Integrative medicine can be seens as an attempt to combine regular academic medical therapies with more evidence-based CAM. In any IM approach one should not simply add CAM to conventional medical care. IM treatment should emphasise health and healing rather than disease and symptomatic treatment, and patient coaching plays a central role.

World wide we see an increased number of medical training programs on CAM and Integrated Medicine (IM) as well as academic centres and hospitals integrating selected CAM into their IM services and research. These trends show a narrowing of the gap between conceptually opposing domains, as a result of patient prefereence and pressure of patient organisations, politics and emerging evidence of effectiveness and safety. Furthermore there is increasingly pressure of students to teach CAM and IM at universities.  This student demand contributed to the first academic CAM courses and the establishment of an academic IM centers in the USA and now progresively in Europe, such as the Unit for Studies of Integrative Health Care at Karolinska Institute in Sweden.

An integrated medicine approach for the treatment of neuropathic pain.

At our institute for neuropathic pain we have explored how to integrate various CAM modalities into mainstream treatment of neuropathic pain, by selecting certain evidence based approaches from CAM and integrating these into the regular pharmacotherapeutical therapy for neuropathic pain.

Neuropathic pain is a pain modality which is very difficult to treat and its impact on quality of life is significant. Single, isolated forms of treatment very often are not sufficient, and only one out of ten patients suffering from neuropathic pain is well treated. In order to treat patients adequately, more treatment modalities are required. Furthermore, a significant number of patiens defer treatment with regular analgesics such as pregabeline, due to side-effects, mostly related to problems in cognition. For all these patients our approach offers a relevant alternative.

At our institute we combine the following treatment modalities in the treatment of painful neuropathy due to diabetes mellitus, chronic idiopathic axonal polyneuropathy (CIAP) and cis-platin induced painful neuropathy:

o acupuncture administered as PENS (percutaneous electrical nerve stimulation),

o supplements such as alpha lipoic acid, acetyl-l-carnitine,

o vitamines such as vitamine D3,

o topical creams such as amitriptyline cream,

o anagesics such as gabapentine and amitriptyline,

o physiotherapy for balance, stability, muscle strenght and endurance,

Treatment response is quite often seen within few weeks, probably due to the analgesic effects of the electrical stimulation via the needles in combination with the topical analgesic creams, that is if patients are not (yet) treated with regular analgesics.

Using this treatment scedule, in an individualized way, helped us to decrease pain intensity scores in the majorities of patients with 50% or more, mostly within 8 weeks. One of the upside form many patients is to experience a significant decrease in pain and increase in quality of life without the troublesome side effects of the normal high dose psychotropic analgesics.  

May 2010, Jan M. Keppel Hesselink, MD, PhD