Pain and Opioid Use: Evidence for Integrating Acupuncture Into Treatment Planning.

The epidemics of pain and opioid use pose unique challenges. Comprehensive approaches are required to address minds, bodies and spirits of individuals who live with pain and/or opioid use. The lack of an effective "quick fix" for either condition necessitates developing effective, innovative and multi-disciplinary avenues for treatment. This analytic article reviews epidemiological and demographic factors associated with pain and with opioid use and additional challenges posed by the Covid-19 epidemic. Several large-scale studies and meta-analyses have examined the role of acupuncture as a nonpharmacological approach to pain management as well as a component of comprehensive strategies to address opioid use disorder. We review and describe these in the context of safety, effectiveness, access and cost-related factors. With one in four U.S. hospitals as well as 88% of Veterans Health Administration facilities incorporating acupuncture, the feasibility of mobilizing and scaling up these treatment resources is being developed and demonstrated. We also identify potential facilitators and barriers to implementing acupuncture treatment. As part of a multi-disciplinary approach to pain management and/or opioid use disorder, we suggest that integrating acupuncture into treatment protocols may represent a viable strategy that is based on and consistent with public health principles.

Long-Lasting Reduction of Blood Pressure by Electroacupuncture in Patients with Hypertension: Randomized Controlled Trial.

Background: Acupuncture at specific acupoints has experimentally been found to reduce chronically elevated blood pressure. Objective: To examine effectiveness of electroacupuncture (EA) at select acupoints to reduce systolic blood pressure (SBP) and diastolic blood pressures (DBP) in hypertensive patients. Design: Two-arm parallel study. Patients: Sixty-five hypertensive patients not receiving medication were assigned randomly to one of the two acupuncture intervention (33 versus 32 patients). Intervention: Patients were assessed with 24-hour ambulatory blood pressure monitoring. They were treated with 30-minutes of EA at PC 5-6+ST 36-37 or LI 6-7+GB 37-39 once weekly for 8 weeks. Four acupuncturists provided single-blinded treatment. Main outcome measures: Primary outcomes measuring effectiveness of EA were peak and average SBP and DBP. Secondary outcomes examined underlying mechanisms of acupuncture with plasma norepinephrine, renin, and aldosterone before and after 8 weeks of treatment. Outcomes were obtained by double-blinded evaluation. Results: After 8 weeks, 33 patients treated with EA at PC 5-6+ST 36-37 had decreased peak and average SBP and DBP, compared with 32 patients treated with EA at LI 6-7+GB 37-39 control acupoints. Changes in blood pressures significantly differed between the two patient groups. In 14 patients, a long-lasting blood pressure-lowering acupuncture effect was observed for an additional 4 weeks of EA at PC 5-6+ST 36-37. After treatment, the plasma concentration of norepinephrine, which was initially elevated, was decreased by 41%; likewise, renin was decreased by 67% and aldosterone by 22%. Conclusions: EA at select acupoints reduces blood pressure. Sympathetic and renin-aldosterone systems were likely related to the long-lasting EA actions.

Ayurvedic therapy (shirodhara) for insomnia: a case series.

BACKGROUND: Insomnia is one of the most common complaints faced by primary care practitioners after pain. Non-pharmacological management of Insomnia that is noninvasive is gaining interest among patients with insomnia. PURPOSE: To determine the feasibility of recruiting and retaining participants in a clinical trial on shirodhara, Ayurvedic oil dripping therapy, for insomnia in the United States and also to investigate the therapeutic usefulness of Shirodhara for insomnia using standardized outcome measures. DESIGN: Case series. STUDY INTERVENTION AND DATA COLLECTION: Shirodhara with Brahmi oil was done for 45 minutes on each participant for 5 consecutive days. Insomnia Severity Index (ISI) was used to evaluate the severity of insomnia as well as to determine the response to Shirodhara therapy. Data were collected at baseline, end of the treatment (day 5) and 1 week after the treatment ended (follow-up). RESULTS: Two males and eight females with a mean age of 40 years (range 23 to 72), SD ± 14.2, were enrolled in the study. One dropped out of the study, but all remaining nine participants experienced improvement at the end of treatment. The percentage of improvement range varied from 3.85% to 69.57%. At follow-up, most participants continued to improve. Comparison of means between baseline and day 5 indicated an overall significant improvement (P < .005), but in a comparison of baseline vs 1 week posttreatment the improvement was not significant (P < .089). No adverse events were reported during the study. CONCLUSION: Shirodhara with Brahmi oil may be beneficial for moderate to severe insomnia. It is feasible to recruit and retain participants for such therapies in the United States. It is important to validate these findings and investigate the mechanism of action using a larger sample and rigorous research design.

Effects of acupuncture for cancer pain and quality of life - a case series.

BACKGROUND: Many cancer patients seek complementary and alternative medicine (CAM) including acupuncture to manage their cancer-related symptoms or side effects of treatments. Acupuncture is used to manage cancer pain and improve quality of life (QoL). This study aimed to conduct a preliminary study on a case series to evaluate the feasibility of acupuncture for treating cancer pain and to collect preliminary data on the effectiveness of acupuncture in treating cancer pain and improving QoL. METHODS: A semi-standardized acupuncture treatment comprising one to three treatment sessions (20-30 minutes per session) per week for 8 weeks was provided by four licensed acupuncturists, who had more than 5 years of clinical experience, at the University Health Center. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C3) and a visual analogue scale (VAS) for pain rating were used as the outcome measures to assess pain and QoL. Data were collected at baseline, immediately after 2, 4, 6, and 8 weeks of treatment and at 4 weeks after treatment completion (week 12). RESULTS: Two males and five females with a median age of 66 years (range: 44-71 years) completed the study. For the VAS, the percentage of improvement ranged between 18% and 95%. The baseline mean raw score was reduced from 51 mm to 36 mm at the end of week 8 and to 23 mm at the end of week 12. The percentage of overall QoL improvement ranged between 20% and 100%. The mean raw score for QoL improved with time. The baseline score was increased from 55 to 69 at the end of treatment (week 8) and to 73 after the follow-up (week 12). CONCLUSIONS: This pilot study on a case series showed that acupuncture might be beneficial for reducing pain and improving QoL in cancer patients.

Influence of comorbidities on improvement of fibromyalgia symptoms when treated with acupuncture: a short report.

BACKGROUND: Fibromyalgia syndrome (FMS) is associated with chronic widespread pain, mood alteration, and disability. A definitive treatment plan has not been identified. The genesis of FMS is unclear and generally occurs in women. PURPOSE: To determine whether patient-identified most disruptive comorbidity (MDC) secondary to FMS may have mediated recovery for individual patients. This is a probative analysis of data from an effectiveness study published in the March 2006 issue of Alternative Therapies in Health and Medicine. (2006;12(2):34-41.) METHODS: The American College ofRheumatology (ACR) criteria for FMS was used in participant selection; 21 participants completed the study. RESULTS: The original outcome study indicated significant changes on standardized measures using specific points and numbers of treatment within an 8-week period. The preliminary data on influence ofMDC on improvement were differential related to self-report MDC by patients. CONCLUSIONS: For all MDCs combined, participants experienced significant improvement at 8 weeks of treatment. Participants with irritable bowel syndrome as their MDC generally had a lower percentage of improvement than other MDC cohort groups. This finding has implications for treatment.

Do chiropractors identify with complementary and alternative medicine? Results of a survey.

OBJECTIVES: Chiropractic in the United States exhibits characteristics of both mainstream health care and complementary and alternative medicine (CAM). The purpose of this project was to investigate the opinions of a sample of chiropractic faculty and practitioners on the appropriate classification of their profession, in terms of CAM versus mainstream. DESIGN: This was a descriptive study conducted by means of an electronically administered survey to a sample of chiropractic college faculty and practicing chiropractors. SAMPLE POPULATION: The faculty sample consisted of all faculty members holding Doctor of Chiropractic (D.C.) degrees at 4 chiropractic colleges, 2 in the Midwest and 2 in southern California. The practitioner sample consisted of all 108 participants, located in 32 states in the United States, in a chiropractic practice-based research network. SURVEY INSTRUMENT: The survey instrument was based on one used with permission from its authors, who had developed and used it to gather information about respondents' concepts and definitions of health and disease, in order to compare the broad categories of practitioners-mainstream medicine, integrated medicine (IM), and CAM. RESULTS: Of 191 D.C. faculty invited to participate, 71 (37%) completed the survey. Of the 108 practicing D.C.s invited to participate, 61 (57%) completed the survey. Of the total sample of 132, 69% did not agree that chiropractic should be categorized as CAM. Twenty-seven percent (27%) of 132 thought that chiropractors should be classified as IM; 20% of practitioners and 6% of faculty considered chiropractic mainstream medicine. CONCLUSIONS: The majority (69%) of the chiropractors in this sample rejected being characterized as CAM practitioners, showing some preference for the term IM (27%).

Herbal treatments of asthma: a systematic review.

BACKGROUND: Asthma is a condition, often chronic, characterized by respiratory symptoms, variable airflow limitation and/or airway hyper-reactivity with symptoms causally related to family history, environmental influences, exposure to viruses and allergens as examples. The high economic burden associated with asthma is associated primarily with health care costs, missed work or school days. This systematic review was conducted to determine the study quality of articles investigating ayurvedic/collateral herbs, the effectiveness/efficacy and safety profile, as reported in the studies. METHODS: Literature searches were conducted using PubMed, EMBASE, Mantis, Ovid, Annotated Bibliography of Indian Medicine, and Cochrane library to identify published trials on herbal medicines for asthma of which Ayruvedic herbals are a subset. Randomized Controlled Trials (RCTs) and Quasi-Experimental Designs (QEDs) were included in this systematic review. The classic Jadad Scale, Singh RCT Scale with additional domains than Jadad, Safety Scoring Scale for clinical trials and the Singh QED Scale based on expanded features of QEDs were used to assess study quality. Herbs included in Traditional Chinese Medicine were excluded from this review. Forty-two articles were retrieved and 37 studies were ultimately reviewed utilizing 3 independent evaluators/1 arbitrator. RESULTS: Articles reviewed indicated benefit from most of the herbs used either as a primary or adjunctive treatment for Asthma. Study quality was mixed and therefore caution in interpretation of findings of usefulness of these herbals must be suggested. Limited safety information was mixed and generally was related to GI symptoms, though one herbal investigated reported more serious side effects. CONCLUSIONS: Herbs may be useful in treatment of asthma. There is insufficient evidence to make recommendations for or against the use of these herbals. Established effectiveness must be balanced with study quality and safety profile for the herb.

Ayurvedic and collateral herbal treatments for hyperlipidemia: a systematic review of randomized controlled trials and quasi-experimental designs.

BACKGROUND: Ischemic heart disease (IHD) is a leading cause of morbidity and mortality in both developing and developed countries. An underlying cause of IHD involves retention and deposit of serum lipids in coronary arteries, decreasing blood flow. Drugs (conventional and herbal) are used to lower levels of serum cholesterol to help prevent IHD. The Ayurvedic medicine pharmacopoeia identified herbs that might contribute to a decrease in cholesterol and therefore reduce the risk of IHD. METHODS: Literature searches were conducted at 3 points: 2003, 2004, and 2007. Databases searched included PubMed, the National Library of Medicine, the National Center for Complementary and Alternative Medicine, Ovid, and EBSCO Information Services, and other search strategies also were used. Each article was assessed for quality by 3 people, and discrepancies were resolved by arbitration using a fourth person, who also read and scored each article. Additional assessments of safety using a scale and determination of reported efficacy/effectiveness of the randomized controlled trials (RCTs) and quasi-experimental designs (QEDs) were made. RESULTS: RCTs generally received high quality scores and improved by decade of publication. More than 50% of garlic, more than 80% of guggul, and 100% of Arjuna RCTs reported product effectiveness. Safety scores did not improve by decade. The QEDs received medium and high quality scores, and 93% of them reported effectiveness. The QEDs had a higher mean score for safety reporting than the RCTs. CONCLUSIONS: Many studies received high quality scores and noted safety information and reported effectiveness or efficacy in a clear manner. This finding was not consistent with other systematic reviews that have found the highest reported efficacy/ effectiveness in studies of poorer quality. Ayurvedic herbs reviewed here should be considered by physicians when trying to manage hyperlipidemia in their patients.

Interactive atlas of histology: a tool for self-directed learning, practice, and self-assessment.

PURPOSE: An interactive atlas of histology was developed for online use by chiropractic students to enable them to practice and self-assess their ability to identify various histological structures. This article discusses the steps in the development, implementation, and usefulness of an interactive atlas of histology for students who take histology examinations. METHODS: The atlas was developed by digitizing images imported through a video-microscope using actual microscope slides. Leica EWS 2100 and PowerPoint software were used to construct the atlas. The usefulness of the atlas was assessed through a comparison of histology exam scores between four classes before and four classes after the use of the atlas. Analysis of admissions data, including overall grade point average (GPA), science and nonscience GPA, and a number of course units, was done initially to avoid any identifiable differences in the academic competency between the two being compared. A survey of the students was also done to assess atlas usefulness and students' satisfaction with the atlas. RESULTS: Analysis of histology exam scores showed that the average scores in the lab exam were significantly higher for the classes that used the atlas. Survey results showed a high level of student satisfaction with the atlas. CONCLUSION: The development and use of an online interactive atlas of histology for chiropractic students helped to improve lab exams scores. In addition, students were satisfied with the features and usefulness of this atlas.

Effectiveness of acupuncture in the treatment of fibromyalgia.

CONTEXT: Fibromyalgia syndrome (FMS) is a prevalent musculoskeletal disorder associated with pain, mood state alteration, and disability. A structured and effective treatment plan for palliative care has not been established. The genesis of FMS is not clear. FMS occurs primarily in adult women. DESIGN: Using a quasi-experimental clinical design and following the criteria of the American College of Rheumatology (ACR), for FMS, 21 participants completed the study. The mean age was 53.6 years. The data were collected at baseline and at 1 and 2 months. Acupuncture treatments included 17 points for FMS symptoms, and 8 outcome measures were collected. RESULTS: The Fibromyalgia Impact Questionnaire (FIQ) showed significant differences at 1 and 2 months. For the SF-12, 3 subscales showed significant differences between baseline and 2 months. Four of 6 items were significantly changed. The mean number of general health symptoms was significantly decreased by 2 months. For the Catastrophe Index, significant differences were found for baseline vs 2 months. Pain threshold scores were significantly different at end of treatment for 5 bilateral tender points. There was significant improvement in Beck Depression items for both 1- and 2-month periods. In a multivariate regression model, 5 covariates were included--age, number of weeks in treatment, number of doctors treating, number of general symptoms, and baseline FIQ score. The results indicated significant age effect. This analysis showed that the higher the FIQ score, the more positive the change experienced by study participants. Number of weeks in treatment, number of doctors who treated, and total number of general health symptoms did not have a significant effect on outcomes. CONCLUSIONS: Significant improvement was experienced by participants at 8 weeks of treatment. Acupuncture treatment as delivered was effective at reducing FMS symptoms in this outcome study.

Safety and effectiveness of an L-lysine, zinc, and herbal-based product on the treatment of facial and circumoral herpes.

CONTEXT: L-lysine, an essential amino acid, inhibits normal replication of Herpes simplex virus (HSV), shortening the normal course and duration of the disease. This study was conducted to determine the effectiveness of a combination of L-lysine with botanicals and other nutrients in relieving the symptoms of facial and circumoral herpes. METHODS: This small pilot study was conducted using an outcome (open-label) model. Thirty male and female participants (15 in each group) meeting the inclusion/exclusion criteria were admitted to the study. The 10 outcome measures used to monitor the sores were tingling, itching, burning, tenderness, prickling, soreness, bump/swelling, small blister(s), oozing blister(s), and crusting, as well as before-and-after photographs of the lesion, and a daily diary. RESULTS: At the end of treatment the ointment produced full resolution in 40 percent of the participants by the third day and in 87 percent by the end of the sixth day. A cold sore episode may last up to 21 days without treatment. CONCLUSIONS: Overall data indicated significant improvement in participants by the sixth day of treatment for all but two participants. There were no adverse effects reported during this study.

Dangshen (Codonopsis pilosula) and Bai guo (Gingko biloba) enhance learning and memory.

CONTEXT: An exploration of the usefulness of several common Chinese herbs used for Acquisition and Retention singly or in combination is required. OBJECTIVE: To test (1) whether Gingko biloba (Bai guo) in combination with Codonopsis pilosula (Dangshen) or Gingko biloba (GB) alone could enhance memory acquisition and retention of normal human subjects, better than a placebo and (2) to investigate whether the overall health status can be affected by these supplements. DESIGN: A double blind randomized placebo controlled trial design was used to determine the efficacy of these two products compared to placebo. PARTICIPANTS AND SETTING: Sixty participants, aged 21- 60 years, who were either students or faculty of the Southern California University of Health Sciences. INTERVENTION: Each combination capsule was made up of 75mg of Codonopsis pilosula total glycosides and 40mg GB extract. Each GB capsule consisted of 40mg of Gingko biloba as an aqueous extract and. The placebo pill was similar in shape and color to that of the other two capsules. All the participants regardless of the group were instructed to take one pill twice a day with food. OUTCOME MEASURES: The primary outcome measure was a computerized, standardized acquisition and retention test provided by Digital Acumen, Inc. The secondary outcome measures were the SF-12 and the Medical Symptom Questionnaire ( 1997 healthcomm International, Inc. And Immuno Laboratories, Inc.) RESULTS: Mean age was 28 years; almost two thirds of the sample were males. The study adopted repeated measure analysis using data from three measurement points for between group analysis. GB group was compared to placebo, and CPG/GB group was also compared to placebo. These individual comparisons were made to determine whether the active products produced better results than chance. The between groups findings indicate that both products are better than placebo at producing improvements in acquisition and retention and overall health status. CONCLUSION: In our participant population, the combination product seems to be better than GB alone in improving the cognitive function and overall health.

The effectiveness of Commiphora mukul for osteoarthritis of the knee: an outcomes study.

CONTEXT: Ayurveda, the traditional system of healthcare in India, has many remedies for Osteoarthritis (OA). One of the ingredients most commonly found in Ayurvedic arthritis formulas is guggul, an oleoresin of the herb Commiphora mukul (CM). The authors have conducted both preclinical and clinical investigations of guggul for reduction of pain, stiffness, and improved function, and to determine tolerability in older patients with a diagnosis of OA of the knee. METHODS: The study was conducted using an outcome, quasi-experimental, model. Thirty male and female participants meeting the inclusion/exclusion criteria, with a score of 2 or more on the Kellegran-Lawrence scale for at least 1 knee, were admitted in the study. CM was administered in capsule form (500 mg concentrated exact delivered TID) along with food. The WOMAC Total Score was used as a primary outcome measure. VAS scales, 6-minute walk-test, and WOMAC subscales were used as outcome measures. RESULTS: At the end of treatment, there was a significant difference in the scores of the primary and secondary outcome measures. On the primary measure, WOMAC total score, participants were significantly improved (P < 0.0001) after taking the supplement for 1 month and continued to improve at the 2-month marker and follow-up. Secondary measures of pain in the VAS format demonstrated participant improvement; however, mood state, and current pain were not significantly different (P < 0.05) than baseline until the 2 month assessment (P < 0.001). CONCLUSIONS: Overall data indicate significant improvement for participants during the trial in both scales and objective measures used for assessment purposes. There were no side effects reported during the trial. CM appears to be a relatively safe and effective supplement to reduce symptoms of OA.