The Use of Complementary Therapies in the Management of IBD

1
The Use of Complementary Therapies in the
Management of IBD

• Christine Whitehouse
• BSc (Hons), F.I.C.H.T. (A.R.P.), M.P.A.C.T,
  M.B.R.A.,M.I.F.R

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What is Complementary Alternative Medicine
(CAM) ?

• Diagnosis, treatment and/or prevention which
  complements mainstream medicine by contributing
  to a common whole, by satisfying a demand not met
  by orthodoxy or by diversifying the conceptual
  framework of medicine
• (Ernst, 2000 p.1133)

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Complementary Alternative Medicine (CAM) Use in
the UK

• 20 of UK adult population reported to use CAM
  (Ernst White, 2000)
• Huge increase in recent years Integrated
  Medicine high on DoH Agenda

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CAM Use in IBD

• Very popular amongst IBD patients in USA and
  Canada - 47 of IBD patients reported to use CAM
  in recent study (Hilsden et al, 2003).
• London study (Langmead et al, 2002) indicated use
  by 28 of IBD patients.

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Reasons Cited for CAM Use in IBD

• Serious side effects of conventional drug therapy
• Orthodox treatment did not provide effective
  management
• Control over the disease
• (Sharple et al, 2004)

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Pros Cons of Drug Therapy

• Corticosteroids reduce inflammation in approx.
  80 of cases
• Side effects include adrenal suppression, long
  term risk of diabetes, thinning of bone, muscle
  skin, glaucoma cataracts.

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• Aminosalicylate drugs induce maintain
  remission
• Side effects include headache, nausea, diarrhoea
  allergic reactions, also liver, kidney,
  pancreas lungs may be affected.
• Immunomodulators used to maintain control of
  inflammation whilst withdrawing from steroid
  drugs - 40 effective
• Side effects include bone marrow depression,
  hepatic fibrosis, pneumonitis, opportunistic
  infections

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CAM and IBD

• Particularly suitable for patient group because
• 
  
  
  
  
• Inability of conventional medicine to provide
  effective management
• The difficult symptoms of IBD
• The need to facilitate relaxation and the
  reduction in anxiety

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Herbal Medicine

• Phytotherapy / Phytomedicine / Botanical
  Medicine.
• Oldest form of medicine.
• Western herbalism is based on the methods of
  Roman doctor Galen (130-201 AD).
• Very popular form of CAM amongst IBD patients

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Herbal Medicine - Caution!

• NATURAL DOES NOT AUTOMATICALLY MEAN SAFE.

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Advantages of Herbal Medicine

• Familiar process.
• Prescribed for individual, not the disease.
• Less likely to have harmful side effects than
  conventional medications.
• Can often be used with medicine prescribed by a
  doctor
• Potential for reducing conventional medication
  (GP approval).

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Disadvantages of Herbal Medicine

• Some forms should not be used with GP prescribed
  medication.
• Some herbs taste very unpleasant.
• Must take medicines as directed
• Infrequent visits to herbalist may lack of
  emotional support
• Herbs might not work quickly enough when the
  problem is life threatening.

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Research Herbal Medicine for IBD

• Much anecdotal evidence to support benefits of
  ALOE VERA for inflammatory conditions.
• Clinical trial (Langmead et al., 2004).
• Placebo-controlled trial of TURMERIC indicated
  some therapeutic benefit in patients with mild
  inflammation (Ghosh, 2002).

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Homeopathy

• From Greek similar suffering
• Theory Like cures like
• Samuel Hahneman (1755 - 1843)
• Uses diluted doses of plants, minerals and animal
  products.

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Homeopathic Remedies
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Homeopathy - Advantages

• Suitable for many conditions - energy medicine.
• Non-addictive.
• No known side-effects.
• Healing process is gentle and deep.
• Often see improvement very quickly.
• Recognised therapy.

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Homeopathy - Disadvantages

• Can take time to find right remedy for individual
• May be anti-doted by coffee, peppermint, and
  other preparations.
• Conventional drugs, surgery or dental treatment
  may cause homeopathic remedies to be ineffective.

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Homeopathy - Research

• Considerable anecdotal evidence to support use
  for IBD
• Results of double-blind random trials show
  significant differences between placebo
  homeopathic tablets
• Patients with active disease those undergoing
  surgery can be treated with homeopathy to improve
  general health.

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Difficulties in Researching the Use and
Benefits of CAM in IBD

• Up to 30 of patients will improve during the
  course of a treatment trial even if taking a
  placebo alone (Kane, 1997).
• Trials are time-consuming and costly and the
  majority are financed by pharmaceutical companies
  that have no commercial interest in researching
  CAM (Kane, 1997)

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Research The Use/Benefits of CAM in the
Management of IBD

• Limited formal research into the use of CAM for
  the control of IBD in the UK.
• Lack of scientific proof of benefit CAM viewed
  with suspicion by many orthodox practitioners.
• More research now being funded generally by DoH
  FIHealth.

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Dietary Therapy

• Frequently investigated amongst IBD patients
• Liquid elemental diets shown to be useful in
  treating children with CD
• Fish Oil study - effective in maintaining
  remission in CD (Belluzzi et al, 1996)
• Synbiotics study (Furrie et al, 2005)
• Sulphites (Cummings, 2005)

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What is Reflexology?

• Holistic Treatment
• Based on the work of Dr William Fitzgerald
• Systematic pressure therapy applied to the soles
  of the feet or the palms of the hands.
• Does not set out to heal specific ailments
• Aims to stimulate self-healing and encourage
  balance
• Currently unregulated

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How can Reflexology help in IBD management?

• Not intended to replace current medications
• Aim is to produce a state of relaxation and
  homeostasis (balance)
• May help to reduce stress levels and promotes the
  bodys self-healing response
• Relief from various symptoms

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The Pain Factor

• Two thirds Abdominal Pain
• gtone third Joint Pain
• ?one third Back Pain
• 39 Pain Constant/Daily Basis
• 19 Sleep Affected min. 1 x per week

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Why Reflexology May be Suitable for IBD patients

• Suitable for all age groups.
• Non-invasive.
• Easily performed in a variety of settings.
• Minimal disturbance to the patient.

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Reflexology - The Theory

• Theory is that the tension, congestion possible
  disease in the body are mirrored in the feet
  hands
• Each foot and hand represents one half of the
  body
• Corresponding reflex for every organ system of
  the body

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• System of 10 longitudinal zones
• 5 on each foot/hand
• Divide body into segments
• Conduits for flow of energy from foot/hand
  reflexes to the corresponding parts of the body

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TheReflexZones
(Booth, 2002)
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Foot Map
(Booth, 2002)
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Research

• Much anecdotal evidence of efficacy in the form
  of
• Patient reports
• Published practitioner case studies
• Difficulties in research
• Few studies conducted
• Lack of formal evidence

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The Future

• Steps toward regulation
• FIHealth and Government Initiatives - Integrated
  Healthcare System
• Wider choice of therapies may become routinely
  available

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Professional Associations

• British Reflexology Association
• Telephone [phone]
• www.britreflex.co.uk
• FHT (ICHT, PACT)
• Telephone [phone]
• www.fht.org.uk

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Reflexology Forum

• Reflexology Forum
• Telephone [phone]
• www.reflexologyforum.org

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Other Therapies That May Offer Relief For The IBD
Patient

• Self-help Techniques
• Aromatherapy
• Massage
• Relaxation/Visualisation
• Hypnotherapy

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Thank you for listening

• ANY QUESTIONS?
• For further information e-mail
• C.Whitehouse_at_hotmail.co.uk