The evidence for acupuncture as a treatment for rheumatologic conditions.

Individuals with rheumatic disorders, particularly those with more severe, chronic conditions, are likely to be frequent users of complementary and alternative medical therapies. Although large-scale clinical trials have yet to be conducted, there is moderately strong evidence that acupuncture may be effective for treating both osteoarthritis and fibromyalgia. The utility of acupuncture in treating rheumatoid arthritis has not been demonstrated in large, randomized controlled trials. Physicians who treat patients with rheumatic conditions should become knowledgeable about the literature on both the effectiveness of acupuncture for these conditions as well as its potential to cause adverse side effects in particular patient groups.

The public debate over alternative medicine: the importance of finding a middle ground.

As the use of alternative medical therapies has grown in the United States, so has the controversy surrounding it. Many conventional medicine practitioners and researchers often express strong negative attitudes toward alternative medicine therapies and practitioners. Likewise, many alternative medicine practitioners and activists often express strong negative attitudes toward conventional medicine and its methods. Unfortunately, such highly polarized viewpoints tend to dominate the public debate over alternative medicine in this country, obscuring the empirical evidence. This article discusses the evidence pertaining to some of the major controversies surrounding alternative medicine and why there is a critical need to find a more moderate approach to resolving such controversial issues. A potential model for finding a middle ground in this debate is presented.

Complementary medicine treatments for fibromyalgia syndrome.

Fibromyalgia is a chronic-pain-related syndrome associated with high rates of complementary and alternative medicine (CAM) use. Among the many CAM therapies frequently used by fibromyalgia patients, empirical research data exist to support the use of only three: (1) mind-body, (2) acupuncture, and (3) manipulative therapies for treating fibromyalgia. The strongest data exist for the use of mind-body techniques (e.g. biofeedback, hypnosis, cognitive behavioural therapy), particularly when utilized as part of a multidisciplinary approach to treatment. The weakest data exist for manipulative techniques (e.g. chiropractic and massage). The data supporting the use of acupuncture for fibromyalgia are only moderately strong. Also, for some fibromyalgia patients, acupuncture can exacerbate symptoms, further complicating its application for this condition. Further research is needed not only in these three areas, but also for other treatments being frequently utilized by fibromyalgia patients.

Is acupuncture effective in the treatment of fibromyalgia?

BACKGROUND: We conducted this study to assess the effectiveness of acupuncture in the treatment of fibromyalgia syndrome (FMS), report any adverse effects, and generate hypotheses for future investigation. METHODS: We searched MEDLINE, EMBASE, Manual Therapy Information System, the Cochrane registry, the University of Maryland Complementary and Alternative Medicine in Pain, the Centralized Information Service for Complementary Medicine, and the National Institutes of Health Office of Alternative Medicine databases for the key words "acupuncture" and "fibromyalgia." Conference abstracts, citation lists, and letters supplemented the search. We selected all randomized or quasi-randomized controlled trials, or cohort studies of patients with FMS who were treated with acupuncture. Methodologic quality, sample characteristics, type of acupuncture treatment, and outcomes were extracted. Statistical pooling was not performed because of the differences in control groups. RESULTS: Seven studies (3 randomized controlled trials and 4 cohort studies) were included; only one was of high methodologic quality. The high-quality study suggests that real acupuncture is more effective than sham acupuncture for relieving pain, increasing pain thresholds, improving global ratings, and reducing morning stiffness of FMS, but the duration of benefit following the acupuncture treatment series is not known. Some patients report no benefit, and a few report an exacerbation of FMS-related pain. Lower-quality studies were consistent with these findings. Booster doses of acupuncture to maintain benefit once regular treatments have stopped have been described anecdotally but not investigated in controlled trials. CONCLUSIONS: The limited amount of high-quality evidence suggests that real acupuncture is more effective than sham acupuncture for improving symptoms of patients with FMS. However, because this conclusion is based on a single high-quality study, further high-quality randomized trials are needed to provide more robust data on effectiveness.

Complementary and alternative medicine: herbal therapies for diabetes.

Interest in and use of complementary and alternative medicine have increased in recent years, with as much as 40% of the general population having used some form of complementary and alternative medicine in the past year. Although recent national surveys have not adequately assessed the use of complementary and alternative medicine in minority populations, its use in many minority populations is at least equal to and possibly greater than that in the general population. One condition for which minority populations are likely to use complementary and alternative medicine therapies is diabetes, which is particularly prevalent in Mexican-American and Native-American communities. Many minority cultures have a long history of using herbal preparations to treat diabetes, and recent research suggests that some herbal therapies may have a role in the treatment of this complex disease. However, many questions remain regarding the proper use of herbal therapies for diabetes, particularly in regard to dosage and contaminants. Therefore, physicians who work with minority populations should ask patients about their use of these therapies and must become knowledgeable about their safety and efficacy.

Religious commitment and health status: a review of the research and implications for family medicine.

The empirical literature from epidemiological and clinical studies regarding the relationship between religious factors (eg, frequency of religious attendance, private religious involvement, and relying on one's religious beliefs as a source of strength and coping) and physical and mental health status in the areas of prevention, coping, and recovery was reviewed. Empirical studies from the published literature that contained at least 1 measure of subjects' religious commitment and at least 1 measure of their physical or mental health status were used. In particular, studies that examined the role of religious commitment or religious involvement in the prevention of illness, coping with illnesses that have already arisen, and recovery from illness were highlighted. A large proportion of published empirical data suggest that religious commitment may play a beneficial role in preventing mental and physical illness, improving how people cope with mental and physical illness, and facilitating recovery from illness. However, much still remains to be investigated with improved studies that are specially designed to investigate the connection between religious involvement and health status. Nevertheless, the available data suggest that practitioners who make several small changes in how patients' religious commitments are broached in clinical practice may enhance health care outcomes.

Issues in the use of complementary/alternative medical therapies for low back pain.

Unfortunately, current conventional medical treatments for low back pain are not managing the problem effectively. Standard approaches to treatment, particularly surgery, may even be exacerbating the problem and causing additional pain and suffering. In this context, it is understandable that LBP patients often go outside of the conventional medical system seeking other treatment options. Conventional medical physicians who treat low back pain patients, therefore, need to become more aware of the fact that their patients may be using complementary/alternative medical therapies.

Establishing a research agenda for investigating alternative medical interventions for chronic pain.

This article describes the University of Maryland School of Medicine's Center for Complementary Medicine Research approach to developing an agenda for investigating alternative medical treatments for chronic pain syndromes. This agenda includes conducting extensive literature searches and analyses to form a knowledge base for making clinical decisions on which chronic pain syndromes are in greatest need of better therapies, as well as which alternative medical therapies offer the greatest therapeutic promise for these specific chronic pain syndromes. To date, the Center has identified back pain, arthritis, and fibromyalgia as the chronic pain syndromes that contribute the greatest clinical and economic burden to overall chronic pain statistics. Not coincidentally, patients with these diagnoses are the greatest users of alternative therapies. The Center has identified acupuncture, homeopathy, manual/manipulative therapies, and mind-body therapies as the alternative medical therapies offering the greatest clinical potential for these three general chronic pain diagnoses. Preliminary data from the Center's ongoing clinical trials programs are presented.