Sangeetha Nayak

Use of unconventional therapies by individuals with multiple sclerosis

Objective: To examine the prevalence and patterns of use of complementary and alternative medicine (CAM) among individuals with multiple sclerosis (MS) in the USA and to explore the reasons for use, symptoms treated and perceived effectiveness of these therapies. Methods: Surveys were mailed to the entire mailing list of the MS Foundation, constituting 11 600 individuals with MS or their family members; 3140 adults with MS returned surveys, yielding a response rate of 27.1%. Results: More than half of the responding sample (57.1%) had used at least one CAM modality. The longer that people had MS and the less satisfied they were with conventional health care the more likely they were to use CAM therapies. The most common reasons for using CAMs were the desire to use holistic health care (i.e., treatments that recognized the interrelatedness of mind, body and spirit) and dissatisfaction with conventional medicine. Ingested herbs were the most frequently used CAM modalities (26.6%), followed by chiropractic manipulation (25.5%), massage (23.3%) and acupuncture (19.9%). Women were 25% more likely than men and whites were 30% more likely than non-whites to use CAM therapies. There was no significant relationship between the frequency of use and the reported efficacy of the CAM techniques (r = 0.17, p > 0.10). Conclusions: The prevalence of CAM use in this population warrants more research on the efficacy and safety of these therapies, especially those with high usage or high efficacy ratings, such as herbs, chiropractic manipulation and massage, but for which there is little or no research evidence for efficacy or safety.

Psychiatric comorbidities in a community sample of women with fibromyalgia

Abstract Prior studies of careseeking fibromyalgia (FM) patients often report that they have an elevated risk of psychiatric disorders, but biased sampling may distort true risk. The current investigation utilizes state‐of‐the‐art diagnostic procedures for both FM and psychiatric disorders to estimate prevalence rates of FM and the comorbidity of FM and specific psychiatric disorders in a diverse community sample of women. Participants were screened by telephone for FM and MDD, by randomly selecting telephone numbers from a list of households with women in the NY/NJ metropolitan area. Eligible women were invited to complete physical examinations for FM and clinician‐administered psychiatric interviews. Data were weighted to adjust for sampling procedures and population demographics. The estimated overall prevalence of FM among women in the NY/NJ metropolitan area was 3.7% (95% CI = 3.2, 4.4), with higher rates among racial minorities. Although risk of current MDD was nearly 3‐fold higher in community women with than without FM, the groups had similar risk of lifetime MDD. Risk of lifetime anxiety disorders, particularly obsessive compulsive disorder and post‐traumatic stress disorder, was approximately 5‐fold higher among women with FM. Overall, this study found a community prevalence for FM among women that replicates prior North American studies, and revealed that FM may be even more prevalent among racial minority women. These community‐based data also indicate that the relationship between MDD and FM may be more complicated than previously thought, and call for an increased focus on anxiety disorders in FM.

Sexual and physical abuse in women with fibromyalgia syndrome: a test of the trauma hypothesis

Objectives:According to the trauma hypothesis, women with fibromyalgia syndrome (FMS) are more likely to report a history of sexual and/or physical abuse than women without FMS. In this study, we rely on a community sample to test this hypothesis and the related prediction that women with FMS are more likely to have posttraumatic stress disorder than women without FMS. Methods:Eligibility for the present study was limited to an existing community sample in which FMS and major depressive disorder were prevalent. The unique composition of the original sample allowed us to recruit women with and without FMS from the community. A total of 52 female participants were enrolled in the present FMS group and 53 in the control (no FMS) group. Sexual and physical abuse were assessed retrospectively using a standardized telephone interview. Results:Except for rape, sexual and physical abuse were reported equally often by women in the FMS and control groups. Women who reported rape were 3.1 times more likely to have FMS than women who did not report rape (P < 0.05). There was no evidence of increased childhood abuse in the FMS group. Women with FMS were more likely to have posttraumatic stress disorder symptoms (intrusive thoughts and arousal) as well as posttraumatic stress disorder diagnosis (P < 0.01). Discussion:With the exception of rape, no self-reported sexual or physical abuse event was associated with FMS in this community sample. In accord with the trauma hypothesis, however, posttraumatic stress disorder was more prevalent in the FMS group. Chronic stress in the form of posttraumatic stress disorder but not major depressive disorder may mediate the relationship between rape and FMS.

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.

A community-based survey of fibromyalgia-like pain complaints following the World Trade Center terrorist attacks.

&NA; A purported pathogenic mechanism for the development of fibromyalgia, a medically unexplained syndrome involving widespread pain, is stress and associated psychiatric disorder. The major stressor of recent World Trade Center terrorist attacks provides a natural experiment for evaluating this mechanism. This study sought to determine whether symptoms consistent with fibromyalgia increased post‐September 11 and whether exposure to specific terrorism‐related events or prior depression predicted symptom increase. In a large community sample of women in the New York/New Jersey metropolitan area (n=1312), a cohort initially surveyed for pain and psychiatric symptoms before September 11th were recontacted approximately 6 months after the attacks to assess current symptoms and specific terrorism‐related exposures. ‘Fibromyalgia‐like’ (FM‐L) four‐quadrant pain reports consistent with a diagnosis of fibromyalgia were compared at baseline and follow‐up. Result showed that FM‐L rates did not increase significantly between baseline and post‐attack follow‐up. Event exposure did not relate to FM‐L onset at follow‐up, nor did depressive symptoms at baseline interact with event exposure. Depressive symptoms did not predict new onsets better than the extent of their comorbidity with FM‐L at baseline. The failure to detect a significant increase in symptoms consistent with a diagnosis of fibromyalgia and the failure of new onsets of such symptoms to be accounted for by exposure to major stressors or prior depressive symptoms suggests that these hypothesized risk factors are unlikely to be of major importance in the pathogenesis of fibromyalgia.

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.

Convergence of results regarding fibromyalgia and depression as part of the same spectrum of disorders: response to Arnold et al.

logistic regression for familial aggregation of two disorders. II. Analysis of studies of eating and mood disorders. Am J Epidemiol 2001b;153:506–14. Hudson JI, Mangweth B, Pope Jr HG, De Col C, Hausmann A, Gutweniger S, Laird NM, Biebl W, Tsuang MT. Family study of affective spectrum disorder. Arch Gen Psychiatry 2003;50:170–7. Raphael KG, Janal MN, Nayak S, Schwartz JE, Gallagher RM. Familial aggregation of depression in fibromyalgia: a community-based test of alternative hypotheses. Pain 2004;110:449–60.