EPQ Project: Introduction to Complementary and Alternative Medicine

This is the introduction of my report which formed part of my EPQ project, "To What Extent Should Traditional Chinese Medicine Be Available as a Complementary and Alternative Therapy in the NHS for Pain Relief in Palliative Care?"

Complementary and alternative medicine, also known as CAM, has had a long and controversial history. Some swear by its health benefits, but others dismiss it completely as quackery. CAM comprises a group of diagnostic or therapeutic systems of healthcare that is separate from conventional medicine (also known as western medicine). Conventional medicine is distinct from CAM because of its evidence-based or scientific nature as opposed to a set of cultural practices that may be seen in CAM.
Figure 1: Some examples of CAM and how they are classified.
People use CAM in different ways. The Oxford Handbook of Complementary Medicine states that if CAM is used alongside conventional medical treatment, then the therapy or treatment is used as a complementary treatment. However, if CAM is used instead of conventional treatment, then the therapy is described as alternative medicine. Others may refer to CAM being used to help maximise the benefits of conventional treatment, and this is known as integrative medicine.

There are different types of CAM (see Figure 1), placed into discrete categories according to how they work: biologically-based therapies that involve the consumption of products, energy therapies that consist of channelling healing energy, mind-body interventions that use the mind to create a positive effect on the body and manipulative therapies that involve the movement or manipulation of the body.

Whole medical systems usually take into account all of these different types of therapies.

Traditional Chinese Medicine, or TCM, is a whole medical system that has received controversy recently (see Figure 2) due to an absence of regulation, lack of scientific basis, use of animal products in its medicinal treatments and the toxicity of some of the herbal medicines used.

Figure 2: Newspaper headlines & tweets show the controversy that TCM has received over the last few years.
Sources: The Daily Mail, David Colquhoun, The Korean Times, Shrewsbury Living, Twitter

Amidst all the controversy, according to the Oxford Handbook of Palliative Care and the Nursing Times, it is becoming more frequently used by patients (Ernst & White, 2000), especially terminally ill patients, for pain relief, for many reasons, including desperation and the many side effects of conventional medicine. Traditional Chinese Medicine, however, is not funded by the NHS.

Palliative care is a branch of medicine that aims to prevent and relieve suffering and to support the best possible quality of life for patients with advanced, progressive or life-limiting conditions, many of whom are terminally ill. Palliative care also involves enhancing the quality of life and helping patients to live as actively as possible, and alleviating the side effects of medication, like chemotherapy. Palliative care neither aims to prolong or curtail the lifespan of the patient (Watson, et al., 2005), but is mainly concerned with maximising the quality of life of patients through the management of symptoms (see Figure 3), especially pain, which is the most frequently seen symptom in palliative care. 50% of all cancer patients experience some level of pain (Running & Turnbeaugh, 2011) and many patients are increasingly relying on an integrative approach of CAM to achieve a state of analgesia.

Although there are many different types of pain, the one thing, however, that is common in all patients with pain is that pain limits the patient’s quality of life, and this is why it is very important for patients to achieve analgesia, the state of being pain-free. This can be achieved using analgesics, painkilling drugs, which are given on an analgesic ladder (as pain increases, the medication given is also increased and adjuvants, additional medication to increase the benefits of the analgesics are given). These medications do, however, carry side effects, which often push people away from conventional medicine.

Figure 3: Key symptoms managed by palliative care, the analgesic pain ladder
(World Health Organisation, 2004) and the side effects of analgesics.

Pain can also be controlled by CAM, the main principles of which usually involve a holistic therapy (the whole body is being treated, not just the cause of an ailment) and the support of physical, psychosocial and emotional factors.

These holistic principles make CAM increasingly popular with patients, with an average of 40% of patients with life-threatening or chronic illness using CAM compared to 28% of the general UK population (Watson, et al., 2005).

Some reasons for an increased reliability on CAM include the holistic nature of the therapy, dissatisfaction with conventional medicine being ineffective, side effects of conventional medicine, poor patient-physician relationship, long waiting lists, desperation and rejection of orthodox medicine (see Figure 4).

Figure 4: Reasons for increased reliability of CAM on pain relief (Ernst & White, 2000).
The font size indicates the popularity of the reason

It seems then that if CAM works, then surely it should be on the NHS. However, there are many reasons, more than just the treatment’s efficacy (how well it works), which allows a therapy to be approved on to the NHS by the National Institute for Health and Clinical Excellence (NICE). Other factors are taken into account including the benefit to the patient, cost and cost-effectiveness and whether the therapy would help the NHS achieve set targets, gaining information and evidence from doctors, drug companies and patients.

Information such as evidence for the efficacy or the QALY of a therapy would be considered. The QALY or the quality-adjusted life year is a measure of how much long a quality life a patient can be expected to gain from having the therapy, taking into account a patient’s well-being, independence and other factors.

For example, acupuncture, which is part of Traditional Chinese Medicine, has already been approved to be used in the NHS for the early management of persistent non-specific low back pain. But why is not Traditional Chinese Medicine approved, especially for something as important to quality of life as for pain relief? Indeed, TCM does have its own system of diagnosing and treating pain that is vastly different to conventional medicine, but if palliative care is all about reducing symptoms like pain, then perhaps TCM should be approved as a method of pain relief in the NHS.

This study has been done to determine the extent to which Traditional Chinese Medicine should be available in the NHS as a complementary and alternative therapy to treat pain in palliative care patients.

To conduct the study, three research questions have been posed:

1. How is TCM used in palliative care pain relief?
2. Is TCM cost effective in pain relief?
3. To what extent is it important to have freedom to choose CAM despite the costs?

This will involve researching how TCM is used in pain relief, including its risks and benefits; how cost-effective TCM is, including a comparison between conventional medicines and whether freedom of choice of therapy is more important in palliative care pain relief than the cost of the drug. This will be done through surveys, interviews and careful consideration of existing literature.

From early on in the project, I predicted that TCM will be more expensive and less cost-effective than conventional medicine and that this has been a barrier for its acceptance onto the NHS, but that people will feel that freedom of choice is very important.

For more on my methodology, click here.

  • Ernst, E. & White, A., 2000. The BBC survey of complementary medicine use in the UK. Complementary Therapy Medicine, March.pp. 32-36.
  • Watson, M., Lucas, C. & Hoy, A., 2005. Oxford Handbook of Palliative Care. s.l.:Oxford University Press.
  • Running, A. & Turnbeaugh, E., 2011. Oncology Pain and Complementary Therapy: A Review of the Literature.. Clinical Journal of Oncology Nursing, pp. 374-379.

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