In recent years, hypnotherapy has become recognized in several areas of healthcare. Hypnotherapists treat a range of chronic conditions, including pain, anxiety, addictions and phobias. Hypnotherapy is practised by several healthcare professionals, including psychologists, counsellors and doctors. One session lasts 30–90 minutes and, depending on the condition and the responsiveness of the patient, 6–12 sessions are normally recommended. Autogenic training is a self-hypnotic technique, which, after some instruction, can be practised without the help of a therapist.
What is the evidence?
People who are suggestible generally respond best. Dozens of clinical trials show that hypnotherapy is effective in reducing pain, anxiety and the symptoms of irritable bowel syndrome. However, according to reliable reviews by the Cochrane Collaboration, it is not effective for smoking cessation, even though it is frequently promoted in this context. There is much less research for autogenic training, but the existing evidence is encouraging for anxiety, stress, hypertension, insomnia and some pain syndromes.
Hypnotherapy and autogenic training are relatively safe, but they should not be used by people with psychoses or other severe mental problems. With hypnotherapy, the recovery of repressed or false memories can create problems, and cases of false-memory syndrome (i.e. remembering distressing events which, in reality, have never occurred) have been reported.
Conclusion
The prudent use of hypnotherapy can be helpful for some patients. Whether this is a specific effect of the treatment or a non-specific (placebo) effect is difficult to say. Autogenic training has the added advantage of being an economical self-help approach that maximizes each patient’s own involvement. Neither treatment is associated with serious risks when applied correctly.
Leech Therapy
The application of live leeches to the skin in order to treat a range of illnesses.
Background
Hirudo medicinalis is a small, black, worm-like animal. It is capable of attaching itself to humans or animals, sucking substantial amounts of blood from the skin. During this process, it increases considerably in size and finally, when it is saturated with blood, it drops off.
Leeches were used for medicinal purposes in ancient Babylon, and in more recent centuries in Europe as a mode of bloodletting, as discussed in Chapter 1. Today their only use in conventional medicine is in plastic surgery: clinical trials show that applying leeches post-operatively improves the cosmetic results of some operations.
In alternative medicine, leeches are employed for a range of conditions. Some therapists believe that they eliminate toxins from the body; others use them to treat painful local conditions such as osteoarthritis.
While sucking blood, leeches inject pharmacologically active substances into the body. Initially they inject an anaesthetic substance which enables them to bite through the skin without causing pain. Subsequently they excrete a substance that prevents blood from clotting so that they can suck blood easily. This substance is called hirudoine and is a well-researched anticoagulant. It can now be synthesized and is used widely in mainstream medicine for its anticoagulation properties.
What is the evidence?
A German group recently published a series of clinical trials which suggested that the application of several leeches over the knee eases the pain of osteoarthritis. These studies still await independent replication.
All other claims of the alternative use of leech therapy are unsupported by evidence.
If done properly, there are few risks. Many patients, however, might feel uncomfortable about leech therapy, either because of the aesthetic aspects of the treatment or the fact that, after one session, the animals are usually destroyed.
Conclusion
Leeches have a long history of medical use. There is some evidence that their use is effective in reducing the pain of osteoarthritis of the knee. There is no evidence to support their use for any other treatment performed by an alternative therapist.
Magnet Therapy
The use of magnetic fields from static magnets, which are usually worn on the body, to treat various conditions, most frequently pain.
Background
Nowadays, rapidly fluctuating magnetic fields are employed in conventional medicine in hi-tech imaging instruments and for promoting the healing of bone fractures. However, alternative medicine tends to focus on the use of static magnets, which give rise to a permanent magnetic field.
Such static magnets have always attracted the interest of physicians, but the boom in magnet therapy began in Europe in the eighteenth century. Although static magnets fell out of favour as medicine progressed, a plethora of static magnets are today again popular within alternative medicine. Their use is promoted for many conditions, most frequently to alleviate chronic pain. These static magnets are worn as wrist bands, belts, leg wraps, shoe inlays, patches, etc. Magnetic mattresses or seat covers are also available. The magnetic strength of these devices varies between 10 and 1,000 Gauss. Static magnets can be purchased through numerous outlets and, more often than not, the consumer/patient would not have had any contact with a healthcare practitioner.
Subtle effects of magnetic fields are observable, for instance, on cell cultures. The question is whether these translate into any therapeutic benefit.
What is the evidence?
Most of the clinical research on static — meaning constant field strength rather than fluctuating strength — magnets relates to pain control. Researchers at Exeter University recently included nine placebo-controlled, randomized trials in a meta-analysis. The results do not support the use of static magnets for pain relief. For other problems, such as menstrual symptoms or varicose veins, the evidence is equally unconvincing.
Static magnets are unlikely to cause direct adverse effects. As they are usually self-administered, there is a danger of missing serious diagnoses and losing valuable time for early treatment of serious diseases.
Conclusion
Static magnets are popular, and the market is booming, but it is important to realize that there is no evidence that they offer any medical benefit, and indeed there is no reason why they ought to. There is more information about magnet therapy in Chapter 5.
Massage Therapy
The manipulation of the tissues close to the body surface (e.g. muscles and tendons) using pressure, traction and vibration.
Background
Massage is as old as medicine itself; indeed, it seems to be a human reflex to rub ourselves where we feel pain. Today many variations exist; for example, classical ‘Swedish’ massage focuses on muscular structures and is popular throughout Europe. Other forms of massage treatment include:
Bowen therapy: gentle soft-tissue technique influencing the nervous system.
Lymphatic drainage: massaging along lymph channels to enhance lymph flow.
Marma massage: traditional Indian massage.
Myofascial release: technique reducing tension in fascia and connective tissue.
Relaxation massage: gentle superficial techniques.
Rolfing: forceful massaging where the therapist’s whole body applies pressure.
Sports massage: muscular techniques adapted for the needs of athletes.