Common sense and common experience suggest that
CAM use should be regarded as the rule, not the
exception, in athletes.- Athletes may use CAM therapies to enhance perform-
ance, decrease recovery time after workouts, or speed
return to play following an injury. - Examples of CAM treatments commonly used by
athletes to enhance performance include caffeine
(guarana), creatine, ginkgo biloba, hormone supple-
ments, and ephedra. Examples of CAM treatments
typically used for pain control or accelerated return
to play include iontophoresis, microcurrent, spinal
manipulation, homeopathic arnica, and acupuncture. - The high pressure and high stakes of athletic compe-
tition, together with the exceptionally small margin
that separates success from failure, demand that sports
medicine physicians exercise great vigilance in pro-
tecting the athletes entrusted to their care.
Where Can I Find Good Evidence
on CAM Therapies?
- The best type of evidence to use in evaluating a CAM
therapy depends on the following:- Risks posed by the therapy
- Cost of the therapy
- Information preference of the individual patient
- Availability of other proven, effective, and safe
therapies for the patient’s condition
- Randomized controlled trials(RCTs) are important
for evaluating high risk and/or high cost therapies
because RCTs provide essential safety and risk/bene-
fit data; however, RCTs have some important limita-
tions. RCTs are difficult and expensive to sustain for
long periods of study. Additionally, the results of an
RCT depend greatly on the careful selection of the all-
important “control” group (Jonas, Linde, and Walack,
1999). - Clinical outcomes research is another, less recog-
nized type of research trial that is useful in studying
CAM therapies. Outcomes research is more similar
to clinical practice than RCTs: It involves a wider
range of patients over longer periods of time and
allows for variations in care caused by interactions
with multiple providers. Outcomes research exam-
ines the probability that a therapy will produce a
beneficial effect and provides an estimate of how
large that effect will be in everyday clinical practice.
For long-term, chronic conditions and their thera-
pies, outcomes research often provides the only rel-
evant evidence (Walach, Jonas, and Lewith, 2002).
•Table 75-1 lists a number of sources for obtaining
quality evidence on specific CAM therapies and
practices.- The patient’s individual beliefs and personality can
affect the likelihood of therapeutic efficacy. If a
patient believes that a specific therapy will alleviate
their condition, this prior plausibility has its own ther-
apeutic effect. - If conventional medicine offers a safe, proven therapy
that is acceptable to the patient, any potential CAM
therapy must pass equally stringent evidence stan-
dards for efficacy and safety before being considered
as a viable treatment option.
- The patient’s individual beliefs and personality can
454 SECTION 5 • PRINCIPLES OF REHABILITATION
TABLE 75-1 Internet Resources—Reliable CAM Evidence
for Physicians
The Cochrane Library
The library contains a database of systematic reviews featuring RCTs of
CAM and conventional therapies, as well as a controlled trials
register that provides bibliographic listings of controlled trials and
conference proceedings.
Abstracts of the reviews and trials are available free of charge at
http://www.cochrane.org.
Full text copies of all materials are available thru several subscription
services including gateway.ovid.com.
PubMed
The most comprehensive and popular medical search engine has new
clinical queries filter to assist in limiting your search results. The
most comprehensive search is obtained by using the key words
“complementary medicine.”
Free access at multiple websites including http://www.pubmed.org
National Center for Complementary and Alternative Medicine
The clinical trials section contains an index of trials by treatment or
condition. The index can also be accessed via http://www.clinicaltrials.gov
or thru PubMed.
The NCCAM website is http://www.nccam.nih.gov.
National Library of Medicine
Powerful search engine allows searches across all government
guidelines, plus PubMed. Synonym and related terms search option is
very helpful for CAM therapies with multiple common names.
The search engine may be accessed free of charge at hstat.nlm.nih.gov.
Individual guidelines from many government agencies can be found at
http://www.guideline.gov or http://www.cdc.gov/publications.
Natural Medicines Comprehensive Database
The online database contains comprehensive listings and cross-listings
of natural and herbal therapies, including very helpful sections on “all
known uses” and “herb-drug interactions.” The database also offers
an extensive review of the available pharmacologic evidence.
From the publishers of The Prescriber’s Letter,the database can be
accessed via a purchased subscription at http://www.naturaldatabase.com.
ePocrates Rx Pro
PDA listing of alternative medicines, but does not contain information
on nonmedicinal modalities (acupuncture or manipulation). Provides
names, common uses, suggested dosages and a multicheck feature
that checks the patients medical regimen for drug–drug, herb–herb,
and drug–herb interactions.
Alternative medicine content is available only with the purchase of
ePocrates Rx Pro, not with the free version of ePocrates Rx.
http://www.epocrates.com.ABBREVIATION: RCT = randomized controlled trials; CAM =
complementary and alternative medicine.