Complementary and alternative medicine for veterans and military personnel

A growing body of research evidence shows that complementary and alternative medicine (CAM) has health benefits for US military veterans and active duty personnel, according to" Building the Evidence Base for Complementary and Integrative Medicine Use among Veterans and Military Personnel," a special December supplement to Medical Care. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The special issue presents new studies and commentaries on the benefits and increasing use of CAM techniques in the Veterans Health Administration (VHA) and other military health settings. "The papers in this supplement represent promising steps to improve the health of veterans and active military personnel," according to an introductory article by Guest Editors Stephanie L. Taylor, PhD, of Greater Los Angeles VA Healthcare System and A. Rani Elwy, PhD, of Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Mass. "They mirror the countless stories we hear from veterans and their providers about the positive effect that CAM is having on their lives."

Studies Show Value of CAM for Improving Health of Military Personnel

The supplement presents 14 original studies reporting on specific CAM therapies and on the current use, perceptions, and acceptance of CAM in veterans and current military personnel. The special issue of Medical Care is sponsored by the VHA's Office of Patient Centered Care and Cultural Transformation.

Complementary and alternative medicine therapies are increasingly available, used, and appreciated by military patients, according to Drs Taylor and Elwy. They cite statistics showing that CAM programs are now offered at nearly 90 percent of VA medical facilities. Use CAM modalities by veterans and active military personnel is as at least as high as in the general population.

Previous systematic reviews have reported benefits of CAM treatments for many of the important problems seen in military populations, including chronic pain, anxiety, posttraumatic stress disorder (PTSD), and depression. Those prior results suggest that CAM therapies are "moderately effective" for these conditions--although these conclusions must be weighed against the weaknesses of the evidence base.

Highlights of the research included in the special issue include:

• Studies reporting benefits of specific types of meditation practices. One study finds that a mindfulness-based intervention reduced depression and improved psychological well-being in veterans with PTSD. A study of mindfulness-based stress reduction for veterans shows reductions in anxiety and depression, as well as suicidal thoughts.
• A report showing beneficial effects of acupuncture for veterans with PTSD. In addition to reduced severity of PTSD symptoms, the study shows improvements in depression, pain, and physical and mental health functioning. Another study finds that most veterans use vitamins and nutritional supplements, often substituting them for prescription drugs.
• Studies showing high rates of use and favorable perceptions found of CAM modalities among veterans of the Gulf War and Operation Enduring Freedom/Operation Iraqi Freedom. Veterans with PTSD are more likely to be accepting of CAM therapies.
• Reports describing the rates and preferred types of CAM mind-body and other modalities among military members and veterans, as well as on health care providers' attitudes toward CAM. While VA providers vary in their knowledge of CAM, many perceive benefits for their patients.

A commentary by Laura P. Krejci, MSW, and colleagues of the VA's Office of Patient Centered Care & Cultural Transformation discusses the role of CAM in meeting the "number one strategic priority" of providing "personalized, proactive, patient-driven health care to veterans." Dr Wayne B. Jonas and colleagues of the Samueli Institute, Alexandria, Va., draw attention to several bodies of research on CAM in the US military. They conclude that current policy and priorities leave "the majority of active duty service members, veterans, and their families to fend for themselves, to pay for or go without the beneficial effects of CAM and integrative medicine practices."

While the studies in the special issue show progress, Drs Taylor and Elwy stress the need for additional rigorous research to better understand CAM's potential for managing important conditions seen in military populations. They conclude, "It is time for more funding to be awarded to CAM ...to improve the capacity of the field to carry out rigorous CAM research, which in turn will benefit veterans and military personnel, as well as the general population."

Study shows integrative medicine relieves pain and anxiety for cancer inpatients

Pain is a common symptom of cancer and side effect of cancer treatment, and treating cancer-related pain is often a challenge for health care providers.

The Penny George Institute for Health and Healing researchers found that integrative medicine therapies can substantially decrease pain and anxiety for hospitalized cancer patients. Their findings are published in the current issue of the Journal of the National Cancer Institute Monographs.

"Following Integrative medicine interventions, such as medical massage, acupuncture, guided imagery or relaxation response intervention, cancer patients experienced a reduction in pain by an average of 47 percent and anxiety by 56 percent," said Jill Johnson, Ph.D., M.P.H., lead author and Senior Scientific Advisor at the Penny George Institute.

"The size of these reductions is clinically important, because theoretically, these therapies can be as effective as medications, which is the next step of our research," said Jeffery Dusek, Ph.D., senior author and Research Director for the Penny George Institute.

The Penny George Institute receives funding from the National Center of Alternative and Complementary Medicine of the National Institutes of Health to study the impact of integrative therapies on pain over many hours as well as over the course of a patient's entire hospital stay.

"The overall goal of this research is to determine how integrative services can be used with or instead of narcotic medications to control pain," Johnson said.

Researchers looked at electronic medical records from admissions at Abbott Northwestern Hospital between July 1, 2009 and December 31, 2012. From more than ten thousand admissions, researchers identified 1,833 in which cancer patients received integrative medicine services.

Patients were asked to report their pain and anxiety before and just after the integrative medicine intervention, which averaged 30 minutes in duration.

Patients being treated for lung, bronchus, and trachea cancers showed the largest percentage decrease in pain (51 percent). Patients with prostate cancer reported the largest percentage decrease in anxiety (64 percent).

Complementary and Alternative Medicine for Posttraumatic Stress Disorder Symptoms

A Systematic Review

1. Helané Wahbeh, ND, MCR1,2⇑
2. Angela Senders, ND1,2
3. Rachel Neuendorf, MS2
4. Julien Cayton, BA1

1. ¹Oregon Health and Science University, Portland, OR, USA
2. ²National College of Natural Medicine, Portland, OR, USA

1. Helané Wahbeh, ND, MCR, Oregon Health and Science University, 3181 SW Sam Jackson Park Road CR120, Portland, OR 97239, USA. Email: wahbehh@ohsu.edu

Abstract

Objectives. To (1) characterize complementary and alternative medicine studies for posttraumatic stress disorder symptoms, (2) evaluate the quality of these studies, and (3) systematically grade the scientific evidence for individual CAM modalities for posttraumatic stress disorder.

Design. Systematic review. Eight data sources were searched. Selection criteria included any study design assessing posttraumatic stress disorder outcomes and any complementary and alternative medicine intervention. The body of evidence for each modality was assessed with the Natural Standard evidence-based, validated grading rationale.

Results and Conclusions. Thirty-three studies (n = 1329) were reviewed. Scientific evidence of benefit for posttraumatic stress disorder was strong for repetitive transcranial magnetic stimulation and good for acupuncture, hypnotherapy, meditation, and visualization. Evidence was unclear or conflicting for biofeedback, relaxation, Emotional Freedom and Thought Field therapies, yoga, and natural products. Considerations for clinical applications and future research recommendations are discussed.

Acupuncture enhances antidepressant effect of Seroxat

Acupuncture is more effective than oral antidepressants in improving depressive symptoms, and produces fewer side effects than tricyclic antidepressants. Despite the continued development of antidepressants and alternative/synergistic therapies, major depressive disorder has not been comprehensively recognized and treatment outcome is often insufficient. An epidemiological study addressing depression showed that poor recognition and treatment are largely linked to the lack of an accurate assessment tool and to patients' economic situation.

Prof. Yong Huang and team from Southern Medical University in China compared the clinical efficacy of acupuncture/electroacupuncture combined with an antidepressant drug, with that of an antidepressant drug alone, using the Symptom Checklist-90. Researchers found that administration of Seroxat alone or in combination with acupuncture/electroacupuncture can produce a significant effect in patients with primary unipolar depression. Furthermore, acupuncture/electroacupuncture has a rapid onset of therapeutic effect and produces a noticeable improvement in obsessive-compulsive, depressive and anxiety symptoms. These findings have been published in the Neural Regeneration Research (Vol. 9, No. 2, 2014).

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Article: "Acupuncture/electroacupuncture enhances anti-depressant effect of Seroxat: the Symptom Checklist-90 scores " by Junqi Chen1, Weirong Lin2, Shengxu Wang3, Chongqi Wang3, Ganlong Li1, Shanshan Qu3, Yong Huang3, Zhangjin Zhang4, Wei Xiao3 (1 The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong Province, China; 2 The Shenzhen TCM hospital, Shenzhen, Guangdong Province, China; 3 School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong Province, China; 4 School of Chinese Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China)

Chen JQ, Lin WR, Wang SX, Wang CQ, Li GL, Qu SS, Huang Y, Zhang ZJ, Xiao W. Acupuncture/electroacupuncture enhances anti-depressant effect of Seroxat: the Symptom Checklist-90 scores. Neural Regen Res. 2014;9(2):213-222.

Yoga-based interventions hold promise for smoking cessation

This study provided a review of evidence-based yoga interventions’ impact on smoking cessation. The researchers reviewed articles obtained from MEDLINE (PubMed), EBSCOHOST, PROQUEST, MEDINDIA, CINAHL, Alt HealthWatch, and AMED databases. Inclusion criteria were as follows: (a) study published between 2004 and 2013, (b) study published in English language, (c) study used yoga-based interventions, (d) study involved smokers with varying level of smoking, (e) study used any quantitative design, and (f) study had physiological and/or psychological outcomes. 

A total of 10 studies met the inclusion criteria. Designs were 2 pre–post tests and 8 randomized controlled trials. 

A majority of the interventions were able to enhance quitting smoking rates in the participants under study. 

Adequate Doses of Massage Treatment Necessary for Relief of Neck Pain

Neck pain is a common and debilitating condition, and massage therapy is commonly used to treat it, yet there is little quality research on the optimal dose of therapeutic massage for neck pain. Randomizing 228 patients with chronic neck pain to five different groups receiving various doses of massage for a five-week period, researchers found the benefits of massage treatments for chronic neck pain increase with dose. Specifically, they found that patients who received 30-minute treatments two or three times weekly were not significantly better than a wait-listed control group in terms of achieving a clinically meaningful improvement in neck dysfunction or pain. In contrast, patients who received 60-minute treatments two or three times weekly showed significant improvement in neck dysfunction and pain intensity compared to the control group. Compared with their control counterparts, massage participants were three times more likely to have clinically meaningful improvement in neck function if they received 60 minutes of massage twice a week and five times more likely if they received 60 minutes of massage three times a week. The authors conclude patients who receive massage treatment for chronic neck pain may not be realizing benefits from treatment because they are not receiving an effective treatment dose.

Yoga regulates stress hormones and improves quality of life for women with breast cancer undergoing radiation therapy

For women with breast cancer undergoing radiation therapy, yoga offers unique benefits beyond fighting fatigue, according to research from The University of Texas MD Anderson Cancer Center.

The preliminary findings were first reported in 2011 by Lorenzo Cohen, Ph.D., professor and director of the Integrative Medicine Program at MD Anderson, and are now published in the Journal of Clinical Oncology. This research is part of an ongoing effort to scientifically validate mind-body interventions in cancer patients and was conducted in collaboration with India's largest yoga research institution, Swami Vivekananda Yoga Anusandhana Samsthana in Bangalore, India.

Researchers found that while simple stretching exercises counteracted fatigue, patients who participated in yoga exercises that incorporated controlled breathing, meditation and relaxation techniques into their treatment plan experienced improved ability to engage in their daily activities, better general health and better regulation of cortisol (stress hormone). Women in the yoga group were also better equipped to find meaning in the illness experience, which declined over time for the women in the other two groups.

The study also assessed, for the first time, yoga benefits in cancer patients by comparing their experience with patients in an active control group who integrated simple, generic stretching exercises into their lives.

"Combining mind and body practices that are part of yoga clearly have tremendous potential to help patients manage the psychosocial and physical difficulties associated with treatment and life after cancer, beyond the benefits of simple stretching," said Cohen.

To conduct the study, 191 women with breast cancer (stage 0-3) were randomized to one of three groups: 1) yoga; 2) simple stretching; or 3) no instruction in yoga or stretching. Participants in the yoga and stretching groups attended sessions specifically tailored to breast cancer patients for one-hour, three days a week throughout their six weeks of radiation treatment.

Participants were asked to report on their quality of life, including levels of fatigue and depression, their daily functioning and a measure assessing ability to find meaning in the illness experience. Saliva samples were collected and electrocardiogram tests were administered at baseline, end of treatment, and at one, three and six months post-treatment.

Women who practiced yoga had the steepest decline in their cortisol levels across the day, indicating that yoga had the ability to help regulate this stress hormone. This is particularly important because higher stress hormone levels throughout the day, known as a blunted circadian cortisol rhythm, have been linked to worse outcomes in breast cancer.

Additionally, after completing radiation treatment, only the women in the yoga and stretching groups reported a reduction in fatigue. At one, three and six months after radiation therapy, women who practiced yoga during the treatment period reported greater benefits to physical functioning and general health. They were more likely to find life meaning from their cancer experience than the other groups.

According to Cohen, research shows that developing a yoga practice also helps patients after completing cancer treatment.

"The transition from active therapy back to everyday life can be very stressful as patients no longer receive the same level of medical care and attention. Teaching patients a mind-body technique like yoga as a coping skill can make the transition less difficult."

Through a grant from the National Cancer Institute, Cohen and his team are now conducting a Phase III clinical trial in women with breast cancer to further determine the mechanisms of yoga that lead to improvement in physical functioning, quality of life and biological outcomes during and after radiation treatment. A secondary aim of the trial, but one of great importance, stressed Cohen, is assessing cost efficiency analysis for the hospital, health care usage costs in general and examining work productivity of patients.