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Alternative medicine is rapidly growing in popularity. In what
may eventually prove to be the most frequently cited medical journal
article in the postwar era, Eisenberg and colleagues demonstrated
in 1993 that nearly 40% of Americans utilized alternative
medical therapies, and spent more out of pocket for these approaches
than they spent out of pocket for mainstream medical treatments.1 A
follow-up study in 1998 showed continued dramatic growth in these
practices.2 The National Institutes of Health (NIH)
has supported an Office of Alternative Medicine since 1993, but
thanks to steady increases in congressional funding, it was recently
upgraded to a division within the NIH. The November 1998 issues
of several of the American Medical Association (AMA)-sponsored specialty
journals were devoted to the topic of complementary and alternative medicine
(commonly abbreviated CAM); Micozzi’s 1996 text on alternative
medicine3 was only the first of many. This rapid
rise in interest to what was previously a fringe topic lends an
aura of novelty to these techniques, but a cursory look at some
of the most common CAM techniques (acupuncture, homeopathy, yoga)
shows that these are, in fact, traditional, if not ancient, therapies.
And so it should not be surprising that the most common symptom
that brings people to their health care providers—pain—has
a long and rich tradition of CAM interventions. This chapter outlines
some of the more prominent and promising CAM approaches to pain
conditions, both acute and chronic, at the same time that it outlines
some fundamental similarities and differences between CAM and mainstream
biomedical therapies.
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To appreciate the relationship between CAM and allopathic medicine,
it is helpful to consider three distinct paradigms of medical treatment.
The approach taught in medical schools today, and practiced in hospitals
worldwide, is known as allopathic medicine, from the Greek allos,
meaning “other” because disease pathology is felt
to be an outside force to be countered by biomedical treatment interventions.
Thus, military metaphors predominate (e.g., the “war” on
cancer, our therapeutic “armamentarium”) and treatments
are physically focused: medications, surgery, and radiation predominate.
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Over the past 30 years, as an outgrowth of Hans Selye’s
work on stress response systems, a second model integrating the
mental and physical dimensions of health has emerged. Initially
called the biopsychosocial model, it is now better known as psychoneuroimmunology,
or more globally as mind-body medicine.4 In this
system, diseases are felt to be created when the autonomic nervous
system and the endocrine system react to negative psychological,
emotional inputs and inappropriately elicit the fight-or-flight
reaction. Treatments focus on balancing sympathetic overdrive by
using mind-body techniques such as biofeedback, hypnosis, and meditation
to elicit the counterbalancing relaxation response (see Chapter 14, Psychotherapeutic Management of Chronic Pain), or by introducing new
thought and behavior patterns into a person’s life through
cognitive-behavioral approaches.
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But many of the best known techniques in CAM can clearly not
be explained by either the biomedical or the mind-body paradigm, ...