Health Psychology

Chapter 14:

Alternative Medicine

Dec 7, 2007

Classes #43

Complementary and Alternative Medicine (CAM)

A group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine

Healing therapies that typically fall outside the Western biomedical model of disease, diagnosis, and treatment

Examples of CAM

Acupuncture Imagery

Aromatherapy Magnets

Biofeedback Massage

Chiropractic Prayer

Diets Reflexology

Exercise Relaxation

Folk remedies Self-help/support groupsHerbal/botanical therapy Spiritual healing (by others) Homeopathy Vitamins

Hypnosis Yoga

Complementary and Alternative Medicine (CAM)

The list of what is considered to be CAM changes continually as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge

Why do people use CAM?

Desire for health and wellness (1) Prevention Cancer- recent estimate 83% (2) Pain

Musculoskeletal pain Back and neck pain

Who uses CAM? Kessler 2001

Surveys show large increase in past 50 years in U.S. and other industrialized countries

Eisenberg 1998 Between 1990 to 1997, increase from 34% to 42% of US

households reporting CAM use Barnes 2004

In 2002, 75% of U.S. adults reported use of CAM in lifetime and 62% in past 12 months (when prayer included)

Who uses CAM?

Who uses CAM?

Palinkas 2000 Surveys of primary care clinic populations

show 28-47% utilization of CAM 21% of patients in primary care practices

reported using CAM for the same health problem for which they sought conventional care on that visit

Who uses CAM?

Chiropractic and massage are most frequently used practitioner-based CAM therapies (1). An estimated 8-17% of US population visits a

chiropractor each year, 33% over lifetime. About 1/3 of US population reports having ever

had a therapeutic massage. Individuals in rural and underserved

communities are particularly likely to use chiropractic care (2).

4 Reasons for Improvement

In general, four reasons why people improve: Effective treatment Illness improved on its own Patient was misdiagnosed Patient expectations

Lets take a closer look at this one… The story of “Mr. Wright” (page 435-436)

Placebo Effect

Talbot (2000) Placebos are at least half as effective for

controlling pain as are active drugs like aspirin and codeine

Blakeslee (1999) Placebos are just as effective as SSRI’s

Is it biological as well???

Vincent and Furnham (1997) Classically conditioned

Benson (1996) “Remembered wellness”

Brody (2000) Placebos tap into the body’s natural “inner pharmacy”

Bendetto (1996) Interesting experiment in which researchers claim a

placebo enhanced the activity of endorphin release (see page 437)

A closer look at the most widely used alternative treatments…

Acupuncture Mind-Body Therapies

Hypnosis Relaxation and Meditation Spirituality and Prayer

Chiropractic Naturopathic Medicine

Acupuncture

Used for most common ailments – backaches, headaches, arthritis, allegies, muscles aches and spasms, etc. Shen Nung (Father of Chinese Medicine)

Qi Energy running through our body

14 main meridians Needles bring us back to homeostasis

Deqi Sensation is felt (not painful)

Acupuncture

How does it work??? ???

Does it work? Chronic pain – yes Substance abusers – yes

How much research? A lot but unfortunately not without many limitations

Other issues… Good news: More insurance companies covering this Bad news: Conventional methods may be abandoned

Hypnosis An altered state of consciousness brought on

by special techniques and that produces responsiveness to suggestions for changes in experience and behavior

Probably around since antiquity, the rediscovery of hypnosis is commonly credited to Franz Anton Mesmer

Franz Anton Mesmer (1734-1815)

Mesmer would pass magnets over the bodies of ailing people, some of who would lapse into a trancelike state and then awaken much improved At the time many thought Mesmer’s work was linked to

quackery… Today skepticism remains as books on hypnosis is often

grouped with those on parapsychology, ghosts, and witchcraft

Nevertheless, most psychologists believe it to be a respectable topic for scientific study

Can hypnosis work on anyone?

Can you be hypnotized against your will? Hypnotic Susceptibility

Degree to which a person responds to hypnotic suggestions

Willingness to be hypnotized is most important factorA key quality of hypnotically susceptible people is if

they can become deeply absorbed in imaginative activities (Fantasy-prone personalities)

Stanford Hypnotic Suggestibility Scale

Can hypnosis alleviate pain?

Yes – this has been clearly established in experiments… Hypnotized subjects report far less pain than

others when their arms are placed in ice water

Why?

2 Theories Selective Attention Theory Dissociation Theory

Selective Attention Theory

We feel little or no pain because our thoughts are away from it – like the injured athlete who still completes the play or the person who refuses to look at that needle Aspects of the Gate Control Theory???

Dissociation Theory: A divided consciousness?

A dissociation or split between different levels of consciousness – dissociating the sensation of pain with our emotional suffering Hilgard (1986): “the hidden observer”

Reports of Pain in Hypnosis

Relaxation and Meditation

Progressive Muscle Relaxation Active training in tensing and relaxing muscles

Mindfulness Meditation “awareness without thought”

Transcendental Meditation Focused awareness on a single object or word

(mantra)

Spirituality and Prayer

Recent trend: Medicine and spiritual healing coming together

Does spirituality promote health? 80% in US say yes But scientific evidence is mixed

Chiropractic

Chiropractic and massage are most frequently used practitioner-based CAM therapies An estimated 8-17% of US population visits a chiropractor

each year, 33% over lifetime. About 1/3 of US population reports having ever had a

therapeutic massage.

Individuals in rural and underserved communities are particularly likely to use chiropractic care For example: Chiropractors in every zip code region in

Kentucky

Naturopathic Medicine

Herbal therapy Used by 12-14% of the US population, up from 2.5%

in 1990 (Kaufman, 2002) 16-18% of patients taking prescription medications

also take herbal remedies (Kaufman, 2002) Food Supplements

Strong evidence supporting benefits Dietary Medicine

Another strong link to better health as correct diet appears to cut down risk for most of major chronic illnesses (heart disease, strokes, some cancers)

Naturopathic Medicine

Do they work? Again, studies show mixed results

Why do people use CAM?

Very few individuals rely exclusively upon alternative modalities Most individuals who use CAM do so because

of preference and the perception that the combination of CAM and conventional treatments is superior to either alone

When conventional care is not relieving their symptoms.

Who practices CAM?

Wide variation in background and approach Diversity in training programs

Some weekend and/or distance learning certificate programs

Non-MD acupuncture programs require2,000-3,000 hours (4 year masters degree)

Chiropractic training involves 4 years beyond 2 or 4 years of college

No standardization of approach to accreditation and licensure Most require 300-500 hours and CEUs

Variations by type of practitioner and by state

Who practices CAM?

Chiropractors Around 66,000 DCs in US Most accepted professional therapy Licensed in all states High patient satisfaction

Massage Therapists Over 46,000 AMTA members in US Most common CAM modality in hospital-

based programs Licensed in 2/3 of states

Who practices CAM?

Increasing numbers of dual-trained practitioners… RNs

Holistic Nursing Certification Therapeutic Touch, Healing Touch

MDs American Board of Holistic Medicine American Board of Medical Acupuncture

What about communication?

Eisenberg (2001) Between 40 and 70% of CAM users do not

disclose their use to their physician.

WHY?

Why does this matter?

Kaufman (2002) The substantial overlap between use of

prescription medications and herbal supplements raises concerns about unintended interactions

Patient use of CAM is often a clue to values and preferences that need to be acknowledged

Health psychologists role…

1. Always ask! “What else are you doing for your health?”

2. Be open and nonjudgmental.

3. Consider patient preferences and values.

4. Encourage self-monitoring of results.

Eisenberg 1997

Health psychologists role…

5. Coordinate care as appropriate.

6. Be honest about your lack of knowledge and open to education.

7. Monitor safety and efficacy, arrange follow-up.

8. Document all discussions and advice.

Eisenberg 1997

Where are we now?

There is an urgent need for more and better trials of CAM therapies and the increased research suggests we are going in that direction

Research funding 1992 $2 M 2004 $117.7 M

www.nccam.nih.gov

Where does this leave us?

Many conventional treatments have been adopted without good quality

research are costly are invasive are likely to have adverse effects

AND often provide inadequate relief

Where does this leave us?

CAM interventions generally are low cost are low risk are free of serious side effects

AND are widely used

CAM: evidence and research Cancer-related symptoms

Research in progress on Nausea related to chemotherapy

Acupuncture Ginger

Pain and end-of-life symptoms Massage Acupuncture

Fatigue L-carnitine Massage

www.nccam.nih.gov/clinicaltrials

CAM: evidence and research Cancer-related symptoms

Research in progress on Quality of life

Distant healing (glioblastoma) Mindfulness-based art therapy Healing touch (advanced cervical)

Lymphedema Massage, manual lymph drainage

(breast cancer)

www.nccam.nih.gov/clinicaltrials

Framework for approaching CAMin clinical situations

Protect against dangerous practices Permit practices that are harmless and that

may help Promote and use practices that are safe

and effective Partner with patients and encourage

communication about CAM

Jonas 2000

Evidence-based Medicine (EBM) and CAM

EBM aims to integrate

best research evidence clinical expertise patient values

Sackett 2000

Integrative Medicine A combination of mainstream medical therapies

and CAM therapies for which there is high-quality scientific evidence of safety and effectiveness

Credits http://www.mc.uky.edu/cam/cam_presentations/CAM%20an%20integrative

%20approach%202004-11-06.ppt