Symptoms

Patients use CIM for many reasons: as an adjunct to conventional therapy, as a way to support their overall health and well-being, in place of conventional therapy, and as a means to improve the symptoms that come from their disease and the symptoms that can come from conventional medical treatment. These symptoms can include fatigue, nausea, headache, pain, nasal congestion, dry mouth, and hoarseness.

Patient Self-treatments

Most forms of CIM that are non–practitioner based are based on patient self-treatment. Despite the high prevalence of patient use, fewer than half of the patients who use CIM typically discuss it with their clinician, and health care professionals do not consistently inquire about or record patients’ use of CIM. This is concerning because the potential for interactions between CIM modalities and patients’ thyroid cancer treatment is unknown, for example, the potential drug-herb interactions or the interaction with anesthetics. Despite the evidence that patients are using CIM modalities at a significant rate and the significant data on CIM use available to clinicians, there is room for improvement in communication between providers and patients.

Physicians and patients may have a lack of confidence in communication and a lack of knowledge of CIM and its effect on health care outcomes. Physicians and trainees in all health professions represent a prime target for curricula about CIM. Physicians may be aware that patients are using CIM, but many respondents report that being asked meant only filling in a box on forms without a physician asking any further questions. This indicates that CIM use is not treated in the same manner as other types of medications. Because the data are poor, knowledge of side effects and medication interactions is limited. Additionally, because most CIM modalities are accessible without prescription, patients may not turn to a physician for information on CIM use, which potentially harms patient-provider communication further. Physicians should ask their patients about any CIM, including both patient-based and practitioner-based therapies, and be prepared to discuss them to the best of their ability.

Natural Products

Natural products cover a wide span. They may include the use of

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  Herbal medicines

  
  
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  Vitamins

  
  
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  Minerals

  
  
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  Dietary supplements

  
  
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  Specific foods (eg, kelp), diets, aka “nutritional” food supplements, including probiotics

The term “natural products” can be confusing, because use of a daily multivitamin or regular use of calcium or other mineral supplements is not universally considered to constitute CIM, and many patients may follow a specific diet for reasons other than their current medical issue. The most popular products include fish oil/omega-3 fatty acids and Echinacea among children. Not all natural products must be taken orally; for example, eucalyptus oil is often used for patients with upper respiratory symptoms and has transitioned from practitioner-applied therapy to self-medication because it is widely available as a rub or application oil over the counter.

The Food and Drug Administration (FDA) evaluates dietary supplement products and ingredients under a different set of regulations from those covering conventional foods and drug products. Under the Dietary Supplement Health and Education Act of 1994, the dietary supplement or dietary ingredient manufacturer is responsible for ensuring that a dietary supplement or ingredient is safe before it is marketed and the FDA is responsible for taking action against any unsafe dietary supplement product after it reaches the market. Most importantly, manufacturers only need to register their products with the FDA if it is a new ingredient to get FDA approval before producing or selling dietary supplements, but manufacturers must comply with the dietary supplement Current Good Manufacturing Practices for quality control. In addition, the manufacturer, packer, or distributor whose name appears on the label of a dietary supplement marketed in the United States is required to submit to the FDA all serious adverse event reports associated with use of the dietary supplement in the United States. Enforcement of these regulations is difficult and onerous given the widespread nature of these products.

On a historical note, natural products have been used since the earliest times known to improve health. The personal effects of the mummified prehistoric iceman found in the Italian Alps in 1991 included medicinal herbs. The Ebers Papyrus and the writings of Galen and Hippocrates evaluated and recommended specific herbs for specific disease states and contained numerous herbal prescriptions and remedies. By the Middle Ages, thousands of botanic products had been grown specifically for their medicinal effects and cataloged extensively.

Any discussion of natural products also needs to refer to the area of whole medical systems, because many of these, including ayurveda, Chinese medicine, and homeopathy, incorporate natural products in their approach.

Mind and Body Medicine

CIM mind and body practices focus on the potential (and potent) interactions between the brain, mind, and body through the use of behaviors to promote health. The most common forms of mind and body medicine are

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  Deep breathing

  
  
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  Meditation

  
  
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  Yoga

This idea that the mind is important in the treatment of illness is an ancient one. Humanity has used behaviors to try to alter the world around them from the Neanderthals’ use of cave drawings to Anasazi rain dances and Haitian voodoo. Hippocrates and Galen reference the use of massage for healing, and the Vedas documented Indian yoga sutras for the treatment of body ailments from seals thousands of years old. This concept is used today in using placebos as controls (and the unfortunately common nocebo effect).

Meditation techniques may include specific postures, focused attention, or a recommended inward focus to reduce distractions. The concept is to relax the body and mind by suspending or removing constant thoughts and attitudes. The intended goal is to improve calmness and balance and thereby improve patients’ ability to cope with illness and possibly to enhance overall health and well-being.

Yoga (to use or to unite) as a discipline incorporates not only the physical practice but also mental and spiritual practice. Yoga used for health purposes typically combines physical postures, breathing techniques, meditation, and mental focus. As with many of these practices, yoga can be used not just for specific health conditions but also for overall well-being.

There are innumerable mind-body practices, including deep breathing, guided imagery, hypnotherapy, guided relaxation, qigong, and tai chi, all of which have as their goals focus and attention for health.

Manipulative and Body-based Practices

Manipulative and body-based practices mostly focus on bodily structures and systems, primarily the spine, bones and joints, soft tissue, and circulatory and lymphatic systems. The 2 most common of these are

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  Chiropractic/osteopathic manipulation

  
  
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  Massage

In chiropraxy/osteopathic manipulation, practitioners use their hands ( chiro , in Greek, means hand) or, on occasion, a device to perform manipulation, most commonly around a joint with a degree of force. A wide variety of practitioners incorporate this form of manipulation, including chiropractors, osteopathic physicians, naturopathic physicians, physical therapists, and some allopathic physicians. The goal of the treatment is to relieve pain and improve physical functioning.

Massage is a hands-on technique that involves manipulating muscle and soft tissue with the aim of increasing the flow of blood and oxygen to that area. Massage not only can be used for relief of pain but can also incorporate other approaches, including acupressure points to alleviate stress, improve relaxation, and aid with anxiety and depression.

Acupuncture is an alternative approach originating in ancient China that uses the manipulation of acupuncture points by the use of insertion of thin, solid needles to achieve health through the correction of perceived imbalances in the flow of qi through channels known as meridians. Acupressure is the manipulation of these points by the use of pressure rather than through the needles.

Additional practitioner-based approaches include

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  Chelation, where products are taken orally to detoxify heavy metals believed to be causing deleterious effects

  
  
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  Cupping, where local suction is created on the skin with heat or mechanical devices with the intent of improving blood flow and thereby overall health

  
  
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  Thermal-auricular therapy (also known as ear candling)

  
  
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  Moxibustion using the burning of the mugwort herb, often in conjunction with acupuncture

There are several folk remedies still in common use, including talismans that can be worn, copper bracelets, and poultices applied to the skin. Alternative approaches to wound healing include the use of maggots for infected wounds, leaches for skin grafts, sugar/honey for chronic ulceration, and various forms of urea/papaya enzyme (papain) for decubitus ulcers.

Many practitioner-based therapies have licensing requirements that may vary from state to state; these serve to ensure a basis for training, practice, and patient information that practitioners meet the basic standards as set by national guidelines (eg, massage therapy and chiropraxy).

Whole Medical Systems

Just as patients come from different cultures that have evolved over time, so have whole medical systems developed apart from conventional or Western medicine. Most of these incorporate a worldview with a combination of botanic products and physical and spiritual practices with a unique view toward the meaning or cause of disease. For example, traditional Chinese medicine incorporates the theory of balance (yin/yang) with the 5 phases of process and change. Most commonly, traditional Chinese medicine incurs the use of botanic products, yoga, and so forth to restore harmony in the body because disease is viewed as disharmony.

Ayurvedic medicine arose in India and is based on the 3 energies, or dosas, and 5 elements that must be in balance; treatments include hygiene, plant-based medicines, elimination of toxins, and restoration of proper fluid movement.

Homeopathy arose in Europe as a way to stimulate the body’s ability to heal itself through the like-cures-like approach of giving very small doses of substances that can be toxic in larger amounts. Naturopathy also supports the body’s presumed ability to heal itself through dietary and lifestyle manipulations along with other CIM therapies.

Other CIM Practices

Movement therapies are additional forms of CIM, also intended to improve stress and encourage overall health and well-being. These can include

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  The Feldenkrais method

  
  
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  The Alexander technique

  
  
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  Pilates

  
  
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  Rolfing

  
  
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  Structural integration

Traditional healers can be considered a form of CIM, because they use methods often based on cultural theories, beliefs, and worldviews. Examples include

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  Shamans

  
  
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  Native American healers

  
  
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  Medicine men

Energy field manipulation is an ancient concept, based on either theoretic energy fields or known measurable energy forms (eg, magnet therapy and light therapy). The theoretic fields are also called putative or biofields and center around the concept that humans have subtle, often unmeasurable, energy. These practices include the transfer of energy to a patient either from a practitioner or from a universal energy and include qigong and Reiki, among others.

There are several practices not commonly considered CIM but that do not fit into the status of allopathic medicine. These include

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  Biofeedback

  
  
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  Spiritual practices or prayer

  
  
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  The use of marijuana or other mind-altering substances for medicinal purposes

Espiritism and vodun are more commonly practiced among patients with African heritage, and are more centered on religious aspects of the spiritual health of patients.