Jae-Heung Cho

Acupuncture for chronic low back pain: a multicenter, randomized, patient-assessor blind, sham-controlled clinical trial.

Study Design. Multicenter, randomized, patient-assessor blind, sham-controlled clinical trial. Objective. To investigate the efficacy of acupuncture treatment with individualized setting for reduction of bothersomeness in participants with chronic low back pain (cLBP). Summary of Background Data. Low back pain is one of the main reasons of disability among adults of working age. Acupuncture is known as an effective treatment of cLBP, but it remains unclear whether acupuncture is superior to placebo. Methods One hundred thirty adults aged 18 to 65 years with nonspecific LBP lasting for at least last 3 months prior to the trial participated in the study from 3 Korean medical hospitals. Participants received individualized real acupuncture treatments or sham acupuncture treatments for more than 6 weeks (twice a week) from Korean Medicine doctors. Primary outcome was change of visual analogue scale (VAS) score for bothersomeness of cLBP. Secondary outcomes included VAS score for pain intensity and questionnaires including Oswestry Disability Index, general health status (Short Form-36), and Beck Depression Inventory (BDI). Results There were no baseline differences observed between the 2 groups, except in the Oswestry Disability Index. One hundred sixteen participants finished the treatments and 3- and 6-month follow-ups, with 14 subjects dropping out. Significant difference in VAS score for bothersomeness and pain intensity score of cLBP has been found between the 2 groups (P < 0.05) at the primary end point (8 wk). In addition, those 2 scores improved continuously until 3-month follow-up (P = 0.011, P = 0.005, respectively). Oswestry Disability Index, the Beck Depression Inventory, and Short Form-36 scores were also improved in both groups without group difference. Conclusion. This randomized sham-controlled trial suggests that acupuncture treatment shows better effect on the reduction of the bothersomeness and pain intensity than sham control in participants with cLBP.

Cervical epidural abscess after cupping and acupuncture

STUDY DESIGN Retrospective case report. OBJECTIVE Report of an uncommon complication of cupping and acupuncture. SUMMARY OF BACKGROUND DATA Epidural abscess after cupping and acupuncture therapies is quite rare. Only a few cases of epidural abscess after acupuncture have been reported. The present report describes a case of cervical epidural abscess that developed after cupping and acupuncture. METHODS A 47-year-old woman presented with swelling and pain in the posterior nuchal region. Magnetic resonance imaging of the cervical spine revealed a well-enhanced epidural mass at the C1-C3 level that was determined to be an epidural abscess. RESULTS The symptoms related to epidural abscess resolved after treatment with antibiotics. CONCLUSION Although a rare complication, epidural abscess is a possibility when applying cupping and acupuncture. Therapists need to be aware of human anatomy in the vicinity of the puncture and must give continuous attention to hygiene throughout the procedure.

Effects of a Brief Qigong-based Stress Reduction Program (BQSRP) in a distressed Korean population: a randomized trial

BackgroundDistressed individuals in Korea may benefit from the practice of mind–body exercises such as Qigong. However, the effectiveness of such techniques needs to be investigated.MethodsFifty participants who were eligible to this study were randomized into a group receiving a 4-week intervention of a brief Qigong-based stress reduction program (BQSRP) or a wait-list control group. Before and after the intervention period, saliva samples were collected and questionnaires were completed on perceived stress, anxiety, “Hwa-Byung” (anger syndrome), and quality of life. Salivary cortisol has emerged in mind-body therapy research as an easy-to-collect, relatively inexpensive, biologic marker of stress. Salivary corisol were collected to evaluate physiological effect of BQSRP. Between-group comparisons of change from baseline to study completion were analyzed by analysis of covariance for the Perceived Stress Scale and independent two sample t- tests for other measures.ResultsCompared with the control group, the BQSRP intervention group displayed significantly larger decreases in Perceived Stress Scale scores (p = 0.0006), State Anxiety scores (p = 0.0028), Trait Anxiety scores (p < 0.0001), personality subscale scores of the Hwa-Byung Scale (p = 0.0321), symptoms scores of the Hwa-Byung Scale (p = 0.0196), and a significantly larger increase in World Health Organization Quality of Life Abbreviated version scores (p s < .05). Salivary cortisol levels were not changed.ConclusionsThe BQSRP appears to be effective in reducing stress perception, anxiety, anger, and improving quality of life (KCT0000056).

Efficacy of a 0.1% Capsaicin Hydrogel Patch for Myofascial Neck Pain: A Double-Blinded Randomized Trial

OBJECTIVE The objective of this study was to evaluate the efficacy of a hydrogel patch containing capsaicin 0.1% compared with a placebo hydrogel patch without capsaicin to treat chronic myofascial neck pain. DESIGN The study was designed as a double-blinded randomized controlled trial. Setting.  The study was set at Kyung-hee University Hospital at Gangdong, Korea. SUBJECTS Sixty-one participants between 18 and 65 years with at least 3 months duration of neck pain and a clinical presentation of myofascial pain syndrome were enrolled in the study from September 1 to November 20, 2010. Interventions.  Participants received capsaicin 0.1% hydrogel patches or control hydrogel patches without capsaicin according to the randomization scheme. All participants were instructed to apply one patch to each side of the neck and shoulder girdle overlying the point of maximal pain for 12 hours daily during the duration of the 4-week study. OUTCOME MEASURES Each participant completed five surveys at baseline, at 2 weeks after the start of treatments, and at the conclusion of the 4-week study. The primary outcome measure was visual analog scale (VAS). Other outcome measures included the Neck Disability Index (NDI), Becks Depression inventory (BDI), Short Form 36 Korean version, and Euroqol 5-D. RESULTS Fifty-seven patients completed the study. The mean VAS, NDI, and BDI scores were significantly decreased at 2 and 4 weeks after the start of the intervention in both groups. There was no significant difference between the two groups in any of the outcome measures. CONCLUSIONS   Future research may help to discern specific effects of capsaicin, trigger point stimulation by application of the patch, and the placebo effect.

Osteogenic differentiation of human mesenchymal stem cells promoted by the crude extracts of the mixture of Cortex mori radicis, Patrinia saniculaefolia

The present study investigated the effect of Cortex mori radicis (CMR) and Patrinia saniculaefolia (PS) on the osteogenic differentiation of the human mesenchymal stem cell. CMR and PS have been used as herbal medicine in traditional Korean medicine for a long time. Mesenchymal stem cells that can differentiate into adipocyte, chondrocyte and osteocyte recently issued as a therapeutic agent for degenerative disease. Here, mesenchymal stem cells isolated from synovial fluid of osteoarthritis patient, were cultured in specific media to differentiate into osteogenesis. Osteogenic differentiated mesenchymal stem cells were confirmed using Von Kossa and Arizarion Red S staining. And, the cells were divided into 4 groups: control group, CMR treated group, PS treated group and mixture treated group. To determine the effect of the herbal samples on the osteogenic mesenchymal stem cell, OCT4, SOX2 and NANOG mRNA expressions, known as the key maintenance factors of mesenchymal stem cell was measured using real-time Polymerase Chain Reaction (PCR). As a result, the maintenance factors, OCT4, SOX2 and NANOG, were more increased in cells treated by CMR, PS and the mixture of two herbs than control group. Therefore, we confirmed the enhancing effect of CMR, PS and their mixture on the osteogenic differentiation of mesenchymal stem cells which derived from the synovial fluid of osteoarthritis patient. This study demonstrates that the effect of the herbal samples on the osteogenic differentiation of human mesenchymal stem cell may have a possibility to be a therapeutic agent for the osteoarthritis patients.

Association between Hypertension and the Prevalence of Low Back Pain and Osteoarthritis in Koreans: A Cross-Sectional Study.

Background Hypertension and musculoskeletal disorders are highly prevalent in adult populations. The objective of this study was to investigate the association between hypertension and prevalence of low back pain (LBP) and osteoarthritis in Koreans. Methods A total 17,128 participants (age ≥20 years) who answered low back pain and osteoarthritis items in the 4th Korean National Health and Nutrition Examination Survey (2007–2009) were analyzed. Odds ratios were calculated using logistic regression and were adjusted for age, sex, income level, education, occupation, BMI, smoking status, alcohol consumption, and physical activity. Results Lifetime prevalence of LBP in hypertensive subjects was 34.4%, and that of osteoarthritis 26.2%. LBP prevalence was significantly lower in hypertensives (fully adjusted OR 0.79; 95% CI 0.70–0.90), and both LBP and osteoarthritis prevalence was significantly lower in participants with systolic blood pressure ≥140mmHg than those with <120mmHg (fully adjusted OR 0.81; 95% CI 0.70–0.94, and 0.81; 95% CI 0.68–0.96, respectively). Prevalence of LBP in subjects with diastolic blood pressure ≥90mmHg was also significantly lower than those with <80mmHg (fully adjusted OR 0.73; 95% CI 0.63–0.85). LBP and osteoarthritis prevalence did not differ by systolic or diastolic blood pressure interval in respondents taking antihypertensive medication. LBP and osteoarthritis prevalence increased with longer hypertension duration (fully adjusted p for trend 0.028, and 0.0008, respectively). Conclusions Hypertension showed an inverse relationship with LBP and osteoarthritis prevalence, which may be ascribed to hypertension-associated hypalgesia, and antihypertensive medication intake and longer hypertension duration attenuated this association.

Acupuncture with non-steroidal anti-inflammatory drugs (NSAIDs) versus acupuncture or NSAIDs alone for the treatment of chronic neck pain: an assessor-blinded randomised controlled pilot study

Objective To investigate the feasibility and sample size required for a full-scale randomised controlled trial of the effectiveness of acupuncture with non-steroidal anti-inflammatory drugs (NSAIDs) for chronic neck pain compared with acupuncture or NSAID treatment alone. Methods A total of 45 patients with chronic neck pain participated in the study. For 3 weeks the acupuncture with NSAIDs treatment group took NSAIDs (zaltoprofen, 80 mg) daily while receiving acupuncture treatment three times a week. The acupuncture treatment group received treatment three times a week and the NSAID treatment group took NSAIDs daily. The primary outcomes were to determine the feasibility and to calculate the sample size. As secondary outcomes, pain intensity and pain-related symptoms for chronic neck pain were measured. Results With regard to enrolment and dropout rates, 88.2% of patients consented to be recruited to the trial and 15.6% of participants were lost to follow-up. The sample size for a full-scale trial was estimated to be 120 patients. Although preliminary, there was a significant change in the visual analogue scale (VAS) for neck pain intensity between the baseline measurement and each point of assessment in all groups. However, there was no difference in VAS scores between the three groups. Conclusions This pilot study has provided the feasibility and sample size for a full-scale trial of acupuncture with NSAIDs for chronic neck pain compared with acupuncture or NSAID treatment alone. Further research is needed to validate the effects of acupuncture with NSAIDs. Clinical Trial Registration NIH ClinicalTrials.gov NCT01205958.

Minimum Clinically Important Difference and Substantial Clinical Benefit in Pain, Functional, and Quality of Life Scales in Failed Back Surgery Syndrome Patients.

Study Design.. Prospective observational 1-year study. Objective.. To determine minimum clinically important difference (MCID) and substantial clinical benefit (SCB) of outcome measures in failed back surgery syndrome (FBSS) patients, as these metrics enable assessment of whether and when an intervention produces clinically meaningful effects in a patient. Summary of Background Data.. Several methods have been devised to quantify clinically important difference, but MCID and SCB for FBSS patients has yet to be determined. Methods.. Patients with persisting/recurrent low back pain (LBP) and/or leg pain after lumbar surgery who completed 16 weeks of treatment (n = 105) at two hospitals in Korea from November 2011 to September 2014 were analyzed. Global perceived effect was used to determine receiver operating characteristic curves in visual analogue scale (VAS), Oswestry disability index (ODI), and short form-36 (SF-36) in an anchor-based approach. Results.. MCIDs for ODI, LBP and leg pain VAS, physical component summary, mental health component summary (MCS), and overall health scores of SF-36 were 9.0, 22.5, 27.5, 10.2, 4.0, and 8.9, and SCBs were 15.0, 32.5, 37.0, 19.7, 19.3, and 21.1, respectively. MCID and SCB area under the curve was ≥0.8, and ≥0.7, respectively. Conclusion.. LBP and leg pain VAS, ODI, and physical component summary of SF-36 may be used to measure responsiveness in FBSS patients. Level of Evidence: 3

The hydrolysed products of iridoid glycosides can enhance imatinib mesylate-induced apoptosis in human myeloid leukaemia cells.

Several studies have demonstrated that deregulated activation of signal transducer and activator of transcription 3 (STAT3) has been associated with survival, proliferation, chemoresistance and angiogenesis of tumour cells. Thus, inhibition of STAT3 expression could be a potent therapeutic approach for cancer treatment. Using several leukaemia cell lines, the effect of the hydrolysed‐catalpol (H‐catalpol) and hydrolysed‐aucubin (H‐aucubin) products on the STAT3 signalling pathway, inhibition of BCR–ABL activation, cellular proliferation and potentiation of imatinib mesylate‐induced apoptosis was investigated. We found that iridoid glycosides (catalpol and aucubin) did not exert any cytotoxicity in the tumour cells, whereas both H‐catalpol and H‐aucubin exhibited significant cytotoxic effects on K562 human myeloid leukaemia cells. Indeed, H‐catalpol and H‐aucubin down‐regulated BCR–ABL phosphorylation and inhibited constitutive STAT3 activation through abrogating upstream JAK2 and c‐Src and constitutive STAT5 activation leading to apoptosis through caspase‐3 activation. Hydrolysed‐catalpol enhanced the apoptosis induced by imatinib mesylate and this correlated with down‐regulation of gene products that mediate cell proliferation (cyclin D1), and cell survival (Bcl‐2, Bcl‐xL and survivin); all known to be regulated by the STAT3. Overall, our results provide novel insight into the role of hydrolysed iridoids in potentially treating leukaemia through the modulation of STAT3 signalling pathway. Copyright

Effects of acupuncture on serum metabolic parameters in premenopausal obese women: study protocol for a randomized controlled trial

BackgroundComplex metabolic changes cause obesity, making weight loss difficult. For this reason, understanding metabolism is important, and considering the shortcomings of conventional treatment options for obesity, acupuncture is a possible option. However, evidence supporting its efficacy on metabolic parameters in obese patients is lacking. The aim of this study is to investigate the effects of acupuncture on serum metabolic parameters in premenopausal obese women.Methods/designThis ongoing study is a randomized, patient-assessor blind, two-arm parallel non-penetrating sham-controlled clinical trial. Eligible participants, premenopausal adult women (19 years of age or older) with a clinical diagnosis of obesity (body mass index of 25 kg/m2 or more) blinded to the treatment received, will be randomly allocated blindly into the real acupuncture treatment group (manual acupuncture plus electroacupuncture, n = 60) or the sham acupuncture control group (sham acupuncture plus placebo acupuncture without electrical stimulation, n = 60) and receive treatment two times a week for a total of 12 sessions over 6 weeks. The primary outcome measure is the serum cholesterol and triglyceride (TG) levels at baseline and endpoint. The secondary outcomes are body weight, body fat mass, muscle mass, waist and hip circumference, other serum metabolic profiles, International Physical Activity Questionnaire (IPAQ), Social Readjustment Rating Scale (SRRS), Stress Response Inventory (SRI), Fatigue Severity Scale (FSS), the Korean version of the Beck Depression Inventory (BDI), and urine metabolites. Adverse events will be assessed at every visit.DiscussionThe results of this trial (which will be available in 2015) will provide important clinical evidence for the effect of acupuncture on serum metabolites and demonstrate how acupuncture can be helpful for the treatment of obesity.Trial registrationTrial registration registered via US National Institutes of Health Clinical Trials registry (ClinicalTrials.gov) on 11 November 2014, identifier: NCT02066090.