Evaluation of Silver Nanoparticle Toxicity in Skin in Vivo and Keratinocytes in Vitro

IntroductionProducts using the antimicrobial properties of silver nanoparticles (Ag-nps) may be found in health and consumer products that routinely contact skin.ObjectivesThis study was designed to assess the potential cytotoxicity of Ag-nps in human epidermal keratinocytes (HEKs) and their inflammatory and penetrating potential into porcine skin in vivo.Materials and MethodsWe used eight different Ag-nps in this study [unwashed/uncoated (20, 50, and 80 nm particle diameter), washed/uncoated (20, 50, and 80 nm), and carbon-coated (25 and 35 nm)]. Skin was dosed topically for 14 consecutive days. HEK viability was assessed by MTT, alamarBlue (aB), and CellTiter 96 AQueous One (96AQ). Release of the proinflammatory mediators interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor-α (TNF-α) were measured.ResultsThe effect of the unwashed Ag-nps on HEK viability after a 24-hr exposure indicated a significant dose-dependent decrease (p < 0.05) at 0.34 μg/mL with aB and 96AQ and at 1.7 μg/mL with MTT. However, both the washed Ag-nps and carbon-coated Ag-nps showed no significant decrease in viability at any concentration assessed by any of the three assays. For each of the unwashed Ag-nps, we noted a significant increase (p < 0.05) in IL-1β, IL-6, IL-8, and TNF-α concentrations. We observed localization of all Ag-nps in cytoplasmic vacuoles of HEKs. Macroscopic observations showed no gross irritation in porcine skin, whereas microscopic and ultrastructural observations showed areas of focal inflammation and localization of Ag-nps on the surface and in the upper stratum corneum layers of the skin.ConclusionThis study provides a better understanding Ag-nps safety in vitro as well as in vivo and a basis for occupational and risk assessment. Ag-nps are nontoxic when dosed in washed Ag-nps solutions or carbon coated

Managing the symptoms of neuropathic pain: An exploration of patients' experiences

The debilitating effects of chronic neuropathic pain on everyday life are considerable but little is known about how individual sufferers manage these effects. Virtually nothing is known about what patients prefer, what measures they take themselves, when, or in what combinations. The aim of this study was to explore patients’ reports of how they managed their neuropathic pain symptoms. Three focus groups including 10 participants were used to generate qualitative data on both individual and shared experiences of managing their symptoms of neuropathic pain. Discussions were recorded and transcribed verbatim. Data were analysed using thematic analysis, identifying categories and broader themes of importance to patients. The most common management strategy was the use of conventional medications, often associated with poor effectiveness and unpleasant side-effects. Complementary and alternative medicine was ineffective but many found resting or retreating helpful. They exhibited a repeated cycle of seeking help to manage the pain, with each unsuccessful attempt followed by new attempts. Some had tried to accept their pain, but there was insufficient psychological, social, emotional and practical support to allow them to do this successfully. This exploratory study provides a basis from which to develop a larger study to validate and extend the findings. Other issues meriting research are the effectiveness of cognitive behavioural therapies for those with neuropathic pain; and an exploration and subsequent evaluation of different types of social, practical and emotional support needed to help live with neuropathic pain

Complementary and alternative medicine use in families of children with cerebral palsy

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66295/1/j.1469-8749.2003.tb00414.x.pd

Complementary and alternative medicines (CAMs) and adherence to mental health medications

BACKGROUND: Medication regimes are often poorly adhered to, and the negative consequences of this are well recognised. The dynamics underlying non-adherence are less understood. This paper examines adherence to prescription medications for mental health difficulties in relation to the use of complementary and alternative medicines (CAMs). This was based on suggestions that within medical pluralism, CAMs may reduce adherence to conventional prescription medications for reasons such as their further complicating the medication regime or their being perceived as a substitute with less adverse side effects than conventional prescription medications. METHODS: Data used was from the National Comorbidity Study Replication (NCS-R), specifically those 1396 individuals who reported taking a prescription drug for mental health difficulties within the last 12 months and under the supervision of a health professional. This subsample was selected due to their being the only subgroup questioned regarding their medication adherence. Other demographic and health factors were also considered. RESULTS: The use of complementary medicines alongside the conventional medicines bore no significant relation to odds of reporting adherence versus non adherence. Ethnicity and medication count were significant predictors of adherence versus non-adherence. CONCLUSIONS: The above findings are discussed from the point of both promoting the use of CAMs and increasing health professionals’ understanding of the dynamics underlying adherence, or the lack thereof, and subsequently informing interventions to reduce the problems associated with this issue in terms of increased health care needs and reduced quality of life

Attitudes towards complementary and alternative medicine in chronic pain syndromes: a questionnaire-based comparison between primary headache and low back pain

<p>Abstract</p> <p>Background</p> <p>Complementary and Alternative Medicine (CAM) is widely used and popular among patients with primary headache or low back pain (LBP). Aim of the study was to analyze attitudes of headache and LBP patients towards the use of CAM.</p> <p>Methods</p> <p>Two questionnaire-based surveys were applied comparing 432 primary headache and 194 LBP patients.</p> <p>Results</p> <p>In total, 84.75% of all patients reported use of CAM; with significantly more LBP patients. The most frequently-used CAM therapies in headache were acupuncture (71.4%), massages (56.4%), and thermotherapy (29.2%), in LBP thermotherapy (77.4%), massages (62.7%), and acupuncture (51.4%). The most frequent attitudes towards CAM use in headache vs. LBP: "leave nothing undone" (62.5% vs. 52.1%; p = 0.006), "take action against the disease" (56.8% vs. 43.2%; p = 0.006). Nearly all patients with previous experience with CAM currently use CAM in both conditions (93.6% in headache; 100% in LBP). However, the majority of the patients had no previous experience.</p> <p>Conclusion</p> <p>Understanding motivations for CAM treatment is important, because attitudes derive from wishes for non-pharmacological treatment, to be more involved in treatment and avoid side effects. Despite higher age and more permanent pain in LBP, both groups show high use of CAM with only little specific difference in preferred methods and attitudes towards CAM use. This may reflect deficits and unfulfilled goals in conventional treatment. Maybe CAM can decrease the gap between patients' expectations about pain therapy and treatment reality, considering that both conditions are often chronic diseases, causing high burdens for daily life.</p

The BraveNet prospective observational study on integrative medicine treatment approaches for pain

BACKGROUND: Chronic pain affects nearly 116 million American adults at an estimated cost of up to $635 billion annually and is the No. 1 condition for which patients seek care at integrative medicine clinics. In our Study on Integrative Medicine Treatment Approaches for Pain (SIMTAP), we observed the impact of an integrative approach on chronic pain and a number of other related patient-reported outcome measures. METHODS: Our prospective, non-randomized, open-label observational evaluation was conducted over six months, at nine clinical sites. Participants received a non-standardized, personalized, multimodal approach to chronic pain. Validated instruments for pain (severity and interference levels), quality of life, mood, stress, sleep, fatigue, sense of control, overall well-being, and work productivity were completed at baseline and at six, 12, and 24 weeks. Blood was collected at baseline and week 12 for analysis of high-sensitivity C-reactive protein and 25-hydroxyvitamin D levels. Repeated-measures analysis was performed on data to assess change from baseline at 24 weeks. RESULTS: Of 409 participants initially enrolled, 252 completed all follow-up visits during the 6 month evaluation. Participants were predominantly white (81%) and female (73%), with a mean age of 49.1 years (15.44) and an average of 8.0 (9.26) years of chronic pain. At baseline, 52% of patients reported symptoms consistent with depression. At 24 weeks, significantly decreased pain severity (−23%) and interference (−28%) were seen. Significant improvements in mood, stress, quality of life, fatigue, sleep and well-being were also observed. Mean 25-hydroxyvitamin D levels increased from 33.4 (17.05) ng/mL at baseline to 39.6 (16.68) ng/mL at week 12. CONCLUSIONS: Among participants completing an integrative medicine program for chronic pain, significant improvements were seen in pain as well as other relevant patient-reported outcome measures. TRIAL REGISTRATION: ClinicalTrials.gov, NCT0118634

NIH-National Center for Complementary and Alternative Medicine- Comprehensive Strategic Plan and Budget to Reduce and Eliminate Health Disparities

CAM practices can be described as those not presently considered an integral part of conventional medicine. Recent national surveys document substantial and growing use of CAM in the United States, with most people using CAM in addition to, rather than instead of, conventional care. However, little is known about CAM use in racial and ethnic minority populations. To the degree that minority populations are using CAM as an alternative to, rather than complementing conventional care, increased integration of CAM modalities and systems with the conventional health care system may help overcome some of the barriers to use of conventional medical services for minority populations, potentially enhancing access for minority populations to proven therapies. NCCAM’s research additionally has the potential for contributing to the elimination of health disparities by supporting research into the health behaviors of racial and ethic minority populations, thereby supporting culturally competent health care. To this end, NCCAM’s activities and research initiatives will focus on identifying and understanding the gaps in knowledge regarding CAM use in minority populations. This plan is organized in priority order by area of emphasis, and within areas of emphasis by objective and by initiative. The areas of emphasis have been chosen to coincide with those in the NCCAM Five-Year Strategic Plan. Investing in Research is the primary area of emphasis, with initiatives addressing population based research on CAM use as well as research on disease-specific CAM approaches. The second area of emphasis, Training CAM Researchers, will target initiatives to diversify the CAM research community. Expanding Outreach is the third area of emphasis, highlighting the importance of developing effective communication with professional and lay communities in order to make the research findings relevant to minority populations