Spotlight: Complementary and Alternative Medicine Research

May 2014

Whether acupuncture, meditation, or herbal medicine, it's estimated that almost 38 percent of adults in the U.S. ¹ have used some kind of complementary or alternative medicine (CAM) treatment. The National Institute of Health's National Center for Complementary and Alternative Medicine (NCCAM) defines complementary and alternative medicine as "a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine."² Complementary and alternative medicine therapies vary widely, and can include mind-body practices such as meditation, acupuncture, or tai chi; natural products like probiotics, herbs, or minerals; and other complementary treatments including homeopathy, naturopathy, or traditional Chinese medicine. ³

The first system-wide survey of CAM therapy availability within VA hospitals was conducted in 2002, and a follow-up survey was conducted in 2011. ⁴ Results from the 2011 survey showed that 89 percent of VA facilities offered CAM therapies, and 65 percent provided those therapies directly. The survey also identified the five most common CAM ⁵ therapies available at VA facilities:

• 72% offered meditation,
• 66% provided stress management or relaxation therapy,
• 58% offered guided imagery,
• 53% offered progressive muscle relaxation, and
• 50% provided biofeedback.

According to the survey, for those facilities not directly providing services onsite, referrals to licensed CAM practitioners were available, with acupuncture being the most commonly referred treatment. The top reasons cited for offering CAM to VA patients were to promote wellness, respond to patient preferences, and provide an adjunct to chronic care.⁶

To support Veterans' preferences for CAM therapies, it is important to build an evidence-base for treatments that prove effective and feasible to implement. Investigators with VA's Health Services Research and Development Service (VA HSR&D) conduct a variety of investigations that contribute to that evidence-base. Several of these studies, both ongoing and completed, include:

• Mindfulness Based Stress Reduction for Women at Risk for Cardiovascular Disease. Slated to conclude in June 2017, this study seeks to examine the impact of mindfulness-based stress reduction (MBSR) on cardiovascular disease in women Veterans. Investigators will enroll women Veterans between the ages of 35 and 70 years who have at least two cardiovascular disease risk factors. Participants will be randomized into either an 8-week MBSR program or a standard health education program. Investigators have two objectives:
  • determine the extent to which training in MBSR improves psychological well-being, decreases inflammatory burden, and reduces cardiovascular risk in women Veterans; and
  • pevaluate protective and risk factors thought to moderate the effect of MBSR on psychological well-being, inflammatory burden, and cardiovascular risk in women Veterans.

Given that cardiovascular disease is a major cause of mortality, and that MBSR has not been evaluated in women Veterans at risk for cardiovascular disease, positive study results may have broader implications for reducing cardiovascular disease in the general population.

• Acupuncture for Symptom Management in Veterans with Hepatitis C . Slated to conclude in May 2014, this study will look at several components surrounding acupuncture therapy for Veterans being treated for hepatitis C virus. Investigators have four objectives:
  • determine whether acupuncture is an acceptable therapy for helping Veterans with HCV to manage their symptoms of fatigue, depression, and pain;
  • explore and describe symptom changes over time, particularly week to week variability;
  • test the range and variability of symptoms;
  • describe the experience of undergoing acupuncture therapy for symptom management, and, in a larger study, explore whether acupuncture influences adherence to interferon treatment.

• The Effect of Acupuncture on PTSD-Related Insomnia . Completed in 2011, this single-site, randomized, controlled trial examined the impact of group auricular (outer ear) acupuncture on PTSD-related insomnia in Veterans of Operation Enduring Freedom and Operation Iraqi Freedom. Participants were assigned to one of three groups: group auricular acupuncture, a "sham" auricular acupuncture control, and a true control. Results showed that Veterans receiving group auricular acupuncture had higher nap times and higher acupuncture quality satisfaction scores than the other two groups. Study results were published in the December 2013 issue of Medical Acupuncture.
  
  
• Improving the Treatment of Chronic Pain in Primary Care. Completed in 2009, this study examined the willingness of Veterans experiencing chronic pain unrelated to cancer to try complementary and alternative medicine (CAM) and explore differences between CAM users and non-users. The study enrolled 401 participants from five VA primary care clinics in a randomized controlled trial. Participants had self-reported prior use and willingness to try chiropractic care, massage therapy, herbal medicines, and acupuncture. Prior CAM users were compared with non-users on demographic characteristics, pain-related clinical characteristics, disease burden, and treatment satisfaction. Results showed that more than 80 percent of all participants would be willing to try one of the four CAM therapies offered. Further, findings provided evidence to support the VA's increasing movement toward offering CAM modalities as treatment options for pain. Investigators suggest that additional research would help determine pain treatment effectiveness and cost-effectiveness of specific CAM therapies. Study results were published in the Journal of Rehabilitation Research and Development in 2011.
  
  
  

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