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Armour M, Al-Dabbas MA, Ee C, Smith CA, Ussher J, Arentz S, Lawson K, Abbott J. The effectiveness of a modified Gui Zhi Fu Ling Wan formulation (Gynoclear™) for the treatment of endometriosis: a study protocol for a placebo-controlled, double-blind, randomised controlled trial. Trials 2021; 22:299. [PMID: 33883001 PMCID: PMC8058744 DOI: 10.1186/s13063-021-05265-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Endometriosis is the presence of tissue similar to that of the endometrium outside the uterine cavity and is the most common cause of chronic pelvic pain. Current non-surgical treatments such as non-steroidal anti-inflammatories, oral contraceptive pills and hormonal treatments have limited effectiveness, and the side effect profile is bothersome. This study will evaluate the efficacy of Gynoclear™ by change in endometriosis-related pain based on the Endometriosis Pain Daily Diary (EPPD) scores. Methods This randomised, double-blind, placebo-controlled trial will recruit a minimum of 90 adult participants across Australia who have a laparoscopic visualisation/confirmation of endometriosis in the last 5 years and have current moderate or greater pelvic pain. Participants will be randomly allocated in a 1:1 ratio to receive either Gynoclear™ (active) or placebo. Gyncolear’s active ingredients are Carthamus tinctorius (Safflower), Cinnamomum cassia (Chinese cinnamon), Poria cocos (Hoelen), Paeonia suffriticosa (Tree peony), Paeonia lactiflora (Peony) and Salvia miltiorrhiza (Red sage). Participants are asked to complete a total of 5 months’ worth of pain diary entries via the EPDD v3, including 1-month screening, 2-month treatment period and 1-month post-treatment follow-up. The primary outcome variable is change in endometriosis-related pain based on the EPDD v3 scores. Secondary outcomes include change in health-related quality of life via the Endometriosis Health Profile (EHP-30), SF-12 and EQ-5D scores as well as changes in rescue analgesic usage, dyspareunia and fatigue via the EPDD. Discussion This study will determine the safety and efficacy of Gynoclear™ to reduce the severity and duration of non-cyclical pelvic pain, dysmenorrhoea, dyspareunia and other symptoms of endometriosis. Study outcomes will be of interest to health professionals and members of the public who suffer from endometriosis. Trial registration Australia and New Zealand Clinical Trials Registry ACTRN12619000807156. Registered on 3 June 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05265-x.
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Affiliation(s)
- Mike Armour
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,Translational Health Research Institute (THRI), Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Mahmoud A Al-Dabbas
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Caroline A Smith
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.,Translational Health Research Institute (THRI), Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Jane Ussher
- Translational Health Research Institute (THRI), Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Susan Arentz
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Kenny Lawson
- Translational Health Research Institute (THRI), Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Jason Abbott
- University of New South Wales, Royal Hospital for Women, Randwick, NSW, 2031, Australia
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Armour M, Sinclair J, Noller G, Girling J, Larcombe M, Al-Dabbas MA, Hollow E, Bush D, Johnson N. Illicit Cannabis Usage as a Management Strategy in New Zealand Women with Endometriosis: An Online Survey. J Womens Health (Larchmt) 2020; 30:1485-1492. [PMID: 33275491 DOI: 10.1089/jwh.2020.8668] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Endometriosis affects around 10% of women worldwide. Many women with endometriosis struggle with finding adequate pain management, and data from other countries suggest that women use cannabis, either legal or illicit, to help manage their endometriosis symptoms. The aim of this study was to determine use of cannabis where endometriosis was self-identified as a condition that was being treated with cannabis, as well as the impact of cannabis use on the usage on other pharmaceuticals. Materials and Methods: A cross-sectional online survey of those using cannabis for health-related conditions run between May and July 2019. This article reports on the subset of this larger data set for those reporting they had a diagnosis of endometriosis and/or polycystic ovary syndrome. Data were collected on demographics, modes of cannabis administration, symptoms treated, changes in pharmaceutical usage, and adverse events. Results: Two hundred thirteen valid responses were analyzed. Mean age of respondents was 32 years and 79.8% were current cannabis users. The most common outcomes that cannabis was used for were to improve pain relief (95.5%) and to improve sleep (95.5%). Respondents reported that their symptom was "much better" for pain (81%), sleep (79%), and nausea or vomiting (61%). Over three-quarters (81.4%) indicated cannabis had reduced their normal medication usage. Over half (59%) were able to completely stop a medication, most commonly (66%) analgesics. Opioids (40%) were the most common class of analgesic stopped. Conclusions: Cannabis is reported as an effective intervention for pain and other endometriosis symptoms with potential substitution effects on opioid usage.
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Affiliation(s)
- Mike Armour
- NICM Health Research Institute, Western Sydney University, Sydney, Australia.,Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
| | - Justin Sinclair
- NICM Health Research Institute, Western Sydney University, Sydney, Australia
| | - Geoff Noller
- Department of General Practice & Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jane Girling
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Maria Larcombe
- Department of General Practice & Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Mahmoud A Al-Dabbas
- NICM Health Research Institute, Western Sydney University, Sydney, Australia
| | - Erika Hollow
- Coastal Health, Greymouth, Aotearoa, New Zealand
| | - Deborah Bush
- Endometriosis New Zealand, Auckland, New Zealand
| | - Neil Johnson
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia.,Auckland Gynaecology Group and Repromed Auckland, Auckland, New Zealand.,Department of Obstetrics & Gynaecology, University of Auckland, Auckland, New Zealand
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Ee C, de Courten B, Avard N, de Manincor M, Al-Dabbas MA, Hao J, McBride K, Dubois S, White RL, Fleming C, Egger G, Blair A, Stevens J, MacMillan F, Deed G, Grant S, Templeman K, Chang D. Shared Medical Appointments and Mindfulness for Type 2 Diabetes-A Mixed-Methods Feasibility Study. Front Endocrinol (Lausanne) 2020; 11:570777. [PMID: 33123089 PMCID: PMC7573307 DOI: 10.3389/fendo.2020.570777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/10/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Type 2 diabetes (T2DM) is a major health concern with significant personal and healthcare system costs. There is growing interest in using shared medical appointments (SMAs) for management of T2DM. We hypothesize that adding mindfulness to SMAs may be beneficial. This study aimed to assess the feasibility and acceptability of SMAs with mindfulness for T2DM within primary care in Australia. MATERIALS AND METHODS We conducted a single-blind randomized controlled feasibility study of SMAs within primary care for people with T2DM living in Western Sydney, Australia. People with T2DM, age 21 years and over, with HbA1c > 6.5% or fasting glucose >7.00 mmol/L within the past 3 months were eligible to enroll. The intervention group attended six 2-h programmed SMAs (pSMAs) which were held fortnightly. pSMAs included a structured education program and mindfulness component. The control group received usual care from their healthcare providers. We collected quantitative and qualitative data on acceptability as well as glycemic control (glycated hemoglobin and continuous glucose monitoring), lipids, anthropometric measures, blood pressure, self-reported psychological outcomes, quality of life, diet, and physical activity using an ActiGraph accelerometer. RESULTS Over a 2-month period, we enrolled 18 participants (10 females, 8 males) with a mean age of 58 years (standard deviation 9.8). We had 94.4% retention. All participants in the intervention group completed at least four pSMAs. Participants reported that attending pSMAs had been a positive experience that allowed them to accept their diagnosis and empowered them to make changes, which led to beneficial effects including weight loss and better glycemic control. Four pSMA participants found the mindfulness component helpful while two did not. All of the seven participants who contributed to qualitative evaluation reported improved psychosocial wellbeing and found the group setting beneficial. There was a significant difference in total cholesterol levels at 12 weeks between groups (3.86 mmol/L in intervention group vs. 4.15 mmol/L in the control group; p = 0.025) as well as pain intensity levels as measured by the PROMIS-29 (2.11 vs. 2.38; p = 0.034). CONCLUSION pSMAs are feasible and acceptable to people with T2DM and may result in clinical improvement. A follow-up fully-powered randomized controlled trial is warranted. CLINICAL TRIAL REGISTRATION Australia and New Zealand Clinical Trial Registry, identifier ACTRN12619000892112.
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Affiliation(s)
- Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- *Correspondence: Carolyn Ee, ; Dennis Chang,
| | - Barbora de Courten
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Nicole Avard
- Next Practice Health, Erina, Sydney, NSW, Australia
| | - Michael de Manincor
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Mahmoud A. Al-Dabbas
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Jie Hao
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kate McBride
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Shamieka Dubois
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Rhiannon Lee White
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Catharine Fleming
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Garry Egger
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | | | - John Stevens
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Freya MacMillan
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Gary Deed
- Mediwell Clinic, Brisbane, QLD, Australia
| | - Suzanne Grant
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kate Templeman
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Dennis Chang
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- *Correspondence: Carolyn Ee, ; Dennis Chang,
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