Natural Standard Blog

Water Aerobics for Arthritis Pain

Aerobic and stretching exercises in warm water can bring some relief from pain caused by osteoarthritis of the hip or knee, as well as improve daily function, a new review suggests.

Danish researchers explained that clinical experience indicates that aquatic exercise may have advantages for osteoarthritis patients.

The study compared the effectiveness and safety of aquatic-exercise interventions in the treatment of knee and hip osteoarthritis.

Researchers searched MEDLINE from 1949, EMBASE from 1980, CENTRAL (Issue 2, 2006), CINAHL from 1982, Web of Science from 1945, all up to May 2006. There was no language restriction.

The review found that there is a lack of high-quality studies in this area. In total, six trials (800 participants) were included. At the end of treatment for combined knee and hip osteoarthritis, there was a small-to-moderate effect on function and a small-to-moderate effect on quality of life.

A minor effect of a three percent absolute reduction and 6.6 percent relative reduction from baseline was found for pain. There was no evidence of effect on walking ability or stiffness immediately after end of treatment. No evidence of effect on pain, function or quality of life was observed in the one trial including participants with hip osteoarthritis alone.

Only one trial was identified including knee osteoarthritis alone, comparing aquatic exercise with land-based exercise. Immediately after treatment, there was a large effect on pain, with 22 percent relative percent improvement, but no evidence of effect on stiffness or walking ability.

The review authors concluded that aquatic exercise appears to have some beneficial short-term effects for patients with hip and/or knee osteoarthritis while no long-term effects have been documented. Based on this, one may consider using aquatic exercise as the first part of a longer exercise program for osteoarthritis patients.

Furthermore, the researchers suggested that the controlled and randomized studies in this area are still too few to give further recommendations on how to apply the therapy, and studies of clearly defined patient groups with long-term outcomes are needed to decide on the further use of this therapy in the treatment of osteoarthritis.

For more information about integrative therapies for osteoarthritis, please visit Natural Standard’s Foods, Herbs & Supplements and Health & Wellness databases.

Chili Peppers for Pain

Researchers may have discovered a new hot-chili-pepper-based pain reliever, a new study reports.

Researchers from Massachusetts General Hospital and Harvard Medical School in Boston, Massachusetts, explained that most local anesthetics (pain relievers) used clinically are relatively hydrophobic molecules that gain access to their blocking site on the sodium channel by diffusing into or through the cell membrane. These anesthetics block sodium channels, and thereby, the excitability of all neurons, not just sensory neurons.

The study tested the possibility of selectively blocking the excitability of primary sensory nociceptor (pain-sensing) neurons by combining a derivative of the common anesthetic lidocaine with capsaicin, the ingredient that makes chili peppers hot. They injected the chemicals into the paws of rats and measured their ability to sense pain from a heat source. The study found that the animals were able to tolerate much more heat than usual.

Researchers then injected the anesthetic near the sciatic nerve of the rats and pricked their paws with nylon probes. The animals seemed to ignore the painful prick, but continued to move normally and responded to other stimuli.

The study authors concluded that the drug may be useful in surgical procedures and childbirth and may also eventually lead to more effective chronic pain treatments.

FDA: New Flu Vaccine Approved

The U.S. Food and Drug Administration (FDA) has approved Afluria®, an additional seasonal influenza vaccine for the immunization of people ages 18 and older.

According to the FDA, Afluria® is intended to protect adults from influenza type A and type B flu viruses. Influenza, commonly known as the flu, is a contagious respiratory illness that can cause annual epidemics.

Influenza viruses are transmitted through the air in tiny droplets when someone with the infection coughs, sneezes or talks. Individuals are then exposed to the virus through inhalation, or by contact with objects such as telephones, door handles, railings or computer keyboards. An infection may occur when the virus is then transferred to the eyes, nose or mouth.

Every year in the United States, an average five to 20 percent of the population gets the flu, and more than 200,000 people are hospitalized from flu complications, such as dehydration (loss of water), high fever (over 102 degrees Fahrenheit) and extreme fatigue. About 36,000 people die from flu every year.

Some patients, such as older people, young children and people with certain health conditions that lower immunity, including cancer, human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), are at high risk for serious flu complications. Children are two to three times more likely than adults to get sick with the flu.

The approval of Afluria®, which is manufactured by CSL Limited of Parkville, Australia, brings the number of seasonal influenza manufacturers licensed for the U.S. market to six, the FDA reports.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that the six manufacturers will supply a record 132 million doses of influenza vaccine for the 2007-2008 influenza season, based on current manufacturing trends.

The FDA suggested that it is best to be immunized as soon as the vaccine is available, usually in September. However, getting a flu shot any time during influenza season is also appropriate because the influenza season often peaks late.

The most commonly reported adverse events associated with Afluria® were tenderness, pain, redness and swelling at the injection site and headache, fatigue and muscle aches.

Afluria® contains inactivated influenza viruses grown in chicken eggs. People who are allergic to eggs or any other component of the vaccine should not receive Afluria®.

The vaccine is administered as a single injection in the upper arm, and is available in both a single-dose, preservative-free, pre-filled syringe and a multi-dose vial with thimerosal, a mercury derivative, as a preservative.

Physiotherapy Rehabilitation Following Spine Operations

Physiotherapy appears to be only slightly beneficial following disc herniation operations, a new study reports.

The goal of physical therapy, or physiotherapy, is to improve mobility, restore function, reduce pain and prevent further injury by using a variety of methods including exercises, stretches, traction, electrical stimulation and massage. Special tools are used, such as hot or cold packs, crutches, braces, treadmills, prosthetics, compression vests, computer-assisted feedback, lasers and ultrasound.

A disc herniation occurs when, as a disc degenerates, it herniates or extrudes back into the spinal canal. The weak spot in a disc is directly under the nerve root, and a herniated disc in this area puts direct pressure on the nerve often causing pain to spread down the patient's leg to the foot.

In disc hernation surgery, typically only the small portion of the disc that is pushing against the nerve root needs to be removed and the majority of the disc remains intact.

Researchers from Vienna Medical University in Austria conducted a three-group, randomized, single blinded, controlled trial investigating the effectiveness of physiotherapy-based rehabilitation starting one week after lumbar disc surgery.

In addition, the researchers tried to estimate the contribution of specific effects to the observed outcome (efficacy).

In the study, a total of 120 patients following first-time, uncomplicated lumbar disc surgery were randomly assigned to "comprehensive" physiotherapy, "sham" neck massage or no therapy. Before enrollment, all subjects completed a minimal physiotherapeutic intervention.

Physiotherapy was administered by experienced physiotherapists and consisted of 20 sessions per patient over 12 weeks. Masseurs administered "sham massage" to the neck. The amount of treatment time was equal to that of physiotherapy. The main outcome measure was the Low Back Pain Rating Score at six and 12 weeks, and 1.5 years after randomization. Secondary parameters were patients' overall satisfaction with treatment outcome and socioeconomic and psychologic measures.

Results of the study revealed a significantly better improvement in the physiotherapy group than in the untreated group. Low Back Pain Rating Score outcome, however, did not significantly differ between physiotherapy and "sham" therapy. There was a tendency toward significance between the sham therapy and no therapy.

Within the 1.5-year follow-up, Low Back Pain rating scales remained significantly improved compared with baseline, but there were no significant outcome differences. No statistically significant between-group differences were found for the secondary outcome parameters.

The study authors concluded that as compared with no therapy, physiotherapy following first-time disc herniation operation is effective in the short-term. However, because of the limited benefits of physiotherapy relative to "sham" therapy, it is open to question whether this treatment acts primarily physiologically in patients following first-time lumbar disc surgery, but psychological factors may contribute substantially to the benefits observed.

For more information on physiotherapy, please visit Natural Standard's Health & Wellness database.

Ginkgo for Anxiety

Ginkgo biloba, commonly used as an anti-dementia agent that enhances cognitive functioning and stabilizes mood in cognitively impaired elderly subjects, may also help treat anxiety related to cognitive decline, a new study reports.

Ginkgo biloba has been used medicinally for thousands of years. Today, it is one of the top selling herbs in the United States.

Ginkgo is used for the treatment of numerous conditions, many that are under scientific investigation. Available evidence demonstrates Ginkgo's efficacy in the management of intermittent claudication, Alzheimer's/multi-infarct dementia and "cerebral insufficiency" (a syndrome thought to be secondary to atherosclerotic disease, characterized by impaired concentration, confusion, decreased physical performance, fatigue, headache, dizziness, depression and anxiety).

Although not definitive, there is promising early evidence favoring the use of Ginkgo for memory enhancement in healthy subjects, altitude (mountain) sickness, symptoms of premenstrual syndrome (PMS) and reduction of chemotherapy-induced end-organ vascular damage.

Researchers from Germany conducted a study with 107 patients with generalized anxiety disorder (82 patients) or adjustment disorder with anxious mood (25 patients), according to the diagnostic and statistical manual of mental disorders, third edition - revised (DSM-III-R). The patients were randomized to daily doses of 480 milligrams EGb 761 (Ginkgo extract), 240 milligrams EGb 761 or placebo for four weeks.

Intention-to-treat (ITT) analyses were performed on the primary outcome measure, the Hamilton rating scale for anxiety, the secondary variables, the clinical global impression of change (CGI-C), the Erlangen anxiety tension and aggression scale (EAAS), the list of complaints (B-L') and the patient's global rating of change. The Hamilton rating scale for anxiety total scores decreased by -14.3 (+/-8.1), -12.1 (+/-9.0) and -7.8 (+/-9.2) in the high-dose EGb 761, the low-dose EGb 761 and the placebo group, respectively. Changes were significantly different from placebo for both treatment groups. Regression analyses revealed a dose-response trend.

The study authors concluded that the Ginkgo extract (EGb 761) was significantly superior to placebo on all secondary outcome measures. It was safe and well tolerated and may thus be of particular value in elderly patients with anxiety related to cognitive decline.

For more information on Ginkgo biloba, please visit Natural Standard's Foods, Herbs & Supplements database.

Magnet Therapy for Pain

A new study investigated the use of static magnets for pain relief and found them to be ineffective.

The use of magnets to treat illness has been described historically in many civilizations and was suggested by ancient Egyptian priests and in the 4th century BC by Hippocrates.

In modern times, magnetic fields play an important role in Western medicine, including use for magnetic resonance imaging (MRI), pulsed electromagnetic fields and experimental magnetic stimulatory techniques.

The magnetic field from permanent (static) magnets is different from electromagnetic radiation and may have different effects on the body. There are numerous published theories regarding the possible medicinal value of static magnets or electromagnetic fields, although high-quality scientific research is lacking.

Proposed mechanisms include: effects on blood vessels (improvements in blood circulation, increases in oxygen content of the blood, alkalinization of bodily fluids, decreases in blood vessel wall deposition of toxic materials or cholesterol plaques, relaxation of blood vessel due to effects on cellular calcium-channels), effects on the nervous system (alterations in nerve impulses, blockage of nerve-cell conduction), reduction of edema (fluid retention), increases in local tissue oxygen, increases in endorphins, relaxation of muscles, changes in cell membranes or stimulation of acupoints (similar to the proposed activity of acupuncture needles).

Researchers from Peninsula Medical School, Universities of Exeter and Plymouth in the United Kingdom explained that static magnets are marketed with claims of effectiveness for reducing pain, although evidence of scientific principles or biological mechanisms to support such claims is limited.

The systematic review and meta-analysis assessed the clinical evidence from randomized trials of static magnets for treating pain. Systematic literature searches were conducted from inception to March 2007 for the following data sources: MEDLINE, EMBASE, AMED (Allied and Complementary Medicine Database), CINAHL, Scopus, the Cochrane Library and the UK National Research Register. All randomized clinical trials of static magnets for treating pain from any cause were considered. Trials were included only if they involved a placebo control or a weak magnet as the control, with pain as an outcome measure.

Twenty-nine potentially relevant trials were identified. Nine randomized placebo-controlled trials assessing pain with a visual analogue scale were included in the main meta-analysis; analysis of these trials suggested no significant difference in pain reduction.

The researchers concluded that the evidence does not support the use of static magnets for pain relief, and therefore magnets cannot be recommended as an effective treatment. However, for osteoarthritis, the evidence is insufficient to exclude a clinically important benefit, creating an opportunity for further investigation.

For more information on magnet therapy, please visit Natural Standard's Health & Wellness database.

Herbal Medicines in Early Drug Development for the Treatment of HIV Infections and AIDS

A new review study investigated the effects of herbal medicine in patients with HIV and AIDS and found some benefit.

Researchers from Beijing University of Chinese Medicine in China systematically assessed the beneficial and harmful effects of herbal medicines in people with HIV infection and AIDS.

Based on a Cochrane review and updated searches, they identified the available evidence on herbal medicines compared with placebo or antiretroviral drugs in patients with HIV infection, HIV-related disease or AIDS.

Ten randomized controlled trials, involving 571 individuals with HIV infection or AIDS, met the inclusion criteria.

The authors noted that some herbal medicines, such as IGM-1, seem to be effective in symptom improvement, but generally no significant effect on antiviral or immunity enhancement among reviewed herbs was seen.

The authors reported that combined treatment of Chinese herbal medicine, SH and antiretroviral agents showed increased antiviral benefit compared with antiretrovirals alone.

The study authors concluded that there may be beneficial effects from some of the tested herbs but more evidence from larger studies is needed to support this evidence in the future.

For more information on integrative treatment options for HIV/AIDS, please visit Natural Standard's Medical Conditions and Comparative Effectiveness databases.

Resveratrol for Cancer Prevention

A new study investigated the clinical benefits of resveratrol, a naturally occurring polyphenol identified in over 70 plant species including nuts, grapes, pine trees, certain vines and red wine, and found it to have cancer preventative (chemopreventative) properties.

Resveratrol is thought to play a role in the prevention of heart disease. A substantial amount of attention has been directed in recent years toward resveratrol for its potential health benefits in humans due to investigation of the French paradox that coronary heart disease mortality in France is lower than observed in other industrialized countries with a similar risk factor profile due to the frequent consumption of red wine.

Resveratrol has been shown in animal and laboratory studies to exhibit antioxidant, anticancer, antiproliferative, antifungal, antiviral and antibacterial effects. Being a constituent of grapes and wines, initial work was focused on linking resveratrol to the beneficial cardiovascular effects of moderate wine intake. However, studies have expanded to examine its effects in a variety of conditions, including various cancers, bacterial infections, fungal infections, viral infections, amyotrophic lateral sclerosis, diabetic polyneuropathy, Alzheimer's disease, Parkinson's disease, chronic obstructive pulmonary disease (COPD) and acute pancreatitis.

Researchers from the University of Texas Health Science Center noted that resveratrol has been shown to possess chemopreventive properties against several cancers and cardiovascular diseases. Recently, resveratrol has been shown to have positive effects on age longevity, lipid levels and a preventative quality against certain cancers and viral infections.

The study explained that resveratrol induces apoptosis (cell death) by up-regulating the expression of certain proteins and simultaneously down-regulating the expression of others. Resveratrol causes growth arrest at G1 and G1/S phases of cell cycle by inducing the expression of CDK inhibitors p21/WAF1/CIP1 and p27/KIP1.

Resveratrol has also been shown to reduce inflammation via inhibition of prostaglandin production, cyclooxygenase-2 activity and nuclear factor-kappaB activity. Modulation of cell signaling pathway by resveratrol explains its diverse bioactivities related with human health. Resveratrol also potentiates the apoptotic effects of cytokines, chemotherapeutic agents and gamma-radiation.

Pharmacokinetic and pharmacodynamic studies demonstrated that the main target organs of resveratrol are the liver and kidney, and it is metabolized by hydroxylation, glucuronidation, sulfation and hydrogenation.

As a chemoprevention agent, resveratrol has been shown to inhibit tumor initiation, promotion, and progression.

The review authors concluded that there is growing evidence that resveratrol can prevent or delay the onset of various cancers, heart diseases, ischemic and chemically induced injuries, pathological inflammation and viral infections.

For more information on resveratrol, please visit Natural Standard's Foods, Herbs & Supplements database.

Mediterranean Diet and Rheumatoid Arthritis

A new study found that a community-based intervention promoting a Mediterranean-type diet in patients with rheumatoid arthritis may be effective in relieving some of the symptoms of the disease through a healthier diet.

The Mediterranean diet is rich in heart-healthy fiber and nutrients, including omega-3 fatty acids and antioxidants. The diet generally includes: fruits, vegetables and unsaturated "good" fats, particularly olive oil. Olive oil has been associated with benefits such as lower blood pressure and a lower risk for heart disease. In addition, olive oil may benefit people with type 2 diabetes.

The Mediterranean diet is based on the healthy eating and lifestyle habits of the people living in southern Italy, the Greek island of Crete and other areas of Greece in the early 1960s.

The diet has become a popular area of study due to observations made in the 1960s of low incidences of chronic diseases, such as heart disease and high cholesterol. Additionally, high life-expectancy rates exist among populations who consumed a traditional Mediterranean diet. Therefore, the Mediterranean diet gained much recognition and worldwide interest in the 1990s as a model for healthful eating.

Proponents claim that the Mediterranean diet can be used to decrease the risk of heart-related problems such as high blood pressure, high cholesterol, heart attacks and Alzheimer's disease.

Researchers from Glasgow Royal Infirmary Castle Street in the United Kingdom suggested that the Mediterranean diet may benefit individuals with rheumatoid arthritis.

The study sought to overcome obstacles to healthy eating by a community-based intervention promoting a Mediterranean-type diet in patients with rheumatoid arthritis living in socially deprived areas of Glasgow.

In the study, 130 female patients with rheumatoid arthritis aged 30-70 years (median 55) and a disease duration of eight years were recruited from three hospital sites. The intervention group (75 participants) attended weekly two-hour sessions for six weeks in the local community, including hands-on cooking classes backed up with written information. The control group (55 participants) was given dietary written information only. Both groups completed food frequency questionnaires and clinical and laboratory measures were assessed at baseline, three and six months.

Significant benefit was shown in the intervention group compared with controls for patient global assessment at six months, pain score at three and six months, early morning stiffness at six months and Health Assessment Questionnaire score at three months.

Analysis of the food frequency questionnaires showed significant increases in weekly total fruit, vegetable and legume consumption and improvement in the ratio of monounsaturated:saturated fat intake and systolic blood pressure in the intervention group only. The cooking classes were positively received by patients and tutors.

The study authors concluded that a six week intervention may improve consumption of healthier foods. If implemented more widely, the authors suggested that it may prove a popular, inexpensive and useful adjunct to other rheumatoid arthritis treatment.

For more information on the Mediterranean diet, please visit Natural Standard's Health & Wellness database.

Falling for CAM

Recent studies indicate the growing popularity of Complementary and Alternative Medicine (CAM), as both the general public and healthcare sector fall for new integrative possibilities.

A review conducted by researchers at the Universities of Exeter and Plymouth in the United Kingdom expressed concern over the need for more clinical, scientific evidence and trials in CAM journals.

The authors explained that previous research suggested that CAM journals publish few clinical trials, systematic reviews and meta-analyses and a high proportion of positive articles.

The study described the content of major CAM journals in 2005 and compared key findings with secondary data from previous years.

The study found that there is an apparent shift away from effectiveness research in CAM journals. The authors suggested that further investigation is needed as well as comparisons with other journals. The large proportion of positive articles published in CAM journals appears to not adequately reflect the best available evidence on the effectiveness of these therapies. This has implications for those using CAM journals as their main source of information in this area.

Another study conducted by scientists at the Université de Sherbrooke in Canada explained that the use of complementary and alternative medical therapies is common and increasing, particularly for children with chronic disease.

Researchers explained that the purpose of their study was to describe the use of CAM by children and to identify factors that may influence the use of CAM.

The cross-sectional descriptive study included children who were visiting a pediatric outpatient clinic. Parent's satisfaction about primary care was evaluated with the Parent's Perceptions of Pediatric Primary Care Quality questionnaire.

The study found that 54 percent of children used at least one type of CAM in the previous year. No sociodemographic characteristic difference was found between user and nonuser groups. Children most often used CAM to treat musculoskeletal problems (27 percent), psychological problems (24percent) or infections (20 percent).

Factors that influenced CAM use were "word of mouth" (36 percent), "reference by a physician" (28 percent), "personal experience by parents" (28 percent) and "no adequate resources in 'traditional' medicine" (21 percent).

Forty-seven percent of CAM users used prescribed medications simultaneously. Most users (75 percent) believed that CAM had no potential adverse effects or interactions with prescribed medication. Only 44 percent of CAM users were known as such by their physician. The primary care satisfaction was significantly lower in CAM users versus nonusers. Parents of CAM users were less satisfied in the areas of accessibility, knowledge of the patient and communication.

The study authors concluded that it is important that physicians systematically elicit families' expectations of treatment and be aware of the range of therapies used by children.

Finally, researchers at Oregon Health & Science University School of Medicine in Portland, Oregon conducted a survey containing a variety of assessments of attitudes toward CAM and the personality traits of adventurousness and tolerance to ambiguity among students entering four Portland, Oregon doctoral-level health professional schools and an allopathic medical school in the Upper Midwest (University of Nebraska College of Medicine) during the 2004-2005 academic year.

Students of naturopathy (63 students) and Oriental Medicine (71 students) were the most "CAM positive," adventurous and tolerant of ambiguity, and Midwestern allopathic medical students (58 students) the least. In general, chiropractic students (89 students) and allopathic medical students from the Pacific Northwest (95 students) were intermediate in CAM attitudes between these two groups. Female students were more "CAM positive" in all schools compared to male students.

The study authors concluded that students have high levels of interest in CAM upon entrance to their schools. Health professional discipline, geographic location, personality qualities and gender appear to influence CAM attitudes in entering students.

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