ACUPUNCTURE

Study: Physical Therapy for IC/PBS

A recent well designed study indicates that myofascial physical therapy can be helpful in people suffering from interstitial cystitis / painful bladder syndrome (IC/PBS).

 

Nuts and bolts of the study

 

  • A randomized controlled trial of 10 scheduled treatments of myofascial physical therapy (MTP) vs global therapeutic massage (GTM)  was performed at 11 clinical centers in North America.
  • Women recruited were diagnosed with interstitial cystitis/painful bladder syndrome with demonstrable pelvic floor tenderness on physical examination and a limitation of no more than 3 years’ symptom duration.
  • The primary outcome was the proportion of responders defined as moderately improved or markedly improved in overall symptoms compared to baseline on a 7-point global response assessment scale.
  • Secondary outcomes included ratings for pain, urgency and frequency, the O’Leary-Sant IC Symptom and Problem Index, and reports of adverse events.
  • The global response assessment response rate was 26% in the global therapeutic massage group and 59% in the myofascial physical therapy group (p = 0.0012 – indicating positive statistical significance in science jargon)
  • Pain, urgency and frequency ratings, and O’Leary-Sant IC Symptom and Problem Index decreased in both groups during follow-up, and were not significantly different between the groups.
  • 62% (50 of 81) of participants reported at least 1 adverse event – most commonly pain  – classified as mild in 12% (10 of 81), moderate in 35% (28 of 81) or severe in 15% (12 of 81).
  • After the initial 12 weeks of treatment there was a decrease in follow-up of 30 (77%) of the 39 patients assigned to MPT and on 28 (67%) of the 42 assigned to GTM.
  • Of the 30 patients initially treated with MPT 4 (13%) had elected to continue with MPT during the 3-month follow-up. Of the 28 patients initially treated with GTM 8 (29%) had elected to receive MPT during the 3-month followup.
  • At the end of the follow-up phase the final outcome of interest (GRA) was completed by just 11 of 42 (26%) in the GTM group and 23 of 39 (59%) in the MPT group. Therefore, we are unable to draw any conclusions about the durability of treatment outcomes in either group.
  • Pain was the most common adverse event, occurring at similar rates in both groups.

My take on this:

This study had numerous strengths as discussed in the journal article: it was prospective (as opposed to retrospective – less valid), multicenter, randomized design with a standardized protocol for pelvic floor MPT and a positive control.

Monotherapy, that is, the use of one therapeutic approach for treatment of a disease or physical symptom does not bring a cure for IC/PBS patients. Each therapy, whether it is MTP or other, is one piece of the puzzle.

There is four areas that work synergistically which will get you closer to a cure in my experience: physical medicine, diet and nutrition, healing the gut and psychological treatment. All are very important – the psychological aspect may be even more crucial.

 

1. Physical medicine. It is unquestionably important to treat IC/PBS with some form of physical medicine with either MTP, acupuncture or both if myofascial disorders are found. Specialized physical therapy, like MTP, is the better-researched treatment and brings about 30 to 50% short-term relief  (1 to 3 months approximately) in my experience.  Research suggest that acupuncture brings about relief as well.  In numerous randomized trials, acupuncture has shown efficacy for pelvic pain related to prostatitis (Lee et al. 2011). There is much overlap in symptoms of patients with prostatitis and IC/ PBS.

2. Dietary approach.  Not all foods proposed to increase IC symptoms are problematic in my experience. Tea, coffee, wine, soda, citrus foods and tomatoes are most important to limit or eliminate.  I find the biggest food culprit is wheat and gluten products – not typically known as a problem food for IC.  If the patients does not address the psychological aspect of IC then eating becomes aguishly difficult – the enjoyment of eating diminishes and a subconscious neurosis with food develops. This is not fun.

3. Treat the gut. Most IC/PBS have GI problems: excess, gas, bloating, constipation, indigestion,etc. Eliminating food allergens, consumption of probotics, fish oils and maybe digestive enzymes before a meal can be helpful.

4. Psychological approach. No you are no crazy but you know stress makes symptoms worse. Moreover, a past stressor, a relationship breakup, sudden death of a love one, loss of a job, etc may actually have contributed to the cause of your IC/PBS symptoms. While some people develop chronic migraines, back pain or neck pain when stressed, you develop pelvic pain and urinary dysfunction.  Everyone has their thing, IC /PBS is yours.

A good psychotherapist is of absolute importance. Don’t get me wrong, you are not making up your symptoms up (it’s not in your head), the pain and urinary problems are real but the initial trigger is deeply imbedded in your subconscious mind. Your job is to define what that is and resolve it. Acceptance or forgiveness may do the trick if appropriate to you, I don’t know but try to figure it out.  The “over-the-hump” cure lies with resolving the subconscious initial trigger of the problem and managing daily stress more effectively.

 

Doggy bag message:

Relief from IC / PBS is journey. Mainstream medicine is of little help at this point and most urologist do not want to treat IC patients, unfortunately – MORE ON THIS HERE. There are a few who are experts in the area: Drs. Robert Moldwin, Philip Hanno, Elizabet Kavaler, just to name a few.   MTP, acupuncture, biofeedback are all  very helpful and important. As is proper nutrition and healing the gut.  Cure, ultimately comes from properly addressing the psychological triggers  you may not have connected your symptoms with and stress management.  Once psychogenic aspects are addressed, “problem foods” become less of a problem and your digestive issues resolve as well. It is all connected.

 

Good luck with your journey. Let me know how you do.

 

Reference:

IC-network: http://www.ic-network.com/

Fitzgerald MP et al.Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol. 2012 Jun;187(6):2113-8.

Lee SH, Lee BC. Use of acupuncture as a treatment method for chronic prostatitis/chronic pelvic pain syndromes. Curr Urol Rep. 2011 Aug;12(4):288-96.

Acupuncture treatment for Interstitial Cystitis – any evidence?

After my last blog post I received numerous emails from numerous health care practitioners asking on the scientific evidence regarding acupuncture treatment of interstitial cystitis.

Before I present this information, keep in mind that not everything that works can be proven – especially therapies that are 5000 years old.  The importance of scientific investigation in all forms of medicine cannot be understated – we have made huge advances in medicine through science. However, for a practitioner to just depend on scientific data while working in the “trenches” trying improve our patients health is short sighted.

In the words of arguably the best scientist to ever live, ” Not everything that counts can be counted and not everything that can be counted counts.”  – Albert Einstein

A good doctor incorperates 3 things in their approach: science, clinical experience and the therapeutic relationship with the patient.

OK, I am jumping out of my soap box now.

Here’s the existing scientific data on acupuncture and interstitial cystitis (and associated conditions)

( I have taken this from other of my writings on the topic)

 

Patients with IC/PBS can potentially gain benefit from 10 to 20 sessions of acupuncture (Whitmore, 2002).  Alraek has been able to show in a study with 61 women that traditional Chinese medical (TCM) diagnosis can be useful in cystitis (Alraek et al. 2000).

In a study of 14 patients, Rapkin and Kames found that 6 to 8 weeks of acupuncture reduced the pain of IC (Rapkin and Kames, 1987).

One reported a case study of a 31-year-old woman whose IC symptoms were reduced with acupuncture to the kidney and bladder meridians (Lyons, 2001).

One Norwegian study of 67 adult women with a history of recurrent lower UTI were randomized into three groups in which one received acupuncture treatment, one had sham acupuncture, and one was given no treatment. A statistically significant 85% in the acupuncture group was free of cystitis during the 6-month observational period, as compared with 58% in the sham group and only 36% in the control group (Aune et al. 1998).

As you can see, the scientific data regarding acupuncture treatment for interstitial cystitis is limited at this time. Good randomized trials with the use of acupuncture are desperately needed for this patient population.

Keep posted as we are developing such studies at our institution at NYU.

 

Reference:

Whitmore KE. Complementary and alternative therapies as treatment alternatives for interstitial cystitis. Rev Urol. 2002;4(suppl 1):S28–S35.

Alraek T, Aune A, Baerheim A (2000) Traditional Chinese medicine syndromes in women with frequently recurring cystitis: frequencies of syndromes and symptoms. Complement Ther Med 8:260-265

Rapkin AJ, Kames LD. The pain management approach to chronic pelvic pain. J Reprod Med. 1987;32:323–3271.

Lyons P. Acupuncture treatment for interstitial cystitis: a case report. Am AcadMed Acupunct. 2001. http://www.medicalacupuncture.org.ezproxy.med.nyu.edu. Published 2001. Accessed November 1, 2007.

Aune A, Alraek T, LiHua H. Acupuncture in the prophylaxis of recurrent lower urinary tract infection in adult women. Scand J Prim Health Care 1998;16:37-39.

Men with hot flashes on Hormone therapy should do Acupuncture

One of the main methods of treating advanced prostate cancer is by chemically depleting the body of testosterone – also known as Androgen Deprivation Therapy (ADT). There are a few drugs on the market used for this purpose but Lupron is one of the most common.

A prospective study conducted in the department of radiation oncology and the acupuncture section of New York Methodist Hospital and Weill Cornell Medical College of Cornell University, both in New York, researchers evaluated 14 men who were experiencing hot flashes due to hormone therapy for prostate cancer. Upon enrolling in the study, the men were given a hot flash score (HFS) to evaluate their discomfort from daily hot flashes. The mean initial HFS was 28.3 (Ashamalla et al. 2011)

Participants then received acupuncture twice a week for 30 minutes at a time for four weeks. Two weeks after receiving acupuncture, their HFS was measured again and had dropped more than half to 10.3. At six weeks post-treatment, their HFS was 7.5. After eight months, the men were evaluated again and their mean HFS was 7.

This is not the only study that proves acupuncture can help this group of men. Beer et al, demonstrated 25% response rate to placebo treatment for hot flashes in men on hormone deprivation therapy. (Beer et al. 2010).

Men on ADT should not be suffering from hot flashes when safe and effective treatments like acupuncture are available. To seek an acupuncturist near you go to www.acufinder.com.

 

In Optimal Health,

Dr. Geo

Sources:

Hani Ashamalla, Ming L. Jiang, Adel Guirguis, Francesco Peluso, Mark Ashamalla. Acupuncture for the Alleviation of Hot Flashes in Men Treated With Androgen Ablation Therapy. International Journal of Radiation OncologyBiologyPhysics, 2011; 79 (5)

Beer TM, Benavides M, Emmons SL, Hayes M, Liu G, Garzotto M, Donovan D, Katovic N, Reeder C, Eilers K. Acupuncture for hot flashes in patients with prostate cancer. Urology. 2010 Nov;76(5):1182-8.

 

Acupuncture helps with prostatitis – study shows

Like other forms of chronic pain, chronic prostatitis is a complex condition with no simple solutions. Successful management of chronic prostatitis depends on treating the original source of the pain as well as the neurological and psychosocial problems that often accompany it. As a result, your doctor may prescribe several different types of medication. Some men also benefit from cognitive behavioral therapy, which can help improve coping strategies and psychological well-being. But what if you’ve tried medications and they haven’t helped your chronic prostatitis?

 

Should you give acupuncture a try?

 

Results from a small study in The American Journal of Medicine suggest that acupuncture may provide relief to men with chronic prostatitis. The study compared the potential benefits of acupuncture versus sham (inactive) treatments in 89 men who had symptoms of chronic prostatitis for three or more of the past six months and who had a score of 15 or higher on the National Institutes of Health Chronic Prostatitis Symptom Index. The men were randomly assigned to receive two acupuncture treatments or two sham treatments a week for 10 weeks. The sham treatments were nearly identical to genuine acupuncture needle insertions except for the location and depth of placement. True acupuncture was nearly twice as effective as the sham procedure in relieving chronic prostatitis symptoms. Moreover, patients treated with acupuncture were more than twice as likely as the men given the inactive treatment to experience long-term prostatitis relief. Few of the men experienced complete resolution of their symptoms.

This study supports findings from other trials showing a benefit from acupuncture for chronic prostatitis. More study is needed before the treatment can definitively be recommended, but if nothing else has worked for you, a trial of acupuncture might be worth considering.

 

My take on this

In my clinical experience , acupuncture is extraordinarily helpful for this group of men. Another useful approach is eliminating food intolerance’s. The common one are wheat and dairy but there could be a few others. An ALCAT test can be useful to determine which foods one may be intolerant to.

 

Source: Lee SW, Liong ML, Yuen KH, Leong WS, Chee C, Cheah PY, Choong WP, Wu Y, Khan N, Choong WL, Yap HW, Krieger JN. Acupuncture versus sham acupuncture for chronic prostatitis/chronic pelvic pain. Am J Med. 2008 Jan;121(1):79.e1-7.

In optimal health,

 

Dr. Geo