Acupuncture Therapy in a Group Setting for Chronic Pain.

Objective: This project was designed to test the feasibility and effectiveness of acupuncture therapy given in a group setting for chronic pain. Design: Nonrandomized, repeated measures quasi-experimental trial. Setting: Care was delivered in a primary care clinic waiting area after clinic hours. Subjects: Included were primary care patients (≥18 years old) with chronic pain of the neck, back, shoulder, or osteoarthritis of any site of at least three months' duration. Methods: Subjects received eight weekly acupuncture therapy sessions in a group setting. Acupuncture therapy included a combination of palpation, acupuncture needling, Tui na, Gua sha, and auricular treatment. Baseline pain levels were established in a two- to four-week run-in; assessment of the intervention impact on pain intensity, mood, and functional status were made at the end of the treatment period (eight weeks) and 16 weeks after completion of intervention (24 weeks). Results: Of the total 113 participants recruited for the trial, 96 completed the 24-week protocol. We found a statistically and clinically significant decrease in pain severity, pain interference, and depression in our study population. There were no serious adverse events. Conclusions: Acupuncture therapy offered in the group setting was effective in reducing pain severity, pain interference, and depression in patients with chronic neck, back, or shoulder pain or osteoarthritis. Benefit persisted through the 24-week measure despite no additional treatment. This finding has potentially important implications for improving access to effective acupuncture treatment for patients with limited financial resources.

Impact of the Urban Zen Initiative on patients' experience of admission to an inpatient oncology floor: a mixed-methods analysis.

PURPOSE: The purpose of this study was to evaluate the impact of the Urban Zen Initiative, an "optimal healing environment" intervention, at Beth Israel Medical Center on both quantitative and qualitative measures of the experience of patients admitted for inpatient oncology care. MATERIALS AND METHODS: A quasi-experimental design was used comparing a baseline sample of patients admitted to the oncology floor before the intervention to a similar group admitted during the intervention. Data collected included the Profile of Mood States, the EuroQol-5D (EQ-5D), and, on a subset of patients, a semistructured qualitative interview. RESULTS: Patients in the intervention group experienced significantly less emotional distress during their stay when compared to patients in the baseline group. There were also significantly greater improvements in pain and discomfort during the stay in the treatment group as compared to controls. The qualitative analysis described a number of possible explanations for this change including increased sense of connection and control as well as specific techniques for symptom relief. CONCLUSIONS: It is possible to improve the experience of patients admitted for inpatient cancer care with a "healing environment" intervention. Further studies are needed that incorporate randomized design and the ability to examine specific components of the intervention independently as well as the impact of the intervention as a whole.

Randomized trial of the effect of an integrative medicine approach to the management of asthma in adults on disease-related quality of life and pulmonary function.

PURPOSE: The purpose of this study was to test the effectiveness of an integrative medicine approach to the management of asthma compared to standard clinical care on quality of life (QOL) and clinical outcomes. METHODS: This was a prospective parallel group repeated measurement randomized design. Participants were adults aged 18 to 80 years with asthma. The intervention consisted of six group sessions on the use of nutritional manipulation, yoga techniques, and journaling. Participants also received nutritional supplements: fish oil, vitamin C, and a standardized hops extract. The control group received usual care. Primary outcome measures were the Asthma Quality of Life Questionnaire (AQLQ), The Medical Outcomes Study Short Form-12 (SF-12), and standard pulmonary function tests (PFTs). RESULTS: In total, 154 patients were randomized and included in the intention-to-treat analysis (77 control, 77 treatment). Treatment participants showed greater improvement than controls at 6 months for the AQLQ total score (P<.001) and for three subscales, Activity (P< 0.001), Symptoms (P= .02), and Emotion (P<.001). Treatment participants also showed greater improvement than controls on three of the SF-12 subscales, Physical functioning (P=.003); Role limitations, Physical (P< .001); and Social functioning (P= 0.03), as well as in the aggregate scores for Physical and Mental health (P= .003 and .02, respectively). There was no change in PFTs in either group. CONCLUSION: A low-cost group-oriented integrative medicine intervention can lead to significant improvement in QOL in adults with asthma.

Cost savings in inpatient oncology through an integrative medicine approach.

OBJECTIVES: To evaluate the cost impact of an integrative medicine intervention on an inpatient oncology service. STUDY DESIGN: This study used nonrandomized, nonequivalent groups. A baseline sample of inpatient oncology patients at Beth Israel Medical Center admitted to the medical oncology unit before implementation of the Urban Zen Initiative were compared with patients admitted after the Urban Zen Initiative was in place. METHODS: The Urban Zen Initiative incorporated yoga therapy, holistic nursing techniques, and a "healing environment" into routine inpatient oncology care. Length of stay and medication use data were extracted from Beth Israel's decision support electronic database. We compared length of stay, total medication costs, and costs of as-needed medications for both groups: the baseline sample of inpatient oncology patients and patients exposed to the Urban Zen healing environment initiative. RESULTS: We had complete cost data on 85 patients in our baseline group and 72 in our intervention group. We found no difference in length of stay between the 2 groups. We found a significant decrease in use of antiemetic, anxiolytic, and hypnotic medication costs as well as a decrease in total medication costs in the Urban Zen sample compared with the baseline group. CONCLUSIONS: An integrative medicine approach including yoga therapy, holistic nursing, and a healing environment in the inpatient setting can decrease use of medications, resulting in substantial cost savings for hospitals in the care of oncology patients.

Multimodal mind/body group therapy for chronic depression: a pilot study.

Chronic depression is a highly debilitating psychobiological disorder that affects mind, body, and spirit. The need for effective integrative treatments for depression is fueled by high recurrence and relapse rates, as well as growing consumer demand for natural and holistic approaches that recognize depression is a systemic problem. A 24-week multimodal group treatment program was piloted to assess whether psychoeducation, lifestyle modification, meditation, and mind/body skills training would reduce symptomatology and improve overall balance and well-being in nonmedicated patients with moderate depression. The group treatment was conducted in a healing space associated with an academic integrative medicine center. Fourteen adult patients (mean age = 51.7 years) participated in two treatment groups (seven patients per group). Treatment efficacy was evaluated by changes on the Beck Depression Inventory (BDI-II), the primary outcome measure, completed at pretreatment (week zero), posttreatment (week 12), and two follow-up points (weeks 16 and 24). Positive affect and overall well-being were assessed using the Symptom Checklist-90 Revised, the Life Orientation Test, the Short Form Health Survey-12, and the Psychological Well-Being Index. Comparisons of pretreatment and posttreatment scores on the BDI-II showed a clinically significant decline in depressed mood and negative affect (P < .001), as well as significant improvement across the positive affect and well-being measures. This outcome, which was statistically sustained for six months, suggests that a multimodal holistic mind/body group approach can benefit a segment of the chronically depressed population.

The impact of acupuncture and craniosacral therapy interventions on clinical outcomes in adults with asthma.

OBJECTIVE: Synergy has been proposed between modalities operating at different levels of action. Acupuncture and craniosacral therapy are two very different modalities for which synergy has been proposed. This study sought to test for such synergy and to determine if complementary therapies would improve pulmonary function and quality of life for people suffering from asthma, as well as reducing anxiety, depression, and medication usage. DESIGN: Subjects were randomly assignment to one of five groups: acupuncture, craniosacral therapy, acupuncture and craniosacral, attention control, and waiting list control. METHODS: Subjects received 12 sessions of equal length with pretreatment and posttreatment assessment of pulmonary function, asthma quality of life, depression, and anxiety. Medication use was also assessed. RESULTS: Synergy was not demonstrated. When treatment was compared with the control group, statistically treatment was significantly better than the control group in improving asthma quality of life, whereas reducing medication use with pulmonary function test results remained the same. However, the combination of acupuncture and craniosacral treatment was not superior to each therapy alone. In fact, although all active patients received 12 treatment sessions, those who received all treatments from one practitioner had statistically significant reductions in anxiety when compared with those receiving the same number of treatments from multiple practitioners. No effects on depression were found. CONCLUSIONS: Acupuncture and/or craniosacral therapy are potentially useful adjuncts to the conventional care of adults with asthma, but the combination of the two does not provide additional benefit over each therapy alone.

Homeopathy.

Especially in the United States, homeopathy has not become integrated into mainstream medical practice; this is partly because of the historical paucity of quality published research studies or quality educational programs. More recently, there have been better-designed studies in reputable journals, although historically most studies have been inconclusive or of poor methodology. The confusion around homeopathy in the United States exists for several reasons: 1. One of the main reasons for the relative disinterest or opposition to homeopathy is that even well-designed clinical studies on homeopathy leave the reader without any protocol-driven tools to take into daily practice. Individualization of treatment, or, as it is called today, differential therapeutics, is the main requirement of successful homeopathic prescribing. Only well-trained homeopathic practitioners are able to carry out such a task. In many articles that reported positive outcomes for homeopathy, numerous homeopathic remedies had been prescribed for the same diagnostic category. Critics suggest that the pooling of data from trials using different therapeutic agents to assess the overall success of homeopathic prescribing is incorrect. Research protocols that employ combination remedies, in which a medication contains several homeopathic remedies, fall into the same category. 2. Many of the positive and negative studies published are flawed with numerous methodologic problems. One of the most common problems is a lack of objective validated outcome measures. Another common problem is a small sample size. In most positive and negative meta-analyses published to date, research data are pulled together artificially based on either a diagnostic category or a particular remedy. Frequently the concentration of the remedy used and the conditions to which it has been applied are different. Ernst and Pittler published a letter with a critique of the methodology used in one of the meta-analyses of clinical trials of homeopathy. Most importantly, professional homeopaths and conventional scientists criticize the choice of remedy or the condition to which it was applied or both. The design and follow-up in migraine studies has been criticized extensively by one of the world's leading homeopaths, Vithoulkas (personal communication, 1997). Most of the Arnica studies have been designed with either an inappropriate dosing regimen or an inappropriately chosen procedure. In most positive studies on homeopathy, the outcome measures were subjective and poorly quantifiable. 3. Few well-designed studies have been reproduced by independent research teams. This situation exists for two major reasons: lack of sufficient funding and lack of a sufficient number of well-trained homeopaths qualified and interested to participate in research. 4. More rigorous educational programs on homeopathy for professionals need to be encouraged. Most of the existing programs are designed for consumers; academic continuing medical education-quality courses are needed. Meanwhile, while the debate around homeopathy still continues in conventional medical circles, the general public has been using the services of homeopathic practitioners and homeopathic remedies increasingly. In many countries, homeopathy and other complementary modalities have been integrated successfully into a larger armamentarium for the modern physician. According to a study published in 1995 in the Journal of the American Board of Family Practice, 69% of family practice physicians expressed interest in learning more about homeopathy. Increasing public and professional interest calls for attempts to study homeopathy in a more systematic way and to provide quality academic overview for medical practitioners. The growing number of complementary and alternative medicine centers affiliated with major teaching hospitals should provide a solid interface between evidence-based biologic medicine and many emerging complementary and alternative medicine modalities, including homeopathy.