Reduced basal ganglia μ-opioid receptor availability in trigeminal neuropathic pain: A pilot study

Abstract Background Although neuroimaging techniques have provided insights into the function of brain regions involved in Trigeminal Neuropathic Pain (TNP) in humans, there is little understanding of the molecular mechanisms affected during the course of this disorder. Understanding these processes is crucial to determine the systems involved in the development and persistence of TNP. Findings In this study, we examined the regional μ-opioid receptor (μOR) availability in vivo (non-displaceable binding potential BPND) of TNP patients with positron emission tomography (PET) using the μOR selective radioligand [11C]carfentanil. Four TNP patients and eight gender and age-matched healthy controls were examined with PET. Patients with TNP showed reduced μOR BPND in the left nucleus accumbens (NAc), an area known to be involved in pain modulation and reward/aversive behaviors. In addition, the μOR BPND in the NAc was negatively correlated with the McGill sensory and total pain ratings in the TNP patients. Conclusions Our findings give preliminary evidence that the clinical pain in TNP patients can be related to alterations in the endogenous μ-opioid system, rather than only to the peripheral pathology. The decreased availability of μORs found in TNP patients, and its inverse relationship to clinical pain levels, provide insights into the central mechanisms related to this condition. The results also expand our understanding about the impact of chronic pain on the limbic system.http://deepblue.lib.umich.edu/bitstream/2027.42/112555/1/12990_2012_Article_533.pd

Bachelor i akupunktur

Innledning: I denne oppgaven ønsker vi å søke i litteraturen etter akupunkturens virkemekanismer, sett fra et vestlig medisinsk perspektiv, knyttet til behandling av smerter. Metode: Litteraturstudie, med fokus på forskning, ble brukt som metode for å løse denne oppgaven. For å finne fram til relevant og antatt pålitelig forskning ble databaser gjennom Helsebiblioteket brukt og det ble gjort avgrensede søk med spesifiserte inklusjons og eksklusjonskriterier. Resultat: Resultatene viser at det er gjort mye forskning de siste tiårene om de bakenforliggende mekanismene bak akupunktur og dens effekt på smertelindring sett i vestlig perspektiv. Oppgaven tar for seg noen av de mest sentrale funnene og dette innbefatter gate control theory, Diffuse Noxious Inhibitory Control (DNIC), adenosin og adenosinfosfat, opioider, serotonin og noradrenalin. Resultatene sier også noe om individuell effekt av behandling samt overordnet hva forskningen sier om hva som skjer i hjernen og i huden ved behandling med akupunktur. Konklusjon: Resultatene viser at en stor del av de biokjemiske endringer som skjer ved akupunkturbehandling kan kartlegges, men at forståelsen av de bakenforliggende mekanismene fortsatt er til dels uavklart

Combining Modern Pharmacology with Integrative Medicine: A Biopsychosocial Model for Comprehensive Pain Care

The medical community recognized last decennia the multidimensional nature of pain and proposed multimodal biopsychosocial management. The most compelling reason to embrace integrative pain strategies is to mitigate patient risk. For patients with chronic pain and pain refractory to conservative medicine, it is essential to assess all factors involved with the chronicity. With significant themes, nutrition and microbiome, neuroplasticity, homeostasis, and the side effects of medication, acupuncture has progressively gained a place in this multimodal evaluation. Therapeutic multimodality approaches the perspective of physiological rehabilitation and chronobiological improvement of the quality of life. Illustrated by various clinical situations, the objective of management is to seek a synergy in the mechanisms of action of treatments to improve quality of life and reduce the need for xenobiotics and, consequently, the side effects. The mechanism of action of integrative medicine, and acupuncture improved with a better understanding of genetics, and epigenetics. As opposed to sham and placebo, acupuncture activates other brain regions. In controlled trials, the strict inclusion and exclusion criteria result in the treatment of a “selected” patient population, which is not always comparable to the patients seen in daily practice. The integrative approach is better illustrated by case reports

Fisiología de la acupuntura. Revisión narrativa.

Antecedentes: la acupuntura es la técnica más representativa de la medicina tradicional china y se encuentra envuelta en cierta controversia debido a sus concepciones filosóficas y espirituales y a sus afianzadas raíces orientales. Si bien escasa, algunas evidencias experimentales parecen apoyar su aplicación clínica y efectividad en el tratamiento del dolor. Numerosos estudios han relacionado los mecanismos de acción de dicha técnica con los relativos al sistema nervioso con el objetivo de arrojar algo de luz al porqué de su efectividad clínica. Se han propuesto mecanismos a nivel periférico, central y un imprescindible rol de los efectos placebo. No obstante y, a día de hoy, no se ha encontrado un consenso entre las diferentes teorías propuestas. Objetivos: establecer una relación entre las diferentes hipótesis y teorías más contrastadas y relevantes a partir de la recolección de información sobre investigación básica de los mecanismos fisiológicos de acción de la acupuntura. Material y Métodos: se realizó una búsqueda en la base de datos PubMed entre los meses de Noviembre de 2013 y Abril de 2014. Tras la aplicación de criterios de inclusión y de exclusión, se analizó el nivel de evidencia de los artículos a partir del factor de impacto de las revistas en las que fueron publicados. Resultados: la acupuntura parece guardar relación con mecanismos específicos y no específicos, periféricos y centrales a nivel del sistema nervioso. Conclusiones: la acupuntura actúa a través de la liberación de cascadas inflamatorias, la activación de nociceptores, fibras Aδ y C, mecanismos inhibitorios descendentes y áreas y redes supraespinales. La liberación de diferentes transmisores y la implicación de mecanismos no específicos como los efectos placebo son esenciales en los mecanismos de acción de la acupuntura.Background: acupuncture is the more representative technique in the traditional Chinese medicine and it is often involved in controversy due to its philosophical and spiritual conceptions and its braced oriental roots. However, its clinical implementation and efficacy in the pain treatment have been proved partially. Several studies have related the action mechanism of acupuncture with the ones related to the nervous system in order to clarify the reason of its clinical effectiveness. Peripheral and central mechanisms have been proposed to answer this question, as well as the essential role of the placebo effects. Nevertheless, no consensus among the theories proposed has been reached to answer the conundrum that the efficacy of acupuncture supposes. Aims: to establish a relation between the hypotheses and the more relevant and corroborated theories from a physiological information compilation about the action mechanisms of acupuncture. Resources and Methodology: the information research was done in the database PubMed from November 2013 to April 2014. After employing the criteria of inclusion and exclusion, the article’s level of evidence was analyzed as of the impact factor of the journals where they were included. Results: acupuncture seems to be connected to the specific, non-specific, peripheral and central mechanisms in the nervous system. Conclusions: acupuncture acts through releasing inflammatory substances, activating nociceptors, Aδ and C fibers, descending antinociceptive pathways and supraespinal areas and networks. The liberation of different transmitters and the involvement of non-specific mechanisms - as the placebo effects- are essential in the action mechanisms of acupuncture.Grado en Fisioterapi

Fisiología de la acupuntura. Revisión narrativa.

Antecedentes: la acupuntura es la técnica más representativa de la medicina tradicional china y se encuentra envuelta en cierta controversia debido a sus concepciones filosóficas y espirituales y a sus afianzadas raíces orientales. Si bien escasa, algunas evidencias experimentales parecen apoyar su aplicación clínica y efectividad en el tratamiento del dolor. Numerosos estudios han relacionado los mecanismos de acción de dicha técnica con los relativos al sistema nervioso con el objetivo de arrojar algo de luz al porqué de su efectividad clínica. Se han propuesto mecanismos a nivel periférico, central y un imprescindible rol de los efectos placebo. No obstante y, a día de hoy, no se ha encontrado un consenso entre las diferentes teorías propuestas. Objetivos: establecer una relación entre las diferentes hipótesis y teorías más contrastadas y relevantes a partir de la recolección de información sobre investigación básica de los mecanismos fisiológicos de acción de la acupuntura. Material y Métodos: se realizó una búsqueda en la base de datos PubMed entre los meses de Noviembre de 2013 y Abril de 2014. Tras la aplicación de criterios de inclusión y de exclusión, se analizó el nivel de evidencia de los artículos a partir del factor de impacto de las revistas en las que fueron publicados. Resultados: la acupuntura parece guardar relación con mecanismos específicos y no específicos, periféricos y centrales a nivel del sistema nervioso. Conclusiones: la acupuntura actúa a través de la liberación de cascadas inflamatorias, la activación de nociceptores, fibras Aδ y C, mecanismos inhibitorios descendentes y áreas y redes supraespinales. La liberación de diferentes transmisores y la implicación de mecanismos no específicos como los efectos placebo son esenciales en los mecanismos de acción de la acupuntura.Background: acupuncture is the more representative technique in the traditional Chinese medicine and it is often involved in controversy due to its philosophical and spiritual conceptions and its braced oriental roots. However, its clinical implementation and efficacy in the pain treatment have been proved partially. Several studies have related the action mechanism of acupuncture with the ones related to the nervous system in order to clarify the reason of its clinical effectiveness. Peripheral and central mechanisms have been proposed to answer this question, as well as the essential role of the placebo effects. Nevertheless, no consensus among the theories proposed has been reached to answer the conundrum that the efficacy of acupuncture supposes. Aims: to establish a relation between the hypotheses and the more relevant and corroborated theories from a physiological information compilation about the action mechanisms of acupuncture. Resources and Methodology: the information research was done in the database PubMed from November 2013 to April 2014. After employing the criteria of inclusion and exclusion, the article’s level of evidence was analyzed as of the impact factor of the journals where they were included. Results: acupuncture seems to be connected to the specific, non-specific, peripheral and central mechanisms in the nervous system. Conclusions: acupuncture acts through releasing inflammatory substances, activating nociceptors, Aδ and C fibers, descending antinociceptive pathways and supraespinal areas and networks. The liberation of different transmitters and the involvement of non-specific mechanisms - as the placebo effects- are essential in the action mechanisms of acupuncture.Grado en Fisioterapi

Acupuncture effects on pain and health status in women with fibromyalgia: a randomized clinical trial

This study aims to evaluate the effects of acupuncture on pain and health status in women with fibromyalgia. The present randomized, controlled, double-blind clinical trialwas carried out with one sample of 40 women diagnosed with fibromyalgia .They were randomized into one acupuncture group (n = 20; 51.7 ± 6.5 years old) and one sham acupuncture group (n = 20; 49.7 ± 7.2 years old). Acupuncture (points: pericardium 6, heart 7, large intestine 4, stomach 36, spleen-pancreas 6, and liver 2, variable depth with Deqi stimulation) and sham acupuncture (15mm lateral to the acupoint, outside the meridian line) were performed for 30min., once a week, and with a four-week follow-up. Pain (Visual Analogue Scale), algometry (lateral epicondyle, trapezius, suboccipital, 2nd rib), and health status (Fibromyalgia Impact Questionnaire) was assessed before the first and after the last intervention. Data were analyzed by the intention-to-treat.Acupuncture reduced pain by 16% (p<0.001) and improved health status by 21% (p<0.001). The improvement in health status (p<0.001) is due to the increased ability to work and go out, and reduced pain, fatigue, tiredness, and depression. Acupuncture reduced pain and improved health statusin women with fibromyalgia

USO DA ACUPUNTURA NA DOR

A acupuntura compreende a inter-relação do homem com o ambiente, através da teoria dos cinco elementos e das energias yin e yang. Seu objetivo é compreender os fatores que ocasionaram ao indivíduo o seu desequilíbrio energético e tentar restabelece-lo. A utilização da acupuntura no tratamento da dor ocorre através do estímulo no corpo causado pelas agulhas, fazendo que as substâncias responsáveis pela sensação de bem-estar, como endorfina e serotonina sejam liberadas, restabelendo o equilíbrio e o funcionamento do corpo. A procura do alívio das dores é uma das razões para o crescente número de pesquisas sobre a acupuntura. O presente estudo teve como objetivo reunir os dados existentes na literatura para compreender e demonstrar a utilização da acupuntura no tratamento da dor. Para isso, realizou-se uma revisão bibliográfica utilizando dados obtidos a partir da literatura disponível no PubMed, ScienceDirect e Google Acadêmico. Uma tabela foi elaborada utilizando 35 artigos publicados entre o período de 1998 a 2016, os quais demonstraram o efeito da acupuntura na dor. Concluiu-se que não há uma padronização no tratamento da acupuntura para dor, porém a mesma demonstrou-se eficaz na redução da dor e na melhora da qualidade de vida das pessoas.

An overview of systematic reviews of complementary and alternative therapies for fibromyalgia using both AMSTAR and ROBIS as quality assessment tools

Abstract Background Fibromyalgia (FM) is a chronic, debilitating pain disorder. Dissatisfaction with conventional medicine can lead people with FM to turn to complementary and alternative medicine (CAM). Two previous overviews of systematic reviews of CAM for FM have been published, but they did not assessed for risk of bias in the review process. Methods Five databases Medline, Embase, AMED (via OVID), Web of Science and Central were searched from their inception to December 2015. Reference lists were hand-searched. We had two aims: the first was to provide an up-to-date and rigorously conducted synthesis of systematic reviews of CAM literature on FM; the second was to evaluate the quality of the available systematic review evidence using two different tools: AMSTAR (Shea et al. BMC Med Res Methodol 15; 7:10, 2007) and a more recently developed tool ROBIS (Whiting et al. J Clin Epidemiol 69:225-34, 2016) specifically designed to assess risk of bias in systematic reviews. Any review that assessed one of eight CAM therapies for participants diagnosed with FM was considered. The individual studies had to be randomised controlled trials where the intervention was compared to placebo, treatment as usual or waitlist controls to be included. The primary outcome measure was pain, and the secondary outcome measure was adverse events. Results We identified 15 reviews that met inclusion criteria. There was low-quality evidence that acupuncture improves pain compared to no treatment or standard treatment, but good evidence that it is no better than sham acupuncture. The evidence for homoeopathy, spinal manipulation and herbal medicine was limited. Conclusions Overall, five reviews scored 6 or above using the AMSTAR scale and the inter-rater agreement was good (83.6%), whereas seven reviews achieved a low risk of bias rating using ROBIS and the inter-rater agreement was fair (60.0%). No firm conclusions were drawn for efficacy of either spinal manipulation or homoeopathy for FM. There is limited evidence for topical Capsicum, but further research is required. There is some evidence to support the effectiveness of acupuncture for FM, but further high-quality trials are needed to investigate its benefits, harms and mechanisms of action, compared with no or standard treatment. Systematic review registration PROSPERO CRD42016035846

Role of brain imaging in disorders of brain-gut interaction: a Rome Working Team Report.

Imaging of the living human brain is a powerful tool to probe the interactions between brain, gut and microbiome in health and in disorders of brain-gut interactions, in particular IBS. While altered signals from the viscera contribute to clinical symptoms, the brain integrates these interoceptive signals with emotional, cognitive and memory related inputs in a non-linear fashion to produce symptoms. Tremendous progress has occurred in the development of new imaging techniques that look at structural, functional and metabolic properties of brain regions and networks. Standardisation in image acquisition and advances in computational approaches has made it possible to study large data sets of imaging studies, identify network properties and integrate them with non-imaging data. These approaches are beginning to generate brain signatures in IBS that share some features with those obtained in other often overlapping chronic pain disorders such as urological pelvic pain syndromes and vulvodynia, suggesting shared mechanisms. Despite this progress, the identification of preclinical vulnerability factors and outcome predictors has been slow. To overcome current obstacles, the creation of consortia and the generation of standardised multisite repositories for brain imaging and metadata from multisite studies are required

Complementary and Integrative Health Services in a Low-resource Community: a Retrospective Examination

ABSTRACT COMPLEMENTARY AND INTEGRATIVE HEALTH SERVICES IN A LOW-RESOURCE COMMUNITY: A RETROSPECTIVE EXAMINATION by Barbara M. Wesson The University of Wisconsin – Milwaukee, 2017 Under the Supervision of Professor Ron Cisler Study Background and Significance: Complementary and Integrative Health (CIH) continues to be widely utilized despite a lack of consensus regarding its efficacy. Since 2001, CORE El Centro (CEC) has been providing acupuncture, massage, reiki, and mindful movement classes, charging sliding scale fees in a low-resource, primarily Latino community; underrepresented in the CIH literature. Purpose: This study examined the association between CIH use (time and treatment), subjective well-being assessments, biometrics records, as well as the association of reduced fees on service utilization in a low-resource community. Methods: CEC provided information from 1278 de-identified client records spanning 24-months. Within those records, 622 clients had received four or more treatments. Data preparation included reduction of 29 dependent variables (the subjective well-being questions) into four Health Factors (cognitive, emotional, physical, and medical). Additional dependent variables included total number of health conditions reported and a General Health response. Independent variables included length of engagement and types and frequencies of services used. Associations were examined between level of payment for services, utilization, and health conditions. Spaghetti and scatter plots were used to explore trends of change across time. Paired sample tests assessed significant change between assessments. Results: General Health, Total Health Conditions, and three Health Factor scores improved over time. Biometric health status indicators did not change significantly, but were with normal range at the first recording. Clients receiving four or more treatments averaged 12 treatments over eight months. A significant inverse association existed between payment level and Health Conditions. Clients in the low payment level group that reported more Health Conditions used more services and clients in the highest payment level group that reported fewer Health Conditions used more services. Conclusion: The cost of CIH may be one of the primary barriers to utilization, because when fees for service are scaled to income a low-resource community will use CIH. The Latino community demonstrated they will use CIH. Increased use by individuals with chronic conditions was supported. Subjective health and well-being improved. This study supports the rich history of research asserting the complexity in the study of CIH in a community-based center. Future Directions: There is a need to create community based research to further understand CIH as well as the socioeconomic and cultural influence inherent in CIH utilization. The next step is to create deeper partnerships between Universities and health care systems toward developing systems for tracking, monitoring, and analysis that are effective for both research and practitioners of CIH