Wednesday, November 02, 2016

What Is Cupping Therapy? Uses, Benefits, Side Effects, and More

 Cupping therapy is an ancient form of alternative medicine in which a therapist puts special cups on your skin for a few minutes to create suction. People get it for many purposes, including to help with pain, inflammation, blood flow, relaxation and well-being, and as a type of deep-tissue massage.

The cups may be made of:
  •     Glass
  •     Bamboo
  •     Earthenware
  •     Silicone

Cupping therapy might be trendy now, but it’s not new. It dates back to ancient Egyptian, Chinese, and Middle Eastern cultures. One of the oldest medical textbooks in the world, the Ebers Papyrus, describes how the ancient Egyptians used cupping therapy in 1,550 B.C.


Acupuncture proves fertile ground for a healthy conception

Can acupuncture really increase a woman's chances of conceiving? Research has found that acupuncture treatment can have a positive effect on those trying for a baby and can actually aid the conception process. Over the past twenty years, fertility problems have increased dramatically. At least 25* percent of couples in the UK planning a baby will have trouble conceiving, and more and more couples are turning to fertility treatments to help them start a family.

Fertility focused acupuncture treatment can help to increase blood flow to the reproductive organs, balance hormone levels, regulate the menstrual cycle and help improve the lining of the uterus and quality of eggs released. Additionally, conditions such as polycystic ovaries and endometriosis have also been shown to improve with acupuncture

Men today also face fertility problems. Benefits to male fertility have been helped by acupuncture with positive effects on sperm count, morphology and mobility.


Source: British Acupuncture Council

Related: Infertility: Acupuncture, A valuable Ally

Monday, October 31, 2016

Acupuncture Relieves Rhinitis & Prevents Oral Ulcers

Acupuncture relieves nasal congestion due to rhinitis. Research published in the Shanghai Journal of Acupuncture and Moxibustion demonstrates that acupuncture combined with moxibustion alleviates nasal congestion, swelling, post-nasal drip, and a runny nose.The research confirms that acupuncture exerts an anti-inflammatory action, enhances immunity, and is effective in the prevention of immunological related disease.

The research compared the effectiveness of acupuncture plus moxibustion with nasal drops containing nitrofurazone and ephedrine. The total effective rate of the nasal drop medication was 55%. Acupuncture combined with moxibustion achieved an 85% total effective rate for the alleviation of rhinitis signs and symptoms.


Friday, October 28, 2016

These 3 acupuncture points are banned for pregnant women, here's why..

Many Traditional Chinese Medicine therapists consider acupuncture to be a safe and effective form of alternative medicine for pregnant women. Complications arising from the application acupuncture therapy during pregnancy are rare; however some acupuncture points should be used with caution or avoided  during pregnancy.

Below we have listed three acupoints many acupuncturists would agree should be avoided throughout every trimester. Although these are three of the most popular and widely used acupoints in an acupuncturist’s arsenal, their dynamically powerful action on a patient’s qi makes them a risky choice during pregnancy.


Thursday, October 27, 2016

Musculoskeletal Injections: A Review of the Evidence

Injections are valuable procedures for managing musculoskeletal conditions commonly encountered by family physicians. Corticosteroid injections into articular, periarticular, or soft tissue structures relieve pain, reduce inflammation, and improve mobility. Injections can provide diagnostic information and are commonly used for postoperative pain control. Local anesthetics may be injected with corticosteroids to provide additional, rapid pain relief. Steroid injection is the preferred and definitive treatment for de Quervain tenosynovitis and trochanteric bursitis. Steroid injections can also be helpful in controlling pain during physical rehabilitation from rotator cuff syndrome and lateral epicondylitis. Intra-articular steroid injection provides pain relief in rheumatoid arthritis and osteoarthritis. There is little systematic evidence to guide medication selection for therapeutic injections. The medication used and the frequency of injection should be guided by the goal of the injection (i.e., diagnostic or therapeutic), the underlying musculoskeletal diagnosis, and clinical experience. Complications from steroid injections are rare, but physicians should understand the potential risks and counsel patients appropriately. Patients with diabetes who receive periarticular or soft tissue steroid injections should closely monitor their blood glucose for two weeks following injection.


Am Fam Physician. 2008 Oct 15;78(8):971-976.

Sunday, October 23, 2016

Providing Value-Based Regional Anesthesia: It’s a Matter of Angles

The value of the services that anesthesiologists provide is being examined more closely than ever. Indeed, determining the true value of regional anesthesia can only be done within the context of its many costs, most of which are not monetary.

“‘Value’ is the name of the game in medicine these days,” said Brian E. Harrington, MD, staff anesthesiologist at Billings Clinic Hospital, in Billings, Mont. “Yet I don’t think a lot of anesthesiologists have a great understanding of the concept of value and how we can impact it,” he said during the 21st Annual Jefferson Anesthesia Conference.

Value = Benefit/Cost

“Many anesthesiologists limit their perception of the value of regional anesthesia to its benefits: less pain, faster rehabilitation and better patient satisfaction,” Dr. Harrington said. “But value is actually benefit per cost.”


Saturday, October 22, 2016

The Effect of LI4 Acupressure on Labor Pain Intensity and Duration of Labor

One of the most pressing concerns and fears for pregnant women is the pain of labor, which leads to an increase in the number of cesarean sections. Pain relief in labor is an important issue in obstetric care, however, as yet, there is no standard and accepted technique for the relief of that pain without side effects.

Generally, there are two options for pain relief during labor, these use either pharmacological or non-pharmacological methods. Pharmacological methods have adverse side effects for the mother and fetus, whereas non-pharmacological methods are free from side effects.

Acupressure is a non-invasive method which is used to augment labor, provide pain relief, and shorten delivery time. It increases the intensity of uterine contractions (based on Montevideo unit) without affecting the duration and intervals of uterine contractions and, eventually, reduces the duration of delivery.

A single-blinded, randomized, control trial was carried out over a seven-month period, between October 2011 and April 2012, at Dr. Shariati University Hospital in Bandar Abbas, Iran. The trial was approved by the Ethics Committee of Hormozgan University of Medical Sciences (HUMS), Iran.

Our study suggests that L14 acupressure is a suitable non-pharmacological technique that is easy to perform and effective in elevating pain, without causing adverse side effects for the mother or baby. It can be used to reduce pain during the active phase of labor rather than using pharmacological methods. According to the World Health Organization’s policies to reduce the rate of cesarean deliveries and promotion of safe childbirth, it is necessary to make childbearing pleasant and reduce maternal fear of natural childbirth using safe methods to reduce labor pain and increase the rate of vaginal delivery. In order to make this possible, midwives need training in using non-pharmacological techniques and the attitudes and policies of the hospitals need to be altered. Due to the simplicity and safety of the acupressure technique, additional research using a larger sample size and in combination with other techniques to apply pressure on different points of body is suggested.


Oman Med J. 2014 Nov; 29(6): 425–429. doi:  10.5001/omj.2014.113

Friday, October 21, 2016

Palliative care viewed as a stigma, despite improving quality of life

Study indicates education, rebranding could help spread benefits

The term palliative care carries a stigma for patients and their caregivers, who regard it as synonymous with impending death. Education, and possibly a name change, will be necessary to be able to integrate palliative care into routine advanced cancer care, according to new research in CMAJ (Canadian Medical Association Journal).

Palliative care is designed to improve the quality of life of patients with a serious illness and their families. The World Health Organization and all major national and international cancer societies encourage early access to palliative care. Research indicates that for people with advanced cancer, early palliative care benefits both physical and mental health and can even extend life.


Thursday, October 20, 2016

Peri-op Clonidine: Benefits Not There, But Hypotension Is

Anesthesiologists who use perioperative clonidine in the hope of reducing acute postoperative pain or opioid consumption need to reconsider their efforts.

According to a randomized controlled trial at the Cleveland Clinic, in Ohio—the largest such trial ever—researchers found that the drug has neither of these perceived benefits, and its use may come at the expense of hypotension.

“Anesthesiologists have been using clonidine for sedation and analgesia for years, even though it’s primarily a blood pressure medication,” said Alparslan Turan, MD, professor of anesthesiology and vice chair of the Department of Outcomes Research at the Cleveland Clinic. “However, the only place where it’s been proven to work is in epidural and caudal analgesia. Oral and transdermal use have not been tested in large trials, and the data in the literature is not that solid.”


Wednesday, October 19, 2016

Evaluation of six videolaryngoscopes in 720 patients with a simulated difficult airway

Videolaryngoscopes are aggressively marketed, but independent evaluation in difficult airways is scarce. This multicentre, prospective randomized controlled trial evaluates six videolaryngoscopes in patients with a simulated difficult airway.

This trial revealed differences in the performance of six videolaryngoscopes in 720 patients with restricted neck movement and limited mouth opening. In this setting, first-attempt success rates were 85–98%, except for the A.P. Advance™ difficult airway blade. Highest success and lowest tissue trauma rates were achieved by the McGrath™ and C-MAC™ D-blade, highlighting the importance of the videolaryngoscope blade design. 


Br. J. Anaesth. 116 (5): 670-679. doi: 10.1093/bja/aew058

Tuesday, October 18, 2016

How Chinese Medicine and Acupuncture Can Help Intrauterine Insemination Succeed?

Overall success rates for IUI are 15-20%, with 6% from natural IUIs and up to 30% for IUIs done with fertility drugs. Chinese Medicine, however, can greatly improve these success rates by combining acupuncture, reproductive organ massage and Chinese herbs, all of which have a proven positive effect on conception and implantation.

Acupuncture assists the body in regulating the Hypothalamus-Pituitary-Ovarian axis thus balancing the hormones to produce an increased number of follicles and better quality eggs. It also increases the blood flow to the uterus and increases the thickness of the uterine lining to improve implantation rates. Acupuncture also relaxes the nervous system and decreases stress levels to dramatically improve chances of pregnancy. It diminishes the side effects of ovulation and hormonal support drugs. And, for men, acupuncture improves sperm samples by increasing semen counts, motility, and morphology thus aiding in the natural fertilization process during IUI.


Acupuncture Relieves Cerebral Palsy Complications

Acupuncture alleviates cerebral palsy related hearing disorders and excess drooling.

Hospital researchers find acupuncture effective for relieving excessive drooling and for improving hearing in cerebral palsy patients. In a surprise finding, the optimal acupuncture needle retention time for benefitting hearing was not the longest retention time. A shorter duration produced superior patient outcomes. Take a look at the findings and protocols to learn what the researchers discovered.

Acupuncture is an effective treatment for cerebral palsy related complications, including drooling and hearing disorders. In a clinical study conducted at Neijiang Second People’s Hospital, researchers Xie and Lu determined that acupuncture and massotherapy significantly alleviate drooling and improve quality of life scores for cerebral palsy patients. Evidence suggests that cerebral palsy (CP) related drooling is correlated with motor impairments affecting swallowing (Senner et al.). This condition affects the overall quality of life and may impede speech and increase risk of infectious diseases.

Xie and Lu conclude that cerebral palsy patients treated with acupuncture and massotherapy had significantly greater positive patient outcomes than patients in the control group that did not receive either acupuncture or massotherapy. Patients receiving acupuncture with massotherapy demonstrated less drooling and significant improvements in fine motor movements, adaptive behavior, and social behavior over the control group. Acupuncture plus massotherapy patients also demonstrated the ability to take meals independently more significantly than the control group.


Thursday, October 13, 2016

Misunderstanding of palliative care leads to preventable suffering

A new review says palliative care's association with end of life has created an "identity problem" that means the majority of patients facing a serious illness do not benefit from treatment of the physical and psychological symptoms that occur throughout their disease.

The editorial is co-authored by palliative care experts at Harvard Medical School, Massachusetts General Hospital, the American Cancer Society, and Johns Hopkins University, and appears in the New England Journal of Medicine. The authors say palliative care should be initiated at the same time as standard medical care for patients with serious illnesses, and not brought up only after treatment has failed.


Early provision of specialty palliative care improves quality of life, lowers spending, and helps clarify treatment preferences and goals of care for patients with advanced cancer. However, widespread integration of palliative care with standard medical treatment remains unrealized, and more evidence is needed to show the potential gains of early palliative care in other populations. This will require improved public and professional awareness of the benefits of palliative care and coordinated action from advocacy groups, health professionals, educators, and policymakers. Patients who access earlier specialty palliative care have better clinical outcomes at potentially lower costs — a compelling message for providers, policymakers, and the general public.


Sources: ScienceDaily ,   N Engl J Med

Wednesday, October 12, 2016

The Role of Acupuncture in Assisted Reproductive Technology

The aim of this paper was to provide reliable evidence by performing a systematic review and meta-analysis for evaluating the role of acupuncture in assisted reproductive technology. All randomized controlled trials that evaluated the effects of acupuncture, including manual, electrical, and laser acupuncture (LA) techniques, on the clinical pregnancy rate (CPR) and live birth rate (LBR) of in vitro fertilization (IVF) or artificial insemination were included. The controlled groups consisted of no acupuncture and sham acupuncture groups. The sham acupuncture included sham acupuncture at acupoints, sham acupuncture at non- or inappropriate points, sham LA, and adhesive tapes. Twenty-three trials (a total of 5598 participants) were included in this paper. The pooled CPR from all acupuncture groups was significantly higher than that from all controlled groups, whereas the LBR was not significantly different between the two groups. However, the results were quite distinct when the type of control and/or different acupuncture times were examined in a sensitivity analysis. The results mainly indicate that acupuncture, especially around the time of the controlled ovarian hyperstimulation, improves pregnancy outcomes in women undergoing IVF. More positive effects from acupuncture in IVF can be expected if a more individualized acupuncture programs are used.


World Arthritis Day 2016 - The Future is in Your Hands

This year's theme for World Arthritis Day is 'It's in your hands, take action.'
People with rheumatic and musculosceletal diseases (RMDs) are taking action everyday to live their lives to the fullest.

This year, World Arthritis Day is asking people to share their stories about how they have taken action to live their life to the fullest with a rheumatic and musculoskeletal disease (RMD) in order to provide greater education to people both within the RMD community and the general public. You can share your story via social media, using the hashtag #WADStory, or upload your story directly to the World Arthritis Day website

The Future in your hands’ forms part of the wider two-year World Arthritis Day campaign:
'It's in your hands, take action'
  • RMDs affect a quarter of all people in the European Union – that’s over 120 million people –
    more individuals than any other disease group
  • RMDs can affect people of all ages including children and babies and if not treated
    appropriately, daily activities such as walking, climbing stairs, cooking and personal hygiene
    and working are affected – reducing quality of life and impacting on physical abilities
  • The prevalence of clinical anxiety and depression in those with RMDs is about twice that
    seen in the general population

Facts and figures
  • RMDs affect a quarter of all people in the European Union – over 120 million people
  • Almost every family in Europe is affected by RMDs in some way
  • In the industrialised world, RMDs affect more individuals than any other disease group
  • RMDs affect both men and women of all ages, including children and babies. However, some RMDs are more common among certain populations. For example, rheumatoid arthritis, scleroderma, fibromyalgia, and lupus predominantly affect women. Spondyloarthropathies and gout are more common in men
  • RMDs are the biggest cause of sick leave and premature retirement worldwide
  • RMDs have a huge economic burden on global healthcare systems. In Europe, public spending totals over €200 billion per year. They are the most expensive diseases for the European health and socio-economic systems. The costs are associated with diagnosis, treatment, drugs, care, assistive devices, home modifications, and research. In addition, decreased productivity and absence from work as a result of RMDs contributes significantly to these costs
  • If left untreated, some RMDs may reduce life expectancy
"Taking part in the ‘The Future in your Hands’ campaign as an individual is easy
Get Active Now. Get Involved ! "

Tuesday, October 11, 2016

Effect of palliative care-led meetings for families of patients with chronic critical illness

Among families of patients with chronic critical illness, the use of palliative care-led informational and emotional support meetings compared with usual care did not reduce anxiety or depression symptoms, according to a study appearing in the July 5 issue of JAMA.

Patients are considered to have developed chronic critical illness when they experience acute illness requiring prolonged mechanical ventilation or other life-sustaining therapies but neither recover nor die within days to weeks. It is estimated that chronic critical illness affected 380,000 patients in the United States in 2009. Family members of patients in the intensive care unit (ICU) experience emotional distress including anxiety, depression, and posttraumatic stress disorder (PTSD). Palliative care specialists are trained to provide emotional support, share information, and engage patients and surrogate decision makers in discussions of patient values and goals of care.


Monday, October 10, 2016

Fluid Management Strategy for Thoracic Surgery

San Diego—The optimal range of fluid administration in patients undergoing lung resection surgery has been a controversial topic in anesthesia. There are hazards at both ends of the spectrum: Liberal o verhydration can lead to fluid-induced lung injury, while conservative fluid-management strategies have a risk for organ ischemia.

According to a review of the recent literature, however, researchers may be closer to establishing “safe” fluid limits.

“The evidence has shown that intraoperative fluid administration should be at a base rate of 1 to 2 mL/kg per hour plus replacement of blood losses,” said Jens Lohser, MD, MSc, FRCPC, associate professor and head of thoracic anesthesia at the University of British Columbia, in Vancouver. “In addition, overall fluid administration of more than 6 mL/kg per hour intraoperatively and a 24-hour fluid balance in excess of 20 mL/kg should be avoided, as they have been associated with acute lung injury.” Dr. Lohser presented the findings at the Society of Cardiovascular Anesthesiologists 2016 annual meeting.


Sunday, October 09, 2016

Acupuncture Point Vitamin Injections Alleviate Menstrual Pain

Vitamin K3 injections into acupuncture point SP6 relieves menstrual cramping and pain. Researchers from institutions including Columbia University (New York), Stanford University School of Medicine (Palo Alto), and University of California at San Francisco (UCSF) completed a six year study of dysmenorrhea. The study design was : double-blind, double-dummy, randomized controlled trial. The researchers concluded, “Acupuncture point injection of vitamin K3 relieves menstrual pain rapidly and is a useful treatment in an urban outpatient clinic.”

Primary dysmenorrhea affects approximately 85% of women and the pain is severe in approximately 20% of women experiencing menstrual pain. Although the pathophysiology is not identical in all cases, uterine prostaglandin hormones at high levels contribute to cramping and lower abdominal pain. The pain may last from several hours to days.


Saturday, October 08, 2016

World Hospice and Palliative Care Day 2016

8 October 2016

Living and dying in pain: It doesnt have to happen

The theme of World Hospice andPalliative Care Day 2016 is: ‘Living and dying in pain: It doesn’t have to happen’.

75% of the world population does not have adequate access to controlled medications for pain relief.
As a result, millions of people suffer from pain which is avoidable and could be managed with proper access to the correct medications.

Various barriers prevent people in need from accessing these essential medications. 

The World Day campaign will examine three major barriers for access to pain relief, and provide case studies, advocacy resources, and examples of good practice to help address these.

Restrictive regulations
    • Unduly restrictive regulations limit access to pain relief and palliative care for people and families in need
    • Balance is needed to ensure access to essential controlled medicines for pain management while ensuring that they are not used for illicit purposes
    • Pain management is the right of the person with pain
    • Pain management without significant risk of dependence is possible through education of healthcare workers and patients
    • Many national laws and regulations exceed the measures required by the Single Convention on Narcotic Drugs
      • Examples:
        • Most countries limit morphine prescriptions to 10 mg injectable twice daily, guaranteeing that pain will not be effectively controlled.
        • In some jurisdictions, physicians can be charged with a crime should they make documentation errors that are not prosecuted elsewhere.
        • Restrictions and expensive requirements discourage pharmaceutical companies from producing morphine, and pharmacies from stocking it
        • Legally available morphine is difficult, if not impossible, to obtain in some countries.
        • This forces some patients or their family members to buy opioids through illegal channels, which puts them in danger of arrest and prosecution.
      • How is this being addressed?
        • Romania has removed all excessive regulatory restrictions on opioid prescribing with no reported cases of misuse.
        • In Kerala, India, a two-year study of people being treated for pain with oral morphine found no instances of misuse or diversion
        • In Uganda specially trained nurses are legally allowed to prescribe liquid morphine solution for people accessing palliative care.
    • Oral morphine and other WHO essential palliative care medications should be legally available and accessible in all countries
Poor education
    • Opiophobia is the fear in the health professions of prescribing opioid medications which prevents people from receiving pain relief
      • Examples
        • Doctors and nurses are not educated about pain management and prescribing morphine or are taught that morphine and other opioids are dangerous and should be used as little as possible
        • Doctors and nurses are not taught how to assess and manage pain
        • There is fear that anyone using opioids will become addicted/dependent
        • In most countries, there is no way to qualify as a palliative care specialist and no inclusion of palliative care training in medical or nursing schools, as well as no continuing education for health professionals to counteract opiophobia.
      • How is this being addressed?
        • An increasing number of countries are now including palliative care education for medical and nursing students
        • The Hospice Africa Uganda morphine initiators’ course at the Institute of Hospice and Palliative Care in Africa trains healthcare workers from all over Africa in how to safely prescribe and administer morphine.
        • The University of Cape Town runs a Master’s course and Postgraduate Diploma in Palliative Medicine which use distance learning so that busy professionals can expand access to palliative care and pain management, as well as the research base on this topic.
        • In Tajikistan a course on pain relief and palliative care is being developed for police professionals.
    • Unreasonable fear of opioid use leads to increased suffering worldwide
Economic barriers
    • Morphine is inexpensive to produce yet expensive to bring to market in many places with unduly restrictive regulations. As a result the pharmaceutical industry has no incentive to produce and market oral morphine for pain management.
      • Examples
        • The profit margin for oral morphine tablets is too low to be of interest to most pharmaceutical producers
        • Higher cost analgesics such as fentanyl are easier to obtain in many countries than oral morphine, which is the standard of pain management in palliative care.
      • How is this being addressed?
        • Lebanon requires pharmaceutical importers to register and import inexpensive immediate and slow release morphine to be allowed to import expensive opioids.
        • In Colombia the Fondo Nacional de Estupefacientes (FNE) is responsible for the purchase and national distribution of opioid medications (morphine, hydromorphone, and methadone) in the country.
        • A morphine manifesto ( has been signed by 64 organizations calling for universal availability of immediate release morphine.

Friday, September 30, 2016

Study Finds Link Between Weather and Chronic Pain

There may be something to the old adage about “feeling under the weather.”
Early results from a smartphone-based weather study in the UK show that rain and lack of sunshine have an impact on how we perceive pain.

Over 9,000 people are participating in The University of Manchester’s Cloudy with a Chance of Pain project,  using a special app to record their daily pain levels. 

The app also captures hourly weather conditions using the phone’s GPS, giving researchers the ability to compare the pain data with real-time local weather.

Researchers reviewed data from participants in three cities – Leeds, Norwich and London – and found that as the number of sunny days increased from February to April, the amount of time participants spent in severe pain decreased.


Pain News Network - By Pat Anson, Editor

Living with Chronic Pain After Being Labeled an Addict

I am writing this article from the perspective of a patient who has chronic back pain and also an unwarranted, doctor-imposed label of “addiction.” 

As most people can imagine, having both of these problems -- chronic pain and a substance use disorder -- can be very difficult for a healthcare provider to manage. Imagine though how harmful it is when someone is diagnosed or labeled as an addict and it is not an appropriate diagnosis. 

The new polite wording for addiction is "chemical dependence," "substance use disorder" or "opiate dependence." 

But these terms are not helpful either, since they have the same meaning to most healthcare professionals, as well as the general public.

To make matters worse, I was totally unaware that this diagnosis was ever made and it was never explained to me that it would be in my medical record. I want to share some of the problems this has caused me. 


Pain News Network- By Patricia Young, Guest columnist

Thursday, September 29, 2016

Acupuncture Reverses Facial Paralysis

Acupuncture is effective for the treatment of facial paralysis and improves patient outcomes for patients taking medications.

Hospital researchers find acupuncture effective for the treatment of facial paralysis. Across multiple hospital investigations, researchers document effective acupuncture protocols that yield significant positive patient outcomes for facial paralysis patients. In addition, acupuncture, infrared therapy, and moxibustion demonstrate the ability to significantly improve positive patient outcome rates for patients taking pharmaceutical medications.

Acupuncture and infrared heat therapy are effective for the treatment of facial paralysis. Researchers from the Third People’s Hospital in Chongqing determined that combining acupuncture and infrared heat therapy with conventional facial paralysis medications improves the rate of positive patient outcomes for the the treatment of this condition. Facial paralysis is a disorder in which the facial muscles are dysfunctional, causing immobility, and it may occur in any age demographic. In the Third People’s Hospital investigation, facial paralysis patients who received supplementary infrared heat therapy and acupuncture reported a 91.67% total treatment effective rate while those in the control group reported a 60.42% total treatment effective rate. The addition of acupuncture and infrared therapy increased the effectiveness by 31.25%.


Wednesday, September 28, 2016

Experimental Drug Reduces Migraine Days by Half

An experimental injectable drug reduces the number of migraine days by 50 percent or more in patients who suffer from chronic migraine, according to the results of a new study released by drug makers Amgen and Novartis.

The Phase II study of AMG 334 -- also known as erenumab – involved 667 patients who suffered an average of about 18 migraine days per month.  A reduction of 50% or more in monthly migraine days was observed in four out of ten patients taking a 140 mg dose of erenumab. Patients taking a 70 mg dose had a 40% reduction in migraine days compared to a placebo drug.  

Significant improvements were also noted in quality of life, headache impact, disability, and pain interference compared to the placebo.

“Chronic migraine patients lose more than half of their life to migraines with 15 or more headache days a month, facing intolerable pain and physical impairment,” said Stewart Tepper, MD, a professor of neurology at the Geisel School of Medicine at Dartmouth. “As a neurologist, these findings are exciting because they demonstrate that erenumab could serve as an important new therapy option for reducing the burden of this often-disabling disease.”

Tuesday, September 27, 2016

Opioids are not necessarily evil – Michael Schatman

Since 1999 the use of opioids for pain management has quadrupled in the USA, resulting in what is now well known as the ‘opioid epidemic’ – too many people are now unnecessarily reliant on the drugs and opioid-related overdoses have rocketed. The prescription of opioids within the USA is now considered to be one of the biggest health crises facing the nation, however the battle to ‘fix’ the problem is complex.

Michael Schatman has worked in multidisciplinary chronic pain management for over 30 years and has published more than 90 journal articles on pain management and pain bioethics. He recently published an article discussing the ‘MEDD myth’, exploring the impact of reliance on unreliable techniques for calculating opioid doses within the medical literature and in the generation of opioid guidelines. We contacted Michael to find out more about this as well as his extensive work around the ongoing opioid epidemic in the USA.


Monday, September 26, 2016

Fertility Acupuncture 101: Treatment Plans

Acupuncture Treatments for IVF cycle

Here's a disclaimer. Everyone is unique and Traditional Chinese Medicine (TCM) is based upon the tenet of uniqueness. That said, the most common question we get at Pulling Down the Moon is about a “typical” treatment plan. So, with the caveat that your situation is unique and your practitioner will tailor treatment to suit your needs, here’s a good solid overview of what a typical fertility acupuncture treatment plan looks like.

In your acupuncturist’s ideal world, starting acupuncture treatments at least three months prior to an IVF cycle would provide an optimal preparatory period. During this prep period we will focus generally on your overall health (adjusting lifestyle and dietary practices that lead to imbalance) and specifically on the maturation of the egg.


Wednesday, September 21, 2016

Echogenic Needles Provide Best Needle Visualization at Steeper Angles of Insertion

Anesthesiologists looking to achieve good needle visualization at steeper angles of insertion may get better results using echogenic needles with beam steering versus using these technologies individually, new research suggests.

“Needle visualization is of utmost importance when providing regional anesthesia care and to provide a safe and efficacious block,” said Christopher Prabhakar, MD, lead study author and clinical instructor in the Department of Anesthesiology, Pharmacology and Therapeutics at the University of British Columbia, in Vancouver.

Echogenic needles use coatings or notchings to increase the amount of ultrasound beams that get bounced back, while beam steering “angles the beam of the ultrasound transducer to provide a more perpendicular angle with respect to the needle that is inserted,” Dr. Prabhakar said. Although both technologies can improve visualization, there is “no appreciation for what is the best technology to use at moderate angles of insertion between 40 to 60 degrees,” the researchers wrote. They conducted the study to determine whether beam steering will improve visibility when used with echogenic (Pajunk SonoPlex Stim 22 gauge, 80 mm) and nonechogenic (Pajunk UniPlex NanoLine 22 gauge, 80 mm) needles within that range.


Tuesday, September 20, 2016

What Does a Migraine Look Like?

Sometimes there’s an aura. Or bright lights. Or blurred vision.

About a billion people worldwide suffer from headaches caused by migraines, which affect three times as many women as men. Most non-sufferers understand the headache part, but explaining what a migraine looks like isn’t easy – which is why the makers of Excedrin invented a simulator to help people better understand  migraines and the impact they can have.

"Migraines are more than bad headaches – the pulsing pain can be debilitating, and the associated symptoms like nausea and extreme sensitivity to light and sound, really impact people's lives," said Dr. Elizabeth Seng, a New York based psychologist.

GSK Consumer Healthcare brought together several migraine sufferers and had them explain the symptoms they most often experience during a migraine episode, including aura, sensitivity to light and blurred vision. The symptoms were then replicated with the simulator and conducted in a controlled environment from everyday life – like riding the subway or going to a restaurant -- to give non-sufferers the chance to safely experience the full range of migraine symptoms

Many found the experience unsettling and nauseating, as you’ll see in this short video that Excedrin recently began airing on TV and over the Internet:

More stories...

Source: Pain News Network

A new finding could help explain why painkillers are so addicting

Researchers at the University of Colorado-Boulder tested opioids -- like morphine -- on rats, and found a few days' worth of doses caused months of chronic pain.

The painkillers were found to spur a "cascade" of reactions that led to more pain signals being fired from nerve cells in the spinal cord and brain.

"What we found were those rats that were treated with placebo control were recovering about 4 to 5 weeks after that," said researcher Peter Grace. "But those rats that had morphine took twice as long to recover. So, it took about 10 or 11 weeks to return to normal threshold."

Distinguished Professor Linda Watkins said, "This is a very ugly side to opioids that had not been recognized before."

Grace suggests if painkillers work the same way in humans as they do in rats, it could help explain why they're so addictive. Using them could cause more pain, which, in turn, leads people to use them longer, leading to a vicious cycle.
This research could lead to better pain treatments.

 Full Article -



Monday, September 05, 2016

Skin Care Benefits of Acupuncture

  I suffered from debilitating migraines for years, and after experiencing countless negative side effects (and little relief) from powerful medications, I had just about given up on treatment. That is until a close friend of mine recommended her acupuncturist. She had been seeing him for about a month for her headaches, anxiety, and hormone imbalances and had nothing but glowing reviews. I quickly booked an appointment, and after regular treatments, I found that my migraines had considerably subsided, leaving me with only one or two painful days a month instead of the 15-plus days I was used to. 

  That's when I decided to do some digging. What couldn't acupuncture treat? Nearly nothing, as it turns out. Acupuncture is shockingly versatile, even for skin care. It's a great alternative method for aging skin and breakouts in lieu of more-invasive procedures like Botox and heavy-duty acne medications. So far, I've been blessed with clear, firm skin, but when the time comes to get more serious about my complexion, I'd rather go with preventative options over corrective ones. I sat down with my acupuncturist, Dr. Min Zhang, a practitioner for over 25 years, to get the skin care scoop.


Wednesday, August 24, 2016

Anesthesiologists Must Be Active in Patient Selection for Ambulatory Surgery

Surgeons may push anesthesia providers to participate in inappropriate or ill-fitting procedures at ambulatory surgery centers (ASCs), which is why it’s important to push back based on evidence-based practices to boost quality and positive outcomes.

“We should be the gatekeepers of patients coming to ASCs so we can be the gatekeepers of outcomes, too,” said Girish Joshi, MD, professor of anesthesiology and pain management at the University of Texas Southwestern Medical School, in Dallas, and past president of the Society for Ambulatory Anesthesia (SAMBA). Dr. Joshi spoke about patient selection in the ambulatory surgery setting at “Driving Change in Ambulatory Anesthesia,” a joint meeting held by SAMBA and the American Society of Anesthesiologists (ASA).


Monday, August 22, 2016

Impact of an Electronic Pain and Opioid Risk Assessment Program

Are There Improvements in Patient Encounters and Clinic Notes?

The American Academy of Pain Medicine recently published an article by researchers at Inflexxion Inc., Newton-Wellesley Hospital’s Pain Management Center, Brigham and Women’s Hospital Pain Management Center, and at the University of Mississippi Medical Center, Family Medicine, that discusses the impact of PainCAS, a comprehensive electronic self-report pain and opioid risk assessment system, on clinical documentation and patient/provider communication.
Highlights from the study concluded that:
  • Significant differences in favor of an electronic pain assessment condition were found
  • Preliminary results indicate an electronic pain assessment program increases documentation of key elements of pain patient information in the medical record and improved discussion of substance abuse issues in the patient-physician encounter
  • Standardization of assessments can lead to long-term improved quality of care
For more information about this study, please see the abstract.

Saturday, August 20, 2016

Current Concepts In the Management of The Difficult Airway

Management of the difficult airway remains one of the most relevant and challenging tasks for anesthesia care providers. This review focuses on several of the alternative airway management devices/techniques and their clinical applications, with particular emphasis on the difficult or failed airway. It includes descriptions of many new airway devices, several of which have been included in the ASA Difficult Airway Algorithm.

A common factor preventing successful tracheal intubation is the inability to visualize the vocal cords during the performance of DL. Many devices and techniques are now available to circumvent the problems typically encountered with a difficult airway using conventional DL.


Most airway problems can be solved with relatively simple devices and techniques, but clinical judgment born of experience is crucial to their application. As with any intubation technique, practice and routine use will improve performance and may reduce the likelihood of complications. Each airway device has unique properties that may be advantageous in certain situations, yet limiting in others. Specific airway management techniques are greatly influenced by individual disease and anatomy, and successful management may require combinations of devices and techniques.


Thursday, August 18, 2016

Acupuncture Relieves Osteoporotic Spinal Fracture Pain

Acupuncture is effective for the treatment of osteoporotic compression fractures of the spine. Researchers tested the efficacy of a specialized form of acupuncture and found it effective for enhancing pain reduction for patients with spinal compression fractures due to osteoporosis.

Acupuncture combined with medications produced significantly greater positive patient outcomes including pain reduction and improvements in activities of daily living over medications only as a standalone therapy.


Tuesday, August 16, 2016

5 Holistic Pain Relief Therapies for Palliative Care Patients

Palliative care is care that provides pain relief, and is used with curative measures, but does not act towards a cure on its own. In other words, it helps make patients more comfortable as they struggle against serious illnesses.

Best practice in medicine suggests that patients undergoing palliative care benefit most from a holistic approach. Holistic approaches include physical, psychological, and spiritual comfort.
As a result, therapies that help patients can be provided not only by doctors and nurses but also by counselors, therapists, massage therapists, or even family and friends of the patient. These actors can provide complementary pain relief therapies, which are able to help reduce pain and improve quality of life, and support the patient as a whole.


Sunday, August 14, 2016

Multimodal Analgesic Protocol Improves Analgesia, Pain Documentation After Arthroplasty

The implementation of a multimodal analgesic protocol may be a simple, effective way to boost the documentation of preoperative pain scores and opioid use in an acute pain service, new research suggests.

Multimodal protocols for nonopioid analgesia using acetaminophen, cyclooxygenase-2 inhibitors, gabapentinoids and peripheral nerve catheters have been shown to decrease opioid use and improve patient analgesia, according to researchers from the University of Florida, in Jacksonville. However, the effect of these protocols on baseline assessment of patient pain and opioid use, which is “key to providing an appropriate level of postoperative analgesia,” has not been investigated, they wrote.


Anesthesiology News

Friday, August 12, 2016

Percutaneous Electrical Neurostimulation for Detoxification in Opioid-Dependent Chronic Pain Patients

Percutaneous Electrical Neurostimulation for Detoxification in Opioid-Depend reduction in opioid-dependent patients (detoxification) always has been challenging. However, when the scenario also includes a chronic, severe pain problem, as either an initiating or underlying cause of that dependence, the process can be significantly more difficult.

Wednesday, August 10, 2016

Combination Dexamethasone Reduces Pain, Enhances Nerve Block Duration Compared With Systemic Dex Alone

The combination of systemic and perineural dexamethasone improved pain scores and decreased opioid requirements after compared with systemic dexamethasone alone, a new study shows. According to the data, when combined with systemic dexamethasone (8 mg), perineural dexamethasone (4 mg) also improved pulmonary function in patients postoperatively compared with control.

“When bupivacaine is administered as an intercostal nerve block in the presence of systemic dexamethasone, patients are probably getting around 20 hours of pain relief,” said Dermot P. Maher, MD, MS, pain medicine fellow at Massachusetts General Hospital and Harvard Medical School, in Boston. “But if you add [perineural] dexamethasone to that mixture, they get around 24 to 28 hours of relief...


Tuesday, August 09, 2016

Acupuncture Alleviates Migraines

Acupuncture and cupping are effective for migraine relief. Tianjin University of Traditional Chinese Medicine researchers tested two acupuncture protocols. One of the acupuncture protocols achieved a 100% total effective rate with an 88.6% complete recovery rate. This involved a combination of acupuncture and cupping. Another protocol, using only acupuncture, achieved a 94.3% total effective rate with a 62% complete recovery rate. The superior positive patient outcomes achieved in the acupuncture plus cupping protocol were achieved using a set of specialized acupuncture points.

Migraines are headaches of moderate to severe intensity that are unilateral or throbbing. Attacks range from several hours to several days per migraine. Nausea, vomiting, sensitivity to sound and light, auras, flashes of light, and blind spots are often concomitant. According to the Mayo Clinic staff, “Clinical trials have found that acupuncture may be helpful for headache pain.”


Sunday, August 07, 2016

Can treatment success with 5% lidocaine medicated plaster be predicted in cancer pain with neuropathic components or trigeminal neuropathic pain?

An expert group of 40 pain specialists from 16 countries performed a first assessment of the value of predictors for treatment success with 5% lidocaine-medicated plaster in the management of cancer pain with neuropathic components and trigeminal neuropathic pain. Results were based on the retrospective analysis of 68 case reports (sent in by participants in the 4 weeks prior to the conference) and the practical experience of the experts. Lidocaine plaster treatment was mostly successful for surgery or chemotherapy-related cancer pain with neuropathic components.

A dose reduction of systemic pain treatment was observed in at least 50% of all cancer pain patients using the plaster as adjunct treatment; the presence of allodynia, hyperalgesia or pain quality provided a potential but not definitively clear indication of treatment success. In trigeminal neuropathic pain, continuous pain, severe allodynia, hyperalgesia, or postherpetic neuralgia or trauma as the cause of orofacial neuropathic pain were perceived as potential predictors of treatment success with lidocaine plaster. In conclusion, these findings provide a first assessment of the likelihood of treatment benefits with 5% lidocaine-medicated plaster in the management of cancer pain with neuropathic components and trigeminal neuropathic pain and support conducting large, well-designed multicenter studies.


Thursday, August 04, 2016

Acupuncture Relieves Post-Stroke Anxiety & Depression

Acupuncture relieves anxiety and depression experienced by stroke patients. Researchers from the Shanghai University of TCM (Traditional Chinese Medicine) investigated the efficacy of acupuncture and medications for the treatment of post-stroke anxiety and depression. The SSRI (serotonin reuptake inhibitor drug sertraline demonstrated a 73.3% total efficacy rate. Conventional acupuncture achieved an 80% total effective rate. Another group received a treatment protocol of Sun Si-Miao’s ghost acupoints combined with sertraline. The combination group achieved a 93.3% total effective rate. The researchers concluded that the combination of acupuncture with drug therapy is safe and effective for the treatment of anxiety and depression due to post-stroke syndrome.

Sertraline is an antidepressant used for the treatment of depression, panic attacks, anxiety, and obsessive-compulsive disorder. Common side effects include drowsiness, dizziness, nausea, insomnia, decreased libido, inability to have an orgasm, constipation, and stomach pain. The group receiving sertraline received dosages ranging between 25 and 75 mg/day based on the condition and severity of side effects.


Wednesday, August 03, 2016

Palliative Care Sometimes Adds To Families’ Stress Burden

Palliative-care counseling from trained specialists is not routinely needed for all families of patients with chronic critical illnesses and sometimes it might worsen their emotional distress, cautions a recent study.

 Habitually providing scarce palliative care services to cases indiscriminately may be ineffective when the meetings are limited to just one or two sessions, reported researchers in the July 5 issue of JAMA.

 Family caregivers were no less depressed or anxious when they received only routine counseling from staff members in intensive care units, researchers found. With further support and training, ICU teams could deliver primary palliative care for surrogate decision makers of some patients, they suggested.


Tuesday, August 02, 2016

Reduced Cancer Risk, Improved Survival With Neuraxial Anesthesia

Neuraxial anesthesia (NA) appears to be associated with improved overall survival (OS) in patients undergoing surgery for tumor resection, particularly in those with colorectal cancer. According to a recent meta-analysis published in Oncotarget (2016;7:15262-15273), the authors identified a correlation between the use of NA and reduced risk for cancer recurrence.

 The authors found significantly improved OS and reduced cancer recurrence with NA versus general anesthesia (GA). This finding is among those that show that anesthetic technique correlates with clinically important outcomes, including mortality and morbidity. “Specifically, we found a positive association between neuraxial anesthesia and improved OS in colorectal cancer (HR [hazard ratio] 0.653; 95% CI 0.430-0.991, P=0.045, the random-effects model),” they explained.

 “Our results suggest that … the use of [NA] has been found to be associated with improved OS after colorectal cancer, prostate cancer, gastro-oesophageal cancer, laryngeal and hypopharyngeal cancer, and ovarian cancer surgery,” the researchers wrote.


Monday, August 01, 2016

ERAS Pathway Improves Analgesia, Opioid Use and PONV Following Total Mastectomy

New Orleans—With surgery still the primary treatment for breast cancer, strategies to minimize acute postoperative pain have the potential for signific
ant benefit, perhaps even preventing development of chronic pain. A research team at the University of California, San Francisco (UCSF) has moved much closer to this lofty goal. They developed an enhanced recovery after surgery (ERAS) pathway that significantly decreased opioid consumption, acute postoperative pain, and postoperative nausea and vomiting (PONV) in women undergoing total mastectomy.

 “There’s a movement in anesthesia to improve patient care by implementing ERAS pathways,” said Monica Harbell, MD, assistant clinical professor of anesthesia and perioperative care at UCSF’s School of Medicine. “Nevertheless, there haven't been many enhanced recovery pathways in breast surgery. So we wanted to apply the principles of enhanced recovery in an effort to get our patients mobilized earlier, more active and involved in their care, and hopefully achieve better outcomes and greater patient satisfaction.”


Sunday, July 31, 2016

New Study Highlights Risks of Combining Benzodiazepines and Opioids

Although prescribing benzodiazepines concurrently with opioid analgesics has been shown to raise the risk for fatal overdose, new research documents a risk that is four times that of opioids taken alone, and even at low doses. The new study was published online in the British Medical Journal (2015;350:h2698).

Additionally, the authors found a dose-dependent association with overdose risk. This may “help prioritize how we address this risk,” said Roger Chou, MD, professor in the Departments of Medicine and Medical Informatics and Clinical Epidemiology at Oregon Health & Science University (OHSU) School of Medicine, and a staff physician in the Internal Medicine Clinic at OHSU, in Portland, who was not involved in the research. “Meaning, you can start by identifying patients on high doses of benzos, and go from there.”


Saturday, July 30, 2016

Acupuncture Relieves Irritable Bowel Syndrome

Acupuncture alleviates irritable bowel syndrome (IBS). Researchers from the Heilongjiang University of Chinese Medicine investigated the efficacy of electroacupuncture for the treatment of IBS. A comparison group in the clinical trial received oral administration of pinaverium bromide. The acupuncture treatment group demonstrated an 86.7% improvement rate. The drug group demonstrated a 50% improvement rate.

Chinese herbal medicine has also been shown effective for the treatment of IBS in modern research. The Journal of the American Medical Association (JAMA) published the findings of a randomized double-blinded placebo-controlled trial noting that Chinese herbal medicine “offer(s) improvements in symptoms for some patients with IBS.” The study represents a joint effort by gastroenterologists and herbalists.