36 PATIENT EDUCATION: A PRACTICAL APPROACH
thecourseofthedecade.Theyestimatedthatapproxi-
mately40percentofAmericansusedsomeformbyalter-
nativemedicinetherapyandthatmorethan$600million
wasspentonalternativemedicineservicesandproducts
in 1997.
3,4
More recent utilization data from the 2007
NationalHealthStatisticsReportsestimatesthatapprox-
imately 38 percent ofthe American population uses at
least one type of CAM therapy.
5
Complementary and
alternativemedicineusewasshowntobemostprevalent
among women, those with higher levels of education,
adultsaged30–69years,thoseofhighersocioeconomic
status, adults suffering from chronic illnesses, adults
livingintheWest,andformersmokers.
5
Thesamestudy
revealedthefollowingCAM therapies weremostcom-
monly used by US adults: natural products, which are
primarily herbal (17.7 percent); deep breathing exer-
cises (12.7 percent); meditation (9.4 percent); chiro-
practic or osteopathic manipulation (8.6 percent);
massage(8.3percent);andyoga(6.1percent).
5
Ameri-
cansreportedspending$33.9billiononCAMin2007,
44percentofwhichwasspentonnaturalproducts.
6
Why People Use CAM
AsubstantialamountofCAMisusedforchronicmedical
conditions,promotionofhealth and wellness,and disease
prevention.Mostindividualschoosecomplementarymedi-
cine becausethey believeit aims to treat theperson as a
whole.Complementaryandalternativemedicineusersoften
perceivethattheirpractitionersappearmoreconcernedwith
their health outcomes and that CAM practitioners allow
patients more autonomy regarding their health decisions.
Other reasons for use arenoninvasive techniques, a focus
on the mind and body together, and dissatisfaction with
traditionalallopathicmedicine.
2
How Do People Pay for CAM Treatments?
Most people receiving CAM therapies must pay out of
pocketfortheirtreatments.Somehealthinsuranceplans
offercoverage,buteach company isdifferent,and CAM
coverage is typically limited. Occasionally chiropractic,
acupuncture, massage therapy, biofeedback, and natur-
opathycanbecovered.
7,8
Beforereceivingtreatment,itis
importantthatpatientsknowwhatserviceswillbereim-
bursed by contacting their insurance company or agent
foradviceonCAMcoverage.
9
Major Types of CAM
TherearemanydifferenttypesofCAM,toonumerousto
coverinonechapter.Whatiscoveredrepresentsthemore
commonformsofCAMpatientswillquestionthehealth-
careproviderabout.
Mind–Body Medicine
Mind–body medicine is a type of CAM that focuses on
specictechniquesthataimtoharnessthepowerofthe
mind to optimize the natural processes of the human
body.Mind–bodytechniquesincludeyoga;biofeedback;
meditation; and art, music, and dance therapy.
10
Nearly
onefthofadultsintheUnitedStateshaveusedoneor
moretypesofmind–bodytherapieswithinthelastyear.
10
A study conducted by researchers at Harvard Medical
Schoolfoundthatmorethanhalfoftherespondentsused
mind–body medicine along with conventional medical
treatment, and onefth used mind–body medicine as
their primary treatment for conditions such as anxiety,
depression, and musculoskeletal pain syndromes when
conventional medicine did not prove effective.In addi-
tion, participants reported a high level of satisfaction with
mind–body medicine and reported that it signicantly
helpedwithmedicalconditions.
11
Meditation is dened as theact offocusing one’s full
attention on a designated object of meditation, such as
one’s breath.
10
This selfregulationof attention has been
showntohelppeoplecopewithpainandaidtheimmune
system through an increase in antibody production and
reductionin the inammatory process.
10
Meditation has
also been shown effective in helping patients cope with
and/or reduce symptoms of cancer, depression, anxiety,
bromyalgia,andchronicpain.
12
Yogaisagroupofexercisesperformedwiththegoalof
reachingcompletepeacefulnessofbodyandmind,which
mayhelpindividualsrelaxandmanagestressandanxiety.
Thevariousstylesofyogausedforhealthpurposestypi-
cally combine physical postures, breathing techniques,
andmeditationorrelaxation.
10
The2002NationalHealth
Interview Survey found that yoga is one of the top 10
CAMmodalitiesusedandthatapproximately15million
adultsusedyogaforhealthpurposes.
5
Yogaisthoughtto
helpincreaseexibility,balance,weightloss,andmanage-
ment of chronic health conditions when coupled with
conventionaltreatment.Forexample,breathingandrelax-
ationtechniquesmayhelpreducecardiovasculardisease
risks by helpingto lowerblood pressureandheart rate.
Also,yogamayhelpconditionssuchasbackpain,mul-
tiplesclerosis,andosteoarthritisoftheknees.
13
Thehealth
benets of yoga were supported by a recent study that
statedagroupofindividualswhopracticedyogaexperi-
encedlesspainandfunctionaldisabilityandlessdepres-
sion than did the nonyoga group.
14
Caution should be
taken by pregnantwomen and elderly and/or frail indi-
vidualswhendecidingwhetherornottopracticeyoga.
Biofeedbackistheuseofelectronicdevicesthathelp
controlphysiologicfunctions,suchasheartrate,muscle
tension, and breathing in order to enhance health.
10
Biofeedback may be an effective treatment to help
peoplecopewithhypertension,coronaryarterydisease,
headaches, constipation, diarrhea, asthma, and even
somecentralnervoussystemdisorderssuchasseizures
andattentiondecit/hyperactivitydisorder.
10,15
Current
researchsuggeststhatbiofeedbackmaybeaneffective
treatmentfordecreasingtheintensityandfrequencyof
tensionheadaches.
16
Lastly,art,music,anddancetherapiesareincreasingly
popular forms of mind–body medicine. These types of
therapies utilize drawing, painting, sculpting, creative
movement,andmusic to helppeoplecopewith anxiety,
depression,andabuse.Arttherapycanhelpanindividual
Chapter 4: Complementary and Alternative Medicine 37
expresshisorheremotionsandthoughtsthroughdrawing.
Also,throughtheexpressionofdance,anindividualcan
createapositiveselfimageandsenseoffreedomthrough
expressive movement. Music therapy can include song-
writing, playing music, or relaxation and imagery with
music.Researchsuggeststhatlisteningtomusicstimulates
endorphins,whichinturnlowerbloodpressure,heartand
respiratoryrate,andincreasebloodow,allofwhichhelp
maintainphysiologichomeostasis.
17
Furthermore,astudy
conductedonmovementtherapysuggeststhatdancemay
be a signicant therapy for adolescents with psychiatric
disorders.
16
Biologically Based Practices
Biologicallybasedpracticesincorporatetheutilizationof
natural products to promote health. The following are
examplesofsomebiologicallybasedproducts:dietarysup
plements, such as vitamins, minerals, amino acids, pro-
teins, probiotics and herbs; functional foods, such as
chocolate or cranberries, which are believed to contain
activeingredientsthatarebenecialtohealth;andwhole
diettherapy.
1
In2007,18percentofAmericansreported
usingnaturalproducts,and52percentsaidtheyhadtaken
sometypeofsupplementinthepreviousmonth.Themost
often used natural products were sh oil, glucosamine,
echinacea,axseed,andginseng,andthemostcommonly
reportedsupplements weremultivitamins/multiminerals,
vitaminsEandC,calcium,andBcomplexvitamins.
5,18
Naturalproductsareconsideredtobesimilartofoods,
not drugs. Therefore,manufacturersof natural products
arenotallowedtomakeanyspecichealthbenetclaims.
Also,becausetheseproductsareconsideredtobefoods,
theyarenotevaluatedforefcacy,quality,purity,orsafety
bytheUSFoodandDrugAdministration.
19
Itisimportant
forpatientstorealizethatall natural doesnotmeanthe
productissafeorvoidofsideeffects.Manypatientswho
take herbal products do not talk with their healthcare
providerabouttheirherbaluse;therefore,itisimportant
toaskpatientsspecicallyaboutanyherbalproductsthey
maybetaking.Herbalproductsaregenerallynotrecom-
mended during pregnancy and breastfeeding. It is also
important to inform patients that natural products may
potentiallyinteractwithprescriptionmedications,result-
inginincreasedriskofadverseeffects.
Table 4–1 provides an overview of biologically based
productsthat areconsideredsafe and have moderate to
highqualityevidenceoftheirefcacy.
20
Table 4–2 provides
an overview of selected biologically based productsthat
Table 4–1
Biologically Based Products Considered Safe and Have Moderate- to High-Quality Evidence
of Their Efcacy
Product Indications Safety Considerations
St. John’s Wort Mild to moderate depression May lower serum levels of oral contraceptives,
warfarin, digoxin, and cyclosporins
Saw palmetto Benign prostatic hyperplasia May increase bleeding when taken with
anticoagulants and may interact
with hormonal medications
Fish oil High triglycerides Increased bleeding risk at high doses
Glucosamine sulfate Mild to moderate osteoarthritis May cause gastric problems such as nausea or
diarrhea; diabetics should monitor blood glucose
Melatonin Jet lag, insomnia Avoid in patients taking warfarin or antiseizure
medications
Ginkgo biloba Claudication Increased bleeding risk at higher doses
Table 4–2
Biologically Based Products Considered Safe and Have Low- to Moderate-Quality Evidence
of Their Efcacy
Product Indications Safety Considerations
Ginseng High blood glucose/glucose intolerance Cytochrome P-450 interactions
Echinacea Treatment of upper respiratory infections Use caution with immunosuppressed patients
Probiotics Irritable bowel syndrome May cause increased atulence and diarrhea

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