Complementary Therapies in Medicine

Editorial Board

2012-08-01

Acute effects of traditional Thai massage on electroencephalogram in patients with scapulocostal syndrome

2012-03-05

Summary: Objective: To investigate acute effects of traditional Thai massage (TTM) on brain electrical activity (electroencephalogram (EEG) signals), anxiety and pain in patients with scapulocostal syndrome (SCS).Design: A single-blind, randomized clinical trial.Setting: The School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Thailand.Intervention: Forty patients, who were diagnosed with SCS, were randomly allocated to receive a 30-min session of either TTM or physical therapy (PT) using ultrasound therapy and hot packs.Outcomes: Electroencephalogram (EEG), State Anxiety Inventory (STAI), and pain intensity rating.Results: Results showed that both TTM and PT were associated with significant decreases in anxiety and pain intensity (p<0.01). However, there was a significantly greater reduction in anxiety and pain intensity for the TTM group when compared with the PT group. Analysis of EEG in the TTM group showed a significant increase in relaxation, manifested as an increase in delta activity (p<0.05) and a decrease in theta, alpha and beta activity (p<0.01). Similar changes were not found in the PT group. The EEG measures were also significantly different when compared between the groups (p<0.01), except for delta activity (p=0.051), indicating lower states of arousal with the TTM treatment.Conclusion: It is suggested that TTM provides acute neural effects that increase relaxation and decrease anxiety and pain intensity in patients with SCS.

Efficacy of acupressure for non-pharmacological stress reduction in college students

2012-01-06

Summary: Objectives: Identifying a non-pharmacological intervention to reduce the stress response could be particularly beneficial to college students, a group prone to considerable stress. Acupressure has shown some efficacy in reducing stress in adults following stroke or traumatic brain injury (TBI), but multiple treatments were required. Results from single treatments in healthy populations have been mixed.Design: The current study used a randomised, placebo-controlled, single-blind design to investigate the use of a single acupressure treatment for stress reduction in healthy college students (n=109) during a stressor.Interventions: Participants were randomly assigned to one of three single, 40-min interventions: active acupressure, placebo acupressure, or a relaxation CD control. A math task stressor administered before and after the intervention assessed intervention effects on stressor responsivity.Main outcome measures: Stress responses were measured by physiological (heart rate (HR), heart rate variability (HRV), skin conductance response (SCR)) and subjective measures (State Anxiety Inventory, nine-item Psychological Stress Measure) of anxiety and stress.Results: All interventions were associated with the following changes during the post-intervention stressor compared to the pre-intervention stressor: reduced HR (p<0.001), increased HRV (p<0.024), reduced SCR (p<0.001), reduced subjective stress scores (p<0.001), and increased correct answers (p<0.001). Although all groups demonstrated stress reduction, there were no significant group differences after a single treatment.Conclusions: All interventions significantly reduced the stress response, although not differently. The lack of active acupressure-associated treatment effects appears to be due to insufficient dosing.

Acupuncturist perceptions of serving as a clinical trial practitioner

M.E. Thompson, J. Jenkins, A. Smucker, S. Smithwick, D. Groopman, L.M. Pastore — 2012-02-10

Summary: Objective: This article describes the experience of four acupuncturists in terms of what it meant for them to be a practitioner in a recently completed sham-controlled acupuncture randomized control trial (RCT) with a standardized protocol.Design: At the completion of the RCT for women with ovarian dysfunction, study acupuncturists (2 male MD/acupuncturists and 2 female professional acupuncturists) were queried about their perceptions of participating in the RCT using both written responses to 5 open-ended questions and a focus group interview. Data was analyzed to categorize responses and identify themes.Setting: Virginia, USA.Results: The acupuncturists’ experience of participating in a RCT was generally very positive, including: usual practitioner/participant relationships, collegial sharing, and increased patient volume and diversity. There was angst expressed about the unknown RCT results. While there were concerns about standardizing the acupuncture session (“dilutes the power of acupuncture therapeutics”), the acupuncturists’ were supportive of the pre-established protocol. The acupuncturists overall did not have concerns with a sham intervention arm because the sham recipients did not know their treatment arm and felt as satisfied with study participation as the true acupuncture recipients.Conclusions: Despite initial misgivings about both a standardized protocol and a sham arm, all practitioners discovered positive aspects of being a study acupuncturist. The analysis highlights the need for communication before, during and after a clinical trial between the study investigators and the intervention practitioners. As stake holders in the perception of CAM therapies with the public and with conventional medicine practitioners, it would benefit future research on CAM to similarly assess experiences of being a CAM study practitioner in order to enhance provider recruitment and reduce provider drop-out.

Multiple interacting factors corresponding to repetitive use of complementary and alternative medicine

2012-02-10

Summary: Objective: To examine the factors correlating with repetitive use of complementary and alternative medicine (CAM).Research design: In 2006, a community-based epidemiological survey was conducted in Taiwan. A total of 2457 participants (1237 men and 1220 women) aged 18 and over participated in the study.Results: From the application of regression tree analysis and the Health Belief Model, we have noticed the following findings. First, demand motive was the most dominant discriminator factor for the repetitive use of CAM. Second-layer discriminators were evaluated on the basis of action benefits and barriers, as well as sources of action information. Another predominant factor is the heterogeneity of individual background. When participants used CAM for treatment of illness, their household income was ≥1000 US dollars per month, they had past experience of western medicine seeking without effects and aged between 30 and 60 years, the predicted mean values for all types of CAM use is 5.62 (the highest). By contrast, when participants used CAM for maintenance of health, their household income was <2000 US dollars per month, they are male, with moderate or good self-rated health who had less than 9 education years, the predicted mean values for all types of CAM use is 1.36 (the lowest).Conclusion: Upon the above components, it assists us to understand the multiple interactive reasons on people's repetitive use of CAM. It also provides essential information for specific CAM issues. Furthermore, from the different perspectives; it stimulates the thoughts for the future medical care projects.

Prevalence and use of herbal products in the Czech Republic: Over-the-counter survey among adult pharmacies clients

Karel Knotek, Vladimir Verner, Petra Chaloupkova, Ladislav Kokoska — 2012-02-10

Summary: Objectives: To analyse which species of herbs are preferred by Czech adult respondents, the most important predictors influencing their use, and information sources used.Method: Data were collected face-to-face via an interviewer-administrated structured questionnaire from convenience sample of adults from metropolis, as well as peri-urban and rural areas, from February to June 2007.Results: There is a high prevalence (56.6%) of herbal product (HPs) use as well as herb-drug co-medication without frequent physician consultation. Literature is the main source of herbal product information, followed by mass media (20%) and family tradition (12%). In comparison to other countries, differences in urban–rural perspectives were observed regarding information sources as well as preferences of local herb species. Mentha×piperita (18.4%), Melissa officinalis (12.4%), Plantago lanceolata (12.2%), Tilia cordata (11.8%) and Matricaria recutita (10.7%) are the most preferred herb species for herbal products preparation. Gender, educational status and age are significant factors that influence the number of herb species used. Head or chest colds, stomach or intestinal illnesses and immunity and regeneration support are the most common ailments treated by herbal products according to our respondents.Conclusion: High utilisation of herbal products was confirmed and the most important predictors of use were identified. Further research is needed to validate and/or replicate our results. Our survey may provide a basis for pharmacists, physicians, healthcare providers as well as for policy makers to effectively manage increasing prevalence of herbal products among the Czech population.

Development of a questionnaire for the diagnosis of Qi stagnation

2012-02-27

Summary: The objective of this study was to develop a questionnaire for the diagnosis of Qi stagnation. At first, we made the preliminary version of the questionnaire from 30 symptoms most frequently mentioned about Qi stagnation in classic books of Oriental Medicine. Two hundred and seven participants completed the preliminary version of the questionnaire rating the severity of 30 symptoms. Those participants were assessed for Qi stagnation by 2 physicians. Logistic regression analysis was performed between the physicians’ assessment of Qi stagnation and the severity of symptoms in the preliminary questionnaire. The final version of the questionnaire was developed with 23 symptoms that had significant odds ratios. The Cronbach's α coefficient was 0.83. The area under the curve was 0.90 and cut-off value for diagnosis of Qi stagnation was 28.5 in receiver operating characteristic (ROC) analysis. Sensitivity and specificity were 0.83 and 0.80, respectively. The Spearman's correlation coefficient was 0.72 in the test–retest. This questionnaire would enable standardization and objective verification of the diagnosis of Qi stagnation.

Use of complementary and alternative medicine in recurrent vulvovaginal candidiasis—Results of a practitioner survey

C.J. Watson, M. Pirotta, P. Myers — 2012-02-23

Summary: Background: The mainstream long term management of recurrent vulvovaginal candidiasis (RVVC) often results in poor outcomes. It is expensive and unacceptable for many women who therefore have incorporated complementary and alternative medicine (CAM) into their personal care plan.Objective: To ascertain clinicians’ knowledge of CAM and their recommendations for the use of CAM and non-pharmacological management in women with RVVC.Design and setting: Anonymous, single page, self completed survey using convenience sampling at a vulval disorders meeting in New South Wales, Australia in 2009.Participants: Sixty six health professionals (medical practitioners, dermatologists, nurses and allied health professionals).Results: Most clinicians reported asking about their patients’ use of CAM and non-pharmacological management of RVVC, although only around half reported recommending it. CAM management included lactobacillus, oral and vaginal yoghurt, vinegar, garlic, Chinese medicine and tea-tree oil. Non-pharmacological management included dietary changes and use of cotton undergarments. Lactobacillus was the most commonly recommended CAM.Conclusion: CAM is popular with patients and many clinicians actively recommend its use in RVVC despite limited supporting evidence. Further research in the area of CAM and RVVC is long overdue.

An investigation of the possible interaction between the use of Vitamin C and highly active antiretroviral therapy (HAART) adherence and effectiveness in treated HIV+ women

2012-04-09

Summary: Objectives: Our goal in this study was to examine how Vitamin C interacts with antiretroviral therapy in individuals with HIV. We specifically evaluated how Vitamin C impacts highly active antiretroviral therapy (HAART) adherence and HAART effectiveness as adjudicated by HIV viral loads and CD4 cell counts. Women served as their own controls, comparing periods of Vitamin C usage with periods of non-usage.Design: An intra-individual, cross-sectional comparative study ‘nested’ in the WIHS observational cohort study.Subjects: Women in the Women's Interagency HIV Study (WIHS).Outcome measures: Adherence, CD4 count and viral load.Results: Our study population was drawn from 2813 HIV+ participants who contributed 44,588 visits in WIHS from October, 1994 to April, 2009. Among them, there were 1122 Vitamin C users with 4954 total visits where use was reported. In the multivariate model adjusting for age, education, race, income, drug use, Vitamin C use order and depression score, there was a 44% increase in the odds of ≥95% HAART adherence among participants during their period of Vitamin C use compared to when they were not using Vitamin C (OR=1.44; 95% CI=1.1–1.9; P-value=0.0179). There was an association with Vitamin C usage and CD4 counts on viral loads.Conclusion: Vitamin C usage appears to be associated with improved adherence. Future Vitamin C studies should target specific HAART drugs, and prospective clinical outcomes.

Cervical epidural abscess after cupping and acupuncture

Jun-Hwan Lee, Jae-Heung Cho, Dae-Jean Jo — 2012-03-29

Summary: Study design: Retrospective case report.Objective: Report of an uncommon complication of cupping and acupuncture.Summary of background data: Epidural abscess after cupping and acupuncture therapies is quite rare. Only a few cases of epidural abscess after acupuncture have been reported. The present report describes a case of cervical epidural abscess that developed after cupping and acupuncture.Methods: A 47-year-old woman presented with swelling and pain in the posterior nuchal region. Magnetic resonance imaging of the cervical spine revealed a well-enhanced epidural mass at the C1–C3 level that was determined to be an epidural abscess.Results: The symptoms related to epidural abscess resolved after treatment with antibiotics.Conclusion: Although a rare complication, epidural abscess is a possibility when applying cupping and acupuncture. Therapists need to be aware of human anatomy in the vicinity of the puncture and must give continuous attention to hygiene throughout the procedure.

Spinal manipulations for tension-type headaches: A systematic review of randomized controlled trials

P. Posadzki, E. Ernst — 2012-01-03

Summary: Aims: The objective of this systematic review was to assess the effectiveness of spinal manipulations as treatment option for tension type headaches.Methods: Eight databases were searched from their inception to May 2011. All randomized trials were considered, if they investigated spinal manipulations performed by any type of healthcare professional for treating tension type headaches in human subjects. The selection of studies, data extraction, and validation were performed independently by two reviewers. The Cochrane tool and the Jadad score were used to assess methodological quality of trials.Results: Five randomized clinical trials (RCTs) met the inclusion criteria. Their methodological quality was mostly high and ranged between 2 and 4 on the Jadad score. Four RCTs suggested that spinal manipulations are more effective than drug therapy, spinal manipulation plus placebo, sham spinal manipulation plus amitriptyline or sham spinal manipulation plus placebo, usual care or no intervention. One RCT showed no difference in daily hours of headache, pain intensity, and daily analgesic use compared to soft tissue therapy plus placebo laser.Conclusions: The evidence that spinal manipulation alleviates tension type headaches is encouraging, but inconclusive. The low quantity of the available data prevent firm conclusion.

The efficacy of Chinese herbal medicine as an adjunctive therapy for colorectal cancer: A systematic review and meta-analysis

Linda L.D. Zhong, Hai-Yong Chen, William C.S. Cho, Xiao-ming Meng, Yao Tong — 2012-03-05

Summary: Although Chinese herbal medicine (CHM) has been widely used as an adjunctive therapy for colorectal cancer in Asia, its efficacy is not well defined. The purpose of this systematic review is to assess the efficacy of CHM as an adjunctive therapy to chemotherapy for the patients with colorectal cancer. Randomized controlled trials with CHM to treat colorectal cancer were extensively searched in seven databases. Two researchers independently assessed the quality and validity of included trials and extracted outcome data for synthesis. 20 trials were included for analysis. Compared to using chemotherapy alone, CHM combined with chemotherapy significantly increased 1- and 3-year survival rate [odds ratio (OR) 2.41, 95% confidence interval (CI) 1.32–4.41; OR 2.40, 95% CI 1.49–3.87]. The combined therapy significantly slowed colorectal cancer progression (OR 0.50, 95% CI 0.32–0.77) and improved quality of life (OR 3.43, 95% CI 2.35–5.02). It had positive effects in immunoregulation. CHM as an adjunctive therapy also had significant advantages in reducing the adverse effects of chemotherapy. This systematic review suggests that CHM as an adjunctive therapy with chemotherapy versus chemotherapy alone has significant efficacy in terms of prolonging survival, enhancement of tumor response, improvement of quality of life, immunoregulation, and alleviation of acute adverse effects. However, a firm conclusion could not be reached because of the poor quality of the included trials. Further trials with higher quality are required and the efficacy in other forms of advantages remains to be further determined.

Defining Pilates exercise: A systematic review

Cherie Wells, Gregory S. Kolt, Andrea Bialocerkowski — 2012-03-15

Summary: Objectives: To describe Pilates exercise according to peer-reviewed literature, and compare definitions used in papers with healthy participants and those with low back pain.Design: A systematic review of literature was conducted. A search for “pilates” within the maximal date ranges of the Cochrane Library, Medline, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, ProQuest: Nursing and Allied Health Source, Proquest: Medical and Health Complete, Scopus, Sport Discus, and Web of Science, was undertaken. To be included, papers needed to describe Pilates exercise, and be published in English within an academic, peer-reviewed journal. There were no restrictions on the methodological design or quality of papers. Content analysis was used to record qualitative definitions of Pilates. Frequencies were calculated for mention of content categories, equipment, and traditional Pilates principles. Frequencies were then compared statistically in papers with healthy participants and those with low back pain.Results: 119 papers fulfilled inclusion criteria. Findings suggest that Pilates is a mind–body exercise that focuses on strength, core stability, flexibility, muscle control, posture and breathing. Exercises can be mat-based or involve use of specialised equipment. Posture was discussed statistically significantly more often in papers with participants with low back pain compared to papers with healthy participants. Traditional Pilates principles of centering, concentration, control, precision, flow, and breathing were discussed on average in 23% of papers. Apart from breathing, these principles were not mentioned in papers with low back pain participants.Conclusions: There is a general consensus in the literature of the definition of Pilates exercise. A greater emphasis may be placed on posture in people with low back pain, whilst traditional principles, apart from breathing, may be less relevant.

Announcement

2012-08-01