Alternative treatments

Done anything alternative lately? If so, you have a lot of company. When we surveyed 45,601 Consumer Reportssubscribers online, we found that three out of four were using some form of alternative therapy for their general health. More than 38 million adults make in excess of 300 million visits to acupuncturists, chiropractors, massage therapists, and other complementary and alternative practitioners each year in the United States.

Despite the hoopla over alternative treatments, when we asked respondents how well the therapies they used worked for 12 common health problems, results showed that they were usually deemed far less helpful than prescription medicine for most of the conditions.

Even widely used dietary supplements ranked far below over-the-counter medications in many cases. But hands-on treatments such as chiropractic and deep-tissue massage, as well as the mind-body practice of yoga dominated the lists of helpful alternative treatments for discomfort from conditions such as back pain, neck pain, and osteoarthritis.

Carola Hamann, 42, of San Francisco said she has found that yoga, combined with monthly chiropractic adjustments and some exercises her physical therapist recommended, has helped a lot to relieve pain in her hips from osteoarthritis and other concerns. She keeps her medical doctor informed about therapies she has tried but notes that her chiropractor "sees how everything's connected."

Of alternative treatments used for general health, mainstream vitamins and minerals were the most widely used, with 73 percent of respondents taking them. But 57 percent said they used dietary supplements other than vitamins or minerals. And about one in five reported using mind-body therapies such as yoga or hands-on therapies such as massage.

A total of 30,332 survey respondents gave us their perceptions of the helpfulness of treatments for their most bothersome conditions over the past two years. The respondents were Consumer Reports subscribers, and our findings might not be representative of the general population. Respondents based their opinions on personal experience, so the results can't be compared with scientific clinical trials. And our results do not take into account the power of the placebo effect, the tendency of people to find even simulated or sham interventions helpful.

Why these treatments?

For most conditions we asked about, the No. 1 reason respondents gave for choosing an alternative treatment was simply that they were "a proponent" of it.

"Some people use these therapies because it's just the way they were raised," says Richard Nahin, Ph.D., M.P.H., senior adviser for scientific coordination and outreach at the National Institutes of Health's National Center for Complementary and Alternative Medicine.

Some say they have gone through a transformational process, such as a major illness that has caused them to look at their life in a different way, Nahin says. Others believe dietary supplements are safer than prescription medication because they're natural, even though that's not necessarily the case, he says.

And for some conditions, people choose alternative treatments to avoid the side effects of conventional medications. That was true for about two out of five respondents suffering from insomnia.

When Michael Shannon, 63, of Ocala, Fla., reinjured his back in 2008 he immediately found the closest chiropractor. After the initial 90-minute session, he walked out feeling that it had helped a lot. "It was amazing," Shannon says. After four more chiropractic sessions of about 15 minutes each, along with occasional sessions of massage therapy, he was largely symptom-free. When he feels his back tightening up again, he schedules another adjustment. "It's magical," he says.

One in four respondents undergoing chiropractic treatment for any condition said their chiropractor was more interested and insightful than their medical doctors. More than 30 percent of respondents who had acupuncture felt the same way.

The role of doctors

Our survey found that the wall between conventional doctors and alternative medicine isn't as high as you might assume. Our readers said doctors were generally aware of their use of alternative therapies for their medical conditions.

For instance, 57 percent of people who got Shiatsu massage, usually for back or neck pain, said their doctors knew about it, and so did 81 percent of those who sought chiropractic care.

Sixty-five percent of those who practiced progressive relaxation said their medical caregivers knew about it, as did 68 percent of readers who meditated. A majority of those taking dietary supplements, vitamins, and minerals said their doctors were aware of it.

But doctors were selective in their endorsement of dietary supplements, our survey showed. They tended to point patients toward products with some clinical evidence behind them, such as fish oil for cardiovascular problems, and glucosamine and chondroitin for osteoarthritis.

"We have to be responsible captains of our own health ship," says Avis Brown, 65, of Morgan Hill, Calif., a reader who participated in our survey. "And doctors are our navigators." She said that she received a diagnosis of fibromyalgia about 18 years ago but that massage, meditation, and a sugar-free diet have helped her remain free of symptoms for more than 10 years.

In many cases, a substantial minority of respondents using a particular treatment said their doctors were the ones who had pointed them to it in the first place. Twenty-eight percent of readers who used deep-tissue massage, usually for back or neck pain, said their doctors had recommended it. So did 26 percent of people who used deep-breathing exercises and 21 percent who went to a chiropractor.

Though it's still a rarity, some doctors are adding alternative treatments to their own therapeutic tool kit. Brenda Bourassa, 65, of Winslow, Maine, gets regular acupuncture treatments for her neck pain from Rick Hobbs, M.D., a family physician in nearby Waterville. She says that she was skeptical at first but that the treatments have helped. "I believe that eventually it will eliminate the pain, not just relieve it on a temporary basis," she says.

Hobbs said he became interested in acupuncture in 2004. He now limits his practice mainly to acupuncture and integrative medicine and is president of the American Academy of Medical Acupuncture. "People still think of me as a family doctor as well as an acupuncturist," he says. "My patients stuck with me."

Though prescription medication was the most helpful allergy treatment, over-the-counter drugs ranked far above any of the other therapies. Seventy-nine percent of herbal-tea users found it to be at least a little helpful (slightly less than the proportion that found it to be at least a little helpful for treating colds). Of the few who tried chiropractic, two in five said it helped a lot despite insufficient evidence for its use.

Differences of less than 3 percentage points are not meaningful.

Most have tried prescription drugs and rated them significantly more helpful than all other anxiety treatments, including over-the-counter drugs, the least helpful treatment. Fourteen percent said they were not using any treatments.

Differences of less than 5 percentage points are not meaningful.

Chiropractic outperformed all other back-pain treatments, and prescription medication rated about the same as deep-tissue massage, yoga, or Pilates. Over-the-counter medication was less helpful than hands-on therapies but performed about the same as progressive relaxation and meditation. (See the results for neck pain.)

What the research says

Most back pain clears up on its own within a month or two. Staying active may curb pain and speed recovery. Acupuncture, chiropractic, and yoga are possibly effective for low-back pain. There might be some benefit to acupressure or meditation, but research is preliminary. A recent expert assessment found that spinal manipulation, exercise, standard medical care, and physical therapy appear to be equally helpful for low-back pain.

Precautions

See a doctor if you have back pain with fever, numbness, weakness, a change in bowel or bladder function, leg-muscle atrophy, a history of cancer, or pain associated with a recent trauma.

Differences of less than 5 percentage points are not meaningful.

Prescription drugs beat a dozen other cold and flu treatments that readers used. Over-the-counter medication ranked as well as deep-breathing exercises and goldenseal. Insufficient clinical evidence exists to support the use of goldenseal or chiropractic for treating colds but there’s some evidence that echinacea, vitamin C, and zinc are possibly effective.

Differences of less than 4 percentage points are not meaningful.

Eight in 10 respondents tried prescription medication, and two-thirds of them said it helped a lot. Around a third who used meditation or yoga rated that treatment highly. Ten percent said they were not using any depression treatments.

Differences of less than 8 percentage points are not meaningful.

Most respondents tried prescription medications and found that they helped a lot. Over-the-counter drugs were rated less highly as digestive treatments. Probiotics got higher marks than yogurt containing lactobacillus acidophilus.

Differences of less than 4 percentage points are not meaningful.

A majority of readers who used deep-tissue massage or prescription drugs said their chosen fibromyalgia treatments helped a lot. Those who tried chiropractic or deep-breathing exercises said they helped as much as or more than over-the-counter medications.

What the research says

The antidepressants duloxetine (Cymbalta) and milnacipran (Savella), and the anticonvulsant pregabalin (Lyrica) are approved for treating symptoms. Other antidepressants might also help. There’s only limited evidence that over-the-counter capsaicin cream reduces pain. Aerobic and strength-training exercises can help. Clinical trials have found that SAMe eased symptoms better than placebo, but in our survey, too few fibromyalgia patients used supplements for us to evaluate their helpfulness.

Precautions

See a doctor about widespread pain, extreme tiredness, and poor sleep before they interfere with your daily life.

Differences of less than 10 percentage points are not meaningful.

Readers rated prescription medications significantly more helpful than all other headache treatments. Most tried over-the-counter drugs, and just more than half said they helped a lot.

Differences of less than 3 percentage points are not meaningful.

Almost two-thirds of those who used prescription medication said it helped a lot; only one in five users rated over-the-counter drugs as highly for insomnia treatment. Most who used mind-body practices said they helped at least a little. Insomnia medicines have side effects that may include dependency and worsening sleep problems when abused, misused, or taken too often.

Differences of less than 3 percentage points are not meaningful.

Fewer than half of respondents used prescription medication, but most who did said it helped a lot as an IBS treatment. One in three users rated probiotics highly, but only a small percentage who tried yogurt containing lactobacillus acidophilus thought it helped.

Differences of less than 3 percentage points are not meaningful.

Around six in 10 of those who used chiropractic or deep-tissue massage said it helped a lot as a neck treatment. But respondents rated Swedish massage and prescription medication a toss-up. Most people used over-the-counter medication, but only one in four said it helped a lot. And even fewer of those who used supplements thought they were beneficial.

What the research says

Some preliminary evidence suggests that spinal manipulation or a gentler version called mobilization, combined with exercise, can significantly reduce pain. Without exercise, the chiropractic treatments seem ineffective.

Precautions

Neck pain is usually gone within days or weeks. If it lasts longer or gets worse, see a doctor. Chiropractic procedures on the neck have been linked with severe side effects including stroke, which appears to be very rare.

Differences of less than 7 percentage points are not meaningful.

Osteoarthritis was the condition respondents were most likely to treat with a combination of prescription drugs, over-the-counter medications, and alternative therapies. More than half of the people who tried prescription drugs said they helped a lot as an osteoarthritis treatment. But deep-tissue massage and yoga were rated almost as helpful.

What the research says

Prescription and over-the-counter drugs often provide only partial pain relief. Glucosamine sulfate and SAMe are likely effective in easing pain and improving joint function. Acupuncture is possibly effective. Though there’s insufficient evidence on yoga, preliminary research suggests that it might help.

Precautions

See a doctor if you have severe joint pain or disability, or if your joint is red, warm, or swollen.

Differences of less than 3 percentage points are not meaningful.

The charts accompanying this report are based on responses to the 2010 Annual Questionnaire conducted by the Consumer Reports National Research Center. The red bars represent the proportion of readers using a treatment for a condition who said it “helped a lot.” Unless otherwise noted, the analysis of research findings came from the Natural Medicines Comprehensive Database, an independent research group, based on the scientific evidence that was current as of June 2011.

If you decide to try any of these treatments, talk with your physician first to set realistic expectations for improvement. Survey respondents who said their condition was severe still benefited from these alternative therapies but not quite as much as others.

Many insurers cover acupuncture and chiropractic, and some offer discounts for other treatments. Check with your plan. Some treatments might qualify for reimbursement from your flexible spending or health savings account.

We asked our partners at the Natural Medicines Comprehensive Database, an independent research group, to assess evidence on the alternative therapies. Where given, prices are the average per visit as recorded in the federal government's most recent (2008) Medical Expenditure Panel Survey of a national sample of patients and providers.