This is a technical paper exploring what occurs in the brain during acupuncture and in the ensuing time period. It also looks at the difference in the brain between sham (superficial) acupuncture and verum or real acupuncture. They also correlate this activity with Heart Rate Variability, a measure of the autonomic nervous system balance. It has the added feature of citing my research study at least twice... The abstract can be found at the link, the entire paper can be downloaded from nlm also. Some excerpts of the paper follow and short discussion.
http://www.ncbi.nlm.nih.gov/pubmed/18337009?ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Pain. 2008 Jun;136(3):407-18.
Acupuncture modulates resting state connectivity in default and sensorimotor brain networks
Our results demonstrate for the first time that acupuncture can enhance the post-stimulation spatial extent of resting brain networks to include anti-nociceptive, memory, and affective brain regions. This modulation and sympathovagal response may relate to acupuncture analgesia and other potential therapeutic effects.
A review of the literature suggests that acupuncture influences a diverse set of bodily organs and functions including brain processing [25, 26] and autonomic nervous system (ANS) activity [1, 44].
It has long been known that the analgesic effects of acupuncture may actually peak long after cessation of active needle stimulation [58]. ..
Furthermore, recent reports have suggested that ANS(Autonomic Nervous System) response to acupuncture (measured by heart rate variability, HRV, [49]) may be linked to clinical response for different chronic pain populations [60]. As variable peripheral ANS response to acupuncture may influence post-stimulation brain activity, we also sought to explore the relationship between acupuncture induced ANS outflow to the heart as estimated by HRV and acupuncture induced changes in RSN (Resting state network) connectivity.
We also sought to explore the relationship between acupuncture-induced autonomic modulation and subsequent change in RSN connectivity. Increased DMN (Default Mode Network) connectivity with the hippocampal formation was anti-correlated with acupuncture-induced increase in sympathetic modulation, and correlated with parasympathetic modulation. ..
Our data contribute to these results by suggesting that when acupuncture induces a sympathovagal shift toward parasympathetic, the hippocampal formation has greater connectivity with the DefaultModeNetwork, a brain network thought to subserve self-referential cognition and autobiographical memory [14]. While pain is known to modulate autonomic outflow [18], the response is typically increased sympathetic tone. However, increased hippocampal/DMN connectivity following acupuncture was associated decreased sympathetic and increased parasympathetic modulation, suggesting that acupuncture modulation of DMN connectivity may not result from classic pain-like aspects of this complex intervention. Interestingly, other groups have found that acupuncture-induced decrease of LF/HF ratio, relating a shift in sympathovagal balance toward greater parasympathetic modulation, may relate to acupuncture therapeutic effects on chronic pain [60]. Our correlative results connecting HRV metrics with enhanced DMN connectivity should to be replicated in a clinical population to investigate this possible connection with clinical efficacy...
Not that I can speak to the entirety of this complicated and excellent study, but they are exploring why acupuncture would decrease the stress response, and why it might lead to prolonged pain relief in chronic pain patients. Since chronic pain is a syndrome where the suffering of the patient is not in direct correlation to the nociceptive stimulus, it is postulated in this paper that the acupuncture sets up a new memory of sorts which requires the default mode network connectivity with certain brain regions. They showed that the acupuncture increased the connectivity of the Default Mode Network with the hippocampus, which is connected with the Autonomic Nervous System, which caused a decrease in the stress response as demonstrated by HRV (Heart Rate Variability) analysis.
In sum, this paper may show why the stress response can be lowered by acupuncture, as my own research paper suggested.
Wednesday, October 21, 2009
Friday, October 9, 2009
Heart Rate Variability, TENS, and Body Composition
Study from Evidence Based Complementary and Alternative Medicine September 22, 2009 done by a Taiwanese group (http://ecam.oxfordjournals.org/cgi/content/full/nep145v1) looks at obesity in postmenopausal women. They evaluated the effect of Transcutaneous Electric Acupoint Stimulation (TEAS) as a function of body composition and heart rate variability. Body composition was used as a screening test (percentage body fat >30%, waist >80cm.) The study group received TEAS twice a week for 30 minutes for 12 weeks. The control group did not receive any intervention. HRV and body composition was measured at the 4th,8th, and 12th week. Waist circumference and % body fat were significantly less than those of the control group at the 8th and 12th week. HRV increased as measured by SDNN from the 4th to the 8th week, but was no different from controls at the 12th week.
They conclude that TEAS treatment improves body composition and has a transient effect on the HRV in postmenopausal women with obesity.
Unfortunately, there was no sham TENS applied, so this is not a truly controlled study. But this study, nonetheless, raises some interesting questions. First of all, TENS is a therapy that could be applied by patients at home, which could be an incredibly convenient therapeutic help to people afflicted with obesity. It is very interesting that the HRV increased with TENS treatment, and it is impossible to know if the HRV improved because of body composition changes or vice versa. I will look forward to further studies to see if this effect can be corroborated. It should also be noted that the subjects weight did not change, only their lean mass.
They conclude that TEAS treatment improves body composition and has a transient effect on the HRV in postmenopausal women with obesity.
Unfortunately, there was no sham TENS applied, so this is not a truly controlled study. But this study, nonetheless, raises some interesting questions. First of all, TENS is a therapy that could be applied by patients at home, which could be an incredibly convenient therapeutic help to people afflicted with obesity. It is very interesting that the HRV increased with TENS treatment, and it is impossible to know if the HRV improved because of body composition changes or vice versa. I will look forward to further studies to see if this effect can be corroborated. It should also be noted that the subjects weight did not change, only their lean mass.
Wednesday, September 30, 2009
PSA test unreliable and "unusable"
In a follow up on a previous post (http://ksparrowmd.blogspot.com/2009/03/prostate-screening-test-psa-may-not.html) there is now another study, this time from the British Medical Journal, showing that PSA testing does not give enough valuable information to be worth doing.
http://www.nlm.nih.gov/medlineplus/print/news/fullstory_89847.html
FRIDAY, Sept. 25 (HealthDay News) -- The inability of the prostate specific antigen (PSA) test to distinguish between deadly and harmless prostate cancers makes it unusable as a population-wide screening tool, new research claims.
Because of its unreliability, results from the test lead to overdiagnosis and overtreatment, according to two reports in the Sept. 25 online edition of BMJ.
"Our findings strongly indicate that, in addition to PSA, further biomarkers are needed before inferring population-based screening for prostate cancer," said Benny Holmstrom, a urologist with Gavle Hospital in Gavle, Sweden, and lead author of the first study.
"The direct implication of our findings in a screening situation is that no matter which PSA cut-off you adopt for selecting men for further diagnostic work-up, you will either have too many false positives or too many false negatives," said study co-author Mattias Johansson, a postdoctoral fellow at Umea University in Sweden."
"Given the current trend in lowering the PSA cut-off to about 3 nanograms per milliliter, it seems clear that a large number of healthy men will be subject to painful, stressful and costly diagnostic procedures," he said. "In addition, and perhaps more serious, is the wide overdiagnosis of slow-growing tumors causing unnecessary medical treatment and anxiety..."
http://www.nlm.nih.gov/medlineplus/print/news/fullstory_89847.html
FRIDAY, Sept. 25 (HealthDay News) -- The inability of the prostate specific antigen (PSA) test to distinguish between deadly and harmless prostate cancers makes it unusable as a population-wide screening tool, new research claims.
Because of its unreliability, results from the test lead to overdiagnosis and overtreatment, according to two reports in the Sept. 25 online edition of BMJ.
"Our findings strongly indicate that, in addition to PSA, further biomarkers are needed before inferring population-based screening for prostate cancer," said Benny Holmstrom, a urologist with Gavle Hospital in Gavle, Sweden, and lead author of the first study.
"The direct implication of our findings in a screening situation is that no matter which PSA cut-off you adopt for selecting men for further diagnostic work-up, you will either have too many false positives or too many false negatives," said study co-author Mattias Johansson, a postdoctoral fellow at Umea University in Sweden."
"Given the current trend in lowering the PSA cut-off to about 3 nanograms per milliliter, it seems clear that a large number of healthy men will be subject to painful, stressful and costly diagnostic procedures," he said. "In addition, and perhaps more serious, is the wide overdiagnosis of slow-growing tumors causing unnecessary medical treatment and anxiety..."
Sunday, September 27, 2009
Anti depressants and heart defects
http://www.nlm.nih.gov/medlineplus/news/fullstory_89795.html
THURSDAY, Sept. 24 (HealthDay News) --
"Women who take certain antidepressants during the first three months of pregnancy may have a slightly increased risk of giving birth to babies with heart defects.
Septal heart defects -- malformations in the wall separating the right side of the heart from the left -- were more common among women taking antidepressants in the first trimester, Danish researchers found. Some of these heart defects resolve on their own, while others require surgery.
The risks were seen in sertraline (trade names Zoloft and Lustral) and in citalopram (Celexa), both of which belong to the class of medications known as selective serotonin reuptake inhibitors (SSRIs)."
Women who took more than one SSRI early in their pregnancy had a fourfold higher risk of having babies with this problem, said the authors of a study appearing online Sept. 24 in BMJ."
Overall, it doesn't sound as if the threat is particularly large from the way the data is presented, but this topic is certainly worth keeping an eye on. The article goes on to underscore the risk of women with major depression going off anti-depressants in pregnancy implying that the risk/benefit ratio is in favor of keeping the medications in place. I doubt many would argue with that, but the fact of the matter is that these medications are not only prescribed for women with severe depression. On the contrary, these medications are one of the most prescribed medications out there, and often women do not know they are pregnant until well into the second month so there is some cause for concern.
THURSDAY, Sept. 24 (HealthDay News) --
"Women who take certain antidepressants during the first three months of pregnancy may have a slightly increased risk of giving birth to babies with heart defects.
Septal heart defects -- malformations in the wall separating the right side of the heart from the left -- were more common among women taking antidepressants in the first trimester, Danish researchers found. Some of these heart defects resolve on their own, while others require surgery.
The risks were seen in sertraline (trade names Zoloft and Lustral) and in citalopram (Celexa), both of which belong to the class of medications known as selective serotonin reuptake inhibitors (SSRIs)."
Women who took more than one SSRI early in their pregnancy had a fourfold higher risk of having babies with this problem, said the authors of a study appearing online Sept. 24 in BMJ."
Overall, it doesn't sound as if the threat is particularly large from the way the data is presented, but this topic is certainly worth keeping an eye on. The article goes on to underscore the risk of women with major depression going off anti-depressants in pregnancy implying that the risk/benefit ratio is in favor of keeping the medications in place. I doubt many would argue with that, but the fact of the matter is that these medications are not only prescribed for women with severe depression. On the contrary, these medications are one of the most prescribed medications out there, and often women do not know they are pregnant until well into the second month so there is some cause for concern.
Friday, September 11, 2009
Medical Research Corruption Continues
http://www.nytimes.com/2009/09/11/business/11ghost.html?_r=1&ref=health
September 11, 2009 Ghostwriting Is Called Rife in Medical Journals, By DUFF WILSON and NATASHA SINGER
Following up on a previous blogpost (http://ksparrowmd.blogspot.com/2009/04/corruption-between-drug-companies-and.html) about the common practice of drug companies facilitating and, at times, even doing the research studies for their own products, the NYTimes is reporting that six of the top medical journals had a significant number of articles that were written by "ghostwriters." "Ghostwriters" are authors from drug companies whose names do not appear on the list of authors on a research study. This is an obvious blow to transparency, since the authors could not be traced to the company they work for. From the article-
"Six of the top medical journals published a significant number of articles in 2008 that were written by ghostwriters financed by drug companies, according to a study released Thursday by editors of The Journal of the American Medical Association.
Among authors of 630 articles who responded anonymously to an online questionnaire created for the study, 7.8 percent acknowledged contributions to their articles by people whose work should have qualified them to be named as authors on the papers but who were not listed.
In the scientific literature, ghostwriting usually refers to medical writers, often sponsored by a drug or medical device company, who make major research or writing contributions to articles published under the names of academic authors.
The concern, the researchers said, is that the work of industry-sponsored writers has the potential to introduce bias, affecting treatment decisions by doctors and, ultimately, patient care.
According to the study, responding authors reported a 10.9 percent rate of ghostwriting in The New England Journal of Medicine, the highest rate among the journals.
Editors of the Boston-based journal said Thursday that they were “puzzled” and “skeptical” of the findings. "
September 11, 2009 Ghostwriting Is Called Rife in Medical Journals, By DUFF WILSON and NATASHA SINGER
Following up on a previous blogpost (http://ksparrowmd.blogspot.com/2009/04/corruption-between-drug-companies-and.html) about the common practice of drug companies facilitating and, at times, even doing the research studies for their own products, the NYTimes is reporting that six of the top medical journals had a significant number of articles that were written by "ghostwriters." "Ghostwriters" are authors from drug companies whose names do not appear on the list of authors on a research study. This is an obvious blow to transparency, since the authors could not be traced to the company they work for. From the article-
"Six of the top medical journals published a significant number of articles in 2008 that were written by ghostwriters financed by drug companies, according to a study released Thursday by editors of The Journal of the American Medical Association.
Among authors of 630 articles who responded anonymously to an online questionnaire created for the study, 7.8 percent acknowledged contributions to their articles by people whose work should have qualified them to be named as authors on the papers but who were not listed.
In the scientific literature, ghostwriting usually refers to medical writers, often sponsored by a drug or medical device company, who make major research or writing contributions to articles published under the names of academic authors.
The concern, the researchers said, is that the work of industry-sponsored writers has the potential to introduce bias, affecting treatment decisions by doctors and, ultimately, patient care.
According to the study, responding authors reported a 10.9 percent rate of ghostwriting in The New England Journal of Medicine, the highest rate among the journals.
Editors of the Boston-based journal said Thursday that they were “puzzled” and “skeptical” of the findings. "
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