What is integrative medicine?

Integrative medicine is the practice of medicine that focuses on the whole person and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing.

It combines state-of-the-art, conventional medical treatments with other therapies that are carefully selected and shown to be effective and safe. The goal is to unite the best that conventional medicine has to offer with other healing systems and therapies derived from cultures and ideas both old and new.

Integrative medicine is based upon a model of health and wellness, as opposed to a model of disease. Whenever possible, integrative medicine favors the use of low-tech, low-cost interventions.

The integrative medicine model recognizes the critical role the practitioner-patient relationship plays in a patient's overall healthcare experience, and it seeks to care for the whole person by taking into account the many interrelated physical and nonphysical factors that affect health, wellness, and disease, including the psychosocial and spiritual dimensions of people's lives.

Many people mistakenly use the term integrative medicine interchangeably with the terms complementary medicine and alternative medicine, also known collectively as complementary and alternative medicine, or CAM. While integrative medicine is not synonymous with CAM, CAM therapies do make up an important part of the integrative medicine model.

Because, by its very nature, the components of integrative medicine cannot exist in isolation, CAM practitioners should be willing and able to incorporate the care they provide into the best practices of conventional medicine.

For example, CAM therapies such as acupuncture, yoga, meditation, and guided imagery are increasingly integrated into today's conventional treatment of heart disease, cancer, and other serious illnessesand scientific evidence supports this approach to health and healing.

Coordinating all of the care given to a patient is a cornerstone of the integrative medicine approach. Your primary care physician should work in tandem with such practitioners as your integrative medicine physician, integrative health coach, nutritionist, massage therapist, and acupuncturist.

Developed by experts at Duke Integrative Medicine, part of the Duke University Health System, the Wheel of Health is a guide to integrative medicine and health planning that represents Duke's unique approach to integrative medicine. It illustrates nine key areas of health and wellness and underscores the interrelatedness of body, mind, spirit, and community in the experience of optimum vitality and wellness, as well as in the prevention and treatment of disease.

While hundreds of CAM therapies can be used in conjunction with conventional treatments, the key to making the most of integrative medicine is to pursue only those therapies proven to be safe, effective, and appropriate for a patient's individual health status. Evidence-based CAM therapies often used in tandem with conventional medical care include the following:

Acupuncture

Acupuncture is the insertion of hair-thin, stainless steel needles into the skin at specific locations to manipulate the flow of energy in the body. The National Institutes of Health states that acupuncture is proven to treat pain, nausea, and vomiting. Other conditions for which acupuncture appears promising include asthma, menstrual cramps, and osteoarthritis.

Conventional medicine asserts that acupuncture stimulates the nervous system, which releases chemicals that change the perception of pain and influence the body's internal regulation system. Chinese medicine says it restores the body's proper energy flow, which stimulates its natural healing abilities.

Certain biofield therapies

Biofield therapies are techniques that seek to tap into and manipulate the body's own healing energy. Biofield therapies fall under the National Center for Complementary and Alternative Medicine's category of energy medicine, and they include reiki, healing touch, qigong, and polarity therapy.

Many biofield techniques involve gentle touch aimed at promoting mental, physical, and physical well-being. The goal is to facilitate unrestricted energy flow throughout the body; promote balance, peace, and relaxation; and stimulate the body's healing energy. Studies have shown some types of touch therapies to be beneficial to patients ranging from premature infants to chronic pain sufferers to cancer patients.

Guided imagery

A visualization technique that teaches people to focus on positive mental pictures, guided imagery is based upon the belief that the mind can affect the body's functions. It is used to promote relaxation, reduce stress, and help the mind effect positive changes in the body.

Proponents suggest that stimulating the brain in this way can affect the endocrine and nervous systems, which can lead to improvements in immune system function. There is also evidence that guided imagery can lower blood pressure. The best available research indicates that guided imagery is a valuable relaxation technique and is useful as a complementary therapy. At least one major health maintenance organization is now offering visualization tapes to all presurgical patients.

Hypnotherapy

A state of focused attention during which consciousness is altered and distractions are blocked, hypnosis enables people to focus deeply on one thing and is a means of promoting relaxation and reducing pain and stress.

The health-promoting benefits of hypnotherapy are widely accepted. Hypnosis can divert patients' attention away from pain by inducing a state of deep relaxation. It has been proved to alleviate nausea and vomiting. There are even documented cases of hypnotized patients undergoing surgery without anesthesia.

Some scientists believe that hypnosis causes the brain to release natural painkillers, while others think hypnosis works through the unconscious mind and the power of suggestion.

Mindfulness techniques

Mindfulness refers to moment-to-moment awareness that enables people to engage fully with the present moment, the fullness of life, and their own inner resources for healing, adapting, and growing. Through practices such as meditation, participants develop skills that enable them to relax deeply and truly experience what is going on both inside and outside themselves.

Mindful eating and mindfulness-based stress reduction (MBSR) have proved to be effective tools in whole-person medicine.

Yoga

Yoga, which means "to yoke" or "to unite," is an ancient practice designed to unify the body and mind, the individual and the universal. While Westerners typically think of hatha yoga, which stresses physical postures, breathing exercises, and meditation, there are actually many types of yoga, most of which can be practiced by people of all levels of health and fitness.Overall, the practice seeks to balance and integrate mind, body, and spirit; to enhance energy flow; and to stimulate the body's natural healing processes by teaching people how to release tension, relax, strengthen weak muscles, and stretch tight ones.

A number of other CAM therapies have proved to be effective complements to conventional medical treatments, including massage and reflexology; biofeedback and relaxation training; movement therapy; and dietary supplements such as vitamins, minerals, and herbal preparations.

More information about CAM therapies is available at the National Center for Complementary and Alternative Medicine

or in The Duke Encyclopedia of New Medicine: Conventional and Alternative Medicine for All Ages (2006).

While people turn to integrative medicine for many reasons, studies show that the majority do so because they consider it to be more aligned with their values, beliefs, and philosophies about health and life than a strictly conventional medical approach is.

Some prefer the customized, personal care that comes with integrative medicine's whole-person perspective. Others believe it is only logical to incorporate health strategies into their lives from the widest array of proven approaches possible. They think an integrative approach will allow them to achieve or maintain the best health possible.

Studies conducted at Duke Integrative Medicine show that patients who participate in integrative medicine programs realize more profound health benefits than those who don't. Such programs can be one-on-one learning with a single health coach, or they can be an "immersion" into a healthful lifestyle. An immersion program may involve several days of on-site living, during which patients participate in a number of medical and therapeutic sessions, are surrounded by a team of integrative medicine experts, and work with a health coach during and after the program.

If you're considering supplementing your conventional medical care with a complementary or alternative therapy, or if you're already practicing a nonconventional therapy, you should speak with your doctor. First, he or she may be able to recommend a qualified practitioner. Second, if your doctor is kept informed of your CAM therapies, he or she can provide medical oversight and consider those therapies when moving forward with your overall healthcare strategy.

Because integrative medicine practitioners include physicians of every specialty as well as doctors of osteopathic medicine, mental health professionals, mind-body specialists, and practitioners such as massage therapists and acupuncturists, their educational and accreditation requirements vary widely, as does the regulation of their fields.

Don't hesitate to ask about a practitioner's training and experience. Those worth their salt will have nothing to hide and should be happy to refer you to the professional organizations that trained, licensed, or certified them if you have additional questions about their qualifications.

Experts recommend that prospective patients look for practitioners who fundamentally believe in integrative medicine's mind-body-spirit-community philosophy. A useful litmus test for screening CAM practitioners is to ask about their willingness to collaborate with conventional healthcare professionals.

Patients should avoid practitioners who automatically advocate all CAM therapies or discount all conventional medicine practices. Likewise, use caution with conventional medicine practitioners who instantly write off integrative medicine or automatically advocate all mainstream medicine therapies.

Experts also suggest that prospective patients take a cue from what many of us do when choosing a conventional practitioner: Talk with people whose opinions you respect. Ask friends, family members, and coworkers to share their experiences and make recommendations.

Additional recommendations about choosing integrative medicine practitioners are available at the National Center for Complementary and Alternative Medicine or in The Duke Encyclopedia of New Medicine: Conventional and Alternative Medicine for All Ages (2006).

Many health insurance providers do not cover the complementary and alternative therapies that are often used in integrative medicine. Some cover select treatments such as including acupuncture, as well as some mind-body therapies.

Patients should speak with their insurance representatives before pursuing these treatments and be clear about exactly what type of CAM treatment they are considering as part of integrative medicine. Patients whose policies do not cover CAM therapies may wish to discuss self-payment options with prospective caregivers.

Patients who have health care reimbursement accounts through their employers will find that many integrative medicine therapies are covered by these plans.

More information on integrative medicine is available at these websites recommended by the U.S.News & World Report library.

National Center for Complementary and Alternative Medicine

Founded in the early 1990s, the National Center for Complementary and Alternative Medicine is an office of the National Institutes of Health. The center investigates integrative therapies through scientific research, then makes its findings available through its publications and website. The site boasts a wealth of information for professionals and the general public. Topics range from herbs and botanicals, massage, and mind-body medicine to how to pay for treatment and talk with your doctor. Interested users may also sign up for an E-mail newsletter and an RSS feed with the latest updates. MedLine Plus

An online service of the U.S. National Library of Medicine and the National Institutes of Health, MedLine Plus offers an overview of complementary and alternative medicine. Drawing from government, academic, and professional sources, MedLine Plus has compiled articles giving an overview of the integrative medicine field, descriptions of various treatments, links to government clinical trials, and a discussion of how integrative medicine might be used for particular groups: women, children, and seniors. Center for Integrative Medicine

This research and care center, based at the University of Maryland School of Medicine, investigates and practices integrative medicine, with a particular expertise in traditional Chinese medicine. The website's complementary and alternative medicine index contains informative articles about conditions, treatments, and herbs. The center, located in Baltimore, also runs clinical trials. Osher Center for Integrative Medicine

The Osher Center for Integrative Medicine is a multidisciplinary program at the University of California-San Francisco School of Medicine. Its goal is to combine alternative and traditional medical practices to treat all aspects of a patient: "biological, psychological, social, and spiritual." Office of Cancer Complementary and Alternative Medicine

Part of the National Cancer Institute, this office focuses on the scientific study of complementary cancer treatments. People living with cancer may be interested in the site's list of clinical trials or the publication "Thinking about Complementary and Alternative Medicine". The booklet addresses such topics as choosing a doctor, managing care, and finding trustworthy sources of information.

Memorial Sloan-Kettering Cancer Center Integrative Medicine Service

Duke Integrative Medicine

Duke Integrative Medicine is committed to transforming the way health care is delivered in the 21st century. Informed by rigorous academic research and education, our expert providers integrate the best of Western scientific medicine with proven complementary therapies to address the whole personbody, mind, spirit, and community. Our innovative model of care is focused on healing and provides personalized, comprehensive support across time. Last reviewed on 1/28/10

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Integrative medicine - US News