CAM PAK 11-6-2014 Prof Adi Hidayat

8/11/2019 CAM PAK 11-6-2014 Prof Adi Hidayat

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Pengobatan komplementer danalternatif (Complementary and

Alternative Medicine)


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Sasaran belajar

Mampu mendefinisikan pengobatan

komplementer dan alternatif

(PKA)/{complementary and alternativemedicine (CAM)} dalam hubungannya

dengan pengobatan konvensional

Mampu mereview penemuan danpenelitian mutakhir tentang PKA/CAM


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Sasaran belajar

Mampu berkomunikasi dan menasihatkan

pasien tentang PKA/CAM baik evidence-based research maupun patient values

and preferences.


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Definisi PKA/CAM Setiap tindakan baik yang tidak diajarkan di fakultas

kedokteran maupun tidak tersedia di rumah sakit(Interventions neither taught in medical school, norgenerally available in hospital) (1)

Pengobatan yang berada diluar model biomedisBarat tentang penyakit, diagnosis dan pengobatan(healing therapies that typically fall outside theWestern biomedical model of disease, diagnosis,

and treatment) (2)


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Definisi PKA/CAM

The World Health Organisation : "all

forms of health care which usually lie

outside the official health sector (3)


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Apakah pengobatankomplementer berbeda dengan

pengobatan alternatif ? Ya (4)

PK digunakan bersama pengobatan

konvensional. Misal aromatherapy untukmengurangi rasa tidak enak pasien setelah operasi

PA digunakan untuk menggantikan pengobatan

konvensional, misal diet khusus unuk pengobatankanker dan bukan pembedahan radiasi atau

kemoterapi


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Apakah kedokteran integrasi(integrative medicine)?

Integrative medicine combines treatments

from conventional medicine and CAM forwhich there is some high-quality evidence

of safety and effectiveness.


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Lima tipe mayor dari PKA (4) Whole Medical Systems,traditional Chinese

medicine, homeopathy, naturopathy, botanical,acupuncture, moxibustion and Ayurveda

Mind-body interventions, meditation, prayer,mental healing, art, music, or dance.

Biologically-based treatments substancesfound in nature, herbs, foods, and vitamins. Some

examples dietary supplements, herbal products,unproven therapies (shark cartilage to treatcancer),lifestyle (exercise,relaxation).


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Tipe mayor dari PAK Manipulative and body-based methods

manipulation and/or movement of one ormore parts of the body, chiropractic orosteopathic, and massage.

Energy therapies two types: i) Biofieldtherapiesqi gong, Reiki, and TherapeuticTouch, ii) Bioelectromagnetic-based

therapies, pulsed fields, magnetic fields, oralternating-current or direct-current fields.


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Jenis PKA di masyarakatAcupuncture Imagery

Aromatherapy Magnets

Biofeedback Massage

Chiropractic Prayer

Diets ReflexologyExercise Relaxation

Folk remedies Self-help/support groups

Herbal/botanical therapy Spiritual healing (by others)

Homeopathy Vitamins

Hypnosis Yoga


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Siapa pengguna PKA?

1997, 47% penduduk US menggunakan PAK(5)

2002, 75%of U.S. adults reported use of

CAM in lifetime and 62%in past 12 months(when prayer included) (6)

Survei Sosial Ekonomi Nasional tahun 2001,

31,7% menggunakan obat tradisional, dan

9,8% pengobatan tradisional (7)


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Mengapa masayarakatmenggunakan PKA ?

WHO 80% masyarakat menggunakan PKA

Desire for health and wellness

Prevention Cancer- recent estimate 83% (8)

Pain : -Musculoskeletal pain

Back and neck pain


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Why do people use CAM?

Desire for health and wellness (1)

Prevention

Cancer- recent estimate 83% (2)

Pain

Musculoskeletal pain

Back and neck pain


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What do CAM users want?

Empowerment in medical interactions

Chance to share their own views about healthand healing

Health provider who will spend time with them

Someone who will answer their questions


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Evidence-based Medicine (EBM)and CAM

EBM aims to integrate

best research evidence clinical expertise

patient values


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EBM and CAM

While some scientific evidence exists

regarding some CAM therapies, for most

there are key questionsthat are yet to be

answered through well-designed scientific

studiesquestions such as whether they are

safe and whether they workfor the diseasesor medical conditions for which they are used.


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Where does this leave us?

CAM interventions generally

are low cost

are low risk

are free of serious side effects

AND

are widely used.


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CAM: evidence and research

Glucosamine/Chondroitin Arthritis

Echinacea for the Prevention and

Treatment of Colds

St John's wort) in major depressive disorder

Acupuncture for Osteoarthritis


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Glucosamine/Chondroitin Arthritis

Intervention Trial (GAIT) Study Results(9)

Supplement combination of glucosamine

plus chondroitin sulfate did not provide

significant relief from osteoarthritis painamong all participants.

However, a smaller study participants with

moderate-to-severe pain showed significantrelief with the combined supplements.



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CAM: evidence and research Echinacea for the Prevention and Treatment of

Colds in Adults: Research Results and

Implications for Future Studies (10)

437 healthy adult volunteers were assigned at random

to receive one of the three E. angustifoliapreparationsor a placebo. They received in two phases: a

"prophylaxis" and a treatment phase. The prophylaxis

phase lasted 7 days. On the 7 day, the already treated

subjects were exposed to a nasal spray containing avirus that induces signs and symptoms of a cold in

about 2 days.


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CAM: evidence and research Volunteers were isolated for 5 days, tested them,

appearance and severity of cold signs and

symptoms

None of the three preparations of E. angustifoliaat

the 900 mg per day dose had significant effects onthe severity or duration of symptoms among those

who developed colds. However, critics of this study

believe the dose of E. angustifoliaused was too

low.


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CAM: evidence and research Effect of Hypericum perforatum (St John's wort) in

major depressive disorder: a randomized controlledtrial. (11)

OBJECTIVE: To test the efficacy and safety of awell-characterized H perforatum extract (LI-160) in

major depressive disorder.

DESIGN AND SETTING: Double-blind,randomized, placebo-controlled trial conducted in12 academic and community psychiatric researchclinics in the United States.


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CAM: evidence and research PARTICIPANTS: Adult outpatients (n = 340)

recruited with major depression and a baselinetotal score on the Hamilton Depression Scale(HAM-D) of at least 20.

CONCLUSION: This study fails support theefficacy of H perforatum in moderately severemajor depression. The result may be due to lowassay sensitivity of the trial, but the completeabsence of trends suggestive of efficacy for H

perforatum is noteworthy (perlu diperhatikan).


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Acupuncture for peripheral joint osteoarthritis Asystematic review and meta-analysis (12)

Objective. To evaluate the evidence for the

effectiveness of acupuncture in peripheral joint

osteoarthritis (OA). Methods. Systematic searches were conducted on

Medline, Embase, AMED, Cochrane Library,

CINAHL, British Nursing Index, PsychINFO and

CAMPAIN


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Results. Thirty-one possibly relevant studies wereidentified and 18 RCTs were included.

Conclusions. Sham (pura-pura)-controlled RCTs

suggest effects of acupuncture for pain control in

patients with peripheral joint OA. Considering itsfavourable safety profile acupuncture seems an

option worthy of consideration particularly for knee

OA.


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What about communication?

Between 40 and 70% of CAM users do notdisc losetheir use to their physician.

WHY?

Patients usually say that they do not report

because they are not asked.


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Why does this matter?

The substantial overlap between use ofprescription medications and herbal

supplements raises concerns about unintended

interactions.

Patient use of CAM is often a clue to values

and preferencesthat need to be

acknowledged.


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How can we communicate?

1. Always ask!What else are you doing for yourhealth?

2. Be open and nonjudgmental.

3. Consider patient preferences and values.

4. Be honestabout your lack of knowledge

5. Sadar adanya efek samping & kontraindikasi


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Efek samping/kontraindikasi (13)

Echinacea : autoimmune rseponse, tidak bolehdiberikan AIDS, TBC, multiple sclerosis

St Johns wort : efek samping fotosensitif akibat

komponen hipericin

Ginkgo biloba ; efek inhibitor on platelet-activatingfactor, avoid pasien bleeding disorders,

thrombocytopenia, bilateral subdural hematoma


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Daftar Pustaka

1. Eisenberg DM, Kessler RC, Foster C.

Unconventional medicine in the United States :

prevalence, cost and patterns of use. N Engl J

Med 1993;328:246-52.

2. Drivdahl CE, Miser WF: The use of alternative

healthcare by a family practice population. J

Am Board Fam Prac1998, 11:193-9.


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Daftar Pustaka

3. Gureje O, Von Korff M, Gregory SE, Richard G.

Persistent pain well-being. A World Health

Organization study in primary care. JAMA1998,280:147-51.

4. National Center for Complementary and Alternative

Medicine (NCCAM). What Is CAM? Available at :

http://nccam.nih.gov/health/whatiscam/. AccessedNovember 22, 2007.
http://nccam.nih.gov/health/whatiscam/http://nccam.nih.gov/health/whatiscam/


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Daftar Pustaka

5. Eisenberg DM, Davies RF, Ettnier SL. Trends in

alternative medicine uses in the United States

1990-97. JAMA 1998;280:1569-75.6. Barnes P, Powell-Griner E, McFann K, Nahin R.

CDC Advance Data Report #343. Complementary

and Alternative Medicine Use Among Adults:

United States, 2002.Atlanta, 2004.


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Daftar Pustaka

7. Departemen Kesehatan R.I. Wajib Daftar bagiPengobatan Tradisional. Available at :http://www.depkes.go.id/index.php?option=news&task=viewarticle&sid=434. Accessed

November,22,20078. National Center for Complementary and

Alternative Medicine (NCCAM). The Use ofComplementary and Alternative Medicine in the

United States. Available at :http://nccam.nih.gov/health/whatiscam/.

Accessed November 22, 2007
http://www.depkes.go.id/index.php?option=news&task=viewarticle&sid=434http://www.depkes.go.id/index.php?option=news&task=viewarticle&sid=434http://nccam.nih.gov/health/whatiscam/http://nccam.nih.gov/health/whatiscam/http://www.depkes.go.id/index.php?option=news&task=viewarticle&sid=434http://www.depkes.go.id/index.php?option=news&task=viewarticle&sid=434


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Daftar Pustaka

9. Clegg DO, Reda DJ , Harris CL, Klein MA, O'DellJR, Hooper MM. Glucosamine, chondroitin sulfate,

and the two in combination for painful knee

osteoarthritis. N Engl J Med 2006;354:795-808.

10. Turner RB, Bauer R, Woelkart K, Hulsey TC,Gangemi JD. An evaluation of Echinacea

angustifolia in experimental rhinovirus infections.

N Engl J Med 2005; 353: 341-8.


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Daftar Pustaka

11. Hypericum Depression Trial Study Group.Effect of Hypericum perforatum (St John's wort)

in major depressive disorder: a randomized

controlled trial. JAMA 2002;10:1807-14.

12. Kwon YD, Pittler MH, Ernst E. Acupuncture forperipheral joint osteoarthritis : a systematic

review and meta-analysis. Rheumatology

2006;45:13317.


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Daftar Pustaka

13. Silverstein DD, Spiegel AD. Are physicians

aware of the risks of alternative medicine? J Com

Health 2001; 26 :159-74.


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CAM PAK 11-6-2014 Prof Adi Hidayat

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