Complementary and alternative medicine

Complementary and alternative medicine

1. ALTERNATE SYSTEM OF MEDICINE/COMPLEMENTARY THERAPIES - By Miss Shweta Sharma M.Sc . Nursing II year AIIMS ,Jodhpur

2. DEFINITION Alternative therapies: It refers to a broad group of natural and spiritual healing methods that are different than the conventional western medicine (or pharmaceutical medicine). Many of these healing methods have been used for centuries in many different cultures. They are used instead of conventional or mainstream medical modalities. Complementary therapies are used in conjunction with conventional or mainstream medical modalities.

3. COMPLEMENTARY AND ALTERNATIVE MEDICINE THERAPY (CAM) The field is very broad and constantly changing. The National Centre for Complementary and Alternative Medicine (NCCAM) defines CAM as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.

4. Classifications according to NCCAM, complementary and alternative medicine therapy (CAM) Whole medical systems Mind-body interventions Biologically based therapies Manipulative and body-based methods Energy therapies Homeopathic, naturopathic, traditional, Chinese, ayurvedic, acupuncture Meditation, relaxation, imagery, biofeedback, hypnosis Dietary supplements, herbs, foods, vitamins, natural substances Chiropractic, osteopathy, massage Biofield therapy, Bioelectromagnetic therapy

5. Whole Medical System It includes the following: •Ayurveda •Traditional Chinese Medicine (TCM): Acupuncture and acupressure •Unani •Siddha •Homeopathy •Naturopathy

6. Ayurveda It is a system of traditional medicine native to India and practiced in other parts of the world as a form of alternative medicine. The word ayurveda consists of the words ‘ ayus ’, meaning ‘longevity’, and ' veda ', meaning 'related to knowledge' or ‘science’. Its focus is on the balance of mind, body and spirit. Disease is viewed as an imbalance between a person's life force (prana) and basic metabolic condition ( dosha ). The earliest literature on Indian Medical Practice appeared during the Vedic period in India. The Suśruta Samhita and the Charaka Samhita were influential works on traditional medicine during this era.

7. Ayurveda stresses the use of plant-based medicines and treatments. Hundreds of plant-based medicines are employed, including cardamom and cinnamon. Some animal products may also be used, for example, milk, bones, and gallstones. In addition, fats are used both for consumption and for external use. Minerals, including sulfur, arsenic, lead, copper sulfate and gold are also consumed as prescribed. This practice of adding minerals to herbal medicine is known as rasa shastra.

8. Unani Unani Medicine is based on the Greece philosophy. According to Basic Principles of Unani, the body is made up of the four basic elements, i.e. Earth, Air, Water, Fire which have different Temperaments, i.e. Cold, Hot, Wet, Dry.

9. Treatment dependent on the Temperament ( Mizaj ), hereditary effects, signs and symptoms, external observation, examination of the pulse ( Nubz ), urine and stool. Dietotherapy ( Ilaj-bil-Ghiza ), Climatic therapy ( Ilaj-bil-Hawa ), Regimental therapy ( Ilaj -bit- Tadbir ; includes diaphoresis, diuresis, massage, cauterization, emesis, exercise). Pharmacotherapy ( Ilaj -bid- Dawa ): Local herbal drugs. Only minor surgery is in vogue in this system.

10. Traditional Chinese Medication (TCM) It is one of the most comprehensive medical systems. Practitioners of TCM view human beings in terms of five dimensions. These include •Qi [ energy resulting from interaction between Yin (cold, heavy, moist and negative) and Yang (hot, dry, light and positive)] •Jing (genetic material of physical body) •Shen (spirit) •Blood •Yin Ye fluids (lubricates the organs)

11. The body is considered to be a series of energetic pathways known as Meridian system . Specific points along the pathways referred to as acupoints.

12. Acupuncture It is an alternative medicine that treats patients by insertion and manipulation of needles in the body. Its proponents variously claim that it relieves pain, treats infertility, treats disease, prevents disease, promotes general health, or can be used for therapeutic purposes.

13. There are numerous theories about how acupuncture works: It stimulates the release of pain-relieving endorphins. It influences the release of neurotransmitters. It influences the autonomic nervous system. It stimulates circulation. It influences the electrical currents of the body.

14. Conditions that are benefitted from Acupuncture: Neurologic disorders: Migraine headaches, peripheral neuropathy and trigeminal neuralgia Gastrointestinal disorders: Colitis, constipation, gastritis, ulcers Respiratory conditions: Asthma, bronchitis, rhinitis Eye disorders: Myopia, conjunctivitis Musculoskeletal disorders : Tennis elbow, sciatica

15. Acupressure It is an ancient healing art that uses the fingers to press key points on the surface of the skin to stimulate the body's natural self-curative abilities. When these points are pressed, they release muscular tension and promote the circulation of blood and the body's life force to aid healing. Acupuncture and acupressure use the same points, but acupuncture employs needles, while acupressure uses the gentle but firm pressure of hands (and even feet).

16. Homeopathy Homeopathy is a form of alternative medicine in which practitioners treat patients using highly diluted preparations that are believed to cause healthy people to exhibit symptoms that are similar to those exhibited by the patient. The basic principle of homeopathy, known as the "law of similars ", is "let like be cured by like".

17. Homeopathic remedies are prepared by serial dilution with shaking by forceful striking on an elastic body, which homeopaths term succussion . Each dilution followed by succussion is assumed to increase the effectiveness. Homeopaths call this process potentization. Dilution often continues until none of the original substances remains. Apart from the symptoms, homeopaths examine aspects of the patient's physical and psychological state, then homeopathic reference books known as repertories are consulted, and a remedy is selected based on the totality of symptoms.

18. Siddha Siddha medicine is a form of medical treatment of diseases using substances of all possible origins in a way that balances the possible harmful effect of each substance. This form of medicine was professed and practiced by siddhars who wrote their recipes on palm-leaves for the use of future generations. Siddha medicine was developed by outstanding Dravidians (ancient Tamils), locally called Cittars . Preparations are made mainly out of the parts of the plants and trees such as leaves, bark, stem, root, etc., but include also mineral and some animal substances.

19. This form of medicine is still today well-known in South India. The use of metals like gold, silver and iron powders (Sanskrit bhasma ) in some preparations is a special feature of siddha medicine, which claims it can detoxify metals to enable them to be used for stubborn diseases. This claim is especially relevant in the case of mercury which is relatively often used in the system; medicine containing purified mercury should only be received, if at all, from a highly qualified practitioner of the art.

20. Naturopathy Naturopathy is a system of man building in harmony with the constructive principles of Nature on physical, mental, moral and spiritual planes of living. According to the manifesto of British Naturopathic Association, "Naturopathy is a system of treatment which recognises the existence of the vital curative force within the body." It therefore, advocates aiding human system to remove the cause of disease, i.e. toxins by expelling the unwanted and unused matters from human body for curing diseases.

21. Mind Body Interventions Mind-body medicine uses the power of thoughts and emotions to influence physical health. As Hippocrates once wrote, "The natural healing force within each one of us is the greatest force in getting well." This is mind- body medicine in a nutshell. Methods by which an individual can, independently or with assistance, consciously control some functions of the sympathetic nervous system (e.g. heart rate, respiratory rate, blood pressure).

22. Leading mind-body techniques are: Meditation Relaxation Biofeedback Imagery Hypnosis Aromatherapy Yoga

23. 1. Meditation It often involves invoking or cultivating a feeling or internal state, such as compassion, or attending to a specific focal point. Meditation is generally an internal, personal practice and done without any external involvement, except perhaps prayer beads to count prayers, though many practitioners of meditation may rely on external objects such as candle flames as points on which to focus their attention as an aid to the process. It is quieting of the mind by focusing attention on sound or image or own breathing.

24. Health Benefits of Meditation Include: Decreased respiration Slowed heart rate Decreased blood pressure Improved mood Heightened awareness Efficient and effective oxygen consumption Spiritual calm Stress relief Relaxation Reduced level of lactic acid Improved functioning of the immune system

25. 2. Relaxation Stands quite generally for a release of tension , a return to equilibrium. It is any method, process, procedure, or activity that helps a person to relax; to attain a state of increased calmness; or otherwise to reduce levels of anxiety, stress or anger. Relaxation techniques are often employed as one element of a wider stress management program and can decrease muscle tension, lower the blood pressure and slow heart and breath rates, among other health benefits. It is a therapeutic process incorporating the basic elements of meditation.

26. Basic elements of relaxation technique are: A quiet environment A comfortable position Focused attention It involves progressive muscle relaxation. Progressive relaxation is the alternate tensing and relaxing of muscles. Nurses can use relaxation techniques to reduce pain and stress in clients.

27. A technique of using the imagination to visualize a soothing, pleasant image. Benefits of this technique include: decreased physical tension, decreased anxiety, and decreasing the adverse effects of chemotherapy.

28. 4. Biofeedback In this, people are trained to control certain bodily processes that normally occur involuntarily, such as heart rate or blood pressure. These processes can be measured and displayed on a monitor that the person watches.

29. It measures physiological responses such as muscle tension, skin temperature, and heart rate to improve health by using signals from client's own body. It is effective for a number of conditions, including headaches, urinary incontinence, hypertension, chronic pain, etc. Uses of biofeedback: A restorative method in rehabilitation settings for clients who have lost sensation and function as a result of injury or illness To relieve tension headaches, migraines and backache To lower blood pressure.

30. 5. Hypnosis The earliest definition of hypnosis was given by Braid, who coined the term "hypnotism" as an abbreviation for "neuro- hypnotism", or nervous sleep, which he opposed to normal sleep, and defined as: "a peculiar condition of the nervous system, induced by a fixed and abstracted attention of the mental and visual eye, on one object, not of an exciting nature. Therapeutic hypnosis: It induces an altered state of consciousness or awareness resembling sleep during which the person is more receptive to suggestion. Hypnosis also enhances client's ability to form images (for guided imagery).

31. Uses of hypnosis: Pain management IBS Weight loss Soothing anxious surgical patients Sports performance Anaesthesia Skin disease Habit control Quit smoking

32. 6. Yoga Sanskrit root " yuj " meaning "to control, to unite, joining, conjunction and means." Outside India, yoga is typically associated with asanas (postures) or as a form of exercise. Goals- Improving health to achieving moksha; liberation from all worldly suffering and the cycle of birth and death (samsara), at which point there is a realization of identity with the supreme Brahman. In Mahabharata, yoga is described as entering the world of brahma, as brahman.

33. 7. Aromatherapy Uses volatile plant materials (essential oils) and similar aromatic compounds for the purpose of improving a person's mood, cognitive function or health Generic term; used by manufacturers (of personal care and hygiene products), massage therapists, chiropractors, nurses and doctors OTC products that make use of essential oils (menthol) include mouthwashes, liniments and rubbing ointments (Vicks Vaporub ) Essential oils useful in the treatment of infectious disease Used as medicines, with other herbal preparations, by doctors in France (commonly) Used in pain management, anxiety/depression, and Alzheimer's disease.

34. Biologically-based Therapies Most common among the biologically-based therapies are: Dietary supplements Foods Herbs Vitamins Natural substances

35. Diet Therapy According to this therapy, the food must be taken in natural form. Fresh seasonal fruits, fresh green leafy vegetables and sprouts are excellent. These diets are broadly classified into three types which are as follows: Eliminative Diet: Liquids-Lemon, Citric juices, Tender coconut water, Vegetable soups, Butter-milk, Wheat grass juices, etc. Soothing Diet: Fruits, Salads, Boiled/Steamed vegetables, Sprouts, Vegetable chutney, etc. Constructive Diet: Wholesome flour, Unpolished rice, Little pulses, Sprouts, Curd, etc.

36. Macrobiotic diet: Predominantly a vegan diet (no animal products except fish). Initially used in the management of a variety of cancers. Emphasis placed on whole cereal grains, vegetables and unprocessed foods. Orthomolecular medicines: Increased intake of nutrients such as Vitamin C and beta carotene. Diet used in treatment of cancer, schizophrenia and certain chronic diseases such as hypercholesterolemia and coronary artery disease.

37. Ayurvedic Herbs The herbal products are used in the form of powder, tonic, etc. These could be a single herb or a mixture of many herbal products, depending on the diseases and the treatment required. Some common herbal remedies include the following: Garlic Peppermint Chamomile Phytochemicals: These are non-nutritive, physiologically active compounds present in plants in very small amounts. They protect against cancer and prevent heart disease, stroke, and cataracts. Main source for phytochemicals is fruits and vegetables. Consumption of a wide variety of fruits and vegetables provides best supply.

38. Antioxidants and Free Radicals Antioxidants: Substances that prevent or inhibit oxidation, a chemical process whereby a substance is joined to oxygen. Free radicals: Antioxidants prevent tissue damage related to these, which are unstable molecules that alter genetic codes and trigger the development of cancer growth.

39. Manipulative and Body-based Methods These methods use techniques of manipulating or moving various body parts to achieve therapeutic outcomes. It includes: Chiropractice Osteopathy Massage Tai chi

40. Chiropractice : It emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine. The main chiropractic treatment technique involves manual therapy, including manipulation of the spine, other joints, and soft tissues; treatment also includes exercises and health and lifestyle counseling. It is based on the principle that the brain sends vital energy to every organ in the body via the nerves originating in the spinal column . The body is rebalanced and realigned using "spinal adjustment" techniques.

41. Massage: It is use of the hands to direct or redirect the flow of the body's energy fields and enhance balance within those fields. It includes touch, therapeutic touch or healing touch, acupressure, and reflexology. The means of perceiving or experiencing through tactile sensation.

42. Therapeutic Touch Based on the ancient practice of the laying on of hands and using the hands to direct energy to achieve a balanced state Non-contact Therapeutic Touch (NCTT), “Healing Touch," or Distance Healing It is an energy therapy, practitioners say, promotes healing and reduces pain and anxiety. Practitioners of therapeutic touch state that by placing their hands on, or near, a patient, they are able to detect and manipulate the patient's energy field.

43. Touch in Nursing Practice An integral part of assessment Promotes bonding An important means of communication Assists in soothing, calming, and comforting Helps keep the client oriented

44. Cultural Considerations of Touch Ask permission before touching a client. Tell the client what is going to happen. The meaning of touch and the body areas acceptable to touch vary from culture to culture.

45. Reflexology Art and science of enervating over 7,000 nerves in the feet believed to correspond to every muscle system and organ in the body. Promotes health by relieving pressures and accumulation of toxins in the corresponding body part. Reflexology, or zone therapy is an alternative medicine involving the physical act of applying pressure to the feet, hands, or ears with specific thumb, finger, and hand techniques without the use of oil or lotion.

46. Energy Therapies These are alternative therapies that involve the use of purported energy fields. There are two main types- Biofield therapy Bioelectromagnetic therapy

47. Biofield Therapies They are intended to affect energy fields that purportedly surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples include Qigong, Reiki, and Therapeutic touch. Reiki is a spiritual practice developed in 1922 by Japanese Buddhist Mikao Usui. It uses a technique commonly called palm healing as a form of complementary and alternative medicine and is, sometimes, classified as oriental medicine by some professional bodies.

48. Steps of palm healing: Recipients lay down on a massage table and relax with loose, comfortable clothing. Practitioner enters a calm state of mind and mentally prepared for the treatment without talking. Practitioner placing his hands on the recipient in various positions. Hands kept still for 3 to 5 minutes before moving to the next position.

49. General coverage of the head, the front and back of the torso, the knees, and feet. 12-20 positions are used, with the whole treatment lasting 45 to 90 minutes. Some use a fixed set of hand positions, while others use their intuition to guide them as to where treatment is needed, sometimes starting the treatment with a "scan". Recipient often feels warmth or tingling, even when a non-touching approach is used. Instantaneous "cures" of specific health problems are not usually observed.

50. Electromagnet therapy It is a pseudoscientific alternative medicine practice involving the use of static magnetic fields. Practitioners claim that subjecting certain parts of the body to magnetostatic fields produced by permanent magnets has beneficial health effects. Although hemoglobin, the blood protein that carries oxygen, is weakly diamagnetic (when oxygenated) or paramagnetic (when deoxygenated) the magnets used in magnetic therapy are many orders of magnitude too weak to have any measurable effect on blood flow.

51. Products include magnetic bracelets and jewelry; magnetic straps for wrists, ankles, knees, and the back; shoe insoles; mattresses; magnetic blankets (blankets with magnets woven into the material); magnetic creams; magnetic supplements; plasters/patches and water that has been “magnetized”. Application is usually performed by the patient.

52. Biological Effects Accelerated healing Greater cellular energy (increased ATP) Vasodilatation Reduced inflammation and edema Muscle relaxation Cell membrane changes Enhanced movement of calcium, sodium and other ions Bone formation

53. Improved oxygenation Better sleep Lysis of clots Reduction in platelet adhesion Increased fertility Enhanced cognitive ability Improved central and peripheral nerve function Reduced stress and better mood

54. Osteoporosis and Arthritis Bioelectromagnetic Therapy has proven effective in healing non-union fractures and stimulates the formation of new bone with documented benefits in osteoporosis and arthritis. With correct treatment, significant increases of bone density have been documented in remarkably short periods of time. Osteoporosis patients frequently suffer from " compression" fractures due to fragile bones. Bioelectromagnetics has been reported to alleviate pain, heal existing fractures and prevent future breaks as normal bone density is restored.

55. Other Important Modalities Humor: It determines the client's perception of what is humorous. It can relieve anxiety, improve respiratory function, promote relaxation, enhance immunological function, and decrease pain by stimulating endorphin production.

56. Pet therapy: It has many applications including overcoming physical limitations, improving mood, lowering blood pressure, and improving socialization skills and self-esteem. Music therapy: Pleasurable sound and music can reduce stress, perception of pain, anxiety, and feelings of isolation.

57. Hydrotherapy: It involves the use of water for pain-relief and treating illness. It continues to be widely used for burn treatment, although shower-based hydrotherapy techniques have been increasingly used in preference to full immersion methods, partly for the ease of cleaning the equipment and reducing infections due to contamination.

58. ALTERNATIVE/COMPLEMENTARY MODALITIES AND NURSING These modalities give nurses additional tools to meet client needs. For the theory of human care, the very basis of nursing is interaction and connection between two human beings. The modality of healing presence is a significant, important technique to provide trust, support and to initiate the caring encounter necessary for nursing to take place.

59. Nursing Theories/Conceptual Models of the Context for Professional Nursing Some of the modalities are compatible with the principles and concepts of specific nursing theories. In other cases, the theories themselves provide a mandate for a specific kind of nursing intervention. Nursing theory provides the concepts to reflect on nursing care and on the use of alternative/complementary modalities. Roy states that the “nurse acts as a regulatory force to modify stimuli affecting adaptation”. Music therapy and aromatherapy are specific modalities that change the environment in which the client finds him/herself and are expressly designed to change the context of care.

60. DRAWBACKS OF ALTERNATIVE MEDICINE Not subjected to testing. Attempts to disprove this fact sometimes use the appeal, i.e. "That which is natural cannot be harmful". Since 1938, the FDA regulated homeopathic products. Homeopathic remedies are extremely dilute, thus considered safe, but their products are exempt from goods manufacturing practice requirements (expiry date and identity and strength of products and their alcohol concentration). Treatment delay. Danger increased when used as a complement to standard medical care: A Norwegian study examined the association between the use of alternative medicine and cancer survival. 515 patients using standard medical care for cancer were followed for 8 years. 22% of those patients used complementary care. The study revealed that death rates were 30% higher in alternative medicine users than in those who did not use alternative medicine (AM).

61. 1.Complementary and alternative medicine in chronic neurological pain A study was done to evaluate the current recommendations for CAM therapies in key neurological disorders by Shri Kant Mishra, Bhavesh Trikamji , Elizabeth Togneri in 2015 . Sources like PubMed, Embase , UCLA libraries, USC libraries, and National Center for Complementary and Alternative Medicine (NCCAM) books were searched to gather data for this review. The current recommendations for CAM therapies in headaches, neck pains, lower back pains, neuropathic pains, and cancer-related pains were discussed. The CAM therapies discussed include natural therapies, mind and body therapies, and several other modalities. The study concluded that in spite of vast literature available on the CAM therapies for neurological disorders; there is little evidence for the most beneficial CAM remedies that target common neurological disorders. Although new CAM modalities are brought to light in addition to those that have existed for centuries, further scientific data from evidence-based studies is needed to accurately compare the CAM therapies amongst each other and allopathic treatments.

62. 2.Complementary and Alternative Medicine Use among U.S. Adults with Common Neurological Conditions A study was conducted by Rebecca Erwin Wells, Russell S. Phillips, Steven C. Schachter, and Ellen P. McCarthy in 2010 to determine patterns, reasons for, and correlates of complementary and alternative medicine (CAM) use in United States (U.S.) adults with common neurological conditions. The study compared CAM use between adults with and without common neurological conditions (regular headaches, migraines, back pain with sciatica, strokes, dementia, seizures, or memory loss) using the National Health Interview Survey of 23,393 U.S. adults. Adults with common neurological conditions used CAM more frequently than those without (44.1% vs. 32.6%). Nearly half of adults with back pain, sciatica, memory loss, and migraines reported use of CAM. Mind/body therapies were used the most; alternative medical systems were used the least. Over 50% of adults with common neurological conditions who used CAM had not discussed their use with their health care provider. Significant correlates of CAM use among adults with common neurological conditions include higher than high school education, anxiety in the prior year, living in the west, being a former smoker, and light alcohol use. The study concluded that CAM is used more frequently among adults with common neurological conditions than those without.

63. 3.Cross-sectional survey of complementary and alternative medicine used in Oregon and Southwest Washington to treat multiple sclerosis: A 17-Year update A survey was done in 2001 to see the complementary and alternative medicine used in Oregon and Southwest Washington to treat multiple sclerosis. In 2018, a revised survey in the same region was administered to describe updated patterns of CAM use in pwMS and to compare changes in use, perceived benefit, and patterns of communication between participants and providers regarding CAM over the past 17 years. 81% of respondents in 2018 (n = 1014) used a CAM supplement (vitamins, minerals, herbs), 39% used mind-body therapies (mindfulness, massage), 41% used specific diet, and 81% used exercise to treat their multiple sclerosis. Since 2001, use of supplements, exercise, and mind-body therapies have increased (65% to 81%, 67 to 81%, and 14% to 39%). Participants were also nine times more likely to speak to their neurologists about CAM use (6.7% to 55.4%). In 2018, factors associated with CAM use included female sex, progressive disease, and longer time since multiple sclerosis diagnosis. These findings highlight the high and increasing prevalence of CAM use in pwMS and factors associated with CAM use, and underscore the importance of research to investigate safety and efficacy of these therapies.

64. SUMMARY AND CONCLUSION Complementary and alternative medicine treatments are increasingly employed to supplement traditional Western medicine treatments in neurology. These include acupuncture, natural tactic medicine, homeopathic medicine, massage, chiropractic treatment, herbal medicine, exercise regimens, dietary interventions, etc.

65. REFERENCES Navdeep Kaur Brar, HC Rawat. Textbook of Advanced Nursing Practice. Jaypee Brothers Publication. New Delhi. First edition. 2015. Pg. no. 933-942. PubMed . Mishra SK, Trikamji B, Togneri E. Complementary and alternative medicine in chronic neurological pain. Indian J Pain [serial online] 2015 [cited 20 Aug 2020];29:73-81. Available from: http://www.indianjpain.org/text.asp?2015/29/2/73/153594 PubMed . Complementary and Alternative Medicine Use among U.S. Adults with Common Neurological Conditions. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3050588/ [cited 20 Aug 2020] Oregon Health & Sciences University. “Cross-sectional survey of complementary and alternative medicine used in Oregon and Southwest Washington to treat multiple sclerosis: A 17-Year update”. by Elizabeth Silbermann et al. Multiple Sclerosis and Related isorders doi:10.1016/j.msard.2020.102041[cited 20 Aug 2020]