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Complementary and Alternative Medicine

Complementary and Alternative Medicine is a topic covered in the 5-Minute Clinical Consult.

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Basics

  • Complementary and alternative medicine (CAM) are medical and health care systems, practices, and products not presently considered part of conventional medicine.
  • The National Center for Health Statistics (NCHS) reports nonvitamin, nonmineral dietary supplements, chiropractic or osteopathic manipulation, yoga, and massage therapy are the most common complementary health approaches.
  • Medical professionals who incorporate CAM into their medical practice often refer to this model as “integrative medicine.”

Description

  • Definitions and additional terms
    • Complementary medicine is used in conjunction with conventional medicine to address a health concern. For example, massage plus physical therapy for low back pain or medication plus osteopathic manipulation for recurrent headaches.
    • Alternative medicine is used in place of conventional medicine to promote healing of conditions not fully explained by the conventional biomedical model or for which the effectiveness of therapy is not yet established by clinical research.
    • Integrative medicine is the combination of allopathic medicine with CAM and may be provided to the patient by a single licensed medical professional trained in CAM or by a group of diverse health care providers.
    • Holistic is a descriptive term for a practitioner’s approach to patient care. Holistic care assesses the emotional, spiritual, mental, and physical state of wellness of the patient and works to provide comprehensive care. A holistic practice may include practitioners of different disciplines to address multiple aspects of wellness or illness.
  • Biologically based therapies: diets, herbals, vitamins, supplements, flower essences
  • Manipulative and body-based methods
    • Massage therapy is manipulation of the body’s soft tissues, using knowledge of anatomy and physiology to restore function, promote relaxation, and relieve pain. There are different types of massage.
    • Osteopathic manipulative medicine includes indirect techniques (e.g., muscle energy, myofascial release, osteopathy in the cranial field, and strain–counterstrain approach) as well as direct action techniques (high-velocity thrusts).
    • Craniosacral therapy is a gentle release of bony and fascial restrictions in the craniosacral system (cranium, sacrum, spinal cord, meninges, CSF).
    • Chiropractic therapy focuses on the musculoskeletal and nervous systems and how imbalances in these systems can affect general health. It is used to treat back, neck, and joint pain. Doctors of chiropractic (DCs) complete 4 to 5 years of intensive training in anatomy, physiology, and manipulation.
  • Mind–body medicine
    • Meditation is a practice of detachment in which a person sits quietly, generally focusing on the breath, while releasing thoughts from the mind with the intention to center the self, restore balance, and enhance well-being. Mindfulness meditation involves making oneself aware of the most immediate of activities in order to gain control over actions and anxiety.
    • Spiritual practices (e.g., prayer)
    • Yoga is an exercise of mindfulness, meditation, strength and balance, composed of asanas (postures) and pranayamas (focused breathing).
    • Aromatherapy uses highly concentrated plant extracts to stimulate healing. Aromatic oils are rubbed on the skin, aerosolized, or used in compresses.
    • Relaxation techniques include breathing exercises, progressive muscle relaxation, and guided imagery.
    • Tai chi and qi gong are Chinese exercise systems that combine meditation, regulated breathing, and flowing dance-like movements to enhance and balance chi (qi)—life force energy.
  • Alternative medical systems
    • Traditional Chinese medicine incorporates Chinese herbs and acupuncture. Acupuncture is the practice of regulating chi by inserting thin needles at specific points along meridian pathways of the body. Chi movement is responsible for animating and protecting the body; relieving pain; and regulating cellular blood flow, oxygen delivery, and nourishment.
    • Ayurvedic medicine originated in India and is one of the world’s oldest medical systems. It uses healing modalities and herbs to integrate and balance the body, mind, and spirit.
    • Homeopathy is based on the concept that very dilute quantities of an offending agent can stimulate innate immunity. In general, homeopathic remedies are considered safe and unlikely to cause serious adverse reactions. Only three states license homeopaths.
    • Naturopathy regimens include herbs, vitamins, supplements, dietary counseling, homeopathic remedies, manipulative therapies, acupuncture, and hydrotherapy. 4-year doctoral training programs are available; however, only 20 states/territories have licensing laws for naturopathic practitioners.
  • Energy therapies
    • Reiki, which means “source energy,” is a healing practice from Japan. Laying hands lightly on the patient or holding the hands just above the body, the reiki practitioner facilitates spiritual and physical healing by stimulating life force energy.
  • Common reasons patients choose CAM
    • Additive therapy to address issues not covered by conventional medical treatment
    • Conventional medicine has been unsuccessful in fully addressing ailment.
    • Preventive health care
    • Desire for a holistic or natural approach to well-being
    • Preference for noninvasive treatment options
    • Concern about medication side effects
    • Desire to include spiritual support into healing
    • Cultural or familial belief system more aligned with “natural” solutions not provided for or supported by the standard allopathic model of health care

Epidemiology

  • All ages use CAM, but it is most prevalent among adults aged 30 to 69 years.
  • Gender ratio: female > male
  • College graduates and residents of western states are more likely to use CAM.
  • Cancer survivors are more likely than the general population to use CAM.
  • Six most used CAM therapies:
    • Nonvitamin, nonmineral dietary supplements (18%)
    • Chiropractic and osteopathic manipulation (8.5%)
    • Yoga (8%)
    • Massage (7%)
    • Meditation (4%)
    • Special diets (3%)

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Citation

Stephens, Mark B., et al., editors. "Complementary and Alternative Medicine." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816261/all/Complementary_and_Alternative_Medicine.
Complementary and Alternative Medicine. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816261/all/Complementary_and_Alternative_Medicine. Accessed April 18, 2019.
Complementary and Alternative Medicine. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816261/all/Complementary_and_Alternative_Medicine
Complementary and Alternative Medicine [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 18]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816261/all/Complementary_and_Alternative_Medicine.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Complementary and Alternative Medicine ID - 816261 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816261/all/Complementary_and_Alternative_Medicine PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -