Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture.
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The mechanism of action of acupuncture remains largely unknown. The reaction to acupuncture needling known as 'de qi', widely viewed as essential to the therapeutic effect of acupuncture, may be a key to understanding its mechanism of action. De qi includes a characteristic needling sensation, perceived by the patient, and 'needle grasp' perceived by the acupuncturist. During needle grasp, the acupuncturist feels pulling and increased resistance to further movement of the inserted needle. We hypothesize that 1) needle grasp is due to mechanical coupling between the needle and connective tissue with winding of tissue around the needle during needle rotation and 2) needle manipulation transmits a mechanical signal to connective tissue cells via mechanotransduction. Such a mechanism may explain local and remote, as well as long-term effects of acupuncture. (+info)
Pain management in polycystic kidney disease.
(50/1563)
Pain is a common complaint in patients with autosomal-dominant polycystic kidney disease, and a systematic approach is needed to differentiate the etiology of the pain and define an approach to management. A thorough history is the best clue to the multifactorial causes of the pain, superimposed upon an understanding of the complex innervation network that supplies the kidneys. The appropriate use of diagnostic radiology (especially MRI) will assist in differentiating the mechanical low back pain caused by cyst enlargement, cyst rupture and cyst infection. Also, the increased incidence of uric acid nephrolithiasis as a factor in producing renal colic must be considered when evaluating acute pain in the population at risk. MRI is not a good technique to detect renal calculi, a frequent cause of pain in polycystic kidney disease. If stone disease is a possibility, then abdominal CT scan and/or ultrasound should be the method of radiologic investigation. Pain management is generally not approached in a systematic way in clinical practice because most physicians lack training in the principles of pain management. The first impulse to give narcotics for pain relief must be avoided. Since chronic pain cannot be "cured," an approach must include techniques that allow the patient to adapt to chronic pain so as to limit interference with their life style. A detailed stepwise approach for acute and chronic pain strategies for the patient with autosomal dominant polycystic kidney disease is outlined. (+info)
Influence of elastic bandage on knee pain, proprioception, and postural sway in subjects with knee osteoarthritis.
(51/1563)
OBJECTIVES: To investigate whether a "standard" sized (that is, a size that would be prescribed by a physiotherapist) elastic bandage (S-bandage) around the knee of subjects with knee osteoarthritis (OA) would, in the short term (a) reduce pain, (b) improve knee joint proprioception, and (c) decrease sway in comparison with a looser (L-bandage). METHODS: In a cross over, within-subject study, 68 subjects (49 women, 19 men; mean age 67.1, range 36-87) with symptomatic and radiographic knee OA were randomly assigned to either an S-bandage or an L-bandage. Two weeks later they were assigned to the opposite bandage size. Knee pain (10 cm visual analogue scale (VAS)), knee proprioception, and static postural sway were assessed for each bandage two weeks apart. During each visit assessments were performed at baseline, after 20 minutes of bandage application, and immediately after bandage removal. RESULTS: The S-bandage did not have any effect on knee pain, proprioception, or postural sway. The L-bandage reduced knee pain significantly (pre-bandage application: median VAS 4.36, IQR 3.84 -4.90; after 20 minutes of bandage application: median VAS 3.80, IQR 3.3-4.3, p<0.001), improved static postural sway (pre-bandage: median sway 4.50, IQ range 3.5-6.4; bandage applied: median sway 4.45, IQ range 3.4-6.3, p=0.027), but had no significant influence on knee proprioception. CONCLUSIONS: In subjects with knee OA application of an elastic bandage around the knee can reduce knee pain and improve static postural sway. This outcome depends on the size of applied bandage. (+info)
Safety aspects of acupuncture in palliative care.
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Acupuncture can mask symptoms of cancer and tumour progression. It is not safe to use such a therapy without full knowledge of the clinical stage of the disease, and the current status of orthodox therapy. Contraindications to acupuncture needling include an unstable spine, severe clotting disorder, neutropenia and lymphoedema. Whilst semi-permanent needles are used increasingly in symptom control and pain management they should not be used in patients with valvular heart disease or in vulnerable neutropenic patients. Acupuncture has an increasing role in support for pain and symptom management, but patients should not be advised to abandon conventional treatments in favour of complementary or alternative therapies alone, and should not have their hopes raised inappropriately, or have any guilt projected on to them for the cause of their cancer. (+info)
A combination of systematic review and clinicians' beliefs in interventions for subacromial pain.
(53/1563)
The aim of the study is to determine which treatments for patients with subacromial pain are trusted by general practitioners (GPs) and physiotherapists, and to compare trusted treatments with evidence from a systematic critical review of the scientific literature. A two-step process was used: a questionnaire (written case simulation) and a systematic critical review. The questionnaire was mailed to 188 GPs and 71 physiotherapists in Sweden. The total response rate was 72% (186/259). The following treatments were trusted, ergonomics/adjustments at work, corticosteroids, non-steroidal anti-inflammatory drugs, movement exercises, acupuncture, ultrasound therapy, strengthening exercises, stretching, transcutaneous electric nerve stimulation, and superficial heat or ice therapy. The review, including efficacy studies for the treatments found to be trusted, was conducted using the CINAHL, EMBASE and MEDLINE databases. Evidence for efficacy was recorded in relation to methodological quality and to diagnostic criteria that labelled participants as having subacromial pain or a non-specific shoulder disorder. Forty studies were included. The methodological quality varied and only one treatment had definitive evidence for efficacy for non-specific patients, namely injection of corticosteroids. The trust in corticosteroids, injected in the subacromial bursa, was supported by definitive evidence for short-term efficacy. Acupuncture had tentative evidence for short-term efficacy in patients with subacromial pain. Ultrasound therapy was ineffective for subacromial pain. This is supported by tentative evidence and, together with earlier reviews, this questions both the trust in the treatment and its use. The clinicians' trust in treatments had a weak association with available scientific evidence. (+info)
Deep brain stimulation of the centre median-parafascicular complex in patients with movement disorders.
(54/1563)
The centre median-parafascicular (CM-Pf) complex of the thalamus is considered to be a possible target for deep brain stimulation (DBS) in patients with movement disorders. In a prospective study on the effect of CM-Pf DBS versus somatosensory thalamic DBS on chronic neuropathic pain, three of 12 patients had additional movement disorders. Bifocal quadripolar electrodes were implanted by computed tomography guided stereotactic surgery under local anaesthesia contralaterally to the side of the pain for test stimulation. Two of the three patients with movement disorders had permanent implantation of CM-Pf electrodes. During test stimulation of the left CM-Pf complex for several days, a 67 year old woman received no benefit with respect to the neuropathic pain, but the choreoathetotic movements of her right foot ceased. As the pain syndrome was not improved, she decided not to have permanent implantation. A 74 year old man with postzoster neuralgia and allodynia enjoyed excellent relief from his pain with chronic CM-Pf DBS. In addition, improvement in the tremor at rest was noted. A 72 year old man had sustained reduction in his stump dyskinesias. Further evaluation of the possible role of the "forgotten" central and medial thalamic nuclei in the treatment of movement disorders may be warranted. (+info)
An audit of 500 acupuncture patients in general practice.
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This is an audit of 500 patients treated in a general practice setting. Acupuncture clinics are provided on two evenings each week and are funded by the practice. Short treatment times are favoured but this varies according to condition and response. A wide variety of conditions have been treated the commonest being neck pain, low back pain, shoulder problems, hayfever, knee osteoarthritis, and migraine. An overall improvement of 73% was obtained with 61% classified as 'significant improvement' or 'cure'. Amongst the adverse effects recorded, retained needles and forgotten patients have been the most concerning and have led to changes in practice following 'critical incident' meetings. (+info)
An audit of the effectiveness of acupuncture on musculoskeletal pain in primary health care.
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Little is known about the use of acupuncture in general practice. We performed a retrospective review of the use of acupuncture in relieving musculoskeletal pain, a condition that is commonly encountered in general practice. A sample of 116 patient records was reviewed, from which 92 patients (mean age 52 years, 64% female) met the inclusion criterion of musculoskeletal pain. Information obtained included age, sex, diagnosis, duration of the problem, length of treatment (weeks), number of treatments, duration of each treatment (minutes), number of needles used, level of benefit obtained from the treatment, and recurrence of pain. There were many different conditions encountered. We found an association between the general practitioner using fewer needles and patients experiencing greater pain relief. This could be a reflection of treating myofascial pain syndromes, which often appear to respond well to a single needle in the key trigger point. Overall, we found that sixty-nine percent of patients had a good or excellent response to acupuncture treatment. We recommend acupuncture as a treatment option for patients who do not respond to the usual therapies (non-steroidal anti-inflammatory drugs) for musculoskeletal conditions. (+info)