The use of complementary and alternative therapies for chronic pain following spinal cord injury: a pilot survey.

OBJECTIVE: The purpose of this study was to determine the patterns and reasons for the use of complementary and alternative medicine (CAM) as a treatment for chronic pain among individuals with spinal cord injuries (SCI). METHODS: Telephone surveys were conducted in a sample of 77 people with SCI and chronic pain. RESULTS: Of those surveyed, 40.3% had used at least one CAM technique to manage chronic pain. The most common reason was dissatisfaction with conventional medicine. Acupuncture was the most frequently used modality, followed by massage, chiropractic manipulation, and herbal medicine. Acupuncture was rated lowest for satisfaction with pain relief, and massage was rated highest. Individuals not using conventional pain medication or who desired greater control over their health care practices tended to use more CAM techniques than others. Income, insurance coverage, and duration of pain were related to use of CAM. In general, CAM methods were effective for some and totally ineffective for others, indicating selective utility in this population. CONCLUSIONS: Despite this small opportunistic sample, the prevalence of CAM among individuals with SCI appears similar to that in the general population. A placebo-controlled trial is needed to evaluate the efficacy of various therapies in the SCI population. The fact that the most effective therapy, massage, was not frequently used suggests the need for more awareness of and research into this technique.

Flexyx Neurotherapy System in the treatment of traumatic brain injury: an initial evaluation.

OBJECTIVE: To conduct a preliminary experimental evaluation of the potential efficacy of Flexyx Neurotherapy System (FNS), an innovative electroencephalography (EEG)-based therapy used clinically in the treatment of traumatic brain injury (TBI). PARTICIPANTS: Twelve people aged 21 to 53 who had experienced mild to moderately severe closed head injury at least 12 months previously and who reported substantial cognitive difficulties after injury, which interfered with their functioning. DESIGN: Participants were randomly assigned to an immediate treatment group or a wait-list control group and received 25 sessions of FNS treatment. They were assessed at pretreatment, posttreatment, and follow-up with standardized neuropsychological and mood measures. RESULTS: Comparison of the two groups on outcome measures indicated improvement after treatment for participants' reports of depression, fatigue, and other problematic symptoms, as well as for some measures of cognitive functioning. Most participants experienced meaningful improvement in occupational and social functioning. CONCLUSION: On the basis of these results, FNS appears to be a promising new therapy for TBI and merits more extensive evaluation.

Blood pressure response to acupuncture in a population at risk for autonomic dysreflexia.

OBJECTIVE: To determine whether acupuncture can lead to autonomic dysreflexia (AD) when used to treat chronic pain in individuals with spinal cord injury (SCI). DESIGN: Acupuncture analgesia study. SETTING: Medical rehabilitation research center. PARTICIPANTS: Fifteen participants with post-SCI chronic pain who were at risk for AD (ie, SCI at or above T8). INTERVENTIONS: Half-hour acupuncture treatment sessions twice a week for 7.5 weeks, for a total of 15 treatments. Acupuncture needles were inserted both above and below the patient's spinal lesion level. Blood pressure (BP) was measured before and after acupuncture treatments. MAIN OUTCOME MEASURES: Systolic BP (SBP) and diastolic BP (DBP). Participants monitored for signs and symptoms of AD. RESULTS: On average, SBP and DBP remained stable across all 15 treatment sessions. None of the participants experienced any symptoms of AD. However, examination of individuals' BP readings indicated acute elevations (20 mmHg or higher) in SBP for 3 of the 15 participants. CONCLUSIONS: Although none of the 15 participants who were at risk for developing AD developed symptoms consistent with this diagnosis, 3 displayed an acute elevation in SBP, suggesting a pattern of imminent AD. Comorbid hypertension appeared to contribute to the elevation in 1 patient. Therefore, careful monitoring of patients with SCI or hypertension during acupuncture treatments is advisable.

Ginkgo biloba extract: mechanisms and clinical indications.

OBJECTIVE: Ginkgo biloba may have a role in treating impairments in memory, cognitive speed, activities of daily living (ADL), edema, inflammation, and free-radical toxicity associated with traumatic brain injury (TBI), Alzheimer's dementia, stroke, vasoocclusive disorders, and aging. The purpose of this review is to provide a synthesis of the mechanisms of action, clinical indications, and safety of Ginkgo biloba extract. DATA SOURCES: Empirical studies, reviews, chapters, and conference proceedings were identified in the following databases: Medline, the Research Council for Complementary Medicine based on the British Library database, and Psychlnfo. Ginkgo biloba, EGb 761, Tanakan, Tebonin, Rokan, and LI 1370 were the principal index terms. STUDY SELECTION AND DATA EXTRACTION: Controlled clinical studies with both positive and negative findings are included, in addition to animals studies illustrating mechanisms of activity. DATA SYNTHESIS: Ginkgo has shown activity centrally and peripherally, affecting electrochemical, physiologic, neurologic, and vascular systems in animals and humans with few adverse side effects or drug interactions. Ginkgo shows promise in patients with dementia, normal aging, and cerebrovascular-related disorders. Clinical indications include memory, information processing, and ADL. CONCLUSIONS: Ginkgo shows promise in treating some of the neurologic sequelae associated with Alzheimer's disease, TBI, stroke, normal aging, edema, tinnitus, and macular degeneration. Mechanisms of action may include antioxidant, neurotransmitter/receptor modulatory, and antiplatelet activating factor properties. While safe, caution is advised when recommending ginkgo to patients taking anticoagulants. Future studies should examine dose effects, component activity, mechanisms, and clinical applications.

Clinical heparin coated cardiopulmonary bypass: reduction of systemic heparin requirements for redo cardiac surgery.

The authors compared blood loss, transfusion requirements, and heparin doses for reoperative cardiac surgery using either: a) a Duraflow (Baxter Corporation, Irvine, CA) heparin coated cardiopulmonary bypass (CPB) system or b) standard CPB. Twenty patients underwent redo cardiac surgery while supported with heparin coated CPB, and 17 patients underwent redo cardiac surgery with standard CPB. The following data are presented as mean +/- standard deviation. The heparin coated CPB circuit group received significantly less heparin than the standard CPB group (322 +/- 80 IU/kg versus 448 +/- 80 IU/kg, p < 0.01). There was no difference in blood loss in the first 24 postoperative hrs or mean transfusion requirements for the two groups. Despite the reduced dose of heparin, the mean activated clotting time in the heparin coated group was similar to the mean activated clotting time of the standard CPB group (577 +/- 98 sec versus 612 +/- 117 sec, p = ns). In conclusion, heparin coated CPB without reduced activated clotting time does not reduce transfusion requirements or blood loss in reoperative cardiac surgery. The heparin coated CPB system allows maintenance of the activated clotting time level despite reduced heparin doses.