Role of Tai Chi in the Treatment of Rheumatologic Diseases

Rheumatologic diseases (e.g., fibromyalgia, osteoarthritis, and rheumatoid arthritis) consist of a complex interplay between biologic and psychological aspects, resulting in therapeutically challenging chronic conditions to control. Encouraging evidence suggests that Tai Chi, a multi-component Chinese mind?Cbody exercise, has multiple benefits for patients with a variety of chronic disorders, particularly those with musculoskeletal conditions. Thus, Tai Chi may modulate complex factors and improve health outcomes in patients with chronic rheumatologic conditions. As a form of physical exercise, Tai Chi enhances cardiovascular fitness, muscular strength, balance, and physical function. It also appears to be associated with reduced stress, anxiety, and depression, as well as improved quality of life. Thus, Tai Chi can be safely recommended to patients with fibromyalgia, osteoarthritis, and rheumatoid arthritis as a complementary and alternative medical approach to improve patient well-being. This review highlights the current body of knowledge about the role of this ancient Chinese mind?Cbody medicine as an effective treatment of rheumatologic diseases to better inform clinical decision-making for our patients.     

Complementary and alternative medicine use as health self-management: rural older adults with diabetes

OBJECTIVE: . This study describes complementary and alternative medicine (CAM) use among rural older adults with diabetes, delineates the relationship of health self-management predictors to CAM therapy use, and furthers conceptual development of CAM use within a health self-management framework. Methods. Survey interview data were collected from a random sample of 701 community dwelling African American, Native American, and White elders residing in two rural North Carolina counties. We summarize CAM use for general use and for diabetes care and use multiple logistic modeling to estimate the effects of health self-management predictors on use of CAM therapies. RESULT: . The majority of respondents used some form of CAM for general purpose, whereas far fewer used CAM for diabetes care. The most widely used CAM categories were food home remedies, other home remedies, and vitamins. The following health self-management predictors were related to the use of different categories of CAM therapies: personal characteristics (ethnicity), health status (number of health conditions), personal resources (education), and financial resources (economic status). Discussion. CAM is a widely used component of health self-management among rural among older adults with diabetes. Research on CAM use will benefit from theory that considers the specific behavior and cognitive characteristics of CAM therapies.     

The role and effect of complementary and alternative medicine in systemic lupus erythematosus

The use of complementary and alternative medicine (CAM) is common among patients with systemic lupus erythematosus (SLE), especially those with active disease who often have poorer quality of life and significant unmet needs. It is important for the rheumatologist to be aware of these therapies and to ask the patient with SLE about their active use or future interest in CAM. Future studies on the effectiveness of the aforementioned therapies will be crucial to find better ways for the rheumatologist to integrate their use into the care of the patient with SLE.     

Why I would want to use complementary and alternative therapy: a patient's perspective

People are increasingly turning to complementary therapy as an adjunct to traditional care, but a large percentage do not share that information with their physician. People with rheumatic disease use alternative and complementary therapies for many reasons, and they use a wide variety of therapies. Chronic diseases are among the most difficult to treat with traditional Western medications that attack symptoms, while more alternative and complementary therapies offer relief through other means. Everyone involved--medical doctor, patient, and complementary practitioner--needs to know about the entire treatment regimen and handle it with the patient's overall, long-term health and quality of life in mind. Organizations such as the Arthritis Foundation and professional holistic groups can partner to increase knowledge and further enhance quality of life for people with rheumatic disease.     

Use And Assessment Of Complementary And Alternative Therapies By Intravenous Drug Users

Intravenous drug users often have many health conditions in addition to their drug addiction, yet may be isolated from conventional sources of care. They have never before been examined for their use of complementary and alternative medicine (CAM) therapies. Our purpose was to study the prevalence and predictors of CAM use among persons with a history of intravenous drug use through a cross-sectional survey of intravenous drug users examining their utilization of health services, including CAM therapies. A total of 548 persons with a history of intravenous drug use, recruited from a needle-exchange program and a methadone maintenance clinic, both in Providence, Rhode Island, participated. Overall prevalence of any CAM use in the past 6 months, frequency of use of individual named CAM therapies and domains, and demographic and clinical characteristics associated with CAM users, reasons for CAM use and self-perceived effectiveness of CAM were also measured. Of the 548 participants, 45% reported use of at least one CAM therapy. The top three therapies—religious healing, relaxation techniques, and meditation—were all from the mind–body domain. Having a higher education and lower self-rated health were the two strongest predictors of CAM use, followed by having a regular doctor or clinic, being white and younger. There was a high level of self-perceived effectiveness of CAM therapies (4.1 on a scale of 1–5), and CAM users were likely to use CAM for reasons related to their addiction.     

The role of complementary and alternative medicine in diabetes

Complementary and alternative medicine (CAM) describes a diverse group of medical and health care systems, practices, and products not currently considered to be part of conventional medicine. Inadequacies in current treatments for diabetes have led 2 to 3.6 million Americans to use CAM for diabetes treatment, despite limited studies of safety and efficacy of CAM methods. CAM is used mostly by West Indians, Africans, Indians, Latin Americans, or Asians. Prayer, acupuncture, massage, hot tub therapy, biofeedback, and yoga have been used as well as various plant remedies for treating diabetes. Several CAM practices and herbal remedies are promising for diabetes treatment, but further rigorous study is needed in order to establish safety, efficacy, and mechanism of action. In the meantime, it is important to be aware that many patients with diabetes may be using CAM and to consider potential interactions with conventional medicines being used.     

Ethical considerations of complementary and alternative medical therapies in conventional medical settings

Increasing use of complementary and alternative medical (CAM) therapies by patients, health care providers, and institutions has made it imperative that physicians consider their ethical obligations when recommending, tolerating, or proscribing these therapies. The authors present a risk-benefit framework that can be applied to determine the appropriateness of using CAM therapies in various clinical scenarios. The major relevant issues are the severity and acuteness of illness; the curability of the illness by conventional forms of treatment; the degree of invasiveness, associated toxicities, and side effects of the conventional treatment; the availability and quality of evidence of utility and safety of the desired CAM treatment; the level of understanding of risks and benefits of the CAM treatment combined with the patient's knowing and voluntary acceptance of those risks; and the patient's persistence of intention to use CAM therapies. Even in the absence of scientific evidence for CAM therapies, by considering these relevant issues, providers can formulate a plan that is clinically sound, ethically appropriate, and targeted to the unique circumstances of individual patients. Physicians are encouraged to remain engaged in problem-solving with their patients and to attempt to elucidate and clarify the patient's core values and beliefs when counseling about CAM therapies.     

Complementary and alternative medicine use among HIV-positive people: research synthesis and implications for HIV care

Use of complementary and alternative medicine (CAM) is prevalent among HIV-positive individuals despite the success of antiretroviral treatments and limited evidence of CAM's safety and efficacy. To characterize the potential impact of CAM use on HIV care, we conducted a systematic review of 40 studies of CAM use among HIV-positive people. The goals of this review are to: (1) describe the demographic, biomedical, psychosocial and health behavior correlates of CAM use; (2) characterize patient-reported reasons for CAM use; and (3) identify methodological and conceptual limitations of the reviewed studies. Findings confirm that a high proportion of HIV-positive individuals report CAM use (M=60%). Overall, CAM use is more common among HIV-positive individuals who are men who have sex with men (MSM), non-minority, better educated and less impoverished. The use of CAM is also associated with greater HIV-symptom severity and longer disease duration. HIV-positive CAM users commonly report that they use CAM to prevent or alleviate HIV-related symptoms, reduce treatment side-effects and improve quality of life. Findings regarding the association between CAM use, psychosocial adjustment and adherence to conventional HIV medications are mixed. While the reviewed studies are instrumental in describing the characteristics of HIV-positive CAM users, this literature lacks a conceptual framework to identify causal factors involved in the decision to use CAM or explain implications of CAM use for conventional HIV care. To address this concern, we propose the use of health behavior theory and discuss implications of review findings for HIV care providers.     

Complementary and alternative medicine use by patients with inflammatory bowel disease: An Internet survey.

OBJECTIVES: To determine the degree and determinants of the use of complementary and alternative medicine (CAM) by patients with inflammatory bowel disease (IBD) with the use of the Internet and to compare the results with those found by using a similar survey in patients attending gastroenterology clinics in Calgary, Alberta. SUBJECTS AND METHODS: A cross-sectional survey of 263 patients with IBD with the use of a World Wide Web-based, structured questionnaire was conducted. RESULTS: Complementary therapies had been used by 46% of patients in the previous two years. Current use was reported by 34%. Vitamins, herbal products and natural health practices were the most commonly reported therapies. Side effects and lack of effectiveness of standard therapies were the most commonly cited reasons for seeking complementary medicine. However, despite this, respondents who had previously received surgery, or intravenous or oral steroids were less likely to be current CAM users. Important differences between the determinants of and reasons for CAM use in the present study and those of a similar study of IBD patients in a local tertiary care setting were noted. CONCLUSIONS: Complementary medicine use is common in patients with IBD. Differences in the determinants of and reasons for CAM use noted between the present Internet sample and a gastroenterology clinic sample suggest that conclusions from the present study and from previous studies based only on clinic samples provide a limited view of CAM use by people with IBD. More comprehensive assessments are needed.     

Pathophysiology and treatment of diabetic peripheral neuropathy: the case for diabetic neurovascular function as an essential component

Worldwide, diabetes and its complications are major causes of morbidity, decreased quality of life, mortality and increasing health care costs. Patients with diabetes attempt to control blood pressure, lipids and blood glucose levels to decrease their risk of macrovascular and microvascular complications, such as diabetic peripheral neuropathy (DPN). Even with control of these risk factors for vascular disease, many patients still develop complications. Targeted therapies to the underlying mechanisms of diabetic neuropathy are essential to slow the progression of the disease. This review describes the signs, symptoms and diagnosis of DPN. Additionally, new therapies and the complex etiology that contributes to the development of diabetic neuropathy are described (oxidative stress, hyperglycemia, advanced glycated end products, autoimmunity, neurotrophic factors and protein kinase C beta).     

Emerging credentialing practices, malpractice liability policies, and guidelines governing complementary and alternative medical practices and dietary supplement recommendations: a descriptive study of 19 integrative health care centers in the United States

BACKGROUND: Little is known about policies governing the integration of complementary and alternative medical (CAM) therapies and providers. METHODS: To document emerging approaches in 19 US hospitals regarding credentialing, malpractice liability, and pharmacy policies governing integration of CAM therapies and providers into conventional medical settings, we surveyed 21 academic medical centers and 13 non-academically affiliated hospitals that are nationally visible and are integrating CAM therapies into conventional medical settings. Of the 19 respondents, 11 were tertiary care hospitals, 6 were community hospitals, 1 was a freestanding center associated with a community-based hospital, and 1 was a university-based rehabilitation hospital. RESULTS: Institutions had no consistent approach to provider mix and authority within the integrative care team, and minimum requirements for professional liability insurance, informed consent disclosure, and hiring status. Less than a third had a formal (stated) policy concerning dietary supplements; those selling supplements in their pharmacy lacked consistent, evidence-based rationales regarding which products and brands to include or exclude. Although many hospitals confiscated patient supplements on admission, institutions had inconsistent criteria regarding allowance of home supply. CONCLUSIONS: Hospitals are using heterogeneous approaches to address licensure, credentialing, scope of practice, malpractice liability, and dietary supplement use in developing models of integrative care. The environment creates significant impediments to the delivery of consistent clinical care and multisite evaluations of the safety, efficacy, and cost-effectiveness (or lack thereof) of CAM therapies (or integrative models) as applied to management of common medical conditions. Consensus policies need to be developed.     

Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey

BACKGROUND: Little is known about perceptions of complementary and alternative medical (CAM) therapy relative to conventional therapy among patients who use both. OBJECTIVE: To document perceptions about CAM therapies among persons who use CAM and conventional therapies. DESIGN: Nationally representative, random-household telephone survey. SETTING: The 48 contiguous U.S. states. PARTICIPANTS: 831 adults who saw a medical doctor and used CAM therapies in 1997. MEASUREMENTS: Perceptions about helpfulness and patterns of CAM therapy use relative to conventional therapy use and reasons for nondisclosure of CAM therapies. RESULTS: Of 831 respondents who saw a medical doctor and used CAM therapies in the previous 12 months, 79% perceived the combination to be superior to either one alone. Of 411 respondents who reported seeing both a medical doctor and a CAM provider, 70% typically saw a medical doctor before or concurrent with their visits to a CAM provider; 15% typically saw a CAM provider before seeing a medical doctor. Perceived confidence in CAM providers was not substantially different from confidence in medical doctors. Among the 831 respondents who in the past year had used a CAM therapy and seen a medical doctor, 63% to 72% did not disclose at least one type of CAM therapy to the medical doctor. Among 507 respondents who reported their reasons for nondisclosure of use of 726 alternative therapies, common reasons for nondisclosure were "It wasn't important for the doctor to know" (61%), "The doctor never asked" (60%), "It was none of the doctor's business" (31%), and "The doctor would not understand" (20%). Fewer respondents (14%) thought their doctor would disapprove of or discourage CAM use, and 2% thought their doctor might not continue as their provider. Respondents judged CAM therapies to be more helpful than conventional care for the treatment of headache and neck and back conditions but considered conventional care to be more helpful than CAM therapy for treatment of hypertension. CONCLUSIONS: National survey data do not support the view that use of CAM therapy in the United States primarily reflects dissatisfaction with conventional care. Adults who use both appear to value both and tend to be less concerned about their medical doctor's disapproval than about their doctor's inability to understand or incorporate CAM therapy use within the context of their medical management.     

Quantity and quality of complementary and alternative medicine recommendations in clinical practice guidelines for type 2 diabetes mellitus: A systematic review

AimsApproximately 70% of Americans with diabetes have used complementary and alternative medicine (CAM) in the past year. Healthcare providers often receive minimal training on these therapies and subsequently rely on clinical practice guidelines (CPGs) to supplement their knowledge about the safe and effective use of CAM for the treatment/management of type 2 diabetes mellitus (T2DM). The purpose of this systematic review is to determine the quantity and assess the quality of CAM recommendations in CPGs for the treatment and/or management of T2DM.Data synthesisMEDLINE, EMBASE, and CINAHL were systematically searched from 2009 to 2020, in addition to the Guidelines International Network and the National Center for Complementary and Integrative Health websites. CPGs containing treatment and/or management recommendations for T2DM were eligible; those with CAM recommendations were quality-assessed with the AGREE II instrument twice, once for the overall CPG and once for the CAM sections. Twenty-seven CPGs were deemed eligible, of which 7 made CAM recommendations. Mean scaled domain percentages were (overall, CAM): scope and purpose (89.7%, 79.8%), clarity of presentation (85.7%, 48.4%), stakeholder involvement (67.9%, 28.2%), applicability (54.8%, 20.2%), rigour of development (49.7%, 35.7%), and editorial independence (44.1%, 44.1%).ConclusionsQuality varied within and across CPGs; domain scores across CAM sections generally scored lower than the overall CPG. Given that CAM therapies for T2DM are only represented in one-quarter of eligible CPGs and are of lower quality, a knowledge gap exists for healthcare providers who seek evidence-based information on this topic in order to effectively counsel inquiring patients.     

Correlates of complementary and alternative medicine (CAM) use in Chicago area children with diabetes (DM)

AimsTo correlate complementary and alternative medicine (CAM) use in children with diabetes mellitus (DM) with DM control and other family or disease characteristics.MethodsParents/guardians of children with DM were interviewed about demographics, clinical characteristics, CAM use, health care beliefs, psychosocial variables, and religious beliefs. The child's hemoglobin A1c (HgbA1c) value from the visit was collected. Statistical analyses included χ², Fisher's exact test, and 2-sample t-tests.Results106 families with type 1 DM were interviewed. 33% of children tried CAM in the last year; 75% of parents had ever tried CAM. Children most commonly tried faith healing or prayer; parents most commonly tried faith healing or prayer, chiropractic, massage, and herbal teas. Children were more likely to have used CAM if their parents or siblings used CAM or their family was more religious. They were more likely to have discussed CAM with their providers if they used CAM. Parents of child CAM users reported more problems with DM treatment adherence.ConclusionsChildren with DM used CAM. There were no differences in DM control, demographics, healthcare beliefs, stress, or quality of life between CAM users and non-users. Practitioners should inquire about CAM use to improve DM care for children.     

Complementary and alternative medicine use among people with asthma and health-related quality of life

Objective: This study investigated the relationship between complementary and alternative medicine (CAM) use and self-reported health-related quality of life among people with asthma. Method: Data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) survey and the 2010 Asthma Callback Survey (ACBS) were used. Survey respondents were men and women with asthma who were 18–99 years of age who responded to both surveys. Results: CAM use was associated with an increase in the number of days of poor mental health (OR?=?1.02, 95% CI 1.02, 1.03) and poor physical health (OR?=?1.02, 95% CI 1.01, 1.02). The odds ratios are adjusted for covariates such as asthma severity, age, sex, race/ethnicity, income, and educational attainment. CAM users report more days of poor mental health (7.2 versus 4.6) and poor physical health (9.6 versus 6.5) compared with those not using CAM therapies. Conclusions: Contrary to the hypotheses, CAM use is associated with poorer health-related quality of life. Implications for research and practice are discussed in detail.     

Use of complementary therapies in patients with cardiovascular disease

Previous studies have suggested that patients with chronic medical conditions use complementary and alternative medicine (CAM) at a higher rate than the general population. Despite recent interest in CAM for cardiovascular disease, few data are available regarding patterns of use in patients with cardiovascular disease in the United States. This study used the 2002 National Health Interview Survey and analyzed data on CAM use in 10,572 respondents with cardiovascular disease. Among those with cardiovascular disease, 36% had used CAM (excluding prayer) in the previous 12 months. The most commonly used therapies were herbal products (18%) and mind-body therapies (17%). Among herbs, echinacea, garlic, ginseng, ginkgo biloba, and glucosamine with or without chondroitin were most commonly used. Among mind-body therapies, deep-breathing exercises and meditation were most commonly used. Overall, CAM was used most frequently for musculoskeletal complaints (24% of respondents who used mind-body therapies, 22% who used herbs, 45% who used any CAM). Mind-body therapies were also used for anxiety or depression (23%) and stress or emotional health and wellness (16%). Herbs were commonly used for head and chest colds (22%). Fewer respondents (10%) used CAM specifically for their cardiovascular conditions (5% for hypertension, 2% for coronary disease, 3% for vascular insufficiency, < 1% for heart failure or stroke). Most, however, who used CAM for their cardiovascular condition perceived the therapies to be helpful (80% for herbs, 94% for mind-body therapies). CAM use was more common in younger respondents, women, Asians, and those with more education and greater incomes. In conclusion, CAM use, particularly herbs and mind-body therapies, is common in the United States in patients with cardiovascular disease and mirrors use in the general population. CAM use specifically to treat cardiovascular conditions, however, is less common.     

The conundrum of diabetic neuropathies—Past,present, and future

Diabetic neuropathy (DN) remains arguably the most prevalent chronic complication in people with both type 1 and type 2 diabetes, including in youth, despite changes in the current standards of clinical care. Additionally, emerging evidence demonstrates that neuropathy affects a large proportion of people with undiagnosed diabetes and/or prediabetes, as well as those with obesity. Here we summarize the latest epidemiology of DN, recent findings regarding the pathophysiology of the disease, as well as current outcome measures for screening and diagnosis, in research and clinical settings. The authors discuss novel perspectives on the impact of social determinants of health in DN development and management, and the latest evidence on effective therapies, including pharmacological and nonpharmacological therapies for neuropathic pain. Throughout the publication, we identify knowledge gaps and the need for future funding to address these gaps, as well as needs to advocate for a personalized care approach to reduce the burden of DN and optimize quality of life for all affected individuals.     

Long-term trends in the use of complementary and alternative medical therapies in the United States

BACKGROUND: Although recent research has shown that many people in the United States use complementary and alternative medical (CAM) therapies, little is known about time trends in use. OBJECTIVE: To present data on time trends in CAM therapy use in the United States over the past half-century. DESIGN: Nationally representative telephone survey of 2055 respondents that obtained information on current use, lifetime use, and age at first use for 20 CAM therapies. SETTING: The 48 contiguous U.S. states. PARTICIPANTS: Household residents 18 years of age and older. MEASUREMENT: Retrospective self-reports of age at first use for each of 20 CAM therapies. RESULTS: Previously reported analyses of these data showed that more than one third of the U.S. population was currently using CAM therapy in the year of the interview (1997). Subsequent analyses of lifetime use and age at onset showed that 67.6% of respondents had used at least one CAM therapy in their lifetime. Lifetime use steadily increased with age across three age cohorts: Approximately 3 of every 10 respondents in the pre-baby boom cohort, 5 of 10 in the baby boom cohort, and 7 of 10 in the post-baby boom cohort reported using some type of CAM therapy by age 33 years. Of respondents who ever used a CAM therapy, nearly half continued to use many years later. A wide range of individual CAM therapies increased in use over time, and the growth was similar across all major sociodemographic sectors of the study sample. CONCLUSIONS: Use of CAM therapies by a large proportion of the study sample is the result of a secular trend that began at least a half century ago. This trend suggests a continuing demand for CAM therapies that will affect health care delivery for the foreseeable future.     

Use and assessment of complementary and alternative therapies by intravenous drug users

Intravenous drug users often have many health conditions in addition to their drug addiction, yet may be isolated from conventional sources of care. They have never before been examined for their use of complementary and alternative medicine (CAM) therapies. Our purpose was to study the prevalence and predictors of CAM use among persons with a history of intravenous drug use through a cross-sectional survey of intravenous drug users examining their utilization of health services, including CAM therapies. A total of 548 persons with a history of intravenous drug use, recruited from a needle-exchange program and a methadone maintenance clinic, both in Providence, Rhode Island, participated. Overall prevalence of any CAM use in the past 6 months, frequency of use of individual named CAM therapies and domains, and demographic and clinical characteristics associated with CAM users, reasons for CAM use and self-perceived effectiveness of CAM were also measured. Of the 548 participants, 45% reported use of at least one CAM therapy. The top three therapies--religious healing, relaxation techniques, and meditation--were all from the mind-body domain. Having a higher education and lower self-rated health were the two strongest predictors of CAM use, followed by having a regular doctor or clinic, being white and younger. There was a high level of self-perceived effectiveness of CAM therapies (4.1 on a scale of 1-5), and CAM users were likely to use CAM for reasons related to their addiction.