9 Alternative therapies for musculoskeletal conditions Luis Vitetta * BSc (Hons), PhD, GradDip IntgrMed, GradDip NutrEnvMed Associate Professor and Principal Research Fellow Unit of Health Integration, School of Medicine, University of Queensland, Level 2, Centres for Health Research, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Queensland 4102, Australia Flavia Cicuttini MBBS (Hons), PhD, MSc, DLSHTM, FRACP, FAFPHM Professor, Monash University, Head, Musculoskeletal Unit DEPM, and Head, Rheumatology Unit Alfred Hospital, Prahran, Melbourne, Victoria 3181, Australia Avni Sali MBBS, PhD, FRACS, FACS, FACNEM Professor and Director National Institute of Integrative Medicine, 28 Bell St, Heidelberg Heights, Melbourne, Victoria 3081, Australia The use of complementary and alternative medicine is complex and nuanced. Patterns of use of complementary and alternative medicine differ among racially and ethnically different groups. Multivariate models of utilization indicate that ethnicity plays an independent role in the imple- mentation of these modalities, in seeking practitioners and in health problems for which assis- tance is required. Moreover, there are many reasons why people use complementary and alternative medicine: conventional treatment may not be working as well as they would like; they want greater relief of symptoms and/or disability; they have issues with side-effects of phar- maceutical treatment; they wish to reduce some of the stress that comes from living with a chronic illness and want to cope better; they believe that complementary and alternative ther- apies are safer and ‘natural’; and they are influenced by the widespread advertising and attractive claims that are made for many natural products. Although there are more than 150 different kinds of syndromes and conditions associated with arthritis, this review will focus on currently available evidence-based medicine for the two most common conditions diagnosed in Western countries – osteoarthritis and rheumatoid arthritis – for which people seek and then implement complementary and alternative medicine modalitites. * Corresponding author. Tel.: þ61 7 3240 2903; Fax: þ61 7 3240 6858. E-mail address: l.vitetta@uq.edu.au (L. Vitetta) 1521-6942/$ - see front matter ª 2007 Elsevier Ltd. All rights reserved. Best Practice & Research Clinical Rheumatology Vol. 22, No. 3, pp. 499–522, 2008 doi:10.1016/j.berh.2007.12.007 available online at http://www.sciencedirect.com