Efficacy and Safety of Medicinal Plants or Related Natural Products for Fibromyalgia: A Systematic Review Language of publication restrictions in systematic reviews gave different results depending on whether the intervention was conventional or complementary. For randomized controlled trials, the quality of reports of complementary and alternative medicine was as good as reports of conventional medicine. A Longitudinal Analysis of Complementary and Alternative Medicine Use by a Representative Cohort of Young Australian Women with Asthma, 1996–2006 Evidence-based Complementary and Alternative Medicine. Reasons for referrals of children and adolescents to alternative medicine in southern Israel. Methodological issues in trials of complementary and alternative medicine interventions. Factors That Influence Practitioners' Interpretations of Evidence From Alternative Medicine Trials: A Factorial Vignette Experiment Embedded in a National Survey Components of effective randomized controlled trials of hydrotherapy programs for fibromyalgia syndrome: A systematic review Commentary on the Cochrane Review of acupuncture and assisted conception. The use of complementary and alternative medicines by patients with peripheral neuropathy Factors influencing the use of complementary and alternative medicine and whether patients inform their primary care physician. Integration of Complementary and Alternative Medicine Therapies into Primary-Care Pain Management for Opiate Reduction in a Rural Setting. Ethical issues concerning research in complementary and alternative medicine. Research into complementary and alternative medicine: problems and potential A pilot study of external qigong therapy for patients with fibromyalgia. Use of Complementary Therapies Among Primary Care Clinic Patients With Arthritis Use of complementary and alternative therapies in community-dwelling older adults. EEG ALPHA SENSITIZATION IN INDIVIDUALIZED HOMEOPATHIC TREATMENT OF FIBROMYALGIA Perceptions about Complementary Therapies Relative to Conventional Therapies among Adults Who Use Both: Results from a National Survey Familial aggregation of depression in fibromyalgia: a community-based test of alternate hypotheses A comprehensive approach to rehabilitation interventions following breast cancer treatment - a systematic review of systematic reviews Effect of pilates training on people with fibromyalgia syndrome: a pilot study.
To assess the effects of medicinal plants ( MPs ) or related natural products ( RNPs ) on fibromyalgia ( FM ) patients , we evaluate the possible benefits and advantages of MP or RNP for the treatment of FM based on eight r and omized placebo-controlled trials ( RCTs ) involving 475 patients . The method ological quality of all studies included was determined according to JADAD and “ Risk of Bias ” with the criteria in the Cochrane H and book for Systematic Review s of Interventions 5.1.0 . Evidence suggests significant benefits of MP or RNP in sleep disruption , pain , depression , joint stiffness , anxiety , physical function , and quality of life . Our results demonstrated that MP or RNP had significant effects on improving the symptoms of FM compared to conventional drug or placebo ; longer tests are required to determine the duration of the treatment and characterize the long-term safety of using MP , thus suggesting effective alternative therapies in the treatment of pain with minimized side effects OBJECTIVE To assess whether language of publication restrictions impact the estimates of an intervention 's effectiveness , whether such impact is similar for conventional medicine and complementary medicine interventions , and whether the results are influenced by publication bias and statistical heterogeneity . STUDY DESIGN AND SETTING We set out to examine the extent to which including reports of r and omized  controlled trials ( RCTs ) in language s other than English ( LOE ) influences the results of systematic review s , using a broad data set of 42 language -inclusive systematic review s , involving 662 RCTs , including both conventional medicine ( CM ) and complementary and alternative medicine ( CAM ) interventions .  RESULTS For CM interventions , language -restricted systematic review s , compared with language -inclusive ones , did not introduce biased results , in terms of estimates of intervention effectiveness ( r and om effects ration of odds rations ROR=1.02 ; 95 % CI=0.83 - 1.26 ) . For CAM interventions , however , language -restricted systematic review s result ed in a 63 % smaller protective effect estimate than language -inclusive review s ( r and om effects ROR=1.63 ; 95 % CI=1.03 - 2.60 ) . CONCLUSION Language restrictions do not change the results of CM systematic review s but do substantially alter the results of CAM systematic review s. These findings are robust even after sensitivity analyses , and do not appear to be influenced by statistical heterogeneity and publication bias OBJECTIVE To compare the quality of reporting of reports r and omized controlled trials ( RCTs ) published in English and in language s other than English ( LOE ) , and to determine whether there were differences between conventional medicine ( CM ) and complementary and alternative medicine ( CAM ) reports . STUDY DESIGN AND SETTING We examined more than 600 RCTs associated with 125 systematic review s. We extracted characteristics of each RCT using a st and ardized data collection form . We assessed quality using the Jadad scale and the adequacy of allocation concealment . RESULTS There were only minor differences in the quality of reports of RCTs published in English compared with other language s ( median quality score of 3 vs. 2 , P=.10 ) , and the quality of reports of CAM RCTs was similar to the CM reports ( median score of 3 vs. 2 , P=.14 ) . There was no effect of language of publication on quality of reporting for CM trials ( median score of 2 vs. 2 , P=.12 ) . Among CAM trials , however , overall quality scores were higher for reports in English than for reports in other language s ( median score of 3 vs. 2 , P=.04 ) . CONCLUSION The overall quality of reports published in language s other than English is similar to that of English- language reports . Moreover , the overall quality of reporting of RCTs of CAM interventions is as good as that for CM interventions Background . There is evidence of asthma patients using complementary and alternative medicine ( CAM ) . This article reports the findings of the first ever longitudinal study of CAM use among women with asthma from a large nationally representative sample . Methods . A longitudinal analysis of question naires completed in 1996 , 2000 , 2003 , and 2006 as part of the Australian Longitudinal Study on Women 's Health . The cohort began with 14,701 r and omly selected young women ( aged 18–22 years ) .  CAM use was defined as a consultation with a range of complementary practitioners in the 12 months prior to each survey . Statistical analyses included the use of generalized estimating equations . Results . Over the 10-year period , approximately 26 % of the women were asthmatic . Asthmatic women were significantly more likely to use CAM  ( 19 % , 22 % , and 36 % for surveys 2–4 , respectively ) than non-asthmatic women ( 15 % , 20 % , and 32 % for surveys 2–4 , respectively ) .  CAM use increased as time since asthma diagnosis increased . However , only the increase in consultations with a naturopath/herbalist remains statistically significant when the CAM modalities are considered individually alongside asthma status . The longitudinal model suggests that women with asthma are 1.13 ( 95 % CI : 1.05–1.21 ) times more likely to consult with a CAM practitioner ( p < .001 ) . The study also shows that CAM users have a higher dissatisfaction with conventional healthcare services and consultations when compared to CAM non-users . Conclusion . These findings suggest that women with asthma may turn to CAM after conventional care fails to adequately address their healthcare needs We introduce the current research on complementary and alternative medicine ( CAM ) in the West , which we refer to as Evidence -based CAM ( EBCAM ) , and discuss its characteristics , problems , and perspectives . Compared with the common attitude of CAM research ers in Japan , that of EBCAM research ers is more objective and often self-critical . EBCAM research is still developing because r and omized controlled trials on CAM have many method ological flaws . Caution should be employed in interpreting provisional conclusions of relevant systematic review s. CAM research ers in Japan should view the case report method from a perspective other than efficacy . Also , they will have to prepare evidence in response to dem and s from CAM consumers . Priority of research subjects from various kinds of CAM should be decided according to their popularity . Therefore , a large-scale survey on CAM use in Japan is essential OBJECTIVES The use of complementary and alternative medicine ( CAM ) has increased over recent years . Little is known about the use of CAM by children and adolescents . The study objectives were to characterize reasons for referrals and types of therapy for children and adolescents who turned to a CAM clinic . DESIGN An observational study with prospect i ve collection of data through interviews with the parents conducted by the clinic triage physician using question naires . SUBJECTS Parents of children and adolescents who came for treatment to a CAM clinic . INTERVENTION None . OUTCOME MEASURES The medical reasons for using CAM .  RESULTS The parents of 86 ( 55 % ) of the children who came for CAM in the study period , November 2005 to June 2006 , participated in the study ( 54 males , 62.8 % ) . The mean patient age was 6.75 years ( median , 4.79 ) . The most common reasons for CAM were immunological and allergy problems ( 30 % ) , infectious diseases ( 21.4 % ) , and attention deficit and concentration disorders ( 14.6 % ) . The most common treatment modalities for children and adolescents were  homeopathy  ( 33.7 % ) , reflexology ( 29.7 % ) , and acupuncture ( 18.8 % ) . Most of the immunological problems ( 58.1 % ) and the infectious diseases ( 66.7 % ) were referred for homeopathy , and most of the attention deficit and concentration disorders ( 66.7 % ) were treated by reflexology . Nonmedical reasons for CAM included disappointment with the results of conventional treatment ; the desire for effective , innocuous , supplemental therapy ; and previous experience among parents , friends , and family members . CONCLUSIONS Dem and for CAM therapy for children is driven by universal factors . CAM can be an adjuvant therapy for children with common chronic pediatric problems BACKGROUND Complementary and alternative medicine ( CAM ) use is widespread among cancer patients . Information on safety and efficacy of CAM therapies is needed for both patients and healthcare providers . Well- design ed r and omized clinical trials of CAM therapy interventions can inform both clinical research and practice . OBJECTIVES The aim of this study was to review important issues that affect the design of r and omized clinical trials for CAM interventions . METHODS Using the methods component of the Consoli date d St and ards for Reporting Trials as a guiding framework and a National Cancer Institute-funded reflexology study as an exemplar , method ological issues related to participants , intervention , objectives , outcomes , sample size , r and omization , blinding , and statistical methods were review ed . DISCUSSION Trials of CAM interventions design ed and implemented according to appropriate method ological st and ards will facilitate the needed scientific rigor in CAM research . Interventions in CAM can be tested using proposed methodology , and the results of testing will inform nursing practice in providing safe and effective supportive care and in improving the well-being of patients Background : Clinical trial evidence in controversial areas such as complementary and alternative medicine ( CAM ) must be approached with an open mind . Objective : To determine what factors may influence practitioners ' interpretation of evidence from CAM trials . Research Design : In a mailed survey of 2400 US CAM and conventional medicine practitioners we included 2 hypothetical factorial vignettes of positive and negative research results for CAM clinical trials . Vignettes contained r and omly varied journal ( Annals of Internal Medicine vs. Journal of Complementary and Alternative Medicine ) and CAM treatment type ( acupuncture , massage , glucosamine , meditation , and reiki ) . Response items also included r and omly varied patient circumstances — chronic refractory symptoms and the patient requesting CAM . Measures : All practitioners rated the effectiveness and their willingness to recommend the therapy for a described patient . We used logistic regression to determine the independent influence of the 4 factors on respondents ' effectiveness and legitimacy judgments . Results : A total of 1561 practitioners responded ( 65 % ) . Relative to Reiki , conventional medicine practitioners were most willing to recommend glucosamine  ( OR = 3.0 ; 95 % CI [ 1.6–5.4 ] ) , than massage ( 1.9 [ 1.1–3.3 ] ) , acupuncture ( 1.3 [ 0.8–2.2 ] ) , and meditation ( 1.2 [ 0.7–2.0 ] ) . CAM practitioners rated  acupuncture as effective more than other CAM therapies ( OR = 5.8 [ 2.6–12.8 ] compared with Reiki ) , and were more willing to recommend acupuncture  ( OR = 12.3 [ 4.8–31.8 ] ) . When presented evidence of inefficacy , CAM practitioners were most willing to recommend acupuncture  relative to other CAM therapies ( OR = 15.5 [ 9.0–26.9 ] ) . Conclusions : Practitioners ' judgments about CAM trial evidence depend on the type of treatments reported . Confirmation bias may play a role in the clinical translation of new evidence from clinical trials Aim Previous systematic review s have found hydrotherapy to be an effective management strategy for  fibromyalgia syndrome ( FMS ) .  The aim of this systematic review was to summarize the components of hydrotherapy programs used in r and omized controlled trials . Method A systematic review of r and omized controlled trials was conducted . Only trials that have reported significant FMS-related outcomes were included . Data relating to the components of hydrotherapy programs ( exercise type , duration , frequency and intensity , environmental factors , and service delivery ) were analyzed . Results Eleven r and omized controlled trials were included in this review . Overall , the quality of trials was good . Aerobic exercise featured in all 11 trials and the majority of hydrotherapy programs included either a strengthening or flexibility component . Great variability was noted in both the environmental components of hydrotherapy programs and service delivery . Conclusions Aerobic exercise , warm up and cool-down periods and relaxation exercises are common features of hydrotherapy programs that report significant FMS-related outcomes . Treatment duration of 60 minutes , frequency of three sessions per week and an intensity equivalent to 60%–80 % maximum heart rate were the most commonly reported exercise components . Exercise appears to be the most important component of an effective hydrotherapy program for FMS , particularly when considering mental health-related outcomes Background —Acupuncture has recently been studied in assisted reproductive treatment ( ART ) although its role in reproductive medicine is still debated . Objectives —To determine the effectiveness of acupuncture  in the outcomes of ART . Search strategy —All reports which describe r and omised controlled trials of acupuncture in assisted conception were obtained through search es of the Menstrual Disorders and Subfertility Group Specialised Register , CENTRAL , Ovid MEDLINE ( 1996 to August 2007 ) , EMBASE ( 1980 to August 2007 ) , CINAHL ( Cumulative Index to Nursing & Allied Health Literature ) ( 1982 to August 2007 ) , AMED , National Research Register , Clinical Trials register ( www . clinical trials.gov ) , and the Chinese data base of clinical trials . Selection Criteria —R and omised controlled trials of acupuncture for couples who were undergoing ART comparing acupuncture treatment alone or acupuncture with concurrent ART versus no treatment , placebo or sham acupuncture plus ART for the treatment of primary and secondary infertility . Women with medical illness deemed contraindications for ART or acupuncture were excluded . Data Collection and Analysis —Sixteen r and omised controlled trials were identified that involved acupuncture and assisted conception . Thirteen trials were included in the review and three were excluded . Quality assessment and data extraction were performed independently by two review authors . © 2010 Elsevier Inc. All rights reserved . Corresponding author : Eric Manheimer , MS , Research associate , University of Maryl and School of Medicine , Center for Integrative Medicine East Hall , 520 W. Lombard Street Baltimore , MD 21201 , emanheimer@compmed.umm.edu , Telephone : 410 - 706 - 6169 , Fax : 410 - 706 - 6214 . * Both authors contributed equally to this work . The Cochrane Complementary Medicine Field is the group within the Cochrane Collaboration focused on facilitating the conduct of Cochrane systematic review s of CAM therapies . The CAM Field represents an international collaborative effort among research ers , clinicians , consumers , and CAM practitioners from nearly every continent . The Field ’s central office is located at the Center for Integrative Medicine , University of Maryl and School of Medicine , 520 W. Lombard St , Baltimore , MD 21201 . For more information , contact Eric Manheimer at : emanheimer@compmed.umm.edu . Publisher 's Discl aim er : This is a PDF file of an unedited manuscript that has been accepted for publication . As a service to our customers we are providing this early version of the manuscript . The manuscript will undergo copyediting , type setting , and review of the result ing proof before it is published in its final citable form . Please note that during the production process errors may be discovered which could affect the content , and all legal discl aim ers that apply to the journal pertain . NIH Public Complementary and alternative medicine ( CAM ) therapies have become increasingly popular and are used regularly by patients with chronic neurological disorders . The prevalence and characteristics of CAM use by patients with peripheral neuropathy is unknown . We performed a prospect i ve , question naire-based study to determine the prevalence and patterns of use of CAM therapies in 180 consecutive out patients with peripheral neuropathy . The use of CAM was reported by 77 patients ( 43 % ) with neuropathy . The most frequent were megavitamins ( 35 % ) , magnets ( 30 % ) , acupuncture ( 30 % ) , herbal remedies ( 22 % ) , and chiropractic manipulation ( 21 % ) ; 37 ( 48 % ) tried more than one form of alternative treatment . Seventeen respondents ( 27 % ) thought their neuropathy symptoms improved with these approaches . Those who used CAM were slightly younger ( mean age 62 vs. 65 years , p = 0.05 ) and more often college educated ( 39 % vs. 24 % , p = 0.03 ) compared to CAM nonusers . They also more often reported burning neuropathic pain ( 62 % vs. 44 % , p = 0.01 ) . Patients with diabetic neuropathy used CAM  more frequently than others ( p = 0.03 ) . The most common reason for using CAM was inadequate pain control ( 32 % ) . Almost half of patients did not consult a physician before starting CAM . We conclude that there is a high prevalence of  CAM  use in our patients with neuropathy , and one-quarter reported that their symptoms improved . CAM users were better educated than nonusers , but most did not discuss CAM treatments with their physician . Neuropathic pain was substantially more common in CAM users , and lack of pain control was the most common reason for CAM use OBJECTIVES Use of complementary and alternative medicines ( CAMs ) is widespread . Several studies have explored why individuals chose to use CAM but there are fewer data to explain how its use ' dovetails ' with conventional medicine . This study aim ed to determine the prevalence of CAM use in the adult population in Australia and the proportion that seek advice or tell their primary care physician after CAM use , and also to investigate which demographic characteristics , health behaviours and health status are associated with CAM use and disclosure . DESIGN A cross sectional survey . METHODS a r and om sample of 1261 adults was interviewed as part of 2010 Queensl and Social Survey , which contained questions about  CAM use , frequency of use , types of CAM used , reasons for use , discussing and reporting CAM use with the doctor and confidence in CAM use . Relationships were explored using bivariate and multiple logistic regression . MAIN OUTCOME MEASURES use of CAM ; sought advice from doctor before CAM use ; informed doctor after CAM use . RESULTS 61.7 % of respondents had used self-prescribed CAM  or visited a CAM practitioner . Being female and being younger predicted CAM use . Being male and in better health predicted seeking advice from the doctor before and also after CAM use . CONCLUSION Our results confirm the relatively high use of CAM in Queensl and , Australia and found that a significant proportion of people did not seek advice from their primary care physician before using CAM , or disclose its use afterwards . These factors should be taken into account in the doctor-patient consultation BACKGROUND Opiates are no longer considered the best strategy for the long-term management of chronic pain . Yet , physicians have made many patients dependent on them , and these patients still request treatment . Complementary and alternative medicine ( CAM ) therapies have been shown to be effective , but are not widely available and are not often covered by insurance or available to the medically underserved . METHODS Group medical visits ( GMVs ) provided education about non-pharmacological methods for pain management and taught mindfulness techniques , movement , guided imagery , relaxation training , yoga , qigong , and t'ai chi .  Forty-two patients attending GMVs for at least six months were matched prospect ively with patients receiving conventional care .  RESULTS No one increased their dose of opiates . Seventeen people reduced their dose , and seven people stopped opiates . On a 10-point scale of pain intensity , reductions in pain ratings achieved statistical significance ( p = 0.001 ) . The average reduction was 0.19 ( 95 % confidence interval [ CI ] 0.12 - 0.60 ; p = 0.01 ) . The primary symptom improved on average by -0.42 ( 95 % CI -0.31 to -0.93 ; p = 0.02 ) on the My Medical Outcome Profile , 2nd version . Improvement in the quality -of-life rating was statistically significant ( p = 0.007 ) with a change of -1.42 ( 95 % CI = -0.59 to -1.62 ) . In conventional care , no patients reduced their opiate use , and 48.5 % increased their dose over the two years of the project . CONCLUSIONS GMVs that incorporated CAM therapies helped patients reduce opiate use . While some patients found other physicians to give them the opiates they desired , those who persisted in an environment of respect and acceptance significantly reduced opiate consumption compared with patients in conventional care . While resistant to CAM therapies initially , the majority of patients came to accept and to appreciate their usefulness . GMVs were useful for incorporating non-reimbursed CAM therapies into primary medical care The use of complementary and alternative medicine ( CAM ) has grown dramatically in recent years , as has research on the safety and efficacy of CAM treatments . Minimal attention , however , has been devoted to the ethical issues relating to research on CAM . We argue that public health and safety dem and rigorous research evaluating CAM therapies , research on CAM should adhere to the same ethical requirements for all clinical research , and r and omized , placebo-controlled clinical trials should be used for assessing the efficacy of CAM treatments whenever feasible and ethically justifiable . In addition , we explore the legitimacy of providing CAM and conventional therapies that have been demonstrated to be effective only by virtue of the placebo effect The growing use of unsubstantiated complementary and alternative medicine therapies by people in the United States1 along with its increasing coverage by third party payers2 encouraged Congress to create the National Center for Complementary and Alternative Medicine ( NCCAM ) at the National Institutes of Health . The centre 's mission is “ to explore complementary and alternative healing practice s in the context of rigorous science ; to educate and training CAM research ers ; and to disseminate authoritative information to the public and professionals.”3 To complete this mission , NCCAM supports publicly relevant and scientifically rigorous research to identify those complementary and alternative medicine practice s that are safe and effective . The centre 's re sources , although generous ( $ 68.3 m ( £ 46 m ) for fiscal year 2000 ) , are not sufficient to study all complementary and alternative medicine practice s. NCCAM therefore developed criteria to help prioritise the many possible research opportunities ( box ) . As part of the evaluation process , NCCAM seeks advice from its national advisory council , complementary and alternative medicine and conventional clinicians , members of the scientific research community , the public , sister federal agencies , and other stakeholders . # # # # Summary points Many early clinical trials investigating complementary and alternative medicine have had serious flaws Clinical investigations of complementary and alternative medicine are made difficult by factors such as use of complex , individualised treatments and lack of st and ardisation of herbal medicines Other problems include difficulties in accruing , r and omising , and retaining patients and in identifying appropriate placebo interventions Despite these complexities , rigorously design ed clinical trials are possible , including pragmatic studies of complete complementary and alternative medicine systems Strong commitment is required from the research community to provide information about complementary and alternative medicines to the public and health professionals Staff at the centre are often asked why limited re sources are being spent on research that is perceived as replicating previously published work , especially when other western countries have OBJECTIVES Although qigong is an important part of Traditional Chinese medicine ( TCM ) based on a philosophy similar to acupuncture , few studies of qigong exist in the Western medicine literature . To evaluate qigong therapy as a modality in treating chronic pain conditions such as fibromyalgia syndrome ( FMS ) , we report a pilot trial of 10 women with severe FMS who experienced significant improvement after external qigong therapy ( EQT ) .  DESIGN Ten patients with FMS completed five to seven sessions of EQT over 3 weeks with pre- and posttreatment assessment and a 3-month follow-up . Each treatment lasted approximately 40 minutes . OUTCOME MEASURES Tender point count ( TPC ) and Fibromyalgia Impact Question naire ( FIQ ) were the primary measures . McGill Pain Question naire ( MPQ ) , Beck Depression Inventory ( BDI ) , anxiety , and self-efficacy were the secondary outcomes . RESULTS Subjects demonstrated improvement in functioning , pain , and other symptoms . The mean TPC was reduced from 136.6 to 59.5 after EQT treatment ; mean MPQ decreased from 27.0 to 7.2 ; mean FIQ from 70.1 to 37.3 ; and mean BDI from 24.3 to 8.3 ( all p < 0.01 ) . Many subjects reported reductions in other FMS symptoms , and two reported they were completely symptom-free . Results from the 3-month follow-up indicated some slight rebound from the post-treatment measures , but still much better than those observed at baseline . CONCLUSIONS Treatment with EQT result ing in complete recovery for some FMS patients suggests that TCM may be very effective for treating pain and the multiplicity of symptoms associated with FMS . Larger controlled trials of this promising intervention are urgently needed Introduction Use of complementary and alternative medicine ( CAM ) for chronic conditions has increased in recent years . There is little information , however , on CAM use among adults with clinic-confirmed diagnoses , including arthritis , who are treated by primary care physicians . Methods To assess the frequency and types of CAM therapy  used by Hispanic and non-Hispanic white women and men with osteoarthritis , rheumatoid arthritis , or fibromyalgia , we used stratified r and om selection to identify 612 participants aged 18–84 years and seen in university-based primary care clinics . Respondents completed an interviewer-administered survey in English or Spanish . Results Nearly half ( 44.6 % ) of the study population was of Hispanic ethnicity , 71.4 % were women , and 65.0 % had annual incomes of less than $ 25,000 . Most ( 90.2 % ) had ever used CAM for arthritis , and 69.2 % were using  CAM at the time of the interview . Current use was highest for oral supplements ( mainly glucosamine and chondroitin ) ( 34.1 % ) , mind-body therapies ( 29.0 % ) , and herbal topical ointments ( 25.1 % ) . Fewer participants made current use of vitamins and minerals ( 16.6 % ) , herbs taken orally ( 13.6 % ) , a CAM therapist  ( 12.7 % ) ,  CAM movement therapies  ( 10.6 % ) , special diets ( 10.1 % ) , or  copper jewelry  or magnets ( 9.2 % ) . Those with fibromyalgia currently used an average of 3.9  CAM therapies  versus 2.4 for those with rheumatoid arthritis and 2.1 for those with osteoarthritis . Current  CAM  use was significantly associated with being female , being under 55 years of age , and having some college education . Conclusion Hispanic and non-Hispanic white arthritis patients  used CAM  to supplement conventional treatments . Health care providers should be aware of the high use of CAM and incorporate questions about its use into routine assessment s and treatment planning OBJECTIVES Although complementary and alternative medicine ( CAM ) use is becoming increasingly prevalent in the United States , knowledge regarding complementary and alternative therapy use in older adults is limited . The purpose s of this study were to ( 1 ) assess the prevalence and patterns of CAM use in a probability-based sample of older adults ; ( 2 ) describe the characteristics of older CAM users ; and ( 3 ) identify factors associated with complementary and alternative medicine use/nonuse . METHODS A cross-sectional survey design was used . An age-stratified sample of community-dwelling adults ages > or=65 ( N=1200 ) was r and omly selected from the Minnesota Driver 's License/ Identification Tape using names from the Twin Cities seven-county metropolitan area . The mailed question naire included items on demographics , health status , health care utilization , CAM modality use , reasons for use , costs , and complementary and alternative therapy use satisfaction . Descriptive statistics , chi-square tests , and regression analysis were performed . RESULTS Overall , 62.9 % ( N=445 ) of the respondents reported use of one or more complementary and alternative medicine modalities with an average of three modalities ( SD+/-1.9 , range 1 - 11 ) . The top five CAM modalities used were nutritional supplements ( 44.3 % ) ,  spiritual healing/prayer  ( 29.7 % ) ,  megavitamins  ( 28.3 % ) , herbal supplements ( 20.7 % ) , and chiropractic ( 17.8 % ) . Maintaining health and treating a health condition were the primary reasons for CAM use . The most common conditions treated were arthritis ( 44.4 % ) and chronic pain ( 23.5 % ) . Demographic variables were not significantly different between CAM users and nonusers . CAM users reported more unhealthy days than nonusers did . Overall satisfaction with CAM use was high ( 80 % ) . Symptoms of a health problem and desire for personal control over health motivated CAM use . The main barriers to CAM use were lack of reason to use and knowledge about CAM .  Only 53 % of users disclosed CAM use to their primary care providers . CONCLUSIONS CAM use is common in older adults , especially those with health problems . The widespread use of oral supplements combined with not disclosing CAM use to primary care providers is a concern Fibromyalgia ( FM ) patients show evidence of sensitizability in pain pathways and electroencephalographic ( EEG ) alterations . One proposed mechanism for the cl aim ed effects of homeopathy , a form of complementary medicine used for FM , is time-dependent sensitization ( TDS , progressive amplification ) of host responses . This study examined possible sensitization-related changes in EEG relative alpha magnitude during a clinical trial of homeopathy in FM . A 4-month r and omized , placebo-controlled double-blind trial of daily orally administered individualized homeopathy in physician-confirmed FM , with an additional 2-month optional crossover phase , included three laboratory sessions , at baseline , 3 and 6 months ( N = 48 , age 49.2 ± 9.8 years , 94 % women ) . Nineteen leads of EEG relative alpha magnitude at rest and during olfactory administration of treatment and control solutions were evaluated in each session . After 3 months , the active treatment group significantly increased , while the placebo group decreased , in global alpha-1 and alpha-2 during bottle sniffs over sessions . At 6 months , the subset of active patients who stayed on active continued to increase , while the active-switch subgroup reversed direction in alpha magnitude . Groups did not differ in resting alpha . Consistent with the TDS hypothesis , sniff alpha-1 and alpha-2 increases at 6 months versus baseline correlated with total amount of time on active remedy over all subjects ( r = 0.45 , p = .003 ) , not with dose changes or clinical outcomes in the active group . The findings suggest initiation of TDS in relative EEG alpha magnitude by daily oral administration of active homeopathic medicines versus placebo , with laboratory elicitation by temporolimbic olfactory stimulation or sniffing Complementary and alternative medical ( CAM ) therapies ( also known as integrative or unconventional therapies ) have been defined as those interventions neither taught widely at U.S. medical schools nor generally available in U.S. hospitals ( 1 , 2 ) . While imperfect , this definition has been used to identify representative CAM therapies , which have been studied for prevalence of use in two national r and om-household telephone surveys ( 1 , 2 ) . Data from these surveys indicate that  CAM therapy use and expenditures increased substantially in the United States between 1990 and 1997 ( 1 ) . Overall prevalence of use increased by 25 % ; total visits by an estimated 47 % , from 427 to 629 million ; and expenditures for  CAM services by an estimated 45 % , which totaled $ 21 billion ( 1 ) . National surveys performed in other countries have suggested similar rates of CAM use throughout the industrialized world ( 3 - 7 ) . Less well documented , however , are the reasons that adults typically use ( and pay out of pocket for ) these therapies , most of which have not been satisfactorily evaluated for relative effectiveness , safety , or mechanisms of action . Only one U.S. national survey published in a peer- review ed journal has explored reasons for CAM use ( 8) . Astin 's survey , conducted in 1994 on a convenience sample of 1035 adults , found that reasons for CAM use included a holistic orientation to health ; having had a transformational experience that changed the person 's world view ; and classification in a cultural group identifiable by their commitment to environmentalism , commitment to feminism , and interest in spirituality and personal growth psychology ( 8) . National surveys in the United States of CAM use in 1990 and 1997 revealed that adults typically do not disclose their use of CAM therapies  to their medical doctors ( 1 , 2 ) . In 1997 , as in 1990 ( 1 ) , fewer than 40 % of CAM therapies used in the previous 12 months were discussed with a medical doctor . A recent analysis of data on U.S. national medical expenditures corroborated these findings and suggested that the percentage of CAM users who disclose their CAM visits to their medical doctors may be as low as 20 % ( 9 ) . This paper summarizes 1997 national survey data on respondents ' perceptions about use and nondisclosure of CAM therapies relative to conventional medical care . Methods Sample We conducted a nationally representative telephone survey between November 1997 and February 1998 . Survey methods were approved by the Beth Israel Deaconess Committee on Clinical Investigations , Boston , Massachusetts . The survey used r and om-digit dialing techniques to select households and r and om selection of one resident per household , age 18 years or older , as the respondent . Eligibility was limited to English- language speakers for whom cognitive or physical impairment did not prevent completion of the interview . The survey sample and weighting methods have been previously described ( 1 ) . Interview The interview was presented as a survey by investigators from Harvard Medical School about the health care practice s of persons in the United States . No mention was made of alternative , integrative , unproven , or complementary therapies in the introductory comments . The first substantive questions addressed perceived health , health worries , days spent in bed , and functional impairment due to health conditions . Next , respondents were asked about their interactions with a medical doctor , defined as a medical doctor , MD , or an osteopath , DOnot a chiropractor or other nonmedical doctor . The term medical doctor was used throughout the remainder of the interview . Respondents were asked if they had experienced any of a list of specified common medical conditions in the previous 12 months . Those who reported experiencing more than three conditions were asked to identify the three most bothersome or serious medical conditions . Respondents were then asked about seeing a medical doctor for these principal medical conditions and about perceptions of confidence in the medical doctor and the helpfulness and efficacy of their interactions . Next , respondents were asked about use of CAM therapies in the past 12 months and over their lifetime and whether each of these therapies was used for each of their principal medical conditions . We distinguished between use under the supervision of a professional ( a provider of CAM therapy ) and personal use without such supervision . Persons who reported having supervised use were asked about the number of visits during the past 12 months to providers of each therapy , perceptions of helpfulness and efficacy , and confidence in their CAM therapy providers . Respondents were asked whether they typically see a CAM provider before , after , or concurrent with their visits to a medical doctor . In addition , respondents were asked whether they agreed or disagreed with a list of thoughts about the use of alternative therapies ( Figure 1 ) . Each question was intended to eluci date perceptions about CAM therapy use relative to conventional care . All users of CAM therapies who had seen their medical doctor in the past year were asked if they had discussed use of each therapy with their medical doctor and if not , why they had not . They were then provided a list of possible reasons why people might not discuss certain therapies with a medical doctor and were asked to say yes to any number of items on the list that explained their own reasons for nondisclosure and no to items that did not . Additional details of the survey instrument are described elsewhere ( 1 ) . Figure 1 . Perceptions about complementary and alternative medical ( CAM ) therapy relative to conventional therapy . white bars shaded bars darkly shaded bars n n Statistical Analysis As previously described ( 1 ) , we calculated sampling weights for each respondent to reflect the probability of selection and to parallel the aggregate distribution of demographic characteristics of the U.S. population . We used SUDAAN software ( 10 ) to compute weighted estimates of the proportion of respondents giving specific answers to study questions . We applied the McNemar test to compare respondents ' evaluations of the helpfulness of CAM therapies and conventional care among respondents who used both for the same medical condition . Role of the Funding Sources This research was funded by grants from the National Institutes of Health , the John E. Fetzer Institute , and the American Society of Actuaries . Additional support for the completion of analyses and manuscript preparation was provided by unrestricted gifts from the Friends of Beth Israel Deaconess Medical Center , the Kenneth J. Germeshausen Foundation , the J.E. and Z.B. Butler Foundation , and The American Specialties Health Plan . None of the sponsors had access to the primary data , nor did they review the manuscript before su bmi ssion . Results Characteristics of the Respondents The weighted survey response rate was 60 % ( 1 ) . The sociodemographic characteristics of the survey sample ( n = 2055 ) were similar to the population distributions published by the U.S. Bureau of the Census ( 1 ) . Among the 2055 survey participants , 1802 ( 87 % weighted ) reported seeing a medical doctor in the previous 12 months . Of these , 831 ( 45 % weighted ) reported using  CAM therapy ( excluding use of self-prayer alone ) in the past 12 months , and 411 ( 23 % weighted ) reported seeing a CAM  provider in the past 12 months ( 1 ) . Perceptions of CAM Relative to Conventional Therapy Use Figure 1 summarizes responses among respondents who used conventional care and CAM therapies in the past 12 months . As a preface to these questions , the interview script read , I am going to read you some thoughts people have about their use of alternative therapies , like chiropractic , massage , acupuncture and the others I mentioned earlier . For each statement , please tell me if you agree or disagree . As shown in Figure 1 , fewer than 1 in 4 ( 21 % ) CAM therapy users ( n = 831 ) agreed with the statement , Alternative therapies are superior to conventional therapies , and roughly 4 of 5 ( 79 % ) respondents agreed that Using both conventional and alternative therapies is better than using either one alone [ for your problems ] . For respondents who saw a CAM therapy provider and a medical doctor ( n = 411 ) , we asked whether they agreed or disagreed that their CAM provider did a better job of listening or explaining their medical problems than their medical doctor . Forty-one percent agreed that their CAM provider was a better listener , and 52 % disagreed ; 42 % agreed that their CAM provider did a better job of explaining their medical conditions , and 56 % disagreed . Sequence of Seeking Care from CAM Providers and Medical Doctors We asked respondents who reported seeing both a medical doctor and a CAM provider during the past 12 months ( n = 411 ) the following : The next questions are about your use of alternative therapies in general . People generally fall into one of three groups regarding their use of alternative medicine . Some people see an alternative provider before they consult a medical doctor ; some see both alternative providers and conventional doctors at the same time ; and some see an alternative provider after they have seen a medical doctor . Which of these best describes your pattern of seeing alternative providers ? As summarized in Figure 2 , 7 of 10 respondents reported typically seeking the services of a CAM provider after or concurrent with their visit to a medical doctor . Fewer than 1 in 6 ( 15 % ) said they saw a CAM therapy provider before seeing a medical doctor . Figure 2 . Sequence of seeking care from complementary and alternative medical ( CAM ) providers and medical doctors . n Overall Helpfulness of Therapies The Table summarizes perceived relative helpfulness for 10 of the most commonly reported principal medical conditions identified in the 1997 national survey among respondents who used both conventional care and CAM therapies for each condition . The CAM therapies were judged more helpful & NA ; Numerous studies report that fibromyalgia ( FM ) , a syndrome characterized by widespread pain and generalized tender points , is comorbid with major depressive disorder ( MDD ) . The current study tests two alternate explanations for their comorbidity using a family study methodology . The first is that FM is a depression spectrum disorder . The second is that depression is a consequence of living with FM . We recruited potential prob and s by initially screening by telephone for FM and MDD among women in the NY/NJ metropolitan area , r and omly selecting telephone numbers from a list of households with women . Eligible women were invited for second stage physical examinations for FM diagnosis and psychiatric interviews for MDD diagnosis . All available adult , first‐degree relatives received psychiatric interviews . Relatives of prob and s were divided into four groups on the basis of the prob and s ' FM and MDD diagnoses ( FM+/MDD+ ( n=156 ) , FM+/MDD− ( n=51 ) , FM−/MDD+ ( n=351 ) and FM−/MDD− ( n=101 ) ) . Results indicated that rates of MDD in the relatives of prob and s with FM but without personal histories of MDD were virtually identical to rates of MDD in relatives of prob and s with MDD themselves . This outcome is consistent with the hypothesis that FM is a depression spectrum disorder , in which FM and MDD are characterized by shared , familially mediated risk factors . The implication s of these findings for a stress‐vulnerability model of FM are discussed Background Breast cancer ( BC ) is the most common type of cancer in women worldwide . Post-treatment , patients suffer from side effects and have various rehabilitation needs , which means that individualization is fundamental for optimal rehabilitation . This systematic review ( SR ) of SRs aims to evaluate the current evidence on rehabilitation interventions in female patients following BC treatment . Methods Full-text SRs published in English from 2009 were search ed in Embase , PubMed , Cinahl Complete , PsycINFO , AMED , SCOPUS , and Cochrane Library . Inclusion criteria : SRs of r and omized or non-r and omized controlled trials investigating the effects of  rehabilitation interventions in women following BC treatment . All outcomes were considered . Method ological quality was evaluated using the AMSTAR 2 tool and interrater agreement was evaluated . Out of 1269 citations retrieved , 37 SRs were included . Results Five rehabilitation areas were identified : exercise and physical activity ( PA ) , complementary and alternative medicine ( CAM ) , yoga , lymphoedema treatment , and psychosocial interventions . The most solid evidence was found in exercise/PA and yoga . Exercise interventions improved outcomes such as shoulder mobility , lymphoedema , pain , fatigue and quality of life ( QoL ) . Effects of yoga were shown on QoL , anxiety , depression , sleep disturbance , fatigue and gastrointestinal symptoms . The effect of CAM was shown on nausea , pain , fatigue , anger and anxiety but these results need to be interpreted with caution because of low method ological quality in included studies in the SRs . Among the lymphoedema treatments , positive effects were seen for resistance training on volume reduction and muscle strength and psychosocial interventions such as cognitive behavioural therapy had positive effects on QoL , anxiety , depression and mood disturbance . Conclusions This SR of SRs show solid positive effects of exercise/PA and yoga for women following BC treatment , and provides extended knowledge of the effects of CAM , yoga , lymphoedema treatment and psychosocial interventions . It is evident that more than one intervention could have positive effects on a specific symptom and that the effects depend not only on intervention type but also on how and when the intervention is provided . The results can be used as a foundation for individualized rehabilitation and aid health care professionals in meeting patients ’ individual needs and preferences . Trial registration PROSPERO ( CRD42017060912 ) UNLABELLED Altan L , Korkmaz N , Bingol U , Gunay B. Effect of Pilates training on people with fibromyalgia syndrome : a pilot study . OBJECTIVE To investigate the effects of Pilates on pain , functional status , and quality of life in fibromyalgia , which is known to be a chronic musculoskeletal disorder . DESIGN R and omized , prospect i ve , controlled , and single-blind trial . SETTING Physical medicine and rehabilitation department . PARTICIPANTS Women ( N=50 ) who had a diagnosis of fibromyalgia syndrome ( FMS ) according to the American College of Rheumatology criteria . INTERVENTION The participants were r and omly assigned into 2 groups . In group 1 , a Pilates exercise program of 1 hour was given by a certified trainer to 25 participants 3 times a week for 12 weeks . In group 2 , which was design ed as the control group , 25 participants were given a home exercise ( relaxation/stretching ) program . In both groups , pre- ( week 0 ) and posttreatment ( week 12 and week 24 ) evaluation was performed by one of the authors , who was blind to the group allocation . MAIN OUTCOME MEASURES Primary outcome measures were pain ( visual analog scale ) and Fibromyalgia Impact Question naire ( FIQ ) . Exploratory outcome measures were number of tender points , algometric score , chair test , and Nottingham Health Profile . RESULTS Twenty-five Pilates exercise and 24 relaxation/stretching exercise  participants completed the study . In group 1 , significant improvement was observed in both pain and FIQ at week 12 but only in FIQ at 24 weeks . In group 2 , no significant improvement was obtained in pain and FIQ at week 12 and week 24 . Comparison of the 2 groups showed significantly superior improvement in pain and FIQ in group 1 at week 12 but no difference between the 2 groups at week 24 . CONCLUSIONS We suggest Pilates as an effective and safe method for people with FMS . Our study is the first clinical study design ed to investigate the role of the Pilates method in FMS treatment . We believe that further research with more participants and longer follow-up periods could help assess the therapeutic value of this popular physical exercise method
There was low- quality evidence that acupuncture  improves pain compared to no treatment or st and ard treatment , but good evidence that it is no better than sham acupuncture .
The evidence for homoeopathy , spinal manipulation and herbal medicine was limited .
No firm conclusions were drawn for efficacy of either spinal manipulation or homoeopathy for FM .
Background Fibromyalgia ( FM ) is a chronic , debilitating pain disorder .
Dissatisfaction with conventional medicine can lead people with FM to turn to complementary and alternative medicine ( CAM ) .
Two previous overviews of systematic review s of CAM for FM have been published , but they did not assessed for risk of bias in the review process .