Treatment Of Chronic Neck Pain See's Narcotic Overuse

Treatment Of Chronic Neck Pain See's Narcotic Overuse

debbie nicholson

• Detroit Alternative Medicine Examiner

Researchers from Duke University and University of North Carolina, reveal in a report printed in November issue of Arthritis and Care Research, that the use of narcotics and diagnostic tested are overused when it comes to treating chronic neck pain. Their data shows that practitioners may disregard more productive treatments for neck pain such as therapeutic exercise. Treatments as this type are good for chronic neck pain however, only 53% of subjects were prescribe this treatment. The information is based on reported data from a representative sample of residents in North Carolina.

Past studies have called attention to neck pain affecting 30 to 50 percent of adults in the general populace regardless of year. Among those patients 50 to 85 percent do not find that their symptoms totally resolved and some still having chronic, impairing pain. Chronic neck pain much alike lower back pain, most of the time does not react to the treatment provided and can have similar economic impact in regards of time loss of employment and larger healthcare costs.

In the study, Adam Goode, PT, DPT and associate from the University of North Carolina, Cecil G. Sheps, Center for Health Services Research, had used information from 2006 telephone survey consisting of 5,357 North Carolina households. Researchers examined responses from 135 adults that were non-institutionalized, over 21 years old and with chronic neck pain, detailed as pain and activity limits almost every day for the past three months or more than 24 occurrences of pain the past year which limited activity for one day or more. Among the participants 56% were female and most were Caucasian 81%.

Findings had shown that the predominance of chronic, impairing neck pain influence in the North Carolina populace of 2.2%. Researchers note the average length of chronic pain was 6.9 years and the subjects visiting around five different healthcare practitioners and 21 ambulatory care cases.

The study also notes participants had received 1.6diagnostic tests like spinal radiographs 45% and MRI at 30%. In the previous year those who had x-rays of the spine, averaged two different sets taken, which researchers report are inconsistent with clinical decision making guidelines for diagnostic imaging. Dr. Goode remarks patients with a long enduring disease, the chances that imaging methods would provide clinically important interferences may decline.

Greater than 56% of the subjects used over-the-counter medications and 29% strong narcotics such as oxycodone. Researchers report medical evidence on effectiveness of medications for the treatment of chronic neck pain is limited.

Rehabilitation conditioning and alternative treatments such as acupuncture are very effective yet few patients in the study had used them.

Below are some noted effective treatments for chronic neck pain.

Acupuncture

Studies have demonstrated acupuncture is effective in relieving certain kinds of chronic neck pain especially from whiplash. There have been a few studies advocating acupuncture can treat degenerative neck disorders like anklosing spondylosis. Acupuncture has worked in many cases when conventional treatments have failed.

Chinese herbs

In some cases of chronic neck pain Chinese herbs may also be prescribed by the practitioner. Some include the formula Ease 2, that will ease muscle tension, ingredients include Peony root and Licorice root.

Chiropractic

Neck adjustments also called cervical manipulation is an exact procedure applied to joints of the neck and usually done by hand. These adjustments improve mobility to the spine and increase range of motion. It also increases movement in adjoining muscles. Patients usually note improved ability to turn neck and tilt head along with decreased pain, soreness and stiffness.

The chiropractor will develop a treatment plan which can consist of one or more types of treatments. These can include massage and therapeutic exercises.

Scientific literature reviews have found evidence that patients who endure chronic neck pain have remarked improvement after chiropractic treatments. High quality evidence was substantiated for the treatment of chronic neck pain and chiropractic treatments.

Massage

Therapeutic massage after ten weeks of care has shown major improvement in functioning and relief of associated symptoms. Researchers have concluded that therapeutic massage is totally safe and does provide benefits for chronic neck pain at least in short term.

http://www.examiner.com/alternative-medicine-in-detroit/treatment-of-chronic-neck-pain-see-s-narcotic-overuse

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Infertility Helped Greatly with Chinese Herbs

Infertility Helped Greatly with Chinese Herbs

Dr. Ting Ting Zhang presented advanced methods for treating infertility at the American College of Traditional Chinese Medicine (ACTCM) in San Francisco, California. New research shows that both common and rare Chinese herbal medicines vastly enhance both the process of conception and subsequent nutrition to the fetus thereby creating a healthy pregnancy. Dr. Zhang was granted a special visa from the Chinese government to bring this vital information to the United States for an acupuncturist continuing education conference at ACTCM. Dr. Zhang is the Gynecology Department Chair of Yue Yang Hospital at the Shanghai University of TCM (Traditional Chinese Medicine) and is renown for her experience in the field of infertility. Dr. Zhang unveiled new ultrasound and hormone testing research revealing that special Chinese herbal medicines promote ovulation and egg development, increase sperm motility and count, and prevent miscarriage. Further, western data confirms that Chinese herbal medicine greatly increases the conception rate of women undergoing artificial insemination.

Dr. Zhang opened up the conference with some basic statistics before presenting detailed cures for infertility. In a recent study of 500 women who were not treated with Chinese herbal medicines, regular sexual intercourse resulted in a 60-70% conception rate. At six months, women became pregnant at a rate of 75-80%. At one year, the rate increased to 80-90%. From age 30 to 34, one in seven women experience infertility. Between the ages of 35 and 40, one in five women are infertile and between the ages of 40 and 44, one in four women experience difficulties with infertility. In up to 55% of cases, infertility is caused by a female reproductive disharmony. In 25-40% of cases, infertility is caused solely by a male reproductive issue. Notably, in 20% of all cases, infertility is caused by both the male and female partners. Using Dr. Zhang’s and the famous Dr. Tai’s treatment regimes, Dr. Zhang demonstrated an incredibly high rate of clinical success in reversing infertility. Dr. Zhang noted that “infertility is a symptom, not a disease.”

Dr. Zhang presented Chinese medicine differential diagnostics in relation western medical findings. Basal body temperature (BBT) charts were revealed to express a process of emerging Yin Essence in the first 12 days of a menstrual cycle followed by a powerful Yang stage. A direct reading of the BBT chart translates into an exact Chinese medicine diagnosis. In addition, Dr. Zhang introduced methods for analyzing hormone tests. For example, high FSH is linked to Yin Deficiency and high LH is linked to Yang Deficiency. A multitude of ways to view BBT, ultrasound, sexual hormone tests, and other western related data were correlated into the Chinese medicine theoretical framework. Dr. Zhang closed the divide between western medical data and Chinese medicine differential diagnostics in her presentation. Acupuncturists can now read the western data, make a Chinese medicine diagnosis, and choose from the correct herbal medicines to promote conception and a healthy pregnancy.

Common conditions leading to infertility are Kidney Yin and Yang deficiency, Liver Qi Stagnation, and Blood Stasis. For women, the main concern is to harmonize the menstrual cycle. Dr. Zhang presented important herbal formulas to address many clinical scenarios and included special herbs to promote ovulation and nourish the fetus. Moreover, Dr. Zhang presented herbal remedies to prevent anti-sperm antibodies such as AsAb and other autoimmune system disorders from leading to infertility. Dr. Zhang also covered the topic of uterine fibroids, their exact relationship to infertility, and how to overcome any impediments they may present. This requires, at the very minimum, an ultrasound test of existing fibroids to determine their exact placement and size.

Dr. Zhang presented step-by-step methods to take an abnormal BBT charted cycle to one that follows a healthy pattern from follicular phase through ovulation to luteal phase and menstruation. The herbal medicines restore the normal ovulation window, optimize the fertility cycle, and enhance the process of a healthy pregnancy and fetus. Dr. Zhang detailed the exact herbs needed to promote egg maturation and those needed to facilitate uptake and transport of eggs into and through the fallopian tube. Further, she presented a detailed herbal medicine regime to optimize the window of opportunity for patients undergoing IVF and IUI. In cases where artificial insemination has previously failed, adding Chinese herbs balances the health of the patient such that artificial insemination becomes successful.

The American College of Traditional Chinese Medicine (ACTCM), located in San Francisco, CA, has a long history of presenting valuable information in the field of Chinese medicine in acupuncture continuing education courses. Without exception, Dr. Zhang has lived up to this reputation and has raised the bar on the efficaciousness of Chinese Medicine in the treatment of infertility. Adam White, L.Ac., President of the Healthcare Medicine Institute, notes that “Dr. Ting Ting Zhang has managed to fully integrate the western model for the treatment of primary and secondary infertility into the Chinese medicine system. We now have a fully integrated understanding of western medical test data in terms of Chinese medicine theory and we have a new understanding of herbs that promote the various stages of conception. Dr. Zhang and her colleagues at Shanghai University of TCM have employed western testing methods to measure the effects of herbal medicines on processes such as ovum development and release, fallopian tube function, and fetal development. Thanks to Dr. Zhang, the clinical efficacy of Chinese medicine in the treatment of infertility has advanced tremendously.”

www.reproductivewellness.com

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Computer Engineering Proves Acupuncture for Stroke Victims

Computer Engineering Proves Acupuncture for Stroke Victims

A recent study shows that acupuncture increases brain activity in stroke victims. Using MRI technology, researchers documented that real acupuncture increased brain activity and functionality and that sham acupuncture and a blank control group did not increase brain activity and functionality. Sham acupuncture is the placement of acupuncture needles in nearby incorrect locations and the control group received no medical treatment. In this study, real acupuncture was proven to benefit ischemia stroke victims using acupuncture in a quantifiable and repeatable study.

The study was conducted in an animal experiment setting on rats and was conducted by a joint effort by Zhejiang University in Hangzhou, China; Department of Acupuncture and Moxibustion, Hubei College of Traditional Chinese Medicine; and the Department of Electronic and Computer Engineering, The Hong Kong University of Science and Technology. The scientists conclude that the immediate effect of acupuncture in the stimulation of brain activity is verified and that further study is therefore recommended.

Citing promising research on the positive effects of acupuncture in the treatment of osteoarthritis of the knee, the scientists conducting the stroke study sought to create an even more stringent research methodology. The study notes, “To quantitatively understand the role of acupuncture, we need to have a statistically significant, biologically interpretable, and quantitatively repeatable measurement under the randomized trial setting.” Using MRI (magnetic resonance imaging), fMRI and microPET imaging techniques, the researchers were able “to measure the glucose metabolic level in the brain which is an important index of brain function.”

Acupuncture points Bai Hui (GV20/Du-20) and Shui Gou (GV26/Du-26) were chosen. The needles were rotated for one minute at a frequency of about 2Hz and then left for four minutes at rest. The needle manipulation technique is repeated six times during the acupuncture session for a total of 30 minutes of acupuncture needle retention. The results were repeatable and measurable. Acupuncture was proven to increase brain activity in the acute stage of ischemia stroke using the brain glucose metabolic level as a quantitative index whereas the sham acupuncture group and the control group received no benefit. The researchers note that this experiment helps to explain Chinese medicine concepts regarding acupuncture with modern scientific language.

Reference:
Using MicroPET Imaging in Quantitative Verification of Acupuncture Effect in Ischemia Stroke Treatment, Xiaoyan Shen1, Hongtu Tang2, Jia Li2, Ting Xiang2, Huafeng Liu1 & Weichuan Yu3

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Early menopause gene research could predict problem

A woman's ability to conceive decreases around 10 years before the menopause

Research into the genetics of early menopause may lead to a simple test for women, says a UK scientist.

One in 20 women starts their menopause before the age of 46 - which can affect their chances of conceiving even a decade earlier.

The study, published in Human Molecular Genetics, found that four genes working in combination appeared to raise the risk significantly.

This could eventually help identify women at greatest risk.

Menopause is normally triggered when the number of remaining eggs in the ovary falls below about 1,000.

However, the biological controls which determine how quickly this ovarian egg reserve is used up are less well understood.

The researchers, from the University of Exeter and the Institute of Cancer Research, looked at four genes already thought to have some link to the menopause.

Continue reading the main story

“Start Quote

A woman's ability to conceive decreases on average 10 years before she starts the menopause.”

Dr Anna MurrayUniversity of Exeter

They took 2,000 women who had experienced early menopause, and a similar number of women who had entered the menopause at the normal age.

They found that the presence of each of the four genes appeared to have some influence on the age of menopause.

Egg depletion

When more than one was found in a woman's genetic makeup, the impact was even greater.

Dr Anna Murray, from the University of Exeter, said that the ability to predict menopause was not just important at the time, but could be crucial to decisions made many years earlier.

In particular, the quicker-than-expected depletion of the egg reserve could make a difference to a woman's ability to conceive.

She said: "It is estimated that a woman's ability to conceive decreases on average 10 years before she starts the menopause.

"Therefore, those who are destined to have an early menopause and delay childbearing until their 30s are more likely to have problems conceiving."

She added: "These findings are the first stage in developing an easy and relatively inexpensive genetic test which could help the one in 20 women who may be affected."

Professor Anthony Swerdlow, from the Institute of Cancer Research, described the findings as a "valuable step" towards helping women work out if they are at risk.

"This may in turn allow them to make informed decisions about their future fertility," he said.

This is not the first attempt to find a way to identify those women who are at greatest risk of an early menopause.

Other methods include using ultrasound to assess the number of eggs left in the ovary, to try to work out how quickly that number is falling.

The latest study is part of a major effort - the Breakthrough Generations Study - following the fortunes of 100,000 women in an effort to reveal the causes of diseases such as breast cancer.

Iranian scientists also say that measuring levels of a hormone called AMH on a three-yearly basis may also be able to predict the problem years in advance.

http://www.bbc.co.uk/news/health-11554958

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Elbow pain and acupuncture

Elbow pain and acupuncture

Palle Rosted MD & Annette Jørgensen MD

Introduction.

Tennis elbow is probably the most common cause of pain in the elbow in general practice. It is typically caused by inflammation of the attachment of the tendons of extensor carpi radialis brevis muscle, but the supinator muscle is also important. The less frequent golfer’s elbow is usually caused by inflammation in flexor communis muscle.

The present range of available treatments are less than adequate for the management of all cases; one study has shown that two weeks of treatment with NSAIDs was no more effective than a placebo, and steriod injections appear to give a shortlived effect with the risk of undesirable morbidity. Acupuncture is frequently proposed as a treatment for these conditions (Hay et al. 1999).

Scientific research

A range of research considers the use of acupuncture in the management of tennis elbow. This is summarised below; from this one might argue that acupuncture, has, at least, a shortlived effect on tennis elbow. Further research on the long term effects is still needed.

In a meta-analysis by Bisset et al. 2005, based on 4 RCTs, it was shown that acupuncture appears to have a duration of the effect for at least 2-8 weeks.

In another systematic review by Trith et al. 2004, the authors found strong evidence for treating lateral epicondylitis, with acupuncture.

In a placebo controlled trial by Fink et al. 2002, 45 patients were allocated to either acupuncture in classical points, such as LI-10, LI-11,and LU-5. As distal point was either LI-4 or TE-5 used. In the placebo group, points several centimeters from the classical acupuncture points were used. Otherwise all procedures in the two groups were similar. Initially there was a significant difference between the two groups, but this had dissappeared at 2 and 12 months follow up, with no clear difference between the groups. However, both groups showed a clear reduction of the pain intensity by the 12 month followup, compared to the initial value.

In another study by same author Fink et al. 2002, it was concluded, that acupuncture in classical acupuncture points, was significantly better than acupuncture in non classical points. However, it needs to be emphasised that 71 % of triggerpoints are situated in classical acupuncture points. This study also demonstrated no significant difference in outcomes between the two groups at 12 month followup, but that the level of pain was significantly reduced in both groups compared to the initial value.

However, in both studies, interpretation of the results may be complex, as a result of the selected placebo procedure. In the first study, classical acupuncture points were used in the test group compared to non-classical points in the placebo group. These points – whether classical or palcebo - are all located within the same spinal segments.

It is well known that acupuncture is a nociceptive stimulus, that induces an inflammatory process locally, that stimulates the peripheral nervous system and thus we register pain. Any nociceptive stimulus, irrespective of the site on the body, will have an influence upon the peripheral nervous system, and therefore an effect on the patients pain. Considering that the procedures of both groups were identical, it is not surprising that an effect was reported in both groups.

In the second study, the authors try to analyze the problem further, by comparing classical acupuncture points with deep needling in muscles against superficial needling. Initially, there was a difference between the two groups. It is accepted that both deep and superficial acupuncture activates the A-delta nerve fibers of the peripheral nervous system. The A-delta fibers from both superficial and deep needling terminate primarily in the second layer in the dorsal horn where the pain is inhibited through a release of enkephalin. However, the A-delta fibers from deep acupuncture, continue via synapse with a second order interneurone to the fifth layer of the dorsal horn, where the fibres crossover and contine via the spinothalamic tract to the midbrain, thalamus etc. As a consequence deep needling will have both a segmental and a central effect.

In contrast the A-delta fibers from superficial needling, does not continue to the fifth layer of the dorsal horn, does not pass to the spinothalamic tracts, and as a consequence superficial stimulation will have a segmental effect only.

It is known that endorphin is released from superior centers in the brain and it is expected that this is the reason for the initial difference between the two groups in the second study of Fink.

In a study by Tsui et al. 2002, the difference between manual acupuncture and electroacupuncture was investigated in 20 patients suffering from elbow pain.

The acupuncture points GB-34 and ST-38 were used in both groups. In the group receiving ectroacupuncture points a frequenzy of 4 HZ was used. The patients were evaluated by grabsize and on a VAS scale for pain.

After 6 treatments, an improvement on 32% was found on the VAS scale, in the manual acupuncture group. In the electropuncture group an improvement of 50% was reported. Equal values were found in the grabsize-scale.* Se artiklen

The explanation for the poor result in the manual acupuncture group, effectively no greater than that explainable with a placebo response, can easily be explained by the choice of acupuncture points. These are remote to the site of problems. It seems more logical to use points within the segments and muscles involved.

A cochrane review by Green et a. 2003 concludes that the present number of studies is too small to either recommend or reject acupuncture. However, the review did conclude that acupuncture appears to have at the very least, a temporary effect.

In a study by Molsberger et al 1994, 48 patients recieved either acupuncture in the point GB-34 or placebo acupuncture, without penetration of the skin on the point BL-13 for the treatment of elbow pain. In the true treatment group there was an improvement of the pain on 55.8 %, compared to 15% in the placebogroup. The pain relief lasted 20 hours in the treatment-group, compared to 1.4 hours in the placebo group.

One might speculate for the reason for the points chosen (extrasegmentary), but at least it probably illustrates that penetration by a needle, anywhere in the body, results in an increase of the endorphine concentration in the blood. One must expect that a better and more lasting effect would have been achieved if a segmental treatment had been used.

The treatment of 82 patients with tennis elbow is described by Haker et al.1990.

The patients were allocated to either deep needling or superficial needling. LU-5, LI-10, LI-11 and LI-12 were used in the treatment group. TE-5 was used as the distant point.

After 10 treatments, a clear improvement was found in the group with deep needling. However, this difference was not found at the follow up after three and twelve months, nor at end of treatment.

However, at the one year follow up, a significant improvement was found in both groups, compared to the start value. That there was no difference between the two groups can easily be explained by the fact that the points used were the same.

In a study by Brattberg 1983, 50 patients who suffered from treatment resistant tennis elbow, were either treated with acupuncture or steroid injections. 61.8% of the group treated with acupuncture showed a significant improvement, compared to the group recieving steroid injections, where an improvement of only 30.8% was found. The patients recieved 6 acupuncture treatments, in 4 weeks. The usual local points were used and as distant point, LI-4 was used.

Possible mode of action

The cause of tennis elbow is always a result of overuse of the extensores muscles around the elbow. This sometimes causes a local imflammatory proces, that, probably secondarily, contributes by either creating new triggerpoints, or activating a latent triggerpoint in the regional muscles.

It is presumed that an active triggerpoint causes a shortening of the muscle as a result of a contraction in the muscle, which in the long term will cause ischaemia in the muscle. This decreased circulation locally, will as a consequence cause a accumulation of waste products, such as lactid acid, which will contribute to a chemical reaction with release of, among other things, potasium ions. Traval et al 1982,1983.

It is proven that acupuncture increases the local blood supply, probably through a decrease in the sympaticus tonus, Kuo et al 2004, Green 2003, leading to vasodialtion, and thus reestablishing the normal hæmodynamic relations in the affected muscle/muscles.

However, the pain is not simply as a result of ischaemia alone. It has been shown that muscular ischaemia does not cause muscular pain during rest. However, use of an ischaemic muscle will lead to the onset of pain. It is belived that this muscular pain during work is initiated by the release of bradykinin, potasium ions and prostaglandins, that then sensitises the nociceptors, Jensen et al 2003.

Practical recommendations for treating tennis elbow.

Like all other diseases treated by acupuncture, a combination of classical acupuncture points and trigger points is often essential for obtaining the best result. Moreover, a biomechanical analysis of the problem is of vital importance to understand the cause of the disease.

The cause for tennis elbow is an overuse in the extensor muscles on the forearm and subsequent activation or development of triggerpoints in the involved muscles.

The extensor muscle is quoted the most important muscles in development of tennis elbow. However, in particular, the supinator muscle seems to be involved in nearly all patients suffering from tennis elbow.

Supinator muscle

Most textbooks recommend the following combination of points LI-10, LI-11 as the most important. As a distant point LI-4 is often recomended. However, one might speculate about the relevance of using the point LI-4. Everyone will agree, that the point LI-4 is located in the adductor pollicis muscle, and one might question the logic in using the point LI-4 for this condition. After all tennis elbow is a localised phenomen, involving muscles around the elbow, and it would be logical to use points in this region only.

The selection of points should be guided by the examination of the forearm, in particular on the radial site. However, muscles are always working in groups, so it is remended to palpate the ulnar site as well.

Standard treatment for tennis elbow

Local pointsLU-5½, LI-10, LI-11 and I-12

Distant pointsNone

Supplementary triggerpoints

NB. the main function of the triceps muscle is on the elbow, and the region needs to be examined in all patients suffering from tennis elbow.

Referencer

Bisset L, Paungmali A, VicenzinoB, Beller E, A systemic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med 2005; 39: 411-22.

Trinh KV, Phillips SD, Ho E, Damsma K. Acupuncture for the alleviation of lateral epicondyle pain: a systematic review. Rheumatology 2004; 43: 1085-90.

Kuo TC. Lin CW. Ho FM. The soreness and numbness effect of acupuncture on the skin blood flow. Am J Chin Med. 2004; 32(1): 117-29.

Green S. Buchbinder R. Barnsley L. Hall S. White M. Smidt N. Assendelft W. Acupuncture for lateral elbow pain. The Cochrane Library. Issue 2. 2003. CD003527.

Jensen TS, Dahl JB. Arendt-Nielsen L. Smerter – en lærebog. 2003. FADL’S Forlag, p141-51

Tsui P. Leung M.C.P. Comparison of the effictiveness between manual acupuncture and electro-acupuncture on patients with tennis elbow. Acupun Electrother Res. 2002; 27: 107-17.

Fink M. Wolkenstein E. Luennemann M. Gutenbrunner C. Gehrke A. Karst M. Chronic epicondylitis: Effects of real and sham acupuncture treatment: A randomised controlled patient- and examiner-blinded long term trial.Forschende Komplementärmedizin - Klassische Naturheilkunde. 2002; 9: 210-5.

Fink M. Wolkenstein E. Karst M. Gehrke A. Acupuncture in chronic epicondylitis: a randomised controlled trial. Rhematol. 2002; 41: 205-9.

Hay E.M. Paterson S.M. Lewis M. Hosie G. Croft P. Pragmatic randomised controlled trial of local corticosteroid injection and naprroxen for treatment of lateral epicondylitis of elbow in primary care. 1999. BMJ; 319(7215): 964-8.

Molsberger A. Hille E. The analgesic effect of acupuncture in chronic tennis elbow pain. Br. J. Rgeumatol. 1994;33: 1162-5.

Travell JG, Simons DG. Myofascial pain and dysfunction II. The trigger point manual. Williams & Wilkins, Baltimore;1992.

Haker E. Lundeberg T. Acupuncture treatment in epicondylagia: A compartive study of two acupuncture techniques. Clinical J. Pain. 1990; 6: 221-6.

Brattberg G. 1983. Acupuncture therapy for tennis elbow. Pain; 16: 285-8.

Travell JG, Simons DG. Myofascial pain and dysfunction I.The trigger point manual. Williams & Wilkins, Baltimore; 1883.

http://www.acupuncturenews.eu/acupuncture/This_Month.html

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