The Use of Complementary and Alternative Medicine - Case Study Example

 Managing Chronic Conditions/Discussing Complementary and Alternative Conditions (CAM) Introduction The use of complementary and alternative medicine (CAM) is one of the methods of practice which have been accepted into the folds of modern medicine. The use of herbal medications, acupuncture, homeopathy, naturopathy, and energy therapies are just some of the forms of CAM which have been incorporated into the current medical practice. The extent of its acceptance has been such that various clinics and hospitals have set aside units in their institutions in order to accommodate such alternative and complementary methods of treatment. This study will primarily consider the case of 70 year old Mrs. Xavier who has had a history of lower back pain over a 2 year period. Mrs. Xavier has had an active social life, but after two serious falls in her home, she has now been living as a semi-invalid. She has taken painkillers and anti-inflammatory medications to ease her pain and discomfort, but they have not eased her symptoms by much. Since her fall, she also has been having trouble sleeping at night and could only get 3 or 4 hours of sleep at a time. On an advice of a friend, she sought help from a chiropractor and a Bowen therapist for therapeutic massages. She also sought advice from a naturopath who claimed that she may benefit from herbal therapy to alleviate her insomnia. Based on these conditions, this paper shall now discuss the factors which may affect the client’s access to CAM. It shall also critically analyze the use of CAM regulation in Singapore. It shall present an understanding of the nursing responsibilities in the use of therapeutic massage and naturopathically prescribed herbal preparations for lower back pain self management in an acute setting. This paper shall also present the advantages and disadvantages of complementary therapies in maintaining health and well-being. Finally, it shall evaluate the effectiveness of complementary therapy in maintaining health and well-being in lower back pain. Discussion Factors affecting client access to CAM A client’s access to CAM may be affected by the physiologic process of aging (Pathak, 2009). The aging process causes a person to have decreased total body water as well as decreased lean body mass, fat, serum albumin levels (Sottosanti, 2005). It also causes decreased hepatic fusion and renal plasma flow, as well as decreased glomerular filtration rate (Sottosanti, 2005). These qualities in the elderly patient restrict her access to CAM. Most of the time, the medications of elderly patients tends to start out at a lower dosage – later increased to higher dosages depending on the patient’s tolerance. Risks in their medication intake include dementia and diminished hearing or vision attributing to poor compliance to medication regimen (Pathak, 2009). The dosages and the potency of herbal medicines and other alternative forms of treatment are difficult to control and their interactions with the patient’s regular maintenance medication cannot often be predicted (Pathak, 2009). They may in fact be taking medications which may interfere with their commonly prescribed drugs (Pathak, 2009). CAM regulation in Singapore Due to its close relations and affinity with its Chinese roots, Singapore has been very much involved with the use of alternative and complementary medicine (King’s Fund, 2008). In the 1990s their traditional Chinese medicine market increased to overwhelming proportions and this prompted the government to pass regulations on the use of alternative and complementary medicine. These regulations have been set in place in order to “enhance the standards of training in and practice of traditional practice” (King’s Fund, 2008). The standards were set in place by the government in order to supervise regulation of Traditional Chinese Medicine (TCM) and to upgrade such standards to be more in keeping with modern medicine. Part of their regulation included the establishment of a board to govern the practice of TCM. Since 2000, the government has sought to implement more laws to regulate the use of TCM; limited provisions have been set forth to regulate CAM, however regulations have been set in place in order to improve the standards of the practice and the safety of patients (King’s Fund, 2008). The practice of TCM practitioners have also been regulated under the TCM Practitioners Act of 2000 and this act has since required acupuncturists and other TCM practitioners to register their practice with the board (Ministry of Health 2003). Herbal medicines have also been regulated by the government in order to assess their quality and safety. The labeling of and the information indicated in these products have also been regulated by the government (Ministry of Health, 2003). Based on the above regulations, Singapore seems to be adequately regulating its CAM use. It has set forth laws which regulate the practice and the use of traditional medicines. It is important to note however that these measures are not wholly adequate. Admittedly, their regulations of some practices in CAM are not yet set in place. These limitations have resulted to incidents of poisoning as documented by emergency care and CAM practitioners. These cases illustrate how the traditional medicine practice in Singapore has not been fully and adequately regulated. These incidents are unfortunate because they could have been prevented through health education and adequate provisions for regulation (Phua, Cham, & Seow, 2008). The perception of people on the use of traditional medicine is safe and natural. They do not even consider the fact that using large amounts of these medications can cause toxicity (Phua, Cham, & Seow, 2008). The regulation of TCM and CAM does not include regulations which relate to health education. Health education should be made a crucial part of TCM and CAM because it helps caution the users to avoid self-medicating and to familiarize themselves about the proper usages of different herbs and herbal medicines (Phua, Cham, & Seow, 2008). There are about 10,000 herbs in TCM and about 1000 of these can have toxic effects on people. It is important to point out that although there are government regulations for TCM use, there are hardly any regulations passed on the use of herbal medicines (Phua, Cham, & Seow, 2008). There is a need for the government to focus also on the regulation of herbal medicines. Its distribution and use should only be upon the advice of trained herbalists and TCM practitioners. In the process, the regulation of TCM and of herbal medicines would be become more functional and safer for the users (Phua, Cham, & Seow, 2008). Since more people are now resorting to the use of TCM and CAM, the government needs to focus their regulations on the risks that these medicines can cause on users. “Similar stringent requirements in dispensing TCM herbs should be applied to protect the public” (Phua, Cham, & Seow, 2008, p. e133). In order to adequately ensure the safety of CAM and TCM users, it is important for the government of Singapore to focus their regulations on all aspects of CAM practice. Nursing responsibilities – therapeutic message The nurse’s responsibility in the delivery of therapeutic massage to the patient is related to pain management. Therapeutic massages are important in elderly care because they help the patient sleep and relax and it speeds up the healing process (Adams, White, & Beckett, 2010). Massage therapy is important for this patient because it highlights the importance of human touch in balancing the advances in the technological aspects of medical care. Massage therapies in the acute setting “offer the possibility to improve the experience for patients who face physical, psychological, and social challenges in an unfamiliar environment” (Adams, White, & Beckett, 2010). Different studies emphasize the fact that massage therapy is very much useful in the acute care setting. Due to its benefits to the elderly patient, the nurse has the responsibility of learning the proper techniques of therapeutic massages in order to gain favorable patient outcomes. In the administration of therapeutic massages to the elderly patient with lower back pain, the nurse must first explain the intervention to the patient and what areas of the patient’s body would be massaged (Snyder & Lindquist, 2006). The patient’s permission for the massage should also be gained. The nurse should also assess the patient’s history and determine if the patient has had massages before and if there were any adverse reactions to the massage (Snyder & Lindquist, 2006). The nurse should then assess the area to be massaged for redness, swelling, or bruising. It is also important to assess if the patient has a hypersensitivity to touch (Snyder & Lindquist, 2006). The nurse should also take the patient’s baseline blood pressure before the massage; massages tend to decrease a patient’s blood pressure. The nurse should then ask patient to verbalize feelings of lightheadedness which may signify decreased blood pressure (Snyder & Lindquist, 2006). She should also check if the patient has had a history of hypertension or heart problems. In such cases, the patient’s pulse rate and respiration should also be monitored during the massage (Snyder & Lindquist, 2006). The therapeutic massage should be gentle, not vigorous in order to avoid afflicting further injury to the patient. The nurse should check the patient for the following conditions: broken bones, varicose veins, recent surgery, severe acute pain, history of blood clots, and treatment with blood thinners (Tran, 2001). If the patient is affirmative for the above conditions, the massage should not be allowed to continue. In the use of herbal and naturopathic remedies, the nurse must again obtain a thorough and accurate history of the patient. The nurse must ask the patient if she is using herbal medicines, prescription, and over-the-counter medications (Stupay & Sivertsen, 2000). If the patient is using herbal and prescription meds, the nurse should ask the patient to bring such medicines to the hospital or acute care setting. If the use of the herbal medicines is deemed harmful to the patient, she should be asked to stop taking them. The cooperation of the patient’s family can be asked, in this case, in order to ensure that the patient would indeed stop taking said medications (Stupay & Sivertsen, 2000). If the herbal medicines are beneficial to the patient, the nurse should consider all factors affecting patient intake. These factors include drug interactions, doses, and adverse effects (Stupay & Sivertsen, 2000). The patient should also be advised not to replace her maintenance medications with herbal supplements. It is also important for the nurse to educate the patient about her herbal medicines – their indications, possible side-effects, and their adverse reactions to other medications (Stupay & Sivertsen, 2000). Advantages and disadvantages of complementary therapies Complementary therapies for lower back pain present various advantages for the patient. Therapies like chiropractic treatment is advantageous in the sense that it helps relieve chronic pain and discomfort (Ehrlich, 2005). These complementary therapies can also help the patient manage the lower back pain while avoiding dependence on prescription medicines. These therapies also teach patients various practices which they can easily integrate into their daily activities. These practices include regular exercise, “maintaining a healthy weight, and practicing good posture” (Ehrlich, 2005). Complementary therapies help teach patients proper posture, bending, and lifting techniques. These therapies also reduce muscle tension, correct posture, relieve pain, prevent chronic back problems, and improve muscle strength (Ehrlich, 2005). Complementary therapy, like special exercises for the lower back and abdomen help to strengthen the abdominal, and lower back muscles (Ehrlich, 2005). Finally, complementary medicine also offers the advantage of presenting an opportunity for active decision-making based on personal experience and professional recommendations (Crowe, et.al., 2010). In this case, the patient becomes an active participant in the management of his condition. There are some disadvantages in the self-management of lower back pain through complementary medicine. For one, there still are not enough studies to prove the effectiveness of these treatments. Moreover, even with sufficient evidence supporting their use, the self-administration of these therapies can be dangerous to the patient (Farm, 2010). Hence, there is a need for these types of treatment to be administered by a qualified CAM practitioner (Farm, 2010). In the patient’s use of chiropractic care, it has to be delivered only by an experienced chiropractor. The manipulation of joints can sometimes cause further injury (such as fractures) when done improperly by an inexperienced chiropractor (Farm, 2010). Effectiveness of complementary therapy in maintaining health and well-being Complementary therapy is very much effective in maintaining health and well-being in the patient with lower back pain. Availing of the services of a chiropractor can provide moderate relief from lower back pains and this type of treatment seems to be as effective as the conventional methods of relieving lower back pain (NCCAM, 2009). It is also a safe method of treatment and its side-effects appear to be minor and are no longer felt after 1 or 2 days. CAM therapies are very much effective forms of treatment based on studies conducted by various researchers and medical practitioners. In an assessment of 33 randomized and controlled trials, results revealed that acupuncture is more effective than sham treatment or no additional treatment (Manheimer, 2005). These studies also revealed that acupuncture, as an alternative and even as a complementary form of treatment, is effective in relieving chronic lower back pains and that it is more effective (than other active therapies) in relieving lower back pains. Major benefits in massage therapy can also be seen in the case of this patient. Massage therapy is part of the touch therapy process and studies indicate that touch therapy greatly benefits elderly patients. In a study by Yu-Shen and Taylor (1999), the authors were able to establish that patients experienced a significant reduction in their pain when they underwent touch therapy – much lower when they underwent other forms of therapy or treatment. This massage therapy also reduced their anxiety and their stress. In effect, touch therapy or massage therapy is very much effective as a complementary treatment in reducing the pain and anxiety of the patient. The above mentioned benefits are just some general indicators of the effectiveness of complementary therapy in maintaining patient health and reducing lower back pain. Other benefits for the patient may be on a more personal scale, depending on patient’s individual tolerance and response to complementary and alternative therapy. Conclusion The patient’s age affects her access to CAM. Since her physiological system has incurred wear and tear throughout the years, the use of CAM has to proceed with extreme caution. More importantly, the use of CAM must be with the advice and possible supervision of expert CAM practitioners. CAM use in Singapore is very much widespread; hence, the government has been setting forth the regulation of TCM and some aspects of CAM use. Its use of herbal medications however, has not been regulated. There is a need for Singapore to set forth regulations on the use of herbal medications. Unfavorable incidents of poisoning have already been seen in the past few years and only with adequate regulation can they be prevented. In the administration of a therapeutic massage to the patient, the nurse has to gain a patient’s accurate and comprehensive history and she must be vigilant in monitoring the patient’s blood pressure and pulse rate. In the patient’s use of herbal medications, such medications must be assessed for their effects to the patient. If these effects are not beneficial to the patient, they must be stopped. Complementary therapies are beneficial to the patient in the sense that they will relieve most of her symptoms without having to risk dependence to prescription pain medications. However, it may be disadvantageous in the sense that only a well-experienced CAM practitioner can deliver such care. In general however, the use of CAM for the patient is effective and highly beneficial. Moreover, since most elderly patients often prefer CAM therapies, higher compliance to such therapy may be gained, and consequently, improved patient outcomes may be achieved. Works Cited Adams, R., White, B., & Beckett, C. (2010) The Effects of Massage Therapy on Pain Management in the Acute Care Setting. International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice, 3(1) Crowe, M., Whitehead, L., Gagan, M., Baxter, D., & Panckhurst, A. (2010) Self-management and chronic low back pain: a qualitative study. Journal of Advanced Nursing, 66(7), pp. 1478–1486 Farm, T. (2010) Advantages and Disadvantages of Chiropractic. HubPages. Retrieved 13 September 2010 from http://hubpages.com/hub/Advantages-and-Disadvantages-of-Chiropractic King’s Fund: Singapore (2008) Regulating Complementary Medical Practitioners. Retrieved 13 September 2010 from www.kingsfund.org.uk/document.rm?id=7489 Low back pain (2010) University of Maryland. Retrieved 13 September 2010 from http://www.umm.edu/altmed/articles/low-back-000101.htm Manheimer, E., White, A., Berman, B., Forys, K., & Ernst, E. (2005) Meta-Analysis: Acupuncture for Low Back Pain. Annals of Internal Medicine, 142(8), pp. 651-663 Ministry of Health: New Zealand (2003) Complementary and Alternative Medicine Current Policies and Policy Issues in New Zealand and Selected Countries. Ministerial Advisory Committee on Complementary and Alternative Health (Publisher) Palma, C. (2010) Chiropractic Care for Back Pain. WebMd. Retrieved 13 September 2010 from http://www.webmd.com/back-pain/chiropractic-pain-relief Pathak, D. (2009) Herbal medications pose risk to elderly population. Baylor College of Medicine. Retrieved 13 September 2010 from http://www.bcm.edu/news/item.cfm?newsID=1334 Phua, D., Cham, G., & Seow, E. (2008) Two instances of chinese herbal medicine poisoning in Singapore. Singapore Medical Journal Case Report, 49(5), pp. e131 Snyder, M. & Lindquist, R. (2006) Complementary/alternative therapies in nursing. New York: Springer Publishing Sottosanti, M. (2005) Alternative Medicine and the Elderly. Associated Content. Retrieved 13 September 2010 from http://www.associatedcontent.com/article/8264/alternative_medicine_and_the_elderly.html?cat=5 Spinal Manipulation for Low-Back Pain (2009) National Center for Complementary and Alternative Medicine. Retrieved 13 September 2010 from http://nccam.nih.gov/health/pain/spinemanipulation.htm Stupay, S. & Sivertsen, L. (2000) Herbal and nutritional supplement use in the elderly. Nurse Practitioner, Springhouse Corporation ProQuest Information and Learning Company Tran, M. (2001) Geriatric massage. Encyclopedia of Alternative Medicine (Publisher) Yu-Shen, L. & Taylor, A. (1999) Effects of Therapeutic Touch in Reducing Pain and Anxiety in an Elderly Population. Integrative Medicine, 1(1), pp. 155-162 Read More