Complementary/Integrative Therapies That Work: A Review of the Evidence

 


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Significant evidence supports the effectiveness and safety of several complementary or integrative treatment approaches to common primary care problems. Acupuncture is effective in the management of chronic low back pain. Mind-body interventions such as cognitive behavior therapy, yoga, tai chi, qi gong, and music therapy may be helpful for treating insomnia. Exercise can reduce anxiety symptoms. Herbal preparations and nutritional supplements can be useful as first-line therapy for certain conditions, such as fish oil for hypertriglyceridemia, St. John's wort for depression, and Ginkgo biloba extract for dementia, or as adjunctive therapy, such as coenzyme Q10 for heart failure. Probiotic supplementation can significantly reduce the likelihood of antibiotic-associated diarrhea. Physicians should caution patients about interactions, and counsel them about the quality and safety of herbal and nutritional supplements.

About one-third of U.S. adults in 2012 reported that they used complementary therapies in the previous year, according to data from the Centers for Disease Control and Prevention.1 Studies have shown that 12% to 64% of patients do not disclose this use to their physician.2 The American Academy of Family Physicians advocates for evidence-based evaluations of integrative medicine to facilitate education, treatment, and counseling of patients.3  This article will discuss the evidence for eight of the best-studied integrative interventions, which primary care physicians should consider incorporating into their practices (Table 1).

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Acupuncture provides benefits for chronic low back pain.

A

46

Coenzyme Q10 is a safe adjunctive therapy in patients with heart failure and may improve clinicaloutcomes.

B

10, 11

Exercise has a small to moderate effect in reducing symptoms in persons with diagnosed anxiety disorders.

B

13, 15

Fish oil is an effective treatment for hypertriglyceridemia.

C

1921

Ginkgo biloba extract EGb 761 improves cognition in patients with dementia.

A

26, 27

Cognitive behavior therapy is effective for the treatment of insomnia.

A

30

Music is effective for improving subjective sleep quality in adults with insomnia.

B

33

Movement-oriented mind-body approaches such as yoga, tai chi, and qi gong may be beneficial for sleep, especially in older adults and cancer survivors.

A

32, 34

Probiotic supplementation significantly reduces the incidence of antibiotic-associated diarrhea.

A

35, 36

St. John's wort (Hypericum perforatum) benefits patients with mild to moderate depression.

A

39


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Acupuncture provides benefits for chronic low back pain.

A

46

Coenzyme Q10 is a safe adjunctive therapy in patients with heart failure and may improve clinicaloutcomes.

B

10, 11

Exercise has a small to moderate effect in reducing symptoms in persons with diagnosed anxiety disorders.

B

13, 15

Fish oil is an effective treatment for hypertriglyceridemia.

C

1921

Ginkgo biloba extract EGb 761 improves cognition in patients with dementia.

A

26, 27

Cognitive behavior therapy is effective for the treatment of insomnia.

A

30

Music is effective for improving subjective sleep quality in adults with insomnia.

B

33

Movement-oriented mind-body approaches such as yoga, tai chi, and qi gong may be beneficial for sleep, especially in older adults and cancer survivors.

A

32, 34

Probiotic supplementation significantly reduces the incidence of antibiotic-associated diarrhea.

A

35, 36

St. John's wort (Hypericum perforatum) benefits patients with mild to moderate depression.

A

39


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

View/Print Table

Table 1.

Summary of Indications for Complementary Therapies

TreatmentIndicationFirst-line vs. adjunctiveComments

Acupuncture

Chronic low back pain

First-line

Should be performed by a licensed practitioner

Coenzyme Q10

Heart failure

Adjunctive

Dosage is 100 mg three times per day

Exercise

Anxiety

First-line

May be helpful in patients with diagnosed anxiety disorders, those with chronic illness without diagnosed anxiety, and those with depression; aerobic exercise is best studied; 30 minutes three to five times per week seems to be most effective

Fish oil

Hypertriglyceridemia

First-line

Lowers triglyceride levels, but unclear if it reduces cardiovascular events; dosage is 4 g of combined eicosapentaenoic acid/docosahexaenoic acid per day; may have minor

The Authors

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BENJAMIN KLIGLER, MD, MPH, is an associate professor in the Department of Family and Community Medicine at Icahn School of Medicine at Mount Sinai, New York, NY....

RAYMOND TEETS, MD, is an associate professor in the Department of Family and Community Medicine at Icahn School of Medicine at Mount Sinai.

MELISSA QUICK, DO, is a family physician at Group Health Cooperative, Seattle, Wash.

Author disclosure: No relevant financial affiliations

Address correspondence to Benjamin Kligler, MD, MPH, Icahn School of Medicine at Mount Sinai, 245 Fifth Ave., 2nd Floor, New York, NY 10016 (e-mail: bkligler@chpnet.org). Reprints are not available from the authors.

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