Despite the prevalence of patients that would benefit from Complimentary and Alternative Medicine (CAM) at EMMC Center for Family Medicine (CFM), practicing physicians lack sufficient education on CAM and knowledge of community resources to refer their patients to.https://scholarworks.uvm.edu/fmclerk/1031/thumbnail.jp

Lazzarini, Laura

Palombo, Angelina

UVM ScholarWorks

     EMMC Center for Family Medicine Alternative Medicine Resources for Primary Care Physicians A compilation of alternative medicine modality descriptions, clinical applications and community resources.  Laura Lazzarini, MS III                                                                                                                 Angelina Palombo, MS III                                                                                             University of Vermont                                                                                                     Class of 2016 9/21/2014  1   Of the 22 surveys returned: ◦ 16/22 (72.7%) of CFM patients expressed interest in alternative medicine ◦ 6/22 (27.2%) of CFM providers had referred a patient to an alternative medicine provider ◦ 20/22 (90.9%) of CFM providers expressed interest in learning about alternative medicine modalities  The top five requested modalities according to patients (physician reported) and providers are pictured below.               Recommendations for future interventions/projects:   Provide informational packet to patients ◦ Accessible in waiting area  Compile informational packet into an easily accessible online database for physicians and possibly patients as well. ◦ Continue adding information, provide search function to view with patient as opposed to having to retrieve informational packet - Print handouts from database for interested patients  Survey of our intervention’s effectiveness, implementation of suggestions for improvement   PatientsAcupunctureHerbal therapyChiropractorReikiBiofeedbackMassageProvidersAcupunctureHerbal therapyReikiBiofeedbackYoga2  Acupuncture  What is acupuncture? Acupuncture is a traditional Chinese medicine technique that uses fine needles to increase or decrease energy flow along certain meridians according to acupuncture theory.  It is good for a variety of complaints and best used in conjunction with standard treatments.    What patients might benefit from acupuncture? While acupuncture is commonly thought of for chronic conditions as a therapy when all others have failed, it has better efficacy for acute problems.  Some examples of complaints: - Acute pain - Chronic pain - Anxiety/stress tension - Fertility treatment - Viral illness symptoms  - Moving a fetus from breech to cephalic position - Stimulation of labor contractions - Seasonal allergies/asthma - Depression - Weight loss, smoking cessation (lower efficacy)  Which patients should NOT receive acupuncture? Acupuncture is safe for all ages, in pregnancy, and can even be given to patients on Coumadin therapy.  A possible contraindication could be patients with uncontrolled psychiatric disorders and eating disorders.  What are the side effects of acupuncture? Patients may be sleepy after the treatment.    What would be a recommended treatment plan? Treatment plans vary according to the complaint; for example, chronic conditions may require many treatments, while other complaints may resolve with just one treatment.  For an acute complaint, three treatments in a week may be warranted.  Patients should start to see benefits after the third treatment at most.  What does acupuncture typically cost? Acupuncture is usually not covered by insurance.  The cost for one treatment may range from $50-$100.  Acupuncturists (versus medical doctors certified in acupuncture) generally cost more.  Resources in the community: - Dr. John Leuenberger, DO at CFM of EMMC  895 Union St #12, Bangor ME - E. Marie Arnberg 100 U.S. Highway 1, Suite 2 04416 Verona Island 207-479-2944    - Dr. Rick Hobbs, MD 121 Silver St, Waterville, ME 04901 (207) 873- 3900 - Kelly Sherman, LAC 43 Acme Rd Suite #A, Brewer, ME 04412 (207) 561-02903  Biofeedback What is biofeedback? Biofeedback is a mind-body technique that allows an individual to learn how to manipulate his or her physiological activity for the purposes of improving health and performance. Precise instruments are used to measure physiological activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature and, in turn, provide rapid, accurate 'feedback' to the user. The individual then uses this enhanced awareness to support desired physiological changes with the goal that these changes endure without continued use of an instrument.  What patients might benefit from biofeedback? An ideal candidate will be motivated with an open mind. Evidence has shown biofeedback to be effective for a variety of ailments that includes the following: - Tension headaches - Bladdery dysfunction - Irritable Bowel Syndrome - Fecal incontinence - Constipation - Fibromyalgia - Chronic pain - Stress reduction - Hypertension - Raynaud’s disease - Sleep disorders  - Attention deficit disorder  - Asthma  - Tinnitus   Who will NOT benefit from biofeedback? Contraindications to biofeedback therapy include severe structural injuries (ie slipped discs, broken bones, etc), psychoses, major affective disorders, and cognitive impairment.    What are the side effects of biofeedback? Biofeedback is generally well tolerated and there are few side effects. However, machines measuring perspiration emit a small electrical current so people with heart conditions or a pacemaker should be cautious.  What is a typical session and how many are needed? A typical biofeedback session lasts between 30 and 60 minutes. The number of sessions needed to resolve an issue will vary depending on a number of factors, including how quickly an individual learns to control his or her physical responses with the average being 8-10 sessions.  How much does biofeedback therapy cost? An average treatment costs between $35-90. Insurance plans may provide some coverage depending on the ailment biofeedback is being used for. For instance, insurance will likely cover treatment of incontinence, but not stress reduction.  Resources in the community: Jonathan M. Borkum, Ph.D. Health Psych Maine  Health Psych Maine 2 Big Sky Ln, Waterville ME   Northeast Pain Management 1365 Broadway, Bangor ME www.hpmaine.com (207) 872-5800 4  Herbal Therapy  This past August, UVM COM students Mikaela Rodriguez and Suleiman Ismael evaluated several online resources for herbal therapy and compared them based on comprehensiveness, evidence-based medicine, ease of use, availability on EMMC network, and recommendations form the AAFP and WHO and subsequently chose Natural Standard. Their informational flyer, shown below, describes how to access and best utilize Natural Standard.    5  Hypnotherapy What is hypnosis? Hypnosis is a state of mind characterized by deep relaxation, heightened imagination and increased responsiveness to suggestions. By reaching a deeply relaxed state, the conscious mind becomes quiet and the subconscious mind can accept new suggestions for positive change. Individuals are awake, aware and in complete control during hypnosis; individuals can accept or reject any suggestion and can emerge from hypnosis at any time.   Which patients will benefit most from hypnotherapy at your practice? Patients who are motivated for results and willing to put in effort will benefit most from hypnotherapy. Conditions for which hypnotherapy has been beneficial include:  - Smoking - Weight management - Asthma - Insomnia - High Blood Pressure - Panic attacks, Anxiety  - Fears and phobias - Migraines - Pain - Morning Sickness - Birth Preparation - Stress   Which patients will likely NOT benefit from hypnotherapy? Individuals that want hypnosis to be a “magic pill” with little effort to make the results happen will likely not benefit from hypnotherapy. Contraindications to hypnotherapy include cognitive impairment, schizophrenia, psychosis, severe depression and chronic pain that has not been diagnosed by a doctor.  Are there side effects from hypnotherapy? Hypnosis is safe if done with a qualified hypnotherapist, but, in rare cases, it can cause headaches, dizziness, nausea, false memories and anxiety.  What does a typical treatment and how many are needed? A first session is two hours in length and consists of a discussion about what the patient would like addressed, an explanation of hypnosis and how it works, followed by a hypnotherapy session.  The session may be recorded and given to the individual for repetition of the session as repetition will provide better results. The number of treatments needed vary from patient to patient.  How much does hypnotherapy cost?  Sessions can cost between $100-150 on average, with sessions typically lasting 1.5-2 hours. Some patients are able to use flexible health spending accounts for specific health conditions such as smoking and weight management, but not for conditions like anxiety or insomnia.  Resources in the community:  Eric Brown, M.D.  EMMC Center for Family Medicine  895 Union St. #12, Bangor ME  (207) 973-7979    Evelyn Conrad, HC Absolute Hypnotherapy 60 Washington St, Brewer ME www.Absolutehypnotherapy.com (207) 945-9804 6  Reiki  What is Reiki? Reiki is a hands-on Japanese relaxation technique that aims to relax a patient.  The practitioner may place their hands on or above a patient’s seven “chakras,” which are considered meeting places of energy channels of the body.  They may also place their hands over a specific part of the body that is causing the patient suffering in some way.  The patient remains fully clothed on a table, and may listen to music or guided imagery.  What patients might benefit from Reiki? Patients of any age, from infants to the very elderly can receive Reiki treatment.  Common candidates for Reiki include: - Anxiety/stress management - Physical trauma - Stroke/physical rehabilitation - Asthma - COPD - Palliative care - Nausea - Pain management - OCD - ADHD - Arthritis - Cancer - Cardiovascular disease  Who should NOT receive Reiki? There are no contraindications for Reiki treatment.  What are the side effects of Reiki? Patients may be sleepy after the procedure.  In acute injuries, Reiki may “bring pain to the surface” and cause pain to increase.  Patients can become emotional.  What would be a recommended treatment plan? There is no defined Reiki treatment plan.  A general suggestion is for three treatments.  Some patients may benefit from just one treatment.  How much does Reiki cost? A modality similar to Reiki, called “Healing Touch,” is more standardized and used in hospitals and may start to be covered by insurance by the end of 2014.  Reiki is not currently covered by insurance and an hour session usually can cost between $40-$60.   Resources in the community: - Blue Heron Wellness Center:  81 Main St, Bangor ME.  www.theblueheronwellnesscenter.com - Anja Prestridge, RN: www.heavnlychi.com - Qi Gong Studio: 27 State St, Suite 36, Bangor ME. www.qigongstudio.com -  EMMC and CancerCare offer in-hospital free Reiki treatments from Reiki volunteers    7  Yoga What is yoga? Yoga is an ancient practice from traditional Indian (Ayurvedic) medicine that combines breathing and meditation exercises with physical body movements or postures. While there are many styles of yoga, any style can improve strength, flexibility, and balance and all styles release tension in the body, quiet the mind and help relax the person.  What are some of the different yoga styles and who will benefit from each?  Hatha: Beginners  Slow-paced, gentle, focused on breathing and meditation. Designed to introduce beginners to yoga with basic poses and relaxation techniques.   Relieves stress, provides exercise, improves breathing   Iyengar: Beginner  Iyengar utilizes different props like straps, blankets, and blocks are to assist in strengthening the body and maintaining proper bodily alignment. Standing poses are emphasized, and are often held for long periods of time.  Builds up body strength. Good for those with injuries, balance issues, and chronic medical conditions like arthritis, back pain or neck pain, as they are likely to benefit from modification to the poses.   Viniyoga: Beginners  Consists of long, deep stretches and focuses on the breath and how it affects each pose.  Helps with flexibility, recovery from injury, body awareness, and relaxation. Good for back or neck problems   Vinyasa: Beginner and up  A series of 12 poses where movement is matched to the breath designed to link breath with movement and to build lean muscle mass throughout the body  Improves strength and flexibility, tones the abdominal muscles, and reduces the risk of heart disease, high blood pressure, and type II diabetes.   Bikram: Beginner and up  Practiced in a 95 to 100 degree room and consists of a series of 26 poses that allows for loosening of tight muscles and sweating.  Speeds up recovery from an injury, enhances flexibility (heat allows deeper stretch) and cleanses the body  NOT appropriate for those with cardiovascular disease because of the strain placed on the body when vigorously exercising in the heat.   Ashtanga: Difficult  Ashtanga yoga is a form of power yoga that is fast-paced and intense with lunges and push-ups.  Maintains strength and stamina, relieves stress, improves coordination, and helps with weight loss.   8  Who will NOT benefit from yoga? People with structural defects such as herniated disks or osteoporosis, for example, should avoid deep forward bends, and anyone with neck problems or hypertension should avoid headstands. People with shoulder or wrist problems may need to adapt or skip poses that put too much pressure on these joints.   Are there any side effects from yoga? With proper instruction, yoga is typically seen as a safe, low impact exercise; however, as with any form of exercise, side effects include risk of injuries such as pulled muscles, tendons, etc. Bikram yoga with its heat can be associated with nausea, lightheadedness, fainting and cardiovascular instability.  What is a typical yoga session and how many are typically needed? A typical yoga class lasts 45 min- 1 hour. The number of sessions required for effectiveness will vary among patients with repetition increasing likelihood of success. If patients are comfortable that they can perform poses safely on their own, they are encouraged to practice yoga at home. Mats and adaptive equipment required can usually be purchased at stores like Target or Walmart.   How much does yoga cost? The average cost of a yoga class is $10-15, with better rates if purchasing multiple classes at once. However, yoga classes are often offered at gyms and cost is included in gym membership fee.  Resources in the community: Encourage patients to search their local gyms for availability of yoga classes.  Om Land Yoga   9 Central St, Bangor, ME  (207) 249-9180    19 Mill St, Orono, ME  (207) 249-9180   9  Resources 1. About biofeedback. (n.d.). Biofeedback Institute of San Francisco. Retrieved September 17, 2014, fromhttp://www.biofeedbacksf.com/Biofeedbacksf/About%20Biofeedback.html 2. Bassotti G, Chistolini F, Sietchiping-Nzepa F, et al. “Biofeedback for pelvic floor dysfunction in constipation”. BMJ 2004; 328:393. 3. Brody, Jane (4 November 2008). "''The Possibilities in hypnosis, where the patient has the power''". Retrieved September 15, 2014. Nytimes.com.  4. Budzynski, T. H., Stoyva, J. M., Adler, C. S., & Mullaney, D. EMG biofeedback and tension headache: A controlled-outcome study. Psychosomatic Medicine, 35, 484-496. 5. Chiarioni G, Whitehead WE, Pezza V, et al. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology 2006; 130:657. 6. Desikachar, T.K.V. with Kausthub Desikachar and Frans Moors (1994), The Viniyoga of Yoga: Applying Yoga for Healthy Living (Second Reprint, 2001 ed.), Chennai, India: Krishnamacharya Yoga Mandiram 7. Durand, Vincent; Barlow, Mark; David (2009). Association for Applied Psychophysiology and Biofeedback. "What is Biofeedback". Abnormal psychology: an integrative approach. Belmont, CA: Wadsworth Cengage Learning. p. 331. 8. Fucarino, Chiara. “5 Different types of yoga- Which one suits you the best?. Retrieved September 17, 2014. http://www.dailycupofyoga.com/2012/06/09/5-different-types-of-yoga-which-one-suits-you-the-best/ 9. Glazer H. I., Laine C. D. (2006). "Pelvic floor muscle biofeedback in the treatment of urinary incontinence: A literature review". Applied Psychophysiology and Biofeedback 31(3): 187–201. 10. Grinder, J and Bandler, R (1976) Patterns of the Hypnotic Techniques of Milton H.Erickson: Volume 1. 11. Lee BH, Kim N, Kang SB, et al. The Long-term Clinical Efficacy of Biofeedback Therapy for Patients With Constipation or Fecal Incontinence. J Neurogastroenterol Motil 2010; 16:177. 12. Lehrer P. M., Smetankin A., Potapova T. (2000). "Respiratory sinus arrhythmia biofeedback therapy for asthma: A report of 20 unmedicated pediatric cases using the Smetankin method". Applied Psychophysiology and Biofeedback 25 (3): 193–200. 13. Karavidas M. K., Tsai P., Yucha C., McGrady A., Lehrer P. M. (2006). "Thermal biofeedback for primary Raynaud's phenomenon: A review of the literature". Applied Psychophysiology and Biofeedback 31 (3): 203–216. 14. Khattab, K., Khattab, A., Ortak, J., Richardt, G. & Bonnemeir, H. (2007, December). Iyengar Yoga Increases Cardiac Parasympathetic Nervous Modulation Among Healthy Yoga Practitioners. Evidence-based Complementary & Alternative Medicine, 4(4), 511-517. 15. Maehle, Gregor. Ashtanga Yoga The Intermediate Series: Mythology, Anatomy, and Practice, Novato, CA: New World Library (2012) 16. Mendoza, M. E.; Capafons, A. (2009). "Efficacy of clinical hypnosis: A summary of its empirical evidence". Papeles del Psicólogo 30 (2): 98–116 17. Mikel Burley, Haṭha-Yoga: Its Context, Theory, and Practice, Delhi: Motilal Banarsidass Publ., (Jan 1, 2000) 18. Nestoriuc Y, Martin A, Rief W, Andrasik F (September 2008). "Biofeedback treatment for headache disorders: a comprehensive efficacy review". Appl Psychophysiol Biofeedback 33(3): 125–40.   19.  Robertson, D (2012). The Practice of Cognitive-Behavioural Hypnotherapy: A Manual for Evidence-Based Clinical Hypnosis. London: Karnac. 20. Wilson, Cynthia. "Different types of yoga and their benefits". Womenio. Retrieved 16 September 2014. 

Alternative Medicine Resources for Primary Care Physicians

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Alternative Medicine Resources for Primary Care Physicians

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