Transcript Cam Presentation

Complimentary
and Alternative
Medicine
Michelle Nissen
Angela Robinson
Teresa Siefke
Complementary and
Alternative Medicine
(CAM)
Objectives
• Define Complimentary and Alternative
therapies
• Discuss the prevalence of CAM in
society today
• Identify common therapies used in
CAM
• Identify the risks of using CAM
• Provide credible resources for the use
of CAM
Definition
• Complimentary Medicine
– medicines used that are not
mainstream but are used
together with conventional
medicine
• Alternative Medicine
– non-mainstream medicines used
in place of conventional therapies
(US Department of Health and Human Services, 2013)
Categories of
CAM
(Frass et al., 2012, p. 47)
Prevalence
Approximately 32.2% of the
population uses some form of
CAM - not including prayer
1997- 12.2 billion out of pocket
2007 – 34 billion out of pocket
(Frass et al., 2012)
Prevalence
Most used therapies
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•
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•
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Homeopathic
Acupuncture
Chiropractic Manipulation
Phytotherapy/Herbal Medicine
Massage
Five medical conditions that use CAM
•
•
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•
•
Back pain
Depression
Insomnia
Severe headaches
Stomach ailments
(Frass et all., 2012)
Iridology
http://www.iridologyphg.com/
Analyze color, pigment distribution, and lacunae are
believed to allow diagnosis of abnormalities and
believe that these changes are “seen” before clinical
manifestations are detected
(Munstedt, et al., 2005)
Iridology
• Analyze the iris to detect
certain diseases
• 110 subjects to identify cancer
– Only three cases were correctly
identified
– Yielded sensitivity of only 0.04
• Despite its popularity, iridology
has shown no real benefit
(Munstedt, et al., 2005)
Diet
• Low fat (LF) vs low carbohydrate (LC)
– One year randomized clinical trial
•
•
•
•
woman 25-50 years old
BMI 27-40 kg/m²
non-diabetic
generally healthy
• Total plasma insulin to determine the
IR and IS individuals
– IR >10.6 μIU/ml
– IS <6.9 μIU/ml
– Intermediate levels were excluded
(McClain, Otten, & Gardner, 2013)
Insulin Resistant
• LF diet
– less likely to adhere and lose
weight when compared to IS
• LC diet
– more success with weight loss
• Improved insulin levels
compared to other groups
– Degree of weight loss correlated
with improved insulin
(McClain, Otten, & Gardner, 2013)
Twelve-month change in
diet by insulin resistance
status in diet groups
(McClain, Otten, & Gardner, 2013, p. 89)
Mediterranean
• MedDiet consists mainly of
– Fruits, vegetables, cereals, whole
grain breads, beans, nuts, seeds
– Locally grown fresh and seasonal
foods
– Sugars and honey only a few times
per week
– Fat mainly from olive oil, low
amount of cheese, yogurt
– Low red meat, high fish
– Moderate red wine
(Hartley, Clarke, Hooper, Thorogood, & Stranges, 2013)
MedDiet & CVD
• Survey of 11 RCTs
– None could positively link
MedDiet to outcomes
– Most showed reduction in
individual CVD risk factors
• Small reductions in cholesterol,
LDL-C, triglycerides, and lowered
blood pressure
• No significant increase in HDL or
reduction in diabetes risk
(Hartley, Clarke, Hooper, Thorogood, & Stranges, 2013)
Metabolic
Syndrome (MetS)
• Increased risk of CVD
• Pro-inflammatory state with
elevated levels of inflammatory
markers
– C-reactive protein (CRP)
– Interleukin-6 (IL-6)
– Interleukin-8 (IL-8)
– Tumor necrosis factor-α (TNF-α)
(Richard, Couture, Desroches, & Lamarche, 2013)
MedDiet & MetS
• Four phase study
– 5-week: control-feeding diet
(isocaloric/weight maintain)-to minimize
inter-individual variations attributed to
individual diet
– 5-week: controlled feeding MedDiet
(isocaloric, no weight loss)-evaluate
impact on inflammation before weight
loss
– 20-week: free-living feeding for weight
loss (-500kcal/day) with dietician
assistance to reach a minimum of 5%
body weight reduction
– 5-week: MedDiet after weight loss
(isocaloric feeding/weight maintain)
(Richard, Couture, Desroches, & Lamarche, 2013)
Four Phase Study
Design
(Richard, Couture, Desroches, & Lamarche, 2013, p. 53)
Results
• Even without clinically significant weight loss, a
significant decrease in plasma CRP was found.
• Without clinically significant weight loss, little
impact on IL-6, IL-18, and TNF-α were seen
• these are adipose tissue-derived cytokines
(Richard, Couture, Desroches, & Lamarche, 2013, p. 54)
Issues
• Traditional Remedies account for
35% of Acute Kidney Injury
• The mortality rate is from 24% to
75%
• Factors contributing to
nephrotoxicity
–
–
–
–
–
Incorrect use
Incorrect route of administration
Co-existing Illness
Interactions with other medications
Poor Storage
(Luycks, 2012)
Issues
•
•
•
•
•
•
•
•
•
•
•
•
alfalfa, and black cohash – transplant rejection
CKLS -a liver and spleen purifier –acute interstitial
nephritis
Cone flower (part of echinacia) used for fever or
prevention of colds- renal tubular acidosis and
hypokalemai
Creatinine- used for body building- acute interstitial
nephritis
Hydralazine sulfate- for cancer- hepatorenal syndrome
Ma- huang (contains euphedra) nephrolithiasis
Licorice- weight loss- ATN due to rhabdomyolysis
Pennyroyal- to induce abortion- ATN hepatorenal
syndrome
Spanish fly blister beetle- sexual stimulant, wart
removal- ATN, glomerular injury protein urea
St johns wort- depression- transplant rejection
Vitamin C- infection, cancer, fatigue, viral infectionstubular calcium oxalate crystal deposition
Wormwood oil- stimulates digestion- rhabdomyolysis
(Luycks, 2012)
Chelation
• Chelators bind to metal ions and are
then excreted via urine or feces
– Have been used for treatment of heavy
metal accumulation and toxic
poisoning, e.g. lead (Pb)
• Established for the treatment of
mylodysplastic syndromes (MDS) and
transfusional iron overload
• MDS is characterized by ineffective
hemopoiesis, may progress to acute
myeloid leukemia and approximately
90% are anemic
(Gattermann, 2008)
Guidelines
• WHO classification of MDS 2002
– Refractory anemia
– Refractory anemia with ringed
sideroblasts
– Refractory anemia with excess blasts
– Cytopenia with multilineage dysplasia
– Refractory cytopenia with multilineage
dysplasia
– Ringed sideroblasts
– Unclassified meylodysplastic syndrome
– 5q-syndrome (separate subtype)
(Gattermann, 2008)
Supportive Therapy
• RBC transfusion, no agreed upon
Hb threshold
– Asian-Pacific 6-9 g/dL
– Latin America 7-10 g/dL
– Italian Society of Hematology
>8 g/dL
– Hb >10g/dL is rare
• Case-by-case basis, symptoms,
and co-morbid processes such as
cardiac function, oxygenation,
and quality of life
(Gattermann, 2008)
Iron Overload
• Chronic transfusions result in iron
overload from catabolism of
erythrocytes
– iron levels exceeding binding
capacity of transferrin
• Monitor iron overload by serum
ferritin is useful
– not as accurate as superconducting
quantum interference device
(SQUID) or hepatic MRI
(Gattermann, 2008)
Chelation Therapy
• Recommended to treat iron
overload
• Initiation of therapy
– When serum ferritin is ≥1000
μg/L
– Patient has received two units of
RBC per month for one year
(Gattermann, 2008; NCCN task force report, 2009)
Medications
(NCCN task force report, 2009, p. S6)
Alzheimer’s Disease
• Metal ions accumulate in the
brain in neurodegenerative
diseases like Alzheimer’s
Disease (AD)
– copper (Cu)
– iron (Fe)
– zinc (Zn)
– aluminum (Al)
(Hegde, et al., 2009)
Alzheimer’s cont.
• AD can have high levels
compared to a normal brain
– Cu 400 μM-vs-70 μM
– Zn 1 mM-vs-350 μM
• Clioquinol (CQ)-specific Cu-Zn chelator
• CQ has been banned in the US since 1971
• PBT2, another hydroxyquinoline ligand is
in Phase IIa double blind trials in mouse
model for AD
(Hegde, et al., 2009)
Natural Chelators
• Polyphenols
– have antioxidant, anti-inflammatory,
and metal chelating properties
• Flavanoids are the largest group
– include anthocyanins and
anthoxanthins
– anthoxanthins further divided
• flavones, isoflavones, flavanols, and
flavans
(Hegde, et al., 2009)
Curcumin
• Curcumin also has antiinflammatory properties
that are believed to
reduce the swelling
within neuronal cells
• Curcumin can bind with
several metals, reducing
their toxicity
– include binding with
redox-active metals such
as Cu and Fe
(Hegde, et al., 2009)
http://www.google.com/imgres?imgurl=http://www.curcuminres
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EGCG
• Polyphenols
– Epigallocatechin-3gallate (EGCG), a
polyphenolic, is the
major component of
green tea
– Green tea polyphenols
are potent metal
chelators, including Fe
and Cu, which are
associated with the
pathogenesis in AD
(Hegde, et al., 2009)
http://www.google.com/imgres?imgurl=http://www.bjjee.com/wpcontent/uploads/2013/01/keep-calm-and-drink-green-tea39.png&imgrefurl=http://www.bjjee.com/nutrition/the-benefits-of-greentea-lemon-for-bjjplayers/&h=240&w=210&tbnid=yVwi9XLVMcKpvM:&zoom=1&tbnh=104&
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Anthroposophy
Medicine
• Anthroposophical medicine
was developed/inspired by
Rudolf Steiner; Austrian
philosopher and scientist
(1861-1925)
• Anthropos = human; Sophia =
wisdom
• Focused on the entire human
being
• Extension to conventional
medicine
• Anthroposophical doctors are
fully licensed, board certified
http://www.rudolfsteineraudio.com
Anthroposophic Medicine and Therapies in America, 2014)
/
Anthroposophical
Medicine
• Rudolph Steiner joined a Dutch
physician, Dr. Ita Wegmen to open
first Anthroposophical medical
clinic in Arleshim, Switzerland
• Dr. Wegmen developed a cancer
treatment using extract from
mistletoe, called Iscar, later
developed into Iscador
• Iscador approved in Germany and
a number of countries, clinical
trials in U.S.A.
https://www.google.com/
Anthroposophic Medicine and Therapies in America, 2014
Countries practicing AM
http://www.ivaa.info/anthroposophic-medicine/facts-and-figures-am-worldwide/therapists-in-anthroposophic-medicine/
Mind-Body
Therapies
Mind-body medicine
concentrates on:
• The interactions among the mind,
brain, body, and behavior
• The ways in which emotional,
mental, social, spiritual,
experimental, and behavior
influences can affect one’s health
National Institute of Health, 2010
Tai Chi
• Originated in ancient China, began as a
martial arts meaning “self-defense”
• Consists of slow, relaxed, graceful movements
concentrating on body and mind
• Referred to as “Meditation in motion”
• Tai Chi safely promotes improvement with
balance, flexibility, and cardiovascular in
aging adults with chronic conditions
• RCT compare the effectiveness of stroke
survivor patients with Tai Chi, silver sneakers,
and usual care on physical function, fall rate,
and quality of life during a 12 week
intervention
• Tai Chi led to improved aerobic endurance
and reduced fall rates
Taylor-Piliae et al., 2014
Qigong
• Similar to Tai Chi, most researcher
combine the two
• Focus on physical movement, mental
focus, and deep breathing
• Most effective with strengthening
bones, cardiovascular fitness,
balance, and quality of life
• Researchers of Institute of Integral
Qigong and Tai Chi analyzed 77
articles and 66 RCT’s, n=6410, strong
evidence with positive health benefits
of Tai Chi and Qigong
Qigong & Tai Chi
Alexander Technique
•
•
•
Improves mobility posture performance and alertness
Relieves chronic stiffness, tension and stress
In Asthma
– Improved
• Forced expiratory flow 9%
• Maximal inspiratory pressure 12%
• Maximum Voluntary Ventilation 6%
(Cates, 2012)
•
In Low back pain
– Improved
• Number of day in pain from 27 of 28 to 3 of 28
(Woodman and Moore, 2012)
https://www.youtube.com/watch?v=-u8Py3GCYf4
(American Society for the Alexander Technique, 2014)
Feldenkrais Method
Two Techniques
• Functional Integration
• Uses skilled manipulation and passive
movements
• Awareness Through
Movement
• Uses guided attention and
purposeful movement
(The Feldenkrais Institute, 2013)
Feldinkrais Method
• Improves balance, mobility and
balance confidence
• Shown to decrease a patients fear
of falling
(Ullmann, Willians, Hussey, Durstine, McClenaghan ,
2010)
• Found significant improvement in
physical and emotional well being
and pain
• Increased ability to focus on
positive aspects of recovery and
decrease in dwelling on pain
(Conners, Pile, Nichols, 2011)
Massage
• Massage therapy uses the hands to
press, rub, and manipulate soft tissue
• One of the fastest growing aspects of
CAM
– 31% of Americans received a massage
in the last 5 years
– 15% of Americans discussed massage
with their physicians in the past year
– 59% of patients would like to see
massage covered by insurance
(American Massage Therapy Association, 2012; National Center
for Complimentary and Alternative Medicine, 2014)
Massage
(Adams, White and Beckett, 2010, p. 8 )
Massage
CHF
• Improved blood pressure, heart rate,
respiratory rate and oxygen saturation
• Reported a reduction in anxiety
(Chen
et al., 2013)
Oncology
• Included in the Evidence Based
Practice Guidelines for Integrative
Oncology
– Found that massage significantly
reduced pain and improved mood
(Deng et al., 2009)
Reflexology
• Certain pressure points on the
hands, feet and ears correspond
with different body organs
• Applying pressure to different
areas will improve function in the
organ associated with this area.
• Found to be beneficial in pain
associated with cancer and
diabetic neuropathy
(Dalal, Maran, Pandey, & Tripathi, 2014, p. 6)
Rolfing
• Based on the concept that our
connective tissue connects all
parts of the body including
muscles, bones, nerves and
organs
• Very similar to massage but
described as almost painfulworks to balance the length and
tone of all of the soft tissues in
the body
(The Rolf Institute of Structural Integration, 2014)
Chiropractic
Manipulation
• The process of applying
controlled force to the spine or
joint to restore mobility, relieve
pain and muscle tightness
• Based on the theory that tissues
undergo chemical and physical
changes that cause inflammation
and pain
• Manipulation of these tissues
restores mobility and alleviates
pain
(The American Chiropractic Association, 2014)
Chiropractic
Manipulation
• Spinal Manipulation is included in
the Guidelines for control of low back
pain by the American College of
Physicians and the American Pain
Society
• The Agency for Research and Quality
also recommends the use of spinal
manipulation for low back pain
• Use of the guidelines as part of the
hospital based standardized care
pathway resulted in a 95%
satisfactory rating and a 68%
reduction in pain
(National Center for Complimentary and Alternative Medicine, 2014)
Chiropractic
Manipulation
Patients evaluated for low
back pain received
standardized or chiropractic
treatment
Top graph does not show a
significant reduction in pain
the participants reported,
however many fewer pain
days with chiropractic
therapy and no narcotic use
(Bishop, Quon, Fisher, & Dvorak, 2010, p. 1061)
Osteopathic
Manipulation
• Very similar to Chiropractic
Manipulation however is
performed by a doctor
osteopathic medicine
• This therapy has also been
shown to reduce the need for
analgesics when used for relief
of back pain
(Seffinger et al., 2010)
Magnetic Therapy
• Ionizing electromagnetic fields
energy decreases calcium
transport alterations in human
lymphocytes, supports natural
killer cells to fight cancer and
viruses, modulates traumatic
brain injury, and reduces postop infections
(Ross & Harrison, 2013)
Music Therapy
• Classical Music
– anxiety, depression, cardiovascular
disturbances, pain, stress, and sleep
disorders
• Popular Music
– eye opener
• Meditation Music
– sedative effects
• Music from the Patients Youth
– help with motivation, concentration
and improved mood
(Trappe, 2012)
Music Therapy
Cardiac Disease
• Reduces pain and respiratory rate
• Reduces anxiety
• Reduces systolic blood pressure and heart
rate
• Improves sleep following cardiac
procedures or surgery
• Reduces level of cortisol
• Increases levels of oxytocin and PA02
• Led to lower levels of anxiety compared to
subjects given midalozam
(Dileo, 2013; Trappe, 2010)
Light Therapy
• Light therapy involves exposure
to blue light for a certain
amount of time each day
• This exposure results in:
– Increased sleep time of 18%
– Increases in total sleep time
– Decreases in awakenings
– Improvement in daytime fatigue
(Tamrat, Huyn-Le, & Goyal ,2013, Chong, Tan, Tay, Wong, & AncoliIsreal, 2013, DPsych, Ponsford, Taffe, Lockley, &Rajaratnam ,2014)
Acupuncture
• One of the oldest healing
practices in the world
• Developed in ancient China
• Stimulates parts of the body to
regulate flow of Qi along
pathways called Meridians
• Done with very thin needles or
cups or mugwart
(National Center for Complimentary and Alternative Medicine, 2014)
Acupuncture
Chinese Acupuncture
Treatment based on extensive questioning and
observation
Japanese Acupuncture
Uses the least amount of stimulation possible to
affect the greatest amount of change
Korean Hand Acupuncture
Hands are seen as microcosms of the body and
needles are inserted into specific parts of the hand
Auricular Acupuncture
The ears are the microcosms of the body and
needles, seeds, and tacks are placed in and around
the ear. Used for substance abuse
Scalp Acupuncture
The scalp is seen as the microcosm. Used a lot for
motor impairment and spinal conditions
Non-Insertion Acupuncture
Uses blunt needles made of silver or platinum to
touch the skin at specific points
Cupping
Influences the flow of Qi and blood. The suction
stimulates blood flow to the area
Moxibustion
Burning mugwart to warm specific acupuncture
sights and promote Qi
(Solleivo, 2012)
Acupuncture
Anxiety and Surgery
(Acar, Cuvas, Ceyham, & Dikman, 2013, p. 421)
Acupuncture
• Cerebral Aneurysm Rupture
– Reduced angiographic
vasospasm
– Reduced delayed ischemic
neurologic deficit
(Ko et al., 2013)
Aromatherapy
Laparoscopic intra-abdominal
surgery (LABG) chosen for:
– Similar postoperative
requirements due to uniformity
of surgery technique
– Visceral pain does not typically
respond well to opioids
– Reducing opioid adverse effects
in morbidly obese patients
(Kim, et al., 2001)
Post-operative pain
Use of Lavender oil decreased
amount of morphine use
• Lavender (n=26) 2.38 mg
• Placebo (n=27) 4.26 mg (P<.04)
There was no statistical significance in
the need for antiemetics or
antihypertensives
(Kim, et al., 2001)
Work Stress
Seven categories:
• Environment, structure,
changes
• Non-optimal work
arrangements
• Patient care demands
• Collaboration with others
• Workload
• Role conflict and
ambiguity
• Personality factors; Type
A behavior patterns and
locus of control
http://jeffreysterlingmd.files.wordpress.com/2014/01/stressmanagement-checklist-to-survive-and-thrive.jpg
(Davis, Cooke, Holzhauser, Jones, & Finucane, 2005)
Study
• 15 minute seated massage
– 16 per week for 12 weeks
– Participants chosen at random with
subsequent consent to participate
– Massages per participant averaged
2.7 per person
• Music via earphones
• Aromatherapy spray mist
– One of four scents, chosen by
participant
(Davis, Cooke, Holzhauser, Jones, & Finucane, 2005)
ED Nurses
• Data collection of Perceived
Occupational Stress Scale
(POSS) and consisted of 46
questions
• Pretest and posttest response
of 48% was achieved
• 86% improvement in anxiety
after massage
(Davis, Cooke, Holzhauser, Jones, & Finucane, 2005)
Relaxation
Techniques
•
•
•
•
•
•
•
Autogenic training
Biofeedback
Deep-breathing exercises
Guided Imagery
Meditation
Self Hypnosis
Prayer
Autogenic Training
• Autogenic training was developed
by, German neurologist Johannes
Schultz, about a 100 years ago
• Autogenic = self-generating; you
are in control
• AT is composed of six mental
exercises aimed at reducing anger,
tension, and stress
• AT main goal is to achieve a relaxed
state of main and decrease stress
(National Center for Complementary and Alternative Medicine, 2014)
Autogenic Training
• Concentrates on reducing anxiety, depression, stress,
and GI disturbances
• 59 patients, randomized chose to participant in a study
with standardized care or autogenic training
• The results; baseline standard deviation at two and five
months, BP & HR baseline and at five months
Anxiety
State
Baseline
2
5
SD
Month Month
BP
5
Month
HR
5
Month
Experimental
group
10.3
9.8
8.8
17.9
7.3
14.3
9.3
Control group
11.3
14.5
15.5
15
22.3
12.2
11.6
(Kanji, N., White, A., & Ernest, E.,2004)
Autogenic Training &
Tension Headaches
• Seven clinical control trials included
• Different methods of CAM methods were
chosen to evaluate headaches
• Hypnosis, biofeedback, autogenetic
training, and control groups
• The results: inconclusive, the presence of
evidence is insufficient
• Self-Hypnosis did show a small
improvement
• Biofeedback is more effective than AT &
the preferred treatment
(Kanji, N., White, A. R., & Ernest, E., 2006)
Biofeedback
•
•
•
•
•
•
Developed in the 1960’s to train experimental
research subjects to alter brain activity, BP, HR, and
other functions not controlled voluntarily
Use electronic devices to teach a person how to
consciously produce relaxation state
Physical therapist use biofeedback in stroke patients
to help regain movement in paralyzed muscles
Psychologists use it in anxious or tense patients to
produce a calming affect
Specialists incorporate with patients experiencing
pain
Can assist in reducing migraines or tension
headaches, digestive disorders, hypertension, cardiac
arrhythmias, Raynaud's disease, epilepsy, and some
movement disorders
(Andrasik, 2010)
Biofeedback & Headaches
• Techniques: biofeedback-assisted relaxation
response or more specialized approaches
• Biofeedback-assisted relaxation response for
headaches has bend evaluated for decades via
comprehensive reviews by expert panels and
meta-analytic statistical analysis
• Relaxation training, thermal biofeedback
combined with relaxation training,
electromyographic biofeedback, and cognitivebehavioral therapy may be considered as
treatment options for prevention of migraine
(Grade A evidence)
• Behavioral therapy(biofeedback, relaxation) may
be combined with preventive drug therapy to
achieve additional clinical improvement for
migraine relief (Grade B evidence)
• Evidenced-based recommendations are not yet
possible on the use of hypnosis, acupuncture,
TENS, cervical manipulation, or hyperbaric oxygen
as preventative or acute therapy for migraine
(Grade C evidence)
(Andrasik, 2010)
Biofeedback Statistics
of Migraine Patients
(Andrasik, 2010, p. 75)
Guided Imagery/
Self-Hypnosis
Self-Hypnosis
Meditation
• Meditation refers to a group of
techniques: mantra meditation, relaxation
response, and mindfulness meditation
• Developed in the Eastern religious or
spiritual traditions
• Meditation is practiced globally for health
and well-being, outside of the traditional
development
• Meditation teaches a person how to
focus, concentrating on mindful thoughts,
feelings, and sensations while observing
in nonjudgmental way
• Most used for anxiety, pain, depression,
stress, insomnia, and overall wellness
Meditation
Mood, BP, & Heart rate reduction
• Mindfulness meditation is used to reduce negativity,
depression, tension, fatigue, anxiety and lower heart
rate
• A study conducted identified a significant drop in
negative mood, 88%
Lower Acute Respiratory Infections
• Comparison of a control, exercise, and mindfulness
meditation group underwent monitoring of ARI’s
and the outcomes monitoring incidence, duration,
and global severity.
• The results conducted a significant reduction of
ARI’s with meditation (incidence, duration, and
global severity) when compared to the control
group
• Incidence 33%, duration 43%, and global severity
60% lower if a person practiced mindfulness
meditation when compared to the control group
(Zeidan, Johnson, Gordon, & Goolkasian, 2010; Barrett et al., 2010)
Yoga
- Historical origins in ancient
Indian philosophy
- Incorporates mind and body
- Combines physical posture,
breathing techniques, meditation,
and distinct philosophy
- Different types of Yoga
- Yoga is sixth common used CAM
National Institute of Health, 2014
Benefits of Yoga
Decrease low back pain
Reduce anxiety and stress
Enhance quality of life
Improve overall fitness and
well-being
• Improve mood/ depression
•
•
•
•
Yoga and Chronic
Back Pain
• A RCT n= 228 adults; enrolled in yoga,
stretching exercises, or issued a selfcare book to examine the best
reduction in back pain
• After 12 weeks of therapy yoga group
were superior to the self-care group for
function, -2.5[95% CI, -3.7 TO -1.3];
P<.001 & mean difference symptoms, 1.1 [95% CI, -1.7 TO -0.4]; P<.001.
• 26 Weeks mean difference yoga
superior, -1.8 [95% CI, -3.1 TO -0.5];
P<.001
• Yoga was not superior to stretching
Yoga and Smoking
Cessation
• A study of 55 women, randomized to
examine yoga and smoking cessation
compared to general health and
wellness group
• At end of eight weeks yoga
demonstrated 24hour smoking
cessation vs wellness condition, (46.9%
vs 17.4%; odds ratio 4.19; 95% CI, 1.215.1; P=0.029
• Yoga more likely to have attained 7-day
point prevalence abstinence (7PPA) vs
wellness condition; (40.6% vs 13% odd
ratio; 4.56; 95%CI, 1.1-18.6; P=0.034
Yoga & Anxiety
Bock et al., p.245 2012
Issues
• Yoga low-impact
• Low side effects
• Recommend guidance of welltrained instructor
• Stroke and nerve pain, rare
possibilities
• Pregnant women with certain
medical history should avoid
some types of yoga
National Center of Complementary Alternative Medicine, 2014
Hypnosis
• Also known as hypnotherapy
• Evolved in the 1700’s accidentally by
somnambulism (sleepwalking).
• Focused relaxation state of awareness to alter
desired medical conditions
• Facilitate communication between bilateral
sides of the brain
• Person is always in control, but fully relaxed
• Three aspects to hypnosis: absorption,
dissociation, and suggestibility
• Commonly used to treat anxiety, chronic pain,
depression, GI disturbances, HTN, insomnia,
and hot flashes cancer or postmenopausal
women
National Center for Complementary Alternative Medicine, 2014
Hypnosis Studies
• Multiple meta-analyses support
hypnosis for management of
symptoms associated with
chemotherapy, surgical & invasive
procedures
• Results identified a reduction in
symptomology; N/V, pain, anxiety,
and distress
• Emotional distress improved 82%
undergoing invasive procedures
• Post-operative anxiety reduced with
hypnosis
Lew, Kravits, Garberoglio, & Williams, 2011
Guided Imagery
• Focuses on pleasant images or
visualizations to replace negative
or stressful occurrences
• Promotes relaxation
• Most commonly used to promote
sleep, calm emotions, reduce
anxiety, depression, and decrease
pain
Group Therapy & Cognitive
Behavior Therapy
• Similar in nature, focus on cognitive
(thoughts) and behavior (actions) to
change an underlying concern
• A RCT comparing multidimensional
family therapy and cognitive
behavior or a drug addiction
• Data gathered at baseline,
termination, six, and twelve months,
n=224
• Results determined both
interventions are promising
treatments
Liddle, Dakof, Turner, Henderson, & Greenbaum, 2008
Homeopathic
Pet Therapy
• Animal-assisted therapy is a complementary
intervention, primarily dogs
• Evidence supporting therapeutic animal visits
for medical and surgical patients with
pervasive developmental disorders; cerebral
palsy, speech disorders, cardiovascular
disease, Alzheimer's disease, schizophrenia,
cancer, spinal cord injuries, and extended
rehabilitation facilities
• A literature review provided Class IIa-IIb
evidence, recommending animal-assisted
therapy to optimize healing environments
Pet Therapy Studies
Prayer