- Email: [email protected]
Auricolotherapy and treatment of pain in musculoskeletal disorders
Oral Presentations / European Journal of Integrative Medicine 4S (2012) 9–123
27
OP-041
OP-042
A randomised control trial on the effectiveness of osteopathic manipulative treatment in reducing pain and improving the quality of life in elderly patients affected by osteoporosis
Overview of over 2500 Orthopaedics Clinical Cases treated with Homotoxicology
Papa Liria 1 , Mandara Alfonso 1 , Bottali Michele 1 , Gulisano Vincenzo 1 , Orfei Stefano 2 1 ICOM,
Cinisello Balsamo, Milan, Italy Martinelli, Cinisello Balsamo, Milan, Italy
2 Fondazione
Background: In the elderly population, a decrease in bone mineral density (osteoporosis) is often associated with a decrease in quality of life (QOL), an increase in self-reported body pain. This pain originates from the musculoskeletal system and can potentially affect different areas of the body. Aim: The aim of this study was to investigate the effect of osteopathic manipulative treatment (OMT) on self-reported pain and QOL in an elderly population using a randomised placebocontrolled trial. Methods: Patients were randomly assigned to either six sessions of OMT (OMT, n = 37) or an equivalent number of sham manipulative treatment sessions (SMT, n = 35). The main outcome variables were QOL measured by Quality of life questionnaire of the European Foundation for Osteoporosis41 (QUALEFFO-41) and overall bodily pain measured using a visual analogue scale (VAS). Data were analysed using a two-factor analysis of variance (ANOVA) (treatment × time) for repeated measurements with an α-level set at 0.05. Results: Overall, OMT significantly decreased disability compared to SMT. This effect was demonstrated by a significant interaction in the overall disability score (p = 0.001) and the Mental well-being (p = 0.058), Health perception (p = 0.005) and Pain (p = 0.003) QUALEFFO-41 subscales. There was no significant difference (no interaction) for pain as measured by VAS and for the Daily activities, Walking, Household cleaning and Leisure-time activities QUALEFFO-41 subscales (p > 0.05). No adverse effects were recorded during the study. Discussion: This study demonstrated that, in a group of elderly subjects affected by osteoporosis, OMT was able to increase self-reported QOL while the effect on body pain perception is unclear. This overall improvement in QOL appears to be caused by an improvement in psychological factors (i.e., Mental well-being and Health perception) rather than physical factors. In fact, all QUALEFFO-41 subscales related to physical function demonstrated no significant interaction. The effect of OMT on pain perception is less clear. In fact, there was no effect on pain as assessed by VAS, while a significant improvement was observed when the QUALEFFO-41 subscale was used. This could be due to the metric properties of the two pain measurement methods; an alternative explanation could be that VAS measures mainly pain quantity while QUALEFFO-41 subscales measure mainly pain quality. The lack of effect of OMT on physical function needs to be confirmed by more direct measurements of this variable. http://dx.doi.org/10.1016/j.eujim.2012.07.536
Borsalino Giovanni The use of homotoxicology in 2500 orthopaedic clinical cases is reported. Drawing on previous experience, the author underlines how conventional medicine too often deals, in particular in orthopaedics, with the somatic factor neglecting the psychic side, forgetting the absolute need for a psychosomatic view of the human being. Homotoxicology, through psycho-neuroendocrine-immunology (P.N.E.I.), overcomes such a dualism, even in an apparently only mechanical specialisation such as orthopaedics. Homotoxicology achieves remarkable therapeutic results in orthopaedics, thanks to the possibility of injecting drugs by means of infiltrations or mesotherapy. The case histories of over 2500 patients are presented, performed on the entire Locomotor Apparatus, showing the technique of approach to patients, the instrumental examinations employed and the drugs administered. Out of over 2500 treatments, more than 81% overall gave positive results, with a maximum of 90% for the cervical rachis and a minimum of less than 65% for the hip joint. Moreover, it is emphasised how homotoxicology, free from toxic side effects, not only allows the achievement of therapeutic results unthinkable until now, but also manages to eliminate a number of surgical operations, with both human and economic advantages. The overview concludes by highlighting that any orthopaedist having an open mind has the chance to obtain successful outcomes rapidly and to prove the effectiveness of homotoxicology. http://dx.doi.org/10.1016/j.eujim.2012.07.537 OP-043 Auricolotherapy and treatment of pain in musculoskeletal disorders Conti Tommaso 1 , Da Frè Monica 2 , Traversi Antonella 1 , Montelatici Roberto 1 , Terranova Filippa 1 , Monechi Valeria 1 , Baccetti Sonia 1 1 Fior di Prugna Referring Center for Complementary Medicine of Tuscany Region, Local Health Unit of Florence, Florence, Italy 2 Observatory of Epidemiology, Regional Health Agency of Tuscany, Florence, Italy
Background: Pain in musculoskeletal disorders is a commonly occurring problem that involves high social and individual costs. Side effects of painkillers limit their use. Systematic reviews and randomised controlled trials show that a number of treatments usually applied in this field are not effective; on the other hand, there is clinical evidence of the effectiveness of physical exercise, acupuncture and auricolotherapy. Aim: The aim of this project is to evaluate the effectiveness of auricolotherapy on the pain of patients suffering from chronic musculoskeletal disorders.
28
Oral Presentations / European Journal of Integrative Medicine 4S (2012) 9–123
Methods: The efficacy of a cycle of auricolotherapy was evaluated in 247 patients affected by musculoskeletal pain, in the Center of TCM Fior di Prugna (Local Health Unit of Florence) through a self-administered questionnaire (Numeric Pain Intensity Scale/NRS and Present Pain Intensity/PPI scale, at rest and during movement) before and at the end of treatment. The NRS scale ranges values from 0 (no pain) to 10 (the worst pain imaginable) and the PPI scale from 1 (absence of pain) to 5 (terrible pain). The therapeutic protocol includes the search for painful points in the ear through baresthesic diagnosis of the areas antihelix, helix, fossa anthelicis and navicular fossa of the ear (corresponding to spinal column and limbs) and a few general points of analgesic, antiphlogistic, myorelaxing and psychic types. The painful points in the ear (no more than seven) were treated unilaterally by needles (0.13 × 0.25) left in situ once a week for 20 min; afterwards permanent needles were applied for 1 week. Results: Before the treatment, the patients (183 females and 64 males; mean age 64.5 years, range 23–88 years) had a mean value of pain measured on the NRS scale of 5.0 at rest and 6.58 during movement; on the PPI scale, the median value was 3 at rest and 4 during movement. After the treatment, the mean values on the NRS scale were respectively 3 and 4.1, and the median on PPI scale, 2 and 2.5. On the NRS scale, there was at least 40% pain reduction in 139 subjects at rest (64.6%) and 133 (53.8%) during movement. On the PPI scale, the pain reduction was at least 1 point respectively in 72.1% and 68.4% of patients at rest and during movement. Conclusions: Auricolotherapy can be an effective and simple method to reduce pain in musculoskeletal disorders, also in combination with usual care. There is a need for randomised controlled trials to verify the efficacy of this protocol of treatment.
combining therapies aimed at correcting the structural changes caused by the syndrome, to restore the altered functions of these patients, influencing the behaviour towards healthy and active lifestyles. Therapy must cover all three levels in which this syndrome is structured: organic, functional and psychological. The structural alterations of the antinociceptive system can be contrasted with antidepressants than with electroacupuncture. Both these procedures erase the memory of pain and restore a central descending nociceptive inhibition by raising the pain threshold at physiological levels. The alterations of muscle function can be mitigated by warm baths and also by physical aerobic exercises, or stretching. Very useful are also some additions such as magnesium, L-carnitine, sulphur-adenosyl-methionine and antioxidants. The psyche of patients will be helped by antidepressants and electroacupuncture and also by behavioural or psychological therapies such as support groups and if necessary psychotherapy. Method: A total of 21 patients (20 females and one male), mean age 47.57 ± 12.20 years, affected by primary fibromyalgia from a mean period of 91.38 ± 86.49 months, were treated with an integrated approach: two sessions of electroacupuncture in a week, a dose of amitriptyline varying from 10 to 30 mg in the evening, a warm bath in the morning to counteract muscle rigidity, an hour a day of aerobic exercises with also stretching exercises, as well as supplements of magnesium, L-carnitine, sulphur-adenosyl-methionine and antioxidants. A support group for fibromyalgic patients was provided once a week. Results: The results show a significant decrease in pain, measured using the McGill Pain Questionnaire, which passes from the mean value of the total score of 34.76 ± 15:31 before the therapy to 14:19 ± 10.54 at the end of therapy. The pain relief lasted until the last measurement was made 6 months after the treatment.
http://dx.doi.org/10.1016/j.eujim.2012.07.538
http://dx.doi.org/10.1016/j.eujim.2012.07.539
OP-044
OP-045
Integrated approach to primary fibromyalgia treatment Francesco 1 ,
Giovanni 2 ,
Stefano 3 ,
Ceccherelli Asero Alzeni Lovato Antonello 4 , Rossato Massimo 5 , Gagliardi Giuseppe 6 1 A.I.R.A.S.
and FISA, Padua Belpasso (CT) 3 A.I.R.A.S., Florence 4 A.I.R.A.S., Lonigo, VI 5 International Federation of Stabilometry and Posturology Society FISA, A.I.R.A.S, CIES ITALIA, IASP, Padua 6 A.I.R.A.S., Spinea, Italy 2 A.I.R.A.S.,
Background: Fibromyalgia is a chronic painful syndrome that affects up to 6% of the world population. It is associated with sleep and mood disorders, fatigue and functional disability. Its pathogenesis involves a disorder of the central modulation of pain, impairment of the descending inhibitory system and hyperactivity of substance P. Because of the extensive symptomatology of patients with fibromyalgia and its multifactorial pathogenesis, its ideal treatment requires an integrated approach
Craniosacral therapy in chronic neck pain patients–a randomised sham-controlled trial Haller Heidemarie, Lauche Romy, Cramer Holger, Gass Florian, Rampp Thomas, Saha Felix, Dobos Gustav University of Duisburg-Essen, Chair of Complementary and Integrative Medicine, Essen, Germany Background: Chronic neck pain is a significant public health problem that cannot be solved just in terms of symptomatic medicine. One answer might be craniosacral therapy (CST) as an integrative approach in pain management and prevention. Until now, evidence for CST is known from clinical practice and quite a few scientific trials, but there are no randomised controlled trials on efficacy and safety with an appropriate control condition. Aim: This study aimed to investigate the effect of CST on chronic non-specific neck pain as compared to sham treatment. Methods: A total of 54 patients suffering from chronic nonspecific neck pain were randomised 1:1 to either a CST group
27
OP-041
OP-042
A randomised control trial on the effectiveness of osteopathic manipulative treatment in reducing pain and improving the quality of life in elderly patients affected by osteoporosis
Overview of over 2500 Orthopaedics Clinical Cases treated with Homotoxicology
Papa Liria 1 , Mandara Alfonso 1 , Bottali Michele 1 , Gulisano Vincenzo 1 , Orfei Stefano 2 1 ICOM,
Cinisello Balsamo, Milan, Italy Martinelli, Cinisello Balsamo, Milan, Italy
2 Fondazione
Background: In the elderly population, a decrease in bone mineral density (osteoporosis) is often associated with a decrease in quality of life (QOL), an increase in self-reported body pain. This pain originates from the musculoskeletal system and can potentially affect different areas of the body. Aim: The aim of this study was to investigate the effect of osteopathic manipulative treatment (OMT) on self-reported pain and QOL in an elderly population using a randomised placebocontrolled trial. Methods: Patients were randomly assigned to either six sessions of OMT (OMT, n = 37) or an equivalent number of sham manipulative treatment sessions (SMT, n = 35). The main outcome variables were QOL measured by Quality of life questionnaire of the European Foundation for Osteoporosis41 (QUALEFFO-41) and overall bodily pain measured using a visual analogue scale (VAS). Data were analysed using a two-factor analysis of variance (ANOVA) (treatment × time) for repeated measurements with an α-level set at 0.05. Results: Overall, OMT significantly decreased disability compared to SMT. This effect was demonstrated by a significant interaction in the overall disability score (p = 0.001) and the Mental well-being (p = 0.058), Health perception (p = 0.005) and Pain (p = 0.003) QUALEFFO-41 subscales. There was no significant difference (no interaction) for pain as measured by VAS and for the Daily activities, Walking, Household cleaning and Leisure-time activities QUALEFFO-41 subscales (p > 0.05). No adverse effects were recorded during the study. Discussion: This study demonstrated that, in a group of elderly subjects affected by osteoporosis, OMT was able to increase self-reported QOL while the effect on body pain perception is unclear. This overall improvement in QOL appears to be caused by an improvement in psychological factors (i.e., Mental well-being and Health perception) rather than physical factors. In fact, all QUALEFFO-41 subscales related to physical function demonstrated no significant interaction. The effect of OMT on pain perception is less clear. In fact, there was no effect on pain as assessed by VAS, while a significant improvement was observed when the QUALEFFO-41 subscale was used. This could be due to the metric properties of the two pain measurement methods; an alternative explanation could be that VAS measures mainly pain quantity while QUALEFFO-41 subscales measure mainly pain quality. The lack of effect of OMT on physical function needs to be confirmed by more direct measurements of this variable. http://dx.doi.org/10.1016/j.eujim.2012.07.536
Borsalino Giovanni The use of homotoxicology in 2500 orthopaedic clinical cases is reported. Drawing on previous experience, the author underlines how conventional medicine too often deals, in particular in orthopaedics, with the somatic factor neglecting the psychic side, forgetting the absolute need for a psychosomatic view of the human being. Homotoxicology, through psycho-neuroendocrine-immunology (P.N.E.I.), overcomes such a dualism, even in an apparently only mechanical specialisation such as orthopaedics. Homotoxicology achieves remarkable therapeutic results in orthopaedics, thanks to the possibility of injecting drugs by means of infiltrations or mesotherapy. The case histories of over 2500 patients are presented, performed on the entire Locomotor Apparatus, showing the technique of approach to patients, the instrumental examinations employed and the drugs administered. Out of over 2500 treatments, more than 81% overall gave positive results, with a maximum of 90% for the cervical rachis and a minimum of less than 65% for the hip joint. Moreover, it is emphasised how homotoxicology, free from toxic side effects, not only allows the achievement of therapeutic results unthinkable until now, but also manages to eliminate a number of surgical operations, with both human and economic advantages. The overview concludes by highlighting that any orthopaedist having an open mind has the chance to obtain successful outcomes rapidly and to prove the effectiveness of homotoxicology. http://dx.doi.org/10.1016/j.eujim.2012.07.537 OP-043 Auricolotherapy and treatment of pain in musculoskeletal disorders Conti Tommaso 1 , Da Frè Monica 2 , Traversi Antonella 1 , Montelatici Roberto 1 , Terranova Filippa 1 , Monechi Valeria 1 , Baccetti Sonia 1 1 Fior di Prugna Referring Center for Complementary Medicine of Tuscany Region, Local Health Unit of Florence, Florence, Italy 2 Observatory of Epidemiology, Regional Health Agency of Tuscany, Florence, Italy
Background: Pain in musculoskeletal disorders is a commonly occurring problem that involves high social and individual costs. Side effects of painkillers limit their use. Systematic reviews and randomised controlled trials show that a number of treatments usually applied in this field are not effective; on the other hand, there is clinical evidence of the effectiveness of physical exercise, acupuncture and auricolotherapy. Aim: The aim of this project is to evaluate the effectiveness of auricolotherapy on the pain of patients suffering from chronic musculoskeletal disorders.
28
Oral Presentations / European Journal of Integrative Medicine 4S (2012) 9–123
Methods: The efficacy of a cycle of auricolotherapy was evaluated in 247 patients affected by musculoskeletal pain, in the Center of TCM Fior di Prugna (Local Health Unit of Florence) through a self-administered questionnaire (Numeric Pain Intensity Scale/NRS and Present Pain Intensity/PPI scale, at rest and during movement) before and at the end of treatment. The NRS scale ranges values from 0 (no pain) to 10 (the worst pain imaginable) and the PPI scale from 1 (absence of pain) to 5 (terrible pain). The therapeutic protocol includes the search for painful points in the ear through baresthesic diagnosis of the areas antihelix, helix, fossa anthelicis and navicular fossa of the ear (corresponding to spinal column and limbs) and a few general points of analgesic, antiphlogistic, myorelaxing and psychic types. The painful points in the ear (no more than seven) were treated unilaterally by needles (0.13 × 0.25) left in situ once a week for 20 min; afterwards permanent needles were applied for 1 week. Results: Before the treatment, the patients (183 females and 64 males; mean age 64.5 years, range 23–88 years) had a mean value of pain measured on the NRS scale of 5.0 at rest and 6.58 during movement; on the PPI scale, the median value was 3 at rest and 4 during movement. After the treatment, the mean values on the NRS scale were respectively 3 and 4.1, and the median on PPI scale, 2 and 2.5. On the NRS scale, there was at least 40% pain reduction in 139 subjects at rest (64.6%) and 133 (53.8%) during movement. On the PPI scale, the pain reduction was at least 1 point respectively in 72.1% and 68.4% of patients at rest and during movement. Conclusions: Auricolotherapy can be an effective and simple method to reduce pain in musculoskeletal disorders, also in combination with usual care. There is a need for randomised controlled trials to verify the efficacy of this protocol of treatment.
combining therapies aimed at correcting the structural changes caused by the syndrome, to restore the altered functions of these patients, influencing the behaviour towards healthy and active lifestyles. Therapy must cover all three levels in which this syndrome is structured: organic, functional and psychological. The structural alterations of the antinociceptive system can be contrasted with antidepressants than with electroacupuncture. Both these procedures erase the memory of pain and restore a central descending nociceptive inhibition by raising the pain threshold at physiological levels. The alterations of muscle function can be mitigated by warm baths and also by physical aerobic exercises, or stretching. Very useful are also some additions such as magnesium, L-carnitine, sulphur-adenosyl-methionine and antioxidants. The psyche of patients will be helped by antidepressants and electroacupuncture and also by behavioural or psychological therapies such as support groups and if necessary psychotherapy. Method: A total of 21 patients (20 females and one male), mean age 47.57 ± 12.20 years, affected by primary fibromyalgia from a mean period of 91.38 ± 86.49 months, were treated with an integrated approach: two sessions of electroacupuncture in a week, a dose of amitriptyline varying from 10 to 30 mg in the evening, a warm bath in the morning to counteract muscle rigidity, an hour a day of aerobic exercises with also stretching exercises, as well as supplements of magnesium, L-carnitine, sulphur-adenosyl-methionine and antioxidants. A support group for fibromyalgic patients was provided once a week. Results: The results show a significant decrease in pain, measured using the McGill Pain Questionnaire, which passes from the mean value of the total score of 34.76 ± 15:31 before the therapy to 14:19 ± 10.54 at the end of therapy. The pain relief lasted until the last measurement was made 6 months after the treatment.
http://dx.doi.org/10.1016/j.eujim.2012.07.538
http://dx.doi.org/10.1016/j.eujim.2012.07.539
OP-044
OP-045
Integrated approach to primary fibromyalgia treatment Francesco 1 ,
Giovanni 2 ,
Stefano 3 ,
Ceccherelli Asero Alzeni Lovato Antonello 4 , Rossato Massimo 5 , Gagliardi Giuseppe 6 1 A.I.R.A.S.
and FISA, Padua Belpasso (CT) 3 A.I.R.A.S., Florence 4 A.I.R.A.S., Lonigo, VI 5 International Federation of Stabilometry and Posturology Society FISA, A.I.R.A.S, CIES ITALIA, IASP, Padua 6 A.I.R.A.S., Spinea, Italy 2 A.I.R.A.S.,
Background: Fibromyalgia is a chronic painful syndrome that affects up to 6% of the world population. It is associated with sleep and mood disorders, fatigue and functional disability. Its pathogenesis involves a disorder of the central modulation of pain, impairment of the descending inhibitory system and hyperactivity of substance P. Because of the extensive symptomatology of patients with fibromyalgia and its multifactorial pathogenesis, its ideal treatment requires an integrated approach
Craniosacral therapy in chronic neck pain patients–a randomised sham-controlled trial Haller Heidemarie, Lauche Romy, Cramer Holger, Gass Florian, Rampp Thomas, Saha Felix, Dobos Gustav University of Duisburg-Essen, Chair of Complementary and Integrative Medicine, Essen, Germany Background: Chronic neck pain is a significant public health problem that cannot be solved just in terms of symptomatic medicine. One answer might be craniosacral therapy (CST) as an integrative approach in pain management and prevention. Until now, evidence for CST is known from clinical practice and quite a few scientific trials, but there are no randomised controlled trials on efficacy and safety with an appropriate control condition. Aim: This study aimed to investigate the effect of CST on chronic non-specific neck pain as compared to sham treatment. Methods: A total of 54 patients suffering from chronic nonspecific neck pain were randomised 1:1 to either a CST group