Ibuprofen inducing kidney damage

NSAID-ibuprofen-pills-300x199

A new study published in the July 2017 edition of Emergency Medicine Journal —— Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial

The findings are:

  • Kidney injury was quite common. About 44% of these ultramarathoners experienced significantly reduced kidney function by the end of the race.
  • Kidney injury was more common among those taking ibuprofen. Just over half of the NSAID-takers had reduced kidney function, while about one-third of those in the placebo group did. Despite these findings, the differences in rates of kidney injury were not statistically significant.
  • The severity of kidney injury was greater in the ibuprofen group.
  • A faster finish and greater weight loss during the race (likely due to greater dehydration) increased the likelihood of kidney injury.

Ibuprofen and related medications (called non-steroidal anti-inflammatory drugs, or NSAIDs) are used for a number of conditions, including arthritis, back pain, and headache.

More than a dozen different NSAIDs are available, including naproxen (as in Naprosyn or Aleve), celecoxib (Celebrex), diclofenac (Voltaren) and indomethacin (Indocin). Aspirin is also an NSAID, though it is usually taken in small doses for its blood thinning effects (to prevent heart attack or stroke) rather than for pain.

The safety profile of NSAIDs is generally quite good,  but still they can cause trouble.

  • Upset stomach
  • intestinal bleeding
  • cardiovascular problems
  • The risk of heart attack may be increased among users of NSAIDs, especially among those at increased risk (such as those who have had a previous heart attack).
  • Plus, kidney injury.

So what?

If you are taking an NSAID regularly, you should be having regular blood monitoring, including measures of kidney function. And if you have significant kidney disease, you should probably avoid non-aspirin NSAIDs altogether. Ask your doctor whether you are a good candidate for NSAID use. They can be quite helpful, and many of their side effects can be avoided with proper precautions.

from Harvard Health Publications —— Is it safe to take ibuprofen for the aches and pains of exercise?

Acupuncture Found Effective for Chronic Fatigue Syndrome

chronic-fatigue-symptoms

Chronic fatigue syndrome is defined as an illness characterized by severe disabling fatigue lasting for at least six months that is worsened by minimal physical or mental exertion. In the sphere of biomedicine, no definitive etiology has been identified. There are no key features or typical symptoms, but a sore throat, depression, and myalgia may all be present.

The biomedical etiology of chronic fatigue syndrome (CFS) remains unclear. However, it has been suggested that psychological and social factors, viral loads, and immune system dysfunction may contribute to the condition. Previous studies find that CFS may be associated with a bias towards a Th2 type of response in Th1/Th2 immune balances. Acupuncture’s ability to balance Th1 and Th2 may be one mechanism responsible for its effective action in the treatment of CFS.

Major causes of suffering include pain, paralysis, mental illness, nausea, immune system imbalances, and fatigue. CFS and other clinical scenarios involving severe fatigue are a significant source of suffering and may be as severe as any other form of illness or complication. One concern is that since there is no clearly defined etiology within hospital medicine for CFS, patients may be marginalized or receive incomplete care.

There are instances in which patients are given psychiatric medications without addressing the biophysical sources of CFS. This focus on treating only the symptom and not the root cause of CFS potentially leads to prolonged suffering. Given the results of the research data, acupuncture with moxibustion is a reasonable treatment option, referable by primary healthcare physicians.

The study involved 133 voluntary patients from the Beijing Chaoyang Fatou Community Health Service Center. All were diagnosed with CFS. Inclusion criteria were established based on the CDC (US Centers for Disease Control and Prevention) criteria for CFS and included the following:

  • Experienced unexplained persistent or relapsing chronic fatigue for more than six months, which is not substantially alleviated by rest, and results in substantial reduction in previous levels of occupational, educational, social, or personal activities. [6]

In addition, the aforementioned is concurrent with four or more of the following symptoms:

  • Substantial impairment in short-term memory or concentration
  • Sore throat
  • Tender lymph nodes
  • Muscle pain
  • Multi-joint pain without swelling or redness
  • Headaches of a new type, pattern, or severity
  • Unrefreshing sleep
  • Post-exertional malaise lasting more than 24 hours

The acupoints selected for the acupuncture and acupuncture plus moxibustion groups were the following:

  • GV20 (Baihui)
  • CV17 (Danzhong)
  • CV6 (Qihai)
  • CV4 (Guanyuan)
  • ST36 (Zusanli)
  • SP6 (Sanyinjiao)
  • LI4, LV3 (Siguan: Hegu plus Taichong)

The results indicate that warm needling acupuncture or standard acupuncture is more effective than sham acupuncture. The study by Lu et al., mentioned in this report, demonstrates that acupuncture is safe and effective for the treatment of chronic fatigue syndrome. Important features of TCM protocols are that they produce a high total effective rate without any significant adverse effects.

original article —— Healthcare Medicine Institute

 

 

Acupuncture Cuts Postoperative Pain after Neck Surgery

neiguan shousanli

Acupuncture is effective for pain relief after surgery of the cervical spine. Researchers find electroacupuncture applied to acupoints Hegu (LI4) and Neiguan (PC6) safe and effective for achieving significant pain relief. Surgery on the anterior cervical spine is a complex procedure. Analgesics including fentanyl and sufentanil may be used to alleviate postoperative pain. However, due to concerns regarding respiratory depression, they are often prescribed at low dosages leading to only a partial painkilling effect. The results of the perioperative research finds acupuncture effective for pain relief and for stabilizing hemodynamics during surgery. 

Acupuncture point Hegu is traditionally used by licensed acupuncturists to relieve pain and dredge the acupuncture meridians. Neiguan is used by licensed acupuncturists to calm the shen (spirit), which has a tranquillising effect. Neiguan is also used to regulate the heartbeat, alleviate nausea, and to reduce pain. Together, these acupoints may be used to relieve pain in patients undergoing cervical spine surgery. Using electroacupuncture at the acupoint sites has the advantage of providing continuous acupoint stimulation, effectively relieving pain and reducing the required dosage of opioid analgesics. Moreover, it is a straightforward procedure to administer with minimal risk of adverse effects.

Foshan Chinese Medicine Hospital researchers (Zhou et al.) find that electroacupuncture significantly reduces the dosage of remifentanil and propofol required during surgical anaesthesia. The researchers determined that electroacupuncture produces additional benefits during surgery, heart rate and mean arterial blood pressure are more stable when electroacupuncture is applied. Postoperatively, patients in the electroacupuncture study group regained consciousness more quickly and had a shorter extubation (endotracheal tube removal) period compared with the control group that did not receive acupuncture.

Visual analogue scale (VAS) and Ramsay evaluations were used to measure pain and sedation. The evaluations were taken immediately after extubation and again at 2, 4, 8, 12 and 24 hours after extubation. The results showed significant positive patient outcomes for patients receiving electroacupuncture. For example, at 4 hours after extubation, the electroacupuncture group achieved better sedation and pain relief than the control group.

In the control group, 6 patients experienced nausea, vomiting, constipation and other adverse effects while only 1 patient in the electroacupuncture group experienced these issues. Electroacupuncture was applied perioperatively. The frequency of patient controlled analgesic administration was recorded for 24 hours after surgery. The control group self-administered analgesics a total of 116 times while the electroacupuncture group self-administered only 21 times. The researchers note that electroacupuncture stimulation reduced the overall need for pharmaceutical analgesics. The results indicate that electroacupuncture significantly reduces pain following surgery.

Zhou W, Chen YX & Ou JY. (2014). Electroacupuncture on Hegu Point and Neiguan Point to Treat Acute Pain after Surgery on Anterior Cervical Spine. World Journal of TCM. 9(4).

Acupuncture for treating migraine

migraine

Lately, one of our patients had great result of treating migraine by acupuncture. The patient was in a severe migraine attack when she presented in our clinic one month ago, had instant relief afterwards, and has been migraine-free ever since! 

Here are some information about migraine from National Health Services.

A migraine is usually a moderate or severe headache felt as a throbbing pain on one side of the head. In some cases, the pain can occur on both sides of head and may affect face or neck.

Other symptoms commonly associated with a migraine include:

  • nausea
  • vomiting
  • increased sensitivity to light and sound – which is why many people with a migraine want to rest in a quiet, dark room

Migraine is a common health condition, affecting around 1 in every 5 women and around 1 in every 15 men. They usually begin in early adulthood.

—————————————————————————————————————————————–

Click here to see the advices from Harvard Medical Publications regarding migraine prevention.

—————————————————————————————————————————————–

Here are some evidence of the effectiveness of acupuncture for migraine: 

With increasing scientific evidence for the effectiveness of acupuncture, the Royal London Homoeopathic Hospital has concentrated on the challenge of providing NHS acupuncture on the scale and frequency required to treat the large number of sufferers with chronic painful conditions including headache and migraine, facial pain, back and neck pain and knee osteoarthritis. —— The Migraine Trust in UK

The available evidence suggests that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches. Contrary to the previous findings, the updated evidence also suggests that there is an effect over sham, but this effect is small. The available trials also suggest that acupuncture may be at least similarly effective as treatment with prophylactic drugs. Acupuncture can be considered a treatment option for patients willing to undergo this treatment. As for other migraine treatments, long-term studies, more than one year in duration, are lacking. —— Cochrane Review

A sound body of evidence exists supporting the use of acupuncture for migraine prophylaxis. Acupuncture is at least as effective as prophylactic drug therapy for migraine and it is safe, long-lasting and cost-effective. Although there seems to be little difference between the two, Chinese acupuncture points might be marginally more effective than non-Chinese points. —— The role of acupuncture in the treatment of migraine. CMAJ. 2012 Mar 6; 184(4): 391–392.

The literature reports on the successful treatment of migraine with acupuncture. Although none of the studies made to date fulfil the necessary quality criteria, there is no doubt about the efficacy of acupuncture in the treatment of migraine. —— Value of acupuncture in treatment of migraine. Anaesthesiol Reanim. 1995;20(6):150-2.

Verum acupuncture treatment is more effective than sham acupuncture based on either Chinese or Western nonacupoints in reducing the discomfort of acute migraine. Verum acupuncture is also clearly effective in relieving pain and preventing migraine relapse or aggravation. These findings support the contention that there are specific physiological effects that distinguish genuine acupoints from nonacupoints. —— Acupuncture for treating acute attacks of migraine: a randomized controlled trial. Headache. 2009 Jun;49(6):805-16.

Among patients with migraine without aura, true acupuncture may be associated with long-term reduction in migraine recurrence compared with sham acupuncture or assigned to a waiting list. —— The Long-term Effect of Acupuncture for Migraine ProphylaxisA Randomized Clinical Trial. JAMA Intern Med. 2017;177(4):508-515. 

 

Can the weather really worsen arthritis pain?

rain=pain

Many arthritis sufferers notice that the weather affects their symptoms. They might say, “Who needs weather report when you have arthritis?”

If it’s true that the weather can worsen arthritis pain, how does that work?

Is there any scientific evidence to explain it?

These questions have been asked for many years without good answers, although researchers are keeping trying to understand it better.

Here are some answers from Harvard Health Publications.

“Past studies examining the effect of rain, humidity, and other weather-related factors on symptoms of arthritis have been inconclusive, and in some cases, contradictory.”

A dutch research involving 222 participants with “wear-and-tear” type of arthritis, found that “over a two-year period, pain and stiffness were slightly worse with rising barometric pressure and humidity, although the overall average impact was small.”

Another study included more than 800 adults living in one of six European countries and who had osteoarthritis of the hip, knee, or hands. It concluded that “higher humidity was linked with increasing pain and stiffness, especially in colder weather.”

 

Coincidentally, or not coincidentally, according to Chinese Medicine theory, there are six pathogenic factors – wind, coldness, dryness, wetness(high humidity), heat and fire, and the main factors leading to joint pain are wind, coldness and wetness. This is recorded in classical books like Huangdi Neijing (Inner Canon of the Yellow Emperor) and modern teaching textbooks. 

Scoliosis

scoliosis

Scoliosis is a sideways curvature of the spine.

You probably don’t look directly at spines often, but you might notice that some people have uneven shoulders or hips when they are standing.

The angle of the curve may be small, large or somewhere in between. But anything that measures more than 10 degrees is considered scoliosis.

Symptoms:

Scoliosis doesn’t normally improve without treatment, but it isn’t usually a sign of anything serious and treatment isn’t always needed if it’s mild. Symptoms can vary from mild to severe.

  • Uneven shoulders
  • One shoulder blade that appears more prominent than the other
  • the ribs sticking out on one side
  • Uneven waist
  • One hip higher than the other
  • leaning to one side
  • a visibly curved spine
  • Some people with scoliosis may also have back pain. This tends to be more common in adults with the condition.

Causes:

In around 80% cases, the cause of scoliosis is unknown. It appears to involve hereditary factors, because the disorder tends to run in families. It may be caused by:

  • Underlying nerve or muscle condition, such as cerebral palsy or muscular dystrophy
  • Birth defects affecting the development of the bones of the spine
  • Injuries to or infections of the spine
  • Wear and tear of the spine with age – this is called degenerative scoliosis, which affects older adults

Management:

Treatment for scoliosis depends on the age, how severe the curve is, and whether it’s likely to get worse with time.

  • Braces
  • Pain relief, such as painkillers, spinal injections.
  • Electrical stimulation of muscles
  • Surgery

It’s not clear whether back exercises help improve scoliosis, but general exercise is good for overall health and shouldn’t be avoided unless advised by your doctor.

See your GP if you think you or your child has scoliosis. It’s unlikely that there’s anything seriously wrong, but it’s best to get checked out.

Sources: National Health Service. Mayo Clinic.

Acupuncture is an option for pain relief and electrical stimulation of muscles.

 

Pregnancy-related back/pelvic/hip pain

pregnacy back pain

Acupuncture is a safe non-pharmaceutical treatment, and highly effective in treating pregnancy-related back/pelvic/hip pain. 

The use of maternity acupuncture within a New Zealand public hospital: Integration within an outpatient clinic

Debra Betts RN, BHSc, PhD • Jo McMullan RCpN, BM, DPH • Leonie Walker PhD, Dip Ac, MBAC

ABSTRACT

Background: In June 2008, a maternity acupuncture service began operating within a Hutt Valley Hospital outpatient department, offering access to free acupuncture care for pregnancy and postnatal related conditions. This was the first and, to date, the only clinic of this type within a New Zealand hospital.

Objective:To retrospectively describe and analyse routinely collected data from 2013 and 2014, on treatment delivered in this clinic. Specifically we report on the number of women treated, their presenting condition, referral patterns and patient centred outcomes for those women presenting with back or pelvic/hip pain.

Methods: Data on the primary reason for seeking acupuncture and referral pathway were collected on a woman’s initial visit. For those women presenting with back or pelvic/hip pain, a Measure Yourself Medical Outcome Profile (MYMOP) form was also completed, with a follow-up form completed on each subsequent visit until discharge.

Findings: Two hundred and sixty-one women received treatment. The majority were referred through Lead Maternity Carer (LMC) midwives and were requesting acupuncture treatment for labour preparation, back or pelvic/hip pain. MYMOP reporting demonstrated a high level of patient satisfaction, with 80% of women reporting a change in their pain that was clinically significant.

Conclusion: Data from this clinic illustrate a successful partnership between mainstream and complementary medicine, offering integrated healthcare to women in a public health system. Acupuncture offered a non-pharmaceutical treatment option and for those with back or pelvic/hip pain delivered high levels of patient satisfaction. It is hoped that this article will stimulate further interest in the under-researched area of maternity acupuncture.

Source: New Zealand College of Midwives Journal • Issue 52 • 2016