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

Acupuncture and its Benefits

Acupuncture has started in ancient years and has come a long way. It is one of the original Chinese traditional medicines. It has a lot of variations that are practiced and taught throughout the world. It has also been the subject of active scientific research both in regard to its basis and therapeutic effectiveness since the late 20th century but remained controversial among medical researchers and clinician.

Acupuncture is the procedure of inserting and manipulating needles into various points on the body. The focus of acupuncture therapy is to promote health and alleviate pain and suffering.

Three concepts of acupuncturist as to its perspective view on health and sickness are as follows:

  • vital energy

  • energetic balance

  • energetic imbalance


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New York Times article on Acupuncture

The New York times published this article two days ago. Here are the details and my thoughts on this article:
A debate was fueled last week by a study for arthritis research. Researchers from MD Anderson Cancer Center in Houston found that among 455 patients with painful knee arthritis, acupuncture delivered no more relief than a sham treatment.
Actually, patients got significant pain relief from both treatments an average reduction of one point on a scale of 1 to 7. And critics contend that the study was poorly designed. 

For one thing, they note, patients in both groups received treatment with needles and electrical stimulation; the main difference was that in the sham group, the needles were not inserted as deeply and the stimulation was far shorter in duration.
In the real world, however, a trained acupuncturist would customize the treatment to a patient’s specific symptoms. But in this study, the patients in the acupuncture group all received needles inserted in the same way.
Rather than proving that acupuncture does not work, in other words, the study may suggest that it works even when administered poorly. But the real lesson, acupuncture supporters say, is how difficult it can be to apply Western research standards to an ancient healing art.

But the study’s lead author, Dr. Maria E. Suarez-Almazor, notes that the sham treatment was developed with the help of trained acupuncturists. In a drug study, an equal response in the treatment and placebo groups would prove the drug does not work, she says.
A 2007 study of 1,200 back-pain patients, financed by insurance companies in Germany, showed that about half the patients in both real and sham acupuncture groups had less pain after treatment, compared with only 27 percent of those receiving physical therapy or other traditional back care.

When the German researchers tracked how much pain medicine the patients used, they detected a noticeable difference between real acupuncture and the sham treatment. Only 15 percent of patients in the acupuncture group required extra pain drugs, compared with 34 percent in the sham group. The group receiving conventional back therapy fared even worse than those receiving fake acupuncture: 59 percent of those patients needed extra pain pills.
Another study  financed by the National Institutes of Health and published in 2004, found that acupuncture significantly reduced pain and improved function in knee arthritis patients compared with a sham treatment or routine knee care.
But that result has been called into question because the patients in the sham group probably figured out they were not getting the real thing. They received only two needle insertions in the abdomen, while a needle was simply pressed along nine areas of the leg and taped to the skin to mimic acupuncture. A mock electrical stimulation machine whirred and blinked nearby, but didn’t deliver any current to the body.

This year, researchers at Henry Ford Hospital in Detroit solved the problem of creating a sham acupuncture treatment: they didn’t have one. Instead, they compared acupuncture to a proven remedy, the drug Effexor, an antidepressant that has been shown to significantly reduce hot flashes in breast cancer patients.
The results were striking. Acupuncture relieved hot flashes just as well as Effexor, with fewer side effects. The acupuncture recipients reported more energy and even an increased sex drive, compared with women using Effexor.

Source: A version of this article appeared in print on August 24, 2010, on page D5 of the New York edition of The Times.
My take on this
Acupuncture has been successfully used for thousands of years. Acupuncture is an integral part of my practice, particularly with erectile dysfunction, interstitial cystitis and chronic prostatitis. The reductionist approach in modern western science makes it challenging to come to any scientific conclusions regarding the benefits of acupuncture. Still and all, modern science has validated the use of acupuncture to treat: arthritic pain, depression , lower back pain and chronic non-bacterial prostatitis.
Particularly with prostatitis, a condition that is agonizing for men who suffer from it, acupuncture has revealed to be exceptionally effective. This is extremely good news for prostatitis sufferers since there is limited effective conventional therapies for this disorders and often times results in frustration from the patient and their well meaning physician.

Here is the current research on acupuncture and chronic prostatitis:
This study was done in Malaysia, in a hospital with traditionally trained acupuncturists on its staff, in conjunction with the University of Washington Department of Urological Surgery. It was funded by the NIH and published in the American Journal of Medicine. There were 90 subjects randomized into two groups. They compared acupuncture at traditional points to sham acupuncture with more superficial needling 15 mm to the left of traditional points. They used no adjunctive treatments. They minimized interaction between participants and acupuncturists. They looked for a primary endpoint of a 6 point decrease from baseline to week 10 in a validated scale of symptoms, the NIH Chronic Prostatitis Symptom Index (NIH-CPSI), and for secondary outcomes including complete resolution and decreased scores at other intervals. They found that acupuncture was twice as effective as sham acupuncture for the primary endpoint (73% vs. 48%, p=0.02) at 10 weeks, that more acupuncture patients had complete resolution of symptoms (18 vs. 10, p=0.07), and that acupuncture recipients had a greater long-term response 20 weeks after completing therapy (32% vs. 13%, p=0.04). (Lee,SW et al., 2009)

This study was done in Korea and was published in the journal Urology. It was a three-arm study comparing advice and exercise (A & E) alone to A&E plus electroacupuncture (where the acupuncture needles were electrically stimulated) to A&E plus sham acupuncture. There were only 13 men in each group. The sham acupuncture involved (1) more superficial needling, (2) placement 15 mm to the left of acupuncture points, and (3) the sound of the pulse generator without actual electrical stimulation. In the acupuncture group they found a significant reduction in the NIH-CPSI scores for pain, but no reduction in the scores for urinary symptoms or quality of life. On another scale, the International Prostate Symptoms Score, there were no significant differences.
There was also some correlation between prostatitis symptoms and prostaglandin E and beta endorphin levels, so they measured these in post-massage urine samples. They found a significant decrease in prostaglandin level in the electroacupuncture group (p=0.023) and a non-significant increase in the other two groups. (Lee SH, LeeBC, Urology 2009)
Another study Acupuncture was performed using disposable stainless steel needles, which were inserted into the bilateral BL-33 points and rotated manually every 10 minutes for 30 minutes. The treatment was repeated every week for 5 weeks without other therapeutic maneuvers
RESULTS: No side effects were recognized throughout the treatment period. The average pain and QOL scores of the NIH-CPSI 1 week after the 5th acupuncture treatment decreased significantly (P < 0.05 and P < 0.01, respectively) compared with the baseline. The maximum width of the sonolucent zone 1 week after the 5th treatment also decreased significantly (P < 0.01, compared with the baseline). Intrapelvic venous congestion demonstrated by MR venography was significantly improved in four patients.(Honjo H et al 2004)

German Study Finds Acupuncture Improves Exercise Tolerance in Heart Patients

 

Acupuncture can improve exercise tolerance in patients suffering from chronic heart failure, according to new research from Germany.

The finding comes from a clinical pilot study by the team headed by Dr. Johannes Backs, physician and study director at the Department of Internal Medicine III (Cardiology, Angiology, and Pneumology — Medical Director: Professor Dr. Hugo Katus) of Heidelberg University Hospital. The needles do not increase the heart’s pump function, but they seem to have an influence on skeletal muscle strength and thus can increase the walk distance that heart patients can cover. The results of the clinical study, which was conducted with a comparison group treated with placebo acupuncture using dull needles, have been published in the medical journal Heart.


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