Electroacupuncture's effect on thermal pain perception correlation with fMRI

This study looks at fMRI in 5 subjects during heat pain, and then with Optimal electroacupuncture and Minimal electroacupuncture.  Both types of acupuncture suppressed the brain activation from heat pain, but the optimal electroacupuncture more so. They used 5Hz electroacupuncture which is a somewhat unconventional choice, since most studies look at either 2Hz or 100Hz.
This type of suppression could be of great clinical value in cases of chronic pain, since one school of thought is that the brain recruits more and more "real estate" the longer it goes on.  So if you can suppress those inputs, perhaps the vexing chronic pain pattern may diminish. Full article at the link.  (For more information about my practice, please click here.)

The analgesic effect of electroacupuncture on acute thermal pain perception-a central neural correlate study with fMRI

Shivshil Shukla,¹ Artour Torossian,² Jeng-Ren Duann,³ and Albert Leung⁴

Received December 8, 2010; Accepted June 7, 2011.

Background

Electrical acupuncture (EA) has been utilized in acute pain management. However, the neuronal mechanisms that lead to the analgesic effect are still not well defined. The current study assessed the intensity [optimal EA (OI-EA) vs. minimal EA (MI-EA)] effect of non-noxious EA on supraspinal regions related to noxious heat pain (HP) stimulation utilizing an EA treatment protocol for acute pain and functional magnetic resonance imaging (fMRI) with correlation in behavioral changes. Subjects underwent five fMRI scanning paradigms: one with heat pain (HP), two with OI-EA and MI-EA, and two with OI-EA and HP, and MI-EA and HP.

Results

While HP resulted in activations (excitatory effect) in supraspinal areas known for pain processing and perception, EA paradigms primarily resulted in deactivations (suppressive effect) in most of these corresponding areas. In addition, OI-EA resulted in a more robust supraspinal sedative effect in comparison to MI-EA. As a result, OI-EA is more effective than MI-EA in suppressing the excitatory effect of HP in supraspinal areas related to both pain processing and perception.

Conclusion

Intensities of EA plays an important role in modulating central pain perception.

Bisphosphonates require caution, new labelling for Fosamax, Actonel, and Boniva

To file under "Beware of Blockbuster Drugs."  See previous post entitled :Drugs causing the problems they're supposed to prevent

Stronger Cautions Backed on Bone Drugs for Women
By DUFF WILSON

Two advisory panels to the Food and Drug Administration on Friday recommended increasing the cautionary language on the product labels of bone-building drugs taken by more than five million women in the United States.

But they stopped short of specifying what the safety warnings should say and did not recommend limiting use of the drugs to a proposed five years. About 11 percent of women 55 and older take the drugs to prevent bone fractures...
The benefits of the drugs have only been proven for three to five years, not longer, F.D.A. staff members said, warning about links to those rare conditions after longer use....

Several women who have suffered the unusual fractures testified at the meeting.

Dr. Jennifer P. Schneider, whose thigh broke as she was standing in a New York subway, presented her own review of 111 cases.

Almost all took the drug for more than five years, most for a pre-osteoporosis condition called osteopenia, she said. Many felt pain in the thigh before the bone suddenly broke.

The first such drug, Fosamax, was marketed by Merck in 1995. Others include Actonel and Atelvia from Warner Chilcott and Boniva from Roche Therapeutics. Worldwide sales last year were $7.6 billion.

At a conference at UCSF last year, "Controversies in Women's Health,"  I was very interested in the topic of bisphosphonates which was on the agenda.  The professor who gave the talk made light of any nasty side effects, but he also had published conflicts of interests.  He had done some of the initial work funded by the pharmaceutical industry. 

Breast Cancer Rates in Marin County

I made dinner for some friends last night and my friend who is also an alternative Medical doctor alerted me to the results of this study about breast cancer rates in Marin.  The basic finding is that the cancer rates were elevated in Marin due to combined estrogen and progesterone replacement therapy.  I have to admit I thought that the cause was going to be something more unique, such as the chemicals unleashed with kitchen remodels, or some earth magnetic anomaly.

Marin women's breast
cancer study compiles
unique database

By Nels Johnson, Marin Independent Journal

Posted: 08/26/2011 10:46:45 AM PDT

Updated: 08/29/2011 11:45:35 AM PDT



The exhaustive, ground-breaking probe --
launched after Marin County logged one of the
highest breast cancer rates in the nation -- is an
ongoing analysis by a consortium including county
health staff, the Buck Institute for Age Research, the
Northern California Cancer Center, Zero Breast
Cancer and others.

Data include saliva samples from 8,500 Marin
women that allows hormone study as well as genetic
analysis of DNA, along with review of health
histories, childbirth and breast-feeding data and
environmental and personal risk factors including
drug and alcohol use.

By analyzing data, researchers may glean clues
"about why would it be that breast cancer rates are
so elevated in this little county," said Larry Meredith,
head of the county Department of Health and Human
Services.

Intense interest in the study, launched in 2005, was
spurred around the nation after a National Cancer
Institute study indicated Marin s 1998-2002 rate of
cancer in non-Hispanic white women was 175 cases
per 100,000. At the time, the

rate was about the same as San Francisco, 7 percent
higher than the rest of the Bay Area, 9 percent
higher than Los Angeles and 18 percent higher than
the United States.

The good news: Marin s rate has fallen in recent
years, with 2009 statistics indicating a rate of 147
cases per 100,000 women -- but still higher than
the state s recent overall rate of 139...


He noted the falling Marin rate coincides with fewer
women taking a mix of hormone therapies.
Researchers using the database are trying to figure
out why.

I thought this comment after the article was interesting, since stress and its consequences is one of my areas of keen interest.  Anecdotal, but interesting nonetheless. (Info on my practice here.)

i have done my own non-scientific research working in a reconstructive and plastic surgeon's office for 7 years (and also a breast cancer survivor myself) and have found that about 99% of women that have come through our office as newly diagnosed breast cancer patients, are well-educated, working full-time in crazy demanding jobs, mothers, and taking on a world of STRESS! Not all of these women have all of these things going on, but, all of them have STRESS in common. The old and young patients are A type perfectionist type women and this is causing their immune systems to be suppressed and allowing cancer cells to multiply...i think if someone could find a suppressent for the stress hormone, CORTISOL, they would have the key to reducing breast cancer rates. I hope one of these coordinators reads this from the above study...it's not rocket science and maybe I found the missing clue to the CURE!

HRV Analysis in the Acupuncture Clinic: Feasibility and Effectiveness

I had to rework my abstract for the upcoming (click on the logo for a link)
So I'll go ahead and post it here.  I've been working on my poster presentation and I will probably try to illustrate how I use the HRV to help guide my treatments rather than try to convince anyone of the scientific validity of the approach.  Once I get it all together, I'll post it here.  The committee wanted my abstract not to be so, er, abstract.  So I included the conditions treated and type of acupuncture used.  But since it had to be under 2,300 characters, I ended up changing it a fair amount. (For info on my practice, please click here.)

Heart Rate Variability Analysis in the Acupuncture Clinic: Correlation with Clinical Outcomes

Kristen Sparrow, MD

Private Practice

San Francisco, California

Background:  Heart Rate Variability (HRV) analysis is a non-invasive method of assessing autonomic tone and has been studied in conjunction with acupuncture in a number of contexts. Acupuncture can lower sympathetic tone and enhance vagal activity, i.e decrease the stress reponse.

 In contrast to the research setting, there are time and efficiency constraints in the private acupuncture practice. In addition there can be monitoring artifacts which make frequency and time domain HRV analysis unreliable.  The author hypothesizes that analysis using nonlinear HRV analysis in addition to the aforementioned analysis methods will give a more sensitive and dependable evaluation of the patients’ autonomic state and show a more consistent correlation with clinical outcomes. The ultimate goal is to use HRV as an additional feedback in the clinic to achieve better results and hence, better outcomes.

Objective:

To correlate patient’s responses to acupuncture treatment with their intra- treatment HRV measurements across time, frequency and nonlinear domains.

Design, Setting, and Patients:  Case study of 20 patients representing 80 treatment sessions. The presenting diagnoses were varied including hypertension(3), low back pain/sciatica (3), headache/migraine(5), depression/anxiety(4), peripheral neuropathy (2), allergy (1), IBS(1), PCOS (1).

Intervention: All patients received body acupuncture according Traditional Chinese Medicine principles. Electro-acupuncture was used if following a protocol (PCOS), or if manual acupuncture was not proving effective.  HRV data was collected after needle placement for 20 minutes, and analyzed after treatment. 

Main Outcome Measure: Patients were assessed by symptom resolution. Their HRV data were compared for the time frames “a” (60 to 360 sec) and “b” (360 to 660 sec) using Kubios shareware for:

1. Time series: pnn50 %

2. Frequency Domain: FFT (LFR/HFR) ratios and HFR%

3. Nonlinear results:  Poincaré Plots (SD1/SD2) and Sample entropy

Results:

Patients who responded to their acupuncture treatment tended to exhibit a decrease in LFR/HFR in the segment “a,” compared to “b” by at least 30% and/or an increase from “a” to “b” in the nonlinear measurement SD1/SD2 by at least 20%.

 Non-responders, or patients who were aggravated by a particular treatment tended to show no change or an increase in their LFR/HFR from “a” to “b”   and a decrease in their SD1/SD2 from “a” to “b.”

Conclusions: In this study the correlation between increased HRV during acupuncture treatment and positive response to acupuncture was supported. Use of nonlinear analysis in addition to frequency domain measures added to the sensitivity of HRV outcome measures.

Stents Fail to Stop Strokes in Study

I would say "oh well," except strokes are a serious and can be extremely debilitating so it's a tragic study.  Again, I think we'll find prevention, though not glamorous nor exciting has got to be mission. I wrote about stents here, and medical device controversy here, here and here. You may want to read the article in its entirety if these topics interest you.  The stents cost $21,000 to insert, and Medicare would only pay if the patients were part of a study.  $21,000 could probably pay for a private nurse to go to the patient's house every day for 5 years to make sure they took their meds, ate their green leafies, and took their walk.  I know I'm being churlish...

Study Is Ended as a Stent Fails to Stop Strokes
By GINA KOLATA

A promising but expensive device to prop open blocked arteries in the brain in the hope of preventing disabling or fatal strokes failed in a rigorous study, researchers reported on Wednesday. Those who got the device actually had so many more strokes than those assigned to control risk factors, like blood pressure, cholesterol and diabetes, that the study was abruptly terminated.

The Food and Drug Administration approved the device six years ago on the basis of a humanitarian exemption, which did not require solid evidence that it would prevent strokes. Thousands of patients got the devices since then, according to the study’s lead researcher. The finding that the devices actually more than doubled the rate of stroke or death raised serious questions about whether the F.D.A.’s procedures for approving such a medical device ended up putting patients at risk.

The study comes just a month after an expert panel at the Institute of Medicine, a major scientific group, recommended that the F.D.A. replace its more usual regulatory system for devices because it failed to establish the safety and efficacy of less risky devices, like artificial hips, before licensing.

While neurologists were deeply disappointed by the study’s outcome, they also said it was better to find out that the treatment was, on balance, harmful before it became standard medical practice.

Larry Kessler, an expert on medical devices and a former director in the F.D.A.’s Center for Devices and Radiological Health, said that the humanitarian exemption made sense sometimes, but that the new study showed its dangers.

If the study’s findings hold up, Dr. Kessler said the approval of the brain stents “should be something the F.D.A. is very concerned about.” The agency, he added, has the authority to withdraw its approval...

The study’s results, published online Wednesday in The New England Journal of Medicine, were sobering. Thirty three patients, or 14.7 percent, who got the stent had a stroke in the first month, and five died. Among those who had medical therapy, 13 patients, 5.8 percent, had strokes in the first month. One died, but not from a stroke.

The medical therapy group actually did better than expected, perhaps because they were prompted and hounded to get their risk factors under control and also, Dr. Chimowitz said, because they took two drugs to prevent clots, aspirin and clopidogrel, for 90 days.

For more information about my practice, please click here.

Anti bacterial Soaps: Doing More Harm Than Good?

This is a long and complicated topic, so I've hesitated to wade into it.  But since my default setting is to be wary of new and improved and highly touted health related products,  I never did buy into the craze for hand sanitizers.  I've found some good sources on this issue, some scientific and some in the mainstream press.  The main culprit seems to be triclosan, a biocide, that can have some nasty side effects on development if ingested.  Long story short, it hasn't been regulated much yet, in spite of some real dangers related to its use (nosocomial infections, accidental ingestions in children, increased antibiotic resistant bacteria, increase in asthma in adult users to name a few.)
A study out of Madrid showed induced resistance in a particular strain of pathogen Stenotrophomonas maltophilia. To quote their article

"The wide utilization of biocides poses a concern on the impact of these compounds on natural bacterial populations. Furthermore, it has been demonstrated that biocides can select, at least in laboratory experiments, antibiotic resistant bacteria. This situation has raised concerns, not just on scientists and clinicians, but also on regulatory agencies, which are demanding studies on the impact that the utilization of biocides may have on the development on resistance and consequently on the treatment of infectious diseases and on human health."

An article from way back in 1984 found that Operating Room soap became colonized with a pathogen, serratia marcescens, because that pathogen was not susceptible to triclosan, so it's hardly like this is a new issue.

Even if you manage to stay out of the hospital, and don't use the antibacterial soaps with Triclosan yourself, it may get to you anyway since grey water irrigation is becoming more and more common and triclosan is often present in the grey water.  It can then get into plants and into the food chain.

This is a brief article in Mother Jones about  the controversy surrounding triclosan.  It's the same story of moneyed interests versus public good, as we've seen in certain medical device and pharmaceutical issues.

This article from a few years ago, also from Mother Jones give a number of facts about germaphobia in the United States.  I'll include a few here.  So, first do not harm.  Wash your hands often and well throughout the day, but stay away from antimicrobials and hand washes.

Triclosan, the active ingredient in many antimicrobial soaps, has been detected in women's breast milk and 58% of US waterways.

Poison centers counted 9,600 kids under 6 who ingested ethanol-based hand sanitizer in 2006, a 24% increase over 2005.

Australian doctors have treated kids' eczema by giving them "dirt pills" containing good bacteria.

A 2007 study found that adults who regularly use household cleaning sprays are 30-50% more likely to develop asthma.

Pediatricians prescribe antibiotics to more than 50% of kids who complain of sore throats.

The Lancet reports that American doctors order antibiotics for 80% of patients with sinus infections—usually caused by the cold virus.

Penicillin-resistant microbes first appeared in 1947, 4 years after the drug was released. The antibiotic was sold over the counter until the mid-1950s.

In 1974, 2% of staph infections were resistant to antibiotics; today, more than 60% are.

Methicillin-resistant Staphylococcus aureus (mrsa) infects nearly 95,000 Americans annually and kills more than 18,500.

85% of mrsa infections are linked to health care facilities.

New Mexico governor Bill Richardson, who holds a world record for handshaking (13,392 in 8 hours), never uses hand sanitizer: "You're going to collect bacteria just by existing."

(For information about my practice please click here.)