Complementary and Alternative Pain Therapy in the Emergency Department

Complementary and Alternative Medicines in Oral Health Care: An Integrative Review

Complementary and alternative medicine (CAM) uses a holistic approach that finds natural solutions that help the immune system to fight off infection and diseases. In conventional medicine, the diseases are treated as a series of symptoms developed and not its actual cause or etiology, but CAM commonly targets the exact cause of the disorder thereby stimulating the body's healing process. This is based on an integrative literature review of methods and techniques used as complementary and alternative approaches for oral health care. A comprehensive electronic database search was conducted in PubMed, CINAHL, MEDLINE, EMBASE, Google, Google Scholar, and SCOPUS. Medicinal plants such as Medicago Sativa, Aloe Barbadensis Miller (Aloe Vera), and Trifolium Pratense (Red Clover) have excellent applications in treating gum disorders, prevent tooth decay, and have demonstrated good antifungal activity in the oral cavity. Homeopathic medicines such as Belladonna, Antimonium crudum, and Chamomilla have useful applications in relieving toothache. In Chinese medicine, various acupressure points (Acupuncture) have been used to relieve pain related to tooth, head-and-neck region, sinusitis, etc. Dental professionals can utilize these treatment modalities in their practice along with other conventional procedures as an integrative treatment approach to achieve better outcomes.

Is hypnosis a valid alternative to spontaneous breathing general anesthesia for claustrophobic patients undergoing MR exams? A preliminary retrospective study

Background

The purpose of our retrospective study was to assess the termination rate and the image quality of MR exams performed in claustrophobic patients under medical hypnosis, as compared to patients undergoing MR under spontaneous breathing general anesthesia.

Methods

Our study was approved by the ethics committee. The “hypnosis group” included consecutive patients that had previously interrupted an MR exam because of claustrophobia. The “control group” included patients undergoing MR under pharmacologic sedation. Two experienced radiologists assessed, randomly, independently and blinded the image quality of the two groups using a symmetrical Likert scale: 0 = non-diagnostic images; 1 = bad image quality; 2 = fair image quality; 3 = good image quality; 4 = very good image quality. Descriptive statistics was performed.

Results

Eighty patients were included, equally distributed between the two groups. Every patient was able to complete the MR exam. Ratings 3 and 4 represented the majority of ratings. Both readers rated the MR exams with score 3 or 4 in 66.25% (53/80) of MR exams. Only 5% (4/80) of MR exams were rated below score 2. The majority of the MR exams showed good or very good image quality. No significant difference was found in image quality between the two (p = 0.06) groups. The agreement between the two readers according to the k score was 0.105.

Conclusions

Medical hypnosis is a valid alternative to spontaneous breathing general anesthesia in patients unable to undergo MR due to claustrophobia, allowing good quality images.

Beneficial Effects of Guided Imagery or Clinical Massage on the Status of Patients in a Progressive Care Unit

BACKGROUND

Patients in the progressive care unit typically experience high levels of pain and anxiety and exhibit difficulty sleeping.

OBJECTIVE

To determine whether either clinical massage or guided imagery could reduce pain and anxiety and improve sleep.

METHODS

This study included 288 inpatients on 2 floors of a progressive care unit. On 1 floor, each patient was offered daily a 15-minute complimentary clinical massage, whereas the patients on the other floor were provided access to a 30-minute guided-imagery recording. Patients were asked to rate their pain and anxiety levels immediately before and after the massage intervention or were asked whether the guided-imagery intervention was helpful for pain, anxiety, or insomnia.

RESULTS

The massage intervention showed an immediate and significant reduction in self-reported pain and anxiety (P < .001); likewise, a significant number of patients self-reported that guided imagery helped alleviate pain, anxiety, and insomnia (P < .001).

CONCLUSION

The results of this study indicate that clinical massage and guided imagery can benefit patients in the progressive care unit.

Use of non-pharmacological interventions for comforting patients in palliative care: a scoping review

BACKGROUND

Palliative care aims to provide the maximum possible comfort to people with advanced and incurable diseases. The use of non-pharmacological interventions to promote comfort in palliative care settings has been increasing.However, information on implemented and evaluated interventions, their characteristics, contexts of application, and population is scattered in the literature, hampering the formulation of accurate questions on the effectiveness of those interventions and, consequently, the development of a systematic review.

OBJECTIVE

The objective of this scoping review is to examine and map the non-pharmacological interventions implemented and evaluated to provide comfort in palliative care.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

This scoping review considered all studies that focused on patients with advanced and incurable diseases, aged 18 years or older, assisted by palliative care teams.

CONCEPT

This scoping review considered all studies that addressed non-pharmacological interventions implemented and evaluated to provide comfort for patients with advanced and incurable diseases.It considered non-pharmacological interventions implemented to provide not only comfort but also well-being, and relief of pain, suffering, anxiety, depression, stress and fatigue which are comfort-related concepts.

CONTEXT

This scoping review considered all non-pharmacological interventions implemented and evaluated in the context of palliative care. This included home care, hospices or palliative care units (PCUs).

TYPES OF SOURCES

This scoping review considered quantitative and qualitative studies, and systematic reviews.

SEARCH STRATEGY

A three-step search strategy was undertaken: 1) an initial limited search of CINAHL and MEDLINE; 2) an extensive search using all identified keywords and index terms across all included databases; and 3) a hand search of the reference lists of included articles.This review was limited to studies published in English, Spanish and Portuguese in any year.

EXTRACTION OF RESULTS

A data extraction instrument was developed. Two reviewers extracted data independently. Any disagreements that arose between the reviewers were resolved through discussion, or with a third reviewer. When necessary, primary authors were contacted for further information/clarification of data.

PRESENTATION OF RESULTS

Eighteen studies were included covering 10 non-pharmacological interventions implemented and evaluated to provide comfort. The interventions included one to 14 sessions. The interventions lasted between five and 60 minutes. Most of the interventions were implemented in PCUs and hospice settings. Ten of the 18 interventions were implemented and evaluated exclusively in cancer patients.

CONCLUSIONS

Ten non-pharmacological interventions were identified, of which the most common were music therapy and massage therapy. Their characteristics differed significantly across interventions and even in the same intervention. They were mostly implemented in palliative care units and hospices, and in patients with a cancer diagnosis. These data raise questions for future primary studies and systematic reviews.

IMPLICATIONS FOR RESEARCH

Future research should focus on the implementation of interventions not only with cancer patients but also with non-cancer patients and patients receiving palliative care at home. Systematic reviews on the effect of massage therapy and music therapy should be conducted.

Self-reported pain relief interventions of patients before emergency department arrival

INTRODUCTION

Pain is the most common reason for visiting the Emergency Department (ED), and pain management is an important aspect of emergency care. Pain management might begin before emergency department arrival, by a patient's self-administered medications or alternative therapies.

AIM

This study aimed to determine Turkish patients' self-reported pain relief interventions before ED arrival.

METHODS

A prospective questionnaire survey was used for the study. A total of 150 adult ED patients from a teaching hospital ED in a two month period constituted the sample of the study.

RESULTS

Of the patients surveyed, 62.7% had used medication and/or alternative therapies. Medication use was 30.1%, alternative therapy use was 21.3%, and use of both medication and alternative therapies before ED arrival was 11.3%.

CONCLUSION

The rate of self-administered intervention for pain relief before ED arrival was high. ED nurses have to take these interventions into account while performing pain assessment. The information may help to achieve better pain management in the ED.

The potential contributions of traditional Chinese medicine to emergency medicine

BACKGROUND:

Despite the fact that traditional Chinese medicine (TCM) has been developed and used to treat acute and urgent illness for many thousands of years. TCM has been widely perceived in western societies that TCM may only be effective to treat chronic diseases. The aim of this article is to provide some scientific evidence regarding the application of TCM in emergency medicine and its future potential.

METHODS:

Multiple databases (PubMed, ProQuest, Academic Search Elite and Science Direct) were searched using the terms: Traditional Chinese Medicine/ Chinese Medicine, Emergency Medicine, China. In addition, three leading TCM Journals in China were searched via Oriprobe Information Services for relevant articles (published from 1990—2012). Particular attention was paid to those articles that are related to TCM treatments or combined medicine in dealing with intensive and critical care.

RESULTS:

TCM is a systematic traditional macro medicine. The clinical practice of TCM is guided by the TCM theoretical framework – a methodology founded thousands of years ago. As the methodologies between TCM and Biomedicine are significantly different, it provides an opportunity to combine two medicines, in order to achieve clinical efficacy. Nowadays, combined medicine has become a common clinical model particular in TCM hospitals in China.

CONCLUSIONS:

It is evident that TCM can provide some assistance in emergency although to combine them in practice is still its infant form and is mainly at TCM hospitals in China. The future effort could be put into TCM research, both in laboratories and clinics, with high quality designs, so that TCM could be better understood and then applied in emergency medicine.

Are the Current Complementary and Alternative Therapies Available for the Treatment of Low Back Pain and Chronic Fatigue Syndrome Reliable Clinically? A Review of the Literature

Low back pain and chronic fatigue syndrome are major work-related disablers affecting millions around the globe today. This article assesses the clinical reliability of complementary and alternative therapies in the treatment of low back pain and chronic fatigue syndrome using the existing accessible literature. Multiple bibliographic databases that include medical, general health care, and natural medicine literature were searched for relevant terms and conclusions. The authors examined all abstracts obtained through the search and reviewed the full text of the relevant articles along with the additional supporting articles that resulted from the search. It is observed from the literature that most of the complementary and alternative treatments available today are clinically reliable for the treatment of low back pain, as significantly evidenced. However, not many studies support the clinical reliability of the use of complementary and alternative therapies in the treatment of chronic fatigue syndrome.

Development of a novel rating system to assess lower-limb comfort

BACKGROUND

Comfort evaluation techniques are commonplace in medicine. However, measures of lower-limb comfort are infrequently used in the sporting environment. The purpose of this study was to develop an instrument for measuring lower-limb comfort, which will extend previous work in the field of injury awareness.

METHODS

A lower-limb comfort index (LLCI) was developed for use in the environment of elite sport. Forty professional footballers participated in development of the index. The study had three components. A critical appraisal of the literature established the need for an LLCI. The second phase involved 20 professional footballers establishing and testing the components of the comfort index as an instrument for measuring comfort.

RESULTS

Nonparametric statistics (the McNemar test) in phase 2 indicated that the LLCI demonstrated good responsiveness to suitability (P = .019) and ease of use (P < .01). After a high level of agreement for responses, the third stage required 20 players to pilot test the reliability of the LLCI in a controlled environment. Repeated measures of difference between two periods for sum comfort (intraclass correlation coefficient = 0.99) and individual anatomical segments (κ = 0.72-1) provided confidence that the comfort index was reliable.

CONCLUSIONS

The LLCI showed good trait construct to provide confidence to conduct a future study to investigate interrater consistency in a wider cohort of professional footballers under different conditions, such as match-day and training-week environments.

Pain management in the emergency department and its relationship to patient satisfaction

Background:

Pain is the most common reason due to which patients come to the emergency department (ED).

Aim:

The purpose of this study was to measure the correlation, if any, between pain reduction and the level of satisfaction in patients who presented to the ED with pain as their chief complaint.

Materials and Methods:

This study used a randomly selected group of patients who presented to the ED with pain of 4 or more on the Visual Analogue Pain Scale (VAS) as their chief complaint to a level one adult and pediatric trauma center. Instruments that were used in this study were the VAS, Brief Pain Inventory (BPI), and the Medical Interview Satisfaction Scale (MISS). They were administered to patients by research fellows in the treatment rooms. Statistical analysis included frequencies, descriptive, and linear regression. This study was approved by the Internal Review Board.

Results:

A total of 159 patients were enrolled in the study. All patients were given some type of treatment for their pain upon arrival to the ED. A logistic regression showed a significant relationship to reduction in pain by 40% or more and customer service questions.

Conclusions:

A reduction in perceived pain levels does directly relate to several indicators of customer service. Patients who experienced pain relief during their stay in the ED had significant increases in distress relief, rapport with their doctor, and intent to comply with given instructions.

Yoga and disc degenerative disease in cervical and lumbar spine: an MR imaging-based case control study

The objective of the current study was to find out whether yoga practice was beneficial to the spine by comparing degenerative disc disease in the spines of long-time yoga practitioners and non-yoga practicing controls, using an objective measurement tool, magnetic resonance imaging. This matched case-control study comprised 18 yoga instructors with teaching experience of more than 10 years and 18 non-yoga practicing asymptomatic individuals randomly selected from a health checkup database. A validated grading scale was used to grade the condition of cervical and lumbar discs seen in magnetic resonance imaging of the spine, and the resulting data analyzed statistically. The mean number of years of yoga practice for the yoga group was 12.9 ± 7.5. The overall (cervical + lumbar) disc scores of the yoga group were significantly lower (indicating less degenerative disc disease) than those of the control group (P < 0.001). The scores for the cervical vertebral discs of the yoga group were also significantly lower than those of the control group (P < 0.001), while the lower scores for the yoga group in the lumbar group approached, but did not reach, statistical significance (P = 0.055). The scores for individual discs of yoga practitioners showed significantly less degenerative disease at three disc levels, C3/C4, L2/L3 and L3/L4 (P < 0.05). Magnetic resonance imaging showed that the group of long-term practitioners of yoga studied had significantly less degenerative disc disease than a matched control group.

Traditional medicine in oman: its role in ophthalmology

Aim:

To present three patients with ocular disease who developed a range of complications following use of traditional medications.

Settings and Design:

Case series

Methods:

Three patients who were examined in the Ophthalmic department of a tertiary care teaching hospital in the Sultanate of Oman between 2003 and 2004, seeking care following use of traditional medicines and or healing practices for various ophthalmic problems described below.

Results:

The first patient was a computer professional with a chalazion; the patient used a plant extract from ‘Calotropis procera’ as a part of the treatment. He developed corneal edema with decrease in vision in his left eye following application of the plant extract. Treatment with topical steroids and antibiotics resulted in a complete clinical and visual recovery. The second patient developed a fungal corneal ulcer (dermatophyte - Trichophyton mentagrophyte) after sustaining injury with an animal tail to the right eye and used honey for pain relief prior to presentation. She responded poorly to anti-fungal treatment, underwent a penetrating keratoplasty with recurrence of infection in the graft that resulted in a vascularized corneal scar. The third patient was a five-year-old child who was treated with ‘wasam’ on the occiput for intraocular inflammation following bilateral uncomplicated cataract extraction. Following this treatment the topical steroid was discontinued. The ‘Wasam’ treatment indirectly resulted in exacerbation of the intraocular inflammation and secondary glaucoma and poor vision as well as ‘Wasam ulcers’ on the occiput. Despite treatment of the intraocular inflammation, the visual outcome was poor.

Conclusion:

Traditional medicine in Oman is sought by many for variable reasons. Lack of evidence-based scientific data on its safety or efficacy does not deter the Omanis from flocking the traditional healers. However, when applied in the treatment of ocular diseases, traditional medicine and healing practices seem to cause more harm than benefit for the patient.

The effects of deep breathing training on pain management in the emergency department

PURPOSE

The purpose of this study was to measure the impact of deep breathing exercises on the pain levels in patients who presented to the emergency department (ED) with pain as their chief complaint. A secondary purpose was to measure the impact of deep breathing teaching on indicators of patient satisfaction.

METHODS

This was an observational study of patients who presented to the ED with pain as their chief complaint to an urban level one Emergency Department. Patients were randomized into a control group and an experimental group. The control group received the usual treatment for pain. The experimental group received the usual treatment for pain, but also received deep breathing exercises. For the measurement of pain prior to treatment, the brief pain inventory (BPI) was used. The visual analogy system (VAS) was used to measure pain prior to and after treatment and deep breathing were administered. For the measurement of patient satisfaction, the medical interview satisfaction scale (MISS) was used.

RESULTS

There was no significant difference between those who received the deep breathing education and those that did not with regards to postmedication pain levels. There was however, a significant difference in customer service satisfaction within the area of doctor/patient rapport and intention to follow treatment.

CONCLUSION

The usefulness of deep breathing exercises was shown to be ineffective in reducing pain levels; however, the majority of those who received deep breathing education felt it was useful. The exercise was effective in increasing patient's feelings of rapport and intentions to follow their doctor's directives.

Gosha-jinki-gan reduces transmitter proteins and sensory receptors associated with C fiber activation induced by acetic acid in rat urinary bladder

AIM

We determined if Gosha-jinki-gan, a traditional Chinese herbal mixture, reduced the presence of the tachykinins neurokinin A, neurokinin B, and substance P, as well as the transient receptor potential vanilloid 1 (TRPV1) and P2X3 purine receptors that are functionally associated with C fibers in the urinary bladder.

METHODS

Thirty-six female rats were fed with either a standard diet or one supplemented with 1.08% Gosha-jinki-gan. After 4 weeks, the urinary bladders were instilled with either saline or 0.1% acetic acid. After 30 min, the bladders were removed and expression of the tachykinins and the TRPV1 and P2X3 receptors was determined by immunohistochemistry and mRNA expression.

RESULTS

In rats fed with the standard diet, the tachykinins and the TRPV1 and P2X3 receptors expressed nearby or within urothelium of the acetic acid-treated rats increased compared with the saline-instilled rats. In rats pretreated with Gosha-jinki-gan, the tachykinins and the TRPV1 and P2X3 receptors in the acetic acid-treated rats also increased compared with the saline-instilled rats. However, with the instillation of acetic acid, the tachykinins and the TRPV1 and P2X3 receptors of Gosha-jinki-gan pretreated rats decreased compared with standard diet fed rats. The mRNA expression levels of neurokinin A, substance P, and the TRPV1 receptor in acetic acid-treated Gosha-jinki-gan pretreated rats were lower than that in acetic acid-treated standard diet fed rats. Gosha-jinki-gan did not destroy nerve fibers within the bladders.

CONCLUSIONS

Gosha-jinki-gan partially reduced the tachykinins and TRPV1 and P2X3 purine receptors without destroying the nerve fibers.

Pain management in patients with chronic kidney disease

Pain has been reported to be a common problem in the general population and end-stage renal disease (ESRD) patients. Although similar data for pre-ESRD patients are lacking, we recently reported that the prevalence of pain is also very high (>70%) among pre-ESRD patients at a Los Angeles County tertiary referral centre. The high prevalence of pain in the CKD population is particularly concerning because pain has been shown to be associated with poor quality of life. Of greater concern, poor quality of life, at least in dialysis patients, has been shown to be associated with poor survival. We herein discuss the pathophysiology of common pain conditions, review a commonly accepted approach to the management of pain in the general population, and discuss analgesic-induced renal complications and therapeutic issues specific for patients with reduced renal function.

The effectiveness of wet-cupping for nonspecific low back pain in Iran: a randomized controlled trial

OBJECTIVES

To determine the efficacy of wet-cupping for treating persistent nonspecific low back pain.

BACKGROUND

Wet-cupping therapy is one of the oldest known medical techniques. It is still used in several contemporary societies. Very minimal empirical study has been conducted on its efficacy.

DESIGN

Randomized controlled trial with two parallel groups. Patients in the experimental group were offered the option of referral to the wet-cupping service; all accepted that option. The control group received usual care.

SETTING

Medical clinic in Kermanshah, Iran.

PARTICIPANTS

In total, 98 patients aged 17-68 years with nonspecific low back pain; 48 were randomly assigned to experimental group and 50 to the control group.

INTERVENTION

Patients in the experimental group were prescribed a series of three staged wet-cupping treatments, placed at 3 days intervals (i.e., 0, 3, and 6 days). Patients in the control group received usual care from their general practitioner.

MAIN OUTCOME MEASURES

Three outcomes assessed at baseline and again 3 months following intervention: the McGill Present Pain Index, Oswestry Pain Disability Index, and the Medication Quantification Scale.

RESULTS

Wet-cupping care was associated with clinically significant improvement at 3-month follow-up. The experimental group who received wet-cupping care had significantly lower levels of pain intensity ([95% confidence interval (CI) 1.72-2.60] mean difference=2.17, p<0.01), pain-related disability (95% CI=11.18-18.82, means difference=14.99, p<0.01), and medication use (95% CI=3.60-9.50, mean difference=6.55, p<0.01) than the control group. The differences in all three measures were maintained after controlling for age, gender, and duration of lower back pain in regression models (p<0.01).

CONCLUSIONS

Traditional wet-cupping care delivered in a primary care setting was safe and acceptable to patients with nonspecific low back pain. Wet-cupping care was significantly more effective in reducing bodily pain than usual care at 3-month follow-up.

Policy for therapeutic massage in an academic health center: a model for standard policy development

CONTEXT

Massage is the most common complementary and alternative medicine (CAM) therapy used in hospitals in the United States. As such, it is often the first CAM therapy to be integrated with conventional medicine. However, few academic medical centers have a written standard policy to guide this integration. This lack of standard policy may impede institutions from offering massage therapy as a clinical service, and may put health care professionals and institutions at risk through a failure to clearly address criteria for practice credentials or malpractice liability.

OBJECTIVE

To create a clinical policy for therapeutic massage that may be used as a template for development of policy in academic health centers.

RESULTS

We present a clinical policy for therapeutic massage, developed by the University of Michigan Health System, that defines therapeutic massage, provides guidelines for the credentialing and professional conduct of massage therapists, lists indications and contraindications for therapeutic massage, and addresses malpractice in accordance with the specific culture and needs of academic health centers. This policy was created by health care professionals after review of existing evidence and consideration of national criteria for massage therapy. This policy is intended to be used as a template for the development of a standard policy for therapeutic massage by health system administrators, medical directors, and massage professionals, to support the integration of therapeutic massage within their institutions.

CONCLUSIONS

With minor modifications of this policy by individual institutions, adoption of this policy may facilitate the thoughtful integration of this CAM therapy into academic health care settings, meeting the unique requirements of academic health care institutions while serving the needs of patients.