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In addition to the medications used routinely in modern medicine, consumers have access to many substances that are not considered a part of conventional or mainstream pharmacotherapeutics. These substances often consist of natural products such as herbal preparations, vitamins, minerals, and other nutritional substances that consumers take to promote optimal health or to treat various conditions. These products are usually classified as dietary supplements by the U.S. Food and Drug Administration (FDA) and are therefore not subjected to the rigorous testing and scrutiny required for prescription drugs and many over-the-counter medications.

These nontraditional products are often described as complementary and alternative medications (CAMs), to differentiate them from the more conventional medications that are classified as drugs by the FDA. To be specific, a complementary medication is a substance that is used in addition to or instead of a conventional treatment, whereas an alternative medication is used as a substitute for a more traditional or mainstream treatment.1,2 Other terms are applied to specific interventions, such as herbal remedies, naturopathic treatments, phytomedicines, and so forth. However, for the purpose of this chapter, the term CAM will be used to encompass the array of substances that fall outside conventional pharmacotherapeutic regimens.

CAMs and other healing philosophies (meditation, yoga, acupuncture, etc.) have been a mainstay in certain cultures and societies. Western cultures, however, have generally been more aligned with conventional treatments and medications. Nonetheless, the interest and use of CAMs in persons living in the United States has increased dramatically over the past several years.

Because CAMs represent such a broad range of substances and interventions, it is difficult to address this topic in a single chapter. This chapter will present a general overview of the topic and will then describe some of the common CAMs that are taken by persons undergoing physical rehabilitation. This chapter’s intent is to alert you to some of the more pertinent and unique aspects of CAM use and to help you understand how these substances can affect how patients respond to rehabilitation interventions.


Misconceptions About CAM Safety

Many CAMs are derived from natural sources such as herbs and other plants. Therefore, some consumers assume that a “natural” product is inherently safer than a synthetic or manufactured chemical.4,5 These individuals may likewise believe that they can take an unlimited amount of a CAM—that is, they may exceed dose limits with the idea that the product can do no harm. These misconceptions can lead to tragic consequences, as was the case with ephedra. Ephedra, derived from an evergreen shrub, also contains epinephrine (adrenaline). As discussed in Chapter 20, epinephrine is a powerful agonist (stimulant) of alpha and beta receptors on various tissues throughout the body. People took ephedra to capitalize on these effects, especially its adrenaline-like effects in promoting weight loss and ...

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