Integrative medicine reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, healthcare professionals and disciplines to achieve optimal health and healing. This incorporates a combination of conventional (allopathic) medicine and complementary medicine approaches that have demonstrated safety and effectiveness. The two main components of integrative medicine studies are the understanding and application of the inclusive approach and familiarity with the variety of frequently used complementary treatments and the practitioners in those fields. With the integration of Chinese medicine and other complementary medical approaches in the Western world and the accumulation of research in these fields, the need to become familiar with them arose. About 15 years ago, the necessity to make the topic of integrative medicine accessible to specialists in family medicine was raised. Family medicine is the primary care approach that deals with prevention, treatment and coordination between primary and secondary medicine. Evidently, those doctors are expected to be the first to adopt this extensive approach. Since 2010, the course has been an obligatory part of the family medicine interns' curriculum at Tel Aviv University. Acquaintance with integrative medicine and its uses needs to be part of the education of interns in family medicine in an in-depth manner and in all different specialties, each in its relevant usage.
Evidence synthesis for whole medical systems, defined as complete systems of theory and practice that have evolved independently from biomedicine. is challenging. This paper provides a framework for evidence synthesis of Traditional, Complementary and Integrative Medicine (TCIM) systems incorporating context and complexity. A systematic review program on the effects of homeopathic preparations is used as a practical illustration of the proposed framework. A systems perspective considers the patient as a complex system of interconnected regulative subsystems embedded in a complex environment, and disease as a dysregulation of the dynamic adaptive state of the organism. Most TCIM systems, including homeopathy, aim to stimulate regulative systems and their functions to regain homeostasis. The consequences of these principles for the approach to evidence synthesis of TCIM systems are explored and explained. A systems perspective takes into account a plurality of evidence sources, including 'real-world' clinical data such as case reports, case series and cohort studies. The systematic review program focuses on comparative studies of homeopathy in various clinical indications and includes both non-randomized prospective studies of interventions (NRSIs) and randomized controlled trials (RCTs). For risk-of-bias assessments, use is made of respectively ROBINS-I and ROB2. Evidence certainty is graded transparently and rigorously based on the GRADE framework. An experienced patient advocate is involved in the research program and input from patient advisors who experienced the clinical indication under investigation is incorporated. RCT and NRSI evidence on homeopathic preparations for a range of clinical indications will be synthesised. A limitation, from a complex systems perspective, is that the implication of these findings will still need to be contextualized within the broader context of the existing state of knowledge. An 'evidence eco-system' that includes complementary sources of information will be required to inform decisions. Evidence synthesis of TCIM systems can move beyond conventional approaches by framing evidence within its complexity and context, together with real-world data and patient perspectives. This approach entails methodological challenges and will require gap analyses to guide future research and improve the applicability for public health and individualized patient care.
The World Health Organization recently issued new definitions of traditional medicine, complementary medicine and integrative medicine (TCIM), raising questions about their implementation in different languages. This paper explores the knowledge and perceptions of TCIM terms in the German public with the aim of identifying term(s) that could be the most useful in public and political dialogue on TCIM in Germany. This study is based on a cross-sectional survey of an online-representative sample of the German-speaking residential population aged 18-75 years (n=4,065), using a comprehensive questionnaire on TCIM use, attitudes and terms. Descriptive analyses were performed and decision trees calculated, using Exhaustive Chi-squared Automatic Interaction Detection (CHAID) to identify predictors of self-perceived TCIM benefit. The German term "Naturheilkunde" (literal translation from German: "knowledge of natural healing") was the most familiar term (55.3%), followed by alternative medicine (43.8%), complementary medicine (19.2%) and integrative medicine (15.6%). Conventional medicine generated the most positive attitude (63.1%), followed by NHK (52.0%), integrative medicine (41.1%), complementary medicine (35.0%) and alternative medicine (25.1%). The CHAID algorithm identified a positive attitude to "Naturheilkunde" as the most significant predictor (p<0.001) for experiencing benefit from TCIM. Attitudes towards complementary medicine or alternative medicine were no relevant predictors in this analysis. The historically rooted German term "Naturheilkunde" was the best known and positively connoted TCIM term in our study. Furthermore, a positive attitude towards Naturheilkunde was strongly associated with experiencing benefit from TCIM. While "integrative medicine" is yet unfamiliar within the German public, the positive connotations it evokes and its perceived benefits suggest it also has potential for public discourse. We recommend a national Delphi process with TCIM-experts and -stakeholders in Germany to clearly define, prioritize and align commonly used TCIM terms in Germany. The selection of terminology for public discourse should consider the insights from this study as well as appropriate communication expertise.
Traditional, Complementary, and Integrative Medicine (TCIM) has been established in the academic context of universities. In recent years, strategies have been developed worldwide to strengthen the role of TCIM in supporting the health of the population. Online databases are a common way for obtaining evidence-based information. This article is an update of a former systematic review from 2010 on published databases resources for TCIM. The databases CINAHL, CAMbase, Web of Science, MEDLINE/PubMed, and Google Scholar search engine were searched for databases related to TCIM published in peer-reviewed journals between 2010 and November 2024. All included databases were visited online, and information on the origin, content, and scope of the database was extracted. A total of 6579 articles were identified through the literature search. After exclusion of irrelevant articles, full-text screening of 127 articles yielded 37 new databases. Together with 16 still available old databases, these mainly contained information on herbal therapies (n = 15) and Traditional Chinese Medicine (n = 11) from 18 different countries. Newly identified medicinal plant databases offer various scientific resources such as crude drugs, indigenous plants, and structures for natural and phytochemical components with molecular biological content. This literature review illustrates the dynamic development in the database landscape over the last 15 years. While the number of bibliographic databases is shrinking, databases in the field of medical plants/herbal therapy content are on the rise, which might be due to advances in plant genomics and molecular biology.
Recognizing and prioritizing the factors that influence the selection of treatment options is essential for effective health service planning and an appropriate health care delivery system. This study aimed to identify and prioritize the barriers and facilitators to the use of Traditional, Complementary, and Integrative Medicine (TCIM) in Iran. A two-phase, mixed-methods study was conducted. First, a two-round Delphi survey was conducted with a panel of 32 experts, including specialists in Persian medicine (PM) and health policymakers, to acheive consensus on a list of barriers and facilitators within the Iranian context. Subsequently, the Analytical Hierarchy Process (AHP) was applied with a 12-expert panel to determine the relative weight and priority of the agreed-upon criteria. The Delphi process yielded consensus on 18 facilitators and nine barriers. The facilitators were categorized into two main dimensions (Cultural and social facilitators, and Systemic facilitators) and six sub-dimensions. In comparison, the barriers formed four main dimensions (service delivery barriers, policy challenges, financial barriers, and knowledge and attitudinal barriers). Quantitative AHP results revealed that among facilitators, "effects of health professionals" (Final Weight: 0.29) was the most critical dimension, with "Recommendation and referral by conventional physicians (CPs)" (Final Weight: 0.18) as its top factor. Conversely, among barriers, "Policy Challenges" (Final Weight: 0.50) was the most significant dimension, substantially outweighing others. The findings highlight that the recommendation of TCIM by CPs are the strongest facilitator; yet, overarching policy challenges critically hamper its implementation. Addressing this disconnect requires integrated policy reforms and interdisciplinary collaboration to leverage TCIM within Iran's health care system effectively.
To map digital resources on traditional, complementary and integrative medicine, including databases, repositories, libraries and web portals providing access to traditional knowledge, research or policy information. We undertook a rapid review of publications related to digital resources on traditional medicine. We also surveyed specialists in traditional medicine for referrals to digital resources. We searched PubMed®, Embase, the Virtual Health Library of the Pan American Health Organization and Google. Eligible resources were digital platforms indexing traditional medicine knowledge, research or policy. From the publications identified, we retrieved relevant digital resources and extracted data on their scope, content and geographic distribution. From 102 studies, we identified 358 potentially relevant digital resources on traditional medicine across all regions of the World Health Organization (WHO). We included 125 of these resources in our inventory of traditional medicine digital resources. The Western Pacific Region accounted for 36% (45/125) of the resources, led by China with 34 resources, and the Americas accounted for 24% (30/125) of the resources, with 24 resources from the United States of America. Most digital resources focused on pharmacological or clinical applications; only five addressed Indigenous medicine. Digital resources on traditional, complementary and integrative medicine are diverse but fragmented. Codified systems are predominant while Indigenous traditions are marginalized. WHO's Traditional Medicine Global Library offers an opportunity to correct these imbalances by creating an inclusive, ethically governed platform that safeguards knowledge systems and supports their equitable integration into global health. Identifier les ressources numériques sur la médecine traditionnelle, complémentaire et intégrative, y compris les bases de données, référentiels, bibliothèques et portails Web donnant accès à des connaissances traditionnelles, à des recherches ou à des informations en matière de politiques. Nous avons procédé à un examen rapide des publications liées aux ressources numériques sur la médecine traditionnelle. Nous avons également interrogé des spécialistes en médecine traditionnelle afin d’obtenir des références vers des ressources numériques. Nous avons effectué des recherches dans PubMed®, Embase, la bibliothèque virtuelle de santé de l’Organisation panaméricaine de la Santé et Google. Les ressources éligibles étaient des plateformes numériques répertoriant les connaissances, les recherches ou les politiques en matière de médecine traditionnelle. Les publications identifiées nous ont permis de récupérer les ressources numériques pertinentes et d’extraire des données sur leur portée, leurs contenus et leur répartition géographique. Dans 102 études, nous avons identifié 358 ressources numériques potentiellement pertinentes sur la médecine traditionnelle dans toutes les régions de l’Organisation mondiale de la Santé (OMS). Nous avons inclus 125 de ces ressources dans notre inventaire des ressources numériques sur la médecine traditionnelle. La région du Pacifique occidental représentait 36% (45/125) des ressources, la Chine arrivant en tête avec 34 ressources, et les Amériques représentaient 24% (30/125) des ressources, avec 24 ressources provenant des États-Unis d’Amérique. La plupart des ressources numériques étaient axées sur les applications pharmacologiques ou cliniques. Seules cinq d’entre elles traitaient de la médecine autochtone. Les ressources numériques sur la médecine traditionnelle, complémentaire et intégrative sont diverses, mais fragmentées. Les systèmes codifiés prédominent, tandis que les traditions autochtones sont marginalisées. La Bibliothèque mondiale de l’OMS sur la médecine traditionnelle offre la possibilité de corriger ces déséquilibres en créant une plateforme inclusive et régie par des principes éthiques qui préserve les systèmes de connaissances et soutient leur intégration équitable dans le système mondial de la santé. Cartografiar los recursos digitales sobre medicina tradicional, complementaria e integrativa, incluidas bases de datos, repositorios, bibliotecas y portales web que proporcionan acceso a conocimientos tradicionales, investigaciones o información normativa. Se realizó una revisión rápida de publicaciones relacionadas con recursos digitales sobre medicina tradicional. Asimismo, se consultó a especialistas en medicina tradicional para identificar recursos digitales pertinentes. Se realizaron búsquedas en PubMed®, Embase, la Biblioteca Virtual en Salud de la Organización Panamericana de la Salud y Google. Se consideraron elegibles las plataformas digitales que indexaban conocimientos, investigaciones o políticas sobre medicina tradicional. A partir de las publicaciones identificadas, se recuperaron recursos digitales pertinentes y se extrajeron datos sobre su alcance, contenido y distribución geográfica. A partir de 102 estudios, se identificaron 358 recursos digitales potencialmente pertinentes sobre medicina tradicional en todas las regiones de la Organización Mundial de la Salud (OMS). De estos, se incluyeron 125 recursos en el inventario de recursos digitales sobre medicina tradicional. La Región del Pacífico Occidental representó el 36% (45/125) de los recursos, encabezada por China con 34 recursos, mientras que la Región de las Américas representó el 24% (30/125), con 24 recursos procedentes de los Estados Unidos de América. La mayoría de los recursos digitales se centraban en aplicaciones farmacológicas o clínicas; solo cinco abordaban la medicina indígena. Los recursos digitales sobre medicina tradicional, complementaria e integrativa son diversos, pero fragmentados. Los sistemas codificados predominan, mientras que las tradiciones indígenas permanecen marginadas. La Biblioteca Mundial de Medicina Tradicional de la OMS ofrece una oportunidad para corregir estos desequilibrios mediante la creación de una plataforma inclusiva y regida por principios éticos que salvaguarde los sistemas de conocimiento y apoye su integración equitativa en la salud mundial. تحديد الموارد الرقمية المتعلقة بالطب التقليدي والتكميلي والتكاملي، بما في ذلك قواعد البيانات، والمستودعات، والمكتبات، والبوابات الإلكترونية التي تتيح الوصول إلى المعرفة التقليدية، أو الأبحاث، أو المعلومات المتعلقة بالسياسات. قمنا بإجراء مراجعة سريعة للمنشورات المتعلقة بالموارد الرقمية حول الطب التقليدي. كما قمنا باستطلاع آراء المتخصصين في الطب التقليدي للحصول على إحالات إلى الموارد الرقمية. قمنا بالبحث في قواعد بيانات ®PubMed وEmbase، والمكتبة الصحية الافتراضية لمنظمة الصحة للبلدان الأمريكية، وGoogle. كانت الموارد المؤهلة عبارة عن منصات رقمية تقوم بفهرسة المعرفة أو الأبحاث أو السياسات المتعلقة بالطب التقليدي. من المنشورات التي تم تحديدها، قمنا باسترجاع الموارد الرقمية ذات الصلة، واستخرجنا بيانات عن نطاقها ومحتواها وتوزيعها الجغرافي. من بين 102 دراسة، قمنا بتحديد 358 موردًا رقميًا محتملًا ذي صلة بالطب التقليدي عبر جميع مناطق منظمة الصحة العالمية (WHO). أدرجنا 125 من هذه الموارد في قائمتنا للموارد الرقمية للطب التقليدي. استحوذت منطقة غرب المحيط الهادئ على %36 (45/125) من الموارد، بقيادة الصين في ظل وجود 34 موردًا، واستحوذت الأمريكتان على %24 (30/125) من الموارد، مع 24 موردًا من الولايات المتحدة الأمريكية. قامت معظم الموارد الرقمية بالتركيز على التطبيقات الدوائية أو الإكلينيكية؛ ولم تتناول سوى خمسة منها الطب التقليدي. الموارد الرقمية المتعلقة بالطب التقليدي والتكميلي والتكاملي متنوعة ولكنها مجزأة. وتسود الأنظمة المقننة بينما يتم تهميش التقاليد التقليدية. توفر المكتبة العالمية للطب التقليدي التابعة لمنظمة الصحة العالمية فرصة لتصحيح هذه الاختلالات، وذلك من خلال إنشاء منصة شاملة تخضع لقواعد أخلاقية تحمي أنظمة المعرفة، وتدعم دمجها بشكل منصف في الصحة العالمية. 旨在了解传统、补充和整合医学相关数字资源,包括提供传统知识、研究或政策信息访问权限的数据库、信息库、图书馆和门户网站。. 我们对涉及传统医学数字资源的出版物进行了速览综述。我们还面向传统医学领域的专家开展了调研活动,以了解其推荐使用的数字资源。我们搜索了 PubMed®、Embase、泛美卫生组织的虚拟健康图书馆和谷歌 (Google),然后将可检索到传统医学知识、研究或政策的数字平台纳入了适用数字资源的范畴。我们从已确定的出版物中检索到了相关数字资源并提取了有关此类资源范围、内容及地理分布情况的数据。. 基于 102 项研究,我们在世卫组织 (WHO) 所有区域内共找到了 358 个可能有关的传统医学数字资源。我们将其中 125 个资源列入了我们的传统医学数字资源清单中。在列入清单的这些资源中,西太平洋区域占 36% (45/125),其中又以中国(34 个资源)的占比最高;美洲区域占 24% (30/125),其中 24 个资源来自于美利坚合众国。大多数数字资源侧重于药理作用或临床应用;仅五个资源涉及土著医学。. 尽管传统、补充和整合医学相关数字资源种类繁多,但此类资源过于零散,未形成体系。编码化系统逐步占据主导地位,而土著传统则有向边缘化发展的趋势。世卫组织的传统医学全球图书馆创建了一个具有包容性且符合伦理规范的平台来保护知识系统和支持以公平合理的方式将此类知识系统整合到全球健康系统中,从而确保有机会纠正此类失衡现象。. Составить карту цифровых ресурсов по традиционной, комплементарной и интегративной медицине, в том числе баз данных, репозиториев, библиотек и веб-порталов, предоставляющих доступ к информации о традиционных знаниях, научных исследованиях или политике в данной области. Авторы выполнили краткий обзор публикаций, посвященных цифровым ресурсам по традиционной медицине. Были также опрошены специалисты по традиционной медицине, которые могли бы дать рекомендации по цифровым ресурсам. Поиск проводился по базам данных PubMed®, Embase, Виртуальной библиотеке здоровья Панамериканской организации здравоохранения, а также в Google. В рассмотрение включались цифровые платформы, индексирующие информацию по знаниям, соответствующим научным исследованиям и политике в области традиционной медицины. Из выявленных публикаций были извлечены соответствующие цифровые ресурсы и данные об их тематическом охвате, содержимом и географическом распределении. По данным 102 исследований было выявлено 358 потенциально релевантных цифровых ресурсов по традиционной медицине во всех регионах Всемирной организации здравоохранения (ВОЗ). 125 из них авторы включили в перечень цифровых ресурсов по традиционной медицине. На долю Западного Тихоокеанского региона пришлось 36% (45/125) ресурсов, во главе списка идет Китай с 34 ресурсами из них, а на долю Американского континента – 24% (30/125), где 24 ресурса представляли Соединенные Штаты Америки. Большинство цифровых ресурсов были посвящены вопросам фармакологии или клинического применения, и только пять освещали вопросы медицины коренных народов. Цифровые ресурсы по традиционной, комплементарной и интегративной медицине отличаются разнообразием, но в то же время и фрагментированностью. Преобладают кодифицированные системы, тогда как традиции коренных народов остаются на периферии. Глобальная библиотека ВОЗ по традиционной медицине предлагает возможность исправить этот дисбаланс, создав инклюзивную, управляемую на основе этических принципов платформу, которая защищает системы знаний и поддерживает их равноправное включение в систему мирового здравоохранения.
Women's health care remains largely shaped by biomedical paradigms that prioritize reproductive functions and physiological outcomes, often sidelining subjective, social, and cultural dimensions. Traditional, Complementary, and Integrative Medicine (TCIM) is frequently presented as an alternative, yet its incorporation into women's health tends to follow biomedical logics of validation. The aim of this scoping review was to analyze how TCIM in women's health is configured in indexed scientific publications, combining Joanna Briggs Institute (JBI) methods with an interpretive lens from Cultural Studies and the Expanded Circuit of Culture. Because this approach analyzes scientific literature as a cultural artifact rather than aggregating clinical efficacy data, its application for establishing classical biomedical guidelines is limited; however, it provides a rigorous critical interpretation of the field. Searches were conducted in ten national and international databases with no language or year limits; of 2,474 records identified, 1,079 met the inclusion criteria. Data were mapped quantitatively and qualitatively, treating articles as cultural artifacts. Four discursive configurations emerged: "practice efficiency and efficacy" studies (45.6%; n = 492), focused on safety and physiological outcomes and often reducing complex systems to isolated techniques; descriptive and prevalence studies (41.5%; n = 448), which portrayed TCIM use mainly through sociodemographic profiles and consumer behavior; a category addressing institutionalization and methodological challenges (6.8%; n = 74), examining the structural and epistemological conditions for TCIM recognition within formal health systems; and a smaller group centered on emancipatory care and subjective experience (6.1%; n = 65), foregrounding autonomy, therapeutic bonding, and ancestral knowledges. Overall, the field is strongly dominated by biomedical translation, which sanitizes sensorial, spiritual, and relational dimensions and upholds epistemic hierarchies, yet counter-hegemonic narratives persist at the margins, indicating possibilities for epistemic pluralism and more emancipatory approaches to women's health. https://doi.org/10.17605/OSF.IO/7TZP2.
Traditional and complementary medicine (T&CM) is used by many populations for healing purposes. For Muslims, these methods include religiously sourced and spiritually based practices, such as consuming herbs and foods mentioned by Prophet Muhammad and performing specific worship activities believed to hasten healing. This paper examined the use of T&CM among American Muslim women and the associations between sociodemographic and religious characteristics and such use. This was an exploratory, cross-sectional survey among English-speaking, adult Muslim women recruited from Chicago mosques and community centers. Participants completed a self-administered survey with items assessing sociodemographic and religious characteristics, as well as usage of traditional complementary and alternative treatments. Descriptive statistics were tabulated, ANOVA and Pearson's chi-squared tests were used to assess bivariate relationships, and multivariate linear and ordered logistic regression models were used to determine associations between outcome variables-religious and nonreligiously sourced complementary and alternative modalities-and independent variables. A total of 254 participants completed the survey. Approximately 70% of participants employed Prophetic medicine, and 50% consulted an alternative healer when facing a health problem. Several sociodemographic and religious factors were associated with the use of complementary/alternative modalities. Notably, immigrants had higher odds of using treatments sourced in sayings of the Prophet Muhammad than those who were born in the U.S. (odds ratio [OR] = 2.41, p < 0.039), whereas those who had lived longer in the U.S. had lower odds of using complementary/alternative modalities than individuals whose duration of stay was shorter (OR = 0.33, p < 0.031). With regard to religiosity, participants with negative religious coping had lower odds of using folk methods (OR = 1.16, p < 0.001) but had higher odds of using nonreligious T&CM (OR = 1.15, p < 0.002). Many American Muslim women utilize T&CM for healing, with the most prevalent modalities being Prophetic medicine and worship activities. T&CM use appears to be associated with demographic features. Further research to unpack the surrounding behavioral and decisional contexts of T&CM, specifically whether it is used integratively or in lieu of allopathic methods, and by whom, is needed.
Osteoarthritis (OA) is a degenerative joint condition mostly affecting the knees characterized by cartilage degradation, synovial inflammation, and chronic pain, with limited effective treatments with minimal side effects. Traditional, complementary, and integrative medicine (TCIM), such as numerous medicinal plants, acupuncture, and folk herbalism, among others, have been historically used to treat symptoms associated with OA, which include joint pain, stiffness, and inflammation. Several herbs and their bioactive constituents have shown potential to modulate key inflammatory pathways like the NLRP3 inflammasome, which is an important regulator of innate immune responses in OA pathophysiology. This review aims to investigate the underlying mechanisms and potential of TCIM to alleviate OA-related pain by modulating the NLRP3 inflammasome. A comprehensive literature search across multiple databases, including PubMed, Cochrane Library, Embase, Google Scholar, Scopus, and Web of Science by using a set of MESH and relevant keywords like "NLRP3", "TCIM", "OA", and "Animal" for articles published from January 2000 to August 2024. Twenty-two in vivo studies met the inclusion criteria for the systematic review, and 21 studies for the meta-analysis. Across these studies, TCIM interventions consistently reduced NLRP3, IL-1β, IL-18, and Caspase-1 expression compared with OA controls. Pooled effects were consistently moderate-to-large across all molecular, with low between-study heterogeneity (I² ≈ 0%). Subgroup analyses by OA model, intervention type, and species indicated broadly similar directions of effect. TCIM shows potential therapeutic approaches for managing OA-related pain by targeting the NLRP3 inflammasome in preclinical OA models. Further research should investigate the clinical translation of these findings to address the unmet need for effective analgesics in OA.
How does biomedicine interact with complementary and alternative medicines (CAMs)? Existing studies emphasize boundary work and epistemological distinctions, but give limited attention to the professional contexts shaping biomedical responses. Adopting a social space perspective, this study argues that variation in biomedical responses to CAMs arises from healthcare space structures-specifically, the social distance between biomedicine and CAMs and physicians' social positions. Drawing on a comparative study of Hong Kong and Chinese mainland, we show that biomedical physicians adopt two distinct professional norms toward traditional Chinese medicine (TCM): an exclusive norm in Hong Kong and an integrative norm in Chinese mainland. Evidence from in-depth interviews with physicians indicates that these norms reflect differing patterns of social distance between biomedicine and TCM and the stratified social positions of physicians in the two regions. By foregrounding professional context, this study offers a spatial framework for understanding variation in biomedical responses to CAMs across sociocultural settings.
Integrative approaches are widely used to manage chemotherapy-induced peripheral neuropathy (CIPN). This review aimed to evaluate the effects of various integrative approaches on CIPN, quality of life (QoL), pain, and balance in patients with colorectal cancer (CRC), and to assess any associated adverse effects. A comprehensive search was conducted using eight English and Chinese databases, from inception to January 2025. Randomized controlled trials and quasi-experimental studies were included in data analysis and synthesis. A narrative synthesis was used to present the findings, and the pooled effect size was calculated when there were two or more randomized controlled trials of the same type of intervention. Methodological quality assessment was assessed by the Effective Public Health Practice Project (EPHPP). Thirteen studies involving 638 patients were included in this review. In two randomized controlled trials, multimodal exercise programs significantly reduced CIPN severity in patients with colorectal cancer (CRC) at post-intervention (SMD = -0.70, 95% CI -1.36 to -0.07, p =0.03). One trial also reported sustained effects up to four weeks post-intervention (Cohen's d = 0.58, p =0.031). Additionally, a low methodological quality pilot study (7 participants) showed improvements in CIPN following multimodal exercise. Furthermore, hand-foot exercise (Number of study, N=1), massage therapy (N=2) and henna application (N=1) demonstrated significant positive effects on neuropathy (p < 0.05) immediately post-intervention, while Goshajinkigan (N=2) suggested a significant effect of prevention of worsening of CIPN instead of the improvement of CIPN symptoms (p<0.05). Aerobic exercise (N=2), acupuncture (N=1), and therapeutic ultrasound (N=1) did not demonstrate significant benefits in CIPN management in patients with CRC. Only exercise interventions demonstrated significant benefits for pain, balance, and QoL in patients with CRC experiencing CIPN (p< 0.05). No existing studies have examined psychological interventions for CIPN in patients with CRC. Multimodal exercise programs showed promising improvements in CIPN, while exercise interventions improve QoL, balance, and pain in patients with CRC. The heterogeneity of the reviewed studies limited the evaluation of the pooled effect sizes of different interventions. Additionally, small sample sizes in the reviewed studies and studies lacking long-term outcome evaluation limited the overall findings of this review. Therefore, high-quality studies with larger sample sizes are required to investigate the long-term effects of integrative interventions on CIPN management in patients with CRC. : CRD42025644115.
To map the development of international standards (IS) and international good practice guidelines (IGPG) across the field of traditional, complementary and integrative medicine (TCIM) and establish a comprehensive repository. A systematic search was conducted using PubMed, Web of Science, EMBASE, ProQuest, and the Cochrane Library, as well as relevant websites, with the assistance of artificial intelligence tools. This search combined MeSH terms and keywords, and was further supplemented by non-systematic human expert input, covering the period from January 2000 to April 2025. Duplicates were removed and all records were screened based on pre-defined criteria for TCIM-relevant IS/IGPG and TCIM- and IS/IGPG-related systematic reviews, implementation documents and commentaries. 2026 records met inclusion criteria: (a) TCIM-relevant IS/IGPG documents (n = 1,624); and (b) TCIM- and IS/IGPG-related secondary documents (systematic reviews, perspectives and commentaries, n = 402). These IS/IGPG were produced by 33 international organisations and consortia, broadly applicable to TCIM or specific to a particular TCIM modality. Our data showed acceleration in IS/IGPG production over the past two decades. An analysis of the secondary literature provided a broad overview of the disease spectrum and the application of IS/IGPG in TCIM studies. A comprehensive repository for TCIM-related IS/IGPG has been established. These IS/IGPG can be expected to play important roles for an efficient implementation of the World Health Organization Traditional Medicine Strategy 2025-2034. Future work should focus on disseminating, implementing and harmonising these IS/IGPG, evaluating their effectiveness and refining them, while promoting global parity in access, implementation and coverage. The Open Science Framework (https://doi.org/10.17605/OSF.IO/H8UFM).
Vitality refers to an organism's inherent energy that supports adaptive functioning and well-being. Both frailty and depressive disorders are characterized by energy depletion and are commonly associated with fatigue, reduced subjective well-being, and impaired quality of life. Assessing vitality may serve as a complementary approach to identify conditions associated with energy depletion, while offering clinically meaningful information beyond that captured by disorder-specific measures alone. The Integrative Vitality Scale (IVS) measures the physical and psychological dimensions of vitality. This study examined the clinical validity of the IVS in frailty and depressive disorders. Data were drawn from two independent South Korean samples: adults aged ≥65 years assessed for frailty (Study 1) and adults aged ≥19 years assessed for depressive disorders (Study 2). Correlation analysis was used to examine the associations between IVS scores and fatigue, subjective well-being, and quality of life. Receiver operating characteristic (ROC) curve analysis was used to evaluate screening performance against structured clinical interview-based reference standards. Hierarchical regression analyses were used to test the incremental explanatory value of the IVS beyond the established measures of frailty and depression. The IVS total and subscale scores were negatively associated with frailty, depressive symptoms, and fatigue, and positively associated with subjective well-being and quality of life. Physical vitality demonstrated good screening performance, with overall discriminative ability in a similar range to that of a clinician-rated frailty measure. For depressive disorders, the IVS total score showed fair screening performance, with overall discriminative ability in a similar range to that of the widely used self-report depression scale. Hierarchical regression analyses further indicated that the IVS explained additional variance in fatigue, subjective well-being, and quality of life beyond the established measures of frailty and depressive symptom severity, with physical vitality primarily related to fatigue, and psychological vitality being more strongly related to well-being and quality of life. The IVS demonstrated clinical validity as a self-report screening and assessment tool for conditions characterized by energy depletion. Beyond initial screening, the IVS provides patient-centered information on functional status that is not fully captured by disorder-specific measures, supporting its complementary role in clinical screening contexts. Further validation in representative and community-based samples is required before broader public health applications can be considered. https://cris.nih.go.kr/cris/search/detailSearch.do?seq=27011&status=5&seq_group=27011&search_page=M, identifier KCT0009372; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=26780&status=5&seq_group=26780&search_page=M, identifier KCT0009263.
Radiation enteropathy (RE) is a debilitating complication following radiotherapy, with currently limited treatment options. Multi-target intervention strategies such as Traditional Chinese Medicine (TCM) botanical formulas and acupuncture have been investigated as potential complementary approaches for its management. This review systematically synthesizes the evidence on TCM botanical formulas (e.g., Modified Baitouweng Decoction, Xihuang Pill, TJ-14) and acupuncture for the treatment of RE. Existing studies suggest multiple mechanisms of action, including anti-inflammatory and antioxidant effects, regulation of apoptosis and proliferation, restoration of intestinal barrier integrity, and modulation of gut microbiota. Clinical studies have reported improvements in symptoms and reductions in inflammatory markers, while preclinical models have demonstrated protective effects against radiation-induced intestinal injury. However, the current body of evidence is generally constrained by methodological limitations. Many clinical studies have small sample sizes and lack rigorous designs (e.g., absence of randomized controls), while mechanistic research often provides limited causal inference and relies on models with questionable clinical relevance, resulting in a significant translational gap. Based on this appraisal, we critically evaluate the limitations of existing research and propose future directions. These include: (i) employing CRISPR-based microbiome editing to investigate causal mechanisms; (ii) developing pharmacokinetic-pharmacodynamic (PK-PD) models for dose individualization; and (iii) utilizing innovative trial designs such as Bayesian adaptive trials to bridge the gap between empirical practice and evidence-based medicine. Rigorous further investigation is essential to define the role of these TCM interventions within the integrative treatment strategy for RE.
In universal health systems such as the Brazilian Unified Health System (SUS), chronic conditions and multimorbidity threaten the sustainability of care. This Perspective connects Traditional, Complementary and Integrative Health (TCIH) with a Transdisciplinary Integrative Health Approach to reframe chronic conditions. Grounded in three pillars (complexity, a multidimensional conception of the human being, and the logic of the included third) the approach understands health and disease as emergent properties of living systems integrating physical, metabolic, vital, mental and supramental (spiritual and systemic) dimensions. We summarize limitations of linear risk-factor models, describe how TCIH practices can act at different dimensions and levels of 'downward causation', and present arterial hypertension with obstructive sleep apnoea as an illustrative case from the Brazilian SUS, including a vignette involving continuous positive airway pressure (CPAP) and multidimensional transdisciplinary diagnosis. Rather than opposing the biomedical model, the framework positions conventional care, TCIH practices and community-based, nature-based interventions as complementary resources within universal systems. We conclude with implications for training family health teams, designing lines of care and using epidemiological segmentation to plan responses centered on the person and the territory that are clinically effective, culturally resonant and ecologically responsible. By integrating TCIH with a transdisciplinary perspective, chronic conditions can be addressed in ways that support both individual wellbeing and the broader agenda of sustainable and equitable universal health systems.
Background Radical remission refers to the unexpected and often medically unexplained recovery from chronic or terminal illnesses, including cases where conventional treatment has failed or been declined. Historically, such remissions have been viewed with skepticism and labeled anecdotal. However, emerging evidence suggests these cases may reflect a complex interplay of psychological, emotional, behavioral, and spiritual factors. Documenting and analyzing such experiences can provide valuable insights into nonlinear healing processes that challenge conventional biomedical paradigms. Objective This study aimed to examine recurring psychological, emotional, behavioral, and integrative health-related factors reported by individuals who experienced radical remission. It focused on recurring themes such as mindset shifts, emotional processing, lifestyle changes, and beliefs, including the use of integrative medicine approaches alongside conventional treatment. Methods A retrospective, observational study was conducted involving 60 individuals who reported either full or significant remission from severe or incurable conditions, including late-stage cancers, autoimmune diseases, and multi-organ failure. Participants completed a structured, IRB-approved questionnaire that examined demographic background, disease history, conventional and complementary treatment usage, psychological states, emotional processing, and spiritual or existential experiences. Responses were summarized using descriptive analysis, and recurring psychological, behavioral, and integrative health-related factors were identified through thematic coding. Results Five dominant themes emerged across the dataset: (1) an unwavering belief in the possibility of healing, despite medical prognosis; (2) intentional emotional work and release of unresolved trauma; (3) reconnection with a deeper sense of life purpose or meaning; (4) active engagement with complementary and alternative therapies as part of a holistic approach; and (5) a profound spiritual or existential transformation. These findings point to healing as a multifactorial, individualized process driven as much by internal transformation as by external action. Conclusion The study highlights the need for a broader, integrative framework in healthcare - one that includes emotional, cognitive, and spiritual dimensions alongside physical treatment. Radical remission may not be a random phenomenon but rather the outcome of deep psychological shifts and intentional life changes. Recognizing and studying these experiences can enrich patient-centered care, inform clinical practice, and open new avenues for research into the dynamics of healing.
We examined the prevalence and patterns of complementary health approaches (CHA) use and interest in CHA research participation among COSMOS older adults. We conducted cross-sectional analyses of the COSMOS Study 2024 survey that asked participants about their use of and research interest in six CHA categories (manual therapies, mind-body therapies, herbal products, acupuncture, spiritual practices, and cannabis/psychedelics). We compared key baseline sociodemographic, lifestyle, and clinical characteristics between CHA users and non-users overall, and for each CHA category. We used multivariable logistic regression models to estimate the odds of CHA use in the past 12 months and ever in lifetime. Of the 16,144 participants who responded (median age, 77.5 y), 58.8% and 76.4% indicated using CHA at least once in the past 12 months and ever in lifetime, respectively, and 50.4% reported interest in participating in CHA research. The highest prevalence of recent use was observed for spiritual practices (38.6%; 95% CI, 37.8-39.3) and lifetime use for manual therapies (51.9%; 95% CI, 51.2-52.7). A history of falls or depression was linked to higher odds of recent and lifetime CHA use. The high prevalence of selected CHA highlights the need to identify evidence gaps for safety, harm, and public health impact for new focused research studies. Limited generalizability to more diverse and medically underserved populations underscores the need for continued integrative health research.
Fibromyalgia is a complex, heterogeneous and often disabling syndrome that seriously affects the quality of life of patients. It is characterized by chronic widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive impairment. Its pathophysiology remains poorly understood, and conventional treatments often offer limited efficacy while carrying significant side effects, highlighting the urgent need for alternative therapeutics strategies. We report a retrospective case series evaluating a novel protocol that combines low frequency Pulsed Electromagnetic Field (PEMF) therapy, medical ozone insufflation, and targeted nutritional supplementation in three patients with refractory fibromyalgia who had previously shown inadequate response to conventional treatments. Following the intervention, patients experienced substantial pain relief and significant improvement in quality of life, which were sustained at the 30-day follow-up assessment. These findings suggest that the combination of PEMF and ozone therapy may induce durable physiological benefits, presenting a promising complementary strategy for managing refractory fibromyalgia.
Although student loans have made health professional education accessible for a greater proportion of the US population, rising student indebtedness has incited considerable discourse. This study aimed to characterize US chiropractors' self-reported student loan debt, student loan relief opportunities, and perceived value of chiropractic training. A 38-item cross-sectional, anonymous, electronic survey was developed. Chiropractors who graduated from a US-based, Council on Chiropractic Education-accredited Doctor of Chiropractic program (DCP) were recruited. The survey was conducted between February 2025 to March 2025. Survey domains included (1) demographics, (2) financial characteristics, (3) loan relief, and (4) educational and career value. Descriptive statistics and visualizations were used for analysis. A total of 1,455 responses were collected. The mean (SD) and median (Q1-Q3) student loan debt at graduation was $176,297 ($89,460) and $185,000 ($120,000-$240,000). At survey completion, 85% retained student loan debt, averaging $232,062 ($102,691) with a median of $240,000 ($177,500-$290,000). Mean (SD) gross income in 2023 was $99,068 ($100,349); median (Q1-Q3) was $76,000 ($50,000-$115,000). Approximately 87% of respondents reported being ineligible or unsure about eligibility for loan relief programs. Over half (53.3%) disagreed or strongly disagreed that their DCP provided a positive return on investment (ROI), and approximately 70% rated the financial ROI of DCP training as low or very low. Perceptions of non-financial ROI were more favorable. Overall, 65% would not choose a chiropractic career again; among them, 67.3% would pursue a career in another healthcare field. US chiropractors are burdened with considerable student loan debt that outpaces gross income. The findings of this study are commensurate with prior studies investigating chiropractic educational debt, yet likely are not unique to the profession and represent larger challenges faced by many modern US health professions. Innovation is likely needed to support the sustainability of the chiropractic profession given tension between educational debt and income.
Juvenile idiopathic arthritis (JIA) is one of the most common chronic rheumatic diseases and requires coordinated and targeted treatment strategies to avoid long-term disability. Existing guidelines from Western countries may not address region-specific factors, including genetic heterogeneity, limited treatment availability, and limitations in healthcare infrastructure, in the Asia Pacific region. The aim of this systematic literature review (SLR) and meta-analysis was to provide up-to-date evidence for the Asia Pacific League of Associations for Rheumatology (APLAR) recommendations for managing polyarticular course JIA (pcJIA) and temporomandibular joint (TMJ) arthritis. This systematic review followed PRISMA guidelines, with searches conducted on MEDLINE, Embase, Web of Science, Scopus, and CENTRAL through January 2025. Included studies addressed pharmacologic or non-pharmacologic treatments for pcJIA and TMJ involvement. Studies were limited to publications not already covered in existing guidelines. The Cochrane Rob2 tool and GRADE approach were used to assess quality and evidence certainty. Meta-analyses were performed where applicable. Of the initial 9424 records, 86 studies were included in the qualitative analysis. Methotrexate remains the csDMARD of choice, and subcutaneous administration may be more advantageous. Biological DMARDs, particularly abatacept and tocilizumab, have evidence for good efficacy and acceptable safety profiles. Emerging evidence supports the use of JAK inhibitors. Biosimilars were reported to have efficacy and safety comparable to those of originator biologics in observational studies. Limited evidence suggests that gradual medication tapering after achieving inactive disease status reduces the risk of flares. Evidence for physiotherapy, occupational therapy, and complementary medicine was of very low certainty due to methodological heterogeneity. This SLR offers new evidence to support region-specific clinical practice in JIA. While many findings support global recommendations, important evidence gaps remain, particularly in tapering, biosimilar use, TMJ management, and non-pharmacological therapies. These insights will directly inform APLAR's upcoming clinical practice guideline for pcJIA and TMJ arthritis.