Complementary health approaches (CHA) are healthcare approaches developed outside mainstream conventional medicine. Many are long-standing wisdom traditions (e.g. acupuncture, yoga). Others are contemporary (e.g. chiropractic, homeopathy– both developed when modern medicine was also nascent). The most commonly used CHA among adults in the United States of America are nonvitamin, nonmineral, natural products, deep breathing exercises, meditation, chiropractic or osteopathic manipulation, massage, and yoga. In 2007, it was estimated that approximately 11.2% (US $33.9 billion) of the total out-of-pocket healthcare expenditures in the United States were on CHA (1). 

Variation in pain intensity and magnitude of disability among patients with musculoskeletal illness is largely accounted for by variations in symptoms of depression, catastrophic thinking, and heightened illness concern. It is possible that patients with greater stress, distress, and less effective coping strategies might be more likely to seek the use of complementary health approaches.

Cognitive behavior therapy (CBT) is used to address unhelpful cognitions, emotions, and behaviors, teaching people to cultivate more adaptive ones. From the biopsychosocial model of illness, CHA use in orthopedic patients may be filling a gap in care that could be enhanced by the substitution of CBT. The underreferral of orthopedic patients to CBT could be contributing to an increase in the use of CHA.

This study addressed the primary null hypothesis that there are no demographic, illness-related, or psychological factors associated with CHA use among patients with upper extremity illness.

We found that 56% of hand surgery outpatients already use or plan to use CHA in the treatment of their upper extremity illness (2). Patients who sought CHA had less effective coping strategies than those who did not seek CHA, which is consistent with recent research that suggests the use of CHA in cancer patients is more prevalent among people with greater fears, uncertainties, and dissatisfaction. CHA use might reflect a passivity and helplessness, whereas an active role in optimizing self-efficacy would increase health. CHA may be filling a gap that might also be addressed by mind-body treatments, such as CBT, that are proven to alleviate symptoms and limitations in a diverse patient population.

Our research on the utilization of complementary care is focusing on several areas:

1. We are aiming to identify if patients are more likely to use CHA due to specific differences in physician practice.
2.  We are addressing the relative benefit of CHA treatments compared with CBT.

References

1. Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. National health statistics reports no. 12. Published 2008. http://www.cdc.gov/nchs/data/nhsr/nhsr012.pdf.
2. O’Connor C, Braun Y, Nota SP, Baloda T, Ring D. The Association of Complementary Health Approaches With Mood and Coping Strategies Among Orthopedic Patients. Hand (N Y). 2016 Sep;11(3):295-302. PubMed PMID: 27698631.