Complementary and alternative medicines

Complementary and alternative medicines

Complementary medicine is a therapeutic approach that is used together with conventional medicine. An example might be a patient seeking help from aromatherapy to help with pain control after undergoing surgery. Alternative medicine is a therapeutic approach which is used instead of conventional medicine. An example might be a patient, having been informed that they have hypertension, deciding to use garlic to lower blood pressure.

The US National Centre for Complementary and Alternative Medicine (NCCAM) defines CAM as ‘practices that are unproven by science and not presently considered an integral part of conventional medicine’ (also referred to as biomedicine, mainstream or allopathic medicine). This definition of CAM acknowledges that CAM is not an absolute description and that, as CAM practices are proven safe and effective, they will be integrated with mainstream health care. Some have gone further to propose that the split between conventional and alternative should be replaced by good and bad medicine where the former implies rigorously tested treatments with demonstrable efficacy, safety and quality, whether they originate from the conventional or alternative traditions.

Acupuncture

Acupuncture practised in China and elsewhere in Asia over thousands of years, which involves the placement of fine needles at specific points along defined ‘meridians’ in the skin. Acupuncture is often carried out in conjunction with traditional Chinese herbal medicine. There are 65 reviews of acupuncture on the Cochrane database - one published review reported benefits from P6 acupoint stimulation in reducing postoperative nausea and vomiting (PONV). There are relatively few complications but, when not practised properly, serious adverse outcomes including infections and punctured organs are possible.

Homeopathy

Homeopathy is based on the principle of administering infinitesimally low concentrations of substances that are capable of inducing symptoms similar to those in the affected patient if they are given in pharmacological or toxicological doses. Homeopathy is based on the premise that the same medicine, in extremely low doses will be curative. Homeopaths may use animal, mineral, and synthetic materials in their preparations. Few good clinical trials have evaluated homeopathic therapy. Some homeopathic practitioners argue that, because the medicine is individually tailored to alleviating the specific symptoms of an individual patient, it is not amenable to assessment by conventional randomised controlled trials. Reassuringly little evidence of harm beyond delaying use of effective therapy.

Herbal medicine

Herbal medicine has been practised for thousands of years and is based on the use of plants or plant extracts in the treatment or prevention of symptoms associated with many medical conditions. In Europe, herbal medicines are now generally used for minor or self-limiting conditions, without the need to be prescribed by a medical practitioner. Other longstanding herbal medicine traditions include traditional Chinese herbal medicine, Ayurvedic medicine (South-East Asia), and Kampo (Japan). Herbal medicines may contain a range of biologically active compounds in the same preparation, and some of the individual compounds have been isolated and used in pure form in conventional medicines (e.g. digoxin).

Aromatherapy

Aromatherapy uses extracts of aromatic plants, known as ‘essential oils’, which are applied topically after dilution in a carrier oil or lotion, frequently using a massage treatment. Aromatherapy has been advocated to reduce disturbed behaviour an improve motivation in dementia but there are no reliable studies to back up this proposal – more large-scale randomised controlled trials are required. Aromatherapy products are generally well-tolerated when used appropriately and are unlikely to be harmful.