Kyung-Eun Choi

Mindfulness-Based Stress Reduction for Integrative Cancer Care – a Summary of Evidence

This paper provides a comprehensive overview of the relevant existing evidence, and critically appraises the use of mindfulness-based stress reduction (MBSR) in cancer care. Furthermore, a meta-analysis was conducted in order to investigate the effect of MBSR on quality of life (QoL), mood, and distress. Besides 6 reviews (5 systematic, 1 meta-analytic) which are reported separately, a total of 19 original research papers fully met the inclusion criteria for the systematic review. The 19 original papers consisted of 5 randomised controlled trials (RCTs), 4 non-randomised controlled trials (NRCTs), 9 observational studies (OS) and 1 two-arm observational study. The included outcome measures were QoL, mood, and distress. Cohen’s effect size d was computed for each category. Estimating the effect on QoL, a total of n = 248 patients out of 6 studies was included and the overall effect size was 0.29 (95% confidence interval (CI) 0.17–0.40; p ≤ 0.00005). Calculating the effect on mood, a total of n = 411 patients out of ten studies were included, and the overall effect size was 0.42 (95% CI 0.26–0.58; p < 0.0001). Reduction in distress revealed an overall effect size of 0.58 (95% CI 0.45–0.72; p < 0.0001; n = 587 patients out of 15 studies). MBSR programmes can improve QoL and mood, and reduce distress in cancer patients. However, there is an urgent need for more high quality RCTs implementing adequate controls, longer follow-up periods, sufficient samples sizes, clear descriptions of patients’ psychological profiles, and the accompanying utilisation of qualitative measures.

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.

Randomized Controlled Trial of Pulsating Cupping (Pneumatic Pulsation Therapy) for Chronic Neck Pain

Background: Pneumatic pulsation therapy may combine the effects of cupping therapy and massage. This study investigated the effect of pneumatic pulsation therapy on chronic neck pain compared to standard medical care. Methods: 50 patients (79.15% female; 46.17 ± 12.21 years) with chronic nonspecific neck pain were randomized to treatment group (TG; n = 25) or control group (CG; n = 25). The TG received 5 pneumatic pulsation treatments over a period of 2 weeks utilizing a mechanical device. Treatment was applied as a combination of moving and stationary pulsating cupping. Main outcome measure was pain intensity in pain diaries (numerical rating scale). Secondary outcome measures included functional disability (NDI), quality of life (SF-36), and pain at motion. Sensory thresholds, including pressure pain threshold, were measured at pain-related sites. Results: After the intervention, significant group differences occurred regarding pain intensity (baseline: 4.12 ± 1.45 in TG and 4.20 ± 1.57 in CG; post-intervention: 2.72 ± 1.62 in TG and 4.44 ± 1.96 in CG; analysis of covariance: p = 0.001), NDI (baseline: 25.92 ± 8.23 and 29.83; post-intervention: 20.44 ± 10.17 and 28.83; p = 0.025), and physical quality of life (baseline: 43.85 ± 7.65 and 41.66 ± 7.09; post-intervention: 47.60 ± 7.93 and 40.49 ± 8.03; p = 0.002). Further significant group differences were found for pain at motion (p = 0.004) and pressure pain threshold (p = 0.002). No serious adverse events were reported. Conclusion: Pneumatic pulsation therapy appears to be a safe and effective method to relieve pain and to improve function and quality of life in patients with chronic neck pain.

Can a Multimodal Mind-Body Program Enhance the Treatment Effects of Physical Activity in Breast Cancer Survivors With Chronic Tumor-Associated Fatigue? A Randomized Controlled Trial

Background. Chronic fatigue is one of the most restricting symptoms following primary breast cancer treatment, but clinical studies on symptom management are rare. The objective was to evaluate the impact of a multimodal mind–body program (MMMT), including moderate physical activity as compared with a walking intervention alone, on chronic fatigue symptoms of women with stage I to IIIA breast cancer. Patients and Methods. Sixty-four women (mean age = 56.7 years) suffering from chronic fatigue after active tumor treatment were randomly assigned to either an experimental or a control (n = 32 each) intervention (10 weeks). Fatigue, quality of life (QoL), functional well-being, anxiety, and depression were measured with standard questionnaires at baseline, after 10 weeks, and after 3 months. Results. Compared with baseline, both groups had reduced fatigue scores after treatment without any significant difference between groups (posttreatment, Δ = −0.3, confidence interval = −1.6 to 1.0, P = .678; follow-up, Δ = −0.4, confidence interval = −1.8 to 0.9, P = .510). All patients also improved regarding QoL and general functional well-being. Conclusion. Since both interventions reduced fatigue symptoms and enhanced QoL to a similar extent, we observed no verifiable add-on effect of the MMMT regarding fatigue symptoms. Considering the higher costs with additional expenditure related to MMMT, home-based walking intervention is recommended.

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.

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.

The Western model of integrative oncology — the contribution of Chinese medicine

Western integrative oncology (IO) combines conventional mainstream medicine with complementary and alternative medicine (CAM) for the care of cancer patients. Since it includes patient orientation and the holistic approach of many CAM options, IO offers not only preventive measures, but also a wide spectrum of treatment modalities for all stages of illness, from the acute phases through the rehabilitation period. Many therapeutic methods of IO are supported by scientific evidence, for example, dietary and nutritional counseling, exercise, and mind-body medicine, among others. IO also includes therapeutic interventions of traditional Chinese medicine (TCM). At present acupuncture, qigong, and foot massage play an important role in the Western care of cancer patients. However, unlike in China, in Western countries herbal remedies are usually only used during those periods in which chemotherapy is not applied in order to avoid herb-drug interactions. Instead, acupuncture is widely used to manage the side-effects that often accompany chemotherapy. This paper focuses on the role of Chinese medicine in Western IO and reviews the scope and limitations of IO in the care of cancer patients today. The future challenges of IO will also be discussed in this paper.

P02.164. The effects of five sessions of cupping massage on chronic non-specific neck pain: a randomized controlled pilot study

Methods 50 patients with cNP (age 53.3 ± 10.4 yrs) were examined at baseline and then randomized to treatment (TG) or standard medical care (SMC). Data were collected at baseline (T1) and T2 (for TG after treatment). TG received five treatment sessions of CM, while the SMC group was waiting. Subjective outcome measures included visual analogue scale for pain (VAS), Neck Pain Disability Index (NDI), and quality of life (SF36). Neurophysiologic testing included Quantitative Sensory Testing subtests mechanical detection threshold (MDT), pressure pain threshold (PPT), vibration threshold (VDT) and two-point discrimination (2PD) at the point of maximum pain (Pmax), close to maximum pain (Pclose), and hand and foot as control areas. ANCOVA analyses were conducted across post-pre differences with baseline values as covariates.

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.