Contents
13.1 Principles of Treatment . . . 233
13.2 Description of Treatment . . . 234
13.3 Method of Delivery . . . 234
13.3.1 Alternative Medical Systems . . . 234
13.3.2 Mind–Body Interventions . . . 234
13.3.3 Biologically Based Treatments . . . 235
13.3.4 Body Manipulation . . . 235
13.3.5 Energy Therapies . . . 235
13.4 Potential Side Effects . . . 235
13.5 Special Considerations . . . 237
13.6 Future Perspectives . . . 238
References . . . 238
13.1 Principles of Treatment
Complementary and alternative medicine (CAM) therapy includes diverse medical and holistic prac- tices and products that are not presently considered to be part of conventional medicine. Although some scientific evidence exists regarding some CAM thera- pies, for most there are scientific questions that have not been answered, such as whether they are safe and whether they work for the diseases or medical condi- tions for which they are used.
The list of what is considered to be CAM changes continually as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge. These therapies may be used in conjunction with conventional, or modern, medicine (comple- mentary) or in place of modern medicine (alterna- tive):
▬Complementary medicine is used together with conventional medicine. An example of a comple- mentary therapy is using massage to help lessen nausea and vomiting while receiving chemothera- py.
▬Alternative medicine is used in place of conven- tional medicine. An example of an alternative therapy is using a special diet to treat cancer in- stead of undergoing surgery, radiation, or chemo- therapy that has been recommended by a conven- tional doctor.
Complementary
and Alternative Therapy
Nancy E. Kline
Factors that prompt parents to choose complementa- ry or alternative therapy for their children include the following:
▬Desire to avoid toxicities of conventional therapy
▬Ability to provide treatment at home
▬Preference for natural over synthetic medicine
▬Failure of conventional therapy to provide a cure
▬Serious or chronic illness that carries a poor prog- nosis
13.2 Description of Treatment
Complementary and alternative therapy can be sepa- rated into five categories: (a) alternative medical sys- tems, (b) mind-body interventions, (c) biologically- based treatments, (d) manipulation and body-based methods, and (e) energy therapies (Table 13.1) (Na- tional Center for Complementary and Alternative Medicine, 2003).
13.3 Method of Delivery
13.3.1 Alternative Medical Systems
In homeopathic medicine, small, highly diluted quantities of medicinal substances are given to cure symptoms. However, when the same substances are given at higher or more concentrated doses, they cause those symptoms. Naturopathic medicine is based on the theory that natural healing forces exist within the body. These forces help the body heal from disease and attain better health. Practices may in- clude dietary modifications, exercise, and acupunc-
ture, which is a method of treating pain injuries and diseases by inserting solid, extremely thin needles into precise points on the body. This insertion may be accompanied by manual, electrical, or heat stimula- tion of the needles.
13.3.2 Mind–Body Interventions
Mind-body interventions use a variety of techniques designed to enhance the mind’s capacity to affect bodily function and symptoms. Several that were previously considered alternative therapy have be- come mainstream (e.g., patient support groups and cognitive-behavioral therapy). Other mind-body techniques still considered complementary or alter- native therapy include meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance.
Meditation, relaxation, and guided imagery facili- tate the mind’s capacity to affect bodily function and symptoms. Meditation is practiced throughout the world but has its origins in India, China, and Japan. It is often part of a religious practice (Chiaramonte, 1997). Meditation is self-directed and is aimed at re- laxing the body and mind. The person focuses on a particular object, sound, or image for a period of time, thereby cleansing the mind of stressors. Several studies have shown that meditation yields positive results for stress reduction and effective coping mechanisms (Greene et al., 1999).
Relaxation is the absence of anxiety and skeletal muscle tension. Relaxation techniques include deep breathing exercises, autogenic relaxation, music, and progressive muscle relaxation. The techniques are easy to learn and perform and can be done alone or
Table 13.1. Types of complementary and alternative therapies
Type of therapy Examples
Alternative medical systems Homeopathic and naturopathic medicine
Mind-body interventions Medication, prayer, art, music
Biologically-based treatments Herbs, dietary supplements
Body manipulation Chiropractic or osteopathic manipulation
Energy therapies Therapeutic touch, electromagnetic fields
in a group. Relaxation is often used in combination with guided imagery, which deliberately introduces healthful images to encourage relaxation or to allevi- ate a symptom. Relaxation and guided imagery can be used to decrease acute symptoms, stress, fatigue, pain, blood pressure, pulse, and respiration; to induce sleep; to increase endorphins; and to stimulate the immune system (Chiaramonte, 1997).
13.3.3 Biologically Based Treatments
Biologically-based therapies in CAM use substances found in nature, such as herbs, foods, vitamins, di- etary supplements, and other so-called “natural” but as yet scientifically unproven therapies (e.g., shark cartilage). Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail.
Dietary supplements are provided in many forms, in- cluding tablets, capsules, powders, geltabs, extracts, and liquids. A wide array of supplement products are available worldwide and include vitamins, miner- als, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin.
13.3.4 Body Manipulation
Body-based methods are based on manipulation and/or movement of one or more parts of the body.
Therapeutic massage may bring relief to patients who are suffering from pain, have pathological tight- ening of skeletal muscle, or have not responded to more traditional physical therapies. Examples in- clude massage and chiropractic or osteopathic ma- nipulation.
13.3.5 Energy Therapies
Healing touch is one of a long line of healing tradi- tions based on the belief in a universal healing ener- gy. Therapeutic touch is derived from an ancient technique called laying-on of hands. It is based on the premise that it is the therapist’s healing force that af- fects the patient’s recovery, that healing is promoted when the body’s energies are in balance, and that, by
passing their hands over the patient, healers can identify energy imbalances. Therapeutic or healing touch uses light, gentle touch to affect the energy sys- tem physically, mentally, emotionally, and spiritually.
Therapeutic touch has been used to increase the body’s own healing potential; accelerate healing; de- crease pain, swelling and spasms; and induce relax- ation, peace, and well-being (Lorenzi, 1999).
Magnetic therapy was used thousands of years ago by the Egyptians and Greeks. There are several theories regarding the mechanism of how magnetic therapy works. It is believed that magnets enhance blood flow to the affected area, thereby decreasing inflammation and pain and speeding healing. Mag- nets are also thought to activate electrical activity in the body and cause the release of certain neurotrans- mitters to decrease pain. Lastly, magnets are believed to realign and balance the body’s own electromag- netic field to facilitate self-healing by improving circulation, cellular oxygenation, and metabolism (Lorenzi, 1999).
Electromagnetic fields (EMFs, also called electric and magnetic fields) are invisible lines of force that surround all electrical devices. The earth also pro- duces EMFs; electric fields are produced when there is thunderstorm activity, and magnetic fields are be- lieved to be produced by electric currents flowing at the earth’s core.
13.4 Potential Side Effects
Herbs and spices have been used for common and chronic ailments for centuries. Many of the conven- tional medicines used today are made from elements found in nature. Substantial research exists to sup- port the use of some herbal and spice remedies for common illnesses, such as chamomile for colic, gold- enseal for diarrhea, and tea tree oil and aloe vera for skin infections. Others require judicious use because of the risk of serious toxicity with overdose. The in- gredients used in emetics may damage the mouth, tongue, esophagus, stomach, and duodenum. Peri- anal excoriation, hemorrhagic ulcerative proctocoli- tis, and electrolyte imbalance have been reported fol- lowing colonic enema therapy.
Table 13.2. Common dietary and herbal supplements
Supplement Common uses How taken Side effects
Chamomile (flowers) Anxiety, sedation Tea or tincture taken internally Allergic reaction
Antispasmodic Botulism
Colic
Anti-inflammatory
Aloe vera Burns Gel applied topically or taken
(pure gel from leaves) Constipation internally Diarrhea
Skin ulcers Gastric cramping
Oral ulcers Contact dermatitis
Immune stimulant
Black tea Antioxidant Brewed, taken internally Nausea
Green tea Diarrhea
Goldenseal (roots) Diarrhea Tincture taken internally Hypotension
Antiseptic or applied topically Hypertension
Acne DO NOT USE IN INFANTS Local irritation
Immune stimulant <1 MONTH OF AGE Nausea, vomiting
Echinacea Immune stimulant Tinctures, capsules, or tablets None reported (leaves, roots, flowers) Colds taken internally
Ear infection
Cayenne Improves circulation Used in cooking None reported
Improves appetite Added to fruit juice for Heals ulcers an energizing drink
Cinnamon Diarrhea Used in soups, stews, None reported
Nausea fruit juice, tea
Improves digestion Oral ulcers
Cloves Stimulates appetite Used in soups, stews, None reported
Diarrhea fruit juice, tea
Nausea Vomiting
Coriander Indigestion Flavoring used in salads, None reported
Stimulates appetite stews, soups
Fennel Abdominal cramps Used in stews, tea None reported
Flatulence Stimulates appetite
Ginger Improves digestion Used in stir-fried foods, None reported
Nausea stews, soups, tea
Diarrhea
Abdominal cramps Stimulates appetite Colds
Alternative remedies appear to be relatively safe.
A review of 19 clinical trial reports, 19 case (or case series) reports, and 15 homeopathic pathogenetic tri- als were reviewed. The mean incidence of adverse effects was higher with homeopathy than with place- bo, but all were mild and transient. Perhaps more striking is the fact that 36 reports did not report on collection or incidence of adverse effects at all. How- ever, adverse event data are poorly and inconsistent- ly collected and reported, so this conclusion should be interpreted with caution (Dantas and Rampes, 2000).
Examining acupuncture for life-threatening ad- verse reactions revealed a number of potential prob- lems, not all of which are recognized commonly.
Fifty-six articles were reviewed (including overviews, epidemiological surveys, and case reports) examin- ing two main areas: rate of infection and traumatic injury (Ernst and White, 1997). Infections linked to acupuncture and the improper handling of needles or their reuse without adequate sterilization included hepatitis B and C, HIV, bacterial endocarditis, and staphylococcal septicemia. Other traumatic events included cardiac tamponade and punctured heart, including at least one actual death.
Table 13.2 provides a brief list of some dietary and herbal therapies used for symptom management, the conditions they are used to treat, and the side effects they may produce.
13.5 Special Considerations
Complementary and alternative therapies may be usefully incorporated into the patient’s treatment regimen for pediatric cancer. Various dietary supple- ments, herbs, and magnetic therapy are often used in hopes of boosting immune function and providing a cure. However, as a single therapy for malignancy, these treatments may jeopardize recovery and would be regarded as dangerous if other treatments of es- tablished effectiveness were delayed or rejected.
Many patients use complementary or alternative treatments but may be reluctant to share the infor- mation. One study showed that 40% of patients who utilized CAM therapies did not disclose the informa- tion with their health care providers (Eliopoulos, 1999). It is very important for parents to know whether a certain alternative therapy they are consid- ering may cause a serious reaction when taken in conjunction with conventional treatments. The fol- lowing questions may be useful to ascertain whether a parent has opted to use therapies in addition to the prescribed regimen:
▬What unacceptable side effects has your child had from the medicines that we have prescribed?
▬Dietary supplements or other nonprescription therapies are very commonly used by people who have cancer. Do you have any questions regarding these treatments?
Table 13.2. (Continued)
Supplement Common uses How taken Side effects
Turmeric Improves digestion Used in stir-fried foods None reported
Antiseptic Antioxidant
Shark cartilage Angiogenesis inhibitor Liquid Nausea
Anti-inflammatory Powder Vomiting
Immune stimulant Injectable form Abdominal cramping
Topical preparation Constipation Hypotension Hyperglycemia Hypercalcemia
13.6 Future Perspectives
Clinical trials of complementary and alternative therapy are taking place throughout the world. Al- though many of these treatments have already been in use for years, there is not appropriate scientific knowledge available about them similar to that gained from studies of conventional medicine. How- ever, many patients are already using CAM, and with- out this scientific knowledge, they may be at risk for serious effects from taking the wrong dose, using the treatment in the wrong way, or using it with another treatment with which it adversely interacts.
A few therapies for which studies are underway include acupuncture; herbs such as Ginkgo biloba;
dietary supplements such as green tea glucosamine, chondroitin, saw palmetto, and soy; and massage. Ex- amples of diseases and conditions for which these CAM therapies are being studied include arthritis, neurological disorders, cardiovascular disease, and cancer.
References
Chiaramonte D.R. (1997) Mind-body therapies for primary care physicians. Primary Care 24:787–807
Dantas F., Rampes H. (2000) Do homeopathic medicines pro- voke adverse effects? A systematic review. British Homeo- pathic Journal 89(1):S35–38
Eliopoulos C. (1999) Using complementary and alternative therapies wisely. Geriatric Nursing 20:139–143
Ernst E., White A. (1997) Life-threatening adverse reactions after acupuncture? A systematic review. Pain 71:123–126 Greene K.B., Berger J, Reeves C, Moffat A, Standish L.J., Cal-
abrese C. (1999) Most frequently used alternative and com- plementary therapies and activities by participants in the AMCOA study. Journal of the Association of Nurses in AIDS Care 10:60–73
Lorenzi E.A. (1999) Complementary/alternative therapies: So many choices. Geriatric Nursing 20:124–133
National Center for Complementary and Alternative Medicine (2003) Understanding complementary and alternative medicine. http://nccam.nih.gov/health
