Chapter 77

Alternative medicine is rapidly growing in popularity. In what may eventually prove to be the most frequently cited medical journal article in the postwar era, Eisenberg and colleagues demonstrated in 1993 that nearly 40% of Americans utilized alternative medical therapies, and spent more out of pocket for these approaches than they spent out of pocket for mainstream medical treatments.1 A follow-up study in 1998 showed continued dramatic growth in these practices.2 The National Institutes of Health (NIH) has supported an Office of Alternative Medicine since 1993, but thanks to steady increases in congressional funding, it was recently upgraded to a division within the NIH. The November 1998 issues of several of the American Medical Association (AMA)-sponsored specialty journals were devoted to the topic of complementary and alternative medicine (commonly abbreviated CAM); Micozzi’s 1996 text on alternative medicine3 was only the first of many. This rapid rise in interest to what was previously a fringe topic lends an aura of novelty to these techniques, but a cursory look at some of the most common CAM techniques (acupuncture, homeopathy, yoga) shows that these are, in fact, traditional, if not ancient, therapies. And so it should not be surprising that the most common symptom that brings people to their health care providers—pain—has a long and rich tradition of CAM interventions. This chapter outlines some of the more prominent and promising CAM approaches to pain conditions, both acute and chronic, at the same time that it outlines some fundamental similarities and differences between CAM and mainstream biomedical therapies.

To appreciate the relationship between CAM and allopathic medicine, it is helpful to consider three distinct paradigms of medical treatment. The approach taught in medical schools today, and practiced in hospitals worldwide, is known as allopathic medicine, from the Greek allos, meaning “other” because disease pathology is felt to be an outside force to be countered by biomedical treatment interventions. Thus, military metaphors predominate (e.g., the “war” on cancer, our therapeutic “armamentarium”) and treatments are physically focused: medications, surgery, and radiation predominate.

Over the past 30 years, as an outgrowth of Hans Selye’s work on stress response systems, a second model integrating the mental and physical dimensions of health has emerged. Initially called the biopsychosocial model, it is now better known as psychoneuroimmunology, or more globally as mind-body medicine.4 In this system, diseases are felt to be created when the autonomic nervous system and the endocrine system react to negative psychological, emotional inputs and inappropriately elicit the fight-or-flight reaction. Treatments focus on balancing sympathetic overdrive by using mind-body techniques such as biofeedback, hypnosis, and meditation to elicit the counterbalancing relaxation response (see Chapter 14, Psychotherapeutic Management of Chronic Pain), or by introducing new thought and behavior patterns into a person’s life through cognitive-behavioral approaches.

But many of the best known techniques in CAM can clearly not be explained by either the biomedical or the mind-body paradigm, ...

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