Complementary and Alternative Medicine Sourcebook, 7th Ed.

By Omnigraphics

Provides consumer health information about alternative and complementary medical therapies, including dietary supplements, mind-body medicine, and manipulative and body-based therapies, along with facts about alternative treatments for specific diseases and conditions.

• Language: English
• Publisher: Omnigraphics
• Release date: Dec 1, 2021
• ISBN: 9780780819818

Book preview

Preface

About This Book

Complementary and alternative medicine (CAM) therapies play a key role in the healthcare of many Americans. The National Center for Complementary and Integrative Health (NCCIH) found that the use of CAM therapies in the past 12 months significantly increased among U.S. children (aged 4 to 17 years). These alternative therapies, alone or in conjunction with mainstream medicines, are often used to treat an increasing variety of diseases and conditions, such as arthritis, anxiety, back pain, cancer, diabetes, heart disease, and sleep problems.

Complementary and Alternative Medicine Sourcebook, Seventh Edition provides updated information for people considering these therapies for general well-being or specific health conditions. It discusses how to select a CAM practitioner, talk with a primary healthcare provider about using CAM, evaluate information on the Internet, and pay for CAM therapies. It describes whole medical systems, such as Ayurveda, traditional Chinese medicine, Native-American medicine, acupuncture, homeopathy, and naturopathy. It also talks about the safe use of dietary supplements, including vitamins, minerals, and herbs. Information on biological-based therapies (BBTs), mind–body medicine, manipulative and body-based therapies, and energy-based therapies are also included. The book concludes with a glossary of terms and a diretory of organizations related to CAM.

How to Use This Book

This book is divided into parts and chapters. Parts focus on broad areas of interest. Chapters are devoted to single topics within a part.

Part 1: An Overview of Complementary and Alternative Medicine identifies the use of CAM in the United States, and answers questions about how consumers choose a CAM practitioner and pay for treatments. Statistics on CAM use in specific populations, including children, and the elderly are also included, along with tips on avoiding health fraud and spotting Internet scams.

Part 2: Alternative Medicine Systems describes whole medical systems practiced in cultures throughout the world that evolved separately from conventional medicine as it is practiced in the United States. These include Ayurvedic medicine and their product caution, traditional Chinese medicine, Native-American medicine, acupuncture, acupuncture for cancer, homeopathy, and their product caution, and naturopathy.

Part 3: Dietary Supplements identifies vitamins, minerals, herbs, and botanicals, and other food and dietary substances taken to improve health or nutrition. Readers will also find tips on ensuring supplement safety and selecting specific products to support bone and joint health, immune system functioning, mood regulation, probiotics supplements for gastrointestinal health, weight-loss efforts, sports, and energy supplements. It also provides information on fraudulent dietary supplements and using dietary supplements wisely.

Part 4: Biological-Based Therapies discusses CAM practices that strive to enhance or improve health using substances found in nature. This part highlights biologically based techniques including apitherapy, aromatherapy and essential oils, and diet-based therapies such as detoxification diets, fasting, popular fad diets, Gerson therapy, and vegetarianism.

Part 5: Mind–Body Medicine describes CAM techniques that focus on using the mind to improve health or reduce unwanted symptoms, such as biofeedback, deep breathing, guided imagery and hypnosis, meditation, prayer and spirituality, relaxation training, tai chi, qi gong, and yoga. In addition, readers will find information about practices focused on healing via creative expression in art, music, and dance.

Part 6: Manipulative and Body-Based Therapies offers information about the Alexander Technique, aquatic therapy, massage therapy, chiropractic care, craniosacral therapy, Feldenkrais method, and kinesiotherapy, Pilates, reflexology, lymphatic drainage, massage therapy, Rolfing structural ­integration, tui na, and other CAM therapies that involve movement or manipulation of one or more parts of the body.

Part 7: Energy-Based Therapies discusses CAM therapies that encourage healing through the manipulation of energy fields such as feng shui, shiatsu, therapeutic therapy and Reiki, polarity therapy, and magnet therapy.

Part 8: Alternative Treatments for Specific Diseases and Conditions highlights scientific research of CAM therapies for treating arthritis, asthma, cancer, chronic pain, cognitive decline, diabetes, fibromyalgia, headache, hepatitis, low-back pain, menopausal symptoms, seasonal allergies, and sleep disorders. The use of CAM for treating mental-health problems, including anxiety and addiction, is also discussed.

Part 9: Additional Help and Information provides a glossary of terms and a directory of organizations related to CAM.

Bibliographic Note

This volume contains documents and excerpts from publications issued by the following U.S. government agencies: Federal Trade Commission (FTC); MedlinePlus; Mental Illness Research, Education and Clinical Centers (MIRECC); National Cancer Institute (NCI); National Center for Complementary and Integrative Health (NCCIH); National Center for Posttramatic Stress Disorder (NCPTSD); National Institute of Environmental Health Sciences (NIEHS); National Institute on Aging (NIA); News and Events; NIH News in Health; NIH Osteoporosis and Related Bone Diseases – National Resource Center (NIH ORBD – NRC); Office of Cancer Complementary and Alternative Medicine (OCCAM); Office of Dietary Supplements (ODS); Office on Women’s Health (OWH), Smokefree Women, U.S. Bureau of Labor Statistics (BLS); U.S. Department of Homeland Security (DHS); U.S. Department of Veterans Affairs (VA); U.S. Food and Drug Administration (FDA); and U.S. National Library of Medicine (NLM).

It also contains original material produced by Omnigraphics and reviewed by medical consultants.

About the Health Reference Series

The Health Reference Series is designed to provide basic medical information for patients, families, caregivers, and the general public. Each volume provides comprehensive coverage on a particular topic. This is especially important for people who may be dealing with a newly diagnosed disease or a chronic disorder in themselves or in a family member. People looking for preventive guidance, information about disease warning signs, medical statistics, and risk factors for health problems will also find answers to their questions in the Health Reference Series. The Series, however, is not intended to serve as a tool for diagnosing illness, in prescribing treatments, or as a substitute for the physician–patient relationship. All people concerned about medical symptoms or the possibility of disease are encouraged to seek professional care from an appropriate healthcare provider.

A Note about Spelling and Style

Health Reference Series editors use Stedman’s Medical Dictionary as an authority for questions related to the spelling of medical terms and The Chicago Manual of Style for questions related to grammatical structures, punctuation, and other editorial concerns. Consistent adherence is not always possible, however, because the individual volumes within the Series include many documents from a wide variety of different producers, and the editor’s primary goal is to present material from each source as accurately as is possible. This sometimes means that information in different chapters or sections may follow other guidelines and alternate spelling authorities. For example, occasionally a copyright holder may require that eponymous terms be shown in possessive forms (Crohn’s disease vs. Crohn disease) or that British spelling norms be retained (leukaemia vs. leukemia).

Medical Review

Omnigraphics contracts with a team of qualified, senior medical professionals who serve as medical consultants for the Health Reference Series. As necessary, medical consultants review reprinted and originally written material for currency and accuracy. Citations including the phrase Reviewed (month, year) indicate material reviewed by this team. Medical consultation services are provided to the Health Reference Series editors by:

Dr. Vijayalakshmi, MBBS, DGO, MD

Dr. Senthil Selvan, MBBS, DCH, MD

Dr. K. Sivanandham, MBBS, DCH, MS (Research), PhD

Health Reference Series Update Policy

The inaugural book in the Health Reference Series was the first edition of Cancer Sourcebook published in 1989. Since then, the Series has been enthusiastically received by librarians and in the medical community. In order to maintain the standard of providing high-quality health information for the layperson the editorial staff at Omnigraphics felt it was necessary to implement a policy of updating volumes when warranted.

Medical researchers have been making tremendous strides, and it is the purpose of the Health Reference Series to stay current with the most recent advances. Each decision to update a volume is made on an individual basis. Some of the considerations include how much new information is available and the feedback we receive from people who use the books. If there is a topic you would like to see added to the update list, or an area of medical concern you feel has not been adequately addressed, please write to:

Managing Editor

Health Reference Series

Omnigraphics

615 Griswold St., Ste. 520

Detroit, MI 48226

Part 1 | An Overview of Complementary and Alternative Medicine

Chapter 1 | What Is Complementary and Alternative Medicine?

Complementary and alternative medicine (CAM) is the term for medical products and practices that are not part of standard medical care. People with cancer may use CAM to:

Help cope with the side effects of cancer treatments, such as nausea, pain, and fatigue

Comfort themselves and ease the worries of cancer treatment and related stress

Feel that they are doing something to help with their own care

Try to treat or cure their cancer

Integrative medicine is an approach to medical care that combines standard medicine with CAM practices that have been shown through science to be safe and effective. This approach often stresses the patient’s preferences, and it attempts to address the mental, physical, and spiritual aspects of health.

Standard medical care is practiced by health professionals who hold an M.D. (medical doctor) or D.O. (doctor of osteopathy) degree. It is also practiced by other health professionals, such as physical therapists, physician assistants, psychologists, and registered nurses. Standard medicine may also be called biomedicine or allopathic, Western, mainstream, orthodox, or regular medicine. Some standard medical care practitioners are also practitioners of CAM.

Complementary medicine is used along with standard medical treatment but is not considered by itself to be standard treatment. One example is using acupuncture to help lessen some side effects of cancer treatment.

Alternative medicine is used instead of standard medical treatment. One example is using a special diet to treat cancer instead of cancer drugs that are prescribed by an oncologist.

Types of Complementary and Alternative Medicine

Scientists learn about CAM therapies every day, but there is still more to learn. Some of the therapies listed below still need more research to prove that they can be helpful. If you have cancer, you should discuss your thoughts about using CAM with your healthcare provider before using the therapies listed below.

People may use the term natural, holistic, home remedy, or Eastern Medicine to refer to CAM. However, experts often use five categories to describe it. These are listed below with examples for each.

Mind–Body Therapies

These combine mental focus, breathing, and body movements to help relax the body and mind. Some examples are:

Meditation. Focused breathing or repetition of words or phrases to quiet the mind.

Biofeedback. Using simple machines, the patient learns how to affect certain body functions that are normally out of one’s awareness (such as heart rate).

Hypnosis. A state of relaxed and focused attention in which a person concentrates on a certain feeling, idea, or suggestion to aid in healing.

Yoga. Systems of stretches and poses, with special attention given to breathing.

Tai chi. Involves slow, gentle movements with a focus on the breath and concentration.

Imagery. Imagining scenes, pictures, or experiences to help the body heal.

Creative outlets. Interests such as art, music, or dance.

Biological-Based Practices

This type of CAM uses things found in nature. Some examples are:

Vitamins and dietary supplements

Botanicals, which are plants or parts of plants. One type is cannabis.

Herbs and spices, such as turmeric or cinnamon

Special foods or diets

Manipulative and Body-Based Practices

These are based on working with one or more parts of the body. Some examples are:

Massage. The soft tissues of the body are kneaded, rubbed, tapped, and stroked.

Chiropractic therapy. A type of manipulation of the spine, joints, and skeletal system.

Reflexology. Using pressure points in the hands or feet to affect other parts of the body.

Biofield Therapy

Biofield therapy, sometimes called energy medicine, involves the belief that the body has energy fields that can be used for healing and wellness. Therapists use pressure or move the body by placing their hands in or through these fields. Some examples are:

Reiki. Balancing energy either from a distance or by placing hands on or near the patient.

Therapeutic touch. Moving hands over energy fields of the body.

Whole Medical Systems

These are healing systems and beliefs that have evolved over time in different cultures and parts of the world. Some examples are:

Ayurvedic medicine. A system from India in which the goal is to cleanse the body and restore balance to the body, mind, and spirit.

Traditional Chinese medicine. Based on the belief that health is a balance in the body of two forces called yin and yang.

Acupuncture is a common practice in Chinese medicine that involves stimulating certain points on the body to promote health, or to lessen disease symptoms and treatment side effects.

Homeopathy. Uses very small doses of substances to trigger the body to heal itself.

Naturopathic medicine. Uses various methods that help the body naturally heal itself. An example would be herbal treatments.

The Safety of CAM

Some CAM therapies have undergone careful evaluation and have been found to be generally safe and effective. These include acupuncture, yoga, and meditation to name a few. However, there are others that do not work, might be harmful, or could interact negatively with your medicines.

Natural Does Not Mean Safe

Complementary and alternative medicine therapies include a wide variety of botanicals and nutritional products, such as herbal and dietary supplements, and vitamins. These products do not have to be approved by the U.S. Food and Drug Administration (FDA) before being sold to the public. Also, a prescription is not needed to buy them. Therefore, it is up to you to decide what is best for you. Some tips to keep in mind:

Herbal supplements may be harmful when taken by themselves, with other substances, or in large doses. For example, some studies have shown that kava kava, an herb that has been used to help with stress and anxiety, may cause liver damage. And St. John’s wort, which some people use for depression, may cause certain cancer drugs to not work as well as they should.

Tell your doctor if you are taking any dietary supplements, even vitamins, no matter how safe you think they are. This is very important. Even though there may be ads or claims that something has been used for years, they do not prove that it is safe or effective. This is even more true when combined with your medicines.

Talk with your doctor about what you should be eating. It is common for people with cancer to have questions about different foods to eat during treatment. Yet it is important to know there is not just one food or special diet that has proved to control cancer.

It is always important for you to have a healthy diet, but especially now. Do the best you can to have a well-rounded approach, eating a variety of foods that are good for you.

Talk with Your Doctor before You Use CAM

Cancer patients who want to use CAM should talk with their doctor or nurse. This is important because things that seem safe could be harmful or even interfere with your cancer treatment. It is also a good idea to learn if the therapy you are thinking about has been proven to do what it claims to do. Questions to ask may be:

What types of CAM therapies might help you:

Reduce your stress and anxiety

Feel less tired

Deal with cancer symptoms and side effects, such as pain or nausea

Do not be afraid to ask questions. Doctors want to know what concerns you have so they can give you the best possible care. Let them know that you would like to use CAM methods and want their input.

_____________

This chapter includes text excerpted from Complementary and Alternative Medicine, National Cancer Institute (NCI), May 5, 2021.

Chapter 2 | CAM Use in the United States

Chapter Contents

Section 2.1—CAM Use Survey

Section 2.2—CAM Use and Children

Section 2.3—CAM Use in Older Adults

Section 2.1 | CAM Use Survey

This section includes text excerpted from National Health Interview Survey 2017, National Center for Complementary and Integrative Health (NCCIH), September 3, 2021.

According to data from the National Health Interview Survey (NHIS), the number of American adults and children using yoga and meditation has significantly increased over previous years and the use of chiropractic has increased modestly for adults and held steady for children.

Adults’ Use of Yoga, Meditation, and Chiropractors

A report based on data from the National Health Interview Survey (NHIS) found that the use of yoga, meditation, and chiropractors in the past 12 months among U.S. adults increased from 2012 to 2017.

Survey Highlights

Yoga was the most commonly used complementary health approach among U.S. adults in 2012 (9.5 percent) and 2017 (14.3 percent).

The use of meditation increased more than threefold from 4.1 percent in 2012 to 14.2 percent in 2017. In 2012, chiropractic care was as popular as yoga, followed by meditation; however, the popularity of meditation surpassed that of chiropractic care to become the second most used approach among those surveyed in 2017.

The use of chiropractors increased from 9.1 percent in 2012 to 10.3 percent in 2017.

In 2017, women were more than twice as likely to use yoga compared with men (19.8 percent versus 8.6 percent). Women were also more likely than men to use meditation (16.3 percent versus 11.8 percent) and see a chiropractor (11.1 percent versus 9.4 percent).

Non-Hispanic white adults were more likely to use yoga, meditation, and chiropractors compared with Hispanic and non-Hispanic Black adults.

Figure 2.1. Adults’ Use of Yoga, Meditation, and Chiropractors. Copyright©

2022 Omnigraphics.

The use of yoga was highest among adults aged 18 to 44 compared to older adults, while the use of meditation and chiropractic care was higher among adults aged 45 to 64 years compared with younger and older age groups.

Children’s Use of Yoga, Meditation, and Chiropractors

A new report based on data from the NHIS found that from 2012 to 2017 the use of yoga and meditation in the past 12 months significantly increased among U.S. children (aged 4 to 17 years). The percentage of children using yoga more than doubled and the percentage of children meditating showed an almost tenfold increase. The report, by researchers at the NCCIH and the NCHS of the CDC, is published as an NCHS Data Brief.

The complementary health questionnaire was developed by NCCIH and the NCHS. The questionnaire is administered every 5 years as part of the NHIS, an annual study in which tens of thousands of Americans are interviewed about their health- and illness-related experiences. Previous surveys have identified yoga,

Figure 2.2. Children’s Use of Yoga, Meditation, and Chiropractors. Copyright © 2022 Omnigraphics.

meditation, and chiropractic care as some of the most commonly used approaches by both children and adults, and this report examined changes over time in the percentage of children that used yoga, meditation, and chiropractors in the past 12 months.

Survey Highlights

The percentage of children who used yoga in the past 12 months increased significantly from 3.1 percent in 2012 to 8.4 percent in 2017.

The use of meditation also increased significantly from 0.6 percent in 2012 to 5.4 percent in 2017.

There was no significant difference in the use of chiropractic care between 2012 and 2017 (3.5 percent versus 3.4 percent).

Girls (11.3 percent) were significantly more likely to have used yoga compared with boys (5.6 percent). However, there were no significant differences between boys and girls in the use of meditation or chiropractic care.

Figure 2.1. Ten Most Common Complementary Health Approaches among Children – 2012

(Source: National Conference on Health Statistics (NCHS) 2015.)

Note: *Dietary supplements other than vitamins and minerals

Figure 2.2. Disease or Conditions for Which Complementary Health Approaches Are Most

Frequently Used among Children – 2012

(Source: National Conference on Health Statistics (NCHS) 2015.)

Note: *Dietary supplements other than vitamins and minerals

In 2017, older children (aged 12 to 17 years) were more likely to have used meditation and chiropractic care than younger children (aged 4 to 11 years).

Non-Hispanic white children were more likely to have used yoga and chiropractic care than non-Hispanic Black children or Hispanic children.

Section 2.2 | CAM Use and Children

This section includes text excerpted from Children and the Use of Complementary Health Approaches, National Center for Complementary and Integrative Health (NCCIH), March 2017. Reviewed November 2021.

Patterns in the Use of Complementary Health Approaches for Children

The National Health Interview Survey (NHIS) included a comprehensive survey on the use of complementary health approaches by almost 45,000 Americans, including more than 10,000 children aged 4 to 17. The survey found that 11.6 percent of the children had used or been given some form of complementary health product or practice, such as yoga or dietary supplements, during the past year. Data from the NHIS found that from 2012 to 2017 the use of yoga and meditation in the past 12 months significantly increased among U.S. children (aged 4 to 17 years). The percentage of children using yoga more than doubled and the percentage of children meditating showed an almost tenfold increase.

The most frequently used approaches for children were natural products (fish oil, melatonin, and probiotics), and chiropractic or osteopathic manipulation.

For children, complementary health approaches were most often used for back or neck pain, other musculoskeletal conditions, head or chest colds, anxiety or stress, attention deficit hyperactivity disorder (ADHD) or attention deficit disorder (ADD), and insomnia or trouble sleeping.

Other studies show that children in the United States who use or are given complementary health approaches vary in age and health status. For example:

About 10 percent of infants are given teas or botanical supplements, usually for fussiness or stomach problems.

About 40 percent of children aged 2 to 8 are given dietary supplements containing vitamins or minerals. However, that age group generally eats a nutritionally adequate diet.

Teens are particularly likely to use products that claim to improve sports performance, increase energy levels, or promote weight loss.

Children with chronic medical conditions, including anxiety, musculoskeletal conditions, and recurrent headaches, are more likely than other children to use complementary health approaches, usually along with conventional care.

What the Science Says about the Safety and Side Effects of Complementary Health Approaches for Children

Dietary supplements result in about 23,000 emergency room visits every year. Many of the patients are young adults who come to the emergency room with heart problems from taking weight-loss or energy products. One-fifth of the visits are children; most of whom took a vitamin or mineral when unsupervised. (Child-resistant packaging is not required for dietary supplements.)

Some dietary supplements contain contaminants, including drugs, chemicals, or metals.

Children’s small size, developing organs, and immature immune system make them more vulnerable than adults to having allergic or other adverse reactions to dietary supplements.

Some products may worsen conditions. For example, echinacea is a type of ragweed so people sensitive to ragweed may also react to echinacea.

Do not rely on asthma products sold over-the-counter (OTC) and labeled as homeopathic, the U.S. Food and Drug Administration (FDA) warns. Homeopathic remedies and dietary supplements are not evaluated by the FDA for safety or effectiveness.

Biofeedback, guided imagery, hypnosis, mindfulness, and yoga are some of the complementary health approaches that have the best evidence of being effective for children for various symptoms (such as anxiety and stress) and are low risk. However, spinal manipulation, a common complementary approach, is associated with rare but serious complications.

More to Consider

Make sure that your child has received an accurate diagnosis from a licensed healthcare provider.

Educate yourself about the potential risks and benefits of complementary health approaches.

Ask your child’s healthcare provider about the effectiveness and possible risks of approaches you are considering or already using for your child.

Remind your teenagers to talk to their healthcare providers about any complementary approaches they may use.

Do not replace or delay conventional care or prescribed medications with any health product or practice that has not been proven safe and effective.

If a healthcare provider suggests a complementary approach, do not increase the dose or duration of the treatment beyond what is recommended (more is not necessarily better).

If you have any concerns about the effects of a complementary approach, contact your child’s healthcare provider.

As with all medications and other potentially harmful products, store dietary supplements out of the sight and reach of children.

Tell all your child’s healthcare providers about any complementary or integrative health approaches your child uses. Give them a full picture of what you do to manage your child’s health. This will help ensure coordinated and safe care.

Selecting a Complementary Health Practitioner

If you are looking for a complementary health practitioner for your child, be as careful and thorough in your search as you are when looking for conventional care. Be sure to ask about the practitioner’s:

Experience in coordinating care with conventional healthcare providers

Experience in delivering care to children

Education, training, and license

Section 2.3 | CAM Use in Older Adults

This section includes text excerpted from Mind and Body Practices for Older Adults, National Center for Complementary and Integrative Health (NCCIH), August 2019.

Mind and Body Practices for Older Adults

Many older adults turn to complementary and integrative health approaches, often as a reflection of a healthy self-empowered approach to well-being. Natural products often sold as dietary supplements are frequently used by many older people for various reasons despite safety concerns or a lack of evidence to support their use. Although there is a widespread public perception that the botanical and traditional agents included in dietary supplements can be viewed as safe, these products can contain pharmacologically active compounds and have the associated dangers.

Mind and body practices, including relaxation techniques and meditative exercise forms such as yoga, tai chi, and qi gong are being widely used by older Americans, both for fitness and relaxation and because of perceived health benefits. A number of systematic reviews point to the potential benefit of mind and body approaches for symptom management, particularly for pain.

The number of older adults is growing worldwide. Research with older adult volunteers is growing, and some extant data is available. There is, however, a need for clinical trials with different symptoms and long-term follow-up to increase the evidence base.

Mind and Body Practices for Older Adults: What the Science Says

Osteoarthritis

In 2012, the American College of Rheumatology (ACR) issued recommendations for using pharmacologic and nonpharmacologic approaches for OA of the hand, hip, and knee:

The guidelines conditionally recommend tai chi, along with other nondrug approaches such as manual and thermal therapies, self-management programs, and walking aids, for managing knee OA.

Acupuncture is also conditionally recommended for those who have chronic moderate-to-severe knee pain and are candidates for total knee replacement but are unwilling or unable to undergo surgical repair.

What Does the Research Show?

A comparative effectiveness randomized controlled trial involving 204 participants with symptomatic knee arthritis found that tai chi produced beneficial effects similar to those participants who received a standard course of physical therapy. A 2016 systematic review and meta-analysis of 18 randomized controlled trials involving a total of 1,260 participants found that tai chi showed positive evidence on relief of chronic pain from osteoarthritis. A 2013 meta-analysis of seven randomized controlled trials involving 348 participants with osteoarthritis found that 12-week tai chi is beneficial for improving arthritis symptoms and physical function.

A NCCIH-funded review of meta-analyses and systematic reviews on acupuncture for chronic back pain, OA, and headache found that acupuncture generally appears better than standard care or waitlist controls for people with OA but may not provide additional benefit for people with OA who are receiving advice and exercise. A 2010 systematic review of 16 trials of 3,498 patients examined the effects of acupuncture in OA in peripheral joints and found that although acupuncture, when compared to a sham treatment, showed statistically significant, short-term improvements in osteoarthritis pain, the benefits were small and not clinically relevant. In contrast, acupuncture, when compared to a waiting list control, showed statistically significant and clinically relevant benefits in people with peripheral joint OA.

Safety

Tai chi appears to be a safe practice. Complaints of musculoskeletal pain after starting tai chi may occur but have been found to improve with continued practice.

There are few complications associated with acupuncture, but adverse effects such as minor bruising or bleeding can occur; infections can result from the use of nonsterile needles or poor technique from an inexperienced practitioner.

Sleep Disorders

Current Clinical Practice Guidelines from the American Academy of Sleep Medicine (AASM) recommend psychological and behavioral interventions, such as stimulus control therapy or relaxation therapy, or cognitive-behavioral therapy for insomnia (CBT-I), in the treatment of chronic primary and secondary insomnia for adults of all ages, including older adults.

What Does the Research Show?

2008 Clinical Practice Guidelines issued by the AASM recommend psychological and behavioral interventions in the treatment of chronic primary and secondary insomnia. The guidelines state: Initial approaches to treatment should include at least one behavioral intervention such as stimulus control therapy or relaxation therapy, or the combination of cognitive therapy, stimulus control therapy, sleep restriction therapy with or without relaxation therapy – otherwise known as cognitive-behavioral therapy for insomnia (CBT-I).

Results from a randomized controlled trial involving 60 adults aged 75 years and over with chronic insomnia suggest that mindfulness-based stress reduction is an efficient therapy for chronic insomnia.

A randomized controlled trial examined the comparative efficacy of cognitive-behavioral therapy (CBT), tai chi, and sleep seminar education control in 123 older adults with chronic and primary insomnia. The study found that CBT performed better than tai chi and sleep seminar education in remission of clinical insomnia, and also showed greater improvement in sleep quality, sleep parameters, fatigue, and depressive symptoms than the tai chi and sleep seminar education groups. Compared with the sleep seminar education control, tai chi was associated with improvements in sleep quality, fatigue, and depressive symptoms, but not insomnia remission.

A systematic review of 20 studies involving eight complementary health approaches for insomnia found evidentiary support in the treatment of chronic insomnia for tai chi.

Safety

Relaxation therapies and CBT-I are considered safe.

Menopausal Symptoms

Overall, research suggests that some mind and body approaches, such as yoga, tai chi, and meditation-based programs may provide some benefit in reducing common menopausal symptoms.

What Does the Research Show?

A systematic review and meta-analysis of 12 randomized controlled trials involving a total of 1,016 women found that psychological interventions, including CBT, mindfulness-based therapy, and behavioral therapy reduced hot flashes in the short- and medium-term and other menopausal symptoms in the short-term.

A review of 21 papers assessed mind and body therapies for menopausal symptoms. The researchers found that yoga, tai chi, and meditation-based programs may be helpful in reducing common menopausal symptoms including the frequency and intensity of hot flashes, sleep and mood disturbances, stress, and muscle and joint pain.

A Cochrane review of 16 randomized controlled trials involving 1,155 women found that when acupuncture was compared with sham acupuncture, there was no evidence of difference in their effect on hot flashes. However, when acupuncture was compared with no treatment, there appeared to be some benefit from acupuncture. Acupuncture was less effective than hormone therapy. The low quality of evidence and lack of control with sham acupuncture for some of the studies led the reviewers to conclude that there is insufficient evidence to determine whether acupuncture is effective for controlling menopausal vasomotor symptoms.

Safety

Meditation is considered to be safe for healthy people. There have been rare reports that meditation could cause or worsen symptoms in people who have certain psychiatric problems, but this question has not been fully researched. People with physical limitations may not be able to participate in certain meditative practices involving physical movement. Individuals with existing mental or physical health conditions should speak with their healthcare providers prior to starting a meditative practice and make their meditation instructor aware of their condition.

Overall, clinical trial data suggest yoga as taught and practiced in these research studies under the guidance of skilled teacher has a low rate of minor side effects. However, injuries from yoga, some of them serious, have been reported in the popular press. People with health conditions should work with an experienced teacher who can help modify or avoid some yoga poses to prevent side effects.

Tai chi is considered to be a safe practice. Complaints of musculoskeletal pain after starting tai chi may occur but have been found to improve with continued practice.

There are few complications associated with acupuncture, but adverse effects such as minor bruising or bleeding can occur; infections can result from the use of nonsterile needles or poor technique from an inexperienced practitioner.

Herpes Zoster (Shingles)

There have only been a few studies on the effects of tai chi on cell-mediated immunity to varicella zoster virus following vaccination, but the results of these studies have shown some benefit. Other interventions such as acupuncture, cupping, neural therapy, and intravenous vitamin C (ascorbic acid) have been studied for their effects on duration of neuropathic pain and post-herpetic neuralgia due to herpes zoster, but these studies have been small.

What Does the Research Show?

A randomized controlled trial in more than 100 healthy older adults found that those people who participated in a 16-week tai chi program had higher levels of cell-mediated immunity to varicella zoster virus following shingles vaccination than those who received the same vaccine but participated in a health education program instead of tai chi.

Findings from a systematic review and meta-analysis of nine randomized controlled trials involving a total of 945 participants suggest a potential benefit from acupuncture and moxibustion in reducing pain intensity from shingles; however, overall there is insufficient evidence from high-quality studies.

Safety

Tai chi is considered to be a safe practice. Complaints of musculoskeletal pain after starting tai chi may occur but have been found to improve with continued practice.

There are few complications associated with acupuncture, but adverse effects such as minor bruising or bleeding can occur; infections can result from the use of nonsterile needles or poor technique from an inexperienced practitioner.

Poor Balance/Risk of Fall

There is evidence that tai chi may reduce the risk of falling in older adults. There is also some evidence that tai chi may improve balance and stability with normal aging and in people with neuro-degenerative conditions, including mild-to-moderate Parkinson disease (PD) and stroke.

What Does the Research Show?

A recent Cochrane review of 108 randomized controlled trials involving 23,407 community-living participants aged 60 years and older found that exercise programs reduce the rate of falls and the number of people experiencing falls in older people living in community settings. The review also found that tai chi may reduce the rate of falls by 19 percent (low-certainty evidence) and may reduce the number of people who experience falls by 20 percent (high-certainty evidence).

A meta-analysis of 10 studies found that for at-risk adults and older adults, tai chi may reduce the rate of falls and injury-related falls over the short term (less than 12 months) by approximately 43 percent and 50 percent, respectively.

A Cochrane review of 30 studies involving 2,878 older adults assessed the effects of exercise interventions, which included tai chi, for reducing fear of falling in community-dwelling older people. Reviewers concluded that exercise interventions had low-quality evidence that they reduce the fear of falling immediately following the intervention and insufficient evidence to determine whether these interventions reduce fear of falling after the intervention has ended. The review also examined whether exercise interventions reduced the number of falls in participants as a secondary outcome but was considered incomplete because only a portion of the studies in the analysis evaluated this outcome.

Safety

Tai chi is considered to be a safe practice. Complaints of musculoskeletal pain after starting tai chi may occur but have been found to improve with continued practice.

Cognitive Decline

There is some evidence that suggests mind-and-body exercise programs such as tai chi and yoga may have the potential to provide modest enhancements of cognitive function in older adults without cognitive impairment.

What Does the Research Show?

A systematic review and meta-analysis of 19 randomized controlled trials involving a total of 2,539 older adults found that compared to a control group, mind-and-body exercise (such as tai chi and yoga) showed significant benefits on cognitive performance, global cognition, executive functions, learning and memory, and language. All of these programs involved actions and breathing techniques associated with mind-and-body exercise (e.g., stretching and abdominal breathing). However, more high-quality studies are needed before definitive conclusions can be drawn.

However, another systematic review of 16 randomized controlled trials found the evidence was insufficient to draw conclusions about the effectiveness of tai chi for improving cognition.

Safety

Tai chi is considered to be a safe practice. Complaints of musculoskeletal pain after starting tai chi may occur, but have been found to improve with continued practice.

Chapter 3 | Healthcare Providers and CAM

Chapter Contents

Section 3.1—Selecting a CAM Practitioner

Section 3.2—Tips for Talking with Your Healthcare Providers about CAM

Section 3.1 | Selecting a CAM Practitioner

This section contains text excerpted from the following sources: Text in this section begins with excerpts from 6 Things to Know When Selecting a Complementary Health Practitioner, National Center for Complementary and Integrative Health (NCCIH), August 26, 2013. Reviewed November 2021; Text under the heading Finding a Complementary Health Practitioner is excerpted from How to Find a Complementary Health Practitioner, National Center for Complementary and Integrative Health (NCCIH), June 15, 2011. Reviewed November 2021.

If you are looking for a complementary health practitioner to help treat a medical problem, it is important to be as careful and thorough in your search as you are when looking for conventional care.

Here are some tips to help you in your search:

If you need names of practitioners in your area, first check with your doctor or other healthcare provider. A nearby hospital or medical school, professional organizations, state regulatory agencies or licensing boards, or even your health insurance provider may be helpful. Unfortunately, the National Center for Complementary and Integrative Health (NCCIH) cannot refer you to practitioners.

Find out as much as you can about any potential practitioner, including education, training, licensing, and certifications. The credentials required for complementary health practitioners vary tremendously from state to state and from discipline to discipline.

Once you have found a possible practitioner, here are some tips about deciding whether she or he is right for you:

Find out whether the practitioner is willing to work together with your conventional healthcare providers. For safe, coordinated care, it is important for all of the professionals involved in your health to communicate and cooperate.

Explain all of your health conditions to the practitioner, and find out about the practitioner’s training and experience in working with people who have your conditions. Choose a practitioner who understands how to work with people with your specific needs, even if general well-being is your goal. And, remember that health conditions can affect the safety of complementary approaches; for example, if you have glaucoma, some yoga poses may not be safe for you.

Do not assume that your health insurance will cover the practitioner’s services. Contact your health insurance provider and ask. Insurance plans differ greatly in what complementary health approaches they cover, and even if they cover a particular approach, restrictions may apply.

Tell all your healthcare providers about the complementary approaches you use and about all practitioners who are treating you. Keeping your healthcare providers fully informed helps you to stay in control and effectively manage your health.

Finding a Complementary Health Practitioner

The MedlinePlus Directories page (www.medlineplus.gov/directories.html) from the United States. The National Library of Medicine (NLM) lists organizations for some professions and provides links to directories of libraries and various types of health professionals, services, and facilities.

Tell all your healthcare providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Section 3.2 | Tips for Talking with Your Healthcare Providers about CAM

This section contains text excerpted from the following sources: Text in this section begins with excerpts from 4 Tips: Start Talking with Your Health Care Providers about Complementary Health Approaches, National Center for Complementary and Integrative Health (NCCIH), March 14, 2012. Reviewed November 2021; Text under the heading Tips for Talking to Your Provider about CAM is excerpted from Talking about Complementary and Alternative Medicine with Health Care Providers: A Workbook and Tips, Office of Cancer Complementary and Alternative Medicine (OCCAM), January 23, 2013. Reviewed November 2021.

When patients tell their providers about their use of complementary health practices, they can better stay in control and more effectively manage their health. When providers ask their patients, they can ensure that they are fully informed and can help patients make wise healthcare decisions.

Here are four tips to help you and your healthcare providers start talking:

List the complementary health practices you use on your patient history form. When completing the patient history form, be sure to include everything you use – from acupuncture to zinc. It is important to give healthcare providers a full picture of what you do to manage your health.

At each visit, be sure to tell your providers about what complementary health approaches you are using. Do not forget to include over-the-counter (OTC) and prescription medicines, as well as dietary and herbal supplements. Make a list in advance and take it with you. Some complementary health approaches can have an effect on conventional medicine, so your provider needs to know.

If you are considering a new complementary health practice, ask questions. Ask your healthcare providers about its safety, effectiveness, and possible interactions with medications (both prescription and nonprescription).

Do not wait for your providers to ask about any complementary health practice you are using. Be proactive. Start the conversation.

Tips for Talking to Your Provider about CAM

Talking to your healthcare providers about your use of CAM is important. Before each visit, think about what you would like to discuss and use the suggestions below to have more effective conversations with your providers about your CAM use.

Preparing for Your Visit

To maximize the time you have with your healthcare providers, prepare 1–2 questions before each visit regarding concerns you may have about CAM therapies.

Sometimes it may be up to you to start the conversation. Some easy ways to bring up CAM use with your healthcare providers would be to say, I’m looking for your thoughts on how I can include complementary and alternative therapies in my treatment plan or I’ve been thinking about ways to make myself feel better, so I’ve started a yoga routine and take a multivitamin daily.

You may want to bring along a limited amount of information from trusted sources if you feel it will help you to communicate your CAM interests with your healthcare providers.

During Your Visit

At each visit, remember to discuss the CAM therapies you are using.

Inform your healthcare providers of any additional symptoms you may be experiencing as a result of your treatment, such as cancer-related fatigue.

It may be helpful to restate your commitment to standard treatments if you think your healthcare providers are concerned about your use of complementary therapies.

Ask your healthcare providers to direct you to additional resources about CAM therapies or providers.

Do not be afraid to ask for clarifications if something is unclear or you need additional information.

If you cannot speak with your doctor about your CAM use, you can also talk to the nurse practitioner (NP), physician assistant (PA), nurse, or other medical staff at your doctor’s office.

After Your Visit

Future appointments may require more time to discuss your concerns with your healthcare providers – ask the receptionist or appointment coordinator about scheduling longer appointments.

Remember, obtaining a second opinion is always an option. Second opinions can help strengthen your relationship with your existing doctor, clarify diagnoses, provide different options for treatment, and may even lead you to a doctor who is better suited to address your needs.

Chapter 4 | Insurance Issues and Paying for CAM Treatment

Use of Complementary Health Approaches in the United States

Data from the National Health Interview Survey (NHIS) shows that 33 percent of adults and almost 12 percent of children use complementary health approaches and that the most commonly used approach is natural products (dietary supplements other than vitamins and minerals). Fish oil is the dietary supplement most often used by adults and children. As for other complementary health approaches, adults and children most often turn to chiropractic or osteopathic manipulation, yoga, meditation, and massage therapy.

Out of Pocket Spending on Complementary Health Approaches

People seem to be willing to pay out of pocket (not through insurance) for certain complementary health approaches. In fact, out of pocket spending on these approaches for Americans aged four and older amounts to an estimated $30.2 billion per year, according to the NHIS. This includes:

$14.7 billion out of pocket for visits to complementary and integrative health practitioners such as chiropractors, acupuncturists, and massage therapists

Figure 4.1. Total Heathcare Spending

*National Health Expenditure Data for 2012. U.S. Department of Health and

Human Services (HHS), Centers for Medicare and Medicaid Services (CMS)

†Self-care purchases includes, for example, homeopathic medicines and self-help

materials such as books or CDs related to complementary health topics.

‡Other conventional care includes dental care, nursing homes, home healthcare,

nondrug medical products, hospital care, and other professional services.

(Source: "The Use and Cost of Complementary Health Approaches in the United

States," National Center for Complementary and Integrative Health (NCCIH).)

$12.8 billion out of pocket on natural products

About $2.7 billion on self-care approaches (homeopathic medicines and self-help materials, such as books or CDs, related to complementary health topics)

This out of pocket spending for complementary health approaches represents 9.2 percent of all out of pocket spending by Americans on healthcare ($328.8 billion) and 1.1 percent of total healthcare spending ($2.82 trillion).

Insurance Coverage of Complementary Health Approaches

Many Americans use complementary health approaches, but the type of health insurance they have affects their decisions to use these practices. In a study, researchers analyzed 2012 NHIS data on acupuncture, chiropractic, and massage, and compared that with data from 2002. While use rates for all three approaches rose, the increase was much more pronounced among those who did not have health insurance. For those who had health insurance, coverage for these three approaches was more likely to be partial than full.

If you would like to use a complementary or integrative approach and do not know if your health insurance will cover it, you should contact your health insurance provider to find out.

Some questions to ask your insurance provider include:

Is this complementary or integrative approach covered for your health condition?

Does it need to be:

Preauthorized or preapproved?

Ordered by a prescription?

Do you need a referral?

Does coverage require seeing a practitioner in the network?

Do you have coverage if you go out of network?

Are there any limits and requirements – for example, on the number of visits or the amount you will pay?

How much do you have to pay out of pocket?

Keep records about all contacts you have with your insurance company, including notes on calls and copies of bills, claims, and letters. This may help if you have a claim dispute.

If you are choosing a new health insurance plan, ask the insurance provider about coverage of complementary or integrative health approaches. You should find out if you need a special rider or supplement to the standard plan for these approaches to be covered. You should also find out if the insurer offers a discount program in which plan members pay for fees and products out of pocket but at a lower rate.

Sources of Information on Insurers

Your state insurance department may be able to help you determine which insurance companies cover specific complementary or integrative health approaches. The USA.gov provides contact information for state and local consumer agencies, including insurance regulators. Professional associations for complementary health specialties may monitor insurance coverage and reimbursement in their field.

Asking Practitioners about Payment

If you are planning to see a complementary or integrative practitioner, it is important to understand about payment. Here are some questions to ask:

Costs. What does the first appointment cost? What do follow-up appointments cost? Is there a sliding scale based on income? How many appointments are you likely to need? Are there other costs (e.g., tests, equipment, supplements)?

Insurance. Do they accept your insurance plan? What has been their experience with their plan’s coverage for people with your condition? Do you file the claims, or do they take care of that?

Federal Health Benefit Programs

The federal government helps with some health expenses of people who are eligible for federal health benefit programs, such as programs for veterans, people aged 65 and older (Medicare), and people who cannot afford healthcare (Medicaid, funded jointly with the states).

Information on health benefits for veterans is available from the U.S. Department of Veterans Affairs (VA). Information on Medicare and Medicaid is available from the Centers for Medicare & Medicaid Services (CMS). A handbook, Medicare & You (www.medicare.gov/medicare-and-you), explains what services Medicare covers.

Two other Internet resources – Benefits.gov and the Health and Insurance page (www.opm.gov/healthcare-insurance/healthcare/plan-information/plans) on the OPM Website – explain federal health benefit programs. Benefits.gov has a benefits finder that can help you learn more about qualifying for programs.

_____________

This chapter includes text excerpted from Paying for Complementary and Integrative Health Approaches, National Center for Complementary and Integrative Health (NCCIH), June 2016. Reviewed November 2021.

Chapter 5 | Complementary, Alternative, or Integrative Health: What Is In a Name?

Complementary versus Alternative

According to a national survey, many Americans – more than 30 percent of adults and about 12 percent of children – use healthcare approaches that are not typically part of conventional medical care or that may have origins outside of usual Western practice. When describing these approaches, people often use alternative and complementary interchangeably, but the two terms refer to different concepts:

If a nonmainstream approach is used together with conventional medicine, it is considered complementary.

If a nonmainstream approach is used in place of conventional medicine, it is considered alternative.

Most people who use nonmainstream approaches also use conventional healthcare.

In addition to the terms complementary and