Reflexology: Ancient Foot Massage Technique May Ease Cancer Symptoms

A study led by a Michigan State University researcher offers the strongest evidence yet that reflexology -- a type of specialized foot massage practiced since the age of pharaohs -- can help cancer patients manage their symptoms and perform daily tasks. Funded by the National Cancer Institute and published in the latest issue of Oncology Nursing Forum, it is the first large-scale, randomized study of reflexology as a complement to standard cancer treatment, according to lead author Gwen Wyatt, a professor in the College of Nursing.

"It's always been assumed that it's a nice comfort measure, but to this point we really have not, in a rigorous way, documented the benefits," Wyatt said. "This is the first step toward moving a complementary therapy from fringe care to mainstream care."

Reflexology is based on the idea that stimulating specific points on the feet can improve the functioning of corresponding organs, glands and other parts of the body. The study involved 385 women undergoing chemotherapy or hormonal therapy for advanced-stage breast cancer that had spread beyond the breast. The women were assigned randomly to three groups: Some received treatment by a certified reflexologist, others got a foot massage meant to act like a placebo, and the rest had only standard medical treatment and no foot manipulation. Wyatt and colleagues surveyed participants about their symptoms at intake and then checked in with them after five weeks and 11 weeks.

They found that those in the reflexology group experienced significantly less shortness of breath, a common symptom in breast cancer patients. Perhaps as a result of their improved breathing, they also were better able to perform daily tasks such as climbing a flight of stairs, getting dressed or going grocery shopping. Wyatt said she was surprised to find that reflexology's effects appeared to be primarily physical, not psychological.

"We didn't get the change we might have expected with the emotional symptoms like anxiety and depression," she said. "The most significant changes were documented with the physical symptoms."

Also unexpected was the reduced fatigue reported by those who received the "placebo" foot massage, particularly since the reflexology group did not show similarly significant improvement. Wyatt is now researching whether massage similar to reflexology performed by cancer patients' friends and family, as opposed to certified reflexologists, might be a simple and inexpensive treatment option. Reflexology did not appear to reduce pain or nausea, but Wyatt said that could be because the drugs for combating those symptoms are generally quite effective, so the women may not have reported them to begin with.

Although health researchers only recently have begun studying reflexology in a scientifically rigorous way, it's widely practiced in many parts of the world and dates back thousands of years.

"Reflexology comes out of the Chinese tradition and out of Egypt," Wyatt said. "In fact, it's shown in hieroglyphics. It's been around for a very long time." Wyatt's co-authors include MSU statistics and probability professor Alla Sikorskii and College of Nursing research assistant Mei You, along with colleagues from Northwestern University and the University of Texas Health Science Center at Houston.

Meditation may reduce death, heart attack and stroke in heart patients

African Americans with heart disease who practiced Transcendental Meditation regularly were 48 percent less likely to have a heart attack, stroke or die from all causes compared with African Americans who attended a health education class over more than five years, according to new research published in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes.

Those practicing meditation also lowered their blood pressure and reported less stress and anger. And the more regularly patients meditated, the greater their survival, said researchers who conducted the study at the Medical College of Wisconsin in Milwaukee.

"We hypothesized that reducing stress by managing the mind-body connection would help improve rates of this epidemic disease," said Robert Schneider, M.D., lead researcher and director of the Institute for Natural Medicine and Prevention in Fairfield, Iowa. "It appears that Transcendental Meditation is a technique that turns on the body's own pharmacy — to repair and maintain itself."

For the study, researchers randomly assigned 201 people to participate in a Transcendental Meditation stress-reducing program or a health education class about lifestyle modification for diet and exercise.

*Forty-two percent of the participants were women, average age 59, and half reported earning less than $10,000 per year.
*Average body mass index was about 32, which is clinically obese.
*Nearly 60 percent in both treatment groups took cholesterol-lowering drugs; 41 percent of the meditation group and 31 percent of the health education group took aspirin; and 38 percent of the meditation group and 43 percent of the health education group smoked.

Those in the meditation program sat with eyes closed for about 20 minutes twice a day practicing the technique, allowing their minds and bodies to rest deeply while remaining alert.

Participants in the health education group were advised, under the instruction of professional health educators, to spend at least 20 minutes a day at home practicing heart-healthy behaviors such as exercise, healthy meal preparation and nonspecific relaxation.

Researchers evaluated participants at the start of the study, at three months and every six months thereafter for body mass index, diet, program adherence, blood pressure and cardiovascular hospitalizations. They found:

*There were 52 primary end point events. Of these, 20 events occurred in the meditation group and 32 in the health education group.
*Blood pressure was reduced by 5 mm Hg and anger decreased significantly among *Transcendental Meditation participants compared to controls.
*Both groups showed beneficial changes in exercise and alcohol consumption, and the meditation group showed a trend towards reduced smoking. Although, there were no significant differences between the groups in weight, exercise or diet.
*Regular meditation was correlated with reduced death, heart attack and stroke.

Cardiovascular disease is the leading cause of death worldwide. Death from heart disease is about 50 percent higher in black adults compared to whites in the United States. Researchers focused on African Americans because of health disparities in America.

"Transcendental Meditation may reduce heart disease risks for both healthy people and those with diagnosed heart conditions," said Schneider, who is also dean of Maharishi College of Perfect Health in Fairfield, Iowa.

"The research on Transcendental Meditation and cardiovascular disease is established well enough that physicians may safely and routinely prescribe stress reduction for their patients with this easy to implement, standardized and practical program," he said.

Meditation Produces Enduring Changes in Emotional Processing in the Brain

A new study has found that participating in an 8-week meditation training program can have measurable effects on how the brain functions even when someone is not actively meditating. In their report in the November issue of Frontiers in Human Neuroscience, investigators at Massachusetts General Hospital (MGH), Boston University (BU), and several other research centers also found differences in those effects based on the specific type of meditation practiced.

"The two different types of meditation training our study participants completed yielded some differences in the response of the amygdala -- a part of the brain known for decades to be important for emotion -- to images with emotional content," says Gaëlle Desbordes, PhD, a research fellow at the Athinoula A. Martinos Center for Biomedical Imaging at MGH and at the BU Center for Computational Neuroscience and Neural Technology, corresponding author of the report. "This is the first time that meditation training has been shown to affect emotional processing in the brain outside of a meditative state."

Several previous studies have supported the hypothesis that meditation training improves practitioners' emotional regulation. While neuroimaging studies have found that meditation training appeared to decrease activation of the amygdala -- a structure at the base of the brain that is known to have a role in processing memory and emotion -- those changes were only observed while study participants were meditating. The current study was designed to test the hypothesis that meditation training could also produce a generalized reduction in amygdala response to emotional stimuli, measurable by functional magnetic resonance imaging (fMRI).

Participants had enrolled in a larger investigation into the effects of two forms of meditation, based at Emory University in Atlanta. Healthy adults with no experience meditating participated in 8-week courses in either mindful attention meditation -- the most commonly studied form that focuses on developing attention and awareness of breathing, thoughts and emotions -- and compassion meditation, a less-studied form that includes methods designed to develop loving kindness and compassion for oneself and for others. A control group participated in an 8-week health education course.

Within three weeks before beginning and three weeks after completing the training, 12 participants from each group traveled to Boston for fMRI brain imaging at the Martinos Center's state-of-the-art imaging facilities. Brain scans were performed as the volunteers viewed a series of 216 different images -- 108 per session -- of people in situations with either positive, negative or neutral emotional content. Meditation was not mentioned in pre-imaging instructions to participants, and investigators confirmed afterwards that the volunteers had not meditated while in the scanner. Participants also completed assessments of symptoms of depression and anxiety before and after the training programs.

In the mindful attention group, the after-training brain scans showed a decrease in activation in the right amygdala in response to all images, supporting the hypothesis that meditation can improve emotional stability and response to stress. In the compassion meditation group, right amygdala activity also decreased in response to positive or neutral images. But among those who reported practicing compassion meditation most frequently outside of the training sessions, right amygdala activity tended to increase in response to negative images -- all of which depicted some form of human suffering. No significant changes were seen in the control group or in the left amygdala of any study participants.

"We think these two forms of meditation cultivate different aspects of mind," Desbordes explains. "Since compassion meditation is designed to enhance compassionate feelings, it makes sense that it could increase amygdala response to seeing people suffer. Increased amygdala activation was also correlated with decreased depression scores in the compassion meditation group, which suggests that having more compassion towards others may also be beneficial for oneself. Overall, these results are consistent with the overarching hypothesis that meditation may result in enduring, beneficial changes in brain function, especially in the area of emotional processing."

Complementary and alternative therapy improved lives of arthritis patients

Nearly a quarter of patients with rheumatoid arthritis and osteoarthritis used complementary and alternative therapy (CAT) to help manage their condition, according to a study in the November issue of the Journal of Clinical Nursing.

Researchers interviewed 250 patients aged between 20 and 90 years of age. More than two-thirds (67%) had rheumatoid arthritis and the remainder had osteoarthritis. They found that 23% used CAT in addition to prescribed drugs and that just under two-thirds of those (64%) felt that the therapy was beneficial, reporting improvements in pain intensity, sleeping patterns and activity levels.

"Our study underlines the importance of healthcare professionals being knowledgeable about the potential use of CAT when providing medical care to patients with arthritis" says lead author Professor Nada Alaaeddine, Head of the Regenerative and Inflammation Lab in the Faculty of Medicine, University of St Joseph, Beirut, Lebanon.

"Although CAT might have beneficial effects in rheumatoid arthritis and osteoarthritis, patients should be cautious about their use and should tell their healthcare providers that they are using them to make sure they don't conflict with their existing treatment."

Key findings of the survey included:
*CAT users had an average age of 45 years, significantly younger than the average non CAT user, who was aged 57 years.
*CAT use was higher in patients with osteoarthritis (29%) than rheumatoid arthritis (20%).
*The most common CAT used was herbal therapy (83%), followed by exercise (22%), massage (12%), acupuncture (3%), yoga and meditation (3%) and dietary supplements (3%).
*Just under a quarter of the patients using CAT (24%) sought medical care because of possible side effects, but they were not serious and were reversible. The most common side effects included skin problems (16%) and gastrointestinal problems (9%).
*Just under a quarter of the patients using CAT (24%) sought medical care because of possible side effects, but they were not serious and were reversible. The most common side effects included skin problems (16%) and gastrointestinal problems (9%).
*The majority did not tell their healthcare provider about their CAT use (59%).
*CAT users were asked to rate the amount of pain they felt and the percentage who said that they experienced no pain rose from 12% to 43% after CAT use. The number who slept all night rose from 9% to 66%.
*CAT users also reported an improvement in daily activities. The percentage who said that their pain did not limit them at all rose from 3% to 12% and the percentage who said they could do everything, but with pain, rose from 26% to 52%.

"CAT use is increasing and this study shows that it provided self-reported benefits for patient with rheumatoid arthritis and osteoarthritis" says Professor Alaaeddine. "It is, however, important that patients discuss CAT use with their healthcare practitioner and that they are made aware of possible side effects, in particular the possible interactions between herbal and prescribed drugs."

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.

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.

Yoga proves to reduce depression in pregnant women, boost maternal bonding

University of Michigan study the first to show evidence that mindfulness yoga may offer effective treatment for depressed new mothers to be



Prenatal yoga may help women cope with depression

It’s no secret that pregnancy hormones can dampen moods, but for some expectant moms, it’s much worse: 1 in 5 experience major depression.

Now, new research shows that an age-old recommended stress-buster may actually work for this group of women: yoga.

Pregnant women who were identified as psychiatrically high risk and who participated in a 10-week mindfulness yoga intervention saw significant reductions in depressive symptoms, according to a University of Michigan Health System pilot feasibility study. Mothers-to-be also reported stronger attachment to their babies in the womb.

The findings were published in Complementary Therapies in Clinical Practice.

“We hear about pregnant women trying yoga to reduce stress but there’s no data on how effective this method is,” says lead author Maria Muzik, M.D., M.S., assistant professor of psychiatry and assistant research scientist at the Center for Human Growth and Development. “Our work provides promising first evidence that mindfulness yoga may be an effective alternative to pharmaceutical treatment for pregnant women showing signs of depression.

“This promotes both mother and baby wellbeing.”

Mental health disorders during pregnancy, including depression and anxiety, have become a serious health concern. Hormonal changes, genetic predisposition and social factors set the stage for some expectant moms to experience persistent irritability, feelings of being overwhelmed and inability to cope with stress.

Untreated, these symptoms bear major health risks for both the mom and baby, including poor weight gain, preeclampsia, premature labor and trouble bonding with the new baby.

While antidepressants have proven to effectively treat these mood disorders, Muzik says, previous studies show that many pregnant women are reluctant to take these drugs out of concern for their infant’s safety.

“Unfortunately, few women suffering from perinatal health disorders receive treatment, exposing them and their child to the negative impact of psychiatric illness during one of the most vulnerable times,” Muzik says. “That’s why developing feasible alternatives for treatment is critical.”

Evidence suggests women are more comfortable with nontraditional treatments, including herbal medicine, relaxation techniques and mind-body work.

Yoga continues to grow in popularity but in the United States, many classes concentrate on yoga as “exercise,” omitting the practice of being fully present in the moment and aware, authors say.

Meanwhile, mindfulness yoga – which combines meditative focus with physical poses – has proven to be a powerful method to fight stress and boost energy.

For the U-M research study, women who showed signs of depression and who were between 12-26 weeks pregnant participated in 90-minute mindfulness yoga sessions that focused on poses for the pregnant body, as well as support in the awareness of how their bodies were changing to help their babies grow.

Funding for follow up work on this subject was recently provided by a grant from the Institute for Research on Women and Gender.

“Research on the impact of mindfulness yoga on pregnant women is limited but encouraging,” Muzik says. “This study builds the foundation for further research on how yoga may lead to an empowered and positive feeling toward pregnancy.”

Mindfulness Meditation Reduces Loneliness in Older Adults

Mindfulness Meditation Training Also Lowers Inflammation Levels and Alters Gene Expression

For older adults, loneliness is a major risk factor for health problems — such as cardiovascular disease and Alzheimer's — and death. Attempts to diminish loneliness with social networking programs like creating community centers to encourage new relationships have not been effective.

However, a new study led by Carnegie Mellon University's J. David Creswell offers the first evidence that mindfulness meditation reduces loneliness in older adults. Published in "Brain, Behavior & Immunity," the researchers also found that mindfulness meditation — a 2,500-year-old practice dating back to Buddha that focuses on creating an attentive awareness of the present moment — lowered inflammation levels, which is thought to promote the development and progression of many diseases. These findings provide valuable insights into how mindfulness meditation training can be used as a novel approach for reducing loneliness and the risk of disease in older adults.

"We always tell people to quit smoking for health reasons, but rarely do we think about loneliness in the same way," said Creswell, assistant professor of psychology within CMU's Dietrich College of Humanities and Social Sciences. "We know that loneliness is a major risk factor for health problems and mortality in older adults. This research suggests that mindfulness meditation training is a promising intervention for improving the health of older adults."

For the study, the research team recruited 40 healthy adults aged 55-85 who indicated an interest in learning mindfulness meditation techniques. Each person was assessed at the beginning and end of the study using an established loneliness scale. Blood samples also were collected.

The participants were randomly assigned to receive either the eight-week Mindfulness-Based Stress Reduction (MBSR) program or no treatment. The MBSR program consisted of weekly two-hour meetings in which participants learned body awareness techniques — noticing sensations and working on breathing — and worked their way toward understanding how to mindfully attend to their emotions and daily life practices. They also were asked to practice mindfulness meditation exercises for 30 minutes each day at home and attended a daylong retreat.

The researchers found that eight weeks of the mindfulness meditation training decreased the participants' loneliness. Using the blood samples collected, they found that the older adult sample had elevated pro-inflammatory gene expression in their immune cells at the beginning of the study, and that the training reduced this pro-inflammatory gene expression, as well as a measure of C-Reactive Protein (CRP). These findings suggest that mindfulness meditation training may reduce older adults' inflammatory disease risk.

"Reductions in the expression of inflammation-related genes were particularly significant because inflammation contributes to a wide variety of the health threats including cancer, cardiovascular diseases and neurodegenerative diseases," said study collaborator Steven Cole, professor of medicine and psychiatry and biobehavioral sciences at the UCLA School of Medicine.

While the health effects of the observed gene expression changes were not directly measured in the study, Cole noted that "these results provide some of the first indications that immune cell gene expression profiles can be modulated by a psychological intervention."

Creswell added that while this research suggests a promising new approach for treating loneliness and inflammatory disease risk in older adults, more work needs to be done. "If you're interested in using mindfulness meditation, find an instructor in your city," he said. "It's important to train your mind like you train your biceps in the gym

Yoga reduces stress; now it's known why

Six months ago, researchers at UCLA published a study that showed using a specific type of yoga to engage in a brief, simple daily meditation reduced the stress levels of people who care for those stricken by Alzheimer's and dementia. Now they know why.

As previously reported, practicing a certain form of chanting yogic meditation for just 12 minutes daily for eight weeks led to a reduction in the biological mechanisms responsible for an increase in the immune system's inflammation response. Inflammation, if constantly activated, can contribute to a multitude of chronic health problems.

Reporting in the current online edition of the journal Psychoneuroendocrinology, Dr. Helen Lavretsky, senior author and a professor of psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior, and colleagues found in their work with 45 family dementia caregivers that 68 of their genes responded differently after Kirtan Kriya Meditation (KKM), resulting in reduced inflammation.

Caregivers are the unsung heroes for their yeoman's work in taking care of loved ones that have been stricken with Alzheimer's and other forms of dementia, said Lavretsky, who also directs UCLA's Late-Life Depression, Stress and Wellness Research Program. But caring for a frail or demented family member can be a significant life stressor. Older adult caregivers report higher levels of stress and depression and lower levels of satisfaction, vigor and life in general. Moreover, caregivers show higher levels of the biological markers of inflammation. Family members in particular are often considered to be at risk of stress-related disease and general health decline.

As the U.S. population continues to age over the next two decades, Lavretsky noted, the prevalence of dementia and the number of family caregivers who provide support to these loved ones will increase dramatically. Currently, at least five million Americans provide care for someone with dementia.

"We know that chronic stress places caregivers at a higher risk for developing depression," she said "On average, the incidence and prevalence of clinical depression in family dementia caregivers approaches 50 percent. Caregivers are also twice as likely to report high levels of emotional distress." What's more, many caregivers tend to be older themselves, leading to what Lavretsky calls an "impaired resilience" to stress and an increased rate of cardiovascular disease and mortality.

Research has suggested for some time that psychosocial interventions like meditation reduce the adverse effects of caregiver stress on physical and mental health. However, the pathways by which such psychosocial interventions impact biological processes are poorly understood.

In the study, the participants were randomized into two groups. The meditation group was taught the 12-minute yogic practice that included Kirtan Kriya, which was performed every day at the same time for eight weeks. The other group was asked to relax in a quiet place with their eyes closed while listening to instrumental music on a relaxation CD, also for 12 minutes daily for eight weeks. Blood samples were taken at the beginning of the study and again at the end of the eight weeks.

"The goal of the study was to determine if meditation might alter the activity of inflammatory and antiviral proteins that shape immune cell gene expression," said Lavretsky. "Our analysis showed a reduced activity of those proteins linked directly to increased inflammation.

"This is encouraging news. Caregivers often don't have the time, energy, or contacts that could bring them a little relief from the stress of taking care of a loved one with dementia, so practicing a brief form of yogic meditation, which is easy to learn, is a useful too."

Lavretsky is a member of UCLA's recently launched Alzheimer's and Dementia Care Program, which provides comprehensive, coordinated care as well as resources and support to patients and their caregivers. Lavretsky has incorporated yoga practice into the caregiver program.

Group yoga improves motor function and balance long after stroke

Group yoga can improve motor function and balance in stroke survivors, even if they don't begin yoga until six months or more after the stroke, according to "Post-Stroke Balance Improves With Yoga: A Pilot Study," published online July 26 in the journal Stroke.

Forty-seven older adults, three-quarters of whom were male, participated in the study. They were divided into three sections: One section engaged in twice-weekly group yoga for eight weeks; the second section met twice weekly for group yoga and was provided with a relaxation audio recording to use at least three times weekly; and the third section received usual medical care that included no rehabilitation.

The yoga classes, taught by a registered yoga therapist, included modified yoga postures, relaxation and meditation. Classes grew more challenging each week.

Improvement in balance was statistically significant and clinically meaningful. It was also greater than previously found by other post-stroke exercise trials. Study participants reported they increasingly attempted new activities in different, more challenging environments and, while aware of potential fall risk, grew confident in maintaining their balance.

"For patients, like those in our study, natural recovery and acute rehabilitation therapy typically ends after six or, less frequently, 12 months," said Regenstrief Institute investigator Arlene Schmid, Ph.D., OTR, a rehabilitation research scientist with the Center of Excellence on Implementing Evidence-Based Practice at the Richard Roudebush VA Medical Center and assistant professor of occupational therapy at Indiana University-Purdue University Indianapolis, who led the study. "We found that yoga exercises significantly extended rehabilitation beyond the first year after stroke."

Yoga may be more therapeutic than traditional exercise because the combination of postures, breathing and meditation may produce different effects than simple exercise, according to Dr. Schmid, who plans to further study the effectiveness of group yoga to improve balance, quality of life and participation in everyday activities. She notes that yoga's mind-body connection may be what makes it more powerful and engaging than other strengthening exercise.

Reflexology Proves Beneficial For Non-Cardiology Patients

In a study examining the effects of reflexology in healthy patients and patients with heart disease, researchers have found that applying pressure to the upper the heart reflex point on the left foot had an effect on the hearts of healthy patients but not on those with cardiac disease.

The study, conducted by researchers at the University of Stirling, found that massage to the heart reflex point had a small effect on heart function in healthy patients but not in the hearts of cardiology patients. In addition, they found that when pressure was applied to areas of the feet not related to the heart there was not change in heart function.

According to reflexologists, each part of the hands and feet are connected with specific organs in the body. Applying pressure with specific thumb, finger, and hand techniques to specific organ reflex points is believed to increased blood flow to the organ.

In this study, the team focused on the upper left ball of the sole which is said to 'map' to the heart and compared this area to other areas of both feet.

Jenny Jones, Ph.D., from the School of Nursing, Midwifery & Health, explained:

"Reflexology is unique because it makes quite specific claims that it increases blood flow and this is something you can scientifically test. In our experiment with healthy people there was an inexplicable change in the heart function which occurred only when the heart reflex point area was massaged. We have no idea what caused this change se we have applied for funding to investigate this further."

Jones continued:

"Cardiology patients have problems with coronary blood flow so we wanted to find out if there was any impact on their heart function whilst receiving reflexology too. Interestingly, there was no effect on the hearts of cardiology patients; however all the patients found the treatment to be really relaxing, so it seems to be a safe and useful relaxation tool for cardiac patients to use.

We want to investigate further why the hearts of cardiology patients are not affected in the same way as the healthy volunteers, with medication being a possible cause. We also want to research and better understand why this one area of the foot - the upper left ball of the sole - had an effect on the heart."

Professor Steve Leslie, a cardiologist from the Cardiac Unit at Raigmore Hospital, said:

"Most patients responded well to conventional medicine but for some patients symptoms of cardiac disease persist despite best medical treatments. For these patients we wished to test if reflexology was safe. The results of this study, demonstrated that reflexology did not affect cardiac function, heart rate or blood pressure and therefore it would appear safe for patients, even those with significant cardiac disease to undergo reflexology. Whether reflexology can improve cardiac symptoms requires further research."

According to Jones, the complementary therapies market in the UK is huge and shows that there is a great deal of public interest in the topic.

Jones explained: "There are limitations of what we can do with clinical medicine but there has not been much scientific research available on complementary therapies such as reflexology to help people decide if they work or not.

However, if people are choosing to pay to have these complementary therapy treatments to treat symptoms when we have a health care service which is free, you need to ask what it is that these therapies offer that is missing in conventional healthcare."

The researchers plan to conduct further studies in order to determine whether the effect observed in this study is repeated in patients with various gradations of heart disease and other patients groups.

Health Benefits of 'Mindfulness-Based Practices'

Practices Derived from Buddhist Meditation Show Real Effectiveness for Certain Health Problems, Reports Journal of Psychiatric Practice

Specific types of "mindfulness practices" including Zen meditation have research-proven benefits for patients with certain physical and mental health problems, according to a report in the July Journal of Psychiatric Practice. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

"An extensive review of therapies that include meditation as a key component—referred to as mindfulness-based practices—shows convincing evidence that such interventions are effective in the treatment of psychiatric symptoms and pain, when used in combination with more conventional therapies," according to Dr William R. Marchand of the George E. Wahlen Veterans Affairs Medical Center and the University of Utah in Salt Lake City.

Mindfulness Techniques Show Health Benefits_Dr Marchand reviewed published studies evaluating the health benefits of mindfulness-based practices. Mindfulness has been described as "the practice of learning to focus attention on moment-by-moment experience with an attitude of curiosity, openness, and acceptance." Put another way, "Practicing mindfulness is simply experiencing the present moment, without trying to change anything."

The review focused on three techniques:_• Zen meditation, a Buddhist spiritual practice that involves the practice of developing mindfulness by meditation, typically focusing on awareness of breathing patterns._• Mindfulness-based stress reduction (MBSR), a secular method of using Buddhist mindfulness, combining meditation with elements of yoga and education about stress and coping strategies._• Mindfulness-based cognitive therapy (MBCT), which combines MBSR with principles of cognitive therapy (for example, recognizing and disengaging from negative thoughts) to prevent relapse of depression.

Dr Marchand found evidence that MBSR and MBCT have "broad-spectrum" effects against depression and anxiety and can also decrease general psychological distress. Based on the evidence, MBCT can be "strongly recommended" as an addition to conventional treatments (adjunctive treatment) for unipolar depression. Both MBSR and MBCT were effective adjunctive treatments for anxiety.

Research data also supported the effectiveness of MBSR to help reduce stress and promote general psychological health in patients with various medical and/or psychiatric illnesses. On its own, MBSR was helpful in managing stress and promoting general psychological health in healthy people. There was also evidence that Zen meditation and MBSR were useful adjunctive treatments for pain management.

How do these practices work to affect mental and physical health? Dr Marchand discusses recent research showing the impact of mindfulness practices on brain function and structure, which may in part account for their psychological benefits. "These mindfulness practices show considerable promise and the available evidence indicates their use is currently warranted in a variety of clinical situations," he concludes.

The article includes some proposed evidence-based guidelines for incorporating mindfulness-based practices into health care. So far there's little evidence on which patients are most likely to benefit, but Dr Marchand suggests that patient preferences and enthusiasm are a good guide. He comments, "The most important considerations may be desire to try a mindfulness-based practice and willingness to engage in the regular practice of seated meditation."

Finding right meditation technique key to user satisfaction

A new study published online July 7 in EXPLORE: The Journal of Science and Healing highlights the importance of ensuring that new meditators select methods with which they are most comfortable, rather than those that are most popular.

If they do, they are likely to stick with it, says Adam Burke, the author of the study. If not, there is a higher chance they may abandon meditation altogether, losing out on its myriad personal and medical benefits. Burke is a professor of Health Education at SF State and the director of SF State's Institute for Holistic Health Studies.

"Because of the increase in both general and clinical use of meditation, you want to make sure you're finding the right method for each person," he said. Although meditation has become significantly more popular in the U.S., Burke said, there have been very few studies comparing multiple methods head to head to examine individual preference or specific clinical benefits.

To better understand user preference, Burke compared four popular meditation methods -- Mantra, Mindfulness, Zen and Qigong Visualization -- to see if novice meditation practitioners favored one over the others. The study's 247 participants were taught each method and asked to practice at home and, at the end of the study, evaluate which they preferred. The two simpler methods, Mantra and Mindfulness, were preferred by 31 percent of study participants. Zen and Qigong had smaller but still sizable contingents of adherents, with 22 percent and 14.8 percent of participants preferring them, respectively.

The results show the value of providing new practitioners a simpler, more accessible method of meditation. But they also emphasize that no one technique is best for everyone, and even less common methods are preferred by certain people. Older participants, who grew up when Zen was becoming one of the first meditation techniques to gain attention in the U.S., in particular were more likely to prefer that method.

"It was interesting that Mantra and Mindfulness were found to be equally compelling by participants despite the fact that they are fundamentally different techniques," Burke said. Mindfulness is the most recent meditation technique to gain widespread popularity, he added, and is often the only one with which a novice practitioner or health professional is familiar. Not surprisingly, Mindfulness was the method most preferred by the youngest participants.

"If someone is exposed to a particular technique through the media or a healthcare provider, they might assume because it's popular it's the best for everyone," Burke said. "But that's like saying because a pink dress or a blue sport coat is popular this year, it's going to look good on everybody. In truth, different people like different things. One size does not fit all."

If an individual is not comfortable with a specific method for any reason, he said, they may be less likely to continue meditating and would lose out on such benefits as reduced stress, lower blood pressure or even treatment for addiction.

Burke hopes to see more comparative meditation studies, especially to determine if particular methods are better at addressing specific health issues, such as addiction. If that's the case, he said, healthcare professionals would be able to guide patients toward techniques that will be most effective for them. Additional studies are also needed to determine if there is a way to predict which method will be best suited for any particular individual, he said.

Touch Therapy Helps Reduce Pain, Nausea in Cancer Patients

A new study by the University of Kentucky Markey Cancer Center shows that patients reported significant improvement in side effects of cancer treatment following just one Jin Shin Jyutsu session. Jin Shin Jyutsu is an ancient form of touch therapy similar to acupuncture in philosophy.

Presented at the 2012 Markey Cancer Center Research Day by Jennifer Bradley who is the Jin Shin Jyutsu integrative practitioner at Markey, the study included 159 current cancer patients. Before and after each Jin Shin Jyutsu session, Bradley asked patients to assess their symptoms of pain, stress and nausea on a scale of 0-10, with 0 representing no symptoms.

The study found that in each session patients experienced significant improvement in the areas of pain, stress, and nausea with the first visit and in subsequent visits as well. The mean decreases experienced were three points for stress and two points for both pain and nausea.

"I was pleased to see quantitatively the improvements that patients noted in these primary areas of discomfort," said Bradley. "It was interesting to note that regardless of age, sex or diagnosis, cancer patients received a statistically significant improvement in the side effects from treatment. It is encouraging to note that Jin Shin Jyutsu made improvements in these areas without adding additional unwanted effects that so often occur with medication interventions."

Funded by a grant from the Lexington Cancer Foundation, Jin Shin Jyutsu is considered part of an integrative treatment plan available at the UK Markey Cancer Center. Bradley offers Jin Shin Jyutsu to all cancer patients at no charge. Patients may self-refer, though half are referred by their physician or Markey staff.

During a Jin Shin Jyutsu session, patients receive light touches on 52 specific energetic points called Safety Energy Locks as well as fingers, toes, and midpoints on the upper arm, upper calf and lower leg in predetermined orders known as "flows." Patients remained clothed except for shoes and all hand placements are done over clothing.

Sessions were performed in the Jin Shin Jyutsu Treatment Room, Chemotherapy Outpatient Clinic, or in the patient's hospital room. The study also noted that the greatest overall improvement came from sessions held in the Jin Shin Jyutsu Treatment Room, where sessions are generally of a longer duration.

The study did not include controls for several parameters including the time between sessions or location and duration of service. Bradley's next study will control more of these variables, and her team will access patients' medical records over the time period of their participation to evaluate changes in patients’ medication usage for cancer and symptom management of pain, stress and nausea.

"The American Cancer Society has noted that quality of life is an issue for all cancer patients; those undergoing treatment, late stage patients, and cancer survivors," Bradley said. "There is a need for additional research to develop evidence-based interventions that have a positive impact on the quality of life for all of these individuals without adding to their burden. From what I have seen in my office and the results shown in the study, I believe that Jin Shin Jyutsu has great promise in this area.”

Should Spinal Manipulation for Neck Pain Be Abandoned?

The effectiveness of spinal manipulation divides medical opinion. On the British Medical Journal website, experts debate whether spinal manipulation for neck pain should be abandoned.

Spinal manipulation is a technique that involves the application of various types of thrusts to the lumbar spine (lower back) or cervical spine (neck) to reduce back pain, neck pain and other musculoskeletal conditions.

Neil O'Connell and colleagues argue that cervical spine manipulation "may carry the potential for serious neurovascular complications" and that the technique is "unnecessary and inadvisable."

They say that studies "provide consistent evidence of an association between neurovascular injury and recent exposure to cervical manipulation." Such injuries include vertebral artery dissection (a tear to the lining of the vertebral artery, which is located in the neck and supplies blood to the brain) and stroke.

They point to a Cochrane review of randomised trials of neck manipulation or mobilisation which concluded that as a stand-alone treatment, manipulation provides only moderate short term pain relief versus controls, sham manipulation, or muscle relaxants, and is unlikely to offer meaningful long term benefit for people with neck pain.

Other recent large, high quality trials reinforce this message, suggesting that manipulation is not superior when directly compared with other physical interventions such as exercise, they add.

They argue that, given the equivalence in outcome with other forms of therapy, manipulation seems to be clinically unnecessary. "The potential for catastrophic events and the clear absence of unique benefit lead to the inevitable conclusion that manipulation of the cervical spine should be abandoned as part of conservative care for neck pain," they conclude.

But David Cassidy and colleagues argue that cervical spine manipulation is a valuable addition to patient care and should not be abandoned.

They point to high quality evidence that "clearly suggests that manipulation benefits patients with neck pain" and raises doubt about any causal (direct) relation between manipulation and stroke.

When combined with recent randomised trial results, "this evidence supports including manipulation as a treatment option for neck pain, along with other interventions such as advice to stay active and exercise," they say.

However, they acknowledge that, when risk, benefit, and patient preference are considered, "there is currently no preferred first line therapy, and no evidence that mobilisation is safer or more effective than manipulation. Thus the identification of safe and effective interventions for neck pain remains a high priority."

They conclude: "We say no to abandoning manipulation and yes to more rigorous research on the benefits and harms of this and other common interventions for neck pain."

Meditation practice may decrease risk for cardiovascular disease in teens

Regular meditation could decrease the risk of developing cardiovascular disease in teens who are most at risk, according to Georgia Health Sciences University researchers.

In a study of 62 black teens with high blood pressure, those who meditated twice a day for 15 minutes had lower left ventricular mass, an indicator of future cardiovascular disease, than a control group, said Dr. Vernon Barnes, a physiologist in the Medical College of Georgia and the Georgia Health Sciences University Institute of Public and Preventive Health.

Barnes, Dr. Gaston Kapuku, a cardiovascular researcher in the institute, and Dr. Frank Treiber, a psychologist and former GHSU Vice President for Research, co-authored the study published in Evidence-Based Complementary and Alternative Medicine.

Half of the group was trained in transcendental meditation and asked to meditate for 15 minutes with a class and 15 minutes at home for a four-month period. The other half was exposed to health education on how to lower blood pressure and risk for cardiovascular disease, but no meditation. Left ventricular mass was measured with two-dimensional echocardiograms before and after the study and the group that meditated showed a significant decrease.

"Increased mass of the heart muscle's left ventricle is caused by the extra workload on the heart with higher blood pressure," Barnes explained. "Some of these teens already had higher measures of left ventricular mass because of their elevated blood pressure, which they are likely to maintain into adulthood."

During meditation, which Barnes likens to a period of deep rest, the activity of the sympathetic nervous system decreases and the body releases fewer-than-normal stress hormones. "As a result, the vasculature relaxes, blood pressure drops and the heart works less," he said.

School records also showed behavioral improvements.

"Transcendental meditation results in a rest for the body that is often deeper than sleep," Barnes said. "Statistics indicate that one in every 10 black youths have high blood pressure. If practiced over time, the meditation may reduce the risk of these teens developing cardiovascular disease, in addition to other added health benefits. "

In-patient, out-patient stroke rehab might benefit from yoga

Researchers looking into the value of adapted yoga for stroke rehabilitation report that after an eight-week program, study participants demonstrated improved balance and flexibility, a stronger and faster gait, and increased strength and endurance.

The study, involving researchers from the Richard L. Roudebush VA Medical Center in Indianapolis, Indiana University-Purdue University Indianapolis and IU Bloomington, exposed older veterans recovering from stroke to yoga. The men and women had completed their post-stroke occupational and physical therapy before the study but continued to have impairments.

The findings from two new analyses of the study will be presented on Wednesday during the annual meeting of the American College of Sports Medicine in San Francisco.

Arlene Schmid, rehabilitation research scientist at the Roudebush VA Medical Center and principle investigator of the VA-funded study, said loss of functional strength, flexibility and endurance is common after a stroke, which can lead to long-term disability. She said 5 million Americans are living with the consequences of stroke, which can alter patients' lifestyles through decreased independence in activities of daily living, limited mobility and reduced participation in society.

"Clinicians need methods to manage and improve these post-stroke physical impairments," said Schmid, also an assistant professor of occupational therapy in the School of Health and Rehabilitation Sciences at IUPUI.

Her analysis, "Physical Improvements After Yoga for People With Chronic Stroke," examined gains in functional strength, flexibility and endurance as a result of the yoga and found significant improvements in all areas. The yoga activities, she said in her report, might have "improved neuromuscular control, likely allowing for strength improvements in affected limbs, sides or areas of disuse."

Tracy Dierks, associate professor of physical therapy in the School of Health and Rehabilitation Sciences, focused his analysis of study findings on how well study participants could walk after the program.

In "The Effect of Balance Exercise Therapy on Gait Parameters in Individuals With Chronic Stroke," he reports that after the yoga program, the study participants showed improved balance and faster gait speeds with longer steps or strides. But, while the veterans could walk faster, they were unable to sustain this faster speed for the duration of the six-minute test.

"The gait findings from our study have the potential to greatly impact clinical practice for gait recovery," Dierks said. "The yoga intervention was designed to improve balance, not gait; we did not focus on improving gait at all. Yet we saw major improvements in most clinical gait measurements. But one often overlooked deficit remained: the inability to sustain gait speed for endurance."

Schmid concluded in her presentation that it might be appropriate to include yoga in the in-patient or out-patient rehabilitation people receive after a stroke. Such a class should be taught by a yoga therapist who has had additional training in anatomy and physiology and how to work with people with disabilities

Early Treatment by a Physical Therapist Associated with Reduced Risk of Health Care Utilization and Reduced Overall Health Care Costs

A new study published in Spine shows that early treatment by a physical therapist for low back pain (LBP), as compared to delayed treatment, was associated with reduced risk of subsequent health care utilization and lower overall health care costs.

Using a national database of employer-sponsored health plans, researchers examined a sample of 32,070 patients who were newly consulting a primary care physician for low back pain. Patients were identified and categorized based on their use of physical therapist services within 90 days of the consultation. Those who were referred to a physical therapist early (within 14 days of the consultation) showed a reduced risk of subsequent health care utilization and experienced lower overall health care costs than did those patients with delayed treatment by a physical therapist (within 15-90 days of consultation).

During an 18-month follow-up period, researchers found that early treatment by a physical therapist was associated with reduced risk of subsequent surgery, injections, physician visits, opioid use, and advanced imaging, along with a corresponding reduction in overall LBP-related medical costs relative to delayed treatment by a physical therapist. Total health care costs for patients receiving early care from a physical therapist were an average of $2,736.23 lower.

According to the study's lead author, Julie M. Fritz, PT, PhD, ATC, associate professor in the Department of Physical Therapy at the University of Utah and clinical outcomes research scientist at Intermountain Health care in Salt Lake City, "The value of referring patients to physical therapy who are newly consulting primary care physicians for low back pain likely depends on the timing of the referral and how patients adhere to physical therapy guidelines that recommend maintaining and improving activity levels." She added, "Despite the fact that primary care practice guidelines generally recommend delaying referral to a physical therapist for several weeks, we found that about half the patients receiving treatment from a physical therapist did so within two weeks, which is a practice that may be justified by emerging evidence."

Fritz explained that one possible reason for the link between early care by a physical therapist and positive outcomes may be that physical therapists can contribute to promoting a greater sense of self-reliance in managing LBP and confidence in a positive outcome. "If a physical therapist's treatment assists in developing self-efficacy, it is reasonable to expect it would have greater impact when implemented very early, before negative expectations have become reinforced and entrenched." Fritz added that early care administered by a physical therapist may offer an alternative to management strategies that can foster a sense of dependency in the patient, such as use of MRI or opioids.

The study found that patients using a PPO plan were more likely to receive early treatment from a physical therapist (53.4%) as compared with those using an HMO plan (44.7%). Also, the highest rates of physical therapist utilization were found in the Northeast and West. Patients in the Midwest were more likely to seek early treatment from a physical therapist (58.7%).

An April 20 study in Spine also supports the benefits of early physical therapy for low back pain. In this study, researchers found that patients who received physical therapy early (within 30 days) after an episode of acute low back pain had a lower risk of subsequent medical service usage (surgery or epidural steroid injections) than patients who received physical therapy later. In this study, authors analyzed a national sample of the Centers for Medicare and Medicaid Services' physician outpatient billing claims.

Currently 47 states and the District of Columbia allow some form of direct access to physical therapists for treatment/intervention, although some states impose restrictions if patients have not been referred by a physician.

Coauthors of the study were John D. Childs, PT, PhD, associate professor and director of research, US Army-Baylor University Doctoral Program in Physical Therapy, Ft Sam Houston, San Antonio, TX; Robert S. Wainner, PT, PhD, associate professor, Texas State University - San Marcos, San Marcos, TX, and Timothy W. Flynn, PT, PhD, distinguished professor, Rocky Mountain University of Health Professions.

The study was funded by grants from the Orthopedic and Private Practice Sections of the American Physical Therapy Association (APTA) and the American Academy of Orthopaedic and Manual Physical Therapists. Funds were also provided by a faculty grant from Texas State University.

The American Physical Therapy Association (APTA) represents more than 80,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Learn more about conditions physical therapists can treat and find a physical therapist in your area at www.moveforwardpt.com. Consumers are encouraged to follow us on Twitter (@moveforwardpt) and Facebook.

A quick fix is possible for sacroiliac joint pain in many children and adolescents

Investigators report that a simple bedside manual therapy to correct a painful misaligned sacroiliac joint was highly successful in a group of 45 patients 10 to 20 years of age. Thirty-six patients (80 percent) obtained significant pain relief, whereas nine patients (20 percent) experienced minimal to no relief. In 24 patients (53 percent) complete resolution of pain was experienced immediately upon treatment. Only two patients required a second treatment because of symptom recurrence. These findings are reported in a new article, "Sacroiliac joint pain in the pediatric population. Clinical article," by Stoev and colleagues, published in the June 2012 issue of the Journal of Neurosurgery: Pediatrics, scheduled to appear online today.

Investigators at Washington University in St. Louis and St. Louis Children's Hospital conducted a retrospective analysis of patient records in children and adolescents with low back pain who had been referred to a single neurosurgeon, Jeffrey R. Leonard, M.D., between 2005 and 2011. At the initial consultation, the patients performed a variety of physical maneuvers designed to evaluate whether their pain stemmed from misalignment of the sacroiliac joint. In 48 patients pain was attributed to this misalignment. There were 37 female and 11 male patients with a mean age of 15.7 years (range 10 to 20.6 years). The average duration of symptoms was 7 months (range 0.25 to 48 months). Before treatment the patients' mean pain score was 5.7 (range 3 to 9.5) on a 10-point visual analog scale ranging from 0 = no pain to 10 = most extreme pain. Three patient files were incomplete, and therefore the investigators could only report results on pain relief in the 45 pediatric patients in whom complete follow-up data were accessible.

Treatment consisted of sacroiliac joint manipulation accomplished by performing isometric hip contraction and extension. Physical therapists call this procedure the "muscle energy technique." The patient flexes and extends the hip while the physical therapist provides resistance to the move. This forces the sacroiliac joint back into proper alignment. Most patients experienced improvement in their symptoms, and more than half of the patients had immediate pain relief following treatment.

When asked whether the investigators were surprised to find that such a simple technique could bring about pain relief in so many patients, Dr. Leonard said, "No we were not surprised. We were surprised by the number of patients who actually presented with this problem. These children have had prior imaging studies, procedures, or been in back pain for over a year."

Following treatment, patients were given instructions for at-home exercises to strengthen muscles in the region to ensure that sacroiliac joint alignment would be maintained. Dr. Leonard believes that patients were compliant with these exercises "because a large number of patients were in significant debilitating pain which kept them out of activities. This simple manipulation allowed them to potentially leave clinic pain free." In this study only two patients needed repeated treatment.

The authors state that there are no clear estimates on how many children and adolescents suffer pain from misaligned sacroiliac joints, but low back pain is fairly common. Unlike adults whose sacroiliac joint–related pain is usually related to disc deterioration or joint disease, children and adolescents are more likely to experience pain due to repeated stress from athletic activities. Girls are more susceptible (77% in this study) because of the laxity of the female developing pelvic girdle.

As the authors point out, the source of low back pain is often difficult to identify, which can make patients face long periods of painful symptoms, drug dependency, and/or unnecessary surgical procedures. The take-away message from this study is that simple manual manipulation should be tried in children and adolescents whose low back pain is suspected to be caused by a misaligned sacroiliac joint. The therapy described in this paper is cost-effective, takes little time, and poses no negative consequences to the patient. The authors found that this simple manipulation procedure can provide sustained relief in most patients.

COPD: Acupuncture appears linked with improvement in patients with chronic obstructive pulmonary disease

According to a small clinical trial reported by investigators from Japan, acupuncture appears to be associated with improvement of dyspnea (labored breathing) on exertion, in patients with chronic obstructive pulmonary disease (COPD), according to a study published Online First by Archives of Internal Medicine, a JAMA Network publication.

The management of dyspnea is an important target in the treatment of COPD, a common respiratory disease characterized by irreversible airflow limitation. COPD is predicted to be the third leading cause of death worldwide by 2020, according to the study background.

Masao Suzuki, L.Ac., Ph.D., of Kyoto University and Meiji University of Integrative Medicine, Kyoto, Japan, and colleagues conducted a randomized controlled trial from July 2006 through March 2009. A total of 68 patients diagnosed with COPD participated, and 34 were assigned to a real acupuncture group for 12 weeks, plus daily medication. The other 34 were assigned to a placebo acupuncture group in which the needles were blunt (and appeared to, but did not enter the skin). The primary measure was the evaluation of a six-minute walk test on a Borg scale where 0 meant "breathing very well, barely breathless" and 10 signified "severely breathless."

"We demonstrated clinically relevant improvements in DOE [dyspnea on exertion] (Borg scale), nutrition status (including BMI), airflow obstruction, exercise capacity and health-related quality of life after three months of acupuncture treatment," the authors note.

After 12 weeks of treatment, the Borg scale score after the six-minute walk test improved from 5.5 to 1.9 in the real acupuncture group. No improvement was seen in the Borg scale score in the placebo acupuncture group before and after treatment (4.2 and 4.6, respectively), according to the study results.

"Randomized trials with larger sample sizes and longer-term interventions with follow-up evaluations are necessary to confirm the usefulness of acupuncture in COPD treatment," the authors conclude.

Invited Commentary: Reevaluating Acupuncture Research Methods

In an invited commentary, George T. Lewith, M.A., M.D., F.R.C.P., M.R.C.G.P, and Mike Thomas, Ph.D., F.R.C.P., of the University of Southampton, Hampshire, England, write: "Where does this study lead us? The authors note that acupuncture must be used in addition to conventional care, and although this is undoubtedly correct, it may have significant economic implications."

They continue: "Evaluating traditional interventions, such as acupuncture, that are widely available has many implications, including the fact that best practice and dose response have rarely been evaluated scientifically as would be the case for a new pharmaceutical agent."

"This study points to an important potential role for acupuncture in COPD management. These findings demand larger but equally methodologically rigorous confirmatory studies if we are to consider integrating this approach into our management strategy," they conclude.

Acupuncture can improve skeletal muscle atrophy

A team of Japanese researchers will reveal study results Monday at the Experimental Biology 2012 meeting that show how acupuncture therapy mitigates skeletal muscle loss and holds promise for those seeking improved mobility through muscle rejuvenation.

"It is my hope that this study will demonstrate acupuncture's feasibility with regard to improving health among the elderly and medical patients. Our findings could identify acupuncture as the primary nonpharmacological treatment to prevent skeletal muscle atrophy in the future," says Akiko Onda, an acupuncturist and graduate student at the Waseda University School of Sport Sciences, who has been conducting a series of studies on skeletal muscle atrophy for the past four years. Her presentation will be at 12:25 p.m. Monday, April 23, at the American Society for Biochemistry and Molecular Biology annual meeting, which is part of EB2012.

Loss of skeletal muscle mass has a profound effect on the ability of the elderly and the sick to engage in physical activity. Because skeletal muscle has high plasticity, interventions such as exercise training, improved nutrition and mechanical stimulation are often recommended to prevent atrophy. Unfortunately, these can be challenging goals for those who are already frail or who have severe medical conditions. Onda insists an alternative nonpharmacological intervention is urgently required, and so she and her collaborators in two labs at Waseda University decided to explore how acupuncture affects skeletal muscle at the molecular level.

"The main focus of this study is changes in the mRNA expression levels of muscle-specific atrophic genes such as atrogin-1," Onda says. "Muscle mass and structure are determined by the balance between protein degradation and synthesis."

The team showed that decreases in muscle mass in mice and in the mRNA expression level of the E3 ubiquitin ligase atrogin-1 can be significantly reversed by acupuncture.

In spite of the World Health Organization's endorsement of acupuncture and the widespread use of acupuncture as a treatment for various diseases, acupuncture is still regarded by many as obscure and suspicious, and its underlying molecular mechanisms are almost completely unknown.

"Our results have uncovered one molecular mechanism responsible for the efficacy of acupuncture treatment and clarified its usefulness in preventing skeletal muscle atrophy in mice," Onda said. "We hope to introduce acupuncture as a new strategy for preventing skeletal muscle atrophy in the future. Further investigations into its molecular mechanisms will help to decrease the medical community's suspicion of acupuncture and provide us with a better understanding of how acupuncture treatment prevents skeletal muscle atrophy.

Meditation Makes You More Creative

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Certain meditation techniques can promote creative thinking. This is the outcome of a study by cognitive psychologist Lorenza Colzato and her fellow researchers at Leiden University, published 19 April in Frontiers in Cognition.

This study is a clear indication that the advantages of particular types of meditation extend much further than simply relaxation. The findings support the belief that meditation can have a long-lasting influence on human cognition, including how we think and how we experience events.

Two ingredients of creativity

The study investigates the influences of different types of meditative techniques on the two main ingredients of creativity: divergent and convergent styles of thinking.

* Divergent thinking

Divergent thinking allows many new ideas to be generated. It is measured using the so-called Alternate Uses Task method where participants are required to think up as many uses as possible for a particular object, such as a pen.

* Convergent thinking

Convergent thinking, on the other hand, is a process whereby one possible solution for a particular probem is generated. This method is measured using the Remote Associates Task method, where three unrelated words are presented to the participants, words such as 'time', 'hair' and 'stretch'. The particpants are then asked to identify the common link: in this case, 'long'.

Analysis of meditation techniques

Colzato used creativity tasks that measure convergent and divergent thinking to assess which meditation techiques most influence creative activities. The meditation techniques analysed are Open Monitoring and Focused Attention meditation.

* In Open Monitoring meditation the individual is receptive to all the thoughts and sensations experienced without focusing attention on any particular concept or object.
* In Focused Attention meditation the individual focuses on a particular thought or object.

Different types of meditation have different effects

These findings demonstrate that not all forms of meditation have the same effect on creativity. After an Open Monitoring meditation the participants performed better in divergent thinking, and generated more new ideas than previously, but Focused Attention (FA) meditation produced a different result. FA meditation also had no significant effect on convergent thinking leading to resolving a problem.

Naturopathic care can improve blood sugar, mood in diabetes

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Holistic approach added to benefits of usual care in joint Group Health–Bastyr University study

Study link: Adjunctive naturopathic care for type 2 diabetes: patient-reported and clinical outcomes after one year

A new joint study by Group Health Research Institute and Bastyr University Research Institute found that type 2 diabetes patients who received naturopathic care (as an adjunct to conventional care) had lower blood-sugar levels, better eating and exercise habits, improved moods, and a stronger sense of control over their condition than did patients receiving only conventional care.

The findings, published today in BMC Complementary and Alternative Medicine, show that complementary and alternative medicine (CAM) may have several positive effects on people with type 2 diabetes, which affects nearly 26 million Americans.

“The news is encouraging for those fighting the disease,” said Ryan Bradley, ND, MPH, director of the Center for Diabetes and Cardiovascular Wellness at Bastyr University and its clinic, the Bastyr Center for Natural Health. “Patients involved in the study cited the benefits of trying different approaches to find the best ways to minimize the effects of type 2 diabetes. In many ways, that strategy mirrors our partnership with Group Health in this research study—working together to discover the best possible solutions.”

Forty study participants received counseling on diet, exercise, and glucose monitoring from four naturopathic physicians (NDs) in addition to conventional diabetes care from their medical doctors, including prescription medications. Many of the participants also received stress-management care and dietary supplements. Researchers then compared these 40 participants with 329 patients receiving only conventional diabetes care.

In six months and about four naturopathic treatment visits, participants demonstrated improved self-care, more consistent monitoring of glucose, and improved moods. Hemoglobin A1c rates (a measure of blood-sugar control) were nearly a full percentage point lower for those patients. This compares with a drop of only 0.5 percent over the same time period for 329 clinically similar patients receiving only conventional diabetes care. The encouraging findings from this small observational study will need to be confirmed by a randomized trial with larger numbers of participants, according to Dr. Bradley.

Finding more effective ways of treating type 2 diabetes is important because it is one of the top-10 causes of death in Americans and is costly to treat: $1 out of every $10 spent on health care in the United States is used to fight type 2 diabetes, at a cost of $178 billion every year.

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National Study Shows Integrative Medicine Is Effective in Treating Common and Costly Health Conditions

A new survey of 29 integrative medicine centers around the U.S. found that 75 percent reported success using integrative practices to treat chronic pain and more than half reported positive results for gastrointestinal conditions, depression and anxiety, cancer and chronic stress.

The results of the survey, Integrative Medicine in America: How Integrative Medicine Is Being Practiced in Clinical Centers Across the United States, are being released today by The Bravewell Collaborative.

“What we have seen in our clinics over the past 14 years is that more and more people are turning to integrative therapies to help them with health problems,” says William Stewart, MD, the co-founder and Medical Director of California Pacific Medical Center’s Institute for Health and Healing. “This survey shows that for many patients, particularly those with chronic health issues, the multidimensional team approach of integrative medicine works.”

“With chronic health issues costing the U.S. economy more than $1 trillion a year, it’s essential to find the most effective ways to treat and prevent the most prevalent conditions,” said Donald Abrams, MD, co-author of the report and professor of clinical medicine at the University of California San Francisco.

Integrative medicine is an approach that puts the patient at the center of care and addresses the full range of physical, emotional, mental, social, spiritual and environmental influences that affect health. Employing a personalized strategy that considers the patient's unique conditions, needs and circumstances, integrative medicine uses the most appropriate interventions from an array of scientific disciplines to heal illness and disease and help people regain and maintain optimal health.

Twenty-nine integrative medicine centers, - including CPMC’s Institute for Health and Healing, part of the Sutter Health network - were surveyed by The Bravewell Collaborative. All participating centers were affiliated with hospitals, health systems and/or medical and nursing schools. Patient services include adult care (100% of those surveyed), geriatric care (97%), adolescent care (86%), OB-GYN care (72%), pediatric care (62%) and end-of-life care (66%). Findings from the report, which evaluated trends in prevention and wellness, patient outcomes, and emerging norms of care and reimbursement, suggest that the practice of integrative medicine offers promise for increasing the effectiveness of care and improving people’s health.

The interventions prescribed most frequently by practitioners in the study, usually in combination, were: food/nutrition, supplements, yoga, meditation, traditional Chinese medicine/acupuncture, massage and pharmaceuticals.

“It’s important to remember that these therapies are often used in conjunction with other medical approaches, such as chemotherapy and/or surgery,” says Dr. Stewart. “At the IHH we work with each patient and their other caregivers to come up with an approach that is best suited for them. Our care integrates traditional and contemporary healing practices.”

“This report illustrates the great potential of integrative medicine to help prevent illness and foster lifelong health,” explained Christy Mack, President of The Bravewell Collaborative. “These approaches not only treat the whole person but also empower individuals to be active participants in their health care.”
Participating Integrative Medicine Centers:

- Alliance Institute for Integrative Medicine
- Arizona Center for Integrative Medicine
- Cancer Treatment Centers of America
- The Center for Integrative Medicine at the University of Colorado
- Center for Life University of New Mexico
- Cleveland Clinic Center for Integrative Medicine
- Continuum Center for Health and Healing
- Duke Integrative Medicine
- 11th Street Family Services of Drexel University
- GW Center for Integrative Medicine
- Greenwich Hospital Integrative Medicine Program
- Institute for Health & Healing at California Pacific Medical Center
- Jefferson-Myrna Brind Center of Integrative Medicine
- Marino Center for Integrative Health
- University of Maryland Center for Integrative Medicine
- Integrative Medicine Program, Mayo Clinic
- Integrative Medicine Center at MD Anderson Cancer Center
- Northwestern Integrative Medicine
- OSU Center for Integrative Medicine
- UCSF Osher Center for Integrative Medicine
- Osher Clinical Center
- Penny George Institute for Health and Healing
- Scripps Center for Integrative Medicine
- Simms-Mann Health and Wellness Center at Venice Family Clinic
- Center for Integrative Medicine and Wellness at Stamford Hospital
- Stanford Center for Integrative Medicine
- Susan Samueli Center of Integrative Medicine
- University of Wisconsin Integrative Medicine
- Vanderbilt Center for Integrative Health
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