Complementary and alternative medicine in wound healing

Advances in Wound Care, Nov/Dec 1999 by Salcido, Richard

COMPLEMENTARY AND ALTERNATIVE MEDICINE COVERS A WIDE variety of healing philosophies, approaches, and therapies, including acupuncture, chiropractic services, naturopathy, herbal medicine, homeopathy, and massage therapy, and it has emerged as an important concept for the health care industry. The reason? Consumers of health care today are more interested in, and more educated about, options outside the traditional boundaries of health care.

Their growing exploration of complementary and alternative medicine led Congress in 1992 to mandate establishment of the Office of Alternative Medicine as part of the National Institutes of Health. In 1998, Congress further mandated establishment of the National Center for Complementary and Alternative Medicine (NCCAM).

The purpose of the NCCAM is to facilitate evaluation of alternative therapies to determine their effectiveness. The NCCAM collaborates with other government agencies in this effort. For example, the NCCAM meets regularly with the Food and Drug Administration (FDA) to enlist the FDA's cooperation in reevaluating rules and regulations governing research on devices, acupuncture needles, herbs, and homeopathic remedies.

The NCCAM also serves as an information clearinghouse for the public, media, and health care professionals; facilitates and conducts research; and provides funding opportunities in response to requests for proposals from the field. For example, NCCAM corresponds with alternative medicine organizations to keep them aware of opportunities for research support and development.

Honey, Sugar, and Maggots

Complementary and alternative medicine is nothing new to wound care practitioners. The history of wound care is replete with examples of alternative practices. Numerous case reports in the literature, for example, describe wound treatment with various substances such as honey, sugar, iodine, and meat tenderizer. Reports on maggot therapy continue to appear in the literature, yet this therapy has failed to maintain a position as "clinically accepted" in this country, mainly because of aesthetics.

Seaweed, aloe vera, and other plant products have become standard ingredients impregnated into various wound dressings, which are approved for use by the FDA. Paradoxically, FDA approval is not required when these substances are sold over-the-counter, as they are not considered to be pharmaceuticals. In addtion, FDA-approved medications-including Maalox and Dilantin-have been used off-label by practitioners to manage wounds.

In recent times, electrical stimulation and magnetic therapies have emerged as accepted modalities in the treatment of chronic wounds; acupuncture and electroacupuncture have also gained a following. Massage therapy has been advocated as a treatment strategy for a number of chronic conditions, and there is research to back up some of the claims. However, according to the clinical practice guidelines on pressure ulcers published by the Agency for Health Care Policy and Research, massage is not recommended in the treatment of pressure ulcers. Interestingly, the evidence to support this "nonrecommendation" is lacking.

Applying Evidence-Based Standards

The number of unproven complementary and alternative medicine strategies and options for wound healing provide us with a tremendous opportunity to reexamine old treatments and apply them in the current environment. We are faced with consumers (our patients) who are demanding more information, more options, and more ability to participate in treatment decisions. As we move forward to the new millennium, it will be important for us to remember that the concept of evidenced-based medicine does not apply only to mainstream wound management. We owe it to our patients to apply the same scientific rigor to complementary and alternative medicine to ensure that these practices are safe and efficacious.

For more information on the NCCAM and complementary and alternative therapies, consult the Web site http://nccam,nih.gov, or call 1-889-644-6226.

Richard "Sal" Salcido, MD, is the Editor-in-Chief of Advances in Wound Care. He is Professor and Chairman of the Department of Rehabilitation Medicine at the University of Pennsylvania Health System, Philadelphia, PA.