Alternative methods for the control of pain.

T AVMA has recently issued a statement regarding the use of “Complementary and Alternative Veterinary Medicine” (CAVM) and defines it is a “heterogeneous group of preventive, diagnostic, and therapeutic philosophies and practices” that includes but is not limited to: “aromatherapy; Bach flower remedy therapy; energy therapy; low energy photon therapy; magnetic field therapy; orthomolecular therapy; veterinary acupuncture, acutherapy, and acupressure; veterinary homeopathy; veterinary manual or manipulative therapy (similar to osteopathy, chiropractic, or physical medicine and therapy); veterinary nutraceutical therapy; and veterinary phytotherapy.” The practitioners of many of these disciplines often refer to themselves as holistic practitioners because the approach to diagnosis and therapy involves a careful look at the animal’s whole mental and physical well-being. The above guidelines suggest that all practitioners of veterinary medicine should approach their patients in a holistic fashion, and this is further emphasized by the article preceding the guidelines that exhorts veterinarians to reunify the animal mind and body. Western medicine often uses a problem-oriented approach to the diagnosis of a condition and therapy of the patient, and this focuses attention on those ailments that are causing illness without necessarily paying attention to the overall well-being of the animal. This narrow focus is one of the reasons for the popularity of complementary and alternative approaches to medicine both for people and animals. Busy Western practitioners often focus quickly on a specific problem and spend little time with the client and patient. Practitioners of alternative disciplines tend to take more time with their clients and patients to understand the whole range of factors that might contribute to the current concern. This has an impact on the welfare of the patient in that the longer time spent taking the history and diagnosing the patient may lead to a greater understanding of the mind and body of that individual. This is not to say that many veterinarians using Western approaches ignore factors such as nutrition, exercise, and environment, but the economics of practice push them to short consultation times and rapid diagnoses with little time for consideration of the larger picture. Veterinary curricula have only recently begun to increase time devoted to nutrition and behavior in recognition of the major role these can play in health and disease, so many practitioners feel poorly educated in these aspects of health care. The guidelines on CAVM state that “recommendations for effective and safe care should be based on available scientific knowledge and the medical judgment of the veterinarian.” Veterinarians are looking for methods to alleviate the pain and suffering of their patients, and so the first welfare issue concerning the use of alternative techniques has to be “do they control pain?” This author has a rudimentary understanding of acupuncture and does not pretend to be an expert in any modality of alternative care, so the review that follows is by no means comprehensive. The author has tried to find scientific evidence for the efficacy of each therapeutic modality, and these are largely derived from the human literature because so little work has been published on clinical efficacy in animals.