ABSTRACT
A back pain treatment program was developed for the outpatient, primary care clinic setting. In this pilot study, measured functional status scores improved in a cohort of patients enrolled in the program. The program consists of a series of 5 monthly group appointments and follows a sequential curriculum involving multiple therapeutic modalities. These modalities include exercise, social interaction, motivation/raison d'être, holistic coaching, music, and behavioral modelling. The program provides a forum for the discussion and implementation of complementary and alternative approaches, alongside mainstream approaches, and represents a model of integrative medical practice.
Subject(s)
Back Pain/therapy , Complementary Therapies/methods , Integrative Medicine/methods , Pain Management/methods , Physical Therapy Modalities , Adult , Back Pain/psychology , Humans , Male , Motivation , Outcome Assessment, Health Care , Pilot Projects , Primary Health Care , Program DevelopmentABSTRACT
Extracts of four plant portions (roots, stems, leaves and flowers) of Urtica dioica (the stinging nettle) were prepared using accelerated solvent extraction (ASE) involving water, hexanes, methanol and dichloromethane. The extracts were evaluated for their anti-inflammatory and cytotoxic activities in an NF-κB luciferase and MTT assay using macrophage immune (RAW264.7) cells. A standardized commercial ethanol extract of nettle leaves was also evaluated. The methanolic extract of the flowering portions displayed significant anti-inflammatory activity on par with a standard compound celastrol (1) but were moderately cytotoxic. Alternatively, the polar extracts (water, methanol, ethanol) of the roots, stems and leaves displayed moderate to weak anti-inflammatory activity, while the methanol and especially the water soluble extracts exhibited noticeable cytotoxicity. In contrast, the lipophilic dichloromethane extracts of the roots, stems and leaves exhibited potent anti-inflammatory effects greater than or equal to 1 with minimal cytotoxicity to RAW264.7 cells. Collectively these results suggest that using lipophilic extracts of stinging nettle may be more effective than traditional tinctures (water, methanol, ethanol) in clinical evaluations for the treatment of inflammatory disorders especially arthritis. A chemical investigation into the lipophilic extracts of stinging nettle to identify the bioactive compound(s) responsible for their observed anti-inflammatory activity is further warranted.
Subject(s)
Anti-Inflammatory Agents/pharmacology , Cytotoxins/pharmacology , Macrophages/drug effects , Plant Extracts/pharmacology , Urtica dioica/chemistry , Animals , Anti-Inflammatory Agents/chemistry , Cytotoxins/chemistry , Flowers/chemistry , Luciferases/metabolism , Macrophages/immunology , Mice , Molecular Structure , NF-kappa B/agonists , Plant Extracts/chemistry , Plant Leaves/chemistry , Plant Roots/chemistry , Plant Stems/chemistryABSTRACT
CONTEXT: Patients often combine prescription medications with herbal and dietary substances (herein referred to as herbal medicines). A variety of potential adverse herb-drug interactions exist based on the pharmacological properties of herbal and prescription medications. OBJECTIVE: To determine the incidence of potential and observed adverse herb-drug interactions in patients using herbal medicines with prescription medications. DESIGN: Consecutive patients were questioned about their use of herbal medicines in 6 outpatient clinics. Patients reporting use of these products provided a list of their prescription medications, which were reviewed for any potential adverse herb-drug interactions using a comprehensive natural medicine database. Any potential adverse herb-drug interactions prompted a review of the patient's chart for evidence of an observed adverse herb-drug interaction. MAIN OUTCOME MEASURE: The rate of potential and observed adverse herb-drug interactions. RESULTS: Eight hundred four patients were surveyed, and 122 (15%) used herbal medicines. Eighty-five potential adverse herb-drug interactions were found in 49 patients (40% of herbal medicine users). Twelve possible adverse herb-drug interactions in 8 patients (7% of herbal medicine users) were observed. In all 12 cases, the severity scores were rated as mild, including 8 cases of hypoglycemia in diabetics taking nopal (prickly pear cactus). CONCLUSIONS: A substantial number of potential adverse herb-drug interactions were detected and a small number of adverse herb-drug interactions observed, particularly in diabetics taking nopal. Screening for herbal medicine usage in 804 patients did not uncover any serious adverse interactions with prescription medications.
