Key Research Findings

Complementary and integrative medicine (CIM) is frequently used by oncology teams to reduce physical and emotional side effects related to cancer treatment. 10

Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures that are often ineffective, may be costly, and can be associated with undesirable side effects. 7 Because chronic pain affects the whole person (body, mind, and spirit), patient-centered CIM therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. 7 Active self-care CIM (ACT-CIM) therapies allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. 7 To date, there are no systematic reviews examining the full range of ACT-CIM used for chronic pain symptom management. 7

CIM is an evolving area of collaboration between oncology, the patient and their beliefs, and practitioners of complementary medicine. 20 Evidence-informed decision-making is necessary to advise patients on which treatments may be incorporated into standard of care treatments for cancer. 20 Patients use CIM for a variety of reasons and often have unrealistic expectations of cure or disease modifications; on the other hand, there is increasing evidence that symptoms, side effects, and dysfunction related to cancer and its treatment can be ameliorated by CIM approaches to improve patient satisfaction and quality of life. 20 Open communication between patients and providers is paramount. 20

This study examined the association between physical activity and the reported use of complementary medicine by patients with breast and gynecological cancer referred or self-referred to a complementary/integrative medicine (CIM) consultation within a palliative care context. 25 Physical activity was found to be associated with a greater use of CIM (specifically herbal/dietary supplement use and acupuncture) in patients with breast and gynecological cancer during oncology treatment. 25 Further research is needed to explore whether CIM use and physical activity are influenced by patients' health-belief models of care, and whether the CIM consultation can promote physical activity among these patients. 25

This study aimed to formulate an optimized formulation of berberine-phytantriol-loaded liquid crystalline nanoparticles (BP-LCNs) and to investigate the in vitro anti-cancer activity in a human lung adenocarcinoma A549 cell line. 23 The BP-LCN formulation possessing optimal characteristics that was used in this study had a favorable particle size and entrapment efficiency rate (75.31%) and a superior drug release profile. 23 The potential mechanism of action of the formulation was determined by measuring the mRNA levels of the tumor-associated genes PTEN, P53, and KRT18 and the protein expression levels with a human oncology protein array. 23 BP-LCNs decreased the proliferation, migration, and colony-forming activity of A549 cells in a dose-dependent manner by upregulating the mRNA expression of PTEN and P53 and downregulating the mRNA expression of KRT18. 23 Similarly, BP-LCNs also decreased the expression of proteins related to cancer cell proliferation and migration. 23 This study highlights the utility of phytantriol-based LCNs in incorporating drug molecules with low GI absorption and bioavailability to increase their pharmacological effectiveness and potency in NSCLC. 23

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder. 13 Approximately, around 2% to 3% percent of the general population experience symptoms of OCD over the course of their lifetime. 13 OCD can lead to economic burden, poor quality of life, and disability. 13 The characteristic features exhibited generally in OCD are continuous intrusive thoughts and periodic ritualized behaviours. 13 Variations in genes, pathological function of Cortico-Striato-Thalamo-Cortical (CSTC) circuits and dysregulation in the synaptic conduction have been the major factors involved in the pathological progression of OCD. 13 However, the basic mechanisms still largely unknown. 13 Current therapies for OCD largely target monoaminergic neurotransmitters (NTs) in specific dopaminergic and serotonergic circuits. 13 However, such therapies have limited efficacy and tolerability. 13 Drug resistance has been one of the important reasons reported to critically influence the effectiveness of the available drugs. 13 Inflammation has been a crucial factor which is believed to have a significant importance in OCD progression. 13 A significant number of proinflammatory cytokines have been reportedly amplified in patients with OCD. 13 Mechanisms of drug treatment involve attenuation of the symptoms via modulation of inflammatory signalling pathways, modification in brain structure, and synaptic plasticity. 13 Hence, targeting inflammatory signaling may be considered as a suitable approach in the treatment of OCD. 13 The present review focuses mainly on the significant findings from the animal and human studies conducted in this area, that targets inflammatory signaling in neurological conditions. 13 In addition, it also focusses on the therapeutic approaches that target OCD via modification of the inflammatory signaling pathways. 13

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects 0.6%-1.7% of children. 16 The etiology of autism is hypothesized to include both biological and environmental factors (Watts, 2008). 16 In addition to the core symptoms of social-communication delay and restricted, repetitive interests, co-occurring irritability/aggression, hyperactivity, and insomnia negatively impact adaptive functioning and quality of life of patients and families. 16 Despite years of effort, no pharmacologic agent has been found that targets the core symptoms of ASD. 16 The only FDA-approved agents are risperidone and aripiprazole for agitation and irritability in ASD, not for core symptoms. 16 Though they effectively reduce irritability/violence, they do so at the expense of problematic side effects: metabolic syndrome, elevated liver enzymes, and extrapyramidal side effects. 16 Thus, it is not surprising that many families of children with ASD turn to nonallopathic treatment, including dietary interventions, vitamins, and immunomodulatory agents subsumed under complementary-integrative medicine (CIM). 16 Per recent studies, 27% to 88% of families report using a CIM treatment. 16 In an extensive population-based survey of CIM, families of children with more severe ASD, comorbid irritability, GI symptoms, food allergies, seizures, and higher parental education tend to use CIM at higher rates. 16 The perceived safety of CIM treatments as “natural treatment” over allopathic medication increases parental comfort in using these agents. 16 The most frequently used CIM treatments include multivitamins, an elimination diet, and Methyl B12 injections. 16 Those perceived most effective are sensory integration, melatonin, and antifungals. 16 Practitioners working with these families should improve their knowledge about CIM as parents currently perceive little interest in and poor knowledge of CIM by physicians. 16 This article reviews the most popular complementary treatments preferred by families with children with autism. 16 With many of them having limited or poor quality data, clinical recommendations about the efficacy and safety of each treatment are discussed using the SECS versus RUDE criteria. 16

Complementary integrative medicine, such as mindfulness-based interventions, (MBI) have demonstrated efficacy in the treatment of depression, anxiety, substance use disorders (SUDs), and pain. 15 Mindfulness-based relapse prevention (MBRP) is an aftercare intervention targeting SUD relapse that integrates cognitive-behavioral relapse prevention and mindfulness meditation practices, raising awareness of substance use triggers and reactive behavioral patterns. 15 This study evaluated the efficacy of MBRP in reducing relapse in veterans following completion of an SUD treatment program. 15

Major depressive disorder (MDD) or Depression is one of the serious neuropsychiatric disorders affecting over 280 million people worldwide. 19 It is the 4th important cause of disability, poor quality of life, and economic burden. 19 Women are more affected with the depression as compared to men and severe depression can lead to suicide. 19 Most of the antidepressants predominantly work through the modulation on the availability of monoaminergic neurotransmitter (NTs) levels in the synapse. 19 Current antidepressants have limited efficacy and tolerability. 19 Moreover, treatment resistant depression (TRD) is one of the main causes for failure of standard marketed antidepressants. 19 Recently, inflammation has also emerged as a crucial factor in pathological progression of depression. 19 Proinflammatory cytokine levels are increased in depressive patients. 19 Antidepressant treatment may attenuate depression via modulation of pathways of inflammation, transformation in structure of brain, and synaptic plasticity. 19 Hence, targeting inflammation may be emerged as an effective approach for the treatment of depression. 19 The present review article will focus on the preclinical and clinical studies that targets inflammation. 19 In addition, it also concentrates on the therapeutic approaches’ that targets depression via influence on the inflammatory signaling pathways. 19

Major depressive disorder (MDD) is a medical condition involving persistent sadness and loss of interest; however, conventional treatments with antidepressants and cognitive behavioral therapy have limitations. 14 Based on the pathogenesis of MDD, treatments using herbal medicines (HM) have been identified in animal studies. 14 We conducted a systematic review of clinical studies to identify neurobiological outcomes and evaluate the effectiveness of HM in treating MDD. 14 A meta-analysis was performed by searching nine databases from their inception until 12 September 2022, including 31 randomized controlled trials with 3133 participants, to examine the effects of HM on MDD using neurobiological biomarkers and a depression questionnaire scale. 14 Quality assessment was performed using a risk of bias tool. 14 Compared to antidepressants alone, HM combined with an antidepressant significantly increased concentrations of serotonin (SMD = 1.96, 95% CI: 1.24-2.68, p < 0.00001, I² = 97%), brain-derived neurotrophic factor (SMD = 1.38, 95% CI: 0.92-1.83, p < 0.00001, I² = 91%), and nerve growth factors (SMD = 2.38, 95% CI: 0.67-4.10, p = 0.006, I² = 96%), and decreased cortisol concentrations (SMD = -3.78, 95% CI: -4.71 to -2.86, p < 0.00001, I² = 87%). 14 Although HM or HM with an antidepressant benefits MDD treatment through improving neuroendocrine factors, these findings should be interpreted with caution because of the low methodological quality and clinical heterogeneity of the included studies. 14

treatment summary

Complementary and integrative medicine (CIM) is frequently used by oncology teams and has shown to reduce physical and emotional side effects related to cancer treatment. 10 Especially, research focusing on chronic pain management suggests that ACT-CIM therapies allow for more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. 7 Also, CIM is suggested to be able to improve symptoms, side effects, and dysfunction related to cancer and its treatment. 20 Herbal medicines (HM) combined with antidepressants significantly increased concentrations of serotonin, brain-derived neurotrophic factor, and nerve growth factors, and decreased cortisol concentrations compared with antidepressants alone. 14

Benefits and Risks

Benefit Summary

Complementary and integrative medicine (CIM) may help to reduce physical and emotional side effects in cancer patients. 10 CIM may improve symptoms, side effects, and dysfunction related to cancer and its treatment, improving patient satisfaction and quality of life. 20 Especially, in chronic pain management, ACT-CIM therapies allow for more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. 7 Also, herbal medicines (HM) combined with antidepressants have shown to have a beneficial impact on MDD treatment by improving neuroendocrine factors. 14

Risk Summary

CIM may carry the risk of side effects. Some CIM therapies may interact with prescription medications. 10 There are some CIM therapies that have not been proven effective. 10 Also, although herbal medicines (HM) combined with antidepressants have shown to have a beneficial impact on MDD treatment by improving neuroendocrine factors, these findings should be interpreted with caution because of the low methodological quality and clinical heterogeneity of the included studies. 14

Comparison Between Studies

Commonalities Between Studies

Many studies have suggested that CIM can help to reduce physical and emotional side effects in cancer patients. 10 CIM may improve symptoms, side effects, and dysfunction related to cancer and its treatment, improving patient satisfaction and quality of life. 20 Especially, in chronic pain management, ACT-CIM therapies allow for more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. 7

Differences Between Studies

There is variability in the findings of studies regarding the effectiveness and safety of CIM therapies. 10 Further research is needed to determine whether a particular CIM therapy is effective for a specific symptom or disease, or if CIM causes interactions with prescription medications. 10 Also, although herbal medicines (HM) combined with antidepressants have shown to have a beneficial impact on MDD treatment by improving neuroendocrine factors, these findings should be interpreted with caution because of the low methodological quality and clinical heterogeneity of the included studies. 14

Consistency and Contradictions of the Findings

There is both consistency and contradiction in the findings of research regarding the effectiveness of CIM. 10 Further research is needed to determine whether a particular CIM therapy is effective for a specific symptom or disease, or if CIM causes interactions with prescription medications. 10 Also, although herbal medicines (HM) combined with antidepressants have shown to have a beneficial impact on MDD treatment by improving neuroendocrine factors, these findings should be interpreted with caution because of the low methodological quality and clinical heterogeneity of the included studies. 14

Cautions About Applying the Results to Real Life

There are some cautions to keep in mind when using CIM. 10 CIM should be used as a complementary therapy, not a replacement for prescription medication. 10 It is necessary to talk to your doctor before starting any CIM therapy. 10 There are some CIM therapies that have not been proven effective. 10 Also, although herbal medicines (HM) combined with antidepressants have shown to have a beneficial impact on MDD treatment by improving neuroendocrine factors, these findings should be interpreted with caution because of the low methodological quality and clinical heterogeneity of the included studies. 14

Limitations of Current Research

Many studies that have investigated the effectiveness and safety of CIM have been limited by small sample sizes and low methodological quality. 10 Further research is needed to determine the effectiveness and safety of particular CIM therapies. 10 Also, further research is needed to examine the effectiveness of HM combined with antidepressants in MDD treatment. 14

Future Directions for Research

Future research should include studies with larger sample sizes and higher methodological quality to assess the effectiveness and safety of CIM therapies. 10 Further research is needed to determine the effectiveness and safety of particular CIM therapies. 10 Also, further research is needed to examine the effectiveness of HM combined with antidepressants in MDD treatment. 14

Conclusion

CIM has the potential to improve the quality of life for cancer patients and others with many different diseases. 10 There are some cautions to keep in mind when using CIM. 10 CIM should be used as a complementary therapy, not a replacement for prescription medication. 10 It is necessary to talk to your doctor before starting any CIM therapy. 10 There are some CIM therapies that have not been proven effective. 10 Further research is needed to determine the effectiveness and safety of CIM. 10

List of Treatments

Active self-care CIM (ACT-CIM) therapies, Acupuncture, Herbal/dietary supplement use, Mindfulness-based interventions (MBI), Mindfulness-based relapse prevention (MBRP), Melatonin, Sensory integration, Antifungal agents, Herbal medicines (HM), Antidepressants