An Introduction to Complementary and Alternative Therapies

To get the best results, you need to form close ties with your health-care team and become a full partner in your health-care treatment. Learning daily living strategies to manage your arthritis gives you a greater feeling of control and a more positive outlook. To support arthritis research or to learn more, contact The Arthritis Society: An Introduction to Complementary and Alternative Therapies 1.800.321.1433 This publication was reviewed and approved by The Arthritis Society's Medical Advisory Committee and the Therapeutics Committee of The Canadian Rheumatology Association. 1.800.321.1433 The Arthritis Society, May 2010

What are complementary or alternative therapies Complementary and alternative therapies are treatments that do not fall within the scope of traditional western medicine. Examples include naturopathic medicine, homeopathic remedies and osteopathy. You may hear about special herbs, acupuncture, energy fields, meditation and many others. In some cases, complementary and alternative therapies may be helpful in addressing arthritis pain and fatigue. It is helpful to find out which therapies can be used safely as an adjunct to your current treatments. Your health-care provider and this booklet can help you navigate this area. Did you know In a recent study of people with arthritis, more than 80 per cent of participants have tried at least one alternative therapy. 1 It is important to remember that many of these treatments have not yet been studied to prove if they are effective. Some of them may even be harmful. There are fraudulent and unproven claims that certain substances can cure arthritis. Some of these products may actually be dangerous or interfere with the treatment prescribed by your health-care provider. 1 More than 80 per cent have tried at least one alternative therapy: see Callahan et al. (2009). Use of complementary and alternative medicine among patients with arthritis. Prev Chronic Dis. Apr 6(2): A44. 1

Introduction Always inform your health-care provider of any complementary and alternative therapies you are taking, receiving or would like to try. Your health-care provider can offer valuable advice about these treatments, help you avoid possible interactions with existing therapies and help you to successfully manage your arthritis. Common complementary and alternative therapies There are many types of complementary and alternative therapies that you may have heard about. Some of these include: Disciplines: Homeopathy Naturopathy Osteopathy Physical and Topical Treatments: Acupuncture Biofeedback Bracelets (copper,magnetic) Lakota Massage Therapy Supplements: Chondroitin sulphate Devil s claw Glucosamine MSM (methylsulfonylmethane) Psychological Techniques: Meditation Relaxation exercises Visualization When assessing information on complementary and alternative therapies, it is critical to verify that the sources are trustworthy and that the findings are based on scientifically proven research. Treatments must be shown to be effective in clinical studies where the treatments are tested on people who have arthritis. These studies must be supervised and reviewed by acknowledged experts in the field of arthritis. Patient testimonials or product statements that are not backed by research evidence cannot be relied upon, as these positions are often personal opinion rather than studied and analyzed results. Points to remember Don t forget that there is still no known cure for arthritis. For more than 60 years, The Arthritis Society, along with other organizations, has been funding researchers in their search for a cure for arthritis. Although many effective medications and treatments have been found, no cure has been discovered to date. As you search for information about arthritis, you may encounter a number of claims stating that products can cure arthritis. Always read the fine print and be cautious of the promises these treatments make. Considering that there are more than 100 forms of arthritis in adults and children, it is unlikely that there will be only one cure. Keep in mind that a team approach to managing arthritis produces better results. Working with a health-care team composed of various specialists and professionals helps ensure that you are receiving the most appropriate care and treatments for you. Your health-care team may include several of the following: Family Physician Nurse/Nurse Practitioner Rheumatologist Orthopedic Surgeon Pharmacist Physiotherapist Occupational Therapist Dietitian Psychologist/ Psychiatrist Social Worker Kinesiologist Athletic Therapist Chiropractor 2 3

Although you are the leader of your health-care team, you should have one health-care professional that you rely on as a co-captain. This person can help clarify any questions or concerns you may have. If you are considering complementary or alternative therapies, the risks and advantages should be discussed with your health-care provider, especially if you are thinking of changing or replacing prescribed treatments. If you see more than one health-care professional, it s important to keep track of the individual treatment advice and to share the advice of one team member with another. This sharing of information helps ensure that your treatment plan is the most effective. The Arthritis Society offers a free, downloadable Pain Management Diary at /paindiary that works as a useful tool to keep track of your treatments, pain levels and appointments. If you are using complementary or alternative treatments, they should be included in this form. Learn about your type of arthritis. There are more than 100 types of arthritis in adults and children, and various ways to treat and manage them. Some types are inflammatory, such as juvenile arthritis, rheumatoid arthritis, ankylosing spondylitis, gout and psoriatic arthritis. Other types are degenerative, such as osteoarthritis. Being informed about your specific type of arthritis will help you determine the best treatment plan for you. Be savvy. If there are non-traditional therapies that you believe will help relieve your symptoms, speak to your health-care provider. The Arthritis Society also offers programs to help you manage pain, and understand arthritis and its management. Call the Arthritis Information Line at 1.800.321.1433 or visit to learn more about the Chronic Pain Management Workshop, Arthritis Self-Management Program or other educational programs in your area. While reading about your disease and complementary and alternative therapies, consider some of the advice below to help you feel assured and comfortable with the information you are using. Finding credible sources on complementary and alternative therapies Today, the Internet has become a primary source of information for consumers. Verifying the credibility of the information can be difficult, but there are several ways to be sure that what you are reading is trustworthy. Be cautious of information that is passed on to you as a testimonial. It helped me and my friends, so it will help you. Avoid anything that results in monetary benefit for the promoter. Look for credible studies or proof that your complementary or alternative choice is beneficial for your type of arthritis, works and is safe for you to try. If you are considering purchasing a product, it s important to be cautious of items that are sold via multi-level marketing schemes. These products are sold by people you may know or be acquainted with, but they have a financial interest in getting you not only to buy the product but to begin selling it as well.these opportunities are often more about the sales pyramid rather than the product being sold. Avoid therapies or treatments that use words such as miracle, cure and guaranteed. If it sounds too good to be true, it usually is. 4 5

Below are some questions to ask yourself when you are learning about complementary and alternative therapies:!!! Is the author an expert in the field with recognized credentials and a designation Is the information published on the website of a recognized, well-known, highly regarded organization Is the information current and relevant to your type of arthritis and situation Is the information sufficient to justify its use in children Is the information Canadian-based If not, where did the study take place Is the resource easy to understand with user-friendly language Does the resource provide well-balanced information that suits your lifestyle Does the resource avoid promises of quick-fix solutions or cures Does the information encourage you to consult with your health-care provider Is the study funded by a company or person that sells the product If you do try a complementary or alternative therapy, try only one at a time and give it at least a three-month trial to determine its effectiveness. However, remember to discuss this decision with your health-care team and report right away any adverse effects you may experience. Understanding and trusting research information When referring to research information, keep in mind that a single research study may not be enough to support a finding. If results have been substantiated by more than one study, there is more likelihood that they are valid. 6 7

8 Recommended online resources Below is a list of online resources that can help you learn more about complementary and alternative therapies.this list was prepared in conjunction with The Arthritis Society s Medical Advisory Committee. The Arthritis Society Website - This site provides a wide range of information in both English and French about types of arthritis, tips for living well with arthritis and programs available across Canada. There is also information about arthritis research. MedEffect - www.healthcanada.gc.ca/medeffect Health Canada s Marketed Health Products Directorate operates the MedEffect program that provides centralized access to new safety information about health products. MedEffect informs the public about potential risks associated with certain drugs or health products and provides access to adverse reaction reports. Go online or call toll-free at 1.866.234.2345. Cochrane Collaboration - /cochranereviews The Cochrane Musculoskeletal Review Group (CMSG) is a specialized group of researchers and consumer representatives that belong to the Cochrane Collaboration, an international not-for-profit organization that encourages informed decisions about health care.this Group prepares, maintains and promotes reviews of the effects of various health-care treatments. CMSG members review the available literature to determine the best evidence to support specific arthritis treatments.they explore the evidence for and against the effectiveness and appropriateness of treatments in specific circumstances. Health on the Net - www.hon.ch The Health on the Net Foundation (HON) is the leading organization promoting and guiding the use of reliable online medical and health information, and its appropriate and efficient use. Created in 1995, HON is a non-profit, non-governmental organization accredited to the Economic and Social Council of the United Nations. Its website is a search portal that directs users to reliable information based on search terms that they enter. National Institute for Health: National Centre for Complementary & Alternative Medicine - www.nccam.nih.gov This is a United States government website with evidence-based, peer-reviewed information on complementary and alternative therapies. National Institute for Health: Office of Dietary Supplements - http://dietary-supplements.info.nih.gov This is a United States government website with evidence-based, peer-reviewed information on dietary supplements. Quackwatch - www.quackwatch.org This is a United States-based website that focuses on providing accurate, candid information in relation to health fraud or questionable medical practices and treatments. Arthritis Research Campaign - www.arthritisresearchuk.org This website is from a United Kingdom-based arthritis charity. Under the arthritis info tab in the publications section for people with arthritis, there is an area called Other treatments and surgery. Here, information on complementary and alternative treatments can be found. Google - www.google.com Google searches can be helpful when looking for information online. Look for websites from medical sources or universities, as this will indicate there is some research to support the information provided. Wikipedia - www.wikipedia.org Wikipedia is a free, web-based, multilingual encyclopedia written collaboratively by volunteers from around the world. Anyone with Internet access can make changes to Wikipedia articles. Because anyone can edit Wikipedia, it is important when searching and reading topics on the site to look at the sources and links provided to ensure the accuracy of the information. If you are unfamiliar with Wikipedia, before getting started, you can visit the about section to gain valuable insight to make the most of your Wikipedia search. Online Publications: The Arthritis Foundation in the US offers The Arthritis Supplement Guide,a comprehensive online publication discusses arthritis supplements. Download it at www.arthritistoday.org/treatments/supplement-guide/index.php The Arthritis Research Campaign in the UK has prepared a report, Complementary and Alternative Medicines for the Treatment of Rheumatoid Arthritis, Osteoarthritis and Fibromyalgia, that examines many treatments scientifically and rates them on their efficacy for specific types of arthritis.you can download it at www.arthritisresearchuk.org/arthritis_information/complementary_ therapies.aspx 9

Online Medical Journals: Online medical journals are another great source of information. This information, however, is not written for average consumers. Since it is prepared for health-care professionals, the terms and information can be difficult to understand. These journals do share some brief overviews of recently published studies, although access to the full site may be limited to accredited members or health-care professionals. Articles may be available for purchase. If you see a study of interest, this is a topic you may want to discuss with your health-care provider. Some popular online medical journals related to arthritis are listed below. The Journal of Rheumatology - www.jrheum.org The Journal of Rheumatology is a monthly international publication owned by the Canadian Rheumatology Association. The journal features research articles on clinical subjects from scientists working in rheumatology and related fields. Arthritis & Rheumatism - www.rheumatology.org Arthritis & Rheumatism is the monthly journal of the American College of Rheumatology and contains peer-reviewed articles on diagnosis, treatment, laboratory research and socio-economic issues related to all forms of rheumatic disease. The magazine can be found under the Publications section of the website. Registration is required. Annals of the Rheumatic Diseases - www.ard.bmj.com Annals of the Rheumatic Diseases is an international peer-reviewed journal committed to promoting the highest standards of scientific exchange and education. It covers all aspects of rheumatology, which includes the spectrum of musculoskeletal conditions, arthritic disease and connective tissue disorders. Registration is required. Recommended Reading This section provides information on books recommended by people who have arthritis and that are available at your local library or bookstore. Alternative Answers to Arthritis & Rheumatism Anne Charlish and Peter Fisher, Grange Books PLC, UK, 2007 ISBN-10: 1840139315 This book includes an introduction on understanding arthritis and a review of a variety of complementary treatments, such as acupuncture and acupressure, reflexology and biofeedback, massage and the Alexander technique. Conventional treatments are also covered and there is a living with arthritis section that discusses exercise, diet, pain and adaptive equipment. Alternative Treatments: an A to Z Guide Dorothy Foltz-Gray, The Arthritis Foundation, Atlanta, GA, 2007 ISBN-10: 0912423536 This book provides the most up-to-date information on more than 100 natural treatments for arthritis in an easy-to-use A to Z format. Treatments included are: glucosamine, chondroitin, boswellia, SAM-e, shark cartilage, Chinese medicine, Alexander technique, rolfing and craniosacral therapy. Scientific evidence about these treatments and information about safety concerns and side effects are investigated. A-Z Guide to Drug-Herb-Vitamin Interactions Alan R. MD Gaby and Healthnotes, Three Rivers Press, Roseville, CA, 2006, 2 Rev Exp Edition ISBN-10: 0307336646 This guide discusses how to improve health and avoid problems when using common medications and natural supplements together. It provides a description of prescription drugs and trade names, and the interactions (both positive and negative) with vitamins, herbs, minerals and diet. 10 11

Natural Health, Natural Medicine: The Complete Guide to Wellness and Self-Care for Optimum Health Andrew Weil, MD, Houghton Mifflin Company, New York, NY, 2004, Revised Edition ISBN-10: 0618479031 This book provides a basic collection of strategies and methods to maintain optimum health and treat common ailments. Topics include: designing a plan for a healthier lifestyle; learning how to maintain the immune system; avoiding heart attacks and strokes; reducing the risk of cancer; choosing the right vitamins and supplements to achieve maximum nutritional health; and taking advantage of home remedies for common ailments. Take Control of Your Health: The Essential Roadmap to Making the Right Health Care Decisions William Feldman, MD FRCPC, Key Porter Books Ltd, 2007 ISBN-10: 1552638804 This book is designed to help patients navigate through health information, tests and health-care practices. The main objective is to ensure the decisions patients make regarding their treatments are well informed. Additional Resources: The Arthritis Society offers a number of free information brochures on various topics and specific types of arthritis.to receive your free copy, call the Arthritis Information Line at 1.800.321.1433 or download them at /publications. Notes Make a Donation The Arthritis Society is fighting for a world without arthritis and helps people live their lives to the fullest by combating the limitations arthritis can impose. We trust that you found this information valuable and helpful as you battle arthritis. Please help us continue funding arthritis research, educational programming and services by making a donation today.to donate, visit us online at, call 1.800.321.1433 or cut out the form below and mail it to: The Arthritis Society, Attention: Data Services, 393 University Avenue, Suite 1700, Toronto, ON M5G 1E6. -- - - - - - - - - - -- - - - - - -- - - - - - -- - - - -- - - -- -- - - - -- -- - - - -- - -- - -- - - -- -- -- -- - - - I would like to help FIGHT ARTHRITIS by making a donation to The Arthritis Society. Name: Address: City: Province: Postal Code: Tel: Email: Here is my gift of: $25 $50 $100 Other $ Enclosed is my cheque, payable to The Arthritis Society. OR Please charge my: Visa MasterCard American Express Card Number: Expiry Date: Signature: 12 CAT