An Overview of Integrative Care Options for Patients with Chronic Wounds
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Index: Ostomy Wound Manage. 2012;58(5):44–51.
Integrative care incorporates aspects of traditional and nontraditional medicine, also often referred to as holistic or complementary and alternative medicine. Providing integrative wound care involves addressing physical, psychosocial, and spiritual components of the whole person. Several care models, including the Seven Balance Point Model, include holistic considerations, as well as promotion of physical health recommendations involving nutrition, sleep, exercise, and emotional, social, and spiritual well-being. The quality of life of patients with chronic wounds may be negatively affected by chronic and procedural pain, sleep disturbance, social, and emotional concerns.
Although research into the role of integrative medicine in wound care is limited, experiences from other disciplines suggest wound pain may be addressed using acupuncture, yoga, biofeedback, guided imagery, massage, healing touch and therapeutic touch, aromatherapy, and topical medical-grade honey. In addition, patients who are incontinent or have incontinence-related skin damage or peristomal complications may benefit from biofeedback to better control incontinence. Research to increase understanding about the role of holistic care for patients with wound, stoma, and continence-related problems in general, and its effect on the quality of life of palliative care patients in particular, will help clinicians provide evidence-based and patient-centered care.
Keywords: wounds, review, pain, complementary medicine, holistic
Potential Conflicts of Interest: none disclosed
Addressing the needs of a person with a chronic wound involves physical (wound healing, wound-related pain reduction, odor control), psychosocial (stress, anxiety, and depression), and spiritual (the patient’s relationship with a higher power) components. Approaches to care may incorporate complementary and alternative medicine (CAM) practices. Several terms are used interchangeably in the literature to represent the breadth of CAM practices1 and include holistic, complementary and alternative, nontraditional, and integrative medicine. These terms are similar but not necessarily interchangeable. Holistic medicine encompasses whole person care (eg, body, mind, spirit). Complementary and alternative and nontraditional medicine incorporate various diagnostic and therapeutic approaches to enhance traditional Western medicine. Nontraditional medicine includes, but is not limited to, acupuncture, massage, and healing touch. Some nontraditional practices are based on results of well-designed clinical studies, are reproducible from practitioner to practitioner, and have a place in traditional medicine therapy.
Aspects of alternative medicine — eg, electrodermal testing, iridology, and hair analysis — are not reproducible from practitioner to practitioner and may not be evidence-based.2 As such, alternative diagnostic testing should not replace a patient’s medical history and physical exam. Some US integrative naturopathic medical schools teach acupuncture. Patients with chronic pain may be prescribed (narcotic) medications by a Western physician; CAM can be used to enhance prescription medication pain control through use of acupuncture depending on the patient’s pain severity and type.3 Integrative medicine combines traditional and nontraditional practices for an enhanced patient-centered model of healing, and this term will be used throughout the rest of this review.
Mind, body, and spiritual healing require a personalized, integrative team approach to adequately care for these aspects of the human journey. Integrative medicine has a role in palliative care.