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Homeopathic remedies for the treatment of osteoarthritis: A systematic review
Abstract
Osteoarthritis is a common rheumatic disease. Limitations of conventional medical management of this condition indicate a real need for safe and effective treatment of osteoarthritic patients. The authors review the clinical evidence for and against the effectiveness of homeopathic medicines in the treatment of patients with osteoarthritis. A systematic review of all randomised controlled clinical trials of homeopathic treatment of patients with this condition is presented. A comprehensive search yielded four trials which are discussed in detail. The authors conclude that the small number of randomised clinical trials conducted to date, although favouring homeopathic treatment, do not allow a firm conclusion as to the effectiveness of homeopathic remedies in the treatment of patients with osteoarthritis. The clinical evidence appears promising, however, and more research into this area seems warranted.
... It is estimated that around 30-41% of adults with arthritis in the US are CAM users [9][10][11][12]. Various modalities of CAM are commonly used for the treatment of arthritis such as homeopathy, acupuncture, naturopathy, chiropractic or osteopathic manipulation, and massage [12][13][14][15][16][17]. e main predicting factors for CAM use among adults with arthritis were believed to be the lack of effectiveness of conventional therapy [18], joint pain, and poor functional status [12]. ...
... AOR: adjusted odds ratios; CI: confidence interval; CAM: complementary alternative medicine; ref: reference group. [13][14][15][16]. For instance, a systematic review of forty-three studies has evaluated the safety and efficacy of acupuncture for arthritis. ...
Objective:
To examine the association between sex and the use of complementary and alternative medicine (CAM) among adults with arthritis.
Methods:
Data from the 2012 National Health Interview Survey on CAM use for adults with arthritis were analyzed. Five different multivariable regression models were used to examine the association between sex and CAM use after adjusting for demographics, socioeconomics, perceived health status, functional limitations, comorbid chronic conditions, body mass index, and personal health practices.
Results:
The number of subjects who met the eligibility criteria and were eventually included in the study was 7,919 adults with arthritis. Around half of the study sample reported ever using CAM (n = 4,055), and about 27% (n = 2,016) reported using CAM in the past 12 months. Women have a significantly higher rate of ever utilization of CAM compared to their male counterparts (62.2% vs. 37.8%) as well as CAM use over the past 12 months (66.1% vs. 33.9%). After controlling for other covariates that can potentially affect the use of CAM, women had higher odds of ever using CAM (AOR = 1.68, 95% CI = 1.55-1.81) as well as the CAM use in the past 12 months (AOR = 1.63, 95% CI = 1.49-1.78) compared to men. Functional limitation and multiple comorbidities were associated with CAM use among women.
Conclusions:
The utilization rate of CAM among women with arthritis is significantly higher compared to their male counterparts, which highlights the need to screen adults with arthritis, particularly women, for potential drug-CAM interactions. Also, practicing patient-centered care is important, which should allow the patients to discuss the potential benefits and risks of CAM use with their healthcare providers.
... The dominance of psora sycosis miasm in this study highlights the complexity of OA and the need for anti-miasmatic approaches in homoeopathy. Rhus Toxicodendron was effective in the management of OA before and after the intervention of Thuja which corresponds with the review study on homoeopathic remedies used in the treatment of OA, in 2001 [10] . The findings of this study in a sample of 30 cases suggest that Thuja occidentalis has the potential to enhance the outcomes of homoeopathic treatment for OA. ...
... 5 The interventional treatment for knee OA mostly includes topical or oral nonsteroidal anti-inflammatory drugs and short-term use of intra-articular steroid injections. 6 Considering the longterm use of conventional medications and various side effects associated with it, there is an increasing tendency for the use of complementary and alternative medicine therapies for the treatment of knee OA. [7][8][9][10] The American College of Rheumatology/Arthritis Foundation Guideline 2019 recommends yoga, acupuncture and tai-chi in the management of knee OA. 11 Despite some promising results in homeopathy, quality research is scarce in support of individualized homeopathic medicines (IHMs) in the treatment of knee OA. [12][13][14][15][16][17][18][19] The majority of the conducted research has focused on the use of non-IHMs rather than IHMs. Thus, with a dearth of conclusive evidence, this feasibility trial was planned to explore the effects of IHMs beyond placebos and to address the feasibility issues of pursuing a larger and definitive trial of knee OA in the future. ...
Introduction This study aimed at examining the feasibility issues of comparing individualized homeopathic medicines (IHMs) with identical-looking placebos for treating knee osteoarthritis (OA).
Methods Forty eligible patients participated in this double-blind, randomized (1:1), placebo-controlled feasibility trial in the outpatient clinics of a homeopathic hospital in West Bengal, India. Either IHMs or identical-looking placebos were administered, along with mutually agreed-upon concomitant care guidelines. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was the primary outcome measure, and derived Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores from KOOS, EQ-5D-5L questionnaire, and Visual Analog Scale (VAS) were the secondary outcomes; all measured at baseline and after 2 months. Group differences and effect sizes (Cohen's d) were estimated using an intention-to-treat approach. p-Values less than 0.05 (two-tailed) were considered statistically significant.
Results Enrolment/screening and trial retention rates were 43% and 85% respectively. Recruitment was difficult owing to the coronavirus disease 2019 (COVID-19) lockdown. Group differences were statistically significant, favoring IHMs against placebos in all the KOOS sub-scales: symptoms (p < 0.001), pain (p = 0.002), activities of daily living (p < 0.001), sports or recreation (p = 0.016), and quality of life (p = 0.002). Derived WOMAC scores from KOOS favored IHMs against placebos: stiffness (p < 0.001) and pain (p < 0.001). The EQ-5D-5L questionnaire score (p < 0.001) and EQ-5D-5L VAS scores (p < 0.001) also yielded significant results, favoring IHMs over placebos. All the effect sizes ranged from moderate to large. Sulphur was the most frequently prescribed homeopathic medication. Neither group reported any harm or serious adverse events.
Conclusion Although recruitment was sub-optimal due to prevailing COVID-19 conditions during the trial, the action of IHMs was found to be superior to that of placebos in the treatment of knee OA. Larger and more definitive studies, with independent replications, are required to substantiate the findings.
Trial registration: CTRI/2021/02/031453.
... Clinical study with homeopathic calcium (medium-potency calcium) showed increase in bone density in post-menopausal women [16]. Clinical studies with homeopathic formulations composed of Rhus toxicodendron showed positive trend towards the effectiveness on osteoarthritis patients [17]. Another clinical study reported in the homeopathy treatment showed significant improvement in fracture line, fracture edge and fracture union [18]. ...
Bone is a dynamic organ and plays crucial role in maintaining skeletal functions. The maintenance of bone is a continuous process
... Clinical study with homeopathic calcium (medium-potency calcium) showed increase in bone density in post-menopausal women [16]. Clinical studies with homeopathic formulations composed of Rhus toxicodendron showed positive trend towards the effectiveness on osteoarthritis patients [17]. Another clinical study reported in the homeopathy treatment showed significant improvement in fracture line, fracture edge and fracture union [18]. ...
Air leaks in the ventilatory circuit pose a significant challenge in anesthesiology and critical care settings, originating from several common and uncommon causes. In this case report, we highlight an unusual instance of air leakage attributable to the incidental insertion of an esophageal temperature probe into the trachea. Video laryngoscopy played a pivotal role in diagnosing the air leak. It is imperative for anesthesiologists to consider all oral and nasal devices in case of circuit leakage.
... Osteoarthritis (OA) is the degenerative rheumatic disease of articular cartilage and eventual loss of joint space [1] . According to estimates, OA is the tenth most common reason for nonfatal burden with the prevalence up to 40% in India. ...
To assess the evidence for homoeopathic medication taken orally in variouspotencies in the treatment for osteoarthritis. Randomized clinical trials as well as animal experiments comparing homoeopathic medicine to placebo or alternative therapies for osteoarthritis (OA) were considered for inclusion. Systematic database searches and manual backtracking through reference list were used to find them. Information on the result, statistical significance, comparison to the placebo or alternative treatment, and side effects were retrieved. The primary studies methodological caliber was assessed until January 2023. In this review, four trials were chosen, and three of them found evidence that the centesimal scale of potency was successful in treating OA. One study had potency on a decimalscale. The majority of the research design substances investigated lacked significant negative effects. The so-called most recent and fresh form of potencies, 50 millesimal (LM scale) has notyet been researched.As conclusion, we were unable to reach any conclusions regarding the proper scale of potency because the data from the published articles was so limited due to the dearth of randomized controlled trials in the field. It is expected that research would increase and focus in particular on the practical applicability of homoeopathic medicine in various potencies
... Foto do comprimento intestinal total em ratos Wistar infectados com 5x10 6 formas tripomastigotas da cepa y de T. cruzi aos 315 dias de infecção para os diferentes grupos experimentais: CI-Controle infectado e tratado com solução hidroalccólica 7% (etanolágua), grupo LY-infectado e tratado com Lycopodium diluição 1:1x10 26 , grupo PH-infectado e tratado com Phosphorum diluição 1:1x10 26 . A-PH animal 7, B-CI animal 10, C-LY animal 12. (SHIPLEY et al., 1983;DAVENAS et al., 1987;BILDET et al., 1989;POITEVEN et al., 1998;MESQUITA, 1998;ABEL et al., 2000;BONAMIN, 2001;WAINE, 2001;LONG & ERNST, 2001;STOCK-SCRÖER et al., 2009;FERRAZ, 2011 ...
A doença de Chagas causada pelo parasita Trypanosoma cruzi acomete milhões de pessoas no mundo e não conta com um medicamento de ação efetiva para o seu tratamento etiológico. As drogas disponíveis, o nifurtimox e o benznidazol possuem índices de cura baixos com efeitos colaterais e toxidade que dificultam a adesão dos pacientes à terapia. Este fato impulsiona a busca por alternativas de tratamento que sejam mais efetivas e menos agressivas. Sendo assim, este trabalho teve como objetivo a avaliação dos efeitos clínicos apresentados por Rattus norvergicus infectados por T. cruzi e tratados com soluções ultradiluídas de Lycopodium clavatum ou Phosphorus. O estudo envolveu 93 ratos com quarenta e cinco dias de idade infectados intraperitonealmente com 5x106 formas tripomastigotas sanguíneos da cepa Y de T. cruzi, distribuídos nos grupos: Sadio SD (n=13) - controle não infectado e não tratado, grupo CI (n=27) - controle infectado e tratado com solução hidroalccólica 7% (etanol – água), grupo LY diluição 1:1x1026 (n=27) - infectado e tratado com Lycopodium, grupo PH diluição 1:1x1026 (n=26) - infectado e tratado com Phosphorum. Os animais foram avaliados clinicamente através dos parâmetros peso, temperatura, consumo de água e ração, quantidade de excretas, diâmetro e comprimento intestinal, aspecto da pelagem e consistência das fezes. Este estudo mostrou que os parâmetros utilizados foram importantes para a definição clínica da infecção de Rattus novergicus, linhagem Wistar pelo T. cruzi. Mostrou que os medicamentos LY e PH apresentam efeitos benéficos na evolução da clínica dos animais tratados. A utilização de Lycopodium clavatum e Phosphorus diluídos na proporção de 1:1x1026, apresentaram efeitos diferentes. Oito e seis parâmetros de quatorze analisados mostraram efeitos positivos para LY e PH, respectivamente. Os parâmetros consumo de água e ração, quantidade de excretas, diarreia, alopecia difusa e comprimento intestinal apresentaram diferenças significativas em relação ao controle infectado mostrando que mais estudos são necessários com o uso de medicamentos ultradiluídos na infecção pelo T. cruzi.
... Activities such as water aerobics (Silva et al. 2008), physiotherapy, and strength training are well known to increase the stability and strength of the affected joints and muscles (Bannuru et al. 2019;Hochberg et al. 2012). Intermittent cold and hot therapy, when paired with more alternative therapeutic choices like acupuncture, yoga, and homeopathic remedies (Long and Ernst 2001) like arnica, bryonia, and calcium carbonate, can also supplement as treatment options to provide temporary relief for joint pain and stiffness (Connelly et al. 2015;Bannuru et al. 2019;Hochberg et al. 2012). ...
Aging is a multifactorial process that encompasses a wide range of physiological
implications including onset of age- associated diseases and eventually death. Although recent years have seen a surge in the number of anti- aging interventions after the elucidation of the hallmarks of aging, a special attraction for gerontologists is the dietary restriction interventions which comprise caloric restriction (CR) and intermittent fasting (IF) strategies. CR is the reduction in calorie intake by 30-40% without causing malnutrition and improves health and increases lifespan in many model organisms. An alternative to CR is Intermittent Fasting, another DR intervention widely popular since ancient times in the form of religious fasting that is now being scientifically explored for its ability to impact metabolism in a way that is beneficial in reducing age- associated ailments and overall health and physiology. IF exerts its action through the activation of bioenergetics sensors and genes associated with longevity like AMPK and sirtuins. Some of the health benefits of fasting include reduction in body weight and obesity, and reduced incidence of diseases like cancer, cardiovascular disorders, neurodegeneration, inflammation and metabolic syndrome. The ketogenic diet and mediterranean diet are amongst the variants that are widely popular as IF regimen today.
... Calcarea Flourica (CF) is one of the homoeopathic medicines for osteoarthritis, but research confirmation remains scarce. The drawbacks and negative effects of traditional medical treatment express concerns about osteoarthritis treatment being safe and efficient [17] .A study found that there are no gastrointestinal toxicity or other side effects associated with homoeopathic treatment [18] , and the few clinical trials that have been done to far favour homoeopathic treatment for individuals with osteoarthritis [19] . According to van Wassenhoven M, homoeopathy has a significant role in the management of arthritic conditions [20] . ...
Background: Osteoarthritis is characterized by the destruction of joint cartilage. As the cartilage deteriorates, the bones of the joint begin to push against each other, causing pain and stiffness, often hindering or limiting movement. The joints which bear most of the weight of body is affected by osteoarthritis such as hip, knee, vertebra, and hand, it is a disease of cartilage in which interleukin play an important role. Materials and methods: This prospective, open label, randomized controlled trial was conducted at Govt. Medical Homeopathic College, Bhopal, and Madhya Pradesh over a period of one year. A total of 60 patients with Osteoarthritis were randomized to receive Individualised Homoeopathic medicine (IH) or Calcarea Flourica 6X (CF) and outcome assessment was done using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) & Numerical Rating Scale (NRS) scales. Result: Our study observed that WOMAC score at baseline, there was no significant difference in WOMAC score between IH and CF group (76.23±3.90 vs. 76.06±3.70; p = 0.866). Conclusion: Both Individualized homeopathic treatment as well as Calcarea Fluor are effective in reducing pain and functional outcomes in patients with osteoarthritis. However, individualized homeopathic treatment provided a better efficacy than Calcarea Fluor.
... However, a small number of trials performed to date precludes a firm conclusion. [21] Some documents show doubt about the reproducibility of homoeopathy in rheumatic diseases, double-blind, randomised and controlled pilot study of OA with homoeopathy did not appear superior to placebo and suggested larger multicentric, randomised and controlled trials. [22] Get. is not used frequently by homoeopathic practitioners. ...
Introduction: Rheumatism alludes to various painful medical conditions which influence joints, bones, ligaments, tendons and muscles. It is also called musculoskeletal disease which is portrayed by pain and a gradual diminishing in the range of motion and function, in one or more areas of the musculoskeletal structure. In a few specific diseases, there are indications of inflammation, swelling, redness and warmth in the influenced zones like in osteoarthritis (OA), rheumatoid arthritis, etc.
Cases Summary: Four cases of Osteoarthritis were treated with Gettysburg water (Get.) as a potentised homoeopathic medicine. Each case was followed up with clinical observation and reported according to the criteria of the HOM-CASE guidelines. Assessment of homoeopathic treatment and its effect was carried out using the visual analogue scale (VAS) during every visit. Improvement in all cases was evident from the reduction of pain in the affected joints and relief in other associated symptoms within 2–6 months of treatment. VAS scores for the cases ranged from 8 to 4 in all cases. Complaints associated with chronic OA were relieved by potentised Get. This case series has shown promising outcomes and a further high-quality clinical trial is needed for the establishment of effectiveness data for the said medicine.
... Various studies have been done using individualised homoeopathic medicine selection based either on the totality of characteristic symptoms as per Hahnemann or general symptoms as per Kent. [28][29][30] There are research studies available on the role of personality in general and five-factor model of personality in particular in patients suffering from osteoarthritis. However, so far no works of literature available in peer-reviewed journals on valid attempts of linking personality with homoeopathic medicine selection. ...
Background: Individualisation is the process of arriving at the image of the patient for the selection of remedy. The customary way of individualisation of the patient is through the construction of totality of symptoms. The little explored area in Homoeopathy is individualisation solely based on personality characteristics. Objective: The objective of this study was to compare the effect of individualised homoeopathic medicine administered based on totality of symptoms vis-à-vis personality in patients suffering from knee osteoarthritis. Methods: The observational study includes 60 clinically diagnosed cases of osteoarthritis knee, of which 30 cases were administered the homoeopathic medicine selected on the basis of totality of symptoms and thirty cases based on personality. Randomisation was done using computer-generated numbers. The personality of the patients was assessed through the 44-item Big-Five Inventory. A self-made tool, transcribing trait items to rubrics of the homoeopathic repertory, was prepared. The knee osteoarthritis scores on physical function, pain and patient global estimate in Routine Assessment of Patient Index Data 3 (RAPID3) sheet, before and after treatment, were compared. Results: The paired difference mean of RAPID3 in totality of symptom-based administration was 4.06 and for personality-based administration was 1.92 with a standard deviation of 3.91 and 3.29, respectively. The test result is statistically significant at 0.05 level (P < 0.05). Conclusion: Administration of individualised Homoeopathy medicine based on totality of symptoms is found to be more effective as compared to individualised Homoeopathy medicine based on personality amongst patients suffering from osteoarthritis knee.
... Homeopathic treatment has been proven to provide relief from sign and symptoms of arthritic disorders as seen by the literature review from a large number of case reports [4][5][6][7][8][9][10]. Abundant references are available in homeopathic textbooks and repertories related to joint disorders. ...
Objective:
The objectives of the study were to clinically evaluate the role of Rhus toxicodendron, a homoeopathic medicine, in its various attenuations (Q, 30C, 200C, 1M) prescribed as a single medicine or with other homeopathic medicines for relieving the signs and symptoms of arthritic disorders and also to determine their useful potencies, frequency of administration and building up a new dose repetition protocol and guidelines for practice.
Methods:
It was a multi-centric, observational study carried out between the years 2016-2018. A total of 91 patients with arthritic disorder were selected according to the pre-defined parameters. The detailed case recording was done for each case and the patients were monitored for assessing the status of their condition according to the pre-defined criteria and the results were evaluated.
Results:
Out of the 91 patients, 78 patients improved in varying degrees with marked improvement seen in 34 patients, moderate in 27 patients and mild in 17 patients. No improvement was seen in 13 patients.
Conclusion:
Outcome of the study shows that homeopathic medicines are useful in managing arthritic disorders. However, further study with predefined laboratory and radiological investigation needs to be conducted. Other objectives of the study which included identifying the most useful potencies of Rhus toxicodendron and their frequency of administration could not be achieved. From the available results, a dose repetition observation has been provided and further study for new repetition protocol and guidelines is being formulated for conducting further trials.
... Homeopathic treatment has been proven to provide relief from sign and symptoms of arthritic disorders as seen by the literature review from a large number of case reports [4][5][6][7][8][9][10]. Abundant references are available in homeopathic textbooks and repertories related to joint disorders. ...
Objective: The objectives of the study were to clinically evaluate the role of Rhus toxicodendron, a homoeopathic
medicine, in its various attenuations (Q, 30C, 200C, 1M) prescribed as a single medicine or with other homeopathic
medicines for relieving the signs and symptoms of arthritic disorders and also to determine their useful potencies,
frequency of administration and building up a new dose repetition protocol and guidelines for practice. Methods:
It was a multi-centric, observational study carried out between the years 2016-2018. A total of 91 patients with
arthritic disorder were selected according to the pre-defined parameters. The detailed case recording was done for
each case and the patients were monitored for assessing the status of their condition according to the pre-defined
criteria and the results were evaluated. Results: Out of the 91 patients, 78 patients improved in varying degrees with
marked improvement seen in 34 patients, moderate in 27 patients and mild in 17 patients. No improvement was seen
in 13 patients. Conclusion: Outcome of the study shows that homeopathic medicines are useful in managing arthritic
disorders. However, further study with predefined laboratory and radiological investigation needs to be conducted.
Other objectives of the study which included identifying the most useful potencies of Rhus toxicodendron and their
frequency of administration could not be achieved. From the available results, a dose repetition observation has been
provided and further study for new repetition protocol and guidelines is being formulated for conducting further trials.
... [167] La Biblioteca Cochrane no halló suficiente evidencia clínica para evaluar la eficacia de los tratamientos homeopáticos para el asma, 18 la demencia, 19 trastorno por déficit de atención con hiperactividad 20 o la inducción del parto. 21 Otros investigadores no encontraron evidencia de que la homeopatía sea beneficiosa para la osteoartritis, 22 las migrañas, 23,24,25 el dolor muscular de aparición tardía 26 o el eccema. 27 En un artículo de 2012 publicado en Skeptical Inquirer, 28 Edzard Ernst analizó las publicaciones del grupo de investigación que ha publicado la mayoría de los estudios clínicos del tratamiento homeopático entre los años 2005 y 2010. ...
Resumen clínico de meta-análisis Cochrane sobre la homeopatía.
... Сторонники метода обосновывают его действие ненаучным принципом «биологической энергетической памяти воды». Следует отметить, что практически все хорошо организованные РКИ показали отсутствие разницы между эффектом гомеопатических препаратов и ПЛ [218][219][220][221]. ...
The main manifestation of joint and spine diseases, such as osteoarthritis, nonspecific back pain, and soft tissue rheumatic disorders, is musculoskeletal pain (MSP). It leads to considerable morbidity as well as temporary and permanent disability in millions of people of our country. These people need adequate medical care and most significantly a
prompt and maximally complete analgesia. Unfortunately, serious problems are being faced in this field of medicine.
The lack of a unified approach or continuity in the therapeutic process, inadequate knowledge of the pathogenesis of
MSP and of the possibilities of its therapy may substantially hamper the work of practitioners.
The meeting of Russian experts who were represented in different medical specialties and discussed the optimization
of MSP treatment policy was held in Moscow on 20 June 2015. According to the results of the meeting, the authors
identified the main points regarding the theoretical and practical aspects of MSP and also proposed an algorithm for
the treatment of this pathology. It seems that the use of this algorithm will be able to facilitate the work of practitioners
and to enhance the efficiency and safety of analgesic therapy.
... Some systematic reviews (SRs) of homeopathy have focused on specific clinical conditions, typically examining placebo-controlled trials, with conclusions about efficacy of homeopathic medicines that are variously positive, 4-6 negative [7][8][9] or non-conclusive. [10][11][12] Other SRs have adopted a 'global' or 'comprehensive' approach, examining the RCT research literature on homeopathy in general, including the broad spectrum of clinical conditions that have been researched, and by all forms of homeopathy. Most of these comprehensive SRs reached the cautious conclusion that, overall, the effect of a homeopathic medicine differs from that of placebo. ...
Background This study focuses on randomised controlled trials (RCTs) of individualised homeopathic treatment (IHT) in which the control (comparator) group was other than placebo (OTP).
Aims To determine the comparative effectiveness of IHT on health-related outcomes in adults and children for any clinical condition that has been the subject of at least one OTP-controlled trial. For each study, to assess the risk of bias and to determine whether its study attitude was predominantly ‘pragmatic’ or ‘explanatory’.
Methods Systematic review. For each eligible trial, published in the peer-reviewed literature up to the end of 2015, we assessed its risk of bias (internal validity) using the seven-domain Cochrane tool, and its relative pragmatic or explanatory attitude (external validity) using the 10-domain PRECIS tool. We grouped RCTs by whether they examined IHT as an alternative treatment (study design Ia), adjunctively with another intervention (design Ib), or compared with a no-intervention group (design II). For each RCT, we identified a ‘main outcome measure’ to use in meta-analysis: ‘relative effect size’ was reported as odds ratio (OR; values >1 favouring homeopathy) or standardised mean difference (SMD; values < 0 favouring homeopathy).
Results Eleven RCTs, representing 11 different medical conditions, were eligible for study. Five of the RCTs (four of which in design Ib) were judged to have pragmatic study attitude, two were explanatory, and four were equally pragmatic and explanatory. Ten trials were rated ‘high risk of bias’ overall: one of these, a pragmatic study with design Ib, had high risk of bias solely regarding participant blinding (a bias that is intrinsic to such trials); the other trial was rated ‘uncertain risk of bias’ overall. Eight trials had data that were extractable for analysis: for four heterogeneous trials with design Ia, the pooled OR was statistically non-significant; collectively for three clinically heterogeneous trials with design Ib, there was a statistically significant SMD favouring adjunctive IHT; in the remaining trial of design 1a, IHT was non-inferior to fluoxetine in the treatment of depression.
Conclusions Due to the low quality, the small number and the heterogeneity of studies, the current data preclude a decisive conclusion about the comparative effectiveness of IHT. Generalisability of findings is limited by the variable external validity identified overall; the most pragmatic study attitude was associated with RCTs of adjunctive IHT. Future OTP-controlled trials in homeopathy should aim, as far as possible, to promote both internal validity and external validity.
... Homeopathic physicians must know the four basic types of homeopathy:, clinical homeopathy, classical homeopathy, isopathy, and complex homeopathy. For chronic diseases such as osteoarthritis, the `classical' homeopathic approach is mostly in practice [52]. Regarding the efficacy of classical homeopathy there is a great need of more research, particularly for differentiating treatment effects [53]. ...
Background: Efficacy of homeopathic remedies is still a topic of discussion because homeopathic remedy has always been a matter of bitter controversy. Now a day’s, homeopathy in one of the most recognized and safe form of treatment practiced worldwide, other than many conventional medicines. Recently the issue has been addressed in various ways. In this systematic review we documented the evidence about the efficacy of homeopathic medicines.
Objective: The main objective of the study was to systematically review the evidence supporting efficacy of homeopathic remedies.
Methodology: Extensive computerized literature searches were performed. PubMed, Google scholar, science direct, and Medline were searched. Full length articles of clinical trials of homeopathic medicines were studied. All randomized double blind, placebo-controlled clinical trials and prospective observational studies were including. Human trials related articles were included and articles which were not related to our study were excluded. Animal studies, pilot studies, case series and review articles were not included in this study. We did not impose restrictions according to time of publication, assessed the articles according to predefined criteria.
Results: Total 155 articles were searched through different data bases. Initially, 66 full length articles were screened for our study, out of which 24 articles were excluded because pilot studies, case series and animal trials were not included in this review. Finally, 42 original research articles were assessed for this review.
Conclusion: We concluded that homeopathic remedies are effective to heal afflicted persons but still there is need to conduct more refined research to strengthen this evidence.
... The effectiveness of homeopathy in osteoarthritis is assessed in three systematic reviews [4,47,48] which include four controlled and randomised clinical trials, and a non-randomised trial, the five trials involving 998 patients. From four controlled clinical trials, the non-individualised prescription of Rhus toxicodendron 6X has a significantly lower effectiveness than that of an anti-inflammatory, but this non-individualised trial has been much criticised by homeopathic doctors, because it did not respect any rule of individualisation [20]. ...
The Australian government recently published a report investigating the effectiveness of homeopathy in many diseases, using as a source systematic reviews of clinical trials in homeopathy. The study of 57 systematic reviews enabled the analysis of 68 pathological conditions. However, this method leads to the exclusion of well conducted trials and sometimes to far too categorical analyses. Moreover, no homeopathic doctor with expertise on the subject took part in this work. Analysing each situation studied by the working group, we provide additional information and put forward proposals to determine in which areas controlled clinical trials or more pragmatic studies can be carried out.
... This is also a fact that homeopathy, due to lack of high quality evidence have some deficient area. For instance, in some of the clinical conditions homeopathy have inconclusive result such as Anxiety [83], Chronic asthma [84], Dementia [85], Depression [86], Headache and migraine treatment [87], HIV/AIDS [88], Induction of labor [89] and Osteoarthritis [90] whereas in other diseases such as Ailments of childhood and adolescence [91], Attention deficit hyperactivity disorder [92], Cancer [93], Delayed-onset muscle soreness [94], Headache and migraine prevention [95] and Insomnia [96], homeopathy have little or no evidence of treatment. The research in homeopathy may be focused and special attention should be provided towards diseases where little or no evidence of homeopathic treatment is present. ...
Background: Homeopathy, as an alternative treatment system for the treatment of various diseases, is widely used in various regions of the world. However the clinical benefits of homeopathy remains controversial. Aim of the Study: This review highlights the most up-to-date and current clinical trials and research carried out in the field of homeopathy and to compare its effectiveness in combating various diseases. Methodology: A retrospective literature search was performed from 2012 to 2017. All the articles, containing clinical trials in human subjects, were searched in different databases such as google scholar, science direct, web of science, Scopus, Springer Link and Sci Finder etc. using the keywords i.e. clinical trials in homeopathy, current clinical status of homeopathy, homeopathy and treatment of diseases, clinical cases in homeopathy and clinical studies in homeopathy. Results: Twenty one articles met the inclusion criteria and were included in this review. The results of these clinical studies showed an effective outcome for homeopathy treatment in various diseases such as atopic dermatitis, eczema, respiratory tract infections, asthma, hay fever and pulmonary tuberculosis etc. However, for some of the diseases such as depression, mental fatigue, cancer, HIV, anxiety, dementia, induction of labor, osteoarthritis, migraine and insomnia etc. no proper clinical evidence for a safe and effective use of homeopathy exists. Furthermore, the research quality of most the homeopathy clinical trials are objectionable and negatively analyzed by various authors in terms of sample size, reproducibility and replication of data as well as lack of proper guidelines for performing homeopathy research. Conclusion: To build credibility in health care system and attract more patients as well as professional practitioners towards this system of alternative treatment, more focus in terms of quality research and practically applicable clinical trials i.e. efficacy trials (near to optimal laboratory conditions) is needed.
... Participants who were given Rhus tox, reported a greater reduction in pain when walking and also showed reduction in the structural deformity as similar to the results of previous studies. 21,22 In this study, the effectiveness of Rhus tox in the treatment of OA of the knee was evaluated over a time period of 12 months in 30 patients fulfilling the case definition and inclusion criteria. The evaluation was based on improvement with respect to signs, symptoms and pathology (if present) and, on the statistical verification the scores were taken before and after treatment. ...
p class="abstract"> Background: Arthritis and rheumatism are among the commonest forms of chronic disease and, with an aging population, are set to become commoner still. Strictly speaking, arthritis means disease of the joints, while rheumatism is disease of the soft connective tissues which support and move the joints. There are many problems with current conventional treatment of arthritis and rheumatism. Although the new generation of NSAIDs is safer, they are only glorified painkillers, which do not affect the basic disease process. Similarly for rheumatoid arthritis, a range of powerful drugs is available but all of these have long and alarming lists of side effects. Thus the main aim of this research study is to prove the efficacy of Homoeopathy in managing cases of Osteoarthritis without any side-effects .
Methods: 30 cases were selected fitting the case definition. Age group of 45-79 years was chosen for the study. Inclusion and exclusion criteria were laid down. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Kellgren and Lawrence system of classifying the severity of knee-osteoarthritis were used to assess the severity and outcome.
Results: All the results were tabulated. Graphical presentation was made of all the observations. Scores before and after treatment was compared. It was found that there was vast difference in scores before and after treatment .
Conclusions: Rhus tox was found to be effective in managing cases of Osteoarthritis of Knee Joint . </p
... Retrospective studies and case histories suggest that recovery or clinical improvement may be achieved with homeopathic treatments for conditions such as osteoarthritis, ankylosing spondylitis and rheumatoid arthritis (116). A systematic review of the clinical evidence for and against the effectiveness of homeopathic remedies in the treatment of patients with osteoarthritis has been published (117). Its authors conclude that, although the small number of randomised clinical trials conducted thus far tend to favour homeopathic treatment, they do not provide any conclusive evidence as to the effectiveness of homeopathic remedies in the treatment of osteoarthritis patients. ...
... Arthrose L'efficacité de l'homéopathie dans l'arthrose est évaluée dans trois revues systématiques [4,47,48] qui incluent quatre essais cliniques contrôlés et randomisés, et un essai non randomisé, les cinq essais regroupant 998 patients. Parmi les quatre essais cliniques contrôlés, la prescription non individualisée de Rhus toxicodendron 6XH a une efficacité significativement inférieure à celle d'un anti-inflammatoire, mais cet essai non individualisé a été beaucoup critiqué par les médecins homéopathes, car il ne respectait aucune règle d'individualisation [20]. ...
Le gouvernement australien a récemment publié un rapport étudiant l’efficacité de l’homéopathie dans de nombreuses pathologies, ceci en utilisant, comme source, des revues systématiques relatives aux essais cliniques réalisés en homéopathie. L’étude de 57 revues systématiques a permis l’analyse de 68 états pathologiques. Cependant, cette méthode conduit à l’exclusion d’essais bien conduits et à des analyses parfois excessivement tranchées. De plus, aucun médecin homéopathe expert sur le sujet n’a participé à ce travail. Analysant chaque situation étudiée par le groupe de travail, nous apportons des informations complémentaires et effectuons des propositions afin de déterminer dans quels domaines des essais cliniques contrôlés ou des études plus pragmatiques peuvent être effectués.
... Retrospective studies and case histories suggest that recovery or clinical improvement may be achieved with homeopathic treatments for conditions such as osteoarthritis, ankylosing spondylitis and rheumatoid arthritis (116). A systematic review of the clinical evidence for and against the effectiveness of homeopathic remedies in the treatment of patients with osteoarthritis has been published (117). Its authors conclude that, although the small number of randomised clinical trials conducted thus far tend to favour homeopathic treatment, they do not provide any conclusive evidence as to the effectiveness of homeopathic remedies in the treatment of osteoarthritis patients. ...
... Em relação aos medicamentos homeopáticos, não há estudos suficientes para determinar sua efetividade. Entretanto, Long e Ernst, em estudo de revisão sistemática, concluíram que existe uma tendência positiva para a utilização desses medicamentos no tratamento da OA (47) . É necessária a realização de novos estudos para comprovar sua eficácia. ...
... However, scientific research has so far not provided evidences solid enough to support the effectiveness of CAM as treatment options for rheumatologic conditions including OA and has remained ambiguous 11 . Reviews have remained contradictory in conclusions [12][13][14][15][16][17][18] . Few low-potency homoeopathic complexes in the randomised controlled trials seemed to posses significant effects in OA 19 , but the potential of individualised homoeopathy remained untested. ...
Introduction Homoeopathy seems scientifically implausible and is the most controversial form of complementary and alternative medicine therapies. This review aims to summarise the treatment effects of homoeopathy in osteoarthritis.
... 6 Reviews have remained contradictory in conclusions. [7][8][9][10][11][12][13] Few low-potency homeopathic complexes in the randomized controlled trials seemed to have significant effects in osteoarthritis, 14,15 but the potential of individualized homeopathy remained untested so far. Hence, based on small to moderate effect sizes for the wide range of symptomatic treatments, conventional medicine in a personalized approach remains the mainstay of treatment. ...
Few homeopathic complexes seemed to produce significant effects in osteoarthritis; still, individualized homeopathy remained untested. We evaluated the feasibility of conducting an efficacy trial of individualized homeopathy in osteoarthritis. A prospective, parallel-arm, double-blind, randomized, placebo-controlled pilot study was conducted from January to October 2014 involving 60 patients (homeopathy, n = 30; placebo, n = 30) who were suffering from acute painful episodes of knee osteoarthritis and visiting the outpatient clinic of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, West Bengal, India. Statistically significant reduction was achieved in 3 visual analog scales (measuring pain, stiffness, and loss of function) and Osteoarthritis Research Society International scores in both groups over 2 weeks (P < .05); however, group differences were not significant (P > .05). Overall, homeopathy did not appear to be superior to placebo; still, further rigorous evaluation in this design involving a larger sample size seems feasible in future. Trial registration: Clinical Trials Registry, India (CTRI/2014/05/004589).
© The Author(s) 2015.
... Retrospective studies and case histories suggest that recovery or clinical improvement may be achieved with homeopathic treatments for conditions such as osteoarthritis, ankylosing spondylitis and rheumatoid arthritis (116). A systematic review of the clinical evidence for and against the effectiveness of homeopathic remedies in the treatment of patients with osteoarthritis has been published (117). Its authors conclude that, although the small number of randomised clinical trials conducted thus far tend to favour homeopathic treatment, they do not provide any conclusive evidence as to the effectiveness of homeopathic remedies in the treatment of osteoarthritis patients. ...
... Rather they scientifically test the 'placebo only' hypothesi s -and they have found that explanatory model lacking. Early attempts at assessing impact in specific conditions by selective meta -analyses (for example in osteoarthritis 14 and post -operative ileus 15 ) mostly note the positive trend but have to conclude tha t there is not yet enough data to draw firm conclusions. Rather they scientifically test the 'placebo only' hypothesis -and they have found that explanatory model lacking. ...
Osteoarthritis (OA) is a prevalent degenerative joint disease that affects millions of people worldwide, causing pain, stiffness, and reduced mobility. Conventional treatments often focus on managing symptoms, but holistic healing approaches, particularly through Homoeopathy, offer a unique perspective by addressing the underlying causes and promoting overall well-being. This manuscript explores the principles of holistic healing in the context of Homoeopathic strategies for relieving osteoarthritis. Firstly, it's crucial to acknowledge the lack of conclusive scientific evidence regarding homoeopathy's efficacy in treating specific medical conditions, including osteoarthritis. However, several theoretical principles and anecdotal reports suggest it could offer benefits. In osteoarthritis, homoeopaths aim to address the underlying imbalances and triggers contributing to the disease process, rather than simply masking symptoms. Commonly used homoeopathic remedies for osteoarthritis include Rhus toxicodendron, Bryonia, and Calcarea carbonica. These remedies, chosen based on individualization and symptom presentation, are believed to address joint pain, inflammation, stiffness, and overall well-being.
Osteoarthritis (OA) is a prevalent degenerative joint disease that affects millions of people worldwide, causing pain, stiffness, and reduced mobility. Conventional treatments often focus on managing symptoms, but holistic healing approaches, particularly through Homoeopathy, offer a unique perspective by addressing the underlying causes and promoting overall well-being. This manuscript explores the principles of holistic healing in the context of Homoeopathic strategies for relieving osteoarthritis. Firstly, it's crucial to acknowledge the lack of conclusive scientific evidence regarding homoeopathy's efficacy in treating specific medical conditions, including osteoarthritis. However, several theoretical principles and anecdotal reports suggest it could offer benefits. In osteoarthritis, homoeopaths aim to address the underlying imbalances and triggers contributing to the disease process, rather than simply masking symptoms. Commonly used homoeopathic remedies for osteoarthritis include Rhus toxicodendron, Bryonia, and Calcarea carbonica. These remedies, chosen based on individualization and symptom presentation, are believed to address joint pain, inflammation, stiffness, and overall well-being.
Introduction: Osteoarthritis is a long-term chronic disease characterized by deterioration of cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movements. The disease most commonly affects the joints in the knees, hands, and feet and is relatively common in the shoulder and hip joints. While osteoarthritis is related to aging, it is associated with a variety of risk factors including obesity, lack of exercise, genetic predisposition, bone density, occupational injury, trauma, and gender. Primary osteoarthritis is a condition in which the protein makeup of cartilage decreases with age, repetitive use of joints over the years causes damage to the cartilage that leads to joint pain and swelling. Secondary osteoarthritis is mostly caused by another underlying disease for ex: Osteoarthritis due to obesity, repeated Trauma or surgery to the abnormal Joints at birth, gout, Rheumatoid arthritis, Diabetes mellitus & other hormonal disorders. This study aims to show the utility of homeopathic medicines on the patients suffering from Osteoarthritis, and to compare the results of Polarity Analysis Software and BTPB in the manement of Osteoarthritis,Using WOMAC score for before and after intervention Comparision. Materials and method 30 patients, in the age group of 30 to 70 years, diagnosed with Osteoarthritis, were selected to conduct this study. Out of the 30 patients, 57% of patients were females and 43% were males in the study. The changes were evaluated before and after treatment. Response to treatment was determined by WOMAC Index which includes pain, stiffness and ADL, before and after the treatment. After careful examination, study, and repertorization with the help of Boenninghausen therapeutic pocket book and polarity analysis each of the 15 cases was analyzed by using both the repertories, and the similimum was prescribed to the patients. Results: In this study, total of 32 Patients have registered out of which 30 patients were able to complete their treatment and 2 cases were dropout, the age group involved in this study is varying from 35-70 years age old people Among 30 Patients of 60% of patients had both their knees affected, 20% of had their left knee affected and 20% of patients had issues with the right knee. Patients the Distribution of patients according to the Medicine Prescribed for the treatment of knee osteoarthritis. Belladonna, Sulphur, and Kali Carb each of this medicine were prescribed to 10% of patients under study. WOMAC Index was used as the assessment tool, before and after intervention scores were statistically analysed; the pain, stiffness, and functional limitation subcategories were statistically assessed using the 't-test before intervention and after the intervention. Here average "WOMAC Score Difference" is compared for both Repertory BTPB and Polarity Analysis. When BTPB Repertory is used, the average "WOMAC score difference" is 28.67 + 6.03(mean± sd) before and after the intervention of treatment for knee joint pain. When Polarity Analysis is used, the average "WOMAC score difference "is 35.53+ 7.71 (mean± sd) before and after the intervention of treatment for knee joint pain. To test the hypothesis: The average "WOMAC score difference", based on BTPB and Polarity analysis treatment is the same, a two-sample t-test is used. The t-statistic value is-2.72 and the p-value of 0.01* is significant. Conclusion: The medicines, which were selected and prescribed on the basis of chief complaint, after the repertorization from BTPB and Polarity Analysis software, showed significant result in the treatment of osteoarthritis. Homeopathic medicines obtained after repertorizing from Polarity Analysis software are effective in the treatment of osteoarthritis. The results are supportive to open new paths for future studies on Osteoarthritis and homeopathic treatment. As the sample size was small further studies with larger sample sizes are needed.
Homoeopathy is widespread, and users claim to benefit from it. However, clear evidence of its efficacy over placebo is not available to date. As a consequence, a social separation between homoeopathy users and mainstream medicine exists, exposing these patients to many risks. Our primary objective is to assess homoeopathy efficacy by systematically reviewing existing systematic reviews and meta‐analyses and to systematically review trials on open‐label placebo (OLP) treatments. A secondary objective is to understand if homoeopathy as a whole may be considered as a placebo treatment. PubMed/Medline, Embase, Google Scholar, and Cochrane Library were systematically searched for systematic reviews and meta‐analyses on homoeopathy efficacy, and 61 studies were included. Same databases plus Journal of Interdisciplinary Placebo Studies (JIPS) were also systematically searched for randomised controlled trials (RCTs) on OLP treatments, and 10 studies were included. Databases were searched up to 24 February 2018. Two authors independently screened all retrieved articles and selected studies eligible for inclusion. The quality of reviews of included studies was evaluated with a dedicated NIH tool in the first review, whereas the risk of bias of trials of included studies was assessed with the specific Cochrane tool in the second review. Qualitative syntheses show that homoeopathy efficacy can be considered comparable to placebo, and that OLP treatments may be effective in some health conditions. Placebo effects like placebo itself, treatment context, physician–patient relationship, and other nonspecific factors can define the idea of placebo treatments, which may be effective in some conditions. If homoeopathy efficacy is comparable to placebo, and if placebo treatments can be effective in some conditions, then homoeopathy as a whole may be considered as a placebo treatment. Reinterpreting homoeopathy as a placebo treatment would define limits and possibilities of this practice. This perspective shift suggests a strategy to manage patients who seek homoeopathic care and to reconcile them with mainstream medicine in a sustainable way.
Background The randomised controlled trial (RCT) is considered the ‘gold standard’ for establishing treatment efficacy or effectiveness of an intervention, but its data do not infer response in an individual patient. Individualised clinical care, a fundamental principle in complementary and alternative medicine (CAM), including homeopathy, seems well disposed in principle to being researched by single-patient (N-of-1) study design. Guidelines for reporting N-of-1 trials have recently been developed.
Objective To overview the current status in the literature of the N-of-1 method and its application in medicine, including CAM. To consider whether the N-of-1 trial design offers an opportunity for novel research in homeopathy.
N-of-1 Trial Design The N-of-1 trial applies the principles of the conventional crossover, blinded, RCT design. The treatment under study and the comparator are repeated in a randomised order, and with suitable washout time, over a defined period. N-of-1 design is constrained for use in chronic stable conditions, and for interventions that have quick onset and cessation of effect, with modest or negligible carryover. Outcome data can be aggregated and interpreted for the individual subject; they can also be pooled with data from several similar N-of-1 trials, enabling more generalisable conclusions.
The N-of-1 Trial in CAM The typical individualisation of patient care can be accommodated in N-of-1 study design if the patient and the specific therapeutic intervention are selected within the constraints of the method. Application of the N-of-1 method in CAM has been advocated but has been mainly limited, in practice, to a small number of studies in herbal and traditional Chinese medicine.
The N-of-1 Trial in Homeopathy Individualised homeopathy can be accommodated for investigation within the same methodological constraints; less in-depth homeopathic approaches to prescribing are also amendable to investigation using the N-of-1 method. No such studies have been published. We identify three main targets in its ready applicability to homeopathy: (1) to optimise clinical care in an individual patient; (2) to investigate whether the outcomes of treatment using homeopathy differ from those of placebo; (3) to aggregate data from a series of N-of-1 trials to enable broader conclusions about a group of patients or intervention.
Conclusion The N-of-1 trial design offers important new investigative possibilities in homeopathy and should be explored as a means to optimise individualised health care or investigate effectiveness of the homeopathic intervention compared with placebo in individual subjects.
Homoeopathy in the era of evidence based medicine.
A number of forms of complementary or alternative medicine currently practised have their origins in the western intellectual tradition: Western Europe and North America. This chapter aims to outline some of the more common forms of CAM of western origin, particularly those supported by evidence of clinical effectiveness.
Die Homöopathie ist eine Therapiemethode, die seit mehr als 200 Jahren praktiziert wird und eine beträchtliche Zahl an Heilungserfolgen vorzuweisen hat. Die Evidenzlage hinsichtlich der klinischen Forschung zur Homöopathie ist nach strengen Kriterien mindestens als ambivalent zu beurteilen und weist eine stark positive Tendenz auf, wenn im Rahmen von Meta-Analysen nicht nur einige wenige Studien berücksichtigt werden, sondern ein sinnvolles Gleichgewicht zwischen Selektionskriterien und Aussagekraft geschaffen wird. Die Gründe für die Verzerrungen bei der Beurteilung des Phänomens Homöopathie sind auf der wissenschaftlichen Paradigmenebene zu suchen und wurzeln letztlich in spezifischen erkenntnistheoretischen Vorannahmen, die in ihrer unreflektierten Form als Weltanschauung angesprochen werden können.
Diese Weltanschauung kann in als eine Form des reduktionistischen Materialismus identifiziert wer-den, welcher in Verbindung mit einem unkritischen Szientismus dafür genutzt wird, Erkenntnissi-cherheit und eine wissenschaftlich methodische Fundierung zu prätendieren. Dieser Komplex erweist sich im Rahmen einer epistemologischen Analyse als transzendentalphilosophisch haltloses metaphysisches Konstrukt, welches keinesfalls dazu geeignet ist, als Kriterium für Wissenschaftlichkeit zu fungieren, oder gar a priori über die Möglichkeit respektive Unmöglichkeit bestimmter Phänomene zu befinden. Der unkritische Umgang eines Teils der Homöopathiekritik mit den eigenen epistemologischen Voraussetzungen führt somit zu der paradoxen Situation, dass unter Berufung auf wissenschaftliche Grundsätze zentralen Postulaten der wissenschaftlichen Methode eine Absage erteilt wird.
Vor dem Hintergrund der Science Studies lässt sich konstatieren, dass die Homöopathie nicht nur mit epistemologischen Setzungen in Konflikt gerät, sondern dass naturwissenschaftliche Grundsätze und die Methodik der klinischen Forschung in ein soziales Gefüge eingebettet sind, in welchem neben statistisch auswertbaren Daten ebenso die Denkgewohnheiten und Erwartungshaltungen von Peer-Review-Gutachtern und die hiermit in Zusammenhang stehenden Publikationsmöglichkeiten eine Rolle spielen. Nicht zuletzt ist an dieser Stelle zu konstatieren, dass Wissenschaft als soziales System über mannigfaltige Überschneidungen und Verquickungen mit anderen Systemen verfügt, zu denen sicherlich auch die Ökonomie gehört. In dieser Hinsicht ist es durchaus denkbar, dass eine wissenschaftliche Ächtung der Homöopathie mit bestimmten wirtschaftlichen Interessen konform geht, wenn sie nicht sogar teilweise durch solche motiviert sein sollte.
Abschließend werden mit der Kategorienlehre, der Semiotik und den wissenschaftstheoretischen Überlegungen des amerikanischen Philosophen Charles Sanders Peirce Ansätze präsentiert, welche die aufgezeigten Aporien des reduktionistischen Materialismus vermeiden. Es wird ein begriffliches Instrumentarium eingeführt, mit dessen Hilfe sich die entsprechenden Verkürzungen bei der Interpretation des Phänomens Homöopathie klar benennen und auch umgehen lassen, ohne auf unzulässige metaphysisch aufgeladene Theoreme zu-rückgreifen zu müssen.
Die Homöopathie steht innerhalb der vorliegenden Analyse stellvertretend für sämtliche Gegen-standsbereiche, die sich einer einfachen Deutung durch materialistisch-reduktionistische Erklä-rungsmuster im dargestellten Sinne entziehen. Insgesamt lässt sich die Schlussfolgerung ziehen, dass die Grenzen gängiger Erklärungsmodelle und erkenntnistheoretischer Paradigmen häufig anhand von wissenschaftlichen Anomalien erkennbar werden und dann einer umfassenden Revision unterzogen werden sollten, um global neue Zugänge und Perspektiven für die Wissenschaft zu erschließen, die nicht den Beschränkungen einer dem Fortschritt hinderlichen Weltanschauung unterliegen.
Complementary and alternative medicine (CAM) has recently attracted attention because of its widespread use, associated costs, and unknown effects. Osteoarthritis (OA) is a common disease in the population. Many different therapeutic interventions are currently employed for the management of OA, including pharmacological and non-pharmacological options. Continuous pain is characteristic of this chronic disease, and the rate of CAM usage for OA is estimated to be high. Patients suffering from OA are often tempted to try 'alternative' treatment options. CAMs include herbal medicines, traditional medicines (Ayurvedic or Chinese), vitamin, mineral and nutritional supplements, homeopathic medicines and aromatherapy products. The aim of this review was to assess the use of CAM in the treatment of patients with OA.
Introduction
Observations about controlled clinical trials expressed by Max Haidvogl in the book Ultra High Dilution (1994) have been appraised from a perspective two decades later. The present commentary briefly examines changes in homeopathy research evidence since 1994 as regards: the published number of randomised controlled trials (RCTs), the use of individualised homeopathic intervention, the ‘proven efficacy of homeopathy’, and the quality of the evidence.
Methods
The commentary reflects the details of RCTs that are available in a recently published literature review and by scrutiny of systematic reviews of RCTs in homeopathy.
Results
The homeopathy RCT literature grew by 309 records in the 18 years that immediately followed Haidvogl's article, with more than a doubling of the proportion that investigated individualised homeopathy. Discounting one prior publication, the entire systematic review literature on homeopathy RCTs post-dates 1994. A total of 36 condition-specific systematic reviews have been identified in the peer-reviewed literature: 16 of them reported positive, or tentatively positive, conclusions about homeopathy's clinical effectiveness; the other 20 were negative or non-conclusive. Reviews typically have been restricted in the strength of their conclusions by the low quality of the original RCT evidence. Three comprehensive systematic reviews concluded, cautiously, that homeopathy may differ from placebo; a fourth such review reached negative conclusions. A recent high-quality meta-analysis concluded that medicines prescribed in individualised homeopathic treatment may have small, specific, effects.
Conclusions
Despite important growth in research activity since 1994, concerns about study quality limit the interpretation of available RCT data. The question whether homeopathic intervention differs from placebo awaits decisive answer.
IntroductionAt the end of 2011, a report was published by the Ministry of Health on the use of natural therapies in Spain, which included an analysis of the scientific evidence on homeopathy.Objectives
To critically analyze the scientific and methodological bases of this report, and provide an update based on a systematic analysis of the scientific evidence on homeopathy.MethodologyWe performed a scientific analysis of the content of the report together with a literature search for systematic reviews/meta-analyses published up to June 2011 by using the key word “homeopathy” in Medline, Embase and Cochrane. Manual searches were also performed in the main digital libraries on homeopathy.ResultsThe Ministry of Health's report shows major limitations that prevent generalization of its results: a) the report does not specify the inclusion/exclusion criteria of 9 of the studies included and consequently the validity of the selected articles cannot be evaluated: b) a flowchart of the studies found and analyzed is lacking; c) the scales and measures used to evaluate the quality of the articles cited are not specified; d) the studies are limited to literature reviews in specific diseases or therapeutic areas; d) the literature search was restricted to studies published up to 2007, even though the conclusions drawn in the report were generalized to 2011. In our review, we found 30 additional systematic reviews/meta-analyses to the 9 reviews cited in the report. These reviews analyze the efficacy of homeopathy in 23 indications, 14 more than those included in the report. There is solid scientific evidence on homeopathy in diverse indications, such as childhood diarrhea, upper respiratory tract infections, dizziness and radiodermitis, among others.Conclusions
The evaluations in the Ministry of Health's report are insufficiently transparent and systematic and contain major methodological biases that prevent generalization of its results. There is solid scientific evidence in various indications that show that homeopathy has an effect beyond the placebo effect.
Comment. – Osteoarthritis represents one of the most frequent pathologies today, and its current management requires the combination of pharmaceutical and non pharmacological strategies. Moreover, osteoarthritis constitutes one of the main diseases leading to the requirement to the alternative medicines.News and key points. – This overview resumes the main recommendations in the light of recent controlled clinical trials concerning the not medicinal coverage of osteoarthritis : importance of the information and the education of the patient, the importance of the establishment of programs of physical exercises, the need for a reduction of the weight excess for knee osteoarthitis. Some controlled studies tried to estimate the symptomatic efficiency of acupuncture, homoeopathy or the contribution of minerals, vitamins... The appeal to the alternative said medicines is approached on this review.Perspectives and projects. – If certain not medicinal strategies have a sufficient proof of efficiency today, on the other hand number of propositions still have not, at the moment, demonstrated by superiority and by efficiency versus placebo. Numerous controlled studies should be organized to confirm or exclude the place of treatments such as homoeopathy, minerals...
The Health Technology Assessment report on effectiveness, cost-effectiveness and appropriateness of homeopathy was compiled on behalf of the Swiss Federal Office for Public Health (BAG).
Materials and Methods
Databases accessible by Internet were systematically searched, complemented by manual search and contacts with experts, and evaluated according to internal and external validity criteria.
Results
Many high-quality investigations of pre-clinical basic research proved homeopathic high-potencies inducing regulative and specific changes in cells or living organisms. 20 of 22 clinical systematic reviews detected at least a trend in favor of homeopathy. In our estimation 5 studies yielded results indicating clear evidence for homeopathic therapy. The evaluation of 29 studies in the domain „Upper Respiratory Tract Infections/Allergic Reactions” showed a positive overall result in favor of homeopathy. 6 out of 7 controlled studies were at least equivalent to conventional medical interventions. 8 out of 16 placebo-controlled studies were significant in favor of homeopathy. Swiss regulations grant a high degree of safety due to product and training requirements for homeopathic physicians. Applied properly, classical homeopathy has few side-effects and the use of high-potencies is free of toxic effects. A general health-economic statement about homeopathy cannot be made from the available data.
Conclusion
Taking internal and external validity criteria into account, effectiveness of homeopathy can be supported by clinical evidence and professional and adequate application be regarded as safe. Reliable statements of cost-effectiveness are not available at the moment. External and model validity will have to be taken more strongly into consideration in future studies.
Arthrosis is, as we all know, a disease having high prevalence that uses a large amount of health care resources in both Primary Health Care and in the Hospital. The present “Good clinical practice recommendations in arthrosis” Guide aims to provide basic knowledge in this disease and to help to reach the best objectives on the diagnostic and the-rapeutic levels to incorporate them into our daily clinical activity. These options should be based on tests supported categorically and that will be indicated within the context and development of this Guide. Even so, the lines of research for arthrosis regarding action on the risk factors and on the use of drugs that can only be developed from the natural history of the disease and from the long term follow-up over years, that is from Primary Health Care.
In this study we compared the efficacy and tolerability of hyaluronic acid (HA) and Orgotein following intra-articular administration to patients suffering from osteoarthritis of the knee. Patients received five injections of either HA or Orgotein at the rate of one injection a week for five weeks. There was a one month follow-up period after the final injection to assess the long term efficacy and tolerability of both products. Results showed that both treatments were effective in reducing pain symptoms and in improving joint mobility. However the effects of HA were considerably greater after the third injection and these persisted up to the end of the follow-up period resulting in significant differences in favour of the HA-treated group for the intensity of spontaneous pain, pain at rest, joint flexibility, morning stiffness and effusion volume. Overall judgements of efficacy expressed by physicians and patients confirmed the greater efficacy of HA treatment.
One of the major concerns regarding the use of nonsteroidal antiinflammatory drugs (NSAID) in the treatment of patients with arthritis is the high incidence of gastrointestinal (GI) side effects. Important issues regarding NSAID and upper GI complications include the following: (1) the magnitude of the association between NSAID therapy and clinically important gastric or duodenal ulcers or upper GI bleeding; (2) the subgroup(s) of patients who are at increased risk for upper GI side effects; and (3) the economic impact of NSAID induced upper GI toxicity. A causal association between NSAID use and the development of clinically important ulcer disease or its complications, including upper GI bleeding, is supported by available epidemiologic data. Furthermore, data suggest that up to one third of all direct costs of care may be attributed to the treatment of NSAID induced GI side effects. Approaches to this problem, such as the development of safer NSAID that are equally effective, need to be pursued.
In a double-blind, placebo-controlled crossover study to compare the homoeopathic remedy Rhus tox. 6X with fenoprofen in osteoarthritis of the hip and knee, fenoprofen was shown to have beneficial analgesic and anti-inflammatory effects which differed significantly from those of placebo. The effects of Rhus tox. 6X and placebo did not differ significantly. Patient preference was for fenoprofen. Side-effects were not severe but were seen more frequently with fenoprofen. Similar results were seen in all patients regardless of whether they had been referred to and assessed by a homoeopathic physician or a rheumatologist.
In a study of 531 consecutive admissions to an acute geriatric admitting unit in England in a four-month period, 33 cases of upper gastro-intestinal (UGI) bleeding were diagnosed. There was a close relationship between UGI bleeding and the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and it is argued that this is a causal link. In view of the dangers of NSAID ingestion by elderly patients, many of whom are using them for analgesic rather than anti-inflammatory reasons, it is suggested that simple analgesics such as paracetamol should be used for maintenance therapy of osteoarthritis in the elderly, with NSAIDs being reserved for treatment of true arthritis in selected patients.
A wide variety of pharmacologic and surgical approaches may be successfully used to control the pain of osteoarthritis and maintain optimal joint function. Understanding of the pathophysiologic mechanisms of the disease and their correlation with clinical and radiographic findings is essential in selecting an appropriate strategy. Clinical guidelines are discussed.
Not only has our understanding of cartilage structure, synthesis and breakdown increased over the last decade, but so have the possibilities for investigation and treatment of osteoarthritis. New strategies for investigation include ultrasound, magnetic resonance imaging, radionuclide scintigraphy, monitoring of biochemical markers for cartilage breakdown and miniarthroscopy. There is greater appreciation of the importance of exercise and analgesics in pain management, and drugs to retard cartilage breakdown are under development.
It is well known that complementary medicine is demanded by numerous patients and used by many doctors. In a representative postal survey of 793 female and male doctors working in practices and hospitals in the town and in the district of Kassel we could confirm the wide distribution of these procedures, especially as far as doctors in practice are concerned. It was the special interest of our study to analyse the motives for the use and the indications and to ask for a detailed and differential assessment of 18 complementary techniques.
Although therapeutically beneficial, nonsteroidal anti-inflammatory drugs are associated with serious gastrointestinal side effects, including ulceration, hemorrhage, and perforation. Endoscopic studies indicate that up to 30% of chronic NSAID users will develop gastroduodenal ulceration. Various case-control studies have reported an association between ulcer-related complications or deaths and NSAID use. An imprecise correlation has been found to exist between the presence of NSAID-induced gastrointestinal damage and symptoms, such as dyspepsia and pain. It is now thought that the major deleterious effects of NSAIDs on the gastrointestinal tract are related to the ability of systemically absorbed NSAIDs to alter gastric and duodenal defense mechanisms, primarily via inhibition of mucosal prostaglandin synthesis. Although various therapeutic agents have been investigated for their ability to prevent NSAID-induced ulcers, only the prostaglandin analogue misoprostol has been shown to significantly reduce the incidence of both gastric and duodenal ulcers in NSAID users. Recently, the Misoprostol Ulcer Complications Outcomes Safety Assessment trial demonstrated that misoprostol also reduces the most serious complications of NSAID-induced ulcers, namely bleeding, perforation, and gastric outlet obstruction.