Chapter 25
Alternative Medicine

The purpose of this chapter is to give you information about alternative kinds of medicine practices. In a general sense, alternative medical practices are those that are not usually practiced in hospitals by your conventional doctor or taught in medical schools. Some examples include herbal supplements, chiropractic manipulation, massage, and acupuncture.

Public interest in alternative (or complementary or integrative) medicine is increasing. One large survey estimated that one out of every three adults in the United States used some type of alternative medicine. Over 70% of these adults, however, did not feel comfortable telling their doctor about this. Another study showed that one out of every four people taking prescription medicines also took some kind of herbal "natural" supplement. A natural supplement can be an herbal, mineral, botanical (phytomedicine, from plants), vitamin, or nutraceutical (chemically derived) substance.

Most people think that natural supplements cannot do any harm. Unfortunately, some of these preparations can have negative side effects or interfere with the way your prescription medication is supposed to work. It is very important that you ask your doctor before taking any natural supplement, especially if you are already taking a prescription medicine. It is also important to talk to your doctor before trying an alternative therapy, such as acupuncture or chiropractic manipulation. Some types of chiropractic manipulation can alter the stability of your spine (see section on Potential for Harm).

 
DIFFERENT CATEGORIES OF ALTERNATIVE MEDICINE

• Phytomedicines: The use of plants and plant products as therapeutic agents and supplements. This includes herbs, minerals, vitamins, and botanical sources.
• Nutraceuticals: Supplements that are advertised as "natural" but are derived from chemicals instead of plants and are not prescription drugs regulated by the Food and Drug Administration.
• Energy Medicine: A variety of therapies that focus on altering "energy fields" in the body and thus affecting metabolic and functional processes. This includes acupuncture and homeopathy.
• Nutritional Medicine: The use of nutritional interventions to treat chronic and acute diseases, prevent illness, and maintain health.
• Mind/Body Medicine: The use of techniques from a variety of cultural and belief systems to identify and treat disorders thought to be influenced by a mind and body connection. This includes counseling, prayer, meditation, and visualization.
• Physical and Manual Medicine: This term encompasses several different fields such as massage, chiropractic, rolfing, reiki, and therapeutic touch.

 
RESEARCH ON ALTERNATIVE MEDICINES

Until recently, it has been difficult for doctors to gain access to reliable information. Some doctors are interested in learning more about alternatives, and some are not. Most physicians and scientists agree that there is not enough research about most alternative medicine treatments to support prescribing these treatments.

Alternative medicine is not taught in conventional medical schools, where your physicians were trained. Also, many more physicians prescribe alternative therapies in Europe than in the United States. The obstacles to incorporating alternative medicines into mainstream health care include lack of research proving effectiveness, economics, ignorance about treatments, and lack of standards of practice.

In 1993, Congress established the Office of Alternative Medicine within the National Institutes of Health (NIH). The purpose was to determine the effectiveness of alternative medical treatments and help with integrating treatments found to be effective into mainstream medical practice. In 1998, this office became a free-standing entity called the National Center for Complementary and Alternative Medicine.

It is very important to discuss any alternative treatments you are considering with your doctor, so that you and your doctor can determine safety and effectiveness for your individual situation.

 
NATURAL SUPPLEMENTS ARE NOT FDA APPROVED

Prescription and over-the-counter (not requiring a prescription) medicines have been approved for safety and effectiveness by the Food and Drug Administration (FDA), an agency of the federal government. To be approved, each medicine must go through a very costly and lengthy process of research. The FDA determines what the active ingredients are, the effectiveness of the ingredients, safety, possible side effects, contraindications, and the recommended doses.

The FDA does not approve or regulate any natural supplement, for several reasons. Herbal and botanical preparations contain multiple ingredients. The quantity, quality, and strength of these ingredients are often unknown and can vary from plant to plant. These compounds are not patentable, so the herbal manufacturer could never make enough money to afford to seek research trials and approval from the FDA.

The federal government is concerned, however, about the growing number of people who take natural supplements. In 1994 Congress passed the Dietary Supplement Health and Education Act to establish an Office of Dietary Supplements, governed by the NIH. This agency has begun collecting and compiling scientific information and research about the safety and effectiveness of dietary supplements. The web site is dietarysupplements.info.nih.gov.

 
DISTRIBUTION

In the United States, herbs are sold as nutritional supplements. Herbs can be taken in many forms: infusions, concoctions, potions, salves, oils, compresses, and pills. Until recently, these supplements were found only in health food stores, but now they are found in most pharmacies and supermarkets and are marketed over the internet.

In addition, herbal supplements are being added to food and drink products sold in grocery stores. It is possible to find St. John’s wort added to cereal and ginseng or ginkgo biloba added to drinks. Product research is not available to determine the potency of herbs added to food or possible food/herb interactions. Nothing on food labels describes potential interactions of herbs with prescription medicines.

 
EFFECTIVENESS

There is limited evidence, based on scientific research, that some categories of alternative medicine are effective. Several studies have indicated that therapeutic touch, massage, and acupuncture have improved both acute and chronic medical conditions. Some natural supplements have shown promising improvements in particular diseases and their symptoms.

There is still a lot of research that needs to be done. Despite the lack of scientific evidence, many people who use alternative medicine have a very strong belief system that the particular modality works for them, based on their own individual experience.

 
POTENTIAL FOR HARM

Although there is still a great deal we do not understand about these treatments, we do know that some harmful results and side effects can occur. Always read the labels of any natural supplement, since there are several on the market that contain trace amounts of toxic substances (such as arsenic).

Never take a natural supplement if you are also on a prescription medicine without first consulting with your doctor. Herbs can either enhance or destroy the actions of other herbs or drugs. St. John’s wort, for example, should not be taken at the same time as prescription antidepressants because it can cause toxicity. Ginkgo decreases platelet function and can greatly increase the effect of aspirin or coumaidin, beyond the therapeutic range into a potentially dangerous range. Two published reports link ginkgo with bleeding from the eye and in the brain (subdural hematoma). Guarana contains more caffeine than many cups of coffee. People with high blood pressure should avoid guarana, goldenseal, ma huang, and licorice.

Some people believe that because a substance is "natural", it can do them no harm. This is not the case. Rattlesnake venom, strychnine, and a large number of plants, for example, are "natural" substances that are also highly toxic.

 
SOME CONTRAINDICATIONS

Here are some alternative therapies and contraindications for them--that is, some conditions that would indicate against the use of a particular alternative therapy. This list by no means covers all the areas of alternative medicine. Tables 25.1 and 25.2 list the adverse effects of some nutritional supplements and herbs. Herbs can enhance or block the action of other drugs. Many SCI patients have "polypharmacy" ("many drugs"), with a long list of prescription drugs. Herbal preparations that may effect endocrine function and neurogenic bowel and bladder should be used with extreme caution. Tables 25.1 and 25.2 are only examples of some of the preparations more commonly used by people with SCI and are by no means comprehensive lists. In people with SCI, herbals may cause gastrointestinal distress or anticholinergic effects (resulting in urinary retention or constipation), which may trigger autonomic dysreflexia (AD). Those subject to AD should avoid products that increase blood pressure, such as ephedra, guarana, goldenseal, ma huang, and licorice. Many products can potentiate (make more potent) the effects of aspirin or coumadin. Some products, such as guarana or echinacea, may cause a diuretic effect, causing dehydration, tachycardia, orthostatis, and impaction.

• Acupuncture should not be used over open wounds or soft-tissue infections. Use with caution in skin that does not have normal sensation. Placement of acupuncture pins can increase spasticity.
• Chiropractic therapy should not be used if there is any possibility of spinal instability, recent surgery, neurological changes, or presence of spinal cord syrinx. People with spinal cord injury are more at risk for osteoporosis below the level of injury, and osteoporotic bones are more prone to fracture. Forceful chiropractic maneuvers can cause shearing of skin that lacks sensation and cause skin wounds. See your SCI doctor before considering any chiropractic treatment.
• Native American sweat lodges should generally not be used by people with spinal cord injury, since excessive sweating causes dehydration. Dehydration can cause severe constipation and bowel impaction and lead to urinary tract infections and decubitus ulcers.

TABLE 25.1. Adverse Effects of Selected Nutritional Supplements

TABLE 25.2. Adverse Effects Associated with Selected Herbs

 
HEALTH PLAN COVERAGE

The majority of insurance plans offer limited coverage for nutrition counseling, biofeedback, psychotherapy, acupuncture, preventive medicine, and chiropractic and osteopathic medicine. You should check with your health-care plan before starting any new treatment.

 
RESOURCES

 
Publications

The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines.
M. Blumental. American Botanical Council, 1998.

Professional’s Handbook of Complementary and Alternative Medicines.
C. Fetrow. Springhouse, 1998.

Fundamentals of Complementary and Alternative Medicine.
M. Micozzi. Churchill Livingstone, 1996.

PDR for Herbal Medicines.
N. Montvale. Medical Economics Company, 1998.

The Medical Advisor, the Complete Guide to Alternative and Conventional Treatments.
Time-Life Books, 1996.

Natural Medicines.
J. Jellings. Pharmacist’s Letter.

 
Web Sites

www.altmedicine.com
Alternative Health News Online provides alternative, complementary, and preventive health news.

www.hcrc.org
The Healthcare Reality Check provides science-based information on alternative and complementary medicine.

altmed.od.nih.gov
The National Center for Complementary and Alternative Medicine at the National Institutes of Health conducts and supports basic and applied research and training and disseminates information on complementary and alternative medicine to practitioners and the public.

www.HealthAtoZ.com
HealthAtoZ is a comprehensive health and medical resources developed by healthcare professionals and includes web sites, interactive tools, community tools, and information centers.

dietary-supplements.info.nih.gov
This web site provides information about the Office of Dietary Supplements, including its origins, programs, activities, and scientific resources. It is organized to help you quickly and easily find the information you seek.

 

SCI Self-Care Guide Main Page Chapter 1     SCI Anatomy & Physiology Chapter 2     Skin Care Chapter 3     Circulatory System Chapter 4     Respiratory Care Chapter 5     Range of Motion Chapter 6     Bladder Management Chapter 7     Bowel Management Chapter 8     Nutrition Chapter 9     Medications Chapter 10   Nerves, Muscles, and Bones Chapter 11   Autonomic Dysreflexia Chapter 12   Pressure Sores Chapter 13   Psychosocial Adjustment Chapter 14   Sexual Health & Rehabilitation

Chapter 15   Community Resources Chapter 16   Vocational Rehabilitation Chapter 17   Recreation Chapter 18   Driver’s Training Chapter 19   Attendant Management Chapter 20   Home Modifications Chapter 21   Approaching Discharge Chapter 22   Pain after Spinal Cord Injury Chapter 23   Substance Abuse and SCI Chapter 24   Exercise Chapter 25   Alternative Medicine Chapter 26   Equipment Chapter 27   Staying Healthy Glossary