The engagement of psychology with complementary medicine: A critical integrative review.

Amidst the global rise in complementary medicine (CM) use for mental health, a substantial number of clients consulting a psychologist also utilise at least one form of CM. Yet, how psychologists should engage with CM in their clinical practice (e.g., how to respond to a client disclosing CM use or enquiries regarding CM products or services for mental health) remains contested and unclear. In response, a systematic integrative review was conducted to examine empirical literature reporting on one or more aspects of the relationship between psychology (incorporating clinical practice, professional associations and academia) and CM, and how that relationship may relate to or inform psychologists' engagement with CM in their clinical practice. Twenty-seven peer-reviewed articles met the specific inclusion criteria and quality appraisal was employed. Analysis shows a substantial number of psychologists are engaging with, or are interested in engaging with, CM in their clinical practice. Analysis identified a dissonance between psychologists' engagement with CM in clinical practice and the limited engagement of the broader discipline of psychology with CM. Further research is required to understand these differing types of engagement with a view to helping inform relevant policy and practice guidelines, and ultimately assist psychologists in navigating CM in their clinical practice.

Characteristics of Marginalized Populations Seeking Acupuncture: Findings from an Observational Study of an Inner-City Community Health Service.

Introduction: Marginalized populations experience health inequities and are often underserved within existing health systems. Australian marginalized populations and their use of complementary medicine, including acupuncture, lack investigation. We have collected information on the health-seeking behaviors of marginalized individuals who utilize an acupuncture service within a community-based integrative health setting. Methods: A secondary analysis of pre-existing data involving the linking of three datasets. Information was collected across four domains: health characteristics, socio-demographics, health services utilization, and vulnerability markers. Bivariate analysis using Fisher's exact and chi-square tests additional to logistic regression analysis were conducted to determine the characteristics of the study population. All data once analyzed were then presented as a cumulative statistic. Results: Study participants (n = 42) included 28% of individuals with reported histories of homelessness (n = 12) and 32% with a history of psychological trauma (n = 13). Eighty-three percent (n = 31) of the population sought acupuncture to manage pain and 91% (n = 36) for musculoskeletal conditions. Sixty-three percent (n = 24) reported a mental health diagnosis, most commonly depression (n = 18). Participants were most likely to engage with three other health services within the study setting, in addition to acupuncture. Participants with an illicit substance abuse problem were 12 times more likely to seek a greater number of acupuncture treatments, and individuals with trauma histories were twice as likely to attend the acupuncture clinic eight or more times. Discussion: Our study findings suggest a robust level of engagement with acupuncture treatment among the target population and a willingness to engage with integrative health services when barriers to uptake such as accessibility and affordability are removed. Findings support current evidence pertaining to acupuncture's use as an adjunct to managing pain in marginalized populations as well as a perceived acceptability and feasibility of the integration of acupuncture within conventional health settings. There is the further observation that acupuncture in a group setting is suitable for a marginalized population and an interest in commitment to treatment among individuals with substance abuse problems.

Hydrotherapeutic Heat Application as Support in Febrile Patients: A Scoping Review.

Background: Most often, fever is still treated by lowering body temperature with medication. In complementary and integrative health care, patients are supported during illness to use the positive effects of fever. Accompanying applications from the field of hydrotherapy are often used for gentle cooling, but there are references that warming in fever can also be used as a support. The aim of this scoping review was to identify available evidence on how, when, and why patients with fever are treated with heat application. Methods: The MEDLINE, CINAHL, EMBASE, COCHRANE, Google, and Google Scholar databases as well as references of identified literature were searched. As sources of evidence, publications studying patients who received heat application or were kept warm in febrile condition, regardless of medical situation, type of health care setting, and geographical background, were taken into consideration. Results: The literature search identified 1698 publications, of which only 7 were included. Methods of applying heat were the use of electric warming blankets, hot packs, hot-water bottles, or hot water footbaths. Most of the studies on heat application used temperatures of about 40°C and reported significantly lower body temperature after heat application. Conclusions: The literature suggests that hydrotherapeutic heat application is a common and well-appreciated method in Middle Eastern and Asian regions to support febrile patients. Using heat to support the energy-intensive and uncomfortable phase of rising fever may improve comfort, prevent unnecessarily high fever, and save biological energy. Therefore, high-quality studies on the role of heat application in fever are expected to be of high relevance for future fever management guidelines and integrative health care in general.

Integrating Traditional Medicine and Healing into the Ghanaian Mainstream Health System: Voices From Within.

In this study, I employed interpretive ethnographic qualitative design to explore perceptions of and proposals from traditional healers, biomedical practitioners, and health care consumers regarding integrating traditional medicine and healing in Ghana. Data were gathered through focus groups, in-depth individual interviews, and qualitative questionnaires and analyzed thematically. The results revealed positive attitudes toward integrating traditional medicine in Ghana and a discursive discourse of power relations. The power imbalance between biomedical and traditional practitioners regarding what integrative models to adopt is sanctioned by formal education and institutional structure. As a result, multiple approaches for integration were made, including patient co-referrals, collaborations between biomedical and traditional medical practitioners, and creating a unit for traditional medicine and healers at the outpatients' department for patients to choose either biomedicine or traditional medicine. Incorporating aspects of traditional healing in the training of biomedical practitioners and creating a space for knowledge sharing were also proposed. These integrative models reflected the distinctive interests of healers and biomedical practitioners. Considering these findings, I recommended policy options for consideration toward achieving an integrative health care system in Ghana.

Conventional and Complementary Health Care Approaches Used by American Adults Reporting Joint Pain: Patterns from the National Health Interview Survey 2012.

Objective: To describe patterns of conventional health care (CH) and complementary and alternative medicine (CAM) use among U.S. adults reporting recent joint symptoms in a nationally representative sample. Design: This study uses the adult alternative medicine supplement from the 2012 National Health Interview Survey (NHIS). Location: United States. Subjects: Nationally representative cross-sectional sample of non-institutionalized U.S. residents. Of 34,525 respondents who answered the alternative medicine supplement, approximately 30% (n = 10,964) reported recent pain symptoms (pain, aching, stiffness). Outcome measures: Among adults reporting joint symptoms, we examine reported use of CH, CAM, both CH and CAM, or neither specifically for joint symptoms or joint condition. Results: Among adults reporting joint symptoms in the past 30 days, 64% reported using only CH for their joint pain, whereas ∼10% reported using CAM. Among those using CAM for their joint symptoms, 83% also sought help from a CH practitioner. CAM-only users comprised only 1.6% of the sample of joint pain sufferers. Those who reported using both CH and CAM for joint pain were more likely to report a diagnosis of a joint condition compared with CAM-only users, but also reported higher comorbidities and worse self-reported health. Conclusion: Most U.S. adults reporting recent joint pain seek care only from a CH practitioner, although among the 10% who report CAM use for joint conditions, a strong majority also report seeking care from a CH practitioner. CH and CAM providers should consistently inquire about other forms of treatment their patients are using for specific symptoms to provide effective integrative health care management.

Informing the Model of Care for an Academic Integrative Health Care Center: A Qualitative Study of Primary Care Stakeholder Views.

Objectives: To engage with local primary care stakeholders to inform the model of care for a proposed academic integrative health care center incorporating evidence-informed traditional, complementary, and integrative medicine (TCIM) in Sydney, Australia. Design: In-depth semistructured interviews, informed by community-based participatory research principles, were conducted to explore primary care stakeholder preferences and service requirements regarding the proposed Western Sydney Integrative Health (WSIH) center in their local district. Setting: Telephone and face-to-face interviews at primary care clinics in Sydney. Subjects: Thirteen participants took part in the study: eight general practitioners (GPs) and five primary care practice managers (PMs). Methods: GPs were recruited through local GP newsletters, closed GP Facebook groups, and snowballing. PMs were recruited through a national PM newsletter. The semistructured interviews were audiorecorded and transcribed verbatim before conducting a thematic analysis. Results: Three main themes emerged: (1) the rationale for "why" the WSIH center should be established, (2) "what" was most important to provide, and (3) "how" the center could achieve these goals. Participants were willing to refer to the service, acknowledging the demand for TCIM, current gaps in chronic disease care, and negligible Government funding for TCIM. They endorsed a model of care that minimizes out-of-pocket costs for the underserved, incorporates medical oversight, integrates evidence-informed TCIM with conventional health care, builds trust through interprofessional communication and education, and provides sound clinical governance with a strong focus on credentialing and risk management. It was proposed that safety and quality standards are best met by a GP-led approach and evidence-based practice. Conclusions: Our findings demonstrate that participants acknowledged the need for a model of care that fits into the local landscape through integrating conventional health care with TCIM in a team-based environment, with medical/GP oversight to ensure sound clinical governance. Findings will be used with input from other stakeholder groups to refine the WSIH model of care.

Integration of traditional and western treatment approaches in mental health care in Pacific Island Countries.

OBJECTIVE: To explore the extent of integration of traditional and western approaches in mental health care in Pacific Island Countries (PICs). METHOD: Examination of national mental health policies and literature review. RESULTS: Traditional healers were included as resources for mental health in four of the seven policies that we were able to access. While their role in mental health care is widely acknowledged in the literature, there are few empirical studies exploring integration. CONCLUSION: Local research on integrative mental health care is needed to guide mental health policy and service development in PICs. Any research must include the full range of formal and informal service providers as well as patients and families.

What's in a Definition? Holistic Nursing, Integrative Health Care, and Integrative Nursing: Report of an Integrated Literature Review.

Background: Nurses and others have used various terms to describe our caring/healing approach to practice. Because terms used can influence our image of ourselves and the image others have of us, we sought to clarify their meanings. Questions: How are the terms holistic nursing, integrative health care, and integrative nursing defined or described? Do we identify with these definitions/descriptions? Are the various terms the same or are they distinct? Method: We conducted an integrated review of peer-reviewed literature following the process described by Whittemore and Knafl. Using standard search methods, we reviewed full texts of 94 published papers and extracted data from 58 articles. Findings: Holistic describes "whole person care" often acknowledging body-mind-spirit. Holistic nursing defines a disciplinary practice specialty. The term integrative refers to practice that includes two or more disciplines or distinct approaches to care. Both terms, integrative and holistic, are associated with alternative/complementary modalities and have similar philosophical and/or theoretical underpinnings. Conclusions: There is considerable overlap between holistic nursing and integrative nursing. The relationship of integrative nursing to integrative health care is unclear based solely on definitions. Consideration of terms used provides opportunities for reflection, collaboration, and growth.

Whole Systems Within Whole Systems: The Oregon Health Plan's Expansion of Services for Back and Neck Pain.

OBJECTIVES: The authors employ a Whole Systems framework to explore implementation of new guidelines for back and neck pain in Oregon's Medicaid system. Whole Systems research is useful for understanding the relationship between complementary and integrative health care (CIH) and conventional health care systems in real-world clinical and practice settings. DESIGN: Preliminary results are from an observational study designed to evaluate state-wide implementation of CIH and other non-pharmacological treatments for neck and back pain among Oregon Medicaid patients. This natural experiment, even in early stages, provides insight into the challenges of integrating Whole Systems oriented therapies into Medicaid billing and treatment. METHODS: Qualitative data are drawn from: (1) semi-structured interviews with representatives of each of the 16 coordinated care organizations (CCOs) responsible for administering the Oregon's Medicaid insurance through the Oregon Health Plan (OHP); and (2) open-ended survey responses from acupuncturists in all 16 CCO areas. RESULTS: Implementation of the new policy guidelines poses logistical and epistemological challenges. Differences in worldview, inadequate reimbursement, and simple lack of awareness of CIH among medical providers are some of the factors that pose barriers to merging CIH therapies into conventional frameworks. CONCLUSIONS: In this article, we explore the potential for a Whole Systems perspective to better explain the complexity of integrating CIH and other non-pharmacological services into a state financed health care system. Oregon's expansion of services for back and neck pain presents an opportunity to explore challenges and successes in melding multiple approaches to health and pain management into a managed system such as the OHP.

Pharmacy Competencies for Interprofessional Integrative Health Care Education.

Objective. To address the gap in evidence-based knowledge among pharmacy students and practicing pharmacists regarding complementary and integrative health approaches due to insufficient education and a lack of standardized training. Methods. The National Center for Integrative Primary Healthcare (NCIPH) developed 22 pharmacy competencies linked to a set of 10 interprofessional "metacompetencies" in integrative health care. Results. The NCIPH pharmacy competencies are well-aligned with the current educational standards and Center for the Advancement of Pharmacy Education (CAPE) outcomes for pharmacy programs. Therefore, the NCIPH competencies may provide a foundation for the incorporation of interprofessional integrative health care education into pharmacy curricula. Conclusion. The NCIPH pharmacy competencies in integrative health care, linked to the interprofessional "metacompetencies," are aligned with educational standards and outcomes, and may serve as a basis for pharmacy curriculum.

Regarding: "Insurance Reimbursement for Complementary Healthcare Services".

In the article, "Insurance Reimbursement for Complementary Healthcare Services," we reported that the likelihood of reimbursement for complementary health care services in New Hampshire was significantly lower as compared with services of primary care physicians. The relatively low likelihood of reimbursement for integrative health care suggests that many patients who want such services must pay for them out of pocket. Affordable access to these services may be similarly limited in other states; certainly the utilization of integrative health care services varies significantly across the US states, and such variation may be tied to likelihood of reimbursement. Unwarranted geographic variation in reimbursement for integrative health care services is likely to compound inequities in access to health care in general, particularly for people of lower socioeconomic status. The aspirational value of Health Justice asserts the obligation of societies to attend to the basic health needs of all, with particular attention to the disadvantaged. A new project under development, The Atlas of Integrative Healthcare, is intended to support the advancement of health justice. The Atlas project is expected to support the policy goals of the integrative health care community with regard to helping patients access the high-value integrative health care services that they need and want.

Measuring patients' health and suffering - the first stages of instrument development.

BACKGROUND: Patients have reported unanticipated and transformative health changes in existential character after integrative healthcare rehabilitation. Although there are several instruments measuring patients' experiences of health, identified instruments do not sufficiently capture patients' experiences of health and suffering after integrative health care. From a caring science perspective, health and suffering are understood as an integral part of human life. The objective of this study was to develop a first version of an instrument to measure patients' experiences of health and suffering, focusing on existential signs. METHODS: This Swedish study used a methodological design with three iterative phases for instrument development. Firstly, an item pool was developed based on qualitative patient interviews (n = 64). Subsequently, the relevance of the items was explored in two rounds of cognitive patient interviews (n = 5 and n = 3). Finally, expert consultations (n = 5) were used to further refine the instrument. The construct of the instrument, its dimensions and domains emerged through the iterative development process. RESULTS: The first phase development of the instrument resulted in two inter-related overarching dimensions: existential signs of 'Health' and 'Suffering', characterised by five domains: 'Life passion and energy', 'Personal freedom', 'Relationships', 'Presence in life' and 'Meaning'. Instrument items were formulated using contemporary language and word pairs to reflect a movement and relation between health and suffering. The cognitive interviews and expert opinions helped refine items and domains. CONCLUSIONS: The dimensions, domains and items of the instrument 'Existential signs of health and suffering' are well represented in caring science theories. Further clinical implementation and evaluation of the instrument, including psychometric properties, will allow for greater diversity in terms of context generalisability and patient characteristics. The instrument is anticipated to be of value for evaluations in research, development of healthcare practice and theory development in caring science.

Integrative health care - Toward a common understanding: A mixed method study.

OBJECTIVE: To generate a multidisciplinary stakeholder-informed definition of integrative health care (IHC). METHODS: A mixed-method study design was used, employing the use of focus groups/semi-structured interviews (phase-1) and document analysis (phases 2 and 3). Phase-1 recruited a purposive sample of Australian health consumers/health providers. Phase-2 interrogated websites of international IHC organisations for definitions of IHC. Phase-3 systematically searched bibliographic databases for articles defining IHC. Data were analysed using thematic analysis. RESULTS: Data were drawn from 54 health consumers/providers (phase-1), 23 IHC organisation webpages (phase-2) and 23 eligible articles (phase-3). Seven themes emerged from the data. Consensus was reached on a single, 65-word definition of IHC. CONCLUSION: An unambiguous definition of IHC is critical to establishing a clearer identity for IHC, as well as providing greater clarity for consumers, health providers and policy makers. In recognising the need for a clearer description, we propose a scientifically-grounded, multi-disciplinary stakeholder-informed definition of IHC.

Catalyzing development of best practice guidelines for community-managed health programs: Case study of a community-academic partnership

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> There is a need to standardize community health practices, while still adhering to principles of community involvement, to ensure social acceptability and equitable access to health services. A set of Best practice guidelines (BPGs) were thus developed through a community-academic partnership (CAP) between the Integrative Medicine for Alternative Healthcare Systems Philippines, Inc. and its affiliated community-managed health programs (CMHPs), the University of the Philippines, and Bicol University.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study aimed to report the process and insights gained from the crafting of the BPGs.</p><p style="text-align: justify;"><strong>METHODS:</strong> The BPGs were developed using a community-based participatory research approach and focused on top ten (10) diseases based on local prevalence and experiences of its CMHPs.</p><p style="text-align: justify;"><strong>RESULTS:</strong> BPGs were developed for eight (8) communicable diseases (common cold/cough, influenza, measles, pulmonary tuberculosis, acute gastroenteritis, amebiasis, scabies, and intestinal parasitism); and two (2) noncommunicable diseases (diabetes and hypertension), which also provided information on signs and symptoms, initial referral criteria, management, and, where appropriate, specific use of medicinal plants, acupressure, and traditional massage. Emerging issues from this project include how community involvement led to the development of BPGs, the need to update its content, its potential application as a model for costing public health interventions, its anticipated benefits to health workers, the state of local health service delivery, and how the project epitomizes the ideal concept of community-academic partnerships.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> As a CAP project, this process holds promise as a catalyst for stakeholder engagement and health service delivery improvement. Further studies are necessary to map out other potential challenges and success factors, especially the socio-cultural, political, and health impact of CAPs.</p>

Integrative health care - What are the relevant health outcomes from a practice perspective? A survey.

BACKGROUND: Integrative health care (IHC) is an innovative approach to health care delivery. There is increasing focus on and demand for the evaluation of IHC practices. To ensure such evaluations capture their full scope, a clear understanding of the types of outcomes relevant to an IHC approach is needed. The objective was to describe the health domains and health outcomes relevant to IHC practices in Canada. METHODS: An online survey of Canadian IHC clinics. Survey questions were informed by the IN-CAM Health Outcomes Database. Descriptive statistics were used to summarize the data. Chi square tests were used to compare responses between clinic types and patient groups served. RESULTS: Surveys were completed by 21 clinics (response rate: 50%). Physical, psychological, social, individualized and holistic were identified as applicable health domains by more than 90% of the clinics. Spiritual domain was the least relevant (70% of clinics). A number of relevant outcomes within each domain were identified. A core set of outcomes were identified and included: fatigue, anxiety, stress, and patient-provider relationship, and quality of life. Clinics with primarily conventional health practitioners were less likely to address overall well-being (p = 0.04), while clinics that provided care to a specialized patient population (i.e. cancer patients) or a mix of general and specialized patients were less likely to address religious practices (p = 0.04) or spiritual experiences (p = 0.007). CONCLUSIONS: Outcomes across health domains should be considered in the evaluation of IHC models to generate an understanding of the full scope of effectiveness of IHC approaches. The core set of outcomes identified may facilitate this task. Ethics approval (Ethics ID REB14-0495) was received from the Conjoint Health Research Ethics Board at the University of Calgary.

Collaborating with medicine? Perceptions of Australian naturopaths on integrating within the conventional medical system.

Complementary and alternative medicine (CAM) is an increasingly prevalent part of contemporary health care. Whilst there have been some attempts to understand the dynamics of CAM integration in the health care system from the perspective of conventional care providers and patients, little research has examined the view of CAM practitioners. This study aims to identify the experiences of integration within a conventional healthcare system as perceived by naturopaths. Qualitative semi-structured interviews were conducted using a purposeful sample of 20 practising naturopaths in South East Queensland, Australia to discuss their experiences and perceptions of integrating with conventional medical providers. Analysis of the interviews revealed five broad challenges for the integration of CAM according to naturopaths: competing paradigms between CAM and conventional medicine; co-option of CAM by conventional medical practitioners; the preservation of separate CAM and conventional medical worlds by patients and providers due to lack of formalised relations; negative feedback and biases created through selective or limited experience or information with CAM; and indifferent, reactive and one-sided interaction between CAM and conventional medical providers. Naturopaths support the integration of health services and attempt to provide safe and appropriate care to their patients through collaborative approaches to practice. The challenges identified by naturopaths associated with integration of CAM with conventional providers may impact the quality of care of patients who choose to integrate CAM and conventional approaches to health. Given the significant role of naturopaths in contemporary health-care systems, these challenges require further research and policy attention.

Complementary Medicine and the Role of Oncology Nurses in an Acute Care Hospital: The Gap Between Attitudes and Practice.

PURPOSE/OBJECTIVES: To describe hospital nurses' knowledge, attitudes, and practices regarding complementary medicine (CM); to compare the knowledge and attitudes of nurse managers to staff nurses with diverse oncology experience; and to assess attitudes toward integrating CM into the role of the hospital oncology nurse. 
. DESIGN: Descriptive, cross-sectional study.
. SETTING: Rambam Health Care Campus in northern Israel.
. SAMPLE: A convenience sample of 434 hospital nurses with varied oncology experience.
. METHODS: Nurses completed a knowledge and attitude questionnaire developed for the current study. Data were analyzed using parametric and nonparametric statistical tests. 
. MAIN RESEARCH VARIABLES: Hospital nurses' knowledge of and attitudes toward CM, and attitudes toward integrating CM into the role of the hospital oncology nurse.
. FINDINGS: Nurses lack knowledge and are unaware of the risks associated with CM. However, they believe this approach can improve the quality of life of patients with cancer; 51% expressed an interest in receiving training. Oncology nurses were ambivalent about the feasibility of applying an integrative approach, whereas nurse managers expressed significantly more positive attitudes toward integrating CM within the scope of nursing practices.
. CONCLUSIONS: A large discrepancy remains between nurses' strong interest in CM and awareness of associated benefits, and their ambivalence toward its integration in their nursing practice. 
. IMPLICATIONS FOR NURSING: Although improving nurses' knowledge should be mandatory, it remains insufficient; a shift in the approach to integrating CM into conventional health care is needed, from practitioners' responsibility to healthcare policymakers' responsibility. Legislations and policies are necessary, along with providing respectable infrastructures.

Whole-body hyperthermia and a subthreshold dose of citalopram act synergistically to induce antidepressant-like behavioral responses in adolescent rats.

BACKGROUND: Open and randomized, double blind, placebo-controlled clinical trials have demonstrated clinical efficacy of infrared whole-body hyperthermia in treatment of major depressive disorder (MDD). Demonstration of antidepressant-like behavioral effects of whole-body hyperthermia in preclinical rodent models would provide further support for the clinical use of infrared whole-body hyperthermia for the treatment of MDD, and would provide additional opportunities to explore underlying mechanisms. METHODS: Adolescent male Wistar rats were habituated daily for 7days to an incubator (23°C, 15min), then exposed, 24h later, to an 85-min period of whole-body hyperthermia (37°C) or control conditions (23°C), with or without pretreatment with a subthreshold dose of the selective serotonin reuptake inhibitor, citalopram (5mg/kg, s.c., 23h, 5h, and 1h before behavioral testing in a 5-min forced swim test). Rectal temperature was monitored daily and immediately before and after the forced swim test to determine the relationship between body temperature and antidepressant-like behavioral responses. RESULTS: Whole-body hyperthermia and citalopram independently increased body temperature and acted synergistically to induce antidepressant-like behavioral responses, as measured by increased swimming and decreased immobility in the absence of any effect on climbing behaviors in the forced swim test, consistent with a serotonergic mechanism of action. CONCLUSIONS: Preclinical data support use of infrared whole-body hyperthermia in the treatment of MDD.

Practitioners' use of shared concepts in anthroposophic pain rehabilitation.

PURPOSE: To elucidate the meaning of anthroposophic practitioners' conceptualizations of caring for persons living with chronic pain. METHODS: Interviews were conducted with 15 practitioners working with rehabilitation of persons with chronic pain at an anthroposophic hospital in Sweden. The interviews were analyzed using a phenomenological hermeneutical method. FINDINGS: When practitioners discussed patient care, they used a shared language with particular concepts. Concepts, such as "trauma," "self," and "life intention," were interpreted as a means of understanding persons with pain and their current life situation. The meaning of the concepts also had explicit or implicit implications for the caring process, e.g., the concept "caring shelter" referred to an inherent and continuous part of the caring culture enabling patients' own exploration of their life and suffering and the meaning of their pain in the context of their lives. CONCLUSIONS: The practitioners' use of a conceptual language is here interpreted as a sign of a shared "caring culture" that enabled them to understand patients and their suffering from an existential perspective. A reciprocal understanding within a caring culture may extend the abilities of practitioners to engage in a dialog with patients about life and health as intertwined with the phenomenon of pain. Implications for rehabilitation In the rehabilitation process, health practitioners' language may contribute to shaping a caring culture that emphasis an understanding of patients' needs of health. Shared concepts in rehabilitation might increase health practitioners' possibilities to support patients from broader and more personalized perspectives, involving not only biopsychosocial aspects but also existential dimensions. The shared conceptual understanding of anthroposophic practitioners in this study may serve as an example to practitioners in other pain rehabilitation settings, developing a contextual understanding of their central concepts, and caring values.