Research - Pain
Effectiveness of Hatha Yoga Versus Conventional Therapeutic Exercises for Chronic Nonspecific Low-Back Pain
Osama Neyaz, Lukram Sumila, Srishti Nanda, and Sanjay Wadhwe
Abstract
Objective: To determine whether the effectiveness of Hatha yoga therapy is comparable to conventional therapeutic exercises (CTEs) for reducing back pain intensity and back-related dysfunction in patients with chronic nonspecific low-back pain (CNLBP).
Design: The study was a prospective randomized comparative trial, divided into two phases: an initial 6-weekly supervised intervention period followed by a 6-week follow-up period.
Settings: This study was conducted at Department of Physical Medicine and Rehabilitation and Centre for Integrative Medicine and Research of a tertiary care hospital.
Subjects: Patients between 18 and 55 years of age with complaint of CNLBP persisting ≥12 weeks with pain rating ≥4 on a numerical rating scale (0–10).
Intervention: A total of six standardized 35-min weekly Hatha yoga sessions (yoga group) and similarly 35-min weekly sessions of CTEs (CTE group), designed for people with CNLBP unaccustomed to structured yoga or CTE program. Participants were asked to practice on nonclass days at home.
Outcome measures: The primary outcome measures were Defense and Veterans Pain Rating Scale (DVPRS) (0–10) and 24-point Roland Morris Disability Questionnaire (RDQ). Secondary outcomes were pain medication usage per week and a postintervention Perceived recovery (Likert seven-point scale) of back-related dysfunction. Outcomes were recorded at the baseline, 6-week follow-up, and 12-week follow-up.
Results: Seventy subjects were randomized to either yoga (n = 35) or CTE group (n = 35). Data were analyzed using intention-to-treat, with last observation carried forward. Both yoga and the CTE group have shown significant improvement in back pain intensity and back-related dysfunction within both the groups at 6- and 12-week follow-ups compared to baseline. No statistically significant differences in the pain intensity (DVPRS; at 6 weeks: n = 35, difference of medians 1.0, 95% confidence interval [−5.3 to 3.0], p = 0.5; at 12 weeks: n = 35, 0.0 [−4.2 to 5.0], 0.7) and back-related dysfunction (RDQ; at 6 weeks: n = 35, 1.0 [−9.6 to 10.6], 0.4; at 12 weeks: n = 35, 0.0 [−8.8 to 10.6], 0.3) were noted between two groups. Improvements in pill consumption and perceived recovery were also comparable between the groups.
Conclusion: Yoga provided similar improvement compared with CTEs, in patients with CNLBP
Source : Journal Alternative and Complementary Medicine
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The effect of a garlic supplement on the pro-inflammatory adipocytokines, resistin and tumor necrosis factor-alpha, and on pain severity, in overweight or obese women with knee osteoarthritis
Sahar Dehghania Elham Alipoorb Ahmad Salimzadehc Mehdi Yaserid Mostafa Hosseinid Christine Feinle-Bissetef Mohammad Javad
Abstract
Background
Osteoarthritis (OA) is a prevalent degenerative joint disease, which is associated with chronic and disabling pain. The adipocytokines, resistin and tumor necrosis factor-alpha (TNF-α), might play a role in OA pathogenesis and outcomes.
Purpose
The aim of this study was, therefore, to assess the anti-inflammatory and analgesic effects of a garlic supplement on serum resistin and TNF-α concentrations and on pain severity in overweight or obese women with knee OA.
Study design
Randomized, double-blind, placebo-controlled, parallel-design trial.
Methods
In this study, 80 post-menopausal overweight or obese women (25 ≤ BMI ≤ 40 kg/m2, age 50–75 years) with mild to moderate knee OA were enrolled. Patients were randomly divided into two groups to receive twice-daily either garlic tablets (total: 1000 mg) or placebo for 12 weeks. The primary outcome measures were fasting serum concentrations of resistin and TNF-α, and pain severity (assessed using 0–10 point visual analogue scale (VAS)).
Results
At week 12, resistin concentrations were significantly decreased in the garlic group (6.41 ± 2.40 to 5.56 ± 2.16 ng/ml; P = 0.008). Serum TNF-α levels did not change significantly within or between the two groups. Pain scores were significantly reduced in the garlic (6.8 ± 2 to 5.3 ± 2.3; P = 0.002), but not in the placebo (6.7 ± 2.4 to 6.2 ± 2.5; P = 0.674), group. Pain scores were also significantly lower in the garlic, compared with the placebo, group following supplementation (5.3 ± 2.3 vs. 6.2 ± 2.5; P = 0.043).
Conclusions
The findings suggest that garlic supplementation for 12 weeks might reduce pain severity in overweight or obese women with knee OA, which may, at least in part, be mediated via a reduction in the pro-inflammatory adipocytokine, resistin.
Source : Journal Phytomedicine
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Clinical EFT (Emotional Freedom Techniques) Improves Multiple Physiological Markers of Health
Donna Bach, ND, Gary Groesbeck, BCIA, Peta Stapleton, PhD
Abstract
Emotional Freedom Technique (EFT) is an evidence-based self-help therapeutic method and over 100 studies demonstrate its efficacy. However, information about the physiological effects of EFT is limited. The current study sought to elucidate EFTs mechanisms of action across the central nervous system (CNS) by measuring heart rate variability (HRV) and heart coherence (HC); the circulatory system using resting heart rate (RHR) and blood pressure (BP); the endocrine system using cortisol, and the immune system using salivary immunoglobulin A (SigA). The second aim was to measure psychological symptoms. Participants (N = 203) were enrolled in a 4-day training workshop held in different locations. At one workshop (n = 31), participants also received comprehensive physiological testing. Posttest, significant declines were found in anxiety (−40%), depression (−35%), posttraumatic stress disorder (−32%), pain (−57%), and cravings (−74%), all P < .000. Happiness increased (+31%, P = .000) as did SigA (+113%, P = .017). Significant improvements were found in RHR (−8%, P = .001), cortisol (−37%, P < .000), systolic BP (−6%, P = .001), and diastolic BP (−8%, P < .000). Positive trends were observed for HRV and HC and gains were maintained on follow-up, indicating EFT results in positive health effects as well as increased mental well-being
Source : Journal of Evidence Based Integrative Medicine
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Not Just Mind Over Matter: Reviewing With Patients How Mindfulness Relieves Chronic Low Back Pain
Natalia E. Morone, MD, MS
Abstract
The current opioid crisis has spurred the need for nonpharmacological therapies for chronic low back pain. In a study published in JAMA Internal Medicine, we reported that in 282 older adults with chronic low back pain, an 8-week mind-body group program modeled on Mindfulness-Based Stress Reduction (MBSR) decreased long-term pain and increased short-term function. Barriers to uptake remain such as patient resistance to accepting the benefits of nonpharmacological treatments for chronic low back pain. They may fear the clinician does not believe their pain complaint because they are not being offered a pain pill. By not appreciating the value of the therapy in helping their chronic low back pain, the patient may not be compliant with recommendations. Resistance likely derives from lack of understanding how a mind-body approach like MBSR can help relieve the sensation of pain as well as help increase function. Clinicians can help break through this barrier by educating their patients about the different ways in which MBSR works to reduce pain and improve function. In this commentary, we will discuss how our findings can inform the discussion clinicians have with their patients regarding the ways MBSR can relieve back pain. Pain processing is complex and top-down regulation is not fully engaged when pain is treated with pharmacotherapy alone. We share that our study showed a clinically meaningful reduction in pain and improvement in function and discuss some of the possible underlying mechanisms of MBSR’s effect.
Source : Journal of Evidence-Based Integrative Medicine
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The Effectiveness of Aromatherapy in Reducing Pain: A Systematic Review and Meta-Analysis
Shaheen E. Lakhan,1,2 Heather Sheafer,1and Deborah Tepper3
Abstract
Background. Aromatherapy refers to the medicinal or therapeutic use of essential oils absorbed through the skin or olfactory system. Recent literature has examined the effectiveness of aromatherapy in treating pain.Methods. 12 studies examining the use of aromatherapy for pain management were identified through an electronic database search. A meta-analysis was performed to determine the effects of aromatherapy on pain.Results. There is a significant positive effect of aromatherapy (compared to placebo or treatments as usual controls) in reducing pain reported on a visual analog scale (SMD = −1.18, 95% CI: −1.33, −1.03; p<0.0001). Secondary analyses found that aromatherapy is more consistent for treating nociceptive (SMD = −1.57, 95% CI: −1.76, −1.39, p<0.0001 ) and acute pain (SMD = −1.58, 95% CI: −1.75, −1.40, p<0.0001 ) than inflammatory (SMD = −0.53, 95% CI: −0.77, −0.29, p<0.0001 ) and chronic pain (SMD = −0.22, 95% CI: −0.49, 0.05, p=0.001), respectively. Based on the available research, aromatherapy is most effective in treating postoperative pain (SMD = −1.79, 95% CI: −2.08, −1.51, p<0.0001 ) and obstetrical and gynecological pain (SMD = −1.14, 95% CI: −2.10, −0.19,p<0.0001). Conclusion. The findings of this study indicate that aromatherapy can successfully treat pain when combined with conventional treatments.
Source : Journal Evidence Based Complementary and Alternative Medicine
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Beyond Pills: Acupressure Impact on Self-Rated Pain and Anxiety Scores
Elizabeth Monson, Diane Arney, Beth Benham, Rebekah Bird, Erika Elias, Kami Linden, Kimberly McCord, Cathy Miller, Tammy Miller, Lori Ritter, and Deanna Waggy
Abstract
Objectives: To determine impact of an acupressure protocol on self-rated pain and anxiety scores.
Design: Retrospective database analysis of self-rated pain and anxiety scores before and immediately after administration of stress release acupressure protocol.
Participants: Participants include hospitalized patients, nurses, and public.
Intervention: Involves a 16-point stress release acupressure protocol.
Outcome measures: Outcome measures involve pre- and post-treatment self-rated pain scores (0–10) with the Wong-Baker Faces Scale and pre- and post-treatment self-rated anxiety scores (0–10) on a visual analog scale.
Results: Five hundred and nineteen acupressure treatments were retrospectively analyzed with pre- and post-treatment self-rated pain and anxiety scores, where 0 represented no pain or anxiety and 10 represented the worst pain and anxiety. Overall, participants demonstrated a two-point decrease in pain scores and a four-point decrease in anxiety scores post-treatment. Hospitalized patients demonstrated a four-point decrease in pain scores and a five-point decrease in anxiety scores post-treatment. Nurses demonstrated a three-point decrease in pain scores and four-point decrease in anxiety scores post-treatment. Public population demonstrated a one-point decrease in pain scores and two-point decrease in anxiety scores post-treatment. Seventy-five percent of participants were highly satisfied with acupressure treatments, and 96% of treatments were administered in less than 30 minutes.
Conclusions: Acupressure is a highly satisfactory complementary therapy that can demonstrate a clinically significant decrease in self-rated pain and anxiety scores.
Source : Journal Alternative and Complementary Medicine
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Acute effect of different concentrations of cayenne pepper cataplasm on sensory-motor functions and serum levels of inflammation-related biomarkers in healthy subjects
Nejc Sarabon (1,2), Stefan Löfler (3), Jan Cvecka (4), Wolfgang Hübl (5), Sandra Zampieri (6)
Abstract
Physical medicine therapies are often used in treating widespread musculoskeletal disorders, such as neck and low back pain. Herbal cataplasms containing rubefacient substances, such as Cayenne pepper, or galenic preparations like Munari cataplasm are commonly used as natural medications to treat painful areas. In this paper we show the effects of a 20-min application of Cayenne pepper and kaolin powder cataplasm (CPC) on healthy subjects. Treatment effects were evaluated by cold/hot feeling on visual analogue scale, blood pressure, body temperature, skin light touch sensations, two-point discrimination, and pain threshold to a mechanical stimulus, before and immediately after, 15 min after and 30 min after different concentration of Cayenne pepper in CPC preparation on healthy subjects. Maximal voluntary trunk extension force and trunk extension submaximal force matching error were also measured. In addition, the resulting optimal CPC mixture was tested for its safety by measuring changes in circulating levels of inflammatory-related biomarkers after 20-min application. The results indicate that the 5% concentration of Cayenne pepper in the preparation of CPC is the best choice, since no additional effects can be obtained with the 10% concentration, and the effects are higher than those observed at the 2.5% concentration. Importantly, 5% CPC application did not induce a significant increase of inflammatory-related biomarkers, suggesting that 20-min application has no negative side effects at systemic levels. Further studies are needed to investigate the immediate and long-term effects of repeated CPC applications as well as to understand the intersecting underlying mechanisms activated by Capsaicin and other identified factors, in order to be more extensively used in the field of physical medicine therapies.
Source : European Journal of Translational Myology
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Medicinal herbs in the treatment of neuropathic pain: a review
Fatemeh Forouzanfar 1 , Hossein Hosseinzadeh
Abstract
Chronic neuropathic pain is a common significant and debilitating problem that presents a major challenge to health-care. Despite the large number of available drugs, there are no curative conventional treatments for neuropathic pain. Nowadays, more attention has been focused on the herbal formulation in the field of drug discovery. Therefore, we performed an extensive review about herbal drugs and plants that exhibited protective effects on neuropathic pain. In this review, the beneficial effects of each plant in different neuropathic pain model, either in animals or in patients are reported. Moreover, the possible involved mechanisms for the protective effects are discussed. The more common plants which are used for the treatment of neuropathic pain are included as: Acorus calamus, Artemisia dracunculus, Butea monosperma, Citrullus colocynthis, Curcuma longa, Crocus sativus, Elaeagnus angustifolia, Ginkgo biloba, Mitragyna speciosa, Momordica charantia, Nigella sativa, Ocimum sanctum, Phyllanthus amarus, Pterodon pubescens Benth, Rubia cordifolia and Salvia officinalis. Furthermore, the most pathways which are known to be involved in pain relief by means of herbal remedies are anti-oxidant activity, anti-inflammatory, antiapoptotic, neuroprotective and calcium inhibitory actions. In conclusion, this review suggests that some herbal plants can be suitable candidates for the treatment of neuropathic pain.
Source : Iranian Journal of Basic Medical Science
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Neural mechanisms supporting the relationship between dispositional mindfulness and pain
Zeidan, Fadela,*; Salomons, Timb; Farris, Suzan R.a; Emerson, Nichole M.a; Adler-Neal, Adriennea; Jung, Youngkyooc; Coghill, Robert C.a,d
Abstract
Interindividual differences in pain sensitivity vary as a function of interactions between sensory, cognitive–affective, and dispositional factors. Trait mindfulness, characterized as the innate capacity to nonreactively sustain attention to the present moment, is a psychological construct that is associated with lower clinical pain outcomes. Yet, the neural mechanisms supporting dispositional mindfulness are unknown. In an exploratory data analysis obtained during a study comparing mindfulness to placebo analgesia, we sought to determine whether dispositional mindfulness is associated with lower pain sensitivity. We also aimed to identify the brain mechanisms supporting the postulated inverse relationship between trait mindfulness and pain in response to noxious stimulation. We hypothesized that trait mindfulness would be associated with lower pain and greater deactivation of the default mode network. Seventy-six meditation-naive and healthy volunteers completed the Freiburg Mindfulness Inventory and were administered innocuous (35°C) and noxious stimulation (49°C) during perfusion-based functional magnetic resonance imaging. Higher Freiburg Mindfulness Inventory ratings were associated with lower pain intensity (P = 0.005) and pain unpleasantness ratings (P = 0.005). Whole brain analyses revealed that higher dispositional mindfulness was associated with greater deactivation of a brain region extending from the precuneus to posterior cingulate cortex during noxious heat. These novel findings demonstrate that mindful individuals feel less pain and evoke greater deactivation of brain regions supporting the engagement sensory, cognitive, and affective appraisals. We propose that mindfulness and the posterior cingulate cortex should be considered as important mechanistic targets for pain therapies.
Source : Journal Pain
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Cannabis Roots: A Traditional Therapy with Future Potential for Treating Inflammation and Pain
Natasha R. Ryz,1,* David J. Remillard,1 and Ethan B. Russo2
Abstract
Introduction: The roots of the cannabis plant have a long history of medical use stretching back millennia. However, the therapeutic potential of cannabis roots has been largely ignored in modern times.
Discussion: In the first century, Pliny the Elder described in Natural Histories that a decoction of the root in water could be used to relieve stiffness in the joints, gout, and related conditions. By the 17th century, various herbalists were recommending cannabis root to treat inflammation, joint pain, gout, and other conditions. There has been a subsequent paucity of research in this area, with only a few studies examining the composition of cannabis root and its medical potential. Active compounds identified and measured in cannabis roots include triterpenoids, friedelin (12.8 mg/kg) and epifriedelanol (21.3 mg/kg); alkaloids, cannabisativine (2.5 mg/kg) and anhydrocannabisativine (0.3 mg/kg); carvone and dihydrocarvone; N-( p-hydroxy-b-phenylethyl)-p-hydroxy-trans-cinnamamide (1.6 mg/kg); various sterols such as sitosterol (1.5%), campesterol (0.78%), and stigmasterol (0.56%); and other minor compounds, including choline. Of note, cannabis roots are not a significant source of D9 - tetrahydrocannabinol (THC), cannabidiol, or other known phytocannabinoids.
Conclusion: The current available data on the pharmacology of cannabis root components provide significant support to the historical and ethnobotanical claims of clinical efficacy. Certainly, this suggests the need for reexamination of whole root preparations on inflammatory and malignant conditions employing modern scientific techniques.
Source : Cannabis and Cannabinoid Research
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Mindfulness-based cognitive therapy for headache pain: An evaluation of the long-term maintenance of effects
Melissa A.Dayac Beverly E.Thorn
Abstract
Objectives
This study aimed to examine the durability of gain patterns following an 8-week Mindfulness-Based Cognitive Therapy (MBCT) for headache pain program.
Design
A secondary analysis of a randomized controlled trial was conducted. Participants (N = 19) were individuals with headache pain who completed both the MBCT program as well as a 6-month follow-up assessment at a headache clinic or a university psychology clinic. Standardized measures of the primary outcomes (pain intensity and pain interference) and secondary outcomes (pain catastrophizing, mindfulness, activity engagement, pain willingness, and self-efficacy) were administered. Paired-samples t tests and effect sizes were examined.
Results
Significant (uncorrected ps < .05) pre- to post-treatment gains were found for pain intensity, pain interference, pain catastrophizing, activity engagement and self-efficacy, and these gains were maintained at 6-months post-treatment. Effect sizes for the significant changes from pre- to post-treatment, and from pre-treatment to follow-up were mostly consistent across epochs (.62 ≤ ds ≤ −1.40), indicating steady maintenance of effects. Improvement in mindfulness and pain willingness was non-significant immediately post-treatment and at follow-up, with small effects observed.
Conclusions
This study adds to a growing body of literature supporting the durability of MBCT for painful conditions. Results indicated a consistent pattern of maintenance of treatment-related gains across a number of key pain-related outcomes. Future research with a larger sample is needed to investigate the mechanisms underlying these continued gains in order to optimize targeted relapse-prevention.
Source Complementary Therapies in Medicine
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A randomized, double blind, placebo controlled, cross over study to evaluate the analgesic activity of Boswellia serrata in healthy volunteers using mechanical pain model.
Prabhavathi K1, Chandra US1, Soanker R1, Rani PU1.
Abstract
OBJECTIVE:Experimental pain models in human healthy volunteers are advantageous for early evaluation of analgesics. All efforts to develop nonsteroidal anti-inflammatory drugs (NSAIDs) which are devoid of gastrointestinal and cardiovascular system effects are still far from achieving a breakthrough. Hence we evaluated the analgesic activity of an ayurvedic drug, Boswellia serrata by using validated human pain models which has shown its analgesic activity both in-vitro and preclinical studies to evaluate the analgesic activity of single oral dose (125 mg, 2 capsules) of Boswellia serrata compared to placebo using mechanical pain model in healthy human subjects.
MATERIALS AND METHODS:After taking written informed consent, twelve healthy subjects were randomized (1:1) to receive single oral dose of Boswellia serrata (Shallaki (®)) 125 mg, 2 capsules or identical placebo in a crossover design. Mechanical pain was assessed using Ugo basile analgesymeter (by Randall Selitto test) at baseline and at 1 hr, 2 hrs and 3 hrs after test drug administration. Pain Threshold force and time and Pain Tolerance force and time were evaluated. Statistical analysis was done by paired t-test.
RESULTS:Twelve healthy volunteers have completed the study. Mean percentage change from baseline in Pain Threshold force and time with Boswellia serrata when compared to placebo had significantly increased [Force: 9.7 ± 11.0 vs 2.9 ± 3.4 (P = 0.05) and time: 9.7 ± 10.7 vs 2.8 ± 3.4 (P = 0.04)] at third hr. Mean Percentage change from baseline in Pain Tolerance force and time with Boswellia serrata when compared to placebo had significantly (P ≤ 0.01) increased at 1 hr, 2 hrs and 3 hrs.
CONCLUSION:In the present study, Boswellia serrata significantly increased the Pain Threshold and Pain Tolerance force and time compared to placebo. Both study medications were well tolerated. Further multiple dose studies may be needed to establish the analgesic efficacy of the drug.
Source : Indian Journal of Pharmacology
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Curcumin downregulates expression of opioid-related nociceptin receptor gene (OPRL1) in isolated neuroglia cells
Ean-JeongSeo a ThomasEfferth a Alexander Panossian b
Abstract
Background
Curcumin (CC) exerts polyvalent pharmacological actions and multi-target effects, including pain relief and anti-nociceptive activity. In combination with Boswellia serrata extract (BS), curcumin shows greater efficacy in knee osteoarthritis management, presumably due to synergistic interaction of the ingredients.
Aim
To elucidate the molecular mechanisms underlying the analgesic activity of curcumin and its synergistic interaction with BS.
MethodsWe performed gene expression profiling by transcriptome-wide mRNA sequencing in human T98G neuroglia cells treated with CC (Curamed®), BS, and the combination of CC and BS (CC-BS; Curamin®), followed by interactive pathways analysis of the regulated genes.
Results
Treatment with CC and with CC-BS selectively downregulated opioid-related nociceptin receptor 1 gene (OPRL1) expression by 5.9-fold and 7.2-fold, respectively. No changes were detected in the other canonical opioid receptor genes: OPRK1, OPRD1, and OPRM1. Nociceptin reportedly increases the sensation of pain in supra-spinal pain transduction pathways. Thus, CC and CC-BS may downregulate OPRL1, consequently inhibiting production of the nociception receptor NOP, leading to pain relief. In neuroglia cells, CC and CC-BS inhibited signaling pathways related to opioids, neuropathic pain, neuroinflammation, osteoarthritis, and rheumatoid diseases. CC and CC-BS also downregulated ADAM metallopeptidase gene ADAMTS5 expression by 11.2-fold and 13.5-fold, respectively. ADAMTS5encodes a peptidase that plays a crucial role in osteoarthritis development via inhibition of a corresponding signaling pathway.
Conclusion
Here, we report for the first time that CC and CC-BS act as nociceptin receptor antagonists, selectively downregulating opioid-related nociceptin receptor 1 gene (OPRL1) expression, which is associated with pain relief. BS alone did not affect OPRL1 expression, but rather appears to potentiate the effects of CC via multiple mechanisms, including synergistic interactions of molecular networks.
Source : Journal Phytomedicine
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Analgesic Effects of Reflexology in Patients Undergoing Surgical Procedures: A Randomized Controlled Trial
Samuel Attias, Keren Sivan, Ofri Avneri, Avigail Sagee, Eran Ben-Arye, Ofra Grinberg, Gideon Sroka, Ibrahim Matter, and
Elad Sch
Abstract
Objective: Inadequate treatment of pain in patients undergoing surgery is associated with unsatisfactory perioperative outcomes. The aim of this study was to examine the role of reflexology in addition to standard analgesic treatment in postoperative pain management.
Design: This was a prospective, unblinded pragmatic controlled trial.
Setting/Location: Study participants included patients who were admitted to the general surgery department.
Interventions: Patients in the intervention group received reflexology while standard analgesic care was administered similarly in both groups.
Outcome measures: Pain intensity at rest and in motion was evaluated using visual analog scale (VAS [0–10]) at baseline, and 60–90 min after treatment.
Results: Pain reduction was clinically and statistically significant in the reflexology group, both for pain at rest (from mean VAS of 4.4 to 3.1, N = 77, p < 0.0001) and for pain in motion (from 6.2 to 4.2, N = 77, p < 0.0001). In the control group, pain at rest was not reduced at follow-up (from 4.7 to 4.6, N = 87, p = 0.92), nor was pain in motion (from 5.8 to 5.7, N = 87, p = 0.65). Comparison of mean difference for pain showed significant improvement in the reflexology group compared to the standard of care group (p < 0.0001). The most significant pain reduction in the reflexology group was observed among patients who had moderate-severe baseline pain (VAS >4).
Conclusion: Adding reflexology to standard analgesic care is effective in reducing postoperative pain at rest and in motion, especially for patients experiencing moderate to severe pain.
Source : Journal Alternative and Complementary Medicine
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Integration of Complementary and Alternative Medicine Therapies into Primary-Care Pain Management for Opiate Reduction in a Rural Setting
Mehl-Madrona Lewis, Mainguy Barbara, and Plummer Julie.
Abstract
Background: Opiates are no longer considered the best strategy for the long-term management of chronic pain. Yet, physicians have made many patients dependent on them, and these patients still request treatment. Complementary and alternative medicine (CAM) therapies have been shown to be effective, but are not widely available and are not often covered by insurance or available to the medically underserved.
Methods: Group medical visits (GMVs) provided education about non-pharmacological methods for pain management and taught mindfulness techniques, movement, guided imagery, relaxation training, yoga, qigong, and t'ai chi. Forty-two patients attending GMVs for at least six months were matched prospectively with patients receiving conventional care.
Results: No one increased their dose of opiates. Seventeen people reduced their dose, and seven people stopped opiates. On a 10-point scale of pain intensity, reductions in pain ratings achieved statistical significance (p = 0.001). The average reduction was 0.19 (95% confidence interval [CI] 0.12–0.60; p = 0.01). The primary symptom improved on average by −0.42 (95% CI −0.31 to −0.93; p = 0.02) on the My Medical Outcome Profile, 2nd version. Improvement in the quality-of-life rating was statistically significant (p = 0.007) with a change of −1.42 (95% CI = −0.59 to −1.62). In conventional care, no patients reduced their opiate use, and 48.5% increased their dose over the two years of the project.
Conclusions: GMVs that incorporated CAM therapies helped patients reduce opiate use. While some patients found other physicians to give them the opiates they desired, those who persisted in an environment of respect and acceptance significantly reduced opiate consumption compared with patients in conventional care. While resistant to CAM therapies initially, the majority of patients came to accept and to appreciate their usefulness. GMVs were useful for incorporating non-reimbursed CAM therapies into primary medical care.
Source : Journal of Alternative and Complementary Medicine
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Scientific investigation of crude alkaloids from medicinal plants for the management of pain
- Mohammad Shoail, Syed Wadood Ali Shah, Niaz Ali,Ismail Shah,Shafi Ullah, Mehreen Ghias, Muhammad Nawaz Tahir,Farah Gul, Sohail Akhtar, Abd Ullah, Wajid Akbar andAsad Ullah
Background
Tissue damage is associated with pain, which is an alarming sign. Aspirin and morphine have been widely used in recent decades for management of pain. Medicinal herbs have been in use for treatment of different diseases for centuries. Many of these herbs possess analgesic activity with relatively less incidences of adverse effects. The strong positive correlation of alkaloids in medicinal plants for analgesic activity persuades an intention to determine possible analgesic activity of total alkaloids extracted from the selected medicinal plants using animal models to answer its possible mechanisms.
Methods
Crude alkaloids from selected medicinal plants (Woodfordia fruticosa, Adhatoda vasica, Chenopodium ambrosioides, Vitex negundo, Peganum harmala and Broussonetia papyrifera) were extracted as per reported literature. The test crude alkaloids were screened foracute toxicity study. Writhings induced by acetic acid, tail immersion method and formalin-induced nociception assay procedures were used for possible analgesic effects of the crude alkaloids.
Results
Crude alkaloids were safe up to dose of 1250 mg/kg body weight in mice. The alkaloids significantly reduced the abdominal constrictions, and increased the time for paw licking response in both phases with a significant raise in latency time in nociception models (P ≤ 0.05). Moreover, the antinociceptive response was significantly attenuated by pretreatment with naloxone suggesting involvement of the opioid receptors for possible antinociceptive action.
Conclusions
Crude alkaloids of Woodfordia fruticosa and Peganum harmala showed prominent analgesic potentials through inhibition of peripheral as well as central nervous system mechanisms. Further work is required for isolation of the pharmacologically active constituents.
Source : BMC Complementary and Alternative Medicine
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Complementary and alternative medicine therapies for chronic pain.
Bauer BA1, Tilburt JC2, Sood A2, Li GX3,4, Wang SH4,5.
Abstract
Pain afflflicts over 50 million people in the US, with 30.7% US adults suffering with chronic pain. Despite advances in therapies, many patients will continue to deal with ongoing symptoms that are not fully addressed by the best conventional medicine has to offer them. The patients frequently turn to therapies outside the usual purview of conventional medicine (herbs, acupuncture, meditation, etc.) called complementary and alternative medicine (CAM). Academic and governmental groups are also starting to incorporate CAM recommendations into chronic pain management strategies. Thus, for any physician who care for patients with chronic pain, having some familiarity with these therapies-including risks and benefits-will be key to helping guide patients in making evidence-based, well informed decisions about whether or not to use such therapies. On the other hand, if a CAM therapy has evidence of both safety and efficacy then not making it available to a patient who is suffering does not meet the need of the patient. We summarize the current evidence of a wide variety of CAM modalities that have potential for helping patients with chronic pain in this article. The triad of chronic pain symptoms, ready access to information on the internet, and growing patient empowerment suggest that CAM therapies will remain a consistent part of the healthcare of patients dealing with chronic pain.
Conclusions
The triad of chronic pain symptoms, ready access to information on the internet, and growing patient empowerment suggest that CAM therapies will remain a consistent part of the healthcare of patients dealing with chronic pain. Emerging data documenting effi cacy of CAM treatments, particularly massage, acupuncture and mindbody therapies for chronic pain supports this movement. As the use of CAM expands, clinicians and patients will need to recognize the potential for harm, as well as the potential for untapped benefi ts within this realm. An open non-judgmental discussion with the patients about CAM therapies can help foster the therapeutic relationship and trust that is critical in dealing with a long-term challenge such as chronic pain. The older approach with patients interested in CAM might have been summed up as "either/or"—either you utilize conventional medicine or you use CAM—but there was rarely a middle ground. Such a dismissive attitude did little to quell patient interest, but simply ensured that future information about such therapies would not come from a physician. It also encouraged patients not to disclose future or ongoing usage of supplements— resulting in challenges when adverse events occurred but with no way to recognize the potential role of supplements. A newer and more collaborative framework is "both/and" where we expect patients will continue to avail themselves of both the best conventional medicine has to offer, and the best evidence-based CAM therapies.
Source : Evidence Based Complementary and Alternative Medicine
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Antinociceptive and Anti-inflammatory Activities of the Lectin from Marine Red Alga Solieria filiformis
Ticiana Monteiro Abreu1, Natássia Albuquerque Ribeiro1, Hellíada Vasconcelos Chaves2, Roberta Jeane Bezerra Jorge3, Mirna Marques Bezerra4, Helena Serra Azul Monteiro3, Ilka Maria Vasconcelos1, Érika Freitas Mota5, Norma Maria Barros Benevides1
Abstract
Lectins are proteins that bind to specific mono- or oligosaccharides. This study aimed to evaluate the antinociceptive and anti-inflammatory effects of the lectin from the red marine alga Solieria filiformis. The animals (n = 6) were pretreated with S. filiformis lectin 30 min before they were given the nociceptive or inflammatory stimulus. The antinociceptive activity was evaluated in Swiss mice using the abdominal writhing, formalin, and hot plate tests. The anti-inflammatory properties were evaluated in Wistar rats using carrageenan-induced peritonitis and paw edema induced by different phlogistic agents. The S. filiformis lectin toxicity was assayed through its application in mice (7 days). S. filiformis lectin significantly reduced the number of abdominal writhings and reduced the paw licking time in the second phase of the formalin test (p < 0.05), but it did not prolong the reaction time in the hot plate test (p > 0.05). Furthermore, S. filiformis lectin reduced neutrophil migration in a peritonitis model and reduced paw edema induced by carrageenan, dextran, and serotonin (p < 0.05). Additionally, the administration of S. filiformis lectin resulted in no signs of systemic damage. Thus, S. filiformis lectin appears to have important antinociceptive and anti-inflammatory activities and could represent a potential therapeutic agent for future studies.
Source : Journal Planta Medica
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Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back PainA Randomized Clinical Trial
Daniel C. Cherkin, PhD1,2,3; Karen J. Sherman, PhD1,4; Benjamin H. Balderson, PhD1; Andrea J. Cook, PhD1,5; Melissa L. Anderson, MS1; Rene J. Hawkes, BS1; Kelly E. Hansen, BS1; Judith A. Turner, PhD6,7
Abstract
Importance Mindfulness-based stress reduction (MBSR) has not been rigorously evaluated for young and middle-aged adults with chronic low back pain.
Objective To evaluate the effectiveness for chronic low back pain of MBSR vs cognitive behavioral therapy (CBT) or usual care.
Design, Setting, and Participants Randomized, interviewer-blind, clinical trial in an integrated health care system in Washington State of 342 adults aged 20 to 70 years with chronic low back pain enrolled between September 2012 and April 2014 and randomly assigned to receive MBSR (n = 116), CBT (n = 113), or usual care (n = 113).
Interventions CBT (training to change pain-related thoughts and behaviors) and MBSR (training in mindfulness meditation and yoga) were delivered in 8 weekly 2-hour groups. Usual care included whatever care participants received.
Main Outcomes and Measures Coprimary outcomes were the percentages of participants with clinically meaningful (≥30%) improvement from baseline in functional limitations (modified Roland Disability Questionnaire [RDQ]; range, 0-23) and in self-reported back pain bothersomeness (scale, 0-10) at 26 weeks. Outcomes were also assessed at 4, 8, and 52 weeks.
Results There were 342 randomized participants, the mean (SD) [range] age was 49.3 (12.3) [20-70] years, 224 (65.7%) were women, mean duration of back pain was 7.3 years (range, 3 months-50 years), 123 (53.7%) attended 6 or more of the 8 sessions, 294 (86.0%) completed the study at 26 weeks, and 290 (84.8%) completed the study at 52 weeks. In intent-to-treat analyses at 26 weeks, the percentage of participants with clinically meaningful improvement on the RDQ was higher for those who received MBSR (60.5%) and CBT (57.7%) than for usual care (44.1%) (overall P = .04; relative risk [RR] for MBSR vs usual care, 1.37 [95% CI, 1.06-1.77]; RR for MBSR vs CBT, 0.95 [95% CI, 0.77-1.18]; and RR for CBT vs usual care, 1.31 [95% CI, 1.01-1.69]). The percentage of participants with clinically meaningful improvement in pain bothersomeness at 26 weeks was 43.6% in the MBSR group and 44.9% in the CBT group, vs 26.6% in the usual care group (overall P = .01; RR for MBSR vs usual care, 1.64 [95% CI, 1.15-2.34]; RR for MBSR vs CBT, 1.03 [95% CI, 0.78-1.36]; and RR for CBT vs usual care, 1.69 [95% CI, 1.18-2.41]). Findings for MBSR persisted with little change at 52 weeks for both primary outcomes.
Conclusions and Relevance Among adults with chronic low back pain, treatment with MBSR or CBT, compared with usual care, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain.
Source : JAMA
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Mindfulness Meditation Relieves Pain, but Works Differently Than Opioids in the Body
Previous research has shown that mindfulness meditation helps relieve pain, but researchers have been unclear about how the practice induces pain relief—specifically, if meditation is associated with the release of naturally occurring opiates. Results from a new study, funded in part by the National Center for Complementary and Integrative Health, demonstrate that mindfulness meditation does not rely on the endogenous opioid activity to reduce pain, which is an important consideration for using meditation to treat chronic pain. The study, conducted by researchers at Wake Forest School of Medicine and Cincinnati Children’s Hospital Medical Center, was published in The Journal of Neuroscience.
Researchers recorded pain reports in 78 healthy adults during meditation or a non-meditation control in response to painful heat stimuli and intravenous administration of the opioid antagonist naloxone (a drug that blocks the transmission of opioid activity) or placebo saline. Participants were randomized to one of four treatment groups: 1) meditation plus naloxone; 2) control plus naloxone; 3) meditation plus saline; or 4) control plus saline. People in the control groups were instructed to “close your eyes and relax until the end of the experiment.”
The researchers found that participants who meditated during saline administration had significantly lower pain intensity and unpleasantness ratings compared to those who did not meditate while receiving saline. Importantly, data from the meditation plus naloxone group showed that naloxone did not block meditation’s pain-relieving effects. No significant differences in reductions of pain intensity or pain unpleasantness were seen between the meditation plus naloxone and the meditation plus saline groups. Participants who meditated during naloxone administration also had significantly greater reductions in pain intensity and unpleasantness than the control groups.
These findings demonstrate that mindfulness meditation reduces pain independently of opioid neurotransmitter mechanisms. The researchers noted that because opioid and non-opioid mechanisms of pain relief interact synergistically, the results of this study suggest that combining mindfulness-based and pharmacologic/nonpharmacologic pain-relieving approaches that rely on opioid signaling may be particularly effective in treating pain.
Reference
- Zeidan F, Adler-Neal AL, Wells RE, et al. Mindfulness-meditation-based pain relief is not mediated by endogenous opioids. Journal of Neuroscience. March 26, 2016. Epub ahead of print.
Source : NIH National Centres for Complementary and Integrative Health
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Passiflora incarnata attenuation of neuropathic allodynia and vulvodynia apropos GABA-ergic and opioidergic antinociceptive and behavioural mechanisms
- Urooj Aman,
- Fazal Subhan
- Muhammad Shahid,
- Shehla Akbar,
- Nisar Ahmad,
- Gowhar Ali,
- Khwaja Fawad and
- Robert D. E. Sewell
Abstract
Passiflora incarnata is widely used as an anxiolytic and sedative due to its putative GABAergic properties. Passiflora incarnata L. methanolic extract (PI-ME) was evaluated in an animal model of streptozotocin-induced diabetic neuropathic allodynia and vulvodynia in rats along with antinociceptive, anxiolytic and sedative activities in mice in order to examine possible underlying mechanisms.
Methods
PI-ME was tested preliminary for qualitative phytochemical analysis and then quantitatively by proximate and GC-MS analysis. The antinociceptive property was evaluated using the abdominal constriction assay and hot plate test. The anxiolytic activity was performed in a stair case model and sedative activity in an open field test. The antagonistic activities were evaluated using naloxone and/or pentylenetetrazole (PTZ). PI-ME was evaluated for prospective anti-allodynic and anti-vulvodynic properties in a rat model of streptozotocin induced neuropathic pain using the static and dynamic testing paradigms of mechanical allodynia and vulvodynia.
Results
GC-MS analysis revealed that PI-ME contained predominant quantities of oleamide (9-octadecenamide), palmitic acid (hexadecanoic acid) and 3-hydroxy-dodecanoic acid, among other active constituents. In the abdominal constriction assay and hot plate test, PI-ME produced dose dependant, naloxone and pentylenetetrazole reversible antinociception suggesting an involvement of opioidergic and GABAergic mechanisms. In the stair case test, PI-ME at 200 mg/kg increased the number of steps climbed while at 600 mg/kg a significant decrease was observed. The rearing incidence was diminished by PI-ME at all tested doses and in the open field test, PI-ME decreased locomotor activity to an extent that was analagous to diazepam. The effects of PI-ME were antagonized by PTZ in both the staircase and open field tests implicating GABAergic mechanisms in its anxiolytic and sedative activities. In the streptozotocin-induced neuropathic nociceptive model, PI-ME (200 and 300 mg/kg) exhibited static and dynamic anti-allodynic effects exemplified by an increase in paw withdrawal threshold and paw withdrawal latency. PI-ME relieved only the dynamic component of vulvodynia by increasing flinching response latency.
Conclusions
These findings suggest that Passiflora incarnata might be useful for treating neuropathic pain. The antinociceptive and behavioural findings inferring that its activity may stem from underlying opioidergic and GABAergic mechanisms though a potential oleamide-sourced cannabimimetic involvement is also discussed.
Source : BMC Complementary and Alternative Medicine
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Ocimum gratissimum Essential Oil and Its Isolated Compounds (Eugenol and Myrcene) Reduce Neuropathic Pain in Mice
.Paula-Freire LI1, Molska GR2, Andersen ML1, Carlini EL2.
Abstract
Ocimum gratissimum is used in popular medicine to treat painful diseases. The antihypernociceptive properties of O. gratissimum essential oil and two of its active components (eugenol and myrcene) were tested in a model of neuropathic pain induced by a chronic constriction injury of the sciatic nerve. In tests to determine chronic antinociception, adult male C57BL/6 J mice were treated orally with corn oil (control group), O. gratissimum essential oil at doses of 10, 20, or 40 mg/kg or eugenol or myrcene at doses of 1, 5, or 10 mg/kg for 14 days after surgery. Pregabalin (20 mg/kg) was used as a standard in this study. The treatment with 20 and 40 mg/kg of O. gratissimum essential oil and at doses of 5 and 10 mg/kg of the active components were able to promote antihypernociception in both mechanical (von Frey) and thermal (hot plate) tests. The treatment with the essential oil of the plant or eugenol was effective in reducing the levels of interleukin-1β in the sciatic nerve. Our findings demonstrate that O. gratissimum essential oil and its isolated active components possess antihypernociceptive activity in neuropathic pain models.
Source : Planta Medica
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Effectiveness of Acupuncture for Treating Sciatica: A Systematic Review and Meta-Analysis
Zongshi Qin,1,2 Xiaoxu Liu,1,2 Jiani Wu,1 Yanbing Zhai,1,2 and Zhishun Liu1
Abstract
This is a systematic review and meta-analysis, which aimed to assess the current evidence on the effects and safety of acupuncture for treating sciatica. In this review, a total of 11 randomized controlled trials were included. As a result, we found that the use of acupuncture may be more effective than drugs and may enhance the effect of drugs for patients with sciatica, but because of the insufficient number of relevant and rigorous studies, the evidence is limited. Future trials using rigorous methodology, appropriate comparisons, and clinically relevant outcomes should be conducted.
Source : Evidence Based Complementary and Alternative Medicine
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The Anti-Inflammatory Actions of Auricular Point Acupressure for Chronic Low Back Pain
Wei-Chun Lin, 1 Chao Hsing Yeh, 1 , * Lung-Chang Chien, 2 Natalia E. Morone, 3 Ronald M. Glick, 4 and Kathryn M. Albers 5
Abstract
Background. Auricular point acupressure (APA) is a promising treatment for pain management. Few studies have investigated the physiological mechanisms of APA analgesics.
Method. In this pilot randomized clinical trial (RCT), a 4-week APA treatment was used to manage chronic low back pain (CLBP). Sixty-one participants were randomized into a real APA group (n = 32) or a sham APA group (n = 29). Blood samples, pain intensity, and physical function were collected at baseline and after 4 weeks of treatment.
Results.Subjects in the real APA group reported a 56% reduction of pain intensity and a 26% improvement in physical function. Serum blood samples showed (1) a decrease in IL-1β, IL-2, IL-6, and calcitonin gene-related peptide [CGRP] and (2) an increase in IL-4. In contrast, subjects in the sham APA group (1) reported a 9% reduction in pain and a 2% improvement in physical function and (2) exhibited minimal changes of inflammatory cytokines and neuropeptides. Statistically significant differences in IL-4 and CGRP expression between the real and sham APA groups were verified.
Conclusion. These findings suggest that APA treatment affects pain intensity through modulation of the immune system, as reflected by APA-induced changes in serum inflammatory cytokine and neuropeptide levels.
Source : Evidence Based Complementary and Alternative Medicine
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Auricular Acupressure Can Modulate Pain Threshold
Antonietta Santoro,1 Stefania Lucia Nori,1 Letizia Lorusso,1 Carmine Secondulfo,1 Marcellino Monda,2 and Andrea Viggiano1
1Department of Medicine and Surgery, University of Salerno, 84084 Fisciano, Salerno, Italy
2Department of Experimental Medicine, Second University of Naples, 80138 Naples, Italy
Abstract
The objective of our study was to investigate if auriculotherapy (AT) can modulate pain threshold. In our experiments, AT consisted of placing Vaccaria seeds over the “fingers point” of one ear. Two groups of healthy volunteers were enrolled for the study. Each subject was asked to perform an autoalgometric test developed by our group on three occasions: before, 1 hour after, AT and 24 hours after AT. Participants of the first group received a 2-minute long session of AT, while participants of the second group received a 2-minute long session of sham treatment, consisting of a puncture/massage above the skin of the neck. The autoalgometric test consisted of applying an increasing pressure with the finger-tips and finger-backs of four fingers by the subjects themselves (i.e., eight sites were evaluated) against a round-shaped needle for two times: until a minimum pain sensation (first time, minimal test) or a maximally tolerable pain sensation (second time, maximal test). Our results showed a significant higher pain threshold in the maximal test at 24 hours after AT compared to sham treatment. This result indicates for the first time that AT can increase pain tolerability, rather than affecting the minimal pain threshold.
Source : eCam
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Yoga and chronic pain have opposite effects on brain gray matter
Chronic pain is known to cause brain anatomy changes and impairments, but yoga can be an important tool for preventing or even reversing the effects of chronic pain on the brain, according to a National Institutes of Health (NIH) official speaking at the American Pain Society's annual meeting.
M. Catherine Bushnell, PhD, scientific director, Division of Intramural Research, National Center for Complementary and Integrative Health, NIH, explained in a plenary session address that many chronic pain patients show associated anxiety and depression as well as deficits in cognitive functions. In addition, brain imaging studies in rats and humans have shown alterations in gray matter volume and white matter integrity in the brain caused by the effects of chronic pain.
"Imaging studies in multiple types of chronic pain patients show their brains differ from healthy control subjects," said Bushnell. "Studies of people with depression show they also have reduced gray matter, and this could contribute to the gray matter changes in pain patients who are depressed. Our research shows that gray matter loss is directly related to the pain when we take depression into account," said Bushnell.
Gray matter is brain tissue with numerous cell bodies and is located in the cerebral cortex and subcortical areas. The impact of gray matter loss depends on where it occurs in brain. Decreased gray matter can lead to memory impairment, emotional problems and decreased cognitive functioning.
Bushnell said there is compelling evidence from studies conducted at NIH/NCCIH and other sites that mind-body techniques, such as yoga and meditation, can counteract the brain anatomy affects of chronic pain. "Practicing yoga has the opposite effect on the brain as does chronic pain," said Bushnell.
She said the studies show yoga practitioners have more gray matter than controls in multiple brain regions, including those involved in pain modulation. "Some gray matter increases in yogis correspond to duration of yoga practice, which suggests there is a causative link between yoga and gray matter increases," Bushnell noted.
Assessing the impact of brain anatomy on pain reduction, Bushnell said gray matter changes in the insula or internal structures of the cerebral cortex are most significant for pain tolerance. "Insula gray matter size correlates with pain tolerance, and increases in insula gray matter can result from ongoing yoga practice," said Bushnell.
"Brain anatomy changes may contribute to mood disorders and other affective and cognitive comorbidities of chronic pain. The encouraging news for people with chronic pain is mind-body practices seem to exert a protective effect on brain gray matter that counteracts the neuroanatomical effects of chronic pain," Bushnell added.
Source : Science Daily
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Low Dose Vaporized Cannabis Significantly Improves Neuropathic Pain
Barth Wilsey, MD, Thomas D. Marcotte, PhD, Associate Professor, Reena Deutsch, PhD, Statistician, Ben Gouaux,Research Associate, Staci Sakai, Research Associate, and Haylee Donaghe, Research Associate
Abstract
We conducted a double-blind, placebo-controlled, crossover study evaluating the analgesic efficacy of vaporized cannabis in subjects, the majority of whom were experiencing neuropathic pain despite traditional treatment. Thirty-nine patients with central and peripheral neuropathic pain underwent a standardized procedure for inhaling either medium dose (3.53%), low dose (1.29%), or placebo cannabis with the primary outcome being VAS pain intensity. Psychoactive side-effects, and neuropsychological performance were also evaluated. Mixed effects regression models demonstrated an analgesic response to vaporized cannabis. There was no significant difference between the two active dose groups’ results (p>0.7). The number needed to treat (NNT) to achieve 30% pain reduction was 3.2 for placebo vs. low dose, 2.9 for placebo vs. medium dose, and 25 for medium vs. low dose. As these NNT are comparable to those of traditional neuropathic pain medications, cannabis has analgesic efficacy with the low dose being, for all intents and purposes, as effective a pain reliever as the medium dose. Psychoactive effects were minimal and well-tolerated, and neuropsychological effects were of limited duration and readily reversible within 1–2 hours. Vaporized cannabis, even at low doses, may present an effective option for patients with treatment-resistant neuropathic pain.
Source : Journal Pain
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Vitamin D and Central Hypersensitivity in Patients with Chronic Pain
Roland von Känel, MD,*† Veronika Müller-Hartmannsgruber, MD,* Georgios Kokinogenis, MD,* and Niklaus Egloff, MD*†
Abstract
Background. Low vitamin D is implicated in various chronic pain conditions with, however, inconclusive findings. Vitamin D might play an important role in mechanisms being involved in central processing of evoked pain stimuli but less so for spontaneous clinical pain.
Objective. This study aims to examine the relation between low serum levels of 25-hydroxyvitamin D3 (25-OH D) and mechanical pain sensitivity.
Design. We studied 174 patients (mean age 48 years, 53% women) with chronic pain. A standardized pain provocation test was applied, and pain intensity was rated on a numerical analogue scale (0–10). The widespread pain index and symptom severity score (including fatigue, waking unrefreshed, and cognitive symptoms) following the 2010 American College of Rheumatology preliminary diagnostic criteria for fibromyalgia were also assessed. Serum 25-OH D levels were measured with a chemiluminescent immunoassay.
Results. Vitamin deficiency (25-OH D < 50 nmol/L) was present in 71% of chronic pain patients; another 21% had insufficient vitamin D (25-OH D < 75 nmol/ L). After adjustment for demographic and clinical variables, there was a mean ± standard error of the mean increase in pain intensity of 0.61 ± 0.25 for each 25 nmol/L decrease in 25-OH D (P = 0.011). Lower 25-OH D levels were also related to greater symptom severity (r = −0.21, P = 0.008) but not to the widespread pain index (P = 0.83) and fibromyalgia (P = 0.51).
Conclusions. The findings suggest a role of low vitamin D levels for heightened central sensitivity, particularly augmented pain processing upon mechanical stimulation in chronic pain patients. Vitamin D seems comparably less important for selfreports of spontaneous chronic pain.
Source : Journal Pain Medicine
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Effects of Mindfulness Meditation on Chronic Pain: A Randomized Controlled Trial
- Peter la Cour PhD1,* and
- Marian Petersen PhD2
Abstract
Objective This randomized controlled clinical trial investigated the effects of mindfulness meditation on chronic pain.
Design A total of 109 patients with nonspecific chronic pain were randomized to either a standardized mindfulness meditation program (mindfulness-based stress reduction [MBSR]) or to a wait list control.
Methods Pain, physical function, mental function, pain acceptance, and health-related quality of life were measured. The SF36 vitality scale was chosen as the primary outcome measure; the primary end point was after completing the MBSR course. Within a 2.5-year period, 43 of the 109 randomized patients completed the mindfulness program, while 47 remained in the control group. Data were compared at three time points: at baseline, after completion of the course/waiting period, and at the 6-month follow-up.
Results Significant effect (Cohen's d = 0.39) was found on the primary outcome measure, the SF36 vitality scale. On the secondary variables, significant medium to large size effects (Cohen's d = 0.37–0.71) were found for lower general anxiety and depression, better mental quality of life (psychological well-being), feeling in control of the pain, and higher pain acceptance. Small (nonsignificant) effect sizes were found for pain measures. There were no significant differences in the measures just after the intervention vs the 6-month follow-up.
Conclusion A standardized mindfulness program (MBSR) contributes positively to pain management and can exert clinically relevant effects on several important dimensions in patients with long-lasting chronic pain.
Source : Journal Pain Medicine
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Oral Intake of a Liquid High-Molecular-Weight Hyaluronan Associated with Relief of Chronic Pain and Reduced Use of Pain Medication: Results of a Randomized, Placebo-Controlled Double-Blind Pilot Study
Gitte S. Jensen, Victoria L. Attridge, Miki R. Lenninger, and Kathleen F. Benson
ABSTRACT
The goal for this study was to evaluate the effects of daily oral intake of a consumable liquid fermentate containing high-molecular-weight hyaluronan, as well as to perform a basic evaluation of safety and tolerability. A randomized, double-blind placebo-controlled study design was used to examine the effects of oral intake of hyaluronan on chronic pain conditions. Safety assessment included a complete blood count with differential, blood chemistry and electrocardiogram. The study duration was 4 weeks, where three tablespoons (45 mL) product or placebo was ingested during the first 2 weeks, and two tablespoons (30 mL) was consumed during the last 2 weeks. Seventy-eight people between the age of 19 and 71 years enrolled, and 72 people completed the study. Statistical analysis was performed using the two-tailed independent ttest for between-group significance and using the paired t-test for within-group significance. A reduction in pain scores was seen after 2 weeks of consumption of both placebo (P < .1) and active (P < .065) product; the reduction was more pronounced in the group consuming the active test product. Using ‘‘within-subject’’ analysis, a highly significant reduction in chronic pain scores was seen after 2 weeks of consumption of three tablespoons of active product (P < .001), whereas only a mild nonsignificant reduction in pain scores was seen in the placebo group. During the reduced intake for the last 2 weeks of study participation, pain scores showed a slight increase. During the last 2 weeks, a significant increase in the quality of sleep (P < .005) and level of physical energy (P < .05) was seen. The pain reduction during the initial 2 weeks was associated with significant reduction in the use of pain medication (P < .05). Consumption of an oral liquid formula containing highmolecular-weight hyaluronan was associated with relief of chronic pain.
Source : Journal Medicinal Food
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Herbal medicine for low-back pain
- Hanna Oltean1,
- Chris Robbins1,
- Maurits W van Tulder2,
- Brian M Berman3,
- Claire Bombardier4,
- Joel J Gagnier5,*
Abstract
Low-back pain (LBP) is a common condition and imposes a substantial economic burden upon people living in industrialized societies. A large proportion of people with chronic LBP use complementary and alternative medicine (CAM), visit CAM practitioners, or both. Several herbal medicines have been purported for use in treating people with LBP. This is an update of a Cochrane Review first published in 2006.
Objectives
To determine the effectiveness of herbal medicine for non-specific LBP.
Search methods
We searched the following electronic databases up to September 2014: MEDLINE, EMBASE, CENTRAL, CINAHL, Clinical Trials.gov, World Health Organization International Clinical Trials Registry Portal and PubMed; checked reference lists in review articles, guidelines and retrieved trials; and personally contacted individuals with expertise in this area.
Selection criteria
We included randomized controlled trials (RCTs) examining adults (over 18 years of age) suffering from acute, sub-acute, or chronic non-specific LBP. The interventions were herbal medicines which we defined as plants used for medicinal purposes in any form. Primary outcome measures were pain and function.
Data collection and analysis
A library scientist with the Cochrane Back Review Group conducted the database searches. One review author contacted content experts and acquired relevant citations. We downloaded full references and abstracts of the identified studies and retrieved a hard copy of each study for final inclusion decisions. Two review authors assessed risk of bias, GRADE criteria (GRADE 2004), and CONSORT compliance and a random subset were compared to assessments by a third individual. Two review authors assessed clinical relevance and resolved any disagreements by consensus.
Main results
We included 14 RCTs (2050 participants) in this review. One trial on Solidago chilensis M. (Brazilian arnica) (20 participants) found very low quality evidence of reduction in perception of pain and improved flexibility with application of Brazilian arnica-containing gel twice daily as compared to placebo gel. Capsicum frutescens cream or plaster probably produces more favourable results than placebo in people with chronic LBP (three trials, 755 participants, moderate quality evidence). Based on current evidence, it is not clear whether topical capsicum cream is more beneficial for treating people with acute LBP compared to placebo (one trial, 40 participants, low quality evidence). Another trial found equivalence of C. frutescens cream to a homeopathic ointment (one trial, 161 participants, very low quality evidence). Daily doses of Harpagophytum procumbens (devil's claw), standardized to 50 mg or 100 mg harpagoside, may be better than placebo for short-term improvements in pain and may reduce use of rescue medication (two trials, 315 participants, low quality evidence). Another H. procumbens trial demonstrated relative equivalence to 12.5 mg per day of rofecoxib (Vioxx®) but was of very low quality (one trial, 88 participants, very low quality). Daily doses of Salix alba (white willow bark), standardized to 120 mg or 240 mg salicin, are probably better than placebo for short-term improvements in pain and rescue medication (two trials, 261 participants, moderate quality evidence). An additional trial demonstrated relative equivalence to 12.5 mg per day of rofecoxib (one trial, 228 participants) but was graded as very low quality evidence. S. alba minimally affected platelet thrombosis versus a cardioprotective dose of acetylsalicylate (one trial, 51 participants). One trial (120 participants) examining Symphytum officinale L. (comfrey root extract) found low quality evidence that a Kytta-Salbe comfrey extract ointment is better than placebo ointment for short-term improvements in pain as assessed by VAS. Aromatic lavender essential oil applied by acupressure may reduce subjective pain intensity and improve lateral spine flexion and walking time compared to untreated participants (one trial, 61 participants,very low quality evidence). No significant adverse events were noted within the included trials.
Authors' conclusions
C. frutescens (Cayenne) reduces pain more than placebo. Although H. procumbens, S. alba, S. officinale L., S. chilensis, and lavender essential oil also seem to reduce pain more than placebo, evidence for these substances was of moderate quality at best. Additional well-designed large trials are needed to test these herbal medicines against standard treatments. In general, the completeness of reporting in these trials was poor.
Source : Cochrane Library
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Bioactive Polyphenols from the Methanol Extract of Cnicus arvensis (L.) Roth Demonstrated Antinociceptive and Central Nervous System Depressant Activities in Mice
Mahmudur Rahman,1 Amina Khatun,2 Mst. Luthfun Nesa,3 Hemayet Hossain,4 and Ismet Ara Jahan4
1Natural Product Chemistry and Pharmacology Research Laboratory, Faculty of Health Sciences, Department of Pharmacy, Northern University Bangladesh, Dhaka 1205, Bangladesh
2Phytochemistry and Pharmacology Research Laboratory, Department of Pharmacy, Manarat International University, Dhaka 1216, Bangladesh
3Department of Pharmacy, Atish Dipankar University of Science and Technology, Dhaka 1213, Bangladesh
4Chemical Research Division, BCSIR Laboratories, Bangladesh Council of Scientific & Industrial Research, Dhaka 1205, Bangladesh
Abstract
Cnicus arvensis is used by many ethnic groups for inflammation, pain, and other ailments. In this study, reducing sugar, carbohydrate, alkaloid, steroid, tannin, flavonoid, and saponin groups were identified using standard chromogenic method. In high-performance liquid chromatography, vanillic acid and epicatechin were identified in the extract. Antinociceptive test by acetic acid induced writhing inhibition resulted 43.17 and 95.08% inhibition for 100 and 200 mg/kg body weight, comparing with standard diclofenac Na with 74.86% inhibition for 25 mg/kg body weight. In formalin induced paw licking test for antinociceptive activity, the extract inhibited 69.87 and 75.55% licking for 150 and 300 mg/kg body weight comparing with the inhibition (68.56%) of diclofenac Na for 10 mg/kg body weight at first phase. At late phase, the extract showed 73.12 and 87.46% licking comparing with licking inhibition (71.69%) by diclofenac Na at the same dose. In open field test for CNS depressant activity, the extract showed depression of locomotor activity for 150 and 300 mg/kg body weight comparing with diazepam for 10 mg/kg body weight. All results were statistically significant (P<0.01). The identified polyphenols are reputed for antinociceptive and CNS depressant activity. The present findings support the use of this plant in pain.
Source : Journal Evidence Based Complementary and Alternative Medicine
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Experienced Practitioners Reap Genetic Changes After a Day of Mindfulness Meditation
Results of a recent study cofunded by NCCAM suggest that one day of intense mindfulness by experienced meditators led to biological changes including expression of certain genes that play roles in inflammation and pain. Anti-inflammatory and pain-relieving drugs have similar effects on these genes. Findings from the study appear in the journal Psychoneuroendocrinology.
Mindfulness meditation practices are a form of training that focuses attention on breathing to develop increased awareness of the present. The study, conducted in 40 participants, focused on gaining more knowledge about molecular and genetic effects of this type of meditation and also on testing the feasibility of the study approach for future work.
Researchers divided participants into two groups. The first (active) group, which consisted of 19 people who had practiced daily meditation for at least 3 years, performed 8 hours of intensive mindfulness practice during one day. The other group, a control group of 21 people who had no experience with meditation, spent 8 hours performing quiet leisure activities in the same setting as the meditators. The researchers took blood samples before and after both interventions and analyzed them for certain biological factors, including the expression of various genes important in the regulatory processes for inflammation, circadian rhythms (which refer to the body’s internal “clock”), or histones (proteins in cells that attach to DNA). Researchers also took samples of participants’ saliva to determine the levels of the hormone cortisol as an indicator of recovery time after participants took a test that put them under acute stress.
The investigators found no significant differences between the active and control groups in these biological factors at the study’s start. However, after the interventions, the meditators showed some changes not seen in the control group. These included reduced expression levels of certain genes related to inflammation and histones. The reduced levels for two of these genes were associated with faster recovery from the stress test. No significant differences occurred between groups with respect to circadian genes.
The researchers suggested that their findings may offer a possible mechanism for explaining beneficial effects from meditation on inflammatory disorders, and an avenue for future research in chronic inflammatory conditions.
Reference
- Kaliman P, Álvarez-López MJ, Cosín-Tomás M, et al. Rapid changes in histone deacetylases and inflammatory gene expression in expert meditators. Psychoneuroendocrinology. 2014;40:96–107.
Source : NNCAM
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Anti-inflammatory, analgesic and anti-pyretic activities of standardized root extract of Jasminum sambac.
Sengar N1, Joshi A1, Prasad SK2, Hemalatha S3.
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE:The plant Jasminum sambac L. (Oleaceae) is cultivated throughout India. The leaves and roots of the plant are used traditionally in the treatment of inflammation, fever and pain. The leaves of the plant have been reported to posses significant anti-inflammatory and analgesic activities.
OBJECTIVE:To scientifically validate anti-inflammatory, analgesic and anti-pyretic activities of roots from J. sambac.
METHODS:Ethanol root extract of J. sambac (EJS) was standardized using HPTLC and was subjected to acute oral toxicity study. Further, analgesic activity of EJS at 100, 200 and 400 mg/kg, p.o. was evaluated using writhing test on Swiss albino mice and tail-flick test on Charles Foster albino rats. Anti-inflammatory activity of EJS was assessed by carrageenan-induced rat paw oedema, cotton pellet-induced granuloma and Freund's adjuvant-induced arthritis models, while antipyretic activity was evaluated using Brewer's yeast induced pyrexia. In addition, biochemical parameters such as alkaline phosphatase (ALP), aspartate transaminase (AST), alanine transaminase (ALT), lipid peroxidation (LPO), superoxide dismutase (SOD) and catalase (CAT) in blood serum and edematous tissue of rats exposed to acute (carrageenan) and granulomatous tissue in sub-chronic (cotton pellet granuloma) inflammation models were also evaluated.
RESULTS:Phytochemical analysis of EJS revealed the presence of flavonoids, phenols, saponins, tannins and carbohydrates in major quantities, while the quantity of hesperidin in EJS (using HPTLC) was found to be 4.25 % w/w. EJS at 400 mg/kg, p.o. reduced writhing count up to 49.21%, whereas in tail-flick test, EJS in a dose dependent manner increased latency in flicking tail. EJS at 400 mg/kg, p.o. showed significant anti-inflammatory activity after 2nd, 3rd, 4th and 6th h of treatment in carrageenan-induced edema, while a 33.58% inhibition in cotton pellet induced granuloma formation was observed at same dose level. EJS significantly (p<0.001) inhibited adjuvant-induced arthritis and also showed significant antipyretic activity. Further, a significant reversal in alterations of all the biochemical parameters (except ALP) in tissues was also observed.
CONCLUSION:The study confirms the anti-inflammatory, analgesic and antipyretic activity of EJS which may be attributed to the presence of various phytoconstituents quantified especially hesperidin which have already been reported for its significant role in treatment of inflammation and associated problems.
Source : Journal Ethnopharmacol
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Effects of Anethole in Nociception Experimental Models
Alessandra Mileni Versuti Ritter,1 Franciele Queiroz Ames,1 Fernando Otani,1 Rubia Maria Weffort de Oliveira,2 Roberto Kenji Nakamura Cuman,1 and Ciomar Aparecida Bersani-Amado1
1Department of Pharmacology and Therapeutics, Laboratory of Inflammation, State University of Maringá, Avenida Colombo 5790, 87020-900 Maringá, PR, Brazil
2Department of Pharmacology and Therapeutics, Laboratory of Brain Ischemia and Neuroprotection, State University of Maringá, Maringá, PR, Brazil
Abstract
This study investigated the antinociceptive activity of anethole (anethole 1-methoxy-4-benzene (1-propenyl)), major compound of the essential oil of star anise (Illicium verum), in different experimental models of nociception. The animals were pretreated with anethole (62.5, 125, 250, and 500 mg/kg) one hour before the experiments. To eliminate a possible sedative effect of anethole, the open field test was conducted. Anethole (62.5, 125, 250, and 500 mg/kg) showed an antinociceptive effect in the writhing model induced by acetic acid, in the second phase of the formalin test (125 and 250 mg/kg) in the test of glutamate (62.5, 125, and 250 mg/kg), and expresses pain induced by ACF (250 mg/kg). In contrast, anethole was not able to increase the latency time on the hot plate and decrease the number of flinches during the initial phase of the formalin test in any of the doses tested. It was also demonstrated that anethole has no association with sedative effects. Therefore, these data showed that anethole, at all used doses, has no sedative effect and has an antinociceptive effect. This effect may be due to a decrease in the production/release of inflammatory mediators.
Source : Evidence Based Complementary and Alternative Medicine
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Anti-Nociceptive Activity of Fractionated Root Extract of Strophanthus Hispidus Dc (Apocynaceae)
Agbaje Esther Oluwatoyin, Fageyinbo Muyiwa Samuel
Abstract
Strophanthus hispidus DC belongs to the family of plants known as Apocynaceae, they are popularly known as poison arrow vine, brown strophanthus and hairy strophanthus in western part of Africa including Nigeria. This study investigated the anti-nociceptive property of ethyl acetate, n-butanol and aqueous fractions of the root extract of Strophanthus hispidus DC (Apocynaceae) in rodents of both sexes. The fractions, at a dose of 200 mg/kg each were given via oral route to the animals used in the various models-acetic acid-induced mouse writhing test, formalin- induced pain, Haffner's tail clip test, hot plate-induced pain and tail immersion test. In each of the models, the ethyl acetate fraction, n-butanol fraction and aqueous fraction of Strophanthus hispidus each possesses a significant (P<0.05, P< 0.01, P< 0.001) anti-nociceptive effect. The anti-nociceptive activity of the fractions was mediated through central and peripheral mechanism. The effect of the extract was comparable to that produced by peripheral analgesics the NSAIDs (aspirin) and centrally acting analgesic opioids (morphine) used as positive control in the various models employed. Phytochemical analysis of the fractions indicated the presence of flavonoids, cardiac glycosides, tannins, alkaloids and anthraquinones which also contributed to the anti-nociceptive activity of the extract. These findings showed the plant as a novel therapy for pain.
Source : Journal of Natural Remedies
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Evaluation of antinociceptive effect of methanolic extract of leaves of Crataeva nurvala Buch.-Ham.
Md Moniruzzaman1 and Mohammad Zafar Imam2*
1 College of Pharmacy, Dongguk University, Goyang 410-820, Republic of Korea
2 Department of Pharmacy, Stamford University Bangladesh, 51 Siddeswari Road, Dhaka 1217, Bangladesh
Abstract
Background Crataeva nurvala Buch.-Ham. (Family: Capparidaceae) is widely used as anti-inflammatory, contraceptive, laxative, lithotropic, febrifuge and as tonic in traditional medicine. This study evaluated the antinociceptive effect of the methanolic extract of the leaves of Crataeva nurvala (MECN).
Methods The antinociceptive activity was investigated using heat-induced (hot-plate and tail-immersion test) and chemical-induced (acetic acid, formalin and glutamic acid) nociception models in mice at different doses (50, 100, and 200 mg/kg, p.o.) of MECN. Morphine sulphate (5 mg/kg, i.p.) and diclofenac sodium (10 mg/kg, i. p.) were used as reference analgesic drugs.
Results MECN produced significant dose-dependent antinociception when assessed using hot plate test, tail immersion test and acetic acid-induced abdominal writhing test (65.55%). Likewise, MECN at similar doses produced significant dose-dependent inhibition in both neurogenic (50.82%) and inflammatory pain (73.53%) induced by intraplantar injection of formalin (2.5% formalin, 20 μl/paw). Besides, MECN also significantly inhibited the glutamate-induced (10 μM/paw) pain in mice (74.68%). It was demonstrated that pretreatment with naloxone (2 mg/kg, i.p.) significantly reversed antinociception produced by MECN in hot plate and tail immersion test suggesting the involvement of opioid receptor. In addition, administration of glibenclamide (10 mg/kg, i.p.), an ATP-sensitive K+ channel antagonist could not reverse antinociceptive activity induced by MECN.
Conclusion The results suggest that MECN possesses antinociceptive activity involving inhibition of opioid system as well as the glutamatergic system supporting its traditional uses.
Source : BMC Complementary and Alternative Medicine
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Additive Antinociceptive Effects of a Combination of Vitamin C and Vitamin E after Peripheral Nerve Injury
- Ruirui Lu,
- Wiebke Kallenborn-Gerhardt,
- Gerd Geisslinger,
- Achim Schmidtko
Abstract
Accumulating evidence indicates that increased generation of reactive oxygen species (ROS) contributes to the development of exaggerated pain hypersensitivity during persistent pain. In the present study, we investigated the antinociceptive efficacy of the antioxidants vitamin C and vitamin E in mouse models of inflammatory and neuropathic pain. We show that systemic administration of a combination of vitamins C and E inhibited the early behavioral responses to formalin injection and the neuropathic pain behavior after peripheral nerve injury, but not the inflammatory pain behavior induced by Complete Freund's Adjuvant. In contrast, vitamin C or vitamin E given alone failed to affect the nociceptive behavior in all tested models. The attenuated neuropathic pain behavior induced by the vitamin C and E combination was paralleled by a reduced p38 phosphorylation in the spinal cord and in dorsal root ganglia, and was also observed after intrathecal injection of the vitamins. Moreover, the vitamin C and E combination ameliorated the allodynia induced by an intrathecally delivered ROS donor. Our results suggest that administration of vitamins C and E in combination may exert synergistic antinociceptive effects, and further indicate that ROS essentially contribute to nociceptive processing in special pain states.
Source : PLOSone
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Auricular Point Acupressure to Manage Chronic Low Back Pain in Older Adults: A Randomized Controlled Pilot Study
Chao Hsing Yeh,1 Natalia E. Morone,2 Lung-Chang Chien,3 Yuling Cao,4 Huijuan Lu,4 Juan Shen,5 Leah Margolis,1 Shreya Bhatnagar,1 Samuel Hoffman,1 Zhan Liang,1 Ronald M. Glick,6 and Lorna Kwai-Ping Suen7
1School of Nursing, University of Pittsburgh, 3500 Victoria Street, 440 Victoria Building, Pittsburgh, PA 15261, USA
2Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, School of Medicine, Veterans Administration, Pittsburgh Healthcare System, Geriatric Research, Education and Clinical Center, 230 McKee Place Suite 600, Pittsburgh, PA 15213, USA
3Division of Biostatistics, University of Texas, School of Public Health at San Antonio Regional Campus and Research to Advance Community Health Center, University of Texas Health Science Center at San Antonio Regional Campus, 7411 John Smith Drive, Suite 1050 Room 505, San Antonio, TX 78229, USA
4School of Nursing, Fudan University, 305 Fenglin Road, Shanghai, China
5School of Nursing, Suzhou Health College, No. 28 Kehua Road Northern District of Suzhou International Education Park, Suzhou, China
6Departments of Psychiatry, Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213, USA
7School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
Abstract
This prospective, randomized clinical trial (RCT) pilot study was designed to (1) assess the feasibility and tolerability of an easily administered, auricular point acupressure (APA) intervention and (2) provide an initial assessment of effect size as compared to a sham treatment. Thirty-seven subjects were randomized to receive either the real or sham APA treatment. All participants were treated once a week for 4 weeks. Self-report measures were obtained at baseline, weekly during treatment, at end-of-intervention (EOI), and at a 1-month follow-up. A dropout rate of 26% in the real APA group and 50% in the sham group was observed. The reduction in worst pain from baseline to EOI was 41% for the real and 5% for the sham group with a Cohen’s effect size of 1.22 (P<0.01). Disability scores on the Roland Morris Disability Questionnaire (RMDQ) decreased in the real group by 29% and were unchanged in the sham group (+3%) (P<0.01). Given the high dropout rate, results must be interpreted with caution; nevertheless, our results suggest that APA may provide an inexpensive and effective complementary approach for the management of back pain in older adults, and further study is warranted.
Source : Journal Evidence Based Complementary and Alternative Medicine
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Antinociceptive and Anti-Inflammatory Activities of the Sesame Oil and Sesamin
Érika Maria Henriques Monteiro 1, Lucas Apolinário Chibli 1, Célia Hitomi Yamamoto 2, Mônica Cecília Santana Pereira 2, Fernanda Maria Pinto Vilela 2, Mírian Pereira Rodarte 2, Míriam Aparecida de Oliveira Pinto 2, Maria da Penha Henriques do Amaral 2, Marcelo Silva Silvério 2, Ana Lúcia Santos de Matos Araújo 2, Aílson da Luz André de Araújo 2, Glauciemar Del-Vechio-Vieira 2 and Orlando Vieira de Sousa 2,*
1 Pharmaceutical Sciences Post-Graduation Program, Faculty of Pharmacy, Federal University of Juiz de Fora, Campus Universitário, Juiz de Fora, Minas Gerais 36036-900, Brazil;
2 Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Juiz de Fora, Campus Universitário, Juiz de Fora, Minas Gerais 36036-900, Brazil;
Abstract
Sesame oil is widely consumed as nutritious food, cooking oil, and in pharmaceuticals and food. In this study, the antinociceptive and anti-inflammatory properties of the sesame oil and sesamin were investigated. The sesame oil and sesamin reduced the number of abdominal contortions at the doses 100, 200, or 400 mg/kg. The first and second phases of the time paw licking were inhibited by sesame oil and sesamin (100, 200, or 400 mg/kg). After 90 min of treatment, sesame oil and sesamin increased the reaction time on a hot plate (200 or 400 mg/kg). Considering the tail-immersion assay, the sesame oil and sesamin produced significant effect after 60 min at the doses of 100, 200, or 400 mg/kg. After 4 h of application of the carrageenan, the sesame oil and sesamin were effective against the paw edema. The exudate volume and leucocyte migration were also reduced by sesame oil and sesamin. These results suggest that sesamin is one of the active compounds found in sesame oil and justify the antinociceptive and anti-inflammatory properties of this product.
Source : Journal Nutrients
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With Lavender Aromatherapy, Children Required Fewer Analgesics following Tonsillectomy
Soltani R, Soheilipour S, Hajhashemi V, Asghari G, Bagheri M, Molavi M.
Evaluation of the effect of aromatherapy with lavender essential oil on post-tonsillectomy pain in pediatric patients: A randomized controlled trial. Int J Pediatr Otorhinolaryngol. 2013;77(9):1579-1581.
Tonsillectomy is among the most common childhood surgeries. One of its main complications is pain, which can cause poor oral intake and dehydration post-surgery, leading to morbidity and delayed recovery. No ideal treatment is available. Because children may also experience postoperative nausea and vomiting, pain relievers delivered through non-oral routes are needed. Many aromatic and medicinal plants contain chemical compounds that make them appropriate for aromatherapy, which is noninvasive and can be applied continuously to patients. Lavender (Lavandula angustifolia) is used in traditional medicine for its analgesic and anti-inflammatory activities. These authors, from Iran, explain that in Iranian folk and traditional medicine, lavender is used as a carminative, diuretic, antiepileptic, antirheumatic, and pain reliever. They conducted a randomized, controlled, prospective research study to evaluate the effectiveness of aromatherapy with lavender essential oil on post-tonsillectomy pain in children.
The study, conducted at Isfahan (Iran) University of Medical Sciences, included 48 patients aged 6 to 12 years who underwent tonsillectomy. Following surgery, all patients received acetaminophen (10-15 mg/kg per dose) every 7 hours for pain. The patients in the treatment group (n=24) also inhaled lavender essential oil every 6 hours by applying 4 droplets of the oil on their palm, rubbing their hands together, and inhaling it for 3 minutes. Neither the manufacturer of the lavender essential oil nor the oil's chemical profile was included in the article.
The frequencies of daily use of acetaminophen and nocturnal awakening due to pain, as well as pain intensity, were recorded for each patient for the first 3 days after surgery. Pain intensity was assessed by using a visual analog scale (VAS).
The authors report that the use of lavender essential oil significantly reduced the frequency of acetaminophen use during each of the 3 postoperative days (P<0.001). It did not, however, significantly impact pain intensity or frequency of nocturnal awakening.
The authors explain that the lack of effect on pain severity in this study and in previous studies may be due to the use of analgesic agents in both groups, making the assessment of pain intensity more difficult, and to the subjective nature of the VAS in measuring pain intensity.
The lack of a placebo in the control group and the small sample size are limitations of this study. Details regarding the essential oil should have been included in this article.
The authors conclude, "This study suggests that aromatherapy with lavender essential oil decreases analgesic requirement following tonsillectomy in pediatric patients. This could be a cost-effective, available and safe treatment option."
―Shari Henson
Source : American Botanical Council
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Antinociceptive Potential of Terminalia Catappa (Indian Almond) Leaves in Swiss Albino Rat
Saurabh Arjariya*, Nitin Nema, Swati Tiwari, Ritu Dubey
Sagar Institute of Pharmaceutical Sciences, Sagar (M.P.), India.
Abstract
Terminalia catappa (almond) is a combretaceous plant whose leaves are widely used as a folk medicine for treatments of dermatitis, hepatitis, inflammatory disease, diabetes and other disease. The Antinociceptive activity of the aqueous extract of Terminalia catappa leaves was studied using the tail flick method, glacial acetic acid induced writhing and the hot plate test in albino rats. The aqueous extract (500mg/kg) produced a significant (p<0.01) dose-dependent inhibition of abdominal writhing in rat. The extract of Terminalia catappa (500 mg/kg) showed significant (p<0.05) dose depend increase in tail flick lantency in rat and the result of the hot plate test showed a dose – related and time dependant significant (p<0.01) increase in pain threshold in rat 15 min after treatment at all the doses used in the study. The result indicates that the aqueous extract of Terminalla catappa leaves posseses analgesic activity which may mediated through both central and peripheral mechanism.
Source : American Journal of Phytomedicine and Clinical Therapeutics
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Neuropharmacological studies of Piper auritum Kunth (Piperaceae): antinociceptive and anxiolytic-like effects
R. Estrada-Reyes*, A. Martínez-Laurrabaquio, D. Ubaldo Suárez and A.G. Araujo-Escalona
Laboratorio de Fitofarmacología, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Delegación Tlalpan, Mexico City, 14370, Mexico.
Abstract
P. auritum Kunth leaves commonly known as “hierba santa” or “acuyo” or false Kava is used in Mexican Traditional Medicine as a tranquilizing and appetite stimulant agent, as well as a remedy for the relief of headache. The objective of the present work was to evaluate the effects of organic and aqueous extracts of Piper auritum Kunth (Piperaceae) leaves on the Central Nervous System (CNS) in mice. For acute toxicity evaluation, the LD50 of all extracts were determined according to Locke's method. Effects of both the organic and aqueous extracts of P. auritum leaves were tested in sodium pentobarbital-induced sleep, hot plate and open field tests. The anxiolytic-like effects were determined in burying behavior and hole-board models. In this study we demonstrated for the first time that both organic andaqueous extracts of the leaves of P. auritum possess antinociceptive effect while at higher doses the organic extracts exert a depressant effect on the CNS in mice. The aqueous extract showed antinociceptive and anxiolytic-like effects in the model tested, without affecting the locomotor activity of experimental animals. Acute toxicity tests show that the intake of extracts of different polarities of P. auritum involves no health risks. The present study supports, in part, the uses of P. auritum leaves as a tranquilizer, sedative agent, and as a remedy for the relief of pain in Mexican traditional medicine.
Source : Journal of Medicinal Plant Research
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Antinociceptive activity of methanol extract of Hyoscyamus reticulatus L. in mice
Oto G*,, Ozdemir H, Yaren B, Yetkin Y, Tas A, Tanrıtanır P, Öztürk F
Department of Pharmacology, Medical Faculty, Yuzuncu Yil University, Van, Turkey
Department of Physiology, Medical Faculty, Yuzuncu Yil University, Van, Turkey Department of Veterinary Surgery, Veterinary Faculty, Yuzuncu Yil University, Van, Turkey Van Health High School, Yuzuncu Yil University, Van, Turkey Department of Biology, Faculty of Sciences, Yuzuncu Yil University, Van, Turkey
Abstract
In the present study acute toxicity and possible antinociceptive effect of the metanolic extract of Hyoscyamus reticulatus L. was investigated in Swiss - albino mice of either sex. To assess Hyoscyamus reticulatus L. extract’s acute toxicity it was given intraperitonelly to the mice (6 in each group) in dose 50, 100, 200, 400, 800, 1200 and 1600 mg/kg body weight. After probit analyze of mortality at 24, 48 and 72h after administration, 25, 50 and 100 mg/kg were determinate as safe doses for antinociceptive evaluation. Two models were used to study the effects of the extracts on nociception, acetic acid-induced writhing test and hot plate test in mice. Hyoscyamus reticulatus L. extract was administered intraperitoneally 30 minutes prior to pain induction. The metanolic extract in 50 mg/kg dose showed significant (p<0.05) analgesic activity comparable with diclophenac sodium, evidenced by increase in the reaction time by hot plate method and significant (p<0.05) reduction in acetic acid - induced writhings in mice in 100mg/kg dose with a maximum effect of 35.56 % reduction. These effects were compared with the control and standard drug, diclophenac sodium (50 mg/kg, p.o). The results indicate that metanolic extract of Hyoscyamus reticulatus L. possesses a significant antinociceptive activity in both central and peripheral pain models in mice and therefore, it can be used as supplemental therapy in acute or chronic pain conditions.
Source : American Journal of Phytomedicine and Therapeutics
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Music for pain relief
- M Soledad Cepeda1,*,
- Daniel B Carr2,
- Joseph Lau3,
- Hernando Alvarez4
Abstract
Background The efficacy of music for the treatment of pain has not been established.
Objectives To evaluate the effect of music on acute, chronic or cancer pain intensity, pain relief, and analgesic requirements.
Search methods We searched The Cochrane Library, MEDLINE, EMBASE, PsycINFO, LILACS and the references in retrieved manuscripts. There was no language restriction.
Selection criteria We included randomized controlled trials (RCTs) that evaluated the effect of music on any type of pain in children or adults. We excluded trials that reported results of concurrent non-pharmacological therapies.
Data collection and analysis Data was extracted by two independent review authors. We calculated the mean difference in pain intensity levels, percentage of patients with at least 50% pain relief, and opioid requirements. We converted opioid consumption to morphine equivalents. To explore heterogeneity, studies that evaluated adults, children, acute, chronic, malignant, labor, procedural, or experimental pain were evaluated separately, as well as those studies in which patients chose the type of music.
Main results Fifty-one studies involving 1867 subjects exposed to music and 1796 controls met inclusion criteria.
In the 31 studies evaluating mean pain intensity there was a considerable variation in the effect of music, indicating statistical heterogeneity ( I2 = 85.3%). After grouping the studies according to the pain model, this heterogeneity remained, with the exception of the studies that evaluated acute postoperative pain. In this last group, patients exposed to music had pain intensity that was 0.5 units lower on a zero to ten scale than unexposed subjects (95% CI: -0.9 to -0.2). Studies that permitted patients to select the music did not reveal a benefit from music; the decline in pain intensity was 0.2 units, 95% CI (-0.7 to 0.2).
Four studies reported the proportion of subjects with at least 50% pain relief; subjects exposed to music had a 70% higher likelihood of having pain relief than unexposed subjects (95% CI: 1.21 to 2.37). NNT = 5 (95% CI: 4 to 13).
Three studies evaluated opioid requirements two hours after surgery: subjects exposed to music required 1.0 mg (18.4%) less morphine (95% CI: -2.0 to -0.2) than unexposed subjects. Five studies assessed requirements 24 hours after surgery: the music group required 5.7 mg (15.4%) less morphine than the unexposed group (95% CI: -8.8 to -2.6). Five studies evaluated requirements during painful procedures: the difference in requirements showed a trend towards favoring the music group (-0.7 mg, 95% CI: -1.8 to 0.4).
Authors' conclusions Listening to music reduces pain intensity levels and opioid requirements, but the magnitude of these benefits is small and, therefore, its clinical importance unclear.
Plain language summary
Music for pain relief Music should not be considered a first line treatment for pain relief as the magnitude of its benefits is small. Listening to music for treatment of pain offers potential advantages of low cost, ease of provision, and safety. This systematic review included 51 studies involving 3663 subjects. The review authors found that music reduced pain, increased the number of patients who reported at least 50% pain relief, and reduced requirements for morphine-like analgesics. However, as the magnitude of these positive effects is small, the clinical relevance of music for pain relief in clinical practice is unclear
Source : The Cochrane Library
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Acupuncture in the Management of Acute Dental Pain
Cássia Maria Grillo, Ronaldo Seichi Wada, Maria da Luz Rosário de Sousa
Abstract
Introduction
Acute dental pain is the main reason for seeking dental services to provide urgent dental care; there is consensus about the use of alternative therapies, such as acupuncture, to control dental pain in pre-dental care.
Objective
Evaluate the use of acupuncture in reducing the intensity of acute dental pain in pre-dental care, in patients waiting for treatment in emergency dental care.
Materials and methods
This study was conducted at the after-hours emergency dental care center of the Piracicaba Dental School and at the Emergency Center Dental Specialties I in Piracicaba, São Paulo (Brazil). The sample consisted of 120 patients. A Visual Analog Scale (VAS) was used to measure pain intensity. All patients underwent one session of acupuncture; the points LI4, ST44, and CV23 were selected, used alone, or combined.
Results
A reduction in pain was observed (in 120 patients: mean initial VAS = 6.558 ± 1.876, mean final VAS = 0.962 ± 2.164, p < 0.00001).
Conclusion
The results of this study indicate that the effects of acupuncture analgesia could be a technical adjunct to pain control in patients with acute dental pain, contributing to the restoration of health with social benefits.
Source : Journal of Acupuncture and Meridian Studies
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Smoking Associated With Worse Back Pain
Patients with spinal disorders who quit smoking may experience substantial improvements in back pain, according to the findings of an analysis of a prospectively maintained database.
Caleb Behrend, MD, from the University of Rochester Medical Center in New York, and colleagues present their findings in an article published in the December issue of the Journal of Bone & Joint Surgery.
The authors mention that smoking has been identified as a modifiable risk factor for chronic pain disorders. "Furthermore, with regard to chronic pain disorders, smokers have reported an increased magnitude of pain when compared with nonsmokers," the authors write. "Glassman et al. found that smoking cessation in patients undergoing spinal arthrodesis was associated with increased patient satisfaction, fusion rates, and return to work."
In the study, the authors reviewed questionnaires for 5333 patients completed at the time of entry into care and at the time of the latest follow-up. Patient-reported pain scores were assessed using a visual analog scale (VAS).
Compared with never-smokers, current smokers reported significantly greater pain scores at the latest follow-up (mean VAS score, 4.49 [95% confidence interval (CI), 4.15 - 4.84] vs 3.59 [95% CI, 3.49 - 3.70]; P < .001).
Patients who quit smoking reported significantly greater improvements compared with current smokers in worst (mean VAS score, −1.56 [95% CI, −1.94 to −1.17] vs −0.70 [95% CI, −0.90 to −0.51]; P = .013), current (mean VAS score, −1.07 [95% CI, −1.44 to −0.70] vs −0.46 [95% CI, −0.66 to −0.28; P < .05), and average (mean VAS score, −1.23 [95% CI, −1.56 to −0.86] vs −0.46 [95% CI, −0.66 to −0.27]; P = .024) weekly pain.
In addition, nearly 2-fold more patients who quit smoking reported a more than 30% decrease in worst pain than current smokers (32.0% vs 16.6%), and never-smokers reported a greater mean improvement in disability as determined by the Oswestry Disability index than current smokers (−7.3 points [95% CI, −8.1 to −6.5 points] vs −4.6 [95% CI, −5.6 to −3.6]).
According to the authors, limitations of the study include their inability to capture the effects of all possible factors that may influence pain and determine when patients stopped smoking or experienced improvements in pain.
They conclude that smoking cessation programs are needed to improve chronic pain among patients with spinal conditions. "The present study supports the need for smoking cessation programs for patients with axial or radicular pain of spinal etiology, given a strong association between improved patient-reported pain and smoking cessation," the authors write.
Asked for independent comment, David O. Werner, MD, from the Mayo Clinic, Rochester, Minnesota, agreed with the authors' conclusion. "This suggests that tobacco use interventions should be an integral part of pain treatment," Dr. Werner told Medscape Medical News. "Given the tremendous health benefits of quitting, clinicians should take every opportunity to help every smoker quit, but if pain is improved, this makes the issue even more urgent for the pain physician."
One coauthor received a grant from the Southwestern Foundation. One coauthor received grants or has grants pending with FOT and Goldstein. The other authors and the commentator have disclosed no relevant financial relationships.
J Bone Joint Surg Am. 2012;94:2161-2166. Abstract
Source MedScape
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Yoga Shown Effective for Treating Chronic Neck Pain
According to published estimates, some 20 percent of the population suffers from chronic neck pain caused by a variety of structural dysfunctions in the neck, resulting in impaired quality of life and lost work time. A German study published in The Journal of Pain showed that yoga appears to be an effective treatment for neck pain and provides added benefits of improved psychological well being and quality of life.
The mainstay of conservative treatment for neck pain is non-steroidal anti-inflammatory medication, and the evidence of its effectiveness is contradictory while side effects, such as nausea and dizziness, are well known. The authors noted that one type of yoga, called lyengar yoga, has been shown effective in other pain syndromes, including low back pain. This activity uses supportive props and the sequences of postures can be tailored to address an individual's medical problem. No randomized controlled clinical trials have been published to assess the efficacy of lyengar yoga for adults with chronic neck pain.
Researchers at Charité-University Medical Center in Berlin and other sites in Germany and Austria studied 77 volunteer patients. Thirty-eight were assigned to the yoga group and 39 to a group treated with exercise. Unfortunately, the dropout rate was higher than anticipated as 24 subjects withdrew or were lost to follow-up. This reduced the study sample to 25 patients in the yoga group and 28 in self-care exercise. They were asked to complete a standardized questionnaire at the outset of the study, after four weeks, and after ten weeks.
The findings showed there was a significant and clinically important reduction in pain intensity in the yoga group. The authors reasoned that yoga might enhance both the toning of muscles and releasing of muscle tension. Relaxation responses, therefore, could reduce stress related muscle tension and modify neurobiological pain perception. They concluded, based on the study data, that lyengar yoga can be a safe and effective treatment option for chronic neck pain. The study results are consistent with the demonstrated benefits of yoga for treating low back pain.
Source : Science Daily
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Acupuncture Does Help With Pain Sweeping new study finds it helps more than standard treatments
Millions of Americans who use acupuncture can take heart from a new study that provides evidence that the ancient Chinese healing therapy can help reduce chronic pain by as much as 50 percent — welcome news for sufferers of back pain, arthritis, headaches and other painful conditions.
A rigorous review of 29 randomized controlled trials, involving nearly 18,000 patients, shows that acupuncture was better at relieving pain than over-the-counter medicines and other common treatments, says Andrew Vickers, a researcher at Memorial Sloan-Kettering Cancer Center in New York, who led the multinational study.
"What this study provides is fairly strong evidence that acupuncture is an effective treatment for chronic pain," Vickers says, adding that about 3 million Americans use acupuncture each year.
In these trials, some people suffering from back and neck pain, osteoarthritis, chronic headache and shoulder pain received standard acupuncture treatment, in which tiny needles are inserted into traditionally specified points on the skin. Others received fake acupuncture treatments, in which the needles were inserted at random points on the skin, or they were "treated" with needles that retracted into handles instead of entering the skin. Additional participants received no needle-based treatment at all.
Overall, those treated with real acupuncture had their pain symptoms reduced by 50 percent. Those who received sham needling saw a 43 percent drop in pain, while the no-acupuncture group reported their pain was reduced by 30 percent. A placebo effect — the strong psychological belief in a treatment's effectiveness — likely accounts for the greater improvements seen with sham therapy than no therapy. The study, funded by the National Institutes of Health and published in the Archives of Internal Medicine, drew on the work of dozens of researchers across the United States and Europe. Vickers says he and his collaborators painstakingly checked the original patient data as part of their review.
"It's a potentially very important article," says Edgar L. Ross, M.D., director of the Pain Management Center at Brigham and Women's Hospital in Boston and an associate professor at Harvard Medical School. Ross, who works with an acupuncturist at his center, says he sees similar benefits, although the average 50 percent pain reduction reported in the study was greater than that experienced by his patients. In his practice, "it's closer to 25 or 30 percent reduction in pain scores."
Western-trained doctors are increasingly willing to recommend acupuncture to their patients, but there's still no clear scientific explanation for why it works, Ross says. One theory is that acupuncture triggers the release of endorphins, natural painkilling compounds in the brain. Another is that it affects neurotransmitters, the chemical messengers that help brain cells communicate pain.
"It's very safe in trained hands," Ross says, though he also believes in a pain management plan that uses a mixture of techniques. Acupuncture "is certainly a very viable therapy," but it should be considered as one part of a whole pain treatment plan, he adds.
Source : AARP
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New Study Review Examines Benefits of Music Therapy for Surgery Patients
A new study review published by the University of Kentucky found that music therapy can be beneficial to patients before, during and after a surgical procedure and may reduce pain and recovery time.Published in the Southern Medical Journal, the review examined the use of music in the preoperative, intraoperative and postoperative stages of the surgical process, and music was shown to have positive results in all three stages. Patients were less anxious before the procedure and recovered more quickly and satisfactorily after by being exposed to music intra- and post-operation. They also required less sedative medication and reported better satisfaction with their medical experience.
"Music therapists have long known that music can be an effective tool to manage pain and anxiety," said Lori Gooding, UK director of music therapy and lead author on the review. "Here at UK, our music therapists regularly use music-based interventions to help patients manage both pain and anxiety.”
Some research suggests that music-based interventions can be effective in reducing anxiety, pain perception and sedative intake. Music that is selected by trained personnel is preferred because specific guidelines for music selection should be followed in order to maximize its positive effect on patients, though the patient's musical tastes should still be considered. It is suggested that several "playlists" be offered and the patient can choose one that best suits their tastes.
Characteristics of the music are also important in effective music therapy. Among other features, the tempo, rhythm and volume of the music can be carefully controlled in order to maximize the positive effect that music can have. Calm, slow, gentle music was shown to produce the most positive results and facilitate relaxation and pain reduction in patients. Data proposes that music could be beneficial in reducing cost and length of stay in intensive care units.
Other findings show that medical music therapists serve as good consultants when implementing music medicine-based interventions. Specialized training can help them to better manage pain and anxiety in surgical patients and it has been proposed that live performances for patients are more effective than recorded music.
UK began providing music therapy for patients in Kentucky Children’s Hospital, UK Chandler Hospital and UK Good Samaritan Behavioral Health in October 2010. Based on the findings from this review, Gooding and her team have begun implementing two pilot programs in the pre-op unit at UK, one for procedural support/pain and the other for patient distress.
"Our goal is to decrease patient pain and anxiety as well as improve satisfaction with the surgical experience," Gooding said. "We also hope the program benefits staff by allowing them to do their jobs more easily and effectively.”
The UK Music Therapy program, which was established as part of the Lucille Caudill Little Performing Arts in HealthCare Program, is a unique partnership between the UK School of Music and UK HealthCare. Since the program's inception, Gooding has worked to establish its clinical, academic and research components. Educating the health care, university and local communities about the evidenced-based benefits of music therapy is a vital role in program development.
Source : Newswise
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