Comparative efficacy of acupuncture, venesection, and physical therapy on chronic low back pain outcomes: a randomized clinical trial

Objective

Chronic low back pain (CLBP) imposes considerable financial and social burden with poor response to medical and surgical treatments. Alternatively, acupuncture and venesection(Fasd) are traditionally used to alleviate nociceptive and musculoskeletal pains. This study aimed to evaluate the effectiveness and the safety of acupuncture and venesection on CLBP and patient functionality.

Methods

The current study was a single-blinded, randomized clinical trial with balanced allocation, conducted in the Department of Physical Medicine & Rehabilitation Medicine, in 2022. One hundred five CLBP patients who had no back pain-attributable structural or major diseases were randomly allocated into three parallel arms and received either physical therapy (PTG), acupuncture (APG), or venesection (VSG). Pain severity and functional aspects were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI) during the study. VAS and ODI scores were defined as the primary outcomes.

Results

Ninety-five patients were reviewed in the final analysis (PTG=33, APG=30, VSG=31). Demographic data showed equal group distribution. Statistical analysis showed all procedures had reduced VAS score immediately after the first session, after the last session, and after follow-up; however, APG and VSG values were significantly lower (P<0.05). Pain reduction results in follow-up period were more sustainable in APG and VSG as compared to PTG (P<0.01). ODI results revealed global improvement after the last session of the treatment in all groups, while APG had more significant results (P<0.05). During the follow-up period, ODI still tended to decrease in VSG, non-significantly increased in APG, and significantly increased in PTG. Only two patients reported fainting after receiving venesection.

Conclusion

Considering the pain and functional scores, both acupuncture and venesection can reproduce reliable results. Acupuncture and venesection both have sustained effects on pain and daily function of the patients even after treatment termination, while physical therapy had more relapse in pain and functional limitations.

Similarities and differences between kaiy in Persian medicine and moxibustion in Chinese medicine

Kaiy (medieval cautery) is an ancient method of heat therapy in traditional Persian medicine (TPM). Some of its important applications have been neglected during the medical revolution. Meanwhile, different treatment modalities that incorporate heat, including moxibustion, have progressed in traditional Chinese medicine. In this study, we reviewed the main TPM textbooks that were written specifically in the field of kaiy. We considered the traditional teachings in the context of contemporary information, gathered from the scientific literature about moxibustion and modern cauterization. Some surgical therapeutic indications of kaiy (e.g., debridement and coagulative procedures) have been advanced by the innovation of electro-cauterization. However, those therapeutic applications that were based on the TPM humoral theory for relieving body coldness or myofascial pains-which are similar to moxibustion usages-have not received the same attention. Apart from the broad similarities of kaiy and moxibustion as thermal therapies with similar indications, there is a striking correspondence between kaiy point mapping and acupoints. Therefore, further research on different kaiy aspects is recommended. Please cite this article as: Jaladat AM, Alizadeh Vaghasloo M, Atarzadeh F, Ayati MH, Kazemi AH, Akin E, Hashempur MH. Similarities and differences between kaiy in Persian medicine and moxibustion in Chinese medicine. J Integr Med. 2023; Epub ahead of print.

Effectiveness of acupuncture for fatigue in patients with relapsing-remitting multiple sclerosis: a randomized controlled trial

BACKGROUND

Fatigue is experienced by more than 65% of individuals with multiple sclerosis (MS). Some studies have supported the effectiveness of acupuncture in improving the symptoms of MS.

OBJECTIVE

The present research was intended to investigate the effectiveness of acupuncture plus amantadine compared with amantadine alone on fatigue in patients with relapsing-remitting MS (RRMS) in the remission stage of the disease.

METHODS

In this randomized controlled trial, 60 participants with RRMS suffering from fatigue were recruited and randomized equally to acupuncture (n = 30) and control (n = 30) groups. The acupuncture group received treatment 2 to 3 times per week for 10 sessions over 4 weeks. Both the acupuncture and control groups received amantadine 100 mg daily and routine treatment with immuno-modulators. The primary outcome was the fatigue severity scale (FSS) score, which was evaluated at baseline, and after 2 and 4 weeks. The secondary outcome was the Multiple Sclerosis Quality of Life 54 (MSQOL-54) questionnaire score, measured at baseline and the end of the 4-week treatment period.

RESULTS

The severity of fatigue was reduced in both groups. However, after 4 weeks of treatment, the reduction of fatigue in the acupuncture group was more significant than in the control group (P < 0.01, mean difference (MD) = -1.14, 95% confidence interval (CI): -1.83 to -0.45). Quality of life, including mental and physical status, was significantly improved in the acupuncture group compared with the control group (P < 0.05, MD = 9.09, 95% CI: 0.46 to 17.73). No adverse events occurred in any of the participants.

CONCLUSIONS

Acupuncture combined with amantadine and routine care compared with amantadine and routine care alone appears to be an effective short-term treatment for reducing fatigue and enhancing quality of life, including physical function and mental status, in patients with RRMS.

Warm Cupping of the Posterior Thorax in Combination with Standard Conventional Therapy for ARDS in COVID-19 Patients in ICU: a Case Series

Acute respiratory distress syndrome (ARDS) is commonly found in critically ill patients with coronavirus disease 2019 (COVID-19). As a non-pharmacological treatment of complementary and alternative medicine (CAM), cupping has been clinically used for respiratory symptoms. We sequentially identified a series of patients with COVID-19 with ARDS who were admitted to the intensive care unit (ICU). Warm cupping of the posterior thorax was performed for seven days. We collected longitudinal severity scores on cough, breathlessness, chest tightness, type of oxygen therapy, and oxygen saturation (SpO₂). We hereby report the changes in the severity scores in a series of eight patients who received 21 sessions of cupping in addition to conventional treatments. All patients reported improvement in symptom scores that was matched by an increase in SpO₂ by as much as 3.16%. All patients were discharged and did not require the use of a mechanical ventilator. The results suggest that combining cupping with conventional treatment may provide a good prognosis for patients with COVID-19 with ARDS.

Comparison of therapeutic effects of statins and aloe vera mouthwash on chemotherapy induced oral mucositis

BACKGROUND

Chemotherapy induced oral mucositis is a common problem among patients with cancer. Different therapeutic agents have been evaluated to prevent or treat the disease. Here we aimed to compare therapeutic effects of atorvastatin and aloe vera mouthwash on chemotherapy induced oral mucositis.

METHODS

120 patients with large intestine and gastric cancer who were treated with 5-fluorouracil (FOLFOX4) for the first time were entered and randomized into 3 groups. Group 1 received tablets of atorvastatin 10 mg daily until 2 weeks after chemotherapy sessions plus placebo mouthwash. Group 2 received aloe vera mouthwash plus placebo tablets and group 3 received placebo mouthwash and placebo tablets until 2 weeks after chemotherapy sessions. Severity of mucositis was assessed using world health organization (WHO) indexes. Based on this method, mucositis is divided into 4 grades. This study was approved by Iranian Registry of Clinical Trials (IRCT) with the code of: IRCT20201203049585N1 (https://fa.irct.ir/trial/54037).

RESULTS

Analysis of the incidence of mucositis among patients showed that in placebo group, 50% of patients experienced grade 2 to 4 mucositis. In group 1, 9 patients (22.5%) had grade 2 mucositis and 6 patients (15%) had grade 3 mucositis and 4 patients (10%) had grade 4 mucositis. In group 2, only 1 patient (2.5%) was diagnosed with grade 2 mucositis. These data showed no significant differences between group 1 and group 3 (P=0.674), but the therapeutic results of group 2 were significantly better than those of group 3 (P=0.042) and group 1 (P=0.036).

CONCLUSION

We showed that treatments with aloe vera mouthwash could be an effective choice in prevention of mucositis for patients undergoing chemotherapy. There are also much to discover about effects of aloe vera mouthwash on this disease.

The necessity for integrating traditional, complementary, and alternative medicine into medical education curricula in Iran

BACKGROUND

The use of traditional and complementary medicine (T&CM) is increasing in both developed and developing countries. The school of Persian medicine (PM) in Iran is a comprehensive medical school that is rich in history and has its own special principles, elements, philosophy, and diagnostic and treatment options. Many complementary therapy modalities are also popular and in demand among patients and physicians. The aim of this paper is to provide logic for the policymakers in Iranian medical education to make changes in medical education curricula, particularly on integrating T&CM.

METHODS

We reviewed the global experience in teaching T&CM to medical students, and highlighting the strengths of PM, described why it is necessary to integrate T&CM into general medicine curricula in Iran.

RESULTS

PM is a traditional system of medicine that dates back about 7000 years. Although there are few studies about the safety and effectiveness of PM, research into it has recently been accelerated. There is a suitable opportunity for integrating T&CM with conventional medicine. Physicians should be familiar with T&CM to avoid any contraindications, interactions, and unwanted effects.

CONCLUSION

Traditional medicine is part of Iran's heritage and, thus, needs special attention. Familiarization of physicians with T&CM can help them choose the best treatment options for their patients. To integrate T&CM into the medical education curricula of Iran, a two-credit course has been proposed for implementation across the country.

Effects of clonidine as premedication on plasma renin activity, serum and urine electrolytes and body fluids in general anesthesia. A randomized double blind placebo controlled clinical trial

OBJECTIVES

Clonidine is a relative alpha2 agonist that's used as a premedicative drug in anesthesia in recent years. The aim was to asses the effect of oral clonidine as premedicative drug on 24 hours urine output, urine specific gravity, serum and urine electrolyte level and renin plasma activity

METHOD

A randomized double blind controlled clinical trial was performed in Asali hospital Khoramabad-Iran during 2004. Sixty patients in ASA class 1 and 2, were randomly selected and divided into two groups. One group received clonidine tablet and control group received placebo tablet, orally, ninety minutes before induction of general anesthesia for cystocel-rectocel perineorraphy surgery. In this study we took blood and urine samples for laboratory measurements before as well as 6 hours after taking the tablets. Differences between two groups were analyzed by students T-test.

RESULTS

Significant increase in 24 hours urine output (P = 0.001) was seen in clonidine group, compared to control group. Clonidine group had higher urine electrolyte levels (P < 0.05) however, no differences were seen in blood electrolyte level (P > 0.05). Urine specific gravity was lower in clonidine group (P < 0.05). Significant decrease in plasma renin activity was seen in clonidine group (P = 0.001).

CONCLUSION

This study suggested that clonidine is a safe premedication drug in anesthesia and does not change the serum electrolytes level.

Assessment of clonidine effect as premedicative drug on kidney function

OBJECTIVE

To assess the effect of oral clonidine as a premedicative drug on 24-hour urine output, urine specific gravity, plasma renin activity as well as serum and urine electrolytes levels.

METHODS

This prospective study was carried out on 60 women aged 20-40 years old undergoing repair of cystocoele-rectocoele perineorraphy under general anaesthesia in Asali Hospital in 2004 in Khorramabad, Iran. Subjects were randomly divided into two equal groups of 30 each. Group I and group II received clonidine tablet at the dose of 5 microg/kg and placebo tablet, respectively, 90 minutes before induction of general anesthesia. In this study, blood and urine samples were taken for laboratory measurements prior as well as 6 hours after taking the tablets. Differences between the two groups were compared through Mann-Whitney u-test, chi2 test and t-student test. P-value < 0.05 was considered statistically significant.

RESULTS

There were no significant changes before and after receiving tablets in urine and blood Na and K as well as urine specific gravity in group II (P > 0.05). Group I had higher urine Na and K level (P = 0.001), however, no differences had been shown in blood Na and K level (P > 0.05). Urine specific gravity was lower in group I after receiving tablet (P < 0.009). A significant increase in 24-hour urine output (P = 0.001) and a marked decrease in plasma renin activity was seen in group I (P = 0.001).

CONCLUSION

This study suggests that clonidine is a safe premedicative drug in anaesthesia and does not change the serum electrolytes levels.