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Welcome to today's chat! Our topic is "Alternative Modalities For Health And Well-Being (Tai chi, Yoga, Meditation, Aromatherapy, And More)" and our guests are Ethan Basch, M.D. and Catherine (Kate) Ulbricht, Pharm.D. Ethan Basch, M.D., is co-director of the Natural Standard Research Collaboration, which provides high-level complementary and alternative medicine content for health-care institutions. He is a graduate of Harvard Medical School, and has been a faculty member at Harvard Medical School, Massachusetts General Hospital, University of Rhode Island, and Northeastern University. He serves on the editorial boards of the Journal of Herbal Pharmacotherapy, the Journal of the American Nutraceutical Association, and Harvard Health Publications. Catherine (Kate) Ulbricht, Pharm.D., is a senior attending pharmacist at Massachusetts General Hospital, and an assistant professor at Massachusetts College of Pharmacy, Northeastern University, and the University of Rhode Island. She is a founder of Natural Standard Research Collaboration, which provides high-level complementary and alternative medicine content for health-care institutions. She also is chief editor of the Journal of Herbal Pharmacotherapy. You may submit your questions at any time. Please be patient; this is a live event. When the chat starts, the questions will be read to the expert one at a time. There may be a slight delay as the answers are dictated to the transcriptionist, who then types the responses into the chat room. Please remember that it is not possible to diagnose or give specific recommendations for an individual situation. All questions will be considered with the understanding that the answers will address general issues. You should seek professional help for your personal circumstances. As soon as possible, a transcript of this chat will be available. For those interested in more information on this topic, the transcript will include links to additional resources. Question:
I have suffered a back fracture and am currently undergoing physical therapy. Is there some way of easing the pain without medication? Ethan Basch, M.D.:
Many alternative modalities have been evaluated in the management of pain. Like numerous other chronic conditions that do not have definitive conventional therapies available, people with pain may turn to alternative therapies that have limited supporting scientific evidence. Of the many alternative modalities that have been evaluated for pain, few have been well studied enough to form clear conclusions. Two therapies that have fairly convincing early evidence are hypnotherapy (hypnosis) and therapeutic touch. Other treatments such as magnet therapy, relaxation therapy, TENS (transcutaneous electrical nerve stimulation), or acupuncture have been studied without clear evidence of benefit. Hypnotherapy has been studied for multiple types of pain, including back pain, pain related to cancer, burns, dental procedures, surgery, headache, and numerous other causes. In fact, the United States National Institutes of Health issued a statement in 1995 noting that there was strong evidence supporting the effectiveness of hypnosis in the treatment of chronic cancer pain. Evidence for the use of hypnosis in other types of pain is not as strong, but does suggest some degree of effectiveness. Therapeutic touch, which is a therapy commonly used in nursing, involves the practitioner holding his or her hands a short distance from the patient without actually making contact with the patient. This approach is based on theories of "life energy" that have been criticized in some scientific and medical circles, but this remains a popular therapy with many practitioners. Although this therapy has some similarities to the practice of reiki, which is also based on concepts of life energy channels, the actual practice is different. There is evidence from initial human studies that patients with pain — particularly related to anxiety around medical conditions such as burns, muscle and joint pain, or osteoarthritis — experience improvements following therapeutic touch. In particular, studies suggest that less pain medication following surgery may be required. However, it is important to recognize that most studies have not been well designed and therefore cannot be considered definitive. Question:
Is there any scientific evidence to support the use of reflexology? Kate Ulbricht, Pharm.D.:
Reflexology involves applying pressure to specific areas or points on the feet that are believed to correspond to other body parts. Pressure may also be applied to hands or ears. Reflexology charts consist of pictures of soles of the feet with diagrams of other corresponding parts of the body. The chart may display, for example, that the toes correspond to the head or neck and that the ball of the foot to the chest and lungs, or the arch of the foot to internal organs. The right foot is believed to correspond with the right side of the body and the left foot with the left side. Exactly how reflexology might work remains unclear. None of the proposed mechanisms have been scientifically proven. One theory is that the body contains an invisible flow of energy that, when blocked, can promote illness. It is thought that stimulating nerve endings in the foot can unblock and increase the flow of vital energy to various parts of the body, promoting healing. Reflexology has been studied for stress, anxiety, premenstrual syndrome, headache, irritable bowel syndrome, and comfort in cancer patients, among other indications – although better research is necessary before recommendations can be made. There have been negative studies of reflexology for chronic lower back pain and for diagnosing diseases. Reflexology should not delay diagnosis or treatment with more proven treatments or therapies. You should inform your primary healthcare provider of your intention to try reflexology and tell your reflexology therapist about any conditions you have or medications, herbs or supplements you are taking. Reflexology is contraindicated for those with recent or healing foot fractures, unhealed wounds, or gout flares affecting the foot. Patients with osteoarthritis of the foot or ankle, or vascular disease affecting the legs or feet, should seek medical consultation before trying reflexology. It is also contraindicated during pregnancy. Question:
I am very overweight and was wondering if you think hypnosis could help me or is it just a waste of time? Ethan Basch, M.D.:
There is a small amount of scientific research evaluating the use of hypnosis for weight loss. There is initial evidence to suggest that hypnosis may provide added benefit when used in addition to cognitive behavioral therapy (a type of psychotherapy). However, it is not clear if hypnosis used alone is beneficial for weight loss. Question:
Does tai chi help to activate the immune system? Kate Ulbricht, Pharm.D.:
Tai chi is a system of movements and positions believed to have been developed in 12th-century China. The techniques aim to address the body and mind as an interconnected system, and are traditionally believed to improve posture, balance, flexibility and strength. I am not aware of any published scientific literature supporting the use of tai chi as an immuno-stimulant. Researchers have studied the reduction of risk of falls in the elderly, balance and strength maintenance, depression, anger, and fatigue. Several studies suggest that tai chi may improve heart and lung fitness, muscle strength, coordination, and decrease the risk of osteoporosis. It is not clear if these benefits are different from other forms of exercise. Like many CAM therapies, additional research is needed before a recommendation can be made. Question:
What conditions are helped by the use of aromatherapy? Kate Ulbricht, Pharm.D.:
Aromatherapy is a technique in which essential oils from plants are used with the intention of preventing or treating illness, reducing stress or enhancing well being. There is good scientific evidence for using lavender aromatherapy for anxiety. For agitation in patients with dementia, lemon balm has also shown good results. Aromatherapy sessions may last up to 90 minutes and often begin with an interview. After the aromatherapist gains an understanding of the patient's needs, the therapist selects a blend of oils. These oils are produced by steaming or cold-pressing flowers, leaves, branches, bark, rinds, or roots. The oils are then mixed with a "carrier" which is usually a vegetable oil such as soy, evening primrose, or almond. They are weakened or diluted in alcohol and are then applied to the skin, sprayed in the air or inhaled. Massage is the most common form of absorbing oils into the body through the skin. Although many gift shops sell scented candles, potpourri, and sachets, genuine aromatherapy treatments use higher strength or concentrated essential oils drawn from various herbs. Fragrance oils and products containing manufactured compounds are not used in genuine aromatherapy. Question:
Have there been studies performed which reflect viable benefits of acupuncture for various types of pain? Ethan Basch, M.D.:
Acupuncture has been used traditionally and studied for many different types of pain. This includes pain related to dental procedures, fibromyalgia, post-surgical discomfort, osteoarthritis, burns, musculoskeletal injury, low back pain, neck pain, headache, angina, and several others. There is good initial scientific evidence for pain related to dental procedures and pain related to fibromyalgia. Acupuncture has also been used for asthma, nausea, vomiting, and many more conditions. Overall, it has been difficult to form definitive scientific conclusions about the effectiveness of acupuncture for any disease or condition. This is due to the challenges involved when trying to design research in this area. For example, it is very difficult to design "placebo acupuncture" (also sometimes called "sham acupuncture"). In addition, there is wide spread variation in the ways that different practitioners administer acupuncture. Most studies do not use the same techniques, definitions of pain, or measurements of pain. Therefore, from a rigorous scientific perspective, these problems of quality and standardization prevent a firm conclusion. Many researchers are working on designing studies to overcome these problems in acupuncture research, particularly in promising areas such as dental pain and fibromyalgia. Question:
Meditation, yoga, etc. are often used in cancer treatment. Why is that? Is there something special about cancer? I often see the most alternative treatments advertising to help with this disease versus others. Ethan Basch, M.D.:
Many complementary therapies are used by cancer patients. Like many other chronic conditions, people turn to non-conventional therapies if they feel they are not getting full relief from conventional treatments. One of the reasons that these therapies are highly publicized for cancer patients is simply because cancer is a very common ailment and, therefore, represents a large market. In addition, it is common in cancer to study the effects of therapies on "quality of life" and this is a type of study that is very amenable to the examination to the affects of alternative modalities. In fact, many of these therapies — such as aromatherapy, guided imagery, massage, reflexology, reiki, spiritual healing, tai chi, and therapeutic touch — have been studied for their effects on quality of life and well-being in cancer patients. However, most of this research is early and no clear effects have been established. Nonetheless, the use of these therapies in cancer patients remains widespread and these therapies are often provided to patients at cancer centers. Question:
What is the difference between tai chi, qi gong and yoga? They all seem very similar. Kate Ulbricht, Pharm.D.:
Qi gong is a type of traditional Chinese medicine that is thought to be at least 4,000 years old. There are two main types practiced -- internal and external. Internal qi gong is a self-directed technique that involves the use of sound, movement, and meditation. Internal qi gong actively engages people in their own health and well-being and can be performed without the presence of a master instructor. It may also be practiced daily, and is believed to promote health maintenance and disease prevention. External qi gong (also known as qi emission) is performed by a master using his or her hands on a patient with the aim to project qi energy for the purpose of healing. We defined tai chi briefly earlier in the chat. The modern practice of tai chi often includes sequences of slow movements coordinated with deep breathing and mental attention. Specific forms or poses may last from 5 to 30 minutes. Tai chi is taught in classes or it can be practiced alone. Classes often included fewer than 20 people. Instructors guide pupils through movements encouraging them to keep their bodies stable and upright while shifting weight. A high level of concentration is usually involved and sessions are intensely focused and quiet, which is different from qi gong which involves making sounds. Yoga has been described as the union of body, mind and spirit. The philosophy of yoga is sometimes pictured as a tree with eight branches. There are several schools of yoga practice, which vary in the proportion of the exercises of the different limbs. However, they are similar in working towards the goal of self-realization and control of mental, physiological and psychological parameters. Yoga techniques can be learned in classes or videotaped instruction. Classes usually last from 30 to 90 minutes and are offered at various skill levels. Yoga techniques use gravity, leverage and tension through holding poses for varying lengths of time. Moderator:
Thanks for joining us today. Unfortunately, our time is up. We had a lot of great questions, and I wish we had time to get to them all! Thank you, Dr. Basch and Dr. Ulbricht, for taking time out of your busy schedules to join us this afternoon.
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