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Tufts OCW material is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License. The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors and orthopedic surgeons: The North Carolina back pain project. A comparison of physical therapy, chiropractic manipulation and provision of an educational booklet for the treatment of patients with low back pain. Steyer is an assistant professor of family medicine at the Medical University of South Carolina, Charleston, and a former Robert Wood Johnson clinical scholar at the University of Michigan, Ann Arbor. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.
Evidence for the use of naturopathic techniques often comes from the study of more specific complementary therapies.There are currently four schools of naturopathy in the United States. Individuals study many of the same topics taught in allopathic or osteopathic medical schools. Acupuncture is the ancient practice of inserting fine needles into carefully selected points located along meridians, or energy pathways, in the body.
The meridians have been documented electronically to exist, yet how the disruption of these pathways allows healing to occur remains unknown. I would emphasize to the patient the benefits of conventional chemotherapy, radiation therapy and other treatments offered by physicians who specialize in oncology.
In 1997, a National Institutes of Health (NIH) panel of experts issued a consensus statement for the use of acupuncture. I would encourage the patient to discuss his proposed homeopathic treatment with his oncologists.
According to this statement, clear evidence supports the effectiveness of acupuncture for the treatment of postoperative and chemotherapy-induced nausea and vomiting, nausea associated with pregnancy, and postoperative dental pain.3Typically, acupuncturists receive training at schools of traditional oriental medicine. If no hope is available from conventional medicine, I would try to encourage him to live one day at a time. Many of these schools are now accredited by the Accreditation Commission for Acupuncture and Oriental Medicine.

I would review each herb with the patient in detail and would ask her not to take any herb that I needed more time to review. Once I had reviewed the herbal therapy, I would try to reach a joint decision with the patient regarding what would be safe for her to take. It became an organized discipline approximately 100 years ago when Canadian Daniel David Palmer introduced it in the United States.
Ginkgo biloba is thought to stimulate functioning nerve cells and protect nerve cells from pathologic influences.
There is strong evidence that chiropractic treatment is as beneficial for low back pain as treatment given by primary care providers, orthopedists and physical therapists.5,6 The evidence for the use of chiropractic for other conditions is less compelling.
Thus, it will potentiate the effect of Coumadin and can lead to an increased risk of bleeding. Chiropractors are licensed in all 50 states and must pass either a state licensing examination or an examination given by the National Board of Chiropractic Examiners.Herbal medicine. I would let the patient know of the possible devastating outcome that may occur if he combines these drugs. If he chooses to use Ginkgo biloba, I would stop Coumadin therapy immediately and document the reason for it in the patient’s record.
The Ancient Greeks also used herbal remedies, but it was the Romans who brought herbal medicine to Northern Europe. By remaining open-minded, you can learn a lot about your patients’ use of unconventional therapies. However, as science became more established, people came to believe that synthetic ingredients were more effective than those found in nature and the use of herbal remedies quickly diminished, especially in the United States.
Today, herbs are widely used in Europe and are again gaining popularity in the United States.1,7 Some of the most popular herbal remedies include St. I recommend asking every patient about his or her use of alternative therapies during routine history taking. Encourage your patients to ask alternative providers about their background and training and the treatment modalities they use.
By doing so, your patients will be better equipped to make educated decisions about their health care.Discuss CAM therapies with your patients at every visit.

There is also no guarantee that a herbal product is formulated to ensure that the same amount of active ingredient is present in each tablet. When using herbal therapies, finding a reputable manufacturer is essential to help ensure safety, appropriate use and response.Homeopathy. If you determine the therapy might be harmful, you’ll have to ask the patient to stop using it. Instead, let me suggest that we learn more, keep the lines of communication open and become effective guides for our patients. In other words, a substance that causes symptoms in well individuals can also be used to treat the same symptoms in sick individuals. While Hippocrates understood the basic concepts of homeopathy and used some homeopathic cures, Samuel Hahnemann, a German physician and chemist founded modern homeopathy.
Three states (Arizona, Connecticut and Nevada) do require a license to practice homeopathy, and two states (Delaware and New Hampshire) regulate the practice of homeopathy without licensure.
It is most often used to treat osteoarthritis and non-union bone fractures.Diet and nutrition. Herbal therapy is considered to be the most popular alternative therapy used in the United States.
Examples include psychotherapy, meditation, guided imagery, hypnosis, biofeedback and prayer.
Used most commonly to treat nausea and vomiting (particularly for anesthesia or chemotherapy-induced hyperemesis gravidarum) and post-operative dental pain.Pharmacological and biological treatments. Examples include the use of shark cartilage, EDTA for chelation therapy (for coronary artery disease) and apiotherapy.

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