Archive
Chronic Pain and Complementary Health Practices
Chronic Pain and Complementary Health Practices
Source: National Center for Complementary and Alternative Medicine
Millions of Americans suffer from pain that is chronic, severe, and not easily managed. Pain from arthritis, back problems, other musculoskeletal conditions, and headache costs U.S. businesses more than $61 billion a year in lost worker productivity.
Pain is the most common health problem for which adults use complementary health practices. Many people with conditions causing chronic pain turn to these practices to supplement other conventional medical treatment, or when their pain is resistant or in an effort to advert side effects of medications. Despite the widespread use of complementary health practices for chronic pain, scientific evidence on efficacy and mechanisms—whether the therapies help the conditions for which they are used and, if so, how—is, for the most part, limited. However, the evidence base is growing, especially for several complementary health practices most commonly used by people to lessen pain.
This issue highlights the research status for several therapies used for common kinds of pain, including arthritis, fibromyalgia, headache, low-back pain, and neck pain.
Spinal Manipulation for Low-Back Pain
Spinal Manipulation for Low-Back Pain
Source: National Center for Complementary and Alternative Medicine (NCCAM)
Low-back pain (often referred to as “lower back pain”) is a common condition that usually improves with self-care (practices that people can do by themselves, such as remaining active, applying heat, and taking pain-relieving medications). However, it is occasionally difficult to treat. Some health care professionals are trained to use a technique called spinal manipulation to relieve low-back pain and improve physical function (the ability to walk and move). This fact sheet provides basic information about low-back pain, summarizes research on spinal manipulation for low-back pain, and suggests sources for additional information.
Usage and appraisal of educational media by homeopathic therapists: A cross sectional survey
Usage and appraisal of educational media by homeopathic therapists: A cross sectional survey
Source: BMC Complementary and Alternative Medicine
Background
During recent years the market for homeopathic education media has increasingly diversified with old (books, seminars) and new media (video-seminars, pc-programs, homeo-wiki and internet-courses). However, little is known about homeopaths’ preferences in using educational media and their requirements of this topic. Aim: This survey was designed to gain a better understanding of the usage and appraisal of educational media by homeopaths.Methods
192 homeopathic practitioners (GPs and health practitioners) at a educational conference were asked to answer a standardized questionnaire covering the topics “formal education and context of work” (9 items), “homeopathic practise and usage (24 items), “utilization of educational media” (9 items) and “favoured attributes for educational media” (11 items).Results
Out of 192 homeopaths who attended the conference, 118 completed the questionnaire (response rate 61.5 %). For their continuing homeopathic education they predominantly indicated to use books (scale value from 0=never to 2=always: 1.72) and seminars (1.54) whereas journals (0.98) and the internet (0.65) were used less often. The most favoured attributes concerning medical education media were reliability (1.76), relevance for clinical practice (1.74) and user friendliness (1.6). Less favoured attributes were inexpensiveness (1.1), graphical material (0.92) and interactivity (0.88).Conclusions
The survey illustrates the current situation of medical education media in homeopathy. Although there are parallels to earlier research conducted in conventional GPs, homeopaths are more likely to refer to classical media. New education tools should be designed according to these preferences.
Red Yeast Rice: An Introduction
Red Yeast Rice: An Introduction
Source: National Center for Complementary and Alternative Medicine
Red yeast rice is a traditional Chinese culinary and medicinal product. In the United States, dietary supplements containing red yeast rice have been marketed to help lower blood levels of cholesterol and related lipids. Red yeast rice products may not be safe; some may have the same side effects as certain cholesterol-lowering drugs, and some may contain a potentially harmful contaminant. This fact sheet provides basic information about red yeast rice, summarizes scientific research on effectiveness and safety, discusses the legal status of red yeast rice, and suggests sources for additional information.
Backgrounder — Tai Chi: An Introduction
Tai Chi: An Introduction
Source: National Center for Complementary and Alternative Medicine (NCCAM)
Tai chi, which originated in China as a martial art, is a mind-body practice in complementary and alternative medicine (CAM). Tai chi is sometimes referred to as “moving meditation”—practitioners move their bodies slowly, gently, and with awareness, while breathing deeply. This Backgrounder provides a general overview of tai chi and suggests sources for additional information.
What Every Clinician Should Know About Herb–Supplement–Drug Interactions
What Every Clinician Should Know About Herb–Supplement–Drug Interactions (PDF)
Source: Alternative and Complementary Therapies
Any items that a person takes orally on a supplemental basis–whether they be herbs, dietary supplements, other natural products, or functional foods such as energy drinks and nutritional bars–can interact with each other and with medications. We know that these interactions may have harmful or beneficial effects and can increase or potentiate lev- els of other therapeutics and/or decrease levels of other therapeutics. Dietary supplements can also interact with diagnostic test results and laboratory assays.
It is important to note that interactions caused by supplements can be hard to predict due to a lack of clinical research, compared to reactions caused by drugs, because many products are not standardized to specific ingredients or amounts, and herbal constituents may differ depending on what plant parts the constituents are derived from, for instance, petals, seeds, stems, roots, or leaves. Unlike a prescription drug, for which one can definitively draw the chemical structure graphically, measure it, weigh it, and see it under a microscope, this is more difficult when dealing with natural products.
We have all heard that “natural” does not equal “safe,” but this is really true. If something has a therapeutic action in a human body, this substance can also cause a reaction or an interaction. Supplements are not 100% receptor-specific to only have one effect and no other effects, and what might help one person might hurt another person, just like medications do.
But, remember that not all interactions are bad. Some interactions may be beneficial. An example is if one therapy in- creases the benefit of another or affects electrolyte levels or liver-function test results in a beneficial way. One therapeutic might interact with another in a good way in that it decreases a side-effect or allows a dose of another therapeutic to be lowered, and, therefore, a person experiences a lesser side-effect risk from both therapeutics. Also, a socioeconomic benefit may be, if one purchases or perhaps grows a natural ingredient in a garden, that might be more cost-effective than the alternatives. Purchasing without a prescription may keep insurance costs down over time.
I think it is critical that clinicians consider herbs and supplements as therapeutic options. But, whether we are trained about this in medical school or not, I feel that we have a professional responsibility to educate ourselves and our patients or consumers about the potential for various types of interactions.
See: Risks of Mixing Drugs and Herbal Supplements: What Doctors and Patients Need to Know (Science Daily)
The Flu, the Common Cold, and Complementary Health Practices
The Flu, the Common Cold, and Complementary Health Practices
Source: National Center for Complementary and Alternative Medicine
Each year, approximately 5 to 20 percent of Americans come down with the flu. Although most recover without incident, flu-related complications result in more than 200,000 hospitalizations and between 3,000 and 49,000 deaths each year. Colds generally do not cause serious complications, but they are among the leading reasons for visiting a doctor and for missing school or work.
To prevent or treat these illnesses, some people turn to complementary health practices such as herbs or vitamins and minerals. This issue provides information on “what the science says” about some of these practices for the flu and for the common cold, including zinc, vitamin C, echinacea, and probiotics.
Massage Therapy for Osteoarthritis of the Knee: A Randomized Dose-Finding Trial
Massage Therapy for Osteoarthritis of the Knee: A Randomized Dose-Finding Trial
Source: PLoS ONE
Background
In a previous trial of massage for osteoarthritis (OA) of the knee, we demonstrated feasibility, safety and possible efficacy, with benefits that persisted at least 8 weeks beyond treatment termination.Methods
We performed a RCT to identify the optimal dose of massage within an 8-week treatment regimen and to further examine durability of response. Participants were 125 adults with OA of the knee, randomized to one of four 8-week regimens of a standardized Swedish massage regimen (30 or 60 min weekly or biweekly) or to a Usual Care control. Outcomes included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), visual analog pain scale, range of motion, and time to walk 50 feet, assessed at baseline, 8-, 16-, and 24-weeks.Results
WOMAC Global scores improved significantly (24.0 points, 95% CI ranged from 15.3–32.7) in the 60-minute massage groups compared to Usual Care (6.3 points, 95% CI 0.1–12.8) at the primary endpoint of 8-weeks. WOMAC subscales of pain and functionality, as well as the visual analog pain scale also demonstrated significant improvements in the 60-minute doses compared to usual care. No significant differences were seen in range of motion at 8-weeks, and no significant effects were seen in any outcome measure at 24-weeks compared to usual care. A dose-response curve based on WOMAC Global scores shows increasing effect with greater total time of massage, but with a plateau at the 60-minute/week dose.Conclusion
Given the superior convenience of a once-weekly protocol, cost savings, and consistency with a typical real-world massage protocol, the 60-minute once weekly dose was determined to be optimal, establishing a standard for future trials.
Herbs at a Glance: Cinnamon
Herbs at a Glance: Cinnamon
Source: National Center for Complementary and Alternative Medicine
This fact sheet provides basic information about cinnamon — common names, what the science says, potential side effects and cautions, and resources for more information.
Headaches and Complementary Health Practices
Headaches and Complementary Health Practices
Source: National Center for Complementary and Alternative Medicine
Headaches are one of the most common forms of pain. More than 45 million Americans have headaches severe enough to require the help of a health care professional. Headaches occur when pain-sensitive nerve endings around the scalp, in the blood vessels that surround the skull, in the lining around the brain, and in other areas around the head send impulses to the part of the brain that interprets pain signals from the rest of the body. Some headaches are related to tender spots in head, neck, and shoulder muscles.
Researchers are studying treatments for different types of headaches, including a number of complementary health practices. This issue provides information on “what the science says” about the effectiveness and safety of selected complementary health practices for headaches, including relaxation training, biofeedback, acupuncture, tai chi, cognitive-behavioral therapy, massage, spinal manipulation, and dietary supplements.
Antioxidant and potential anti-inflammatory activity of extracts and formulations of white tea, rose, and witch hazel on primary human dermal fibroblast cells
Antioxidant and potential anti-inflammatory activity of extracts and formulations of white tea, rose, and witch hazel on primary human dermal fibroblast cells
Source: Journal of Inflammation
Background
Numerous reports have identified therapeutic roles for plants and their extracts and constituents. The aim of this study was to assess the efficacies of three plant extracts for their potential antioxidant and anti-inflammatory activity in primary human skin fibroblasts.Methods
Aqueous extracts and formulations of white tea, witch hazel and rose were subjected to assays to measure anti-collagenase, anti-elastase, trolox equivalent and catalase activities. Skin fibroblast cells were employed to determine the effect of each extract/formulation on IL-8 release induced by the addition of hydrogen peroxide. Microscopic examination along with Neutral Red viability testing was employed to ascertain the effects of hydrogen peroxide directly on cell viability.Results
Considerable anti-collagenase, anti-elastase, and antioxidant activities were measured for all extracts apart from the witch hazel distillate which showed no activity in the collagenase assay or in the trolox equivalence assay. All of the extracts and products tested elicited a significant decrease in the amount of IL-8 produced by fibroblast cells compared to the control (p < 0.05). None of the test samples exhibited catalase activity or had a significant effect on the spontaneous secretion of IL-8 in the control cells which was further corroborated with the microscopy results and the Neutral Red viability test.Conclusions
These data show that the extracts and products tested have a protective effect on fibroblast cells against hydrogen peroxide induced damage. This approach provides a potential method to evaluate the claims made for plant extracts and the products in which these extracts are found.
See: Age-Old Remedies Using White Tea, Witch Hazel and Rose May Be Beneficial, Study Suggests (Science Daily)
Curcumin Modulates Nuclear Factor B (NF- B)-mediated Inflammation in Human Tenocytes in Vitro: ROLE OF THE PHOSPHATIDYLINOSITOL 3-KINASE/Akt PATHWAY
Curcumin Modulates Nuclear Factor B (NF- B)-mediated Inflammation in Human Tenocytes in Vitro: ROLE OF THE PHOSPHATIDYLINOSITOL 3-KINASE/Akt PATHWAY
Source: Journal of Biological Chemistry
Inflammatory processes play essential roles in the pathogenesis of tendinitis and tendinopathy. These events are accompanied by catabolic processes initiated by pro-inflammatory cytokines such as interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α). Pharmacological treatments for tendinitis are restricted to the use of non-steroidal anti-inflammatory drugs. Recent studies in various cell models have demonstrated that curcumin targets the NF-κB signaling pathway. However, its potential for the treatment of tendinitis has not been explored. Herein, we used an in vitro model of human tenocytes to study the mechanism of curcumin action on IL-1β-mediated inflammatory signaling. Curcumin at concentrations of 5–20 μM inhibited IL-1β-induced inflammation and apoptosis in cultures of human tenocytes. The anti-inflammatory effects of curcumin included down-regulation of gene products that mediate matrix degradation (matrix metalloproteinase-1, -9, and -13), prostanoid production (cyclooxygenase-2), apoptosis (Bax and activated caspase-3), and stimulation of cell survival (Bcl-2), all known to be regulated by NF-κB. Furthermore, curcumin suppressed IL-1β-induced NF-κB activation via inhibition of phosphorylation and degradation of inhibitor of κBα, inhibition of inhibitor of κB-kinase activity, and inhibition of nuclear translocation of NF-κB. Furthermore, the effects of IL-1β were abrogated by wortmannin, suggesting a role for the phosphatidylinositol 3-kinase (PI-3K) pathway in IL-1β signaling. Curcumin suppressed IL-1β-induced PI-3K p85/Akt activation and its association with IKK. These results demonstrate, for the first time, a potential role for curcumin in treating tendon inflammation through modulation of NF-κB signaling, which involves PI-3K/Akt and the tendon-specific transcription factor scleraxis in tenocytes.
See: Curry Spice Could Offer Treatment Hope for Tendinitis (Science Daily)
A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain
A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain (PDF)
Source: Annals of International Medicine
Massage therapy may be effective for treatment of chronic back pain, with benefits lasting at least 6 months. No clinically meaningful difference between relaxation and structural massage was observed in terms of relieving disability or symptoms.
What’s all the fuss about green tea?
What’s all the fuss about green tea? (PDF)
Source: Center for Science in the Public Interest
Green tea is hot. You can buy a bottled green tea beverage just about anywhere these days. And food manufacturers are adding green tea or its extracts to everything from coffee (one Eight O’Clock coffee blend has compounds from green tea “gently infused” into its beans) to juice drinks (V8 V-Fusion contains “the natural goodness of green tea”).
How good is the evidence that green tea is good for your health? Studies in laboratory animals are impressive, but compelling evidence in humans has been hard to come by.
Delivering Happiness: Translating Positive Psychology Intervention Research for Treating Major and Minor Depressive Disorders
Delivering Happiness: Translating Positive Psychology Intervention Research for Treating Major and Minor Depressive Disorders
Source: Journal of Alternative and Complementary Medicine
Despite the availability of many treatment options, depressive disorders remain a global public health problem. Even in affluent nations, 70% of reported cases either do not receive the recommended level of treatment or do not get treated at all, and this percentage does not reflect cases of depression that go unreported due to lack of access to health care, stigma, or other reasons. In developing countries, the World Health Organization estimates that <10% receive proper depression care due to poverty, stigma, and lack of governmental mental health resources and providers. Current treatments do not work for everyone, and even people who achieve remission face a high risk of recurrence and residual disability. The development of low-cost effective interventions that can serve either as initial therapy for mild symptoms or as adjunctive therapy for partial responders to medication is an immense unmet need. Positive activity interventions (PAIs) teach individuals ways to increase their positive thinking, positive affect, and positive behaviors. The majority of such interventions, which have obtained medium-size effect sizes, have been conducted with nondepressed individuals, but two randomized controlled studies in patients with mild clinical depression have reported promising initial findings. In this article, the authors review the relevant literature on the effectiveness of various types of PAIs, draw on social psychology, affective neuroscience and psychophamacology research to propose neural models for how PAIs might relieve depression, and discuss the steps needed to translate the potential promise of PAIs as clinical treatments for individuals with major and minor depressive disorders.
Zinc Lozenges May Shorten the Duration of Colds: A Systematic Review
Zinc Lozenges May Shorten the Duration of Colds: A Systematic Review
Source: The Open Respiratory Medical Journal
Background: A number of controlled trials have examined the effect of zinc lozenges on the common cold but the findings have diverged. The purpose of this study was to examine whether the total daily dose of zinc might explain part of the variation in the results.
Methods: The Medline, Scopus and Cochrane Central Register of Controlled Trials data bases were searched for placebocontrolled trials examining the effect of zinc lozenges on common cold duration. Two methods were used for analysis: the P-values of the trials were combined by using the Fisher method and the results of the trials were pooled by using the inverse-variance method. Both approaches were used for all the identified trials and separately for the low zinc dose and the high zinc dose trials.
Results: Thirteen placebo-controlled comparisons have examined the therapeutic effect of zinc lozenges on common cold episodes of natural origin. Five of the trials used a total daily zinc dose of less than 75 mg and uniformly found no effect. Three trials used zinc acetate in daily doses of over 75 mg, the pooled result indicating a 42% reduction in the duration of colds (95% CI: 35% to 48%). Five trials used zinc salts other than acetate in daily doses of over 75 mg, the pooled result indicating a 20% reduction in the duration of colds (95% CI: 12% to 28%).
Conclusions: This study shows strong evidence that the zinc lozenge effect on common cold duration is heterogeneous so that benefit is observed with high doses of zinc but not with low doses. The effects of zinc lozenges should be further studied to determine the optimal lozenge compositions and treatment strategies.
+ Full Paper (PDF)
Dietary Supplements—Regulatory Issues and Implications for Public Health
Dietary Supplements—Regulatory Issues and Implications for Public Health
Source: Journal of the American Medical Association
In October 1994, President Clinton signed into law the Dietary Supplement Health and Education Act (DSHEA), and 17 years later, health experts, policy makers, and industry lobbyists continue to spar over the legislation. Classifying dietary supplements as a subcategory of food, DSHEA allowed supplement manufacturers to market products without submitting proof of safety or efficacy to the US Food and Drug Administration (FDA). Currently, for a tainted or otherwise hazardous product to be removed from the supplement marketplace, an agency such as the FDA or the Drug Enforcement Administration must offer evidence that the product is unsafe, contains a controlled substance, or is absent ingredients listed on the product label after the product has appeared in retail outlets. For US health professionals, the fact that more than 150 million US residents use dietary supplements should be a point of concern as many users will almost certainly forgo conventional medical treatment in favor of using products that may offer no medicinal value and taking health advice from medically untrained sales representatives.
Regulation of Dietary Supplements in the Military: Report of an Expert Panel
Regulation of Dietary Supplements in the Military: Report of an Expert Panel
Source: RAND Corporation
The U.S. military has had a longstanding interest in the potential for dietary supplements to enhance performance and optimize health. However, at the same time, they are concerned about the safety dietary supplements, particularly under the conditions faced by some military personnel, and no service-wide policies exist to guide their use. In 2008, RAND Health and the Samueli Institute, under the sponsorship of the U.S. Army, assembled a panel of experts on the use of dietary supplements for performance enhancement and on regulatory issues affecting dietary supplements and conducted an informal 1-day workshop to consider the following questions:
- What types of policies and regulations currently exist regarding the use of dietary supplements in civilian sector groups such as among athletes and those whose jobs demand high levels of physical or cognitive performance?
- What types of policies currently exist in the commercial domain around the point-of-sale for dietary supplements?
- What kind of regulations does the military currently have in place (with respect to the use and purchase of dietary supplements)?
- If it so chose, what could the military do to regulate the use of dietary supplements?
+ Full Document (PDF)
Safety of Probiotics Used to Reduce Risk and Prevent or Treat Disease
Safety of Probiotics Used to Reduce Risk and Prevent or Treat Disease
Source: Agency for Healthcare Research and Quality
There is a lack of assessment and systematic reporting of adverse events in probiotic intervention studies, and interventions are poorly documented. The available evidence in RCTs does not indicate an increased risk; however, rare adverse events are difficult to assess, and despite the substantial number of publications, the current literature is not well equipped to answer questions on the safety of probiotic interventions with confidence.
+ Executive Summary
+ Full Report (PDF)
NCCAM Clinical Digest: Irritable Bowel Syndrome and CAM
NCCAM Clinical Digest: Irritable Bowel Syndrome and CAM
Source: National Center for Complementary and Alternative Medicine
Irritable bowel syndrome (IBS) is a chronic disorder that interferes with the normal functions of the colon. IBS is characterized by symptoms such as abdominal pain, cramping, bloating, constipation, and diarrhea. IBS is challenging to study because its symptoms vary and may disappear for long periods, and because people with IBS tend to respond well to placebos.
This issue summarizes research on some of the most popular complementary and alternative medicine (CAM) therapies people try to treat symptoms of IBS. Overall, although there is some emerging evidence suggesting that some CAM therapies may be helpful for IBS, there have been few large well-designed studies, and most of the studies have had methodological flaws. Systematic reviews generally conclude that more well-designed studies are needed to firmly establish whether CAM therapies are helpful treatments for IBS.
