camwatch

Chang FY, Lu CL. Treatment of irritable bowel syndrome using complementary and alternative medicine. J Chin Med Assoc. 2009 Jun;72(6):294-300. PMID: 19541564

A thoughtful and enlightened review of CAM practices used by patients with irritable bowel syndrome, by researchers at Taipei Veterans General Hospital and National Yang-Ming University School of Medicine in Taipei.

From the abstract:

"Unfortunately, none of the currently available drugs … are globally effective in treating all IBS symptoms, and the advanced receptor-targeted drugs are not always successfully and safely marketed. Consequently, more than half of patients may seek complementary and alternative medicine (CAM) to treat the annoying bowel symptoms. Physicians have considered these CAM measures to have an "enhanced placebo effect". For example, many herbal medicine and plant products are globally used to treat IBS, whereas their efficacies are often inconclusive because of small sample sizes, inadequate data analyses and lack of standardized preparations. Meta-analyses do not establish their true efficacy. Acupuncture has long been employed by patients themselves to treat functional gastrointestinal disorders with satisfactory response, but its effect on IBS does not seem to be promising. Peppermint oil, melatonin and clay-like materials are effective in treating some IBS symptoms, while their true pharmacology remains enigmatic."

CAMWatch: Posts about free-access, peer-reviewed articles on aspects of complementary medicine theory, practice and policy (about the blogger).This blog is not a source for medical advice.

technorati tags: complementary and alternative medicine integrative medicine irritable bowel syndrome

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Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. National health statistics reports; no 12. Hyattsville, MD: National Center for Health Statistics. 2008. [Read the report.]

This nationwide survey of CAM practices in the United States, developed by the National Center for Complementary and Alternative Medicine, was undertaken within the latest National Health Interview Survey.

The study, published in December 2008, includes questions on 36 types of CAM medical and health care systems, practices, and products such as herbal supplements, meditation, chiropractic, and acupuncture used in the previous year.

The authors give their definition of CAM in the Introduction:

"Complementary and alternative medicine (CAM) covers a heterogeneous spectrum of ancient to new-age approaches that purport to prevent or treat disease. By definition, CAM practices are not part of conventional medicine because there is insufficient proof that they are safe and effective. Complementary interventions are used together with conventional treatments, whereas alternative interventions are used instead of conventional medicine."

The survey found that the most commonly used CAM therapies among adults were:

• Nonvitamin, nonmineral, natural products (17.7%)
• Deep breathing exercises (12.7%)
• Meditation (9.4%)
• Chiropractic or osteopathic manipulation (8.6%)
• Massage (8.3%)
• Yoga (6.1%)

This is the first national study in the U.S. to measure CAM use by children. Reported CAM use in children was substantially less than in adults. The most common practices among children were nonvitamin, nonmineral, natural products (3.9%), chiropractic or osteopathic manipulation (2.8%), deep breathing exercises (2.2%), yoga (2.1%), and homeopathic treatment (1.3%).

The report includes a brief discussion of systematic reviews of CAM therapies published between 2002 and 2007, identifying 10 that "found sufficient evidence to conclude that a given CAM therapy was effective for a given condition," including acupuncture and yoga for back pain, and acupuncture for knee pain (including osteoarthritis), insomnia, and nausea or vomiting (in pregnancy, following surgery, and induced by chemotherapy).

CAMWatch: Posts about free-access, peer-reviewed articles on aspects of complementary medicine theory, practice and policy (about the blogger). This blog is not a source for medical advice.

technorati tags: complementary and alternative medicine integrative medicine

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Madsen MV, Gøtzsche PC, Hróbjartsson A. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ. 2009 Jan 27;338:a3115. PMID: 19174438

This study by researchers at Rigshospitalet in Copenhagen looked at 13 trials (3,025 patients) with pain from a number of clinical conditions including knee osteoarthritis, tension-type headache, migraine, low back pain, fibromyalgia, abdominal scar pain, postoperative pain, and procedural pain during colonoscopy.

They found "a small analgesic effect of acupuncture… which seems to lack clinical relevance and cannot be clearly distinguished from bias," and concluded that "whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear." From the discussion:

Our review is the first that identifies and analyses three armed trials of acupuncture for pain, thus providing an estimate of the general analgesic effect of acupuncture and its direct comparison with the analgesic effect of placebo acupuncture. The review is fairly large, includes several trials of high methodological quality, and covers a broad range of common painful conditions…."

Our findings question both the traditional foundation of acupuncture, which is based on the existence of meridians and Qi sensations, and the prevailing hypothesis that acupuncture has an important effect on pain in general. If this hypothesis is wrong, and our results point to that, then acupuncture would seem to be unlikely to have an effect on pain related only to certain conditions, but further studies may examine this question."

CAMWatch: Posts about free-access, peer-reviewed articles on aspects of complementary medicine theory, practice and policy (about the blogger). This blog is not a source for medical advice.

technorati tags: complementary and alternative medicine integrative medicine pain

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Roberts J, Huissoon A, Dretzke J, et al. A systematic review of the clinical effectiveness of acupuncture for allergic rhinitis. BMC Complement Altern Med. 2008 Apr 22;8(1):13 [Epub ahead of print] PMID: 18430229

British researchers undertook this comprehensive analysis of clinical trials through 2007. The authors found that only two of the seven trials they identified were of high quality, and therefore that there is "currently insufficient evidence to support or refute the use of acupuncture in patients with [allergic rhinitis].

As the first such analysis, this study provides a valuable benchmark for future research of acupuncture in this setting and particularly in the design of randomized clinical trials. One observation points to a key difficulty in designing trials for therapies that attempt to engage the body’s capacity for self-healing, the so-called "placebo effect":

Studies in AR frequently demonstrate marked improvements in the placebo group, and this means that large, well-controlled studies are required to demonstrate true effects.

technorati tags: complementary and alternative medicine integrative medicine complementary medicine acupuncture clinical trials placebo effect

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