5/26- CAM: Complementary and Alternative Medicine (250 words)

Complementary and Alternative Medicine, commonly abbreviated as CAM, is commonly used to treat multiple different chronic conditions. More than 25% of American adults have reported having 2 or more chronic conditions in a 2012 survey completed and published by the Centers for Disease Control and Prevention (CDC). Albeit the definition of what defines a chronic condition is subjective (cancer is included), people with these debilitating conditions often turn to complementary and alternative medicine (CAM) for self-care and disease management despite established evidence deeming CAM to be suitable for treating chronic conditions, whether it is supplemental or the primary treatment(s). This survey compared adults with no conditions to adults with 2 or more conditions and demonstrated that adults with these chronic conditions were more likely to use (multi)vitamins and/or (multi)minerals nonvitamins or herbs, mind–body therapies, chiropractic or osteopathic manipulation, massage, movement therapies, special diets, acupuncture, naturopathy, or some combination of these therapies in order to better alleviate their pain. The most common type of CAM utilized was the use of multivitamins, multiminerals, or both (52.7% of those surveyed).

It is important to note the distinction between complementary medicine and alternative medicine. Complementary medicine is used in conjunction with standard medical treatment. An example of complementary medicine is utilizing acupuncture in order to aid in alleviating some side effects of chemotherapy. Alternative medicine, however, is used instead of standard medical treatment. An example of alternative medicine is replacing the patient’s former diet with a special diet to treat cancer instead of the actual cancer drugs prescribed by an oncologist, which may have possible risks as indicated by the lack of chemotherapy. With both types of medicine, it is crucial to remember that simply because something is advertised to be “natural” does not equate to it being safe. The vast majority of botanicals and nutritional products which include herbal and dietary supplements as well as vitamins are not regulated by the United States Food and Drug Administration (FDA), leaving it up to the patient what’s best for them. With this being said, the patient should always consult with their medical provider if these vitamins are right for them and also in what doses.

As mentioned before, a lot of the patients who utilize CAM are cancer patients. In cancer patients, CAM can help to cope with the common inevitable side effects of cancer medications such as tiredness, pain, and nausea. As we know, chemotherapy-induced nausea and vomiting (CINV) is unfortunately a primary side effect of most chemotherapy. CAM can also help a cancer patient feel more at ease by easing the worries of cancer treatment in addition to an attempt to try to cure or at the least alleviate the pain caused by cancer.

Several primary examples of key techniques of complementary and alternative medicine and their indications are listed below-

Acupuncture- chronic pain and nausea.

Chiropractic- back pain.

Herbalism- St. John’s Wort for depression and gingko biloba for intermittent claudication (claudication is pain in the calf, thigh, or hip muscle that’s brought out by exercise and is fortunately typically relieved with a few minutes of rest).

References-

Falci, L, Shi, Z, et al. Multiple Chronic Conditions and Use of Complementary and Alternative Medicine Among US Adults: Results From the 2012 National Health Interview Survey. CDC- Centers for Disease Control and Prevention. https://www.cdc.gov/pcd/issues/2016/15_0501.htm

Complementary and Alternative Medicine. NIH- National Institute of Health: National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/cam

Ernst, E. The role of complementary and alternative medicine. The BMJ. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118903/

What is Complementary and Alternative Medicine? It sounds very familiar to natural medicine? Complementary medicine is a type of medicine that is used in addition to the standard medical treatment. It is not used by itself. Alternative medicine is used in place of the standard medical treatment. Complementary and Alternative Medicine (CAM) can be used alongside cancer treatments to help patients with cancer manage the side effects of treatments such as nausea and pain. It is also a great way to relieve stress. There are different types of CAM therapies that are used. Meditation, yoga, dietary and herbal supplements, acupuncture, chiropractic therapy, and Ayurvedic medicine are a few of the CAM therapies used. CAM therapies can be found to be safe and effective overall bur it is important to get therapies from a certifies practitioner in order to receive the correct treatment.

Acupuncture therapy is part of ancient Chinese medical practice which stimulates certain areas in the body to promote health. Acupuncture uses tiny sterilized needles which are inserted into the skin to a point in which a sensation or pressure is produced. The FDA does regulate acupuncture needles under good manufacturing practices and single-use needles for sterility. Needles that are not sterile might cause an infection as well as making the patient feel pain or soreness during the treatment. There are other methods to acupuncture other than needle insertion and that can include the use of hear, pressure, friction, electromagnetic energy as well as suction which might be the most known, it is also known as cupping. Acupuncture stimulates the central nervous system and releases chemicals into the muscles, brain, and spinal cord which stimulates the body’s natural healing abilities both in the physical and emotional aspect. It is effective in treating nausea caused by chemotherapy, relieving headaches, pain, and other side effects as well.

There is a study on the effect of electroacupuncture on Chemotherapy-Induced Peripheral Neuropathy (CIPN) or Nerve Pain caused by Chemotherapy. This is an active trial that is testing to see if electroacupuncture can increase the effects of regular acupuncture through electrical stimulation. Cancer medications that can have neurotoxic effects include medications in the following drug classes: taxanes (ex. Paclitaxel and Docetaxel), vinca alkaloids (ex. Vincristine and Viblastine), platinum agents (ex. Cisplatin and Oxaliplatin), as well as bortezomib. This study excludes the test on patients with a pacemaker or an electronically charged medical device. The trial is used to see if there is a difference in pain severity within 24 hours of receiving the treatment. This is a great study to test between the efficacy of electroacupuncture compares to standard acupuncture but since this trial is based on asking the pain severity of an individualized patient then this trial might not be completely accurate since pain threshold differs from one patient to another.

Overall, standard acupuncture therapy is shown to be effective in reducing nausea and vomiting caused from anticancer therapies. It is also shown to relieve symptoms such as fatigue and dry mouth as well.

“Acupuncture (PDQ®)–Patient Version.” National Cancer Institute, www.cancer.gov/about-cancer/treatment/cam/patient/acupuncture-pdq.

“Acupuncture.” Johns Hopkins Medicine, www.hopkinsmedicine.org/health/wellness-and-prevention/acupuncture.

“Complementary and Alternative Medicine (CAM).” National Cancer Institute, www.cancer.gov/about-cancer/treatment/cam.

“The Effect of Electroacupuncture on Nerve Pain Caused by Chemotherapy (Chemotherapy-Induced Peripheral Neuropathy).” National Cancer Institute, www.cancer.gov/about-cancer/treatment/clinical-trials/search/v?id=NCI-2021-06312&r=1.

CAM and Oncology

Conventional medicine is a system where medical doctors and other healthcare professionals (nurses, pharmacists, therapists) treat symptoms and diseases using drugs, radiation, or surgery. This type of treatment is well known as “Western Medicine”. However, this style of treatment is not the only way to care for our patients. Eastern Medicine encompasses many components of Complementary and alternative medicine (CAM). Alternative medicine is using any form of an unconventional medicine practice. Complimentary medicine is an integration of unconventional medical practices added to conventional therapy.

According to the National cancer institute, cancer patients may use CAM to: help cope with side effects of their treatment such as nausea pain, and fatigue. Also, they may comfort themselves and ease the worries of cancer treatment and related stress. Integrative medicine is an approach to medical care that combines standard medicine with CAM practices that have shown through science to be safe and effective. This approach emphasizes the patient’s preferences, and it attempts to address the mental, physical, and spiritual aspects of health. Another popular treatment is mind-body therapies. Mind – body therapies combine mental focus, breathing, and body movements to help relax the body and mind. Examples are: medication, biofeedback, hypnosis, yoga, tai chi, creative outlets. Biofeedback uses simple machines the patient learns hoe to affect certain body functions that are normally out of one’s awareness (such as heart rate). Biological based practices are used; vitamins, botanicals (plants or parts of plants such as cannabis), and herbs and spices such as turmeric or cinnamon. The next category is called manipulative and Body based practice which include massage, chiropractic therapy, and reflexology. Biofield therapy is another category of alternative medicine which is the use of reiki and other balancing energy techniques to use pressure and activate energy fields within the body for healing and wellness. The last category is whole medical systems which includes ayurvedic medicine, traditional Chinese medicine, homeopathy, and naturopathic medicine.

Most CAM therapies have undergone careful evaluation and have been found to be generally safe and effective. These include acupuncture, yoga, and mediation, however when using CAM it is important to talk to your healthcare providers to make sure there are no interactions or negative impacts with your current medications. Natural does not always mean safe. Since some CAM therapies incorporated herbal and dietary supplements and vitamins, these products are not approved by the FDA and a prescription is not needed to buy them. Herbal supplements such as kava kava, an herb used to treat stress and anxiety, has been associated with liver damage. St. John’s wart, which can be used as an aid to treat mood disorders, has many interactions with oncology therapies.

Cancer patients who want to incorporate CAM into their regimen can discuss options for reducing stress anxiety, fatigue, and pain, while making sure that they are safe to add to their current treatments.

Additionally, the National Center for Complimentary and Integrative Health (NCCIH) are currently sponsoring or cosponsoring clinical trials that test CAM treatments and therapies in people. For example, a randomized phase III trial studies acupuncture to see how well it works compared to standard therapy for treating dry mouth caused by radiation therapy (xerostomia) in patients with head and neck cancer.

References:

Clinical Trials for Complementary or Alternative Medicine Procedure(s). National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/clinical-trials/cam-procedures. Accessed May 24, 2021.

Complementary and Alternative Medicine (CAM). National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/cam. Accessed May 24, 2021.

Complementary, alternative, and integrative are words that are frequently thrown around interchangeably, but they all have different meanings. Complementary treatment is the use of non-conventional practices that is used together with conventional medicine. Non-conventional practices include acupuncture, massage therapy, meditation, natural products, etc. Alternative treatment is the use of non-conventional therapies used in place of conventional treatment options. Integrative health refers to the incorporation of complementary strategies with conventional therapies in a more structured approach. It focuses on the treating the patient as a whole rather than just the treatment of a disease or organ. It is structured similarly to palliative care in terminally ill patients. It requires the collaboration of many different providers. The use of complementary alternative medicines (CAM) is now being branded as integrative and complementary health approaches (ICHA). Some of these approaches are being seen more frequently as the first treatment options from the patient perspective compared to conventional medicines, especially for patients who suffer from severe mental or physical disorders. Some of the ICHA can be coupled with conventional treatment for an individual’s optimal health and improvement in quality of life. This happens regardless of the therapies not having enough clinical trials or evidence to test their efficacy. ICHA can have varying effects for many patients. Some patients may find relief with these strategies while others may not. The efficacy of ICHA may also depend on the disease and the severity that these approaches may be best suited for.

A study was performed to investigate the use of complementary and alternative medicine for the treatment in patients with fibromyalgia syndrome (FMS). FMS is a chronic illness that affects somatic and cognitive function as well as mental status. Most of the patients with FMS previously used or currently uses complementary or alternative therapies for management of their disease. Another study was conducted to investigate whether patients would choose ICHA and/or conventional treatment to manage their chronic illness. The study found that most patients chose ICHA as their first line of therapy compared to just using conventional medicine. The second most selected option for treatment was the use of ICHA before trying conventional medicine. These treatment approaches are highly favored by patients with mental and somatic illnesses such as depression, rheumatoid arthritis, schizophrenia, and multiple sclerosis. Results from the study showed that patients with mental illnesses were more likely to prefer the use of alternative therapies compared to conventional medicines (i.e. antipsychotics or antidepressants) which further reflects the negative connotation about these classes of drugs and the effect that they have on a patient’s quality of life. A high percentage of cancer patients use ICHA coupled with chemotherapy to treat their cancer. This illustrates the idea that patients who suffer from more severe and chronic diseases prefer the holistic approach to their treatment compared to conventional treatment alone. Although more research needs to be done regarding this line of treatment about the practical use of ICHA, it is apparent that some patients may prefer this type of strategy. Furthermore, it highlights the fact that it is very important to take the patient’s perspective and attitude about their care plan into account.

References

National Center for Complementary and Integrative Health. (2018). Complementary, alternative, or integrative health: what’s in a name. National Institutes of Health. Retrieved from Complementary, Alternative, or Integrative Health: What’s In a Name? | NCCIH (nih.gov).

Berna, F., Göritz, A. S., Mengin, A., Evrard, R., Kopferschmitt, J., & Moritz, S. (2019). Alternative or complementary attitudes toward alternative and complementary medicines. BMC complementary and alternative medicine, 19(1), 83. https://doi.org/10.1186/s12906-019-2490-z

Langhorst, J., Häuser, W., Lauche, R., Perrot, S., Alegre, C., & Sarzi Puttini, P. C. (2014). Complementary and alternative medicine for the treatment of fibromyalgia. Evidence-based complementary and alternative medicine : eCAM, 2014, 408436. https://doi.org/10.1155/2014/408436

Conventional medicine refers to the approach to medicine based on modern science, consisting primarily of medication and surgical intervention. Most healthcare systems and healthcare professionals rely on this approach to better effect patient outcomes. However, there is a growing movement of integrative medicine, especially in the pediatric population. Integrative medicine combines conventional practices with complementary therapies or alternative medicine in a holistic manner by using all appropriate therapeutic approaches. Complementary and alternative medicine (CAM) have been lumped together, perhaps unfairly, and often been widely disregarded by the health care community. CAM therapies, when appropriately managed, may prove beneficial in the patient population.

Complementary medicine refers to treatments that are used as therapeutic adjuncts to conventional care, such as support groups, guided imagery, and nutritional therapy. They are not to be used in place of conventional medicine and should be used as “complements”. Typical practices of complementary medicine seek to address aspects of health not often addressed in conventional care, such as physical, emotional, and social health. Alternative medicine refers to practices that are used in place of conventional medicine and often reside outside medical science, such as herbalism and homeopathy.

Chiropractic is a very popular form of CAM in treating problems related to the musculoskeletal system. It revolves around the theory that the body is a self-healing and self-regulating organism brought together by the structural spine and pelvis and the functional nervous system. Chiropractic care for actual musculoskeletal injuries, such as neck and low back pain, osteoarthritis, headaches, and fibromyalgia, have shown to be beneficial and safe. It is important to recognize its limitations - it can’t treat anything other than musculoskeletal injuries, like allergies, asthma, or hypertension. One of two professional chiropractic organizations, the International Chiropractic Association opposes childhood immunizations, directly going against the entire scientific community.

Acupuncture is a form of CAM originating from traditional Chinese medicine. It is thought that disease occurs when vital energy channels are blocked and resolves when those channels are restored through stimulation of specific points. There are no definitive explanations as to how acupuncture works, but it has proven promising in treating chemotherapy-induced nausea and vomiting, headaches and migraines, and certain kinds of pain.

Homeopathy is a highly controversial topic in the setting of CAM. It is based on the principles of the law of similars and law of dilutions. The law of similars states that a drug or natural substance capable of producing symptoms in a healthy person will cure similar symptoms occurring as a manifestation of disease (e.g., chopping onions to cure dry eyes because chopping onions makes eyes watery). The law of dilutions states that the more dilute a remedy, the greater its potency (e.g., 0.1% solution of ibuprofen is better than a 10% ibuprofen solution at treating a headache). There are limited studies on the efficacy of any and all homeopathic remedies and little high-quality evidence on its benefits over placebos.

References

1. Frass M, Strassl RP, Friehs H, Müllner M, Kundi M, Kaye AD. Use and acceptance of complementary and alternative medicine among the general population and medical personnel: a systematic review. Ochsner J. 2012;12(1):45-56.

2. Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002-2012. Natl Health Stat Report. 2015;(79):1-16.

3. Types of Complementary and Alternative Medicine. Types of Complementary and Alternative Medicine | Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/types-of-complementary-and-alternative-medicine. Accessed July 5, 2020.

4. Complementary and Alternative Medicine (CAM). National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/cam. Accessed July 5, 2020.

Conventional, complementary, and alternative medicine are the three types of therapies available to patients. Conventional medicine is what most people are familiar with and refers to drug and surgery-based approaches. Alternative medicine describes the practice of using other medical treatments like herbalism, acupuncture, and homeopathy. Complementary medicine refers to the use of any form of unconventional product in addition to conventional therapy.

Complementary and alternative medicine (CAM) can be used for a variety of reasons including prevention of illness, maintaining general wellness, reduction of pain, treatment of certain health conditions, and as supplementation to conventional medicine. Some CAM therapies have undergone careful evaluation and are considered to be safe and effective. However, others have been found not only to be ineffective but also possibly harmful. A lot of the CAM therapies lack the research needed to back its safe and effective use due to issues like time for research as well as funding. However, such products can still be sold without FDA approval. For this reason, patients need to be aware of the possible adverse effects and drug interaction of CAM products. For example, St. John’s wort used for depression can interact with conventional therapy and alter its effects. Other supplements, like kava kava used to relieve stress and anxiety, can result in liver damage. Additionally, use of vitamins like vitamin C in excess can affect how chemotherapy and radiation work.

Based on the CDC National Health Statistic Report published in 2007, the 10 most common natural products among adults include fish oil/omega 3, glucosamine, echinacea, flaxseed oil/pills, ginseng, combination herb pills, ginkgo biloba, chondroitin, garlic supplements and coenzyme Q-10. The most popular age group to use CAM to be 40- 69 years old. In addition, CAM has been seen to be most commonly used in those with multiple chronic conditions who have trouble managing their disease. Treatments used in this patient population include meditation to reduce stress, peppermint or ginger tea to relieve nausea and guided imagery to help relieve stress and pain during medical procedures. With all these statistics on CAM use, we can see the importance of patient education. It is important that patients know to discuss with their physician the use of any dietary supplements or other CAM therapies. As pharmacists, we are also essential health care providers and drug experts who can counsel patients and help prevent adverse reactions and drug interactions for the different types of CAM therapies.

• Cdc.gov. 2020. National Health Statistics Reports. [online] Available at: <https://www.cdc.gov/nchs/products/nhsr.htm> [Accessed 26 May 2020].

• Uptodate. 2020. Complementary And Alternative Treatments: Herbs And Medications. [online] Available at: <https://www.uptodate.com/contents/complementary-and-alternative-treatments-for-anxiety-symptoms-and-disorders-herbs-and-medications?search=complementary-and-alternative-medicine-treatments-cam-for-cancer-beyond-thebasics&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2> [Accessed 26 May 2020].

The PowerPoint discusses the use of complementary and alternative medicine compared to conventional medicine. Conventional medicine is the use of mainstream medical and health system practices; it takes a drug and surgery-based approach to medical conditions and disorders. On the other hand, alternative medicine is the use of any non-mainstream practice in place of conventional therapy. If the non-mainstream practice is used in addition to conventional therapy, it is called complementary medicine.

The types of complementary and alternative medicine (CAM) can be separated into different categories: Traditional alternative medicine (acupuncture, homeopathy, Chinese or oriental medicine), Body (chiropractic medicine, massage, tai chi, yoga), Diet and herbs (dietary supplements, herbal medicine), Mind (meditation, hypnosis), and Senses (visualization and guided imagery). The most commonly used CAM is natural products or dietary supplements. For example, people may use fish oil for cardiovascular health, glucosamine for osteoarthritis, or echinacea to support the immune system. People may turn to CAM for a variety of reasons such as to prevent disease, support general wellness, treat specific health conditions, or to supplement conventional medicine. Adults with multiple chronic conditions are more likely to use CAM compared to adults with no conditions.

CAM is also often used in cancer patients to relieve symptoms and improve quality of life during treatment. They are used to relieve side effects of mainstream cancer treatment without the need to take additional drugs or for patients that want to take a more active role in improving their health and wellness.

There are still many questions about the efficacy of CAM. Some studies have been performed on a few natural products that have shown them not to be helpful, but also not necessarily harmful. On the other hand, increasing data has raised concern for potential interactions of CAM with conventional medicine, otherwise known as herb-drug interactions. Other safety concerns fall on the delay or avoidance of conventional medicine with known benefits in patients that take alternative medicine.

CAM is becoming a common practice in health care. Therefore, it is an important area for further research in order to develop a better understanding of its safety and efficacy and communicate it to patients.

References:

· Types of Complementary and Alternative Medicine. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/types-of-complementary-and-alternative-medicine. Accessed May 26, 2020.

· Ernst E. Complementary and alternative therapies for cancer. Hesketh PJ, ed. UpToDate. Waltham, MA: UpToDate Inc. (accessed 2020 May 26).

Conventional medicine is what we see used more often than natural medicine. Conventional medicine is a system in which medical doctors and other healthcare professionals (such as nurses, pharmacists, and therapists) treat symptoms and diseases using drugs, radiation, or surgery. Although this is what is more commonly used, there are different types of therapies that are available for patients to use. The other two types of medicine are alternative medicine and complementary medicine. Alternative medicine is using any form of an unconventional medical practice in place of using the conventional therapy. Complementary medicine is the addition of unconventional medical practices to the conventional therapy for added benefit. Examples of complementary medicine is the addition of natural products, deep breathing, yoga, meditation, homeopathy, etc. A lot of times patients like to use natural products along with their medications. Most commonly used natural products are Omega3, glucosamine, ginseng, coenzyme Q10. This is when pharmacists can make an impact and make sure these natural products don't interact with any of their other medications. Omega 3 most commonly is associated to benefit patients with their cardiovascular health. It is also used as an adjunct to help lower triglycerides when they are above 500. Some reasons CAM can be used is to help prevent illness, reduce pain, treat a specific health condition, or supplement conventional medicine. These can be used by both adults and children, however, it is seen mostly used in adults ages 50-59 years old. Going into further detail it is more commonly used in American Indians, white and the asian population. Although these additional therapies are being used more, there hasn't been an increase in doctors speaking about these and/or prescribing these. If the doctors are prescribing these, I think it would be a safer alternative since they would have all the medical records and make sure these additional supplements are not interacting with their conventional medications as opposed to patients just picking them over the counter without getting advised by a healthcare provider. There are good and bad things about everything. Some pros for these products are that they are cost effective, easily accessible (no prescription needed, patients can easily join yoga/meditation classes), and are usually safe. Some cons are that they can be viewed as not beneficial and can also be considered as waste of money. Along with that, there is no proof that they work, which makes it harder for patients to use these therapies. This is a very interesting topic, however, more studies need to be done to further implement these into different clinical guidelines.

References:

NCI Dictionary of Cancer Terms. National Cancer Institute. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/conventional-medicine. Accessed May 26, 2020.