Of fish oil and back pain - complementary medicine utilization shifts since 2002

The use of complementary and alternative medicine (CAM) by Americans has held steady since 2002; however, the types of therapies adopted have changed over five years.

The Use of Complementary and Alternative Medicine in the United States, from the NIH's National Center for Complementary and Alternative Medicine, follows up the agency's 2002 report. This round, NCCAM offers more details on the use of CAM in kids, as well as CAM use by demographic factors including racial and ethnic groups.

CAM is "Complementary" when used with conventional medicine, and "Alternative" when used as a substitute.

The most commonly used CAM therapies by American adults were "nonvitamin, nonmineral, natural products" -- aka, supplements (17.7%), deep breathing exercises (12.7%), meditation (9.4%), chiropractic or osteopathic manipulation (8.6%), massage (8.3%), and yoga (6.1%). Since 2002, the increases were in deep breathing exercises, meditation, and yoga increased, along with acupuncture, massage therapy, and naturopathy.

The most commonly used supplements were fish oil/omega 3/DHA (37.4%), glucosamine (19.9%), echinacea (19.8%), flax seed oil or pills (15.9%), and ginseng (14.1%).

In terms of health conditions, back pain is by far the most prevalent reason people use CAM. A broad range of musculoskeletal problems induce people to adopt CAM, such as back issues (17.1%), neck issues (5.9%), joint pain or stiffness or other joint condition (5.2%), arthritis (3.5%), and other musculoskeletal conditions (1.8%). The use of CAM for musculoskeletal problems has remained stable since 2002.

The use of CAM for head or chest colds actually fell since 2002 -- perhaps in part due to a false-claims suit against Airborne, the popular cold-aid remedy.

NCCAM found that the use of CAM is positively correlated with number of health conditions and number of doctor visits in the past 12 months. However, 1 in 5 adults with no health conditions and 25% of adults with no doctor visits in the past 12 months used CAM therapies.

Economics plays a role in the adoption of CAM. In both 2002 and 2007, when people delayed conventional health care due to cost, the use of CAM increased.

The largest increases in CAM since 2002 have been the use of acupuncture, deep breathing exercises, massage therapy, meditation, naturopathy, and yoga. NCCAM notes that the increase in these services may in part be due to the greater number of states that license these practices. In addition, NCCAM believes that mass media stories about CAM has raised awareness of these services, further bolstering consumer usage.

Health Populi's Hot Points: Notice the proliferation of Pilates studios on your town's Main Street, and private label natural supplement brands sold by the $millions on TV shopping channels? Based on the NCCAM survey, it may be the same people buying the goods wrapped in new packages: fish oil and red rice yeast replacing the more mundane therapies.

Is it the lack of evidence that's keeping CAM adoption down? rVita, the online CAM portal with the tagline, "Trusted Information. Natural Healing," rightly states in their blog that the, "Airborne suit and a study indicating the high level of toxicity in certain herbal remedies has some wondering how best to evaluate the effectiveness of a wide range of integrative treatments."

There's been little new evidence about the clinical efficacy of CAM therapies. A PubMed search found 40 systematic reviews involving acupuncture, massage therapy, naturopathy, or yoga published between 2002 and 2007. Yet only 25% of the reviews found sufficient evidence to conclude that a given CAM therapy was effective for a given condition.

The one study that did make a difference was published in the Annals of Internal Medicine by Roger Chou, et. al., in 2007: Nonpharmacologic therapies for acute and chronic low back pain: A review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. This review found that acupuncture and massage therapy should be included among recommended therapies for treating back pain.

This recommendation was soon integrated into a joint clinical practice guideline by the American College of Physicians and the American Pain Society.

That's evidence of evidence-based medicine...and EBM working for complementary and alternative medicine, too.