What are the different types of alternative and complementary medicine?

Acupuncture

Acupuncture in Traditional Chinese Medicine relies on the concept that health is fostered by the correction of imbalances of internal energy flow. Fine needles are inserted along specific points on the body, leading to the release of chemicals which contributes to a healing response in the body. The acupuncture points are located along channels or meridians, in which 'qi', or concentrated energy is located. The acupuncturist aims to move 'qi' in an appropriate direction, in order to generate the desired physical and emotional response in the patient.

The number of treatments required depends on a number of factors, including the condition being treated.

The Royal College of General Practitioners have concluded that there is reasonable evidence supporting the use of acupuncture for chronic back pain, but uncertainty regarding acupuncture as treatment for neck pain. However, a recent systematic review concluded that although acupuncture is effective for chronic back pain, it is not more effective than other conventional treatment. Furthermore, there was insufficient evidence to make conclusions about the effectiveness of acupuncture for acute low-back pain.

There is no government legislation governing the regulation of acupuncture treatment in the UK, though there are bodies such as the British Acupuncture Council, British Medical Acupuncture Society and The Acupuncture Association of Chartered Physiotherapists that represents acupuncturists.

In the hands of trained practitioners, the incidence of adverse effects, such as blood contamination, local bleeding are extremely low.

Aromatherapy

Aromatherapy is based on the concept that essential plant oils have therapeutic properties. Typical sources of essential oils include chamomile, lavender, rosemary and tea tree. The essential plant oils are usually diluted into a carrier oil and may be applied to the body via massage, baths or via inhalations. Practitioners believe that the oil molecules are absorbed into the circulation and pass into the nervous system to allow benefits such as relaxation and a general feeling of well-being to be obtained.

An extensive review published by the Cochrane library reviewing all relevant trials on the effectiveness of aromatherapy for symptom relief in patients with cancer showed that aromatherapy may in the short term reduce anxiety in cancer patients, but there was limited evidence to demonstrate whether aromatherapy was effective in reducing the physical symptoms of cancer.

A large number of training organizations in aromatherapy exist in the UK. Some of these organizations belong to the Aromatherapy Organizations Council (AOC): members of the AOC would have trained to standards as defined by the AOC.

Safety testing on essential oils have shown minimal adverse effects. Adverse effects include contact dermatitis among aromatherapists who have had prolonged skin contact with aromatherapy oils, local irritation and phototoxicity. Several of the oils are approved for use as food additives by the US Food and Drug administration.

Chiropathy

Chiropathy refers to practice of treating mechanical disorders of the joints, muscles and ligaments using manual adjustment techniques. Conventional diagnostic techniques such as laboratory investigations and radiographs may be used to aid the diagnosis. There are many distinctive manual adjustment manoeuvres that are used, which may be accomplished with the aid of specialized adjusting tables and equipment. Exercise and rehabilitation may also be utilized as part of the treatment.

Each chiropractic session may last between 30-60 minutes, with the number of visits needed depending on the severity of the condition. More than 2/3s of the conditions that chiropractors treat are musculoskeletal problems, including low back pain, neck pain and headaches. The Royal College of General Practitioners published a set of clinical guidelines in 1999, recommending considering the use of manipulative therapy, including chiropractic treatment, for patients with simple backache who are failing to return to normal activities, or are needing additional pain relief. However, a recent large systematic review published by the Cochrane library has concluded that there was no evidence to suggest that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low-back pain.

All Chiropractors in the UK are registered with the General Chiropractic Council (GCC). The GCC is the statutory body responsible for setting the standards of education, practice and conduct for chiropractors.

Spinal manipulation can result in side effects, although serious complications are extremely rare. Minor complications including local discomfort, headache or tiredness can occur in nearly half of all patients. The incidence of serious complications including vertebrobasilar accidents, disk herniations and cauda equina syndrome has been estimated to range from between 1 per 2 million manipulations to 1 per 400,000 manipulations.

Homeopathy

Homeopathy is based on the principle of similars, and can be best described by the phrase 'like cures like'. Thus, diseases are treated with substances, that when given to healthy individuals, generate the same symptoms as the disease which is being treated. The remedies used are very dilute preparations (usually 1:100 dilutions) made from a number of different substances, which may be material from animal, vegetable or mineral sources, diluted into water.

Homeopaths treat a patient with either a single homeopathic remedy or multiple remedies, which may be given as a tablet, powder or liquid remedy. Patients given more dilute remedies usually take the remedy 3-4 times a day, whereas patients given more potent remedies may only need to take the remedy once daily or as a single one-time dose. Homeopaths typically treat the patient for 2-3 months before assessing the action of the remedy before selecting another. Homeopaths may prefer their patients not to take any non-essential western medication to allow assessment of symptoms, though this practice is not officially endorsed by the British Homeopathic Association.

Homeopaths in the UK can be divided into 2 groups - those who are medically qualified, and those who are non-medically qualified. Medically qualified homeopaths are regulated by the Faculty of Homeopathy, and may work in one of the 5 NHS homeopathic hospitals. Non-medically qualified homeopaths may be represented by The Society of Homeopaths, which recognizes training from 20 Homeopathic colleges throughout the UK.

Direct side effects from the remedies are extremely rare due to the highly dilute nature of the remedies, with the few reported cases involving misuse of remedies such as a child taking an overdose of homeopathic mercury.

Osteopathy

Osteopaths treat their patients based on the concept that a person is a result of a dynamic interaction between the body, min and the spirit. It is this interaction that determines the person's capacity to maintain a healthy state and to recover from illnesses. Osteopaths believe that illness may be caused by both intrinsic and extrinsic factors, and it is through the manipulation of the musculo-skeletal system that influences the person's ability to restore the inherent capacity and resist disease processes.

Each osteopathic session may range from 30 minutes to 1 ½ hours, and begins with a discussion of the problems. The osteopath would then make observations and biomechanical assessments. Radiographs and typical laboratory investigations may be used to reach the diagnosis. Osteopaths treat patients via a number of osteopathic manipulations.

Osteopathy is likely to be beneficial for acute low back pain, neck pain and other conditions associated with dysmenorrhea and headaches. There has been no systematic review to date evaluating the effectiveness of osteopathy for back and neck pain.

Osteopaths are regulated by the government, and this was established by the Osteopaths Act in 1993. The General Osteopathic Council (GOD) is responsible for the regulation and training of osteopaths in the UK.

Minor complications of osteopathic treatment include dizziness, muscular soreness, aggravation of underlying problems. Serious adverse complications including the vertebral artery syndrome are rare, and are estimated to occur in one in about 1 million manipulations.

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