Josephine P. Briggs, M.D.
CAM approaches have sometimes been discounted in popular press as only being helpful for "life's little miseries"—trouble falling asleep, menopausal hot flashes, memory lapses, the need to lose weight, and sexual problems. I'm sure I'm not alone in thinking that these and other "little miseries" have a tremendous impact on one's quality of life and are worth researching.
CAM approaches show promise for helping with a number of very bothersome symptoms. Women with postmenopausal hot flashes may benefit from certain meditative forms of physical exercise like yoga. Acupuncture may help some cancer patients with the nausea and discomforts of chemotherapy. And relaxation techniques, several types of manual therapies and acupuncture may contribute to treating various types of pain. As we think about quality of life and what it means to be well, it is important to recognize that symptoms really matter. In fact, much of health care involves helping people find solutions for tough problems like these. As a physician, I would never diminish the importance of trying to find treatable causes of worrisome symptoms. However, for many conditions and complaints, patients need help with symptom management.
We learned from the National Health Interview Survey that the primary health conditions that lead Americans to turn to complementary and alternative medicine are some very common and troublesome symptoms. Overwhelmingly, people turn to CAM to treat pain—back and neck pain, joint pain, and headaches.
I think all physicians are well aware of the tough clinical problems posed by chronic pain management. In the last two decades there has been a growing awareness by health care providers of the importance of adequate pain control. So, we have learned to ask about pain, to use pain scales, and to talk more with our patients about pain. And in the process, we have learned how often pain is not well controlled. But it is not just a problem of inadequate prescribing; for many patients, we do not have ideal pharmacological solutions. NSAIDs upset the stomach, acetaminophen carries risk of liver disease, and narcotics are highly sedating and pose risks of dependency. So, there is a need to complement the use of drugs with other strategies. At NCCAM we are working to strengthen our portfolio of research on non-pharmacological pain management.
Safety and effectiveness are two important questions. Are the prescribed treatments—both CAM and conventional—alleviating pain and improving function? Building an evidence base is not just about looking at efficacy, but must also address whether the treatment works in a real-world setting.
So, symptoms really matter. Addressing them is key to enhancing health and well-being.