Evidence for the efficacy of complementary and alternative medicines in the management of fibromyalgia: A systematic review
Aberdeen Pain Research Collaboration (Epidemiology Group), School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK. Rheumatology (Oxford, England)
(Impact Factor: 4.48).
03/2010; 49(6):1063-8. DOI: 10.1093/rheumatology/keq025
To critically evaluate the evidence regarding complementary and alternative medicines (CAMs) taken orally or applied topically for the treatment of FM.
Randomized controlled trials of FM using CAMs, in comparison with other treatments or placebo, published in English up to March 2009, were eligible for inclusion. They were identified using systematic searches of bibliographic databases and manual searching of reference lists. Information was extracted on outcomes, and statistical significance, in comparison with alternative treatment or placebo, and side effects were reported. The methodological quality of the primary studies was determined.
Single studies on four CAMs, and three on different approaches to homeopathic care were identified. Their methodological quality was moderate. The homeopathy studies were small, but each reported an improvement in pain. The effects of anthocyanidins, capsaicin and S-adenosylmethionine each showed at least one statistically significant improved outcome compared with placebo. However, the studies of anthocyanidins and capsaicin only demonstrated an improvement in a single outcome, sleep disturbance and tenderness, respectively, of several outcomes considered. No evidence of efficacy was found regarding Soy in a single study. Most of these CAMs were free of major adverse effects and usually associated with only minor adverse effects such as dizziness, nausea and stomach upsets.
There is insufficient evidence on any CAM, taken orally or applied topically, for FM. The small number of positive studies lack replication. Further high-quality trials are necessary to determine whether these initial findings can be supported by a larger evidence base.
Available from: viha.ca
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ABSTRACT: <⁄span> Recent neurophysiological evidence attests to the validity of fibromyalgia (FM), a chronic pain condition that affects >2% of the population.
<⁄span> To present the evidence-based guidelines for the diagnosis, management and patient trajectory of individuals with FM.
<⁄span> A needs assessment following consultation with diverse health care professionals identified questions pertinent to various aspects of FM. A literature search identified the evidence available to address these questions; evidence was graded according to the standards of the Oxford Centre for Evidence-Based Medicine. Drafted recommendations were appraised by an advisory panel to reflect meaningful clinical practice.
<⁄span> The present recommendations incorporate the new clinical concepts of FM as a clinical construct without any defining physical abnormality or biological marker, characterized by fluctuating, diffuse body pain and the frequent symptoms of sleep disturbance, fatigue, mood and cognitive changes. In the absence of a defining cause or cure, treatment objectives should be patient-tailored and symptom-based, aimed at reducing global complaints and enhancing function. Healthy lifestyle practices with active patient participation in health care forms the cornerstone of care. Multimodal management may include nonpharmacological and pharmacological strategies, although it must be acknowledged that pharmacological treatments provide only modest benefit. Maintenance of function and retention in the workforce is encouraged.
<⁄span> The new Canadian guidelines for the treatment of FM should provide health professionals with confidence in the complete care of these patients and improve clinical outcomes.
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ABSTRACT: This study tests several assumptions about the adoption and
implementation of electronic communication media (ECM) in organizations.
The assumptions are based on earlier work in ECM and studies of
organizational communication. The actual study involves the
administration of a survey instrument (long and short versions) to a
total of 600 ECM account holders at an urban mid-eastern university. The
survey determined not only self-reported use of the system but also the
managerial role held by each user and their feelings on organizational
climate and other factors. Results show that ECM is used for
disseminators in organizations, that formal pressure can be used in
organizations to help coerce nonusers to adopt ECM, and that ECM is
considered a good support tool for task-related behavior
System Sciences, 1989. Vol.IV: Emerging Technologies and Applications Track, Proceedings of the Twenty-Second Annual Hawaii International Conference on; 02/1989
Free Radical Biology and Medicine 01/2010; 49. DOI:10.1016/j.freeradbiomed.2010.10.516 · 5.74 Impact Factor
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