and Alternative Modalities
Traditional Western medicine focuses on the
treatment of dis-ease. These treatments or interventions are taught in medical
schools and are used by physicians in the care of patients. Com-plementary and
alternative therapies are often viewed as un-conventional and unorthodox
treatments or interventions not traditionally taught in medical schools. Alternative
therapy stresses the need to treat the whole person, recognizing the
interaction of the body, mind, and spirit. What is considered to be an
alter-native therapy in one culture may actually be a traditional ther-apy in
another. Persons with HIV infection report substantial use of complementary and
alternative medical therapies for symptom management (Swanson et al., 2000).
The use of alternative ther-apy in HIV infection and AIDS has resulted from
disillusionment with standard medical treatment, which to date has provided no
cure. Used with traditional therapies, alternative therapies may improve the
patient’s overall well-being.
therapies can be divided into four categories:
· Spiritual or
psychological therapies may include humor, hypnosis, faith healing, guided
imagery, and positive affirmations.
· Nutritional therapies
may include vegetarian or macro-biotic diets, vitamin C or beta-carotene
supplements, and turmeric, which contains curcumin, a food spice supple-ment.
Chinese herbs, such as traditional herbal mixtures, as well as compound Q (a
Chinese cucumber extract) and Monmordica
charantia (bitter melon), which is given as anenema, are also used.
· Drug and biologic
therapies include medicines not approved by the FDA. Examples of these include
N-acetylcysteine, pentoxifylline (Trental), and 1-chloro-2, 4-dinitrobenzene.
Also included in this category are oxygen therapy, ozone therapy, and urine
· Treatment with physical
forces and devices may include acupuncture, acupressure, massage therapy,
reflexology, ther-apeutic touch, yoga, and crystals.
there is insufficient research on the effects of alter-nate therapies, there is
a growing body of literature reporting ben-efits in the areas of nutrition,
exercise, psychosocial treatment, and Chinese medicine. Clinical trials are in
progress to examine the effect of Chinese herbal treatments of HIV-associated
symp-toms related to inadequate nutrition, such as fatigue, nausea, vomiting,
painful or difficult swallowing, altered taste sensation, and diarrhea. At
present there are no definitive study results that indicate that these
treatments are effective, but some appear promising.
Many patients who use these alternative
therapies do not re-port their use to their health care providers. To obtain a
complete health history, the nurse should ask about the patient’s use of
al-ternative therapies. Patients may need to be encouraged to report their use
to their primary health care provider. Problems may arise when patients are
using alternative therapies while they are participating in clinical drug
trials. They may have significant adverse side effects, making it difficult to assess
the effects of the medications in the clinical trial. The nurse needs to become
fa-miliar with the potential adverse side effects of alternative thera-pies.
The nurse who suspects that the alternative therapy is causing a side effect
needs to discuss this with the patient, the alternative therapy provider, and
the primary health care provider. It is im-portant for the nurse to view
alternative therapies with an open mind and to try to understand the importance
of this treatment to the patient. Doing so will improve communication with the
patient and reduce conflict, so that all involved in care can meet the patient’s