Dr Rachel Harrison Rose Garden Medical Centre Leith, Edinburgh CranioSacral Therapy Dr Rachel Harrison Rose Garden Medical Centre Leith, Edinburgh GP 20 yrs, Homeopathy, CST Still GP Invited because of study Integrative medicine Proud ofNHS Not just pharmacology

who you are? NHS? Education? Parents? who had heard of CST before today Who has experience of CAM? What kinds? Anyone had CST? Kids had CST?

Complementary Therapy on NHS (CAM) General Practice Physiotherapy Mental Health Services Hospices Hospitals RoseGarden: autogenic, acupuncture, cst, homeopathy Physio / pain clinic acupuncture Thistle – CST (Alex) Mental health W Lothian Physio – Karen CST – paid for training Hospices Public demand France: CST considered routine post delivery – osteopaths Michel Odent, Leboyer) USA use of CAM for children stands at 70% in 2006 cf 10% 10 yrs previously

Glasgow Homeopathic Hospital Open to Homeopathy since inception Continues in spite of increasingly aggressive attacks Used to be 4 homeopathic hospitals with beds, now only 2, but lots of outpatient, treat ‘heartsink patients’ homeopathy, massage, reflexology, CST (while I worked there) Anyone had any form CAM on NHS in Belfast? What / How?

Effective Safe Practice Cost of Patient’ Condition to NHS Family Society Safety and cost of treatment Outcome - demonstrate effectiveness New service weigh up How much support do these people/patients/kids need Impact on family of living with ADHD – you know more than me Impact on School, society, the distress of child

Why Complementary Medicine? Condition merits treatment. Orthodox treatment effective? Side effects? Cost? Other treatment? Is orthodox treatment adequate? side effects cost of Strattera in Belfast? – Anyone know? - £240,000 from Gen Practice edinburgh last year What else do we currently offer the kids? Integrative medicine, what is available, use everything that works, together if appropriate, reduce more aggressive treatments? Do we have effective Alternative or Complementary?

Why CranioSacral Therapy? Safe Gentle Addresses Structural Changes Parents can participate Evidence Based Medicine Anne’s chat Get to keep clothes on! Children like it - Jo climbs onto table Safe – no high velocity, less risk Kids can treat family What evidence? Why have any of you chosen some form of therapy? (word of mouth) Why do GPs recommend treatment? Trials? Drug companies? Patients feedback Evidence based medicine: The Gold standard RCT - Ethics, funding, Energy - medication particularly suitable What motivates? Who promotes results? folic acid in ISD, Depression, sugar in prison CAM research, whole person treatments less easy to randomise, rarely poss to placebo but always possible to do outcome studies

My Grumpy teenager – no make up - hand over face or looking away ‘I think you should pay your patients!’ – so sore but sullen before then relaxes / chats/ less rude / more likely to return to revision! Jo 11 yrs old ,++ support at school, often off school, falling off stool, frustrated, constant attention, siblings suffer. – climbs on table, shows me where to put hands. Talks about anger More relaxed and attentive, weaning off strattera

Two consecutive studies Multi Practitioner Study Ten CranioSacral Therapists Up to ten consecutive patients each NHS patients (Single Practitioner) Before and After Questionnaires Evidence base: CST on NHS - started study to allow transparency Colleagues can decide if appropriate to continue funding Look at your handouts Single Practitioner – that’s me. All NHS patients Referred within Rose Garden Medical Centre Talk through pre only

Conditions Treated With CST Number Headaches and Migraine 23 Neck Pain 22 Depression/Anxiety/Stress 18 Back Pain 15 Other Musculoskeletal Problems 13 Unsettled Babies 12 Sleep Problems 4 Gastrointestinal Problems Jaw Tension/Dysfunction 3 Neuralgia Dizziness/Tinnitus Shoulder Pain 2 Other conditions 8 Relate to their handout, 2 columns, Anyone who has had CST want to add a condition/outcome? 130 patients in all (both studies)

Glasgow Homeopathic Hospital Outcome Score +4 Cure +3 Major Improvement +2 Improvement of value in Daily Living +1 Minor Improvement 0 No change -1 Minor Deterioration -2 Deterioration impacting on daily living -3 Major Deterioration -4 Death Post questionnaire after 6 sessions or 6 weeks post treatment - GHHOS Validated tool. Modified - a weakness of study Score for main problem, secondary problem if appropriate, wellbeing GP vists in 6/12 pre and post

Some weird stuff, adults can do this too but little harder to hold them – swimming pool Birth trauma revisited - babe or adult,

46 patients with outcome data 34 (74%) valuable or better improvement in main problem 31 (67%) valuable or better improvement in a secondary problem 30 (65%) also valuable or more improvement in general well-being. 15 (70%) of patients on medication for problem decreased or stopped it. Of 73 multi practitioner patients we have follow up data for 46 This is from the multipractitioner group, Single Practitioner 67 patients results slightly better but self selected Follow up data on almost all but captive audience 2 out of 130 patients reported deterioration – short lived – do get aggravations but often only once and rarely last >1 /52 Note improvement in secondary condition and well being in many patients Not many medications can boast that – iatrogenic disease cause of up to 60% admissions to hospital GPs pleased – drop in drugs bill But best of all….

Single practitioner patients 60% reduction in GP consultation rate AS GPs this is what we love to see Because I had access to notes Interestingly even the patient who said worse after treatment and stopped after 3 sessions (v complex lady/problems) attended 19x in 6/12 before and 8x in subsequent 6/12

Patient Feedback Comments Our experience of CST was very positive and the approach is very encouraging for a new mum. (Mother of unsettled colicky baby) The treatment helped Max (2months old) relax and become calmer in himself. It has helped his breathing and ability to turn his head. So nice to treat them tiny - certainly help settle, colic, feeding, poss long term effects.

Patients Feedback Comments Migraine has been a longstanding problem and I am very happy with my improvement. I feel my improvement is totally due to CST, I feel better after a few sessions than after six months of GP and medicines. (Headaches) I felt better when the treatment started but now it has reverted to what it was before. (Migraine ) Doesn’t work for everyone, other comments on sheet – Verity (not on sheet)’feel more connected to self’ 35 yrs Migraine in 73 yr old stopped after 5 treatments – still get christmas card Back pain – taken off list for surgery

So many have really tights necks and chest, many kids love to get on table

Adolescents with ADHD 28 Adolescents 2 weeks Massage therapy Self rated ‘happier’ Better concentration Less fidgeting Lower Hyperactivity rating Body work of different kinds, Massage compared with Relaxation exercises not so easy to relax – hands on better Importance touch - not just relaxaton

Use of CST in Physically Impaired Population in Southern Ireland 46 service users 0 – 18 years old 20 item survey 100% feedback Symptom control Decrease stress in siblings, parent and patients All parents wanted more treatment Other studies, see reference sheet at end of handout Glicksen – happy to give her address, published in JACM 07mgliksten@gmail.com

Parent Feedback Comments The sessions have markedly improved his coordination and concentration. This allows his siblings to have a normal relationship with him. My Child is always so calm and relaxed after sessions. When the treatment stopped in the holidays the anxiety would start to rise again. Siblings’ health, kids sometimes come with siblings, patient can treat them Munichin Cambridge – 2 sisters diabetic, one totally out of control, free fatty acid levels fluctuate wildly during family therapy, still not normalised 2 hrs later

Why CST? Structural tension Anxiety/sleep Co-ordination Concentration Wellbeing Relaxation Results Some Anne has mentioned, cases mary will discuss Results from Studies – well being and secondary Upledger allows for dialogue –good for emotional Decrease stress and anxiety – self esteem Family benefit Immune System: Salivary IgA shown to increase after hands on work,

References The Use of CST in a physically impaired population in a disability service in Southern Ireland: Glikson M, JACM, November 07 Adolescents with ADHD benefit from Massage Therapy, Adolescene, 1998 Relationship of CranioSacral Findings in School Children with Developmental Problems: Upledger, Journal of American Osteopathic Association, 1978 See sheets

This Service Integrated support Use CST Ensure safety Monitor outcome Demonstrate Effectiveness Proud of British! Pragmatic, use what works – (GP influenced by patients) French trial and theories, years on ethics, CAM illegal unless Doctors No lay Homeopaths but spend far more on homeopathy than uk. Call selves hairdressers, yoga teachers, actually CAM but even further behind than us with regulation/research) Tried to start pilot study into treatment headaches – told I had already demonstrated this should go straight for full trial. British lead the way. Try it, demonstrate outcome while providing service

Dr Rachel Harrison Rose Garden Medical Centre Edinburgh rachelharrison@onetel.com