Tuesday, November 30, 2010

Acupuncture's effect 'isn't just psychological' (?)

This is very poor logic. It would be surprising if sticking needles into people DIDN'T produce brain responses. The question is whether it reduces pain

Acupuncture works directly on the brain to reduce the amount of pain we feel, MRI scans indicate. It limits activity in parts of the brain tasked with gauging pain, an experiment on 18 volunteers found.

Crucially, researchers believe the study shows that acupuncture does not only work on a psychological level - as a 'placebo' - but that is also has a direct 'dampening' effect on the brain's pain processing centres. Many critics believe acupuncture only works as a placebo.

The experiment, conducted by researchers at the Department of Complementary and Integrative Medicine at University of Duisburg-Essen in Germany, looked at brain scans of volunteers who were given mild electric shocks.

Firstly they were given the shocks without acupuncture, and then they were given the same shocks while acupuncture needles were placed between the toes, below the knee and near the thumb.

Researchers then compared MRI scan images - which can measure the small metabolic changes that take place in active parts of the brain - to see whether the responses differed.

Dr Nina Theysohn, who will present the research in Chicago on Tuesday at the annual meeting of the Radiological Society of North America, said: "Activation of brain areas involved in pain perception was significantly reduced or modulated under acupuncture."

These areas included the contralateral supplementary motor area, somatosensory cortex, precuneus bilateral insula and ipsilateral somatomotor cortex. All are involved in pain perception.

The scans also showed that acupuncture worked as a placebo, said the researchers, affecting activity in areas that govern expectation and comprehension of pain such as the anterior insula.

Dr Theysohn said: "Acupuncture is supposed to act through at least two mechanisms—nonspecific expectancy-based effects and specific modulation of the incoming pain signal. "Our findings support that both these nonspecific and specific mechanisms exist, suggesting that acupuncture can help relieve pain."

But Edzard Ernst, professor of complementary medicine at the Peninsula Medical School in Exeter, urged caution. He said: "Studies like this might go some way to explaining how acupuncture works. "We should remember, however, that we are currently not sure whether acupuncture does,in fact,reduce clinical pain.

"In my view, this is the more important question. If acupuncture does not have meaningfull clinical effects, its mechanism is hardly a relevant issue."

Last year the National Institute for Clinical Excellence (Nice) appeared to endorse the traditional Chinese medicine, by announcing that doctors should "consider offering a course of up to 10 sessions of acupuncture over a period of up to 12 weeks" for cases of "non-specific" lower back pain.


A partial cure for hand eczema

When Denise Hyland, an English teacher in Greenwich, south east London, took to wearing a black silk glove in the classroom, the pupils were impressed: after all, Michael Jackson had worn something similar. But when she took the glove off, the reaction changed.

“When they saw my hand they called it 'the lurgy,’” she said.

Denise, who is 58, had chronic hand eczema, a condition which suddenly appeared nearly eight years ago and went on to blight her life. “I was washing up when I felt a searing pain in my right palm. At first I thought it was caused by the washing-up liquid,” she recalls.

Over the next few months, her right hand became painfully inflamed, with red-raw cracks appearing over her entire palm and the front of her thumb. It was the beginning of a pattern. “Over a month my hand would become dry and itchy,” she says. “Then it peeled and turned scaly. This was followed by yellow blisters, cracks, bleeding and weeping. The cells would try to repair my hand by producing thick, rhino-like skin. That would then peel off, leaving soft skin for a short time before the whole thing started again.”

Six million people in the UK are estimated to suffer from this debilitating skin condition. As with other types of eczema, the skin becomes inflamed and broken, causing symptoms such as flaking, itchiness and blisters. Until recently, one in five cases of hand eczema was untreatable. Now a drug called alitretinoin, the first to be developed for hand eczema, is available. Research shows it can help almost 50 per cent of patients who have not responded to other treatments.

Hand eczema can be triggered by a combination of factors, including genetic make-up and, in particular, contact with irritant or allergenic substances at work: high-risk jobs include hairdressing, catering and dentistry. According to Ian Coulson, a consultant dermatologist at Burnley General Hospital, it is the third most common cause of people taking time off work in the UK (just behind backache and stress): an “enormous economic problem” he says.

In Denise’s case the cause of the eczema and why it affected only her right hand was a mystery.

“I had slight eczema in my ears when I was 11. I also have type 2 diabetes and there may be a link to that. One consultant said it was caused by menopause.” She is naturally right-handed, so not being able to use the hand fully made life miserable. “When the rhino skin starts you lose all flexibility,” she continues. “I couldn’t open jars, lift things into the oven or stir pans. It felt as if my hand was on fire and I couldn’t sleep at night.”

Depression is common in sufferers. “My social life died,” says Denise. “I avoided shaking hands with anyone new and wore a glove in the classroom because I was so embarrassed. I also felt embarrassed for my children [Luke, 13 and Giny, 15] when they invited friends home for dinner. I had an open wound which I had to tend day and night.”

Denise began a frantic hunt for help from skin specialists. As well as moisturisers and steroid creams – standard treatments for eczema – her doctor tried her on PUVA. This ultraviolet light treatment reduces the exaggerated immune response that can trigger certain types of eczema. He also tried two powerful drugs. Nothing worked. In desperation she visited an alternative practitioner, living in Spain. “He gave me a list of at least 50 foods to avoid,” she says. “I couldn’t keep it up.”

Denise’s story has a happy ending. She was finally prescribed alitretinoin (brand name Toctino®,) which has been approved by the National Institute for Health and Clinical excellence (Nice) as the first treatment for chronic severe hand eczema, where topical treatments have not worked. Denise took the once-a-day tablets for four months, by which time the eczema had disappeared. Whether it will return is uncertain.

Alitretinoin can have side effects, although Denise’s only problem was a slight sensitivity under her left breast, where her bra fits. The drug is not suitable for everyone. According to Nice, its use should be monitored by a dermatologist or a doctor experienced in treating severe hand eczema and in using this type of drug.

Margaret Cox, chief executive at the Eczema Society, says many people’s lives are made impossible by hand eczema. “They often can’t work, can’t dress themselves, can’t hand over money in shops, and this drug has transformed their lives,” she says.

Denise’s main feeling is relief. “I’ve finally got my life back,” she says.


No comments: