Patients' Use of Complementary, Alternative Medicine on Par With 2002 Levels, Survey Finds

The results of a recently released NIH survey reinforce the need for family physicians to talk to their patients -- both adults and children -- about their use of complementary and alternative medicine, or CAM, therapies.

"We were struck by how much people are turning to CAM for chronic pain, particularly back pain, neck pain, musculoskeletal pain and headache," Josephine Briggs, M.D., director of NIH's National Center for Complementary and Alternative Medicine, or NCCAM, said in a Dec. 10 telebriefing on the 2007 National Health Interview Survey, or NHIS, which found that about 38 percent of adults in the United States and almost 12 percent of children and adolescents use some form of CAM. "It's important that health care providers talk to their patients about CAM for safe and integrative care," she noted.

Questions about patients' use of CAM were included in the 2007 NHIS, an annual study in which Americans are interviewed on their health- and illness-related experiences. It is the second such survey conducted by NCCAM and the CDC's National Center for Health Statistics. The first was done as part of the 2002 NHIS.

The results of the 2007 survey are based on data from more than 23,300 interviews with adults about their own CAM use and more than 9,400 interviews with adults who, for the first time, reported on the use of CAM by their children.

NIH officials said in the telebriefing that comparing the two surveys shows that CAM use by adults has largely "plateaued" -- inching up from 36 percent in 2002 to 38 percent in 2007. Reported CAM use by children was just shy of 12 percent, which the officials said reflects the fact that children are generally healthier than adults.

By ethnic group, CAM use is highest among American Indian/Alaska Native adults, at about 50 percent. Among whites, about 43 percent reported using CAM therapies; among Asians, the rate is about 40 percent. Only 26 percent of blacks reported using CAM, and about 24 percent of Hispanics said they did so. CAM use is most common in the 40- to 60-year-old group, a big difference from the 2002 survey, in which those age 60 and older used CAM the most, officials said.

In addition, CAM use is greater among women, those with higher levels of education, those who are not poor, those living in the West and those who have quit smoking, officials said.

According to the survey, the most frequent CAM therapies used by adults -- at 17.7 percent -- were natural products, such as glucosamine, echinacea and ginseng. That's followed by deep breathing exercises (12.7 percent) and meditation (9.4 percent). Use of deep breathing and meditation showed significant increases from 2002, officials said.

Adults reported using CAM most often to treat pain, including back pain, neck pain, joint pain, arthritis and other musculoskeletal conditions. Adult use of CAM therapies for head and chest colds decreased from 9.5 percent in 2002 to 2 percent in 2007.

Children are five times more likely to use CAM if a parent or relative uses it, and child users have similar characteristics to adult users, according to the survey. However, children use CAM for a greater variety of conditions, including back and neck pain, but also for head or chest colds, anxiety or stress and ADD/ADHD.

Asked in the telebriefing if physicians in traditional medical practices are adopting CAM for their patients, Briggs said they show a "growing interest" in how to integrate these practices into their patients' care. A number of medical schools also are offering integrative medicine programs, she said.

FP Reid Blackwelder, M.D., of Kingsport, Tenn., is one such physician-educator. He has long had an interest in CAM therapies and techniques and said he regularly integrates many such modalities into his family medicine practice.

Professor and program director of the Kingsport Family Medicine Residency at East Tennessee State University and a former member of the AAFP Commission on Continuing Professional Development, Blackwelder told AAFP News Now his patients readily accept CAM and estimates that a substantial proportion of them use one or more CAM therapies. He said he is comfortable recommending a blend of prescription medications, dietary and lifestyle changes, meditation, yoga, traditional Chinese medicine, or other remedies -- a practice he called "integrative medicine."

"I ask patients where they look for their health information and work to understand their health philosophy," Blackwelder said. "I also teach my medical students and residents how important the patient's perspective is.

"To me, the true 'alternative medicine' is the fading art of good bedside manner and superb communication skills. The key to the patient-centered medical home is regaining these skills to allow the patient's concerns, interests and resources to be in charge."