title: Complementary and alternative medicine therapies for the anesthesiologist and pain practitioner: a narrative review.
abstract: OBJECTIVE
  This narrative review provides an overview of the complementary and alternative medicine (CAM) therapies that anesthesiologists and pain management practitioners commonly encounter along with recommendations for evaluation and implementation.
  
  
  METHODS
  A literature search of PubMed was performed using the comprehensive MeSH term, "Complementary Therapies OR Dietary Supplements", and a search was conducted of the various licensing organizations and books published on the topics of CAM and integrative medicine.
  
  
  RESULTS
  In North America, the most commonly encountered CAM therapies include 1) manipulation and procedural therapies; 2) herbs, nutritional supplements (nutraceuticals), and dietary therapies; and 3) mind-body and energy therapies. Controversy exists regarding many of these therapies, particularly those with a higher risk of harm, such as chiropractic manipulation, acupuncture, and nutraceutical use. Several well-conducted studies were analyzed to show how research in CAM can control for placebo responses. Practical considerations are provided for patients and practitioners interested in pursuing or already employing CAM in perioperative and chronic pain management settings.
  
  
  CONCLUSIONS
  Complementary and alternative medicine therapies in general may provide a useful adjunct in the management of chronic pain. Nevertheless, many patients are not aware of the risks and benefits of individual therapies. In the perioperative setting, the most concerning CAM therapy is the use of herbs and other supplements that may produce physiologic and metabolic derangements and may interact with prescription medications. Resources exist to aid pain specialists, anesthesiologists, and patients in the evidence-based utilization of CAM therapies.
authors.affiliation: Veterans Affairs Medical Center, Atlanta, GA, USA. woodbura@gmail.com.|Emory University, 1365 Clifton Road NE, Atlanta, GA, 30322, USA. woodbura@gmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Woodbury
authors.affiliation: Emory University, 1365 Clifton Road NE, Atlanta, GA, 30322, USA.
authors.forename: Stephen Neal
authors.initials: SN
authors.lastname: Soong
authors.affiliation: Veterans Affairs Medical Center, Atlanta, GA, USA.|Emory University, 1365 Clifton Road NE, Atlanta, GA, 30322, USA.
authors.forename: David
authors.initials: D
authors.lastname: Fishman
authors.affiliation: Veterans Affairs Medical Center, Atlanta, GA, USA.|Emory University, 1365 Clifton Road NE, Atlanta, GA, 30322, USA.
authors.forename: Paul S
authors.initials: PS
authors.lastname: García
mesh_terms: D000776:Anesthesiology; D000529:Complementary Therapies; D019587:Dietary Supplements; D006801:Humans; D026441:Mind-Body Therapies; D026201:Musculoskeletal Manipulations; D059408:Pain Management