Is acupuncture effective in treating chronic pain after spinal cord injury?

OBJECTIVES: To evaluate the efficacy of acupuncture as a treatment for chronic pain and secondary symptoms after spinal cord injury (SCI) and to identify disease-specific variables associated with response to treatment. DESIGN: A within-subjects design consisting of a 7(1/2)-week no-acupuncture baseline period followed by a 7(1/2)-week treatment period and a follow-up assessment 3 months posttreatment. SETTING: Medical rehabilitation research center. PARTICIPANTS: Twenty-two people with SCI who experienced moderate to severe pain of at least 6 months' duration. INTERVENTION: A course of 15 acupuncture treatments was administered over a 7(1/2)-week period. MAIN OUTCOME MEASURES: Numeric Rating Scale of pain intensity; ratings of interference with activity, individualized symptom rating, Center for Epidemiologic Studies-Depression Scale; Speilberger State Trait Anxiety Inventory, and General Well-Being Schedule. RESULTS: Ten patients (46%) showed improvement in pain intensity and pain sequelae after treatment. However, 6 patients (27%) reported an increase in pain that was still present 3 months after treatment. CONCLUSIONS: About 50% of the study sample reported substantial pain relief after acupuncture treatment, suggesting that acupuncture may provide pain relief for at least a subgroup of individuals with SCI. Future research is needed to determine what part of this effect is because of acupuncture versus nonspecific effects such as placebo effects and regression to the mean.

Transcriptional regulation of the nitrate reductase gene in Chlorella vulgaris: identification of regulatory elements controlling expression.

Nitrate reductase (NR), the rate-limiting and primary control point of the nitrate assimilation pathway, is regulated at transcriptional and post-transcriptional levels. To better understand how NR is regulated at the transcriptional level in Chlorella vulgaris, studies were performed to identify the factors regulating NR expression. Sequence analysis of the NR promoter identified a number of potential sites that were investigated by mobility shift assays. Of the protein-binding sites found, several., such as USF and E2F are likely involved in the basal NR gene transcription. An indirect repeat sequence with similarity to the sequence recognized by the common plant regulatory factor was identified and shown to bind a Chlorella protein in vitro. Mobility shift assays of a consensus GATA element indicated that proteins able to specifically bind this element are constitutive, regardless of the nitrogen source. Mutational analysis revealed that the GATA core is required for protein binding in vitro. Additionally, a NIT2 zinc-finger domain/glutathione S-transferase fusion protein was found to bind in a sequence-specific manner to this site. In Neurospora crassa and Aspergillus nidulans, consensus GATA elements are bound by the NIT2 protein, which has a major role in the expression of nitrogen-metabolizing genes. The ability of the GATA element to function as a nitrogen response element (NRE) was further examined by in vivo foot-printing. The protection of guanines in the GATA core and surrounding region was observed only in cells grown in the presence of nitrate. These data confirm that a single GATA element has a role in regulating the expression of NR in C. vulgaris.

Acupuncture and Trager psychophysical integration in the treatment of wheelchair user's shoulder pain in individuals with spinal cord injury.

OBJECTIVE: To determine the effectiveness of acupuncture and Trager Psychophysical Integration (a form of manual therapy) in decreasing chronic shoulder pain in wheelchair users with spinal cord injury (SCI). DESIGN: A prospective clinical trial, with subjects randomized to acupuncture or Trager treatment condition. Subjects served as their own controls by including a 5-week pretreatment baseline period and a 5-week posttreatment follow-up period. SETTING: Rehabilitation hospital research department. PARTICIPANTS: Eighteen subjects with chronic SCI and chronic shoulder pain who used manual wheelchairs as their primary means of mobility. INTERVENTION: Ten acupuncture or 10 Trager treatments over a 5-week period. MAIN OUTCOME MEASURES: Changes in performance-corrected Wheelchair User's Shoulder Pain Index (PC-WUSPI) scores during baseline, treatment, and follow-up periods were assessed by using analysis of variance. RESULTS: The mean PC-WUSPI score +/- standard deviation of the 18 subjects at entry was 48.9 +/- 24.6 (range, 8.0-94). No significant change in mean PC-WUSPI scores occurred during the pretreatment baseline period. Mean PC-WUSPI scores decreased significantly during the treatment period in both the acupuncture (53.4%; 23.3 points) and Trager (53.8%; 21.7 points) treatment groups. The reduced PC-WUSPI scores were maintained in both groups throughout the 5-week posttreatment follow-up period. CONCLUSION: Acupuncture and Trager are both effective treatments for reducing chronic shoulder pain associated with functional activities in persons with SCI.

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.

Overview of complementary therapies in physical medicine and rehabilitation.

This article briefly describes the current usage of alternative and complementary medicine in the United States and among chronically ill users of rehabilitation services. Definitions of alternative and complementary medicine are presented with a few examples from among hundreds of existing therapies, with a focus on therapies currently used in rehabilitation contexts. The role of the National Institutes of Health (NIH), in funding research on these therapies is described. Examples of evidence-based therapies include ginkgo biloba for cerebral insufficiency, and acupuncture for stroke, are presented. Future trends are discussed.

Immune changes in alcohol-dependent patients without medical disorders.

INTRODUCTION: We examined a battery of in vitro immune measures in inner city alcohol-dependent (as determined by the Structured Clinical Interview for DSM-III-R (SCID) persons who were without liver or other medical disorders and free of other substance abuse. These subjects were seeking treatment at an ambulatory alcohol treatment center. METHODS: Alcohol-dependent subjects (n = 44) were compared with healthy, nonabusing community subjects (n = 34). Subjects, both male and female, had a mean age of 41 years and were primarily African American. Many were homeless. An extended battery of enumerative and functional immune measures was obtained, as well as information about alcohol consumption. RESULTS: CONTROLLING for age and gender, ANCOVA revealed no differences (p > 0.1) between alcohol-dependent and control subjects in leukocyte and lymphocyte subsets or in circulating CD56+ (natural killer) cells. There were also no significant differences in responses to the mitogens phytohemagglutinin, concanavalin A, or pokeweed mitogen ( > 0.1) or in natural killer cell activity (p > 0.1). There was, however, altered granulocyte function in the alcohol-dependent sample, with decreased phagocytic activity in the alcohol-dependent males (p < 0.04) and gender and age dependent differences in the number of circulating granulocytes (p < 0.01). Granulocyte killing of Staphylococcus aureus, however, did not differ between the groups. CONCLUSIONS: The findings suggest that although males with chronic alcohol dependence have compromised phagocytic function, chronic alcohol-dependent subjects who are free of medical disorders do not have substantial abnormalities in many immune system functions.

Culture-confirmed reinfection of a person with different strains of Borrelia burgdorferi sensu stricto.

In recent years, the utility of serum-based diagnostic testing for Lyme disease has improved substantially; however, recovery by culture of the bacterium from skin biopsies of suspected patients is still the only definitive laboratory test. Reinfection of patients has been assumed to occur but as yet has not been documented by serial isolates from the same person. We present a case of culture-confirmed reinfection of a patient in Menominee County, Michigan. Borrelia burgdorferi was isolated from the skin punch biopsy specimens during each episode of erythema migrans (EM) and was subjected to molecular strain typing, genetic analysis of two outer surface protein genes, protein profile analysis, and serum antibody response testing. Results show that these isolates are distinct strains of the bacterium and that the two episodes of EM were caused by independent infections. This report describes the documented, culture-confirmed reinfection of a human by two different strains of B. burgdorferi.

Immune function in healthy adolescents.

In the present study, we examine immunological functioning in normal healthy African-American and Latino/Latina adolescents recruited from an inner-city high school and an inner-city clinic. A battery of tests was performed with enumerative and functional measures which encompassed both innate and adaptive immunity. We found immune differences related to age, gender, and race on both the enumerative and the functional immune measures. This data expands the available body of information concerning normal immunity in healthy adolescents.

Human immunodeficiency virus-type 1 infection in an inner-city alcohol treatment program.

The human immunodeficiency virus (HIV) infection rate was examined in a selected cohort of healthy clients of an inner-city alcohol treatment center from 1990 through 1993. These subjects were also participating in a research protocol (n = 258) designed to assess immunity and HIV risk behaviors in inner city alcohol-dependent persons. Healthy alcohol-abusing heterosexual clients (165) had HIV testing conducted in an inner-city ambulatory alcohol treatment center between September 1990 and December 1993. Respondents were 93.9% African-American and 3.6% Hispanic; 72.1% were male. Anonymous HIV-1 antibody testing was conducted retrospectively for an additional 80 subjects who participated in the research protocol during the same interval, but for whom HIV-1 antibody testing was not conducted clinically at the time. HIV infection rate among the clinic-tested subjects (n = 165) was 4.4% for individuals who were exclusively alcohol-dependent, 1.4% for non-injecting drug use (IDU) mixed substance abusers, and 46.8% for clients with a history of IDU. Rates did not differ among cohorts tested in different years. Among non-injecting drug users tested in the clinic, all infected respondents (n = 3) were women (p = 0.03). Among those tested anonymously (n = 80), however, infection rate for exclusively alcohol-dependent persons was 16.7%, non-IDU mixed abusers 11.1%, and injecting drug users 48.3%, with seropositive males as well as females in each group. HIV infection rates for the pooled samples (n = 245) were 8.7% for exclusively alcohol-dependent persons, 5.1% for mixed abusers, and 54.5% for injecting drug users. Among non-injecting drug users, exclusively alcohol-dependent women had a significantly higher (p < 0.01) infection rate (20.0%) than the remaining females and males. Infection rates among exclusively alcohol-dependent males, male and female polysubstance non-IDU abusers, and injecting drug users were comparable with that seen in an earlier screening in the same clinic in 1989, with apparently little diffusion of infection from the IDU population to other substance abusers. An exception seemed to be exclusively alcohol-dependent females, who show substantially elevated rates. Age, housing, and other social differences may help segregated substance-abusing populations in the relatively small Newark metropolitan area, although not protecting exclusively alcohol-dependent females.

Isolation of Borrelia burgdorferi from two patients in Michigan.

Borrelia burgdorferi was isolated from skin biopsy specimens of erythema chronicum migrans lesions on two individuals residing in Menominee County, Michigan, in 1992. To our knowledge, these are the first two cases of culture-confirmed Lyme disease in Michigan. In spite of prompt treatment and resolution of illness, antibodies to B. burgdorferi were detectable for at least 3 months in both patients. Both specimens were obtained at different rural medical practices, thus demonstrating that with adequate laboratory support it is feasible to confirm a diagnosis of acute Lyme disease by culture in rural health care settings.