WEEK 4: Complementary & Traditional Therapies

Question 1

What are Conventional treatments?

Answer 1

widely accepted approaches to medical care that have been developed and practiced within the framework of conventional medicine.

Conventional medicine, also known as Western or allopathic medicine, is the mainstream system of healthcare that is based on scientific principles, evidence-based practices, and the use of pharmaceutical drugs and surgery for treatment.

Question 2

Outline Conventional treatments for MSK disorders.

Answer 2

NSAIDS
Glucocorticoids
Disease modifying drugs
Bisphosphonates
Opioid based analgesics
Physiotherapy

Question 3

What are complementary and alternative treatments?

Answer 3

Complementary and alternative medicine (CAM) describes medical products and practices that are not part of standard care.

Question 4

What is standard care?

Answer 4

Standard care is what medical doctors and allied health professionals, such as registered nurses and physiotherapists practice.

Question 5

Compare Alternative vs. complementary medicine.

Answer 5

Alternative medicine means treatments that you use instead of standard ones.

Complementary medicine means non-standard treatments used along with standard ones.

Question 6

Outline Reasons why people use CAM treatments.

Answer 6

1. Ineffective conventional treatment
2. Side-effects of pharmaceutical treatment
3. Health beliefs
   -Reduce the stress of living with a chronic illness
   -Want to cope better
   -Perceived Safety profile of CAMs ‘Natural’
4. Advertising and attractive claims that are made about many natural products.

Question 7

Outline Common Complimentary Therapies For MSK.

Answer 7

Chiropractice
Spinal manipulation therapy
Osteopathy
Acupuncture
Traditional medicine

Question 8

Describe the basic concepts of chiropractice.

State the aims of chiropractice.

Answer 8

Chiropractice uses different approach from standard medicine

The basic concepts of chiropractic therapy are

1. the body has a powerful self-healing ability
2. the body’s structure (mainly the spine) and its function are related, and the relationship affects health
3. the goal of chiropractic therapy is to normalize this relationship.

Aims to “remove interruptions to the flow ofnerve transmission due to vertebral misalignment from any cause.
-Trauma
-Emotional stress

Question 9

Outline Chiropractic treatment modalities.

Answer 9

Adjustment (Spinal Manipulation)

Use of hands to “release the impediment to nerves caused by misaligned spinal bones” (subluxation).
It involves moving a joint in the spine to the end of its range, followed by a light thrust “adjustment.”
It realigns the bones of the spine to make them straighter.

Massage
Exercise instruction.
Ultrasound
Electrical stimulation
Traction

Question 10

Discuss the effectiveness of Spinal Manipulation Therapy SMT.

Answer 10

Spinal Manipulation Therapy SMT

High quality evidence suggests that there is no clinically relevant difference between SMT and other interventions for reducing pain and improving function in patients with chronic low-back pain.

Limited data on treatment outcomes such as
Recovery
Return-to-work
Quality Of Life
Costs Of Care

Combined chiropractic interventions slightly improved pain and disability in the short-term and pain in the medium-term for acute and sub-acute LBP.

Currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions

There was no difference in medium- and long-term disability.

Question 11

What is osteopathy?

Discuss the aim of osteopathy.

Answer 11

A form of manual therapy focusing on treating and strengthening the musculoskeletal framework (joints, muscles and spine).

Its aim is to positively affect the body’s nervous, circulatory and lymphatic systems.

Premise: Many health problems are thought to be caused by poor posture and misalignment of muscles and joints.

Question 12

State 5 Osteopathy: Key Principles.

Answer 12

All parts of the body function together in an integrated manner

The body’s ability to heal itself

If one part of the body is restricted, adaptation is required otherwise inflammation, pain, stiffness and other health conditions result.

Osteopathic treatment reduces pain and stress

Leads to greater mobility providing the body with the opportunity to heal itself

Question 13

Outline osteopathic Treatment Modalities.

Answer 13

Osteopathic Treatment Modalities

Broad range of treatments

Soft tissue stretching
Deep tactile pressure,
Joint mobilization/manipulation (repetitive springing motions or repetitive concentric movements of A joint.

Question 14

Describe Osteopathic tools.

Answer 14

Practitioners use knuckles, elbows, or other tools to slowly stretch the restricted fascia by applying a fewkilograms-force.

Direct myofascial release seeks for changes in the myofascial structures by stretching, elongation of fascia, or mobilizing adhesive tissues.

The practitioner moves slowly through the layers of the fascia until the deep tissues are reached.

Question 15

Where did acupuncture originate from?

Describe the basic principle of acupuncture.

Describe the process.

Answer 15

Originated in China more than 2,000 years ago

Method of encouraging the body to promote natural healing and to improve functioning.

This is done by inserting needles and applying heat or electrical stimulation at very precise acupuncture points.

Question 16

Describe the principle of acupuncture.

Answer 16

Meridians- channels of energy (Qi) run in regular patterns through the body and over its surface.

Are like rivers flowing through the body to irrigate and nourish the tissues.

An obstruction in the movement of these energy rivers is like a dam that backs up in others.

The acupuncture needles unblock obstructions at the dams and reestablish the regular Qi flow through the meridians.

Acupuncture treatments supposedly help the body’s internal organs to correct imbalances in their digestion, absorption, and energy production activities, and in the circulation of their energy through the meridians.

Question 17

Discuss the Acupuncture-The Science.

Answer 17

Needling the acupuncture points stimulates the nervous system to release chemicals in the muscles, spinal cord, and brain.

These chemicals will either change the experience of pain, or they will trigger the release of other chemicals and hormones which influence the body’s own internal regulating system.

In theory - the improved energy and biochemical balance produced by acupuncture results in stimulating the body’s natural healing abilities, and in promoting physical and emotional well-being.

The “gate control theory” and the release of endogenous endorphins have been suggested as explanations for the apparent analgesic effect of acupuncture.

Question 18

Describe the Gate Control Theory of Pain and acupuncture.

Answer 18

Pain signals must pass through a number of “gates” as they move from the area of injury upward through the spinal cord into the brain.
These nerves can handle only a limited number of nerve signals at a time.

The pain signals travels very slowly. We can generate other signals which move faster. The faster signals crowd out the slower ones because of the limited capacity of the nerves.
the pain signals are the slow ones sitting there waiting for an opening to move through. If one can produce enough fast signals, it can effectively crowd out the pain signals.

Acupuncture generates competing stimulus and effectively blocks the slow pain signals from reaching the brain.

Question 19

Gate control theory simplified.

Answer 19

Activity in the pain fibres
opens the gate

Activity in other sensory nerves
closes the gate
Acupuncture

Messages from the brain
concentrating on the pain
or trying not to think about it

Question 20

What are acupuncture points?

Answer 20

Also calledacupoints are locations on the body that are the focus of acupuncture treatments.

Located along the meridians.

Research suggests that acupuncture points may be associated with activation of specific brain areas or areas of lowelectrical impedancein the body.

However overall evidence for the anatomical existence of acupuncture points is not compelling.

Question 21

Outline Cochrane review of 35 RCTs.

Answer 21

For chronic low-back pain,
acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only.

Acupuncture is not more effective than other conventional and “alternative” treatments.

The data suggest that acupuncture and dry-needling may be useful adjuncts to other therapies for chronic low-back pain.

Lower methodological quality studies, need for higher quality trials in this area.

Question 22

What is traditional medicine?

Answer 22

Traditional Medicine (TM) is the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness“ (1).

TM means in our context- traditional healer prescribed herbal medicines

Question 23

Discuss Use of TM in Botswana.

Answer 23

TM use is more prevalent in rural areas compared to urban areas (6).

A study done in Gaborone Village IDCC clinic (2013), reported 37% concomitant use of antiretroviral therapy and traditional medicines.

95% Herbal supplements, over 1/3 were unspecified traditional herbs while 15% took moringa.

Only 18% disclosed the use of TM and 65% disclosed to check if TM interacted with their ART (7).

Question 24

State the Common uses of traditional medicines.

Answer 24

Menstrual problem, heart problem, High BP, diabetes, evil spirits, massage, headaches, cramps, womb problems, asthma, cancer