Uses, Benefits, & Risks or Integrative Medicine

The coverage of Integrative and alternative medicine varies significantly among insurers and available plans. Most cIntegrative and alternative medicine therapies are not covered, although common exceptions usually include chiropractic therapy.  When these approaches are covered by insurance, partial coverage is typically provided. It often depends on factors such as referrals, pre-authorizations, and if the provider is in-network with the insurance plan. It is common for individuals to pay out-of-pocket costs to ensure they can receive the Integrative and alternative care they consider most beneficial to their health outcomes. 

Generally, the best practice when seeking coverage for Integrative and alternative medicine treatments is communicating clearly with the health insurance provider and the practitioner. Health insurance is fairly specific about requirements or criteria that must be met to have coverage. This often includes the number of visits allowed for coverage or the total amount the insurance provider is willing to cover for certain types of care. Since most insurance providers require that treatments, tests, and screenings are medically necessary, requesting a recommendation for Integrative or alternative therapy may be helpful documentation supporting the need for coverage. 

Most health insurance plans have selective or limited coverage for Integrative and alternative medicine therapies. Coverage outcomes can vary on a case-by-case basis, so individuals interested in pursuing these therapies are encouraged to contact their insurance provider for further guidance. 

Sources

“Complementary and Alternative Medicine”. National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/cam

“Paying for Complementary and Integrative Health Approaches”. National Institute of Complementary and Integrative Health. 

https://www.nccih.nih.gov/health/paying-for-complementary-and-integrative-health-approaches

“Will My Insurance Cover Complementary and Integrative Therapies”. American Cancer Society. 

https://www.cancer.org/cancer/managing-cancer/treatment-types/complementary-and-integrative-medicine/complementary-and-alternative-methods-and-cancer/insurance-coverage.html

Virtual reality (VR) therapy is used in palliative and hospice care to improve quality of life, increase comfort levels, decrease stress and anxiety, and enable individuals with end-stage diseases to complete some of the final wishes on their bucket lists. The technology used in VR therapy allows patients to have immersive and rewarding experiences in realistic settings and scenarios that they might otherwise not be able to access due to reduced mobility and deteriorating health. These experiences are not limited to the patient and can be shared with family members and loved ones to foster a few more cherished memories of time spent together. 

VR systems work by displaying simulated environments through headsets and other equipment that enables viewers to interact and explore the surrounding area as if they were physically present. Some systems may also engage with other senses beyond sight, such as the ability to hear or smell. The environments that are accessible in VR can vary based on the system and the patient’s preferences. For example, some VR systems are preloaded with a variety of specific environments or games, but others may include environments that are customized and unique to the patient’s preferences, requests, or interests. This means that patients can experience exploring another country, participate in a favorite hobby, or even pursue an exhilarating adventure whenever they need a break from the reality of their circumstances. 

While providing patients with a greater sense of freedom from physical limitations is helpful, it is not the only benefit associated with the use of VR therapy. Studies in recent years have found that patients who receive VR therapy experience decreased pain, restlessness, anxiety, and blood pressure. 

Although VR therapy offers many benefits, it is important to be aware of potential side effects and safety considerations. Patients who have a risk of falling should only use VR headsets while sitting or lying down, and likewise, this technology should be used with caution in patients who have dementia or similar neurological conditions that can cause increased confusion. 

Although VR therapy is still in the early stages of application in hospice care, it holds significant promise for transforming the experiences of patients who are terminally ill. While there has been limited adoption of VR therapy in hospice, its use cases have proven to have a positive influence on the lives of patients and their loved ones by introducing experiences that can be a source of comfort, bonding, distraction, or even fulfillment of final wishes. More comprehensive research is necessary to fully understand the extent of benefits that VR therapy can provide in end-of-life care scenarios, but it will be interesting to see how this form of technology will continue to develop to support the needs and interests of those who are actively dying. 

Sources

“Using Virtual Reality Program for Hospice Patients”. Mirasol Health. https://hospicecarelc.org/using-virtual-reality-program-for-hospice-patients/ 

“Virtual Reality & Hospice Care Bucket List”. Keystone Hospice. https://keystonehospice.org/hospice-virtual-reality-bucket-list 

“Using Virtual Reality to Improve the Lives of the Terminally Ill”. Guided VR. https://guidedvr.com/vrforhospices/ 

“Using Virtual Reality In Palliative Care: What Experts Say”. Forbes. https://www.forbes.com/health/healthy-aging/virtual-reality-in-palliative-care/ 

Integrative therapies can have unanticipated side effects and risks. Although many of these therapies are considered natural and presumed to be safe, it is essential to acknowledge that they can potentially be harmful. A primary risk associated with Integrative therapies is that they lack regulation and standardization, which is common among traditional therapies and conventional medicine. Conventional medicine is highly regulated and emerges from rigorous medical education and licensing. In contrast, Integrative therapies are subject to inconsistent quality standards and differing levels of professional expertise. 

Some Integrative therapies, such as nutritional supplements, can potentially cause dangerous interactions with conventional medications. They may result in adverse reactions or even reduce the efficacy of prescription or over-the-counter drugs. For this reason, individuals are encouraged to inform their healthcare providers if they are considering incorporating natural remedies or supplements into their regimen. Additionally, some vitamins and minerals can potentially increase the risk of cancer and other serious illnesses.

Another reason Integrative therapies can be risky is that they may delay or prevent individuals from pursuing evidence-based treatments and interventions for serious conditions. Although some Integrative therapies can help relieve symptoms of some health issues, they should not replace conventional medical care. Some symptoms can indicate a more severe medical condition, so it is crucial to get evaluated by a healthcare professional to gain more insight into any health concerns. Individuals with an existing treatment plan should consider discussing their interest in Integrative therapies with a healthcare professional to determine which therapies may be appropriate to include in their current plan. 

Integrative therapies can provide alternative approaches to facilitating health and well-being. Still, they are not without risks and side effects. Individuals are encouraged to stay informed and exercise caution, especially if they plan to combine these therapies with their current conventional medical treatments or prescription drugs. Since reactions to Integrative therapies can vary, it is crucial to maintain consistent communication with a healthcare professional for optimal safety. 

Sources

“Complementary and Alternative Medicine”. National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/cam 

“Are You Considering a Complementary Health Approach?”. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/are-you-considering-a-complementary-health-approach 

“Alternative Medicine”. American Cancer Society. https://www.cancer.org/cancer/managing-cancer/treatment-types/alternative-medicine.html 

Little research exists examining the benefits of Integrative therapies at the end of life. However, several small studies support the use of three types of therapeutic touch to alleviate pain, emotional distress, nausea and anxiety in people who are terminally ill. These include two energy-balancing techniques, reiki and healing touch, along with Compassionate Touch, a technique developed by Pam Brandon, the president and founder of the AGE-u-cate Institute, which combines focused attention, intentional touch and gentle massage with special communication skills. 

Anecdotal reports from patients, caregivers and hospice administrators also support the use of Integrative techniques to control symptoms and increase comfort at the end of life. According to one survey of 54 hospice providers in Nevada and Montana, dying patients received a variety of benefits from an array of Integrative and alternative techniques. These benefits included:

• Decreased anxiety
• Less pain
• Less difficulty breathing
• Enhanced feelings of well-being 
• Greater sense of control 
• Decreased fatigue
• Less psychological distress

Further, benefits were associated with a number of different Integrative therapies and techniques, either alone or in combination. These included the following:

• Acupuncture
• Animal-assisted therapy 
• Aromatherapy
• Art therapy
• Mindfulness meditation
• Hypnosis

• Massage
• Massage combined with aromatherapy 
• Music therapy
• Reflexology
• Therapeutic touch 
• Yoga therapy

Another Integrative therapy that has proven beneficial to patients in hospice and palliative care is mindfulness meditation — a self-directed therapeutic tool that has been shown to be highly effective for dying patients and caregivers alike. One of the most studied Integrative therapies available today, mindfulness meditation and mindfulness-based stress reduction have been shown to provide many benefits, including:

• Decreased psychological distress
• Decreased anxiety
• Increased immune function 
• Decreased inflammatory response
• Lower pain sensitivity
• Less fatigue
• Decreased depressive symptoms
• Improved mood

Additionally, maintaining a regular mindfulness practice helps professional caregivers develop stronger feelings of empathy and avoid “compassion fatigue.” Further, teaching mindfulness techniques to family caregivers may help alleviate caregiver stress and caregiver burnout, a debilitating state of exhaustion that affects up to 40% of family caregivers in the U.S.

Sources

“Reiki”. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/reiki 

“Compassionate Touch”. Age-U-Cate. https://ageucate.com/index.php?main_page=compassionate_touch 

“A Survey of Hospices Use of Complementary Therapy”. Journal of Hospice and Palliative Nursing. https://pmc.ncbi.nlm.nih.gov/articles/PMC2743113/ 

“Caregiver Burnout”. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9225-caregiver-burnout 

Some Integrative therapies have been shown to be helpful in managing the symptoms of cancer and treatment side effects. According to the NCCIH Clinical Digest, preliminary research shows that several Integrativehealth approaches have positive effects on symptoms such as anxiety, depression, nausea and vomiting, and fatigue. Specifically, evidence suggests the following:

• Acupuncture helps ease nausea and vomiting related to cancer chemotherapy and has a small effect on cancer-related pain. It has also shown promise in the treatment of chemotherapy-induced peripheral neuropathy, a common side effect of cancer treatment that causes pain, numbness, weakness and abnormal sensations in the extremities, especially the feet. Acupuncture has also been shown to reduce hot flashes in some women receiving hormonal therapy for breast cancer. 
• Massage therapy may help with anxiety, depression, nausea and vomiting, and pain. In particular, studies support the use of massage to help alleviate symptoms of anxiety and depression in breast cancer survivors and in people undergoing treatment for lung cancer whose anxiety and/or pain are not well-controlled.
• Mindfulness-based stress reduction (mindfulness meditation) may ease symptoms such as stress, anxiety, fatigue, mood issues and sleep problems, especially in women with early-stage breast cancer.
• Yoga may help with stress, anxiety and depression. However, the evidence of this at present is not very strong. 
• Ginger, when used in conjunction with conventional medicines, may be helpful in controlling chemotherapy-induced nausea and vomiting. 

Unfortunately, researchers have conducted few carefully controlled studies on the benefits of Integrative or integrative approaches in cancer care. So the scientific evidence to support most of these strategies is not very strong.

The National Cancer Institute also urges cancer patients to keep in mind that even “natural” products can be harmful if they interfere with traditional care. For example, a 2002 study reported in BMJ showed that the herbal supplement St. John’s wort can speed up the metabolism of some chemotherapy drugs, thus decreasing their effectiveness. St. John’s wort also enhances the metabolism of a number of other drugs, such as the anticoagulant warfarin, the heart medicine digoxin and the immunosuppressant cyclosporine, according to a 2012 Healio report.

The NCI also advises that large doses of some vitamins, including vitamin C, can decrease the efficacy of some cancer drugs. And the herbal supplement kava kava, which is used to alleviate anxiety, can cause severe liver damage, even in people who are healthy. 

Sources

“Complementary Psychological and/or Physical Approaches for Cancer Symptoms and Treatment Side Effects: What the Science Says”. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/providers/digest/mind-and-body-approaches-for-cancer-symptoms-and-treatment-side-effects-science 

“Acupuncture (PDQ®)–Patient Version”. National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/cam/patient/acupuncture-pdq 

“Peripheral Neuropathy”. American Cancer Society. https://www.cancer.org/cancer/managing-cancer/side-effects/pain/peripheral-neuropathy.html 

“Complementary and Alternative Medicine”. National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/cam 

“St John’s wort interferes with chemotherapy, study shows”. The BMJ. https://pmc.ncbi.nlm.nih.gov/articles/PMC1169455/ 

“The Role of Complementary and Alternative Medicine in End-of-Life Care”. Psychiatric Annals. https://journals.healio.com/doi/full/10.3928/00485713-20120323-09 

“What is Kava Kava?” Medical News Today. https://www.medicalnewstoday.com/articles/324015#uses-and-possible-health-benefits 

Americans use Integrative therapies to manage a number of health problems. For example, according to the 2012 National Health Interview Study, about 40% of Americans who suffer from a musculoskeletal pain disorder use Integrative health approaches in some way. However, only 14% of them actually use these approaches to manage their pain. Others report using them to manage stress and improve their overall quality of life. 

As the opioid epidemic continues to claim tens of thousands of American lives each year, researchers have also been looking into the benefits of Integrative therapies in the management of all forms of chronic pain. According to a 2017 literature review by the National Center for Complementary and Integrative Health, studies show that pain sufferers receive some benefit from the following:

• Acupuncture
• Yoga
• Tai Chi
• Massage
• Spinal manipulation
• Hypnosis
• Mindfulness meditation
• Music therapy

However, only acupuncture has been shown to reduce patients’ need for opioids. 

Integrative and alternative therapies are also sometimes useful in the treatment of mental health disorders such as schizophrenia, anxiety, panic disorders and depression. According to the National Alliance on Mental Illness, there is currently little research to support their use, but a few studies have shown promising results. For example:

• Omega-3 fatty acids have been shown to decrease the likelihood that a young person who experiences an episode of psychosis will develop a more chronic and severe form of schizophrenia  
• Folate (also called folic acid and vitamin B9) may help reduce the severity of symptoms of certain mental illnesses, especially in people whose blood levels of this essential vitamin are low. The U.S. Food and Drug Administration has approved one form of folate, l-methylfolate (Deplin) for use as an adjunct to traditional therapies in the treatment of depression and schizophrenia. 
• Equine-assisted therapy, in which a person is trained by a licensed mental health professional to groom, ride and care for horses, has been shown in several small studies to be useful in the management of depression, anxiety and impulsiveness related to mental illness. 

Additionally,  many people who suffer from chronic illnesses such as cancer, heart disease and COPD use various Integrative therapies to manage their symptoms, decrease stress, and achieve a greater sense of overall well-being. 

Sources

“New Analysis of Data Reveals Americans’ Use of Complementary Health Approaches for Musculoskeletal Pain”. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/research/research-results/new-analysis-of-data-reveals-americans-use-of-complementary-health-approaches-for-musculoskeletal-pain 

“Drug Overdose Deaths: Facts and Figures”. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates 

“Chronic Pain and Complementary Health Approaches”. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/chronic-pain-and-complementary-health-approaches-usefulness-and-safety 

“Complementary Health Approaches”. National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Treatments/Complementary-Health-Approaches/