2. How prevalent is the use of CAM in the United States? Most surveys show that about 40% of the U.S. population use one type or another of complementary medicine during a given year. Over 65% use at least one type of CAM therapy in their lifetime. About 70% of younger patients report having used some type of CAM therapy by age 33. 3. What are the major types of CAM therapies? The National Center for Complementary and Alternative Medicine (NCCAM) divides CAM into the following five categories: Alternative medicine systems Mind-body interventions Biologically based techniques Manipulative and body-based methods Energy therapies 4. What are the major precepts of Traditional Chinese Medicine? Traditional Chinese Medicine (TCM) is a holistic approach to health and disease that views both states as part of a continuum. The body is a system of balance, with a primary vital energy called “qi” (pronounced chee) that needs to circulate properly through the body, along lines called “meridians.” There is a complex system of these channels, and most techniques are aimed at establishing appropriate flow and movement of qi. TCM formulates a diagnosis based on eight principles: internal/external, yin/yang, hot/cold, excess/deficiency. 5. What are the major modalities used in TCM? The most commonly used techniques in TCM involve the insertion of acupuncture needles, diet through proper nutrition, preparing and ingesting Chinese herbs, and massage. Exercising the body through such activities as qigong and tai chi (movement exercises) are also thought to be vital. 6. How is acupuncture applied? Acupuncture is literally translated into acus = needle and punctare = penetration. Medically, it refers to skin puncture with needles to produce a given effect. The selection of puncture points varies depending on the underlying pathology. Acupuncture is one of the oldest forms of recorded medical therapy, with documented cases going back more than 4000 years. It is applied by the simple insertion of metal needles along the meridians (i.e., channels) and at local points known as ah shi points. There are different types of acupuncture stimulation, including manual, application of heat, electrical stimulation, moxa (gum wort), or laser. It is unclear that any specific type of acupuncture is superior to another, although anecdotal evidence suggests that electroacupuncture may be useful for myofascial pain syndromes and auriculotherapy for drug addiction. 7. What are some of the variants of acupuncture currently employed for pain management? TCM acupuncture focuses on meridians or channels and intervention at specific sites—depending on the goal, e.g., surgical anesthesia, relief of pain, therapeutic purposes—is presumed to reestablish appropriate energy flow. Other schools support the use of trigger point manipulation with needles, or use of the ear, hand, and scalp as representative points. 8. What are the proposed mechanisms of action for acupuncture analgesia? TCM holds that the mechanism of action for acupuncture analgesia is release of stagnation of qi (the vital force). Needling also produces an increase in blood flow and a decrease of local prostaglandin and histamine release. Many studies reveal that electrostimulation produces effects on the spinal cord, midbrain, and pituitary. Following insertion of an acupuncture needle, there is a release of enkephalin, endorphins, and possibly gammaaminobutyric acid (GABA) at the spinal site; a release of enkephalin, serotonin, and norepinephrine at the midbrain site; and a release of endorphins at the pituitary site. At least three studies have shown that naloxone, an opioid antagonist, can partially reverse the analgesia caused by acupuncture, advocating the strong possibility that at least some of the analgesia is mediated by endogenous opioids. There continues to remain a few skeptics that believe acupuncture works through a placebo effect. 9. What were the conclusions from the U.S. National Institute for Health Acupuncture Consensus Panel meeting in 1997? The U.S. National Institute for Health Acupuncture Consensus Panel’s statement in 1997 held that evidence supported acupuncture for adult postoperative pain (including dental pain), myofascial pain, and low back pain. There was reasonable or promising evidence for acupuncture as a treatment for pain caused by menstrual cramps, tennis elbow, fibromyalgia, osteoarthritis, carpal tunnel syndrome, and headache. There was no evidence to support acupuncture for weight reduction or smoking cessation. 10. True or false: The scientific evidence that acupuncture is effective for fibromyalgia is convincing Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Neuroimaging in the Patient with Pain Pharmacologic Management Tension-Type Headache Neuropathic Pain Cancer Pain Syndromes Temporary Neural Blockade Stay updated, free articles. Join our Telegram channel Join Tags: Pain Management Secrets Jun 14, 2016 | Posted by admin in PAIN MEDICINE | Comments Off on Complementary and Alternative Medicine Full access? Get Clinical Tree
CHAPTER 47 COMPLEMENTARY AND ALTERNATIVE MEDICINE Robert A. Duarte, MD, Charles E. Argoff, MD 1. What is the definition of complementary and alternative medicine? There is no one prototype definition of complementary and alternative medicine (CAM), because the therapies keep changing, as well as moving from alternative to mainstream. At present, the term applies to a number of modalities that are not routinely taught in medical schools and are not generally part of conventional medicine. Presumably, as some of these modalities are shown to be useful, they will enter mainstream teaching and no longer be “alternative,” much as use of nitroglycerine and digitalis did. Chiropractic, osteopathy, and biofeedback have already entered the mainstream and are no longer considered strictly alternative. However, the general philosophy of complementary and alternative medicine is that your body has the ability to heal itself and that prevention of disease, above all, is most important. 2. How prevalent is the use of CAM in the United States? Most surveys show that about 40% of the U.S. population use one type or another of complementary medicine during a given year. Over 65% use at least one type of CAM therapy in their lifetime. About 70% of younger patients report having used some type of CAM therapy by age 33. 3. What are the major types of CAM therapies? The National Center for Complementary and Alternative Medicine (NCCAM) divides CAM into the following five categories: Alternative medicine systems Mind-body interventions Biologically based techniques Manipulative and body-based methods Energy therapies 4. What are the major precepts of Traditional Chinese Medicine? Traditional Chinese Medicine (TCM) is a holistic approach to health and disease that views both states as part of a continuum. The body is a system of balance, with a primary vital energy called “qi” (pronounced chee) that needs to circulate properly through the body, along lines called “meridians.” There is a complex system of these channels, and most techniques are aimed at establishing appropriate flow and movement of qi. TCM formulates a diagnosis based on eight principles: internal/external, yin/yang, hot/cold, excess/deficiency. 5. What are the major modalities used in TCM? The most commonly used techniques in TCM involve the insertion of acupuncture needles, diet through proper nutrition, preparing and ingesting Chinese herbs, and massage. Exercising the body through such activities as qigong and tai chi (movement exercises) are also thought to be vital. 6. How is acupuncture applied? Acupuncture is literally translated into acus = needle and punctare = penetration. Medically, it refers to skin puncture with needles to produce a given effect. The selection of puncture points varies depending on the underlying pathology. Acupuncture is one of the oldest forms of recorded medical therapy, with documented cases going back more than 4000 years. It is applied by the simple insertion of metal needles along the meridians (i.e., channels) and at local points known as ah shi points. There are different types of acupuncture stimulation, including manual, application of heat, electrical stimulation, moxa (gum wort), or laser. It is unclear that any specific type of acupuncture is superior to another, although anecdotal evidence suggests that electroacupuncture may be useful for myofascial pain syndromes and auriculotherapy for drug addiction. 7. What are some of the variants of acupuncture currently employed for pain management? TCM acupuncture focuses on meridians or channels and intervention at specific sites—depending on the goal, e.g., surgical anesthesia, relief of pain, therapeutic purposes—is presumed to reestablish appropriate energy flow. Other schools support the use of trigger point manipulation with needles, or use of the ear, hand, and scalp as representative points. 8. What are the proposed mechanisms of action for acupuncture analgesia? TCM holds that the mechanism of action for acupuncture analgesia is release of stagnation of qi (the vital force). Needling also produces an increase in blood flow and a decrease of local prostaglandin and histamine release. Many studies reveal that electrostimulation produces effects on the spinal cord, midbrain, and pituitary. Following insertion of an acupuncture needle, there is a release of enkephalin, endorphins, and possibly gammaaminobutyric acid (GABA) at the spinal site; a release of enkephalin, serotonin, and norepinephrine at the midbrain site; and a release of endorphins at the pituitary site. At least three studies have shown that naloxone, an opioid antagonist, can partially reverse the analgesia caused by acupuncture, advocating the strong possibility that at least some of the analgesia is mediated by endogenous opioids. There continues to remain a few skeptics that believe acupuncture works through a placebo effect. 9. What were the conclusions from the U.S. National Institute for Health Acupuncture Consensus Panel meeting in 1997? The U.S. National Institute for Health Acupuncture Consensus Panel’s statement in 1997 held that evidence supported acupuncture for adult postoperative pain (including dental pain), myofascial pain, and low back pain. There was reasonable or promising evidence for acupuncture as a treatment for pain caused by menstrual cramps, tennis elbow, fibromyalgia, osteoarthritis, carpal tunnel syndrome, and headache. There was no evidence to support acupuncture for weight reduction or smoking cessation. 10. True or false: The scientific evidence that acupuncture is effective for fibromyalgia is convincing Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Neuroimaging in the Patient with Pain Pharmacologic Management Tension-Type Headache Neuropathic Pain Cancer Pain Syndromes Temporary Neural Blockade Stay updated, free articles. Join our Telegram channel Join Tags: Pain Management Secrets Jun 14, 2016 | Posted by admin in PAIN MEDICINE | Comments Off on Complementary and Alternative Medicine Full access? Get Clinical Tree
