Patients in pain more likely to choose alternative medicine

[Guest guest]

Patients in pain more likely to choose alternative medicine



Oct 19, 2005



Gandey

Winston-Salem, NC - A new study suggests that people with arthritis

are very likely to use complementary medicine for pain and comorbid

conditions. " We found that people who have arthritis use quite a bit

of complementary and alternative medicine of varying kinds, " lead

author Dr Sara Quandt (Wake Forest University School of Medicine,

Winston-Salem, NC) told rheumawire. " While joint pain and poor

functional status were the most common predictors of use, many were

turning to alternatives to treat other conditions. " Quandt says that

unlike previous work, this large representative dataset addresses the

reported reasons for complementary medicine use. " For clinicians,

this means the question, 'What are you doing to treat your

arthritis?' might not get at the variety of alternatives people may

be using for a range of health concerns. "

The study, which appears in the October 15, 2005 issue of Arthritis

and Rheumatism, looks at adults aged 45 years and older [1]. Using

data from the 2002 National Health Interview Survey with a

supplemental section on complementary and alternative medicine, the

researchers compared use in people with and without arthritis. Using

logistic regression, they identified predictors of alternative

medicine use in arthritis patients.

Quandt and colleagues found that biologically based therapies such as

taking herbs or undergoing manipulative therapy were the most

frequently reported alternatives. " These findings underscore the need

for healthcare providers to obtain a complete history of conventional

and complementary medication use from patients, " they write.

During an interview, Quandt said that while other studies have

indicated that people prefer alternative therapies to biomedical

options, the study did not address this question. " Whether

rheumatologists are not able to provide the care people are looking

for or patients would rather go elsewhere, we do not know. "

A second Canadian study has come to a similar conclusion that pain is

the number-one driver of complementary medicine use [2]. In a summary

report of research funded by the Hospital for Sick Children,

affiliated with the University of Toronto, researchers studied the

extent to which young people aged 12 to 19 use complementary and

alternative medicine compared with conventional medical care.





They found that young people with back problems were more likely to

use complementary medicine, followed by youth with disabilities,

asthma, and allergies. Those who turned to alternative medicine were

also likely to be intense users of conventional medicine, seeing

health practitioners on a regular basis and taking pain medications.

" What this says to me is that pain is so difficult to treat and so

unsatisfactorily addressed by conventional medicine that people are

wiling to try anything, " lead author Dr Ann McColl (Queen's

University, Kingston, ON) told rheumawire. " This creates a profile of

a user who has exhausted the possibilities of the conventional system. "

McColl and colleagues found that young people seeking complementary

medicine tended to match the profile of adults in previous studies—

they tended to be older, female, and from well-educated families with

a higher socioeconomic status. The group also found that people in

western Canada, where the healthcare system partially supports

complementary medicine use, were more likely to turn to these

services than people in the eastern provinces.

The study did not look at herbs or vitamins and focused instead on

services such as physiotherapy, massage, acupuncture, and homeopathy.

Both studies were limited by self-report, and neither addressed the

question of efficacy.

BMJ editorialists in favor of investing in alternative medicine research

Also in the news is an editorial in the October 15, 2005 issue of the

BMJ encouraging additional study of complementary therapies [3]. Drs

Trevor (University of Bristol, UK) and Gene Feder (Barts and

the London, Queen 's School of Medicine and Dentistry, London,

UK) argue that patients seek these therapies to address persistent

symptoms and the real or perceived adverse effects of conventional

treatments. They write, " Patients value complementary practitioners

viewing their predicament as a whole and not through the fragmenting

lens of clinical specialization or within the time-pressured

environment of primary care. "

The editorialists discuss the Smallwood report, work that had been

commissioned in the UK by the Prince of Wales to investigate whether

complementary medicine could save the National Health Service money

in the treatment of chronic conditions. The Smallwood findings are

based on a literature review of UK studies of acupuncture,

homoeopathy, chiropractic, osteopathy, and herbal medicine, as well

as costed case studies and interviews with stakeholders.

The report concludes that complementary and alternative therapies

should be targeted at the " effectiveness gaps " of conventional

healthcare—particularly in managing chronic pain and mental

disorders and in palliative care. Commenting on the findings,

and Feder write, " Despite its limitations and the likelihood

of bias in its conclusions, we believe that the Smallwood report

fulfills a useful political function. It should promote more

investment in research on the cost-effectiveness of complementary and

alternative treatments. " They conclude that uncertain evidence of

cost-effectiveness should not exclude complementary medicine from

future reviews and guidelines.

http://www.jointandbone.org/viewArticle.do?primaryKey=581159