- Top 10 Alternative RA Remedies: The Natural Ways I Manage Rheumatoid Arthritis Symptoms
- The takeaway
- Alternative Treatments for Rheumatoid Arthritis
- Alternative Therapies for Rheumatoid Arthritis: Which Treatments Are Worth Trying?
- The Difference Between Primary and Complementary Therapies in RA Treatment
- Integrative Medicine: Traditional Treatments Plus Complementary Therapies
- The Most Promising Alternative Therapies for Rheumatoid Arthritis
- An introduction to CAM
Top 10 Alternative RA Remedies: The Natural Ways I Manage Rheumatoid Arthritis Symptoms
There is no cure for rheumatoid arthritis, but there are treatments. Experts advise people to consult with a rheumatologist on the best medication options for their symptoms.
That’s good advice. But even if you rely on pharmaceutical drugs, there are a variety of natural, holistic, and complementary ways to treat your RA. I’m very aware of these holistic methods because I use many of them myself.
Top 10 alternative remedies
Here are my personal top 10 favorite natural ways to combat RA symptoms and live a healthful lifestyle of wellness, even while I cope with RA.
1. Essential oils
Essential oils and aromatherapy have been used since ancient times — ever hear of frankincense and myrrh? They’re often used to sooth the symptoms of conditions such as RA.
I find lavender works well for relaxation. Peppermint and eucalyptus help me with pain relief. I’ve tried garlic oil because it’s thought to have antibiotic properties and ginger oil because it’s thought to reduce inflammation. There’s another great essential oil-based product that I rely on called Deep Blue Rub, a topical pain relief salve.
Always be mindful of how you use essential oils. Pay attention to any instructions or warnings on the product’s package, and consult an expert or the manufacturer when in doubt. Some oils shouldn’t be used topically or ingested. Many essential oils are designed for use in a diffuser for aromatherapy.
Typically, I use oils topically and aromatically for my own needs. Topically, they often help with pain. Aromatically, they help relax me and improve my mood.
Floatation therapy, also known as sensory deprivation therapy, is a new trend in natural health treatments. During a floating session, you float atop warm, high-density saltwater, in a pitch-black, darkened, and soundproof “pod.” The idea is that it relaxes the mind and body, releases muscle tension, and takes pressure off of the joints.
I can only say good things about it. My husband — who is a personal trainer and American Ninja Warrior competitor! — just went last week and is also a fan. Many people on my Arthritis Ashley online community have also commented on the benefits of floating. It’s wonderful, but proceed with caution if you’re a little claustrophobic, like I am. It takes some getting used to — but I get bad muscle spasms, so I’m all for anything that will relieve some tension!
Cryotherapy and ice baths might sound uncomfortable, but they may be good for people with musculoskeletal chronic pain and inflammatory conditions, such as RA. In fact, cryotherapy was first invented with RA patients in mind!
During a cryotherapy session, you step into a cryosauna tank that’s filled with liquid nitrogen. Your body is exposed to temperatures of below –200ºF (–128ºC). (Yes, you read that correctly!) You’re mostly nude, save for undergarments, socks, mitts, and gloves. This is done ideally for a duration of two to three minutes, or for however long you can tolerate it. I lasted for under two minutes the first time and closer to three minutes the second time.
The idea behind cryotherapy is to put your body into “repair” mode as part of your natural flight-or-fight process. You’ve probably heard you should ice a swollen joint or put ice on an injury. This applies that same anti-inflammatory cooling concept, but to your whole body. The lack of any moisture, dampness, humidity, or wind makes the cold temperature more tolerable.
To me, cryotherapy was far more pleasant than an ice bath would be — and I liked it better than our cold Pittsburgh winters! I don’t know how much it worked, but I definitely left feeling refreshed and invigorated, like I could conquer the world!
4. Herbal tea
Herbal tea can have many soothing benefits. Many people who live with RA choose teas such as green tea, ginger tea, turmeric tea, and blueberry tea. Some companies even make “arthritis-friendly” or “joint comfort” herbal teas.
I drink multiple cups of tea per day, including chamomile or Sleepytime tea at night to help me relax before bed. I can’t go without my tea!
An ancient remedy that has stood the test of time is acupuncture. It’s a part of traditional Chinese medicine but has made its way into Western medicine as well.
During an acupuncture session, an acupuncturist uses very thin needles on certain points of the body. Usually, the needles aren’t inserted very deeply. Each needle coordinates with a body part, body system, or organ. The needles are thought to balance out or interrupt the flow of good and bad energy in the body, also known as the body’s chi or qi.
Acupuncture is somewhat related to the practice of acupressure. (They’re cousins, of sorts.) While modern-day science hasn’t confirmed that acupuncture works as a treatment for RA, some doctors recommend it. It isn’t clear why, but some people with RA report feeling better after acupuncture or acupressure treatments.
I absolutely love it and recommend it — so long as you go to a certified practitioner. It isn’t scary and it isn’t painful. For me, I visualize it releasing toxins and allowing “good vibes” to soak into my body! I definitely feel like it helps with pain, stress, and overall health.
The notion of chiropractic for RA is a tricky one — and it isn’t for everyone. Some rheumatologists and people with RA will advise against seeing a chiropractor. Others are fine with it. I like it in moderation, but some people don’t. It’s up to the individual and their doctor to decide if it’s a good option.
Most chiropractors advise against having chiropractic treatments during an RA flare, especially on the neck. I do engage in treatments, but not on my neck because I had neck surgery in 2011. However, I find that mild chiropractic work in moderation and for maintenance purposes can be a great source of pain relief for me.
I can usually tell when my body is in need of a chiropractic tune-up. If you decide to try this option, just make sure to speak with your doctor first. If your doctor approves, make sure to do your homework and find a reputable chiropractor.
7. Physical therapy (PT)
For me, physical therapy (PT) is a godsend. In the past, exercise was off-limits for folks dealing with RA. But nowadays it’s wholly embraced by most doctors. I wish I had started physical therapy back in middle school when I was first diagnosed!
Like many people living with RA, I find that I feel better with moderate activity. A mild exercise regimen, along with PT as needed, helps keep my joints mobile and my muscles strong and nimble.
PT is also important after some types of surgeries. I had my knee replaced in September 2017, and I still look forward to going to PT three times per week, for two hours or more per session. I do an hour of hydrotherapy in the pool — including a cool aqua treadmill! — and then about an hour on land. This includes weight-bearing and range-of-motion exercises.
I really enjoy it. PT has inspired me to want to keep moving!
I don’t know how I would manage without my monthly 90-minute deep tissue massage. Many people with RA find various types of massages helpful. But as with chiropractic work, massage should be done only as tolerated.
There are different types of massages ranging from hot stone massage to relaxing spa-like massages, trigger point massages, deep tissue massages, and more. You could get a massage done in a spa or salon setting, at a physical therapist’s office, or at a chiropractic clinic.
I personally have a monthly membership to a massage and wellness center and go to the same massage therapist each time. This routine is important for my self-care with RA.
9. Infrared heat therapy and LED light therapy
I use both infrared heat therapy and LED light therapy. Both options use different types of light and heat to reduce inflammation in the body. A good ol’ microwavable heating pad can do the trick too!
If you’re looking into infrared heat therapy, I personally use and recommend Thermotex products.
10. Biofeedback and meditation
Biofeedback and meditation go hand in hand. There are CDs, podcasts, and apps to help anyone learn how to meditate. Some even cater to those with chronic pain. Through biofeedback and pain management meditation, I’ve learned how to shift my focus away from pain.
It also helps me ease stress and anxiety. I’ve tried guided meditation via a CD that my neurologist recommended for pain management. I’ve also used a Muse biofeedback headband. Both are worth a try in my opinion.
It’s always a good idea to consult with a doctor or expert before trying natural approaches to managing your health. The different options that I’ve discussed can generally be used in conjunction with prescription medications — but it’s still a good idea to check.
I personally prefer a mix of traditional and natural approaches to my health. I believe that an integrative and translational, whole-body approach of mind, body, and spirit is best. I take meds when needed, but I try to use natural options whenever I can. A nutritious diet is also very important for a healthy lifestyle while living with RA.
It’s important to remember that every person who has RA is unique. What works for one person may not work for another. Sometimes we have to rely on trial and error, along with good medical advice, to see what works for us. Once we find what works, all of the time and effort spent on our journey to wellness should be worth it.
Ashley Boynes-Shuck is a published author, health coach, and patient advocate. Known online as Arthritis Ashley, she blogs at arthritisashley.com and abshuck.com, and writes for Healthline.com. Ashley also works with the Autoimmune Registry and is a member of the Lions Club. She’s written three books: “Sick Idiot,” “Chronically Positive,” and “To Exist.” Ashley lives with RA, JIA, OA, celiac disease, and more. She resides in Pittsburgh with her Ninja Warrior husband and their five pets. Her hobbies include astronomy, birdwatching, traveling, decorating, and going to concerts.
Alternative Treatments for Rheumatoid Arthritis
Yoga, Massage, and Fish Oil to Help Ease RA Symptoms
Although CAM treatments aren’t part of mainstream medicine, many people find that these treatments help them live with RA. The name may be slightly confusing: Complementary treatments are used with traditional treatments, such as physical therapy, while alternative treatments are used in place of mainstream treatments. However, they are the same treatments; the “difference” lies in whether you use mainstream treatments at the same time.
It’s important to talk to your doctor before trying any of the complementary and alternative medicine treatments below for rheumatoid arthritis. Some CAM treatments may interact with mainstream treatments, such as medications.
In-depth Articles on Other Rheumatoid Arthritis Treatments
- Eating well when you have RA
- Lifestyle changes that can make living with RA easier
- Physical therapy
Acupuncture for Rheumatoid Arthritis
Although very little research has focused exclusively on RA and acupuncture, it may help reduce your RA symptoms.
Acupuncture—an ancient Chinese practice—is rooted in the belief that everyone has an energy force called Chi, or Qi, that flows freely in the body. However, when Chi is blocked, it can create pain and other RA symptoms. To promote a smooth flow of Chi, acupuncturists insert very fine needles to free up Chi channels (meridians) in the body.
Balneotherapy for Rheumatoid Arthritis
Balneotherapy uses water therapeutically to address your rheumatoid arthritis symptoms. With this treatment, you bathe in warm mineral water. Some benefits have been reported, but there’s hasn’t been enough research to prove balneotherapy is effective at treating RA.
Dietary Supplements for Rheumatoid Arthritis
Some dietary supplements may interact with the medications you take, so talk to your doctor before trying them.
- Boswellia (also known as frankincense) may contain properties that boost the immune system (important because rheumatoid arthritis is an autoimmune disease) and reduce inflammation.
- Fish oil contains omega-3 fatty acids, which can help decrease inflammation in the body.
- Turmeric contains curcumin, a compound that can help protect joints from inflammation.
- Ginger may have anti-inflammatory compounds.
- Green tea has substances in it that may be helpful in reducing RA-associated inflammation.
Massage for Rheumatoid Arthritis
Although massage is not yet a proven treatment for RA, you may find that it works for you. It can help relieve chronic pain andincrease your range of motion. There are several types of massage. For example, you can try a hot stone massage or a Swedish massage. Talk to your massage therapist about the massage technique that’s right for you.
Mind-Body Therapies for Rheumatoid Arthritis
- Biofeedback uses a machine to measure how your body reacts to stress. For instance, it calculates your heart rate and body temperature. This technique teaches you how to manage stress, ultimately easing pain and other rheumatoid arthritis symptoms.
- Meditation teaches you to relax your body and mind by checking in with yourself. It can help you cope with your RA-related pain and other symptoms.
- Tai chi—sometimes called “moving meditation”—helps you become more aware of your body and mind through slow, gentle movements and deep breathing.
- Yoga can help reduce pain and relieve stress through a combination of poses, and breathing and mediation exercises.
Additional research is needed to investigate exactly how effective these complementary and alternative medicine treatments are at relieving RA symptoms, but when used in conjunction with mainstream medicine, alternative treatments can help you thrive with rheumatoid arthritis.
Updated on: 11/19/15 View Sources
CAM treatment has traditionally been thought of “alternative” treatment, in the place of mainstream treatments and often used in chronic diseases as a “last resort”, after all other measures had been used unsuccessfully or had unacceptable side effects. In our study, we tried to identify the actual use of CAM in a cohort of patients receiving mainstream medical care and we attempted to identify demographic and clinical factors associated with its use in general and also the choice of individual CAM treatments.
Our study had several limitations, mostly reflecting the methodology followed, and possible biases related to the patient cohort studied. The cross-sectional design of this analysis, the timing of recruitment and interview of patients, and the data collection methodology precluded evaluation of CAM use patterns as it related to disease severity as measured by instruments such as the DAS-28 score. The study format also did not permit us to determine whether use of CAM was influenced by previous or current DMARD therapy and whether it influenced in any way patients’ decisions regarding mainstream therapy. Furthermore, the cohort studied may not reflect the actual US population, as it consisted of an RA population living in a major metropolitan area with relatively high education and potentially enhanced access to medical care. Thus, the results may not be generalizable to the entire RA population and may not reflect trends in other parts of the country or the world.
In this study, 75.9% of our patients reported current or past use of CAM with >10% using 12 different modalities. A wide spectrum of CAM modalities are used, often in combination, by the majority of RA patients. The most widely used form of CAM modalities were nutritional supplements (52.4%), and touch therapies (50.6%). The probable reason behind such high use of nutritional supplements is that they have been commercially popularized for the treatment of RA. In contrast, the high percentage use of touch therapy techniques is related to their traditional role in the cure of musculoskeletal complaints . Moreover, the prevalent use of mind body therapies and nutritional supplements among younger population suggests the existence of a trend for usage of these modalities in early stages of the disease. Previous investigations have reported the use of CAM modalities by elderly patients with longer disease duration, chronic debilities and less educational status . In contrast, our study revealed a trend of CAM usage among younger patients with shorter disease duration, less arthritic pain, and high educational status. Furthermore, we were surprised that no association was seen between CAM use and disability, as measured by the HAQ disability index.
Past surveys have implied that the use of CAM in the self-directed therapy for RA varies between 28% and 90% . This disparity may stem from the varying characteristics of the patient populations surveyed, methods of collecting information, and definitions of CAM. The motivation of patients to try CAM is complex; the willingness to take control of their health-care, the desire to try everything available, the mass-media pressure, and the erroneous notion that CAM is without risks. The strikingly high rate of CAM use may reflect the unfulfilled needs of these patients while receiving specialized care. It is commonly held that patients choose to use CAM because they are dissatisfied with conventional treatments that they consider to be ineffective, dangerous, impersonal, or costly . However, it has been pointed out that disenchantment with conventional medicine is not necessarily the reason why patients turn to CAM . This appears to be supported by a previous study that reported that users of alternative health care are no more dissatisfied with or distrustful of conventional care than nonusers . The use of CAM is not mutually exclusive of mainstream treatments, but can be used as an adjunct treatment by an RA patient population that also seeks traditional care and uses traditional and/or biologic DMARDs. However, our data may be biased by the fact that this was a patient cohort followed at a tertiary referral center and were probably less likely to dismiss traditional treatments and consider CAM as a DMARD alternative.
Evidence supporting the efficacy of these widely used CAM modalities is an issue of significant concern. Despite high use of these modalities among RA patients, no evidence-based (clinical randomized trials) results are available for their efficacy and safety. Many investigations on CAM modalities have shown consistent beneficial outcomes for the treatment of RA. However, most of them were based on animal models of RA, and claim an insufficient evidence for the efficacy of CAM modalities in human medicine. Furthermore, many human studies of CAM modalities in RA were marred by poor methodology and/or small number of subjects studied . On the other hand, the current knowledge vacuum characterizing many CAM modalities, especially their clinical efficacy and mechanism of action, does not justify the a priori disapproval of CAM by modern medicine; it should rather offer a stimulus for well-executed clinical trials to validate or refute the clinical claims made for CAM modalities.
This report, as well as others, demonstrates that use of CAM in RA patients’ is widespread with a broad spectrum of CAM modalities are used, often in combination, by the majority of RA patients. Specific demographic and disease characteristics are associated with distinct subsets of CAM modalities. CAM is often used in early stages of the disease, in conjunction with mainstream treatments. Choice of CAM modalities can also be influenced by the symptoms and signs of the disease. For example, in our cohort patients with less background musculoskeletal pain were more likely to participate in martial art activities, probably due to greater ease and less pain associated with movement. There is no association with disability, as measured by the HAQ disability index. Therefore, CAM is not, as previously thought, RA patients’ last resort.
Alternative Therapies for Rheumatoid Arthritis: Which Treatments Are Worth Trying?
The first thing you should know is this: If you have moderate to severe rheumatoid arthritis, the best way to relieve symptoms and alter the course of the disease is to take disease-modifying anti-rheumatic drugs (DMARDs). No other treatment can stop the inflammation, prevent the joint damage, and reduce the risk of long-term complications that are associated with rheumatoid arthritis (RA) the way DMARDs can.
Complementary therapies aren’t a substitute for medication given to you by your rheumatologist, stresses Scott Zashin, M.D., clinical professor of medicine in the rheumatology division at the University of Texas Southwestern Medical School and attending physician at Texas Health Presbyterian Hospital in Dallas.
The Difference Between Primary and Complementary Therapies in RA Treatment
“Complementary therapies can help — as adjunctive measures — with pain, but they’re not going to change the progression of the disease,” Dr. Zashin explains. “We really want people on the disease-modifying agents so we can slow down the progression of the disease, decrease inflammation, and prevent joint damage and deformity.”
Integrative Medicine: Traditional Treatments Plus Complementary Therapies
That said, some nondrug treatments — particularly exercise and physical therapy — can help relieve the joint pain, stiffness, and inflammation that’s associated with RA. Acupuncture also has a history of evidence to support its use. An integrative medicine approach combines traditional treatment with evidence-based complementary therapies, recognizing both the value of well-studied therapies and the risks for harm.
Integrative medicine doctors are MDs, typically, who practice conventional as well as complementary medicine. You can find one by contacting the nearest medical school, asking for a referral from your doctor, or searching the directory of an organization such as the Academy of Integrative Health & Medicine, The University of Arizona, or The Mayo Clinic.
The Most Promising Alternative Therapies for Rheumatoid Arthritis
While a variety of complementary treatments — besides exercise and physical therapy — are sometimes used for rheumatoid arthritis, the scientific evidence regarding their effectiveness is quite mixed. Before starting an alternative therapy, it’s important to meet with your doctor, to discuss side effects and ensure there are no interactions with any other medication. Here’s a look at three of the more promising alternatives for relieving the symptoms of rheumatoid arthritis:
Fish oil supplements High doses of omega-3 fatty acids — namely, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) — can help relieve pain and inflammation in people with rheumatoid arthritis. A study published in January 2015 in Annals of the Rheumatic Diseases: The EULAR Journal found that when people with early RA took 5.5 grams (g) of these omega-3 fatty acids daily along with a DMARD, they had a higher rate of remission than those who took a low dose of fish oil with their DMARD. “Omega-3s are helpful as an adjunctive therapy for rheumatoid arthritis, but I don’t think they do enough on their own,” says Zashin. As an added perk, these fish oil supplements can help with dry eyes (a common side effect with RA) as well as Sjogren’s syndrome (another autoimmune disease that often accompanies RA). Ashira Blazer, M.D., instructor in the division of rheumatology at New York University School of Medicine at NYU Langone Medical Center in New York City, adds: “Omega-3 fatty acids are good for reducing the elevated cardiovascular risk that comes with rheumatoid arthritis.”
SAMe A naturally occurring compound in the body that’s also sold as a dietary supplement in the United States, S-adenosyl-L-methionine (SAMe) has been studied for use with depression, osteoarthritis, and other health conditions. It’s made in the body when an essential amino acid (methionine) reacts with a molecule that carries energy (adenosine triphosphate). SAMe supplements are “expensive, but they can be helpful for pain and depression,” Zashin says. “A lot of people with RA have secondary fibromyalgia, and SAMe seems to help with the mood issues, pain, and sleep disturbances that are associated with fibromyalgia.” In a review published in March 2010 in The Journal of Alternative and Complementary Medicine, which focused on alternative medical interventions used to treat fibromyalgia and chronic fatigue syndrome, researchers from DePaul University in Chicago concluded that SAMe was one of the few nonpharmacological supplements with the most potential for these health conditions.
Acupuncture In this ancient Eastern practice, very thin needles are inserted into the skin at specific points on the body to promote the flow of energy (or “qi”) throughout the body. There’s a solid amount of scientific evidence regarding the pain-relieving benefits of acupuncture, but studies investigating the practice’s impact on the inflammation, stiffness, and pain of RA have yielded mixed results. A study published in 2008 in the journal Clinical Rheumatology found that while people living with rheumatoid arthritis reported an improvement in their morning stiffness after ten weekly acupuncture sessions, there were no significant improvements in joint swelling and inflammatory markers, nor was there the targeted 20 percent improvement in RA (as measured on the American College of Rheumatology’s improvement scale). Acupuncture is helpful “mostly for pain in large joints, such as the knees, but it won’t help with inflammation from rheumatoid arthritis,” explains Zashin.
Meanwhile, a review published in January 2010 by the Cochrane Collaboration suggests that acupuncture can relieve the pain of osteoarthritis. This is significant because people with RA are susceptible to developing secondary osteoarthritis in the weight-bearing joints due to ongoing RA-induced damage to cartilage, which makes it more vulnerable to wear and tear.
Recent advances have improved drug treatment of rheumatoid arthritis (RA). Despite this fact, most RA patients need lifelong pharmacological therapy. An increasing number of RA patients are resorting to various complementary and alternative medicine (CAM) approaches for relief of symptoms and general well-being. CAM is the term for medical products and practices that are not part of standard care and are not generally taught in conventional medical schools. Alternative medicine is used instead of conventional medicine, whereas complementary medicine is used together with it. CAM has been mainly used to treat back pain or other back problems, neck pain, joint pain or stiffness and anxiety or depression in RA patients.1 For this reason, rheumatologists should be aware of CAM when treating RA patients.
The American College of Rheumatology (ACR) recognizes the interest in CAM approaches in the Position Statement Document. “The ACR supports rigorous scientific evaluation of all modalities that improve the treatment or rheumatic diseases. The ACR understands that certain characteristics of some CAMs and some conventional medical interventions make it difficult or impossible to conduct standard randomized controlled trials. For these modalities, innovative methods of evaluation are needed, as are measures and standards for the generation and interpretation of evidence. The ACR supports the integration of those modalities proven to be safe and effective by scientifically rigorous clinical trials published in the biomedical peer review literature. In the absence of such rigorous clinical trials, the ACR recommends advising patients that potential harm can occur from unproven or alternative therapies and thus advises caution in the use of unproven treatments. The ACR believes healthcare providers should be informed about the more common CAM modalities, based upon appropriate scientific evaluation as described above, and should be able to discuss them knowledgeably with patients”.2
This article provides an overview of the current body of knowledge about the role of CAM in the treatment of RA.
In order to explore available evidence about CAM used in RA patients, we performed a systematic search including Medline and Cochrane library databases. Medline search was performed including the following appropriate combination of MeSH (Medical Subject Heading) terms including: “complementary therapies”, “diet”, “dietary supplements”, “phytotherapy”, “medicinal plants”, “exercise”, “mind-body therapies”, “acupuncture”, “homeopathy”, “hydrotherapy” AND “rheumatoid arthritis”. The references cited in the obtained papers were also examined to identify additional studies not indexed by MEDLINE.
Nutritional intervention has been used in patients with chronic inflammatory diseases. Specifically, nutritional intervention used in RA patients included: supervised fasting (200–300kcal/day) during 7–10 days, Mediterranean diet (small amount of meat, fish, more fruits and vegetables and olive oil), vegetarian diet, vegan diet, elemental diet (liquid diets that contain nutrients that are broken down to make digestion easier) and elimination diet (foods that are thought to be the cause of symptoms are eliminated, and then added one at a time to find which ones cause symptoms).
There is evidence that fasting produces a decrease in pain and inflammation in RA patients.3 However, the inflammation reappears when the patient starts his/her normal diet.4 It has been shown that fasting followed by a vegetarian diet may help patients with RA. The effect of fasting followed by a year of a vegetarian diet was assessed in a randomized, single-blind controlled trial.5 The diet group showed a significant improvement in the number of tender joints, Ritchie’s articular index, number of swollen joints, pain score, duration of morning stiffness, grip strength, erythrocyte sedimentation rate, C-reactive protein, white blood cell count, and a health assessment questionnaire score (HAQ). These benefits in the diet group were still present after one year5 and this improvement can be sustained through an additional follow-up two-year diet period.6
A Mediterranean diet has been proved to reduce blood pressure; improve glucose metabolism, the lipid profile, and lipoprotein particle characteristics and decrease inflammation and oxidative stress.7 In RA patients, a Mediterranean diet decreases pain, morning stiffness, the number of swollen joints and also improves HAQ, Disease Activity Score 28 (DAS28) and disease patient perception.7 Three systematic reviews stated that a Mediterranean diet decreased pain in RA patients.8–10 Moreover, the Mediterranean diet has been recommended for cardiovascular diseases and osteoporosis (frequent RA comorbidities).
A Cochrane review8 assessed the effectiveness and safety of dietary interventions in the treatment of RA. The authors concluded that fasting, followed by 13 months on a vegetarian diet, may reduce pain. The effects of vegan and elimination diets are uncertain due to inadequate data reporting. Trials that studied elemental diets reported no significant differences in pain, function or stiffness.
Nutritional supplementsFish oil
Fish oil is rich in Ω-3 polyunsaturated fatty acids (PUFAs), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which have been associated with reduced expression of TNF-α and interleukin-1β.11,12 These properties are similar to synthetic drugs used in RA patients such as nonsteroidal anti-inflammatory drugs (NSAIDs) and TNF blockers. Furthermore, EPA and DHA can be metabolized in E-series and D-series of resolvins that reduce inflammation.13 The American Heart Association recommends consuming fish oil to reduce the occurrence of cardiovascular disease events in patients with coronary artery disease.14 RA patients present high cardiovascular morbid-mortality rate and fish oil consumption could represent an additional benefit in this population. A meta-analysis suggested that including omega-3 PUFAs at dosages >2.7g/day in the diet for >3 months reduces NSAID consumption in RA patients.15 A systematic review including 23 randomized controlled trials testing marine Ω-3 PUFAs has been performed in patients with RA. This review has showed a modest benefit on joint swelling and pain, duration of morning stiffness, global assessment of pain and disease activity, and a reduction in the use of NSAIDs.16
Proudman et al. studied in a randomized, double-blind controlled trial the effects of fish oil consumption in early RA, employing a ‘treat-to-target’ protocol in combination with disease-modifying anti-rheumatic drugs (DMARDs). Fish oil intake was associated with a higher rate of ACR remissions, and a reduction in DMARDs dosage.17
Although not necessarily clinically significant, when prescribing Ω-3 PUFAs, rheumatologist should be aware that high dose Ω-3 PUFAs are not recommended in patients who may be susceptible to increased bleeding (e.g., patients taking warfarin), because they may increase coagulation times.18
Virgin olive oil
Virgin olive oil contains numerous compounds that exert potent anti-inflammatory and antioxidant actions.19 The main active components of olive oil include oleic acid, linolenic acid, alpha-linoleic acid and phenolic constituents.20,21 Oleic acid is metabolized to eicosatrienoic acid (omega-9 fatty acid) with similar anti-inflammatory properties than fish oil omega-3 fatty acids.21
Berbert et al. evaluated whether supplementation with olive oil could improve clinical and laboratory parameters of disease activity in RA patients who were already taking fish oil supplements. RA patient groups that received fish oil omega-3 fatty acids and olive oil showed a more precocious and accentuated improvement.22
Vitamin D plays a role in the maintenance of the homeostasis of the calcium and phosphorus metabolism. Vitamin D deficiency is linked to osteopenia, which is frequently associated to RA. Nevertheless vitamin D functions go much further since it is considered an immune system regulator. It intervenes in the innate and acquired immune systems.23
In vitro, vitamin D inhibits the activation of IL-2, IL-12, IL-6, interferon gamma (IF-γ), and TNF. Instead, vitamin D promotes monocyte differentiation into macrophages. Moreover, vitamin D has anti-inflammatory qualities through its capacity to regulate the production of prostaglandins.24 In fact, in murine models of human arthritis, vitamin D inhibits the progression of arthritis.25
A meta-analysis summarizes published results on the association between vitamin D intake and the development of RA. The authors conclude that an insufficient vitamin D intake is associated with an elevated risk of RA development.26
Vitamin D supplements could have an effect on RA treatment. Brohult et al. studied the effects of large doses of calciferol on patients with RA in a double-blind clinical trial. After 1 year, high dose oral calciferol therapy showed a positive effect on disease activity in RA patients.27
Furthermore, in a 3-month open-label trial, vitamin D administration as an adjunct therapy with DMARDs was correlated with a decrease in pain and PCR in RA patients. No adverse reactions related to vitamin D were reported.28
Probiotics are live microorganisms that, when administered in adequate amounts, confer health benefits on the host.29 Current evidence suggests that probiotics may play a therapeutic role in chronic inflammatory diseases such as RA.30
In murine models of RA, oral administration of Lactobacillus casei decreased the pro-inflammatory cytokines and improved RA index disease activity in comparison with a control group or even compare with a control group treated with indomethacin.31 Furthermore, So et al. demonstrated that the administration of Lactobacillus casei improved histopathological changes, and the lymphocytic infiltrates in the joints, similarly to the administration of methotrexate (MTX).32
Several studies showed an improvement in HAQ or disease patient perception related to probiotics intake.33–36 However, the evidence of the use of probiotics in humans is scarce. A recently reported randomized, double-blind, clinical trial study showed beneficial effects of Lactobacillus casei in pain, tender and swollen joint counts and DAS28, in RA women patients. It also showed amelioration in PCR, TNFα, IL-12 e IL-10 levels.36 No side effects were described.
Some herbal medicinal products have been shown to interact with the mediators of inflammation and, therefore, may be used in the treatment of RA.37,38 These products can also act as free radical scavengers, and through other mechanisms. For example, topical capsaicin is a highly selective agonist of TRPV1 receptors, which are expressed in afferent neuronal C fibers and some Aδ fibers. Capsaicin induces local depletion of substance P which is thought to be part of its mechanism for pain relief.39
However, few high quality clinical trials have yet been carried out to substantiate the safety and efficacy of herbal medicines, which are not free of potentially serious side effects.
Eleven randomized controlled trials including 940 patients have reported the effects of Tripterygium wilfordii extracts (TWE) in the treatment of RA; the methodological quality of these studies was generally low and the results have been inconsistent.40 A randomized controlled trial by Goldbach-Mansky et al., was conducted to compare the benefits and side effects of TWE with those of sulfasalazine for the treatment of active RA. The results showed that the attainment of the ACR 20 response criteria was significantly higher with TWE extract than with sulfasalazine.41 A multicenter, open-label, randomized controlled trial compared the efficacy and safety of TWE with MTX in the treatment of active RA. After 6 months, the proportion of patients reaching the ACR50 response criteria was 46.4%, 55.1% and 76.8%, respectively, in the MTX, TWE and MTX+TWE groups. The authors concluded that TWE monotherapy was not worse than MTX, and that MTX+TWE was better than MTX alone in controlling disease activity in patients with active RA.42
It has also been suggested that plants such as Borago officinalis, Oenothera blennis and Ribes migrum with a high grade of acid gamma linolenic (AGL) may improve pain and disease activity in RA patients.39 AGL is an essential fatty acid precursor of prostaglandin E1, an eicosanoid with anti-inflammatory and immunomodulatory properties.43 In clinical trials, the AGL group, developed more frequently adverse reactions than the placebo group, although no significant differences were reported. Cases of convulsions due to Oenothera blennis have been reported in epileptic patients or patients being treated with central nervous system medications.39
The quality of herbal medicines can directly affect their safety and efficacy. Good manufacturing practices (GMP) are one of the most important tools to avoid contamination of herbal products.44 If the manufacturer keeps GMP, this issue is rare.
Physical inactivity is the fourth leading risk factor for mortality.45 People who exercise more have lower rates of coronary heart disease, hypertension, stroke, type 2 diabetes, metabolic syndrome, colon cancer, breast cancer, depression and mortality from all causes.46 Physical activity decreases the risk of fracture and loss of bone mineral density and increases muscle mass, strength, power and intrinsic neuromuscular activity.46,47 However, in RA patients physical activity has been considered to increase joint stress, pain, disease activity and joint damage. Then, is it appropriate to recommend exercise to RA patients?
According to the latest evidence, exercise has not been associated with harmful effects on disease activity, pain or radiological damage.48,49 Therefore, physical activity does not worsen RA, and probably provides additional benefits.
Hurkmans et al. reviewed the effectiveness and safety of short-term ( <three months)=”” and=”” long-term=”” (=””> three months) dynamic exercise programs for RA patients. The authors concluded that aerobic capacity training combined with muscle strength training is recommended as routine practice in RA patients. </three>48 A randomized controlled trial showed for the first time that after a 24 week progressive training program, RA patients gained muscle mass, also functional improvement was observed.50 Therefore exercise must be recommended in RA patients. However, physical activity should be of low joint impact in order to avoid pain and musculoskeletal injuries.46
In western countries, mind-body interventions, such as yoga, which combines stress management with physical activity, are growing. Yoga modulates sweating response to dynamic exercise and improves respiratory muscle strength, handgrip strength, handgrip endurance and flexibility.51–53
There is very low evidence of the role yoga plays in RA patients. The methodological quality of the studies is poor because of a lack of patient blindness. Two trials showed a significant improvement of DAS28 associated with yoga.54,55 In other studies, yoga improved pain, HAQ, balance and handgrip strength.54,56,57
Evans et al. aimed to assess the effects of a yoga program on health-related quality of life (HRQoL) for young adults with RA compared with a usual-care waitlist control group. The results of the study suggested that yoga is a feasible and safe complementary treatment for young people with RA, leading to HRQoL, pain, disability, fatigue, and mood benefits.58
No side effects were reported for yoga in RA patients.59
Tai Chi is a Chinese martial art that combines meditation with slow, gentle, graceful movements, as well as, deep breathing and relaxation.60
Wang et al. conducted a systematic review of reports on the effects of Tai Chi over various chronic medical conditions. Nine randomized controlled trials, 23 non-randomized controlled studies, and 15 observational studies were included. Tai Chi appeared to have benefits and also appeared to be safe and effective in promoting balance control, flexibility, and cardiovascular fitness in older patients with chronic conditions.61 Thus Tai Chi may benefit RA patients who have limited strength, mobility and comorbidities (cardiovascular risk, osteoporosis and depression).60
Several reviews about the effect of Tai Chi in RA patients have been published, including a Cochrane Review.59,60,62–64 Tai Chi was associated with improvement in terms of RA disease activity. Although existing evidence remains limited and inconclusive. No adverse events were observed and Tai Chi does not exacerbate RA symptoms.64
Meditation incorporates a diverse range of techniques that helps to focus attention and bring a state of self-awareness and inner calm. Meditation may alleviate patients’ suffering associated with physical, psychosomatic and psychiatric disorders, it can even reduce cardiovascular risk factors.65 Meditation may improve pain,66 anxiety,67 depression in RA patients,68,69 and fibromyalgia.70
In a randomized, waitlist-controlled pilot study Pradhan et al. evaluated the effect of mindfulness meditation on depressive symptoms, psychological status, and disease activity in 63 RA patients. After 2 months, there were no statistically significant differences between groups in any outcomes. After 6 months, there was significant improvement in psychological distress (35% reduction) and well-being. However, the intervention had no impact on RA disease activity.71
Acupuncture is a traditional Chinese medicine where thin needles are inserted in specific points of the body to facilitate the recovery of health and to enhance well-being. The effectiveness or efficacy of acupuncture has been tested in randomized controlled trials with poor methodological standards.72
The mechanism of action in acupuncture is associated with an analgesic effect by interaction with endogen opioids and serotonin mediators. Mayer et al. reported that acupuncture analgesia was blocked after naloxone administration. These findings support the effect of acupuncture over endogenous opioids.73 A positron emission tomography study showed that acupuncture therapy evoked short-term increases in μ-opioid cerebral receptors binding potential.74 Despite these studies, the current evidence about decreased pain due to acupuncture in RA patients is scarce and non conclusive.75
Two studies involving a total of 84 people were included in a Cochrane review. One study used acupuncture and no significant differences between groups were observed.76 In the second study, using electroacupuncture, a significant decrease in knee pain was reported in the experimental group when compared to the placebo group. However, the authors concluded that the poor quality of the trial, including the small sample size preclude any recommendation.77
More recently, two systematic reviews reported that despite some favorable results in active-controlled trials, conflicting evidence exists in placebo-controlled trials concerning the efficacy of acupuncture for RA. Rigorous and well-controlled randomized trials are warranted. Minor adverse events in the acupuncture groups were observed.78–81
Another systematic review assessed the effect of bee venom acupuncture (BVA) used as an RA therapy. The authors concluded that the evidence is insufficient to suggest that BVA is an effective treatment for RA.82
In 1978, the first study of homeopathy in RA patients was published. Ninety-five RA patients were randomized to receive acetylsalicylic acid or homeopathy. After 1 year of treatment, 42.6% patients of the homeopathy group and only 14.6% of the salicylate group continued. During the first year of the study, 33.4% patients of the homeopathy group and 85.4% in the salicylate group withdrew the study.83 Gibson et al. compared orthodox first-line anti-inflammatory treatment plus homeopathy with anti-inflammatory treatment plus an inert preparation. In the treatment group improvement in subjective pain, articular index, stiffness and grip strength were observed.84
In a 6-month double-blind trial, 44 RA patients were entered comparing homeopathy with a placebo. There was no statistically significant difference between groups.85 A randomized controlled trial by Fisher and Scott was conducted to study if homeopathy was effective in reducing the symptoms of joint inflammation in RA. The results of the trial showed no evidence that active homeopathy improves the symptoms of RA.86
Brien et al. sought to assess whether any benefits from complementary homeopathic treatment in patients with RA are due to the homeopathic consultation, homeopathic remedies or both. The authors concluded that homeopathic consultations but not homeopathic remedies are associated with clinically relevant benefits in RA.87 This publication has received several criticisms,88–90 mainly because the insufficient statistical power to detect differences between groups.
In conclusion, we have limited clinical trials with adequate methodology to assess the effectiveness of homeopathy in patients with RA. None of the published studies have reported side effects associated with homeopathic drugs.
Hydrotherapy/Balneotherapy involves the use of water in treatments and in the case of RA is considered the oldest therapy. The recuperative and healing properties of these therapies are based on their mechanic and thermal effects.91 The protracted application of heat, and the pressure exerted by the water carries impulses felt at the skin deeper into the body, where they are instrumental in stimulating the immune system, reducing stress, invigorating circulation and digestion, encouraging blood flow, lessening pain sensitivity and blocking the sympathetic nervous system.92
A Cochrane review assessed the effectiveness of balneotherapy for RA patients. Nine trials, representing 579 people were included. Most trials reported positive findings, but were methodologically flawed to some extent, and withdrawals due to adverse events were not reported.93 Another systematic review found evidence that aquatic exercise had small but statistically significant effects on pain relief and related outcomes in RA. However, due to the poor methodological quality of balneotherapy studies, we are unable to make any conclusion on the effects of this intervention.94
The use of CAM in rheumatology is common.95 The increased interest of RA patients in CAM approaches is a reality, thus rheumatologists should advice their patients with scientific rigor and the best evidence available. In this sense the ACR sets its position which supports rigorous scientific evaluation on all approaches that improve the treatment of rheumatic diseases.2Table 1 presents the CAM approaches that may be beneficial for RA patients, although there is still a long way ahead in terms of research in order to draw firm conclusions. There are no long-term studies, nor studies to assess joint damage progression, however some complementary therapies may represent an opportunity to improve the quality of life of our patients, and in the future may be integrated in the management of RA patients.
CAM modalities that may be beneficial for RA patients.
|Fasting followed by vegetarian diet; Mediterranean diet||May benefit patients with RA.
Mediterranean diet is safe and decreases cardiovascular risk (frequent RA comorbidity).
|Fish oil||Evidence of benefits in the use as complementary therapy in RA.|
|Virgin olive oil||Evidence of benefits in vitro and in vivo in inflammatory diseases such as RA.|
|Vitamin D||Evidence In vitro and in animal experimentation of its anti-inflammatory and immunomodulatory effects. Epidemiological studies suggest that vitamin D supplementation could have a protective effect on the susceptibility to develop RA.|
|Probiotics||Several studies showed an improvement in HAQ or disease patient perception related to probiotics intake.33–36 However, the evidence of the use of probiotics in humans is scarce.|
|Herbal medicinal products||Some herbal medicinal products, like Tripterygium wilfordii, have demonstrated beneficial effects for RA patients. However, there is a very limited evidence base available.|
|Physical Activity||Exercise is recommended in RA patients.|
|Yoga and Taichi||Adapt the exercise to patients’ joint restrictions and may reduce patient stress.|
|Meditation/Mindfulness||Possible improvement in psychological distress and well-being|
|Acupuncture||Conflicting evidence concerning the efficacy of acupuncture for RA patients. There is positive evidence in the treatment of pain.|
|Homeopathy||There is a very limited evidence base available. No adverse reactions were observed.|
|Balneotherapy/Hydrotherapy||Most trials reported positive findings, but methodological quality of balneotherapy studies is poor.|
Conflicts of interest
The authors have no affiliations with or financial interest in any company or organization that could conflict with the views expressed in this manuscript.
Ethical responsibilitiesProtection of people and animals
The authors declare that this research has not been conducted experiments on humans or animals.
Confidentiality of data
The authors declare that this article does not appear patient data.
Right to privacy and informed consent
The authors declare that this article does not appear patient data.
There are many nonsurgical treatments for rheumatoid arthritis you may consider to reduce your symptoms—and alternative therapies should not be overlooked. Acupuncture, herbal supplements, massage, relaxation, and mind-body exercises may effectively ease inflammation and joint pain.
If you’re considering these treatments, talk with your primary doctor or rheumatologist for a referral or recommendation to an alternative, complementary and integrative practitioner. This title can be confusing—even though alternative medicine and complementary medicine follow the same methods, they are different in that alternative forms are used in place of conventional medicine, whereas complementary treatments are used with conventional medicine.
It has been suggested that acupuncture triggers the release of endorphins into the blood stream. Endorphins are your body’s natural pain relievers. Photo Source: 123RF.com.
Below are common alternative treatments for rheumatoid arthritis:
- Acupuncture: Acupuncture is a popular alternative treatment for people with fibromyalgia and back pain, and it may also benefit rheumatoid arthritis sufferers.
Acupuncture is an ancient Chinese practice rooted in the belief that everyone has an energy force called the Chi (sometimes spelled Qi, but both are pronounced “chee”). When Chi is blocked or unbalanced, the body may respond with pain and illness. An acupuncturist aims to free up Chi channels, known as meridians, by inserting extremely thin needles into specific points in your body’s meridians.
Based on your specific pain, the practitioner will likely insert multiple needles that remain in for about 20-40 minutes.
It has also been suggested that acupuncture triggers the release of endorphins into the blood stream. Simply put, endorphins are your body’s natural pain relievers. As such, their release decreases your perception of pain.
Similarly, electroacupuncture uses a needle hooked up to small wires that are connected to light electrical currents to stimulate your meridian points. Heat is often used as part of this therapy.
- Herbal Remedies: Herbal supplements are not proven to ease your RA symptoms, but you might find that they work for you. Some herbal supplements, such as devil’s claw, borage seed oil, white willow bark, and boswellia, are thought to decrease inflammation and pain.
A word of caution: Herbs and herbal supplements (eg, pills, teas) may interfere or cause a serious interaction with over-the-counter and/or prescriptions medications. It is always necessary to speak with your primary treating doctor and obtain his/her recommendation before combining drugs.
- Massage: A massage involves the stroking, kneading, and manipulation of soft tissues, such as muscles and ligaments. When received regularly, massage may help reduce pain.
While massage is not a proven treatment for rheumatoid arthritis, it’s generally safe and free of side effects. However, it’s important that you are not directly massaged at or near any area with arthritis. Massage may also not be right for you if you suffer from osteoporosis, deep vein thrombosis, skin infections, and/or open wounds.
There are more than 100 types of massage techniques. A Swedish massage, for instance, uses long strokes to impact the superficial layers of your muscles. In contrast, a deep tissue massage uses direct pressure and slow strokes to impact your deep layers of muscle and relieve chronic muscular tension.
- Myofascial release is another option. This soft tissue therapy uses massage to stretch and manipulate connective tissues (eg, ligaments), making them more flexible and increasing your range of motion. Your massage therapist will work with you to determine what specific massage will best reduce your RA pain.
- Relaxation Therapy: Also known as meditation, relaxation therapy teaches you to release muscle tension and control your body’s response to stress. Setting aside even five minutes a day to reflect and relax may prove beneficial in lifting your mood and reducing your pain.
- Mind-body Exercise: Yoga and Pilates feature a combination of gentle stretching, focused breathing, core strengthening, and mediation. These exercises also improve balance, posture, and help reduce stress. Mind-body exercises aim to help you control your RA pain so you can live a healthy and active life.
When you start any new medical program, let your practitioner know if you have any health conditions besides your rheumatoid arthritis pain. It’s also important to note that these treatments are most effective when used as complementary treatments (that is, combined with conventional medicine).
An introduction to CAM
What is CAM?
Complementary and alternative medicine (CAM) is a term used to describe a wide range of healing systems that are not typically considered part of mainstream or conventional Western medicine. The goal of conventional medicine is to find the physical source of a particular disease and treat it. For example, if a person has an infection, a conventional doctor may prescribe an antibiotic to kill the invading bacteria. CAM practitioners, on the other hand, take a more “holistic” approach to health care. They believe that health and disease involve a complex interaction of physical, spiritual, mental, emotional, genetic, environmental, and social factors. In order to treat a disease or promote good health, CAM practitioners treat the whole person.
In the United States, this holistic approach to health has been labeled “alternative” for a variety of reasons. Sometimes it is difficult to scientifically test alternative therapies in the same way that prescription drugs are tested. The conventional medical community relies on scientific evidence when evaluating the safety and effectiveness of a particular therapy. And while researchers are now beginning to test CAM therapies, scientific studies have long been focused on conventional treatments, meaning there is more evidence as to whether they work or not. In addition, many non-Western healing practices are not taught in U.S. medical schools, available to patients in U.S. hospitals, or covered by health insurance.
What does complementary medicine and alternative medicine mean?
The terms “complementary medicine” and “alternative medicine” sometimes mean the same thing. But they have different implications. Complementary medicine refers to therapies used in combination with conventional medicine, while alternative medicine is used in place of conventional medicine. An example of complementary medicine is using hypnotherapy (hypnosis) with pain medications to reduce anxiety and enhance relaxation in people recovering from severe burns. An example of alternative medicine would be following a special diet and taking herbs or vitamins rather than medications to treat attention deficit hyperactivity disorder (ADHD).
What is integrative medicine?
The term “integrative medicine” is often used interchangeably with CAM. But it has a different meaning. Health care professionals who practice integrative medicine blend CAM therapies with mainstream medicine, rather than simply adding one complementary therapy (such as herbs) to a standard medical treatment. The foundations of integrative medicine are health-promoting practices, including optimal nutrition, dietary supplements to avoid deficiencies, physical activity, and other health-promoting pursuits. The goal is to facilitate healing by using the least invasive, least toxic, and least costly methods. For example, an integrative treatment for Alzheimer disease may include a combination of the following:
- Prescription medications that increase certain brain chemicals
- Changes in lifestyle (such as walking programs and relaxation training) to reduce anxiety and improve behavior
- Music therapy
More and more Americans are becoming familiar with integrative medicine. Studies have found that this blended approach to health care is safe and effective for several medical conditions.
What are the basic principles of CAM?
Although CAM therapies vary widely, several themes can be traced through them all:
- The focus is on the whole person, the physical, emotional, social, and spiritual.
- Prevention of illness is a primary goal.
- Treatments are highly individualized.
- Treatments are aimed at the causes of illness rather than at its symptoms.
- Treatments are designed to support the natural healing processes of the body.
Who is using CAM?
The healing practices are increasingly being tested for effectiveness and safety in well-designed research studies. Exotic healing practices are becoming more common, and more Americans are turning to integrative medical care than ever before.
The movement toward integrative medicine in the U.S. has been prompted by a growing consumer demand for CAM services. In a survey given of more than 31,000 U.S. adults, nearly 70% reported using at least one form of CAM therapy in their lifetime, making this “unconventional” medical approach one of the fastest growing sectors of American health care. The survey also found that CAM approaches are most often used to treat:
- Back pain and problems
- Neck pain or problems
- Joint pain or stiffness
- Anxiety or depression
However, only about 12% of adults sought care from a licensed CAM practitioner, suggesting that most people who use CAM do so on their own. According to the survey, the 10 most commonly used CAM therapies were:
- Prayer for own health
- Prayer by others for the respondent’s health
- Participation in prayer group for own health
- Natural products (such as herbs, other botanicals, and enzymes)
- Deep breathing exercises
- Chiropractic care
- Diet based therapies (such as Atkins, Pritikin, Ornish, and Zone diets)
The survey also found information about why people use CAM:
- They believed that it would help them when combined with conventional medical treatments.
- They thought CAM would be interesting to try.
- A conventional medical professional suggested they try CAM.
- They felt that conventional medicine was too expensive.
People who have chronic conditions that are difficult to treat effectively may be more likely to pursue CAM methods. Examples include people with irritable bowel syndrome (IBS), rheumatoid arthritis, autism spectrum disorder, attention deficit hyperactivity disorder (ADHD), fibromyalgia, chronic fatigue, and cancer. In one study, published in the Journal of Alternative and Complementary Medicine, people with cancer who received a poor prognosis reported using CAM more often than the better prognosis group. Other studies show that cancer patients experience positive changes and increased spiritual importance as a result of CAM.
Although herbs and supplements are not regulated by the U.S. Food and Drug Administration (FDA), pharmacies across the country are seeing a surge in the demand for these alternative remedies. Pharmacists are being trained to counsel people on the safe and efficient use of CAM therapies. Now, most U.S. medical schools also provide instruction about CAM. More and more health insurance plans are also covering CAM, particularly treatments such as acupuncture and chiropractic care, whose safety and effectiveness for treating certain health problems has been well researched.
What are the major types of CAM?
The National Center for Complementary and Alternative Medicine (NCCAM) classifies CAM therapies into 5 major groups:
- Alternative medical systems. Built upon complete systems of theory and practice. Examples include homeopathy, naturopathy, traditional Chinese medicine (TCM), and Ayurveda.
- Biological medicine. The use of substances found in nature, such as herbs, foods, and vitamins to promote health and healing.
- Energy medicine. Involves the use of energy fields to promote health and healing. Some kinds of energy medicine (known as biofield therapies) aim to influence energy fields believed to surround and penetrate the human body. Examples include qi gong, Reiki, and Therapeutic Touch. Other forms of energy medicine (known as bioelectromagnetic based medicine) use electromagnetic fields, such as electroacupuncture.
- Manual medicine. Based on manipulation and movement of one or more parts of the body. Examples include osteopathy, physical therapy, massage, chiropractic, Feldenkrais, and reflexology.
- Mind/body medicine. Uses a range of techniques to help boost the mind’s ability to influence bodily functions. Examples include biofeedback, deep relaxation, guided imagery, hypnotherapy, meditation, prayer, support groups, and yoga.
What types of policy changes are happening in order to incorporate CAM into the U.S. medical system?
In 1991, under a Congressional mandate, the National Institutes of Health (NIH) established the Office of Alternative Medicine (OAM). The OAM was tasked with evaluating CAM practices, supporting CAM research and training, and establishing a CAM information clearinghouse for the public.
In 1998 Congress established the National Center for Complementary and Alternative Medicine (NCCAM) to take the place of the OAM. NCCAM’s mission is to support CAM research and provide information to health care providers, as well as the public. Among other efforts, NCCAM focuses on research that looks at the safety and effectiveness of herbs and nutritional supplements, and how they might interact with medications. It also evaluates other CAM treatments, such as acupuncture and chiropractic care. NCCAM funds several research centers outside of the NIH. To learn more about the centers and their research agendas, visit the NCCAM web site at nccam.nih.gov/research.
What is the future of CAM?
There are signs that CAM is becoming accepted into mainstream medicine. For example, breakthroughs in CAM research are now published in prestigious Western peer reviewed journals such as the Journal of the American Medical Association and the Annals of Internal Medicine. Still, there are real obstacles to truly integrated medicine. Some of these obstacles include cultural issues, lack of scientific studies, and administrative problems. However, because conventional doctors and CAM practitioners both want to create safe, effective, and affordable treatments, the integration of the best CAM into conventional medicine is already occurring at medical facilities across the country.