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The Use of Complementary and Alternative Medicine for Pain
Abstract
Complementary and Alternative Medicine (CAM) refers to those medical and health care practices, modalities, products, and treatments which are not integrated into conventional medicine in the United States. CAM practices and modalities which are used in conjunction with conventional medical care are considered to be complementary, while those practices and modalities used in place of conventional medicine are considered to be alternative. In both cases, data regarding safety and efficacy are generally not fully available. Among the 27 institutes and centers at the National Institutes of Health (NIH) is the National Center for Complementary and Alternative Medicine (NCCAM). NCCAM is responsible for sponsoring intramural and extramural research on various CAM modalities for a variety of conditions and populations. NCCAM defines CAM as those practices falling into four discrete domains or areas of interest. Biologically active products and practices refer to the use of herbs, foods, and vitamins for health purposes. Examples include the use of dietary supplements, herbal products, and probiotics to promote health and treat various diseases. Energy Therapies use energy fields in the treatment of disease. CAM energy therapies include biofield therapies, such as Reiki, as well as electromagnetic therapies, such as the use of magnetic fields. Mind Body Medicine refers to those practices which enhance the ability of the mind and psychological processes to affect the body. Some mind-body medicine practices include the many varieties of meditation, yoga, Tai Chi, hypnosis, and some forms of art and music therapy. Manipulative and Body-based Practices include practices and procedures which manipulate one or more parts of the body. Chiropractic care, osteopathic manipulation, and massage are all example of manipulative and body-based practices.
... The appropriateness of a comparison group depends on the specific research question being asked, so that researchers can be confident that differences found between groups is due to the hypothesized active ingredient of the yoga intervention. 9,10 Thus, the theoretical mechanism through which the yoga is presumed to operate and the comparison condition would ideally include all of the elements of the yoga condition minus that active ingredient. Of course, in behavioral interventions, the ''active ingredient'' is complex and difficult to identify. ...
... Yet, perhaps because of the heterogeneous nature of yoga, 11,12 the rationale for selecting the comparison is rarely explicated in published reports. 10 One common solution is a passive control, such as a wait-list or usual treatment. 9 Wait-list typically means that participants in the comparison group get usual care for the intervention period but then are able to receive the intervention after the study ends, while participants in a usual care condition simply receive no additional treatment. ...
... While inclusion of these groups in the research design controls for the passage of time and natural course of a given problem or condition, they are limited as controls in mind-body interventions such as yoga, given the many nonspecific factors that may confound results or even constitute important elements of the intervention. 10 However, passive control groups are reasonable in early stages of research, given the practical demands of active comparison groups, whose inclusion require investigators to recruit many more participants and to deliver the comparison condition. ...
... Complementary and alternative medicine (CAM) is commonly and increasingly used to treat myriad health conditions (Barnes, Bloom, & Nahin, 2008) and for maintaining general health (e.g., stress management; Stoney, Wallerstedt, Stagl, & Mansky, 2009). The National Health Information Survey (NHIS), a nationally representative survey of the U.S. population conducted continuously since 1957 and sponsored by the Center for Disease Control and Prevention, first assessed CAM use in 2002. ...
... Tai chi is characterized by slowness of movement, absolute continuity without break or pause, and total focusing of awareness on the moment. The active concentration of the mind is instrumental in guiding the flow of the body's movements (Ospina et al., 2007;Stoney et al., 2009). Traditionally, tai chi is thought to benefit health through its ability to resolve imbalance, blockage, or interruption of ''qi' (vital energy) and restore its flow to maximize health and relieve pain (Mansky et al., 2006). ...
... Because many systematic reviews of mind-body CAM efficacy are based on a small number of studies, most of which are not rigorously conducted, they nearly always point to the limitations of the studies reviewed and conclude that more and better research is needed before firm conclusions can be drawn (Barnes et al., 2008). These limitations highlight the challenges in conducting rigorous research on mind-body therapies as treatments for a variety of conditions and illnesses as well as general health promotion (Stoney et al., 2009). This section presents some of the major research considerations in evaluating and conducting mind-body CAM (Stoney et al., 2009). ...
Objective:
Complementary and alternative medicine (CAM) is increasingly used for treating myriad health conditions and for maintaining general health. The present article provides an overview of current CAM use with a specific focus on mind-body CAM and its efficacy in treating health conditions.
Method:
Characteristics of CAM users are presented, and then evidence regarding the efficacy of mind-body treatments (biofeedback, meditation, guided imagery, progressive muscle relaxation, deep breathing, hypnosis, yoga, tai chi, and qi gong) is reviewed.
Results:
Demographics associated with CAM use are fairly well-established, but less is known about their psychological characteristics. Although the efficacy of mind-body CAM modalities for health conditions is receiving a great deal of research attention, studies have thus far produced a weak base of evidence. Methodological limitations of current research are reviewed. Suggestions are made for future research that will provide more conclusive knowledge regarding efficacy and, ultimately, effectiveness of mind-body CAM. Considerations for clinical applications, including training and competence, ethics, treatment tailoring, prevention efforts, and diversity, conclude the article.
Conclusions:
Integration of CAM modalities into clinical health psychology can be useful for researchers taking a broader perspective on stress and coping processes, illness behaviors, and culture; for practitioners seeking to incorporate CAM perspectives into their work; and for policy makers in directing healthcare resources wisely.
... Mind-body practices, such as guided imagery, Tai Chi, and Yoga use the mind to influence body function. Individuals engage in concentration to generate and visualize mental images (Chan et al., 2017;Posadzki and Ernst, 2011;Stoney et al., 2009). While Belleville (2008); Clare and Woods (2004) investigated subjects with MCI and Chan et al. (2017) subjects with early stages of AD, both could demonstrate improvement in global cognitive functions. ...
Mild cognitive impairment (MCI) is defined as an intermediate state between normal cognitive aging and dementia. It describes a status of the subjective impression of cognitive decline and objectively detectible memory impairment beyond normal age-related changes. Activities of daily living are not affected. As the population ages, there is a growing need for early, proactive programs that can delay the consequences of dementia and improve the well-being of people with MCI and their caregivers. Various forms and approaches of intervention for older people with MCI have been suggested to delay cognitive decline. Pharmacological as well as non-pharmacological approaches (cognitive, physiological, nutritional supplementation, electric stimulation, psychosocial therapeutic) and multicomponent interventions have been proposed. Interventional approaches in MCI from 2009 to April 2019 concerning the cognitive performance are presented in this review.
... É necessária a presença de um profissional capacitado para avaliar a analgesia mais adequada a cada caso. Além destas técnicas, há outras alternativas para alívio da dor, como uso de opióides ou técnicas não farmacológicas como massagem, hidroterapia e acupuntura, entre outras (Stoney, Wallerstedt, Stagl & Mansky, 2009;Guedes-Martins, Guedes, Saraiva & Reynolds, 2014). ...
The quality of early interaction plays a crucial role in child development. Findings from animal and human studies demonstrate hormonal, behavioral and emotional impairment as a result of an impoverished interaction. These results suggest an evolutionary adaptation of mechanisms to maintain high levels of prosocial behaviors. Babies communicate from birth, through gaze, voice, facial expression, gestures, and touch. The aim of the Ph.D. thesis was to improve knowledge of initial interaction through the study of the mother and infant behavior immediately after birth in a naturalistic situation and to investigate the influence of hospital procedures, emotional and social conditions from the mother, infant characteristics as well as average hormonal concentrations of cortisol and DHEA-s. This study was conducted in association with the University of São Paulo Hospital in order to record videos from the first minutes of life of 120 newborns with their mothers. Behaviors were coded every ten seconds focused on: a) infant: motor activity, cry, soothing and open eyes; b) mother: affectionate touch, smile, talking and looking at the baby. The frequency of each behavior was converted into quartiles. Multiple ordinal regressions were performed to predict independent variables and analyses of variances were performed to investigate mean differences of hormonal concentrations. The results pointed out an important contribution of the hospital procedures in promoting early interaction. In general, babies born by normal birth were more likely to show physical activity compared to those born by instrumental delivery, contrary to our initial hypothesis, infants that were not placed skin-to-skin on mothers’ chest were less likely to cry compared to those who had this skin contact. Worse maternal emotional state predicted increased frequencies of infants' cry, highlighting the need to promote well-being during pregnancy. Women who reported conflict with the child’s fathers showed less chance to look and talk to the baby in the delivery room. The analyses yielded differences at birth related to sex: male infants showed a greater chance of crying than females. Mothers, in turn, showed a greater chance of caressing and talking to male babies. Infants whose mothers were in worse emotional condition showed higher concentrations of cortisol, suggesting an influence from mothers’ hormones on the fetus during pregnancy. These results showed the active role of individuals from the first moment of their lives, shedding light on the complex interactions that influence their developmental trajectory since their birth. Thus, assistance to the mother during her pregnancy has been emphasized as an essential tool for her physical and psychological health.
... Besides calligraphy, other common examples are guided imagery, Tai Chi, and Yoga. These practices are characterized with individuals engaging in concentration, and generation and visualization of mental images [15,16]. Benefits brought by mind-body practices have been documented such as enhancing mental health [17], and global [18,19] and specific cognitive function such as attention [20,21] and spatial working memory [6,22]. ...
An 8-week Chinese calligraphy writing course improved working memory and delayed recall memory in older adults with mild cognitive impairment. To a lesser extent, the training also improved attention control, visual scan, and processing speed functions. Further research is needed to confirm the efficacy of the intervention, particularly beyond 8 weeks. The training has potential to be adopted by service.
... Besides calligraphy, other common examples are guided imagery, Tai Chi, and Yoga. These practices are characterized with individuals engaging in concentration, and generation and visualization of mental images [15,16]. Benefits brought by mind-body practices have been documented such as enhancing mental health [17], and global [18,19] and specific cognitive function such as attention [20,21] and spatial working memory [6,22]. ...
Background:
Nonpharmacological intervention for individuals with mild cognitive impairment (MCI) needs further investigation.
Objectives:
Test efficacy of eight-week Chinese calligraphy writing training improving attentional control and working memory.
Methods:
Ninety-nine participants with MCI were randomized into the eight-week calligraphy writing (n = 48) or control (tablet computer) training (n = 51). Outcomes of the interventions were attentional control, working memory, visual scan and processing speed. They were measured at baseline, post-training, and six-month follow-up.
Results:
Calligraphy writing, when compared with control, significantly improved working memory as reflected from DST-Backward sequence (p = 0.009) and span scores (p = 0.002), and divided attention as reflected from CTT2 (p < 0.001), and at the post-training. The unique improvement in working memory (span: p < 0.001; sequence: p = 0.008) of the intervention group was also found at follow-up when comparing with those at baseline. Changes in the other outcome measures were not statistically significant.
Conclusion:
The findings provide support that Chinese calligraphy writing training for eight weeks using a cognitive approach would improve working memory and to a lesser extent attentional control functions of patients with early MCI. They also demonstrate the usefulness of using mind-and-body practice for improving specific cognitive functions.
... Hospice patients might experience nausea and vomiting due to several reasons including bowel constriction, stimulation of the cranial chemotrigger zone, gastroparesis, anxiety, and chlolinergic effects from drugs [81]. Such patients require pharmacist intervention for preparing alternative dosage forms for anti-emetic drugs in the form of a suppository or transdermal gel [86][87][88]. Antiemetics are generally compounded in PLO gels for transderemal administration. ...
The overall objective of this work is to determine the percutaneous absorption of chlorpromazine
hydrochloride from PLO gels and verify the suitability of a topically applied chlorpromazine
PLO gel for use in hospice patients to relieve symptoms such as vomiting and nausea at the end
stages of life. The aims of the present study were to (a) prepare and characterize pluronic lecithin
organogels (PLO gels) of chlorpromazine hydrochloride using isopropyl palmitate or ricinoleic
acid as the oil phase, (b) assess the in vitro percutaneous absorption of chlorpromazine
hydrochloride through porcine ear and human abdominal skin using isopropyl palmitate and
ricinoleic acid PLO gels, and (c) assess the theoretical plasma concentrations of chlorpromazine
from flux values. PLO gels of chlorpromazine hydrochloride were successfully prepared using
isopropyl palmitate or ricinoleic acid as the oil phase and characterized for pH, morphology,
stability, viscosity, thermal analysis using differential scanning calorimetry (DSC), in vitro drug
release and stability. In vitro permeability studies were performed across pig ear and human
abdominal skin using isopropyl palmitate PLO gel and compared with the ricinoleic acid PLO
gel. The pH and viscosity of both PLO gels prepared with isopropyl palmitate and ricinoleic acid
iv
were comparable. The thixotropic property of ricinoleic acid PLO gel was found to be better than
the isopropyl palmitate PLO gel. Both formulations were found to be stable at 25ºC, 35ºC, and
40ºC for up to 60 days. The permeation of chlorpromazine hydrochloride was higher from
ricinoleic acid PLO gel than isopropyl palmitate PLO gel and pure drug solution. Theoretical
steady state plasma concentrations (Css) of chlorpromazine from pure drug solution, isopropyl
palmitate PLO gel and ricinoleic acid PLO gel were found to be 1.05, 1.20, and 1.50 ng/ml. PLO
gels only marginally increased the flux and theoretical Css of chlorpromazine. However,
theoretical Css values for chlorpromazine were much below the required therapeutic
concentration for antiemetic activity in hospice patients. From this study it is clearly evident that
PLO gels fail to deliver the required systemic levels of chlorpromazine following topical
application. To achieve better chlorpromazine hydrochloride skin permeation and thus higher
concentrations of chlorpromazine in plasma, following topical application on the skin, efficient
permeation enhancers should be used.
Child and adolescent depressive disorders are associated with significant psychiatric morbidity and impairment including in a school performance. Depressive disorders are most frequently experienced by adolescents and are highly associated with suicidal thoughts and behaviours. Depression is the commonest psychiatric condition implicated in suicide. For these reasons children and adolescents with depressive disorders often come to the attention of school psychologists. The prevalence, course, co-morbidity and aetiology of depressive disorders are discussed in this chapter. The evidence base for the treatment of depressive disorders is summarized including psychosocial treatments comprising cognitive behavioural therapy, interpersonal therapy, family therapy and supportive therapy as well as medication. This chapter has particular emphasis on the role of the school psychologist in coordinating the assessment and treatment of the young person within the school, managing risk of suicide via the use of safety plans, coordination of the care with the various staff within the school (teachers, administrative staff, principal), as well as liaising with the external professionals. The chapter concludes with consideration of depression in vulnerable youth and ethical and legal issues relevant to the management of depressive disorder within schools.
The study and transmission of East Asian medicine had gathered the attention of researchers in various fields in the Western world, especially in the United States. This study reviews various research papers and summarizes key issues in the spread of East Asian medicine in the United States. The propagation of East Asian medicine in the United States is summarized through the key words of who, when, why, and how. In terms of ‘Who’, Chinese researchers emphasize the role of Chinese parties, while non-Chinese researchers stress the process of internalization. The question of ‘When’ is also controversial. The oldest origin disputed goes back to the 13th century but Bach Franklin’s year 1825 and William Osler’s year 1892 seem more meaningful to Americans. This is because acupuncture was first introduced to the American medical community in 1825. Also, Osler is a relatively interesting figure, as he is the founder of the Johns Hopkins University School of Medicine. Reasons for the question of ‘Why’ are mostly practical as the desire for better treatment techniques propelled East Asian medicine’s inclusion. Yet historically, the yearning for Chinese culture was partially involved as well as academic reasons. As far as ‘How’, Sometimes East Asian medicine was spread through books and records, and direct experience of actual practice. Also, institutionalization of the acupuncturist system and the establishment of educational institutions in America show that East Asian medicine has surpassed the point of mere curiosity, and has grown into a substantial part of American society.
Stress has been implicated in both somatic and mental disorders. The mechanisms by which stress leads to poor health are largely unknown. However, studies in animals suggest that chronic stress causes high basal cortisol and low cortisol response to acute stressors and that such changes may contribute to disease. Previous studies of the Transcendental Mediation® (TM) technique as a possible means of countering effects of stress have reported altered levels of several hormones both during the practice and longitudinally after regular practice of this technique. In this prospective, random assignment study, changes in baseline levels and acute responses to laboratory stressors were examined for four hormones—cortisol, growth hormone, thyroid-stimulating hormone and testosterone—before and after 4 months of either the TM technique or a stress education control condition. At pre- and post-test, blood was withdrawn continuously through an indwelling catheter, and plasma or serum samples were frozen for later analysis by radioimmunoassay. The results showed significantly different changes for the two groups, or trends toward significance, for each hormone over the 4 months. In the TM group, but not in the controls, basal cortisol level and average cortisol across the stress session decreased from pre- to post-test. Cortisol responsiveness to stressors, however, increased in the TM group compared to controls. The baselines and/or stress responsiveness for TSH and GH changed in opposite directions for the groups, as did the testosterone baseline. Overall, the cortisol and testosterone results appear to support previous data suggesting that repeated practice of the TM technique reverses effects of chronic stress significant for health. The observed group difference in the change of GH regulation may derive from the cortisol differences, while the TSH results are not related easily to earlier findings on the effects of chronic stress.
The primary objective of the present review was to determine what pain-relieving effect had been reported for acupuncture and other conscious sedation methods in assisted reproduction therapy since 1990. The secondary objective was to determine pregnancy rates, when possible.
The data source was the Medline database of the National Library of Medicine covering the period January 1990-January 2004. Bibliographies of relevant publications and review articles were scanned. A systematic review and meta-analyses of randomized, controlled trials comparing the pain-relieving effect of acupuncture and other conscious sedation methods was carried out.
Of the 30 trials identified, 12 met the selection criteria for this systematic review and were included in the analysis. Five of the 12 studies reported differences in pain experiences during oocyte aspiration, but it was only possible to group the three trials evaluating the effect of electro-acupuncture (EA). The outcomes of these three studies were homogenous except from maximal and average pain.
No method could be regarded as being superior to another, and no consensus on which method is optimal for pain relief during oocyte retrieval was found. Low doses of lignocaine can, however, be recommended in paracervical block (PCB) as well as EA without pre-medication. The clinical pregnancy rates appeared to be similar between the studies. Since pain experience varies from individual to individual, the optimal method of conscious sedation may also be individualized.
Investigated relation of negative life events (NLE) to initial symptom severity and symptom resolution at 3 months in 2 patient
groups: (a) recurrent abdominal pain (RAP) without identifiable organic etiology, (b) abdominal pain with organic diagnosis.
Symptoms assessed were abdominal pain, somatization symptoms, anxiety, depression. Number of NLE was positively correlated
with anxiety and depression in both groups at clinic visit. NLE predicted resolution of abdominal pain for RAP patients only;
RAP patients with more NLE prior to or following the clinic visit were more likely to maintain their abdominal pain. More
NLE following clinic visit was associated with maintenance of anxiety and somatization symptoms at follow-up in RAP patients.
Results suggest a measure of NLE is not useful in differential diagnosis of patients with and without organic findings, but
is useful in predicting outcome in patients without organic findings.
Our objective was to identify endocrine-related mechanisms capable of mediating preventive effects of stress reduction in hypertensive heart disease. Since beneficial effects of stress reduction accrue over time, this cross-sectional, descriptive study sought differences between healthy students not practicing a systematic technique for reducing stress (the average stress, or AS, group, n = 33) and a similar group who for 8.5 years had practiced the Transcendental Meditation (TM) technique, used widely to reduce stress (the low stress, or LS, group, n = 22). The two groups of students, matched for age and area of study, performed timed collections of urine that included (separately) the entire waking and sleeping portions of 1 day. They also completed the Profile of Mood States and the State-Trait Anxiety Inventory, self-report instruments sensitive to subjective level of stress. Urine samples were analyzed for adrenocortical steroids by radioimmunoassay, for Na+, K+, Mg2+, Ca2+, and Zn2+ by atomic absorption spectrometry, and for neurotransmitter metabolites by reverse-phase, high-performance, liquid chromatography, and spectrophotometry. The two groups differed significantly on most measures. Specifically, the LS group was lower in cortisol and aldosterone and higher in dehydroepiandrosterone sulfate (DS) and the serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA). Excretion of sodium, calcium, zinc, and the norepinephrine metabolite, vanillylmandelic acid (VMA), was also lower in this group, as were Na+/K+ ratio, mood disturbance, and anxiety. In women practicing TM, cortisol correlated inversely and DS directly with number of months of TM practice. The results identify improvements in mood state, adrenocortical activity, and kidney function as probable factors in the preventive and treatment effects of stress reduction. Because suboptimal levels of these parameters result from chronic, subjective stress, the findings add mechanistic support to the contention that hypertensive heart disease is avoidable, even in modern industrialized societies.
Only recently have studies of electrocortical activity, event-related potentials, and regional cerebral blood flow begun to shed light on the anatomical and neurobiological underpinnings of hypnosis. Since twin studies show a significant heritable component for hypnotizability, we were prompted to examine the role of a common, functional polymorphism in contributing to individual differences in hypnotizability. A group of 109 subjects (51 male, 59 female) were administered three psychological instruments and tested for the high/low enzyme activity COMT val-->met polymorphism. We observed a significant correlation between hypnotizability measured by the Stanford Hypnotic Susceptibility Scale (SHSS:C), ability to partition attention (Differential Attentional Processes Inventory or DAPI), and absorptive capacities (Tellegen Absorption Scale or TAS). The effect of COMT on the various dependent variables was initially examined by multivariate analysis that corrects for multiple testing. The dependent variables were SHSS:C hypnotizability scores, four attentional subscales of the DAPI, and TAS total score grouped by the COMT genotype (val/val, val/met, met/met) as the independent variable. Hotelling's Trace statistic was significant when scores were grouped by the COMT genotype (Hotelling's T(2) = 1.88, P = 0.04. Post-hoc testing using the Bonferroni correction shows that the only significant difference is between the val/met vs. the val/val COMT genotypes on hypnotizability. This association was significant for men but not for women. As for all case-control studies, these results need to be interpreted cautiously and require replication. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:771-774, 2000.
The present study investigates the effectiveness of Erikson hypnosis and Jacobson relaxation for the reduction of osteoarthritis pain. Participants reporting pain from hip or knee osteoarthritis were randomly assigned to one of the following conditions: (a) hypnosis (i.e. standardized eight-session hypnosis treatment); (b) relaxation (i.e. standardized eight sessions of Jacobson's relaxation treatment); (c) control (i.e. waiting list). Overall, results show that the two experimental groups had a lower level of subjective pain than the control group and that the level of subjective pain decreased with time. An interaction effect between group treatment and time measurement was also observed in which beneficial effects of treatment appeared more rapidly for the hypnosis group. Results also show that hypnosis and relaxation are effective in reducing the amount of analgesic medication taken by participants. Finally, the present results suggest that individual differences in imagery moderate the effect of the psychological treatment at the 6 month follow-up but not at previous times of measurement (i.e. after 4 weeks of treatment, after 8 weeks of treatment and at the 3 month follow-up). The results are interpreted in terms of psychological processes underlying hypnosis, and their implications for the psychological treatment of pain are discussed.
Few treatments for back pain are supported by strong scientific evidence. Conventional treatments, although widely used, have had limited success. Dissatisfied patients have, therefore, turned to complementary and alternative medical therapies and providers for care for back pain.
To provide a rigorous and balanced summary of the best available evidence about the effectiveness, safety, and costs of the most popular complementary and alternative medical therapies used to treat back pain.
MEDLINE, EMBASE, and the Cochrane Controlled Trials Register.
Systematic reviews of randomized, controlled trials (RCTs) that were published since 1995 and that evaluated acupuncture, massage therapy, or spinal manipulation for nonspecific back pain and RCTs published since the reviews were conducted.
Two authors independently extracted data from the reviews (including number of RCTs, type of back pain, quality assessment, and conclusions) and original articles (including type of pain, comparison treatments, sample size, outcomes, follow-up intervals, loss to follow-up, and authors' conclusions).
Because the quality of the 20 RCTs that evaluated acupuncture was generally poor, the effectiveness of acupuncture for treating acute or chronic back pain is unclear. The three RCTs that evaluated massage reported that this therapy is effective for subacute and chronic back pain. A meta-regression analysis of the results of 26 RCTs evaluating spinal manipulation for acute and chronic back pain reported that spinal manipulation was superior to sham therapies and therapies judged to have no evidence of a benefit but was not superior to effective conventional treatments.
Initial studies have found massage to be effective for persistent back pain. Spinal manipulation has small clinical benefits that are equivalent to those of other commonly used therapies. The effectiveness of acupuncture remains unclear. All of these treatments seem to be relatively safe. Preliminary evidence suggests that massage, but not acupuncture or spinal manipulation, may reduce the costs of care after an initial course of therapy.
Hypnosis has been demonstrated to reduce analogue pain, and studies on the mechanisms of laboratory pain reduction have provided useful applications to clinical populations. Studies showing central nervous system activity during hypnotic procedures offer preliminary information concerning possible physiological mechanisms of hypnotic analgesia. Randomized controlled studies with clinical populations indicate that hypnosis has a reliable and significant impact on acute procedural pain and chronic pain conditions. Methodological issues of this body of research are discussed, as are methods to better integrate hypnosis into comprehensive pain treatment.
Twelve forms of Sun-style tai chi exercise have been developed specifically to reduce the symptoms and improve the physical functioning of arthritic patients, and this randomized study examined the changes in symptoms and physical characteristics in older women with osteoarthritis (OA) at the completion of a 12-week tai chi exercise program.
Seventy-two patients with OA were randomly assigned into 2 groups. Due to a 41% overall dropout rate, 22 experimental subjects and 21 controls completed pre- and post-test measures over a 12 week interval. Outcome variables were physical symptoms and fitness, body mass index, cardiovascular functioning, and perceived difficulties in physical functioning. The independent t test was used to examine group differences.
The homogeneity test confirmed that there were no significant group differences in demographic data and pretest measures. Mean comparisons of the change scores revealed that the experimental group perceived significantly less pain (t = -2.19, p = 0.034) and stiffness (t = -2.13, p = 0.039) in their joints, and reported fewer perceived difficulties in physical functioning (t = -2.81, p = 0.008), while the control group showed no change or even deterioration in physical functioning after 12 weeks. In the physical fitness test, there were significant improvements in balance (t = 3.34, p = 0.002) and abdominal muscle strength (t = 2.74, p = 0.009) for the tai chi exercise group. No significant group differences were found in flexibility and upper-body or knee muscle strength in the post-test scores.
Older women with OA were able to safely perform the 12 forms of Sun-style tai chi exercise for 12 weeks, and this was effective in improving their arthritic symptoms, balance, and physical functioning. A longitudinal study with a larger sample size is now needed to confirm the potential use of tai chi exercise in arthritis management.
During the last 30 years, auricular acupuncture has been used as complementary treatment of cancer pain when analgesic drugs do not suffice. The purpose of this study is to examine the efficacy of auricular acupuncture in decreasing pain intensity in cancer patients.
Ninety patients were randomly divided in three groups; one group received two courses of auricular acupuncture at points where an electrodermal signal had been detected, and two placebo groups received auricular acupuncture at points with no electrodermal signal (placebo points) and one with auricular seeds fixed at placebo points. Patients had to be in pain, attaining a visual analog score (VAS) of 30 mm or more after having received analgesic treatment adapted to both intensity and type of pain, for at least 1 month of therapy. Treatment efficacy was based on the absolute decrease in pain intensity measured 2 months after randomization using the VAS.
The main outcome was pain assessed at 2 months, with the assessment at 1 month carried over to 2 months for the eight patients who interrupted treatment after 1 month. For three patients, no data were available because they withdrew from the study during the first month. Pain intensity decreased by 36% at 2 months from baseline in the group receiving acupuncture; there was little change for patients receiving placebo (2%). The difference between groups was statistically significant (P <.0001).
The observed reduction in pain intensity measured on the VAS represents a clear benefit from auricular acupuncture for these cancer patients who are in pain, despite stable analgesic treatment.
Background: Chronic low back pain is a common problem that has only modestly effective treatment options. Objective: To determine whether yoga is more effective than conventional therapeutic exercise or a self-care book for patients with chronic low back pain. Design: Randomized, controlled trial. Setting: A nonprofit, integrated health care system. Patients: 101 adults with chronic low back pain. Intervention: 12-week sessions of yoga or conventional therapeutic exercise classes or a self-care book. Measurements: Primary outcomes were back-related functional status (modified 24-point Roland Disability Scale) and bothersomeness of pain (11-point numerical scale). The primary time point was 12 weeks. Clinically significant change was considered to be 2.5 points on the functional status scale and 1.5 points on the bothersomeness scale. Secondary outcomes were days of restricted activity, general health status, and medication use. Results: After adjustment for baseline values, back-related function in the yoga group was superior to the book and exercise groups at 12 weeks (yoga vs. book: mean difference, -3.4 [95% Cl, -5.1 to-1.6] [P< 0.001]; yoga vs. exercise: mean difference, -1.8 [Cl, -3.5 to - 0.1] [P= 0.034]). No significant differences in symptom bothersomeness were found between any 2 groups at 12 weeks; at 26 weeks, the yoga group was superior to the book group with respect to this measure (mean difference, -2.2 [Cl, -3.2 to - 1.2]; P < 0.001). At 26 weeks, back-related function in the yoga group was superior to the book group (mean difference, -3.6 [Cl, -5.4 to - 1.8]; P< 0.001). Limitations: Participants in this study were followed for only 26 weeks after randomization. Only 1 instructor delivered each intervention. Conclusions: Yoga was more effective than a self-care book for improving function and reducing chronic low back pain, and the benefits persisted for at least several months.
These data report the findings of a preliminary outcomes analysis (n = 52) of the mind—body intervention arm of a three-pronged study of chronic back pain patients (n = 180). Participants were screened on inclusion—exclusion criteria prior to baseline measures that included a pain visual analog scale, McGill Pain Measure, Beck Depression Scale, Coping Strategies Questionnaire, demographic data, Health Locus of Control Scale and others. Patients were then given a ten-week two-and-a-half hour mind—body intervention that included an educationl component, relaxation response training, and Qi Gong movement therapy. Data indicate that patients scored significantly different on all McGill Pain subscales and all Visual Analog Scale measures, eight Beck Depression Subscales, and some Coping Strategies Questions, and several of the Health Locus of Control Scales at end of treatment. Data indicate usefulness of a multiple-content intervention emphasizing cognitive changes toward the pain through an educational component, instruction in relaxation technique, and a movement therapy to facilitate restoration of function. Additional inter-group analyses are forthcoming.
This study utilized a randomized, double-blind, within subject, crossover design to examine the effect of Reiki and LeShan healing in combination on iatrogenic pain experienced after unilateral operative extraction of the lower third molar. Two separate operations were performed on 21 patients with bilateral, asymptomatic, impacted lower third molar teeth. The patients were randomly assigned to the treatment or control condition prior to the first operation. For the second operation, patients crossed over to the opposite condition - i.e. those subjects who were in the treatment group for the first operation became control group subjects for the second operation, and those subjects who were in the control group for the first operation became treatment group subjects for the second operation.All pre-operative and postoperative conditions were identical for the treatment and control groups for both operations, with the exception that the treatment group received Reiki and LeShan healing postoperatively. The patients assessed their pain intensity using a 100 mm visual analogue scale for postoperative hours 3 through 9, and pain relief using a 5 point scale for hours 4 through 9. A statistically significant difference was found between the treatment and control groups in both the level of pain intensity and degree of pain relief experienced for postoperative hours 4 through 9.
Two hundred twenty-five chronic pain patients were studied following training in mindfulness meditation. Large and significant overall improvements were recorded post-intervention in physical and psychological status. These gains were maintained at follow-up in the majority of subjects. Follow-up times ranged from 2.5-48 months. Status on the McUill Melzack Fain Rating Index (PRI). however, tended to revert to preintervention levels following the intervention. Most subjects reported a high degree of adherence with the meditation techniques, maintenance of improved status over time, and a high degree of importance attributed to the training program. We conclude that such training can have long-term benefit for chronic pain patients.
(C) Lippincott-Raven Publishers.
Keywords:Tai Chi;exercise;arthritis;pain
Study design:
We conducted a structured review of eight mind-body interventions for older adults with chronic nonmalignant pain.
Objectives:
To evaluate the feasibility, safety, and evidence for pain reduction in older adults with chronic nonmalignant pain in the following mind-body therapies: biofeedback, progressive muscle relaxation, meditation, guided imagery, hypnosis, tai chi, qi gong, and yoga.
Methods:
Relevant studies in the MEDLINE, PsycINFO, AMED, and CINAHL databases were located. A manual search of references from retrieved articles was also conducted. Of 381 articles retrieved through search strategies, 20 trials that included older adults with chronic pain were reviewed.
Results:
Fourteen articles included participants aged 50 years and above, while only two of these focused specifically on persons aged >or=65 years. An additional six articles included persons aged >or=50 years. Fourteen articles were controlled trials. There is some support for the efficacy of progressive muscle relaxation plus guided imagery for osteoarthritis pain. There is limited support for meditation and tai chi for improving function or coping in older adults with low back pain or osteoarthritis. In an uncontrolled biofeedback trial that stratified by age group, both older and younger adults had significant reductions in pain following the intervention. Several studies included older adults, but did not analyze benefits by age. Tai chi, yoga, hypnosis, and progressive muscle relaxation were significantly associated with pain reduction in these studies.
Conclusion:
The eight mind-body interventions reviewed are feasible in an older population. They are likely safe, but many of the therapies included modifications tailored for older adults. There is not yet sufficient evidence to conclude that these eight mind-body interventions reduce chronic nonmalignant pain in older adults. Further research should focus on larger, clinical trials of mind-body interventions to answer this question.
In this study, Herbert Benson's (1975) Relaxation Response Meditation program was tested as a possible treatment for Irritable Bowel Syndrome (IBS). Participants were 16 adults who were matched into pairs based on presence of Axis I disorder, primary IBS symptoms and demographic features and randomized to either a six week meditation condition or a six week wait list symptom monitoring condition. Thirteen participants completed treatment and follow-up. All subjects assigned to the Wait List were subsequently treated. Patients in the treatment condition were taught the meditation technique and asked to practice it twice a day for 15 minutes. Composite Primary IBS Symptom Reduction (CPSR) scores were calculated for each patient from end of baseline to two weeks post-treatment (or to post wait list). One tailed independent sample t-tests revealed that Meditation was superior to the control (P=0.04). Significant within-subject improvements were noted for flatulence (P=0.03) and belching (P=0.02) by post-treatment. By three month follow-up, significant improvements in flatulence (P<0.01), belching (P=0.02), bloating (P=0.05), and diarrhea (P=0.03) were shown by symptom diary. Constipation approached significance (P=0.07). Benson's Relaxation Response Meditation appears to be a viable treatment for IBS.
Available evidence indicates deficits in the pain management of children with analgesic drugs used outside licensed boundaries, in situations where their pharmacokinetics are untested. A case series is used to demonstrate the effectiveness of more holistic techniques such as guided imagery and distraction therapy in reducing the pain experienced by children in the hospice setting. Using these techniques it may be possible to reduce the amount of analgesia or the frequency of administration.
Thirty patients with tension-type headache were randomly chosen to undergo a trial of traditional Chinese acupuncture and sham acupuncture. Five measures were used to assess symptom severity and treatment response: intensity, duration and frequency of headache pain episodes, headache index and analgesic intake. The five measures were assessed during a 4 week baseline period, after 4 and 8 weeks of treatment, and 1, 6 and 12 months thereafter. Before the start of the study, each patient was administered the MMPI. Split-plot ANOVAs showed that, compared to baseline, at 1 month after the end of treatment and for the 12 month follow-up, the frequency of headache episodes, analgesic consumption and the headache index (but not the duration or intensity of headache episodes) significantly decreased over time; however, no difference between acupuncture and placebo treatment was found. No single MMPI scale predicted the response to treatment, but the mean MMPI profile of acupuncture non-responders showed the presence of 'Conversion V'.
Serum cortisol and total protein levels, blood pressure, heart rate, lung volume, and reaction time were studied in 52 males 20-25 years of age practicing Dhammakaya Buddhist meditation, and in 30 males of the same age group not practicing meditation. It was found that after meditation, serum cortisol levels were significantly reduced, serum total protein level significantly increased, and systolic pressure, diastolic pressure and pulse rate significantly reduced. Vital capacity, tidal volume and maximal voluntary ventilation were significantly lower after meditation than before. There were also significant decreases in reaction time after mediation practice. The percentage decrease in reaction time during meditation was 22%, while in subjects untrained in meditation, the percentage decrease was only 7%. Results from these studies indicate that practising Dhammakaya Buddhist meditation produces biochemical and physiological changes and reduces the reaction time.
In a controlled study, 40 patients with refractory fibromyalgia were randomly allocated to treatment with either hypnotherapy or physical therapy for 12 weeks with followup at 24 weeks. Compared with the patients in the physical therapy group, the patients in the hypnotherapy group showed a significantly better outcome with respect to their pain experience, fatigue on awakening, sleep pattern and global assessment at 12 and 24 weeks, but this was not reflected in an improvement of the total myalgic score measured by a dolorimeter. At baseline most patients in both groups had strong feelings of somatic and psychic discomfort as measured by the Hopkins Symptom Checklist. These feelings showed a significant decrease in patients treated by hypnotherapy compared with physical therapy, but they remained abnormally strong in many cases. We conclude hypnotherapy may be useful in relieving symptoms in patients with refractory fibromyalgia.
The aim of this study was to conduct a component analysis of a group programme for chronic low back pain patients. Forty-five patients participated in the pain control course, consisting of education about pain and a training in self-hypnosis. A pain diary was used as a measure of pain intensity, up-time and use of pain medication. Psychoneuroticism and depression were assessed using the Symptom Checklist-90 (SCL-90). No evidence was found for a differential efficacy of education or self-hypnosis on pain diary and SCL-90 scores. On completion of the total treatment package, patients manifested statistically significant changes on all measures except reported pain intensity. It is suggested that the pain control course is a non-invasive, inexpensive means of treatment which could be of some value in teaching even more severely disabled low back pain patients to cope more adequately with their pain problem. For this group of patients, a better adjustment to continuing pain may prove to be a more realistic therapy goal than pain reduction.
Ninety chronic pain patients were trained in mindfulness meditation in a 10-week Stress Reduction and Relaxation Program. Statistically significant reductions were observed in measures of present-moment pain, negative body image, inhibition of activity by pain, symptoms, mood disturbance, and psychological symptomatology, including anxiety and depression. Pain-related drug utilization decreased and activity levels and feelings of self-esteem increased. Improvement appeared to be independent of gender, source of referral, and type of pain. A comparison group of pain patients did not show significant improvement on these measures after traditional treatment protocols. At follow-up, the improvements observed during the meditation training were maintained up to 15 months post-meditation training for all measures except present-moment pain. The majority of subjects reported continued high compliance with the meditation practice as part of their daily lives. The relationship of mindfulness meditation to other psychological methods for chronic pain control is discussed.
In a controlled trial the effect of traditional Chinese acupuncture v. placebo acupuncture was evaluated in 18 patients with chronic tension headache (mean disease duration 15 years). All patients suffered from daily or frequently recurring headache, the intensity of which was recorded by the patient over a period of 15 weeks. Each patient was treated by traditional Chinese acupuncture as well as by placebo acupuncture in a cross-over design following randomization. Each period of treatment comprised six treatments. Traditional Chinese acupuncture was found to be significantly more pain-relieving than placebo acupuncture, according to the pain registration of the patients themselves. The pain reduction was 31%. Acupuncture is therefore found to be a reasonable treatment for chronic tension headache.
Systolic blood pressure was measured in 112 subjects practicing the Transcendental Meditation (TM) and TM-Sidhi programs. The subjects were between the ages of 35 and 64 years. A significant difference was found between the systolic blood pressures of subjects (matched for sex, race, and general educational background) practicing the TM and TM-Sidhi programs and norms for the general population. This difference was independent of diet and exercise patterns but related to length of time meditating. A significant difference was also found between short-term (under 5 years) and long-term (over 5 years) participants of the TM program, covarying for age. No previous reports exist concerning the long-term effects of the TM program on blood pressure. Despite methodological problems associated with cross sectional data, the findings suggest the beneficial effects of the long-term practice of the TM and TM-Sidhi programs on systolic blood pressure. Even if self-selection plays a role, the characteristics of an easily identifiable group already showing traits beneficial to the general population deserves further study.
Despite its importance in pain perception, there is a paucity of research investigating the influence of anxiety. This study tested the proposition that anxiety can lead to the exacerbation of pain perception when the source of anxiety is related to the pain experience. When the source is related to something else, anxiety may even reduce the reaction to pain. Sources of anxiety were manipulated in the laboratory--anxiety related to pain and anxiety related to successful learning or the combination of anxiety related to both pain and learning. Verbal, physiological, and behavioral differences were obtained showing that focus upon both the pain and the learning task yielded the strongest pain reactions, while focus upon the learning alone yielded the lowest pain reaction, but the largest learning errors. Focus upon pain was in-between. The theoretical implications of these data were discussed.
This study evaluated the effects of a behavioral stress-management program on anxiety, mood, self-esteem, and T-cell count in a group of HIV-positive men who were asymptomatic except for T-cell counts below 400. The program consisted of 20 biweekly sessions of progressive muscle relaxation and electromyograph biofeedback-assisted relaxation training, meditation, and hypnosis. Ten subjects were randomly assigned to either a treatment group of a no-treatment control group, and the 2 groups were compared on pre- to posttreatment changes in the dependent measures. Analysis showed that, compared with the no-treatment group, the treatment group showed significant improvement on all the dependent measures, which was maintained at a 1-mo. follow-up. Since stress is known to compromise the immune system, these results suggest that stress management to reduce arousal of the nervous system and anxiety would be an appropriate component of a treatment regimen for HIV infection.
Yoga and relaxation techniques have traditionally been used by nonmedical practitioners to help alleviate musculoskeletal symptoms. The objective of this study was to collect controlled observations of the effect of yoga on the hands of patients with osteoarthritis (OA).
Patients with OA of the hands were randomly assigned to receive either the yoga program or no therapy. Yoga techniques were supervised by one instructor once/week for 8 weeks. Variables assessed were pain, strength, motion, joint circumference, tenderness, and hand function using the Stanford Hand Assessment questionnaire.
The yoga treated group improved significantly more than the control group in pain during activity, tenderness and finger range of motion. Other trends also favored the yoga program.
This yoga derived program was effective in providing relief in hand OA. Further studies are needed to compare this with other treatments and to examine longterm effects.
Ischemic pain was examined in adult males with and without a parental history of hypertension. Blood pressure and heart rate were recorded during baseline, cold pressor, and ischemia. Repeated pain ratings were obtained during cold pressor and ischemia, and the McGill Pain Questionnaire was completed after each stressor. A median split was used to identify high and low mean arterial pressure and heart rate reactors to cold pressor. Parental history of hypertension, high heart rate reactivity, and high mean arterial pressure reactivity were each associated with significantly lower ischemic pain ratings on the McGill Pain Questionnaire, suggesting that risk for hypertension is associated with hypoalgesia in normotensives.
Stress-induced physiological reactivity has been shown to correlate with indexes of pain sensitivity, but it has not been demonstrated whether such reactivity can affect subsequent levels of pain threshold, tolerance and self-reported severity. The present study examined whether the degree of physiological reactivity (i.e., blood pressure and heart rate) elicited during an initial psychological stressor could be shown to influence indexes of pain sensitivity during subsequent pain induction. Fifty-two undergraduate men and women were assigned randomly to one of two conditions: perform mental arithmetic (MA) and then undergo a cold pressor task (CP; MA/CP) or vice versa (CP/MA). Subjects were divided into low/high mean arterial pressure (MAP) and low/high heart rate (HR) groups based on reactivity to MA. Principal analyses showed 'condition x MAP reactor group' interactions for pain threshold (F(1,48) = 7.38; P < 0.009) and tolerance (F(1,48) = 9.63; P < 0.003). Post hoc tests revealed that high MAP reactors in the MA/CP condition showed lower pain threshold and tolerance during CP than low MAP reactors in the same condition, while high and low MAP reactors in the CP/ MA condition did not differ. Thus, cardiovascular reactivity during psychological stress may contribute to increased sensitivity to subsequent painful stimulation.
We investigated the effectiveness of acupuncture in childhood migraine in 22 children with migraine, randomly divided into two groups: a true acupuncture group (12 children) and a placebo acupuncture group (10 children). Ten healthy children served as a control group. Opioid activity in blood plasma was assayed by two methods: (1) determination of total (panopioid) activity with an opiate radioreceptor assay, and (2) determination of beta-endorphinlike immunoreactivity by radioimmunoassay. The true acupuncture treatment led to significant clinical reduction in both migraine frequency and intensity. At the beginning of the study, significantly greater panopioid activity was evident in plasma of the control group than in plasma of the migraine group. The true acupuncture group showed a gradual increase in the panopioid activity in plasma, which correlated with the clinical improvement. After the tenth treatment, the values of opioid activity of the true acupuncture group were similar to those of the control group, whereas the plasma of the placebo acupuncture group exhibited insignificant changes in plasma panopioid activity. In addition, a significant increase in beta-endorphin levels was observed in the migraine patients who were treated in the true acupuncture group as compared with the values before treatment or with the values of the placebo acupuncture group. The results suggest that acupuncture may be an effective treatment in children with migraine headaches and that it leads to an increase in activity of the opioidergic system.
Reliable individual differences in electrophysiological measures of prefrontal activation asymmetry exist and predict dispositional mood and other psychological and biological indices of affective style. Subjects with greater relative right-sided activation report more dispositional negative affect and react with greater intensity to negative emotional challenges than their left-activated counterparts. We previously established that such individual differences in measures of prefrontal activation asymmetry were related to basal NK function, with left-activated subjects exhibiting higher levels of NK function than right-activated subjects. The present study was designed to replicate and extend these earlier findings. Subjects were tested in five experimental sessions over the course of 1 year. During the first two sessions, baseline measures of brain electrical activity were obtained to derive indices of asymmetric activation. During sessions 3 and 4, blood samples were taken during a nonstressful period in the semester and then 24 h prior to the subjects' most important final examination. During session 5, subjects were presented with positive and negative film clips 30 min in duration. Blood samples were obtained before and after the film clips. Subjects with greater relative right-sided activation at baseline showed lower levels of basal NK function. They also showed a greater decrease in NK function during the final exam period compared to the baseline period. Subjects with greater relative left-sided activation showed a larger increase in NK function from before to after the positive film clip. These findings indicate that individual differences in electrophysiological measures of asymmetric prefrontal activation account for a significant portion of variance in both basal levels of, and change in NK function.
Despite its increasing use as a complementary therapy to treat pain, acupuncture is rarely considered by pediatricians, in part due to perceptions that it will not be acceptable to pediatric patients. We wished to describe pediatric pain patients' experience with acupuncture treatment for chronic pain.
Retrospective case series.
Subjects were pediatric pain patients referred by the Pain Treatment Service at Children's Hospital in Boston, who went to a pediatric acupuncturist. A research assistant not involved in the patient's care conducted the survey by telephone. Data were analyzed qualitatively and descriptively.
Of 50 eligible patients, 47 families were reached by telephone; all agreed to be interviewed. Patients had a median age of 16 years at the time of referral, 79% were female, and 96% were white. The most common three diagnoses were migraine headache (n = 7), endometriosis (n = 6), and reflex sympathetic dystrophy (n = 5). Patients had a median of 8 treatments (range: 0-60) within 3 months (range: 0-48 months); 85% of families paid out-of-pocket. Acupuncture therapies included needle insertion (98%), heat/moxa (85%), magnets (26%), and cupping (26%). Most patients and parents rated the therapy as pleasant (67% children/60% parents), and most (70% children/59% parents) felt the treatment had helped their symptoms; only 1 said that treatment made symptoms worse.
Pediatric patients with chronic, severe pain found acupuncture treatment pleasant and helpful. Additional, prospective studies are needed to quantify the costs and effectiveness of acupuncture treatment for pediatric pain.
Pain is the major complaint of the estimated one million U.S. consumers who use acupuncture each year. Although acupuncture is widely available in chronic pain clinics, the effectiveness of acupuncture for chronic pain remains in question. Our aim was to assess the effectiveness of acupuncture as a treatment for chronic pain within the context of the methodological quality of the studies. MEDLINE (1966-99), two complementary medicine databases, 69 conference proceedings, and the bibliographies of other articles and reviews were searched. Trials were included if they were randomized, had populations with pain longer than three months, used needles rather than surface electrodes, and were in English. Data were extracted by two independent reviewers using a validated instrument. Inter-rater disagreements were resolved by discussion. Fifty one studies met inclusion criteria. Clinical heterogeneity precluded statistical pooling. Results were positive in 21 studies, negative in 3 and neutral in 27. Three fourths of the studies received a low-quality score and low-quality trials were significantly associated with positive results (P=0.05). High-quality studies clustered in designs using sham acupuncture as the control group, where the risk of false negative (type II) errors is high due to large sample size requirements. Six or more acupuncture treatments were significantly associated with positive outcomes (P=0.03) even after adjusting for study quality. We conclude there is limited evidence that acupuncture is more effective than no treatment for chronic pain; and inconclusive evidence that acupuncture is more effective than placebo, sham acupuncture or standard care. However, we have found an important relationship between the methodology of the studies and their results that should guide future research.
The role of stress in the modulation of the most common gastrointestinal disorders has traditionally been considered a domain of psychology, and has frequently been lumped together with the role of psychiatric comorbidity. Among clinicians, the term “stress” is generally taken as synonymous with psychological (“exteroceptive”) stress. Based on the deeply ingrained Cartesian view in medicine and gastroenterology, stress and psychological factors have been considered fundamentally separate and unrelated to the “real” biological changes underlying organic disease. However, recent breakthroughs in the understanding of the neurobiology of the organism's response to acute and chronic stress, and the evolving understanding of elaborate brain-gut interactions and their modulation in health and disease, are beginning to require a reassessment of chronic stress in the pathophysiology and management not only of functional but also of “organic” gastrointestinal disorders.
Certain stressful life events have been associated with the onset or symptom exacerbation in some of the most common chronic disorders of the digestive system, including functional gastrointestinal disorders (FGD), inflammatory bowel disease (IBD), gastro-oesophageal reflux disease (GORD), and peptic ulcer disease (PUD). Even though methodological differences in reported studies which do and do not support such an association remain to be resolved, the association of sustained stressful life events preceding symptom exacerbation is based on several well designed surveys in patients with FGD,1-4with post-infectious irritable bowel syndrome (IBS),4 and with IBD.5-8 In addition, acute life threatening stress episodes in adult life (rape, post-traumatic stress syndrome) are an important risk factor in the development of functional gastrointestinal disorders.9 Finally, early life stress in the form of abuse plays a major role in the susceptibility of individuals to develop functional as well as IBD10-14 later in life. Thus, depending on the type of stressor, the lag time between the stressful event …
Acupuncture is widely used for the treatment of headache, but its effectiveness is controversial.
To determine whether acupuncture is: - more effective than no treatment - more effective than 'sham' (placebo) acupuncture - as effective as other interventions used to treat idiopathic (primary) headaches.
Electronic searches were performed in MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and the database of the Cochrane Field for Complementary Medicine. We also contacted researchers in the field and checked the bibliographies of all articles obtained.
Randomized or quasi-randomized clinical trials comparing acupuncture with any type of control intervention for the treatment of idiopathic (primary) headaches were included.
Information on patients, interventions, methods, and results was extracted by at least two independent reviewers using a pre-tested standard form. Results on headache frequency and intensity were summarized descriptively. Responder rate ratios (responder rate in treatment group/responder rate in control group) were calculated as a crude indicator of results for sham-acupuncture-controlled trials. Quantitative meta-analysis was not possible due to trial heterogeneity and insufficient reporting.
Twenty-six trials including a total of 1151 patients (median, 37; range, 10-150) met the inclusion criteria. Sixteen trials were conducted among patients with migraine, six among patients with tension-type headache, and four among patients with various types of headaches. The majority of trials had methodological and/or reporting shortcomings. In eight of the 16 trials comparing true and sham (placebo) acupuncture in migraine and tension-type headache patients, true acupuncture was reported to be significantly superior; in four trials there was a trend in favor of true acupuncture; and in two trials there was no difference between the two interventions. (Two trials were uninterpretable.) The 10 trials comparing acupuncture with other forms of treatment yielded contradictory results.
Overall, the existing evidence supports the value of acupuncture for the treatment of idiopathic headaches. However, the quality and amount of evidence are not fully convincing. There is an urgent need for well-planned, large-scale studies to assess the effectiveness and cost-effectiveness of acupuncture under real-life conditions.
Unlabelled:
A study with needle acupuncture was performed in tension-type headache employing a new placebo acupuncture
Method:
Sixty-nine patients (mean age 48.1 years, SD = 14.1) fulfilling the International Headache Society criteria for tension-type headache were randomly assigned to verum or placebo condition. No significant differences between placebo and verum with respect to visual analogue scale and frequency of headache attacks could be observed immediately, 6 weeks and 5 months after the end of treatment. There was a significant but weak improvement in quality of life parameters (clinical global impressions, Nottingham Health Profile) after verum treatment. In decision tree analyses, the changes in clinical global impressions and headache frequency depended significantly on primary headache frequency with a limit value of 24.5 days headache per month. High values in the von Zerssen Depression Score resulted in high mean visual analogue scale values.
One of the oldest forms of health care now has Cochrane evidence of benefit. In the newly updated Cochrane review of massage for low back pain, there is now some evidence to show overall benefit. New, high quality trials show that massage gives some relief from back pain that has continued for many weeks or months - and the benefit may continue at least a year after the course of massage is over. There is still not enough evidence about massage for acute back pain (back pain that started recently). Massage was more likely to work when combined with exercises (usually stretching) and education. The amount of benefit was more than that achieved by relaxation, self-care or acupuncture (although it may be less than the relief possible from manipulation or TENS machines). However, more evidence is still needed on specific forms of massage. There is a trend showing that the greatest benefit came with massage from trained massage therapists who had many years of experience, or licensed massage therapists. It seems that acupressure or pressure point massage techniques provide more relief than classic (Swedish) massage, although more research is needed to confirm this.
Since the first biofeedback (BFB) studies on pediatric pain were published in the early 1980s, most of the studies have focused on the treatment of pediatric migraine. More recently, BFB has also been evaluated in the treatment of tension headache in children. Not surprisingly, most of what we know about the efficacy and mechanisms of BFB in the treatment of children's pain problems concerns the treatment of childhood headache (HA). In this review, we provide a detailed summary of studies that have evaluated BFB in the treatment of childhood HAs with an emphasis on treatment outcome and maintenance of treatment success. Moreover, findings and hypotheses with regard to the mechanisms that may mediate the treatment effects of BFB are addressed. Finally, we discuss specific issues relating to the treatment of pain in children with BFB and outline future directions of research.
In this study, respiratory functions, cardiovascular parameters and lipid profile of those practicing Raja Yoga meditation (short and long term meditators) were compared with those of nonmediators. Vital capacity, tidal volume and breath holding were significantly higher in short and long term meditators than nonmeditators. Long term mediators had significantly higher vital capacity and expiratory pressure than short term meditators. Diastolic blood pressure was significantly lower in both short and long term meditators as compared to nonmeditators. Heart rate was significantly lower in long term meditators than in short term meditators and nonmeditators. Lipid profile showed a significant lowering of serum cholesterol in short and long term meditators as compared to nonmeditators. Lipid profile of short and long term meditators was better than the profile of nonmeditators inspite of similar physical activity. This shows that Raja Yoga meditation provides significant improvements in respiratory functions, cardiovascular parameters and lipid profile.
Current estimates of pediatric complementary and alternative medicine (CAM) use range from 10% to 15%. These estimates are derived from children sampled at health care facilities, with chronic conditions, and/or from countries other than the United States.
To provide a population-based estimate of the prevalence of pediatric CAM use in the United States.
We used the 1996 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the noninstitutionalized US population. The survey asks parents if their children used alternative care practitioners within the previous year. Our analysis included children younger than 18 years and accounted for the complex sampling design of MEPS.
Weighted for the US population, pediatric CAM use was 1.8% (95% confidence interval, 1.3%-2.3%). Participants who used CAM were found in each age category, and the mean age was 10.3 years; 76.8% were white, 54% were female, 32% lived in the West, 66% lived in a metropolitan statistical area, and 36% lived at 100% to 199% of the poverty level. Bivariate chi2 analysis shows that CAM use increased with age (P =.006) and was twice as common in children not living in a metropolitan statistical area (P =.02).
The use of CAM among US children, as measured by the MEPS, is far less prevalent than has previously been asserted. With such disparate estimates, future CAM research efforts would benefit from a consensus regarding what practices constitute CAM and how these practices should be measured.
A majority of people in the United States use alternative or complementary therapy at some point in their lives, and acupuncture is among the most frequently used modalities. Many United States medical schools offer courses in alternative medicine, and a growing number of insurers offer coverage for alternative therapies. This paper critically reviews our current knowledge about the safety and efficacy of acupuncture for neurologic conditions.
Acupuncture is a safe procedure when performed by trained professionals. Complications from acupuncture are rare and mainly related to negligence of sterile technique. Studies of the therapeutic value of acupuncture are fraught with challenging methodologic problems, including the choice of a placebo, a suitable control treatment, and the technique of stimulation applied. Clinical trials of the use of acupuncture for pain syndromes (headache, neck, and back pain), stroke rehabilitation, Parkinson's disease, multiple sclerosis, and substance abuse are reviewed.
Based on the current literature, no definitive recommendation can be made regarding the efficacy of acupuncture for common pain syndromes including headache, and neck and back pain. Better quality clinical trials fail to demonstrate efficacy for the use of acupuncture as part of a rehabilitation program following stroke or as a treatment for drug addiction. Acupuncture may have a role in the treatment of sleep disturbance associated with Parkinson's disease but was not efficacious for the primary symptoms of either Parkinson's disease or multiple sclerosis. In light of increasing public interest and use of alternative therapies, this review may be helpful in promoting more discussion between patients and physicians about the use of acupuncture.
In order to investigate external factors that may influence the magnitude of placebo analgesia as well as psychological factors that mediate placebo analgesia, 13 irritable bowl syndrome (IBS) patients rated evoked rectal distension and cutaneous heat pain under the conditions of natural history (NH), rectal placebo (RP), rectal nocebo (RN), rectal lidocaine (RL) and oral lidocaine (OL). Patients were given verbal suggestions for pain relief and rated expected pain levels and desire for pain relief for both evoked visceral and cutaneous pain, respectively. Large reductions in pain intensity and pain unpleasantness ratings were found in the RP, RL and OL condition as compared to the natural history condition, whereas no significant difference in pain reduction between the three treatment conditions was found. Ratings during RN and NH were not statistically different. Compared to a previous study, which shows that rectal lidocaine reverses visceral and cutaneous hyperalgesia, these results suggest that adding a verbal suggestion for pain relief can increase the magnitude of placebo analgesia to that of an active agent. Since IBS patients rate these stimuli as much higher than do normal control subjects and since placebo effects were very large, they probably reflect anti-hyperalgesic mechanisms to a major extent. Expected pain levels and desire for pain relief accounted for large amounts of the variance in visceral pain intensity in the RP, RL, and OL condition (up to 81%), and for lower amounts of the variance in cutaneous pain intensity. Hence, the combination of expected pain levels and desire for pain relief may offer an alternative means of assessing the contribution of placebo factors during analgesia.
To test the short and longterm benefits of an 8 week mind-body intervention that combined training in mindfulness meditation with Qigong movement therapy for individuals with fibromyalgia syndrome (FM).
A total of 128 individuals with FM were randomly assigned to the mind-body training program or an education support group that served as the control. Outcome measures were pain, disability (Fibromyalgia Impact Questionnaire), depression, myalgic score (number and severity of tender points), 6 minute walk time, and coping strategies, which were assessed at baseline and at 8, 16, and 24 weeks.
Both groups registered statistically significant improvements across time for the Fibromyalgia Impact Questionnaire, Total Myalgic Score, Pain, and Depression, and no improvement in the number of feet traversed in the 6 minute walk. However, there was no difference in either the rate or magnitude of these changes between the mind-body training group and the education control group. Salutary changes occurring by the eighth week (which corresponded to the end of the mind-body and education control group sessions) were largely maintained by both groups throughout the 6 month followup period.
While both groups showed improvement on a number of outcome variables, there was no evidence that the multimodal mind-body intervention for FM was superior to education and support as a treatment option. Additional randomized controlled trials are needed before interventions of this kind can be recommended for treatment of FM.