Complementary and Alternative Medicine

Therapy that isn’t part of mainstream medical treatment. Complementary and alternative medicine, or CAM, encompasses a wide range of mind–body therapies, massage and other types of body manipulation, homeopathy, magnets, and many dietary supplements. The name CAM refers to the two different ways these treatments are used: Complementary medicine is used along with conventional treatments; alternative medicine is used to replace them. The consensus among medical practitioners is that, if CAM for arthritis is used, it should be used to complement standard treatments, not as an alternative to them. The practice of complementing conventional treatments with CAM treatments that have scientific evidence of effectiveness is called integrative medicine.

The use of CAM is controversial, and many of its treatments have limited scientific evidence to support them. Still, CAM has gained a strong following among people with arthritis, with one survey showing about half use some form of CAM. In recent years, many forms of CAM have gained greater acceptance in conventional medicine and may be recommended by doctors, physical therapists, and other health professionals.

Mind–body therapies, such as relaxation, guided imagery, and biofeedback, have been shown to have beneficial effects on pain, physical function, psychological state, and the ability to cope in people with rheumatoid arthritis (RA). There is also some evidence that tai chi can improve the quality of life of people with RA, and that tai chi and yoga may relieve osteoarthritis (OA) pain. However, more study is needed to confirm the benefits of these treatments for people with arthritis.

Several popular CAM treatments used for arthritis involve manipulation of the body. Massage therapy, for example, has a wide following among people with arthritis and has been found in some studies to improve pain and function. Chiropractic manipulation, myofascial release, and transcutaneous electrical nerve stimulation (TENS) are among the many other physical CAM treatments used by people with arthritis. Acupuncture, a therapy involving the insertion of needles in specific areas of the body, is sometimes recommended for pain relief in people with OA; some studies have shown that acupuncture is moderately effective in improving pain, stiffness, and function.

Many dietary supplements are popular among people with arthritis. Fish oil, which contains omega-3 fatty acids, has been found in studies to relieve tender joints and morning stiffness in people with RA. Gamma-linolenic acid (GLA) is an omega-6 fatty acid found in some plants. Preliminary evidence suggests that GLA may relieve joint pain, stiffness, and tenderness in people with RA, although some preparations, particularly those from borage seeds, may harm the liver. There is less evidence for the use of other popular dietary supplements for arthritis; these include boswellia, cherry juice, ginger, green tea, thunder god vine, turmeric, and many others. Some, like thunder god vine, can have serious side effects. Also, the popular treatment method homeopathy, in which natural substances that would normally bring on symptoms of a particular disease are very heavily diluted and used to treat that disease, has not been shown to be effective in trials.

Among the most popular supplements for people with OA are glucosamine and chondroitin, which are often taken together. Because both substances are found in cartilage, the theory is that they help to repair cartilage in joints affected by OA, thereby relieving pain. A major 2006 study funded by the National Institutes of Health tested the effects of glucosamine and chondroitin in people with knee OA. The study had mixed results, with most people finding no difference between glucosamine/chondroitin and an inactive pill. A small subset of people with moderate-to-severe pain had reduced pain from taking glucosamine and chondroitin.

People using any CAM treatment should let their doctors know. Although most CAM treatments are harmless on their own, some may become dangerous in people with certain conditions or people taking certain drugs. For example, some types of massage and other types of body manipulation are not appropriate for people with the bone-thinning condition osteoporosis, and some dietary supplements, including fish oil, interact with common pain relievers. People should not assume that a product is effective and safe just because it is labeled “natural.”

Robert S. Dinsmoor is a medical writer and editor based in Massachusetts.

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