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Complementary 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.
Alternative 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 therapy.
· Treatment with physical forces and devices may include acupuncture, acupressure, massage therapy, reflexology, ther-apeutic touch, yoga, and crystals.
Although 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 needs.
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