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Pengobatan komplementer dan

alternatif (Complementary and
Alternative Medicine)


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Sasaran belajar
Mampu mendefinisikan pengobatan
komplementer dan alternatif
(PKA)/{complementary and alternative
medicine (CAM)} dalam hubungannya
dengan pengobatan konvensional
Mampu mereview penemuan dan
penelitian 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, nor
generally available in hospital)
(1)

Pengobatan yang berada diluar model biomedis
Barat tentang penyakit, diagnosis dan pengobatan
(healing therapies that typically fall outside the
Western 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 pengobatan
komplementer berbeda dengan
pengobatan alternatif ?
Ya
(4)

PK digunakan bersama pengobatan
konvensional. Misal aromatherapy untuk
mengurangi rasa tidak enak pasien setelah operasi
PA digunakan untuk menggantikan pengobatan
konvensional, misal diet khusus unuk pengobatan
kanker dan bukan pembedahan radiasi atau
kemoterapi
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Apakah kedokteran integrasi
(integrative medicine)?

Integrative medicine combines treatments
from conventional medicine and CAM for
which 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 substances
found in nature, herbs, foods, and vitamins. Some
examples dietary supplements, herbal products,
unproven therapies (shark cartilage to treat
cancer),lifestyle (exercise,relaxation).
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Tipe mayor dari PAK
Manipulative and body-based methods
manipulation and/or movement of one or
more parts of the body, chiropractic or
osteopathic, and massage.
Energy therapies two types: i) Biofield
therapies qi gong, Reiki, and Therapeutic
Touch, ii) Bioelectromagnetic-based
therapies, pulsed fields, magnetic fields, or
alternating-current or direct-current fields.


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Jenis PKA di masyarakat
Acupuncture Imagery
Aromatherapy Magnets
Biofeedback Massage
Chiropractic Prayer
Diets Reflexology
Exercise 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 masayarakat
menggunakan 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 health
and 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 questions that are yet to be
answered through well-designed scientific
studies questions such as whether they are
safe and whether they work for the diseases
or 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 pain
among all participants.
However, a smaller study participants with
moderate-to-severe pain showed significant
relief with the combined supplements .
CAM: evidence and research

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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. angustifolia preparations
or 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 a
virus 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. angustifolia at
the 900 mg per day dose had significant effects on
the severity or duration of symptoms among those
who developed colds. However, critics of this study
believe the dose of E. angustifolia used 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 controlled
trial.
(11)

OBJECTIVE: To test the efficacy and safety of a
well-characterized H perforatum extract (LI-160) in
major depressive disorder.
DESIGN AND SETTING: Double-blind,
randomized, placebo-controlled trial conducted in
12 academic and community psychiatric research
clinics in the United States.
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CAM: evidence and research
PARTICIPANTS: Adult outpatients (n = 340)
recruited with major depression and a baseline
total score on the Hamilton Depression Scale
(HAM-D) of at least 20.
CONCLUSION: This study fails support the
efficacy of H perforatum in moderately severe
major depression. The result may be due to low
assay sensitivity of the trial, but the complete
absence of trends suggestive of efficacy for H
perforatum is noteworthy (perlu diperhatikan).
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CAM: evidence and research
Acupuncture for peripheral joint osteoarthritis A
systematic 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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CAM: evidence and research
Results. Thirty-one possibly relevant studies were
identified 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 its
favourable 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 not
disclose their 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 of
prescription medications and herbal
supplements raises concerns about unintended
interactions.

Patient use of CAM is often a clue to values
and preferences that need to be
acknowledged.
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How can we communicate?
1. Always ask! What else are you doing for your
health?
2. Be open and nonjudgmental.
3. Consider patient preferences and values.
4. Be honest about your lack of knowledge
5. Sadar adanya efek samping & kontraindikasi


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Efek samping/kontraindikasi
(13)
Echinacea : autoimmune rseponse, tidak boleh
diberikan AIDS, TBC, multiple sclerosis
St Johns wort : efek samping fotosensitif akibat
komponen hipericin
Ginkgo biloba ; efek inhibitor on platelet-activating
factor, 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 Prac 1998, 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. JAMA 1998,
280:147-51.
4. National Center for Complementary and Alternative
Medicine (NCCAM). What Is CAM? Available at :
http://nccam.nih.gov/health/whatiscam/. Accessed
November 22, 2007.

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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 bagi
Pengobatan Tradisional. Available at :
http://www.depkes.go.id/index.php?option=news
&task=viewarticle&sid=434. Accessed
November,22,2007
8. National Center for Complementary and
Alternative Medicine (NCCAM). The Use of
Complementary and Alternative Medicine in the
United States. Available at :
http://nccam.nih.gov/health/whatiscam/.
Accessed November 22, 2007
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Daftar Pustaka
9. Clegg DO, Reda DJ , Harris CL, Klein MA, O'Dell
JR, 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 for
peripheral 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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