Medically Reviewed On: July 10, 2008

DAVID MARKS, MD: Welcome to our webcast. I'm Dr. David Marks. Alternative or complementary medicine has become increasingly popular over the last few years, especially in the treatment of arthritis. What are these alternative therapies, and do they work?

Joining us to answer these questions is Dr. Allan Gibofsky. He is Professor of Medicine and Public Health at Cornell, and a Rheumatologist at the Hospital for Special Surgery. Welcome.

Next to him is Dr. Ifeoma Okoronkwo, or Dr. O., who is Clinical Instructor at NYU School of Medicine and is an attending physician at the Rusk Institute. Thanks for being here.

What are the different types of alternative therapy that we have to deal with?

IFEOMA OKORONKWO, MD: Well, there is really a broad spectrum of therapies and interventions. One could look at it as that there are mechanical interventions and there are non-mechanical interventions. Some of the more common mechanical interventions would be acupuncture, massage therapy, chiropractic. More esoteric ones would be healing touch, Reiki, etc.

Some of the non-mechanical interventions include some of the oral modalities and medicines, such as herbs. Glucosamine is a very common vitamin or supplement. And also magnets.

DAVID MARKS, MD: Chiropractic. How good is that for arthritis? Is there a place for it?

ALLAN GIBOFSKY, MD: There is a place for it. Again, the word arthritis needs to be recognized as a word that has a broad use in common discussion. The word arthritis is like the word automobile; what make, what model, what color, what options. There are various kinds of arthritis that lend themselves very nicely to massage and adjustment. I think to the extent that massage and adjustment are provided by skilled chiropractors who recognize the limitations on the joints, and the limitations and differences between exercise and rest, a chiropractor can be quite helpful, particularly in those forms of arthritis that are caused by overuse resulting in degeneration.

DAVID MARKS, MD: There is some controversy about chiropractic care amongst the medical community, correct?

ALLAN GIBOFSKY, MD: There is a great deal of controversy. I'll defer to Dr. O. in terms of her opinion as well, but it usually arises out of the use of any modality beyond its indication. When it comes to the treatment of musculoskeletal conditions by manipulation and dealing with the manipulation of the parts of the body, I believe chiropractics is an appropriate adjunct. But when some go to claims about the use of chiropracty in stimulating insulin release or the use of chiropracty in stimulating hormone release, I think that's where we're looking more for evidence to demonstrate its efficacy. Dr. O., your feeling?

IFEOMA OKORONKWO, MD: Indeed, I agree. I think that's actually very well said. It's important, once again, to use your physician as springboard to integrate these alternative forms into their practice. For example, in many arthritic forms, the joints are unstable and chiropractic manipulation can frankly be quite dangerous. So it is really at the approval, so to speak, and agreement as a team between the physician and the patient that you should embark on some of these other therapies.

Chiropractic, as Allan mentioned, does use the concept of manipulation to stimulate the nerves and align the body. It is said to release muscle tension, increase blood flow at times.

DAVID MARKS, MD: And that leads to massage; talking about stimulating blood flow. Is that how it works for arthritis?

IFEOMA OKORONKWO, MD: Well, how does it work is an interesting concept. That is certainly the theory. The deep massage of the tissues in various ways - I say deep massage, but that's only one approach. You can have gentle massage that can also, according to massage therapists, lead to a good therapeutic result. But yes, the increase in blood flow, the drainage of lymphatic system is all sort of said to be part of the efficacy of massage therapy.

ALLAN GIBOFSKY, MD: An integral part to all of the therapies and probably one of the factors involved in their success is the fact that in all of the things that we have been talking about so far, the physician puts her hands on the patient. There is no substitute for putting your hand on the patient and reassuring the patient with your compassion, with your concern, with the gentleness of your touch that you're going to be personally involved in her care. To the extent that chiropracty does this, it is part of the efficacy. To the extent that massage does this, it is part of the efficacy.

There are other reason that these things work, but I believe that part of the reasons that they work is because we're putting the hands of the healer on the patient.

DAVID MARKS, MD: But some of these things may work for some people. The story is that we really need to study them further to see really which ones are more effective and which ones aren't.

ALLAN GIBOFSKY, MD: And when they do work, or when our patients think they work, as long as they are not harming the patient, we need to keep an open mind. I have patients who ask me, "Should I wear a copper bracelet." My response to them is "Absolutely wear a copper bracelet, and remember to put it on when you're reaching for the medication that I prescribed to you." If a medication is working, fine. But if an integrative therapy - and I really love that word. I'm going to begin using it more and more. If an integrative therapy does no harm - and that's the first rubric of our profession, above all do no harm - we really need to be more open-minded and to encourage our patients to make use of what works for them.

DAVID MARKS, MD: Well that's going to be the last word. Thank you both for joining us. And thank you for joining our webcast. I'm Dr. David Marks. Goodbye.