Tim Brunson DCH

Welcome to The International Hypnosis Research Institute Web site. Our intention is to support and promote the further worldwide integration of comprehensive evidence-based research and clinical hypnotherapy with mainstream mental health, medicine, and coaching. We do so by disseminating, supporting, and conducting research, providing professional level education, advocating increased level of practitioner competency, and supporting the viability and success of clinical practitioners. Although currently over 80% of our membership is comprised of mental health practitioners, we fully recognize the role, support, involvement, and needs of those in the medical and coaching fields. This site is not intended as a source of medical or psychological advice. -- Tim Brunson, PhD

Brief Effect of Acupoint Stimulation Using Focused Ultrasound.



Abstract Background: Acupuncture is used worldwide in medical treatment. However, needle insertion damages the skin and patients sometimes feel pain. To avoid such drawbacks, an acupoint stimulation device using focused ultrasound has been developed. Ultrasound stimulation does not damage the skin like acupuncture does because ultrasound can deliver vibration energy to soft tissues noninvasively. Objectives: The aim of this study was to clarify the effect of acupoint stimulation using focused ultrasound. Subjects: Fifty (50) healthy volunteers (40 males and 10 females) were included in this experiment.

Design: Subjects were randomly assigned to two groups. LR-3 was stimulated bilaterally for 36 seconds by focused ultrasound and conventional acupuncture. Brachial artery blood flow volume was monitored by an ultrasound with an echo-tracking system. The hemodynamic parameters were measured before, during, and 30, 60, 180 seconds after stimulation. Results: During stimulation, the blood flow volume of the acupuncture stimulation group decreased significantly (p<0.05) compared with resting value, but that of the focused ultrasound stimulation group did not decrease. Blood flow volume of both groups increased gradually and showed significant increase at 180 seconds after stimulation (p<0.05). Conclusions: Blood flow volume was increased significantly by both focused ultrasound stimulation and conventional acupuncture. Although a significant decrease of blood flow volume during acupuncture stimulation was observed, no such decrease was observed during ultrasound stimulation. Findings of the present study show that noninvasive stimulation of acupoints by focused ultrasound is as effective as conventional acupuncture in blood flow volume of the brachial artery.

J Altern Complement Med. 2012 Dec 7. Tsuruoka N, Watanabe M, Takayama S, Seki T, Matsunaga T, Haga Y. 1 Graduate School of Biomedical Engineering, Tohoku University , Sendai, Japan .

Auricular acupuncture for chemically dependent pregnant women...



Full title: Auricular acupuncture for chemically dependent pregnant women: a randomized controlled trial of the NADA protocol.

BACKGROUND: The prevalence of maternal drug use during pregnancy in North America has been estimated to be as high as 6-10%. The consequences for the newborn include increased risk for perinatal mortality and ongoing physical, neurobehavioral, and psychosocial problems. Methadone is frequently used to wean women off street drugs but is implicated as a cause of adverse fetal/neonatal outcomes itself. The purpose of our study was to test the ability of maternal acupuncture treatment among mothers who use illicit drugs to reduce the frequency and severity of withdrawal symptoms among their newborns.

METHODS: We randomly assigned chemically dependent pregnant women at BC Women's Hospital in Vancouver, British Columbia to daily acupuncture treatments versus usual care. By necessity, neither our participants nor acupuncturists were blinded as to treatment allocation. Our primary outcome was days of neonatal morphine treatment for symptoms of neonatal withdrawal. Secondary neonatal outcomes included admission to a neonatal ICU and transfer to foster care.

RESULTS: We randomized 50 women to acupuncture and 39 to standard care. When analyzed by randomized groups, we did not find benefit of acupuncture; the average length of treatment with morphine for newborns in the acupuncture group was 2.7 (6.3) compared to 2.8 (7.0) in the control group. Among newborns of women who were compliant with the acupuncture regime, we observed a reduction of 2.1 and 1.5 days in length of treatment for neonatal abstinence syndrome compared to the non-compliant and control groups, respectively. These differences were not statistically significant.

CONCLUSIONS: Acupuncture may be a safe and feasible treatment to assist mothers to reduce their dosage of methadone. Our results should encourage ongoing studies to test the ability of acupuncture to mitigate the severity of neonatal abstinence syndrome among their newborns.

Subst Abuse Treat Prev Policy. 2012 Dec 23;7(1):48. Janssen P, Demorest LC, Kelly A, Thiessen P, Abrahams R.

A foot in both worlds: education and the transformation of Chinese medicine in the United States.



Although insufficiently studied, schools of complementary and alternative medicine (CAM) provide substantial insight into the transformation of medicine in the United States. Scholars have suggested that the increasing acceptance of CAM is due to its alignment with biomedical models of professionalization, education, research, and practice. At West Coast University, students of acupuncture and Oriental medicine learn to straddle both Western and Eastern medical worlds through an increasingly science-oriented curriculum and the inculcation of professional values associated with West Coast University's emphasis upon integration with Western medicine as a means of achieving professional status and legitimacy vis-à-vis the dominant biomedical paradigm. The implications of integration with biomedicine for the identity of Chinese medicine are discussed: from the perspective of critical medical anthropology, integration reproduces biomedical hegemony; paving the way toward co-optation of Chinese medicine, the subordination of its practitioners, and, ultimately, the constraint of medical pluralism in the United States.

Med Anthropol. 2013 Jan;32(1):8-24. doi: 10.1080/01459740.2012.694930. Flesch H. a McMaster University , Hamilton , Ontario , Canada.

Neuromuscular electrostimulation techniques: historical aspects and current possibilities in treatme



Application of electricity for pain treatment dates back to thousands of years BC. The Ancient Egyptians and later the Greeks and Romans recognized that electrical fishes are capable of generating electric shocks for relief of pain. In the 18th and 19th centuries these natural producers of electricity were replaced by man-made electrical devices. This happened in following phases. The first was the application of static electrical currents (called Franklinism), which was produced by a friction generator. Christian Kratzenstein was the first to apply it medically, followed shortly by Benjamin Franklin. The second phase was Galvanism. This method applied a direct electrical current to the skin by chemical means, applied a direct and pulsed electrical current to the skin. In the third phase the electrical current was induced intermittently and in alternate directions (called Faradism). The fourth stage was the use of high frequency currents (called d'Arsonvalisation). The 19th century was the "golden age" of electrotherapy. It was used for countless dental, neurological, psychiatric and gynecological disturbances. However, at beginning of the 20th century electrotherapy fell from grace. It was dismissed as lacking a scientific basis and being used also by quacks and charlatans for unserious aims. Furthermore, the development of effective analgesic drugs decreased the interest in electricity. In the second half of the 20th century electrotherapy underwent a revival. Based on animal experiments and clinical investigations, its neurophysiological mechanisms were elucidated in more details. The pain relieving action of electricity was explained in particular by two main mechanisms: first, segmental inhibition of pain signals to the brain in the dorsal horn of the spinal cord and second, activation of the descending inhibitory pathway with enhanced release of endogenous opioids and other neurochemical compounds (serotonin, noradrenaline, gamma aminobutyric acid (GABA), acetylcholine and adenosine). The modern electrotherapy of neuromusculo- skeletal pain is based in particular on the following types: transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation (PENS or electro-acupuncture) and spinal cord stimulation (SCS). In mild to moderate pain, TENS and PENS are effective methods, whereas SCS is very useful for therapy of refractory neuropathic or ischemic pain. In 2005, high tone external muscle stimulation (HTEMS) was introduced. In diabetic peripheral neuropathy, its analgesic action was more pronounced than TENS application. HTEMS appeared also to have value in the therapy of symptomatic peripheral neuropathy in end-stage renal disease (ESRD). Besides its pain-relieving effect, electrical stimulation is of major importance for prevention or treatment of muscle dysfunction and sarcopenia. In controlled clinical studies electrical myostimulation (EMS) has been shown to be effective against the sarcopenia of patients with chronic congestive heart disease, diabetes, chronic obstructive pulmonary disease and ESRD.

Clin Nephrol. 2013 Sup;79(13):12-23. Heidland A, Fazeli G, Klassen A, Sebekova K, Hennemann H, Bahner U, Di Iorio B. Department of Internal Medicine, University of Würzburg, KfH-Kidney Center, Institute of Pharmacology and Toxicology, University of Würzburg, Würzburg, Germany, Institute of Molecular Biomedicine, Medical Faculty, Comenius University, Bratislava, Slovakia, KfH Kidney Center Coburg, Coburg, Germany, and Faculty of Medicine and Surgery, Seconda Universita di Napoli, Italy.

Correlation between facial nerve functional evaluation...



Full title: Correlation between facial nerve functional evaluation and efficacy evaluation of acupuncture treatment for Bell's palsy.

To assess and grade facial nerve dysfunction according to the extent of facial paralysis in the clinical course of acupuncture treatment for Bell's palsy, and to observe the interrelationship between the grade, the efficacy and the period of treatment, as well as the effect on prognosis. The authors employed the House-Brackmann scale, a commonly used evaluation scale for facial paralysis motor function, and set standards for eye fissure and lips. According to the improved scale, the authors assessed and graded the degree of facial paralysis in terms of facial nerve dysfunction both before and after treatment. The grade was divided into five levels: mild, moderate, moderately severe, severe dysfunction and complete paralysis. The authors gave acupuncture treatment according to the state of the disease without artificially setting the treatment period. The observation was focused on the efficacy and the efficacy was evaluated throughout the entire treatment process. Fifty-three cases out of 68 patients with Bell's palsy were cured and the overall rate of efficacy was 97%. Statistically significant differences (P<0.01) were perceived among the efficacy of five levels of facial nerve dysfunction. Efficacy was correlated with the damage level of the disease (correlation coefficient r=0.423, P<0.01). The course of treatment also extended with the severity of facial nerve dysfunction (P<0.01). Differences exist in patients with Bell's palsy in terms of severity of facial nerve dysfunction. Efficacy is reduced in correlation with an increase in facial nerve dysfunction, and the period of treatment varies in need of different levels of facial nerve dysfunction. It is highly necessary to assess and grade patients before observation and treatment in clinical study, and choose corresponding treatment according to severity of damage of the disease.

Zhong Xi Yi Jie He Xue Bao. 2012 Sep;10(9):997-1002. Zhou ZL, Li CX, Jiang YB, Zuo C, Cai Y, Wang R. Department of Acupuncture and Moxibustion, General Hospital of the People's Liberation Army, Beijing 100853, China; E-mail: zhouzhangling@sina.com.

Complementary and alternative medicine treatments among stroke patients in India.



Complementary and alternative medicine (CAM) is commonly used by persons with stroke throughout the world, particularly in Asia. Objective: The objectives of this study were to determine the frequency of CAM use and the factors that predict the use of CAM in stroke patients. Methods: This study was carried out in the stroke units of Christian Medical College, Ludhiana, and Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India, from June 2010 to December 2010. Participants were interviewed using a structured questionnaire (=6 months post stroke). Outcomes were assessed using a modifi ed Rankin Scale (mRS). Results: Three hundred fourteen stroke patients were interviewed; mean age was 57.4 ± 12.9 years, and 230 (73.2%) patients were men. Of 314 patients, 114 (36.3%) had used the following CAM treatments: ayurvedic massage, 67 (59.3%); intravenous fl uids, 22 (19.5%); herbal medicines, 17 (15%); homeopathy, 15 (13.3%); witchcraft, 3 (2.7%); acupuncture, 3 (2.7%); opium intake, 10 (8.8%); and other nonconventional treatments, 10 (8.8%). Patients with severe stroke (P < .0001), limb weakness (P < .0001), dysphagia (P = .02), dyslipidemia (P = .007), hypertension (P = .03), or hemorrhagic stroke (P<.0001) and patients with poor outcome (mRS >2;P < .0001) often used CAM treatments. Conclusion: More than one-third of the patients in this study opted for CAM. Presence of limb weakness, dysphagia, dyslipidemia, hypertension, hemorrhagic stroke, severe stroke, and poor outcome predicted the use of CAM.

Top Stroke Rehabil. 2012 Sep-Oct;19(5):384-94. Pandian JD, Toor G, Arora R, Kaur P, Dheeraj KV, Bhullar RS, Sylaja PN. Stroke Unit, Department of Neurology, Christian Medical College, Ludhiana, Punjab, India.

Efficacy of acupuncture for chronic knee pain...



Full Title: Efficacy of acupuncture for chronic knee pain: protocol for a randomised controlled trial using a Zelen-design randomised controlled trial.

Chronic knee pain is a common and disabling condition in people over 50 years of age, with knee joint osteoarthritis being a major cause. Acupuncture is a popular form of complementary and alternative medicine for treating pain and dysfunction associated with musculoskeletal conditions. This pragmatic Zelen-design randomised controlled trial is investigating the efficacy and cost-effectiveness of needle and laser acupuncture, administered by medical practitioners, in people with chronic knee pain. Two hundred and eighty two people aged over 50 years with chronic knee pain have been recruited from metropolitan Melbourne and regional Victoria, Australia. Participants originally consented to participate in a longitudinal natural history study but were then covertly randomised into one of four treatment groups. One group continued as originally consented (ie natural history group) and received no acupuncture treatment. The other three were treatment groups: i) laser acupuncture, ii) sham laser or, iii) needle acupuncture. Acupuncture treatments used a combined Western and Traditional Chinese Medicine style, were delivered by general practitioners and comprised 8--12 visits over 12 weeks. Follow-up is currently ongoing. The primary outcomes are pain measured by an 11-point numeric rating scale (NRS) and self-reported physical function measured by the Western Ontario and McMaster (WOMAC) Universities Osteoarthritis Index subscale at the completion of treatment at 12 weeks. Secondary outcomes include quality of life, global rating of change scores and additional measures of pain (other NRS and WOMAC subscale) and physical function (NRS). Additional parameters include a range of psychosocial measures in order to evaluate potential relationships with acupuncture treatment outcomes. Relative cost-effectiveness will be determined from health service usage and outcome data. Follow-up assessments will also occur at 12 months. The findings from this study will help determine whether laser and/or needle acupuncture is efficacious, and cost-effective, in the management of chronic knee pain in older people.

BMC Complement Altern Med. 2012 Sep 19;12(1):161. Hinman RS, McCrory P, Pirotta M, Relf I, Crossley KM, Reddy P, Forbes A, Harris A, Metcalf BR, Kyriakides M, Novy K, Bennell KL.

Rehabilitation and treatment of a recreational golfer with hip osteoarthritis: a case report.



This case study reviews the conservative chiropractic treatment of hip osteoarthritis (OA) and the prescription of a rehabilitation program for a recreational golfer. A 49-year-old registered nurse/ college instructor presented with a five year history of left hip OA and pain, recent right hip pain and occasional low back stiffness. Once her symptoms improved, a golf-specific functional rehabilitation program was prescribed in preparation for the upcoming golf season. The initial treatment included ultrasound, soft tissue and myofascial therapy, mobilizations, acupuncture and home advice. Rehabilitative exercises included core and scapular stability exercises, general conditioning, golf specific stretches, functional swinging, proprioceptive and strengthening exercises, and referral to a swing coach. The positive outcomes included increased ranges of motion, decreased pain, as well as improvements in golf driving distance and endurance. Conservative management and golf-specific rehabilitation prescription appears to be beneficial for hip OA and recreational golf performance in this case.

J Can Chiropr Assoc. 2012 Sep;56(3):201-8. Howell ER. Ashbridge's Health Centre, 1522 Queen St. East, Toronto, ON M4L 1E3. E-mail: dremilyhowell@hotmail.com

Effects of auricular acupressure on body weight parameters in patients with chronic schizophrenia.



Auricular acupressure is widely used in complementary and alternative medicine to reduce body weight, but little is known about the effects of auricular acupressure on body weight parameters in patients with chronic schizophrenia. The purpose of this study was to evaluate the effects of auricular acupressure on body weight parameters in patients with chronic schizophrenia. Eighty-six inpatients with schizophrenia were recruited from chronic wards in a psychiatric center. The participants were randomly divided into experimental (acupressure at 4 acupuncture sites: hunger, stomach, shenmen and endocrine) and control groups, and body weight parameters were determined weekly for 8 weeks. There was no significant difference between the experimental and control groups in mean body weight, waist circumference, or body fat percentage at the pretest or during the entire 8-week study period. Therefore, auricular acupressure did not cause body weight reduction in patients with chronic schizophrenia.

Evid Based Complement Alternat Med. 2012;2012:151737. Epub 2012 Sep 10. Ching HY, Wu SL, Chen WC, Hsieh CL. Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan ; Department of Psychiatry, Tsao-Tun Psychiatric Center, Department of Health, Executive Yuan, Nan-Tou 54249, Taiwan.

Complementary medicine, exercise, meditation, diet, and lifestyle modification...



Full title: Complementary medicine, exercise, meditation, diet, and lifestyle modification for anxiety disorders: a review of current evidence.

Use of complementary medicines and therapies (CAM) and modification of lifestyle factors such as physical activity, exercise, and diet are being increasingly considered as potential therapeutic options for anxiety disorders. The objective of this metareview was to examine evidence across a broad range of CAM and lifestyle interventions in the treatment of anxiety disorders. In early 2012 we conducted a literature search of PubMed, Scopus, CINAHL, Web of Science, PsycInfo, and the Cochrane Library, for key studies, systematic reviews, and metaanalyses in the area. Our paper found that in respect to treatment of generalized anxiety or specific disorders, CAM evidence revealed current support for the herbal medicine Kava. One isolated study shows benefit for naturopathic medicine, whereas acupuncture, yoga, and Tai chi have tentative supportive evidence, which is hampered by overall poor methodology. The breadth of evidence does not support homeopathy for treating anxiety. Strong support exists for lifestyle modifications including adoption of moderate exercise and mindfulness meditation, whereas dietary improvement, avoidance of caffeine, alcohol, and nicotine offer encouraging preliminary data. In conclusion, certain lifestyle modifications and some CAMs may provide a beneficial role in the treatment of anxiety disorders.

Evid Based Complement Alternat Med. 2012;2012:809653. Epub 2012 Aug 27. Sarris J, Moylan S, Camfield DA, Pase MP, Mischoulon D, Berk M, Jacka FN, Schweitzer I. Department of Psychiatry, The University of Melbourne, Melbourne, VIC 3000, Australia.

Efficacy observation on osteoarthritis of the knee...



Full title: Efficacy observation on osteoarthritis of the knee treated with the ultrastructural acupotomy therapy at the counter-Ashi points.

To compare the difference in the efficacy on osteoarthritis of the knee between the ultrastructural acupotomy therapy at the counter-Ashi points and the conventional acupuncture-moxibustion therapy. Sixty cases were randomly devided into an ultrastructural acupotomy therapy group (group A) and a conventional acupuncture-moxibustion group (group B), 30 cases in each one. In the group A, the ultrastructural acupotomy therapy was applied to the counter-Ashi points in which pain was alleviated or disappeared on pressure. The treatment was given once a week, lasting for 1 month. In the group B, the acupuncture-moxibustion therapy was applied to Dubi (ST 35), Neixiyan (EX-LE 4), Zusanli (ST 36), Yanglingquan (GB 34), etc. The treatment was given once daily, lasting for 1 month. Before and after treatment, the Visual Analogue Scale (VAS), Lysholm knee joint scale and the affected knee joint flexion angle were observed in the two groups. The clinical efficacy was compared between the two groups. After treatment, the scores of VAS, Lysholm knee joint scale and the affected knee joint flexion angle were improved obviously as compared with those before treatment in either group (P < 0.01, P < 0.05). The results of them in the group A were superior apparently to those in the group B (all P < 0.05). The total effective rate in the group A was superior to that in the group B [80.0% (24/30) vs 60.0% (18/30), P < 0.05]. The ultrastructural acupotomy therapy at the counter-Ashi points achieves the superior clinical efficacy on osteoarthritis of the knee as compared with the conventional acupuncture therapy. It relieves pain and improves the motion range of knee joint effectively. It is simple in operation and less in treatment frequency.

Zhongguo Zhen Jiu. 2012 Jul;32(7):621-4. Liu MR, Li L, He ZW. Department of Acupuncture-Moxibustion and Tuina, The First Affiliated Hospital of Hunan University of CM, Changsha 410007, China.

Survey of studies on drug abstinence with acupuncture in recent 10 years.



The effect of acupuncture on substance withdrawl syndromes and craving relapse prevention of the recent 10 years were reviewed as well as its mechanism. The therapeutic effect and the possible mechanism were analyzed on the basis. From the three aspects of anti protracted abstinence symptoms, craving relapse prevention and mechanism of acupuncture, the development tendency and the prospect of application on drug withdrawl with acupuncture were expected. And it is proposed that clinical observation of acupuncture intervention on craving should be developed, the mechanism of acupuncture impact on cognitive behavior, blocking study and memory processing related to drug addiction should be explored, so as to further give play to the advantages of acupuncture on anti-drug addiction.

Zhongguo Zhen Jiu. 2012 Jul;32(7):669-72. Song XG, Lü H, Cai XH, Zhang RJ. Institute of Acupuncture and Meridian, Anhui University of CM, Hefei 230038, China. zsongxg0128@163.com

Fear-driven cesarean section on request.



Traditionally, women gave birth surrounded by other, experienced women. Modern women not only require continuous support during labor, but they also want to have a part in decision-taking. That is why some of them, regardless of how much or how little medical knowledge they have, want to decide about the way of birth on their own. The aim of this study was to find the underlying cause of the growing percentage of cesarean sections and cesarean sections on request and to find an answer to the question of what can be done to reduce that number. A survey was conducted among 100 nulliparas between 38 and 40 week of pregnancy who were determined to give birth in a natural way, and among 50 nulliparas, in the same gestational age, who requested cesarean section. The analysis of our survey shows that request for cesarean section in 12% of cases resulted from fear of labor pain, more than before were declared 2%. After they were informed about methods of reducing labor pain and guaranteed that those methods would be available, as many as 52% of pregnant women who had previously requested cesarean section changed their mind and wanted to give birth in a natural way (this could reduce cesarean section rate about 52%, p<0.05), and 42% (of the total) wanted to have epidural anesthesia. Better access of pregnant women to information about pharmacological and non-pharmacological methods of reducing labor pain, coupled with the availability of those methods, can reduce the number of cesarean sections on request even by half. In the group of pregnant women determined to have cesarean section, one in four would give it up if they had access to epidural anesthesia, and one in ten if they had access to non-pharmacological methods of reducing labor pain (mainly acupuncture).

Pol Merkur Lekarski. 2012 Aug;33(194):86-9. Pawelec M, Pietras J, Karmowski A, Palczynski B, Karmowski M, Nowak T. First Chair and Department of Gynecology and Obstetrics, Medical University of Wroclaw, Poland. mproust@wp.pl

DoD-NCCAM/NIH Workshop on Acupuncture for Treatment of Acute Pain.



The Department of Defense (DoD) and the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) cosponsored a workshop that explored the possible benefits of acupuncture treatment for acute pain. One goal of the workshop was to establish a roadmap to building an evidence base on that would indicate whether acupuncture is helpful for treating active-duty military personnel experiencing acute pain. The workshop highlighted brief presentations on the most current research on acupuncture and acute pain mechanisms. The impact of various modifiers (stress, genetics, population, phenotypes, etc.) on acute pain pathways and response to acupuncture treatment was discussed. Additional presentations focused on common neural mechanisms, an overview of real-world experience with using acupuncture to treat traumatic acute pain, and best tools and methods specific for acupuncture studies. Three breakout groups addressed the gaps, opportunities, and barriers to acupuncture use for acute pain in military and trauma settings. Different models of effectiveness research and optimal research designs for conducting trials in acute traumatic pain were also discussed.

J Altern Complement Med. 2012 Sep 28. Edwards E, Louis Belard J, Glowa J, Khalsa P, Weber W, Huntley K. 1 Division of Extramural Research, National Center for Complementary and Alternative Medicine , Bethesda, MD.

The importance of supportive care in optimizing treatment outcomes...



Full Title: The importance of supportive care in optimizing treatment outcomes of patients with advanced prostate cancer.

Optimal oncologic care of older men with prostate cancer, including effective prevention and management of the disease and treatment side effects (so-called best supportive care measures) can prolong survival, improve quality of life, and reduce depressive symptoms. In addition, the proportion of treatment discontinuations can be reduced through early reporting and management of side effects. Pharmacologic care may be offered to manage the side effects of androgen-deprivation therapy and chemotherapy, which may include hot flashes, febrile neutropenia, fatigue, and diarrhea. Nonpharmacologic care (e.g., physical exercise, acupuncture, relaxation) has also been shown to benefit patients. At the Georges Pompidou European Hospital, the Program of Optimization of Chemotherapy Administration has demonstrated that improved outpatient follow-up by supportive care measures can reduce the occurrence of chemotherapy-related side effects, reduce cancellations and modifications of treatment, reduce chemotherapy wastage, and reduce the length of stay in the outpatient unit. The importance of supportive care measures to optimize management and outcomes of older men with advanced prostate cancer should not be overlooked.

Oncologist. 2012;17 Suppl 1:23-30. Scotté F. Oncologie Médicale et Unité Fonctionnelle de Soins de Support, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015 Paris, France. florian.scotte@egp.aphp.fr.

Acupuncture for Chronic Low Back Pain...



Full title: Acupuncture for Chronic Low Back Pain: A Multicenter, Randomized, Patient-Assessor Blind, Sham-Controlled Clinical Trial.

Study Design. Multicenter, Randomized, Patient-Assessor Blind, Sham-Controlled Clinical Trial.Objective. To investigate the efficacy of acupuncture treatment with individualized setting for reduction of bothersomeness in participants with chronic low back pain (cLBP).Summary of Background Data. Low back pain is one of the main reasons of disability among adults of working age. Acupuncture is known as an effective treatment for chronic low back pain, but it remains still unclear whether acupuncture is superior to placebo.Methods. One hundred thirty adults aged 18-65 with non-specific LBP of lasting for at least the last 3 months was participated in the three Korean medical hospitals in Korea. Participants got individualized real acupuncture treatments or sham acupuncture treatments over 6 weeks (twice a week) from Korean medicine doctors. Primary outcome was change of Visual Analogue Scale (VAS) score for bothersomeness of cLBP. Secondary outcomes included VAS for pain intensity and questionnaires including Oswestry disability index (ODI), General health status (SF-36), and Beck's depression inventory (BDI).Results. There were no baseline differences observed between two groups except ODI. One hundred sixteen participants finished the treatments and 3-, 6-month follow ups with fourteen subjects' drop-out. Significant difference of VAS for bothersomeness and pain intensity of cLBP have been found between two groups (p<0.05) at the primary end point (8 week). In addition, those two scores have been improved continuously until 3-month follow up (p = 0.011, p = 0.005, respectively). ODI, BDI and SF-36 scores were also improved in both groups without group difference.Conclusion. This randomized sham-controlled trial suggests that acupuncture treatment show the better effects on the reduction of the bothersomeness and pain intensity than sham-control in participants with cLBP.

Spine (Phila Pa 1976). 2012 Sep 28. Cho YJ, Song YK, Cha YY, Shin BC, Shin IH, Park HJ, Lee HS, Kim KW, Cho JH, Chung WS, Lee JH, Song MY. 1Department of Oriental Rehabilitation Medicine, Kyung Hee University, Seoul, Korea 2Department of Oriental Rehabilitation Medicine, Kyung Won University, Sungnam, Korea 3Department of Oriental Rehabilitation Medicine, Sang Ji University, Wonju, Korea 4Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Korea 5Department of Biomedical Statistics, Catholic University of Daegu, Daegu, Korea 6Department of Meridian and Acupoints, Kyung Hee University, Seoul, Korea.

Applied kinesiology: Distinctions in its definition and interpretation.



Modification of the motor system in assessing and treating as well as understanding one of the causes of musculoskeletal dysfunctions is a topic of growing importance in healthcare. Applied kinesiology (AK) addresses this interest in that it is a system which attempts to evaluate numerous aspects of health (structural, chemical, and mental) by the manual testing of muscles combined with other standard methods of diagnosis. It leads to a variety of conservative, non-invasive treatments which involve joint manipulations or mobilizations, myofascial therapies, cranial techniques, meridian and acupuncture skills, clinical nutrition and dietary management, counseling skills, evaluating environmental irritants, and various reflex techniques. The effectiveness of these ancillary treatments is believed to be consistent with the expanded construct validity of the manual muscle test (MMT), as described, although this assertion has primarily been tested in outcome studies. AK and its adjunctive procedures (challenge and therapy localization) are highlighted in this review providing details of its implementation as prescribed by an International College of Applied Kinesiology's Board of Examiners, cited for its scholarly and scientific activities. Because these procedures are believed to identify specific articular, soft tissue, biochemical, or emotional issues underlying muscle function, the applicability of this diagnostic method for all clinicians treating muscle imbalance disorders is described. As of yet, MMT efficacy in therapy localization and challenge techniques has not been established in published, peer-reviewed research. A variety of challenges likewise remain for professional AK to establish itself as an emerging science, with numerous gaps in the literature and testable hypotheses enumerated. Of particular concern are a multiplicity of derivatives of AK that have been described in the literature, which should be greeted with caution in light of the fact that they lack one or more of the essential attributes of AK as described in this report. The validity of these studies which have been critical of applied kinesiology appears in many instances to be no greater than several of the randomized controlled trials, cohort studies, case control studies, and case studies found in this communication to support various aspects of applied kinesiology.

J Bodyw Mov Ther. 2012 Oct;16(4):464-87. doi: 10.1016/j.jbmt.2012.04.008. Epub 2012 May 11. Rosner AL, Cuthbert SC. 1330 Beacon Street, Suite #315, Brookline, MA 02446-3202, USA. Electronic address: arosner66@aol.com.

Conservative care of sports hernias within soccer players: A case series.



To detail the progress of 2 high-level soccer players and 1 recreational soccer player with chronic groin pain that was exacerbated by participation in sports and relieved by rest. The patients under went a conservative treatment plan featuring manual therapy, therapeutic modalities, and plyometric training. The most important examination findings were palpable tenderness over the internal oblique fascia and anterior pubic tubercle, pain with resisted hip adduction, and pain with a resisted abdominal curl-up. Conventional treatment aimed at decreasing healing time of the injury through manual therapy, including soft tissue and modality techniques; rehabilitative exercises, focusing on the pelvic muscles; and plyometric training, aiming at sport specific functional improvement. The conservative treatment approach utilized in this case series involved manual therapy, 1-2 times a week for 6-8 weeks, consisting of soft tissue, laser, microcurrent, and acupuncture; rehabilitative exercise and plyometric training, 3 times a week for 8 weeks, to help improve strength, coordination, and correct pelvic muscle imbalances. Outcome measures included visual analog scale scores and resisted muscle testing. Three soccer players, of varying levels of ability, presenting with a suspected sports hernia (chronic groin pain exacerbated by sports and relieved by rest) were relieved of their pain after 8 weeks of conservative care featuring manual therapy, rehabilitative exercises, and plyometric training.

J Bodyw Mov Ther. 2012 Oct;16(4):540-8. doi: 10.1016/j.jbmt.2012.04.004. Epub 2012 May 5. Yuill EA, Pajaczkowski JA, Howitt SD. Sports Science Resident, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario M2H 3J1, Canada. Electronic address: eyuill@cmcc.ca.

Acupuncture for Chronic Low Back Pain...



Full title: Acupuncture for Chronic Low Back Pain: A Multicenter, Randomized, Patient-Assessor Blind, Sham-Controlled Clinical Trial.

Study Design. Multicenter, Randomized, Patient-Assessor Blind, Sham-Controlled Clinical Trial.Objective. To investigate the efficacy of acupuncture treatment with individualized setting for reduction of bothersomeness in participants with chronic low back pain (cLBP).Summary of Background Data. Low back pain is one of the main reasons of disability among adults of working age. Acupuncture is known as an effective treatment for chronic low back pain, but it remains still unclear whether acupuncture is superior to placebo.Methods. One hundred thirty adults aged 18-65 with non-specific LBP of lasting for at least the last 3 months was participated in the three Korean medical hospitals in Korea. Participants got individualized real acupuncture treatments or sham acupuncture treatments over 6 weeks (twice a week) from Korean medicine doctors. Primary outcome was change of Visual Analogue Scale (VAS) score for bothersomeness of cLBP. Secondary outcomes included VAS for pain intensity and questionnaires including Oswestry disability index (ODI), General health status (SF-36), and Beck's depression inventory (BDI).Results. There were no baseline differences observed between two groups except ODI. One hundred sixteen participants finished the treatments and 3-, 6-month follow ups with fourteen subjects' drop-out. Significant difference of VAS for bothersomeness and pain intensity of cLBP have been found between two groups (p<0.05) at the primary end point (8 week). In addition, those two scores have been improved continuously until 3-month follow up (p = 0.011, p = 0.005, respectively). ODI, BDI and SF-36 scores were also improved in both groups without group difference.Conclusion. This randomized sham-controlled trial suggests that acupuncture treatment show the better effects on the reduction of the bothersomeness and pain intensity than sham-control in participants with cLBP.

Spine (Phila Pa 1976). 2012 Sep 28. Cho YJ, Song YK, Cha YY, Shin BC, Shin IH, Park HJ, Lee HS, Kim KW, Cho JH, Chung WS, Lee JH, Song MY. 1Department of Oriental Rehabilitation Medicine, Kyung Hee University, Seoul, Korea 2Department of Oriental Rehabilitation Medicine, Kyung Won University, Sungnam, Korea 3Department of Oriental Rehabilitation Medicine, Sang Ji University, Wonju, Korea 4Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Korea 5Department of Biomedical Statistics, Catholic University of Daegu, Daegu, Korea 6Department of Meridian and Acupoints, Kyung Hee University, Seoul, Korea.

Integration of complementary and alternative medicine in primary care: What do patients want?



To explore patients' perspectives towards integration of Complementary and Alternative Medicine (CAM) in primary care. A mixed-methods approach was used. This included a survey on use, attitudes and disclosure of CAM, an e-panel consultation and focus group among patients with joint diseases. A total of 416 patients responded to the survey who suffered from osteoarthritis (51%), rheumatoid arthritis (29%) or fibromyalgia (24%). Prevalence of CAM use was 86%, of which 71% visited a CAM practitioner. Manual therapies, acupuncture and homeopathy were most frequently used. A minority (30%) actively communicated CAM use with their General Practitioner (GP). The majority (92%) preferred a GP who informed about CAM, 70% a GP who referred to CAM, and 42% wanted GPs to collaborate with CAM practitioners. Similar attitudes were found in the focus group and upon e-panel consultation. Most patients in primary care want a GP who listens, inquires about CAM and if necessary refers to or collaborates with CAM practitioners. To meet needs of patients, primary care disease management would benefit from an active involvement of GPs concerning CAM communication/referral. This study presents a model addressing the role of patients and GPs within such an integrative approach.

Patient Educ Couns. 2012 Sep 29. pii: S0738-3991(12)00341-2. doi: 10.1016/j.pec.2012.08.013. Jong MC, van de Vijver L, Busch M, Fritsma J, Seldenrijk R. Department Healthcare and Nutrition, Louis Bolk Institute, Driebergen, The Netherlands; Department Health Sciences, Mid Sweden University, Sundsvall, Sweden; National Information and Knowledge Centre for Integrative Medicine (NIKIM), The Netherlands. Electronic address: m.jong@louisbolk.nl.

The importance of supportive care in optimizing treatment outcomes...



Full Title: The importance of supportive care in optimizing treatment outcomes of patients with advanced prostate cancer.

Optimal oncologic care of older men with prostate cancer, including effective prevention and management of the disease and treatment side effects (so-called best supportive care measures) can prolong survival, improve quality of life, and reduce depressive symptoms. In addition, the proportion of treatment discontinuations can be reduced through early reporting and management of side effects. Pharmacologic care may be offered to manage the side effects of androgen-deprivation therapy and chemotherapy, which may include hot flashes, febrile neutropenia, fatigue, and diarrhea. Nonpharmacologic care (e.g., physical exercise, acupuncture, relaxation) has also been shown to benefit patients. At the Georges Pompidou European Hospital, the Program of Optimization of Chemotherapy Administration has demonstrated that improved outpatient follow-up by supportive care measures can reduce the occurrence of chemotherapy-related side effects, reduce cancellations and modifications of treatment, reduce chemotherapy wastage, and reduce the length of stay in the outpatient unit. The importance of supportive care measures to optimize management and outcomes of older men with advanced prostate cancer should not be overlooked.

Oncologist. 2012;17 Suppl 1:23-30. Scotté F. Oncologie Médicale et Unité Fonctionnelle de Soins de Support, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015 Paris, France. florian.scotte@egp.aphp.fr.

Neuroendocrine mechanisms of acupuncture in the treatment of hypertension.



Hypertension affects approximately 1 billion individuals worldwide. Pharmacological therapy has not been perfected and often is associated with adverse side effects. Acupuncture is used as an adjunctive treatment for a number of cardiovascular diseases like hypertension. It has long been established that the two major contributors to systemic hypertension are the intrarenal renin-angiotensin system and chronic activation of the sympathetic nervous system. Recent evidence indicates that in some models of cardiovascular disease, blockade of AT1 receptors in the rostral ventrolateral medulla (rVLM) reduces sympathetic nerve activity and blood pressure, suggesting that overactivity of the angiotensin system in this nucleus may play a role in the maintenance of hypertension. Our experimental studies have shown that electroacupuncture stimulation activates neurons in the arcuate nucleus, ventrolateral gray, and nucleus raphe to inhibit the neural activity in the rVLM in a model of visceral reflex stimulation-induced hypertension. This paper will discuss current knowledge of the effects of acupuncture on central nervous system and how they contribute to regulation of acupuncture on the endocrine system to provide a perspective on the future of treatment of hypertension with this ancient technique.

Evid Based Complement Alternat Med. 2012;2012:878673. Zhou W, Longhurst JC. Department of Anesthesiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA.

Self-administered acupuncture as an alternative to deliberate self-harm: a feasibility study.



The aim of this mixed methods feasibility study was to demonstrate the acceptability, practicality, and safety of training patients who regularly use deliberate self harm (DSH) to self-administer acupuncture as an alternative coping skill for emotional distress. Ten adult patients with a diagnosis of emotionally unstable personality disorder who regularly self-harmed were recruited to the study following baseline assessment by a psychiatrist. An acupuncturist taught participants to self-acupuncture. During the 6-week intervention participants recorded their emotional distress, coping behaviors, thoughts, and feelings in a diary. Face-to-face interviews were used to explore participants' motives for DSH and their experience of acupuncture. Framework analysis was conducted on interview transcripts and diary entries to identify common themes. Mood at baseline and six weeks was measured using the BDI and changes in the use of coping behaviors and acupuncture were measured using diary entries. Subjects used acupuncture regularly through the six-week intervention and over this period there was a reduction in the frequency of DSH. Qualitative analysis identified two broad themes relating to the process and the effects of acupuncture. There was wide variation in the effects experienced by subjects which broadly mapped onto to the wide range of motives behind DSH. BDI scores showed a near significant reduction (p = 0.055) from 44.4. to 34.4 over the 6-week intervention. Patients presenting with deliberate self harm can be safely trained to self-administer acupuncture as an alternative coping skill. Acceptability and effectiveness may vary between patients depending on the complex motives underlying their self-harming behavior. While the pilot study was designed to explore the feasibility of the intervention, results from this limited sample suggest that use of self-administered acupuncture may reduce the frequency of self harming behavior and reduce emotional distress as measured using the BDI.

J Pers Disord. 2011 Dec;25(6):741-54. Davies S, Bell D, Irvine F, Tranter R.

Lifestyle behaviors in women undergoing in vitro fertilization: a prospective study.



OBJECTIVE: To determine the lifestyle behaviors of women before and during an IVF cycle. DESIGN: Prospective survey. SETTING: Private academically affiliated infertility center. PATIENT(S): One hundred eighteen women, ages 18-44, scheduled to undergo an assisted reproductive technology (ART) cycle using their own eggs. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Lifestyle history and daily habit survey. RESULT(S): In the month before their IVF cycle, 92% exercised, 3% smoked, 73% drank alcohol, 76% drank caffeinated beverages, 14% took herbs, and 30% underwent acupuncture. During their ART cycle, 100% exercised, 2% smoked, 49% drank alcohol, 77% drank caffeine, 12% took herbs, and 47% underwent acupuncture. CONCLUSION(S): This is the first prospective assessment of numerous lifestyle habits during an ART cycle. A number of surprising observations were made. Despite physician recommendation against it, some ART patients took herbs while cycling. Patients continue to exercise regularly and drink caffeine daily, and almost half continued to drink alcohol. Lifestyle behavior counseling should be considered for patients pursuing ART. CLINICAL TRIAL REGISTRATION NUMBER: NCT01119391.

Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Fertil Steril. 2012 Jan 2. Domar AD, Conboy L, Denardo-Roney J, Rooney KL. Boston IVF, Waltham, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Alternative therapies useful in the management of diabetes: A systematic review.



Diabetes mellitus is a metabolic disorder in the endocrine system. This dreadful disease is found in all parts of the world and becoming a serious threat of mankind health. There are lots of chemical agents available to control and to treat diabetic patients, but total recovery from diabetes has not been reported up to this date. In addition to adverse effects, drug treatments are not always satisfactory in maintaining euglycemia and avoiding late stage diabetic complications. Alternative to these synthetic agents, plants provided a potential source of hypoglycemic drugs and are widely used in several traditional systems of medicine to prevent diabetes. Several medicinal plants have been investigated for their beneficial effect in different type of diabetes. Other alternative therapies such as dietary supplements, acupuncture, hydrotherapy, and yoga therapies less likely to have the side effects of conventional approaches for diabetes.

J Pharm Bioallied Sci. 2011 Oct;3(4):504-12. Pandey A, Tripathi P, Pandey R, Srivatava R, Goswami S. Department of Pharmacy, Institute of Technology and Management, Gorakhpur, Uttar Pradesh, India.

Integrative Mental Health (IMH): Paradigm, Research, and Clinical Practice.



This paper provides an overview of the rapidly evolving paradigm of "Integrative Mental Health (IMH)." The paradigm of contemporary biomedical psychiatry and its contrast to non-allopathic systems of medicine is initially reviewed, followed by an exploration of the emerging paradigm of IMH, which aims to reconcile the bio-psycho-socio-spiritual model with evidence-based methods from traditional healing practices. IMH is rapidly transforming conventional understandings of mental illness and has significant positive implications for the day-to-day practice of mental health care. IMH incorporates mainstream interventions such as pharmacologic treatments, psychotherapy, and psychosocial interventions, as well as alternative therapies such as acupuncture, herbal and nutritional medicine, dietary modification, meditation, etc. Two recent international conferences in Europe and the United States show that interest in integrative mental health care is growing rapidly. In response, the International Network of Integrative Mental Health (INIMH: www.INIMH.org) was established in 2010 with the objective of creating an international network of clinicians, researchers, and public health advocates to advance a global agenda for research, education, and clinical practice of evidence-based integrative mental health care. The paper concludes with a discussion of emerging opportunities for research in IMH, and an exploration of potential clinical applications of integrative mental health care.

Copyright © 2012 Elsevier Inc. All rights reserved.

Explore (NY). 2012 Jan;8(1):50-7. Lake J, Helgason C, Sarris J. Arizona Center for Integrative Medicine, Tucson, AZ.

Can medical thermal images predict acupuncture adverse events? A case history.



Malaise and fainting are unpleasant acupuncture adverse effects. This paper shows how the use of thermography might identify subjects before the systematic responses become clinically significant.

Acupunct Med. 2012 Jan 6. Norheim AJ, Mercer J. 1The National Research Center in Complementary and Alternative Medicine, NAFKAM, Department of Community Medicine, University of Tromsø, Tromsø, Norway.

Acupuncture - Deep pain with an autonomic dimension?



Stimulation of acupuncture point Pc6, located above the median nerve, has been shown to be effective in treating nausea and vomiting. It has also frequently been reported to cause a heart rate reduction. The mechanism behind this autonomic reaction has not been clarified, so far. We combined brainstem-sensitive functional magnetic resonance imaging with heart rate recording and time-resolved rating of the needling sensation to measure neuronal correlates of sensations and autonomic reactions during acupuncture. On the cortical level, needling sensation activated typical pain-related areas, of which the ventromedial and dorsolateral prefrontal cortex and perigenual anterior cingulate cortex were further involved in mediating the heart rate response. In the brainstem, needling sensation activated nuclei of the descending pain control system, in which a network of hypothalamus, periaqueductal gray, rostral ventromedial medulla, and ventrolateral medulla was identified as the source of the heart rate changes. Our findings indicate that acupuncture may be a special pain stimulus, whose autonomic concomitants could explain its non-analgesic effects and in some cases even have a therapeutic potential.

Copyright © 2011 Elsevier Inc. All rights reserved.

Neuroimage. 2011 Dec 28;60(1):653-660. Beissner F, Deichmann R, Henke C, Bär KJ. Pain & Autonomics - Integrative Research (PAIR), University Hospital of Psychiatry and Psychotherapy, Jena, Germany; Brain Imaging Center, Frankfurt, Germany; Department of Neurology, Goethe University, Frankfurt, Germany.

Prediction and prenosological diagnostics of heart diseases based on energy characteristics



Full title: Prediction and prenosological diagnostics of heart diseases based on energy characteristics of acupuncture points and fuzzy logic.

Many theories of reflexology use ancient concepts which do not coincide with the modern medical terminology of anatomy, physiology and biophysics. This substantially reduces the trust of physicians in reflexology methods. During this research, several mathematical models for the interaction of the internal and biological active points of meridian structures have been proposed. The analysis of these models allows the specification of a list of heart diseases for which reflex diagnostics and reflex therapy methods are most effective and also allows increasing the effectiveness of these procedures. It is shown that good results for the prediction and early diagnosis of diseases from the reaction energy of biologically active points (acupuncture points) are obtained using fuzzy logic decision making.

Comput Methods Biomech Biomed Engin. 2012 Jan 10. Al-Kasasbeh R, Korenevskiy N, Ionescou F, Alshamasin M, Kuzmin A. a Faculty of Engineering Technology , Al-Balqa Applied University , Amman, Jordan.

Prediction and prenosological diagnostics of heart diseases based on energy characteristics



Full title: Prediction and prenosological diagnostics of heart diseases based on energy characteristics of acupuncture points and fuzzy logic.

Many theories of reflexology use ancient concepts which do not coincide with the modern medical terminology of anatomy, physiology and biophysics. This substantially reduces the trust of physicians in reflexology methods. During this research, several mathematical models for the interaction of the internal and biological active points of meridian structures have been proposed. The analysis of these models allows the specification of a list of heart diseases for which reflex diagnostics and reflex therapy methods are most effective and also allows increasing the effectiveness of these procedures. It is shown that good results for the prediction and early diagnosis of diseases from the reaction energy of biologically active points (acupuncture points) are obtained using fuzzy logic decision making.

Comput Methods Biomech Biomed Engin. 2012 Jan 10. Al-Kasasbeh R, Korenevskiy N, Ionescou F, Alshamasin M, Kuzmin A. a Faculty of Engineering Technology , Al-Balqa Applied University , Amman, Jordan.

Complementary and alternative medicine use among veterans with chronic noncancer pain.



We describe prior use and willingness to try complementary and alternative medicine (CAM) among 401 veterans experiencing chronic noncancer pain and explore differences between CAM users and nonusers. Participants in a randomized controlled trial of a collaborative intervention for chronic pain from five Department of Veterans Affairs (VA) primary care clinics self-reported prior use and willingness to try chiropractic care, massage therapy, herbal medicines, and acupuncture. Prior CAM users were compared with nonusers on demographic characteristics, pain-related clinical characteristics, disease burden, and treatment satisfaction. A majority of veterans ( n = 327, 82%) reported prior use of at least one CAM modality, and nearly all (n = 399, 99%) were willing to try CAM treatment for pain. Chiropractic care was the least preferred option, whereas massage therapy was the most preferred (75% and 96%, respectively). CAM users were less likely to have service-connection disabilities (54% vs 68%; chi square = 4.64, p = 0.03) and reported having spent a larger percentage of their lives in pain (26% vs 20%; Z = 1.40, p = 0.04) than nonusers. We detected few differences between veterans who had tried CAM and those who had not, suggesting that CAM may have broad appeal among veterans with chronic pain. Implications for VA policy and practice and for clinicians treating veterans with chronic pain are discussed.

J Rehabil Res Dev. 2011;48(9):1119-28. Denneson LM, Corson K, Dobscha SK. Portland VA Medical Center, PO Box 1034 (P3DEP_PC), Portland, OR 97207. lauren.denneson@va.gov.

An Overview of Complementary and Alternative Medicine Therapies for Anxiety...



Full title: An Overview of Complementary and Alternative Medicine Therapies for Anxiety and Depressive Disorders: Supplement to Efficacy of Complementary and Alternative Medicine Therapies for Posttraumatic Stress Disorder.

BACKGROUND: VA is committed to expanding the breadth of posttraumatic stress disorder (PTSD)-related services available to Veterans. Since depressive and anxiety disorders share common features with PTSD, this report was commissioned to examine the efficacy of complementary and alternative medicine (CAM) therapies for the treatment of depressive and anxiety disorders as a means to detect treatments that might be applicable to PTSD. METHODS: The key questions (KQs) were adapted from the parent report, Efficacy of Complementary and Alternative Medicine Therapies for Posttraumatic Stress Disorder. We searched MEDLINE® (via PubMed®) and the Cochrane Database of Systematic Reviews for recent English-language systematic reviews (SRs) that examined the literature on mind-body medicine, manipulative and body-based practices, and movement or energy therapies, excluding nutritionals, herbal remedies and other supplements. To be included, SRs had to be published within the past five years and be evaluated as a "fair" or "good" quality. Titles, abstracts, and articles were reviewed in duplicate, and relevant data were abstracted by authors trained in the critical analysis of literature. KEY FINDINGS: We identified five relevant SRs on mind-body CAM therapies, but none on manipulative and body-based, movement-based, or energy therapies. Most primary studies were small trials that did not provide descriptions of CAM strategies adequate to permit replication. Dose, duration, and frequency of interventions sometimes varied widely. Key findings were: For anxiety disorders, there is limited evidence on the effectiveness of meditation (n = 2 studies). Studies reported high rates of dropout, suggesting that adherence to meditation may be problematic in a clinical setting; therefore, it is difficult to draw conclusions about the efficacy of meditation for the treatment of anxiety disorders. Relaxation and/or breathing retraining show promise as a CAM therapy for panic disorders. Evidence, however, is limited. Acupuncture shows some promise as a CAM therapy for depression, but results were mixed. For major depressive disorder (MDD), acupuncture showed greater effects than sham control on depressive symptoms but did not improve response or remission rates. It did not differ significantly from short-term use of antidepressants. However, for patients with post-stroke depression, acupuncture was more effective than short-term use of antidepressants. Mindfulness-based stress reduction has shown positive effects on anxiety and depressive symptoms. However, studies are poor to fair quality. No included SRs reported effects on health-related quality of life. Reported results provided limited data on adverse effects or retention rates. The limitations of the current evidence preclude strong conclusions about specific CAM interventions for the treatment of depressive and anxiety disorders. However, limited evidence supports the use of meditation, relaxation training and/or breathing retraining, and mindfulness-based stress reduction for anxiety, as well as acupuncture for depression. This evidence should be considered together with the direct data on CAM treatments for PTSD when planning further treatment studies.

Williams JW , Gierisch JM, McDuffie J, Strauss JL, Nagi A. Washington (DC): Department of Veterans Affairs; 2011 Aug. VA Evidence-based Synthesis Program Reports.

Alternative and complementary treatment for food allergy.



Despite increased consumer interest in complementary and alternative medicine (CAM) for the treatment of food allergy, there remains a relative paucity of knowledge regarding the clinical efficacy, mechanisms of action, and safety of most CAM treatments available to consumers. This article focuses on recent advances in CAM for food allergy, including acupuncture, herbal medicine, probiotics, and alternative approaches to allergen immunotherapy. The mechanism of action of several novel approaches to treatment of food allergy is reviewed, but FAHF-2 is the only investigational herbal formulation currently validated for use in human clinical trials.

Copyright © 2012. Published by Elsevier Inc.

Immunol Allergy Clin North Am. 2012 Feb;32(1):135-50. Wisniewski JA, Li XM. Department of Pediatrics, Division of Allergy and Immunology, University of Virginia, 409 Lane Road, Box 801355, Charlottesville, VA 22908, USA.

Acupuncture in treatment of musculoskeletal disorders of orchestra musicians.



Objective: Playing-related musculoskeletal disorders (PRMD) are common among musicians. Acupuncture is well established in Germany as a treatment for orthopedic conditions, but it is not commonly used in the treatment of PRMD yet. The authors examined the musicians' health literature and provide a brief overview about the background of acupuncture. Three case studies are presented to show possible benefits for the treatment of PRMD. Participants: 2456 medical doctors, members of the German research group for acupuncture. Methods: We searched literature and Medline Database for publications about acupuncture, musicians' medicine and musculoskeletal disorders. Additionally we asked medical doctors, via a questionnaire, about the treatment of professional musicians as patients. Case studies are presented. Results: No research was found to support the use oft acupuncture in PRMD. The survey study found that medical doctors are not satisfied with the quality of medical health care provided to musicians and regard specialist knowledge as being important. Conclusion: Evidence on the benefits of acupuncture for musculoskeletal disorders suggests that it could be of benefit as a complementary treatment of PRMD. We suggest performing clinicaltrials to demonstrate the value of standard treatment, acupuncture and complementary medicine for PRMD.

Work. 2012 Jan 1;41(1):5-13. Molsberger F, Molsberger A. Research Group for Musicians Medicine, Tristanstr, OT Groß Glienicke, Potsdam, Germany Deutsche Gesellschaft für Musikphysiologie und Musikermedizin e.V., Germany Research Group for Acupuncture, Duesseldorf, Germany Hochschule fuer Gesundheit und Sport, Berlin, Germany.

The current use of acupuncture during pregnancy and childbirth.



PURPOSE OF REVIEW: Acupuncture has a growing clientele during pregnancy, delivery and the puerperium for an ever increasing list of indications. Objective evidence for its benefit is necessary to establish its roles in current practice. RECENT FINDINGS: For many of the current uses, randomized studies when conducted using at least one control group have not established any clear advantages from treatment. Those areas which rely upon subjective assessment of symptoms are particularly difficult to investigate without rigorous blinding strategies, separating those who provide the acupuncture from those assessing outcome. Studies investigating the possible therapeutic benefit of acupuncture for managing intrapartum care require outcomes for nulliparae and multiparae to be analysed separately. SUMMARY: Acupuncture therapy may offer some advantage over conventional treatment in the management of hyperemesis gravidarum and postcaesarean section pain and these areas warrant further study. Rigorous randomized studies, particularly those using objective measures, have failed to identify any obvious benefits from acupuncture for many of the other conditions studied.

Curr Opin Obstet Gynecol. 2012 Jan 13. Xu J, Mackenzie IZ. Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.

A Systematic Review of Smoking Cessation Intervention Studies in China.



INTRODUCTION: China has the highest number of tobacco smokers among the world's nations; however, no systematic review has been conducted of clinical trials on the efficacy of smoking cessation interventions in China. This paper summarizes findings of studies in order to compare the effect of pharmacotherapy, counseling, and Traditional Chinese Medicine (TCM) approaches on the abstinence rate. METHODS: Clinical trials of smoking cessation interventions published in English or Chinese were extracted from an electronic search of PubMed and WanFang databases. The search yielded 234 studies from the PubMed and 78 studies from the WanFang. RESULTS: Twenty-nine studies were included in this review. Of these, 11 (37.9%) were randomized controlled trials (RCTs) that assessed the following approaches: counseling (5 studies), TCM (3 studies), pharmacotherapy (1 study), a combination of pharmacotherapy and counseling (1 study), and physician advice (1 study). Pharmacotherapy alone or in combination with counseling generally resulted in a higher abstinence rate than counseling alone. TCM techniques such as acupuncture and ear point seed pressure yielded a much higher abstinence rate than pharmacotherapy and counseling. Findings are inconclusive, however, because most of the TCM studies were noncontrolled trials and did not provide a definition of "abstinence." Findings on the effectiveness of physician advice to quit smoking were also inconclusive. Conclusions:A review of smoking cessation studies revealed that pharmacotherapy was effective in China. More RCTs of TCM approaches and physician advice are needed with long-term follow-up assessments and biochemical verification of self-reported abstinence before these approaches are adopted as evidence-based smoking cessation interventions in China.

Nicotine Tob Res. 2012 Jan 16. Kim SS, Chen W, Kolodziej M, Wang X, Wang VJ, Ziedonis D. 365 Plantation Street, Suite 100, Worcester, MA 01605-2397, USA. sun.kim@umassmed.edu.

Investigation of acupoint specificity by whole brain functional connectivity analysis from fMRI data



Previous neuroimaging studies on acupuncture have primarily adopted functional connectivity analysis associated with one or a few preselected brain regions. Few have investigated how these brain regions interacted at the whole brain level. In this study, we sought to investigate the acupoint specificity by exploring the whole brain functional connectivity analysis on the post-stimulus resting brain modulated by acupuncture at acupoint PC6, with the same meridian acupoint PC7 and different meridian acupoint GB37. We divided the whole brain into 90 regions and analyzed functional connectivity for each condition. Then we identified statistically significant differences in functional correlations throughout the entire brain following acupuncture at PC6 in comparison with PC7 as well as GB37. For direct comparisons, increased correlations for PC6 compared to PC7 were primarily between the prefrontal regions and the limbic/paralimbic and subcortical regions, whereas decreased correlations were mainly between the parietal regions and the limbic/paralimbic and subcortical regions. On the other hand, increased correlations for PC6 compared to GB37 were primarily between the prefrontal regions and somatosensory regions, whereas decreased correlations were mainly related with the occipital regions. Our findings demonstrated that acupuncture at different acupoints may exert heterogeneous modulatory effects on the post-stimulus resting brain, providing new evidences for the relatively function-oriented specificity of acupuncture effects.

Conf Proc IEEE Eng Med Biol Soc. 2011 Aug;2011:2784-7. Feng Y, Bai L, Zhang W, Ren Y, Xue T, Wang H, Zhong C, Tian J.

Meridians and acupoints with opposite locations.



A new combination of acupoints with opposite locations in clinic was proposed according to the running course of meridians and the relation between meridians and acupoints in order to enrich the theory of acupuncture-moxibustion and enhance the therapeutic effect. Points with opposite location refers to bigeminal acupoints locates at the medial and lateral aspects of the limbs or at the anterior or posterior aspects of the trunk, such as Neiguan (PC 6) and Waiguan (TE 5), Quchi (LI 11) and Shaohai (HT 3) as well as Yinlingquan (SP 9) and Yanglingquan (GB 34). Those pairs of points locate respectively at yin meridians and yang meridians with opposite locations or at meridians interiorly and exteriorly related with each other. The application of the combination and the therapeutic effects can be found both in ancient and modern time. Its theoretical foundation rests with the theory of yin-yang and meridians, which takes yin-yang as the core. The characteristics of the combination are as the follows: firstly, it can regulate yin and yang, qi and blood at the same time. Secondly, yin and yang can influence each other; it is easy to locate the other point when one of the pair is located, and it is easy to manipulate by needling two points oppositely at the same time or doing through-and-through needling. The technique is also known with its selection of less point but better effect.

Non-drug therapies for lower limb muscle cramps.



BACKGROUND: About one in every three adults are affected by lower limb muscle cramps. For some people, these cramps reduce quality of life, quality of sleep and participation in activities of daily living. Many interventions are available for lower limb cramps, but some are controversial, no treatment guidelines exist, and often people experience no benefit from the interventions prescribed. OBJECTIVES: To assess the effects of non-drug, non-invasive treatments for lower limb cramp. SEARCH METHODS: We searched the Cochrane Neuromuscular Disease Group Specialized Register (13 September 2011) using the terms: cramp, spasm, contracture, charley horse and lower limb, lower extremity, foot, calf, leg, thigh, gastrocnemius, hamstring, quadriceps. We also searched CENTRAL (2011, Issue 3), MEDLINE (January 1966 to August 2011) and EMBASE (January 1980 to August 2011) and the reference lists of included studies. There were no language or publication restrictions. SELECTION CRITERIA: All randomised controlled trials of non-drug, non-invasive interventions trialled over at least four weeks for the prevention of lower limb muscle cramps in any group of people. We excluded, for example, surgery, acupuncture and dry-needling, as invasive interventions. We selected only trials that included at least one of the following outcomes: cramp frequency, cramp severity, health-related quality of life, quality of sleep, participation in activities of daily living and adverse outcomes. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials, assessed risk of bias and cross checked data extraction and analysis. A third author was to arbitrate in the event of disagreement. We asked the authors of five trials for information to assist with screening studies for eligibility and received four responses. MAIN RESULTS: One trial was eligible for inclusion. All participants were age 60 years or over and had received a repeat prescription from their general practitioner of quinine for nighttime cramps in the preceding three months. This review includes data from only those participants who were advised to continue taking quinine. Forty-nine participants were advised to complete lean-to-wall calf muscle stretching held for 10 s three times per day. Forty-eight participants were allocated to a placebo stretching group. After 12 weeks, there was no statistically significant difference in recalled cramp frequency between groups. No "significant" adverse effect was reported. Limitations in the study's design impede interpretation of the results and clinical applicability. AUTHORS' CONCLUSIONS: There is limited evidence on which to base clinical decisions regarding the use of non-drug therapies for the treatment of lower limb muscle cramp. Serious methodological limitations in the existing evidence hinder clinical application. There is an urgent need to carefully evaluate many of the commonly recommended and emerging non-drug therapies in well designed randomised controlled trials.

Cochrane Database Syst Rev. 2012 Jan 18;1:CD008496. Blyton F, Chuter V, Walter KE, Burns J. School of Health Sciences, Faculty of Health, The University of Newcastle, Health Precinct, PO Box 127, Ourimbah, NSW, Australia, 2258.

Auricular acupuncture effectively reduces state anxiety before dental treatment...



Full title: Auricular acupuncture effectively reduces state anxiety before dental treatment-a randomised controlled trial.

OBJECTIVES: The objective of this study was to analyse whether auricular acupuncture, acupuncture at the outer ear, could reduce state anxiety before dental treatment. METHODS: This prospective, randomised patient-blinded study with 182 patients compared anxiety before dental treatment following auricular acupuncture at the relaxation-, tranquillizer- and master cerebral points (auricular acupuncture group) versus acupuncture at sham points (finger-, shoulder- and tonsil points; sham group) and a non-intervention control group. Anxiety was assessed using the Spielberger State Trait Anxiety Inventory (German version) before auricular acupuncture and 20 min thereafter, immediately before dental treatment. RESULTS: Auricular acupuncture reduced state anxiety score more effectively from 54.7?±?10.8 to 46.9?±?10.4 (mean ± SD) than sham acupuncture from 51.9?±?10.2 to 48.4?±?10.0. In contrast, state anxiety in the control group increased from 51.0?±?11.7 to 54.0?±?11.6 (mean increase +3.0; CI +4.7 to +1.2). The decrease in state anxiety in both intervention groups was statistically significant (p? Clin Oral Investig. 2012 Jan 6. Michalek-Sauberer A, Gusenleitner E, Gleiss A, Tepper G, Deusch E. Department of Special Anaesthesia and Pain Therapy, Medical University of Vienna, Austria, Waehringer Guertel 18-20, 1090, Vienna, Austria, andrea.michalek-sauberer@meduniwien.ac.at.

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