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CPD Zone Update PREMIUM CPD CONTENT FOR £1 PER WEEK Buy UPDATEPLUS for £52+VAT chemistanddruggist.co.uk/update Visit chemistanddruggist.co.uk/update-plus for full details This module covers: March ● Distinguishing alternative therapies from Clinical: Alternative remedies and UPDATE conventional ones interactions month ● Evidence behind and effects of common ● CAM regulations March 7* Clinical therapies such as chiropractic and ear candling ● Alternative therapies March 14 ● The claims behind reiki and advice to give ● Common interactions March 21 Module 1741 patients ● How to help patients make an informed Practice: Skill-mix in the decision on alternative therapies pharmacy March 28 *Online-only for Update Plus subscribers Alternative therapies Nancy Kane 2010 found that, while it had some short- and medium-term benefit for pain and disability Alternative therapies are widely used and in people with lower back pain, there was no readily available in the UK. Most pharmacies good-quality evidence that it was any better or stock some kind of remedy that would not worse than lifestyle changes. Chiropractic is be considered mainstream medicine, and regularly used to treat a variety of conditions many high streets feature acupuncturists such as shoulder pain, epicondylitis (tennis and chiropractors. But are they worth using? elbow), osteoarthritis and headache, but since And how should you go about advising and there is no conclusive evidence that it is supporting patients who would like to try effective for these or any other indications, it something outside of conventional medicine? cannot ethically be recommended. There are many definitions of what Patients should also bear in mind that constitutes alternative medicine, but chiropractic can have substantial adverse the simplest is perhaps to include effects. Around half of all patients report anything outside of conventional practice. side effects of some kind, and while these Medicines and procedures used in the NHS are usually mild (for example headache or and many other healthcare systems are stiffness), they can also be very severe. Spinal generally required to have good quality manipulation can lead to stroke, spinal evidence behind them showing they are both damage, coma and, on rare occasions, death. effective and safe. Patients should be advised to ask about the Usually, once a therapy has satisfied these potential risks and benefits of any chiropractic criteria, it becomes part of conventional manipulation before agreeing to treatment. medicine with a well-defined place in treatment pathways. While this does not Ear candling and halotherapy mean all alternative therapies are Evidence for other therapies is more difficult unsafe or ineffective, it does mean that to find. While there is some evidence there is not usually enough evidence to be Chiropractic has been found to be effective for lower that chiropractic (and therapies such sure of their benefit. back pain but it can have substantial adverse effects as acupuncture) may be useful for some There is as much variety in alternative conditions, other therapies may seem plausible therapies as there is in conventional Chiropractic but lack any evidence of their efficacy. medicine. Community pharmacists are likely One of the most widely known alternative Ear candling and halotherapy are two such to be reasonably well-acquainted with the therapies in the UK is chiropractic. The examples. Ear candling, or thermo-auricular homeopathic remedies and herbal preparations discipline was founded at the end of the therapy, is the practice of lighting a conical that are common on pharmacy shelves, but 19th century and is based around the idea candle in the ear. Practitioners claim that the other therapies may be less familiar. that a great many illnesses are caused by flame creates negative pressure within the There are several issues that need to be subluxations. Chiropractic subluxation is not ear canal that draws out wax and any other considered when advising patients on what can a medically recognised term, but practitioners debris, which is then deposited in the base of be a rather charged and emotive subject. use it to refer to the concept that pathological the candle. This residue is often shown to the This article discusses some of the alternative joint changes, particularly in the spine, lead to patients at the end of the treatment in an effort therapies that are promoted in the UK to treat disease. Chiropractors manipulate the spine to show efficacy. However, it has been shown any number of conditions or simply to support and other joints to alleviate health problems. that the candles do not produce negative good health and wellbeing. Chiropractic should not be confused with pressure, and the detritus present after burning The quality of evidence supporting their use osteopathy, which is a distinct discipline. is, in fact, left-over wax from the candle itself. is highly variable, and every patient should Despite being widely used, there is little In addition, adverse effects such as burns, ear carefully consider what is right for them before good-quality evidence that chiropractic is a canal occlusion and ear drum perforation have starting treatment. useful therapy. A Cochrane review published in been reported. 14 CHEMIST+DRUGGIST 14.03.2015 CPD Zone Update Halotherapy is marketed mainly at people Making informed decisions wary. Without statutory regulation, there with respiratory disease, but is also touted as Patients may ask about alternative therapies is no requirement for practitioners of most a treatment for a variety of other conditions. because they feel their current treatment is disciplines to adhere to professional standards, The treatment involves exposure to an aerosol lacking in some way. Pharmacists should or even to have any recognised qualifications. of either dry salt or saline solution, which is try to ascertain whether patients feel their Several national bodies do exist to represent supposed to reduce the viscosity of respiratory current treatment is not adequate and practitioners, such as the British Hypnotherapy secretions and thereby improve respiratory whether they have raised this with their GP Association, the Association of Reflexologists function. As with ear candling, halotherapy or other prescriber. and the British Acupuncture Council. may appear plausible at first glance, but lacks There may be other reasons why patients Many such associations and registers require any robust evidence of efficacy. explore alternative options, such as feeling that certain minimum qualifications from their A review of the available evidence published their pastoral needs are being neglected even members; however, there is no obligation in 2014 found that, while there were studies though physical or symptomatic needs have to join, and professional standards may be supporting use in people with chronic been met. Either way, it is important to ensure variable. It also means there is no regulatory obstructive pulmonary disease (COPD), they medical requirements are met before patients body to complain to if anything goes wrong, were generally poorly conducted and reported, seek alternative treatment, and particularly and no legal recourse beyond normal civil or and did not provide convincing evidence that that any red-flag symptoms have been assessed criminal proceedings. halotherapy had a useful place in COPD therapy. and fully addressed. Pharmacists should encourage patients to These examples illustrate that, while Although therapies such as those mentioned seek advice from national bodies wherever they alternative therapies may often appear above are not considered strictly mainstream, are available, and to find out as much as they plausible, further investigation is required some are provided by the NHS in certain can about their chosen alternative practitioner to ensure that they are actually useful. In circumstances. Availability will vary from before undergoing treatment. many cases, there are no appreciable harms region to region, depending on what has A few therapies are subject to some from using such therapies, but there can be been commissioned locally, and it may be additional regulation. For example, the Local adverse effects. Other factors should also challenging to determine what is actually Government (Miscellaneous Provisions) Act be considered, such as the cost of missed on offer. 1982 requires people who carry out procedures opportunities – treatments that cannot be The most straightforward approach will that pierce the skin – including acupuncture, pursued because time and other resources are usually be for patients to speak to their GP tattooing and ear piercing – to register being spent on the alternative treatment. These in the first instance to discuss the available with their local authority. This ensures that may be high, such as when a COPD patient options. Local clinical commissioning group minimum health and safety standards are chooses not to use a corticosteroid inhaler and (CCG) staff may also be able to advise on adhered to, such as use of clean needles and pursues halotherapy instead. availability. Where a GP feels that a therapy not safe disposal of used needles and dressings. available on the NHS may be beneficial, they Patients seeking advice on acupuncture Reiki might consider providing a private referral. (or any other procedure that involves skin The final class of therapies are those that However, patients should be made aware that piercing) should be directed to the appropriate make claims with no biological plausibility. doctors are not obliged to make a referral; department of the local council for advice. This This includes disciplines such as reiki, which clinicians can refuse to prescribe any treatment will vary from region to region, but will often be involves a practitioner placing their hands on they do not feel is in the best interests of those the environmental health or licensing team. or near the patient in order to channel energy they are treating. This may be difficult to hear and promote wellbeing. for a patient who feels they would benefit from Additional advice and resources While national bodies such as the Reiki a given therapy.

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