CAM in Chronic Pain and Palliative Care
Complementary and alternative medicine (CAM) encompasses diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. Conventional medicine (also called Western or allopathic medicine) is medicine as practiced by holders of M.D. (medical doctor) and D.O. (doctor of osteopathy) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses. The boundaries between CAM and conventional medicine are not absolute, and specific CAM practices may, over time, become widely accepted. Despite the fact that rigorous, well-designed clinical trials for many CAM therapies are often lacking and, therefore, the safety and effectiveness of many CAM therapies are uncertain, CAM use is common, particularly among individuals with chronic pain and advanced illness. This chapter presents evidence regarding selected CAM modalities in the settings of chronic pain and palliative care. The presentation of the evidence is organized according to the following NCCAM-specified categories: (1) mind–body practices, (2) manipulative and body-based practices, (3) manipulation of energy fields, and (4) biologically based therapies. Where sufficient data are available, the evidence is presented in table format. For some modalities, little evidence is available. For these modalities, the existing evidence is described in the text only. Despite many years of CAM practice and common usage, rigorous scientific research on CAM therapies has occurred only relatively recently. CAM research is limited by methodologic and ethical issues. Gaps in research are thus the norm and the current evidence base is insufficient.
KeywordsPalliative Care Massage Therapy Spinal Manipulation Chronic Neck Pain Chiropractic Care
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