Presentation Overview • Nature, Use, and Claims of CAM • Conducting CAM Research • Ethical Issues in CAM
Alternative & Complementary Therapies • Alternative Therapies are used instead of conventional or mainstream medical modalities. • Complementary Therapies are used in conjunction with conventional or mainstream medical modalities.
Non-traditional Therapies • Ever increasing numbers of health care consumers are using nontraditional treatment modalities.
Roots of Nontraditional Therapies • Ancient Greece: massage, art therapy, herbal therapy. • The Far East: energetic-touch therapies. • China: acupuncture, herbalism. • India: Ayurvedic medicine.
The Shamanistic Tradition • Shamanism refers to the practice of entering altered states of consciousness with the intent of helping others. • The shaman is a folk healer-priest.
Modern Trends • Mind-Body Medicine and Research. • Holism and Nursing Practice. Modern medicine is looking to non-traditional medicine for insight into two main areas:
Mind-Body Medicine and Research • The traditional medical model is founded on the belief that the mind, body, and spirit are separate entities. A relatively new field of science, however, is called: Psychoneuroimmunology.
Psychoneuroimmunology • The study of the complex relationship among the cognitive, affective, and physical aspects of humans.
Body-Mind • The inseparable connection and operation of thoughts, feelings, and physiological functions.
Holism and Nursing Practice As a healing facilitator, the nurse enters into a relationship with the client and can be a: • guide. • change agent. • instrument of healing.
Nurse as Instrument of Healing • Knowledge base. • Intentionality (having conscious direction of goals). • Respect for differences. • Ability to model wellness. To serve in this capacity, a nurse should develop the following attributes:
Using Alternative & Complementary Therapies • Have a non-judgmental attitude. • Ask clients if they use nontraditional therapies. • Get instruction in these therapies before trying to administer them. • Try one or two basic therapies (e.g. massage or guided imagery). • Discuss a therapy with the client before using it.
Common Elements of Alternative & Complementary Interventions • The whole system is considered. • The person is integrated and related to the surroundings. • There exists some life force or energy to be used in the healing process. • Ritual, prescribed practice and skilled practitioners are vital to holistic healing interventions.
Mind-Body (Self-Regulatory) Techniques • Methods by which an individual can, independently or with assistance, consciously control some functions of the sympathetic nervous system (e.g. heart rate, respiratory rate, blood pressure).
Leading Mind-Body Techniques • Meditation • Relaxation • Imagery • Bio-feedback • Hypnosis
Meditation • Quieting the mind by focusing the attention. • Benefits include: stress relief, relaxation, reduced level of lactic acid, efficient & effective oxygen consumption, slowed heart rate, decreased blood pressure, improved functioning of the immune system.
Relaxation • A therapeutic process incorporating the basic elements of meditation. • Basic elements include: a quiet environment, a comfortable position, focused attention, a passive attitude, practice.
Imagery • A technique of using the imagination to visualize a soothing, pleasant image. • Benefits include: decreased physical tension, decreased anxiety, and decreasing the adverse effects of chemotherapy.
Bio-feedback • The measurement of physiological responses that yields information about the relationship between the body and mind and helps clients learn ways to manipulate those responses through mental activity.
Uses of Bio-feedback • A restorative method in rehabilitation settings for clients who have lost sensation and function as result of injury or illness. • To relieve tension headaches, migraines and backache. • To reduce bruxism (grinding of the teeth). • To lower blood pressure. • Temperature bio-feedback useful in treating Raynaud’s disease (constriction and spasms of small arteries).
Therapeutic Hypnosis • Induces an altered state of consciousness or awareness resembling sleep during which the person is more receptive to suggestion. • Hypnosis also enhances client’s ability to form images (for guided imagery).
Body-Movement Therapies • Therapies employing techniques of moving or manipulating various body parts to achieve therapeutic outcomes.
Leading Body-Movement Strategies • Movement and Exercise • Yoga • Tai Chi • Chiropractic Therapy
Energetic-Touch Therapies • Techniques of using the hands to direct or redirect the flow of the body’s energy fields and thus enhance balance within those fields.
Leading Energetic-Touch Therapies • Therapeutic massage • Therapeutic touch • Healing touch • Shiatsu • Acupressure • Reflexology
Cultural Considerations of Touch • Ask permission before touching a client. • Tell the client what is going to happen. • The meaning of touch and the body areas acceptable to touch vary from culture to culture.
Leading Spiritual Therapies • Faith healing. • Healing Prayer and Chanting (Kiirtan). • Shamanism. Spiritual therapies can be helpful modalities in caring for clients. Important spiritual therapies include:
Leading Nutritional/Medicinal Therapies • Phytochemicals. • Antioxidants and Free Radicals. • Macrobiotic Diet. • Herbal Therapy.
Phytochemicals • Non-nutritive, physiologically active compounds present in plants in very small amounts. • Protect against cancer and prevent heart disease, stroke, and cataracts. • Source: fruits and vegetables.
Antioxidants and Free Radicals • Antioxidants: substances that prevent or inhibit oxidation, a chemical process whereby a substance is joined to oxygen. • Free radicals: Antioxidants prevent tissue damage related to these, which are unstable molecules that alter genetic codes and trigger the development of cancer growth.
Other Important Methodologies • Aromatherapy. • Humor. • Pet Therapy. • Music Therapy. • Play Therapy. • Yogic Dances.
Important Terms Associated with Treatment Modalities • Proven - have been scientifically tested in clinical trials. • Experimental - are undergoing regulatory (e.g. FDA) investigations. • Untested - have not been investigated by regulatory bodies. • Folklore - passed through generations. • Quackery - no proven effectiveness, may harm consumer.
What Is CAM? … medical and health care practices outside the realm of conventional medicine, which are yet to be validated using scientific methods Complementary:togetherwith conventional practices Alternative:inplaceof conventional practices
Codeine for pain Digitalis for heart failure Ipecac for poisoning Quinine for malaria Aspirin for fever Behavioral therapyfor headache Hypnosis for smoking cessation Low fat, low cholesterol diets Exercisefor diabetes Support groupsfor breast cancer CAM Modalities Now in Mainstream Medicine
The Appeal of CAM • Media reports of dramatic results • Belief that CAM treatments are natural • Patient empowerment • Focus on spiritual and emotional well-being • Therapist providing “touch, talk, time”
CAM Use in the United States • 62% of adults 18+ used CAM in the past year • More women than men; higher educated; sicker; with more pain • Top 10: • 43% prayed for self • 24% others prayed for you • 19% natural products • 12% deep breathing exercises • 10% participate in prayer group • 8% meditation • 8% chiropractic • 5% yoga • 5% massage • 4% diet-based therapies Barnes et al., CDC ADR, 2004
NCCAM’s Mission • Conduct rigorous research on CAM practices • Train CAM researchers • Inform consumers and health professionals
Who Is the Practitioner? • Medical doctors • CAM practitioners • Traditional healers
Americans spend more out-of-pocket for CAM than for all other health care needs CAM is big business 56% of Americans believe their health plans should cover CAM Many health insurers and HMOs now cover CAM: Blue Cross of Washington and Alaska, Oxford Health, Prudential, Kaiser Permanente CAM Economics
Who uses CAM? • More educated • In poorer health • More affluent • Possess a holistic orientation to health • Had a ‘transformational experience’ • Identification with environmentalism, feminism, spirituality • Report chronic anxiety, pain, UTI, back problems (Astin et al. JAMA ,1998)
Biological Research - It’s All “Natural”…! “People can be induced to swallow anything, provided it is sufficiently seasoned with praise.” Jean Moliere
Dietary Supplements: DSHEA Definition • Product intended to supplement the diet • Contains one or more of the following: • Vitamin • Mineral • Herb or other botanical (not tobacco) • Amino acid • Any other dietary substance • For oral intake as a concentrate, metabolite, extract, constituent, or combination
Patterns of Supplement Use:The Slone Survey • 2590 participants 18 years + • Telephone survey, random sampleFeb 1998 - Dec 1999 • In the preceding week: • 14% of population used herbalsand/or supplements • 16% of prescription drug users used herbals and/or supplements JAMA, 2002
Patterns of Supplement Use:The Slone Survey Ten Most Commonly Used Herbals / Supplements • Ginseng • Ginkgo biloba • Allium sativum • Glucosamine • St. John’s wort • Echinacea • Lecithin • Chondroitin • Creatine • Serenoa repens JAMA, 2002
Patterns of Supplement Use:The Slone Survey Ten Most Common Reasons for taking herbs / supplements • General health/good for you (16%) • Arthritis (7%) • Memory improvement (6%) • Energy (5%) • Immune booster (5%) • Joints (4%) • Supplement diet (4%) • Sleep aid (3%) • Prostate (3%) • No reason (2%) • All other reasons (45%) JAMA, 2002
Challenges of Herbal Medicines • Safety is assumed, not proven • Lack of product standardization • Contamination with drugs, heavy metals • Allergic reactions • Inherent toxicity • Interactions with drugs • Replacing proven therapies
Ephedra: Safety Concerns • Ma huang (Ephedra sineca) – Short-term TCM treatment for asthma, decongestion • Contains L-ephedrine, pseudoephedrine • Major current use in U.S. in combination with caffeine for weight loss, athletic performance • Dozens of reports of severe and life-threatening adverse events in young people