Category Archives: Alternative Medicine

This article was originally published here

Acta Med Indones. 2022 Jan;54(1):97-106.

ABSTRACT

BACKGROUND: The use of complementary and alternative medicine (CAM) is widespread among patients with chronic disease despite lack of supporting evidence for most CAM types. Concerned regarding higher risk of COVID-19 for HIV-infected patients, probably increase the use of CAM during COVID-19 pandemic in this population. This study aimed to assess the prevalence and factors related to CAM use among HIV-infected patients during COVID-19 pandemic, then identify drug- to-drug interaction (DDI) of antiretroviral (ARV) drugs with CAM that they used.

METHODS: The study was conducted in HIV Clinic Cipto Mangunkusumo Hospital in September-October 2021, specifically targeting adults HIV-infected patients routinely using ARV. Demographic and clinical data, including COVID-19 and vaccine history, were taken from clinic survey and hospital medical records data.

RESULTS: 554 of 1275 patients (43.5%) reported using any type of ingested CAM during COVID-19 pandemic, mostly vitamins and/or minerals. Factors related to CAM use were history of COVID-19 infection (aOR 2.28; 95% CI 1.65-3.14) and 2-5 years ARV duration compared to more than 10 years (aOR 1.4; 95% CI 1.02-1.91). Five known potential interactions involving 20 patients and two potential weak interactions involving 8 patients were found, but many of other interactions categorized as unknown. Only limited number of patients (3.8%) were aware about the drug interaction between ARV and CAM that they used.

CONCLUSION: CAM was commonly used by HIV-infected patients on ARV during the COVID-19 pandemics, but patient awareness related to CAM-ARV drug interactions was exteremely low.

PMID:35398830

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The Use of Complementary Alternative Medicine in HIV-infected Patients during COVID-19 Pandemic: Its Related Factors and Drug Interactions with...

How can this combination of treatments help create positive change for individuals struggling with addiction?

The use of opiates and resulting overdoses continue to grow.1,2 Research shows that medications can be useful for curbing cravings and preventing the misuse of narcotics.3 Even though medications have proven helpful, the lack of motivation to change and the incentives for diversion limit treatment compliance.4,5 Individuals inaccurate and unhelpful beliefs about themselves and about substances often interfere with positive change.6 Cognitive behavior therapy (CBT) has been found to be helpful when used together with medication-assisted treatment (MAT).7-9

One of the problems individuals experience when misusing substances is the powerful immediate reinforcement they receive from taking the substance. Indeed, one of the primary reasons people use substances is the immediate reinforcement which, in the moment, is much more compelling than the long-term negative consequences of continued use. By the time most individuals voluntarily talk to an addiction specialist, they have likely experienced negative consequences, including diminished pleasure, negative side effects, and negative social consequences.

Key Techniques in CBT for Substance Use

Individuals who come to treatment are often conflicted. On one hand, they have experienced negative consequences; on the other hand, they are unable to imagine that their lives could be different or better. In CBT, we work with individuals to help them change the trajectory of their lives by placing a renewed focus on the things they value. We help them imagine how their own lives could improve if they were to pursue aspirations that are aligned with their personal values. When individuals place a renewed focus on their values and personal aspirations, they can connect the short-term and long-term consequences of their actions. Individuals find motivation to change their old habits and participate in healthier activities.

With a newfound desire to make changes in their lives, individuals need to make what are often difficult decisions. In CBT, we support individuals in making decisions by doing a cost/benefit analysis. The cost/benefit analysis helps elucidate the relative positive and negative elements of engaging and not engaging in a particular action. By conducting a cost/benefit analysis, individuals gain clarity about the things they value. Accordingly, individuals may make decisions about people with whom it is in their interests to associate, which places to frequent to further their goals, and what things they can do to help them move in a positive direction.

In the throes of addiction, individuals often lose their ability to manage their schedules. In CBT, we help individuals develop schedules with a focus on 2 types of activities. One type of activity increases their level of mastery of things they either need to do or want to do. These activities could include everything from basic hygiene to developing expertise in a profession. The second type of activity increases a persons experience of pleasure, without engaging in substance use. Individuals who suffer from addiction have often lost their ability to experience pleasure when not using drugs. A CBT therapist will help individuals select activities that match their interests and include them on a master schedule designed to include all the different activities they need to do. Having scheduled activities allows less time for the individual to seek out and use substances. The feelings of mastery and pleasure serve as positive reinforcement for engaging in the various activities.

When individuals are caught up in the dynamics of addiction, they often develop negative beliefs about themselves and their abilities. This can lead them to have negative expectations that become self-fulfilling prophesies when situations play out as they predicted. After a person engages in activities that increase their level of competence and pleasure, they gather evidence that contradicts their formerly held beliefs about themselves and about substances. The newly acquired evidence starts a cycle of reinforcement based upon positive assessment, statements, and feelings about themselves. Repeatedly engaging in activities that give them a sense of competence and/or pleasure, combined with positive experiences, lays the foundation for creating new beliefs about their capabilities and capacity for positive feelings.

The continuous use of substances over an extended period can cause a person to become numb to lifes events. Once an individual gives up using substances, the renewed experience of having feelings can be unnerving. Managing emotions can become an important target for therapy. Developing a routine sleep schedule, engaging in healthier eating, and moderating physical elements of emotions may all help an individual learn to better control their feelings. Relaxation techniques, mindfulness exercises, or other activities such as yoga, prayer, and meditation can be very effective ways of helping people tolerate and manage their experience of feeling emotions that they have not felt for a long time. These techniques can be used with people from all walks of life and with varying histories related to substance misuse.

An Illustrative Case Example

Maria was a 22-year-old college student when she was referred for treatment following her arrest for drug possession and distribution. Maria had excelled academically and in multiple sports during high school. She went to college on a softball scholarship and planned to become a physical therapist. Following her freshman year, Maria tore her rotator cuff. Initially, she thought it was a minor injury and continued to play and work out. The tear got worse and, despite surgery, ended her ability to play softball at the college level. The injury was devastating to Maria because not only could she no longer play sports, but she lost her scholarship, had continuous pain and disrupted sleep, and became depressed as a result. She struggled to keep up with her studies. Her greatest relief from the physical pain and emotional upset was the oxycodone she was given following surgery. Her depression made it difficult for her to fully engage in treatment, and although her doctor recommended ibuprofen and alternative treatments, she continued to request the medication. After several months, her doctors discontinued the opiate medication.

Maria, in the meantime, had connected with others who were able to provide street drugs to fill her increasingly greater need for relief. When she was cut off by her doctors, she turned immediately to her friends. Eventually, she expanded her network of people from whom she could acquire and with whom she would share drugs. This eventually led to her arrest. Marias relationship with her parents and her old friends suffered along the way, and her parents were very concerned about her. They expressed a desire to help her find solutions. Marias attorney referred her for CBT treatment after her arrest and before any court appearances.

Initially, Maria was friendly and expressed a desire to participate in treatment. She was quite clear, though, that she did not know how to get along without opioids. Maria felt responsible for getting herself into her current predicament and felt helpless; she thought her future was hopeless and that she had lost any measure of worth. Rather than reminding her of what she had lost or lecturing her about the consequences of her continued drug use, we started therapy by focusing on the things that were important to her before her injury. Sports, academics, family, and friends were always important to her. They all seemed intricately linked to one another, and her injury seemed to take away everything she cared about.

Acknowledging the losses and the difficulties she had experienced, we talked about what her life could be like if she was able to reclaim the things she valued. Her family and academics were still important to her, and although she could not play softball, she was still capable of exercising. In session, we had her imagine that she finished school, renewed her relationship with her parents, and engaged in tolerable levels of exercise. She did not believe that she could be a physical therapist and switched her major to occupational therapy. Her vision of her aspiration served as a strong motivator to get her life back on track.

Still, Maria could not consistently resist her cravings for drugs. We taught her relaxation exercises that she found helpful for her emotional state and calming her urges, but they were not universally effective. We talked about the possibility of medication to help with her cravings. She and her parents had concerns about relying on medications to resolve medication issues, but after doing a cost/benefit analysis of the advantages and disadvantages of trying the medication versus the advantages and disadvantages of not trying the medication, Maria decided to give it a try. The medication had both agonist and antagonistic properties that worked well for controlling her urges and, to some extent, helped with her lingering pain. With those benefits, we then discussed other alternative treatments for pain that included ibuprofen and physical therapy. When Maria gained control of her urges with medication, she felt stronger.

After receiving relief from physical pain and urges to use, Maria was better able to concentrate on achieving her desired life. Initially, she found it challenging to manage her time. We worked together on an activity schedule to make time for her classes and homework. For Maria, it was important that she have a schedule that made time for her parents and other supportive friends, exercise, a routine sleep schedule, and healthy eating. As she followed her schedule and became more active, she felt more confident and competent. She changed the way she thought about herself. Rather than thinking of herself as being helpless and worthless, she recognized the power she had to do many good things with her life and felt increasing more worthwhile as a person.

It had been 3 to 4 years after Marias rotator cuff injury when she was referred for CBT treatment. Simply stated, for a variety of reasons, she had deviated from her previously successful path in life. With about 12 months of CBT and medication, she was able to get her life back on course. At that point, she had been accepted into an Accelerated Rehabilitation Disposition (ARD) program of the court, had completed her bachelors degree, and was accepted into a masters program in occupational therapy. She was still taking her medication, but did not want to have to take it forever. She exercised, but did not get the same level of pleasure as she did from playing high-level competitive sports and was still working on accepting that she could not do what she did before. She was making new, supportive friends whom she liked, although when she saw her old teammates, she experienced sadness that she could not be one of them. Maria maintained her values in life and took major steps toward achieving her aspirations. One thing she recognized was the need for her to continue using the tools she learned to stay on her path of recovery.

Concluding Thoughts

Cognitive and behavioral strategies can be useful in treating opioid use disorder, either on their own or in conjunction with medication. Alone, or with medication, CBT can improve motivation, aid in important decision-making, jumpstart behavioral activation, and facilitate the development of new beliefs about drugs, oneself, and the future. Medication can help patients control their urges so they can better focus on the work of therapy.

Dr Miller is a seasoned clinician, trainer, and administrator who provides oversight to the training and clinical services at Beck Institute as the CBT program director. For more than 25 years, he held leadership positions in a large integrated health system, including roles as director of behavioral health at WellSpan Behavioral Health, as chair of psychology for a 580-bed acute care hospital, and as chief psychologist for an APA-approved internship in clinical psychology that he founded. As a clinician, Dr Miller has used CBT to help individuals of all ages with a myriad of presenting problems coming from forensic, community, educational, and medical settings. He has conducted workshops, written professional articles, and published several resource books for lay readers about personality, depression, anxiety, and stress.

References

1. Drug overdose deaths in the U.S. top 100,000 annually. Centers for Disease Control and Prevention. Press Release. November 17, 2021. Accessed March 24, 2022. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm

2. Substance abuse and addiction statistics. National Center for Drug Abuse Statistics. February 19, 2022. Accessed March 24, 2022. https://drugabusestatistics.org/

3. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Medication-Assisted Treatment for Opioid Use Disorder. The effectiveness of medication-based treatment for opioid use disorder. In Medications for Opioid Use Disorder Save Lives. Eds. Mancher M, Leshner AI. National Academies Press. 2019.

4. Alfonsson S, Johansson K, Uddling J, Hursti T. Differences in motivation and adherence to a prescribed assignment after face-to-face and online psychoeducation: an experimental study.BMC Psychol. 2017;5(1):3.

5. Brown MT, Bussell JK. Medication adherence: WHO cares?Mayo Clin Proc. 2011;86(4):304-314.

6. Rezaeisharif A, Karimi A, Naeim M. Effectiveness of the cognitive restructuring approach on irrational beliefs and hopelessness in individuals with a substance abuse disorder: a randomized controlled trial. Addict Disord Their Treat. 2021;20(4):326-335.

7. Ray LA, Meredith LR, Kiluk BD, et nal. Combined pharmacotherapy and cognitive behavioral therapy for adults with alcohol or substance use disorders: a systematic review and meta-analysis.JAMA Netw Open. 2020;3(6):e208279.

8. Moore BA, Fiellin DA, Cutter CJ, et al. Cognitive behavioral therapy improves treatment outcomes for prescription opioid users in primary care buprenorphine treatment.J Subst Abuse Treat. 2016;71:54-57.

9. McHugh RK, Hearon BA, Otto MW. Cognitive behavioral therapy for substance use disorders.Psychiatr Clin North Am. 2010;33(3):511-525.

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Cognitive Behavior Therapy and Medication-Assisted Treatment for Opioid Use Disorder - Psychiatric Times

Increased use of Ayurvedic, naturopathy, and other such alternative medicines is reportedly leading to liver damage and many other complications during the Covid-19 pandemic, as per Dr Abby Philips of The Liver Institute, Center of Excellence in GI Sciences, Rajagiri Hospital, Aluva.

Dr Abby Philips, who goes by TheLiverDoc on Twitter, said that lack of knowledge and misconceptions about naturopathy and over-reliance on Ayurveda is leading to many such problems, especially triggered during the pandemic.

In an interview with India Today, Dr Philips alleged that there have been cases of liver damage related to the usage of Giloy, a common herb extensively used as Covid prevention medicine.

READ | Covid-19 not going anywhere for next 2-5 years, learn to live with it: Delhi health minister

Here is an excerpt of the interview with Dr Abby Philips:

Q. How has excessive usage of Ayurvedic and naturopathy medication affected people's health during the pandemic?

Much of the claimed benefits of Ayurvedic or other alternative practices for prevention and treatment of Covid-19 have been baseless and mostly extrapolated from weak foundational studies in the lab setting, none conclusively shown of use in human trials. Extraordinary claims require extraordinary evidence. Prevention of infection using herbs or herbal mixtures was rampant during the Covid-19 pandemic. Since these are not regulated like actual drugs and medicines, people were able to get them over the counter and use it for themselves. Even though none of these measures improved responses to Covid-19, some of these adversely affected our citizens.

For example, the rampant use of Giloy as prevention for Covid-19 was associated with severe liver injury leading to death and even liver transplantation in some of the affected. This is just the tip of the iceberg as many such cases due to the use of herbal supplements and multi-herbal products go undiagnosed, and hence the true incidence of this public health issue is not known at this time.

The data on Giloy-liver injury has been published from multiple centers in India and also in the form of a multicenter nationwide study recently.

Similarly, cases of Siddha medicine Kabasura Kudineer induced liver injury and heavy metal toxicities due to Ayurvedic herbal supplements were also well documented during the pandemic.

READ | Why you shouldnt miss the precautionary third Covid vaccine dose

Almost all of the published evidence on Ayurvedic herbals causing harm in the patient and the general population are not due to excessive use, but associated with prescribed suggested use. So, concluding that herbal-related side effects happen only with excessive use is wrong.

Q. About cases that are possibly related to over usage of ayurvedic and naturopathy.

We see up to three new cases of herbal liver injury in our outpatient department on a weekly basis, which drastically increased during the Covid-19 pandemic.

The common herbal liver injury cases that we see include Giloy, ashwagandha, turmeric, green-tea extract, gymnema (gurmar or madhunashini), and most of the time - due to multi-herbal drugs and multiple herbal supplements intake by a patient for a host of conditions such as diabetes, gas trouble, high blood pressure, kidney stones or gall bladder stones and fatty liver. In fact, none of the Ayurvedic herbals have been shown to be of use in any of these conditions.

The cases present with either acute hepatitis where there is just an increase in liver enzymes with or without jaundice, acute liver failure where acute hepatitis leads to liver failure requiring a transplant, or acute chronic liver failure where a stable chronic liver disease patient suddenly worsens and develops multiple organ failure after the herbal liver injury.

None of these are due to over usage - these patients use these herbal products within prescribed limits.

Q. What kind of side effects does Giloy have if consumed excessively?

Giloy can cause an autoimmune-like liver injury that can lead to liver failure requiring liver transplantation in a small group of affected patients. I must emphasize that it is NOT due to overuse or excessive use, but Giloy can cause severe liver injury when used in the prescribed doses also. This is called idiosyncratic liver injury where the liver injury is not dependent on the dose or frequency of the drug or supplement.

Almost all of the liver injury cases identified during the Covid-19 pandemic and also published in medical literature were due to normal, prescribed consumption of Giloy. Giloy has been known to modulate the immune system in such a way that it can lead to an autoimmune attack on the liver leading to severe hepatitis and liver failure.

Giloy must not be consumed by persons with autoimmune disorders and also by those in whom a diagnosed condition associated with autoimmunity, such as diabetes mellitus, hypothyroidism, lupus etc is already known.

Nonetheless, ideally, Giloy must not be consumed at all for any disease prevention or treatment, because strong evidence for clinical benefits with its consumption is lacking in current literature in the human population as studies are mostly done in lab settings, in cell cultures or fruit flies.

Q. What should be the Health Ministry's responsibility over excessive use of ayurvedic medicines?

The Health Ministry along with the Ayush Ministry must bring out joint statements with respect to Ayurvedic medications, for improving public health. This means that together, they must review current evidence of benefits and adverse events of specific herbal/alternative drugs or drug combinations and must inform the public with straightforward facts so that they (the public) and treating physicians can make an informed decision about whether they want to opt for such specific alternative treatment.

The ministry must also mention that it is not excessive use, but also prescribed and suggested doses that can lead to adverse events in the consumer. Who can develop organ damage and what are the safe limits of use of a particular herb are not usually studied with most of the supplements available in the market - because the required toxicity studies in phased trials have not been conducted. These facts must be known to the public.

Q. Any suggestions on Ayurveda, homeopathy, naturopathy, Unani, and another such alternative medicine usage by Covid patients?

Ayurveda, naturopathy, Unani, and Siddha have absolutely no role in the prevention or management of Covid-19. Any evidence to claim that they are useful is flimsy and weak. There are no human clinical trials that are of ideal quality and that have been replicated by several research groups that allow us to prescribe Ayurveda, siddha, or Unani as a preventive or therapeutic modality for Covid-19. This is a plain simple fact and the truth. So, opting for such alternative treatments is not without risks and is definitely without any known benefits.

Now, regarding homeopathy, it is well known that homeopathy does not work for any disease condition and is currently regulated to oblivion by many scientifically progressive nations worldwide. Only in India, the blind promotion of a non-science, quackery-based Homeopathy is taken forward. The best, unknown aspect of Homeopathy for Covid-19 is that Homeopaths themselves have studied Arsenicum album 30C, the Homeopathic remedy peddled by the Ayush Ministry for Covid-19 prevention, and found that Arsenicum Album 30C is absolutely useless for the prevention of Covid-19.

(Dr Abby Philips is a senior physician-scientist in Hepatology, The Liver Institute, Rajagiri Hospital, Kerala. He is also a faculty member of the Guidelines Committee on Drug-Induced Liver Injury of the Asia-Pacific Association for Study of Liver (APASL) and Clinical Advisor and Doctoral Advisory Committee Member Department of Cell and Tissue Culture Sree Chitra Tirunal Institute for Medical Sciences & Technology (Government of India). )

READ: How govt spent Rs 35,000 crore on procuring Covid-19 vaccines | RTI Exclusive

ALSO READ | Nothing to panic, says NTAGI chief after India confirms cases of XE variant of Covid

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Surge in self-medication leading to liver damage during Covid, says Dr Abby Philips - India Today

If you are over the age of 65 and have rheumatoid arthritis (RA), your physician may not be treating you as aggressively as recommended by American College of Rheumatology (ACR). Updated in 2021, the guidelines endorse early treatment with DMARDs (disease-modifying antirheumatic drugs), medications that help decrease pain and prevent joint damage. However, a study published in ACR Open Rheumatology in January 2022, conducted by researchers at University of Michigan (UofM) Medicine, found that older people were receiving this treatment in far fewer numbers than younger people who had RA.

Rheumatoid arthritis is a progressive disease; early, aggressive treatment can reduce symptoms such as fatigue and prevent irreversible joint damage.

The research team used the National Ambulatory Medical Care survey to analyze almost eight million ambulatory visits by patients aged 65 and older from 2005 to 2016 for RA, an inflammatory autoimmune disease that affects more than one million Americans. We discovered that while the guidelines recommend that everybody with the RA diagnosis should be on some form of treatment, less than half of older adults are on any form of treatment, which is lower than what we expect. In the younger population, that number is closer to 80 percent. There is undertreatment overall with the DMARDs. Even among those, the biologics are the newer medications that have significantly changed the outcomes with rheumatoid arthritis, and that are prescribed in fewer proportions in older adults, says Jiha Lee, MD, MHS, a rheumatologist at UofM Health and lead author of the study.

It concluded, DMARD use for older adults with RA remains low from both rheumatologists and PCPs [primary care physicians], including biologic DMARDs, even though American College of Rheumatology guidelines recommend earlier and more aggressive treatment of RA.

Also of interest is that 74 percent of the visits were with rheumatologists; the rest were with primary care physicians PCPs. The study found that any DMARD use was recorded at 56 percent of rheumatologist and 30 percent of PCP visits. Among visits with any DMARD use, 20 percent of rheumatologist visits had two or more DMARDs compared with 6 percent of PCP visits.

If the disease is less than treated, there's a slew of consequences that can happen with that. The most obvious ones are decreasing quality of life, increase in depression rate, increase in pain. I think it's really one of the things that we should pay attention to, says Vinicius Domingues, MD, rheumatologist from Daytona Beach, Florida, and medical advisor to CreakyJoints.

Dr. Lee theorizes that the difference in prescribing can be due to several factors, one of which is ageism. She points to research published in Rheumatology, where rheumatologists were presented with the same clinical scenario of an RA patient, only changing the ages. When the same disease script was for an older patient, the rheumatologists were less likely to suggest aggressive treatment. There may be hesitancy on the patient side but there also may be the same hesitancy on the physician side, she says.

Other concerns are:

There are a lot of other factors that play into this that have yet to be further understood. But that doesn't mean that older patients should be receiving less aggressive treatment if there are better outcomes to be achieved, says Lee.

Dr. Domingues agrees, The risk of side effects increases as you get older, so physicians often want to protect these patients, but actually, you're doing a disservice to them if you don't treat the disease.

Doctors need to get patient-informed consent. Outline to the patient the benefits and possible risks. If the answer is yes, you move forward. If the answer is no, you try to find an alternative medication that has less side-effect profile. And if nothing is achieved, then again, it's the patient decision at the end of the day, but you have to include them into the conversation, explains Domingues.

As noted earlier, PCPs tend to underprescribe for RA significantly more than rheumatologists. Lee urges seeing a rheumatologist over a PCP, if you can. Seeing your primary care doctor can help achieve early diagnosis but they're not the ones who should be responsible for prescribing the DMARDS. Its always much appreciated when they do so there is early treatment, but they should be referring you to a specialist, says Lee.

If you, as an older patient, feel your symptoms are not being well controlled, bring it up to your physician. If your doctor dismisses your concerns with Youre 78, thats what 78 feels like, look for another doctor. Domingues says patients need to be empowered to speak for themselves. You have to voice your concerns about trying to differentiate what is inflammatory arthritis, and what is osteoarthritis, regardless of age. You should mention to your doctor if treatment is not working, you're still complaining of joint pain, joint stiffness, and joint swelling. If your doctor continues not to listen, get a second opinion.

Lee adds, We see patients in the office visits but patients live with this on a day-to-day basis. The more aware and informed they are about their symptoms that they can communicate back to the physician is going to really help inform how to optimize medication use.

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Rheumatoid Arthritis Is Undertreated in Older Adults - Everyday Health

Inflammatory bowel disease (IBD) is an umbrella term for several conditions that affect the intestinal tract. IBD happens when the immune system mistakenly attacks healthy tissue in the intestines.

These are the two main types of IBD:

IBD is a chronic condition that requires lifelong management. Theres no cure for ulcerative colitis or Crohns disease.

There are treatments for IBD, with the goals of reducing inflammation, easing symptoms, and reducing flare-ups.

Lets go over current treatment options for IBD and see whats on the horizon.

The main treatments are medicines and surgery. Your doctor will recommend treatment based on whether you have ulcerative colitis or Crohns disease, as well as the severity of your symptoms.

Some medications are meant for short-term use and others can be taken longer. You may require a combination of medicines. Also, your needs will likely change over time based on symptoms, flare-ups, and remissions.

If you have any other conditions or develop one along the way, that must be taken into account. Among the medications used to treat IBD are:

Aminosalicylates, which may help prevent flare-ups and keep you in remission. These include:

Biologic therapies, which help block proteins that cause inflammation. These include:

Other newer therapies are:

Corticosteroids can help when youre having a flare-up. Theyre fast-acting and meant for short-term use. These include:

Immune system suppressors reduce inflammation and help prevent flare-ups. They can take a few weeks to a few months to start working. These include:

Your doctor may prescribe other medicines for specific symptoms. These may include:

In cases where medications arent working well enough, surgery may help improve quality of life. Some types of ulcerative colitis and Crohns disease surgery are:

Complications of IBD that can be treated surgically include:

Certain lifestyle choices may help with symptoms and affect how you feel overall.

A severe case of IBD can make it difficult to get the nutrients you need through food. But if youre thinking of taking dietary supplements, speak with a doctor so you can do it safely and effectively.

Depending on your symptoms, your doctor may recommend changes to your diet, such as:

Keeping a food diary can help you figure out which foods cause problems. Creating the right diet plan for you can take time, and it may help to meet with a dietitian.

Stress doesnt cause IBD. But living with IBD can be stressful, and that can affect you physically. You may be able to reduce the effects of stress by:

Research suggests that psychological interventions may be helpful for some people with IBD. These may include:

More research is needed to assess the effectiveness of these therapies as they relate to IBD. But if youre feeling stressed out or overwhelmed, you might want to consider seeking help from a qualified therapist. It may also be helpful to join a support group for people with IBD.

According to the National Institutes of Health, some people with Crohns disease can benefit from resting the bowel for a few days or weeks.

This involves drinking only certain liquids or not eating or drinking anything at all. You may need intravenous (IV) nutrition during this time, so its crucial that you do this under a doctors care.

Treatment for IBD has come a long way in recent decades. A wider selection of drugs for ulcerative colitis and Crohns disease is allowing a more personalized approach to treatment. Still, not everyone responds well to treatment.

The Crohns & Colitis Foundation has identified five priorities for research:

Theres also plenty of ongoing research into new and emerging therapies, such as:

You can keep up with the latest research and clinical trials through The Crohns & Colitis Foundation.

Ulcerative colitis and Crohns disease are chronic diseases. Either of these can go into remission for long periods but remission is not a cure. Theres always the chance of a relapse.

Theres no shortage of online or word-of-mouth claims of a cure for IBD. They usually involve sales of expensive:

While some of these things may improve symptoms, they are not a cure. And even natural products can interfere with medications or increase symptoms of IBD. Consult with a doctor before making drastic changes to your diet or taking new supplements of any kind.

You can learn more about complementary therapies from the National Center for Complementary and Alternative Medicine.

Maintaining a healthy diet can help manage symptoms. But theres no specific diet known to cure IBD. Its important to continue with regular medical check-ups even when youre in remission.

Ulcerative colitis and Crohns disease are the two main types of IBD. Both are chronic, inflammatory conditions that require lifelong management.

Despite claims to the contrary, theres no cure for IBD. However, there are many medications to help control flare-ups and manage symptoms. And in some cases, surgery can result in long-term remission.

Research into the exact cause of IBD is ongoing. Its a piece of the puzzle that may eventually lead to a cure. In the meantime, new and more effective treatments are improving quality of life for many people with IBD.

If you have IBD, see your doctor regularly. If your medications arent working, ask about the latest advances in treatment, as well as lifestyle adjustments that might help.

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There's No IBD Cure, But Research Is Ongoing - Healthline

Namami Wellness and Health Edu, an emerging healthcare and hospitality company, has announced the launch of its futuristic wellness centre, Namami Health Retreat and Wellness Sanctuary,at the banks of Periyar River in Ernakulum, Kerala. This retreat provideseducation and services in wellness and health through the ancient sciences of Yoga, Ayurveda, and complementary alternative medicine while integrating scientific approaches to provide a holistic 360-degree approach to enhance life expectancy.

Namami Health has partnered with different national and international organisations like The Yoga Institute, PNNM Ayurveda Medical College and Hospital, Lexi Health and Dr. Shettys Aesthetics to bring on board certified experts in Ayurveda, Naturopathy, Yoga, Acupuncture and fitness. The Namami Approach masters the field of Advanced Aesthetics by providing state-of-art Face and Body Contouring treatments with TESLA Former, Pollogen Maximus and Medifacial.

It also offers different treatments and experiences under Complementary Alternate Medicine, Namami Integrative Methods and Health Technology. Equipped with modern science and advanced technology, the team at Namami offers differentiated Wellness Formulas, keeping the guests needs and requirements in mind.

Speaking on the launch, Vikram Vishwanath, Founder & Director, Namami Wellness and Health Edu, says that, Namami Health Retreat and Wellness Sanctuary is uniquely conceptualized to provide the best of both worlds and create a steady platform to combine remedial traditional wisdom with modern day science and technology. With an aim for all to lead a happier, and healthier version of oneself, our retreat goes beyond everyday wellness retreats and curates tailor made packages with best remedies, functional medicine, post-operative care, treatments, cuisines, activities and accommodation through strategic partnerships and associations in the lap of nature and luxury.

For families with children, the retreat host plenty of fun-filled activities to help develop a childs cognitive skills and creativity. Indoor and outdoor activities are thoughtfully planned to engage every childs interest and imagination. Focusing on Digital Detox, it engages in activities like flameless cooking, jungle gyms, yoga with kids, etc. Families together can take a leisure stroll in the Butterfly Garden, and enjoy bird watching, nature walks, treks and trails.

The resort offers 79 rooms and villas, a range of culinary experiences, curated recreation spaces and a holistic approach towards a healthy lifestyle. The contemporary interiors expand the local living experience based on the traditional principles of architecture, construction and carpentry. Backed by the lush green forests of Kerala, Namami Health Retreat offers a peaceful environment for everyone on the road towards healthy lifestyle.

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Namami Health and Wellness Retreat launched in Kerala - Hotelier India

Living with arthritis and bearing with all the swelling and pain in joints is not easy. The movement restriction and unbearable pain can make everyday tasks difficult for arthritis patients. Two of the most common types of arthritis are osteoarthritis and rheumatoid arthritis, the latter being an autoimmune disorder. There is no treatment for arthritis but it can be managed effectively with diet modifications and regular physical activity. (See pics: Suffering from joint pain? Follow these Ayurveda tips for relief)

Studies have established how eating plant-based food can help improve gut bacteria composition and reduce inflammation and joint pain. In arthritis, inflammation of joints is common and by including anti-inflammatory foods in the diet, the symptoms of the joint disease can be managed. There are certain herbs and spices that make a significant impact in controlling inflammation in the body.

Prachi Mittal, Nutritionist, Diet Couture suggests herbs and spices that arthritis patients should have.

1. Aloe Vera

It is one of the most commonly used herbs in alternative medicine. Its available in many forms, such as pills, powder, gels, and as a leaf. It has anti-inflammatory properties. It doesnt have the negative gastrointestinal effects of nonsteroidal anti-inflammatory drugs (NSAIDs), commonly used for arthritis pain.

2. Ginger

Ginger is extremely effectively in managing arthritis as it helps block inflammation pathways in the body. You can include ginger in your diet by making a tea infused with fresh ginger, add powdered ginger to baked goods,

add powdered ginger or fresh ginger root to savoury dishes, or add grated fresh ginger in a salad or stir fry.

3. Green Tea

It is a popular beverage and the antioxidants in it may help fight the inflammation that occurs with RA or OA

You can take green tea as a beverage, powder (matcha) for sprinkling on food or adding to smoothies or supplements.

4. Turmeric

It is used for ages and has anti-inflammatory properties. This can be added to milk or to other curries and dishes.

5. Cinnamon

There are many ways to incorporate honey and cinnamon in your diet and lifestyle. Adding it to oatmeal, teas, or smoothies is a great option.

Apart from eating the above-mentioned foods, processed foods, salt, red meat, alcohol, among other foods that exacerbate arthritis' joint pain and inflammation must be avoided.

See the article here:

Fight arthritis pain with these amazing herbs and spices - Hindustan Times

This year, the day marks the 266th birth anniversary of famous German physician Dr Christian Friedrich Samuel Hahnemann the founding father of this branch of medicine

Representational image. AFP

World Homeopathy Day is observed on 10 April every year to celebrate the contribution of homeopathy to the world of medicine. The day marks the 266th birth anniversary of famous German physician Dr Christian Friedrich Samuel Hahnemann. Hahnemann is known as the founding father of this branch of medicine.

Apart from esteeming the founder, the day also gives people an opportunity to understand the glorious history of homeopathy and the countless miracles this crucial branch of medicine has been pulling off in the last few centuries. Homeopathy is one of the alternative practices of medicine that generally works by triggering the healing responses of the patients own body and causing fewer side effects.

It is believed by the practitioners that any sickness can be healed by inducing symptoms similar to it. Homeopathy medicines dismantle the origin of the disease completely and leave no chance for their revival in patients bodies.

History

Hahnemann was a renowned scientist, great scholar, and linguist and he was born in Paris on 10 April in the year 1755. He pioneered these alternative medicines in the late 18th century to heal diseases that seemed to be impossible nuts to crack. Hahnemann passed away on 2 July, 1843.

Significance

The day is observed to boost the success rate and create ways to develop homeopathy and make it a well-known practice of medicine around the globe. World Homeopathy Day is celebrated to spread awareness among people about the advantages of this branch of medicine and to find out the challenges associated with it and to create ways to deal with the challenges for its development and growth.

The Union government has also introduced a separate portfolio named the AYUSH ministry which encourages the Indian traditional branches of medicine like ayurveda, homeopathy, and yoga.

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World Homeopathy Day 2022: From history to significance, heres all you need to know - Firstpost

The healing arts are a group of holistic, alternative, and nonmedical practices, which practitioners claim promote health and well-being.

The healing arts include a wide range of practices, including chiropractic, art and music therapy, acupuncture, massage, aromatherapy, naturopathy, Reiki, tai chi, and numerous other practices. They may also include creative expressions in healing, especially as a part of medical care. For example, a psychotherapist may offer therapy outside, or an addiction clinic might offer hikes.

Practitioners may also refer to the healing arts as alternative medicine or complementary medicine. Alternative medicine is another option besides standard treatment, while complementary medicine is an additional form of treatment that a person can use alongside traditional Western care.

Americans are increasingly turning to the healing arts. For example, in a 2015 Gallup poll, about two-thirds of Americans said chiropractic could treat at least some types of pain. Some doctors may even recommend healing arts as a complement to standard care.

People who choose healing arts should consider the role of these practices in their care. However, they should only work with trained providers who encourage them to pursue standard medical treatments rather than asking them to replace typical treatments with healing arts.

The healing arts include a vast array of practices. Some are increasingly mainstream, such as acupuncture and chiropractic, while others remain on the fringe, such as energy healing.

Healing arts have the designation art because they do not follow traditional medical protocols. However, this does not mean they are ineffective. A number of studies suggest some healing arts may improve outcomes, especially for issues that Western medicine struggles to treat effectively, such as chronic pain.

For example, some studies state acupuncture may help with chronic pain from migraine and osteoarthritis. However, many acupuncture studies do not use well-controlled methods, do not compare acupuncture to a placebo, or find that real acupuncture performs no better than sham acupuncture.

The effectiveness of healing arts for resolving health problems varies. Reiki, for example, claims to manipulate energy fields in the body, but there is no scientific evidence to support the idea that such fields exist.

The following are some types of healing arts.

Chiropractors use manipulation techniques, such as moving portions of the body back into alignment. Many of these manipulations focus on treating the spine.

Chiropractors need to have a license in the state in which they practice. State licensing requirements vary, but many states require a college degree. Chiropractors also need to study at a chiropractic school, which takes 3 to 4 years. Some chiropractors seek additional training in specific challenges or patient groups, such as by taking classes on chiropractic and pregnancy.

A licensed chiropractor has the title of doctor of chiropractic.

Learn more about chiropractic.

Traditional Chinese medicine (TCM) uses many different methods, including herbal medicine, acupuncture, acupressure, and tai chi.

Acupuncture uses needles to redirect energy in the body, while acupressure involves placing pressure on specific pressure points to accomplish the same goal.

Acupuncture may help with some chronic pain conditions, but there are also risks, especially if a practitioner uses dirty needles or injures an organ.

Education and training requirements vary for acupuncturists but generally require that people attend acupuncture school and apply for a state license.

Other TCM practitioners may not require formal licensure but often have education in their chosen field. A tai chi practitioner, for example, may train under a respected tai chi expert.

However, it is important to note that TCM practitioners are not medical doctors.

A wide range of mind-body therapies aims to promote relaxation. Some claim to heal the body by healing the mind, and others work to increase mindfulness of the body. For example, biofeedback trains a person to notice subtle changes in bodily states, so they can increase mindfulness and better control those states.

Meditation, hypnosis, progressive muscle relaxation, breathwork, and guided meditation or imagery are also mind-body therapies.

Practitioners of these therapies do not usually need a license and are not medical providers. However, some offer these therapies as part of an umbrella of services. For example, a psychotherapist might provide guided meditation, while a medical doctor might offer biofeedback services.

A range of certifications and training programs can teach people specific techniques for mind-body therapies.

Energy therapies aim to redirect energy in or outside the body to promote healing or well-being. These practices often draw upon notions about energy within the universe or various spiritual practices.

In Reiki, one popular energy therapy, practitioners move their hands lightly just above a person to redirect energy and promote healing.

Because energy therapy does not usually involve changing anything about the body, practitioners do not usually need a license or any specific training. However, many organizations offer training and certifications in various forms of energy medicine.

Energy medicine practitioners are not medical providers. However, licensed medical providers may take additional classes in energy healing modalities, so a doctor could also be a Reiki master. Some hospitals and medical clinics may also offer energy healing.

Learn more about Reiki.

Massage therapy uses massage and pressure to relieve pain.

Each state establishes its own licensing requirements. In general, massage therapists must undergo training to familiarize themselves with various massage techniques and avoid injuring clients.

Massage therapists can also pursue a National Board Certification. This requires them to take classes at an accredited school and gain 500 to 1,000 hours of massage practice experience. They must also complete a licensing exam.

There are many types of massage. Learn more about them.

Herbal medicine refers to a wide range of practices that attempt to use plants and herbs to heal medical conditions or complement medical treatments.

However, the Food and Drug Administration (FDA) does not regulate herbal supplements, meaning anyone can recommend or take them.

Homeopathy, a popular type of herbal medicine, focuses on the belief that small doses of herbs that cause symptoms may actually reduce problematic symptoms. For example, an herb that causes nausea at high doses may counteract nausea at very low doses.

There is no single, specific path a person must take to practice homeopathy.

Some medical doctors or other clinicians, such as nurse practitioners, may recommend herbal remedies. Lay practitioners may also call themselves herbalists or homeopathic medicine experts.

Some professional organizations lobby for herbal medicine and offer formalized training. For example, 26 states offer licensure for naturopathic doctors. These professionals must complete a 4-year educational program and take a licensing exam.

Qi gong, yoga, Pilates, and other movement-based arts offer exercise and stretching. Some practitioners also claim they can help heal some medical conditions. For example, yoga may support relaxation and help with some types of pain.

These interventions do not require any specific training to practice or teach, though many people pursue certification or other programs to conduct classes.

Creative practices, such as singing, dancing, drawing, painting, and other artist expressions, can be healing.

For example, a 2020 systematic review and meta-analysis suggests that music therapy in people with Alzheimers and dementia may improve quality of life, reduce depression, and boost brain function.

A person can pursue creative practices as stand-alone therapies, such as taking a writing workshop to help manage depression. Medical providers can also integrate these practices into other therapies, such as when a nursing home offers weekly music therapy.

Learn more about creative therapy here.

Mainstream healing approaches, such as medicine and psychotherapy, may incorporate creative practices and expression as a form of healing arts. Some examples of these practices include:

For instance:

A huge range of other healing arts may help people as they pursue healing. These arts do not usually require a license to practice or teach them, although an individual could train with various organizations that promote specific interventions. Some other approaches include:

The healing arts are not a replacement for conventional medicine. Instead, they can complement and potentially improve the care a person receives, so an individual might pursue healing arts while undergoing conventional treatment. Additionally, when no conventional treatment is available, they might choose an alternative therapy anecdotally, many individuals claim that they do sometimes work.

In some cases, people use healing arts to counteract the effects of conventional medicine. For example, they might use relaxation techniques to cope with the pain of chemotherapy.

The healing arts may foster a sense of healing, offering a person more support than they get from a mainstream Western practitioner. This may foster a sense of health and healing beyond the benefits of the practice itself.

An individual who undergoes treatment from an acupuncturist or naturopath, for example, may find support from a practitioner who listens attentively and takes their concerns seriously. They may feel less frustrated, more at peace, and more hopeful about their prospects for healing.

Hope may also help heal. A 2020 study found that a greater sense of hope improved overall health, encouraged people to adopt healthy behaviors, and reduced the risks of dying from all causes.

In some cases, healing arts may act as placebos. A placebo induces improvements when a person thinks it will. Importantly, they actually work a person is not faking their improvements with a placebo.

Some healing arts may also offer a distraction from the challenges and pain of their condition. A weekly tai chi class offers something to look forward to, an incentive to exercise, and in many cases, a chance to socialize with others.

Numerous practices fall under the umbrella of healing arts, and some have strong scientific support. And while others have only weak support in the form of a few poorly designed studies, others have no scientific support at all. There is no evidence that healing arts can fully replace conventional care.

However, the healing arts may complement care, ease pain, and help a person feel more in control of their own healthcare. In some cases, insurance may cover healing arts and doctors may recommend them.

Talk with a healthcare professional about how the right healing art form may promote healing and a greater sense of wellness.

More here:

What are the healing arts? - Medical News Today

Breast cancer is one of the most common cancers amongst women in the United States, second only to skin cancer [1]. Each year, about 255,000 new cases of breast cancer are diagnosed in the United States. Additionally, about 100,000 women go on to have some form of mastectomy each year either prophylactically or as a definitive treatment [2]. Unfortunately, these procedures can be very burdensome in terms of post-operative pain and emotional burden for patients. Breast biopsies alone have been shown to contribute to anxiety and depression in women both before and after the procedure due to fear of the procedure itself as well as fear of a potential cancer diagnosis [3]. Therefore, pain management and mental health support are crucial in achieving an optimal recovery [4].

The American Society of Breast Surgeons (ASBrS) has compiled a workgroup to encourage breast surgeons to consider the use of non-opioid alternatives to combat post-operative pain control and mitigate the current opioid crisis. This workgroup has recommended the use of a multidisciplinary approach in combination with standardized quantities of narcotics. It also strongly supports the use of the enhanced recovery after surgery (ERAS) protocol [5]. ERAS protocols have successfully implemented evidence-based practices to reduce post-operative pain, nausea, vomiting, opioid use, and length of hospital stay [6]. They aim to optimize patient outcomes during the pre-surgical, surgical, and post-surgical intervals. This can be accomplished through patient education and pre-surgical counseling, early transitions to oral pain medications post-operatively, and expedited post-procedure mobilization, for example [7]. Although ERAS protocols have been proven to lower both recovery time and post-operative complications in a cost-effective manner, compliance to all protocol items can be difficult to accomplish [8-10].

Gillis et al. conducted a patient-led narrative style study assessing the ERAS protocol patient experience, which brought to light several unaddressed patient needs. The success of ERAS protocols lies in the physical components of surgical recovery; however, these protocols lack to address patients emotional needs. In Gillis et al.s study, patients felt ill-equipped to resolve stressors on their own during the pre-surgical phase and they were not informed of available community resources by their healthcare providers [11].Importantly, patients with a higher psychological burden prior to undergoing a mastectomy faced poorer post-surgical outcomes, including a higher risk of complications, prolonged hospital stays, and increased costs of care [12].

Some women with breast cancer occasionally desire to utilize alternative remedies as a complement to traditional medications [13]. Many women who chose to use complementary therapies cited experiencing greater motivation to heal and an improved sense of control over their health [14].The therapies utilized included massage, meditation, hypnosis, music, myofascial release, aromatherapy, guided imagery, and electro-puncture. The goal of this paper is to provide a systematic review of the adjunctive therapies that have been implemented to augment post-operative recovery in breast surgery patients.

A systematic literature review was conducted in order to determine what non-pharmacologic treatments could be used to optimize breast cancer patient care pre-, peri-, or post-operatively.The search terms were as follows: (alternative medicine or complementary medicine or integrative medicine or holistic medicine or natural medicine or mediation or aromatherapy or music or art or reiki or massage) and (surgery) and (pain). All articles were uploaded from PubMed into COVIDENCE, an online software program used for the production of systematic reviews. Once imported into COVIDENCE, all abstracts underwent initial screening by members of the review team. Studies included in this review required at least one alternative medicine intervention and a description of a pre-, post-, or peri-operative surgical outcome (pain, opioid requirements, infection rate, wound healing, length of stay, hospital readmission, etc.). All systematic reviews, literature reviews, meta-analyses, opinion pieces, non-English, non-human, chronic pain studies, and studies on non-surgical screening techniques (ex: ultrasound, mammography, etc.) were excluded. Articles with a focus on medicationsincluding vitamins, herbs, and supplements were also excluded from this study. Following abstract screenings, the full text of each article was screened using the predetermined inclusion/exclusion criteria, and qualitative data was extracted from all articles which met this criterion. Additionally, the references of select articles were screened in order to identify and include any additional relevant studies.

The original search identified 1,645 total papers related to surgery and holistic medical interventions. Of that, 1,625 studies were excluded because they lacked a surgical intervention on the breast.Of the 20 remaining papers, two were excluded from being non-English studies.Thus, 18 met the criteria for review (Figure 1). The alternative medicine interventions identified in this review include massage therapy, meditation, hypnosis, music, myofascial release, aromatherapy, guided imagery, acupuncture, and electro-puncture.

Massage/Reflexology

Under the overarching term massage, several studies in this review covered subtypes of massage including reflexology, Swedish massage, and acupressure. Reflexology has been used since 2330 BCE to alleviate pain and stress [15,16]. The three main theories behind its efficacy are energy channeling, the breaking down of lactic acid build up and the utilization of the neuromatrix to prevent the transmission of pain [16]. Varying pressures are applied to different areas of the foot. The area that corresponds to the breast spans the distal, dorsal aspect of the foot, proximal to the phalanges. Acupressure is a similar form of therapy that utilizes manual pressure, commonly performed with the fingertips to specific points in the body with the goal of releasing muscle tension.

Three papers utilized foot reflexology as a form of massage. Ucuzal et al. specifically used reflexology in the experimental group in addition to analgesic therapy, while the control group was provided with analgesic therapy alone. This trial demonstrated a significant improvement in pain compared to the control group following reflexology as determined by the Short-Form McGill Pain Questionnaire [17].

The two other studies compared the effectiveness of massage therapy alone to a massage therapy in combination with other interventions. Dilaveri et al. studied breast cancer patients undergoing reconstructive surgery who were evaluated post operatively using visual analog scores (VAS) to determine pain, mood, energy, relaxation, insomnia, stress, anxiety, alertness, fatigue, and tension after massage alone or with the addition of acupuncture. The massage techniques utilized included foot reflexology and Swedish massage. Using the VAS scores, Dilaveri et al. determined that stress and anxiety decreased significantly, while relaxation increased in both treatment groups. Although both groups showed improvement, the massage-only group experienced a greater effect in all metrics [18]. Similarly, Dion et al. concluded that while massage and massage with the addition of meditation individually demonstrated a benefit, the addition of meditation to massage resulted in no additional change to VAS scores when compared to the massage-only group [19].

Thus, the use of massage alone as an adjunctive therapy to patients following breast procedures has shown to be beneficial and can reduce numerous post-operative symptoms including pain and anxiety.

Myofascial Release

Fascia is the connective tissue that encases various structures in the human body. It has tremendous tensile strength and any disruption in the fascial planes can cause dysfunction, pain, and discomfort. Myofascial release is the practice of placing direct pressure on the restricted fascia until a moment of release is felt. Serra-Ano et al. studied the effectiveness of myofascial release compared to placebo manual lymphatic drainage in patients who underwent breast cancer surgery. Fascial manipulation improved the range of motion in the shoulder determined by measuring the active angular reach via a goniometer. Pain severity, measured with VAS scores, was also decreased in patients undergoing myofascial manipulation with greater significance than those undergoing placebo manual lymphatic drainage [20].

Music

Music was first reported to aid in surgical procedures in 1914 [21]. Music can be incorporated into the pre-, peri-, and post-operative time periods with the goals of reducing pain, anxiety, and improving overall patient comfort. The pathophysiology behind its benefit is thought to be due to its ability to attenuate the neuroendocrine stress response to surgery [22]. The genre, dynamics, and duration of the music played is patient dependent, as long as it is used in an appropriate clinical setting.

Six studies evaluated the effect of music on breast-related surgical procedures. Tellez et al. aimed to determine the effect of music on breast biopsies. By analyzing VAS scores, the study concluded that when compared to a standard breast biopsy, the pre- or post-operative addition of music reduced stress, pain, and anxiety [3].

Deng et al. compared the effects of music and the combination of music and aromatherapy in the peri-operative treatment of breast cancer. Patients treated with music therapy demonstrated a reduction in pain intensity and anxiety when compared to standard therapy alone and the combination of music and aromatherapy demonstrated an even greater decrease in pain intensity and anxiety [23].

Soo et al. investigated the impact of relaxing music played during an image-guided core-needle breast biopsy. Using multiple questionnaires, there was a demonstrated reduction in anxiety, fatigue, and pain when compared to the standard care control [24]. Wren et al. studied the effects of music in patients undergoing breast biopsy or breast cancer surgery. There was a significant reduction in pain in those listening to pre-, peri-, and post-operative music compared to the control group [25]. Li et al. similarly demonstrated a reduction in pain for women undergoing radical mastectomy with music therapy [26]. Thus, the addition of music therapy in breast-related surgical procedures has been shown in numerous studies to improve anxiety, fatigue, pain, and stress in the post-operative period.

Aromatherapy

Aromatherapy is the use of essential oils that come from seeds, stems, leaves, needles, petals, flowers, rinds and fruits, woods and resins, roots and rhizomes, and grasses for medical purposes [27]. Four papers explored the use of aromatherapy in breast-related procedures. Chao et al. demonstrated that aromatherapy resulted in a decrease in pain, anxiety and levels of IL-6 and HMGB-1 compared to standard therapy. While the combination of aromatherapy and music therapy was superior to either intervention alone in reducing pain and anxiety, there was no significant difference between music-only and aromatherapy-only interventions [23].

Three papers explored the effect of lavender aromatherapy. Kim et al. investigated the addition of lavender to post-operative oxygen therapy. There was no difference in narcotic requirements or objective pain scores between control and intervention; however, patients in the lavender group reported a higher satisfaction rate with pain control than control patients [28].Franco et al. explored the addition of either lavender fleur oil (LFO) or unscented oil (UO) aromatherapy in the care of breast surgery patients. The study demonstrated that the addition of LFO significantly decreased post-operative anxiety relative to the control group [29]. Shammas et al. examined the effects of lavender oil on post-operative breast cancer outcomes but found no significant differences in peri-operative depression and anxiety scores, pain scores, or sleep scores between the control and intervention groups [30].

Overall, while there were no adverse effects of aromatherapy documented, the evidence supporting the benefits of aromatherapy was mixed in the studies analyzed.

Guided Imagery, Hypnosis, and Meditation

Guided imagery is a relaxation technique, also known as visualization, that involves creating specific conscious experiences, such as imagining oneself on a beach, without the use of external stimuli [31]. When fully immersed in this technique, one can truly perceive the event created by their thoughts [32,33]. According to the United States National Center for Health Statistics, approximately five million adults report using guided imagery to reduce stress and address health-specific complaints [32]. Guided imagery is often used in combination with mediation, hypnosis, and other relaxation exercises as all of these focus on profound thought formation [34,35].

Kwekkeboom et al. tested the efficacy of guided imagery in reducing post-operative pain in women with breast and gynecologic cancers. Participants who underwent breast surgery completed guided imagery tasks and returned pain diaries 48 hours after discharge. Though this study reported a high percentage of patients opting to implement nonpharmacological pain management strategies, pain-related intensity and distress remained similar among patients who used analgesics alone and those who used an analgesic in combination with a nonpharmacologic intervention, such as guided imagery, re-positioning, heat, music, or meditation [36].

Three papers examined the impact of meditation as an intervention, one in patients undergoing autologous tissue reconstruction and two in patients undergoing breast biopsies. Using various scales, both Soo et al. and Wren et al. found that guided meditation reduced pain and anxiety about both breast surgery and the potential cancer diagnosis. Additionally, Wren et al. demonstrated a significant improvement in self-compassion and heart rate over time compared to the control group. The papers differed in that Soo et al. saw a significant reduction in fatigue scores following biopsy, while Wren et al. demonstrated no difference in fatigue compared to controls [24].

Dion et al. analyzed patients who underwent autologous tissue reconstruction and were treated with either massage or massage in combination with mediation. There was no difference in stress, anxiety, relaxation, insomnia, alertness, fatigue, tension, pain, mood, and energy between the two cohorts [19].

In two studies comparing hypnosis to a control group, both demonstrated significant psychological benefits. Schnur et al. investigated the effects of presurgical hypnosis on psychological stress in patients undergoing excisional breast biopsy. Prior to surgery, the hypnosis group had significantly improved relaxation and anxiety and decreased emotional upset and depression compared to the control group [37].

Montgomery et al. investigated the effects of adding a 15-minute hypnotic session prior to a breast-related surgical intervention. Patients receiving required less propofol and lidocaine during the intervention and had decreased post-operative pain, discomfort, fatigue, and nausea [38].

Overall, in terms of pain management, patients who took analgesics experienced similar outcomes to those using guided imagery in combination with analgesics. However, hypnosis and meditation both independently demonstrated significant pain reduction and psychological benefits for patients.

Yoga Therapy

Yoga is a practice that combines a sequence of postures with purposeful breathing and heightened self-awareness in order to achieve a state of relaxation andincreased awareness of the mind, body, and spirit [39]. In recent years, yoga and meditation practices have become an increasingly popular and accepted practice in the United States. The health benefits of yoga practice are widespread. Notably, yoga has been shown to reduce stress, improve blood glucose, blood pressure, and cholesterol levels as well contribute to weight loss [40,41]. In western medicine, Hatha yoga, a commonly practiced form of yogaplaces emphasis on the physical component of the yoga practice [40].

Sudarshan et al. investigated the effects of 12 one-hour weekly Hatha yoga sessions on anxiety, depression, range of motion, and flexibility following breast surgery. The study showed that the Hatha yoga intervention significantly improved flexibility during right and left shoulder abduction, as well as range of motion during left shoulder flexion following breast surgery-related procedure [42].

Electro-Puncture and Acupuncture

Acupuncture is a form of traditional Chinese medicine that involves the stimulation of predefined acupoints on the body in order to stimulate the central nervous system. In the most commonly used form of acupuncture, needles are inserted into the acupoints and subsequently manually manipulated by lifting or twisting the needle. Electroacupunctureis a more recently established technique involving the insertion of two needles within acupoint sites. The two needles serve as electrodes to pass an electric current. One of the major benefits of electroacupuncture is the ability to objectively and quantifiably measure the intensity of the electrical stimulation, which is not possible with the traditional form of acupuncture [43].

Bosco et al. investigated the efficacy of combined electroacupuncture and homeopathic medicine (Arnica montana and Apis mellifica) in place of opioid use in two breast surgery candidates who could not tolerate the standard medications due to liver disease. This combination provided sufficient pain relief, maintained liver function, reduced time spent in the post-surgical recovery area, and total time spent in the hospital [44].

Dilaveri et al. demonstrated that acupuncture in combination with massage resulted in decreased levels of anxiety, relaxation, nausea, fatigue, pain, and mood following breast reconstructive surgery compared to baseline. Although the benefits of this intervention were similar to the benefits of massage-only intervention in regards to fatigue, anxiety, relaxation, nausea, pain, and mood scores, the massage plus acupuncture intervention increased stress levels compared to massage alone [18].

Overall, acupuncture and electro-puncture were able to improve post-surgery outcomes and demonstrated to be helpful alternatives or adjuncts to standard treatment options.

All articles incorporated into this review are summarized inTable 1.

ERAS protocols focus on reducing post-operative pain and improving the patients overall experience. In addition to the standard care addressed in ERAS protocols, a multitude of low-risk adjunctive options exist for increasing patient satisfaction, with the potential for creating superior outcomes. The alternative practices discussed in this review outline such benefits. However, patients are often unaware that complementary measures such as these exist and most physicians do not receive education regarding implementation of these therapies in the clinical setting. Complementary therapies can be tailed to the needs and interests of patients. For instance, patients with an interest in music may benefit more from music therapy compared with patients who lack this interest. Thus, physician and patient education are critical to ensure that patients have the empowering experience of choosing the adjunctive therapies that best fits their needs.

Alternative therapies can play a role in optimizing the surgical experience for patients undergoing breast procedures, but the intervention should be tailored to each patient. If a patient has the autonomy to select which interventions they choose to utilize based on their lifestyle and personal preferences, adherence may be improved. Most interventions are fairly easy to implement and do not add a lengthy teaching component to patient-provider encounters. Additionally, many can be self-administered and/or taught through self-help books, video recordings, and classes. Once introduced in the hospital setting, many interventions can be continued at home with little or no cost to the patient. Furthermore, alternative therapies are extremely low-risk and can be utilized in patients with contraindications to standard medications or those wishing to minimize their medication exposure.

The studies reviewed should be considered in light of limitations. One limitation in several of the papers was the small sample size which could affect the power of the studies. Further studies with a larger sample size are needed to furtherstrengthen the established relationship between alternative therapies and the reduction of post-operative complications.An additional limitation inherent to alternative therapy interventions is lack of concealment or blinding. Given the impossibility of blinding individuals to interventions including massage, meditation, hypnosis, music, myofascial release, aromatherapy, guided imagery, and electro-puncture, patients are aware of the interventions they are receiving. This can lead to a placebo bias that may sway is review [45]. Studies have demonstrated that several neurotransmitter systems, such as opiate and dopamine systems, are involved in the placebo effect, which may explain its impact on pain control [46]. However, these interventions pose essentially no risk relative to their potential benefits. Therefore, the potential benefits of placebo effects may add to the rationale for implementing these interventions.

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Improving Breast Surgery Outcomes Through Alternative Therapy: A Systematic Review - Cureus