A truly complementary approach: A qualitative exploration of complementary and alternative medicine practitioners' views of treating ankylosing spondylitis

Use of complementary and alternative medicine in patients with ankylosing spondylitis

OBJECTIVE

Some studies have shown that the use of complementary and alternative medicine (CAM) is common in patients with chronic painful conditions, such as ankylosing spondylitis (AS). This study aimed to determine the prevalence and types of CAM usage in patients with AS and to evaluate the impact of treatment adherence and beliefs about medicines on CAM usage.

METHODS

This study has a descriptive design. A total of 140 patients with AS were included. The treatment adherence of the patients was evaluated using the Morisky Green Levine Medication Adherence Scale. The Beliefs about Medicines Questionnaire (BMQ-T) was used to assess patients' beliefs about medicines.

RESULTS

Previous or current CAM usage was stated by 40% of the patients. It has been found that CAM usage was significantly high (p<0.05) in patients who were married, older, and diagnosed at older ages. The difference between patients' beliefs about medicines and CAM usage was not statistically significant (p>0.05). The BMQ-T scores were significantly different in terms of the patients' treatment adherence (p<0.05).

CONCLUSION

This study showed that approximately half of the patients with AS were using 1 CAM method. Furthermore, medication adherence and patients' beliefs about medicines did not have any impact on CAM usage, but the patients' beliefs about medicines affected treatment adherence.

Parent use of complementary medicine remedies and services for the management of respiratory tract infection in children: a qualitative study

BACKGROUND

The use of complementary and alternative medicine (CAM) is increasing globally, in both adults and children. A common condition where CAM is used in children is acute respiratory tract infection (ARTI). However, limited information exists regarding specific CAM modalities used in children, and the factors that influence a parent's decision to use CAM for ARTI in children. This research aimed to address this knowledge gap.

METHOD

This research used a qualitative descriptive approach. Parents residing in Greater Melbourne, Australia, who had children aged from 0-12 years, and had used CAM for treating ARTI in their children in the last 12 months, were eligible to participate. Parents' perspectives were captured using individual semi-structured interviews, which were then transcribed verbatim. Data were analysed using content analysis.

RESULTS

Twenty-four families were interviewed. Several strategies to improve trustworthiness were implemented. Three themes underpinning the parents' decision to use CAM emerged from the data: safety, internal drivers and external drivers. Parents used a breadth of different treatments, predominantly food as medicine, followed by aromatherapy and other CAM remedies typically found in the kitchen, to manage ARTI in their children. Parents often used both CAM practitioners and mainstream medicine to manage ARTI in their children. While mainstream medicine was typically used to rule out any sinister pathology, CAM was often used as a frontline treatment option, with food as medicine (e.g. soups) dominating. This was due in part to concerns regarding the negative aspects of pharmaceutical use. Parents utilised a diverse range of information sources to inform their decision-making, including friends, families and the internet; traditional sources of research evidence were generally not used.

CONCLUSION

Child safety was a major factor influencing a primary carer's decision to utilise CAM for ARTI. The safety and effectiveness of remedies utilised by parents now warrants further investigation.

Complementary medicine for axial spondyloarthritis: is there any scientific evidence?

PURPOSE OF REVIEW

Majority of patients with axial spondyloarthritis (axSpA) report use of complementary and alternative medicine (CAM) therapies before and even after the diagnosis, due to perceived efficacy and wide-spread belief that these modalities lack side effects. In this review, we describe the available scientific evidence for the CAM therapies in axSpA.

RECENT FINDINGS

Clinical trials of the CAM therapies in axSpA are generally hampered by small sample size, short duration, difficulties in blinding, lack of control groups and strong placebo effect. Nonetheless, exercise programs like Pilates and mind-body techniques such as Tai Chi may have favorable effect on the disease activity and function. Although not yet confirmed, the modulation of the microbiome with the help of probiotics or fecal transplant has face validity given the evolving scientific rationale. Diet has only limited role in the management of axSpA. Deep tissue massage, omega-3 fatty acids and Stanger bath were found to be useful in small studies. CAM therapies are not always entirely well tolerated, particularly the manipulative techniques like chiropractic and Tui-na in patients with advanced disease and osteoporosis. There are no trials of yoga in axSpA despite the wider acceptance and use of yoga as an effective mind-body technique.

SUMMARY

Larger and better quality clinical trials of CAM therapies are needed to confirm their efficacy and safety in the management of axSpA and to include them in the 'mainstream' medicine.

Use of Complementary and Alternative Medicine in Axial Spondyloarthritis: A Qualitative Exploration of Self-Management

Axial spondyloarthritis (axSpA) is an inflammatory rheumatic condition that is often subject to diagnostic delays. Individuals with axSpA report using complementary and alternative therapies prior to and following diagnosis, though little is known concerning reasons underlying use of such therapies. This study provides detailed insights into the motivation and experiences of complementary and alternative medicine use within a population of individuals with axSpA. Open-ended surveys were completed by 30 individuals (20–69 years; 17 females) diagnosed with axSpA. Subsequent telephone interviews were conducted with eight individuals (39–70 years; five females) diagnosed with axSpA. Data were analyzed using reflexive inductive thematic analysis. Themes of “a learning curve”, “barriers to complementary and alternative therapy use” and “complementary or mutually exclusive” illustrated how participants” increasing understanding of their condition empowered them to explore complementary and alternative therapies use as an adjunct to mainstream care. Individuals with axSpA recommended greater integration between mainstream and complementary and alternative therapies, valuing informed advice from mainstream healthcare professionals before selecting appropriate complementary and alternative therapies for potential use. Healthcare professionals should be proactive in discussing complementary and alternative therapy use with patients and supply them with details of organizations that can provide good-quality information.

"I Could Feel It!": A Qualitative Study on How Users of Complementary Medicine Experience and Form Knowledge About Treatments

Purpose: The aim of this study was to examine how users of complementary and alternative medicine (CAM) experience various forms of treatments, form knowledge about them, and understand the boundaries between CAM and conventional health care. Method: Semistructured qualitative interviews, with 10 CAM users in Sweden, analyzed with qualitative content analysis and quantitative network analysis, and subsequent network visualizations. Findings and Conclusion: The main findings stressed the importance to CAM users of bodies and physical experiences, both in experiencing and forming knowledge about treatments. Physical experience was often contrasted with theoretical understanding. Another key finding was that the CAM users seemed to set up different standards for conventional and public health care and CAM. Although scientific explanations were considered as generally important for legitimacy, and conventional health care was expected to be evidence based, they were less important to personal use and in the use of CAM. In these cases, firsthand experience of positive effects were decisive.

A retrospective study of transcutaneous electrical nerve stimulation for chronic pain following ankylosing spondylitis

This study investigated the effect of transcutaneous electrical nerve stimulation (TENS) for the treatment of patients with chronic pain after ankylosing spondylitis (AS).A total of 72 eligible patients with chronic pain following AS were included. All included patients received exercise and were assigned to a treatment group and a control group equally. In addition, patients in the treatment group also underwent TENS therapy. All patients were treated for a total of 6 weeks. The primary outcome of pain intensity was measured by visual analog scale (VAS). The secondary outcomes included degree of functional limitation, as assessed by Bath Ankylosing Spondylitis Functional Index (BASFI); and quality of life, as evaluated by Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire. All outcomes were assessed before and after 6 weeks treatment. Furthermore, adverse events were also recorded.After 6-week treatment, patients in the treatment group did not show more promising outcomes in pain reduction, as measured by VAS (P = .08); functional evaluation, as evaluated by BASFI (P = .19); as well as quality of life, as assessed by ASQoL (P = .18), compared with patients in the control group. No adverse events occurred in both groups.This study did not exert encouraging outcomes in patients with chronic pain following AS after 6-week treatment.