Note : Many herbs or supplements are considered unsafe when taken before or after surgical procedures. Herbs and supplements can potentially interact with medications, and some therapies may lead to complications, such as increased bleeding. Integrative therapies should only be used after talking to a healthcare provider.
B Good scientific evidence
- Colon therapy : Colon therapy is the use of herbs or water to clean out the colon or large intestine to treat certain health conditions. Surgeons or other healthcare practitioners may use colon irrigation before or during some bowel surgeries to cleanse the colon or improve healing.
- Excessive treatments may allow the body to absorb too much water, which causes electrolyte imbalances, nausea, vomiting, heart failure, fluid in the lungs, abnormal heart rhythms, or coma. Infections have been reported, possibly due to contaminated equipment or as a result of clearing out normal colon bacteria that destroys infectious bacteria. There is a risk of the bowel wall breaking, which is a serious complication that can lead to septic shock and death. Avoid with diverticulitis, ulcerative colitis, Crohn's disease, severe or internal hemorrhoids, rectal/colon tumors, or if recovering from bowel surgery. Avoid frequent treatments with heart or kidney disease. Colonic equipment must be sterile. Colonic irrigation should not be used as the only treatment for serious conditions. Avoid if pregnant or breastfeeding due to lack of scientific data.
C Unclear or conflicting scientific evidence
- Aconite : The aconite plant grows in rocky areas. It is often found in the mountainous woodlands of many parts of Europe, especially France, Austria, Germany, and Denmark. There is limited data on the use of aconite or any of its derivatives in treating pain. Homeopathic aconite may help relieve postoperative agitation, but further information is needed to confirm these results.
- Aconite is highly toxic and is not safe for human consumption. Avoid with heart disease, irregular heartbeat, hemodynamic instability (abnormal blood flow), and gastrointestinal disorders, (such as ulcers, reflux esophagitis, ulcerative colitis, spastic colitis, or diverticulosis). Use cautiously with diabetes or suicidal tendencies. Avoid if younger than 18 years old due to a lack of safety evidence. Avoid if pregnant or breastfeeding.
- Acupressure, shiatsu : During acupressure, finger pressure is applied to specific acupoints on the body. Acupressure is used around world for relaxation, wellness promotion, and the treatment of many health problems. Several studies report that acupressure provides pain relief to patients after surgeries. This research suggests that acupressure may be as effective as intravenous pain medications. However, further evidence is needed from well-designed trials before a firm conclusion can be drawn.
- With proper training, acupressure appears to be safe if self-administered or administered by an experienced therapist. No serious long-term complications have been reported, according to scientific data. Hand nerve injury and herpes zoster ("shingles") cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.
- Arginine (L-arginine) : L-arginine helps maintain the body's fluid balance (urea, creatinine) and aids in wound healing, hair growth, sperm production (spermatogenesis), blood vessel relaxation (vasodilation), and fights infection. One study suggests that arginine may provide benefits when used as a supplement after surgery. It is not clear what the specific role of arginine may be in improving immune function or what dose is safe or effective.
- Avoid if allergic to arginine. Avoid with a history of stroke, liver, or kidney disease. Avoid injections of arginine. Use cautiously if taking blood-thinners, blood pressure drugs, or other drugs, herbs, or supplements with similar effects. Check blood potassium levels while taking arginine. Avoid arginine supplements if pregnant or breastfeeding due to a lack of safety evidence.
- Bovine colostrum : Bovine colostrum is the pre-milk fluid produced from cow mammary glands during the first two to four days after birth. Bovine colostrum confers growth, nutrient, and immune factors to the offspring. Bovine colostrum has been studied in individuals undergoing coronary bypass operations, but no benefit was found. Further study is required before a strong recommendation can be made.
- Avoid if allergic to dairy products. Use bovine colostrum cautiously because toxic compounds, such as polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT), and dichlordiphenyldichloroethylene (DDE), have been found in human colostrum and breast milk. Thus, it is possible that these agents may be found in bovine colostrum. Avoid with, or if at risk of, cancer. Use cautiously with immune system disorders or atherosclerosis (hardening of the arteries). Use cautiously if taking medications, such as anti-diarrheal agents (e.g. Imodium®), insulin, or CNS agents (such as amphetamines, caffeine). Avoid if pregnant or breastfeeding.
- Chamomile : Chamomile is an herb that is commonly taken as a tea. It is unclear whether or not chamomile spray can prevent post-operative sore throat and hoarseness any more than normal saline.
- Avoid if allergic to chamomile or plants in the Asteraceae family, such as aster, chrysanthemum, mugwort, ragweed, or ragwort. Avoid with heart disease, breathing disorders, hormone-sensitive conditions, or central nervous system disorders. Avoid if taking cardiac depressive agents, central nervous system depressants, respiratory depressive agents, or anticoagulants. Use cautiously if taking benzodiazepine, anti-arrhythmic medications, calcium channel blockers, alcohol, sedative agents, anxiolytic medications, spasmolytic drugs, oral medications, or agents that are broken down by the liver. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
- Chiropractic : Chiropractic care focuses on how the relationship between musculoskeletal structure (mainly the spine) and bodily function (mainly nervous system) affects health. Chiropractors use many techniques, including spinal manipulative therapy, diet, exercise, X-rays, and other techniques. It remains unclear if chiropractic manipulative therapy can help treat postoperative atelectasis. Further research is warranted in this area.
- Avoid with vertebrobasilar vascular insufficiency, aneurysms, arteritis, or unstable spondylolisthesis. Avoid use on post-surgical areas of para-spinal tissue. Use cautiously with acute arthritis, brittle bone disease, conditions that cause decreased bone mineralization, bleeding disorders, migraines, or if at risk of tumors or metastasis of the spine. Use extra caution in cervical adjustments. Avoid if pregnant or breastfeeding due to a lack of scientific data.
- Choline : Choline is an essential amino acid that is produced in the body and consumed in the diet. There is a lack of sufficient evidence to recommend for or against the use of choline in patients recovering from surgery.
- Avoid if allergic to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney disorders, liver disorders, or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding, it seems generally safe to consume choline within the recommended adequate intake (AI) parameters. Supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.
- Creatine : There is early evidence that heart muscle may recover better and more rapidly after open-heart surgery if intravenous creatinine is administered during the operation. Further study is needed before a recommendation can be made.
- The U.S. Food and Drug Administration (FDA) has advised consumers to consult their physicians before consuming creatine. Avoid with impaired kidney function or dehydration. Avoid in combination with ephedra. Use cautiously with diabetes, seizure disorders arrhythmia, deep vein thrombosis (DVT), kidney stones, neuromuscular disorders, or in athletes. Use cautiously if taking caffeine, nonsteroidal anti-inflammatory drugs (NSAIDs), nephrotoxic medications, probenecid, trimethoprim, or cimetidine.
- Guided imagery : Guided imagery may involve a number of techniques, including metaphor, storytelling, fantasy, game playing, dream interpretation, drawing, visualization, active imagination, or direct suggestion. Initial evidence suggests that guided imagery relaxation audiotapes may reduce anxiety after surgeries, and may improve healing. More study is needed before a recommendation can be made.
- Guided imagery is usually intended to supplement medical care, not to replace it. Guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified healthcare provider if mental or physical health is unstable or fragile. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously with physical symptoms that can be brought about by stress, anxiety, or emotional upset because imagery may trigger these symptoms. Patients who experience feelings of anxiety while practicing guided imagery, or have a history of trauma or abuse, should speak with their qualified healthcare providers before practicing guided imagery.
- Healing touch : Healing touch (HT) is a combination of hands-on and off-body techniques to influence the flow of energy through a person's biofield. Data from two small studies are inconclusive as to whether HT can benefit patients with post-operative pain. Studies of better design are needed before definitive recommendations for or against HT can be made.
- HT should not be regarded as a substitute for established medical treatments. Use cautiously if pregnant or breastfeeding.
- Hypnotherapy, hypnosis : Hypnosis is a trance-like state in which a person becomes more aware and focused and is more open to suggestion. Research suggests that hypnosis may be helpful for pain and anxiety in various situations, including after surgery. Early research reports that length of hospital stay and psychological well-being may be improved after surgery with the use of hypnotherapy. However, most studies in this area are not well designed, and updated high-quality investigations are needed before a firm conclusion can be drawn. Hypnotherapy has been used to treat health conditions and to change behaviors.
- Use cautiously with mental illnesses (e.g. psychosis/schizophrenia, manic depression, multiple personality disorder, or dissociative disorders) or seizure disorders.
- Liver extract : Liver extract and desiccated liver have been marketed as iron supplements for more than 100 years. The extract is processed cow or pig liver that may either be a freeze-dried brownish powder or a concentrated liquid that has had most of the fat and cholesterol removed. Liver extract may help maintain liver function during urological surgery. More research is needed to define the importance of this normalization of liver function.
- Avoid if allergic to liver extract or its constituents. In general, liver extract should be used cautiously because raw liver may contain liver flukes or the bacterium, Vibrio fetus. Avoid with iron metabolism disorders or iron shortage disorders, such as hemochromatosis. Avoid liver extract from countries where bovine spongiform encephalitis (BSE or "mad cow disease") has been reported. Use cautiously with clotting disorders, compromised immune function, acid reflux disease, or abnormal iron levels. Use cautiously if taking drugs that affect blood cholesterol, antacids, or antiviral agents (especially interferon, or any agents for cancer). Use cautiously in hepatopathic patients with reduced human growth hormone metabolic clearance rate. Avoid if pregnant or breastfeeding.
- Massage : The main goal of massage is to help the body heal itself. Touch is fundamental to massage therapy and is used by therapists to locate painful or tense areas, to determine how much pressure to apply, and to establish a therapeutic relationship with clients. Various massage approaches have been used after surgery with the aim to improve recovery and decrease pain. Further study is needed in this area before a recommendation can be made.
- Avoid with bleeding disorders, low platelet counts, or if taking blood-thinners. Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
- Nasal irrigation : Nasal irrigation is a technique that is used to clear the sinuses. It can be performed by the patient at home or by a professional up to twice daily. Cleaning of the nose with saline solution after endonasal sinus surgery is very often used for postoperative treatment although the efficiency and acceptance of this method has not been examined thoroughly. There is some supportive evidence that nasal irrigation may help remove infectious microorganisms in postoperative care after nasal (including polypectomy) or sinus surgeries. However, these studies are lacking in the performance or description of statistical analysis. A randomized controlled trial with statistical analysis is needed to reveal further information.
- Nasal irrigation is generally well tolerated. Use cautiously with a history of frequent nosebleeds. If the irrigation liquid is hot, the nose may become irritated.
- Physical therapy : The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injury. A variety of techniques, including exercises, stretches, traction, electrical stimulation, and massage, are used during physical therapy sessions. Physical therapy techniques are often used following cardiopulmonary bypass surgery, abdominal surgery, and other surgical procedures, as well as for the prevention of pulmonary complications. Several studies do not show any difference between various chest physiotherapy treatments, such as incentive spirometry, intermittent positive pressure breathing (IPPB), or deep breathing exercises. Overall, it is difficult to compare treatment outcomes across the various studies and more high-quality studies are needed to make a firm recommendation.
- Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist. However, physical therapy may aggravate some pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature, although causality is unclear. Erectile dysfunction has also been reported. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
- Probiotics : Probiotics are beneficial bacteria that are sometimes called friendly germs. They help maintain a healthy intestine and help the body digest foods. They also help keep harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. Limited evidence suggests a probiotic preparation (VSL#3, containing Lactobacilli, Bifidobacteria, and Streptococcus salivarius subspecies thermophilus) may effectively prevent a complication of gastrointestinal surgery, called pouchitis. This condition occurs when the intestines become inflamed. Notably, discontinuation appears to be followed by relapse, while continuation apparently maintains remission and better quality of life. Lactobacillus GG supplementation, however, has had conflicting results in preventing flare-ups. More studies are needed to arrive at concrete recommendations.
- Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
- TENS (transcutaneous electrical nerve stimulation) : Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. There are multiple controlled studies of TENS for pain following various types of surgery, including abdominal surgery, heart surgery, lung surgery, gynecologic surgery, and orthopedic surgery. Research is inconsistent, with a variety of TENS techniques, patient types, and study designs used. Overall, the quality of available research is poor. Although some studies do report improvements in pain and reduced need for pain medications, a well-designed review in 1996 concluded that there is no clear evidence of benefit. Better quality research is necessary in this area before a strong conclusion can be reached.
- Avoid with implantable devices (e.g. defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps). Use cautiously with decreased sensation (e.g. neuropathy) or seizure disorders. Avoid if pregnant or breastfeeding.
D Fair negative scientific evidence
- Beta-carotene : Beta-carotene is a member of the carotenoids, which are very colorful (red, orange, yellow), fat-soluble compounds. They are naturally found in many fruits, grains, oil, and vegetables, including green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers. Study results conclude that peri-operative supplementation with antioxidant micronutrients has limited effects on strength and physical function following major elective surgery.
- Avoid if sensitive to beta-carotene, vitamin A, or any other ingredients in beta-carotene products. Avoid large oral doses in pregnant or breastfeeding women due to a lack of safety evidence.
- Creatine : In two studies investigating the effect of creatine supplementation in individuals undergoing soft tissue surgery, no effect was noted on strength or body composition. Creatine supplementation is likely ineffective given this information and recommendations cannot be made in this field without further study.
- The U.S. Food and Drug Administration (FDA) has advised consumers to consult their physicians before consuming. Avoid with impaired kidney function or dehydration. Avoid in combination with ephedra. Use cautiously with diabetes, seizure disorders arrhythmia, deep vein thrombosis (DVT), kidney stones, neuromuscular disorders, or in athletes. Use cautiously if taking caffeine, nonsteroidal anti-inflammatory drugs (NSAIDs), nephrotoxic medications, probenecid, trimethoprim, or cimetidine.