Functional Somatic Syndromes: Emerging Biomedical Models and Traditional Chinese Medicine

Temporomandibular Myofascial Pain Syndrome-Aetiology and Biopsychosocial Modulation. A Narrative Review

This review elaborates on the aetiology, diagnosis, and treatment of temporomandibular (TMD) myofascial pain syndrome (MPS) regulated by psychosocial factors. MPS impairs functioning in society due to the accompanying pain. Directed and self-directed biopsychosocial profile modulation may be beneficial in the treatment of MPS. Moreover, nutrition is also a considerable part of musculoskeletal system health. A fruit and vegetable diet contributes to a reduction in chronic pain intensity because of its anti-inflammatory influence. Cannabidiol (CBD) oils may also be used in the treatment as they reduce stress and anxiety. A promising alternative treatment may be craniosacral therapy which uses gentle fascia palpation techniques to decrease sympathetic arousal by regulating body rhythms and release fascial restrictions between the cranium and sacrum. MPS is affected by the combined action of the limbic, autonomic, endocrine, somatic, nociceptive, and immune systems. Therefore, the treatment of MPS should be deliberated holistically as it is a complex disorder.

Loss of resources and demoralization in the chronically ill

OBJECTIVE

The study examined whether the association between the severity of physical symptoms and demoralization is mediated by loss of resources in individuals with chronic conditions including conventional diagnoses, functional somatic syndromes, and medically unexplained symptoms.

METHOD

This cross-sectional study evaluated N = 194 patients (mean age = 46, 83.5% female) who reported at least 3 months of persistent physical symptoms using the following self-report instruments: PHQ-15 (modified), Loss of Resources Inventory, Psychosocial Questionnaire - Demoralization Subscale, and PHQ-8. The mediation hypothesis was tested by multiple regression analyses controlling for age, race, employment status, income, educational attainment, and depression.

RESULTS

Participants experienced M = 9.3 out of 16 possible health-related losses (SD = 4.4). Average to severe demoralization scores were indicated by 59.1% of individuals, of which only 17.1% experienced high demoralization. Loss of resources fully mediated the effect of symptom severity on demoralization, explaining 56% of the variance of demoralization and inhibiting the initially significant effect of symptom severity on demoralization to nonsignificant levels [from b = 0.67, 95% CI (0.26, 1.07) to b = 0.03, 95% CI (-0.27, 0.32)].

CONCLUSION

Early recognition of the loss of resources phenomena and interventions to reduce its progression through the introduction of resource gains may diminish, or even prevent, the installation of demoralization in individuals with chronic symptoms.

Auriculotherapy in primary health care: A large-scale educational experience in Brazil

Auriculotherapy consists of physical stimuli applied to the outer ear and is commonly associated with traditional Chinese medicine (TCM). The authors present and discuss the development of a course that offers a semi-on-site auriculotherapy course for Brazilian primary health care (PHC) professionals. The course was funded by the Brazilian Ministry of Health and developed at the Federal University of Santa Catarina in 2015 by a team of experts in auriculotherapy. It consisted of 75 h of distance learning (five sequential modules) and 5 h of on-site learning. The modules included the following items: (1) introduction to integrative practices; (2) ear reflexology; (3) introduction to TCM; (4) biomedical view of auriculotherapy; and (5) auriculotherapy in PHC. The teaching material included a workbook for each module, 14 video lectures and an interactive ear (online resource) to study location and application to the main auricular points. The on-site lectures follow a structured script of ear palpation techniques, auricular seed insertion practice and clinical case discussions, under the supervision of trained instructors. The course was offered in 2016 and 2017 and on-site lectures took place in 25 cities, covering all Brazilian regions, in coordination with municipal or state boards of health. A total of 4273 health professionals concluded the training and their evaluation of the course was highly positive. The Brazilian experience of large-scale training shows the potential to disseminate auriculotherapy in the context of PHC, given that its practice is fast, easy to learn, safe, effective for different health problems and well accepted by the patients.

Irritable bowel syndrome and symptom severity: evidence of negative attention bias, diminished vigour, and autonomic dysregulation

OBJECTIVE

To determine if cognitive processing, and subjective and physiological responses to stress and relaxation differed between an irritable bowel syndrome (IBS) group and control group. How these variables relate to the severity of IBS symptoms was also determined.

METHODS

Twenty-one IBS participants and 20 controls provided cognitive (attention and processing), subjective (perceived stress and vigour), and physiological (heart rate, blood pressure, and skin conductance) data during a relaxation and stress phase. Logistic regression analyses determined which variables are related to the IBS group and hierarchical linear regression assessed how the variables are related to the severity of IBS symptoms.

RESULTS

Subjective and cognitive factors (drowsiness at baseline, total vigour, and reduced Stroop colour-naming accuracy for negative words) are significantly related to IBS, χ2 (3, N=41)=23.67, p<.001, accurately categorising 85% of participants. IBS symptom severity was associated with both subjective (drowsiness at baseline and a smaller reduction in tiredness from relaxation to stress) and physiological (smaller increase in systolic blood pressure from baseline to stress phase and lower skin conductance at baseline) variables. This model predicted IBS severity, F (4, 16)=11.20, p<.001, and accounted for 74% of the variability in scores.

CONCLUSIONS

A negative attention bias, which may be related to a negative self-schema, as well as perceived low vigour were important in categorising IBS. Low subjective vigour and reduced physiological reactivity to both relaxation and stress conditions were associated with IBS severity, suggestive of illness-related allostatic load.

Stress reactivity in traditional Chinese medicine-based subgroups of patients with irritable bowel syndrome

OBJECTIVES

This study aimed to examine differences in autonomic responses to stress, pain perception, and the role of negative affect in these responses in individuals with irritable bowel syndrome (IBS) according to Traditional Chinese Medicine (TCM) classifications.

DESIGN

Fifty-nine female patients with IBS age 18-65 years diagnosed by TCM practitioners as showing primarily an excess (n=32) or an overlap (n=27) pattern (mixed excess and deficiency) were assessed for symptom differences, heart rate, and skin conductance responses to a psychosocial stressor and pain perception. SETTINGS/LOCATIONS: University of California in Los Angeles, California.

RESULTS

Compared with the excess group, the overlap group showed significantly greater overall gastrointestinal symptom severity, abdominal pain, and negative affect. The excess group with higher levels of negative affect showed greater reactivity to stress, whereas the overlap group showed an opposite response pattern. The overlap group showed increased cold sensitivity.

CONCLUSIONS

IBS patients with the overlap pattern have greater disease severity and comorbidity than those with excess alone. Those with excess showed a pattern of increased stress response with greater negative affect, whereas the overlap group with greater deficiency showed lower physiologic arousal with greater negative affect, consistent with depletion resulting from allostatic load.

Promoting integrative medicine by computerization of traditional Chinese medicine for scientific research and clinical practice: The SuiteTCM Project

BACKGROUND

Chinese and contemporary Western medical practices evolved on different cultures and historical contexts and, therefore, their medical knowledge represents this cultural divergence. Computerization of traditional Chinese medicine (TCM) is being used to promote the integrative medicine to manage, process and integrate the knowledge related to TCM anatomy, physiology, semiology, pathophysiology, and therapy.

METHODS

We proposed the development of the SuiteTCM software, a collection of integrated computational models mainly derived from epidemiology and statistical sciences for computerization of Chinese medicine scientific research and clinical practice in all levels of prevention. The software includes components for data management (DataTCM), simulation of cases (SimTCM), analyses and validation of datasets (SciTCM), clinical examination and pattern differentiation (DiagTCM, TongueTCM, and PulseTCM), intervention selection (AcuTCM, HerbsTCM, and DietTCM), management of medical records (ProntTCM), epidemiologic investigation of sampled data (ResearchTCM), and medical education, training, and assessment (StudentTCM).

DISCUSSION

The SuiteTCM project is expected to contribute to the ongoing development of integrative medicine and the applicability of TCM in worldwide scientific research and health care. The SuiteTCM 1.0 runs on Windows XP or later and is freely available for download as an executable application.

Conventional and complementary approaches to chronic widespread pain and its comorbidities

The concept of comorbidities as a challenge for healthcare systems has recently been given increasing attention in leading medical journals. Many patients suffering from chronic pain, especially those who are older or poorer, have more than one pathology (multimorbidity) or more than one set of manifestation of one pathology (comorbidity). These patients present a difficult problem in industrialised societies, with services that are highly specialised and compartmentalised. Systematic reviews of interventions for patients of this kind do not mention acupuncture. Acupuncturists claim that their treatment promotes general well-being and can help with multiple symptoms, but evidence for this claim is currently lacking. Longitudinal research with prospective data collection regarding the effect on morbidity burden is needed.

Mind/Body psychological treatments for irritable bowel syndrome

Currently, the goal of treatment for those with irritable bowel syndrome (IBS) is to improve the quality of life through a reduction in symptoms. While the majority of treatment approaches involve the use of traditional medicine, more and more patients seek out a non-drug approach to managing their symptoms. Current forms of non-drug psychologic or mind/body treatment for IBS include hypnotherapy, cognitive behavioral therapy and brief psychodynamic psychotherapy, all of which have been proven efficacious in clinical trials. We propose that incorporating the constructs of mindfulness and acceptance into a mind/body psychologic treatment of IBS may be of added benefit due to the focus on changing awareness and acceptance of one's own state which is a strong component of traditional and Eastern healing philosophies.

Influence of craniosacral therapy on anxiety, depression and quality of life in patients with fibromyalgia

Fibromyalgia is considered as a combination of physical, psychological and social disabilities. The causes of pathologic mechanism underlying fibromyalgia are unknown, but fibromyalgia may lead to reduced quality of life. The objective of this study was to analyze the repercussions of craniosacral therapy on depression, anxiety and quality of life in fibromyalgia patients with painful symptoms. An experimental, double-blind longitudinal clinical trial design was undertaken. Eighty-four patients diagnosed with fibromyalgia were randomly assigned to an intervention group (craniosacral therapy) or placebo group (simulated treatment with disconnected ultrasound). The treatment period was 25 weeks. Anxiety, pain, sleep quality, depression and quality of life were determined at baseline and at 10 minutes, 6 months and 1-year post-treatment. State anxiety and trait anxiety, pain, quality of life and Pittsburgh sleep quality index were significantly higher in the intervention versus placebo group after the treatment period and at the 6-month follow-up. However, at the 1-year follow-up, the groups only differed in the Pittsburgh sleep quality index. Approaching fibromyalgia by means of craniosacral therapy contributes to improving anxiety and quality of life levels in these patients.

A clinical study of the pulse wave characteristics at the three pulse diagnosis positions of chon, gwan and cheok

In this work, we analyze the baseline, signal strength, aortic augmentation index (AIx), radial AIx, time to reflection and P_T2 at Chon, Gwan, and Cheok, which are the three pulse diagnosis positions in Oriental medicine. For the pulse measurement, we used the SphygmoCor apparatus, which has been widely used for the evaluation of the arterial stiffness at the aorta. By two-way repeated measures analysis of variance, we tested two independent measurements for repeatability and investigated their mean differences among Chon, Gwan and Cheok. To characterize further the parameters that were shown to be different between each palpation position, we carried out Duncan's test for the multiple comparisons. The baseline and signal strength were statistically different (P < .05) among Chon, Gwan and Cheok, respectively, which supports the major hypothesis of Oriental medicine that all of the three palpation positions contain different clinical information. On the other hand, aortic AIx and time to reflection were found to be statistically different between Chon and the others, and radial AIx and P_T2 did not show any difference between pulse positions. In the clinical sense, however, the aortic AIx at each palpation position was found to fall within the 90% confidence interval of normal arterial compliance. The results of the multiple comparisons indicate that the parameters of arterial stiffness were independent of the palpation positions. This work is the first attempt to characterize quantitatively the pulse signals at Chon, Gwan and Cheok with some relevant parameters extracted from the SphygmoCor apparatus.

Novel diagnostic algorithm for the floating and sunken pulse qualities and its clinical test

We propose a novel classification algorithm for the floating pulse and the sunken pulse using a newly defined coefficient (C_fs). To examine the validity of the proposed algorithm, we carried out a clinical test in which 12 oriental medical doctors made pairwise diagnoses on the pulses of volunteering subjects. 169 subjects were simultaneously diagnosed by paired doctors, and the diagnoses in 121 subjects were concordant, yielding an accuracy of 72% and a Matthews correlation coefficient of 0.42, which indicates reasonable agreement between doctors. Two sample T-tests showed that subjects in the sunken pulse group had significantly higher BMI and C_fs (P < .05) than those in the floating pulse group. The pulse classification by the algorithm converged with the diagnoses of paired doctors with an accuracy up to 69%. With these results, we confirm the validity of the novel classification algorithm for the floating and sunken pulses.

Psychosocial predictors of somatic symptoms in adolescents of parents with HIV: a six-year longitudinal study

The objective of this study was to identify salient parent and adolescent psychosocial factors related to somatic symptoms in adolescents. As part of a larger intervention study conducted in New York, 409 adolescents were recruited from 269 parents with HIV. A longitudinal model predicted adolescent somatization scores six years after baseline assessment. Adolescent somatic symptoms were assessed at baseline and at 3-month intervals for the first two years and then at 6-month intervals using the Brief Symptom Inventory. Baseline data from adolescents and parents were used to predict adolescent somatic symptoms. Variables related to increased adolescent somatic symptoms over six years included being younger and female; an increased number of adolescent medical hospitalizations; more stressful life events; adolescent perception of a highly rejecting parenting style; more parent-youth conflict; no experience of parental death; and parental distress over their own pain symptoms. Our findings extend the literature by virtue of the longitudinal design; inclusion of both parent and child variables in one statistical model; identification of study participants by their potentially stressful living condition rather than by disease or somatic symptom status; and inclusion of serious parental illness and death in the study.

Acupuncture: what underlies needle administration?

Acupuncture is an ancient Chinese therapy with its mode of action unclear and efficacy inconclusive. A lack of attention given to the role of psychosocial context presented in clinical provision of acupuncture may mainly account for the current dilemma in acupuncture research. This psychosocial context induces various cognitive and affective processes in the patient while receiving this treatment. On the basis of the analysis of these psychological factors involved in clinical provision of acupuncture and in light of prior studies on the placebo effect, the author hypothesizes that acupuncture works through potentiation and modulation of a highly organized and somatotopic network of endogenous opioids that links expectation, attention and body schema. This hypothesis, which focuses on the contextual factors involved in clinical provision of acupuncture, has immediate clinical and experimental implications and will take the acupuncture debate much further forward.

Variation Analysis of Sphygmogram to Assess Cardiovascular System under Meditation

In this article, we studied how meditation affects the characteristics of the cardiovascular system, mainly based on blood pressure waveforms (BPW). Four parameters derived from BPW include the rising slope (h(1)/t(1)), normalized height of T wave (h(3)/h(1)), normalized height of V(3) valley (h(4)/h(1)) and normalized height of D wave (h(5)/h(1)), where t(1) and h(i), i = 1, ... ,5 are quantitative features of the BPW waveform pattern. A larger value of h(1)/t(1) reflects better heart ejection ability and aorta compliance. A larger value of h(3)/h(1) may infer an arterial system with good elasticity. The decrease (increase) of h(4)/h(1) parameter indicates the decrease (increase) of peripheral resistance of vessels. A larger value of h(5)/h(1) indicates better artery elasticity and aortic valve function. In comparison with the control group, Zen-meditation practitioners have more after-meditation h(1)/t(1), h(3)/h(1) and h(5)/h(1) increase, with more h(4)/h(1) decrease, with statistical significance (P < 0.05). The observation allows us to infer that Zen meditation may effectively improve relevant characteristics of the cardiovascular system.

Role of acupuncturists in acupuncture treatment

Traditional Chinese medicine (TCM) is based on a paradigm of the body different to that of modern biomedicine. Inherent characteristics of TCM necessitate an active and central role of acupuncturists in acupuncture treatment. The author looks at acupuncture in the practical context and analyzes the role of acupuncturists in diagnostic process and treatment delivery. Acupuncture as a complex non-pharmacological therapy depends solely on the acupuncturists' skills, competence and understanding of TCM theory to work. More attention should be given to this important role of acupuncturists in either clinical practice or research on acupuncture.

Bilateral integrative medicine, obviously

Unstated and unacknowledged bias has a profound impact on the nature and implementation of integrative education models. Integrative education is the process of training conventional biomedical and traditional Chinese medicine practitioners in each tradition such that patient care may be effectively coordinated. A bilateral education model ensures that students in each tradition are cross-taught by experts from the ‘other’ tradition, imparting knowledge and values in unison. Acculturation is foundational to bilateral integrative medical education and practice. Principles are discussed for an open-minded bilateral educational model that can result in a new generation of integrative medicine teachers.

Developmental therapeutics: review of biologically based CAM therapies for potential application in children with cancer: part I

This article is a review of the status of biologically based complementary and alternative medicine (CAM) therapies that have potential anticancer activity with a focus on those agents that may be active in childhood cancer. The review presented in 2 parts includes the descriptions of the mechanisms that underlie their effects, the manner by which these agents are identified and evaluated and discussion of some of the limitations of current research. The first part introduces the topic of biologically based CAM therapies. The discussion includes a description the discovery biologically based products for cancer, the classification of these compounds and their use from the perspectives of the Ayurvedic and traditional Chinese medicine systems. Issues associated with evidence-based research of compounds used in these practices are addressed. The second part focuses on preclinical and clinical studies of specific herbs or natural products and their bioactive constituents that demonstrate potential in cancer therapeutics. Turmeric, mistletoe, green tea, ginseng, mushrooms, and micronutrients are representative of compounds that exert their effects through mechanisms attributed to specific chemical classes. The section concludes with a discussion of status of clinical trials of biologically based CAM therapeutics for cancer and the future direction of research.