Rheums, Patients Shift Views on CAM

Dr. Daniel Muller used to teach a class on complementary and alternative medicine at the University of Wisconsin, Madison, but he hasn’t offered it in 2 years. The once-popular elective just wasn’t attracting students.

But today’s medical students don’t see complementary and alternative medicine (CAM) as being out of the mainstream, said Dr. Muller, an associate professor of rheumatology at the university. "They know all about this stuff."

Dr. Muller has literally written the book on CAM in rheumatology. He is the author of "Integrative Rheumatology," which explains how lifestyle interventions and mind-body approaches can fill gaps where traditional therapies fall short. Acceptance of CAM is generally more widespread among younger physicians, he said. Some of them may be elite athletes who have used energy medicine, some suffer from chronic pain and have explored CAM for that reason, and others may be the children of hippies who grew up surrounded by unconventional ideas, Dr. Muller said.

Courtesy of Dr. Daniel Muller

And increasingly, practicing rheumatologists have a positive opinion of CAM approaches, at least according to a survey conducted in 2007 (BMC. Complement. Altern. Med. 2010;10:5). The poll of 345 rheumatologists under age 65 years found that physicians seemed very comfortable recommending certain forms of CAM. For instance, 70% of respondents said they considered body work like massage to be very beneficial or moderately beneficial. And 65% would be very or somewhat likely to recommend it to their patients. Other CAM approaches that were rated highly by physicians include meditation practices and acupuncture.

But rheumatologists who responded to the survey did not have favorable opinions about energy medicine practices like Reiki. Only 11% said energy medicine was beneficial, and only 10% would recommend it to patients. In other areas, such as the use of glucosamine and chondroitin, the findings were mixed. Less than 40% of rheumatologists found the supplements to be beneficial, but 57% would be likely to recommend their use anyway.

Accepting Complementary and Alternative Medicine

The findings generally show a widespread acceptance of CAM, said Dr. Nisha Manek, with the rheumatology department at the Mayo Clinic in Rochester, Minn., and the lead author of the study. Dr. Manek said the figures show that doctors aren’t just approving of these approaches, but they are also willing to give them their stamp of approval with patients.

"It’s one thing to believe in the benefits of a therapy; it’s quite another to recommend it to patients," she said.

Dr. Manek speculated that in the 4 years since the survey was conducted, rheumatologists’ views have likely grown warmer toward CAM. One of the drivers is the enthusiasm among patients.

"Our patients are saying, ‘Look, I want to do better than a prescription. I really want to take charge of my health,’ " she said. "I think complementary therapies are potentially a very powerful driver in preventive medicine."

Dr. Sharon L. Kolasinski, the interim division director of rheumatology at the University of Pennsylvania, Philadelphia, agrees that patients are driving not just the popularity of CAM, but its transformation. For instance, over the last decade, interest in herbal medicines has waned in favor of a greater focus on mind-body and physical interventions. And these physical techniques are adjunctive to conventional treatment, not done as stand-alone therapy, she said.

Yoga, mindfulness meditation, acupuncture, and cognitive therapy are all practices in which patients can participate, she said, and that has helped to spur their popularity. "Patients don’t want to just take pills," said Dr. Kolasinski, who has conducted research on yoga for osteoarthritis management.

Patients are also drawn to the sensibility of some alternative medicine practitioners who take a whole patient approach, she said, as they like the focus on their daily functioning.

Talking to Rheumatology Patients

While the popularity of CAM is still going strong, especially among rheumatology patients with chronic pain, many physicians continue to struggle with how to discuss CAM with their patients. The biggest problem seems to be how to find out what patients are doing besides taking their traditional medications, whether it’s taking dietary supplements or attending a yoga class.

A recent survey conducted by the National Center for Complimentary and Alternative Medicine (NCCAM), part of the National Institutes of Health, and the AARP found that people age 50 years and older don’t talk to their doctors about using CAM. The telephone survey of more than 1,000 people found that while 53% of respondents had used CAM at some point, only about 42% had discussed it with their health care provider. The major reasons respondents gave for not talking about it with their doctors was that their physician never asks and they didn’t know they should bring it up.

NCCAM is trying to address that problem with its "Time to Talk" campaign. It encourages physicians to start a conversation about CAM and includes tips for how find time to address it during a brief office visit.

Dr. Josephine Briggs, the NCCAM director, suggests that physicians begin the conversation by asking, "What are you trying to do to be healthy?" Physicians need to recognize that even if they have doubts about a certain CAM modality, patients are generally turning to CAM as a way to be healthy or to help better manage their symptoms, she said. "I think being open to that dialogue and making it a thoughtful one is the way all of us can best help our patients."

She also encouraged physicians to talk to their patients about how they manage pain, since this is often what drives the use of CAM. Ask patients what helps them relieve their pain outside of traditional medications, she suggested, and if they have tried alternative approaches just as relaxation techniques.

Another problem for physicians in talking about CAM is that they may not be familiar with the evidence around a particular CAM treatment. NCCAM is also trying to tackle that. As part of "Time to Talk," they have put together a list of reliable sources on the latest CAM research. And NCCAM is funding a wide portfolio of research on CAM modalities that could potentially be used to treat musculoskeletal conditions, such as tai chi and yoga in the management of fibromyalgia, back pain, and osteoarthritis of the knee.

"I see these as very promising adjuncts for certain patients," Dr. Briggs said. "The question partly is, ‘Is the patient motivated?’ "

NCCAM is also sponsoring studies on dietary supplements. For example, NCCAM funded a large investigation of glucosamine and chondroitin sulfate to treat pain associated with osteoarthritis of the knee in the Glucosamine /Chondroitin Arthritis Intervention Trial (GAIT). The results, which were originally published in 2006, showed that the combination did not provide significant relief from pain. In addition, a number of NCCAM-funded researchers are studying herb-drug interactions to see how over-the-counter dietary supplements could affect traditional treatments for chronic disease.

Dr. Muller, Dr. Briggs, Dr. Kolasinski, and Dr. Manek had no financial conflicts of interest to disclose.

Dr. Daniel Muller used to teach a class on complementary and alternative medicine at the University of Wisconsin, Madison, but he hasn’t offered it in 2 years. The once-popular elective just wasn’t attracting students.

But today’s medical students don’t see complementary and alternative medicine (CAM) as being out of the mainstream, said Dr. Muller, an associate professor of rheumatology at the university. "They know all about this stuff."

Dr. Muller has literally written the book on CAM in rheumatology. He is the author of "Integrative Rheumatology," which explains how lifestyle interventions and mind-body approaches can fill gaps where traditional therapies fall short. Acceptance of CAM is generally more widespread among younger physicians, he said. Some of them may be elite athletes who have used energy medicine, some suffer from chronic pain and have explored CAM for that reason, and others may be the children of hippies who grew up surrounded by unconventional ideas, Dr. Muller said.

Courtesy of Dr. Daniel Muller

And increasingly, practicing rheumatologists have a positive opinion of CAM approaches, at least according to a survey conducted in 2007 (BMC. Complement. Altern. Med. 2010;10:5). The poll of 345 rheumatologists under age 65 years found that physicians seemed very comfortable recommending certain forms of CAM. For instance, 70% of respondents said they considered body work like massage to be very beneficial or moderately beneficial. And 65% would be very or somewhat likely to recommend it to their patients. Other CAM approaches that were rated highly by physicians include meditation practices and acupuncture.

But rheumatologists who responded to the survey did not have favorable opinions about energy medicine practices like Reiki. Only 11% said energy medicine was beneficial, and only 10% would recommend it to patients. In other areas, such as the use of glucosamine and chondroitin, the findings were mixed. Less than 40% of rheumatologists found the supplements to be beneficial, but 57% would be likely to recommend their use anyway.

Accepting Complementary and Alternative Medicine

The findings generally show a widespread acceptance of CAM, said Dr. Nisha Manek, with the rheumatology department at the Mayo Clinic in Rochester, Minn., and the lead author of the study. Dr. Manek said the figures show that doctors aren’t just approving of these approaches, but they are also willing to give them their stamp of approval with patients.

"It’s one thing to believe in the benefits of a therapy; it’s quite another to recommend it to patients," she said.

Dr. Manek speculated that in the 4 years since the survey was conducted, rheumatologists’ views have likely grown warmer toward CAM. One of the drivers is the enthusiasm among patients.

"Our patients are saying, ‘Look, I want to do better than a prescription. I really want to take charge of my health,’ " she said. "I think complementary therapies are potentially a very powerful driver in preventive medicine."

Dr. Sharon L. Kolasinski, the interim division director of rheumatology at the University of Pennsylvania, Philadelphia, agrees that patients are driving not just the popularity of CAM, but its transformation. For instance, over the last decade, interest in herbal medicines has waned in favor of a greater focus on mind-body and physical interventions. And these physical techniques are adjunctive to conventional treatment, not done as stand-alone therapy, she said.

Yoga, mindfulness meditation, acupuncture, and cognitive therapy are all practices in which patients can participate, she said, and that has helped to spur their popularity. "Patients don’t want to just take pills," said Dr. Kolasinski, who has conducted research on yoga for osteoarthritis management.

Patients are also drawn to the sensibility of some alternative medicine practitioners who take a whole patient approach, she said, as they like the focus on their daily functioning.

Talking to Rheumatology Patients

While the popularity of CAM is still going strong, especially among rheumatology patients with chronic pain, many physicians continue to struggle with how to discuss CAM with their patients. The biggest problem seems to be how to find out what patients are doing besides taking their traditional medications, whether it’s taking dietary supplements or attending a yoga class.

A recent survey conducted by the National Center for Complimentary and Alternative Medicine (NCCAM), part of the National Institutes of Health, and the AARP found that people age 50 years and older don’t talk to their doctors about using CAM. The telephone survey of more than 1,000 people found that while 53% of respondents had used CAM at some point, only about 42% had discussed it with their health care provider. The major reasons respondents gave for not talking about it with their doctors was that their physician never asks and they didn’t know they should bring it up.

NCCAM is trying to address that problem with its "Time to Talk" campaign. It encourages physicians to start a conversation about CAM and includes tips for how find time to address it during a brief office visit.

Dr. Josephine Briggs, the NCCAM director, suggests that physicians begin the conversation by asking, "What are you trying to do to be healthy?" Physicians need to recognize that even if they have doubts about a certain CAM modality, patients are generally turning to CAM as a way to be healthy or to help better manage their symptoms, she said. "I think being open to that dialogue and making it a thoughtful one is the way all of us can best help our patients."

She also encouraged physicians to talk to their patients about how they manage pain, since this is often what drives the use of CAM. Ask patients what helps them relieve their pain outside of traditional medications, she suggested, and if they have tried alternative approaches just as relaxation techniques.

Another problem for physicians in talking about CAM is that they may not be familiar with the evidence around a particular CAM treatment. NCCAM is also trying to tackle that. As part of "Time to Talk," they have put together a list of reliable sources on the latest CAM research. And NCCAM is funding a wide portfolio of research on CAM modalities that could potentially be used to treat musculoskeletal conditions, such as tai chi and yoga in the management of fibromyalgia, back pain, and osteoarthritis of the knee.

"I see these as very promising adjuncts for certain patients," Dr. Briggs said. "The question partly is, ‘Is the patient motivated?’ "

NCCAM is also sponsoring studies on dietary supplements. For example, NCCAM funded a large investigation of glucosamine and chondroitin sulfate to treat pain associated with osteoarthritis of the knee in the Glucosamine /Chondroitin Arthritis Intervention Trial (GAIT). The results, which were originally published in 2006, showed that the combination did not provide significant relief from pain. In addition, a number of NCCAM-funded researchers are studying herb-drug interactions to see how over-the-counter dietary supplements could affect traditional treatments for chronic disease.

Dr. Muller, Dr. Briggs, Dr. Kolasinski, and Dr. Manek had no financial conflicts of interest to disclose.

Dr. Daniel Muller used to teach a class on complementary and alternative medicine at the University of Wisconsin, Madison, but he hasn’t offered it in 2 years. The once-popular elective just wasn’t attracting students.

But today’s medical students don’t see complementary and alternative medicine (CAM) as being out of the mainstream, said Dr. Muller, an associate professor of rheumatology at the university. "They know all about this stuff."

Dr. Muller has literally written the book on CAM in rheumatology. He is the author of "Integrative Rheumatology," which explains how lifestyle interventions and mind-body approaches can fill gaps where traditional therapies fall short. Acceptance of CAM is generally more widespread among younger physicians, he said. Some of them may be elite athletes who have used energy medicine, some suffer from chronic pain and have explored CAM for that reason, and others may be the children of hippies who grew up surrounded by unconventional ideas, Dr. Muller said.

Courtesy of Dr. Daniel Muller

And increasingly, practicing rheumatologists have a positive opinion of CAM approaches, at least according to a survey conducted in 2007 (BMC. Complement. Altern. Med. 2010;10:5). The poll of 345 rheumatologists under age 65 years found that physicians seemed very comfortable recommending certain forms of CAM. For instance, 70% of respondents said they considered body work like massage to be very beneficial or moderately beneficial. And 65% would be very or somewhat likely to recommend it to their patients. Other CAM approaches that were rated highly by physicians include meditation practices and acupuncture.

But rheumatologists who responded to the survey did not have favorable opinions about energy medicine practices like Reiki. Only 11% said energy medicine was beneficial, and only 10% would recommend it to patients. In other areas, such as the use of glucosamine and chondroitin, the findings were mixed. Less than 40% of rheumatologists found the supplements to be beneficial, but 57% would be likely to recommend their use anyway.

Accepting Complementary and Alternative Medicine

The findings generally show a widespread acceptance of CAM, said Dr. Nisha Manek, with the rheumatology department at the Mayo Clinic in Rochester, Minn., and the lead author of the study. Dr. Manek said the figures show that doctors aren’t just approving of these approaches, but they are also willing to give them their stamp of approval with patients.

"It’s one thing to believe in the benefits of a therapy; it’s quite another to recommend it to patients," she said.

Dr. Manek speculated that in the 4 years since the survey was conducted, rheumatologists’ views have likely grown warmer toward CAM. One of the drivers is the enthusiasm among patients.

"Our patients are saying, ‘Look, I want to do better than a prescription. I really want to take charge of my health,’ " she said. "I think complementary therapies are potentially a very powerful driver in preventive medicine."

Dr. Sharon L. Kolasinski, the interim division director of rheumatology at the University of Pennsylvania, Philadelphia, agrees that patients are driving not just the popularity of CAM, but its transformation. For instance, over the last decade, interest in herbal medicines has waned in favor of a greater focus on mind-body and physical interventions. And these physical techniques are adjunctive to conventional treatment, not done as stand-alone therapy, she said.

Yoga, mindfulness meditation, acupuncture, and cognitive therapy are all practices in which patients can participate, she said, and that has helped to spur their popularity. "Patients don’t want to just take pills," said Dr. Kolasinski, who has conducted research on yoga for osteoarthritis management.

Patients are also drawn to the sensibility of some alternative medicine practitioners who take a whole patient approach, she said, as they like the focus on their daily functioning.

Talking to Rheumatology Patients

While the popularity of CAM is still going strong, especially among rheumatology patients with chronic pain, many physicians continue to struggle with how to discuss CAM with their patients. The biggest problem seems to be how to find out what patients are doing besides taking their traditional medications, whether it’s taking dietary supplements or attending a yoga class.

A recent survey conducted by the National Center for Complimentary and Alternative Medicine (NCCAM), part of the National Institutes of Health, and the AARP found that people age 50 years and older don’t talk to their doctors about using CAM. The telephone survey of more than 1,000 people found that while 53% of respondents had used CAM at some point, only about 42% had discussed it with their health care provider. The major reasons respondents gave for not talking about it with their doctors was that their physician never asks and they didn’t know they should bring it up.

NCCAM is trying to address that problem with its "Time to Talk" campaign. It encourages physicians to start a conversation about CAM and includes tips for how find time to address it during a brief office visit.

Dr. Josephine Briggs, the NCCAM director, suggests that physicians begin the conversation by asking, "What are you trying to do to be healthy?" Physicians need to recognize that even if they have doubts about a certain CAM modality, patients are generally turning to CAM as a way to be healthy or to help better manage their symptoms, she said. "I think being open to that dialogue and making it a thoughtful one is the way all of us can best help our patients."

She also encouraged physicians to talk to their patients about how they manage pain, since this is often what drives the use of CAM. Ask patients what helps them relieve their pain outside of traditional medications, she suggested, and if they have tried alternative approaches just as relaxation techniques.

Another problem for physicians in talking about CAM is that they may not be familiar with the evidence around a particular CAM treatment. NCCAM is also trying to tackle that. As part of "Time to Talk," they have put together a list of reliable sources on the latest CAM research. And NCCAM is funding a wide portfolio of research on CAM modalities that could potentially be used to treat musculoskeletal conditions, such as tai chi and yoga in the management of fibromyalgia, back pain, and osteoarthritis of the knee.

"I see these as very promising adjuncts for certain patients," Dr. Briggs said. "The question partly is, ‘Is the patient motivated?’ "

NCCAM is also sponsoring studies on dietary supplements. For example, NCCAM funded a large investigation of glucosamine and chondroitin sulfate to treat pain associated with osteoarthritis of the knee in the Glucosamine /Chondroitin Arthritis Intervention Trial (GAIT). The results, which were originally published in 2006, showed that the combination did not provide significant relief from pain. In addition, a number of NCCAM-funded researchers are studying herb-drug interactions to see how over-the-counter dietary supplements could affect traditional treatments for chronic disease.

Dr. Muller, Dr. Briggs, Dr. Kolasinski, and Dr. Manek had no financial conflicts of interest to disclose.