1. Health Psychology Chapter 14: Alternative Medicine Dec 7, 2007 Classes #43

2. 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

3. Examples of CAM AcupunctureImagery AromatherapyMagnets BiofeedbackMassage ChiropracticPrayer DietsReflexology ExerciseRelaxation Folk remedies Self-help/support groups Herbal/botanical therapySpiritual healing (by others) HomeopathyVitamins HypnosisYoga

4. 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

5. Why do people use CAM? Desire for health and wellness (1) Prevention Cancer- recent estimate 83% (2) Pain Musculoskeletal pain Back and neck pain

6. 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)

7. Who uses CAM?

8. 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

9. 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).

10. 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)

11. 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

12. 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)

13. A closer look at the most widely used alternative treatments… Acupuncture Mind-Body Therapies Hypnosis Relaxation and Meditation Spirituality and Prayer Chiropractic Naturopathic Medicine

14. 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)

15. 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

16. 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

17. 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

18. 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 factor A key quality of hypnotically susceptible people is if they can become deeply absorbed in imaginative activities (Fantasy-prone personalities) Stanford Hypnotic Suggestibility Scale

19. 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

20. Why? 2 Theories Selective Attention Theory Dissociation Theory

21. 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???

22. 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”

23. Reports of Pain in Hypnosis

24. 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)

25. 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

26. 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

27. 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)

28. Naturopathic Medicine Do they work? Again, studies show mixed results

29. 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.

31. 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 require 2,000-3,000 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

32. 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

33. 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

34. What about communication? Eisenberg (2001) Between 40 and 70% of CAM users do not disclose their use to their physician. WHY?

35. 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

36. 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

37. 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

38. 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

39. 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

40. Where does this leave us? CAM interventions generally are low cost are low risk are free of serious side effects AND are widely used

42. 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

43. 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

44. Framework for approaching CAM in 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

45. Evidence-based Medicine (EBM) and CAM EBM aims to integrate best research evidence clinical expertise patient values Sackett 2000

46. Integrative Medicine A combination of mainstream medical therapies and CAM therapies for which there is high- quality scientific evidence of safety and effectiveness

47. Credits http://www.mc.uky.edu/cam/cam_presentations/CAM%20an%20integrative %20approach%202004-11-06.ppt http://www.mc.uky.edu/cam/cam_presentations/CAM%20an%20integrative %20approach%202004-11-06.ppt