Alternative therapies for arthritis treatment. Part 1

Because conventional treatment options focus mostly on pain management, an increasing number of the 43 million people with arthritis are seeking alternative methods of disease management to improve their quality of life. According to a 1998 survey (Eisenberg et al., 1998), those who have used alternative methods to manage their diseases are included in the 50% of Americans who have tried an alternative treatment modality. As the first in a two-part series, this article reviews the historical use of selected alternative therapies and provides current information that will help orthopaedic nurses and other healthcare providers to advise their patients on the use of such treatment modalities.     

Alternative therapies: Part II. Congestive heart failure and hypercholesterolemia

Natural supplements are widely used by the American public but, while claims of their therapeutic effects abound, medical research does not always support their effectiveness. Clinical trials using Q10 for the management of congestive heart failure have had conflicting results; hawthorn is prescribed in Germany for the treatment of this condition, but no trials have been conducted in the United States. Although initial research about the use of garlic in the management of hypercholesterolemia was encouraging, follow-up studies have failed to verify these results. Substituting soy protein for high-fat animal protein diets, however, does have a beneficial effect on serum lipid levels. So far, cholestin (a natural product containing several statins) has proved to be a cost-saving lipid-lowering medication, and fenugreek may offer modest improvement as well. Gugulipid is also promising but requires further research.     

Alternative therapies: Part I. Depression, diabetes, obesity

Natural supplements are widely used in the United States and, while claims of their therapeutic effects abound, medical research does not always support their effectiveness. St. John's wort acts as a weak selective serotonin reuptake inhibitor with fewer side effects. S-Adenosylmethionine (SAMe) has enough of an antidepressant effect to warrant further research. More human studies are needed before garlic, bitter melon, soy and fenugreek supplements can be recommended for the management of diabetes, although chromium may be a promising treatment in some cases. Alpha lipoic acid is used in the treatment of diabetic neuropathy. The effects of ma huang/guarana combinations in obesity have not been well studied. These combinations may have potentially serious side effects but may also offer some benefit. The combination of hydroxycitric acid and garcinia has proved no more effective than placebo.     

Alternative therapies for tobacco dependence

For both hypnotherapy and acupuncture, the evidence of any effect is anecdotal. There are insufficient rigorous studies that are homogeneous in design or results to allow a reliable conclusion on whether or not these therapies are effective. At best, individual smokers who choose one of these interventions for preference should not be discouraged provided that they are informed about the state of the evidence.     

Alternative therapies for tension-type headache

Treatment of tension-type headache remains very challenging. In addition to conventional therapies, alternative methods such as physical therapy, acupuncture, and botulinum toxin have been studied. In this article, recent literature is reviewed and discussed and challenges for the evaluation of these approaches are considered. Although the clinical evidence is still incomplete, certain treatments are promising and the active ongoing research hopefully will soon yield more answers. Of note, the specific issue of psychologic therapy is dealt with elsewhere in this issue.     

Complementary and alternative therapies in occupational health. Part II--Specific therapies.

Dossey (2001) says, "The nurse serves as a facilitator and helps assist the patient and his or her significant others to be in the best state for healing to take place. Nurses are in a unique position to be instruments of healing at all times." According to Fitch (1999), "A fundamental goal of nursing is to comfort." Complementary and alternative therapies offer many self care and comforting remedies help employees prevent disease and promote healing. Occupational health nurses have the ability to educate employees and offer guidance about CAM therapies; encourage self care management of minor complaints; and encourage employees, when appropriate, to seek health care. As employees' use of CAM continues to increase, occupational health nurses need to monitor use of CAM therapies among employees. Nurses should inform the employer, case managers, and insurance companies involved about the potential increase in CAM use to promote changes in the health care system and integrate conventional and CAM therapies as needed. Further research related to CAM therapies continues as the health care system warrants safe, effective, and cost effective ways to promote health and prevent or manage illness.     

Alternative therapies for traditional disease states: menopause

With growing concern about the use of hormone replacement therapy, some women are looking for alternative treatments for menopausal symptoms and preventing postmenopausal cardiovascular disease and osteoporosis. In observational trials, exercise has been associated with decreased vasomotor symptoms. One trial suggested that black cohosh may reduce menopausal symptoms. Soy has been shown to decrease vasomotor symptoms, lower lipid levels, and increase bone density. However, large amounts of soy must be consumed, and it is not clear whether soy consumption causes a decrease in cardiovascular events or fractures. The evidence for St. John's wort is equivocal. Fish oil is helpful for secondary prevention of coronary artery disease.