Winter Newsletter - December 2009


Single point (PC7) for heel pain tested by Zhang and colleagues in Hong Kong and Guangzhou, China in a randomized controlled trial comparing the analgesic effect of PC7 and LI4 for Plantar Fasciitis. The study recruited 53 patients and provided identical single point acupuncture treatment five times a week for 2 weeks at either point. Morning pain was assessed using VAS.

RESEARCH HIGHLIGHTS FROM CHINA:

The primary end point was at one-month post-treatment, and follow up at six months. It reports significant differences in reduction in pain scores, favoring the treatment group, were seen at one month for morning pain (22.6_4.0 versus 12.0_3.0, mean_SEM), overall pain (20.3_3.7 versus 9.5_3.6) and pressure pain threshold (145.5_32.9 versus –15.5_39.4). The findings here lend support that acupuncture on PC 7 may ease heel pain from Plantar Fasciitis rather specifically. Future studies involving sham controls, and further research comparing acupuncture at PC7 against conventional interventions for Plantar Fasciitis as well an assessment of cost effectiveness would shed more light on various questions related to not only the effectiveness of acupuncture but also point specificity of acupuncture effects.

OREGON COLLEGE OF ORIENTAL MEDICINE (OCOM) COMPLETES 4-YEAR NIH/NCCAM RESEARCH EDUCATION GRANT: As acupuncture and Oriental medicine (AOM) increasingly moves into the mainstream of health care, research provides an important bridge between the conventional medicine and AOM communities.  The ability to access, evaluate and disseminate research information is referred to as ‘research literacy’.  These skills need to be integral components of AOM education to enhance practitioner decision-making as well as their communication with patients and clinical colleagues.

A research education program for students and faculty at OCOM was developed with support from a 4-year grant awarded by the NIH/National Center for Complementary and Alternative Medicine (NCCAM); PI: Richard Hammerschlag, PhD.  OCOM was one of nine CAM institutions nationwide, and the only stand-alone AOM college, to receive this award (Kreitzer & Sierpina, EXPLORE 4(1): 74-76, 2008).  

The overarching goals of OCOM’s grant, Acupuncture Practitioner Research Education Enhancement (APREE), were to infuse research literacy and an evidence informed perspective into the curriculum and culture of the college.  The APREE team, a collaboration between OCOM and Oregon Health & Science University School of Nursing, developed a set of nine Research Literate Practitioner competencies that guided many of the grant’s initiatives. Among APREE’s curriculum development accomplishments is a new 1st-year research course that teaches information access skills, frames research as a ‘way of knowing’ and provides grounding for existing 2nd and 3rd year research courses. Curricular initiatives also include faculty-designed, research-related learning activities for use in non-research courses (Lasater et al, ATHM 15(4): 46-54, 2009), a Research Grand Rounds seminar series and a post clinic-shift reflection session.  Faculty development benefited from a 9-month, 1-day per month Research Scholars Program (Hammerschlag et al, JACM 14(4):437-443 2008).  OCOM students themselves created a Research Club and an annual Student Research Conference.

The products and processes of APREE are entered in an electronic repository to facilitate sustainability and further development of research-related educational objectives.  In addition, at the end of the grant period, APREE initiatives were shared with other AOM colleges in a workshop at the October, 2009 meeting of the Council of Colleges of Acupuncture and Oriental Medicine.  The workshop, presented by Susan Fleishman (Research Education Director) and Richard Hammerschlag, offered AOM college representatives the opportunity to learn the benefits and challenges of infusing a research perspective into their classroom and clinical curricula.  We view the successes of APREE as encouraging signs that research literacy and evidence informed practice are becoming increasingly accepted as needed skill sets for present-day practitioners of acupuncture and Oriental medicine (AOM).

 

 

CAN CHINESE HERBAL MEDICINE PREVENT HPV-RELATED ANAL CANCER IN PATIENTS WITH HIV?  Phase II Study for Prevention of Anal Cancer Through Use of a Chinese Herbal Topical Cream. Misha Ruth Cohen
This Chinese herbal study is being conducted to examine whether or not Chinese herbal medicine can prevent HPV-related anal cancer in HIV+ women and men through treatment of high-grade squamous epithelial lesions (HSIL). This Phase II trial is being run at the UCSF CCRC and is now in its second year. The principal investigator is Misha Cohen, OMD, L.Ac. and the study is funded by Gateway for Cancer Research.

Currently the only available therapies for HSIL include different methods of ablation, destruction of the lesions through including freezing, burning or chemical methods. All ablative therapies require days to weeks of recovery with pain and bleeding during that period of time. Also, HSIL recurs in the vast majority of HIV+ people and repeated use of ablative therapies is highly invasive, may be contraindicated due to complications and is often rejected by the person with HSIL.

A self-applied cream has many benefits over these ablative therapies. The cream is non-invasive without any symptoms such as pain or bleeding. There is no period of recovery and patients could attend to their normal daily activities without interruption.  Most of the people that choose to become participants in this study do so precisely because it provides the benefit of a non-invasive treatment.

The ability to use noninvasive integrative medicine therapies such as Chinese traditional medicine, without the expense and morbidity of surgery or other ablative therapies, would represent a major therapeutic advance in the prevention of HPV-related cancers through treatment of anal HSIL, cervical HSIL and vulvar HSIL. 

The study team’s long-term goal is to develop effective noninvasive Chinese herbal medicine therapies that would permit treatment of large lesions or circumferential HSIL to prevent development of HPV-related cancers.
The objective of the current study is to conduct a rigorous randomized placebo-controlled Phase II efficacy trial of a topical Chinese herbal cream AIJP in 56 HIV-positive men and women (28 in each arm) with histologically confirmed anal HSIL.

The central hypothesis is that the Chinese herbal topical cream AIJP will effectively treat anal HSIL in HIV-positive people. The two specific aims to test this hypothesis are:
1) Conduct a Phase II randomized blinded cancer integrative medicine Chinese herb efficacy trial for treatment of anal HSIL in HIV-positive people and
2) Identify potential biologic pathways and mechanisms by which the Chinese traditional medicine intervention may have an effect.

Under the first aim, we are obtaining evidence of lesion regression, data on efficacy, and obtain an effect size for a Phase III trial. Under the second aim, the mechanisms of action have been explored in cancer cell line studies and in vivo HPV testing. This research is innovative because it transforms the traditional knowledge and application of complex traditional Chinese herbal substances into a modern treatment for cancer prevention. We expect to lay the groundwork for large integrative medicine studies of Chinese medicine therapies for prevention and treatment of all forms of HPV-related cancers, including anal, cervical and vulvar HSIL and cancers in both HIV-positive and HIV-negative women and men.

During the first year of the study, there have been a number of successes as well as challenges. Research in the field of complementary and alternative medicine (CAM) and specifically complex herbal medicine interventions for prevention and treatment of cancer has its own unique issues.

At the SAR Conference next March, Misha Cohen will present an oral abstract on In Vitro Cytotoxic Activity of Arnebia Indigo Jade and Pearl Ointment in Human Papilloma Virus (HPV)- associated Cervical Cancer Cell lines.

 

 

Scratch that itch!Itch is a prevalent and vexing symptom of many dermatological and allergological diseases. Conservative treatments of itch are much needed and recent pilot studies suggest that acupuncture shows promise as a therapeutic tool. While pain has been a very common target for acupuncture research, the sensation of itch, which does show interesting similarities to pain sensation, has not received nearly as much attention. However, recent work from Munich, Germany has begun to bridge this gap. Florian Pfab and colleagues have demonstrated acupoint-specific effects on histamine-induced itch in healthy volunteers as well as allergen-induced itch in patients with atopic eczema [1,2]. In their most recent study [2], an allergen stimulus (house dust mite or grass pollen skin prick) was applied to 30 patients with atopic eczema before (direct effect) and after (preventive effect) two forms of acupuncture: real manual acupuncture at points LI-11 and Sp-10, or location-matched ‘placebo-point’ acupuncture at points on the shoulder and thigh. The behavioral results demonstrated that for the direct effect, mean itch sensation was lower for real compared to placebo acupuncture. For the preventative effect, both real and placebo acupuncture demonstrated significant relief compared to a natural history (no-acupuncture) condition. Interestingly, these researchers have also developed a novel fMRI approach to evaluate the brain correlates of itch sensation using a histamine prick coupled with a temperature stimulus which can modulate itch in a precise ON-OFF manner [3]. For eczema patients, published results [4] have suggested that in non-lesioned skin, the beginning of itch provocation produces cerebral deactivation in the thalamus, prefrontal, cingulate, insular, somatosensory and motor cortex. With continued itch sensation, cerebral deactivation is reduced and is replaced by activation of the basal ganglia. In contrast, itch sensation induced in lesioned skin led to brain activation at the beginning of the stimulation in the above-mentioned structures. It will be interesting to see how both real and sham acupuncture impact this brain response pattern in eczema patients, as it will suggest potential mechanisms by which acupuncture works to alleviate itch. Dr. Pfab, who has begun a collaboration with Dr. Vitaly Napadow at the Martinos Center for Biomedical Imaging in Boston, Massachusetts, aspires to ask this very question in his next studies, and will present the results of previous work at the upcoming SAR conference in North Carolina in March of 2010. 

[1] Pfab F, Hammes M, Bäcker M, Huss-Marp J, Athanasiadis GI, Tölle TR, Behrendt H, Ring J, Darsow U. Preventive effect of acupuncture on histamine-induced itch: a blinded, randomized, placebo-controlled, crossover trial. J Allergy Clin Immunol. 2005 
[2] Pfab F, Huss-Marp J, Gatti A, Fuqin J, Athanasiadis GI, Irnich D, Raap U, Schober W, Behrendt H, Ring J, Darsow U. Influence of acupuncture on type I hypersensitivity itch and the wheal and flare response in adults with atopic eczema – a blinded, randomized, placebo-controlled, crossover trial. Allergy. 2009. In press. 
[3] Pfab F, Valet M, Sprenger T, Toelle TR, Athanasiadis GI, Behrendt H, et al. Short-term alternating temperature enhances histamine-induced itch: a biphasic stimulus model. J Invest Dermatol 2006; 126:2673-8. 
[4] Pfab F, Valet M, Sprenger T, Huss-Marp J, Athanasiadis GI, Baurecht HJ, Konstantinow A, Zimmer C, Behrendt H, Ring J, Tölle TR, Darsow U. Temperature modulated histamine-itch in lesional and nonlesional skin in atopic eczema - a combined psychophysical and neuroimaging study. Allergy. 2009. In press.    


Acupuncture for Gulf War Syndrome:  New England School of Acupuncture Receives U.S. Department of Defense Grant Funding to Examine Effectiveness of Acupuncture in Treatment of Gulf War Illness

NEWTON, MA (October 2009) – The New England School of Acupuncture (NESA) is  proud to announce that it is the recipient of a U.S. Department of Defense (DOD) grant to fund a clinical trial that will investigate the effectiveness of acupuncture in the treatment of Gulf War Illness (GWI). 

NESA’s researchers will study how veterans with symptoms associated with GWI, which include persistent fatigue, musculoskeletal pain, depression, impaired concentration and memory, digestive problems, and respiratory distress, respond to acupuncture treatment.  This will be the first treatment trial to date researching the effectiveness of acupuncture in treating this condition.

Out of 700,000 Gulf War veterans, more than 150,000 report suffering from GWI symptoms that persist for years after seeking treatment.  “Many veterans have received treatment directed at their symptoms, but reports from five- and 10-year follow-ups show that symptoms remain, including some which are severe and disabling,” says Lisa Conboy MA, MS, ScD, co-director of the research department and dean of the biomedical department at NESA where she is also principal investigator for the GWI clinical trail.  “Clearly, an effective treatment for these conditions could be of great benefit to sufferers of Gulf War Illness, helping to improve their overall health and quality of life.” 

The trial’s participants will include 120 Gulf War veterans from the Boston/New England area suffering from GWI.  They will be treated at satellite clinics located throughout the Boston/New England area by seasoned licensed acupuncturists with extensive clinical experience diagnosing and treating symptoms associated with GWI.  Veterans will receive care that is directed to their most distressing symptom. As part of this study, in addition to acupuncture treatment, researchers will analyze samples of participants’ blood to better comprehend the mechanisms of GWI and changes associated with acupuncture, focusing on inflammatory changes, immune function, and markers of stress.

 

 Information and links were accurate at the time the newsletter was published.

 


 
 
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