DIMENSIONS OF CARE

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References & Links

American Holistic Medical Association
www.holisticmedicine.org

American Osteopathic Association 
www.am-osteo-assn.org

American Academy of Medical Acupuncture 
www.medicalacupuncture.org

American Academy of Osteopathy 
www.aao.medguide.net

Complementary and Alternative Medicine (CAM) is gaining popularity with the general public, and many health systems are offering these therapies through "integrative" or "holistic" health centers. In these settings, complementary and alternative therapies are usually offered on a fee-for-service basis as a community-based class or individual session. Rarely are physicians directly involved with these programs. Patients who use them are often doing so of their own volition, often out of frustration over a lack of progress or to supplement their "traditional" care to improve their overall health. Even more stunning is the fact that studies show that fewer than 20% of these patients will inform their physician of their "alternative" treatments and any benefits derived from those treatments.

A small but growing number of physicians are combining traditional and alternative therapies in their medical practices. Practices that are combining occupational medicine and CAM are probably even more rare, but growing. Dr. Jacqueline Stoken, DO, is the Medical Director of the Heartland Holistic Health Center in West Des Moines, Iowa, where she is fulfilling her dream of running a holistic health care practice. She chose to become an Osteopath because of her belief in the importance of treating the "whole" person and focusing on the connection between the body-mind-spirit and health and wellness. Her practice is comprised of patients with musculo-skeletal disorders, many of whom were referred to her by orthopedists or another treating physician. Her typical patient has received the traditional Western treatment for his or her condition, has failed to progress, and is often in tremendous pain.

According to Dr. Stoken, "It is not uncommon for workers’ comp patients to have had their problem for one or two years by the time they are referred to me. Their acute treatment has not successfully resolved their condition and either their employer, insurer, or treating provider is looking for something that might work. It would be nice if the market would be more willing to accept alternative therapies at the acute stage of treatment; however most providers and insurers will only consider complementary and alternative therapies as a last resort. Consequently, most of the patients I am currently treating have developed chronic pain in addition to their original injury."

"I use a variety of treatments in my practice, depending on the patient’s history, medical condition, and response to the treatment given. The most common alternative therapies that I have incorporated into my practice are: manipulation, acupuncture, nutritional assessments and counseling, and trigger point injections. We also offer classes on Relaxation, Biofeedback, Breathing, and Yoga; although most injured workers do not have coverage for classes and are less likely to participate in them versus treatments, which are covered by workers’ comp. Typically, a patient will receive one treatment a week for 8-10 weeks, with the average treatment lasting 1-2 hours, depending on the exact condition being treated," explains Dr. Stoken.

Assessing the patient’s nutritional needs and habits is also an important part of her clinical practice. The scientific evidence continues to mount about how diet influences overall health and can be a leading contributor to many diseases. In other cases, chronic deficiencies lead to certain conditions. Whatever the cause, according to Dr. Stoken, "The patient almost always benefits from dietary counseling or vitamin or herbal supplements. For example, I have developed a nutritional assessment for patients with Fibromyalgia that checks their magnesium levels. Low levels of magnesium are associated with muscle spasms, cardiac arrhythmia, migraine headaches, asthma, insomnia, and anxiety. Addressing any underlying nutritional deficiencies is an important component of any successful treatment plan."

"Just as each patient responds differently to medications or treatments rendered under a traditional model, patients respond differently to complementary and alternative therapies. It is probably going to take more clinical outcome studies for many physicians to be willing to utilize or recommend CAM modalities. However, in my practice and experience, most patients have a successful resolution to their injury and alleviation of some, if not all, of their pain. Workers who have been on light duty or off work are able to resume their normal jobs in large part due to the complementary therapies I am using. Many of the patients in my practice cannot tolerate traditional pain medications for one reason or another. In some cases they have a low tolerance for prescribed medications, in other instances they may have developed side effects from long-term use or maybe they have had a substance abuse problem and narcotics are simply not an option for them. For these patients in particular, acupuncture may be their only option for pain relief and control," Dr. Stoken points out.

"One of my patients with a lifting injury was in a lot of pain. He had a history of substance abuse, so he could not take the normally prescribed pain medications. When he came in for treatment, he rated his pain as a ‘10’ on a scale of 1-10, with 10 being the most severe. After a half-hour of treatment, he rated his pain as a ‘4’. I continued treating him with a combination of acupuncture, manipulation, physical therapy, a muscle relaxant, and anti-inflammatory medication. He was pain free and back to full duty within six weeks."

Acupuncture is actually one of the oldest, most commonly used medical procedures in the world, but its popularity in the U.S. has only grown in the last two decades. In 1993, the Food and Drug Administration (FDA) estimated that Americans made between 9-12 million visits to acupuncture practitioners and spent as much as $500 million for those treatments. By this year, it is estimated that there will be 20,000 certified acupuncturists in the US, with over one third of those being physicians. The National Institutes of Health and The World Health Organization have both sponsored numerous clinical studies on the effectiveness of acupuncture. These studies have found that some of the many conditions for which acupuncture is an effective treatment are1 :

Despite this endorsement and the many clinical studies demonstrating its effectiveness, how acupuncture works has not been fully explained, particularly within the framework of Western medicine.

According to Dr. Stoken, "I would still encourage physicians and administrators to keep an open mind about this and other alternative modalities. There is so much in medicine that we do not completely understand. Only recently have we come to understand how aspirin works, but this did not stop us from utilizing it in medical treatment during the last century. I was exposed to acupuncture during my residency and was taught how to perform it and incorporate it into patient care from three physicians. Manipulation was naturally part of my Osteopathic training, along with the Osteopathic philosophy of treating the whole patient, not just specific conditions or body parts. Combining ‘alternative’ treatments with my Western medical training allows me to access the best of both worlds, which maximizes the care and outcomes I am able to achieve for my patients."