Journal of Integrative and Complementary Medicine

To explore the effects of noninvasive interactive neurostimulation used as an adjunct to usual care, on pain and other symptoms in adults with osteoarthritis of the knee.

Randomized, sham-controlled trial.

A university in the southern United States.

Thirty-seven (37) adults with knee osteoarthritis (based on American College of Rheumatology diagnostic criteria).

Seventeen (17) noninvasive interactive neurostimulation (active or sham) sessions over 8 weeks with a week 12 follow-up.

Eleven-point numeric rating scale for weekly pain; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), patient global assessment, and Short-Form Health Survey (SF-36) completed at baseline and weeks 4, 8, and 12.

For the main outcome, pain, the differences between the groups over time did not reach statistical significance (all p > 0.05). However, a clinically important reduction in pain (defined as a 2-point or 30% reduction on an 11-point numeric rating scale) was maintained at week 12 by the active noninvasive interactive neurostimulation group (2.17 points, 34.55% reduction) but not the sham group (1.63, 26.04% reduction). Pain improved over time in participants regardless of group membership (numeric rating scale average pain, p = 0.002; numeric rating scale worst pain, p < 0.001; and WOMAC pain, p < 0.001), as did WOMAC function, WOMAC stiffness, and WOMAC total score (all p < 0.001). Repeated measures ANOVA revealed a statistically significant difference between the groups over time for the SF-36 Vitality scale, F (3, 105) = 3.54, p = 0.017. In addition, the active device group improved on the patient global assessment from baseline to week 8 compared to the sham device group, F (1, 35) = 4.025, p = 0.053.

In this pilot study, clinically important reductions in knee pain were maintained at week 12 in the active, but not the sham, noninvasive interactive neurostimulation group. Further study of this noninvasive therapy is warranted.

The purpose of this study was to describe patients who seek treatment at an acupuncture and Oriental medicine teaching clinic in the United States, and to systematically measure and describe patients' responses after treatment using a prospective study design.

This is a prospective survey of clinic patients at intake and one month following the initial treatment.

Data were collected in an acupuncture and Oriental medicine teaching clinic located in Bloomington, Minnesota.

Of 661 new patients who met eligibility criteria, 485 consented to participate.

Patients were administered two self-report questionnaires: one prior to their initial treatment, and a second sent by mail one month later.

Data collected at intake included demographics such as age, gender, race, ethnicity, education, and employment, as well as main presenting complaint and chronicity. Patients were also asked at intake whether they had consulted with another health care provider, if they were under continued care, and if they had previous experience with Traditional Chinese Medicine (TCM) treatment. Outcome measures included severity, improvement, and satisfaction. Patients were additionally asked if they continued with TCM care for their presenting condition.

Demographics of patients presenting to this teaching clinic were similar to those reported in other outpatient TCM settings. The majority of patients had no previous experience with TCM, and a large percentage was referred by students. Pain was the most common presenting condition, followed closely by wellness care. One month following treatment, most patients reported improvement and satisfaction with care.

Standardized data collection and follow-up resulted in a description of patients and outcomes in an acupuncture and Oriental medicine teaching clinic, which can be used for research, educational, quality assurance, and marketing purposes.

Chinese acupuncture is widely accepted in western countries, and a number of clinical trials are testing Chinese acupuncture, especially for chronic low back pain (cLBP). However, little is known about how practitioners perform acupuncture treatment in daily clinical work and whether treatment styles differ among practitioners and countries.

To investigate whether styles of Chinese acupuncture treatment for cLBP are heterogeneous among different practitioners and countries.

Literature review, a prospective survey of international experts using a questionnaire with open and closed questions, and personal interviews.

Data were collected from 18 experts in 10 different countries. The typical treatment regimen for cLBP, based on a composite of experts' responses, consisted of 11 sessions lasting 25 minutes each, held twice weekly. The typical practitioner inserted 12 needles, would select individual points according to channels and syndromes, and would identify syndromes such as kidney deficiency (yin and yang), cold dampness, and qi and blood stagnation. Preferred points were BL 23, BL 40, GB 34, BL 54, BL 60, BL 54, and Huatuo, although there was a high variation in additional local and distal points. Generally speaking, no expert would administer fewer than 6 treatments, omit Ahshi points, restrict needle insertion to 1 cm or less, or adhere solely to fixed points for all patients.

For the first time it has been shown that there is a broad consistency in fundamental aspects of Chinese acupuncture for cLBP across different kinds of practitioners and different countries. These data can be used as minimal standards for the design and funding of future clinical trials.

Many claims have been made regarding the therapeutic efficacy of acupuncture. However, most controlled clinical studies have been limited to treatment of pain-related disorders and do not provide objective, quantifiable data for analysis. Traditional acupuncture has been applied to chronic obstructive pulmonary disease (COPD). However, only a few studies have been performed to determine the efficacy of this treatment. This study was conducted to determine whether a combination of traditional acupuncture treatment and conservative treatment for COPD improves dyspnea on exercise.

This was a prospective trial with matched-pair parallel groups of patients from the departments of respiratory internal medicine of Gifu University of Medicine, Meiji University of Oriental Medicine, and Gifu Red Cross Hospital, Japan. Thirty patients were divided into the acupuncture group (n = 15) and the control group (n = 15). The control group received conservative treatment with medication only. The acupuncture group received acupuncture treatments once a week for 10 weeks, in addition to conservative treatment with medication. The main outcome measure was the Modified Borg dyspnea scale after the 6-minute walk test.

The acupuncture group had significantly better results on the Borg scale than the control group after 10 weeks (2.2 ± 2.7 versus 6.4 ± 3.4, p = 0.0001, 95% confidence interval, −5.10 to −2.35, paired t-test). The 6-minute walk distance and oxygen saturation at the minimum rate improved significantly in the acupuncture group compared with the control group.

This study demonstrated that acupuncture contributed to the reduction of COPD-related dyspnea on exercise in 15 matched-pair parallel subjects.

The objective of this study was to evaluate the effect of t'ai chi (TC) on heart rate variability (HRV) from baseline to 9 months in patients with coronary artery disease (CAD).

A comparative trial was undertaken comparing the acute and long-term effect of TC on HRV in patients with CAD.

Sixty-one (61) subjects with CAD undergoing percutaneous intervention or coronary bypass grafting for a period of more than 1 month were recruited from the clinics of cardiology and cardiovascular surgery at Chia-Yi Christian Hospital, Taiwan.

The experimental group (n = 22) practiced weekly 90-minute Yang's style TC for 9 months and the control group (n = 39) continued their normal daily physical activity.

HRV was recorded at baseline, 3 months, 6 months, and 9 months in the control group. Resting HRV was recorded before TC exercise and recovery HRV was recorded 30 minutes post TC at the same four time points in the experimental group.

The change in the normalized low-frequency power, normalized high-frequency power, and the low-/high-frequency power ratio between resting and post-TC was significantly different at 9 months when compared with those at baseline, 3, and 6 months. The mean difference in normalized low-frequency power and the low/high-frequency power ratio changed from positive values at baseline, 3, and 6 months to negative values at 9 months. However, there were no significant differences in resting HRV between the patients in TC and control groups in either time domain or frequency domain HRV indices.

The change in heart rate and HRV between resting and post-TC suggested that TC exercise could enhance vagal modulation. The potential beneficial effect of long-term regular TC exercise in patients with CAD merits further investigation.

Fibromyalgia is a common, chronic pain condition for which patients frequently use complementary and alternative medicine, including Reiki. Our objective was to determine whether Reiki is beneficial as an adjunctive fibromyalgia treatment.

This was a factorial designed, randomized, sham-controlled trial in which participants, data collection staff, and data analysts were blinded to treatment group.

The study setting was private medical offices in the Seattle, Washington metropolitan area.

The subjects were comprised 100 adults with fibromyalgia.

Four (4) groups received twice-weekly treatment for 8 weeks by either a Reiki master or actor randomized to use direct touch or no touch (distant therapy).

The primary outcome was subjective pain as measured by visual analog scale at weeks 4, 8, and 20 (3 months following end of treatment). Secondary outcomes were physical and mental functioning, medication use, and health provider visits. Participant blinding and adverse effects were ascertained by selfreport. Improvement between groups was examined in an intention-to-treat analysis.

Neither Reiki nor touch had any effect on pain or any of the secondary outcomes. All outcome measures were nearly identical among the 4 treatment groups during the course of the trial.

Neither Reiki nor touch improved the symptoms of fibromyalgia. Energy medicine modalities such as Reiki should be rigorously studied before being recommended to patients with chronic pain symptoms.

Chronic back pain affects a large proportion of both the general population and of military veterans. Although numerous therapies exist for treating chronic back pain, they can be costly and tend to have limited effectiveness. Thus, demonstrating the efficacy and cost-effectiveness of additional treatment alternatives is important. The purpose of our study was to examine the benefits of a yoga intervention for Veterans Administration (VA) patients.

VA patients with chronic back pain were referred by their primary care providers to a yoga program as part of clinical care. Before starting yoga, a VA physician trained in yoga evaluated each patient to ensure that they could participate safely.

The research study consisted of completing a short battery of questionnaires at baseline and again 10 weeks later.

Questionnaires included measures of pain, depression, energy/fatigue, health-related quality of life, and program satisfaction. Paired t-tests were used to compare baseline scores to those at the 10-week follow-up for the single group, pre–post design. Correlations were used to examine whether yoga attendance and home practice were associated with better outcomes.

Baseline and follow-up data were available for 33 participants. Participants were VA patients with a mean age of 55 years. They were 21% female, 70% white, 52% married, 68% college graduates, and 44% were retired. Significant improvements were found for pain, depression, energy/fatigue, and the Short Form-12 Mental Health Scale. The number of yoga sessions attended and the frequency of home practice were associated with improved outcomes. Participants appeared highly satisfied with the yoga instructor and moderately satisfied with the ease of participation and health benefits of the yoga program.

Preliminary data suggest that a yoga intervention for VA patients with chronic back pain may improve the health of veterans. However, the limitations of a pre–post study design make conclusions tentative. A larger randomized, controlled trial of the yoga program is planned.

The aim of this study was to investigate the influence of herbal medicine (HM) prescribed by doctors of Korean medicine (KMD) on liver function in Korea.

For this multicenter, prospective, observational study, we enrolled patients who wished to take HM prescribed by KMD for various medical purposes in Korea. One hundred and twenty-two (122) patients took HM for an average of 20.6 ± 8.4 (mean ± standard deviation) days, and completed questionnaires.

Liver function tests (LFTs) were performed before (first test) and after each HM treatment (second test). For LFT, aspartate aminotransferase, alanine aminotransferase, total bilirubin (t-Bil), direct bilirubin, alkaline phosphatase, and γ-glutamyl transferase were measured.

There were no significant changes in LFT data between the first and second tests, except in the t-Bil level. However, all data of total bilirubin level in second test were within normal range, except only one patient. Multivariate analysis did not identify any herb that significantly increased t-Bil; hence no hepatotoxic herb was found. Twenty-one (21) of the 122 patients were abnormal on first testing, and 10 at the second testing. Of the patients taking herbs, 4 changed from normal to abnormal and 15 from abnormal to normal (p = 0.019).

The current study showed that ingestion of HM prescribed by KMD did not increase the frequency of abnormal LFTs, at least in the short term.

In previous studies, the relaxant, anticholinergic (functional antagonism), and antihistaminic effects of various extracts and oils of Nigella sativa seed have been demonstrated. In the present study, the prophylactic effect of a boiled aqueous extract of nigella seed on chemical war victims was examined.

Forty (40) chemical war victims were randomly divided into control group (20 patients) and study group (20 patients), and they were studied for 2 months. In the study group 0.375 mL/kg of 50 g% boiled extract and in the control group a placebo solution were administered daily throughout the study. Respiratory symptom score and wheezing were recorded in the beginning (first visit), 30 days after treatment (second visit), and at the end of the study (third visit). Pulmonary function tests (PFTs) were also measured, and the drug regimen of the patients was evaluated at 3 different visits.

All respiratory symptoms, chest wheezing, and PFT values in the study group significantly improved in the second and third visits compared to the first visit (p < 0.05 to p < 0.001). In addition, further improvement of chest wheezing and some PFT values on the third visit were observed compared to the second visit in this group (p < 0.05 to p < 0.001). In the third visits, all PFT values and most symptoms in the study group were significantly different from those of the control group (p < 0.01 to p < 0.001). However, in the control group, there were only small improvements in some parameters in the second and third visits. The use of inhaler and oral β-agonists and oral corticosteroid in the study group decreased at the end of the study, while there were no obvious changes in use of the drugs in control subjects.

The results of this study suggest a prophylactic effect of N. sativa on chemical war victims and warrant further research regarding this effect.

Previously, we found that qi-stimulating events exerted similar frequency-specific effects on the blood pressure pulse spectrum. Because coffee and qi induce similar stimulatory psychological responses, we aimed to determine whether they would induce similar pulse effects. Such a relationship would suggest a close linkage between the physiologic mechanisms underlying the psychostimulatory responses and vascular effects of coffee and qi. Therefore, the profound investigations into the mechanisms underlying the effects of coffee on the central nervous system and the vascular system may help to elucidate the underlying physiology mechanisms of qi.

Each test subject took three rounds of 150 mL coffee (0.1 g/kg, 0.05 g/kg, 0.05 g/kg) in a 30-minute interval. The subject's pulses were recorded at the end of each round. The changes in the test subject's pulse spectrum between before and after coffee consumption were compared with changes induced by a water placebo.

Both coffee and qi caused the intensities of the third, sixth, and ninth harmonics of the pressure pulse spectrum to be relative peaks to their neighboring harmonics.

Our results suggest that the coffee effect may be considered a qi-stimulating event, and there is a common physiologic factor determining the psychostimulatory responses of qi and coffee as well as their effects on the cardiovascular system, which results in a specific frequency pattern in the blood pulse spectrum. Adenosine, which is the main physiologic compound affected by coffee, might also be the key factor affected by qi.

As interest in and use of complementary and alternative medicine (CAM) providers continues to grow, it is important to understand which characteristics incline people to experiment with and become frequent consumers of CAM practitioners. The purpose of this study was to examine how personality, as assessed by the five-factor model, was related to the breadth, frequency, and types of provider-based CAM use. Relationships between the personality factors (Openness, Conscientiousness, Extraversion, Agreeableness, and Neuroticism) and motives for consulting CAM providers were also explored.

A convenience sample of 184 current CAM clients recruited through the offices of 12 conventional medicine and 17 CAM practitioners completed a survey package including measures of health status, CAM use, personality, and motivations for using CAM.

Only Openness and Agreeableness were consistently linked to different dimensions of CAM use, with each associated with consultations with CAM practitioners, and homeopaths and naturopaths in particular. After controlling for sociodemographic and health status variables in the stepwise multiple regressions, Openness was associated with the variety of CAM providers tried, whereas Agreeableness was linked to both the breadth and frequency of CAM consultations. Holistic and proactive health motivations were associated with both personality factors, and Agreeableness was also associated with motives reflecting a desire for shared decision-making.

Findings indicate that individuals who are open and agreeable, as described by the five-factor model of personality, consult CAM practitioners to a greater extent. The motives involved suggest a congruency between CAM and their own perspectives regarding health and patient–provider interactions, which may have implications for understanding treatment adherence and outcomes.

Amyotrophic lateral sclerosis (ALS) of nonmutant superoxide dismutase (SOD) type may be caused by toxicity of the reduced glutathione (GSH) precursors glutamate and cysteine, and sulfite (a metabolite of cysteine), which accumulate when one or more of the enzymes needed for GSH synthesis are defective.

A case is examined where the patient exhibited elevated sulfur on a hair mineral analysis, elevated blood cysteine, positive urine sulfite, elevated urine glutamate, and low whole blood GSH. During the time when strict dietary and supplement measures normalized the patient's whole blood GSH, blood cysteine, and urine sulfite, the patient did not experience additional physical decline. The possible causes of abnormalities of the patient's laboratory test results, as well as the nutrition measures used to normalize them, are discussed in relationship to the functions and importance of cysteine, sulfite, and glutamate in glutathione metabolism in ALS.

Since elevated plasma cysteine has been reported in other ALS patients, sulfite and cysteine toxicity may be involved in other cases of ALS. Patients with ALS with nonmutant-SOD should be tested for sulfite toxicity, cysteine, glutamate and GSH levels, and whether they have low levels of GSH metabolism enzymes. Since glutamate metabolism appears to be inhibited by sulfite, research on the effect of sulfite on glutamate levels in patients with ALS should be pursued. Life might be prolonged in those patients with ALS with sulfite toxicity by closely monitoring the blood cysteine and urine sulfite levels and minimizing their dietary intake, as well as increasing GSH by using sublingual GSH. A long-term solution might be found through research to determine methods to increase GSH synthesis without using sulfur-containing supplements that may add to the cysteine and sulfite toxicity.