Tuesday, October 23, 2012

More Evidence Acupuncture Can Ease Chronic Pain

When it comes to the relief of chronic pain, acupuncture is indeed effective, a sweeping review of previous research finds. The conclusion stems from a fresh analysis of initial raw data that had been collected by 29 studies previously conducted in Germany, Spain, Sweden, the United States and the United Kingdom. Collectively, these past investigations had involved nearly 18,000 patients. "We looked at only the best-quality studies," said study author Andrew Vickers, an attending research methodologist and statistician at the Memorial Sloan-Kettering Cancer Center, in New York City. "So I can say with confidence that what we found is the strongest evidence to date supporting the effectiveness of acupuncture." The study appeared online Sept. 10 in the Archives of Internal Medicine. Acupuncture is age-old Chinese medicinal practice of carefully targeted needle insertion and stimulation at specific points of the body. The review authors acknowledge that although 3 million Americans now undergo acupuncture each year, it's still the subject of a great deal of debate among Western medicine practitioners with respect to its true therapeutic value. Many experts theorize that patients who attest to notable pain relief following an acupuncture procedure are simply deriving the benefits of deeply wishful thinking (otherwise known as the "placebo effect"), rather than any true physiological improvements. The authors of the new study looked at acupuncture's potential impact on four distinct types of chronic pain that each patient had endured for at least one month: back and neck pain, osteoarthritis, chronic headache (including migraines) and shoulder pain. All studies included in the review were randomized controlled trials, considered the gold standard of research. As well, all involved a comparison between acupuncture and either "usual care" involving no acupuncture at all or the use of so-called "sham acupuncture." Sham acupuncture involved the use of retractable or superficially inserted needles in some instances, or nonworking electrical or laser-based stimulation in others. The result: When compared against sham interventions or no acupuncture at all, true acupuncture appeared to be "superior" at relieving all four types of pain in question. Acupuncture was seen to provide more or less equivalent degrees of greater pain relief across all pain types. How much greater? Vickers and his associates explained that, generally speaking, if a patient was to go on to experience a 30 percent drop in pain while undergoing standard care with no acupuncture intervention, those undergoing "sham acupuncture" seemed to experience about a 43 percent drop, while true acupuncture patients experienced a 50 percent fall-off. The authors stressed that although the superiority of true acupuncture over sham acupuncture appeared to be relatively small, the real-world choice patients face is not between acupuncture or fake acupuncture but rather between acupuncture or no acupuncture at all. And in that context they suggested that their findings are "of major importance for clinical practice." "Basically what we see here is that the pain relief difference from acupuncture versus no acupuncture is notable, and important, and difficult to ignore," Vickers said. However, he cautioned that though the analysis suggests that acupuncture is a "reasonable" pain relief option, interested patients should make sure to seek out a qualified practitioner, perhaps by getting a reliable referral from their general practitioner. For his part, Dr. Ed Ross, director of the pain management center at Brigham and Women's Hospital, in Boston, suggested that while acupuncture may work for some it may not work for all. "There is clearly a response to acupuncture among a selected patient population," he said. "And for this seemingly small subset I think it's a viable treatment for chronic pain. However, in general, the studies that have looked into this have not been considered to be particularly scientifically rigorous. So it's been really difficult to say who will be in that subset that will benefit." "So I would say try it, and if it works, great," Ross added. "But I also believe in an interdisciplinary approach to pain management. So acupuncture should be considered as only one part of a whole treatment plan." Because costs for an acupuncture session vary so widely, neither expert could offer a price estimate. At present, most insurance does not cover acupuncture.

Wednesday, October 17, 2012

Hard evidence grows for including meditation in government-sponsored health programs

More people still die from cardiovascular disease than any other illness. Dubbed the number one killer and the silent killer, modern medicine has been researching and incorporating complementary and alternative approaches to help treat and in some cases reverse and hopefully prevent this health problem at an earlier stage of the disease. One of those modalities is meditation. A new research review paper on the effects of the stress-reducing Transcendental Meditation (TM) technique on the prevention and treatment of heart disease among youth and adults provides the hard evidence needed to include such evidence-based alternative approaches into private- and government-sponsored wellness programs aimed at preventing and treating cardiovascular disease. The paper, "Prevention and Treatment of Cardiovascular Disease in Adolescents and Adults through the Transcendental Meditation® Program: A Research Review Update" is published in Current Hypertension Reviews, 2012, Vol. 8, No. 3. In teens, the TM technique has been found to reduce blood pressure, improve heart structure and improve school behavior. According to the paper, the technique has been shown to be a safe alternative. The NIH-sponsored clinical trials conducted with TM mentioned in this review did not observe any adverse effects from TM practice. In adults the technique reduced stress hormones and other physiological measures of stress and produced more rapid recovery from stress, decreased blood pressure and use of blood pressure medication, decreased heart pain in angina patients, cleared the arteries, reducing the risk of stroke, improved distance walked in patients with congestive heart failure, and decreased alcohol and tobacco use, anxiety, depression, and medical care usage and expenditures. The technique also decreased risk of death from heart disease, cancer, and all causes. "These findings have important implications for inclusion of the Transcendental Meditation program in medical efforts to prevent and treat cardiovascular disease," says Dr. Vernon Barnes, lead author and research scientist at Georgia Health Sciences University, in Augusta, Georgia. "This review is potentially more important than individual research papers because it shows that TM has an integrated, holistic effect on all levels of cardiovascular disease," says co-author, Dr. David Orme-Johnson. Orme-Johnson says that no other meditation technique has been shown to produce this constellation of changes, especially when it comes to hard measures of cardiovascular disease. Dr. Barnes said it was important to start preventing heart disease with adolescents before the disease sets. "Adding Transcendental Meditation at a young age could prevent future cardiovascular disease and save many lives, not to mention reduce the national medical bill by billions of dollars." Uniqueness of the Transcendental Meditation technique The uniqueness of the outcomes of the TM technique may have something to do with the mechanics of the practice of the technique itself says Dr. Barnes. "Meditation practices are different from each other and therefore produce different results. And this is a very important consideration when evaluating the application of meditation as an alternative and complementary medical approach." A paper in Consciousness and Cognition discusses three categories to organize and better understand meditation. See Are all meditation techniques the same? The two common categories are focused attention, concentrating on an object or an emotion, like compassion; and open monitoring, being mindful of one's breath or thoughts, either contemplating the meaning of them, or just observing them. Transcendental Meditation uses a different approach and comes under the third category of automatic self-transcending, meditations that transcend their own activity. The TM technique does not employ any active form of concentration or contemplation, but allows the mind to effortlessly experience the thought process at more refined levels until thinking comes to a quiet settled state without any mental activity. The mind is awake inside and the body is resting deeply, a level of rest much deeper than deep sleep. It is this state of restful alertness that allows the body to make the necessary repairs to rebalance its normal functioning. This cumulative process resets the physiology and shows up as reduced symptoms of cardiovascular disease and improved health.