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Research shows rheumatologists accept, use complementary medicine

University of Maryland researchers set out to determine how often rheumatologists, the doctors who treat arthritis and related conditions, use alternative therapies -- either directly themselves or indirectly by referring a patient to another practitioner.

2,000 physicians who were members of the American Academy of Rheumatology were surveyed with 934 responses. 34 percent of doctors, said they had used nutraceutical therapy. Study results were published in the April 2002 issue of the Archives of Internal Medicine.

The alternative therapies listed in the survey were acupuncture; behavioral medicine; biofeedback; chiropractic; counseling/psychotherapy; dietary prescription; electromagnetic application (TENS and PENS); energetic healing; exercise intervention; herbal/botanical medicine; homeopathy; hypnotherapy; magnets; manipulation therapy (non-chiropractic); massage/manual healing; meditation; movement (yoga, qi gong); music/sound; nutraceuticals (cetyl myristoleate, glucosamine, S-adenosylmethionine); prayer and spiritual direction; relaxation techniques; and trigger-point therapy.

At least half of the doctors who responded had actually referred patients to eight of the therapies: acupuncture, behavioral medicine, biofeedback, counseling/psychotherapy, dietary prescriptions, electromagnetic application, exercise and massage.

More than half had either referred or directly used nine of the 22 therapies, with counseling/psychotherapy (85 percent) and exercise (81 percent) receiving the most responses.

Overall, the physicians surveyed were more likely to have referred a patient than to have administered the treatment themselves, with the exception of trigger-point therapy and nutraceuticals. In these cases, 51 percent and 34 percent of doctors, respectively, said they had used the therapy.

After that, the physicians were most likely to have directly been involved in exercise intervention (41 percent); dietary prescription (33 percent); counseling/psychotherapy (24 percent); and electromagnetic applications (10 percent).


"This is an important study," says Dr. John Klippel, medical director of the Arthritis Foundation. "What it reflects is an emerging trend, which has probably been going on for the last 10 years, of rheumatologists becoming involved in complementary and alternative medical therapies."

"I think this has been driven by a couple of things, first and foremost by an interest by people with arthritis in using them," he adds.

"The second thing is that there's a growing body of evidence that [alternative medicine] can play an important role in the comprehensive treatment of someone with arthritis. Studies have appeared in journals that rheumatologists read," he notes.

Klippel adds, however, that "nearly 70 percent of physicians don't discuss alternative therapies with their patients because they do not feel knowledgeable enough."

The results seem to indicate an openness on the part of rheumatologists to alternative therapies, the study concludes.


Barker Bausell, Ph.D., professor, family medicine, University of Maryland School of Medicine, and director, research, University of Maryland Complementary Medicine Program, Baltimore; John Klippel, M.D., medical director, Arthritis Foundation; April 8, 2002, Archives of Internal Medicine.

Key concepts: Complimentary & Alternative Medicine, CAM, rheumatologists