Samuel C. Shiflett

Ginkgo biloba Extract: Mechanisms and Clinical Indications

OBJECTIVE Ginkgo biloba may have a role in treating impairments in memory, cognitive speed, activities of daily living (ADL), edema, inflammation, and free-radical toxicity associated with traumatic brain injury (TBI), Alzheimers dementia, stroke, vasoocclusive disorders, and aging. The purpose of this review is to provide a synthesis of the mechanisms of action, clinical indications, and safety of Ginkgo biloba extract. DATA SOURCES Empirical studies, reviews, chapters, and conference proceedings were identified in the following databases: Medline, the Research Council for Complementary Medicine based on the British Library database, and Psychlnfo. Ginkgo biloba, EGb 761, Tanakan, Tebonin, Rokan, and LI 1370 were the principal index terms. STUDY SELECTION AND DATA EXTRACTION Controlled clinical studies with both positive and negative findings are included, in addition to animals studies illustrating mechanisms of activity. DATA SYNTHESIS Ginkgo has shown activity centrally and peripherally, affecting electrochemical, physiologic, neurologic, and vascular systems in animals and humans with few adverse side effects or drug interactions. Ginkgo shows promise in patients with dementia, normal aging, and cerebrovascular-related disorders. Clinical indications include memory, information processing, and ADL. CONCLUSIONS Ginkgo shows promise in treating some of the neurologic sequelae associated with Alzheimers disease, TBI, stroke, normal aging, edema, tinnitus, and macular degeneration. Mechanisms of action may include antioxidant, neurotransmitter/receptor modulatory, and antiplatelet activating factor properties. While safe, caution is advised when recommending ginkgo to patients taking anticoagulants. Future studies should examine dose effects, component activity, mechanisms, and clinical applications.

Culture and Gender Effects in Pain Beliefs and the Prediction of Pain Tolerance

The goals of this study were (a) to explore beliefs about appropriate or normative pain responses among college students in the United States and India and (b) to examine differences in pain tolerance and intensity ratings and the role beliefs play in predicting pain tolerance. Scales to assess beliefs about appropriate pain responses in males and females were completed by college students in both countries. Ratings of pain intensity were then obtained following the cold pressor test. Results indicated that participants in India were less accepting of overt pain expression than those in the United Cross-Cultural Research, Vol. 34 No. 2, May 2000 135-151 States. Females believed that overt pain expression was more appropriate than did males. Consistent with their beliefs, Indian participants had higher pain tolerance than those in the United States, and males had higher pain tolerance than females. Reported pain intensity predicted 28% of the variance in pain tolerance, whereas beliefs predicted an additional 5%.

Effect of Reiki Treatments on Functional Recovery in Patients in Poststroke Rehabilitation: A Pilot Study

OBJECTIVES The three objectives of this study were: (1) to evaluate the effectiveness of Reiki as an adjunctive treatment for patients with subacute stroke who were receiving standard rehabilitation as inpatients, (2) to evaluate a double-blinded procedure for training Reiki practitioners, and (3) to determine whether or not double-blinded Reiki and sham practitioners could determine which category they were in. DESIGN A modified double-blinded, placebo-controlled clinical trial with an additional historic control condition. SETTING The stroke unit of a major rehabilitation hospital. SUBJECTS Fifty (50) inpatients with subacute ischemic stroke, 31 male and 19 female. INTERVENTIONS There were four conditions: Reiki master, Reiki practitioner, sham Reiki, and no treatment (historic control). Subjects received up to 10 treatments over a 2(1/2)-week period in addition to standard rehabilitation. OUTCOME MEASURES Functional independence measure (FIM), and Center for Epidemiologic Studies--Depression (CES-D) measure. RESULTS No effects of Reiki were found on the FIM or CES-D, although typical effects as a result of age, gender, and time in rehabilitation were detected. Blinded practitioners (sham or reiki) were unable to determine which category they were in. Sham Reiki practitioners reported greater frequency of feeling heat in the hands compared to Reiki practitioners. There was no reported difference between the sham and the real Reiki practitioners in their ability to feel energy flowing through their hands. Post hoc analyses suggested that Reiki may have had limited effects on mood and energy levels. CONCLUSION Reiki did not have any clinically useful effect on stroke recovery in subacute hospitalized patients receiving standard-of-care rehabilitation therapy. Selective positive effects on mood and energy were not the result of attentional or placebo effects.

The use of complementary and alternative therapies for chronic pain following spinal cord injury: a pilot survey.

Abstract Objective: The purpose of this study was to determine the patterns and reasons for the use of complementary and alternative medicine (CAM) as a treatment for chronic pain among individuals with spinal cord injuries (SCI). Methods:Telephone surveys were conducted in a sample of 77 people with SCI and chronic pain. Results: Of those surveyed, 40.3% had used at least one CAM technique to manage chronic pain. The most common reason was dissatisfaction with conventional medicine. Acupuncture was the most frequently used modality, followed by massage, chiropractic manipulation, and herbal medicine. Acupuncture was rated lowest for satisfaction with pain relief, and massage was rated highest.Individuals not using conventional pain medication or who desired greater control over their health care practices tended to use more CAM techniques than others. Income, insurance coverage, and duration of pain were related to use of CAM. In general, CAM methods were effective for some and totally ineffective for others, indicating selective utility in this population. Conclusions: Despite this small opportunistic sample, the prevalence of CAM among individuals with SCI appears similar to that in the general population. A placebo-controlled trial is needed to evaluate the efficacy of various therapies in the SCI population.The fact that the most effective therapy, massage, was not frequently used suggests the need for more awareness of and research into this technique.

Immunity in adolescents with major depression.

OBJECTIVE The association between major depression (MD) and altered immunity appears to be age-related, with differing immune changes found in prepubertal children, young adults, and older adults. There is limited information concerning immunity in adolescents with MD. METHOD Thirty-six otherwise healthy medication-free adolescents (aged 14-20; 23 female) from a community sample, meeting Diagnostic Interview Schedule for Children DSM-III-R criteria for unipolar MD, were compared with 36 nondepressed adolescents matched by gender, age, and racial background. A battery of quantitative and functional immune measures was obtained. RESULTS MD adolescents had increased (p < .05) circulating lymphocytes and lymphocyte subsets; however, altered distribution of lymphocyte subsets was found only for activated T (HLA-DR+) cells (p < .004) and, possibly, natural killer (NK) (CD56+) cells (p < .06), each showing lower percentages in the MD adolescents. Concanavalin A (but not phytohemagglutinin or pokeweed mitogen) mitogen response was lower in the MD adolescents (p < .02). NK cell activity was elevated at higher effector-target ratios (p < .001), an effect not associated with the number of circulating CD56+ (NK) cells. CONCLUSIONS Depressed adolescents showed changes in immune measures that have been found to be altered in other MD groups, although the pattern of effects differs.

A preliminary study of the effect of external qigong on lymphoma growth in mice.

OBJECTIVE To examine the effectiveness of external qigong on the in vivo growth of transplantable murine lymphoma cells in mice. BACKGROUND Qigong is a traditional Chinese health practice that is believed by many to have special preventive and healing power. Underlying the system is the belief in the existence of a subtle energy (qi), which circulates throughout the body, and when strengthened or balanced, can improve health and ward off or slow the progress of disease. To date, much of the literature showing the effects of qi are presented in the non-Western literature, and as such are viewed with considerable skepticism. In an attempt to demonstrate qi in a controlled setting, the effect of external qigong emission from a qigong healer on the in vivo growth of transplantable murine lymphoma cells in mice was explored in two pilot studies. METHODS In study 1, 30 SJL/J mice were injected intravenously with lymphoma cells that localize and exhibit aggressive growth in the lymphoid tissues of untreated syngeneic recipients. These tumor-injected mice were divided into 3 groups: (1). qigong treatment (administered by a qigong healer); (2). sham treatment; and (3). no-treatment control. The sham group received the same number of treatments from a person without training in qigong, who imitated the motions of the qigong healer. The control group received no treatment at all. In study 1, the mice were sacrificed on the 9th or 11th days after tumor-cell injection, and in study 2, the mice were sacrificed on the 10th and 13th days. Tumor growth in lymph nodes (LN) was estimated by LN weight expressed as a percentage of total body weight. RESULTS In study 1, LNs from mice in the qigong-treated group were significantly smaller than LN from mice in either the control group or in the sham treatment group (p < 0.05), suggesting that there was less tumor growth in the qigong-treated mice. In study 2, using the same design as study 1, the same pattern of difference found in study 1 emerged: LN ratio from mice in the qigong-treated group was smaller than that in either the control group or in the sham group. However, these results did not reach statistical significance, partially as a result of larger variances in all groups in this study. CONCLUSIONS These preliminary results, while still inconclusive, suggest that qigong treatment from one particular qigong practitioner might influence the growth of lymphoma cells negatively. Further studies with different practitioners, more repeated trials, and/or different tumor models are needed to further investigate the effects of external qigong on tumor growth in mice.

Stress, Immunity, and Health

Publisher Summary This chapter describes the stress-immunity-health model that is implicit in most psychoneuroimmunology (PNI) research; it focuses on definitional issues surrounding the models various components. It reviews the research on humans that examines the complete model, and to provide a conceptual and methodological context within which to evaluate those studies. The chapter focuses on research that contains some measure of “stress” within the psychosocial component of the model. It reviews the evidence that supports the shorter links in the model: connecting stress to immune function, and immune function to health outcomes. It discusses the role of mediating mechanisms, behavioral and neuroendocrine. The concern for methodological rigor takes on greater importance in PNI because new paradigms that do not appear to be consistent with current scientific thinking are subject to skepticism and disbelief. The fact that PNI continues to be the target of skepticism, is attested to by the controversy generated by a study of the impact of psychosocial factors on clinical outcome in advanced cancer patients.

Opinions and Practices of Medical Rehabilitation Professionals Regarding Prayer and Meditation

OBJECTIVE To assess the attitudes and practices of professionals in the field of physical medicine and rehabilitation (PM&R) regarding prayer and meditation. DESIGN A national mail survey that included questions about the use of a number of complementary and alternative therapies. PARTICIPANTS The survey was mailed to 7,479 physicians, nurses, physical therapists, and occupational therapists who specialize in PM&R, and 1221 (17%) returned completed surveys. RESULTS Although the majority of respondents endorsed prayer as a legitimate health care practice, there was greater belief in the benefits of meditation. Older respondents were more likely to recommend meditation to their patients and more likely to meditate themselves. Gender differences that were observed in opinions and practices are better interpreted as differences in professional specialty. In general, nurses and occupational therapists responded more positively toward meditation and prayer than did physicians and physical therapists. Personal use of a technique was the strongest predictor of professional behaviors. Attitude was a stronger predictor of professional use or referral for prayer than meditation, but correlations between attitude and behavior were generally weak for both techniques. Despite their acceptance of these techniques, the vast majority of rehabilitation professionals did not refer their patients for meditation or religious consultation. CONCLUSIONS Although there were significant relationships among beliefs, and personal and professional behaviors regarding these techniques, a large part of the variance in professional behaviors was not accounted for by age, gender, opinion, or personal behavior, indicating that other influences exert a stronger effect on professional practice decisions.

Commentary: Ginkgo Biloba Extract, Mechanisms, Clinical Indications, and Preliminary Findings

&NA; Ginkgo biloba (GB) may have a role to play in ameliorating impairments in motor, vestibular, memory, and information processing functions as well as in enhancing performance on activities of daily living. GB also may be effective in treating edema, inflammation, and free‐radical toxicity associated with traumatic brain injury (TBI). Clinical indications include Alzheimers dementia, stroke, vaso‐occlusive disorders, aging, macular degeneration, and tinnitus. GB has shown both central and peripheral effects, exerting modulatory effects on electrochemical, physiological, neurological, and vascular systems in animals and humans. Mechanisms of action include antioxidant, neurotransmitter/receptor modulatory, and antiplatelet activating factor properties. There have been few adverse side effects detected or substantiated and drug interactions appear to be minimal. While safe, caution is advised in patients taking anticoagulants or MAO inhibitors. Future studies should examine optimum doses, component activity, mechanisms, and clinical applications.