Prevalence, specific and non-specific determinants of complementary medicine use in Switzerland: Data from the 2017 Swiss Health Survey.

OBJECTIVES: To determine the prevalence of use of complementary medicine (CM) in Switzerland in 2017, its development since the 2012 Swiss Health Survey, and to examine specific and non-specific sociodemographic, lifestyle and health-related determinants of CM use as compared to determinants of conventional health care use. MATERIALS AND METHODS: We used data of 18,832 participants from the cross-sectional Swiss Health Survey conducted by the Swiss Federal Statistical Office in 2017 and compared these data with those from 2012. We defined four CM categories: (1) traditional Chinese medicine, including acupuncture; (2) homeopathy; (3) herbal medicine; (4) other CM therapies (shiatsu, reflexology, osteopathy, Ayurveda, naturopathy, kinesiology, Feldenkrais, autogenic training, neural therapy, bioresonance therapy, anthroposophic medicine). Independent determinants of CM use and of conventional health care use were assessed using multivariate weighted logistic regression models. RESULTS: Prevalence of CM use significantly increased between 2012 and 2017 from 24.7% (95% CI: 23.9-25.4%) to 28.9% (95% CI: 28.1-29.7%), respectively, p<0.001). We identified the following independent specific determinants of CM use: gender, nationality, age, lifestyle and BMI. Female gender and nationality were the most specific determinants of CM use. Current smoking, being overweight and obesity were determinants of non-use of CM, while regular consumption of fruits and/or vegetables and regular physical activity were determinants of CM use. CONCLUSION: Prevalence of CM use significantly increased in Switzerland from 2012 to 2017. Gender, nationality, age, lifestyle and BMI were independent specific determinants of CM use as compared to conventional health care use. Healthier lifestyle was associated with CM use, which may have potentially significant implications for public health and preventive medicine initiatives. The nationality of CM users underlines the role of culture in driving the choice to use CM but also raises the question of whether all populations have equal access to CM within a same country.

[Integrative medicine: scientific literature in 2021]. / Médecine integrative - Littérature scientifique en 2021.

To illustrate the novelties in integrative and complementary medicine in 2021, the authors present a selection of six articles. One of them is specifically related to COVID-19. The other articles deal with themes that are always relevant and where complementary approaches represent a real added value. Two articles focus on low back pain, a common problem in primary care medicine. The others examine acupuncture in the oncological context, the use of therapeutic suggestions in an operative context, and Tai Chi. The authors thus provide an overview of the range of possible complementary therapeutic approaches that are increasingly supported by evidence, inviting them to be better integrated into clinical practice.

Pour illustrer les nouveautés en médecine intégrative et complémentaire en 2021, les auteur·e·s présentent une sélection de six articles. L'un s'intéresse plus spécifiquement au Covid-19. Les autres touchent des thématiques qui restent toujours d'actualité et où des approches complémentaires peuvent représenter une réelle plus-value. Deux articles ont pour thème les lombalgies, problématique courante en médecine de premier recours. Les autres examinent l'acupuncture dans le contexte oncologique, l'utilisation de suggestions thérapeutiques dans un contexte opératoire, et le Tai Chi. Les auteur·e·s donnent ainsi un aperçu de l'éventail d'approches thérapeutiques complémentaires possibles et de plus en plus soutenues par la science, invitant à les intégrer de mieux en mieux dans la pratique clinique.

Are mind-body therapies effective for relieving cancer-related pain in adults? A systematic review and meta-analysis.

OBJECTIVE: To assess whether mind-body therapies are effective for relieving cancer-related pain in adults, since at least one-third of adults with cancer are affected by moderate or severe pain. METHODS: We searched for all randomized or quasi-randomized controlled trials that included adults (≥18 years) with cancer-related pain who were treated with mind-body therapies (mindfulness, hypnosis, yoga, guided imagery, and progressive muscle relaxation) in MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Science Citation Index, Web of Science, trials registers, and reference lists. The primary outcome was pain intensity. We calculated the standardized mean differences and 95% confidence intervals (CIs) and assessed the risk of bias. RESULTS: We identified 40 primary studies involving a total of 3569 participants. The meta-analysis included 24 studies (2404 participants) and showed a significant effect of -0.39 (95% CI -0.62 to -0.16) with considerable heterogeneity (I2  = 86.3%, p < 0.001). After we excluded four "outlier" studies in sensitivity analyses, the effect size remained significant but weaker. There was a high risk of bias in all studies, for example, performance bias due to lack of participant blinding. Patients in multiple settings were included but many studies were of low quality. CONCLUSIONS: Mind-body therapies may be effective in improving cancer pain, but the quality of the evidence is low. There is a need for further high-quality clinical trials.

Complementary and alternative medicine use by pediatric oncology patients before, during, and after treatment.

BACKGROUND: The prevalence of complementary and alternative medicine (CAM) use and the modalities used by pediatric oncology patients vary widely across studies. In addition, the changes in the use of CAM over the course of treatment are understudied. Thus, this study aimed to explore (1) CAM use by pediatric oncology patients in relation to specific time intervals and (2) communication about CAM use between parents and oncologists. METHODS: This retrospective cross-sectional study was conducted among parents of children diagnosed with cancer at a Swiss pediatric hematology-oncology center by means of an online questionnaire. Questions were related to their child's CAM use over different time intervals, sources of information about CAM use, and communication with the oncologists. RESULTS: Among 140 respondents, CAM was used by 54.3% of patients before diagnosis and 69.3% of patients after diagnosis. During each defined time interval, between 50 and 58.8% of the patients used at least one CAM. Homeopathy was the most popular CAM modality used during oncology treatment, during the first year after treatment, and between 1 and 5 years after the end of treatment. Osteopathy was the most popular CAM ≥5 years after the end of oncology treatment. Forty percent of respondents did not discuss CAM with their oncologist. CONCLUSIONS: The high prevalence of CAM use and the different trends of use during the oncology care pathway and afterward underline the need to increase communication about CAM in the pediatric oncology setting, notably regarding benefits and risks of interaction with oncology treatment.

Primary care patients' use of conventional and complementary medicine for chronic low back pain.

PURPOSE: To investigate among primary care patients and their physicians in western Switzerland the prevalence of use, perceived usefulness, and communication about common treatments for chronic or recurrent low back pain (crLBP) including complementary medicine (CM). PATIENTS AND METHODS: A cross-sectional cluster observational study involving 499 crLBP patients visiting 45 primary care physicians (PCPs) was conducted from November 1, 2015, to May 31, 2016. Patients and primary care physicians completed questionnaires about lifetime use and usefulness of 30 crLBP therapies. We conducted multivariate analyses of factors associated with therapy use, including sociodemographic variables, pain duration, insurance coverage, and primary care physicians' characteristics. RESULTS: The five most frequent modalities used at least once by patients were physiotherapy (81.8%), osteopathic treatment (63.4%), exercise therapy (53.4%), opioids (52.5%), and therapeutic massage (50.8%). For their PCPs, the five most useful therapies were physiotherapy, osteopathic treatment, yoga, meditation, and manual therapy. In multivariate analysis, the use of physiotherapy was significantly associated with longer pain duration; osteopathic treatment was associated with age under 75 years, female gender, higher education, and CM insurance coverage. Exercise therapy was associated with non-smoking and longer pain duration. Smokers were more likely and patients of PCPs with CM training were less likely to have used opioids. During their lifetime, 86.6% of the participants had used at least one CM therapy to manage their crLBP, with a mean of 3.3 (SD=2.9) therapies used per participant; 46.1% of participants reported that their PCP did not enquire about CM use. Among CM users, 64.7% informed their PCP about it. CONCLUSION: Patients with crLBP use a variety of treatments, including self-prescribed and unreimbursed therapies, most frequently physiotherapy and osteopathy. The results suggest that PCPs should systematically discuss with their patients the treatments they tried to manage crLBP, including CM.

Complementary medicine use during cancer treatment and potential herb-drug interactions from a cross-sectional study in an academic centre.

Complementary medicine (CM) is used by one third to one half of cancer patients throughout the world. The objective of this study was to describe the prevalence of CM use and the potential for interactions with cancer treatments in an academic oncology centre. A cross-sectional study was conducted among patients undergoing current cancer treatment. Among 132 included patients, 56% had used CM since their cancer diagnosis and 45% were using CM during cancer treatment at the time of the survey. The main CM used were green tea (35%), herbal tea (35%), homeopathy (27%), dietary supplements (27%), and herbal medicines (27%). A small majority of patients (58%) spontaneously mentioned the use of CM to their oncologist. Of 42 identified combinations of concomitant use of biologically based CM and anticancer agents among the study patients, the potential for pharmacokinetic interactions of clinical relevance was not expected in 17 combinations (40%), hypothetical and deemed unlikely in 23 (55%), and of probable low clinical relevance in 2 (5%). Considering the high prevalence of CM use, active enquiries should be made by healthcare professionals to detect symptoms that may relate to CM tolerance and effects or that suggest interactions between CM and cancer treatments.

[Opioid consumption from 1985 to 2015 : The situation in Switzerland, with an international comparison]. / Consommation d'opioïdes entre 1985 et 2015 : chiffres suisses et mise en perspective internationale.

In North America the massive increase in opioid prescriptions for chronic non-cancer pain has been a major health issue for several years. In Switzerland, the situation is less well known. This article aims to present the evolution of the Swiss consumption and replace it in a European and international context using the International Narcotics Control Board database. Between 1985 and 2015, the Swiss opioid consumption raised from 18 to 421 mg/person/year, making Switzerland the 7th largest opioid consumer per capita in the world. This increase could be due to more adequate pain management or liberalized opioid prescription for indications unsupported by the current evidence. Given these elements, further research is needed, yet increased caution is recommended when prescribing opioid drugs.

En Amérique du Nord, la large prescription d'opioïdes dans le cadre de douleurs chroniques non cancéreuses constitue une problématique majeure de santé publique depuis plusieurs années. La situation en Suisse est moins connue. Cet article vise à présenter l'évolution de la consommation suisse et de la replacer dans un contexte européen et international, en utilisant les données de l'International Narcotics Control Board. La Suisse est le 7e consommateur mondial d'opioïdes par habitant. Entre 1985 et 2015, la consommation suisse d'opioïdes forts est passée de 18 à 421 mg/habitant/année. Cette augmentation pourrait être due à une meilleure prise en charge de la douleur, mais aussi à une prescription plus libérale d'opioïdes pour des indications non démontrées. Ainsi, davantage de recherche est nécessaire, et en parallèle une prudence accrue est recommandée aux praticiens lors de la prescription d'opioïdes.