Complementary and Alternative Medicine

One of the leading institutions that collects information on complementary and alternative medicine (CAM), is the National Center for Complementary and Alternative Medicine (NCCAM).  NCCAM is part of the National Institute for Health and funded with public money for the benefit of all Americans.  NCCAM conducted one of the most comprehensive and reliable studies to date on the use of CAM by Americans.  This study, released in May 2004, showed that 74.6% of Americans have tried CAM at least once and that a surprising 62.1% had used CAM in the prior 12 months.  The most recent surveys show that spending for CAM in 1997 was more than Americans paid out-of-pocket for all hospitalizations and about half of what is paid for all out-of-pocket physician services. There is no doubt that Americans are embracing CAM in greatly increasing numbers and with significant spending. 

What is CAM?

According to NCCAM, “CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.” In CAM, complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine.  Some CAM therapies have significant scientific evidence supporting their effectiveness, however, there are many CAM therapies for which there are key questions that are yet to be answered pertaining to effectiveness and safety.  Even though many CAM therapies are considered very safe and some are without known side effects, neuropathic facial pain and TN patients must be educated consumers. 

Five Main Categories of CAM Therapies

NCCAM has a system for categorizing CAM into five main domains:

Alternative medical systems are built upon complete systems of theory and practice.  Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States.  These include homeopathic and naturopathic medicines as well as Chinese medicine and India’s Ayurveda system.

Mind-body medicine focuses on the interactions among the brain, mind, body, and behavior, and the powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health.  It regards as fundamental an approach that respects and enhances each person’s capacity for self-knowledge and self-care, and emphasizes techniques that are grounded in this approach.  It includes stress management, hypnosis, prayer, meditation, mental healing, art, music, dance, counseling, relaxation therapy and others.

Biologically-based therapies include, but are not limited to, botanicals, animal-derived extracts, vitamins, minerals, fatty acids, amino acids, proteins, prebiotics and probiotics, whole diets, and functional foods.  Dietary supplements are a subset of this CAM domain.  Many of the biological therapies today have a foundation in 1000’s of years of application by native populations throughout the world.  For example, by the Middle Ages, thousands of botanical products had been inventoried for their medicinal effects.  Many of these, including digitalis and quinine, form the basis of modern drugs.  Functional foods include examples such as soy, nuts, seeds, blueberries, and cranberries, which have documented benefits.

Manipulative and body-based methods include chiropractic and osteopathic manipulation, massage therapy, craniosacral therapy, and a host of others.  Manipulation and body-based practices focus primarily on the structures and systems of the body, including bone and joints, the soft tissues, and the circulatory and lymphatic systems.  Some were developed from medicinal systems in China, India, or Egypt, while others have been developed in the past 150 years.  Chiropractic has become increasingly accepted by conventional practitioners and insurance companies as an effective therapy for certain ailments including facial pain and TN.

Energy therapies involve the application of electrical and magnetic energy fields.  There are many well-established uses for measurable energy fields to diagnose and treat disease: 

electromagnetic fields in magnetic resonance imaging

cardiac pacemakers

radiation therapy

ultraviolet light for psoriasis

laser keratoplasty

Therapies include:

static magnets

pulsating electrotherapy (used for over 40 years)

low millimeter wave therapy

sound therapy

light therapy (used to treat seasonal affective disorder)

energy medicine involving immeasurable life forces

acupuncture

Qi Gong

homeopathy

therapeutic touch

distance healing

Why are people interested in CAM?

According to NCCAM, many Americans have turned to CAM because of they feel that conventional medicine does not emphasize overall health and instead focuses on elimination of disease.  Some facial pain patients are not satisfied with conventional medicine due to issues such as these: 

the negative side effects of pain medication and surgery.

failure to identify the cause of pain.

cost of taking medication indefinitely.

For these people, CAM offers these possibilities

improve their ability to manage pain.

improve overall health.

identify underlying chronic problems.

improve quality of life.

The NCCAM survey that found the above, noted that most people use CAM along with conventional medicine rather than in place of conventional medicine.  Conventional medicine is excellent in providing diagnostic evaluation, however, the survey points out that a majority of people felt that the conventional treatments alone did not improve overall health to the extent that could be achieved with a integrated CAM/conventional approach.

CAM users report that they like CAM practitioners who listen to them, give them a say in their own treatment decisions, and with whom they can develop a caring relationship.  Also, they may find that health care alternatives are more in agreement with their own beliefs, values, and philosophical purposes toward health and life.

Who is using CAM?

The overwhelming majority of CAM’s growth seems to be on the complementary side as opposed to the alternative side.  Most are using CAM treatment in addition to more conventional therapy.  For example, some are using hot pepper cream or getting chiropractic adjustments in addition to taking carbamazepine.

People have varying opinions and goals regarding CAM, says Dr. Allen Neims, a pharmacology professor and director of University of Florida’s Center for Spirituality and Health. “Many people who seek therapy, especially alternative or complementary therapy, are seeking gentle yet effective treatments with minimal adverse actions,” he says.  “More powerful is not necessarily preferred if the adverse effects are also increased.”

Regarding TN, the majority of people who try CAM are those who have failed at least one of the more conventional approaches.  Included are those who were allergic to the front-line medications, those who didn’t get good relief from medication, those who had troubling side effects from medicine, and those who have failed one or more of the surgeries.  However, a few are using CAM approaches as their first or main treatment.

Those with facial pain other than classic TN pain, such as TN2, TNP and TND, are also more likely to use CAM therapies.

Are CAM therapies tested to see if they work?

While some scientific evidence is available regarding the effectiveness of selected CAM therapies, for most there have not been well-designed scientific studies.  The primary and overwhelming reason for this lack of study is economic.  Unless a product or protocol can be protected by a patent, it becomes too expensive for commercial entities to conduct statistically-designed trials without the ability to protect their investment.  This is the reason most statistically-based research on supplements has been conducted by research institutes that receive grants through either the government or private foundations.  Therefore, many CAM therapies are evaluated based on actual use over time.  Another reason that studies are lacking for some CAM modalities is that treatments are often individualized and vary from patient to patient.  Even bigger variations may crop up between different practitioners or between different brands or types of products.  For example, a study done with synthetic Vitamin E may produce quite different results than a study done with natural mixed tocopherol Vitamin E.  Acupuncture practitioners are trained in a many different protocols and have varying levels of skill which would logically effect outcomes.  In the case of some energy therapies, it is not possible to measure vital energy or Qi, thereby negating the design of an experiment.

A problem specific to TN is the frequency with which it may spontaneously go into remission only to return months or years later.  Such a characteristic makes it difficult to distinguish between success of a treatment and spontaneous remission.  These issues reinforce the need for an active network of TN patients to share anecdotal experiences.  Support groups and other CAM associations may be beneficial in providing information outcomes and safety.   TNA does have networking lists for some of the CAM procedures.

Should I try a CAM therapy?

Are you considering using complementary or alternative medicine?  If so, the National Center for Complementary and Alternative Medicine (NCCAM) has a fact sheet to help you make your decision about using CAM.  It includes frequently asked questions, issues to consider, and a list of sources for further information.  Call NCCAM toll-free in the US at 1-888-644-6226 or e-mail at info@nccam.nih.gov.  The website is www.nccam.nih.gov. 

Resources for Complementary and Alternative Medicine

Books

Striking Back! The Trigeminal Neuralgia and Face Pain Handbook, published by the TNA in 2004. To order, visit www.endthepain.org.

Your Miracle Brain, by Jean Carper, Harper Collins.

Associations

TNA (Trigeminal Neuralgia Association) offers Information Sheets on CAM topics and listings of facial pain and TN patients who are willing to discuss with others their experiences with CAM.  Visit www.endthepain.org, or call 1-800-923-3608.

National Center for Complementary and Alternative Medicine, www.nccam.nih.gov

National Library of Medicine, www.ncbi.nim.nih.gov

Medline Plus, http://medlineplus.gov

The American Association of Naturopathic Physicians, www.naturopathic.org

National Council Against Health Fraud, www.ncahf.org

The Cochrane Library, www.cochrane.org

National Institutes of Health directory of Information Resources Online, http://dirline.nlm.nih.gov

Publications

Natural Health, www.naturalhealthweb.com