Complementary and Alternative Medicine Therapies for Chronic Pain

Pain afflicts over 50 million people in the US, with 30.7% US adults suffering with chronic pain. Despite advances in therapies, many patients will continue to deal with ongoing symptoms that are not fully addressed by the best conventional medicine has to offer them. The patients frequently turn to therapies outside the usual purview of conventional medicine(herbs, acupuncture, meditation, etc.) called complementary and alternative medicine(CAM). Academic and governmental groups are also starting to incorporate CAM recommendations into chronic pain management strategies. Thus, for any physician who care for patients with chronic pain, having some familiarity with these therapies—including risks and benefits—will be key to helping guide patients in making evidence-based, well informed decisions about whether or not to use such therapies. On the other hand, if a CAM therapy has evidence of both safety and efficacy then not making it available to a patientwho is suffering does not meet the need of the patient. We summarize the current evidence of a wide variety of CAM modalities that have potential for helping patients with chronic pain in this article. The triad of chronic pain symptoms, ready access to information on the internet, and growing patient empowerment suggest that CAM therapies will remain a consistent part of the healthcare of patients dealing with chronic pain.     

日本和中国的慢性病人多方面健康控制点的研究

1 Introduction Behavioural modification is considered to be a fundamental element of education for patients,with the aim of a healthy life. Since patients with chronic diseases have lifestyles that are already acquired, it is not so easy to change them, even during treatment. Therefore, it is important to know about the health belief of patients; where the health locus of control is located in their concept of belief,     

MANIPULATIVE TREATMENT OF SUBLUXATION OF THE SACRO-1LIAC JOINT

Subluxation of the sacro-iliac joint is acommon cause of low back pain.Manipula-tive technics for anterior and posterior su-bluxation are described in detail.BetweenJanuary 1981 and April 1982 a series of 65cases were treated by manipulative methods,with 60 patients(92.3%)showing satisfactoryresults.Such manipulation is effective,sim-ple and safe.     

Comparison of simple discectomy and instrumented posterior lumbar interbody fusion for treatment of lumbar disc herniation combined with Modic endplate changes

Background The purpose of this retrospective study was to compare the surgical outcomes of simple discectomy and instrumented posterior lumbar interbody fusion （iPLIF） in patients with lumbar disc herniation and Modic endplate changes.Our hypothesis was that iPLIF could provide better outcome for patients with refractory lumbar disc herniation and Modic changes （LDH-MC）.Methods Ninety-one patients with single-segment LDH-MC were recruited.All patients experienced low back pain as well as radicular leg pain,and low back pain was more severe than leg pain.Forty-seven patients were treated with discectomy and 44 were treated with iPLIE The outcomes of both low back pain and radicular leg pain using visual analogue scale （VAS） as well as the clinical outcome related to low back pain using Japanese Orthopaedic Association （JOA） score were assessed before and 18 months after surgery,respectively.Results Both low back and leg pain were significantly improved 18 months after simple discectomy and iPLIE Compared to patients undergoing simple discectomy,low back pain was significantly reduced in patients undergoing iPLIE but there was no significant difference in leg pain between two groups.Solid fusion was achieved in all patients who underwent iPLIF.Conclusions In patients with LDH-MC,iPLIF can yield significantly superior outcome on the relief of low back pain compared to simple discectomy.Simple discectomy can relieve radicular leg pain as efficient as iPLIE Accordingly,iPLIF seems to be a reliable treatment for patients with LDH-MC and predominant low back pain.     

Anterior herniation of lumbar disc induces persistent visceral pain: discogenic visceral pain

Background Visceral pain is a common cause for seeking medical attention. Afferent fibers innervating viscera project to the central nervous system via sympathetic nerves. The lumbar sympathetic nerve trunk lies in front of the lumbar spine. Thus, it is possible for patients to suffer visceral pain originating from sympathetic nerve irritation induced by anterior herniation of the lumbar disc. This study aimed to evaluate lumbar discogenic visceral pain and its treatment. Methods Twelve consecutive patients with a median age of 56.4 years were enrolled for investigation between June 2012 and December 2012. These patients suffered from long-term abdominal pain unresponsive to current treatment options. Apart from obvious anterior herniation of the lumbar discs and high signal intensity anterior to the herniated disc on magnetic resonance imaging, no significant pathology was noted on gastroscopy, vascular ultrasound, or abdominal computed tomography （CT）. To prove that their visceral pain originated from the anteriorly protruding disc, we evaluated whether pain was relieved by sympathetic block at the level of the anteriorly protruding disc. If the block was effective, CT-guided continuous lumbar sympathetic nerve block was finally performed. Results All patients were positive for pain relief by sympathetic block. Furthermore, the average Visual Analog Scale of visceral pain significantly improved after treatment in all patients （P 〈0.05）. Up to 11/12 patients had satisfactory pain relief at 1 week after discharge, 8/12 at 4 weeks, 7/12 at 8 weeks, 6/12 at 12 weeks, and 5/12 at 24 weeks. Conclusions It is important to consider the possibility of discogenic visceral pain secondary to anterior herniation of the lumbar disc when forming a differential diagnosis for seemingly idiopathic abdominal pain. Continuous lumbar sympathetic nerve block is an effective and safe therapy for patients with discogenic visceral pain.     

Clinical Study of Qingluo Tongbi Granules in Treating 63 Patients with Rheumatoid Arthritis of the Type of Yin-deficiency and Heat in Collaterals

The study is to observe the therapeutic effects of Qingluo Tongbi Granules (清络通痹颗粒QTG) in patients with rheumatoid arthritis (RA) and the changes of immune indexes. In this series there are 63 patients with RA of the type of yin-deficiency and heat in collaterals treated with QTG as the treated group and 55 patients of the same type treated with Tripterygium glycosides as the control group. As a results, in the treated group, the curative rate is 9.52% and markedly effective rate 38.10%, with a total effective rate of 90.48%, while the corresponding rates in the control group are 0, 20.00% and 83.64%, respectively. The curative effect in the treated group is better than that in the control group (P<0.05). Besides, no obvious adverse reactions are found in the treated group. Therefore it is concluded that as a new medicinal preparation QTG is safe and effective in the treatment of RA.     

Hand self-Shiatsu for sleep problems in persons with chronic pain: a pilot study

OBJECTIVE： Difficulty falling asleep （sleep latency） and staying asleep （sleep maintenance） are common problems for persons living with pain. Research demonstrates that sleep problems are, in turn, related to exacerbation of chronic pain. There is a growing body of evidence for a range of pragmatic, non-pharmacological sleep interventions that can potentially be incorporated into pain management programs. This study looks at the outcome of teaching patients with musculoskeletal pain standardized pre-bedtime hand self-Shiatsu （HSS） to reduce sleep latency. METHODS： A case series design, with participants acting as their own controls, was selected to facilitate hypothesis generation for this novel, under-researched intervention. Sleep efficiency, latency and maintenance, sleep beliefs, pain intensity and basic participant demographics were collected at baseline with actigraphy and standardized self-report questionnaires. After one week of baseline data collection, the HSS intervention was taught to participants. Follow-up data were collected at 2 and 8 weeks post-intervention. RESULTS： Data collected at baseline and the two follow-up periods revealed no apparent changes in the objective actigraphy data. However a trend toward improved self-reported sleep latency （time to fall asleep） and sleep duration （time spent asleep） emerged. A number of participants reported they were more concerned with increasing their period of unbroken sleep as opposed to their total sleep time and it is possible that HSS may be useful to be applied during nighttime awakenings as well as before bed. None of the participants reported adverse effects of the intervention. CONCLUSION： These preliminary findings are promising and future studies exploring the mechanism of action and with stronger control of treatment fidelity are indicated.     

Ulcerative Colitis Treated by Acupuncture at Jiaji Points （EX-B2） and Tapping with Plum-blossom Needle at Sanjiaoshu （BL22） and Dachangshu （BL 25）——A Report of 43 Cases

Ulcerative colitis (UC) is an inflammatory disease with unknown causes, which involves the rectum and colon and relates to autoimmunity. As a commonly encountered, difficult and complicated disease of the digestive tract, it is clinically characterized by diarrhea, mucous bloody stool often with pus,abdominal pain, and rectal tenesmus. The majority of the patients have a chronic and intermittent course of disease,     

Microsurgical dorsal root entry zone coagulation for chronic neuropathic pain due to spinal cord and/or cauda equina injuries

Chronic pain is a major problem for patients suffering from spinal cord injury （SCI）.The prevalence of SCI-related pain ranges from 48% to 94% depending on the method of data acquisition and type of pain considered.1 SCI-related neuropathic pain is classified into three subtypes：above-,at-,and below-lesion-level pain.After SCI,it is believed that the dorsal horn of the injured spinal cord expressed increased electrical activity.2 Thus,the neurosurgical procedures for coagulation in the dorsal root entry zone （DREZ） have proved to be most effective in chronic neuropathic pain due to SCI.The aim of this study was to describe the effect and safety ofmicrosurgical DREZ coagulation in treating chronic SCI-related neuropathic pain.     

Anesthetic management of a child with relapsing polychondritis: a case report

Relapsing polychondritis （RP） is a rare disorder of unknown cause. It is characterized by recurrent inflammation of cartilage and connective tissue. Airway complications are the most serious manifestations. The anesthetic management of patients with RP is challenging Airway management is of primary importance because of the potential for collapse of supporting airway structures with resulting inability to intubate and ventilate the patient. Although it tends to occur in middle age （〉 40 years）, it has been reported in younger individuals. Herein we report a case of anesthetic management of a child with RP for tracheotomy combined with insertion of T tube stent and review several other cases.     

Psychosociophysical Factors of Low Back Pain： What Role do They Play for Iranian Nurses？

Objective To examine the effect of psychosocial and physical factors, and demographic variables on low back pain in nurses. The roles of physical and psychosocial factors to low back pain investigated separately, however psychosociophysical model for it require further research especially among nurses. Methods Participants included 261 males and 162 females randomly selected from Namazi, Shahid Faghihi, Shahid Beheshty, and Shahid Chamran hospitals in Shiraz, Iran. A demographic questionnaire, the Low Back Pain Scale, Psychosocial Factor Scale and Physical Factor Scale were used in the study. Results The resulting data showed that in this particular sample psychosocial and physical factors relatively explain low back pain for total sample and both genders, when using a multiple regression model. The MANOVA indicated that gender, marital status, age, education, ethnicity, hospital and ward, type of working shift, type of responsibility in hospital, level of education, professional experience, and aged-group demographical variables are effective in low back pain, and physical and psychosocial factors related to LBP for nurses. Conclusions Significant findings were explained within a psychosociophysical framework for low back pain prevention among nurses and further research trends.     

Comparison of postural control between healthy subjects and individuals with nonspecific low back pain during exposure to visual stimulus

Background Low back pain （LBP） is a common clinical problem.Many researchers have demonstrated that LBP disorders have difference in sensory strategies for postural control.Optokinetic stimulation （OKS） of optic flow has been widely applied to study its effect on vision,but has not been applied to LBP.Here we used OKS on different surfaces to investigate the characteristics of chronic nonspecific LBP （CNLBP） posture control,so as to provide new theoretical and experimental data for further recognizing CNLBP and enriching its treatment.Methods Fifteen individuals with CNLBP （age range 25-40 years） and 15 age and gender-matched control subjects were recruited.Each subject,while standing on a stable or soft surface,was exposed to random-dot patterns projected on a large screen,with the dots displaying expansion （＋） and contraction （-） and velocities including 80°,40°,and 20° per second.The visual stimulus used a ＂stimuli-interval＂ pattern.The peak velocity,different phases＇ standard deviation （SD） of the anterior-posterior centre of pressure （COP） displacements and the total length of the medial-lateral COP sway （LML） for stable surface and soft surface were recorded by force platform.Results The main effect of surface on all parameters was significant,while the main effect of group and OKS showed no significance with the exception of peak velocity （F（3,95）=3.6,P=0.01） and A2 （F（5,140）=9.34,P ＜0.01） for which the effect of OKS was significant.The interactions of group by OKS of A2 （F（5,140）=3.65,P ＜0.01） and group by surface by OKS （F（5,140）=2.83,P=-0.02）,and surface by OKS of A1 and A3 （P ＜0.05） were significant.It was reported that significantly more SD in amplitude in the T2 phase was seen in persons with CNLBP when confronting the ＋ 40 stimuli on the soft surface （P ＜0.05） compared to healthy individuals.Conclusions There was no significance between persons with CNLBP and healthy people when using the stable surface.Subjects with LBP showed decreased efficiency of postural adjustment when exposed to more complicated tasks and environments,especially OKS in the expansion direction,and displayed a visual-dependent phenomenon.This result suggested that the treatment of abnormal motor patterns in people with LBP should take the properties of task and environment into account.     

Chinese herbal medicine Xinfeng Capsule in treatment of rheumatoid arthritis： study protocol of a multicenter randomized controlled trial

BACKGROUND： Rheumatoid arthritis （RA）, as a common systemic inflammatory autoimmune disease, affects approximately 1 in 100 individuals. Effective treatment for RA is not yet available because current research does not have a clear understanding of the etiology and pathogenesis of RA. Xinfeng Capsule, a patent Chinese herbal medicine, has been used in the treatment of RA in recent years. Despite its reported clinical efficacy, there are no large-sample, multicenter, randomized trials that support the use of Xinfeng Capsule for RA. Therefore, we designed a randomized, double-blind, multicenter, placebo-controlled trial to assess the efficacy and safety of Xinfeng Capsule in the treatment of RA. METHODS AND DESIGN： This is a 12-week, randomized, placebo-controlled, double-blind, multicenter trial on the treatment of RA. The participants will be randomly assigned to the experimental group and the control group at a ratio of 1：1. Participants in the experimental group will receive Xinfeng Capsule and a pharmaceutical placebo （imitation leflunomide）. The control group will receive leflunomide and an herbal placebo （imitation Xinfeng Capsule）. The American College of Rheumatology （ACR） Criteria for RA will be used to measure the efficacy of the Xinfeng Capsule. The primary outcome measure will be the percentage of study participants who achieve an ACR 20% response rate （ACR20）, which will be measured every 4 weeks after randomization. Secondary outcomes will include the ACR50 and ACR70 responses, the side effects of the medications, the Disease Activity Score 28, RA biomarkers, quality of life, and X-rays of the hands and wrists. The first four of the secondary outcomes will be measured every 4 weeks and the others will be measured at baseline and after 12 weeks of treatment. DISCUSSION： The result of this trial will help to evaluate whether Xinfeng Capsule is effective and safe in the treatment of RA. TRIAL REGISTRATION： This trial has been registered in ClinicalTrials.gov. The identifier is N CT01774877.     

WHO西太区与世界中医药学会联合会中医名词术语国际标准比较研究:津液辨证(英文)

Intraditional Chinese medicine (TCM),the so-called津液refers to all the fluid and liquid flowingand maintaining inside the human body.In Chineselanguage,津液is a phrase composed of twoChinese characters which describes two differentkinds of fluid or liquid in the human body .According to the theory of TCM,津refers to thepart of fluid that is thin in texture and flowss moothly inside the body while液refers to thepart of fluid that is thick in texture and mainlymaintains in the joints of the body to nourish andlubr...     

Efficacy of Different Iron Controlling Fortificants in Wheat Flour in Iron Deficiency

Objective To observe the different impacts of electrolytic iron, FeSO4, and NaFeEDTA on body iron store of anemic school students. Methods Four hundreds anemic students at the age of 11-18 years were divided into four groups. Of which, three consumed different iron fortificants from wheat flour as food vehicle for six months and one consumed non-fortified flour （control）. The fortification level of electrolytic iron, FeSO4, and NaFeEDTA was 60 mg Fe/kg, 30 mg Fe/kg, and 20 mg Fe/kg, respectively. Blood samples were collected at 0, 2, 4, and 6 months and hemoglobin （Hb）, serum ferritin （SF）, and transferrin receptor （TfR） were measured. Results The hemoglobin levels in three intervention groups increased, the increments of Hb in the NaFeEDTA group were significantly higher than that in the other groups. SF and TfR levels increased in the tested groups and body iron store in the NaFeEDTA group was higher than that in the other groups. These parameters did not show any significant changes in the control group. Conclusion NaFeEDTA and FeSO4 tortified wheat flour has positive impacts on iron status in anemic students and NaFeEDTA is more effective than FeSO4, while electrolytic iron is less effective in improving iron store in anemic students.     

Modulating Effects of Chlorogenic Acid on Lipids and Glucose Metabolism and Expression of Hepatic Peroxisome Proliferator-activated Receptor-α in Golden Hamsters Fed on High Fat Diet

Objective To examine the effects of chlorogenic acid （CGA） on lipid and glucose metabolism under a high dietary fat burden and to explore the possible role of peroxisome proliferator-activated receptor-α （PPAR-α） in these effects. Methods Twenty male golden hamsters were randomly divided into CGA treatment group （n=10, given peritoneal injection of CGA solution prepared with PBS, 80 mg CGA/kg body weight daily）, and control group （n=10, given PBS i.p. at the average volume of the treatment group）. Animals in both groups were given 15% high fat diet. Eight weeks after treatment with CGA, the level of biochemical parameters in fasting serum and tissues and the expression of hepatic mRNA and protein PPAR-α were determined. Results Eight weeks after treatment with CGA, the levels of fasting serum triglyceride （TG）, free fatty acid （FFA）, total cholesterol （TC）, low density lipoprotein cholesterol （LDL-C）, high density lipoprotein cholesterol （HDL-C）, glucose （FSG）, and insulin （FSI） were significantly lower in the GGA treatment group than in the control group. CGA also led to higher activity of hepatic lipase （HL） lower contents of TG and FFA in liver, and lower activity of lipoprotein lipase （LPL） in skeletal muscle. Furthermore, CGA significantly elevated significantly elevated the expression level of mRNA and protein expression in hepatic PPAR-α. Conclusion CGA can modify lipids and glucose metabolism, which may be attributed to PPAR-α facilitated lipid clearance in liver and improved insulin sensitivity.     

A （H1N1） Influenza Pneumonia with Acute Disseminated Encephalomyelitis： A Case Report

INTRODUCTION
A 56-year-old Chinese female patient with A （H1N1） influenza pneumonia accompanied by acute disseminated encephalomyelitis （ADEM） of the Central Nervous System （CNS） is described in this article. The patient had typical clinical manifestation, and the diagnosis was reached after MRI and other examinations. From this case, we can conclude that the virus of A （H1N1） influenza can infect CNS, and we should pay more attention to patients of A （H1N1） influenza pneumonia with neurological complications.     

Integrative techniques using acupuncture,Chinese herbal medicine,diet, and supplements for polycystic ovary syndrome： a case report

Patients with a diagnosis of polycystic ovary syndrome （PCOS） are on the rise. About 4%-12% of women are currently estimated to have this condition. It is hypothesized that PCOS appears in women who have long-standing insulin resistance （1R）, which leads to high androgen and testosterone levels; this ultimately disrupts their menstrual cycles. Some researchers attribute IR to genetic factors, although there have been only minute changes in the human genome in the past 20 000 years. However, even with a stable gene pool, genes can be turned on and offby the environment, food and air quality and toxin exposure.