All physicians understand the limits of current treatments for chronic pain and the potential value that nonpharmacological interventions may have.1 In addition to conventional medications, patients suffering from arthritis also seek other effective treatments for pain relief by means of complementary and alternative medicines (CAM) including mind–body practice, herbal remedies, acupuncture, and supplements. In fact, it is estimated that arthritis is among the top six conditions for CAM use.2 Therefore, the availability of complementary, alternative, and integrative health interventions is becoming a vital component of healthcare systems domestically and globally, and the need for such treatment options for chronic conditions such as RA is growing exponentially. To better inform clinicians of possible alternative medical treatments for our patients with RA, the objectives of this article were to: 1) Offer a conceptual overview of the current body of knowledge on CAM; and 2) Explore multidimensional approaches beyond pharmacological therapies to treat RA.
Concerning the question about whether “Wang’s personal updated but unpublished review” is truly evidence-based medicine and … “should appropriately weigh the overwhelming amount of evidence and protect us from biased reports of promising, uncontrolled, and unpublished results,” I acknowledge that several important published trials were omitted in this overview. They are now listed in the references below.3-8
Concerning skepticism about whether or not NIH efforts in CAM are vital and wisely invested, my response is the following. After a mere two decades of NCCAM efforts on CAM research, it remains a challenge for scientists to continue to evaluate over 3,000 years of clinical or research questions to prove the efficacy of CAM. These challenges include, but are not limited to: 1) current models of biomedicine that restrict CAM research; 2) the complex, confounding, and multivariable factors in CAM systems that require innovation to formulate rigorous, well-designed studies; 3) the compulsion to address critical unmet needs for novel yet effective CAM treatments for patients who struggle with the toxicity and increasing costs of medications; 4) the generation of critical insights into comparative clinical effectiveness research for providing optimal treatments for patients, especially over the long term.
Despite these challenges, we are poised for the start of a major paradigm shift in healthcare. This shift will inevitably tilt towards personalized medicine to optimize health and develop individualized therapy and self-management to combat disease, including RA.
My overview was, therefore, intended to push for and incite further exploration of the mysteries and complexities of the human body and mind in conjunction with CAM use for patients with chronic disabling conditions.
