HEALTH CARE FROM THE INSIDE OUT: Complementary, alternative and integrative medicine explained
by Lorraine Anderson
Got back pain? Or neck pain, joint pain, arthritis, anxiety, high cholesterol, a head or chest cold, severe headaches or migraines, or insomnia? If you have any of these (or any other chronic ailment that is more misery-inducing than life-threatening), you may find yourself exploring alternatives to conventional medical treatment. These are the conditions that most frequently drive adults in the United States to try complementary and alternative medicine (CAM), according to the National Center for Complementary and Alternative Medicine. Back pain outdistances by far all other reasons for seeking alternative treatment and patients with back ailments represent a growing proportion of CAM users.
This certainly makes me feel less alone. Last year when I had lower back pain, I joined the 38 percent of adults and 12 percent of children in America who use CAM regularly. I made multiple visits to an acupuncturist, three different chiropractors, a yoga therapist, bodyworkers offering a range of techniques including massage, myofascial release, Active Release Technique and craniosacral therapy, as well as two different physical therapists. That was all before my integrative MD sent me for an MRI and thence to see a physiatrist and ultimately to a neurosurgeon. It turned out surgery was the answer to my pinched sciatic nerve, but I’ll be using CAM for the rest of my life to stay tuned up.
One thing my tour of CAM revealed is that the Willamette Valley is home to an extraordinary collection of talented healers, many of whom have moved here from other parts of the country. With holistic health clinics in Eugene, Salem, Corvallis and Albany, and health care professionals of every stripe in private practice, we have plenty of choices and all the support we need to pursue lifestyles of health and sustainability.
The Shifting Terrain of Health Care
The terrain of health care is shifting here, as elsewhere, as alternative, complementary, and integrative approaches gain credibility and respectability. The number of integrative clinics, many hospital-sponsored, is growing nationwide and here in our valley. The relationship between traditional and alternative medical care will likely grow closer in the future. Traditional Western medicine with its emphasis on drugs and surgery can’t be beat for treating trauma and acute conditions that require immediate attention, but more of our health problems these days are of the chronic variety, and addressing them effectively requires looking at the whole person rather than just the presenting symptom. Complementary, alternative, and integrative medicine aim to do just that.
Complementary medicine refers to unconventional treatments used in addition to conventional medicine—for example, using meditation in addition to prescription medicine to manage depression. Alternative medicine refers to treatments used instead of traditional medicine. This might mean seeing a naturopath and taking herbal supplements to manage depression instead of seeing your MD. Integrative medicine seeks to combine the best of conventional, complementary and alternative approaches.
What these unconventional approaches to health care have in common is a belief in the ability of the body to heal itself. Practitioners aim not only to alleviate symptoms but also to optimize health by working with and stimulating the body’s natural healing intelligence. They seek the causes underlying symptoms, emphasize prevention and aim to restore a state of balance by addressing the physical, mental/emotional and spiritual aspects of the patient. Often they prescribe lifestyle changes involving diet/nutrition, exercise and mental attitude. The doctor is seen as a teacher who empowers patients to heal root causes from within rather than a hero who intervenes to fix symptoms from without.
The Full Menu of CAM Choices
The National Center for Complementary and Alternative Medicine groups the major types of CAM into four categories:
Mind-body medicine – based on the idea that the mind and body function as a unified field. This category includes a wide range of techniques, from biofeedback and hypnosis to meditation and art therapy.Biologically based practices – using herbs, foods and vitamins.Manipulative and body-based practices – based on healing through touch. This includes chiropractic, osteopathy and massage or other forms of bodywork.Energy medicine – based on affecting the energy field that purportedly surrounds and penetrates the body. This includes qigong (pronounced “chee gung”) and Reiki.
There are also whole medical systems that cut across these domains. These include naturopathic medicine, traditional Chinese medicine and Ayurveda. Holistically oriented or integrative MDs and doctors of osteopathy also cut across domains to assemble individualized programs for patients. Following is a more detailed explanation of naturopathy, traditional Chinese medicine, chiropractic, osteopathy, bodywork and integrative practice.
Naturopathy is based on a belief in the healing power of nature and draws from the healing wisdom of many cultures. Doctors of naturopathic medicine (NDs), or naturopaths, are educated in the Western medical sciences as well as proven natural therapies, including clinical nutrition, physical and botanical medicine, homeopathy, acupuncture and Oriental medicine, and massage. Although naturopaths sometimes work closely with traditional doctors and refer patients to MDs, surgeons and other specialists whenever appropriate, they typically emphasize lifestyle and counsel against using drugs or surgery.
Naturopaths are trained as primary care providers and, as such, they can address the same concerns as a family MD, from pediatrics to geriatrics. Their scope of practice may include laboratory diagnosis and diagnostic imaging, emergency medicine, pharmacology and minor surgery. Naturopaths are currently licensed in only 15 states, including Oregon. The oldest naturopathic medical school in the country, the National College of Natural Medicine, founded in 1956, is located in Portland, and more than 50 percent of the licensed naturopathic physicians practicing in the United States are graduates of NCNM.
Traditional Chinese Medicine
Traditional Chinese Medicine (TCM) is a 3000-year-old system of health care that sees health as depending on the free flow of a subtle energy called chi (or qi, pronounced “chee”). TCM works by guiding the body back to its natural state of balance through the use of acupuncture, herbal medicine, diet therapy, massage techniques and qigong. The conditions it can treat include stress, anxiety, depression, fatigue, back pain, arthritis, headaches, allergies, insomnia, PMS, infertility, menopausal symptoms, irritable bowel syndrome and gastritis.
According to this model, chi flows through the body along energy pathways called meridians. An acupuncturist inserts hair-thin needles into specific points along the meridians to release blockages and restore the proper flow of chi so the body can heal itself. The sterile needles are so fine that they don’t cause pain, although occasionally the patient may feel a zing when the needle is inserted. Many people, myself included, find an acupuncture session to be both relaxing and energizing.
TCM uses herbs blended in a formula customized to the individual patient to correct underlying imbalances in the body as well as to alleviate symptoms. A well-designed Chinese herb formula can treat many different symptoms at once. If you go this route, look for the designation L.Ac. for licensed acupuncturist and MSOM for master of science in Oriental medicine.
Doctors of chiropractic (DCs), also referred to as chiropractors, practice a drug-free, hands-on approach to health care that includes examination, diagnosis and treatment. Chiropractic is based on the idea that a healthy spine is key to preventing pain and injury. The man who started the first chiropractic school in 1897, Daniel David Palmer, pointed to misaligned vertebrae as the source of all disease. Chiropractors usually treat neuro-musculoskeletal complaints and injuries, including but not limited to back pain, neck pain, joint pain in the arms, legs, hands and feet, as well as many types of headaches.
The most common therapeutic procedure performed by chiropractors is spinal manipulation, also called a chiropractic adjustment. They may perform this adjustment by hand while you lie on a special table, or they may use specially designed tools to facilitate the adjustment. They may also use other means of healing such as nutritional supplements, trigger point massage, mechanical traction, or low-frequency microcurrent. Chiropractors are licensed by a state examining board; look for someone who is licensed and has completed the training program at a school accredited by the Council on Chiropractic Education.
A doctor of osteopathic medicine (DO), or osteopath, gets conventional medical training and also learns about the structure of the body in relation to how it functions. Treatment from a DO may involve physical manipulation of your body to diagnose injury or illness and help the body function efficiently. Osteopathic medicine was founded in 1874 by Andrew Taylor Still, MD. Dr. Still identified the musculoskeletal system as a key element of health. He recognized the body’s ability to heal itself, and stressed preventive medicine, eating right and keeping fit. Today, about 60 percent of osteopathic physicians practice in the primary care specialties of family medicine, general internal medicine, pediatrics and obstetrics & gynecology, so you can choose a DO to be your primary care provider.
Massage and other forms of bodywork focus on relieving muscle tension and promoting relaxation by stroking and kneading skin, muscles and tendons. Besides relaxing muscles, massage has been shown in research studies to reduce heart rate, lower blood pressure, increase blood circulation and lymph flow, improve range of motion and increase endorphins. It can assist the healing process after injury or surgery and can help prevent stress-related disorders.
Holistic and integrative health clinics usually have one or more massage therapists on staff, and there are massage therapists in private practice offering all colors and flavors of massage. For example, one clinic offers hot stone therapy, myofascial release, lymphatic drainage, pregnancy, deep tissue, injury treatment, therapeutic, hydrotherapy, Swedish and trigger point massage. Active Release Technique, Bowen method, yoga therapy, Rolfing, and Hellerwork are other species of bodywork.
Integrative medicine (IM), popularized by Andrew Weil, MD, combines proven therapies from multiple disciplines to facilitate a person’s innate ability to heal. The doctor and patient work together using conventional Western medicine, Eastern medicine practices and other manual therapies, as well as movement, mind-body and natural therapies to promote health. My integrative MD, for instance, is also a licensed acupuncturist and works with vitamin and mineral supplements.
An IM doctor is not the same as an osteopathic or naturopathic doctor, although all three share a grounding in conventional medical training. The IM viewpoint is best encapsulated in these words from the American Holistic Medical Association: “We embrace integrative, complementary and alternative medicine techniques; we hold onto what is helpful in allopathic medicine, and we understand that healing includes your body, your mind, your emotions, and your spirit.”
Choosing a Practitioner
How do you choose the approach that’s right for you? You can learn more about any kind of treatment by doing research on the Internet. Then gather information about the practitioners in your area, asking people you know for recommendations. Some practitioners and clinics offer free initial assessments to determine whether you’re a good candidate for their approach. Regardless, you can call and ask for an informational interview before you agree to any particular course of treatment.
Unfortunately, many complementary and alternative approaches are not covered by health insurance, so cost may be a limiting factor. To give you an idea of ranges, my acupuncturist charges $100 for the first visit of an hour and a half to two hours and $68 for subsequent hour-long visits. One chiropractor I visited charges $120 for a new patient consultation/exam (60 minutes) and $75 for an established patient consultation/exam (30 minutes), while another charges $54 per session. I have paid anywhere from $60 to $120 per hour for bodywork.
In the end, it’s a personal choice requiring you to exercise some discernment. The National Center for Complementary and Alternative Medicine warns, “While scientific evidence exists regarding some CAM therapies, for most there are key questions that are yet to be answered through well-designed scientific studies.” The Mayo Clinic Guide to Self-Care advises, “We should avoid being either total skeptics or uncritical embracers of complementary and alternative medicine. Instead, we can hold to the middle ground, where scientific evidence and reason determine our responses.”
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