Acupuncture in Modern Medicine

This book contains four integrated sections: 1) Acupuncture Research; 2) New Developments in Acupuncture; 3) Acupuncture Therapy for Clinical Conditions and 4) Assessment and Accessibility in Acupuncture Therapy. Section 1 provides updates on acupuncture research. From acupuncture effects in modulation of immune system to the role of nitric oxide in acupuncture mechanisms, chapters in this section offer readers the newest trends in acupuncture research. Section 2 summarizes new developments in acupuncture. The included chapters discuss new tools and methods in acupuncture such as laser acupuncture, sham needles, and new technologies. Section 3 discusses acupuncture therapy for clinical conditions. The chapters in this section provide comprehensive and critical views of acupuncture therapy and its application in common clinical practice. Section 4 takes a new look at the issues related to assessment and accessibility in acupuncture therapy. These issues are central to developing new standards for outcome assessment and policies that will increase the accessibility to acupuncture therapy

Chinese herbal medicine for insomnia : evidence and experience

Insomnia, a condition with significant medical consequences, is becoming more and more prevalent worldwide. Hypnotic drugs are associated with dependence, adverse reactions and long-term risks. Psychotherapy is time- and resource-consuming and largely unavailable. As such, many people who present with insomnia also look for alternative treatments. Recent studies show that Chinese herbal medicine (CHM), a traditional herbal medicine based on holistic theories, could be a potential alternative. The aims of this doctoral research were to explore the potential benefits of CHM for the treatment of insomnia and provide guidance in the treatment of insomnia with CHM. For practical reasons, the empirical aspect of the investigation focuses on one specific CHM product, which is Zao Ren An Shen (ZRAS). The research questions include: (1) Is ZRAS a safe and effective treatment for insomnia disorder? (2) How do Chinese medicine clinicians diagnose and treat insomnia with CHM? This doctoral research consists of a narrative review and three major studies: one systematic review, one randomised, placebo-controlled trial and one clinical experience synthesis. In the systematic review, clinical trial that assessed the efficacy and/or safety of ZRAS for insomnia were systematically searched and screened. In the clinical trial, after one week of placebo run-in, 85 participants with insomnia disorder were randomly allocated to either take ZRAS capsule or placebo for four weeks. Insomnia severity, psychological status, fatigue levels, quality of life, subjective sleep parameters, objective sleep parameters, and adverse events were assessed through the intervention period and at a four-weeks follow-up. Both the investigator and the participants were blind to the treatment allocation. In the clinical experience synthesis (CES), clinical experience reports published in the literature, which described treatment of insomnia with CHM, were systematically reviewed and screened. The systematic review shows that ZRAS is safe and effective for insomnia. The randomised trial support ZRAS capsule as a safe and acceptable treatment, yet failed to improve significantly insomnia severity in insomnia patients. These differences may be explained by the poor quality of the studies included in the systematic review. The studies included in the systematic review and the randomised trial both used a standardised intervention approach. However, Chinese medicine clinician recommend an individualised approach, which may contribute to improved outcomes across a broader range of measures

Low Back Pain Pathogenesis and Treatment

Low back pain is a common disorder which affects the lumbar spine, and is associated with substantial morbidity for about 80% of the general population at some stages during their lives. Although low back pain usually is a self-limiting disorder that improves spontaneously over time, the etiology of low back pain is generally unknown and the diagnostic label, "non-specific low back pain", is frequently given. This book contains reviews and original articles with emphasis on pathogenesis and treatment of low back pain except for the rehabilitative aspect. Consisting of three sections, the first section of the book has a focus on pathogenesis of low back pain, while the second and third sections are on the treatment including conservative and surgical procedure, respectively

Choices and Consequences: An investigation into patient choice of provider and provider interventions for low back pain.

A significant portion of healthcare spending is for the treatment of low back pain (LBP). Treatment for low back pain is variable and interventions depend largely upon the provider. This dissertation sought to examine the influence of the first choice of provider, their choice of interventions and the trajectories of health care utilization and patient outcomes. Using the database from a large insurer, we examined data for services billed from July 2015 through July 2018 and conducted a retrospective cohort analysis of patients seeking care for a new episode of LBP. We identified the first provider chosen and examined total medical utilization and LBP costs over the next year. 29,806 unique individuals were identified. Average total cost of care (TCOC) for all medical costs was lowest in those who first sought care with Chiropractic $7,761 (95$7,306, $8,218) or Physical Therapy$11,612 (95% CI: $10,586,$12,638). Highest average TCOC for all medical costs was seen in those who chose the Emergency Department, $20,028 (95$18,903, $21,154). There appears to be an association between the first choice of provider and future healthcare utilization. Using the previously identified data, we narrowed our focus to those who chose the Emergency Department (ED) as the first choice of provider. The goal was to highlight the differences between guideline based and non-guideline based care. 2,895 individuals were analyzed. 1758 (61$18,839 (95% CI: $17,239,$20,385). Low back related spending per episode was also lowest for concordant care $2,635 (95$2,185, $3,084). There appears to be an association between the care delivered in the ED and future healthcare utilization. Finally, we conducted a systematic review (PROSPERO-CRD42020212006) to investigate face-to-face telehealth evaluations or interventions for LBP. 5 studies met our inclusion criteria. The studies found reinforce the existing literature; PTs can perform comparable evaluations and interventions during in-person interactions and face-to-face telehealth environments

Electroanalgesia: Historical and Contemporary Developments

Aims and Objectives: This thesis makes an in-depth examination of the historical, including the eighteenth-century pioneering electrical treatments of the Rev John Wesley, together with contemporary developments in electroanalgesia from the late twentieth-century, including the author's own pilot study, in order to provide a sound, scientific basis for their continuing use. The problem and the hypothesis: Controversy still surrounds the effectiveness of electrical treatments, even after 250 years of application. This is seen in its most researched form as TENS (transcutaneous electrical nerve stimulation) and ALTENS (acupuncture-like transcu taneous electrical nerve stimulation) for chronic back pain. The empirical research making up the main part of the thesis sets out to provide clear evidence to reject the null hypothesis, i.e. that there are no significant clinical effects from the use of electrical treatments for chronic back pain. Methods and findings: The empirical tertiary research centred on a systematic review and meta-analysis, within the framework of the Cochrane Collaboration, of all randomised controlled trials of TENS/ ALTENS for chronic back pain found during rigorous searches of the medical literature. Pooling their results in a meta-analysis established that effective clinical benefits are to be found in the use of ALTENS/TENS for chronic back pain, at least in the short term. Conclusions and recommendations: This wide ranging PhD thesis demonstrates for the first time significant clinical benefits of TENS/ ALTENS for treating patients with chronic back pain and if implemented on a global basis, then considerable numbers of chronic back pain sufferers could benefit

Abstracts of the 6th International Academic Medical Congress of Maranhão (VI COIMAMA) 2019

Abstracts of the 6th International Academic Medical Congress of Maranhão (VI COIMAMA) 201

Development of translational models for intervertebral disc degeneration using a comparative approach for canine and human patients

Intervertebral discs (IVDs) are unique musculoskeletal tissues within functional spinal unit organs comprising the spinal column that distribute loads and allow complex movements for vertebrates. IVD degeneration has been closely associated with manifestations of symptomatic IVD disease (IVDD). IVDD spontaneously occurs in canine and human populations. As such, dogs can serve as highly relevant and ethical preclinical models for both human and canine IVDD. Chondrodystrophic (CD) and non-chondrodystrophic (NCD) breeds of dogs show different phenotypes of IVDD, each of which mimic phenotypes described for human patients. The main goal for this PhD research was to develop and validate canine models for human IVDD with a focus on distinguishing molecular characteristics of key disease phenotypes. Using biomarkers associated with inflammation and degradation, IVD health and disease were characterized for the two species. Taken together, this body of work suggests that CD and NCD dogs demonstrate distinctly different biomarker profiles in both health and disease that represent key human IVDD phenotypes such that they can be used as effective models for translational research towards clinical diagnosis, prevention, and treatment strategies for canine and human degenerative disc disorders.Includes bibliographical references