Integrative Medicine as an Adjunct to Orthopaedic Surgery

James R. Ficke, MD; Nathan M. Moroski, MD; Steven D. Ross, MD; Ranjan Gupta, MD


J Am Acad Orthop Surg. 2018;26(2):58-65. 

In This Article

Other Integrative Medicine Practices

Homeopathic treatment of low back pain was recently examined by Witt et al[22] in prospective multicenter observational study of 129 patients. The authors of the study noted several reports of marked and sustained improvement of symptoms following homeopathic treatment. Quality of life improved based on the Medical Outcomes Study 36-Item Short Form questionnaire. The use of conventional treatment and health services decreased markedly. The number of patients using medication decreased by 50%. The authors concluded that homeopathy is an effective treatment for low back pain.

Tai chi is a Chinese martial art practiced both for its defense training and its health benefits. Peng[23] recently reviewed the effectiveness of tai chi in treating chronic pain, including OA, fibromyalgia, rheumatoid arthritis, low back pain, and headache. Trials were mostly low quality. Tai chi was concluded to be an effective intervention in OA, low back pain, and fibromyalgia. The authors noted the considerable limitations that exist in the literature and the need for high-quality studies.

Qigong is a type of spiritual practice intended to align body, breath, and mind for health meditation; it has roots in Chinese medicine, philosophy, and martial arts. Qigong is practiced for recreation, exercise, relaxation, preventive medicine, alternative medicine, and training for martial arts. Sawynok and Lynch[24] conducted a meta-analysis examining the effect of qigong in patients with fibromyalgia. Regular qigong practice produced improvements in pain, sleep, and physical and mental function that were maintained for 4 to 6 months compared with nonactive groups. However, little difference was shown between the actively treated and the control groups; the active control group had significant improvement over the inactive group. In another systematic review of randomized clinical trials, greater pain reductions were demonstrated in groups who practiced qigong compared with control groups.[40] The authors concluded that the effectiveness of qigong is encouraging and further studies are warranted.

Ayurvedic medicine is one of the world's oldest medicinal systems. It is a system of medicine that has its roots in traditional Hindu medicine. "Ayurveda" combines the Sanskrit words "ayur," meaning life, and "veda," meaning science or knowledge; it originated in India >3,000 years ago and remains one of the country's traditional healthcare systems. Ayurveda promotes the use of herbal compounds, special diets, and other unique health practices for health and treatment of disease. Ayurvedic products have the potential to be toxic, and many substances used have not been studied for safety. Of 193 Ayurvedic products purchased over the internet and manufactured in either the United States or India, 21% contained levels of lead, mercury, or arsenic that exceeded standards for acceptable daily intake.[41]

Most clinical trials of Ayurvedic approaches have been small, have had problems with research design, or lacked appropriate control groups. However, in a randomized controlled trial comparing Boswellia serrata gum resin with placebo in patients with OA of the knee, patients in the treatment group had significant improvements in pain scores and physical function scores compared with those in the placebo group.[25] In addition, Furst et al[42] conducted a double-blind randomized controlled trial that compared Ayurvedic medicine with methotrexate for the treatment of rheumatoid arthritis. The Ayurvedic treatment included 40 herbal compounds. The results showed approximately equivalent outcomes in efficacy in the study group, justifying the need for future inquiry and study.