Felix J. Saha

The Effect of Traditional Cupping on Pain and Mechanical Thresholds in Patients with Chronic Nonspecific Neck Pain: A Randomised Controlled Pilot Study

Introduction. Cupping has been used since antiquity in the treatment of pain conditions. In this pilot study, we investigated the effect of traditional cupping therapy on chronic nonspecific neck pain (CNP) and mechanical sensory thresholds. Methods. Fifty CNP patients were randomly assigned to treatment (TG, n = 25) or waiting list control group (WL, n = 25). TG received a single cupping treatment. Pain at rest (PR), pain related to movement (PM), quality of life (SF-36), Neck Disability Index (NDI), mechanical detection (MDT), vibration detection (MDT), and pressure pain thresholds (PPT) were measured before and three days after a single cupping treatment. Patients also kept a pain and medication diary (PaDi, MeDi) during the study. Results. Baseline characteristics were similar in the two groups. After cupping TG reported significantly less pain (PR: −17.9 mm VAS, 95%CI −29.2 to −6.6; PM: −19.7, 95%CI −32.2 to −7.2; PaDi: −1.5 points on NRS, 95%CI −2.5 to −0.4; all P < 0.05) and higher quality of life than WL (SF-36, Physical Functioning: 7.5, 95%CI 1.4 to 13.5; Bodily Pain: 14.9, 95%CI 4.4 to 25.4; Physical Component Score: 5.0, 95%CI 1.4 to 8.5; all P < 0.05). No significant effect was found for NDI, MDT, or VDT, but TG showed significantly higher PPT at pain-areas than WL (in lg(kPa); pain-maximum: 0.088, 95%CI 0.029 to 0.148, pain-adjacent: 0.118, 95%CI 0.038 to 0.199; both P < 0.01). Conclusion. A single application of traditional cupping might be an effective treatment for improving pain, quality of life, and hyperalgesia in CNP.

Integrative oncology for breast cancer patients: introduction of an expert-based model

BackgroundMalignant breast neoplasms are among the most frequent forms of cancer in the Western world. Conventional treatment of breast cancer may include surgery, hormonal therapy, chemotherapy, radiation and/or immunotherapy, all of which are often accompanied by severe side effects. Complementary and alternative medicine (CAM) treatments have been shown to be effective in alleviating those symptoms. Furthermore, with patient survival rates increasing, oncologists, psychologists and other therapists have to become more sensitive to the needs of cancer survivors that go beyond than the mere alleviation of symptoms. Many CAM methods are geared to treat the patient in a holistic manner and thus are also concerned with the patient’s psychological and spiritual needs.DiscussionThe use of certain CAM methods may become problematic when, as frequently occurs, patients use them indiscriminately and without informing their oncologists. Herbal medicines and dietary supplements, especially, may interfere with primary cancer treatments or have other detrimental effects. Thus, expertise in this highly specialized field of integrative medicine should be available to patients so that they can be advised about the benefits and negative effects of such preparations and practices.Being a beneficial combination of conventional and CAM care, integrative oncology makes possible the holistic approach to cancer care. The concept of integrative oncology for breast cancer is jointly practiced by the Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, academic teaching hospital of the University of Duisburg-Essen, and the Breast Center at Kliniken Essen-Mitte in Germany. This model is introduced here; its scope is reviewed, and its possible implications for the practice of integrative medicine are discussed.SummaryEvidence-based integrative care is crucial to the field of oncology in establishing state-of-the-art care for breast cancer patients.

Craniosacral Therapy for the Treatment of Chronic Neck Pain: A Randomized Sham-controlled Trial

Objectives:With growing evidence for the effectiveness of craniosacral therapy (CST) for pain management, the efficacy of CST remains unclear. This study therefore aimed at investigating CST in comparison with sham treatment in chronic nonspecific neck pain patients. Materials and Methods:A total of 54 blinded patients were randomized into either 8 weekly units of CST or light-touch sham treatment. Outcomes were assessed before and after treatment (week 8) and again 3 months later (week 20). The primary outcome was the pain intensity on a visual analog scale at week 8; secondary outcomes included pain on movement, pressure pain sensitivity, functional disability, health-related quality of life, well-being, anxiety, depression, stress perception, pain acceptance, body awareness, patients’ global impression of improvement, and safety. Results:In comparison with sham, CST patients reported significant and clinically relevant effects on pain intensity at week 8 (−21 mm group difference; 95% confidence interval, −32.6 to −9.4; P=0.001; d=1.02) and at week 20 (−16.8 mm group difference; 95% confidence interval, −27.5 to −6.1; P=0.003; d=0.88). Minimal clinically important differences in pain intensity at week 20 were reported by 78% within the CST group, whereas 48% even had substantial clinical benefit. Significant between-group differences at week 20 were also found for pain on movement, functional disability, physical quality of life, anxiety and patients’ global improvement. Pressure pain sensitivity and body awareness were significantly improved only at week 8. No serious adverse events were reported. Discussion:CST was both specifically effective and safe in reducing neck pain intensity and may improve functional disability and the quality of life up to 3 months after intervention.

Gua Sha bei Migräne in der stationären Entzugsbehandlung von medikamenteninduziertem Kopfschmerz

Gua Sha is a therapeutic method of Traditional Chinese Medicine (TCM) widely used in Asia, particulary in the treatment of chronic pain. By use of the surface-frictioning technique (called ‘Gua’) petechiae and a skin rash similar to millet-seed (called ‘Sha’) are induced. As first observations on the application of that method have been promising, we present the case of a 72-year-old woman. The patient who suffered from chronic headaches, highly profited from Gua Sha during her 14- day inpatient multimodal treatment. This case provides first evidence that Gua Sha is effective in the treatment of headaches. Further research and clinical trials are required to corroborate that evidence.

The Benefit of a Mechanical Needle Stimulation Pad in Patients with Chronic Neck and Lower Back Pain: Two Randomized Controlled Pilot Studies

Objectives. The objective was to investigate whether a treatment with a needle stimulation pad (NSP) changes perceived pain and/or sensory thresholds in patients with chronic neck (NP) and lower back pain (BP). Methods. 40 patients with chronic NP and 42 patients with chronic BP were equally randomized to either treatment or waiting list control group. The treatment group self-administered a NSP over a period of 14 days. Pain ratings were recorded on numerical rating scales (NRSs). Mechanical detection thresholds (MDTs) and pressure pain thresholds (PPTs) were determined at the site of maximal pain and in the adjacent region, vibration detection thresholds (VDT) were measured at close spinal processes. The Northwick Park Neck Pain Questionnaire (NPQ) and the Oswestry Disability Index (ODI) were utilized for the NP and BP study, respectively. Results. NRS ratings were significantly reduced for the treatment groups compared to the control groups (NP: P = .021 and BP: P < .001), accompanied by a significant increase of PPT at pain maximum (NP: P = .032 and BP: P = .013). There was no effect on VDT and MDT. The NPQ showed also a significant improvement, but not the ODI. Conclusions. The mechanical NSP seems to be an effective treatment method for chronic NP and BP.

Pain Modulation by Meditation and Electroacupuncture in Experimental Submaximum Effort Tourniquet Technique (SETT)

CONTEXT Although acupuncture and meditation are widely utilized in the clinical treatment of pain, trials to evaluate their efficacy and modes of action under experimental conditions have yielded equivocal results. OBJECTIVE This feasibility study investigated whether electroacupuncture (EA) and meditation effectively relieve pain within a well-established ischemic pain paradigm (submaximum effort tourniquet technique, SETT). DESIGN In this semirandomized trial, experienced meditators were compared with nonmeditators. The nonmeditating subjects were randomly assigned to either an EA group or a nontreatment group. SETTING The trial was conducted at the Department of Complementary and Integrative Medicine, University of Duisburg-Essen, Essen, Germany. PARTICIPANTS Eight Vipassana meditators (mean experience hours = 2,626.8 ± 1,602.3 hours SD) and 40 control subjects were enrolled. INTERVENTIONS SETT (250 mm Hg, time limit = 30 minutes, pain rating limit = 10) was applied twice (baseline vs treatment) on the nondominant arm; EA was applied to the contralateral acupoints LI4 and LI10 (stimulation 20 minutes prior to and throughout the SETT); meditators were asked to meditate throughout the whole experimental procedure. MAIN OUTCOME MEASURE Pain ratings were obtained every three minutes on a numerical rating scale (0-10). The ratio of the tolerated time to the ratings served as the pain tolerance index. RESULTS At baseline, meditators exhibited significantly greater pain tolerance than the other two groups. During the second or treatment session, pain sensitivity did not change significantly in the nontreatment group, whereas pain tolerance significantly increased and pain ratings decreased to the level of meditation-induced analgesia in the EA group. Electroacupuncture induced no additional pain control benefit for meditators.

Isolated and Combined Effects of Electroacupuncture and Meditation in Reducing Experimentally Induced Ischemic Pain: A Pilot Study

Acupuncture and meditation are promising treatment options for clinical pain. However, studies investigating the effects of these methods on experimental pain conditions are equivocal. Here, the effects of electroacupuncture (EA) and meditation on the submaximum effort tourniquet technique (SETT), a well-established, opiate-sensitive pain paradigm in experimental placebo research were studied. Ten experienced meditators (6 male subjects) and 13 nonmeditators (6 male subjects) were subjected to SETT (250 mmHG) on one baseline (SETT only) and two treatment days (additional EA contralaterally to the SETT, either at the leg on ST36 and LV3 or at the arm on LI4 and LI10 in randomized order). Numeric Rating Scale (NRS) ratings (scale 0–10) were recorded every 3 min. During baseline, meditation induced significantly greater pain tolerance in meditators when compared with the control group. Both the EA conditions significantly increased pain tolerance and reduced pain ratings in controls. Furthermore, EA diminished the group difference in pain sensitivity, indicating that meditators had no additional benefit from acupuncture. The data suggest that EA as a presumable bottom-up process may be as effective as meditation in controlling experimental SETT pain. However, no combined effect of both the techniques could be observed.

Integrative medicine for chronic pain: A cohort study using a process-outcome design in the context of a department for internal and integrative medicine.

Introduction:Integrative medicine inpatient treatment has been shown to improve physical and mental health in patients with internal medicine conditions. The aim of this study was to investigate the effectiveness of a 2-week integrative medicine inpatient treatment in patients with chronic pain syndromes and the association of treatment success with patient-related process variables. Methods:Inpatients with chronic pain syndromes participating in a 2-week integrative medicine inpatient program were included. Patients’ pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were measured on admission, discharge, and 6 months after discharge. Likewise process variables including ability and will to change, emotional/rational disease acceptance, mindfulness, life and health satisfaction, and easiness of life were assessed. Results:A total of 310 inpatients (91% female, mean age 50.7 ± 12.4 year, 26.5% low back pain, and 22.9% fibromyalgia) were included. Using mixed linear models, significant improvements in pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were found (all P < 0.05). Ability to change and implementation, disease acceptance, mindfulness, life and health satisfaction, and light heartedness/easiness likewise improved (all P < 0.05). Improved outcomes were associated with increases in process variables, mainly ability to change and implementation, disease acceptance, life and health satisfaction, and light heartedness/easiness (R2 = 0.03–0.40). Conclusions:Results of this study suggest that a 2-week integrative medicine inpatient treatment can benefit patients with chronic pain conditions. Functional improvements are associated with improved ability to change and implementation, disease acceptance, and satisfaction.

The Effects of Cupping Massage in Patients with Chronic Neck Pain - A Randomised Controlled Trial

Background: Chronic neck pain is a major public health burden with only limited evidence for the effectiveness of complementary therapies. This study aimed to test the efficacy of cupping massage in patients with neck pain. Patients and Methods: Patients with chronic non-specific neck pain were randomly assigned to cupping massage or a wait list control. The intervention group received 5 cupping massages on a twice-weekly basis while the control patients continued their usual treatments. The primary outcome measure was neck pain intensity (0-100 mm visual analogue scale (VAS)) after 3 weeks. Secondary outcomes included pain on movement, functional disability, health-related quality of life, mechanical detection and pain thresholds and adverse events. Results: 50 patients (52.6 ± 10.3 years, 92% female) were randomised to either cupping massage or a wait list (N = 25 each). Patients in the cupping group reported significantly less neck pain post intervention (difference per protocol -14.3 mm, 95% confidence interval (CI) -27.7 to -1.0, p = 0.037; difference intention-to-treat -10.8 mm, 95% CI -21.5 to -0.1, p = 0.047). Significant group differences in favour of the intervention were further found for pain on movement (p = 0.019) and functional disability (p < 0.001), the quality-of-life subscales pain (p = 0.002) and mental health (p = 0.003) and the mental component summary (p = 0.036). Changes were also found for pressure pain sensitivity at the site of maximal pain (p = 0.022). Five adverse events were reported. Conclusions: Cupping massage appears to be effective in reducing pain and increasing function and quality of life in patients with chronic non-specific neck pain. More rigorous studies are needed to confirm and extend these results.

Efficacy of Cabbage Leaf Wraps in the Treatment of Symptomatic Osteoarthritis of the Knee: A Randomized Controlled Trial.

Objectives:Osteoarthritis (OA) of the knee is one of the most common chronic diseases among older adults. This study aimed to test the effects of cabbage leaf wraps (CLWs) in the treatment of symptomatic OA. Methods:Patients with OA of the knee at stages II to III (Kellgren-Lawrence) were randomly assigned to 4 weeks of treatment with CLWs (daily for at least 2h), topical pain gel (TPG) (10 mg diclofenac/g, at least once daily), or usual care (UC). The primary outcome measure was pain intensity (VAS) after 4 weeks. Secondary outcomes included functional disability Western Ontario and McMaster Universities Arthritis Index (WOMAC), quality of life (SF-36), self-efficacy (Arthritis Self-Efficacy Scale-D), physical function (30 s Chair Stand Test), pressure pain sensitivity (PPT), satisfaction, and safety after 4 and 12 weeks. Results:In total, 81 patients were included in this study (42 women, 65.9±10.3 y). After 4 weeks patients in the CLW group reported significantly less pain compared with those in the UC group (difference, −12.1; 95% [confidence interval] CI, −23.1, −1.0; P=0.033) but not when compared with the TPG group (difference, −8.6; 95% CI, −21.5, 4.4; P=0.190). Significant effects were also found in WOMAC, SF-36, 30-second Chair Stand Test, and PPT scores in the CLW group compared with the UC group. Compared with TPG, effects from CLW were found for WOMAC after 4 weeks and for quality of life after 12 weeks. Patients were satisfied with both active interventions, and except for 2 adverse events in both groups the applications were well tolerated. Conclusions:CLWs are more effective for knee OA than UC, but not compared with diclofenac gel. Therefore, they might be recommended for patients with OA of the knee. Further research is warranted.