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Treatment of knee osteoarthritis utilising hirudo medicinalis—Effects on clinical pain and mechanical sensory thresholds
Satellite Symposia / European Journal of Integrative Medicine 2 (2010) 165–172
From a biochemical perspective, optimal nutrition implies an adequate supply of nutrients and energy to all tissues as required by the prevailing metabolic situation. From a psychological point of view nutrition involves the sensations of choosing, preparing, eating and digesting foods. From a sociological perspective nutrition involves social bonding while talking about food and while eating. These different areas of individual need should be recognized and put into the focus of nutritional screening, assessment and care. Several simple but valid screening tools for detecting individuals with impending or active malnutrition are established and screening should be used in all oncological patients. Objective assessment of basic nutritional parameters should best be performed once in all and repeatedly in at-risk patients; this includes at least the usual and the current body weight, height, recent changes in body weight, energy intake, appetite score, performance index and the level of an acute phase protein to estimate systemic inflammatory activation. Psychological and social problems related to nutritional status or functions probably are best detected during a structured interview by an experienced nutritionist. Requirements of energy, fluids, macro- and micronutrients should be known and deficits should be minimized by avoiding and treating nausea, anorexia and gastrointestinal dysfunctions. Attention should be paid to metabolic derangements like metabolic syndrome, systemic inflammation and treatment-induced hyperglycemia. Chronic pain and psychological problems should be relieved carefully and as much as possible. It should be attempted to stabilize or reorganize social contacts and communications that may be deranged by nutritional defects and deficits.
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a consultation and patient involvement in the decision-making process. The different concept of medicine could imply a different approach to knowledge and implementation of SDM by the health professionals resulting in different levels of occupational satisfaction. Methods: The study design was a qualitative analysis of guideline-based interviews which were performed with 30 general and nonmedical practitioners in the Leipzig area between January and April 2008. On this behalf, participants were divided into three groups: conventional general practitioners (COM), general practitioners with mainly complementary and alternative practice (CAM) and nonmedical practitioners (HP). Ten participants of each group were randomly chosen for the interview. The interviews enclosed questions concerning (1) attitude towards and implementation of patient involvement in medical decisionmaking, (2) basic and political conditions as well as feasibility of SDM, (3) patient as well as physician and practitioner factors promoting and restraining SDM, (4) occupational satisfaction especially in respect of a sufficient patient-health professionalrelationship, (5) differences in decision-making in conventional medicine and complementary and alternative medicine. Results and conclusions: Are expected by November 2010. doi:10.1016/j.eujim.2010.09.223 Treatment of knee osteoarthritis utilising hirudo medicinalis—Effects on clinical pain and mechanical sensory thresholds M. Müller a,b,∗ , R. Lauche c , H. Schleenbecker a , R. Lüdtke d , F. Musial c , G. Dobos c , M. Lengsfeld b a
doi:10.1016/j.eujim.2010.09.222 Science for Students The patient–health professional-relationship in conventional versus complementary and alternative medicine S. Länger, J. Ernst ∗ , E. Brähler University of Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany Background: Patient involvement gains more importance in medical decision-making. The traditional paternalistic decisionmaking model is replaced by a bilateral concept known as Shared Decision Making (SDM). This process implicates an interaction wherein patient and health professional act as equal partners in terms of diagnostic and therapeutic decisions. By incorporating patients’ concerns, preferences and perspectives SDM has been advocated to be a decisive factor for a more faithful patient–health professional-relationship, for greater patient confidence and higher efficiency in health care. Objective: The focal idea of this study was: How does the different concept of medicine, conventional versus complementary and alternative medicine, influence the relationship between patient and health professional, particularly the arrangement of
Rheumazentrum Mittelhessen, Bad Endbach, Germany of Marburg, Department of Orthopaedics and Rheumatology, Marburg, Germany c Kliniken Essen-Mitte, Academic Teaching Hospital, Department of Internal and Integrative Medicine, Essen, Germany d Karl and Veronica Carstens Foundation, Essen, Germany b University
Osteoarthritis of the knee is one of the most common chronic diseases in the western world. The most prominent afflictions are pain followed by constrained movement up to immobility and a corresponding reduction in quality of life. Previous randomized studies have shown a significant pain reduction using leaches for the treatment of knee osteoarthritis compared to placebo or standard therapy (topical diclofenac regimen). Based on the results of previous studies, the objective of this pilot study designed as a case series was to explore psychophysical measures of local pain perception at the knee in order to evaluate the effectiveness of leeches in the treatment of knee osteoarthritis. The measures are subtests obtained from the QST (Quantitative sensory testing) protocol, namely the measurement of the MDT (mechanical detection threshold), the VDT (vibration detection threshold) and the PPT (pain pressure threshold). Furthermore the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was obtained before and seven days after therapy in addition to pain
170
Satellite Symposia / European Journal of Integrative Medicine 2 (2010) 165–172
measured by a visual analogue scale (day 0 and day 7). Also the frequency of taking pain medication from day −3 until day 7 was recorded. The study sample consists of 40 patients with uni- or bilateral knee osteoarthritis. First results will be presented and discussed. Acknowledgement: Supported by the Karl and Veronica Carstens Foundation. doi:10.1016/j.eujim.2010.09.224 Adjunctive homeopathic therapy in malignant diseases—A retrospective explorative pilot study with 80 patients K. Gaertner, M. Frass ∗ Medical University Vienna, Vienna, Austria Objectives: The aim of this study was to check the survival time of patients who used adjunctive homeopathic treatment in their cancer therapy. As there are no comparable studies we also searched for material based on which we could generate a hypothesis of the effect of additional homeopathic therapy on patients with cancer. Design: This study involves 80 patients who visited the special outpatient unit “Homeopathy for Malignant Diseases” at the Department of Internal Medicine I of the Medical University Vienna between March 2004 and March 2008 at least three times. The patients received homeopathic treatment mostly in form of Q-potencies based on the method of homeopathic treatment of cancer by Dr. Dario Spinedi and, if needed, different C-potencies due to their current complaints. Subjects and methods: At the mentioned walk-in-clinic we retrospectively collected the patients’ age and sex, their history of diseases, stadium and histology of their neoplasia at the time of diagnoses, their conventional as well as their homeopathic treatment and their date of death. There was no invasive intervention. Survival times of each type of cancer were analysed separately by putting them in relationship with the prognosed survival time corresponding to their stage of disease, as they are described in literature and expressed by experts at the Medical University Vienna for patients who have received conventional cancer therapy only. Therefore, we used descriptive statistics. Results: We found that most of the analyzed patients lived longer than expected by their stage of disease. Conclusion: This aspect needs substantiation. To find out if this effect is due to the homeopathic treatment we now plan a randomized controlled trial with the hypothesis that there is no difference in survival time of patients who used “add-on” homeopathy in their cancer therapy and those who did not. doi:10.1016/j.eujim.2010.09.225
Ayurverda Ayurvedic medicine—A complementary approach to conventional oncology L. Kronpaß ∗ AyurSan Clinic Passau, Germany Being the oldest medical system of the world, Ayurveda medicine has a pool of experiences from more than 2000 years of continuous practice. On contrary to our highly specialised conventional western medicine, Ayurveda applies its therapeutic approach in a strictly holistic way and defines pathogenesis as a complex homoeostasis disorder of spiritual, mental and physical aspects. Ayurveda includes a unique system of structural anatomy (mahabhutas, dhatus, malas, srotas) and functional physical components (dosha, agni). The therapeutic strategy is complemented by elements of spiritual therapy, psychotherapy and strategies of salutogenesis and nutrition. From the holistic perspective of Ayurvedic, cancer is not only understood as a neoplastic occurrence in organs, but also as a profound homoeostasis disorder of the individual components of personality: body, mind and soul. Moreover, Ayurveda considers cancer as provocation of the kapha dosha in the localised organ phase linked to a change of the dosha-connected characteristics to vata dosha, which is pathogenetically responsible for a generalisation. Concerning pathophysiology, the Ayurvedic approach is marked by the strengthening of agni (metabolism), opening and flow improvement of the nadis (transport systems), pain reduction, direct impact on the tumour and stimulation of the body’s immune functions. The concept of OnkoVeda at the AyurSan Clinic will be presented as a model for integrative cancer care. To maintain quality of life has a high importance for cancer patients and Ayurveda could be used as additional treatment to accompany patients in a natural, intuitive and human way for longer periods of time. In addition Ayurveda could be used to treat side effects at the somatic and mental/psychic level and manual therapies within Ayurveda allow to include a more physical and experiential element into the treatment. To include Ayurvedic medicine as additional option in the treatment and palliative care of cancer patients should particularly be considered when establishing cancer centres. doi:10.1016/j.eujim.2010.09.226 Evidence and clinical research for Ayurveda from India R. Manohar ∗ Arya Vaidya Pharmacy, Director of Research, Coimbatore, India Building an evidence base to vouchsafe the credibility of Ayurveda is becoming a top priority amongst the Ayurvedic community in India. Red alerts regarding safety issues concerning products and practices in Ayurvedic therapeutics has sensitized not only the Government Department for Traditional Medicine in India but also the Ayurvedic academia in general.
From a biochemical perspective, optimal nutrition implies an adequate supply of nutrients and energy to all tissues as required by the prevailing metabolic situation. From a psychological point of view nutrition involves the sensations of choosing, preparing, eating and digesting foods. From a sociological perspective nutrition involves social bonding while talking about food and while eating. These different areas of individual need should be recognized and put into the focus of nutritional screening, assessment and care. Several simple but valid screening tools for detecting individuals with impending or active malnutrition are established and screening should be used in all oncological patients. Objective assessment of basic nutritional parameters should best be performed once in all and repeatedly in at-risk patients; this includes at least the usual and the current body weight, height, recent changes in body weight, energy intake, appetite score, performance index and the level of an acute phase protein to estimate systemic inflammatory activation. Psychological and social problems related to nutritional status or functions probably are best detected during a structured interview by an experienced nutritionist. Requirements of energy, fluids, macro- and micronutrients should be known and deficits should be minimized by avoiding and treating nausea, anorexia and gastrointestinal dysfunctions. Attention should be paid to metabolic derangements like metabolic syndrome, systemic inflammation and treatment-induced hyperglycemia. Chronic pain and psychological problems should be relieved carefully and as much as possible. It should be attempted to stabilize or reorganize social contacts and communications that may be deranged by nutritional defects and deficits.
169
a consultation and patient involvement in the decision-making process. The different concept of medicine could imply a different approach to knowledge and implementation of SDM by the health professionals resulting in different levels of occupational satisfaction. Methods: The study design was a qualitative analysis of guideline-based interviews which were performed with 30 general and nonmedical practitioners in the Leipzig area between January and April 2008. On this behalf, participants were divided into three groups: conventional general practitioners (COM), general practitioners with mainly complementary and alternative practice (CAM) and nonmedical practitioners (HP). Ten participants of each group were randomly chosen for the interview. The interviews enclosed questions concerning (1) attitude towards and implementation of patient involvement in medical decisionmaking, (2) basic and political conditions as well as feasibility of SDM, (3) patient as well as physician and practitioner factors promoting and restraining SDM, (4) occupational satisfaction especially in respect of a sufficient patient-health professionalrelationship, (5) differences in decision-making in conventional medicine and complementary and alternative medicine. Results and conclusions: Are expected by November 2010. doi:10.1016/j.eujim.2010.09.223 Treatment of knee osteoarthritis utilising hirudo medicinalis—Effects on clinical pain and mechanical sensory thresholds M. Müller a,b,∗ , R. Lauche c , H. Schleenbecker a , R. Lüdtke d , F. Musial c , G. Dobos c , M. Lengsfeld b a
doi:10.1016/j.eujim.2010.09.222 Science for Students The patient–health professional-relationship in conventional versus complementary and alternative medicine S. Länger, J. Ernst ∗ , E. Brähler University of Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany Background: Patient involvement gains more importance in medical decision-making. The traditional paternalistic decisionmaking model is replaced by a bilateral concept known as Shared Decision Making (SDM). This process implicates an interaction wherein patient and health professional act as equal partners in terms of diagnostic and therapeutic decisions. By incorporating patients’ concerns, preferences and perspectives SDM has been advocated to be a decisive factor for a more faithful patient–health professional-relationship, for greater patient confidence and higher efficiency in health care. Objective: The focal idea of this study was: How does the different concept of medicine, conventional versus complementary and alternative medicine, influence the relationship between patient and health professional, particularly the arrangement of
Rheumazentrum Mittelhessen, Bad Endbach, Germany of Marburg, Department of Orthopaedics and Rheumatology, Marburg, Germany c Kliniken Essen-Mitte, Academic Teaching Hospital, Department of Internal and Integrative Medicine, Essen, Germany d Karl and Veronica Carstens Foundation, Essen, Germany b University
Osteoarthritis of the knee is one of the most common chronic diseases in the western world. The most prominent afflictions are pain followed by constrained movement up to immobility and a corresponding reduction in quality of life. Previous randomized studies have shown a significant pain reduction using leaches for the treatment of knee osteoarthritis compared to placebo or standard therapy (topical diclofenac regimen). Based on the results of previous studies, the objective of this pilot study designed as a case series was to explore psychophysical measures of local pain perception at the knee in order to evaluate the effectiveness of leeches in the treatment of knee osteoarthritis. The measures are subtests obtained from the QST (Quantitative sensory testing) protocol, namely the measurement of the MDT (mechanical detection threshold), the VDT (vibration detection threshold) and the PPT (pain pressure threshold). Furthermore the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was obtained before and seven days after therapy in addition to pain
170
Satellite Symposia / European Journal of Integrative Medicine 2 (2010) 165–172
measured by a visual analogue scale (day 0 and day 7). Also the frequency of taking pain medication from day −3 until day 7 was recorded. The study sample consists of 40 patients with uni- or bilateral knee osteoarthritis. First results will be presented and discussed. Acknowledgement: Supported by the Karl and Veronica Carstens Foundation. doi:10.1016/j.eujim.2010.09.224 Adjunctive homeopathic therapy in malignant diseases—A retrospective explorative pilot study with 80 patients K. Gaertner, M. Frass ∗ Medical University Vienna, Vienna, Austria Objectives: The aim of this study was to check the survival time of patients who used adjunctive homeopathic treatment in their cancer therapy. As there are no comparable studies we also searched for material based on which we could generate a hypothesis of the effect of additional homeopathic therapy on patients with cancer. Design: This study involves 80 patients who visited the special outpatient unit “Homeopathy for Malignant Diseases” at the Department of Internal Medicine I of the Medical University Vienna between March 2004 and March 2008 at least three times. The patients received homeopathic treatment mostly in form of Q-potencies based on the method of homeopathic treatment of cancer by Dr. Dario Spinedi and, if needed, different C-potencies due to their current complaints. Subjects and methods: At the mentioned walk-in-clinic we retrospectively collected the patients’ age and sex, their history of diseases, stadium and histology of their neoplasia at the time of diagnoses, their conventional as well as their homeopathic treatment and their date of death. There was no invasive intervention. Survival times of each type of cancer were analysed separately by putting them in relationship with the prognosed survival time corresponding to their stage of disease, as they are described in literature and expressed by experts at the Medical University Vienna for patients who have received conventional cancer therapy only. Therefore, we used descriptive statistics. Results: We found that most of the analyzed patients lived longer than expected by their stage of disease. Conclusion: This aspect needs substantiation. To find out if this effect is due to the homeopathic treatment we now plan a randomized controlled trial with the hypothesis that there is no difference in survival time of patients who used “add-on” homeopathy in their cancer therapy and those who did not. doi:10.1016/j.eujim.2010.09.225
Ayurverda Ayurvedic medicine—A complementary approach to conventional oncology L. Kronpaß ∗ AyurSan Clinic Passau, Germany Being the oldest medical system of the world, Ayurveda medicine has a pool of experiences from more than 2000 years of continuous practice. On contrary to our highly specialised conventional western medicine, Ayurveda applies its therapeutic approach in a strictly holistic way and defines pathogenesis as a complex homoeostasis disorder of spiritual, mental and physical aspects. Ayurveda includes a unique system of structural anatomy (mahabhutas, dhatus, malas, srotas) and functional physical components (dosha, agni). The therapeutic strategy is complemented by elements of spiritual therapy, psychotherapy and strategies of salutogenesis and nutrition. From the holistic perspective of Ayurvedic, cancer is not only understood as a neoplastic occurrence in organs, but also as a profound homoeostasis disorder of the individual components of personality: body, mind and soul. Moreover, Ayurveda considers cancer as provocation of the kapha dosha in the localised organ phase linked to a change of the dosha-connected characteristics to vata dosha, which is pathogenetically responsible for a generalisation. Concerning pathophysiology, the Ayurvedic approach is marked by the strengthening of agni (metabolism), opening and flow improvement of the nadis (transport systems), pain reduction, direct impact on the tumour and stimulation of the body’s immune functions. The concept of OnkoVeda at the AyurSan Clinic will be presented as a model for integrative cancer care. To maintain quality of life has a high importance for cancer patients and Ayurveda could be used as additional treatment to accompany patients in a natural, intuitive and human way for longer periods of time. In addition Ayurveda could be used to treat side effects at the somatic and mental/psychic level and manual therapies within Ayurveda allow to include a more physical and experiential element into the treatment. To include Ayurvedic medicine as additional option in the treatment and palliative care of cancer patients should particularly be considered when establishing cancer centres. doi:10.1016/j.eujim.2010.09.226 Evidence and clinical research for Ayurveda from India R. Manohar ∗ Arya Vaidya Pharmacy, Director of Research, Coimbatore, India Building an evidence base to vouchsafe the credibility of Ayurveda is becoming a top priority amongst the Ayurvedic community in India. Red alerts regarding safety issues concerning products and practices in Ayurvedic therapeutics has sensitized not only the Government Department for Traditional Medicine in India but also the Ayurvedic academia in general.