ORTHOPEDIC CONFERENCE VALIDATES USE OF ALTERNATIVE MEDICINE

- by Dr. Robert C. Martin

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Earlier this month I attended the American Academy of Orthopedic Surgeons Annual Meeting in San Francisco, CA. As the largest and one of the most prestigious orthopedic meetings in the world the AAOSAM presents a broadband of information on musculoskeletal medicine. One of the symposia I found interesting was on complementary and alternative medicine (CAM).

Once thought of only as "fringe" medicine. Complementary and Alternative Medical Therapies have entered "mainstream" medicine. Many patients are using these therapies, and while many are safe and effective, some are not.

The use of CAM by Americans skyrocketed in the 90's. These therapies are particularly popular with patients who have musculoskeletal disease as evidenced by a 1997 study showing that 53% of all patients using CAM therapies had arthritis, back or neck pain. From 1990 to 1997 the use of CAM therapies increased from 33.8% to 42.1% of those surveyed. The CAM therapy that had increased the most – over 400% - was herbal and nutritional supplements. In 1997, 18% of all prescription users in the USA took herbal medicines and spent over 3.5 billion on herbs and nutritional supplements. The most common reason for the use of CAM therapies was to relieve pain.

With over 20,000 herbs and related products used in the US, it is impossible to keep abreast of all of them, however approximately 20% or 4000 account for 80% of the usage. The most commonly used herbs in the US are Chamomile, Echinacea, Feverfew, Garlic, Ginger, Gingko, Ginseng, Cat's Claw, St John's Wort, Saw Palmetto, Valerian. The most common nutritional supplements are Glucosamine sulfate, Chondroitin Sulfate, MSM (dimethyl sulfone) and s-Adenosylmethionine (Sam-e). All of these nutritional supplements are reported to help stabilize or heal damaged joint cartilage.

Despite the widespread usage of herbal preparations and nutritional supplements in the US there are no requirements to prove efficacy. This often leads to outlandish marketing claims that leave the average consumer expecting unrealistic results. Reputable studies are beginning to appear in the scientific literature that indicate positive clinical effects for some of the more popular nutritional supplements such as glucosamine sulfate.

In addition, evidence from in vitro and animal studies is beginning to appear for a number of the popular herbal products such as feverfew, echinacea and evening primrose. These studies indicate these herbs influence the inflammatory and immune response including prostaglandin biosynthesis and interleukin production (a key factor for the immune system).

Despite the perception that "natural" is synonymous with "safe" these are potent agents that should be treated with respect by both physicians and patients. Of most concern to the orthopedic surgeon is the potential for complications due to herbal or nutritional supplements during and after surgery. For instance, feverfew, garlic, Ginkgo, ginger, and ginseng may alter the ability of your blood to clot. The Anesthesiology Society maintains a web page of herbs and surgical complications at - http://www.asahq.org/Profinfo/herb/list.html.

In addition to the documented effects and interactions of specific herbs and supplements some preparations may contain contaminants or other non-listed medications. Analysis has revealed widely disparate amounts of active ingredients as well as contaminants such as lead and arsenic. This means purchasing from a reputable source is a must.

CAM can be a useful adjunct to treat musculoskeletal problems however the FDA does not regulate this area so the more informed you are the better.