38 PATIENT EDUCATION: A PRACTICAL APPROACH
are considered safe and have low to moderatequality
evidenceoftheirefcacy.
20
Manipulative and Body-Based Practices
ManipulativeandbodybasedpracticesareCAMpractices
that treat illnesses with handson manipulation and/or
movement of body parts. Examples of these treatments
includechiropractorsmanipulatingthetissuessurround-
ingthevertebralcolumntoreducebackpainormassage
therapists massaging and moving muscles to increase
relaxation.
1
A closer look at the two main categories of
manipulativeandbodybasedpracticesincludechiroprac-
ticandmassage.
Chiropracticcareaimstotreatpatientsthroughspinal
manipulation.
7
Spinalmanipulationistheprocessofpas-
sivelymovingintervertebraljointsthroughtheirrangeof
motion.Inaddition,chiropractictheorysaysthatmanipu-
lating the muscle and soft tissue surrounding the spinal
column will allow the body to function at its optimum
capacityandhealitself.Althoughchiropractorsmayclaim
tobeabletotreatawidespectrumofillnesses,mostfocus
primarily on treating neck and back pain. Twentythree
percentofAmericanswhochoseanyCAMtherapydidso
torelievebackandneckpain,andmorethan18million
adultsand2millionchildrenweretreatedbyachiropractor
in2007.
5
AccordingtotheAmericanCollegeofPhysicians
andtheAmericanPainSociety,chiropracticspinalmanipu-
lationisarecommendedtherapyforthetreatmentofacute,
subacute,andchroniclowbackpain;however,treatments
such as medications and physical therapy have shown
similarsuccesses.
21,22
Spinalmanipulationmayalsobean
effective alternative treatment option for neck pain and
cervicogenicheadaches.
23
Patientsshowthemostimprove-
mentwhencombiningspinalmanipulationwithstrength-
eningexercises.
23
Althoughpatientsseekchiropracticcare
formanyconditions,thereiscurrentlylittleevidencesup-
portingtheuseofchiropracticcareforasthma,infertility,
bromyalgia,orinfantcolic.
Massage therapy is the manipulation of soft tissue
structures for relaxation or therapeutic uses. There are
manydifferenttypesofmassagetherapy,suchasSwedish
massage, deep tissue massage, and reexology. These
therapiesareusedformanydifferentreasons,suchaspain
relief,stressandanxietyreduction,headaches,constipa-
tion,relaxation,andrehabilitation.Notallmassagethera-
pistsarerequiredtocompletetrainingand/oracertication
exam, and only 38 states have rules governing massage
therapypractices.
24
AccordingtotheAmericanCollegeof
Physicians and the American Pain Society, massage is a
recommendedtherapyforthetreatmentofsubacuteand
chroniclowbackpain.
9
Ithasalsobeenshowntoreduce
stress, anxiety, and pain associated with migraines and
tensiontype headaches.
25,26
Research also demonstrates
moderate benets of massage therapy in patients with
bromyalgia.
27
Energy Medicine
Energy medicine is a type of CAM that hypothesizes
that the human body is surrounded by energy elds,
calledbioelds.Practitionersofthesetherapiesattempt
to manipulate these bioelds through direct touch of
their hands on or around the body. Energy medicine
includes techniques such as Reiki and therapeutic
touch.
1
Reikiisatherapyinwhichapractitionerseeks
toreleaseanenergyowintothepatienttoactivatethe
bodys own natural healing ability. Reiki is thought to
help with relaxation and stress, chronic pain, and to
speedupthebody’shealingability.
10
Researchisbeing
conducted on the effects of Reiki with various health
conditions;however,evidenceisinsufcienttosuggest
thatReikiisaneffectivetreatmentforanycondition.
28
Lastly,therapeutictouchisaformofenergymedicine
that involves the practitioner placing his or her hands on
oraroundthepatientto identify andrestoreanyenergy
imbalances. The belief is that balancing the energy ow
withinthepatientwillenablehealing.
10
Therapeutictouch
isusedtoaidinthehealingprocess,reducepain,enable
relaxation, and cope with death. As with Reiki, there is
limitedresearch evidencethat validates theeffectiveness
oftherapeutictouch.Thereiscurrentlynonationalcerti-
cation exam or state licensure for either therapeutic
touchorReikipractitioners.
Whole Medical Systems
Wholemedical systems employmultipleCAM therapies
usedtogetherinacompletesystemoftheory.Naturopathy,
homeopathy,andtraditionalChinesemedicine(TCM)are
consideredwholemedicalsystems.
1
Naturopathic Medicine
Thephilosophyofnaturopathicmedicineisbasedonsix
principles:thebodycanhealitself,illnessshouldbepre-
ventedbeforeitoccurs,theunderlyingcauseoftheillness
mustbetreated,anindividualizedtreatmentplaniskey,
thepatientshouldbeeducatedabouthisorhertreatment,
and therapy should be based on a holistic approach.
29
Naturopathicdoctors(ND)arecertiedtopracticenatur-
opathicmedicine,whichemploysallCAMdomains(joint
manipulation, yoga, counseling, diet, exercise, herbal
therapy, and homeopathy) in an attempt to achieve
health.
30
Many patients enjoy visiting their ND because
ofthewholebodyapproach.Someresearchsuggeststhat
NDsmayeffectivelytreatlowbackpainandanxiety.
31,32
However,evidenceforeffectivenessofnaturopathicmed-
icine islimited becausecareis often individualizedand
employsmultiplecombinationsoftreatments.
Homeopathic Medicine
Homeopathywascreated200yearsagobasedonfollow-
ingtwopremises:like cures like and the principle of dilu-
tions.Homeopathypractitionersprescribeahighlydiluted
formofasubstancethatisthoughttostimulatethebody’s
own healing ability. The substance prescribed in very
diluteformwouldtypicallycausethesymptomiftakenin
moreconcentrated form. This belief is termedlike cures
like, meaning that a substance that causes symptoms in
healthy people may cure a sick person with the same
symptoms.
33
Homeopathyishighlycontroversialbecause
itiscontradictorytoscienticthought.Despitethis,nearly
Chapter 4: Complementary and Alternative Medicine 39
4 million people received homeopathic treatment in
2007.
5
The current research shows homeopathy and
placeboresultstobesimilar.
34
Therearesomedatasup-
porting homeopathy for acute dermatitis prophylaxis
duringradiationtherapyandfortreatingstomatitisduring
chemotherapy.
34
Traditional Chinese Medicine
TCMincludestheuseofherbs,acupuncture,moxibustion,
massage, diet, cupping, and mind–body therapy.
35
Moxi-
bustionistheburningofherbsneartheskin,andcupping
includescreatingavacuumwithacuppingjarandplacing
it on the skin to draw the skin up into the cupping jar.
Chinese herbalmedicineandacupunctureareusedmost
frequentlyinTCM.
35
Acupuncture is the technique of inserting long, thin
needlesintospecicareasof thebody, which is thought
torestoreone’sqi(vitalenergy)inordertomaintainand/
orimproveone’shealth.
10
Thepopularityofacupuncture
intheUnitedStatesbegantoincreaseintheearly1970s
after a New York TimesreporterdescribedhowaChinese
physicianhelpedrelievepostsurgicalpainwiththeuseof
verythinneedles.
10
TheuseofacupunctureintheUnited
States continues to grow. A study conducted in 2007
foundthatnearly3.1millionUSadultsand150,000chil-
drenhadusedacupuncturein2006.
5
Themostcommon
reason individuals use acupuncture is for treatment of
backpain,jointpain,neckpain,severeheadache/migraine,
andchronicpain.
36,37
Therearefew adverse effectsrelatedtotheuse of acu-
puncture; however, it is strongly recommended that indi-
viduals seek treatment from a licensed acupuncturist. In
ordertopracticeacupuncture,moststatesrequirepractitio-
nerstobelicensed;specictrainingandlicensingrequire-
mentsdifferamongstates.Mostoftenapractitionermust
completea formal acupuncture education programfrom
anaccreditedinstitutionandthenpassanationalcertica-
tionexam.
38
Currentresearchliteratureislimitedregardingtheuse
ofacupuncture;however,resultsofafewstudiesindicate
evidenceofitseffectivenessforthetreatmentoflowback
pain. According to one article, acupuncture, when used
withconventionaltherapy,providessignicantrelieffrom
lowbackpain.
14
Conclusion
AsscienticresearchregardingtheuseofCAMtherapies
continuestoexpand,evidenceforuseinthemanagement
and treatment of various health conditions will become
moreclear.Healthcareprovidersshouldhaveadiscussion
withtheirpatientsaboutCAMtherapiesinpatienteduca-
tionsessions(e.g.,iftheyareinclinedtousethemorifthey
dousethem)inadditiontoeducatingthemselvesaboutthe
researchevidenceforthecommontherapiessothatoptimal
healthcarecanbeprovidedtoeachpatient.
Acknowledgment
Thischapterwasrewrittenfromthersteditionmanuscript
byRichardD.MumaandCatherineS.Marsh.
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