Complementary and alternative medicine (Proceedings)

What is Complementary and Alternative Medicine (CAM)?

The National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes of Health, defines CAM as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine." Alternative medicine is the use of these modalities instead of conventional medicine while complementary medicine is the application of these modalities in conjunction with conventional medicine. Other synonyms for conventional medicine include allopathic medicine, Western medicine, orthodox medicine, and biomedicine. Conventional medicine is practiced by those that have earned M.D. or D.O. degrees, and by other "allied health professionals" including registered nurses, physical therapists and psychologists.

NCCAM defines integrative medicine as the combination of "standard medicine with CAM practices that have been shown to be effective". For others, integrative medicine is a comprehensive approach to health care that conveys the integration of Western and alternative therapies utilized together. For example, in human medicine, meditation and massage therapy are being used in conjunction with chemotherapy in the treatment of cancer. Integrative medicine is the new wave in health care and will be the future of medicine. Currently it is part of the curriculum at 28 major medical schools in the United States. Functional medicine is a new branch of integrative medicine which utilizes evidence-based, proven methods from alternative and conventional modalities, to look at the individual core physiology of each patient, including historical events and emotional state.

Holistic health is not a modality but a philosophy that views the physical, mental, emotional and spiritual aspects of life as well as relationships, to be closely interconnected and balanced. The focus is on the whole person, not just the disease or clinical signs with which they present. Essentially, it is looking at the body as a complete, WHOLE package.

In 2002, a National Health Interview Survey conducted by the NCCAM and the National Center for Health Statistics (part of the Centers for Disease Control and Prevention) found that 36% of American adults use some form of CAM, but when megavitamin therapy and prayer for health reasons was included, that number jumped to 62%. A recent survey by AARP and NCCAM found that almost two-thirds of people 50 years or older are using some form of CAM but less than one third of them discuss CAM usage with their health providers.

Similar trends are seen in veterinary medicine. A 1990 University of Florida survey revealed that 34% of animal owners utilized some form of CAM. By 1997, survey results showed an increase to 42% but 60% of these people did not provide this information to their regular veterinarian.

Current AVMA Guidelines for Complementary and Alternative Veterinary Medicine do not recognize complementary and alternative medicine as a specialty. Recognition of a veterinary specialty organization by the AVMA requires "demonstration of a substantial body of scientific knowledge. Additionally, the AVMA has not evaluated the training or education programs of other entities that provide certificates for alternative modalities.

While we may not perceive the merit of many CAM modalities that are utilized today, it is our responsibility to be educated on the benefits and risks of the major treatment therapies that are being utilized at an increasing rate by health care professionals and non-health care practitioners.

CAM practices have been grouped into whole medical systems and 4 other domains by NCCAM:

• Whole Medical Systems

• Mind-Body Medicine

• Biologically Based Practices

• Manipulative and Body-Based Practices

• Energy Medicine.

Whole Medical Systems

These are complete, stand-alone medical systems that have evolved over long periods of time in different parts of the world.

Ayurvedic Medicine

This term literally means "the science of life". It is a natural medical system that was developed in India over 5000 years ago and emphasizes the balance of the physical, emotional and spiritual states. Nutrition, meditation, yoga, massage and herbs, controlled breathing and exposure to sunlight are utilized in treatment protocols.

Traditional Chinese Medicine

This is also known as Traditional Oriental Medicine (TOM). This medical system extends as far back as 2200 BC-3000 BC. Health is a balance of Qi (energy), Yin and Yang; disease is therefore an imbalance in the body. Acupuncture, herbal formulas, Tui-na (Chinese medical massage), food therapy and Tai Chi or Qi Gong are utilized to achieve and maintain balance. Acupuncture is widely accepted and has been scientifically proven to be effective in managing chemotherapy-associated nausea and vomiting, and in controlling pain associated with surgery. It has broad applications and can be used in the treatment of problems that involve behavior, neurology, endocrinology, oncology, dermatology, internal medicine and musculoskeletal issues.

Homeopathy

This 200 year old science of natural pharmaceuticals was started by the German physician, Samuel Hahnemann in 1796. This system is based on the "law of similars" or "like treats like". Remedies are derived from plants, animals or minerals. The remedy is selected based upon how closely it will produce the same symptoms that a patient is exhibiting. The remedy is prepared by a dilutional technique so that it retains the energetic pattern of the original substance without causing toxicity. There is not a substantial amount of the original substance left in the remedy. Theoretically, the remedy creates an "artificial disease" in the body that displaces the natural disease and allows the body to help heal itself. The use of homeopathy has created some skepticism and controversy in the scientific community however the 2002 National Health Interview Survey revealed that around 7.4 million people had used homeopathy.

Naturopathic Medicine

Literal translation of "naturopathy" is "nature disease". Naturopathic medicine originated in Europe and utilizes a distinctly natural approach to health and healing. Reportedly, it also has roots in India, along with Ayurveda, but is practiced in many countries around the world. Treatment of disease and injury is through stimulation, enhancement and support of the body's inherent healing capability. The principles of healing are based on observation of the nature of health and disease with continued reexamination of treatments with emerging scientific analysis.

Mind-Body Medicine

Mind-body medicine utilizes the mind's ability to affect physiological function. A variety of techniques are utilized and some are now considered to be mainstream; examples include biofeedback, art, music or dance therapy, medication, spiritual healing/prayer and support groups. Many of these techniques are not directly applicable in veterinary medicine or are self-explanatory so descriptions of these are not listed below. It is important to recognize that benefits the animal guardian receives from these modalities may transfer to the animal as well, especially if the human-animal bond is very close.

Biologically Based Practices

Biologically based practices utilize substances that are found in nature. Botanicals, animal-derived extracts, food, vitamins, minerals, fatty acids, amino acids, proteins, prebiotics, probiotics, and other dietary supplements are included in this domain. It is important to remember that dietary supplements and drugs (both pharmaceutical and over-the-counter drugs) are not regulated similarly by the FDA. On June 22, 2007 the U.S. Food and Drug Administration issued the final rule establishing regulations to require current good manufacturing practices (cGMPs) for dietary supplements. Previously, manufacturers of nutraceuticals followed existing manufacturing requirements for foods, not drugs. Drugs must be deemed safe and effective by the FDA prior to entering the marketplace; conversely ensuring the safety of nutraceuticals is currently under the purview of the manufacturers. The new regulations which took effect in 2007 and 2008, ensure that nutraceuticals are processed in a consistent manner and meet quality standards. The cGMPs apply to all domestic and foreign companies that manufacture, label, hold, package, test, and distribute nutraceuticals in the U.S.

Aromatherapy

Aromatherapy is the therapeutic use of essential oils for psychological and physical well-being. Essential oils are the volatile parts of aromatic plants that have been extracted by steam distillation (e.g., eucalyptus oil) or expression (e.g., grapefruit). These essential oils are inhaled, used topically or ingested. When inhaled, essential oils activate the limbic system and emotional centers of the brain. When used topically, as in massage, they may kill microbes and fungi, and activate thermal receptors. Ingestion (of pharmacological drugs; generally not recommended for home use) may stimulate the immune system. Scientific studies on humans and animals have revealed that lavender oil inhalation has anxiolytic effects.1,2 In a study with hypertensive humans, aromatherapy treatment consisting of lavendar, ylang-ylang and bergamot once daily for 4 weeks, resulted in the reduction of psychological stress responses, serum cortisol levels and blood pressure.3

Chelation therapy

Chelation therapy is the use of chelating agents such as dimercaptosuccinic acid (DMSA), sodium dimercaptopropanesulfonate (DMPS) and alpha lipoic acid (ALA) to remove heavy metals from the body. The most common forms of heavy metal toxicity include lead, arsenic or mercury.

Herbal Medicine

Herbal medicine is often called phytotherapy or botanical medicine. The NIH Office of Dietary Supplements defines a botanical as "a plant or plant part valued for its medicinal or therapeutic properties, flavor, and/or scent. Herbs are a subset of botanicals. Products made from botanicals that are used to maintain or improve health may be called herbal products, botanical products, or phytomedicines." Western herbal treatments typically use a single herb while Chinese and Ayurvedic herbal medicines are commonly mixtures of two or more herbals. Herbal medicine is commonly combined with Acupuncture in veterinary patients.

Manipulative and Body-Based Practices

There are many different modalities within this medical system and new ones are constantly being developed.

Chiropractic

Formal foundation in 1895. Natural method of healing that focuses on spinal health and wellness as the key to overall well-being. Spinal manipulation and adjustment is achieved with pressure. Other treatments may be utilized with adjustment or manipulation, such as ultrasound, electric muscle stimulation, controlled exercise and nutrition

Craniosacral therapy

This therapy was invented in the 1930's by William G. Sutherland, D.O. Craniosacral therapy (osteopathy) is the manipulation of the cranium and sacrum to alleviate pain and other ailments, including cancer. Energy, harmony, balance, rhythm and flow are emphasized in this therapy.

Massage

Manipulation of tissue with hands or special tools.

Osteopathy

Osteopathic medicine traces back to 1874 in the United States and emphasized the neuromuscular system in health and disease. It utilizes manual and physical treatments for the prevention and treatment of disease, particularly musculoskeletal problems.

Tui-na

Also known as An-mo, Tui-na is one of the five branches of Traditional Chinese Medicine and can also be considered as Chinese medical manipulation/massage. There are over 30 different techniques that range from the application of pressure at acupuncture points or meridians, to stretching and gently shaking the limbs. Massage and some chiropractic techniques are utilized.

Veterinary Orthopedic Manipulation (VOM)

similar to the Activator Methods in chiropractic care, VOM uses a hand-held device to reduce subluxations. Healing is based on identifying areas of the nervous system that have "fallen out of communication" and re-establishing neuronal communication to induce healing.

Energy Medicine

Energy medicine is rooted in the belief that the body has energy fields which may be used for healing and wellness. There are two types of energy therapies: biofield therapies and bioelectromagnetic-based therapies. Biofield therapies manipulate the body's energy fields through the application of direct pressure or by the practitioner's placing of his/her hands in or through these energy fields. Bioelectromagnetic-based therapies utilize electromagnetic fields, such as pulsed fields, magnetic fields, alternating current or direct current EM fields.

Qi-gong

One of the five branches of Traditional Chinese Medicine. It involves movement, meditation and controlled breathing to enhance the flow of Qi (roughly translated as energy), improve circulation and enhance the immune system.

Reiki

Energy balancing either remotely or by direct placement of the hands on or near the patient.

Therapeutic touch

Movement of the hands over the body's energy fields

Flower Essences

Developed by Dr. Edward Bach in the early 20th century, this system of medicine uses wildflowers as natural remedies. The action of flower essences is through the "life force" of the flowers utilized. Each flower (type) has a specific energetic pattern which acts on the emotional body enabling the body to heal itself.

Magnetic Therapy

The use of static magnets to relieve pain and increase energy. There is growing evidence that magnetic fields can influence physiological processes.

References

Shaw D, Annett JM, Doherty B, Leslie JC. Anxiolytic effects of lavender oil inhalation on open-field behaviour in rats. Phytomedicine. May 3, 2007.

Umezu T, Nagano K, Ito H, Kosakai K, Sakaniwa M, Morita M. Anticonflict effects of lavender oil and identification of its active constituents. Pharmacol Biochem Behav. 2006 Dec;85(4):713-21.

Hwang JH. Article in Korean. [The effects of the inhalation method using essential oils on blood pressure and stress responses of clients with essential hypertension]. Taehan Kanho Hakhoe Chi 2006 Dec;36(7):1123-34.