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Complementary and Alternative Medicine (CAM)

Basics

  • CAM includes diverse therapies such as:
  • Meditation, mindfulness, relaxation
  • Yoga, tai chi, qigong
  • Specialized diets
  • Herbal supplements
  • Massage, osteopathic manipulative therapy (OMT), chiropractic therapy

  • Ayurveda

  • Integrative medicine coordinates CAM with conventional treatment.

  • Patients seek CAM to:

  • Address symptoms not fully treated by conventional medicine
  • Use a holistic or natural approach
  • Avoid medication side effects
  • Honor cultural or familial beliefs

Epidemiology

  • Most frequent users: females aged 30-69 years.
  • CAM commonly treats musculoskeletal issues; 59-90% of users report pain improvement.
  • Approximately 70% of North Americans have tried at least one CAM therapy.

Commonly Associated Conditions

  • Acute/chronic pain, osteoarthritis, fibromyalgia
  • Insomnia, fatigue
  • Cancer-related symptoms and treatment side effects
  • Headaches, IBS, depression/anxiety
  • Low libido, weight loss, asthma, eczema, tinnitus, autoimmune disease

Diagnosis

  • Assess patient’s:
  • Impact of illness on life
  • Beliefs, goals, attitudes toward conventional and alternative medicine
  • Full medication/supplement list including OTC and herbals

  • Nutrition, exercise, sleep, social support, mood, spirituality

  • Perform focused physical exam, possibly including osteopathic structural exam.

  • Consider behavioral health screening tools like PHQ-9 and GAD-7.

Treatment

  • Evidence supports safety and efficacy variably:
  • Back pain: chiropractic therapy, OMT, massage therapy
  • Nausea (chemotherapy-associated): ginger
  • Migraine prophylaxis: butterbur extract (petasites), riboflavin, CoQ10, magnesium
  • Anxiety, depression, stress: music therapy, meditation, mindfulness, yoga, massage, acupuncture, light therapy, exercise

  • Fatigue: qigong, acupuncture, ginseng

  • Herbal supplements for mood and cognitive support:

  • Anxiety: kava kava, ashwagandha
  • Depression: St. John’s wort, 5-HTP, SAMe, omega-3
  • Migraines: magnesium, riboflavin, CoQ10

  • Dementia: ginkgo biloba

  • Lifestyle adjuncts:

  • Yoga and exercise help with depression and fatigue.
  • Light therapy (10,000 lux for 30 min in AM) benefits mood.
  • Tai chi improves balance, mobility, and fibromyalgia symptoms, especially in elderly.

Issues for Referral

  • Address patient concerns about stigma toward CAM.
  • Confirm provider certification/training before referral.

Complementary & Alternative Medicine Safety and Considerations

  • Common herb-drug interactions:
  • Ginkgo, goldenseal, St. John’s wort have multiple interactions.
  • Potential adverse effects of herbs:
  • Black cohosh reduces statin efficacy.
  • Ginkgo increases bleeding risk.
  • Goldenseal interferes with many drugs.
  • Licorice and senna deplete potassium.
  • St. John’s wort induces CYP3A4, affecting numerous medications.

  • Wormwood and yohimbe raise blood pressure.

  • Elderly considerations:

  • Ginkgo may improve cognition but watch for warfarin interaction.
  • Integrative medicine supports palliative care.

  • Tai chi and gentle yoga reduce falls and improve mobility.

  • Pediatric considerations:

  • Peppermint oil helps functional abdominal pain.
  • Fennel preparations useful in infantile colic.
  • Iron and vitamin A poisoning risks.

Ongoing Care

  • Maintain communication and record sharing between conventional and CAM providers.
  • Monitor patient medication and supplement use carefully.

Patient Education

  • Refer to National Center for Complementary and Integrative Health (NCCIH): https://nccih.nih.gov/
  • Cleveland Clinic resource on complementary medicine: https://my.clevelandclinic.org/health/articles/16883-complementary-therapy

Prognosis and Clinical Pearls

  • CAM supports holistic patient care beyond disease-focused treatment.
  • Outcomes should be assessed by symptom relief, patient satisfaction, and function.
  • OMT, chiropractic, massage, tai chi, acupuncture may aid chronic pain.
  • Yoga, exercise, and light therapy benefit depression.
  • Peppermint oil may relieve IBS-related abdominal pain.
  • Herb-drug interactions require vigilance.
  • Tai chi improves balance and reduces falls in elderly; effective adjunct in fibromyalgia.