I try to keep an open mind, but as someone immersed in science, I tend to view most non-traditional medicine rather skeptically. That said, I've spent many years living in places —like California's Nevada City or Santa Cruz — where integrative therapies abound, and strait-laced me is often the odd one out.
That's why I was particularly eager to chat with and learn more from David Spiegel, MD. A professor of psychiatry and behavioral sciences, Spiegel is the medical director for the Stanford Center for Integrative Medicine and an expert in hypnosis. Here, finally, is a researcher who straddles both worlds, I thought — he can help me peer into the murky world of integrative medicine. And, as you'll read below, I learned quite a bit, including the proper terminology.
What is the difference, if any, between complementary, alternative, and integrative medicine?
We used to call it complementary medicine, which is something in addition or that 'complements' mainstream medicine. Alternative medicine suggests it is used instead of, or to replace traditional medicine, which is not what we recommend. The current term, 'integrative medicine', signifies the integration of non-traditional treatments and practices into a patient's overall care.
Why do people turn to integrative medicine?
It has become a major movement largely because of patients. They are looking for care for things that we don't handle all that well in modern medicine. We do great at treating a broken leg or a heart attack. But for things like chronic pain, or disease-related stress, modern medicine doesn't have all the answers.
We tend to see patients who would rather not have medicine if they can avoid it. They would rather try manipulation like acupuncture or practice hypnosis or mindfulness.
Interest in integrative medicine at Stanford is growing.
What is supported by evidence? What really works?
There are many practices that don’t work, but there are a number that do.
Integrative medicine works well for problems like pain control. It's a good idea to give people alternatives besides often escalating amounts of analgesic medications. Teaching mindfulness or self-hypnosis to manage pain or anxiety or stress is much better than some of the medications we often resort to.
There's increasing evidence that mindfulness, hypnosis and other therapies can help manage some symptoms of chronic fatigue or fibromyalgia as well. A good thing about integrative med is that it’s low-cost and low-risk.
For acupuncture, the clearest evidence of its efficacy is in pain control. Acupuncture works by triggering endogenous opiates. We’ve also been using it for stress and in vitro fertilization and it may help with the stress of pregnancy. In addition, some find it helpful for stress reduction; they just feel better afterwards.
What are you most excited about?
I’m excited about our own work that's looking at mind-body techniques like hypnosis to better manage pain. I think we’re so used to using the brain in pieces, such as by replacing a particular neurotransmitter or by blocking a particular pathway. There's a tremendous growing interest in using the brain as a whole with mindfulness and hypnosis to manage stress and pain.
Also, the idea that we're not simply reacting to our environment but can play a role in managing our response to the environment is gaining currency. And it makes sense — there are better and worse ways to use our brains to deal with stress and pain.
We can take advantage of techniques like practicing self-hypnosis three to four times a day to control pain, stress or insomnia; or meditating once or twice a day; being aware of our thoughts; and practicing compassion for other people. These approaches are becoming much more widely accepted.
Previously: Stanford study shows what happens in brain during hypnosis, "Traceformation:" David Spiegel on how hypnosis can change your brain's perception of your body and Exploring the role of integrative medicine in treating chronic health conditions
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