Chapter 8 - lecture notes PDF

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Friday, February 8, 2019

Chapter 8 Considering Alternative Approaches!

- Alternative & Complementary Medicine! • alternative medicine: used instead of conventional medicine! • complementary medicine: used along with or as a complement to conventional medicine!

• neither practice is rooted in Western medicine! - alternative medical systems! • traditional Chinese medicine! • Ayurvedic medicine! • naturopathy! • homeopathy! - alternative practices! • chiropractic! • massage! • energy healing! • diets and supplements! - mind-body medicine! • meditation and yoga! • biofeedback! • Qi gong and Tai Chi! • hypnosis! Alternative Medical Systems!

- traditional Chinese medicine! • originated in China over 2000 years ago and remains major medical approach in Asian countries! 1

Friday, February 8, 2019

• a vital force called chi animates the body, flowing through channels in the body called meridians!

• meridians connect parts of body to each other and to universe as a whole! • health impairment caused by blocked or stagnant chi — must be balanced for good health!

• body exists in balance between two opposing forces/energies — yin and yang! • variety of techniques to unblock chi, bring yin and yang into balance and restore health!

- acupuncture, acupressure, massage, herbal preparations, diet, and exercise! • acupuncture! - inserting needles into specific points on skin and continuously stimulating needles to unblock chi!

- used by about 1.4% of people in the US! - review of literature shows it is more effective for some forms of pain than others! • better for neck pain than shoulder or elbow! • better for tension-type headache than migraine! • increasing evidence of reduction of arthritis knee pain! - among the most effective treatments for back pain, but none of the treatments were very effective!

- effective when combined with standard medical care for chronic pain! • Ayurvedic medicine! - originated in India over 2000 years ago! - goal is to integrate and balance the body, soul, and mind! - humans born in a state of balance, but events can disrupt balance, which endangers health!

- goals of treatment are to eliminate impurities and increase harmony and balance through changes in diet and exercise!

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• naturopathy! - not an ancient system of medicine! - naturopathy arose in 19th century Europe and holds views that bodies have the power to maintain and return to a state of health!

- some practitioners train in naturopathic colleges and receive doctoral degrees, some don’t have degrees!

- naturopathic practitioners recommend dietary and healthy lifestyle changes, which may include:!

• meditation! • yoga! • massage! • herbal supplements! • homeopathy! - arose in 18th century Germany as an alternative to harsh medical treatments of the time!

- based on principle of “like cures like” — substances have curative power when they produce symptoms like those of disease!

- like all alternative medical systems, takes a holistic approach to health and treatment, including emotional and psychological factors!

- popularity of these have declined in the US! Alternative Practices and Products!

- chiropractic treatment! • founded in 1895 by Daniel David Palmer who believed manipulation of spine was key to curing and preventing disease!

• treatment includes performing adjustments to spine and joints to correct misalignment!

• students have doctoral degrees and are licensed to practice! • approach has become so well accepted that it is covered by many insurance plans!

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• about 8% of adults in US used chiropractic treatment within last year! • most often used for back and neck pain and somewhat effective for both conditions!

- mind-body medicine! • variety of techniques based on the notion that brain, mind, body, and behavior interact in complex ways and emotional, mental, social, and behavioral factors exert effects on health!

• utilizes several techniques to improve health! - meditation! - guided imagery! - yoga! - qi gong! - tai chi! - biofeedback! - hypnosis! - meditation! • mind body approaches to meditation usually do not have religious connotation! • many variations exist, but all have common factors:! - quiet place! - specific posture! - focus of attention! - open attitude! • two most common forms are transcendental and mindfulness meditation! • over 9% of adults in US have practiced it! • transcendental meditation! - usually sit with eyes closed and muscles relaxed, focusing on breathing, and silently repeat a sound or word!

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- religion of mantra meant to distract from outside thoughts! • mindfulness meditation! - origins in ancient Buddhist practice but adopted for modern stress relief! - usually sit in relaxed, upright posture and focus on any thoughts or sensations as they occur, trying to enhance awareness of perceptions and thoughts in nonjudgemental way!

- MBSR and Psoriasis! • psoriasis caused by T cells that attack healthy skin cells as if healing wound! • etiology is unknown but stress makes it worse! - mindfulness and brain imaging! • mindfulness meditation and brain imaging! • during mindfulness meditation, left frontal lobe of brain becomes more active and right lobe less so!

• consistent with an increase in the experience of positive emotions! - guided imagery! • images usually one of three categories:! - replicate peaceful scenes to promote relaxation! - substitute a less desirable behavior with a healthier one! - aimed at healing a damaged part of body! • images need to be self-generated! • must be a positive connotation to image! • should invoke as many senses as possible — can use pictures or sounds to start but then do without!

• hard to evaluate with research — how do we know if/what people are imagining?! • some research to suggest it helps with chronic pain, quality of life in cancer patients, hypertension, obesity, headaches!

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- biofeedback! • techniques involve! - electronic measurement of various biological responses! - immediate relaying of that info to person being tested! - EMG! • most frequently used procedure for coping with stress and pain is electromyography!

• measures electrical discharge in muscle fibers! • thermal biofeedback also common! • shown to be effective with! - low back pain! - tension headache! - migraine headache! - Raynaud’s disease! • as effective as hypnosis or relaxation, but no advantage in treating any stress or pain problem!

- hypnosis! • trancelike state, originated in late 1700s! • controversy over whether hypnosis is an altered state of consciousness or a generalized trait that some people have!

• must be open to experience to be hypnotized! • does it work?! - not effective for every kind of pain or every kind of patient! - for suggestible subjects it works better than placebo and provides high levels of relief from variety of pains, especially acute pain!

- less suggestible subjects respond no better to hypnosis than to a placebo!

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- overall doesn’t work well for headaches and low back pain but works better for cancer pain, burn pain, and surgery pain!

- other mind-body medicine! • qi gong — practice of TCM; series of exercises or movements intended to help body’s energy and restore balance!

• tai chi — a category of qi gong; involves slow, gentle movements! - other mind-body medicine! • energy-healing — general idea that energy can heal the body! • reiki — manipulate energy from the universe to the body of the recipient! - yoga! • uses physical postures, breathing, and meditation! • goal is to balance mind, body, and spirit! • research is limited, but seems to help with anxiety and depression! Does CAM work?!

- who uses CAM?! - increase in use of CAM since 2002?! - pain is most common problem for people who report using CAM! • most people who use CAM use it with traditional medicine, rather than as their only source!

- prevalence of CAM! • varies, depending on what is included in the definition! • natural products are most common, 17.7% of adults last year! • if prayers for health are included, as many as 63% of people used CAM last year! - ethnicity and CAM! • ethnic stereotypes of recent immigrants using CAM is incorrect! • CAM use is associated with being European American, well educated, wealthy, and female!

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• Chinese Americans’ use of CAM depends on how strongly they identify with Asian heritage!

- who uses CAM?! • people who strongly believe in science are less likely to use CAM! • people in poor health more likely to use CAM! - effectiveness of CAM! - CAM treatments for anxiety, stress, and depression! • meditation and mindfulness have proven effective for people with anxiety, stress-related problems, and relapse into depression!

• yoga has also been effective in helping stress-management! • qi gong and tai chi have also been shown to help reduce stress! • acupuncture may help in treating depression! - CAM for pain! • meditation and guided imagery have been shown to be very effective in managing chronic pain!

• tai chi has been shown to be helpful in reducing tension headaches! • tai chi and qi gong have been shown to relieve pain and improve quality of life for people with fibromyalgia!

• acupuncture — helps decrease pain perception and tension headaches! • may not be as effective as some other treatment options! • massage — may be helpful for low back pain! • chiropractic manipulation — recent research has shown only small benefits for back and neck pain!

• biofeedback — shows limited benefits for pain management! - effectiveness of CAM! • has been used to! - achieve lower blood pressure!

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- improve balance! - achieve more rapid healing! - lessen nausea and vomiting! - decrease hostility! - treat insomnia! - limitations of CAM! • limited research examining effectiveness or comparing to placebo! • natural products not regulated! • some herbal remedies and botanical products have dangerous interactions with each other, over the counter drugs or prescription drugs!

• limited availability and high cost! • individuals with some conditions should avoid some treatments! • people may use CAM instead of more effective treatments! - integrative medicine! • integrative medicine mixture of both conventional medicine and CAM! • “best of both worlds”! • faces challenge of melding very different philosophies of treatment but offers benefits of both approaches!

• two areas in which integrative medicine is advancing most rapidly are pain management and cancer treatment!

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