Current Issue : April - June Volume : 2019 Issue Number : 2 Articles : 5 Articles
Background: Chronic low back pain (CLBP) is the most common chronic pain condition and is often resistant to\nconventional treatments. Acupuncture is a popular alternative for treating CLBP but its mechanisms of action\nremain poorly understood. Evidence suggests that pain regulatory mechanisms (particularly the ascending and\nsecondarily the descending pain modulatory pathways) and psychological mechanisms (e.g., expectations, pain\ncatastrophizing and self-efficacy) may be involved in the pathogenesis of CLBP and its response to treatments.\nWe will examine these mechanisms in the treatment of CLBP by electroacupuncture (EA).\nMethods: We present the aims and methods of a placebo-controlled, participant-blinded and assessor-blinded\nmechanistic study. Adult patients with CLBP will be randomized to receiving 16 sessions of real (active) or sham\n(placebo) EA over the course of 8 weeks. The primary pain regulatory measure for which the study was powered is\ntemporal summation (TS), which approximates ascending pain facilitation. Conditioned pain modulation (CPM),\nrepresenting a descending pain modulatory pathway, will be our secondary pain regulatory measure. The primary\npsychological measure is expectations of benefit, and the secondary psychological measures are pain catastrophizing\nand self-efficacy in managing pain. Main clinical outcomes are back pain bothersomeness on a 0â??100 visual analog\nscale (primary), Roland Morris Disability Questionnaire (secondary), and relevant items from the National Institutes of\nHealth (NIH) Patient-Reported Outcome Measures Information System (secondary). We hypothesize that compared\nto sham, real EA will lead to greater reduction in TS after 8 treatment sessions (4 weeks); and that reduction in TS\n(and secondarily, increase in CPM) after 8 treatment sessions will mediate reduction in back pain bothersomeness from\nbaseline to week 10 (clinical response) to EA. We also hypothesize that the three psychological factors are moderators\nof clinical response. With 100 treatment completers, the study is designed to have 80% power to detect a mediumsized\nbetween-group effect (d = 0.5) on temporal summation.\nDiscussion: To the best of our knowledge, this is the first appropriately powered, placebo-controlled clinical trial\nevaluating mechanisms of EA in the treatment of CLBP. Trial registration: ClinicalTrials.gov, NCT02503475. Registered on 15 July 15 2015. Retrospectively registered....
Objectives. To assess the efficacy of acupuncture in treating opioid use disorder (OUD). Design. Systematic review and metaanalysis.\nMethods. PubMed, CochraneCentral Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Cumulative Index to\nNursing and Allied Health Literature (CINAHL), Web of Science, ProQuest Dissertation andTheses, Allied and Complementary\nMedicine Database (AMED), Clinicaltrials.gov, and who.int/trialsearch were searched from inception to 23 December 2017. The\nmethodological quality of selected studies and the quality of evidence for outcomes were assessed, respectively, by the Cochrane\nrisk of bias assessment tool and the GRADE approach. Statistical analyses were conducted by RevMan 5.3. Results. A total of nine\nstudies involving 1063 participants fulfilled the inclusion criteria. The results showed that acupuncture could be more beneficial\nthan no treatment/sham acupuncture in terms of changes in craving for opioid (MD -2.18, 95% CI -3.10 to -1.26), insomnia (MD\n2.31, 95% CI 1.97 to 2.65), and depression (SMD -1.50, 95% CI -1.85 to -1.15). In addition, these findings showed that, compared to\nsham electroacupuncture (EA), EA had differences in alleviating symptoms of craving (SMD -0.50, 95% CI -0.94 to -0.05) and\ndepression (SMD -1.07, 95% CI -1.88 to -0.25) and compared to sham transcutaneous acupoint electrical stimulation (TEAS),\nTEAS had differences in alleviating symptoms of insomnia (MD 2.31, 95% CI 1.97 to 2.65) and anxiety (MD -1.26, 95% CI -1.60\nto -0.92) compared to no treatment/sham TEAS. Conclusions. Acupuncture could be effective in treating OUD. Moreover, EA\ncould effectively alleviate symptoms of craving for opioid and depression, and TEAS could be beneficial in improving symptoms\nof insomnia and anxiety. Nevertheless, the conclusions were limited due to the low-quality and small number of included studies.\nPROSPERO registration number is CRD42018085063....
Mitochondria autophagy, termed as mitophagy, is a mechanism of specific autophagic elimination of mitochondria.\nMitophagy controls the quality and the number of mitochondria, eliminating dysfunctional or excessive\nmitochondria that can generate reactive oxygen species (ROS) and cause cell death. Mitochondria are centrally\nimplicated in neuron and tissue injury after stroke, due to the function of supplying adenosine triphosphate (ATP)\nto the tissue, regulating oxidative metabolism during the pathologic process, and contribution to apoptotic cell\ndeath after stroke. As a catabolic mechanism, mitophagy links numbers of a complex network of mitochondria, and\naffects mitochondrial dynamic process, fusion and fission, reducing mitochondrial production of ROS, mediated by\nthe mitochondrial permeability transition pore (MPTP). The precise nature of mitophagyâ??s involvement in stroke, and\nits underlying molecular mechanisms, have yet to be fully clarified. This review aims to provide a comprehensive\noverview of the integration of mitochondria with mitophagy, also to introduce and discuss recent advances in the\nunderstanding of the potential role, and possible signaling pathway, of mitophagy in the pathological processes of\nboth hemorrhagic and ischemic stroke. The author also provides evidence to explain the dual role of mitophagy in\nstroke....
The aim of this study was to compare the treatment efficacies of superficial acupuncture and traditional acupuncture on trigger\npoints of the upper trapezius muscle. Forty people were recruited and randomly allocated to the traditional and superficial\nacupuncture groups. Each subject received two treatments per week in a four-week period. Outcomes were measured by visual\nanalogue scale (VAS), the Northwick Park neck pain questionnaire scores (NPQ), and pressure pain threshold (PPT) assessments\nof trigger points. Data collected before the interventions were considered as baseline. Assessments were performed after the first\ntreatment and at the end of the second and fourth weeks of treatment. Patients reported significant (p<0.05) and immediate\nimprovements in VAS and PPT for both superficial acupuncture and traditional acupuncture after the first treatment and after two\nand four weeks. Significant improvements (p<0.05) in NPQ were attained after two weeks of treatments in both groups. Because\nsuperficial acupuncture is associated with less pain while producing immediate pain relief, we recommend it for treatingmyofascial\npain syndrome in the upper trapezius muscle....
Background: The loss of mobility during aging impacts independence and leads to further disability, morbidity,\nand reduced life expectancy. Our objective was to examine the feasibility and safety of conducting a randomized\ncontrolled trial of yoga for older adults at risk for mobility limitations.\nMethods: Sedentary older adults (n = 46; age 60â??89) were recruited and randomized to either yoga or a health\neducation comparison group. Yoga sessions (60-min) occurred 2x weekly, and 90-min health education sessions\noccurred weekly, for 10 weeks. The primary outcomes were recruitment rate, intervention attendance, and retention\nat assessments. Adverse event rates and participant satisfaction were also measured. Physical performance measures\nof gait, balance, and strength and self-report outcome measures were administered at baseline and 10-weeks.\nResults: Recruitment lasted 6 months. Retention of participants at the 10-week follow-up was high (89% -\nperformance measures; 98% - self-report questionnaires). Attendance was good with 82% of yoga and 74% of\nhealth education participants attending at least 50% of the sessions. No serious adverse events were reported.\nPatient satisfaction with the interventions was high. The mean effect size for the physical performance measures\nwas 0.35 with some over 0.50. The mean effect size for self-report outcome measures was 0.36.\nConclusions: Results indicate that it is feasible to conduct a larger RCT of yoga for sedentary older adults at risk for\nmobility problems. The yoga and comparison interventions were safe, well accepted, and well attended. Effect sizes\nsuggest yoga may have important benefits for this population and should be studied further...
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