MEDRADSC 3DH3 Lecture Notes - Lecture 5: Ayurveda, Tai Chi, Naturopathy
8 Jun 2020
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Lecture #5: Complementary Therapies in Palliative Care
Review of Last Week:
What are the types (categories) of barriers that exist in the management of optimal pain management in PC?
1. Related to patient & reluctance to discuss some of their pain or realize they are in pain
2. Related to HCP - primary centered around a fear of drug abuse
3. Related to healthcare system - centered on policies for opioid use & as needed prescriptions
4. Related to institution - failure to validate pain resources that are available (ie BC vs Ontario)
5. Related to patient & family - centered around families that have a fear that their loved one will become “high”
Name the 2 categories of nociceptive pain & give an example of each
1. Somatic
a. Arising in the MSK system
b. Having a knowledge in pain & these pains exist upon movement
2. Internal organs/Visceral Pain
a. Pain originating from GI tract, pancreas, etc
b. Results in a dull ache or squeezing/cramping pain
Other type of pain is “Neuropathic Pain”
- Divided into:
1. Pain arising in CNS
2. Pain arising in PNS
Terminology: Are these terms related?
- CAM, Integrative medicine, “Western” medicine, complementary medicine, Holistic medicine (Holism), Alternative medicine,
Biomedicine, Wellness
- These terms are used interchangeably
- Often used by ppl outside the medical community & medical practitioners
“Western Medicine”
- Conventional treatments currently accepted & widely used in the Canadian HC system (ie rad therapy, chemo, surgery) - treating the
disease
- Treats the disease &/or symptoms that stem from the disease
- Opposed to a medicine that understands the disease process & targets the causes
- Many diseases triggered by inflammation by some underlying issue somewhere else in the body - issue with this medicine
- Rigorous scientific research has shown treatment to be safe & effective
- Delivered by medical doctors & other HCPs (ie nurses, MRTs, pharmacist)
- Also called allopathic medicine, biomedicine, conventional medicine, mainstream medicine, or orthodox medicine
- Orthodox: conforming to what is generally accepted as right or true; established & approved
- Cancer Care Ontario: states conventional cancer treatments are treatments currently being used in our Canadian HC system & are
widely accepted; also referred to as mainstream cancer treatments
- Typically given by HC professionals - look at destroying/treating cancer cells so they do not grow & spread
- Safe & effective against cancer (many studies show this)
Areas of Specialization
- Immunology, Hematology, Oncology, Cardiology
- Dermatology, Gastroenterology, Endocrinology, Ophthalmology
- Gynecology, Nephrology, Laryngology, Neurology
- Obstetrics, Orthopedic, Otology, Pediatrics, Urology
- Areas focus on 1 specific region of patient’s body
- Validated through years of scientific evidence
Complementary Medicine
- Used alongside (ie in addition to) conventional/western medicine
- Goal is to help improve overall health & well-being (QOL)
- Supportive role, helps patients cope with spiritual, physical & emotional aspects
- Doesn't directly treat the disease - speaks to patients overall health
- Often based on traditional knowledge (“traditional medicine”) - “east meets west” ideologies
- Includes wide range of modalities; ie) acupuncture, meditation, aromatherapy, herbal medicine, homeopathy, naturopathy, yoga
- Potential for harm/side-effects/contraindications (ie severe allergic reaction)
- May interact with conventional treatment
Examples
- Acupuncture, aromatherapy, art therapy, ayurveda
- Biofeedback, chiropractic therapy, energy therapies, guided imagery
- Hypnosis, massage therapy, medical weed & cannabinoids, meditation
- Music therapy, naturopathic medicine, tai chi
- Traditional chinese herbal remedies, yoga, mind-body medicine
- Recent scientific research is providing insights into effectiveness
Naturopathic Medicine
- Relies on diet & lifestyle to address health problems (natural approaches)
- Important: not always safe; some herbs can interact with prescription drugs, some foods can induce allergic reactions
- Important to tell HC team about drugs, treatments, & remedies being used in addition to the medicine given by HCPs
Areas of Recent Research
- Diet analysis: identify inflammatory vs therapeutic/functional foods
- ie) dairy (inflammatory), oatmeal (lowers cholesterol levels)
- Nutrient therapy: identify therapeutic nutrients & preventative nutrients
- ie) vitamin D for MS
- Herbal medicine: identify herbs that reduce pain, inflammation, increased energy, antioxidant support
- ie) ginger & tumeric (reduces pain), wild blueberries, dark chocolate (antioxidants)
- Acupuncture: pain management, symptoms recovery
Herbal Medicine
- System of healing that uses medicinal plants & natural products to prevent/treat disease & maintain optimal health & wellbeing
- Herbalist: crafts an appropriate botanical treatment from a patient’s range of symptoms
- Knowledge comes from empirical wisdom from years of practice
- Very safe, can be used for anyone - just happens that western medicinist needs to be aware of the herbs being taken
- Interactions are still a possibility
Role of Naturopath: Patient Work-up
- FIrst, identify factors which create or contribute to the inflammation
- Then, mitigate &/or treat those factors to return the body to a balanced state of homeostasis
- Involves good communication with the patient & family
- Need to take in the following:
- Current diagnosis, prognosis, & patient goals
- Acupuncture can be helpful in relieving stress/pain in both late & early stage disease (ie cancer)
- Can prolong life in terms of making the patient more comfortable
- Collect info like the patients current prognosis & diagnosis
- Current medications & supplements to ensure no interactions
- Diet analysis - can any changes can be made here
- Drug-nutrient interactions or enhancements
- Analysis of lifestyle factors influencing primary disease (ie alcohol consumption affecting inflammatory process)
- Determining factors influencing symptoms or progression of disease that can be changed/reversed
- Prevention of end-stage complications of disease
- Educate person/family at adopting changes which will reverse the degenerative process
- Recommend treatment &/or referrals to other physicians or health professionals for co-treatment as required
Example: Vitamin C
- Found in dietary supplements
- Antioxidant - produces collagen
- High doses can be given through IV or orally
- IV can reach higher levels in the blood compared to orally
- High dose has been studied in patients who have cancer - studies show that it can slow the growth of some cancers
(prostate, colon, liver, pancreatic, etc)
- Combining vit C with other anti-cancer therapies may be helpful - others have shown that vit C can make chemo less
effective
- High IV vitamin C - less side effects, help with pain/nausea/etc
Example: Interaction of Tamoxifen & Sesame Seeds
- Used in treatment for breast ca
- When used with sesame seeds, can have a negative interaction - reduces the effect of the drug to decrease tumor sizes
Example: Grapefruit juice
- Has a negative interaction with almost all drugs - alters the way the body metabolizes the medication & affects livers ability to work
the drug throughout the patient’s system
Alternative Medicine
- Used in place of conventional medicines or treatments
- Often lacking in scientific evidence - hard to chose b/n this & western
- May be unsafe or cause harmful side effects
- Potential for disease to advance
What is CAM?
- Term used to encompass both approaches = complementary-alternative
- Complementary medicine: used together with conventional medicine
- Alternative medicine: used in place of conventional medicine
- A group of diverse medical HC practices & products not presently considered a part of conventional medicine
Document Summary
Name the 2 categories of nociceptive pain & give an example of each. Somatic: arising in the msk system, having a knowledge in pain & these pains exist upon movement. Pain originating from gi tract, pancreas, etc: results in a dull ache or squeezing/cramping pain. Cam, integrative medicine, western medicine, complementary medicine, holistic medicine (holism), alternative medicine, Often used by ppl outside the medical community & medical practitioners. Conventional treatments currently accepted & widely used in the canadian hc system (ie rad therapy, chemo, surgery) - treating the disease. Treats the disease &/or symptoms that stem from the disease. Opposed to a medicine that understands the disease process & targets the causes. Many diseases triggered by inflammation by some underlying issue somewhere else in the body - issue with this medicine. Rigorous scientific research has shown treatment to be safe & effective. Delivered by medical doctors & other hcps (ie nurses, mrts, pharmacist)
