Complementary and alternative medicine

What is complementary and alternative medicine?

Complementary and alternative medicine (CAM) is the term used for treatments that are not part of standard (conventional) medical care:

• Complementary medicine is a treatment that is used together with conventional medicine.

• Alternative medicine is a treatment that is used instead of conventional medicine.

However, either term may apply for the same type of treatment. For example, a chiropractor may treat back pain without any other treatment being received (alternative), or may provide the same treatment in addition to you taking conventional medicines for pain relief, or having surgery if needed (complementary).

Conventional (or standard) medical care is used to describe the system in which doctors and other healthcare professionals treat symptoms and diseases using medicines, radiotherapy, or surgery. Physiotherapy and dietetics are other examples of conventional medical care. See also the leaflet called NHS and Other Care Options.

There a number of different complementary and alternative treatments including:

• Manipulation therapies - osteopathy and chiropractic treatment.

• Homeopathy.

• Acupuncture.

• Reflexology.

• Aromatherapy.

• Herbal remedies.

• Hypnosis.

• Macrobiotic diets.

• Faith healing.

Traditional Chinese Medicine includes forms of herbal medicine, acupuncture, cupping therapy, massage, breathing and movement exercises (qi gong), body movement exercises (t'ai chi), diet therapy, and arranging the pieces in living spaces in order to create balance with the natural world (feng shui).

Ayurvedic Medicine is the ancient Indian medical system. It is based on a natural and holistic approach to physical and mental health. Ayurvedic medicine includes diet and special diets, specific Ayurvedic medications, herbal medicine, massage, meditation, yoga, breathing and relaxation techniques, and bowel cleansing.

A 2013 review found that about 1 in 4 people in the UK used complementary and alternative medicine during any one year, and about 9 in every 20 of the population used CAMs at sometime during their lifetime. Herbal medicine was the most used CAM, followed by homeopathy, aromatherapy, massage and reflexology.

Integrative medicine is an approach to medical care that combines conventional medicine with CAM practices that have been shown to be safe and effective. This approach attempts to address the mental, physical and spiritual aspects of health.

Patient picks for Medicine information

Treatment and medication

Where to get medication in an emergency

According to one survey, a shocking 1 in 10 people visit A&E to get medicine if they run out. We all live busy lives, but emergency services are under huge strain and too many visits of this sort can cause serious delays to treatment for people who are seriously unwell. If you're taking repeat medication, you'll know when you collect your prescription exactly when you're going to run out. So how can you avoid adding to the strain on overstretched A&E services?

by Dr Sarah Jarvis MBE, FRCGP

Treatment and medication

Steroid injections

Steroid injections can be used for joint problems and rheumatoid arthritis. They can also be used for some conditions affecting soft tissues, like tendon inflammation or tennis elbow. Steroid injections can be very effective but should be used with other treatments. There is also some evidence that steroid injections may be either completely ineffective or effective for just a relatively short period of time. Other treatments may include medicines for pain relief and physiotherapy, depending on the underlying condition. The side-effects from steroid injections are uncommon. However, the injected area may be sore for the first few days after the injection.

by Dr Hayley Willacy, FRCGP

Advantages of complementary and alternative medicine

Complementary and alternative medicine is used by many people, who feel it is more natural. Some feel the holistic approach benefits them. Others find that CAM provides benefit when the conventional medical approach has not provided enough benefit, or has caused unpleasant side-effects.

Disadvantages of complementary and alternative medicine

It is always essential to make sure that your symptoms are not due to any serious condition that requires further investigation and specific treatment before using any treatment (conventional or CAMs) for your symptoms.

Treating symptoms without realising there is a serious underlying condition can delay you receiving the best treatment to cure the condition. This in turn could make the outlook (prognosis) much worse.

Although CAMs may seem more natural and holistic than most conventional medicine, CAMs can also cause side-effects, are often not effective in treating symptoms, and often don't have any effect on your underlying illness.

How effective is complementary and alternative medicine?

Strong evidence from clinical trials to see whether CAMs are safe and effective is often lacking. It is therefore much harder to decide whether CAMs may provide benefit or cause harm than it is for conventional medicine, which is always under rigorous and continued assessment for the benefits and any possible harm of treatment.

However, if you find the right CAM for you, it can have a benefit on your general well-being, a positive effect on your mind and body, and therefore an improvement in your quality of life.

Manipulation therapies - osteopathy and chiropractic

Osteopathy and chiropractic treatments involve the practitioners using their hands to work with joints, muscles and connective tissue and to diagnose and treat soft tissue imbalances and abnormalities in how your spine functions. Manipulation techniques are commonly used for low back pain, neck pain, shoulder pain, headache and sports injuries.

Osteopathy is regulated by the General Osteopathic Council. Chiropractic is regulated by the General Chiropractic Council.

National Institute for Health and Care Excellence (NICE) guidelines for the treatment of low back pain advise considering referral for manual therapy, including spinal manipulation, as one of the treatment options.

For more information, see the separate leaflet called Osteopaths and Chiropractics.

Homeopathy

Homeopathy is based on the principle that an illness can be treated with a substance, used in small amounts, that produces similar symptoms in a healthy person. Homeopathic medicines are prepared by repeated dilution of the substance. It is believed that the more the dilution, the greater the 'potency' of the homeopathic remedy.

A number of reviews of homeopathy for various conditions have found no convincing evidence that homeopathy provides benefit above a placebo effect. A placebo effect means that a treatment does not have any biological effect but, because of factors such as your own faith in the treatment provider and the treatment itself, it can still make you feel better.

The National Health and Medical Research Council of Australia released a report in 2015 stating it had concluded, having examined the available evidence, "that there are no health conditions for which there is reliable evidence that homeopathy is effective". In the UK, NICE does not recommend the use of homeopathy for any condition.

The Faculty of Homeopathy regulates the training and practice of homeopathy by medically qualified doctors and other healthcare professionals. The most experienced homeopaths have the qualifications FFHom or MFHom. The qualification LFHom indicates a doctor who may use homeopathy in a limited way for minor ailments.

For homeopaths who are not doctors, there is no single registering body. There are a number of professional organisations registering homeopaths in the UK, including The Society of Homeopaths, the British Homeopathic Association, the Alliance of Registered Homeopaths and the Institute for Complementary and Natural Medicine.

Acupuncture

Acupuncture originated in China many years ago. In the UK, it is regulated by organisations such as the British Acupuncture Council. Acupuncture is one the most commonly used CAMs.

Acupuncture is also used by practitioners within the NHS, such as as doctors, nurses and physiotherapists.

Many clinical studies have looked at the evidence for acupuncture in certain conditions. Many reviews of these studies can only conclude that further studies are needed. However, there is stronger evidence that acupuncture can be effective in the following conditions:

• Headache: particularly tension headaches.

• Migraine prevention.

• Neck pain.

• Chronic low back pain.

• Nausea and vomiting during chemotherapy.

• Nausea and vomiting after surgery.

In 2001, a large UK clinical study of 34,000 acupuncture consultations found no reports of serious adverse events (defined as events requiring hospital admission, leading to permanent disability, or resulting in death) as a result of acupuncture treatment.

Reflexology

Reflexology is a system of massage of the feet based on the idea that there are invisible zones running through the body, so that each organ, gland and each part of the body has a corresponding location in the foot.

By applying pressure to these points in the foot, it is thought that, in the target organ, blood circulation is improved, the body relaxes and organs and glands become balanced.

Reviews of clinical studies have failed to demonstrate health benefits of reflexology and trials are generally of poor quality. However, reflexology remains a popular therapy due to some reports of benefit from individual patients, and also the soothing nature of the treatment.

Aromatherapy

Aromatherapy uses plant extract essential oils that are either inhaled, used as a massage oil, applied as a cream, or added to a warm bath. It can be used to treat specific symptoms or used as a relaxant. There are over 400 essential oils, extracted from plants from all over the world.

Popular oils used include chamomile, lavender, rosemary and tea tree. Aromatherapy carrier oils (mainly extracted from nuts and seeds) are used for mixing blends of essential oils in order to make bath oils or massage oils.

Aromatherapy is used to help you feel more relaxed, but is also widely used to treat other conditions, such as chronic pain, depression, anxiety and stress, and poor sleep (insomnia).

The side-effects of aromatherapy can include allergic reactions, headache and nausea. Each essential oil has its own list of possible side-effects and some oils shouldn't be used if you have certain conditions. It is therefore very important for the aromatherapist to know if you have a medical condition, such as diabetes, epilepsy or hypertension, or if you are or may be pregnant.

There is no evidence to suggest that aromatherapy can cure or prevent any illnesses. However, some studies suggest it can promote well-being and may have a general relaxing benefit for people with mental health problems. Aromatherapy is often used to help promote well-being in people with advanced cancer.

Herbal medicine

The health properties of herbs have been used for many centuries. The concern is that many herbal remedies that are for sale have not been thoroughly tested for their benefit, side-effects, interactions with other medicines, or any adverse effects on an unborn baby.

The Medicines and Healthcare products Regulatory Agency (MHRA) is the government agency which is responsible for ensuring that medicines and medical devices work and are acceptably safe. The MHRA website provides information on herbal and homeopathic medicines (see the link in the Further Reading section below).

In particular, the MHRA has published examples of Chinese herbal medicines which contain toxic or even potentially cancer-causing ingredients. Some Chinese herbal creams, marketed as a 'natural' treatment for skin conditions such as eczema, have been found by the MHRA to contain high doses of very potent steroids.

Hypnosis

Hypnosis is provided by some healthcare professionals, and clinical psychologists as well as some without any healthcare qualifications. Hypnosis must only be practised by people who are properly trained, as problems may occur, including accident injuries or implanting false memories into your mind. The British Society of Clinical Hypnosis can help in finding a registered practitioner (see the link in the Further Reading section below).

Evidence of the benefits of hypnosis is limited but examples of conditions for which hypnosis is used as therapy include:

• Smoking cessation.

• Weight control.

• Irrational fears and phobias.

• Stress management.

• Compulsive behaviour.

• Anxiety and panic attacks.

• Pain management during labour and childbirth.

There have been a number of reviews of clinical trials showing no evidence for benefit with other uses of hypnosis, such as for irritable bowel syndrome and induction of labour.

Macrobiotic diets

The aim of special diets, such as the macrobiotic diet, is to avoid foods containing toxins. There is currently not enough evidence to support recommending a macrobiotic diet for treating cancer or any other condition.

Anyone following a strict macrobiotic diet needs dietary advice and dietary supplements to avoid developing conditions due to nutrition deficiencies, such as scurvy (vitamin C deficiency).

Faith healing

Faith healing is well documented in the Bible, along with the observation that it is only effective if you have absolute faith. Faith healing works by the placebo effect. That is to say there is no specific treatment effect but it promotes your own faith to help you feel better. There is no evidence that faith healing is able to help cure any illness.