Clinical and morphological effects of hyperbaric oxygen therapy in patients with interstitial cystitis associated with fibromyalgia.

BACKGROUND: Interstitial Cystitis (IC) is a debilitating disorder of the bladder, with a multifactorial and poorly understood origin dealing with microcirculation repeated damages. Also Fibromyalgia (FM) is a persistent disorder whose etiology is not completely explained, and its theorized alteration of pain processing can compromise the quality of life. Both these conditions have a high incidence of conventional therapeutic failure, but recent literature suggests a significant beneficial response to Hyperbaric Oxygen Therapy (HBOT). With this study, this study we evaluated the effects of HBOT on quality of life, symptoms, urodynamic parameters, and cystoscopic examination of patients suffering from both IC and FM. METHODS: We structured an observational clinical trial design with repeated measures (questionnaires, urodynamic test, and cystoscopy) conducted before and 6 months after a therapeutic protocol with hyperbaric oxygen for the treatment of patients suffering from both IC and FM. Patients were exposed to breathing 100% oxygen at 2 atm absolute (ATA) in a multiplace pressure chamber for 90 min using an oro-nasal mask. Patients undertook a cycle of 20 sessions for 5 days per week, and a second cycle of 20 sessions after 1 week of suspension. RESULTS: Twelve patients completed the protocol. Changes after HBOT were not significant, except for hydrodistension tolerance (mean pre-treatment: 409.2 ml; mean post-treatment: 489.2 ml; p < 0.05). A regression of petechiae and Hunner's ulcers was also noted 6 months after the completion of HBOT. CONCLUSIONS: Our study showed no improvement of symptoms, quality of life, and urodynamic parameters, except for hydrodistension, and a slight improvement in cystoscopic pattern. However, to date, we could not demonstrate the significance of overall results to justify the use of HBOT alone in patients with IC and FM. This observation suggests that additional studies are needed to better understand if HBOT could treat this subset of patients. TRIAL REGISTRATION: NCT03693001 ; October 2, 2018. Retrospectively registered.

The therapeutic efficacy of somatic acupuncture is not increased by auriculotherapy: a randomised, blind control study in cervical myofascial pain.

Auriculotherapy (ear acupuncture) is a therapeutic technique in which points on the auricle are stimulated with needles. Usually it is combined with somatic acupuncture because of possible synergy, although the efficacy of this pairing has neither been confirmed nor disproved. The aim of this study was to verify: (1) if somatic acupuncture can reduce myofascial cervical pain; (2) if concomitant auriculotherapy improves the efficacy of somatic acupuncture. A group of 62 patients affected by cervical myofascial pain was randomly divided into two groups of 31. Group A (6 males and 25 females) underwent eight sessions of somatic acupuncture. Group B (7 males and 24 females) underwent eight sessions of somatic acupuncture in the same way as group A, paired with auriculotherapy. Pain was scored using the McGill Pain Questionnaire before and at the end of treatment, and 1 and 3 months later. The results showed that both somatic acupuncture and somatic plus ear acupuncture have a positive effect in reducing pain. The pain intensity score was 40.70 +/- 17.78 in group A before therapy and 13.32 +/- 9.62 after therapy; in group B it was 38.90 +/- 15.31 and 13.43 +/- 10.96. Somatic plus auriculotherapy was therefore not statistically significantly superior to somatic therapy alone in the treatment of cervical myofascial pain.

Cytokines and liver failure: modification of TNF- and IL-6 in patients with acute on chronic liver decompensation treated with Molecular Adsorbent Recycling System (MARS).

Liver transplantation, considered today as the most effective treatment for end-stage liver diseases, can not always be performed on every patient affected with a liver disease. Patients with end-stage liver diseases, usually have high bilirubin, encephalopathy and renal failure. In these situations cytokines play an important role in different processes, from apoptosis to regeneration. The aim of this clinical study has been to analyse the action of new artificial liver system, called Molecular Adsorbent Recycling System (MARS) on cytokines metabolism in patients affected with acute on chronic liver failure. The results are intriguing because an increase of IL-6 and a decrease of TNF-alpha observed during MARS treatment. The study confirms the efficacy of MARS therapy in terms of homeostasis of the cytokines network and suggests an usefulness of monitoring their level during liver failure.

Acupuncture modulation of capsaicin-induced inflammation: effect of intraperitoneal and local administration of naloxone in rats. A blinded controlled study.

OBJECTIVE: It is believed that acupunctural stimulation induces an analgesic response mainly through a central mechanism: that is, through an increase in the production of opioid peptides and their release at different levels in the nervous system. We sought to establish whether the modulating effect of acupuncture on experimental neurogenic edema can be attributed to a central mechanism only or whether a peripheral mechanism could also exist. Intraperitoneal administration was compared to local administration in the same paw in rats that were injected with capsaicin and in the same dermatome of the acupunctural stimulation. MATERIALS AND METHODS: Experimentation was conducted on 105 male Sprague-Dawley rats weighing 180-220 g, divided into 7 groups as follows: group 1, control; groups 2-4 (15 animals), stimulated with manual acupuncture; group 3 also treated with intraperitoneal naloxone 1 mg/kg; group 4 also treated locally with naloxone (20 microg); groups 5-7 (15 animals), stimulated with 5 Hz and 5 mA electroacupuncture (EAP); group 6 also treated with intraperitoneal naloxone, 1 mg/kg, group 7 also treated locally with naloxone (20 microg). RESULTS: The results indicate that the administration of 1 mg/kg of naloxone intraperitoneally can inhibit the modulating effect of acupunctural stimulation. Equally effective in inhibiting the modulating effect of acupunctural stimulation, although not having a systemic effect, is a 20-microg dose of naloxone administered peripherally on the site of edema induction. CONCLUSION: It is possible to conclude that both systemic and peripheral mechanisms seem to be implicated in the modulating effect of acupuncture on the neurogenic inflammation mechanism.