Thomas Rampp

Effects of Traditional Cupping Therapy in Patients With Carpal Tunnel Syndrome: A Randomized Controlled Trial

UNLABELLED We investigated the effectiveness of cupping, a traditional method of treating musculoskeletal pain, in patients with carpal tunnel syndrome (CTS) in an open randomized trial. n = 52 outpatients (58.5 +/- 8.0 years) with neurologically confirmed CTS were randomly assigned to either a verum (n = 26) or a control group (n = 26). Verum patients were treated with a single application of wet cupping, and control patients with a single local application of heat within the region overlying the trapezius muscle. Patients were followed up on day 7 after treatment. The primary outcome, severity of CTS symptoms (VAS), was reduced from 61.5 +/- 20.5 to 24.6 +/- 22.7 mm at day 7 in the cupping group and from 67.1 +/- 20.2 to 51.7 +/- 23.9 mm in the control group [group difference -24.5mm (95%CI -36.1; -2.9, P < .001)]. Significant treatment effects were also found for the Levine CTS-score (-.6 pts: 95%CI -.9; -.2, P = .002), neck pain (-12.6mm; 95%CI -18.8; -6.4, P < .001), functional disability (DASH-Score) (-11.1 pts; 95%CI -17.1; -5.1, P < .001), and physical quality of life (.3; 95%CI .0; .3, P = .048). The treatment was safe and well tolerated. We conclude that cupping therapy may be effective in relieving the pain and other symptoms related to CTS. The efficacy of cupping in the long-term management of CTS and related mechanisms remains to be clarified. PERSPECTIVE The results of a randomized trial on the clinical effects of traditional cupping therapy in patients with carpal tunnel syndrome are presented. Cupping of segmentally related shoulder zones appears to alleviate the symptoms of carpal tunnel syndrome.

Effects of phlebotomy-induced reduction of body iron stores on metabolic syndrome: results from a randomized clinical trial

AbstractBackgroundMetabolic syndrome (METS) is an increasingly prevalent but poorly understood clinical condition characterized by insulin resistance, glucose intolerance, dyslipidemia, hypertension, and obesity. Increased oxidative stress catalyzed by accumulation of iron in excess of physiologic requirements has been implicated in the pathogenesis of METS, but the relationships between cause and effect remain uncertain. We tested the hypothesis that phlebotomy-induced reduction of body iron stores would alter the clinical presentation of METS, using a randomized trial.MethodsIn a randomized, controlled, single-blind clinical trial, 64 patients with METS were randomly assigned to iron reduction by phlebotomy (n = 33) or to a control group (n = 31), which was offered phlebotomy at the end of the study (waiting-list design). The iron-reduction patients had 300 ml of blood removed at entry and between 250 and 500 ml removed after 4 weeks, depending on ferritin levels at study entry. Primary outcomes were change in systolic blood pressure (SBP) and insulin sensitivity as measured by Homeostatic Model Assessment (HOMA) index after 6 weeks. Secondary outcomes included HbA1c, plasma glucose, blood lipids, and heart rate (HR).ResultsSBP decreased from 148.5 ± 12.3 mmHg to 130.5 ± 11.8 mmHg in the phlebotomy group, and from 144.7 ± 14.4 mmHg to 143.8 ± 11.9 mmHg in the control group (difference -16.6 mmHg; 95% CI -20.7 to -12.5; P < 0.001). No significant effect on HOMA index was seen. With regard to secondary outcomes, blood glucose, HbA1c, low-density lipoprotein/high-density lipoprotein ratio, and HR were significantly decreased by phlebotomy. Changes in BP and HOMA index correlated with ferritin reduction.ConclusionsIn patients with METS, phlebotomy, with consecutive reduction of body iron stores, lowered BP and resulted in improvements in markers of cardiovascular risk and glycemic control. Blood donation may have beneficial effects for blood donors with METS.Trial registrationClinicalTrials.gov: NCT01328210 Please see related article: http://www.biomedcentral.com/1741-7015/10/53

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.

Effectiveness of Home-Based Cupping Massage Compared to Progressive Muscle Relaxation in Patients with Chronic Neck Pain—A Randomized Controlled Trial

Chronic neck pain is a major public health problem with very few evidence-based complementary treatment options. This study aimed to test the efficacy of 12 weeks of a partner-delivered home-based cupping massage, compared to the same period of progressive muscle relaxation in patients with chronic non-specific neck pain. Patients were randomly assigned to self-directed cupping massage or progressive muscle relaxation. They were trained and asked to undertake the assigned treatment twice weekly for 12 weeks. Primary outcome measure was the current neck pain intensity (0–100 mm visual analog scale; VAS) after 12 weeks. Secondary outcome measures included pain on motion, affective pain perception, functional disability, psychological distress, wellbeing, health-related quality of life, pressure pain thresholds and adverse events. Sixty one patients (54.1±12.7 years; 73.8%female) were randomized to cupping massage (n = 30) or progressive muscle relaxation (n = 31). After treatment, both groups showed significantly less pain compared to baseline however without significant group differences. Significant effects in favor of cupping massage were only found for wellbeing and pressure pain thresholds. In conclusion, cupping massage is no more effective than progressive muscle relaxation in reducing chronic non-specific neck pain. Both therapies can be easily used at home and can reduce pain to a minimal clinically relevant extent. Cupping massage may however be better than PMR in improving well-being and decreasing pressure pain sensitivity but more studies with larger samples and longer follow-up periods are needed to confirm these results. Trial Registration ClinicalTrials.gov NCT01500330

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.

Menopause in German and Chinese women—An analysis of symptoms, TCM-diagnosis and hormone status

ObjectiveTo investigate menopause-related symptoms, traditional Chinese Medicine (TCM)-diagnosis and hormone status of two comparable urban samples of menopausal women, one in Essen (Germany) and the other in Shanghai (China).MethodsPatients suffering from menopause-syndrome were recruited from the TCM-outpatient clinic of the University of Duisburg-Essen in Germany (35 subjects) and from the Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine in China (35 subjects). The Kupperman-Index for tracing menopausal symptoms was applied. The complete TCM-diagnosis was carried out by the same investigator in China as well as in Germany. Testosterone and estrogen blood samples were collected once from every woman.ResultsThere were significant differences in specific symptoms of the Kupperman-Index, such as a higher prevalence of formication and depression in German menopausal women; whereas Chinese menopausal women suffered significantly more from vertigo, headache and paraesthesia symptoms. Concerning TCM-diagnosis, Shen (肾)-yang deficiency was diagnosed in 51.43% of the German women in contrast to 5.71 % of the Chinese women; 17.14 % of the German women were diagnosed as having Shen-yin deficiency compared to 74.29 % of the Chinese women. The German women showed significantly lower mean hormone levels for testosterone compared to the Chinese women (P⩽0.0005).ConclusionsGerman and Chinese menopausal women do not show different prevalence but have different patterns of menopausal symptoms. Furthermore, from a TCM point of view, German women suffer more from Shen-yang deficiency whereas Chinese women suffer more from Shen-yin deficiency syndrome. These results are supported by significantly lower levels of testosterone in German women compared to Chinese women, which, in TCM, is a characteristic of yang deficiency.

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.

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.