What are the recommendations for using alternative medicine for chronic conditions?

Recommendations for Using Alternative Medicine in Chronic Conditions

When considering alternative medicine for chronic conditions, healthcare providers should communicate respectfully and non-judgmentally with patients about their use of complementary and alternative medicine (CAM), while ensuring proper assessment, education, documentation, monitoring, and reporting of adverse events. 1

Communication Approach

• Ask patients frequently about their interest in and use of CAM therapies at key timepoints in their disease trajectory, including during initial consultation, when making treatment decisions, when experiencing changes in condition, and at transition points in care 1
• Avoid using jargon or pejorative labels when discussing CAM; instead ask about specific therapies (e.g., natural products, chiropractic care, acupuncture) 1
• Acknowledge patients' reasons for CAM use, which may include symptom management, improved quality of life, sense of control over their condition, or pressure from their social network 1

Assessment Process

• Use a structured approach like the SCOPED framework (Situation, Choices, Objectives, People, Evaluate, Decision) to assess CAM use 1
• Document the assessment of the patient's use of CAM, including type, dose, frequency, potential interactions, and follow-up plan 1
• Identify risk factors and need for education or referrals throughout the disease trajectory 1

Evidence-Based Recommendations for Specific CAM Therapies

For Fibromyalgia:

• Mindfulness/mind-body therapies: Weak recommendation for use based on evidence showing improvements in pain compared to usual care 1
• Multicomponent therapy (combining educational/psychological therapies with exercise): Weak recommendation for use, with evidence showing reduced pain and fatigue, though effects may be short-lived 1
• S-Adenosyl methionine (SAMe): Weak recommendation against use due to limited evidence 1
• Guided imagery and homeopathy: Strong recommendation against use due to methodological flaws in supporting studies 1

For Psoriasis:

• Curcumin supplementation: May benefit patients as adjunctive therapy, though limited literature exists 1
• Oral vitamin D supplementation: Not recommended for psoriasis treatment (topical vitamin D agents are effective) 1
• Stress reduction techniques: Meditation, biofeedback, relaxation techniques, cognitive behavioral therapy, and guided imagery can improve psoriasis severity and should be discussed with interested patients 1

For Inflammatory Bowel Disease:

• Curcumin: Shows promising early signals in pilot studies but lacks sufficient high-quality evidence 1
• Fish oils: Have anti-inflammatory effects but the largest trial in Crohn's disease showed no benefit 1
• Faecal microbial transplantation (FMT): Remains investigational and should only be used in clinical trials for IBD 1
• Acupuncture: Has anecdotal support but lacks controlled trials 1
• Moderate exercise: Shows no harm in IBD and has positive benefits for bone health 1

Safety Considerations

• Monitor for potential interactions between CAM therapies and conventional treatments 1
• Follow up on CAM decisions in subsequent consultations to assess experiences, reinforce information, and adjust plans as needed 1
• Report adverse events associated with CAM therapies to appropriate regulatory bodies 1
• Be aware that some herbal remedies may cause allergic reactions, organ toxicity, or have carcinogenic properties 2
• Consider potential mechanical injuries (with acupuncture) and infectious complications 2

Implementation in Clinical Practice

• Integrate CAM discussions into standard practice to ensure safe and comprehensive care 1
• Recognize that 30-50% of patients with chronic conditions may use CAM, with higher usage among women 1
• Be aware that patients are often reluctant to discuss CAM use with healthcare providers, which can lead to safety concerns when CAM interacts with conventional treatments 3
• Document all discussions about CAM in the patient record to ensure continuity of care 4

By following these recommendations, healthcare providers can support patients in making evidence-informed decisions about CAM use while prioritizing safety and effectiveness for improved morbidity, mortality, and quality of life outcomes.