Integrative Medicine in Primary Care, Part II: Disease States and Body Systems, An Issue of Primary Care Clinics in Office Practice

Roger Zoorob, Vincent Morelli

Description

Complementary and alternative medicine encompasses a wide range of modalities, including acupuncture, herbs and supplements, naturopathy, and body and mind therapies. The use of these healing methods is increasing rapidly, and more and more patients are approaching primary care physicians with questions about them. The purpose of this issue is to help doctors understand the evidence supporting and refuting complementary and alternative medicine techniques so they can provide patients with answers. This is the second of a two-part series, and it focuses on application of complementary and alternative medicine techniques to disease states and body systems.

Sujets

• Family Practice
• General Practice
• Medical
• Médecine

Informations

• Publié par: Saunders
• Date de parution: 17 juin 2010
• Nombre de lectures: 0
• EAN13: 9781455700608
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Primary Care Clinics in Office Practice , Vol. 37, No. 2, June 2010
ISSN: 0095-4543
doi: 10.1016/S0095-4543(10)00034-5

Contributors
Primary Care Clinics in Office Practice
Integrative Medicine in Primary Care, Part II: Disease States and Body Systems
Roger Zoorob, MD, MPH, FAAFP
Department of Family and Community Medicine, Meharry Medical College, 1005 Dr DB Todd Boulevard, Nashville, TN 37208, USA
Vincent Morelli, MD
Department of Family and Community Medicine, Meharry Medical College, 1005 Dr DB Todd Boulevard, Nashville, TN 37208, USA
CONSULTING EDITOR Joel J. Heidelbaugh, MD, FAAFP, FACG
ISSN  0095-4543
Volume 37 • Number 2 • June 2010

Contents
Cover
Contributors
Forthcoming issues
Foreword
Preface
Complementary and Alternative Medicine Usage for Behavioral Health Indications
Herbals Used for Diabetes, Obesity, and Metabolic Syndrome
Integrative Medicine and Gastrointestinal Disease
Alternative Therapies for Common Dermatologic Disorders, Part 1
Alternative Therapies for Common Dermatologic Disorders, Part 2
Common Respiratory Diseases
Alternative Prevention and Treatment of Cardiovascular Disease Part 1
Alternative Prevention and Treatment of Cardiovascular Disease, Part 2
Women’s Health: Selected Topics
Musculoskeletal Disorders
Integrative Medicine Approach to Chronic Pain
Index
Primary Care Clinics in Office Practice , Vol. 37, No. 2, June 2010
ISSN: 0095-4543
doi: 10.1016/S0095-4543(10)00036-9

Forthcoming issues
Primary Care Clinics in Office Practice , Vol. 37, No. 2, June 2010
ISSN: 0095-4543
doi: 10.1016/j.pop.2010.02.013

Foreword
Common Clinical Applications of Complementary and Alternative Medicine

Joel J. Heidelbaugh, MD
Ypsilanti Health Center, 200 Arnet Suite 200, Ypsilanti, MI 48198, USA
E-mail address: [e-mail]


Joel J. Heidelbaugh, MD Consulting Editor
As I stated in the March 2010 issue of Primary Care Clinics in Office Practice dedicated to complementary and alternative medicine (CAM), compiled and edited by Dr Adam Rindfleisch, CAM continues to permeate our lives in popularity, prevalence, and necessity. Moreover, the future of health care will need to warmly embrace provisions for CAM services across all disciplines. Public curiosity and demand for CAM will only increase, so as medical providers, our knowledge and integration must stay ahead of the game to satisfy the needs of patients. On almost a daily basis, it continues to astonish me how many of my patients initially reject a prescription for a standard drug only to ask for a suitable herbal or vitamin alternative to treat their acute and chronic conditions.
This second installment of Primary Care Clinics in Office Practice dedicated to CAM explores alternative therapies related to specific organ system–based diseases and chronic conditions, which is truly a unique collection of reviews. The issue concludes with an integrative medicine approach to chronic pain and musculoskeletal disorders. As primary care clinicians treat increasingly greater numbers of patients afflicted with chronic pain issues (think: How many chronic pain specialists are readily available in your referral network?), and as we grow more skeptical about engaging in chronic opioid management, alternative options must be explored and trialed to prove efficacy. The greatest challenge here may be through enlightening patients that non–narcotic-based options exist and motivating them to engage in self-directed exercise programs, such as yoga.
Similarly, not only are CAM options for pulmonary, gastrointestinal, and dermatologic conditions growing in availability but also patients are learning to ask for them by name. This trend only makes us, as clinicians, look unprepared, unless we have suitable references readily available during patient encounters. The widespread acceptance and use of probiotics for the treatment of various gastrointestinal disorders, including irritable bowel disease, is a prime example of this trend, which has become a billion dollar industry. Lastly, the relationship between CAM and the prevention of cardiometabolic syndrome cannot be denied. Guidelines for appropriate nutrition as well as nutritional supplementation are often numerous and conflicting. Important questions, including, “What effect does coenzyme Q10 have on statin therapy?” and “What can chromium and magnesium supplementation do to improve outcomes in diabetes mellitus?” have the potential to have an impact on daily clinical care.
I offer my collective gratitude to Dr Roger Zoorob and Dr Vincent Morelli for recruiting talented authors to create a natural complement to the March issue on CAM integration into primary care. I find this volume to be a unique arrangement of practical reviews that primary care clinicians can rely on in their daily practices to augment current knowledge in the treatment of commonly encountered diseases in the ambulatory care setting. Despite a lack of many strict evidence-based guidelines based solely on randomized controlled clinical trials, this issue provides readers with novel therapies based on clinical evidence that can be easily integrated into daily practice.
Primary Care Clinics in Office Practice , Vol. 37, No. 2, June 2010
ISSN: 0095-4543
doi: 10.1016/j.pop.2010.02.012

Preface
Complementary and Alternative Medicine

Roger J. Zoorob, MD, MPH
Department of Family and Community Medicine, Meharry Medical College, 1005 Dr DB Todd Boulevard Nashville, TN 37208, USA
E-mail address: [e-mail]
E-mail address: [e-mail]

Vincent Morelli, MD ,
Department of Family and Community Medicine, Meharry Medical College, 1005 Dr DB Todd Boulevard Nashville, TN 37208, USA
E-mail address: [e-mail]
E-mail address: [e-mail]


Roger J. Zoorob, MD, MPH Guest Editor

Vincent Morelli, MD Guest Editor
Herbal therapy is usually underreported by patients, but the available evidence suggests that it is used by more than 15% of the US population. The cost of such therapy exceeds 6 billion dollars per year. Complementary and alternative medicine (CAM), which includes herbs, supplements, and modalities such as acupuncture and chiropractic, is even more extensively used. According to the National Health Statistics reports, the overall prevalence of use comprises more than 38% of the US population. The costs are enormous, approaching 35 billion dollars in out-of-pocket expenses each year.
It is with enthusiasm and hesitation that we accepted the invitation to be the Guest Editors for this issue. The enthusiasm stems from the enormous use by our patients of this therapy, which is not subjected to any strict regulation. Consequently, we hope to shed some light on what is available and what evidence exists for its use by primary care providers. At the same time, we were hesitant to dive into this topic given the scarcity of evidence-based literature and randomized clinical trials and the difficulty of interpretation. No matter how deeply one reviews the evidence, it is insufficient. We alert the reader to this limitation any time this subject is approached.
Primary care providers should query their patients about CAM use in an open and unassuming manner. They must advise patients about potential side effects, what works and what does not, and the possible interaction with allopathic management. However, always remember that the greatest medical invention of all time—penicillin—was the product of a mold and that some ovarian cancer cures were derived from plants. Hence, without nontraditional experimentation, we may never discover great cures. On the other hand, we must be wary of undocumented and unsubstantiated use that may dispose patients to adverse effects.
Finally, our thanks to Elsevier for allowing us the opportunity to present this topic to our readers who are primary care providers and trainees. In spite of the limitations, we hope this issue can guide them through some of the pathways of this enormous and still-only-partially-charted area of care.
Primary Care Clinics in Office Practice , Vol. 37, No. 2, June 2010
ISSN: 0095-4543
doi: 10.1016/j.pop.2010.02.002

Complementary and Alternative Medicine Usage for Behavioral Health Indications

Michele M. Larzelere, PhD * , James S. Campbell, MD, Marta Robertson, MD
Department of Family Medicine, Louisiana State University Health Sciences Center, 200 West Esplanade Avenue, Suite 409, Kenner, LA 70065, USA
* Corresponding author.
E-mail address: [e-mail]

Abstract
Evidence on the use of complementary and alternative medicine (CAM) modalities in the treatment of depression, anxiety, sleep disorders, and attention-deficit/hyperactivity disorder (ADHD) is reviewed. There is strong evidence to support the use of St. John’s wort (SJW) in depression, and growing support for the use of omega-3 fatty acids and S -adenosyl- l -methionine as potential adjuncts to conventional therapies. Evidence is insufficient to support the antidepressant benefit of dehydroepiandrosterone, inositol, folate, and saffron. Only kava has high-quality evidence for use in the treatment of anxiety disorders, and its use is discouraged because of safety concerns. There is preliminary supportive evidence for valerian and inositol treatment of anxiety, but SJW and passionflower have achieved little research support. Melatonin is likely to be useful in treating delayed sleep phase, jet lag, or shift work, but there is little