Complementary and alternative medicine in rheumatology

Complementary and alternative medicine (CAM) has become an important subject for rheumatologists. This article is an attempt to provide an introduction to this subject. It will provide definitions of, and define the prevalence of, CAM. The emphasis of the article is on evaluating the efficacy of CAM treatment modalities. This is achieved by referring to systematic reviews of clinical trials of acupuncture for low back pain, osteo-arthritis, fibromyalgia, inflammatory rheumatoid disease and neck pain. Further areas addressed in this way are herbal remedies, fish oil and glucosamine. Moreover, massage therapy and spinal manipulation for back pain are discussed. The final sections of this review deal with the safety and cost of CAM. It is concluded that, in view of the popularity of CAM with rheumatological patients, rigorous research into CAM is the best way forward.     

Complementary and alternative therapies for fibromyalgia

Fibromyalgia (FM) is a syndrome of chronic widespread musculoskeletal pain that is accompanied by sleep disturbance and fatigue. Clinical treatment usually includes lifestyle modifications and pharmacologic interventions meant to relieve pain, improve sleep quality, and treat mood disorders. These therapies are often ineffective or have been shown in clinical studies to have only short-term effectiveness. Pharmacologic treatments have considerable side effects. Patients may have difficulty complying with exercise-based treatments. Thus, patients seek alternative therapeutic approaches and physicians are routinely asked for advice about these treatments. This article reviews nontraditional treatment alternatives, from use of nutritional and herbal supplements to acupuncture and mindbody therapy. Little is known about efficacy and tolerance of complementary and alternative therapies in FM and other chronic musculoskeletal pain syndromes. Most studies on these treatments have been performed for osteoarthritis, rheumatoid arthritis, or focal musculoskeletal conditions. Clinical trials are scarce; the quality of these trials is often criticized because of small study population size, lack of appropriate control interventions, poor compliance, or short duration of follow-up. However, because of widespread and growing use of alternative medicine, especially by persons with chronic illnesses, it is essential to review efficacy and adverse effects of complementary and alternative therapies.     

Complementary or alternative therapies for osteoarthritis

Complementary or alternative therapies for osteoarthritis are commonly used and therefore it is important that health-care providers and patients are aware of the evidence for or against these approaches. In this article, the best available evidence is reviewed. The results suggest that, for several treatments, the risk-benefit profile is encouraging: acupuncture, several herbal medicines and capsaicin cream. For other therapies the evidence is weak or contradictory: homeopathy, magnet therapy, tai chi, leech therapy, music therapy, yoga, imagery and therapeutic touch. Many other treatments have not been scientifically tested. It is concluded that some complementary or alternative therapies have generated sufficiently promising results to warrant further investigation in large-scale, definitive, randomized clinical trials.     

Complementary and alternative practices in rheumatology

Hundreds of non-conventional treatment modalities have been used to treat patients with diverse diseases. Whatever term is used, non-conventional remedies, complementary medicine and/or alternative therapies (CAM), or even traditional systems of medicine, have become an increasingly prominent part of health-care utilization by the healthy general population and by patients with various diseases, even in an era of rapidly advancing medical technology. It has become a significant topic not just in the lay press but also in the biomedical literature. Since 1966 more than 46,000 publications that bear this or a related term in titles or abstracts have been referenced in Medline alone. Several important journals have devoted editorials and original papers to this subject during past decade. This review presents the most recent data on the epidemiology of CAM utilization by rheumatic patients, with special emphasis on magnitude and patterns of use, and concepts of alternative versus complementary medicine.     

Complementary and alternative medicine in allergy,otitis media,and asthma

There is growing interest on the part of both patients and providers in the use of complementary and alternative medicine (CAM) therapies to treat allergy, otitis media, and asthma. Research efforts investigating CAM are increasing in frequency and quality. Studies suggest possible efficacy for some vitamin and mineral supplements for allergic diseases; results are less clear in asthmatic patients. The use of polyunsaturated fatty acids appears particularly promising for treatment and even prevention of allergy and asthma conditions. Studies also suggest that probiotic preparations have a role in the treatment of allergic conditions. Xylitol gum, syrup, and lozenges have shown efficacy in treatment of acute otitis media, as have some naturopathic herbal remedies. Preliminary results with studies of yoga and various relaxation therapies for treatment of asthmatics suggest that these therapies may have a role, but further work would be needed to document efficacy and delineate the specific types of interventions most appropriate for particular asthmatic populations.     

Patients, physicians, and unproven remedies

Chronic arthritis management is complicated by patient administered unproven treatments. Disease, patient, and physician characteristics all contribute to this problem. Physicians must understand the complex cultural, sociological and psychological variables which encourage the use of unproven treatments. Part of any therapeutic regimen for chronic arthritis should include physician awareness and patient education regarding unproven treatments.     

Complementary and alternative therapies for low back pain

The support for the principles of evidence-based medicine has increased within the field of complementary and alternative medicine (CAM). The objective of this chapter is to determine the effectiveness of CAM therapies compared to placebo, no intervention, or other interventions for acute/subacute and chronic non-specific low back pain (LBP). Results from Cochrane reviews on acupuncture, botanical medicine, massage, neuroreflexotherapy, and spinal manipulation have been used. The results showed that acupuncture is more effective than no treatment or sham treatment for chronic LBP but that there are no differences in effectiveness compared with other conventional therapies. Specific botanical medicines can be effective for acute episodes of chronic non-specific LBP in terms of short-term improvement in pain and functional status; long-term efficacy was not assessed. Massage seems more beneficial than sham treatment for chronic non-specific LBP but effectiveness compared with other conventional therapies is inconclusive. Neuroreflexotherapy appears to be more effective than sham treatment or standard care for chronic non-specific LBP. Spinal manipulation was more effective than sham manipulation or ineffective therapies, and equally effective as other conventional therapies. In summary, the results on CAM therapies for (acute episodes of) chronic LBP are promising but more evidence on the relative cost-effectiveness compared to conventional treatments is needed.     

Complementary and alternative medications in hepatitis C infection简

Chronic hepatitis C (CHC) infection affects almost 3% of the global population and can lead to cirrhosis, liver failure, and hepatocellular carcinoma in a significant number of those infected. Until recently, the only treatments available were pegylated interferon and ribavirin, which traditionally were not very effective and have considerable side effects. For this reason, interest in complementary and alternative medications (CAM) in the management of hepatitis C has been investigated. Some CAM has demonstrated therapeutic potential in chronic hepatitis C treatment. Unfortunately, some CAM has been shown to have the potential to cause drug-induced liver injury. This article will review and evaluate many of the natural molecules that interact with the hepatitis C virus (HCV) life cycle and discuss their potential use and safety in HCV therapy, as well as highlight some important interactions between medical and complementary treatments.     

Complementary and alternative medications in hepatitis C infection

Chronic hepatitis C(CHC) infection affects almost 3% of the global population and can lead to cirrhosis, liver failure, and hepatocellular carcinoma in a significant number of those infected. Until recently, the only treatments available were pegylated interferon and ribavirin, which traditionally were not very effective and have considerable side effects. For this reason, interest in complementary and alternative medications(CAM) in the management of hepatitis C has been investigated. Some CAM has demonstrated therapeutic potential in chronic hepatitis C treatment. Unfortunately, some CAM has been shown to have the potential to cause drug-induced liver injury. This article will review and evaluate many of the natural molecules that interact with the hepatitis C virus(HCV) life cycle and discuss their potential use and safety in HCV therapy, as well as highlight some important interactions between medical and complementary treatments.