Alternatives to Opioids for Pain

17-22 SEGMENT 1: ALTERNATIVES TO OPIOIDS FOR PAIN

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Americans consume 80 percent of the opioid painkillers prescribed worldwide, ultimately resulting in the deaths of more than 20,000 Americans each year of overdoses of these drugs. The crisis is making doctors look at alternative medicine therapies for a substitute for these drugs. Experts discuss modalities that have shown success.

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Guests:

  • Dr. Josie Briggs, Director, National Center for Complementary and Integrative Health, National Institutes of Health
  • Dr. Roger Chou, Professor of Medicine, Oregon Health and Science University and Director, Pacific Northwest Evidence Based Practice Center
  • Dr. David Miller, acupuncturist and medical doctor, East West Integrated Medicine, Chicago, and spokesperson, National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM)

Links for more information:

 

Opioid Alternatives

Reed Pence: People usually start taking opioid painkillers innocently. They want pain relief, and they want it quickly. Their doctors comply and a relatively small proportion will eventually become addicted. Some of those will end up in mortal danger as a result. In 2015, more than 20,000 people in the U.S. died of an overdose of prescription painkillers. And finally Americans have been jarred awake to the crisis. Today, the United States consumes 80 percent of the world’s prescription opioid drug supply, more than 200 million prescriptions per year. But why this imbalance? Are Americans just in more pain than the rest of the world?

Briggs: The numbers you cite are indeed worrisome. What’s especially worrisome is the terrible death rate we are seeing right now from opioids.

Pence: That’s Dr. Josie Briggs, director of the National Center for Complementary and Integrative Health at the National Institutes of Health.

Briggs: Pain management for every country I think is not without its problems, and that we have a healthcare system that isn’t doing a great job is something I am very acutely aware of. I haven’t however, seen good international comparisons to tell us that this problem has been solved anywhere. We do see the problems related to over reliance on opioids as a real major healthcare crisis right now.

Chou: In the United States we do quite a few things differently than the rest of the world for medical care in general. As you know we spend more per capita on medical care than any country in the world to begin with. And then when you look at specific things like management of pain we differ not just with opioids but with a lot of other things. We do a lot more surgery than any other country; we do a lot more MRIs than any other country. So opioids, the statistics are striking, but it’s not the only area where we see that the United States differs.

Pence: That’s Dr. Roger Chou, professor in the department of medicine at Oregon Health and Science University and Director of the Pacific Northwest Evidence Based Practice Center. Chou says back in the 1980s, doctors didn’t use opioids to manage chronic pain; they were only indicated for temporary acute pain, such as that caused by surgery or bone fracture.

Chou: Starting in the 90s that really shifted. There was a lot of belief that we weren’t adequately treating chronic pain. We have a lot of people with chronic pain in this country. And there was a feeling why aren’t we using opioids, which are what we think of as the most powerful painkiller. And there were some though very limited data that opioids might be safe and effective for this use. There were actually regulations passed in many states to make striating chronic pain with opioids allowable so doctors wouldn’t be afraid of getting into trouble for doing this.

Pence: Another change in medical practice at about that time was that pain became known as the fifth vital sign.

Chou: You were required to measure pain in every patient every time they are seen in the clinic or the hospital. People were getting scored on this, so people were afraid, they felt they needed to treat it and again, opioids were there and they were told that they were safe and effective. There were several drugs that came onto the market around that time for example OxyContin or sustained release oxycodone, which was in many places it was the most costly drug to the formulary for a period of time.

Pence: Costly…and for the companies that made them, highly profitable.

Chou: Industry does have a role in this. When OxyContin was released that was accompanied by really an unprecedented marketing push and some misleading information. They said that you didn’t develop tolerance and you wouldn’t withdraw if you were given that medication; so that was part of it. I think that people don’t remember or recognize that two executives from Purdue Pharma pleaded guilty to telling misleading information to the FDA and they served some jail time and Purdue Pharma was fined $500 million.

Pence: For doctors though, Chou says it was simply a desire to treat their patients.

Chou: I think it was this well-meaning intention to help patients who were with chronic pain, not understanding all the data or the risks and benefits of the therapy. And then you get kind of the pharmaceutical company side. So a lot of things that all came together.

Pence: But if opioids aren’t the answer for treating pain, then what? Doctors can’t leave patients with nothing. Finally the medical world is looking at non–pharmacological therapies for chronic pain  — what a lot of people call alternative medicine, modalities such as s spinal manipulation or chiropractic care, massage therapy, acupuncture, traditional Chinese medicine, yoga, tai chi, cognitive behavioral therapy and even meditation and mindfulness training.

Briggs: One of the places we’re partnering with is the veterans administration. The VA has widespread recognition that pain management for veterans is a tough problem and VAs are frequently incorporating acupuncture, yoga, chiropractic care, massage therapy into the care that they offer patients. The center that I lead is in the research business. We support researchers who try to figure out what works and the evidence is still incomplete, but part of what is contributing to this change are the kinds of research studies that are shown that things like yoga seem to help people with chronic low back pain. So it’s an exciting time for change in the way the research that we’ve been supporting is affecting healthcare.

Miller: A lot of pain that comes from orthopedic injury and orthopedic surgery comes from muscle dysfunction. It happens because you’ve disrupted movement around a joint or the muscular sort of balance of the body. And muscular pain can be really quite profound. A lot of migraine pain, a lot of severe headache or orthopedic pain that you see in the clinical environment is really caused by muscular dysfunction.

Pence: That’s Dr. David Miller, licensed acupuncturist and medical doctor with East West Integrated Medicine In Chicago. He’s also a spokesperson for the National Certification Commission for Acupuncture and Oriental Medicine or NCCAOM.

Miller: And acupuncture is an ideal tool for relieving muscular dysfunction and helping cue the body to go back to understanding how do I use myself correctly, biomechanically after having had this insult to the body, which may have been a necessary insult, but nevertheless requires this healing and reorganization. So acupuncture does a couple of things to sum it up. One it cause you to release your own natural pain killing chemicals, two it can modulate the way you perceive pain, and three it can help relax muscles and help the body restore normalcy of function in its biomechanics of movement.

Pence: The American College of Physicians recently released new clinical practice guidelines on managing low back pain incorporating some of these alternative modalities into patient care. But releasing new guidelines doesn’t automatically mean that doctors will follow them or that patients will accept them.

Chou:When I talk to physicians I tell them it’s important to talk to your patients, understand what therapies they’re interested in. It’s probably not going to be that helpful to send somebody to acupuncture who doesn’t think acupuncture makes any sense. We’re mostly trained in a traditional medical paradigm and it tends to be a much more drug-based treatment approach is what most people are familiar with and comfortable with and frankly it’s a lot easier. It’s typically a lot easier for someone to just write a prescription for a pain pill than to talk with the patient about what kinds of therapies might be useful for them.

Pence: And even if doctors might be willing to recommend alternative therapies to their patients, many of them don’t know who to refer their patients to.

Chou: For example, if I want to get somebody into a spinal manipulation there’s insurance coverage areas that I have to deal with. I often am not familiar with the chiropractors in the community, so it’s hard for me to know who to refer somebody to. There’s more paperwork; I often have to write a letter or do some other justification for it. Whereas if I want to send somebody to the surgeon it’s a simple click something on the computer essentially.

Pence: Another barrier to alternative therapy treatment is cost. As Chou mentions, and Miller confirms, many insurance companies don’t cover them.

Miller: We also need to be really pushing out insurance companies to cover these services so that they become viable for everybody and not just those who can afford to pay out off pocket.

Briggs: Pain management is a real driver of healthcare costs. Medicare does cover some of these approaches and insurers will make policy decisions driven in part by the evolving importance of the evidence and the status of the evidence.

Chou: These therapies are a lot harder to study than drug therapies. If you think about a drug therapy it’s easy to give somebody a pill, that’s the true drug and a fake pill or placebo that looks like the true drug, but is just a sugar pill. They don’t know which one is which and you can do a good double blind standard trial like that. It’s really much harder to do that with things like exercise and acupuncture and yoga. Trying to give someone pretend yoga or pretend acupuncture, manipulation is quite difficult.

Pence: However, data is improving. Research subjects say they experience about the same level of pain relief and normal function using alternative therapies as they do when using opioids.

Chou: For example with yoga or something like spinal manipulation you get on average about one point pain relief on a one to ten pain scale, which doesn’t sound like a lot, but then when you look at opioids the average pain relief is maybe a point and a half to two points. So it’s really not that different and of course they are much safer.

Pence: Chou stresses that both doctors and patients need to adjust expectations when it comes to relieving chronic pain.

Chou: When people talk about chronic pain a lot of times they assume that patients want to have their pain gone, which is true to some extent, but if you really talk to people what they say is I want to have my life back. That means getting people functional, getting them back to work, getting them to the point where they can enjoy life and engage with their friends and family. They may involve having some degree of pain, but being able to manage and deal with it. That’s where we want to get them. It’s actually very hard for us to eliminate pain. For many people that’s not a realistic goal.

Pence: Experts are not saying we need to get rid of opioid pain killers altogether. Even alternative therapy practitioners like Miller say opioids have their place.

Miller: There is an appropriate use of opioids in some situations and in situations where patients have extreme pain for some reason, that’s an appropriate place to use opioids on a very controlled temporary basis, in a very monitored basis.

Chou: It’s just that we need to be much more cautious and selective about how we use them. We were pretty cavalier about how we used those medications and we know all the statistics now, the thousands of overdose deaths that occur every year related to prescription opioids and the fact that most patients aren’t all that much better-off on the pain medications than they would be without them. There are some people that we can use relatively low doses as long as we are monitoring them appropriately, but it should not be the mainstay of therapy. Giving somebody a pain pill doesn’t address any of these psychosocial and other contributors to chronic pain that we know are so important now.

Pence: In other words, they don’t address the problem behind the pain, they just cover it up. But it’ll take a long time to incorporate alternative therapies into mainstream medical practice. Both doctors and patients will need time to get used to the idea, and education about how these alternative therapies work. Physicians and insurance companies will also require evidence of their effectiveness. But for many current clients of these therapies, the pain relief they experience is all the proof they need. You can learn more about all of our guests and alternative therapies for pain management by visiting our web site at radio health journal dot net. Our writer/producer this week is Polly Hansen.  I’m Reed Pence.

 

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Is pain medication the only answer?

Alternative medicine

New research is giving pain sufferers a dose of good news. With concerns mounting about the prevalence of opioid use and abuse in the U.S., a new study validates the effectiveness of acupuncture and other non-drug health therapies for pain.

The National Institute of Health’s National Center for Complementary and Integrative Health compiled evidence on how complementary health therapies – including acupuncture, yoga, tai chi, massage therapy and relaxation techniques – are effective in treating chronic pain.

The top five pain conditions commonly treated in primary care settings – back pain, osteoarthritis, neck pain, severe headaches and migraine, and fibromyalgia – were evaluated. The study showed that acupuncture in combination with yoga is the most effective therapy for back pain and acupuncture with tai chi is the most effective treatment for osteoarthritis pain in the knee.

“As addictions to, and deaths from prescription opioids such as oxycodone, hydrocodone and methadone continue to rise, raising awareness on complementary and alternative pain therapies like acupuncture is more important than ever,” said Kory Ward-Cook, Ph.D., Chief Executive Officer of the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). “The research from National Center for Complementary and Integrative Health brings greater attention to the use of acupuncture to treat and relieve chronic pain.”

Experts in the field are pointing to the study, which was published in the “Mayo Clinic Proceedings” journal, as a pivotal opportunity in shifting how patients explore treatment for their pain management. The findings support the benefits of non-drug approaches to help those with chronic pain more safely manage their conditions without the harmful side effects of opioids.

The study explored seven widely-used non-drug treatments:

Acupuncture: Using practices derived from traditional Chinese medicine, practitioners stimulate specific points on the body, most often by inserting thin needles through the skin. Nationally Board-Certified practitioners, whose credentials can be verified through the NCCAOM, are affirmed to have the education and training necessary to competently deliver acupuncture therapy. To learn more or find a NCCAOM board-certified practitioner in your area, visit nccaom.org.

Spinal manipulation or osteopathic manipulation: This approach involves applying controlled force from hands or a device to move a joint past its normal range of operation with the goal of improving health.

Massage therapy: Using hands (or sometimes forearms or elbows), therapists manipulate muscles and soft tissue to relieve tension and pain.

Tai chi: These mind and body practices involve a series of postures and movements integrated with mental focus, breathing and relaxation techniques.

Yoga: A generally low-impact approach to physical well-being, yoga spans physical postures, breathing exercises and meditation. Practicing certain sets of yoga poses may help reduce pain.

Relaxation techniques: There are several types of relaxation techniques, including meditation, that strive to bring the body to its natural state with slower breathing, lower blood pressure and a feeling of increased well-being.

Natural product supplements: Certain dietary supplements such as chondroitin, glucosamine, methylsulfonylmethane (MSM), S-adenosyl-L-methionine (SAMe) and omega-3 fatty acids are commonly used to help treat inflammation often associated with pain.

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People with severe chronic constipation may get relief from a more modern type of acupuncture, new research suggests.

Can acupuncture ease severe constipation?

September 12, 2016 by Karen Pallarito, Healthday Reporter
Can acupuncture ease severe constipation?

(HealthDay)—People with severe chronic constipation may get relief from a more modern type of acupuncture, new research suggests.

After eight weeks of treatment with electroacupuncture —acupuncture involving electrical stimulation—study participants experienced significant symptom and quality-of-life improvements, the study found.

Electroacupuncture uses thin needles inserted beneath the skin that are attached to a device that sends electric pulses into the body.

The study findings suggest a safe and effective option for difficult-to-treat patients, several gastroenterologists said.

“It is heartening to see such rigorously tested alternative therapies, since so many of them are administered without any evidence to support them,” said Dr. Christopher Andrews. He’s a clinical associate professor in the gastroenterology division at University of Calgary Cumming School of Medicine in Canada.

Dr. Henry Parkman, a professor of medicine at Temple University School of Medicine in Philadelphia, said: “This seems to be a good treatment for the refractory patients—those not responding to conventional medical treatments.”

The study involved people with chronic, severe “functional” constipation. These people have difficult, infrequent bowel movements—no more than two per week—not due to other medical conditions or medicines they may be taking, such as opioid painkillers.

For the study, the researchers randomly assigned 1,075 patients to one of two groups. Half received electroacupuncture with needles that pierced the muscle layer of the abdominal wall. The other half received “sham” treatments, with shallow needles at points not considered therapeutic in acupuncture (the “control” group).

Acupuncturists at 15 Chinese hospitals administered the real and sham treatments, consisting of 28 half-hour sessions.

Over the eight-week treatment period, 31 percent of patients in the electroacupuncture group had three or more bowel movements in a week, on average. Only 12 percent of patients in the control group achieved that level of relief.

Bowel movements of three per day to three per week are considered within the range of “normal,” according to the American College of Gastroenterology.

The effects persisted well after treatment. Almost 38 percent of electroacupuncture patients reported three or more bowel movements a week, on average, during the study’s 12-week follow-up period, compared to 14 percent of sham therapy patients.

“We were indeed surprised when we first saw these results,” said Dr. Jia (Marie) Liu of the China Academy of Chinese Medical Sciences in Beijing. She is one of the study authors and the research team’s coordinator.

Liu cited two possible explanations for the post-treatment effects. For one, electroacupuncture has a “good sustained effect, which is one of its advantages,” she said.

What’s more, the research team evaluated weekly average during the treatment and follow-up periods, not just end points, as in many prior studies.

“[Electroacupuncture] needs time to take effect and got its peak at week eight,” she said.

Dr. Daniel Hsu, who practices acupuncture in New York City, said acupuncture—whether through traditional needling or with electrical stimulation—works in two ways.

“It makes the body release its own naturally occurring painkillers” and “it helps the body calm the nervous system,” he said.

Stress can certainly affect digestion and cause constipation, Hsu explained. Acupuncture “flips the switch” on the body’s fight-or-flight response, restoring normal body functions such as defecation, he said.

One potential drawback is the frequency of treatment. Patients in the study received electroacupuncture three to five times per week over eight weeks, which might be a burden for some people, the study authors acknowledged.

On the other hand, because the treatment effects lasted for many weeks, it may be that patients don’t need continuous , Andrews said.

Additional studies are needed to evaluate longer-term outcomes, the study authors noted.

In the United States, acupuncturists are licensed in almost every state but are most prevalent in big cities, particularly on the East and West coasts, Hsu said. He added that most acupuncture colleges teach electroacupuncture.

Neither Medicare nor Medicaid covers acupuncture but some private insurers cover a fixed number of sessions under their policies, Hsu said.

“A lot of practitioners do take insurance if it’s covered,” he said. If not, must pay out of pocket.

Treatment costs may vary widely from one practitioner to the next. Fees generally range from $60 to $120 per session.

The study was published online Sept. 12 in the Annals of Internal Medicine.

More information: The U.S. National Institutes of Health has more about acupuncture.

NIH Review Finds Nondrug Approaches Effective For Treatment of Common Pain Conditions

NIH Review Finds Nondrug Approaches Effective For Treatment of Common Pain Conditions

U.S. study reviews trial results on complementary health approaches for pain relief; aims to assist with pain management

Thursday, September 1, 2016

A review of 105 randomized controlled trials, which included more than 16,000 participants, shows that a variety of complementary health approaches may help manage pain. • Acupuncture• Massage therapy• Relaxation techniques• Tai chi• YogaCitation: Nahin RL, Boineau R, Khalsa PS, StussmanBJ, Weber WJ. Evidence-based evaluation of complementary health approaches for pain management in the United States. Mayo Clin Proc. September 2016;91(9):1292-1306.

Data from a review of U.S.-based clinical trials published today in Mayo Clinic Proceedings suggest that some of the most popular complementary health approaches—such as yoga, tai chi, and acupuncture—appear to be effective tools for helping to manage common pain conditions. The review was conducted by a group of scientists from the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health.

Millions of Americans suffer from persistent pain that may not be fully relieved by medications. They often turn to complementary health approaches to help, yet primary care providers have lacked a robust evidence base to guide recommendations on complementary approaches as practiced and available in the United States. The new review gives primary care providers—who frequently see patients with chronic pain—tools to inform decisionmaking on how to help manage that pain.

“For many Americans who suffer from chronic pain, medications may not completely relieve pain and can produce unwanted side effects. As a result, many people may turn to nondrug approaches to help manage their pain,” said Richard L. Nahin, Ph.D., NCCIH’s lead epidemiologist and lead author of the analysis. “Our goal for this study was to provide relevant, high-quality information for primary care providers and for patients who suffer from chronic pain.”

The researchers reviewed 105 U.S.-based randomized controlled trials, from the past 50 years, that were relevant to pain patients in the United States and met inclusion criteria. Although the reporting of safety information was low overall, none of the clinical trials reported significant side effects due to the interventions.

The review focused on U.S.-based trial results on seven approaches used for one or more of five painful conditions—back pain, osteoarthritis, neck pain, fibromyalgia, and severe headaches and migraine—and found promise in the following for safety and effectiveness in treating pain:

  • Acupuncture and yoga for back pain
  • Acupuncture and tai chi for osteoarthritis of the knee
  • Massage therapy for neck pain with adequate doses and for short-term benefit
  • Relaxation techniques for severe headaches and migraine.

Though the evidence was weaker, the researchers also found that massage therapy, spinal manipulation, and osteopathic manipulation may provide some help for back pain, and relaxation approaches and tai chi might help people with fibromyalgia.

“These data can equip providers and patients with the information they need to have informed conversations regarding nondrug approaches for treatment of specific pain conditions,” said David Shurtleff, Ph.D., deputy director of NCCIH. “It’s important that continued research explore how these approaches actually work and whether these findings apply broadly in diverse clinical settings and patient populations.”

Read more about this report at nccih.nih.gov/pain_review.


About the National Center for Complementary and Integrative Health (NCCIH):NCCIH’s mission is to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health approaches and their roles in improving health and health care. For additional information, call NCCIH’s Clearinghouse toll free at 1-888-644-6226. Follow us on Twitter(link is external), Facebook(link is external), and YouTube(link is external).

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health ®

 

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Acupuncture: A Solution to the Opioid Crisis?

JACKSONVILLE, Fla., Dec. 8, 2015 /PRNewswire-iReach/ —

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Jacksonville, FL — According to the National Institutes of Health, it is estimated 2 million people in the U.S. suffer from substance use disorders related to prescription opioid pain relievers. Forty-six Americans die each day from prescription opioid overdoses–that’s two deaths an hour; and this critical national health issue is on the rise. But, according to the National Certification Commission for Acupuncture and Oriental Medicine, instead of using an addictive prescription drug, pain can effectively be treated using acupuncture.

Photo – http://photos.prnewswire.com/prnh/20151208/294181

Massachusetts General Hospital/Harvard University researchers published a study (September 2015) finding that repeated acupuncture treatment might reduce or eliminate the need for opioids by restoring the balance in key brain regions, altering pain-related attention and memory. The study was published by the National Center for Biotechnology, National Institutes of Health, U.S. Department of Health and Human Services.

“Both NIH and the World Health Organization support acupuncture in the treatment for pain based on randomized controlled trials,” says Bill Reddy, L.Ac., Dipl.Ac. (NCCAOM)® and Director, Integrative Health Policy Consortium, Pinecrest Wellness Center, Annandale, VA.  “Acupuncture is a viable, evidenced-based solution to our nation’s opioid problem with an infrastructure already in place with nearly 17,000 acupuncturists that are both state-licensed and board-certified by NCCAOM® across the nation.”

A 2012 meta-analysis published by the American Medical Association evaluated acupuncture for the treatment of chronic pain involving a total of 17,922 patients suffering from back and neck pain, osteoarthritis and chronic headaches.  The conclusion of the study is that, “Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option.”

In fact, acupuncture may be used in lieu of pain medication and is listed as an “Essential Health Benefit” among benchmark health insurance plans in six states. In the remaining 44 states, acupuncture has partial or full coverage.

“While acupuncture can reduce pain and may help reduce the growing opioid addiction rate, today’s nationally board-certified acupuncturists can address many health concerns including digestive issues, weight loss, headaches as well as improving immune system function and overall health,” says Kory Ward-Cook, PhD, MT(ASCP), CAE, CEO of the NCCAOM®.

In existence for more than 3,000 years, acupuncture and Oriental medicine’s holistic approach can be leveraged not only to treat moderate to severe pain traditionally treated with opioids, but also to maintain health and well-being.

To find a nationally board-certified NCCAOM acupuncturist or Oriental medicine practitioner in your area, go to www.nccaom.org .

About the NCCAOM

With a mission to ensure the safety and well-being of the public, the National Certification Commission for Acupuncture and Oriental Medicine is a nonprofit organization that advances acupuncture and Oriental medicine by establishing and promoting evidence-based standards of competence and credentialing.

Founded in 1982, NCCAOM certification indicates that a practitioner has met national standards for the safe and competent practice of acupuncture and Oriental medicine. Since its inception, the NCCAOM has certified more than 24,000 Diplomates in acupuncture, Chinese herbology, Asian bodywork therapy, and Oriental medicine in America.

For more information about NCCAOM, visit www.nccaom.org.

Media Contact: Mina Larson, NCCAOM, (703) 314-2908,mlarson@thenccaom.org

News distributed by PR Newswire iReach: https://ireach.prnewswire.com

SOURCE NCCAOM

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Patients hospitalized for cancer treatment commonly use complementary and integrative health (CIH) approaches such as nutritional supplements, special diets, and massage according to a new study. About half of participants were interested in acupuncture, biofeedback, and mindfulness meditation.

PRESS RELEASE FROM MARY ANN LIEBERT, INC., PUBLISHERS

FOR IMMEDIATE RELEASE

Contact: Kathryn Ryan
Mary Ann Liebert, Inc., publishers
914-740-2100
kryan@liebertpub.com

New Study Shows High Use of Complementary Therapies by Cancer Inpatients

New Rochelle, NY, December 2, 2015—Patients hospitalized for cancer treatment commonly use complementary and integrative health (CIH) approaches such as nutritional supplements, special diets, and massage according to a new study. More than 95% of patients expressed interest in at least one of these types of therapies if offered during their hospital stay, as reported in the article published in The Journal of Alternative and Complementary Medicine, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers. The article is available to download for free on The Journal of Alternative and Complementary Medicine website until January 2, 2016.

In the article “Improving Patient-Centered Care: A Cross-Sectional Survey of Prior Use and Interest in Complementary and Integrative Health Approaches Among Hospitalized Oncology Patients,” Rhianon Liu and Maria Chao, DrPH, University of California, San Francisco, Osher Center for Integrative Medicine evaluated the use of 12 different CIH approaches by patients in a surgical oncology ward. The most commonly used were vitamins/nutritional supplements (67%), a special diet (42%), and manual therapies such as massage or acupressure (39%).

The study also assessed patient interest in seven different CIH approaches if they were offered, and more than 40% of patients expressed interest in each treatment, including nutritional counseling (77%) and massage (76%). About half of participants were interested in acupuncture, biofeedback, and mindfulness meditation.

Research reported in this publication was supported by the National Center for Complementary and Integrative Health under Award Numbers T32AT003997, K01AT006545, and K24AT007827, and the National Center for Advancing Translational Sciences, under Award Number KL2TR00143.The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

 

 

 

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Eczema on Face – Home Remedies for Eczema

Eczema

eczema evening primrose inside

What is eczema?

Eczema, also known as atopic dermatitis, is a chronic allergic condition in which the skin develops areas of itchy, scaly rashes.

What are the symptoms of eczema?

Eczema can occur on almost any part of the body but eczema on face areas is common, as is eczema on the scalp, inside of elbows, knees, ankles, and hands. It typically appears as extremely itchy patches on the skin. Eczema can get worse when scratched; in fact, itchy skin may appear normal until scratched; the irritating action may then cause the characteristic rash and scales to develop.

Other eczema symptoms include:

  • Areas of dry, leathery skin
  • Blisters that ooze and crust over
  • Redness and inflammation in the affected area

Scratching can introduce infectious agents into the skin, leading to secondary complications including bacterial infection and permanent scars.

What are the causes of eczema?

Eczema is caused by a reaction similar to that of an allergy and can promote chronic inflammation. The condition will often wax and wane and accompany other allergic conditions such as asthma. In some cases, a specific substance, such as certain soaps, detergents, or metals, dust mites, and animal dander, can trigger eczema. For many people, however, there is no known allergen that causes this reaction. Eczema can be worsened by dry climates, exposure to water, temperature changes, and stress.

Who is likely to develop eczema?

Eczema is particularly common in infants and children. A person’s risk of developing the problem also increases if he or she has a family history of eczema or allergic conditions such as asthma and hay fever.

How is eczema diagnosed?

Physicians usually diagnose eczema by conducting a physical exam and asking questions about the patient’s symptoms, medical history, lifestyle, and habits.

What is the conventional treatment for eczema?

Conventional doctors often recommend a combination of self-care techniques and medical therapies to treat eczema. First, people with eczema should avoid any potential triggers that appear to make symptoms worse. Take warm, not hot, showers or baths if you have eczema. Use soap as sparingly as possible, and apply a soothing, hypoallergenic moisturizer immediately after bathing. Physicians may also suggest using over-the-counter anti-itch lotions or low-potency steroid creams.

When these measures don’t alleviate eczema, the doctor may prescribe one or more of the following treatments:

  • Steroids. Prescription steroid creams and ointments – and, in severe cases, oral steroid medications – can relieve the itching and inflammation of eczema, but they can have side effects such as skin thinning and are not recommended for long-term use.
  • Immunomodulators. Newer prescription creams called calcineurin inhibitors (such as pimecrolimus and tacrolimus) work by modulating the body’s immune response. Although these drugs don’t have the same side effects as steroids, their long-term safety isn’t yet clear.

What therapies and home remedies for eczema does Dr. Weil recommend?

In addition to the self-care approaches mentioned above, Dr. Weil recommends considering the following natural treatments for eczema:

  • Allergy is ultimately an inflammatory condition and diet can profoundly influence inflammation throughout the body. Follow an anti-inflammatory diet and avoid pro-inflammatory ingredients.
  • Skin disorders are often strongly linked to psychological stress; conversely, stress-relieving techniques can often be extraordinarily effective in providing relief. Try visualization or hypnotherapy to take advantage of the mind/body connection in allergic skin disorders.
  • Try aloe vera gel, calendula lotion or cream, and chaparral lotion on irritated skin.
  • Take gamma-linolenic acid (GLA). This unusual fatty acid is found in evening primrose oil, black currant oil and borage oil but is very hard to come by in the diet. GLA appears to have nourishing effects on skin, hair, and nails. Take 500 mg twice a day and expect to wait six to eight weeks to see results.
  • Eliminate milk and all milk products, which may irritate the immune system.
  • In addition, therapies in both homeopathy and traditional Chinese medicinehave proven effective for many skin conditions and are worth exploring. See the websites of the National Center for Homeopathy and the National Certification Commission for Acupuncture and Oriental Medicine to find practitioners.

 

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New Study Shows High Use of Complementary Therapies by Cancer Inpatients

New Study Shows High Use of Complementary Therapies by Cancer Inpatients

New Rochelle, NY, December 2, 2015—Patients hospitalized for cancer treatment commonly use complementary and integrative health (CIH) approaches such as nutritional supplements, special diets, and massage according to a new study. More than 95% of patients expressed interest in at least one of these types of therapies if offered during their hospital stay, as reported in the article published in The Journal of Alternative and Complementary Medicine, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers. The article is available to download for free on The Journal of Alternative and Complementary Medicine website until January 2, 2016.

In the article “Improving Patient-Centered Care: A Cross-Sectional Survey of Prior Use and Interest in Complementary and Integrative Health Approaches Among Hospitalized Oncology Patients,” Rhianon Liu and Maria Chao, DrPH, University of California, San Francisco, Osher Center for Integrative Medicine evaluated the use of 12 different CIH approaches by patients in a surgical oncology ward. The most commonly used were vitamins/nutritional supplements (67%), a special diet (42%), and manual therapies such as massage or acupressure (39%).

The study also assessed patient interest in seven different CIH approaches if they were offered, and more than 40% of patients expressed interest in each treatment, including nutritional counseling (77%) and massage (76%). About half of participants were interested in acupuncture, biofeedback, and mindfulness meditation.

Research reported in this publication was supported by the National Center for Complementary and Integrative Health under Award Numbers T32AT003997, K01AT006545, and K24AT007827, and the National Center for Advancing Translational Sciences, under Award Number KL2TR00143.The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Acupuncture for hypertension: Study shows that acupuncture is effective at lowering blood pressure for a month and a half!

by Lynn Griffith

Approximately 70 million American adults have high blood pressure, and only 52 percent of these adults report that their condition is under control. (1)

A new study has found that patients who use acupuncture to treat high blood pressure experienced drops in their blood pressure that lasted up to a month and a half. (2)

There are 350 acupuncture points in the body.  Qi is believed to flow through meridians in the body.  It is at these acupuncture points that the energy flows can be accessed.  In Chinese medicine, illness is thought to be a consequence of an imbalance of the forces.  When needles are inserted into these points, it is believed that the energy flow can be brought back to balance. (3)

acupuncture

New study on acupuncture provides hope for the 70 million American adults who struggle with hypertension!

According to the World Health Organization, acupuncture is effective for treating 28 conditions, and may have therapeutic effect for many more conditions.  The new study confirms that acupuncture is beneficial for treating mild to moderate hypertension and could help lessen the risk of stroke or heart disease. (3)

The study is a culmination of more than a decade of research.  Researchers conducted tests on 65 hypertensive patients who were not receiving any medication to address the issue.  They were separated into two groups.  The subjects were then treated with electroacupuncture.  One group received the electroacupuncture on both sides of the inner wrists and slightly below the knees.  Researchers noticed a drop in blood pressure in 70 percent of the participants, and the drop was maintained for a month and a half. (2)

Acupuncture completed on inner wrists and below the knees showed a noticeable drop in blood pressure for 70 percent of participants!

The research team also noticed that this group had significant declines in blood concentration level of norepinephrine, which constricts blood vessels.  There were no noticeable differences in the other group that received acupuncture in other locations. (2)

Study also showed a significant decline in blood concentration of norepinephrine, which constricts blood vessels

If you struggle with high blood pressure and you would like to avoid medication or get off your existing medication, consider alternative therapies and lifestyle changes.  If you have not tried acupuncture, consider meeting with a licensed acupuncturist to discuss the process and the results that they have noticed.

Sources for this article include:
(1) www.cdc.gov
(2) www.sciencedaily.com
(3) www.medicalnewstoday.com

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Image attributions:
Acupuncture at Taeyoungdang Oriental Medicine, Dongdaemun-gu” by sellyourseoul (Featured Image)
Licensed under CC BY 4.0, images may have been modified in some way

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Acupuncture Dramatically Reduces Hot Flashes in Breast Cancer Survivors, Penn Study Suggests

Acupuncture Dramatically Reduces Hot Flashes in Breast Cancer Survivors, Penn Study Suggests

Findings also Highlight Acupuncture’s Ability to Induce a Stronger Placebo Effect than Oral Medications

Released: 3-Sep-2015 11:05 AM EDT
Source Newsroom: Perelman School of Medicine at the University of Pennsylvania

Newswise — PHILADELPHIA — Acupuncture may be a viable treatment for women experiencing hot flashes as a result of estrogen-targeting therapies to treat breast cancer, according to a new study from researchers at the Perelman School of Medicine at the University of Pennsylvania. Hot flashes are particularly severe and frequent in breast cancer survivors, but current FDA-approved remedies for these unpleasant episodes, such as hormone replacement therapies are off–limits to breast cancer survivors because they include estrogen. The results of the study are published this week in the Journal of Clinical Oncology.

“Though most people associate hot flashes with menopause, the episodes also affect many breast cancer survivors who have low estrogen levels and often undergo premature menopause, following treatment with chemotherapy or surgery,” said lead author Jun J. Mao, MD, MSCE, associate professor of Family Medicine and Community Health. “These latest results clearly show promise for managing hot flashes experienced by breast cancer survivors through the use of acupuncture, which in previous studies has also been proven to be an effective treatment for joint pain in this patient population.”

Hot flashes are brief episodes of flushing, sweating, racing heartbeat and sensations of heat. Precisely how hot flashes arise isn’t known, though they are closely associated with decreased estrogen levels.

In the trial, the research team enrolled 120 breast cancer survivors, all of whom reported experiencing multiple hot flashes per day. Participants were randomized into four different interventions that would analyze how effectively an acupuncture technique known as electroacupuncture – in which embedded needles deliver weak electrical currents – reduces incidents of hot flashes as compared to the epilepsy drug gabapentin, which was previously shown to be effective in reducing hot flashes for these patients. For an eight-week period, participants received gabapentin (900 mg) daily, gabapentin placebo daily, electroacupuncture (twice per week for two weeks, then once weekly), or “sham” electroacupuncture, which involves no actual needle penetration or electrical current.

After the eight-week treatment period, the subjects in the electroacupuncture group showed the greatest improvement in a standard measure of hot flash frequency and severity, known as the hot flash composite score (HFCS). They were followed by the group that had received the “sham acupuncture” treatment. The gabapentin pill group reported less improvement than the sham acupuncture group, and the placebo pill group placed last.

In addition to reporting the greatest reductions in hot flash frequency/severity, both acupuncture groups reported fewer side effects than either of the pill groups.

The Penn researchers surveyed the subjects sixteen weeks after treatment ended, and found that the electroacupuncture and sham electroacupuncture groups had enjoyed a sustained—and even slightly increased—abatement of hot flashes. The pill-placebo patients also reported a slight improvement in symptoms, whereas the gabapentin pill group reported a worsening.

A Better Placebo
Compared to its sham version, electroacupuncture produced a 25 percent greater reduction in HFCS, suggesting that it really could work better – though the modest size of the study precluded a statistically definitive conclusion. However, the study did show with confidence that the sham acupuncture procedure worked better than a placebo pill at relieving hot flashes, presumably by creating a stronger expectation of benefit.

“Acupuncture is an exotic therapy, elicits the patient’s active participation, and involves a greater patient-provider interaction, compared with taking a pill,” Mao said. “Importantly, the results of this trial show that even sham acupuncture – which is effectively a placebo – is more effective than medications. The placebo effect is often dismissed as noise, but these results suggest we should be taking a closer look at how we can best harness it.”

The sham acupuncture procedure also seemed to create a strikingly lower experience of adverse side effects, which were virtually absent in this group. Only one woman reported an episode of drowsiness from the sham acupuncture, whereas the placebo pill recipients reported eight adverse events such as headache, fatigue, dizziness and constipation.

Some have questioned whether acupuncture has a biological effect apart from the power of suggestion. There is evidence from prior studies that it can boost bloodstream levels of endorphins and related painkilling, mood-elevating molecules more directly than via suggestion. Studies also have found that traditional acupuncture works differently than sham acupuncture in the brain. But for patients, that issue may be moot if they can enjoy dramatic improvements in their quality of life, especially compared to no improvement if they receive no treatment.

Co-authors of the paper were Sharon X. Xie, Angela DeMichele and John T. Farrar of Penn Medicine, Marjorie A. Bowman of Wright State University’s School of Medicine, and Deborah Bruner of Emory University’s School of Nursing.

Funding was provided by the National Institutes of Health (K23-AT004112).

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Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $4.9 billion enterprise.
The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report’s survey of research-oriented medical schools. The School is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $409 million awarded in the 2014 fiscal year.
The University of Pennsylvania Health System’s patient care facilities include: The Hospital of the University of Pennsylvania — recognized as one of the nation’s top “Honor Roll” hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital — the nation’s first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2014, Penn Medicine provided $771 million to benefit our community.

 

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