Blending Alternative and Mainstream Therapies

When software engineer Tom Robinson found himself sidelined by a diagnosis of Crohn’s disease, he quickly sought answers via online message boards. After reading dozens of posts from other patients, Robinson became familiar with the most common medications prescribed for this debilitating disease. As he would soon learn firsthand, many of the prescriptions that promised to ease his symptoms produced equally debilitating side effects. Frustrated, Robinson began seeking answers outside of mainstream medicine, eventually incorporating practices like detoxification and meditation into his treatment plan. Today, Robinson’s Crohn’s is in remission and he attributes his restored health to a treatment approach that embraced conventional medicine in tandem with alternative therapies. And he’s not alone in his conviction.

The 2007 National Health Interview Survey (NHIS), which included a comprehensive look at complementary and alternative medicine (CAM) used by Americans, showed that approximately 38 percent of adults use CAM.¹ The study went on to note that several mind and body approaches ranked among the top 10 CAM practices reported by adults. For example, the survey found that 12.7 percent of adults had used deep breathing exercises, 9.4 percent had practiced meditation, and 6.1 percent had practiced yoga. Progressive relaxation and guided imagery also were among the top-10 CAM therapies for adults, while acupuncture had been used by 1.4 percent of adults.

Understanding CAM

CAM is a field of healthcare that is rapidly evolving but difficult to define. The National Center for Complementary and Alternative Medicine defines CAM as a group of diverse medical and healthcare systems, practices and products that are not generally considered part of conventional medicine (also referred to as Western or allopathic medicine).While conventional medicine is practiced by medical doctors and other health professionals such as physical therapists, psychologists and registered nurses, CAM may be administered by an acupuncturist or naturopathic practitioner, or self-administered, as in the case of vitamin supplements, deep breathing exercises and personal meditation.

While people turn to alternative medicine for many reasons, studies show that the majority do so because they consider it to be more aligned with their values, beliefs and philosophies about health and life than a strictly conventional medical approach.And, as the modern healthcare system becomes more and more impersonal, many people are seeking healthcare solutions that address the whole person as opposed to simply treating symptoms. “People are seeking ‘natural’ options to manage their health because they want to feel empowered by seeking the underlying causes of illness,” says Ann Louise Gittleman, PhD,CNS. “They are tired of simply putting a Band-Aid on symptoms and want to address the real issues of ill health from a body, mind and spirit perspective.”

Mind Over Matter: How the Brain Deals with Pain

According to the American Pain Foundation, an estimated 50 million Americans suffer from persistent pain each year.² Chronic pain is typically managed with prescription pain medications that can be both physically and psychologically addictive. Non-pharmaceutical pain treatments are sometimes prescribed by doctors in an effort to get pain under control, while many people with chronic pain choose alternative and complementary therapies as a supplement to their main chronic pain treatment. “There’s a strong mind/body component to managing chronic pain that some CAM treatments address — which drugs don’t,” says Russell Portenoy, MD, chair of the department of pain medicine and palliative care at Beth Israel Medical Center in New York City. “It’s about learning how to use all of your resources to function better.”³

In recent years, the medical community has begun to investigate and support the role of therapies such as biofeedback and meditation in pain control. Research shows that pain is very complex, traveling along two pathways from its originating source back to the brain. One is the sensory pathway that transmits the physical sensation, and the other is the emotional pathway that goes from the injury to the amygdala and the anterior cingulate cortex — areas of the brain that process emotion. In an article published in Health magazine, Dr. Natalia Morone, assistant professor of general internal medicine at the University of Pittsburgh School of Medicine, says: “You may not be aware of it, but you’re having a negative emotional reaction to chronic pain, as well as a physical reaction.”

While still considered controversial, the mind-body connection to illness is becoming more accepted. In a 2005 study, researchers at Stanford University in Palo Alto, Calif., used functional magnetic resonance imaging (fMRI),which measures activity in different areas of the brain, to see whether subjects could learn to control a brain region involved in pain as a tool for altering pain perception. During the study, participants with pain-producing injuries were asked to do things that they knew increased their pain, while using positive and negative imagery. One participant imagined her pain like a flame that would flare and increase as the pain escalated, and then minimize as the pain ebbed. After the test, the participant learned that she had been able to produce a 30 percent to 40 percent reduction in her overall pain.⁴

Biofeedback is another technique that uses the mind to control bodily functions. In a biofeedback session, sensors attached to the body are connected to a monitoring device that measures body functions such as breathing, perspiration, skin temperature, blood pressure and heartbeat. When patients relax and breathe deeply, heart rates dip in response. During the session, patients are able to observe the changing numbers on the monitors and make a connection between their conscious actions and unconscious reactions in the sympathetic nervous system. Because chronic pain or illness is stressful, it can create a vicious cycle of pain, stress and increased pain. Biofeedback can break that cycle and give patients a much-needed sense of control. Kenneth Holroyd, PhD, professor of health psychology at Ohio University, in Athens, Ohio, said this about the effects of biofeedback on migraines: “Through trial and error, you can learn to prevent migraines and to stop migraines when they begin to occur. You can change that physiological response through the action of your mind.”⁵

Stress-Related Diseases on the Rise

Stress has become the great equalizer in modern society, affecting people from all economic, racial and social backgrounds and influencing the lifestyle and healthcare choices of people in almost every age group. According to the American Psychological Association, stress is a top health concern for U.S. teenagers, especially those in grades 9 through 12. Psychologists say that if teens don’t learn healthy ways to manage stress, it could have serious long-term health implications for future generations.

Stress can come from external sources such as work and employment issues, relationship problems and financial pressures, and internal sources such as psychological tendencies and a person’s individual coping skills. As the world we live in becomes increasingly stressful, stress-related illnesses are increasing as well, and the problem is not limited to the U.S. In Britain, stress has overtaken other reasons for long-term workplace absence, outranking repetitive strain injury and medical conditions such as cancer.⁶

Stress-related illnesses can span the spectrum from mild to life-threatening. On the mild side, maladies like head and back pain, insomnia and digestive problems can be bothersome. On the more serious end, heart disease, diabetes, asthma and even Alzheimer’s disease have been linked to stress.While the number of health problems related to stress can appear alarming, stress-management techniques, including many CAM therapies, often offer significant benefits. One study from Duke University Medical Center found that a stress-management program cut the chances that a heart patient would suffer a heart attack or need surgery by 74 percent.⁷

Common alternative therapies for stress management include yoga, acupuncture, meditation and mindful breathing exercises. There’s also some evidence that stress management can strengthen the immune system, and that various relaxation techniques may be an effective part of an overall treatment plan for many common disorders, including high blood pressure, asthma, irritable bowel syndrome, insomnia and fibromyalgia.

Chronic Conditions and Alternative Care

Chronic conditions present a unique challenge for patients and healthcare providers. With no known cure, conditions such as lupus, fibromyalgia and diabetes must be managed rather than actually treated. Even once-fatal diseases like HIV/AIDS and cancer are increasingly becoming chronic conditions with symptoms that require management. For a patient facing the prospect of living with long-term, life-altering illness, “think-outside-of-the-box” healthcare options can become very appealing.

While various CAM therapies have proved useful in the treatment of chronic illness, one particularly promising field of study involves the use of music therapy. Music therapy may incorporate creating music, listening to music or simply talking about music, with the goal being to relieve stress and anxiety, and improve mood and quality of life. But studies show the benefits extend beyond simply making patients feel better.

According to a review published in 2008, music therapy may help patients battle depression.⁸ Researchers compared data from five previously published studies and found that participants receiving music therapy were more likely to see a decrease in depression symptoms (compared with those who did not receive music therapy). According to the review’s authors, patients appeared to experience the greatest benefits when therapists used theory-based therapeutic techniques such as painting to music and improvised singing.

In yet another study, researchers found that music therapy was beneficial to those with coronary heart disease, positively impacting blood pressure, heart rate, respiratory rate and pain. 9 Music therapy also is being used to improve communication skills in children with autism.¹⁰ “Almost all children respond to music. Music is an open sesame, and if you can use it carefully and appropriately, you can reach into that child’s potential for development,” says Dr. Clive Robbins of the Nordoff-Robbins Music Therapy Clinic, which uses music therapy to help handicapped children learn and to relate and communicate with others.

Neurological disorders also have responded to the therapeutic use of music-based therapies. Some reports have shown that patients with neurological disorders who cannot talk or move are often able to sing, and sometimes even dance, to music. Music therapy also can help ease the trauma of grieving, lessen depression and provide an outlet for people who are otherwise withdrawn. “I regard music therapy as a tool of great power in many neurological disorders — Parkinson’s and Alzheimer’s — because of its unique capacity to organize or reorganize cerebral function when it has been damaged,” says Oliver Sacks, MD, professor of neurology at Albert Einstein College of Medicine, New York, and author of Musicophilia: Tales of Music and the Brain.

CAM and Insurance Coverage

The reality for most patients seeking CAM therapies is that few treatments are covered by health insurance plans. According to the 2007 National Health Interview Survey (NHIS), one-third of uninsured respondents younger than age 65 paid “out of pocket” for CAM. The same survey found that adults in the U.S.spend an estimated $33.9 billion out of pocket on CAM treatments annually. Of the $33.9 billion, adults spent an estimated $22 billion on self-care costs such as products, classes and materials, while the remaining $11.9 billion was spent on office visits to CAM practitioners.¹¹

Private health insurance plans may offer coverage of certain CAM therapies such as chiropractic, acupuncture and massage, since these practices have become more accepted by mainstream medicine. Still, overall coverage of CAM therapies is relatively limited compared with conventional therapies. One factor is a lack of scientific evidence regarding the cost-effectiveness of CAM therapies, but as consumer interest in CAM grows, more insurance companies and managed care organizations may consider offering coverage of CAM therapies in the future. And patients who have healthcare reimbursement accounts through their employers may find that many CAM therapies are covered by these plans.