THE ROLE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE IN PARKINSON'S DISEASE

Does complementary and alternative medicine play a role in the treatment of Parkinson’s disease? How do we define “Complementary Medicine”? What is “Alternative Medicine”? How does each of these two terms differ from the “Conventional Medicine” in the treatment of PD?

The study of medicine in the present times has evolved into an integrative approach which considers the need to stimulate the body’s natural healing process. It includes the use of conventional therapy as well as complementary and alternative medicine especially in those disease conditions with no cure or progressive in its course, including those that can be prevented or retarded.

Conventional medicine is defined as the “standard of care” for a particular condition, either because the treatment has been studied scientifically and found to be safe and effective, or because there is consensus that the treatment works.
On the other hand, complementary medicine refers to interventions used in conjunction with conventional medicine. One example of a complementary therapy is the use of acupuncture which now plays a role in pain management of some cancer patients in addition to the use of analgesics.

Whereas alternative medicine pertains to the use of practices that replaces those utilized in conventional medicine. An example is the use of a special diet to treat cancer in place of the use of conventional methods of intervention like surgery, radiation, or chemotherapy as recommended by a doctor.
In the treatment of Parkinson’s disease, “Conventional treatment” refers to the use of a pharmacological agent like Carbidopa/levodopa which has been extensively studied and is routinely used by physicians since it has been found to be efficacious. A “complementary therapy” is use of yoga in addition to the carbidopa/levodopa. An example of alternative therapy is use of herbal medicines instead of carbidopa/levodopa or another first-line medication.

What are the benefits of Complementary and Alternative Medicine?
One of the benefits in using CAM in PD would be the additional information a patient acquires as to the proper diet, exercise, and stress management in coping with his illness. CAM also addresses some of the secondary symptoms of PD such as constipation or fatigue which can be just as troubling, or even more troubling, than the motor symptoms. For some patients, it might also minimize the amount of medication they take in order to delay possible long-term side effects like dyskinesia (involuntary movements).

What are the different types of CAM?
A. Biologically Based Therapies
1. Orthomolecular and megavitamin therapy involve the adjustment of concentrations of molecules normally present in the body (e.g., vitamins, minerals, amino acids, hormones, and metabolic intermediates) for the prevention and treatment of disease. Coenzyme Q 10 and omega-3fatty acid-rich fish oils are examples of supplements in this category used by patients with PD.
2. Phytomedicine is often called herbal or botanical medicine and refers to the therapeutic ingestion of plants. This practice dates back at least 5000 years and has been used by all races, religions, and cultures throughout the world.

B. Energy Medicine
Reiki is a Japanese-derived healing modality in which a healing effect is induced by “life force” energy wherever the patient needs it most. The Reiki practitioner lightly applies hands on a clothed patient and channels healing energy as a general or localized treatment.
C. Manipulative and Body-Based Practices
1. Aromatherapy uses the aromatic oils of plants to improve and maintain well-being. More than three hundred different oils are produced from flowers, leaves, stems, and roots. The action of aromatherapy depends on the link between smell and memories. Massage and penetration of the oils into the body may also have a direct effect.
2. Electric stimulation involves the application of mild electric shocks to the skin. Chiropractors, massage therapists, and other practitioners of body work use this therapy to help relieve pain.
3. Massage therapy is a common therapeutic treatment where manual rubbing, stroking, tapping, and kneading the body (either a particular area or the whole body) is performed for the purpose of treating physical and emotional disorders, increasing blood flow, reducing pain, promoting relaxation, releasing muscle tension, and enhancing general health and well-being.

D. Mind-Body Medicine

1. Biofeedback involves the use of instrumentation to monitor, amplify, and report physiologic data for therapeutic purposes. The main objective of biofeedback is to change or regulate a physical process for better health, such as lowering one’s heart rate with controlled breathing and guided visualization.
2. Relaxation techniques can be helpful in reducing stress levels and include techniques such as progressive muscle relaxation and diaphragmatic breathing. More advanced techniques include hypnosis, guided imagery, and meditation.

E. Whole Medical Systems
1. Ayurveda is Sanskrit for “life knowledge,” and it is one of the oldest known systems of healing. Ayurveda approaches health as the balance of body, mind, emotion, and spirit. Treatments include yoga, meditation, purification regimens, dietary changes, and herbal remedies.
2. Oriental Medicine is an ancient system of diagnosis and treatment that corrects imbalances in Qi, or vital energy, with acupuncture, herbs, massage, nutrition, and movement. Acupuncture uses fine needles gently inserted at specific points along energy pathways of the body to encourage healing. Acupressure and low level laser acupuncture are non-invasive methods also aimed to balance one’s Qi.

3. Naturopathy is an alternative health system which emphasizes the body’s ability to heal itself. Therapies include the use of natural foods and supplements, massage, hydrotherapy, homeopathy, and exercise that supports self-healing. Practitioners of naturopathy generally prefer to use treatment approaches they consider the most natural and least invasive instead of using drugs or surgery.

How to Find the Right CAM Professional

As a general rule, it is prudent to avoid professionals who claim to provide a “cure” for Parkinson’s disease and be wary of those who charge exorbitant fees or ask for a big payment even before services are being offered or products are being delivered.  Every PD patient or his family or caregiver should also observe due diligence in verifying the authenticity, experience and expertise of the CAM professional especially those who advocate sudden withdrawal of prescription drugs for Parkinson’s without a thorough, accurate explanation. Despite the presence of information or studies on this drastic measure, it is best to consult with a neurologist or primary care physician for an opinion, or seek the advice of an integrative medicine physician.

How to Evaluate the Safety and Usefulness of CAM Therapies
A number of complementary and alternative modalities have been adopted by some PD patients and their families despite the absence of reliable studies or definitive proof like massage or Tai chi. However, the more invasive or experimental techniques or procedures should be supported by strong evidence before they are utilized.

It is to the best interest of every PD patient if a center can be put up which will fund research, provide grants to train researchers, and share its findings about CAM therapies with medical professionals and the public through information dissemination via lecture series, continuing medical education programs, and publication databases.

Alternative medicine that may be beneficial to a PD patient should also be evaluated for the possibility of doing more harm than good, especially with the “natural” means which does not always equate with “safe”.  Sometimes, it may take a considerable amount of time and effort before a CAM treatment can be found effective. The CAM therapies coupled with conventional medicine therapies should increase the potential benefits of both treatments. This should be discussed with the neurologist or primary care physician especially when using supplements or herbs since some can interfere with conventional drug treatments.
PD patients who are the most well-informed and have a balanced and realistic view of what conventional medications and alternative therapies can currently provide and who are aware of the limitations and side effects of such are those that are the most successful in coping with their illness. They usually treat CAM therapies with open-minded scepticism and accept that traditional medicines are sometimes necessary. Conventional therapies with CAM will help reduce or delay the effects of Parkinson’s and will arm the PD patient the tools necessary to combat his illness provided that they are properly guided by the medical professional.


REFERENCE:
Young Parkinson's Handbook
A Guide for Patients and Their Families