Complementary therapies have become more popular and more widely available over the last few years. This rapid growth suggests that some people are unhappy with conventional medicine. And some people are also concerned about the side-effects of ever more potent drugs.
Conventional treatment is safe and effective for most people but drugs and surgery cannot fully control the symptoms of arthritis. A recent Department of Health study found that the commonest complaints taken to complementary practitioners were problems with persistent pain. This is a problem which conventional medicine finds difficult to manage.
It is difficult to compare conventional medicine and complementary therapies. Most medical and other healthcare training institutions in the UK provide little instruction in complementary therapies. Similarly, most complementary therapy courses provide little training in conventional medicine. As a result, there are not many examples of complementary therapies and conventional medicine working together.
This booklet will help you decide whether complementary therapies could help your arthritis. After introducing the main features of complementary therapies, it briefly explains what we know about the main complementary therapies that have given people relief from some of their arthritis symptoms.
What are complementary therapies?
There are a wide variety of complementary therapies. They range from ancient systems of medicine, such as acupuncture, homoeopathy and herbalism to treatments such as massage and aromatherapy. They are called ‘complementary’ when they have not traditionally been used in conventional medicine. But this is changing.
What are the main differences between conventional medicine and complementary therapies?
Different complementary therapies have very different philosophies and practices, but most do share a common view of health and healing. Complementary therapies emphasise ‘wellness’. They believe that wellness comes from a balance between the body, the mind and the environment. Illness happens when there is an ‘imbalance’ between these factors.
Conventional (‘allopathic’) medicine tries to treat the specific part of the body which is ‘faulty’. In contrast, complementary therapies concentrate on the whole person – the so-called ‘holistic’ approach. Each person is treated as a unique individual who has his or her own ‘inner resources’ to fight and overcome illness.
Conventional treatment encourages the patient to remain relatively ‘passive’ and to accept their diagnosis and treatment. Complementary therapies demand that you actively participate in your treatment. The ‘holistic’ approach of complementary therapies means you usually have to make more ‘lifestyle’ changes (i.e. diet, exercise and positive thinking) than conventional treatments. This may be a key to their continuing success with those who have tried them.
Both conventional treatment and complementary therapies emphasise the quality of the relationship between the practitioner and patient. A good relationship is essential for a successful outcome.
How do complementary therapies work?
We all know that the body heals itself, that cuts and wounds heal and that the body cells routinely replace themselves. Complementary therapists believe that this self-healing is the basis of all healing. Complementary therapy aims to help the individual to get well and then stay healthy. The basic idea is that people ‘heal themselves’ with the help of a trained practitioner. For example, manipulation by a complementary therapist tries to help the body mobilise its inner healing resources.
What complementary therapies are there?
The main complementary therapies which have been used in arthritis appear in alphabetical order below:
What is acupuncture?
Acupuncture is now often used in physiotherapy and pain relief, so it may already be part of your treatment. Based upon a 2000-year-old system rooted in Chinese philosophy, it involves inserting fine needles into specific points in the body, though it is rarely painful. It seems to relieve pain by diverting or changing the painful sensations which are sent to the brain from damaged tissues and also by stimulating the body’s own painkillers (the so-called endorphins and encephalins). This pain-killing effect may only last a short time at the beginning, but repeated treatment (usually about 6 or 8 weekly sessions) can bring long-term benefit, often over a period of 6 to 9 months. If the pain returns, then some more acupuncture may help for another few months.
As with all treatments to relieve pain (such as physiotherapy and pain-killing drugs), breaking the ‘pain cycle’ sometimes gives permanent relief. To some extent this depends on the stage of your arthritis, although acupuncture can help at almost any stage of the illness. As with many conventional treatments, it cannot cure or reverse the process of arthritis.
Acupuncture may help someone who cannot tolerate drugs through a painful episode, or it may be used to manage pain on a long-term basis. One study of painful swollen osteoarthritic knees compared acupuncture techniques with injections of hydrocortisone. Acupuncture relieved the pain for a longer period but the hydrocortisone was better at reducing swelling.
What is the Alexander technique?
The Alexander technique was developed over a decade in the early 20th century by an Australian actor to improve his voice. Using the technique, people learn to prevent unwanted and harmful habits, such as muscle tension and poor posture.
Alexander technique practitioners prefer to call themselves ‘teachers’ rather than ‘therapists’, as they see what they do as ‘re-education’. A teacher will show you how to release unnecessary tension in your body, to become more aware of yourself, and to improve your body’s alignment and balance. Although sometimes used as a treatment, the Alexander technique may be more useful as a way of preventing problems, such as low back pain.
What is aromatherapy?
Plant extracts have been used for health and well-being for many centuries. In aromatherapy, the essential oils are inhaled, or massaged into the skin, or used in the bath. How these oils work is not entirely understood. Some therapists believe that the essential oil is the ‘soul’ of the plant which has powerful properties to ‘uplift your spirit’ as well as help with more fundamental health problems.
Each essential oil is made up of chemical components which are believed to have individual therapeutic properties. But some of these chemicals can be poisonous (toxic) in large quantities or can harm people with certain conditions such as pregnancy or epilepsy. This is why professional aromatherapists have to understand the chemical components of each oil.
What is chiropractic?
Spinal manipulation therapy has existed since the first millennium, but chiropractic was invented in Canada in the late 19th century. It is now recognised as a valid therapy and is licensed in many countries.
The theory behind chiropractic is that the vertebrae in your spine must be in the correct position – that is, in the correct alignment. If there are problems with the alignment of your vertebrae, then this can cause a range of problems in other organs. Chiropractors manipulate your joints to try to restore alignment. Some practitioners also emphasise a holistic approach, which stresses a proper diet, a healthy lifestyle and a healthy environment.
Chiropractic should not be used where there is inflammation or infection. In these circumstances, it could be harmful. However, qualified practitioners should be aware of this. If you have osteoporosis, ligament damage, fractures or circulatory problems then certain chiropractic techniques should be avoided and the treatment should be used with caution. Again, a qualified practitioner should be aware of this.
What are copper bangles?
Many people with arthritis wear copper bangles. Research has shown that people with arthritis do have enough copper in their bodies for normal health. So it is difficult to understand what effect these bangles can have. There is no research supporting the use of copper bangles.
What is a good diet?
A good diet is essential for healthy living, and is a very important part of many of the therapies listed in this booklet. Carefully planned diets do help some people with arthritis, both in inflammatory (rheumatoid) arthritis and in osteoarthritis. Although a dramatic improvement is unlikely, some people find that changing their diet allows them to reduce the conventional medication they are using. More information about diet in general is given in arc booklet Diet and Arthritis and in the book of the same name by Dr Gail Darlington & Linda Gamlin (see ‘References’).
What are dietary supplements?
Coral calcium is usually bought in sachets and drunk sprinkled in water. One company claims that the residents of the Japanese islands where it is collected live very long and healthy lives because of the natural elements in the water, such as calcium, magnesium and other minerals. Suppliers claim that tiny particles of coral release these elements when put in water and that these elements then help the body’s auto-immune system. There has been no serious research so far into the effectiveness and safety of coral calcium.
Fish oils and other oils
One recent discovery is that certain kinds of oil in the diet help some people with arthritis. These oils contain essential fatty acids (EFAs). Essential means that the body cannot make them for itself, and must get them from food or food supplements. The body uses EFAs to make chemicals which control inflammation. There are two groups of EFAs, as follows:
- omega-3 is found mostly in oily fish (such as salmon, mackerel, pilchard and herring). (This EFA also protects against heart disease)
- omega-6 comes mostly from plant seed oils like evening primrose oil or sunflower oil.
Most chemists and health food shops sell fish oil capsules. Look for the brands that are high in the essential fatty acids EPA and DHA (see Glossary for full names). Fish liver oil (cod or halibut) also contains these EFAs as well as vitamin D, which helps your body absorb calcium. But fish liver oils also contain a lot of vitamin A, which is dangerous in large amounts and must never be taken by women who may become pregnant.
The best known source of omega-6 is evening primrose oil, but it is also in several other plant seed oils, such as blackcurrant seed oil and borage (‘starflower’) oil. These are also available from most chemists and health food shops.
Although it doesn’t contain omega-3, or other EFAs, olive oil has been found in some studies to help people with rheumatoid arthritis. We do not understand at the moment how this works. Taking 1½ tablespoons of olive oil per day, either in addition to your normal diet, or as a replacement for other oil or fat in your diet, is thought to be helpful.
Glucosamine sulphate is usually sold as a nutritional supplement. The manufacturers claim that it helps people with osteoarthritis by encouraging the formation and repair of cartilage, the body tissue which cushions the ends of bones within joints. The body naturally produces its own glucosamine sulphate but people with osteoarthritis do seem to need more than those without arthritis. Research has shown that glucosamine has a small effect on pain. At the moment we do not have evidence of its long-term effectiveness or safety.
Green-lipped mussel extract
Green-lipped mussel extract comes from New Zealand. As with many conventional medicines, several studies found it helpful, while other studies showed no helpful effect. It appears to do no harm, but we do not really know whether it can help your arthritis.
What is healing?
Healing may take many forms, such as faith healing, the ‘laying on of hands’, spiritual healing, lay healing or ‘absent’ healing. Healing has close links with specific belief systems, which may be religious, spiritual, social or cultural.
In a healing session, the healer will try to assess your ‘energy field’ and then try to pass energy to your body by way of a gentle touch or by sweeping their hands near to your body. Distance healing tries to achieve this at a distance through thought, meditation or prayer. The impact and effect of these forms of healing depend upon your beliefs.
What is herbal medicine?
Herbal medicine has been present throughout history. Today about one quarter of pharmaceutical preparations contain at least one active ingredient extracted from plant sources. Whereas conventional medicine tries to isolate the active ingredient of a plant, herbal remedies use the whole plant. Herbalists argue that the natural chemical balance in the whole plant has a better effect on the body than giving a patient just the active ingredients. Herbal treatment uses plants to try to mobilise the self-healing powers of the body.
Herbal remedies are very popular with some people who believe that they help to cure different forms of rheumatism. Some clinical trials have found some benefits, but there is not yet enough information about any specific herb to be absolutely certain about their effects.
If herbal remedies are going to work, you usually need to take them for about 3 months before you feel the full benefit. They are usually safe (non-toxic) but they may sometimes, like drugs, cause side-effects. These side-effects can include nervous depression, irritability, sleeplessness, and even aches and pains in the muscles or joints. If you are thinking of using these remedies, make sure you buy them from a reputable manufacturer to ensure product quality.
What is homoeopathy?
Homoeopathy is a 200-year-old system of medicine. It is based upon the Law of Similars (let like be cured by like – so a treatment for nausea might be a substance that can make you feel sick). The effectiveness of homoeopathic medicines or remedies depends on how they are made. The original, wholly natural, substance is diluted many times in water or alcohol so that only a few molecules of the original substance may survive in the final remedy. An important part of this process is agitation of the liquid between dilutions – this process is thought to maintain the potency of the original substance.
You can easily buy homoeopathic remedies over the counter in health food shops and pharmacies. But we strongly advise you to contact a qualified practitioner to treat any long-standing illness like arthritis. You must also be prepared to give the treatment time to work, sometimes up to 6 months. Homoeopathy usually also requires a change in lifestyle, which could include changing your diet, more relaxation or exercise, to complement the treatment.
Medically qualified homoeopaths can also use orthodox medicine if they wish, as well as the medicines they use in homoeopathy. They can prescribe homoeopathy in a truly complementary manner.
Most doctors find that if a chemical drug does good then it can also do harm if it is wrongly applied or given in the wrong dosage. This rarely happens with homoeopathic preparations. A number of carefully controlled trials have been carried out with homoeopathic medicine, some of them involving arthritis. These suggest that homoeopathy can help, but we cannot say if a specific remedy ‘works’, for hay fever or arthritis. Homoeopathic remedies need to be prescribed on an individual basis, so there is no particular remedy for arthritis, but rather for the individual who may have arthritis.
What is magnetic therapy?
It has been suggested that certain types of magnetic field can help speed up healing and reduce pain in muscular complaints. Physiotherapists use equipment which produces a pulsed magnetic field for this purpose. You may also have seen products such as magnetic bracelets advertised. The manufacturers of these claim that the magnetic field can increase the ability of the blood to carry oxygen and waste products and that people with arthritis and other conditions have reported benefits. However, the bracelets should not be worn by anyone who has a heart pacemaker fitted. Evidence on whether magnetism applied in this way can help arthritis is not conclusive at the moment.
What is manipulation?
Osteopathic and chiropractic manipulations involve small movement to joints, usually in the spine. This can help in some cases of neck pain and back pain due to wear and tear on spinal joints and discs. Several manipulation sessions may be needed, but if it is going to work you should begin to feel some benefit after 3 or 4 sessions. Manipulation should be avoided for joints which are actively inflamed, as it could be harmful. A qualified practitioner should be aware of this.
Doctors and physiotherapists also use manipulation techniques that are very similar to osteopaths and chiropractors. One survey of patients attending a rheumatism clinic in London found that manipulation was the most helpful of the complementary medical treatments they had tried. Indeed manipulation, like acupuncture, is no longer really an uncommon or unorthodox treatment.
What is massage?
Massage has been around for thousands of years, and was probably first used in China. There are many systems of massage now practised in the UK. They all use a manual technique in which a rhythmic movement uses a variety of strokes, kneading or tapping to move the muscles and soft tissue of the body. Massage can be stimulating or sedating, vigorous or gentle, and include the whole body or only part. Oils, creams, lotions or even talcum powder are used.
Massage can reduce your anxiety and stress levels, relieve muscular tension and fatigue, improve circulation and thus reduce pain levels. It is generally very safe and relaxing, but a trained massage therapist will always follow strict guidelines to avoid endangering patients.
What is osteopathy?
Osteopathy is a system of manual medicine where the hands are used to diagnose and treat. There are no harmful side-effects, and osteopaths are taught to use minimal force. It was developed in the late 19th century by an American doctor, who saw the body as a finely-tuned, fully integrated machine, not as a collection of parts.
Osteopaths believe that a problem with the mechanical structure of the body will impair its function, but that the body will heal itself if it is given the right circumstances, i.e. a balanced and healthy lifestyle, or the help of osteopathic manipulation. Ailments such as headaches, skin disorders and digestive disorders are seen as the results of spinal misalignment. Osteopaths believe that their manipulation of the muscles and joints helps the body to combat illness and heal itself.
What is reflexology?
Reflexology is a treatment which applies varying degrees of pressure to different parts of the body to promote health and well-being. It suggests that every part of the body is connected by ‘reflex zones’ or ‘pathways’ which terminate in the soles of the feet, palms of the hands, ears, tongue and head.
Reflexology suggests that tension, congestion or some other imbalance will affect an entire zone and that it is possible to treat one part of the zone to change another part of the body. Gentle pressure is thought to help ‘detoxification’ and promote healing. It can be very relaxing, and thus diminish pain, but there is no evidence to suggest it can directly affect your arthritis.
Most arthritic and rheumatic aches and pains come and go. Even a persistent condition like osteoarthritis may only be painful at times, often because the joint has been twisted and strained. Most pains in bones and joints last for a few days, weeks, or months, but when aches and pains persist we all tend to seek treatment.
About 30% of the British population has used, or is using, some form of complementary medicine. This increases to nearly 60% among those who have arthritis. Some claim great benefit, but as with all arthritic treatments it is often difficult to know if an individual’s improvement is due to the illness waxing and waning naturally or because of a specific treatment.
Complementary therapies can play an important role in encouraging positive changes in lifestyle and outlook, such as increased self-reliance, a positive attitude, learning relaxation techniques and appropriate exercises. Lifestyle changes like these may help to stabilise or improve your arthritis. Often for arthritis a cure is not possible, and these changes can be as important as more conventional treatments.