Title
URL
Description
National Center for Complementary and Integrative Health (NCCIH)
NCCIH is the center within the National Institutes of Health that funds CAM research. The website includes resources to disseminate research findings and to educate patients and providers on the current state of evidence on CAM modalities
Time to Talk
The Time to Talk topics within the NCCIH website include resources to promote dialog on CAM between providers and patients
Within the Time to Talk webpages, there is a page specifically devoted to dietary supplements for OA
Longwood Herbal Task Force (LHTF)
The LHTF is a collaborative project of Boston Children’s Hospital, the Massachusetts College of Pharmacy and Health Sciences and the Dana Farber Cancer Institute. This project produces and disseminates evidence-based information on herbs and supplements, including brief provider summaries, patient information sheets, and in-depth monographs
Natural Standard
Natural standard is an independent collaboration that produces evidence-based monographs on a wide variety of CAM topics
Some recommendations for addressing CAM with patients are as follows:
Be approachable. Many patients fear negatively impacting their relationship with their providers by disclosing CAM use. Even if a modality is not advisable for a patient, approach the matter in a sensitive, educational manner.
Find out where patients are getting their information. Patients may or may not be using reputable sources of information. It may be helpful to have some sources ready to recommend, such as those listed in Table 14.1.
Emphasize that patients should not stop taking conventional treatments without discussion with their provider. Most patients use CAM in conjunction with their conventional treatments. However, in some cases, patients may be hoping for an alternative with fewer side effects; in these cases, they also risk reduced efficacy. For patients with conditions such as RA, foregoing prescribed treatments may lead to irreversible disease progression. It is advisable to discuss the patient’s reasons for using CAM and discuss adherence to conventional treatments.
Provide education and/or resources on potential side effects and interactions. Patients may assume that CAM approaches are safe because they are perceived as “natural”. It is important to discuss potential adverse effects, especially potential interactions between supplements and conventional medications.
Collaborate with the patient to meet care goals. Patients have varied reasons for using CAM approaches. It is helpful to explore the patient’s own goals to collaborate for effective care and symptom management.
In conclusion, certain CAM approaches hold promise as adjunct treatments for reducing arthritis progression and controlling symptoms. However, none of these modalities is currently supported by strong research evidence. Glucosamine, chondroitin, acupuncture, and tai chi have moderate evidence of benefit, but effects are also small. Limited research suggests that certain topical agents, massage therapy, and yoga may be helpful, but more research is needed. It is important for patients to discuss CAM use with providers for collaborative examination of cost and benefit, as well as safety, side effects, and potential interactions with conventional treatments. Given the widespread use of CAM approaches, this is clearly an important area in which collaboration with patients and consideration of their own care goals are important.
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