Complementary

From unconventional therapies to complementary medicine

A 1993 national survey by David Eisenberg and colleagues, published in the New England Journal of Medicine, used the phrase unconventional therapies. It limited the term to 16 commonly used interventions that were neither taught widely in US medical schools nor generally available in US hospitals. In telephone interviews with 1,539 adults conducted in 1990, 34 percent reported using at least one such therapy in the past year. This is a definition by absence from mainstream teaching and hospital care, not by a shared theory.

The US institutional record follows the same pattern. The Institute of Medicine reports that in 1992 Congress established an Office of Unconventional Therapies, later renamed the Office of Alternative Medicine, to explore unconventional medical practices. The NIH almanac dates the enabling funding to October 1991, with $2 million for fiscal year 1992, and records the first director of the office as appointed in October 1992.

Institutions and the CAM pairing

The NIH almanac records that Congress elevated the office to the National Center for Complementary and Alternative Medicine (NCCAM) in October 1998, and renamed it the National Center for Complementary and Integrative Health (NCCIH) in December 2014. The Institute of Medicine adds that the Consortium of Academic Health Centers for Integrative Medicine was launched in 2000 and had 22 member medical schools by 2003. Its stated mission was to integrate biomedicine with the diversity of therapeutic systems.

A 2025 conceptual analysis by Alexander Kremling and Jan Schildmann describes the vocabulary as having shifted over time. In their account, alternative medicine became the more prominent term from the 1990s, giving a category to treatments previously labeled with pejorative terms such as non-scientific or charlatanism, and complementary and integrative followed. They note that the combined abbreviation CAM has dominated discussion since about 2000, citing earlier bibliometric work.

Surveys document rising use

A follow-up national survey by Eisenberg and colleagues, published in JAMA in 1998, compared 1990 with 1997 using comparable questions. Use of at least one of 16 alternative therapies in the previous year rose from 33.8 percent to 42.1 percent. The therapies that rose most included herbal medicine, massage, megavitamins, folk remedies, energy healing and homeopathy. The authors attributed the rise mainly to more people seeking such therapies, not to more visits per person.

How the National Institutes of Health define it

NCCIH states that people often use alternative and complementary interchangeably, but the terms refer to different concepts. In its words, if a non-mainstream approach is used together with conventional medicine, it is considered complementary, and if it is used in place of conventional medicine, it is considered alternative. NCCIH adds that most people who use non-mainstream approaches also use conventional health care.

NCCIH describes integrative health as bringing conventional and complementary approaches together in a coordinated way, with an emphasis on treating the whole person. It classifies complementary approaches by their main input: nutritional (such as herbs, probiotics and dietary supplements), psychological (such as mindfulness), physical (such as massage and spinal manipulation), or combinations such as yoga, tai chi and acupuncture. NCCIH notes the terms continue to evolve.

World Health Organization usage

The WHO traditional medicine strategy for 2014 to 2023 defines complementary medicine, used interchangeably with alternative medicine, as a broad set of health care practices that are not part of a country's own tradition or conventional medicine and are not fully integrated into the dominant health care system. It merges complementary and traditional medicine as traditional and complementary medicine (T&CM).

The strategy for 2025 to 2034, adopted by the Seventy-eighth World Health Assembly, uses the wider phrase traditional, complementary and integrative medicine. The WHO summary of that strategy lists four objectives: strengthen evidence, ensure safety and regulation, integrate such medicine into health systems, and optimize its cross-sectoral value.

Related terms and the other Machipedia labels

On Machipedia, Complementary marks practices commonly used alongside conventional care. It differs from Alternative, which marks practices offered as options in place of it, from Holistic, which marks whole person framings, and from Metaphysical, which marks practices built on non-physical explanations. A practice can carry more than one label.

Contested definitions

The Institute of Medicine concluded in 2005 that no clear and consistent definition of CAM exists, and that no recognized taxonomy organizes the field. It adopted a broad working definition: resources other than those intrinsic to the dominant health system of a society in a given historical period, with boundaries that are not always sharp or fixed. It also reports an argument by Loretta Kopelman that definitions by culture, lack of testing, or lists of therapies each fail to separate CAM from conventional care.

Kremling and Schildmann argue that defining CAM by unconventionality is viable but leaves problems of logic and application. They recommend separating complementary, alternative and integrative, noting the first suggests alongside, the second instead of, and sketch a definition based on probable specific effectiveness. The authors describe the proposal as needing development.

Practices that carry the label on this site

Machipedia pages that carry the Complementary label span several kinds of practice. Acupuncture involves fine needles at selected points, associated with Chinese medical traditions. Massage is a family of hands-on methods applying pressure to soft tissues. Chiropractic and Osteopathy are manual healthcare approaches centered on the spine and joints, or on hands-on assessment and treatment of tissues and joints. Yoga and Tai chi combine movement, breathing and attention, and Meditation is a family of attention practices.

Other labeled pages cover nutrition and plants: Herbal Medicine describes plants and plant extracts used for health purposes, Dietary Supplements covers concentrated vitamins, minerals and similar products taken by mouth, and Aromatherapy covers plant essential oils inhaled or applied diluted. Music Therapy and Art Therapy are therapist-led practices using music or art-making. Reiki, labeled both Metaphysical and Complementary, is described as touch or hand placement to direct energy, and Integrative Medicine is a care model combining conventional treatment with complementary approaches.

Where complementary therapies appear in health services

The NHS states that it does not use herbal medicines, and that it may offer some complementary therapies based on evidence of how well they work and whether they offer value for money. Its examples are acupuncture for long-term pain, migraine-type headaches or severe hiccups, Alexander technique lessons for people with Parkinson's disease who have balance problems, and hypnotherapy for irritable bowel syndrome when other treatment has not worked. These are specific uses of specific therapies, not an endorsement of the whole label.

NCCIH states that integrative approaches have grown within US care settings, for example in pain management for military personnel and veterans and in cancer centers whose programs may offer acupuncture and meditation alongside conventional cancer treatment. It describes research on the value of these programs as early.

Reasons reported in surveys

In both 1990 and 1997 surveys, alternative therapies were used most often for chronic conditions, including back problems, anxiety, depression and headaches. In the 1990 survey, the majority used unconventional therapy for chronic rather than life-threatening conditions, and most who used it for a serious condition also sought treatment from a medical doctor for it.

NCCIH reports from the 2012 National Health Interview Survey that people who take natural product supplements or practice yoga more often do so for wellness than to treat a health condition, whereas people who use spinal manipulation more often do so for treatment. The WHO strategy likewise describes use of traditional and complementary medicine as a complement to conventional care as common in developed countries.

Pain and the shift away from opioids

In the 2022 survey analysis, among adults using any of seven approaches, the share reporting use for pain management rose from 42.3 percent in 2002 to 49.2 percent in 2022. The authors suggested possible drivers: a need for non-opioid options, research suggesting some approaches offer low to moderate pain relief, inclusion of some approaches in pain guidelines, and wider insurance coverage of approaches such as acupuncture. These are the authors' proposals, and the study design cannot show that any of them caused the change.

What was searched

The searches for this page covered NCCIH and NIH pages on definitions, history and national survey statistics, WHO strategy documents, NHS guidance, PubMed records of the 1990 and 1997 national surveys and the 2022 analysis, and open-access scholarship on the definition of CAM. This page reviews the category as a label. It does not assess any individual practice, and it did not review trials of specific therapies.

How common use is

NCCIH reports that the National Health Interview Survey, run by the CDC's National Center for Health Statistics, included complementary health questions in 2002, 2007, 2012, 2017 and 2022. Earlier survey reports state that about 36 percent of US adults used some complementary approach in 2002 and about 38 percent in 2007, with about 12 percent of children in 2007. Question sets differ between years, so these headline figures are not directly comparable.

The 2022 analysis compared seven approaches across 2002, 2012 and 2022: yoga, meditation, massage therapy, chiropractic care, acupuncture, naturopathy, and guided imagery or progressive muscle relaxation. Use of at least one rose from 19.2 percent of adults in 2002 to 36.7 percent in 2022. Meditation was the most used in 2022 at 17.3 percent, and yoga rose to 15.8 percent. The authors listed limits: falling survey response rates, possible recall bias, cross-sectional data and changes in question wording.

Evidence differs by practice

No source reviewed states a single finding for the category as a whole, and the label groups practices with very different evidence. The Institute of Medicine noted that its statements would not apply equally to every CAM modality. The NHS says herbal medicines and complementary therapies are not tested in the same way as standard medicines. NCCIH says large, rigorous studies of a few dietary supplements often found the products did not work for the conditions studied, while research on others is in progress.

For that reason, a reader looking for evidence should consult the individual practice page and the named condition, and not infer one practice's results from another's. Being listed as complementary says how a practice is used, not how well it performs.

Safety depends on the specific practice

NCCIH states that safety depends on the specific therapy and that each complementary product or practice should be considered on its own. It describes psychological and physical approaches such as meditation and yoga as generally considered low in risk for healthy people when practiced appropriately, while noting that for many herbal products there is a lot not known about safety, partly because a supplement manufacturer does not have to prove safety and effectiveness before sale.

The NHS gives practice-specific cautions. Acupuncture, chiropractic and osteopathy may not be suitable for people taking blood thinning medicine or at increased risk of bleeding, and hypnotherapy may not be suitable for people with schizophrenia, a history of psychosis, or epilepsy. It advises against herbal medicines in pregnancy, breastfeeding, kidney or liver problems, and with certain medicines.

Product quality and interactions with medicines

NCCIH names two main safety concerns for dietary supplements: drug interactions, with St. John's wort interfering with the intended effects of antidepressants as an example, and contamination, with supplements found to contain hidden prescription drugs or other compounds, particularly products marketed for weight loss, sexual health and athletic performance. NCCIH adds that taking supplements and medications together may increase or decrease the medicine's effects or interact harmfully.

The 1997 survey estimated that 15 million US adults, 18.4 percent of prescription users, took prescription medications together with herbal remedies or high-dose vitamins. The NHS lists antidepressants, diabetes medicines, blood pressure medicines, blood thinners and hormonal contraception among medicines that may not mix well with herbal medicines, and advises checking with a pharmacist first.

Telling your clinician and keeping necessary care

Disclosure has been low in survey data. In the 1990 survey, 72 percent of respondents who used unconventional therapy did not tell their medical doctor, and in the 1997 survey about 38.5 percent of alternative therapies were disclosed to physicians. NCCIH advises people to list every complementary practice on patient history forms, tell providers at each visit, include supplements and over-the-counter medicines, and ask about safety and interactions before starting something new.

The NHS advises not to stop taking a prescribed medicine without first talking to a doctor, and to seek a doctor's advice for symptoms that do not go away or keep coming back, not only a therapist's. It also advises checking that a private therapist belongs to a professional organization accredited by the Professional Standards Authority. This page is general information, and it does not replace advice from a clinician who knows a person's circumstances.