I. What is Complementary and Alternative Medicine
Complementary and Alternative Medicine CAM is variably defined but generally refers to medical therapies and practices that are not commonly taught at medical colleges or available at major hospitals and clinics in the United States1 2 in contrast to -traditional- or -conventional- medicine which refers to therapies that happen to be provided in most hospitals and clinics.
Sometimes complementary medicine is described as non-traditional therapies which have been used in conjunction with classic therapies to complement their action even though choice medicine is utilised to describe non-traditional therapies that are utilized in location of as an alternative to traditional therapies. Practically speaking most non-traditional therapies are simply classified under the common rubric- CAM therapies. A associated term used in some settings is integrative medicine which highlights the belief that CAM therapies are best employed when integrated with as an alternative to replacing conventional medical care.
II. What are the big kinds of CAM
There are actually lots of distinct ways to categorize CAM therapies. The National Center for Complementary and Alternative Medicine NCCAM – see- would be the scientific branch with the National Institutes of Health that delivers study funding for CAM. Karyotyping It outlines 4 -domains- of CAM and also describes -whole medical systems- which refers to various theories of medical practice like Conventional Chinese Medicine or Homeopathic Medicine that might involve a number of domains of CAM therapies.
A. The Four NCCAM domains of CAM-
1 Mind-Body Medicine – procedures employed to -enhance the minds capacity to have an effect on bodily functions and symptoms- like meditation prayer psychological healing and therapies that use innovative outlets for instance art music and dance.
two Biologically-Based Practices – goods observed in nature for instance herbs and vitamins which may possibly act similarly to drugs by affecting some biological pathway.
3 Manipulative and Body-Based Practices – practices which include chiropractic and massage that involve the manipulation of physique parts.
4 Power Medicine – practices which have been made to have an effect on proposed -energy fields- surrounding the body examples include qi gong Reiki and Therapeutic touch at the same time as the use of conventional electromagnetic fields to influence ailments or signs and symptoms.
Entire medical systems might involve distinctive types of therapies – for example Conventional Chinese Medicine TCM may well involve using herbs a modify in diet regime or program and acupuncture.
B. Passive vs. Active Therapies-
CAM therapies might also be categorized by the -level of involvement- in the patient into three major groups-
one Dietary supplements- which are taken in a comparable style to drugs for example chondroitin for knee discomfort or Echinacea for the typical cold.
2 Passive therapies- require the patient to pay a visit to a provider and acquire some type of therapy examples contain acupuncture massage chiropractic and particular forms of energy healing.
three Active therapies- require the patient to understand a technique or skill and practice that on their very own. Examples include eating habits physical exercise yoga meditation and pressure reduction techniques.
In quite a few ways the -active- therapies are one of the most desirable due to the fact they offer the patient having a tool or skill that theyre able to use indefinitely and at reduced cost. Interestingly though eating habits physical exercise meditation and pressure reduction are at times viewed as CAM therapies there is powerful scientific proof that a lot of of those -common sense- and -lifestyle interventions- lead to marked enhancements within the outcomes of numerous ailments. Even so they are normally nonetheless viewed as CAM therapies as several hospitals and clinics usually do not supply programs that educate these techniques.
III. Why do individuals use CAM therapies
While using CAM has most likely been frequent for decades the challenge received widespread media attention soon after the publication of two national surveys conducted in 1990 and 1997 that identified that 33.8 on the population 1990 and 42.1 with the population 1997 reported using a CAM treatment inside the past year.one two Possibly even more surprising was the fact that the total visits to CAM providers in 1997 numbered 629 million which exceed the number of visits to all US primary care physicians in other words the population at huge was seeing CAM providers far more normally than traditional physicians Also the out-of-pocket expenditures for CAM therapies in 1997 have been estimated to become 27 billion which was comparable towards the out-of-pocket expenditures for all physician solutions within the US. These landmark scientific studies shed light on the fact that practically half of the population was employing CAM therapies and that individuals have been contributing comparable amounts of their own financial sources to CAM and traditional care. These studies had been a significant element inside the increasing public interest and awareness of CAM reflected by the Congressional action to establish the National Center for Complementary and Option Medicine in the National Institutes of Health in October of 1998. NCCAM was charged with conducting research into the safety and efficacy of CAM giving coaching for scientists to conduct investigation and disseminating details about CAM to the public.
A separate national survey performed in 1998 sought to decide why men and women use CAM.3 Interestingly this study located that most patients usually do not use CAM on account of dissatisfaction with conventional care but rather for the reason that CAM was a lot more -congruent with their own values.- Use of CAM was more popular in individuals with-
1 additional education
two poorer wellbeing standing
three a self-described holistic orientation to overall health
4 a prior -transformational experience- that changed the persons worldview
5 any of the following wellness complications- anxiety back difficulties persistent discomfort urinary tract infections
6 classification inside a cultural group identifiable by their commitment to environmentalism feminism or interest in spiritual and individual development psychology.
This research and other people have borne out the conclusion that the use of CAM is specifically typical among patients who have problems which have not responded effectively to traditional medical therapies. Examples contain such challenges as chronic pain psychiatric illness anxiety depression insomnia gastrointestinal illness abdominal pain constipation diarrhea or generalized complaints fatigue malaise where a important percentage of patients have unsatisfactory outcomes. Soon after exhausting conventional solutions for example pain medicines steroid injections or surgery for persistent back pain lots of sufferers look for CAM therapies to relieve signs and symptoms.
IV. Which CAM therapies are most commonly employed
One of the most current and intensive national survey of CAM use was released in 2004 and involved a national sample of 31044 interviews of adults more than the age of 18 in 2002.4 By far the most usually employed CAM therapies are shown inside the attached figure double-click figure for any greater view of your text.
When prayer utilized exclusively for wellness causes was excluded the research observed that 36 of adults had utilised some kind of CAM therapy in the past year. The most usually made use of CAM treatment was all-natural products 18.9 which contains herbal medicines functional foods such as garlic and animal-based items like glucosamine. Deep breathing 11.6 meditation 7.5 chiropractic 7.5 yoga five.1 and massage five.0 have been amongst quite possibly the most normally applied CAM therapies.
The all round use of CAM 36 excluding prayer was decrease than within the national survey conducted in 1997 which concluded that 42.1 of adults had utilised CAM.1 This may well reflect a true decline inside the use of CAM or might be due to differences in survey style which includes the use of diverse definitions of particular CAM practices and differences in the group of sufferers that had been surveyed. Regardless it can be clear using CAM continues to be really prevalent in the United states.
V. Which CAM therapies are successful
As with any medical therapy a determination with the efficacy of a specific CAM treatment is according to a overview of scientific proof which may can be found in many various types
A. Background on evaluating scientific proof-
The highest-quality scientific research for evaluating the efficacy of any intervention CAM or traditional could be the double-blind placebo-controlled randomized trial. These research generate groups of individuals with comparable traits comparable age comparable socioeconomic standing similar severity of medical conditions such as diabetes heart condition etc by randomly assigning sufferers to a treatment or manage group. Using double-blinding indicates that neither the patient nor the individuals conducting the research know irrespective of whether any offered patient is getting the -real- remedy or an identical inactive placebo treatment. Consequently sufferers and research personnel should not be influenced when judging no matter if they have improved simply because they do not know no matter if they are taking the active or the placebo therapy. As soon as the research is completed the investigators -unblind- the information and decide if individuals in the active group enhanced much more or less than patients inside the placebo group.
However there are couple of higher top quality randomized controlled trials carried out on the vast majority of CAM interventions. A overview of studies examining the efficacy of CAM therapies concluded that most randomized controlled trials in this field are of poor quality.five
Many of the evidence regarding the efficacy of CAM interventions comes from anecdotal reports also known as situation reports when they are published in the medical literature. These reports frequently describe a patient who for example may have had severe back discomfort who was provided a CAM treatment for instance acupuncture and who enhanced. These reports offer preliminary evidence that a treatment could be productive however they are really restricted for quite a few reasons-
oneCase reports have no comparison group so its not clear irrespective of whether comparable sufferers or precisely the same patient would have enhanced devoid of the intervention this predicament is occasionally known as a lack of information concerning the -natural history in the disease-.
twoSituation reports usually are not blinded so each the patient as well as the particular person assessing the outcome are mindful of the remedy. This may well bring about a biased interpretation in the effect for example an acupuncturist may possibly firmly think in the efficacy of the intervention and may tend to overestimate the effect. Also the lack of blinding can cause a placebo effect where the observed advantage is not on account of the intervention but to an expectation of advantage though a single can absolutely argue that there exists nothing at all incorrect with a great placebo effect.
3Case reports often involve a single or simply a number of patients and it is not clear if they are representative from the bigger group of patients who have problems with equivalent problems.
You will discover quite a few examples in traditional medicine exactly where extensively held medical beliefs depending on case reports or other related -observational studies- had been later verified incorrect by the higher-quality randomized controlled trials. For example for decades it had been well established medical practice that when post-menopausal ladies have been offered estrogen they seemed to have less heart condition. It had been not until finally various huge randomized controlled trials were performed that it was discovered that estrogen had no helpful effects on heart condition.six The original observations of advantage had been likely because of the fact that females who went for the doctor to acquire estrogen have been far more health-conscious and did other points that lowered their threat of heart condition.
Even so it should also be mentioned that a lot of from the most significant scientific discoveries originally came from situation reports along with the value of case reports to suggest critical possibilities should not be underestimated. For example the phenomenon of a group of 11 guys who have been either homosexual or intravenous drug customers becoming immune deficient was originally described inside a situation series.7 This -anecdotal- observation or situation series led for the discovery from the AIDS virus.
Historical use is often pointed out as an important consideration relating to the efficacy of CAM interventions numerous of which are employed for hundreds or a large number of years. Sad to say historical use will not supply robust evidence of efficacy because it is basically just a -very massive situation series- and suffers from precisely the same complications noted above.
For the vast majority of CAM therapies there is small or no evidence to document efficacy. Having said that the lack of proof should not be equated using a conclusion that a therapy is ineffective. In the absence of scientific proof there exists an equal likelihood that any treatment might be beneficial or damaging.
Also each and every CAM treatment have to be evaluated for efficacy to get a specific indication or medical problem. For example it is actually too broad to inquire the question -Is acupuncture effective- and scientific proof must be additional narrowly focused to answer a question like -Is acupuncture efficient for the remedy of chronic reduced back pain-
B. Brief evaluate with the evidence for efficacy for one of the most frequently utilised CAM therapies-
Herbs along with other dietary dietary supplements- Herbs along with other normal goods are probably the most generally employed CAM therapies utilised by 18.9 or roughly 1 in 5 adults inside the US.4 The vast majority of those normal items are orally ingested despite the fact that a little percentage is applied topically. A latest evaluate report examined the evidence of herbs efficacy from systematic evaluations which are substantial evaluations of all studies of a particular agent for a distinct indication. The results are summarized within the table beneath.eight
Herbal Sales 2001
Probably efficient reducing cholesterol by 4-6
3. Ginkgo biloba
Likely powerful with compact benefit
4. Saw palmetto
Urinary difficulties from enlarged prostate
6. Grape seed
7. Green tea
8. St. Johns wort
Most likely helpful for mild-moderate depression but not big depression
Herbal sales refers towards the percent of all herbal solutions sold in retail organic item merchants in 2001.
Concerns with the use of herbal items- It has been estimated that youll find approximately 20000 herbal products out there inside the Usa.9 The proof for efficacy is extremely restricted for the ten most frequently used herbs and is extremely limited or non-existent for the remainder of your 20000 herbal products. Consistency with the content of herbal items has been problematic. Herbs include several various natural chemical compounds and its hard to understand which if any of these elements have critical biological effects. Even when distinct active ingredients are identified lots of scientific studies have shown that the contents of these herbal merchandise vary extensively.8 Safety scientific studies of herbal products are also very restricted see safety under. There are several case reports of serious adverse effects probably on account of active components inside the herbs contaminants in the product or resulting from interactions with drugs. The Food and Drug Administration has quite restricted oversight of herbs and other dietary supplements. Herbal goods is usually created and marketed without FDA approval along with the producer not the FDA is accountable for making certain the security of a dietary supplement. As a result there are actually a lot of herbal goods that are contaminated with heavy metals drugs incorrectly labeled herbs or incorrect doses of active components. False and misleading marketing and advertising information and facts is frequent with dietary dietary supplements10 which may perhaps give people unrealistic expectations of security or efficacy.
Normally made use of non-herb dietary dietary supplements- Glucosamine and Chondroitin sulfate – there may be ongoing controversy concerning the probable efficacy of glucosamine and chondroitin sulfate for the treatment of osteoarthritis of your knee. A recent systematic review concluded that the symptomatic benefit of chondroitin is minimal or non-existent.11 A large high-quality randomized controlled trial identified that the combination of glucosamine and chondroitin sulfate was not productive for the general group of patients with knee pain but that it had been probably successful within the subgroup of patients with moderate-to-severe discomfort.12 Ongoing research may well shed additional light around the query of efficacy for this supplement.Omega-3 fatty acids – there is certainly strong scientific proof from randomized controlled trials that the standard intake of omega-3 fatty acids either from a diet substantial in fish or from using dietary supplements minimizes the danger of heart condition. The American Heart Association now recommends that sufferers with heart disease take about one gm of long-chain omega-3 fatty acids each day.13 Dietary content material of omega-3 fatty acids varies considerably. Fish is a significant source plus a 3 gram serving of an -oilier- fish for example tuna sardines salmon mackerel and herring contains roughly 1 gm of omega-3 fatty acids. Plant sources of omega-3 fatty acids consist of flaxseed oil canola oil soybean oil and specific nuts including walnuts. A lot of available dietary supplements contain 1 gm of omega-3 fatty acids.
Bottom-line for herbs along with other dietary dietary supplements-You will find absolutely quite a few herbs which have active ingredients which are possibly effective for treating particular problems. It really is estimated that 13 of at the moment utilised drugs originally came from plants. However the existing problems of poor consistency safety concerns scant data to assistance efficacy and inadequate oversight limit the usefulness of herbal merchandise. Specific non-herb dietary supplements for instance omega-3 fatty acids have powerful information to help efficacy. These items are typically simpler than herbs and consequently simpler to study due to the fact theyve only a single or possibly a handful of components.
Acupuncture – Acupuncture is usually a element of Traditional Chinese Medicine that dates back over two000 years and requires the insertion of little needles at precise points within the physique. Using acupuncture is determined by the theory that there are patterns of energy flow through the entire body called Qi – pronounced -chee- and that condition states are resulting from impaired flow of this energy. The use of acupuncture is believed to enhance disease states and signs by restoring the usual flow of Qi. There may be controversy concerning the efficacy of acupuncture for precise situations. Some studies and reviews have concluded that acupuncture is efficient for- post-operative and chemotherapy-induced nausea and vomitingpost-operative dental discomfortother pain syndromes such as menstrual cramps tennis elbow fibromyalgia and back discomfort
Having said that a latest assessment of systematic critiques re-examined prior evidence and set a -higher bar- for establishing efficacy of acupuncture requiring at least four randomized controlled trials with valid outcome measures as well as a total of at least 200 individuals. This study concluded that there is certainly at present no robust evidence that acupuncture operates for any indication.14
A recent large-scale high-quality randomized controlled trial in 1162 individuals with persistent lowback discomfort observed that the two acupuncture and a -sham- or fake acupuncture led to a substantially larger percentage of patients improving compared with normal treatment 47.6 of sufferers with -real acupuncture- and 44.2 of patients with -sham acupuncture- enhanced in comparison with only 27.4 of individuals in the traditional therapy group.15
Similarly a study in 1007 sufferers with osteoarthritis on the knee discovered that both acupuncture and sham acupuncture led to higher results rates than traditional therapy 53.1 good results with acupuncture 51.0 with sham acupuncture and 29.1 with traditional therapy.16Conventional therapy refers towards the use of anti-inflammatory pain medicines.
Bottom line- Acupuncture is just about surely productive for back pain knee discomfort from osteoarthritis and quite possibly for other syndromes of persistent discomfort. The mechanism of this benefit and no matter if it truly is a placebo impact or possibly a physiological impact in the needle placement is unknown.
2. Chiropractic – Despite the fact that there are actually mentions of sure types of spinal manipulations dating back centuries modern chiropractic care began inside the United states of america in 1895 when Dr. David Palmer established the profession and soon after founded the primary college. Chiropractic practice grew in popularity and chiropractors are now the third largest group of wellbeing professionals in the Usa right after physicians and dentists. Chiropractors are licensed in all 50 states and 45 states have state-mandated gains for chiropractic care.17 Chiropractic care is believed to act by means of corrections of malalignments of the spine termed subluxations by using spinal manipulation named spinal adjustments. Chiropractic care could also involve guidance about physical exercise nutrition and lifestyle adjustments. A systematic assessment on the efficacy of chiropractic care spinal manipulation for reduced back pain observed that it had been no far more helpful than basic practitioner care analgesics physical treatment or workout routines.18Other critiques have located that there is insufficient proof to support the efficacy of chiropractic care for asthma and menstrual cramps.19 201 overview identified that chiropractic care could be helpful for the prevention of migraine headaches.21Bottom Line- Despite the widespread recognition of chiropractic care there exists restricted high-quality scientific evidence that it leads to improved outcomes for distinct problems.
three. Massage – Massage is commonly employed by sufferers with disabling painful or terminal situations and has one of many highest physician referral rates of all CAM therapies. Research into the effectiveness of massage for precise indications is restricted and difficult by the problems of designing suitable management or placebo groups.There is sturdy scientific evidence that massage is productive for the relief of chronic back discomfort along with the advantage is higher than that located with relaxation self-care or acupuncture.22In pregnant females massage of your perineal area 1-2 instances per week has been shown to reduce the frequency of perineal trauma throughout childbirth. 22Massage of pre-term or reduced birth excess weight infants improves everyday excess weight gain and may improve weight and reduce post-natal complications at 4-6 months. 22Latest evidence is insufficient to ascertain if massage is efficient to get a wide variety of other indications which includes cancer asthma fecal incontinence and constipation associated with neurological issues neck pain tendonitis and work-related upper extremity discomfort. Bottom Line – massage has been shown to be productive for chronic back discomfort weight get in low-weight infants and prevention of perineal trauma for the duration of childbirth. Evidence for the efficacy of massage for other indications is restricted.
four. Energy healing – Analysis investigating using therapies which have been believed to modify energy fields surrounding the physique such as Reiki Therapeutic Touch and Healing Touch is preliminary. These therapies are generally applied to treat anxiety strengthen relaxation achieve anxiety reduction improve wound healing and to cut back discomfort. Bottom Line- At present there is certainly insufficient scientific evidence to make conclusions with regards to the efficacy of these interventions.
one. Meditation – Meditation has been practiced for centuries in quite a few diverse cultures all through the globe. Though you will find numerous different types and practices of meditation a latest review of all designs located the common theme of -achieving a well-defined state of thoughtless awareness focusing attention to the present moment and away from the unchangeable past or the undetermined future–23There is promising though not definitive proof that meditation may possibly be valuable for epilepsy menstrual cramping menopausal signs and symptoms mood and anxiousness problems autoimmune ailments and emotional disturbances in patients with cancer.23Further analysis is essential to define the prospective advantages of this therapy.
2. Yoga – Yoga is an ancient practice that originated in India and literally signifies -union- in Sanskrit referring to a union between the mind entire body and spirit. While the ancient practice of yoga involves quite a few aspects of psychological and spiritual well becoming the modern day practice of yoga usually refers towards the physical postures or poses designed to enhance strength flexibility and stability. They are normally coupled with deep breathing and relaxation or meditative tactics.There is certainly sturdy scientific proof that yoga is much more productive than self-care for chronic low back pain resulting in enhanced function and decreased discomfort.24There is preliminary proof that yoga may be valuable for enhancing stress-related symptoms and good quality of life in individuals with cancer.25 Some proof also suggests that yoga may well be effective for the therapy of depression and anxiety.26 27
3.Diet program and Exercising – There are quite a few research documenting the wellbeing benefits of diet regime and exercising to get a selection of ailments from reductions in death and disability from diabetes and heart illness to enhancements in mood and general superior of life. Although these therapies might not be deemed -complementary and substitute- the standard care environments most clinics and hospitals often do a poor work of providing access to these therapies and assisting individuals to create nutritious eating habits and exercise practices. Therefore numerous CAM practitioners devote additional time and power to emphasizing and implementing diet plan and workout techniques. Consequently these therapies are typically incorporated within the CAM -umbrella- of solutions. There are a lot of distinct types of diet and physical exercise and an analysis of certain tactics is past the scope of this evaluation.
VI. Are CAM therapies protected
There are substantial issues regarding the safety and efficacy of herbs along with other dietary dietary supplements and their possible to interact with prescription drugs. A lot of severe life-threatening and fatal unwanted effects to dietary dietary supplements happen to be reported inside the medical literature. The unresolved troubles of limited regulation difficulty developing constant items contamination and little or no security testing for most dietary supplements creates great possible for unwanted effects from these merchandise.eight
There may be small information regarding the safety of most other CAM therapies too although most appear to be reasonably safe. Acupuncture is extensively applied but there have been only unusual reports of any unwanted side effects and most of these are minor fainting minor bleeding worsening of signs. The normal use of disposable needles in this nation has reduced the concern more than the danger of infection or illness transmission.28 Similarly youll find couple of issues concerning the safety of massage though some patients will report discomfort or discomfort or worsening of signs and symptoms especially with additional forceful treatments. Really serious complications of chiropractic care have also been reported only rarely and happen to be normally attributed to improper technique.28
On the list of greatest safety concerns with all CAM therapies is that using CAM might delay the diagnosis or regular therapy of a disorder which could in the end worsen the outcome for some sufferers. Because of this sufferers are usually encouraged to examine CAM treatments along with the signs and symptoms or causes that prompted their use with their regular clinical care provider. Unfortunately only a minority of individuals examine their use of CAM together with the conventional care providers. This can be a complicated issue that requires perceptions from sufferers that medical doctors is not going to support their use of CAM as well as a lack of openness to discuss and assistance using CAM therapies around the component of some care providers.
VII. Sources to discover extra and support come to a decision whether to make use of a CAM treatment
one. National Center for Complementary and Alternative Medicine NCCAM -is the Federal Governments lead agency for scientific research on CAM and is 1 with the 27 institutes and centers that make up the National Institutes of Overall health . NCCAM supports investigation and education and disseminates info towards the public.
two. All-natural Standard – is actually a Web-based info service subscription required that conducts considerable reviews with the safety and efficacy of CAM therapies and presents summaries for the two sufferers and clinical providers www.naturalstandard.com.
three. Natural Medicines Complete Database – can be a Web-based information and facts service subscription necessary that also conducts intensive searches of your medical literature and summarizes details about normal solutions dietary supplements for patients and clinical providers www.naturaldatabase.com.
four. Consumerlab.com – is really a Web-based information service subscription required that analyzes the material of dietary supplements to establish in the event the label appropriately reports the real components and whether or not the solutions meet current accepted requirements for contents of precise merchandise www.consumerlab.com.
one.Eisenberg DM Davis RB Ettner SL et al. Trends in choice medicine use inside the United states 1990-1997- benefits of a follow-up national survey. JAMA. Nov 11 199828018-1569-1575.
two.Eisenberg DM Kessler RC Foster C Norlock FE Calkins DR Delbanco TL. Unconventional medicine inside the United states of america. Prevalence fees and patterns of use. N Engl J Med. Jan 28 19933284-246-252.
three.Astin JA. Why sufferers use choice medicine- final results of a national study. JAMA. May perhaps 20 199827919-1548-1553.
four.Barnes PM Powell-Griner E McFann K Nahin RL. Complementary and substitute medicine use amongst adults- United states of america 2002. Adv Data. May possibly 27 2004343-1-19.
five.Linde K Jonas WB Melchart D Willich S. The methodological excellent of randomized controlled trials of homeopathy herbal medicines and acupuncture. Int J Epidemiol. Jun 2001303-526-531.
six.Hulley S Grady D Bush T et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart condition in postmenopausal women. Heart and Estrogenprogestin Replacement Study HERS Study Group. JAMA. Aug 19 19982807-605-613.
7.Masur H Michelis MA Greene JB et al. An outbreak of community-acquired Pneumocystis carinii pneumonia- initial manifestation of cellular immune dysfunction. N Engl J Med. Dec ten 198130524-1431-1438.
8.Bent S Ko R. Generally made use of herbal medicines in the United states- a overview. Am J Med. Apr one 20041167-478-485.
9.Winslow LC Kroll DJ. Herbs as medicines. Arch Intern Med. Nov 9 199815820-2192-2199.
ten.Morris CA Avorn J. Web marketing of herbal merchandise. JAMA. Sep 17 200329011-1505-1509.
11.Reichenbach S Sterchi R Scherer M et al. Meta-analysis- chondroitin for osteoarthritis of your knee or hip. Ann Intern Med. Apr 17 2007146eight-580-590.
12.Clegg DO Reda DJ Harris CL et al. Glucosamine chondroitin sulfate and also the two in combination for painful knee osteoarthritis. N Engl J Med. Feb 23 2006354eight-795-808.
13.Harris WS. Fish oil supplementation- evidence for wellness benefits. Cleve Clin J Med. Mar 2004713-208-210 212 215-208 passim.
14.Derry CJ Derry S McQuay HJ Moore RA. Systematic critique of systematic critiques of acupuncture published 1996-2005. Clin Med. Jul-Aug 2006six4-381-386.
15.Haake M Muller HH Schade-Brittinger C et al. German Acupuncture Trials GERAC for persistent low back pain- randomized multicenter blinded parallel-group trial with three groups. Arch Intern Med. Sep 24 200716717-1892-1898.
16.Scharf HP Mansmann U Streitberger K et al. Acupuncture and knee osteoarthritis- a three-armed randomized trial. Ann Intern Med. Jul four 2006145one-12-20.
17.Shekelle PG. What part for chiropractic in wellbeing care N Engl J Med. Oct 8 199833915-1074-1075.
18.Assendelft WJ Morton SC Yu EI Suttorp MJ Shekelle PG. Spinal manipulative treatment for reduced back pain. A meta-analysis of effectiveness relative to other therapies. Ann Intern Med. Jun three 200313811-871-881.
19.Hondras MA Linde K Jones AP. Manual treatment for asthma. Cochrane Database Syst Rev. 20052-CD001002.
20.Proctor ML Hing W Johnson TC Murphy PA. Spinal manipulation for major and secondary dysmenorrhoea. Cochrane Database Syst Rev. 2006three-CD002119.
21.Bronfort G Nilsson N Haas M et al. Non-invasive physical therapies for chronicrecurrent headache. Cochrane Database Syst Rev. 2004three-CD001878.
22.Ezzo J. What might be learned from Cochrane systematic evaluations of massage that can guide future research J Altern Complement Med. Mar 2007132-291-295.
23.Arias AJ Steinberg K Banga A Trestman RL. Systematic evaluate of your efficacy of meditation techniques as remedies for medical illness. J Altern Complement Med. Oct 2006128-817-832.
24.Sherman KJ Cherkin DC Erro J Miglioretti DL Deyo RA. Comparing yoga physical exercise plus a self-care book for chronic reduced back pain- a randomized controlled trial. Ann Intern Med. Dec 20 200514312-849-856.
25.Bower JE Woolery A Sternlieb B Garet D. Yoga for cancer patients and survivors. Cancer Handle. Jul 2005123-165-171.
26.Kirkwood G Rampes H Tuffrey V Richardson J Pilkington K. Yoga for anxiousness- a systematic assessment from the study evidence. Br J Sports Med. Dec 20053912-884-891 discussion 891.
27.Pilkington K Kirkwood G Rampes H Richardson J. Yoga for depression- the investigation evidence. J Affect Disord. Dec 2005891-3-13-24.
28.Cherkin DC Sherman KJ Deyo RA Shekelle PG. A critique of the proof for the effectiveness security and expense of acupuncture massage treatment and spinal manipulation for back pain. Ann Intern Med. Jun 3 200313811-898-906.
Karyotyping Peter Facinelli is a green celebrity. The Twilight actor is donating his clothes from the movie to a non-profit organization as collectible merchandise in the hopes of drawing in some green cash bids from vampire movie fans interested in collecting memorabilia.
Celeb Property Examiner via greencelebrity Photo credit- IMDb
Superstar Real Estate- Edward Cullens house from Twilight on the market — INSIDE PHOTOS
Celeb Couples- Where Robert Pattinson took Kristen Stewart on his birthday — TWILIGHT romance
Twilight star Kristen Stewart makes Interview magazine cover
What kind of car does Twilights Robert Pattinson drive Is the rumor true actor was hit by a car
Twilight star Robert Pattinson green celeb Johnny Depp go head to head for MTV Movie Award
Look to the stars is reporting the original Twilight dad Peter Facinelli is auctioning some very special home for charity — giving the clothes off his back for the benefit of a non-profit organization.