INTEGRATIVE MEDICINE

“Integrative medicine recognizes the importance of the relationship with the patient, seeing it as the central

therapeutic element.” – CURRENT Medical Diagnosis & Treatment 2014

What is “integrative medicine”?

http://cowpu.com/april-meeting-seo-not-just-for-snake-oil-salesmen/

common misperceptionhttp://mydoctorsf.com/specialties/integrative-medicine.html

actual clinical practice

Understanding and dispelling the “buzzwords” of common practice

Definitions

Alternative Medicine – therapies used in place of conventional care

Complementary Medicine – therapies used in conjunction with mainstream medical therapies; these therapies do not replace medical regimens for serious medical problems but are offered to support the patient and family

Integrative Medicine – integration of complementary and alternative medicine (CAM) therapies into mainstream medical practice based upon evidence of safety and effectiveness within the context of relationship-based care promoting optimal health and well-being

UpToDate: Overview of complementary and alternative medicine in pediatrics.

NIH Classifications of CAM1. Biologically-based

therapies (eg, use of natural products such as fish oil, probiotics, botanical medicines)

2. Mind-body medicine (eg, biofeedback, meditation, guided imagery)

3. Manual medicine (eg, osteopathy, massage therapy, chiropractic)

4. Energy medicine (eg, Reiki, therapeutic touch)

5. Whole systems (eg, traditional Chinese medicine, homeopathy)

Barrows K. Chapter e5. Integrative Medicine. In: Papadakis MA, McPhee SJ, Rabow MW. eds. CURRENT Medical Diagnosis & Treatment 2014. New York: McGraw-Hill; 2014.

Current use of CAM therapiesData published in 2010 by the National Health Interview Survey conducted through the Centers for Disease Control

Nearly 40% of Americans reported some use of CAM therapies in the last year

The most common conditions people sought treatment for included back/neck pain, arthritis, cholesterol management and anxiety

An estimated $36 billion is spent annually on such practices, representing 11.2% of out-of-pocket medical expenditures

Why is this important?

While you may not feel integrative medicine is applicable to your practice, one survey found nearly 70% of patients participating in CAM therapies did disclose this information to their physicians.

Barrows K. Chapter e5. Integrative Medicine. In: Papadakis MA, McPhee SJ, Rabow MW. eds. CURRENT Medical Diagnosis & Treatment 2014. New York: McGraw-Hill; 2014.

Evidence for the use of Integrative Medicine

As EBM becomes a more integral part of a clinician’s life, Integrative Medicine by definition strives to ensure patient safety through similar peer review.

Mind-body medicine Level of Evidence:

A = high quality (consistent from randomized trials or overwhelming evidence from other sources)

B = moderate quality (randomized trials w/ important limitations or very strong evidence from other sources

C = low quality (observational studies or randomized trials w/ serious methodological flaws

Condition

Mind-body Therapy

Level of Evidence

Surgery/Procedure Pain

Hypnosis A

Guided Imagery B

Cancer Pain Hypnosis B

Guided Imagery B

IBS Hypnosis A

Guided Imagery C

Depression Mindfulness Meditation

A

Urinary Incontinence

Biofeedback A

Fecal Incontinence

Biofeedback B(1st line)

Chronic Constipation

Biofeedback A(1st line)

Tension Headache

Biofeedback B

Barrows K. Chapter e5. Integrative Medicine. In: Papadakis MA, McPhee SJ, Rabow MW. eds. CURRENT Medical Diagnosis & Treatment 2014. New York: McGraw-Hill; 2014.

Biologically-based therapies Aged Garlic in the Tx of HTN

Patients w/ previously treated and still uncontrolled HTN (SBP>140mmHg) saw an average SBP 10mmHg lower than the placebo group over a 12wk treatment period – 2010 Australian double-blind parallel randomized placebo controlled trial

Ried K et al. Aged garlic extract lowers blood pressure in patients with treated but uncontrolled hypertension: a randomized controlled trial: Maturitas. 2010 Oct;67(2):144-50.

kid-reborn.blogspot.com

Acupuncture Studies have investigated use in many

areas including post-operative pain, nausea/vomiting, headaches and addictions

A 2008 systematic review of 15 RCTs w/ sham control for acute post-operative pain showed a significant reduction in intensity and opioid consumption

Sun Y et al. Acupunture and related techniques for postoperative pain: a systematic review of randomized controlled trials. Br J Anesth. 2008. Aug;101(2):151-60.

Integrative Medicine Board CertificationIn 2013 it was announced that 2014 will be the first year the American Board of Physician Specialties will begin certifying physicians in the area of Integrative Medicine.

www.prwed.com

Integrative Medicine SIG

What will this SIG be for you?

Goals for the SIG Meetings with practitioners of various

CAM methods SIG dinners Community outreach endeavors

Julian Center Wheeler Mission

Volunteer Opportunities MS1&2s in leadership positions