There is increasing clinical evidence that reflex therapies such as massage, Gua Sha, cupping, wet packs, acupuncture etc. are helpful in reducing symptoms of chronic pain. However, the neurobiological basis of these effects has rarely been investigated even though the increasing knowledge of the pathophysiology of chronic pain syndromes allows for specific hypotheses. Reflex therapies are likely able to influence chronic pain at the level of the nociceptor and the spinal cord. Moreover, it can be speculated that these therapies have a strong impact on relaxation and maybe understood as a social, comforting interaction. Since it is well accepted that the positive effect of grooming has a neurobiological basis in non-human primates, its biosocial impact on wellbeing and pain processing in humans may be underestimated. A synopsis of the neurobiological foundations of pain perception, from the nociceptor up the spinal cord to brain mechanisms provides the basis for the investigation of the 'way of action' of reflex therapies. Specific hypotheses on their neurobiological bases and methods suitable for their investigation are outlined. Further clarification of the mechanisms of action of reflex therapies will support their clinical evidence and add to our understanding of the neurobiology of complementary medicine. Copyright 2008 S. Karger AG, Basel.

Forsch Komplement Med (2006). 2008 Apr;15(2):97-103. Epub 2008 Apr 7. Musial F, Michalsen A, Dobos G. Alfried Krupp von Bohlen und Halbach Foundation, University of Duisburg-Essen, Germany. f.musial@kliniken-essen-mitte.de

Trace and major elements were determined in medicinal herbs (Cynara scolymus, Matricaria chamomilla, Artemisia absinthium L., Achillea millefolium, and Inula britannica) as well as in rhizosphere soil samples. Based on the results obtained after microwave-acid-assisted digestion (nitric acid + hydrogen peroxide) and single-step extraction (ammonium acetate), the real and potential acidity and redox potential of the soils, uptake, mobility, and bioavailability of potassium, calcium, magnesium, iron, manganese, copper, zinc, nickel, chromium, lead, and cadmium are discussed. By calculating the bioconcentration factors and their deviation from the recommended values, elevated concentrations, were explained in terms of contamination and pollution. The concentrations measured in both plants and soil samples were below maximum allowable concentration ranges considered for the European Union.

Nat Med (Tokyo). 2008 Jul;62(3) Razic S, Dogo S, Slavkovic L. Institute of Analytical Chemistry, Faculty of Pharmacy, University of Belgrade, P.O. Box 146, 11221, Belgrade, Serbia. snsn@sezampro.yu

CONTEXT: Stimulant medication can effectively treat 60% to 70% of youth with attention-deficit/hyperactivity disorder (ADHD). Yet many parents seek alternative therapies, and Hypericum perforatum (St John's wort) is 1 of the top 3 botanicals used. OBJECTIVE: To determine the efficacy and safety of H. perforatum for the treatment of ADHD in children. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled trial conducted between March 2005 and August 2006 at Bastyr University, Kenmore, Washington, among a volunteer sample of 54 children aged 6 to 17 years who met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for ADHD by structured interview. INTERVENTION: After a placebo run-in phase of 1 week, participants were randomly assigned to receive 300 mg of H. perforatum standardized to 0.3% hypericin (n = 27) or a matched placebo (n = 27) 3 times daily for 8 weeks. Other medications for ADHD were not allowed during the trial. MAIN OUTCOME MEASURES: Performance on the ADHD Rating Scale-IV (range, 0-54) and Clinical Global Impression Improvement Scale (range, 0-7), and adverse events. RESULTS: One patient in the placebo group withdrew because of an adverse event. No significant difference was found in the change in ADHD Rating Scale-IV scores from baseline to week 8 between the treatment and placebo groups: inattentiveness improved 2.6 points (95% confidence interval [CI], -4.6 to -0.6 points) with H. perforatum vs 3.2 points (95% CI, -5.7 to -0.8 points) with placebo (P = .68) and hyperactivity improved 1.8 points (95% CI, -3.7 to 0.1 points) with H. perforatum vs 2.0 points (95% CI, -4.1 to 0.1 points) with placebo (P = .89). There was also no significant difference between the 2 groups in the percentage of participants who met criteria for improvement (score < or = 2) on the Clinical Global Impression Improvement Scale (H. perforatum, 44.4%; 95% CI, 25.5%-64.7% vs placebo, 51.9%; 95% CI, 31.9%-71.3%; P = .59). No difference between groups was found in the number of participants who experienced adverse effects during the study period (H. perforatum, 40.7%; 95% CI, 22.4%-61.2% vs placebo, 44.4%; 95% CI, 25.5%-64.7%; P = .78). CONCLUSION: In this study, use of H. perforatum for treatment of ADHD over the course of 8 weeks did not improve symptoms. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00100295.

JAMA. 2008 Jun 11;299(22):2633-41. Weber W, Vander Stoep A, McCarty RL, Weiss NS, Biederman J, McClellan J.

School of Naturopathic Medicine, Bastyr University, Kenmore, Washington, USA. wendyw@bastyr.edu

ABSTRACT Objectives: To assess the feasibility and acceptability of studying whole systems of Traditional Chinese Medicine (TCM) and Naturopathic medicine (NM) in the treatment of temporomandibular disorders (TMD), and to determine whether there is indication to support further research. Design: A pilot study using a randomized controlled clinical trial design of whole system TCM and NM versus state-of-the-art specialty care (SC). Setting/location: Kaiser Permanente Northwest (KPNW), and practitioner offices in Portland, Oregon. Subjects: One hundred and sixty (160) women 25-55 years of age attending a KPNW TMD specialty clinic. Interventions: Whole system TCM and NM, and KPNW TMD clinic SC; the intervention protocols were designed to model the individually tailored type of community care offered in alternative medicine practices in Portland and in the KPNW TMD clinic, using protocols that enhanced similarities among practitioners within each system and permitted full descriptions of the treatments provided. Outcome measures: TMD was ascertained using the Research Diagnostic Criteria/TMD; outcomes were self-reported worst and average facial pain and interference with activities (scaled 0-10 where 10 is worst). Results: Of 948 consecutive eligible patients, 160 were randomized to one of three arms; 128 provided endpoint data. TCM and NM demonstrated significantly greater in-treatment reductions for worst facial pain compared to SC (adjusted regression analysis; higher negative values indicate greater improvement, = -1.11 +/- 0.43, p = 0.010 and -1.02 +/- 0.45, p = 0.025 for TCM and NM, respectively, compared to SC) and at 3 months post-treatment (-1.07 +/- 0.51, p = 0.037 and -1.27 +/- 0.54, p = 0.019 for TCM and NM versus SC, respectively). Additionally, TCM provided significantly greater decreases in average pain than SC; NM provided significantly greater decreases than SC or TCM in TMD-related psychosocial interference. Conclusions: These alternative medicine approaches each resulted in significantly greater reduction of pain and psychosocial interference than SC. Further research on the potential benefits of traditional whole systems of medicine for TMD appears warranted. J Altern Complement Med. 2008 Jun;14(5):475-87.

J Altern Complement Med. 2008 Jun;14(5):475-87. Ritenbaugh C, Hammerschlag R, Calabrese C, Mist S, Aickin M, Sutherland E, Leben J, Debar L, Elder C, Dworkin SF.

Department of Family and Community Medicine, The University of Arizona, Tucson, AZ., Department of Nutritional Sciences, The University of Arizona, Tucson, AZ., Department of Anthropology, The University of Arizona, Tucson, AZ.

In the last decade, there has been dramatic changes in all areas of integrative patient care. None has been more dramatic than those in the field of cancer care, which has gone from alternative and complementary treatments delivered outside the conventional setting to the integration of many of these approaches into the care of the cancer patient. In many cases, these changes have been driven by patient demand and supported by private funding and out-of-pocket payments by patients themselves. Virtually all major medical centers have departments devoted to integrative patient care--whether true stand-alone centers or departments with a research interest in this area. This is particularly true of the major cancer centers, many of which-including Memorial Sloan Kettering Cancer Center, New York; M.D. Anderson Cancer Center, Houston, Tex; Johns Hopkins University, Baltimore, Md; Duke University, Durham, NC; and the Dana Farber Cancer Institute, Boston, Mass--have developed integrative cancer programs. In addition, programs such as the Cancer Treatment Centers of America have inpatient and outpatient programs with teams of practitioners, including medical oncologists, surgeons, and radiation therapists, as well as credentialed naturopathic doctors, nutritionists, mind-body specialists and other integrative practitioners. Despite the increased interest in developing integrative approaches to cancer, many medical oncologists remain skeptical about the value of these modalities.

Altern Ther Health Med. 2007 Jan-Feb;13(1):56-64.

Boyd DB.

Program in Integrative Medicine, Greenwich Hospital-Yale, New Haven Health System, USA.

Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to Dr Sierpina at vssierpi@utmb.edu or Dr Kreitzer at kreit003@umn.edu. Submissions should be no more than 700 to 800 words. Please include any Web site or other resource that is relevant, as well as contact information.

Explore (NY). 2007 Mar-Apr;3(2):174-6.

Sierpina VS, Kreitzer MJ, Burke A, Verhoef M, Brundin-Mather R.

University of Texas Medical Branch, TX, USA. vssierpi@utmb.edu

Saunas can be used very effectively for certain cardiovascular problems and as a means to enhance the mobilization of fat-soluble xenobiotics. When saunas are used to reduce blood pressure and enhance blood flow and cardiac functioning, only short sauna sessions (15 minutes) are necessary. When one wants to enhance the mobilization of heavy metals and chemical xenobiotics, longer sessions are needed and those should be medically monitored. But, for either use, saunas are safe and effective and should be used more frequently to benefit the health of our patients and ourselves.

Altern Ther Health Med. 2007 Mar-Apr;13(2):S154-6.

Crinnion W.

Environmental Medicine Center of Excellence, Southwest College of Naturopathic Medicine in Tempe, Arizona, USA.

INTRODUCTION: The National Institutes of Health provided grants to the Oregon Health & Science University (OHSU) and 14 other allopathic academic health centers for the development of curricula in complementary and alternative medicine (CAM). A key component of the curriculum evaluation for OHSU was provided by a survey assessing attitudes toward CAM and selected personality characteristics of entering students in chiropractic, naturopathic, Oriental, and allopathic medicine in the Pacific Northwest and Upper Midwest. METHODS: A survey containing a variety of assessments of attitudes toward CAM and the personality traits of adventurousness and tolerance to ambiguity was administered to students entering four Portland, Oregon doctoral-level health professional schools and an allopathic medical school in the Upper Midwest (University of Nebraska College of Medicine) during the 2004-2005 academic year. RESULTS: Students of naturopathy (n = 63) and Oriental Medicine (n = 71) were the most "CAM positive," adventurous and tolerant of ambiguity, and Midwestern allopathic medical students (n = 58) the least. In general, chiropractic students (n = 89) and allopathic medical students from the Pacific Northwest (n = 95) were intermediate in CAM attitudes between these two groups (all p < 0.05). Female students were more "CAM positive" in all schools compared to male students. CONCLUSIONS: Students have high levels of interest in CAM upon entrance to their schools. Health professional discipline, geographic location, personality qualities, and gender appear to influence CAM attitudes in entering students.

J Altern Complement Med. 2007 Apr;13(3):381-6.

Nedrow AR, Istvan J, Haas M, Barrett R, Salveson C, Moore G, Hammerschlag R, Keenan E.

Oregon Health & Science University School of Medicine, Portland, OR 97239, USA.