New Guidelines Issued For Treatment Of Lower Back Pain

CBS News (2/13, LaPook) reports on its website that the American College of Physicians released new guidelines that says “the first line of therapy” for chronic low back pain “should be non-drug treatments.”     The new guidelines recommend “heat wraps, massage, acupuncture and spinal manipulation” for pain lasting less than three months, and recommend treatments such as “stretching and strengthening exercises, tai chi, yoga, acupuncture, and mindfulness techniques” for pain lasting more than three months.
Newsday (NY) (2/13, Ricks) reports, “The new guidelines emphasize that opioid” pain medications “should be considered only as a last resort.”
The New York Times (2/13, A21, Kolata, Subscription Publication) reports that in its recommendations, the ACP “did not address surgery.” Instead, “its focus was on noninvasive treatment.” In addition, imaging “scans… for diagnosis are worse than useless for back pain patients, members of the group said in telephone interviews.” Scan “results can be misleading, showing what look like abnormalities that actually are not related to the pain.” The new guidelines (2/14) were published in the Annals of Internal Medicine.

Acupuncture and Breast Cancer

  ScienceDaily (Apr. 28, 2008) — Acupuncture provides effective relief from hot flushes in women who are being treated with the anti-oestrogen tamoxifen following surgery for breast cancer, according to new research presented April 18 at the 6th European Breast Cancer Conference (EBCC-6) in Berlin.

  Mrs Jill Hervik, a physiotherapist and acupuncturist at the Vestfold Central Hospital (T?nsberg, Norway), told a news briefing that breast cancer patients who received traditional Chinese acupuncture had a 50% reduction in hot flushes, both during the day and the night, and that this effect continued after the acupuncture ceased.

  “Acupuncture is increasingly used in western countries to treat the problem of hot flushes in healthy post-menopausal women, so we wanted to see whether it was effective in women with breast cancer suffering from hot flushes as a result of their anti-oestrogen medication,” she said.

Tamoxifen can cause many of the symptoms that occur during the menopause, including hot flushes. For healthy women, hormone replacement therapy has traditionally been used to alleviate symptoms, but it is associated with an increased risk of relapse in women with oestrogen sensitive breast cancers.

  In a prospective, single-blind, controlled trial, Mrs Hervik and her supervisor, Dr Odd Mj?land, randomised 59 breast cancer patients to receive either ten weeks of traditional Chinese acupuncture or sham (minimal) acupuncture between March 2003 and December 2006. All were taking tamoxifen following surgery and were postmenopausal. She delivered both the real and the sham acupuncture to the patients, and maintained a neutral treatment atmosphere (e.g. no soft music, and minimal time spent talking to the patients) in order to reduce the placebo effect of the treatments.

  The patients recorded the number of hot flushes they experienced for four weeks before the treatment, during the treatment and during a 12-week follow-up period. Other menopausal symptoms were also measured over the same periods using a quality of life index — the Kupperman Index — that incorporates symptoms such as hot flushes, sweating, sleep problems, depression, dizziness, palpitations, joint pain, headache, vaginal dryness etc.

Both the acupuncture and the sham acupuncture were given twice a week for the first five weeks and then once a week for the next five weeks. The real acupuncture was given using needles inserted at varying depths to a maximum of 3cms at several well-known acupuncture points. For the sham acupuncture, the needles were not inserted so deep (a maximum of 3mm) and in places well way from acupuncture points.

  Mrs Hervik said: “During the treatment, hot flushes were reduced by 50%, both day and night, in the acupuncture group. Three months after the last treatment a further reduction was seen. No significant changes were seen in the sham group during the day. At night there was a slight reduction during the treatment period but, once treatment had ceased, the number of hot flushes increased again.

  “This effect was paralleled in the scores from the Kupperman Index for the real acupuncture group, with a slight reduction also in the sham group. However, once treatment ceased the scores remained lowered for the treatment group, but increased for the sham group.”

  She concluded: “Acupuncture seems to provide effective relief from hot flushes, both day and night, for women taking tamoxifen after surgery for breast cancer. This treatment effect seems to coincide with a general improvement in well-being. Acupuncture has two advantages over other treatments for hot flushes: it is cheap and does not cause adverse side-effects. Our results suggest that acupuncture could be used more widely for treating breast cancer patients suffering from symptoms related to their anti-oestrogen medication.”

Acupuncture may help with fertility

  Acupuncture appears to be a useful fertility aid, according to a new report in the British Medical Journal that found pairing acupuncture with in-vitro fertilization can raise a couple’s odds of getting pregnant by 65 percent.

  In absolute terms, the report found that for every 10 women who supplement IVF with acupuncture, one extra pregnancy will occur.

Although that’s a “modest” effect, it’s important given the emotions and considerable expenses associated with assisted reproduction, said Eric Manheimer, the lead author and a research associate at the University of Maryland Medical School.
 The new report — a synthesis of seven previously published studies involving 1,366 patients — doesn’t address why acupuncture promotes fertility, which patients benefit or what protocol is optimal.

But experts have several ideas. They suggest that the ancient Chinese practice — which involves inserting needles at strategic locations on a person’s body — might enhance blood flow to the uterus, improving the chance that an embryo will successfully implant. Also, it’s thought that acupuncture might stimulate the production of hormones that regulate ovulation and fertility and regulate stress, which can interfere with a pregnancy.

  Some fertility centers have responded with enthusiasm. “We offer acupuncture to all our IVF patients” and between 10 and 20 percent elect to use it, said Dr. Brian Kaplan, a fertility specialist at Fertility Centers of Illinois.

  Kaplan cautioned, however, that he couldn’t recommend acupuncture as a stand-alone fertility treatment without IVF.

  Other scientists are skeptical. Dr. Norbert Gleicher, president of the Center for Human Reproduction, said he didn’t find the scientific literature convincing.

  Gleicher’s fertility centers will arrange for acupuncture occasionally, when patients indicate they want it, he said.

  “None of the studies, including this new one, are definitive,” agreed Dr. Ralph Kazer, chief of reproductive endocrinology at Northwestern University’s Feinberg School of Medicine.
  Two years ago, Northwestern launched a study of up to 220 women in which half get “sham” acupuncture, with needles placed in the wrong locations, and half get the real thing.
  The goal is to determine whether the placement of needles makes a difference or whether the therapy works because women believe it does, Kazer said.
 Summing it up
  The study: A review of existing research has found that acupuncture can boost a woman’s odds of conceiving.
  The caveats: The results apply only when acupuncture is used with in-vitro fertilization. And not all experts are convinced that it helps.

  Local angle: Fertility centers across Chicago are touting acupuncture as a way to help women get pregnant.
  Drawbacks? There are no harmful effects associated with acupuncture, which calls for needles to be inserted across a woman’s body.

Reflexology

  Reflexology is the study, art, and science of applying touch techniques to the Feet, Hands, and outer Ears where theory suggests there is a pressure map resembling a shape of the Human Body. By applying nurturing touch in specific ways, a wide range of health benefits have been reported
  Reflexology is based on the belief that there are reflex areas on the feet (and hands) corresponding to all the parts of the body including major organs. It is believed that applying pressure to specific areas on the feet, hands and ears can affect internal organs and body systems, and therefore promote good health.
   The therapist stimulates and works these organs and systems through the reflexes areas on the hands and feet, applying pressure to the feet with thumb and fingers. Pressure is applied to clear out congestion and restore normal functioning and health.
   Reflexology has many benefits. It feels good. It is pleasant and soothing, and it relaxes the body. Each person responds to a reflexology in a unique way and on occasions may experience a variety of short term reactions, for example, extreme relaxation, tiredness, lethargy or tearfulness. Reflexology is not a ‘cure-all’. However, it does help relieve pain associated with migraine, sinus problems, breathing disorders, digestive problems, circulatory problems, back problems, tension and stress.

What is acupuncture?

Acupuncture is a healing method of traditional Chinese medicine system in which symptoms are relieved or cured by the insertion of thin metal needles into selected points on the skin. By stimulating the certain points and meridians on the surface of the body, it can stimulate and balance the body’s vital energy in order to reduce pain, cure disease, increase immunity, etc. Results of research show that the needling activates deep sensory nerves, which cause the pituitary and midbrain to release endorphins – the brain’s natural painkillers and other biologic factors, which heal the body’s diseases and problems. Acupuncture is widely used in the Far East for pain relief, diseases and body mind care.
The acupuncturist should be trained for at least 5 years before they are allowed to practice in China. The theories taught include both that of Chinese Medicine and basic of western medicine. Acupuncturists in Alberta are registered as qualified acupuncture practitioner and more and more insurance companies cover acupuncture therapy than before.