CAM e-book Flashcards
What conditions is St John’s Wort used for?
There is only evidence for depression and low mood use.
Are there any other interactions with St Johns Wort?
- Antidepressants (can cause serotonin syndrome)
- Sleeping pills and anaesthetics
- Antipsychotics
- Anticoagulants
- Immunosuppressants
- Antihistamines
It can also reduce the effectiveness of common medications to treat cholesterol, heart disease, high blood pressure, migraines, epilepsy, cancer, hepatitus C, HIV and AIDS. Eg. Ciclosporin, digoxin, warfarin, simvastatin, triptans
Mrs Jones then tells you that she has just started taking Microgynon 30. Can she still use St. Johns Wort?
St John’s wort can reduce the level of contraceptives in the blood and make them less effective, increasing the risk of pregnancy and breakthrough bleeding.
St Johns wort is an enzyme inducer so will interact with CYP450 substrates. MHRA guidance states these should not be used in combination.
Therapies can be classified as:
- Medicine based therapies such as herbalism, naturopathy, homeopathy, aromatherapy
- Traditional medicine such as Traditional Chinese Medicine (TCM), Ayurveda
- Manipulative therapies such as Alexander technique, reflexology, massage
- Mind-body therapies such as Reiki, Yoga.
Cochrane Collaboration defines CAM as:
“Complementary medicine includes all such practices and ideas which are outside the domain of conventional medicine in several countries and defined by its users as preventing or treating illness, or promoting health and well-being. These practices complement mainstream medicine by (1) contributing to a common whole; (2) satisfying a demand not met by conventional practices; and (3) diversifying the conceptual framework of medicine.”
The World Health Organisation’s definition is: “[CAM] refer to a broad set of health care practices that are not part of
that country’s own tradition and are not integrated into the dominant health care system.”
There are many reasons why people choose to use CAM. These may include:
- The impression that CAM is safer than orthodox medicine / therapy
- Disenchantment with orthodox medicine as a system and the consultation process
- Perception that prescribed or purchased CAM is good value for money
- Effect of opinion leaders endorsing e.g. royalty (HM the Queen Mother was Patron of the British Homeopathic Association), celebrities etc.
- The environmental association – using ‘natural’ therapies
- Encouragement by the media
- Traditional to their culture e.g. TCM, Ayurveda
There are also many reasons why people choose not to use CAM. These include:
- Lack of scientific evidence
- Believe strongly in ‘scientific medicine’
- Orthodox medicine is working for them so they do not feel the need to look elsewhere
- No belief in CAM – ‘old wives tales’
- Fear of CAM interfering with orthodox medicine
- Fear of poor quality and safety claims
There are many reasons why studies into CAM have been hampered. These include:
- Financial resources and lack of funding from funding bodies
- Lack of research skills in CAM practitioners
- Poor research design in previous studies such as lack of hypothesis to test
- Difficulties designing placebo-controlled trials due to the nature of CAM
- Wide variety within forms of CAM e.g. there are many different ways of practising acupuncture
- Inappropriate extrapolation of results has happened in the past due to small size of studies
- Standardisation is difficult to achieve as patients are treated in different ways due to a holistic approach, even if they present with the same symptoms
- Lack of patients to test
Examples of CAM
As mentioned previously, there are over 700 CAM therapies currently being practised worldwide. Some of the most common forms are:
• Acupuncture • Homeopathy • Herbal medicine / Herbalism • Traditional Chinese Medicine (TCM) • Ayuveda • Chiropratic and osteopathy • Massage Electromagnetic therapy • Kinesiology • Reiki • Qigong
Acupuncture
Acupuncture is a technique involving the insertion of fine needles into the skin at specific points on the body. There are two main forms of discipline: traditional Chinese medicine and Western acupuncture.
TCM acupuncture
The meridian system, or channel network, in TCM, is a path through which life-energy, or qi, flows. Physical or emotion ill health is thought to cause a disruption in the flow of this life energy. In order to correct the disruption the TCM practitioner will stimulate ‘acupoints’ on the meridians using fine needles, applying pressure or using other means. There are 365 acupoints situated on the meridians and another 1000 special use points on the hand, ear and scalp.
The practitioner, or acupuncturist, uses approximately 15-20 3cm solid, sterile disposable needles to stimulate the acupoints (although longer needles may be used in different sites of the body) whilst the patient is lying down. Initially the needles are inserted superficially but then they are inserted deeper into the muscle and are rotated between the practitioners finger and thumb to stimulate
qi and blood flow. Some practitioners may also connect the needles to electrical equipment (battery operated). This is known as electroacupuncture. Once the needles are in place the patient lies back and relaxes for approx 20 minutes. Occasionally a needle, usually located in the ear, will be left in for several days.
A single course of treatment usually involves 10-12 sessions of TCM acupuncture. It is often given with other forms of TCM such as traditional Chinese herbalism or dietary control.
Western acupuncture
Western acupuncture is also known as minimal acupuncture as it involves very brief needling (for no more than a few seconds) with very few needles. The traditional concepts of meridians and acupoints are ignored and trigger points, small hyperirritable areas in injured skeletal muscle known as nodules, are used or they are used to stimulate nerve endings.
Sham acupuncture
Sham acupuncture is where needles are inserted outside of the acupuncture points or trigger points and with a minimal amount of interaction between the patient and practitioner. It is most often used as the control in a randomised controlled trial.
Acupressure
Acupressure is a form of acupuncture where instead of inserting needles pressure is applied, using fingers, thumbs and elbows, to the acupoints. It is claimed to relieve muscular tension, and increase blood flow within the body.
Many community pharmacies will sell elasticated travel bands.
These use acupressure to combat motion sickness by pressing on the wrist acupressure point with a small raised bead.
Homeopathy
“A holistic complementary and alternative therapy based on the concept of ‘like to treat like’ and involves the administration of dilute and ultradilute products prepared according to methods given in homeopathic pharmacopoeias.”
