The Brain Circuitry and Heart Rate Variability Reflections of Nausea

This is a study looking at functional MRI and HRV underlying the autonomic nervous system response to nausea. This is of interest to because nausea is one of the best well studied conditions where acupuncture helps. Given my thesis that lowering sympathetic tone, (lowering the stress response) is an important aspect of acupuncture treatment, this study is pertinent. For more information on my practice, please click here.

A combined HRV-fMRI approach to assess cortical control of cardiovagal modulation by motion sickness.
Conf Proc IEEE Eng Med Biol Soc. 2011 Aug;2011:2825-8.
Kim J, Napadow V, Kuo B, Barbieri R.
Abstract

Nausea is a commonly occurring symptom typified by epigastric discomfort with the urge to vomit. To date, the brain circuitry underlying the autonomic nervous system response to nausea has not been fully understood. Functional MRI (fMRI), together with a point process adaptive recursive algorithm for computation of the high-frequency (HF) index of heart rate variability (HRV) was combined to evaluate the brain circuitry underlying autonomic nervous system response to nausea. Alone, the point process analysis revealed increasing sympathetic and decreasing parasympathetic response during nausea with significant increased heart rate (HR) and decreased HF. The combined HRV-fMRI analysis demonstrated that the fMRI signal in the medial prefrontal cortex (MPFC) and pregenual anterior cingulate cortex (pgACC), regions of higher cortical functions and emotion showed a negative correlation at the baseline and a positive correlation during nausea. Overall, our findings confirm a sympathovagal shift (toward sympathetic) during nausea, which was related to brain activity in regions associated with emotion and higher cognitive function.

Post Spinal Nerve Ligation Hypersensitivity Relieved by Manual Acupuncture (in rats)

This study is looking at acupuncture effectiveness for neuropathic pain. They simulate neuropathic pain by ligating a spinal nerve in the rat and then using traditional acupuncture point stimulation compared with gabapentin.

Manual acupuncture inhibits mechanical hypersensitivity induced by spinal nerve ligation in rats.
Cidral-Filho FJ, da Silva MD, Moré AO, Córdova MM, Werner MF, Santos AR.
Laboratório de Neurobiologia da Dor e Inflamação, Departamento de Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil.
Abstract

Manual acupuncture (MA) has presented analgesic activity against neuropathic pain in patients and animal models, yet a series of questions remain: Is MA effectiveness dependent of acupoint selection or combination? Is it equally efficient when treatment starts on the initial (acute) or sub-chronic phase of spinal nerve ligation (SNL)-induced neuropathy? Is MA effect related to the release of endogenous opioids? Does MA produce similar effects to gabapentin? To answer these questions rats submitted to the L5/L6 SNL injury were treated with unilateral MA (ST36 (Zusanli), SP6 (Sanyingjiao) or ST36+SP6 acupoint stimulation); or with gabapentin (30 mg/kg i.p., used as positive control). Both acupoints have been demonstrated to present analgesic activity and are used in clinical practice and basic science research. In addition, we investigated the influence of naloxone (1 mg/kg i.p., a nonselective opioid receptor antagonist) on MA treatment and also the effect of unilateral ST36+SP6 MA treatment beginning acutely (5 days) or sub-chronically (14 days) after SNL. Our results demonstrate that single or combined unilateral stimulation was able to reduce mechanical hypersensitivity with treatment beginning in both acute and sub-chronic phases of SNL-induced neuropathy; MA effect was blocked by naloxone, and finally; SP6+ST36 MA presented similar effect to gabapentin (30 mg/kg). In conclusion, our results demonstrate, for the first time, that unilateral MA (ST36, SP6 or ST36+SP6) reduces hypersensitivity induced by the SNL with effect dependent of the opioid system and comparable with the one obtained with gabapentin (used as positive control).

For more information on my practice, please click here.

Johnson and Johnson Pays out in Texas Law Suit

This to be tossed into the "Corruption" file, or the "Follow the Money" file. I guess they're sort of one in the same, except the "Corruption" file contains those who have been caught.

January 19, 2012
J. & J. to Pay $158 Million to End Suit Filed by Texas
By REUTERS

Johnson & Johnson said on Thursday that it would pay $158 million to settle a Texas lawsuit accusing the drug maker of improperly marketing its Risperdal antipsychotic drug to state residents on the Medicaid health program for the poor, including children.

The lawsuit accuses the company of pushing Risperdal as “appropriate and safe to treat a broad range of symptoms in populations and disease states for which it had no F.D.A.-approved indication, including in the child and adolescent population...”

“Johnson & Johnson’s scheme to profit from the Medicaid program by overstating the safety and effectiveness of an expensive drug and improperly influencing officials ended up costing taxpayers millions of dollars,” Texas’s attorney general, Greg Abbott, said in a statement...
The company is in various stages of litigation with several other states.

For more information on my practice, please click here.

Drug Cartel Forced to Report Pay Offs

My title is a bit hyperbolic, but not by much. This blog post to be filed in the "It's about time" file. They are planning on extending this regulation to the medical device industry as well. Note that this law is about direct payment to doctors as well as the funding of medical research, which is also corrupted. I've touched on some of these topics here, here, here and here. Those, unfortunately, are just a few of the many posts on this type of corruption that has occurred. I'm not sure how to evaluate the penalties, $10,000 for failure to report, $100,000 for knowingly failing, for a total of $1,000,000 per year. Seems in the "slap on the wrist" range in absolute dollar amount, but the negative press may be the larger punishment. It's something, at least.(For more information about my practice, please click here.)

U.S. to Force Drug Firms to Report Money Paid to Doctors
By ROBERT PEAR

WASHINGTON — To head off medical conflicts of interest, the Obama administration is poised to require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment.

Many researchers have found evidence that such payments can influence doctors’ treatment decisions and contribute to higher costs by encouraging the use of more expensive drugs and medical devices...

Large numbers of doctors receive payments from drug and device companies every year — sometimes into the hundreds of thousands or millions of dollars — in exchange for providing advice and giving lectures. Analyses by The New York Times and others have found that about a quarter of doctors take cash payments from drug or device makers and that nearly two-thirds accept routine gifts of food, including lunch for staff members and dinner for themselves.

The Times has found that doctors who take money from drug makers often practice medicine differently from those who do not and that they are more willing to prescribe drugs in risky and unapproved ways, such as prescribing powerful antipsychotic medicines for children...

Companies will be subject to a penalty up to $10,000 for each payment they fail to report. A company that knowingly fails to report payments will be subject to a penalty up to $100,000 for each violation, up to a total of $1 million a year...

Allan J. Coukell, a pharmacist and consumer advocate at the Pew Charitable Trusts, said: “Patients want to know they are getting treatment based on medical evidence, not a lunch or a financial relationship. They want to know if their doctor has a financial relationship with a pharmaceutical company, but they are often uncomfortable asking the doctor directly.”

Erectile Dysfunction and Anti-inflammatories

To be filed in the "I Did Not Know That" file. From last year, but unknown to me.

Men taking Anti-Inflammatory Drugs more likely to develop Erectile Dysfunction

PASADENA, Calif. March 2, 2011 /PRNewswire/ -- Men who take non-steroidal anti-inflammatory drugs three times a day for more than three months are 2.4 times more likely to have erectile dysfunction compared to men who do not take those drugs regularly, according to a Kaiser Permanente study published online in The Journal of Urology.

The term "nonsteroidal" is used to distinguish these drugs from steroids, which, among a broad range of other effects, have a similar eicosanoid-depressing, anti-inflammatory action. As analgesics, NSAIDs are unusual in that they are non-narcotic.

The most prominent members of this group of drugs are aspirin, ibuprofen, and naproxen, all of which are available over the counter in many areas.

While previous research showed a trend toward this same finding, this observational study used electronic health records, an automated pharmacy database and self-reported questionnaire data to examine NSAID use and ED in an ethnically diverse population of 80,966 men aged 45 to 69 years throughout California.

After controlling for age, race, ethnicity, smoking status, diabetes, hypertension, heart disease, high cholesterol and body mass index, the researchers found that ED was 1.4 times more likely -- a modest risk -- among regular NSAID users compared to men who did not take the drugs regularly. This association was consistent across all age groups

For more information about my practice please click here.
P.S. I sort of see this as a clash of the titans. ED is a bit of a created condition. Though there is true suffering out there, there is a heck of a lot of hype too since it's pitched at a pretty young age group. Anti-inflammatories have also been marketed very intensely even though some of the more recent ones turned out to have some serious side effects. So interesting that the two have intersected. In the article it says that they were expecting to find that anti-imflammatories improved ED. Surprise!!

NFL and Acupuncture

Yay. I remember reading this article when it came out but couldn't find it, it's entitled "Big Men, Little Needles." The New York Jets use acupuncture to keep strong, healthy and pain free.
So can you!!

Needling the body forces the connective tissue aroung the pin to contract stimulating blood flow and releasing endorphins, which act as powerful pain relievers. Inserting acupuncture needles also triggers the production of dopamine a chemical in the braind that plays a part in response to pleasure and pain, which is why some patients feel high afte acupuncture therapy... Not only effective in easing pain, acupuncture can also help the body overcome one of the toughest hurles to healing, inflammation.

For more information about my practice, please click here.

Retained versus non-retained needles and Heart Rate Variability

This is a study published in Chinese looking at the effects of acupuncture at P6 and P5 in healthy volunteers comparing the effects of retained needles to traditional needling. Use of P6 and P5 for cardiac purposes is a time honored prescription. These points are also used in Longhurst's protocol for for high blood pressure (hypertension.) Measuring HRV after needling P6 and P5 has precedent also.
In this study, they found a cardiac excitation initially (which I also find in practice) and then an increase in RR interval, or decrease in heart rate. They found HFR increased, which can be interpreted as an increase in parasympathetic activity. LFR was unchanged, interpreted to mean no change in sympathetic activity. Sadly, since they were healthy volunteers, there can be no clinical correlation with acupuncture effectiveness. Information on my practice here.

[Effects of retained needling and non-retained needling on regulation of the cardiac autonomic nerve].
Zhongguo Zhen Jiu. 2011 Nov;31(11):993-7.
Luo LP, Shen ZY, Yu P
Department of Physiotherapy, The Second Hospital of Sanming City, Sanming 366000, Fujian Province, China. llp77-82@163.com

To investigate the mechanism of retained needling and non-retained needling on the physiologic regulating effect of the cardiac autonomic nerve in healthy persons.
METHODS:

Sixty volunteers were randomly divided into a retained needling group and a non-retained needling group, 30 cases in each group. They were all received perpendicular needling at Neiguan (PC 6) and Jianshi (PC 5) retaining for 20 min in the retained nee dling group and without retaining in the non-retained needling group. The heart rate variability (HRV) indices, i.e., R-R interval, low frequency (LF), high frequency (HF) and LF/HF were observed.
RESULTS:
Compared with before acupuncture, the R-R interval were significant increased during the stimulation period and during the post-stimulation period in the retained needling group, especially during the stimulation period (all P < 0.01), and during the post-stimulation period of 5 min and 10 min in the non-retained needling group (P < 0.01, P < 0.05), then returned to pre-acupuncture level quickly, and the R-R interval in the retained needling group was significant ly higher than that in the non retained needling group at 10 min (P < 0.05). At 5 min, the HF were significantly higher, and the LF/HF were significantly lower than those before acupuncture (P < 0.01, P < 0.05), and there was no obvious change in LF in both groups.
CONCLUSION:
Retained needling and non-retained needling at Neiguan (PC 6) and Jianshi (PC 5) can both excite cardiac vagus nerve briefly and then the acupuncture effects reduce grad ually until disappearance, while no obvious changes can be found with cardiac sympathetic activity. Both of needling can reduce heart rate and the action time of heart rate decrease by retained needling is longer than non-retained needling.

More on Complexity

Sorry for the long gap without posting! I guess I'll blame it on the holidays and getting back to work, though that certainly can't account for such a long window. I'm reworking my website, and will be giving a presentationm though that kind of activity is always going on.
But I wanted to continue a bit with the article by Andrew Ahn, discussed here. I will highlight the pertinent part, because it reflects my thinking about Heart Rate Variability and what it can tell us about the overall health of the patient. He even says that it may reflect a person's "adaptability" which is the conclusion I've come to over the years. Though effective acupuncture treatment most likely is a function of the correct acupoints, the overall state of the subjects system is probably an important factor too. Then the question becomes, how best to nurture that adaptability that will allow for self healing.

Because heart rate is dynamically balanced through many elements, including the autonomic nervous system, respiration, hormones, and other physiologic systems, the heart theoretically should be responsive to, and exhibit increased complexity across, multiple time scales in concert with fluctuations in these elements. The temporal changes of a variable therefore may contain hidden information that is useful for describing the overall system. This capacity to capture the global state of a system or an individual suggests these complexity-based measures may act as surrogates for concepts that were traditionally difficult to measure but considered important for CAM research (e.g., “health” and “adaptability”). Does a homeopathy prescription or massage treatment affect complexity measures of HRV?...
means to understand CAM better, CAM therapies themselves can be thought of as exemplars for how complexity theory can be applied to clinical medicine. Historically, conventional medicine has evolved and developed under a reductionist Cartesian framework. Complex problems such as chronic diseases were typically divided into smaller, simpler, and thus tractable, units. This approach has affected the way practitioners diagnose, treat, and prevent illnesses. Importantly, it has also shaped the practitioner's worldview and heuristic approach to medicine. To incorporate a distinct philosophical framework such as complexity theory to medicine may therefore challenge pervasive entrenched beliefs and perspectives....
In this regard, CAM is uniquely poised to provide the needed perspective and experience. Many CAM therapies are rooted in a worldview most consistent with complexity and systems theory. The human body is viewed holistically and considered dynamic and complex; the mind, body, and spirit are inextricably linked; and the interactions among the organs and individuals are as important as the components themselves... fractal patterns within the body (e.g., reflexology, auricular acupuncture), and the use of minimal interventions to affect the larger system (e.g., acupuncture and homeopathy).

I didn't realize that the traditional medical model was a "reductionist Cartesian model." I've always thought that the limiting perpective of traditional medicine, was that it was mainly developed after the industrial revolution, and so the body is seen as a machine rather than a living, adapting, organism.

More on my practice here.

Acupuncture for Eczema, the role of Basophils

Nice study, but small, looking at acupuncture's effect on the "itch" of eczema and the correlation with basophils. Post on an acupuncture study on eczema here from Napadow. Info on my practice here.

J Altern Complement Med. 2011 Apr;17(4):309-14. Epub 2011 Mar 28.
Effect of acupuncture on allergen-induced basophil activation in patients with atopic eczema:a pilot trial.
Pfab F, Athanasiadis GI, Huss-Marp J, Fuqin J, Heuser B, Cifuentes L, Brockow K, Schober W, Konstantinow A, Irnich D, Behrendt H, Ring J, Ollert
Department of Dermatology and Allergy, Technische Universität München, Biedersteiner Straße 29, Munich, Germany. florian.pfab@lrz.tum.de
Abstract
OBJECTIVE AND METHODS:

The crucial symptom of atopic eczema is itch. Acupuncture has been shown to exhibit a significant effect on experimental itch; however, studies focusing on clinical itch in atopic eczema and corresponding mechanisms are lacking. The study design was a unicenter, single-blinded (observer), prospective, randomized clinical pilot trial with an additional experimental part. In 10 patients with atopic eczema, we investigated the effect of acupuncture treatment (n = 5) compared to no treatment (n = 5) on itch intensity and in vitro basophil CD63 expression upon allergen stimulation (house dust mite and timothy grass pollen) in a pilot trial.
RESULTS:
Mean itch intensity in a visual analog scale was rated significantly lower in the acupuncture group (-25% ± 26% [day 15-day 0]; -24% ± 31% [day 33-day 0]) than in the control group (15% ± 6% [day 15-day 0]; 29% ± 9% [day 33-day 0]). From day 0 (before treatment) to day 15 (after 5 acupuncture treatments) as well as day 33 (after 10 acupuncture treatments), the acupuncture group showed less CD63 positive basophils than the control group regarding stimulation with house dust mite and grass pollen allergen at various concentrations (5 ng/mL, 1 ng/mL, 0.5 ng/mL, or 0.25 ng/mL).
CONCLUSIONS:
Our results show a reduction of itch intensity and of in vitro allergen-induced basophil activation in patients with atopic eczema after acupuncture treatment. Reducing basophil activation can be a further tool in investigating the mechanisms of action of acupuncture in immunoglobulin E-mediated allergy. Due to the limited number of patients included in our pilot trial, further studies are needed to strengthen the hypothesis.

Prostrate Screening Update: First, Do No Harm

On Jan 6th there was an update to the prostate cancer screening study showing that even with a longer follow up time, the screening is of extremely limited benefit. Given the nasty side effects of treatment, (outined below) the recommendation is not to screen with PSA. I've discussed this topic previously here, here, here

Prostate Cancer Screening Shows No Benefit

By TARA PARKER-POPE

Updated findings from one of the largest studies of prostate cancer screening show that the commonly used P.S.A. blood test did not save lives, although questions remain about whether younger men or those at very high risk for the disease might benefit.

Last fall, the United States Preventive Services Task Force concluded that healthy men should no longer be routinely screened for prostate cancer using the prostate-specific antigen, or P.S.A., blood test. That decision was based on findings from five well-controlled clinical trials, including a major American study called the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial, which studied P.S.A. testing in nearly 77,000 men ages 55 to 74...

Because prostate cancer can take several years to develop, the investigators continued to collect data after reporting the initial findings.

In a new paper published today in The Journal of the National Cancer Institute, the scientists report that the additional follow-up time didn’t change the overall conclusion: that regular P.S.A. testing does not save lives and can lead to aggressive treatments that leave men impotent, incontinent or both..

The findings suggest that the type of cancer typically detected by screening is so slow-growing that it often is unlikely to cause harm before the man dies of another cause...

“I think it supports the recommendation that for the average man in the United States, mass screening is probably not beneficial at all,’’ Dr. Andriole said. “It also will keep the discussion open about whether there are indeed subsets of men who do potentially stand to benefit from P.S.A. screening.”

What's old is new again. "The findings suggest that the type of cancer typically detected by screening is so slow-growing that it often is unlikely to cause harm before the man dies of another cause... This is what we were taught in medical centuries ago when I was a medical student.
For more on my practice, please click here.