Chapter ten
ALTERNATIVE/C0MPLEMENTARY MEDICINE
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Chapter tenALTERNATIVE/C0MPLEMENTARY MEDICINE |
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Note: This is the original text of the chapter in the 1992 book and it has not been updated. Page numbers refer to pages in the book.
Some Complementary Therapies
Acupuncture and TENS
Homeopathy
Spiritual healing
Osteopathy, Chiropractic and Manipulation
Herbal Medicine
"I've tried various treatments in the past in my determination to beat Mr 'Itis' (I'm not fond enough of Arthur to call him by his first name!). Let's see, I've had acupuncture, both oriental and English, hypnotherapy (that was a rip-off), osteopathy, a 'miracle machine' called EMMA, herbal remedies, diets and even foreign mussels with green lips would you believe?!" (Marilyn S, in her 30s, with psoriatic arthritis)
For centuries there have been hundreds of 'alternative' remedies claiming miraculous cures for rheumatic and other disorders, and we continue today to be bombarded by media and friends with tales of miracle treatments. A lot of these are just a waste of time and money; others are potentially harmful. But is there any truth in any of the tales? Might there be something in it for us? How are we to know? How can we avoid rip-offs and quacks, keen to make money out of other people's despair and misery?
First of all, don't, for goodness sake, turn your back on orthodox medicine. Though it can't yet produce a cure, it can do a tremendous amount to treat rheumatic disorders. Orthodox doctors are highly skilled, work to a high code of ethics, and aren't out to fleece you of all your money. Try not to get downhearted if finding the right treatment takes time and a trial-and-error approach, but keep at it, and give orthodox medicine a fair chance.
'Good' practitioners of alternative medicine will also usually encourage you not to turn your back on orthodox medicine, but to look on their treatment as 'complementary' rather than as a substitute ('alternative'). Rheumatic disorders are complicated, and it's essential to have correct diagnosis and management by orthodox doctors.
'Bad' practitioners of alternative medicine might well prescribe treatment that's actually harmful to you, besides lining their pockets at your expense. For instance forceful manipulation of the neck in someone with RA could very seriously damage the spinal cord and nerve. Herbal remedies aren't as harmless as often thought: like orthodox prescribed medicines they can sometimes produce unwanted side effects and drug interactions yet they're not subject to the same strict testing and licensing controls as orthodox drugs. Nutritional deficiency problems can result from some 'alternative' diets. Bear in mind too that unorthodox practitioners aren't legally obliged to take out insurance, and you might not be able to get compensation if anything goes wrong.
If you want to try complementary medicine, do first talk to your doctor. OK, s/he may pour cold water on the idea, but don't be put off mentioning it. Explain that you're asking because you want to know if it will do you any harm or will conflict with your orthodox treatment. It's important to check, whatever it is, whether a physical treatment, an external preparation, a tonic, a herb/plant remedy or whatever. Here's what one orthodox doctor has to say: Dr J T Scott, Consultant Physician, Charing Cross Hospital, London and Honorary Physician, Kennedy Institute of Rheumatology:
"Patients are often embarrassed to mention [this], fearing the wrath that may fall upon them when it is learnt that they have strayed from the paths of medical orthodoxy. This should not be the case, however, and doctors are often interested to hear the results: knowing our limitations, we can hardly blame the patient for trying something new… But some of these [alternative practitioners] are not exactly generous with their skills, and anger is an understandable reaction when one hears that a patient with RA has been persuaded to spend large sums of money which she can ill afford, on worthless bits of quackery." (In his Arthritis and Rheumatism. The Facts, Oxford University Press, 1980)
Your doctor might surprise you by not scorning your enquiry. Some have become more open-minded towards complementary medicine, and interested in its uses in treating chronic illnesses. They feel that any treatment with few or no side-effects which might help patients is worth investigating scientifically. Professor Malcolm Jayson, Head of the Rheumatic Diseases Centre at Manchester's Hope Hospital, for example, uses acupuncture for treating certain types of back pain. Bart's hospital in London uses acupuncture for some patients with RA and OA. Spiritual healing is used in Liverpool's Walton Hospital Pain Management Programme and for arthritis patients at Leeds General Infirmary.
Dr J Kenyon MD, MB, ChB, and Dr G T Lewith, MA, MRCP, MRCGP are doctors who established 'The Centre for the Study of Complementary Medicine' in Southampton:
"in the profound belief that treatments such as acupuncture and homeopathy have much to offer mankind and that research and education within these areas were both essential and long overdue… It seems to me that some of the more exciting and potentially useful concepts within medicine exist in the philosophies of the various alternative therapies. Many of these ideas will prove to be false, but if some could be verified and formulated in a more specific and practical manner, then we might reap untold rewards…" (In Alternative Therapies, ed G T Lewith, Heinemann, 1985)
Since 1977 GPs have been allowed by the General Medical Council to refer patients to an alternative practitioner, provided they maintain overall responsibility for the patient. So it's worth asking whether your GP knows of someone suitable. Besides talking to your doctor, find out as much as you can yourself about any therapy that interests you. Look, for instance, at the publications on page 75.
Dr Lewith's Alternative Therapies, mentioned above, is aimed at orthodox health professionals, and deals with acupuncture and transcutaneous nerve stimulation (TENS), manipulation, biofeedback and meditation, homeopathic medicine, and clinical ecology (food sensitivity). It might be worth mentioning to your doctor if s/he's interested but admits to not being terribly well-informed. Though the book contains some difficult medical jargon, some of it's readable by a layperson, eg the chapter on homeopathy.
Bear in mind that what seems to work for someone else won't necessarily work for you. Firstly, because each person's body is different. Secondly, because a characteristic of most chronic inflammatory rheumatic disorders is that they are 'episodic', coming and going unpredictably; so an improvement might have happened anyway. Thirdly, improvement might be due to the placebo effect (see page 80): if people believe a treatment will do them good, then some 20-30% will actually experience an improvement, even if they're being treated with dummy medicines or non-functioning apparatus.
Be wary of being taken for a ride simply to line someone else's pocket. When you come across an advert for a new product or form of treatment, avoid especially those which use words like 'miracle', 'cure', or 'breakthrough'; those which claim to have support from unnamed or suspect 'experts', include testimonials from people who were 'cured', and make vague references to 'published research'.
The best way to find an alternative therapist is on the personal recommendation of your doctor, or, with your doctor's approval, on the recommendation of a friend. Don't be fooled by impressive-looking letters after a therapist's name. Outside orthodox medicine anyone can stick letters after their name and set up as a homeopath, herbalist, or whatever with no qualifications and little or no knowledge of their subject. Find out what the letters stand for, and whether the therapist belongs to one of the well-established professional organisations concerned with training and upholding high codes of practice amongst members.
The British Holistic Medical Association will supply a list of medically qualified practitioners who are also skilled in acupuncture, homeopathy, osteopathy, chiropractic, herbal medicine, breathing and relaxation, meditation, visualisation, exercise, diet, autogenic training, biofeedback, and naturopathy. 'Holistic medicine' means replacing mechanistic approaches to medicine with approaches which respond to a person as a whole within the environment, a person composed of mind, body and spirit. See the BHMA's free leaflet What is Holistic Medicine? Membership of the BHMA is open to orthodox healthcare professionals and members of the public too.
The BHMA also sells self-help tapes on subjects such as Healthy Eating, Introduction to Meditation, The Breath of Life, Undoing Muscular Tension, and Skills in Self-Care, and produces a low-cost helpful reading list of over 100 books on all aspects of 'whole person' health. Topics covered include taking care of yourself – general principles, mind-body relationship, relaxation/stress management, diet, anxiety and depression, families, spirit/inspiration: relationships/personal growth.
The Institute for Complementary Medicine runs a computerised library service about practitioners, research documents and books on homeopathy, acupuncture, herbalism, chiropractic and osteopathy, and produces an annual directory of UK practices and therapies. Practitioners listed have undergone a professional (usually three years) training, subscribe to a code of professional ethics, and are fully insured. The Institute can supply information on other therapies, and has 72 volunteer-staffed local Public Information Points (PIPs).
Acupuncture, TENS treatment, homeopathy, spiritual healing, osteopathy/chiropractic/manipulation, and herbal medicine are dealt with here. For dietary therapy see chapter 9, for meditation and relaxation techniques see chapter 14.
Acupuncture and TENS
Acupuncture's been used in traditional Chinese medicine for more than 2,000 years. It can't cure rheumatic disorders or repair damaged joints, but some people find it relieves pain, though usually only temporarily, lasting anything from a few hours to a few weeks or months. Some patients react by temporarily becoming a little worse after the first or perhaps second acupuncture treatment.
An acupuncturist aims to restore health through restoring 'bodily harmony', by inserting fine, hairlike needles at key acupuncture points found on invisible channels on the body caned meridians. There are over 350 key points on the body, but usually only about 8 to 12 are used at anyone time. Theories suggest that acupuncture may work by stimulating the release of the brain's own pain-killing substances 'endorphins', or by modifying pain messages being sent from damaged tissues to the brain. (See page 79).
Most acupuncturists in Britain practise privately. Acupuncture for pain control is used to a very limited extent in the NHS, for instance a few physios now use it, some hospital pain clinics, and a few consultants, like, for instance Professor Jayson (page 71).
Three main professional bodies provide training courses for acupuncturists, including the British Acupuncture Association, which runs postgraduate courses for registered medical practitioners, dentists, paramedics. All three bodies are represented on the Council for Acupuncture, which publishes a Combined Register of British Acupuncturists and sets professional standards. Members aren't allowed to advertise. In addition, the British Medical Acupuncture Society is an organisation of registered orthodox medical and dental practitioners, all practising acupuncturists, to whom referral is possible through your own doctor. For ethical reasons the Society can't send the list of its members direct to the public. But they can send the list in a sealed envelope for you to give your GP!
Transcutaneous electrical nerve stimulation (TENS) is an adaptation of acupuncture, which uses electrical instead of manual stimulation and works through surface rubber electrodes instead of acupuncture needles. The patient feels a tingling sensation around the electrodes. Apparently the Romans used electric eels to provide similar treatment for people with arthritis!
TENS doesn't work for everyone, and like acupuncture, pain relief is usually temporary, but it's convenient and portable (a small box), though expensive. TENS machines aren't generally available on the NHS, though some GPs have bought their own machines, and lend them out to patients to try. An improvement, if there's going to be one, should have started appearing in some two to three weeks. TENS shouldn't be used by anyone who has a cardiac pacemaker, or while operating heavy machinery or driving a car.
Dr Lewith mentions a number of controlled studies of TENS treatment used for people with low back pain, phantom limb pain, pain caused by osteoarthritis of the knee, and pain caused by RA:
"All these show that… the treatment is effective in approximately 45-50% of patients depending on the condition studied.
"…TENS is now used… in pain clinics, and is generally available in physiotherapy departments throughout the United Kingdom, but there are only a few general practitioners in the United Kingdom who are using this therapy. In my opinion it would be extremely valuable to use TENS as an equivalent therapy to analgesics and non-steroidal anti-inflammatory agents for chronic pain, in the context of general practice, particularly in view of its minimal side-effects…" (In Alternative Therapies)
Homeopathy
Homeopathy is based on the principle that in certain illnesses 'like cures like'. In a healthy person, for instance, the plant belladonna produces a headache, but a minute controlled dose would be prescribed to treat certain types of headache. Quinine taken by a healthy person produces malarial symptoms, but is used to treat someone ill with malaria.
The founder of homeopathy, Samuel Hahnemann, believed it was possible to treat a patient effectively and avoid side-effects by giving only a microscopic amount of a remedy, known as the 'minimum dose'. Looked at scientifically, it's difficult to see how this can work, for these remedies (known as 'potencies') are prepared by being diluted to an incredible extent. Sceptics believe there may be a placebo effect.
As in orthodox medicine, the homeopath takes a history of the illness, and examines the patient physically. Choice of remedy is based on a detailed holistic assessment of the patient's personality as a whole, family and social circumstances, and the way s/he reacts to the illness. The homeopathic remedy used for one person might be totally different from that prescribed to treat the same illness in a different person.
In Alternative Therapies, Dr Lewith looks at alternative theories and describes research investigating how homeopathy might work. Few strictly controlled trials have been carried out, but he describes one on some RA patients, reported in 1980 (Gibson R G, Gibson S L M, MacNeill A D, Watson Buchanan W: 'Homeopathic therapy in rheumatoid arthritis: evaluation by double-blind clinical therapeutic trial': British Journal of Clinical Pharmacology, 9: 453-9):
"[The trial] made a rigid comparison between one group of 23 patients on orthodox first-line anti-inflammatory treatment plus homeopathy and a second group of 23 patients on orthodox first-line treatment plus an inert preparation. There was a significant improvement in the subjective pain, articular index, stiffness and grip strength in those patients receiving homeopathic remedies, and no significant change in the patients who received placebo. Both groups were seen by the same two physicians and the experiment was done under double-blind conditions."
Where appropriate, reputable homeopaths will prescribe conventional drugs (undiluted), as well as or instead of homeopathic remedies. Dr Lewith stresses that homeopathy should be regarded as a complement to conventional therapies, and not as a substitute:
"In certain cases both types of therapy may be used to complement each other. A patient with severe rheumatoid arthritis may still require an analgesic or non-steroidal anti-rheumatic drug as well as his homeopathic remedies, or an asthmatic patient may require inhalers. But with successful homeopathic prescribing it may be possible to reduce other medication and to stop administration of drugs which cause unpleasant side-effects.
"Advanced cases of rheumatoid arthritis or osteoarthritis can be alleviated, but may require additional conventional drugs… The patient's well-being and ability to cope with the disease are often markedly improved, and some relief of pain and stiffness obtained."
However, in a chronic disorder, ongoing treatment's required and a response, if any, may be slow in coming. In the early days, the symptoms may even be worsened temporarily, 'the homeopathic aggravation' or 'healing crisis', though homeopaths usually take this as a sign that improvement will follow.
Many people don't realise that homeopathy is available on the NHS (in theory, anyway), and the remedies used are prescribable in hospital or by GPs in the same way as conventional drugs. In practice however there aren't many homeopathically qualified doctors around, and most are in private practice. There are five homeopathic hospitals in Britain (Royal London, Glasgow, Liverpool, Bristol, and Tunbridge Wells). For information about medically qualified homeopaths and homeopathy, contact the British Homeopathic Association.
Spiritual healing
Over the last few years the Confederation of Healing Organisations (CHO), an umbrella body of 15 healing organisations, has set up trials in hospitals to try to prove the value of spiritual healing. It's being tested in use alongside orthodox treatment for conditions like AIDS, cancer, and even arthritis, for instance in London and outside, at hospitals like the Walton in Liverpool (in its self-help course for people with chronic pain) and at Leeds General Infirmary (for people with arthritis). It's even being tested on horses.
Responsible spiritual healers, belonging to the CHO, don't claim that it will produce instant 'miracle cures', and stress that "healing must be seen as strictly complementary to orthodox medicine… Registered healers are forbidden to indulge in medical diagnosis, manipulation, the prescribing of drugs, or to interfere in the medical regime".
Though spiritual healing may not cure, many people do feel better mentally and spiritually, and better able to cope with physical pain, even if it doesn't go away. How healing may work is a mystery, but healers themselves believe they act as a channel for energy from some outside force, which they pass on and which stimulates the patient's own healing powers. Surprisingly, you don't usually have to be religious to try spiritual healing; you just need to have a strong desire to feel better. YPA Janet Flower contacted a healer:
"I had an open mind as to what would happen and didn't expect miracles, nor on the other hand did I think it would be a useless exercise. I suppose I didn't feel I was really the right sort of recipient, not 'worthy' of receiving healing. I have my own sort of 'faith', and don't go to church; perhaps I felt a bit hypocritical.
"Anyway, Carol reassured me and during the healing session all worries fell away. My mind was completely calm, but also very alert. I definitely felt some kind of 'sensation', which varied on some joints and limbs. Normally, if a joint is playing me up I tend to ignore it as much as possible. During the healing sessions, I was very aware of each joint, and without changing my lifestyle or routines at all, seemed to know whether a joint pain needed rest or exercise. Perhaps I was more able to relax and ease a joint than before – I used to be more inclined either to try to force a joint or just ignore it, neither of which helped! Coupled with a greater awareness of my joints and muscles, I felt a marvellous inner peace (difficult to describe) and at times a kind of glow (like ET?).
"Perhaps it's all due to my vivid imagination but since I've been receiving healing I've felt so much better inside. The feeling I get from each healer is different but it's always gentle, soothing but also invigorating. Like having your batteries charged. I wouldn't claim to be terribly better physically but nevertheless, I'm stronger mentally and spiritually; which makes my physical problems seem to lessen and fade." (In Contact)
For more information contact the Confederation of Healing Organisations (CHO), or the National Federation of Spiritual Healers (NFSH). Payment to part-time healers (who have other jobs to support themselves financially) is usually a small donation. Full-time healers charge fees for sessions which may last 20 minutes to an hour.
Osteopathy, Chiropractic and Manipulation
Each of these treatments uses a degree of controlled force to move a joint. Although in some conditions such treatment may be helpful, that does not usually apply to us, younger people with the inflammatory types of arthritis. As the ARC leaflet on alternative medicine emphasises: "Given to the wrong patient or in the wrong way, it can be disastrous – particularly when applied to the neck."
So do not, ever, try these treatments unless your doctor has specifically agreed. If s/he ever prescribes any form of manipulation for you, it should be undertaken only by physios or doctors specially trained in the technique, and fully briefed on your medical history.
Herbal Medicine
Because herbal and plant remedies are so readily available, many people believe they're harmless, but that's not true, so beware. They can be poisonous, and cause unwanted side-effects, just like any other drugs, and most haven't undergone the same stringent clinical trials as orthodox drugs to test for safety and long-term effects. Comfrey, for instance, traditionally used as a remedy to promote healing of wounds, ulcers, bone fractures and bronchitis, is potentially poisonous to the liver; feverfew can cause ulceration of the mouth and tongue.
The Medicines Control Authority (MCA) issues product licences to medicines it has approved for use. The letters PL, followed by a number, on a herbal remedy label, indicate that it's intended as a medicine, has been assessed by the MCA, and given a product licence. The MCA specifically says that sassafras, comfrey, mistletoe, broom and senecio aureus are not safe for use in herbal remedies, and very many herbs should specifically not be taken in pregnancy, including feverfew, parsley seeds, sage, pennyroyal, black cohosh, berberis, blue cohosh, bloodroot, fumaria, helonias, hydrastis, juniper, kelp, mugwort.
So for goodness sake check with your doctor before trying any herbal remedy, whether purchased or home-made. The Dictionary of Modem Herbalism (Thorsons), includes possible adverse effects. It's by Simon Mills, joint director of the Centre for Complementary Health Studies at Exeter University. His Out of the Earth (Viking, 1992, pricey) examines herbal medicine and its safety in detail. Professor David Phillipson, professor of pharmacognosy (the study of herbal products!) at London University's School of Pharmacy, is currently compiling information on adverse effects.