We read, not very often, thankfully, a first timer's message which conveys: "I won't use Rx meds" because they poison, don't work, fear..." etc.

I rarely respond to messages which are offered with this openness and honesty because I assume this is not the time/place to argue with the underlying position. Still, there are two issues in this study which express my concern:
1. Results of CAM approaches are meager, 2. the failure to be honest with one's physician carries all sorts of implications for long term outcome and safety issues.
=================

Complement Ther Med. 2008 Aug;16(4):220-7.  
USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE BY PATIENTS WITH CLUSTER HEADACHE: results of a multi-centre headache clinic survey.

Rossi P, Torelli P, Di Lorenzo C, Sances G, Manzoni GC, Tassorelli C, Nappi G.

Headache Centre, INI Grottaferrata, Rome, Italy. paolo.rossi90@alice.it

OBJECTIVES: To evaluate the rates, pattern, satisfaction with, and presence of predictors of complementary and alternative medicine (CAM) use in a clinical population of patients with cluster headache (CH). DESIGN AND SETTING: One hundred CH patients attending one of three headache clinics were asked to undergo a physician-administered structured interview designed to gather information on CAM use.

RESULTS: PAST USE OF CAM THERAPIES WAS REPORTED BY 29% OF THE PATIENTS SURVEYED, WITH 10% HAVING USED CAM IN THE PREVIOUS YEAR. ONLY 8% OF THE THERAPIES USED WERE PERCEIVED AS EFFECTIVE, WHILE A PARTIAL EFFECTIVENESS WAS REPORTED IN 28% OF CAM TREATMENTS.

The most common source of recommendation of CAM was a friend or relative (54%). APPROXIMATELY 62% OF CAM USERS HAD NOT INFORMED THEIR MEDICAL DOCTORS OF THEIR CAM USE. The most common reason for deciding to try a CAM therapy was that it offered a "potential improvement of headache" (44.8%). UNIVARIATE ANALYSIS SHOWED THAT CAM USERS HAD A HIGHER INCOME, HAD A HIGHER LIFETIME NUMBER OF CONVENTIONAL MEDICAL DOCTOR VISITS, HAD CONSULTED MORE HEADACHE SPECIALISTS, HAD A HIGHER NUMBER OF CH ATTACKS PER YEAR, AND HAD A SIGNIFICANTLY HIGHER PROPORTION OF CHRONIC CH VERSUS EPISODIC CH. A binary logistic regression analysis was performed and two variables remained as significant predictors of CAM use: income level (OR=5.7, CI=1.6-9.1, p=0.01), and number of attacks per year (OR=3.08, CI=1.64-6.7, p<0.0001).

CONCLUSION: OUR FINDINGS SUGGEST THAT CH PATIENTS, IN THEIR NEED OF AND QUEST FOR CARE, SEEK AND EXPLORE BOTH CONVENTIONAL AND CAM APPROACHES, EVEN THOUGH ONLY A VERY SMALL MINORITY FINDS THEM VERY SATISFACTORY.

PMID: 18638713 [PubMed]

Yeah, but that was not a proper evaluation of CAM, where the usual approach is to widely advertise what can be construed as success stories and to sweep failures under the carpet.    ::)


                 [smiley=smokin.gif]

The article did not report an evaluation OF the specific CAM but only reports what the patient said about the outcome.

Bob Johnson wrote on May 25^th, 2009 at 1:04pm:

there are two issues in this study which express my concern: 1. Results of CAM approaches are meager, 2. the failure to be honest with one's physician carries all sorts of implications for long term outcome and safety issues.

Agree, and:


Quote:

One hundred CH patients RESULTS: PAST USE OF CAM THERAPIES WAS REPORTED BY 29% OF THE PATIENTS SURVEYED, The most common source of recommendation of CAM was a friend or relative (54%). The most common reason for deciding to try a CAM therapy was that it offered a "potential improvement of headache" (44.8%).

100 surveyed.  29% or 29 people reported CAM use, 54% of these by recommendation of friend or relative, about 45% a headache remedy.

29 people can be a small sample.  Results of small groups can have chance variation, limiting statistical significance.  Non-statistically significant results can become folk knowledge difficult to overcome by friends and relatives and of these, there are other possible causes for observation with confounding factors like patient expectations.
  Accurately representing the available alternative options is not apparent in a small sample, none of which are strongly advocated here outside of CB methods.  Some options are trendy, is the scope of choices too narrow, too broad?
  Methods recommended by 45% because they represent a "potential improvement of headache" would stand a good chance of not making headway with clusters.
 Lastly, only 10% reported alternative use in the last year, introducing recall bias including casual noncompliance with alternative methods and any lifestyle change.  

It's unfortunate when counting the beans prevents you from tasting the soup.....

Sorry to hijack this [Johnny] w - h , but it seems relative here. Andrew.  

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Bob Johnson wrote on May 25^th, 2009 at 2:57pm:

The article did not report an evaluation OF the specific CAM but only reports what the patient said about the outcome.

Which can make it seem too much of a generalization for decision making.

Bob Johnson wrote on May 25^th, 2009 at 1:04pm:

1. Results of CAM approaches are meager

Really?  Shrooms, kudzu, melatonin, taurine and magnesium aren't effective for many of us??  


Bob Johnson wrote on May 25^th, 2009 at 1:04pm:

The most common source of recommendation of CAM was a friend or relative.

There's a big part of the problem.  The average friend or relative who reads that meditation or chamomile is good for headaches is not going to help someone with CH.  Even full time practitioners (mainstream or CAM) often have an extremely limited understanding of clusters.  On the other hand, people who frequent this forum have a much better idea of which CAM approaches might actually deliver some relief.  



Bob Johnson wrote on May 25^th, 2009 at 1:04pm:

ANALYSIS SHOWED THAT CAM USERS HAD A HIGHER INCOME, HAD A HIGHER LIFETIME NUMBER OF CONVENTIONAL MEDICAL DOCTOR VISITS, HAD CONSULTED MORE HEADACHE SPECIALISTS, HAD A HIGHER NUMBER OF CH ATTACKS PER YEAR, AND HAD A SIGNIFICANTLY HIGHER PROPORTION OF CHRONIC CH VERSUS EPISODIC CH.

So more of the people who tried CAM were the tough cases who went to regular doctors more frequently but were not getting good results from mainstream medicine?  And the fact that they didn't get results from alternatives supports the idea that CAM is 'meager' and ineffective??  A fair analysis would also point out that conventional medicine is rather unsatisfactory as far as those patients are concerned - if mainstream medicine was all that and a bag of chips, there would have been little reason for them to look elsewhere.


Bob Johnson wrote on May 25^th, 2009 at 1:04pm:

2. the failure to be honest with one's physician carries all sorts of implications for long term outcome and safety issues.

I agree fully.  A patient has a responsibility to their own health to communicate what they are doing/taking to a physician.  The doctor may or may not understand the approach, but should be fully briefed on the assumption that the information is important and might be used.