Integrative Veterinary Medicine:
An Emerging Trend in Veterinary PracticeThis section is compiled by Frank M. Painter, D.C.
Send all comments or additions to: Frankp@chiro.org
FROM: Am J Vet Res 2025 (Oct 10): 1-5 ~ FULL TEXT
OPEN ACCESS Mushtaq A. Memon, BVSc, PhD, DACT • Huisheng Xie, DVM, PhD
Department of Veterinary Clinical Sciences,
College of Veterinary Medicine,
Washington State University,
Pullman, WA
The American Veterinary Medical Association's (AVMA) House of Delegates recently adopted a revised policy on Complementary, Alternative, and Integrative Veterinary Medicine (IVM), reflecting a growing clinical and academic interest in complementary therapies.
IVM is defined as "a comprehensive approach to animal health care that combines conventional veterinary practices with complementary and alternative therapies, such as acupuncture and chiropractic care." While the utilization of IVM is increasing, a critical knowledge gap remains regarding its evidence-based integration into mainstream veterinary practice. This article provides an overview of the purpose, scope, and potential clinical contribution of commonly used modalities, including acupuncture, physical rehabilitation, manual and massage therapies, herbal medicine, and integrative nutrition. Each modality is briefly examined in terms of proposed mechanisms, therapeutic indications, and current research support. The goal is to clarify the role of IVM within veterinary clinical decision-making and promote a balanced, science-informed framework for its application.
Acupuncture, a core IVM modality, uses fine needles to stimulate the body's natural healing mechanisms. Physical rehabilitation targets neurological and musculoskeletal conditions, providing multidimensional care.
Manual therapies apply hands-on techniques to soft tissues, joints, and nerves to promote relaxation, pain relief, and mobility. Integrative nutrition emphasizes personalized dietary plans that support overall health. Botanical medicine leverages the therapeutic properties of plants and their derivatives as part of a holistic treatment strategy.
The takeaway emphasizes the importance of interdisciplinary collaboration, ensuring safety, and ethical practice in offering integrative veterinary care.
Keywords: acupuncture; complementary; integrative; rehabilitation; veterinary.
From the FULL TEXT Article:
Background
The AVMA House of Delegates recently passed a resolution adopting a revised policy on complementary, alternative, and integrative veterinary medicine (IVM). Integrative veterinary medicine is defined as “a comprehensive approach to animal healthcare that combines conventional veterinary practices with complementary and alternative therapies, such as acupuncture (ACP) and chiropractic care.” [1]
Integrative veterinary medicine reflects the growing interest in complementary therapies in both human and veterinary medicine. An analysis of national survey data reported that the proportion of US adults who have at least 1 complementary health approach (eg, ACP, chiropractic, massage, yoga, meditation) increased from 19.2% in 2002 to 36.7% in 2022. [2] Similarly, a bibliometric study of veterinary literature documented a marked rise over the past 2 decades in publications referencing nonconventional therapies, particularly traditional Chinese veterinary medicine (TCVM), herbal medicine, plant products, essential oils, and other natural products. [3]
Integrative veterinary medicine encompasses a wide range of modalities, including ACP, physical rehabilitation, manual and massage therapies, herbal medicine, and integrative nutrition. The overarching goal is to combine the strengths of conventional and complementary approaches to enhance the quality and effectiveness of veterinary care.
This integrated framework reflects a broader societal shift toward complementary and integrative health practices, observed in both human and veterinary medicine. In 2007, approximately 38% of US adults reported using complementary therapies. [4] Many of these adults may also seek complementary therapies for their pets. Even if such treatments are not a core part of a veterinarian’s practice, it is still important to have a basic understanding of the options, their uses, and when they can be effective. [5] The American Animal Hospital Association’s member survey conducted from 1996 through 1999 documented an increase in the proportion of practices reporting the use of alternative therapies, rising from 6% in 1996 to 22% in 1998 and reaching 31% in 1999, indicating a marked upward trend in the provision of complementary and alternative veterinary medicine or IVM services. [6]
The term IVM has increasingly replaced earlier labels, such as “alternative” or “holistic” medicine, signaling a more collaborative and scientifically grounded approach. This shift is mirrored in institutional developments, such as the renaming of the NIH National Center for Complementary and Alternative Medicine to the National Center for Complementary and Integrative Health, a change that underscores a commitment to integrating complementary practices into mainstream healthcare. [7]
Integrative veterinary medicine encompasses a wide range of modalities, including ACP, physical rehabilitation, manual and massage therapies, herbal medicine, and integrative nutrition. As a reflection of a growing paradigm shift, IVM offers veterinarians a multifaceted, evidence-informed approach to treatment that merges traditional Western practices with complementary therapies. This evolution in veterinary medicine aligns with contemporary healthcare values and anticipates a future in which integrated care becomes the standard rather than the exception.
Acupuncture
A recent study [8] evaluated the efficacy of acupuncture and electroacupuncture, integrated within a physiotherapy protocol, for postoperative rehabilitation in dogs with acute intervertebral disc extrusion. The multimodal approach was designed to enhance the recovery of ambulation. Analysis of 41 canine patients demonstrated that incorporating acupuncture into the rehabilitation protocol significantly increased the likelihood of regaining ambulatory function. Another study [9] compared the therapeutic outcomes of decompressive surgery (DSX), electroacupuncture (EAP), and a combined approach (DSX + EAP) in dogs with thoracolumbar intervertebral disc disease (IVDD) and severe neurological deficits persisting for more than 48 hours. Findings indicated that EAP alone was more effective than DSX in promoting ambulation and improving neurological function in dogs with prolonged, severe deficits secondary to thoracolumbar IVDD.
According to this system, Qi circulates through defined pathways called meridians, and disease is understood as a disruption or blockage in this flow. Diagnostic evaluation within TCVM relies heavily on observational methods, such as tongue appearance, pulse quality, and other subtle physical cues. [10, 11]
Acupuncture is one of the most commonly utilized modalities within IVM and is supported by the most extensive body of efficacy literature among complementary therapies. The term ACP originates from 2 Latin words: acus, meaning needle, and pungere, meaning to pierce or prick. Acupuncture involves the insertion of sterile, fine needles to stimulate the body’s natural healing mechanisms, aiming to diagnose, treat, and prevent disease. The core objective of ACP is to achieve therapeutic benefits with minimal trauma. [12]
Acupuncture is thought to relieve pain and reduce inflammation through multiple biological pathways. Needle stimulation triggers the release of natural painrelieving chemicals, such as endorphins and enkephalins, from immune cells, which act on nerve endings and the sympathetic nervous system to block pain signals. Electro-ACP can also activate the hypothalamicpituitary-adrenal axis and influence the autonomic nervous system, leading to broader anti-inflammatory effects. Research further suggests it may mobilize mesenchymal stem cells via hypothalamic activation, supporting tissue repair and regeneration. [13]
The use of fine, sterile needles is referred to as dry-needle ACP. Other common techniques include aqua-ACP, which involves injecting small amounts of fluid (eg, vitamin B12 or saline) into ACP points for prolonged stimulation—particularly useful in patients who cannot tolerate retained needles — and electro-ACP, which involves the application of electrical stimulation to inserted needles. Electro-ACP is employed to enhance neuromodulation and stimulate the release of neurochemicals by varying electrical frequencies. [14]
Acupuncture is commonly utilized for pain management. A recent clinical trial tested ACP in 32 dogs with osteoarthritis. Dogs received either ACP or placebo treatment once a week for 4 weeks. Measures of mobility and activity did not show a clear difference between the 2 groups. However, dog owners reported noticeable improvement in their pets’ comfort and ability to do daily activities after ACP. [15] While ACP is practiced globally — in China, Korea, Japan, Europe, and the Americas — its application varies, much like the regional differences observed in Western medical practice, despite shared foundational principles.
Physical Rehabilitation
Animal physical rehabilitation stands out as a rapidly expanding domain within veterinary medicine. It is gaining prominence in treating small animals and equine and is increasingly recognized as a crucial facet of veterinary care, especially for animals with physical limitations stemming from surgeries or illnesses. [16] This trend is accentuated by advancements in the life expectancy of companion animals and the rise in chronic conditions often linked to movement disorders. [17] The American Association of Rehabilitation Veterinarians defines animal physical rehabilitation as the “diagnosis and management of patients with painful or functionally limiting conditions, particularly those with injury or illness related to the neurological and musculoskeletal systems.” [18]
Similar observations were made in a retrospective analysis of 5,195 integrative patient treatment sessions in a veterinary academic teaching hospital, with 39% involving a combination of therapeutic modalities. Among 274 patients receiving multiple modalities, neurologic and orthopedic diseases were the prominent concerns: 50.7% and 49.6%, respectively. Older neutered or spayed dogs, particularly Dachshunds, were more frequently treated, with common modalities including ACP, laser therapy, electro-ACP, and hydrotherapy (> 50% of patients). [19]
The overarching objective of rehabilitation is to alleviate pain, reduce edema, facilitate tissue healing, restore gait and mobility, rebuild strength, prevent further injury, and enhance overall quality of life. [20] A foundational understanding of the anatomy of animals, such as canines, felines, and equines, is imperative for formulating safe and effective rehabilitation plans. The ideal rehabilitation strategy involves a comprehensive patient assessment to identify musculoskeletal or neurological impairments, discern TCVM patterns, address pain, and employ a combination of rehabilitation therapies (ACP, manual therapy [MT], and therapeutic exercises), along with herbal and pharmaceutical supplements. Additionally, commonly utilized therapeutic modalities encompass cryotherapy, thermotherapy, photobiomodulation, and electrical stimulation.
Therapeutic exercises, whether on land or in water, serve as the linchpin of veterinary rehabilitation, irrespective of the specific problem or diagnosis. Regular reassessment intervals are vital for monitoring the patient’s progress. For a more in-depth exploration of various facets of veterinary rehabilitation, readers are directed to the comprehensive information provided by Koh and Huntingford. [21]
Manual Therapies
Manual therapy is a comprehensive term encompassing veterinary manipulative therapy, massage, touch, osteopathy, and related techniques. [22] Manual therapy involves a skilled, specific hands-on approach utilized by clinicians and therapists to address soft tissues, joints, and nerves of diverse etiologies. The primary objectives of MT are to induce relaxation, enhance circulation, alleviate muscle tension, diminish pain, increase the flexibility of soft tissues, and restore joint mobility. [23] The precise therapeutic mechanism behind MT is not fully elucidated, likely involving a combination of physiological, biomechanical, physical, and psychological effects. [24]
Physiologically, MT may reduce pain through the pain gate theory and stimulate descending inhibitory tracts, leading to pain inhibition and tissue relaxation. [25] Biomechanically, MT can alter tissue extensibility and fluid dynamics by mechanically pressuring and mobilizing soft tissues and joint capsules, thereby facilitating tissue repair and remodeling and improving tissue function. [26]
While MT plays a vital role in the rehabilitation of many patients, there is a scarcity of studies validating its clinical benefits in animals. Two studies [27, 28] suggest that MT, in combination with ACP, may be effective and safe for improving pain relief, physical function, and quality of life in dogs with degenerative diseases, chronic pain, or musculoskeletal pain.
A survey of equine practitioners revealed a generally positive view of MT therapies, with over half referring owners to veterinary chiropractic (manipulative therapy) or massage.29 The reason for equine practitioners’ patient referrals is not entirely clear but may be linked to an understanding of the importance of soft tissue pathology or due to the restrictions on certain drug therapies in performance horses. [30] Studies in horses suggest increased tolerance to pressure and improved vertebral flexibility following spinal manipulative therapy. [31] Massage of equine hind limb muscles has been shown to increase active and passive protraction. [32]
Massage therapy
Massage therapy, defined by Hippocrates as “the art of rubbing,” boasts an extensive history dating back to 2,500 BC, making it one of the earliest documented treatment modalities. [33] Initially described in China, ancient Greeks and Indians also practiced massage, but it was the Roman Empire that notably embraced massage therapy for sports and war injuries. [34, 35] For detailed massage techniques and descriptions, readers are referred to Maler. [33]
Tui-na
Tui-na (pronounced twee-nah) is a Chinese MT used for preventing and treating disease. Tui-na practitioners use various manipulations applied to ACP points (acupoints) and Meridians as well as special limb-stretching movements to prevent and treat diseases. [36] Traditional Chinese veterinary medicine practitioners, from the novice to the senior clinician, can use this unique modality to help more animals.
Tui-na is generally very safe to practice on animals, and they also tend to enjoy the administration of Tui-na techniques. It is especially well suited for fractious or anxious patients or those with an aversion to needles. Tui-na can be effectively used alone for soft tissue injury, pain management, and anxiety. It can also enhance the effects of ACP and herbal medicine for a variety of chronic illnesses. [37] Many Tui-na techniques can be applied as a tool for TCVM pattern diagnosis, which is central to TCVM practice. In addition, it is a tool that can be taught to caregivers to enhance the human-animal bond. [37]
Integrative Nutrition
The timeless maxim “Let food be thy medicine and medicine be thy food” often underscores the pivotal role of nutrition in maintaining optimal health. In the realm of veterinary medicine, contemporary clinical assessment guidelines underscore the significance of nutritional evaluation, with conventional veterinary nutrition forming a cornerstone of the veterinary curriculum. [38]
Embracing an integrative approach to veterinary nutrition empowers practitioners to craft tailored, all-encompassing nutrition plans for each patient. This involves drawing from both established and emerging insights into nutrition and supplements, strategically employed for both nutritional support and therapeutic purposes. [39]
Nutritional assessment and intervention are seamlessly integrated with other IVM modalities, such as physical rehabilitation and sports medicine. Dietary modification can improve performance, preserve lean body mass, reduce inflammation, and improve recovery from injury. [40] Notably, the pet owners seeking physical rehabilitation for their pets commonly grapple with the issue of being overweight or obese. Therefore, a comprehensive exploration of the physiological implications and contemporary guidelines for managing obesity is pertinent. [41–43] The role of diet in various diseases, especially in cancer, has been reported. [44]
Beyond the realm of nutrition’s direct impact on the musculoskeletal system, its interplay with other bodily systems is worth examining. For instance, TCVM emphasizes the incorporation of food therapy as an energetic approach to diets applied by IVM practitioners in their dietary recommendations. Explaining all the details of TCVM’s food therapy is beyond the scope of this article; readers are encouraged to explore the comprehensive insights provided by Fowler and Xie. [45]
Botanical and Herbal Medicine
Herbal medicine, also known as botanical medicine, involves the utilization of plants or plant derivatives with medicinal or therapeutic effects on the body. This encompasses the use of entire plants or specific parts, such as flowers, berries, leaves, stems, and roots, which may contain various active constituents producing therapeutic effects. [46] The application of herbal supplements is on the rise among veterinarians and pet owners, with a notable prevalence in veterinary oncology. [47, 48] Traditional medical systems, including Chinese, Western, Ayurvedic, and indigenous North American practices, incorporate natural products into treatments. Plant-derived products offer potential avenues for drug discovery, exemplified by the reported effects of medical mushrooms on cancer. [49] A Chinese herbal researcher was awarded a Nobel Prize in medicine for the discovery of Artemisia derivatives, now utilized in treating resistant malarial infections in humans. [50, 51] Silymarin, a derivative of milk thistle, is commonly prescribed by veterinarians for hepatic diseases. [50, 51] Numerous publications detail hundreds of herbs and herbal combinations for animal use, drawing from case reports, clinical experience, expert opinions, or data from other species. [52]
Conclusions
In conclusion, IVM represents a progressive approach that blends conventional Western veterinary practices with complementary therapies, driven by the growing interest of humans and animal owners. The term “integrative” reflects a preference over “alternative” or “holistic,” aligning with the broader shift observed in medical practices.
The diverse spectrum of IVM includes ACP, physical rehabilitation, manual therapies, integrative nutrition, and herbal medicine. Acupuncture, rooted in ancient Chinese practices, employs fine needles to stimulate the body’s healing abilities. Physical rehabilitation is crucial for animals with mobility issues, emphasizing a comprehensive approach to veterinary care. Manual therapies involve hands-on techniques to address soft tissues and joints, contributing to pain reduction and improved mobility. Integrative nutrition recognizes the role of tailored diets in promoting overall health. Herbal medicine offers therapeutic benefits in veterinary treatments.
In essence, IVM strives to provide comprehensive, evidence-based care that integrates the best of conventional and complementary approaches for the well-being of animal patients. The evolving landscape of IVM necessitates ongoing education to ensure that veterinarians are adept at navigating this integrative paradigm.
Disclosures
The authors have nothing to disclose. No AI-assisted technologies were used in the composition of this manuscript.
Funding
The authors have nothing to disclose.
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