Complementary and non-medical therapies in ill health
Introduction
A range of interventions and health problems are included.
| Healthcare condition | Intervention | About the findings |
|---|---|---|
| Heart failure | Hawthorn extract | 14 trials |
| Pain | Touch therapy | 24 trials |
| Illness | Intercessory prayer for the alleviation of ill health | 10 trials |
[Click here for a short version of the heart failure consumer summary]
[Click here for a short version of the ill health consumer summary]
Hawthorn extract for heart failure
Chronic heart failure occurs when the heart can no longer adequately pump blood around the body. This causes fluid to build up, particularly in the liver, lungs, hands, and feet. The legs may swell, particularly after standing for a while. People can experience shortness of breath and coughing, especially during exercise or going up stairs (because the lungs cannot function so well). Those who have high blood pressure, narrowed arteries to the heart, infections, congenital heart disease, have had a previous heart attack, or are on some treatments are at risk of developing heart failure.
Diet and controlling weight, stopping smoking and drug treatment are regarded as the first-line approach for most people with chronic heart failure. Diuretic drugs are used to improve symptoms and beta-blockers and angiotensin-converting enzyme (ACE) inhibitors also improve a person’s ability to exercise and their survival.
What is known
Hawthorn extract is made from the dried leaves, flowers, and sometimes the fruits, of the hawthorn bush (Latin name Crataegus monogyna or Crataegus laevigata). The extract can be used as an oral treatment option for chronic heart failure and is referred to as such in most herbal reference texts (for example Ernst 2001; Rotblatt 2002). Its use is approved by the German Commission E.
What the synthesised research says
Taking hawthorn extract in addition to conventional treatments (as an adjunct) resulted in improved symptom control and physiological outcomes limited by heart function, such as the ability to exercise.
Two brands of a standardised hawthorn extract of hawthorn leaf and flower (WS1442 and LI132) were used. Seven of eight trials used the WS 1442 extract, which was standardized to 18.8% oligomeric procyanidins. The daily dose used in these trials ranged from 160 mg to 1800 mg.
How it was tested
The review authors identified 14 double-blind, placebo controlled randomised clinical trials involving 1110 participants. In seven trials most patients were also taking conventional medications. These included diuretics, ACE inhibitors such as captopril, and calcium antagonists. In the other trials it was not clear whether patients were on other medications.
Ten trials including 855 patients with chronic heart failure (New York Heart Association classes I to III) provided data that were suitable for pooling (meta-analysis). Symptoms such as shortness of breath and fatigue clearly improved with hawthorn treatment as compared with placebo (in 4 trials, 239 participants) as did an overall symptom score (2 trials, 239 participants).
Compared with placebo, hawthorn extract increased the maximal workload in patients with chronic heart failure (4 trials, 380 participants); maximal workload is measured using an exercise bicycle where the workload is increased every 2 minutes until the person has to stop. This appeared to be particularly so for people not on other medications for heart failure. Exercise tolerance was also improved (2 trials) and a measure of oxygen consumption by the heart showed a beneficial decrease (5 trials) with hawthorn extract.
Mean age in each trial ranged from 50 to 74 years. Reported co-existing illnesses included previous myocardial infarction, hypertension, hyperlipidemia, coronary heart disease, myocarditis and diabetes mellitus. Length of the treatment ranged from 3 to 16 weeks and the longest follow up was 26 weeks.
Side effects and general cautions
Adverse events, where reported, were infrequent, mild, and transient (even at double the normal dose). They included nausea, dizziness, back pain, flu-like symptoms, and cardiac and gastrointestinal complaints.
Although these data suggest that hawthorn extract is relatively safe, self-medication is inappropriate for people with heart failure, who should be treated by a licensed clinician. Self-medication might also increase the risk of adverse events through herb-drug interactions.
These conclusions are based on small numbers of studies and patients. Trials did not all measure the same outcomes and several did not explain what other heart failure treatments patients were receiving.
Source
Pittler MH, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD005312. DOI: 10.1002/14651858.CD005312.pub2.
Ernst E, Pittler MH, Stevinson C, White AR. The desktop guide to complementary and alternative medicine: an evidence based approach. Edinburgh, UK: Mosby, 2001.
Rotblatt M, Ziment I. Evidence-based herbal medicine. Philadelphia, Pennsylvania: Hanley & Belfus, 2002.
Touch therapies for pain relief in adults
Both persistent long-term and acute pain are common and impact on people’s health. The pain can affect on a person’s sense of wellbeing and interfere with his or her physical and social activities. Severe pain can be overwhelming. Sometimes, the cause of pain cannot be determined or pain remains after the healing of an injury.
Analgesics (painkillers) are the mainstay of the medical management of pain but they do not always remove the pain completely and can produce undesirable adverse effects.
What is known
Touch therapies are energy-based complementary therapies that include Healing Touch, Therapeutic Touch, and Reiki. The practitioners uses hands-on or hands-off (where the hands are over but do not actually touch a person’s body) techniques to influence the client’s energy field. It is believed this effect occurs by exerting energy to restore, energise, and balance the energy field disturbances. The understanding is that sickness and disease are cause by imbalances in the vital energy field.
Having touch therapy can promote relaxation, comfort, a general sense of wellbeing and be useful in treating insomnia and fatigue. Some hospitals make it available to improve health and ease the discomfort and pain associated with medical illness.
Touch therapies have also been reported to speed up healing, reduce pain, ease physical symptoms, and reduce stress and anxiety as well as helping people to express their stored emotions and shift from negative to positive emotions. Some people with chronic illnesses experienced light-headiness, dizziness, irritability, agitation, or a temporary increase in symptoms immediately after the therapy. This may be caused by the energy shift within the body as a result of receiving the touch therapy.
What the synthesised research says
The overall findings were that touch therapies do relieve pain to a small degree, for both acute and long-term pain. More experienced practitioners appeared to have better results in pain reduction. No placebo effect was apparent.
A total of 14 controlled studies (505 participants) involved people with long-term pain including musculoskeletal pain, neuropathic pain, headache, cancer pain, and phantom limb pain; 10 studies (648 participants) looked at acute pain, including the procedural pain of an injection, operation or biopsy, and burn pain.
How it was tested
The Cochrane review authors were able to find 24 controlled studies involving 1153 participants with pain. The use of sham therapy sessions (placebo) or 'no treatment' was compared with Healing Touch (5 trials, 274 participants); Touch Therapy (16 trials, 733 participants); or Reiki (3 trials, 146 participants). The number of treatment sessions ranged from 1 to 12. Duration of treatment ranged from 5 to 90 minutes.
People experiencing touch therapy reported an overall average of 0.8 units (on a 0 to 10 scale) lower pain intensity. Total duration of treatment (duration of a single session multiplied by the number of treatment sessions) did not appear to be important .
It appears that all three types of touch therapy may decrease pain to a certain extent but with variability between the different studies except for Reiki. The people providing Reiki had high levels of training and with their experience pain intensity was more uniformly reduced.
Side effects and general cautions
No side effects were reported with touch therapy in the included studies. Many studies did not describe the experience of the practitioner.
Source
So PS, Jiang Y, Qin Y. Touch therapies for pain relief in adults. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD006535. DOI: 10.1002/14651858.CD006535.pub2.
Intercessory prayer for the alleviation of ill health
Intercessory prayer is organised, regular and committed; where a person or group set time aside to communicate with God on behalf of another who is in some kind of need. Recipients of intercessory prayer may not know that they are being prayed for.
Other forms of prayer include organised prayer to God based around an advanced belief system, individual occasional prayer, spiritual healing, meditation and thanksgiving. Prayers can be spoken from within the framework of a variety of faiths and also by those who do not ascribe to a particular, formalised belief system.
What is known
The consequences of divine intervention may be subtle and not easily identified, which makes measurement of the effectiveness of prayer difficult. Prayer may also have an effect that is not dependent on divine intervention and that is measurable. Trials on the health outcomes of prayer are not about ‘proving’ that there is a God who responds to our prayers.
This review considered trials in which organised prayer, in addition to the standard care, was compared with the relevant medical and non-medical care normally given to people diagnosed with the particular illness. The people praying held some religious belief that they were praying to a God with the intent of aiding people’s recovery.
Meditation, distance healing and non-contact therapeutic touch prayer were not included in this review.
What the synthesised research says
There was no difference found between prayer plus standard care compared to standard care alone on death, general clinical state, readmission to Coronary Care Unit (CCU), or readmission to hospital in those participants unaware of whether or not they were receiving intercessory prayer.
In one trial, involving 1198 participants, those participants who received no prayer experienced fewer postoperative complications compared to those who were aware of receiving intercessory prayer (RR 1.15, CI 1.04 to 1.28). There was no difference between these two groups in terms of death, clinical state, readmission to the CCU, or leaving the study early.
How it was tested
The review authors made a thorough search of the medical literature and identified ten controlled trials randomizing a total of 7646 people. Seven of the ten included studies involved people who were 'acutely ill' with life-threatening conditions: children with leukaemia, people admitted to a coronary care unit (five trials) and people with a blood stream infection. One trial involved participants who were ill with psychological or rheumatic disease and in another trial the participants were under treatment for alcohol abuse.
Some participants were prayed for by groups, others by individuals. The people praying were from diverse religious backgrounds and none personally knew the patients they were praying for. In all trials except one, prayer was undertaken on a daily basis for the period of normal treatment.
In all trials except one, the participants did not know they were being prayed for. One trial informed some participants that they were receiving intercessory prayer from people other than friends or family; this data was analysed separately.
Side effects and general cautions
One trial set out to investigate the extent to which knowing that one is being prayed for influences recovery. The results suggested that those undergoing operations may not wish to know of the prayer that is being offered on their behalf.
Everyone is the recipient of prayer as devout or religious people pray in a general way for those in the world who are sick and suffering, which may confuse both control and intervention groups in a trial.
A caring God may not wish to prolong suffering, so death might be a positive outcome of prayer.
Source
Roberts L, Ahmed I, Hall S, Davison A. Intercessory prayer for the alleviation of ill health. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD000368. DOI: 10.1002/14651858.CD000368.pub3.
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