Hypericum perforatum (St John's wort) beyond depression: A therapeutic perspective for pain conditions.

ETHNOPHARMACOLOGICAL RELEVANCE: Hypericum perforatum L. (Hypericaceae), popularly called St. John's wort (SJW), has a rich historical background being one of the oldest used and most extensively investigated medicinal herbs. Many bioactivities and applications of SJW are listed in popular and in scientific literature, including antibacterial, antiviral, anti-inflammatory. In the last three decades many studies focused on the antidepressant activity of SJW extracts. However, several studies in recent years also described the antinociceptive and analgesic properties of SJW that validate the traditional uses of the plant in pain conditions. AIM OF THE REVIEW: This review provides up-to-date information on the traditional uses, pre-clinical and clinical evidence on the pain relieving activity of SJW and its active ingredients, and focuses on the possible exploitation of this plant for the management of pain. MATERIALS AND METHODS: Historical ethnobotanical publications from 1597 were reviewed for finding local and traditional uses. The relevant data on the preclinical and clinical effects of SJW were searched using various databases such as PubMed, Science Direct, Scopus, and Google Scholar. Plant taxonomy was validated by the database Plantlist.org. RESULTS: Preclinical animal studies demonstrated the ability of low doses of SJW dry extracts (0.3% hypericins; 3-5% hyperforins) to induce antinociception, to relieve from acute and chronic hyperalgesic states and to augment opioid analgesia. Clinical studies (homeopathic remedies, dry extracts) highlighted dental pain conditions as a promising SJW application. In vivo and in vitro studies showed that the main components responsible for the pain relieving activity are hyperforin and hypericin. SJW analgesia appears at low doses (5-100mg/kg), minimizing the risk of herbal-drug interactions produced by hyperforin, a potent inducer of CYP enzymes. CONCLUSION: Preclinical studies indicate a potential use of SJW in medical pain management. However, clinical research in this field is still scarce and the few studies available on chronic pain produced negative results. Prospective randomized controlled clinical trials performed at low doses are needed to validate its potential efficacy in humans.

Impact of study quality on outcome in placebo-controlled trials of homeopathy.

We investigated the influence of indicators of methodological quality on study outcome in a set of 89 placebo-controlled clinical trials of homoeopathy in three different ways: (1) The results of studies meeting single criteria (explicit statement of random allocation, allocation concealment, double-blinding, completeness of follow-up) of methodological quality were compared with those of studies not meeting the criteria in univariate and multivariate analyses; (2) The results of studies scoring above and below predefined scores in two quality assessment scales were compared; (3) Primary studies were consecutively entered into a cumulative meta-analysis according to the summary scores derived from the quality assessment scales. All analyses were performed using meta-regression methods. Studies that were explicitly randomized and were double-blind as well as studies scoring above the cut-points yielded significantly less positive results than studies not meeting the criteria. In the cumulative meta-analyses, there was a trend for increasing effect sizes when more studies with lower-quality scores were added. However, there was no linear relationship between quality scores and study outcome. We conclude that in the study set investigated, there was clear evidence that studies with better methodological quality tended to yield less positive results. Because summarizing disparate study features into a single score is problematic, meta-regression methods simultaneously investigating the influence of single study features seem the best method for investigating the impact of study quality on outcome.

Research methodology: implications for CAM pain research.

The National Cancer Institute's Office of Cancer Complementary and Alternative Medicine established a series of expert panels to develop the state of the science in research methodologies in CAM cancer research. Panelists from both conventional and CAM research draw on their expertise in their relative fields to apply their knowledge and expertise to specific topic areas within cancer CAM. The first panel is focused on cancer symptom research. The discussion and conclusions raised by this panel primarily address pain research but are applicable to other symptoms as well. This article will focus on the panel presentations that are most applicable to CAM pain research in both cancer and noncareer pain populations, identifying the major challenges and conclusions offered by the panelists.

Veterinary clinical research database for homeopathy: placebo-controlled trials.

BACKGROUND: Veterinary homeopathy has led a somewhat shadowy existence since its first introduction. Only in the last three decades has the number of clinical trials increased considerably. This literature is generally not well perceived, which may be partly a consequence of the diffuse and somewhat inaccessible nature of some of the relevant research publications. The Veterinary Clinical Research Database for Homeopathy (VetCR) was launched in 2006 to provide information on existing clinical research in veterinary homeopathy and to facilitate the preparation of systematic reviews. OBJECTIVE: The aim of the present report is to provide an overview of this first database on clinical research in veterinary homeopathy, with a special focus on its content of placebo controlled clinical trials and summarising what is known about placebo effects in animals. RESULTS: In April 2012, the VetCR database contained 302 data records. Among these, 203 controlled trials were identified: 146 randomised and 57 non-randomised. In 97 of those 203 trials, the homeopathic medical intervention was compared to placebo. COMMENT: A program of formal systematic reviews of peer-reviewed randomised controlled trials in veterinary homeopathy is now underway; detailed findings from the program's data extraction and appraisal approach, including the assessment of trial quality (risk of bias), will be reported in due course.

A formal approach to the problem of reproducing experimental effects with homeopathic potencies.

OBJECTIVE: This paper investigates a general concept of reproducibility with regard to its application on experiments with homeopathic potencies. METHODS: The experimental situation for distinguishing a homeopathic potency and its solvent is described in a formal way. This allows the application of the weak law of large numbers. Experimental arrangements are described in a formal way. This allows conclusions to be drawn about the possible existence of nonlocal influences on an experiment. CONCLUSIONS: From a pragmatic as well as from a global point of view, a general concept of reproducibility supports decisions whether or not effects in experiments with homeopathic potencies do exist.

[Homeopathy as a therapeutic system]. / Gomeopatiia kak sistema lecheniia.

A brief account of the major homeopathic principles making up a therapeutic system is presented. The opinions of different authors on the methodology of research into the area of homeopathy are also discussed. In addition, recommendations on the clinical trials of homeopathic methodologies are offered.

¿Cómo podemos obtener información más confiable de los estudios de las patogenesias? Una crítica a las experimentaciones puras / How can e get more reliable information studies of the pathogenesis ? A critique of pure experimentation

Ciertamente, un medicamento debe ser administrado en un cuerpo sano sin ninguna sustancia extraña; cuando el olor y el sabor hayan sido examinados debe tomarse una pequeña dosis y llevar un registro de cada uno de los cambios que se pudieran presentar, tanto en el pulso, la temperatura, la respiración y las secreciones.Una vez analizados los síntomas encontrados en una persona se puede entonces proceder a probarse en el cuerpo de una persona enferma. (AU)

Certainly, a drug must be administered in a healthy body without any foreign substance; when the smell and taste have been examined must take a small dose and keep a record of each of the changes that may arise, both the pulse, temperature, breathing and secreciones.Una after analyzing the symptoms found in a person can then proceed to try on in the body of a sick person. (AU)

¿Cómo podemos obtener información más confiable de los estudios de las patogenesias? Una crítica a las experimentaciones puras / How can e get more reliable information studies of the pathogenesis ? A critique of pure experimentation

Ciertamente, un medicamento debe ser administrado en un cuerpo sano sin ninguna sustancia extraña; cuando el olor y el sabor hayan sido examinados debe tomarse una pequeña dosis y llevar un registro de cada uno de los cambios que se pudieran presentar, tanto en el pulso, la temperatura, la respiración y las secreciones.Una vez analizados los síntomas encontrados en una persona se puede entonces proceder a probarse en el cuerpo de una persona enferma.

Certainly, a drug must be administered in a healthy body without any foreign substance; when the smell and taste have been examined must take a small dose and keep a record of each of the changes that may arise, both the pulse, temperature, breathing and secreciones.Una after analyzing the symptoms found in a person can then proceed to try on in the body of a sick person.

Current management of the neonatal abstinence syndrome: a critical analysis of the evidence.

OBJECTIVE: To systematically and critically analyse and summarise the published evidence for the rational choice of pharmacologic treatment of the neonatal abstinence syndrome (NAS), a frequently observed condition in neonates born to mothers who are dependent on physically addicting drugs. DESIGN: Studies comparing different pharmacological agents for the treatment of NAS were identified utilising MEDLINE and additionally the references cited in pertinent articles. The identified studies were critically analysed regarding their study designs and outcome measures. The reported data for the comparative efficacy of the drugs were summarised and evaluated. RESULTS: Fourteen studies were identified, most of them comparing treatment of NAS with phenobarbital, paregoric or diazepam. However, none of these studies was conducted in a double-blind fashion. Frequently, treatment allocations were not properly randomised. Prenatal drug exposure varied and was often not sufficiently verified. Outcome measures and their evaluations differed widely. Due to the different study objectives and flaws in study design, a combined analysis of the published data in the form of a meta-analysis was not deemed possible. When attempting to compare efficacy, diazepam appears to be less efficacious in treating NAS than phenobarbital or paregoric. The relative efficacy of paregoric and phenobarbital appears to depend upon the antenatal exposure of the neonate and on the outcome measure of the study. Only two studies evaluate the efficacy of pure opioids, none of them in direct comparison to paregoric. It remains questionable whether paregoric, which contains the central stimulant camphor and a large amount of alcohol, should be the opioid of choice for the treatment of NAS. CONCLUSION: Most published studies were conducted prior to the development of clinical epidemiology and modern study design and thus yielded only very limited comparative data on the benefits of different treatment protocols. There is very little evidence regarding the efficacy of different pharmacological therapy regimens to treat NAS. More studies are required to produce the evidence needed to allow a rational choice between treatment modalities of NAS and thus to ensure optimal care of the neonates suffering from this condition.

Consideracoes sobre a aplicacao da tecnica "duplo cego cruzado placebo-controlado" em ensaio clinico com medicamento homeopatico / Considerations about the usefulness of the "Double blind crossover placebo-controlled" method in clinical assays with homeopathic drugs

Os argumentos baseados na inexistencia de substancia far-macologicamente ativa no medicamento homeopatico contrapoe-se nao so com a praticamente inexistente pesquisa homeopatica pura como tambem com a fragilidade da metodologia empregada nos raros trabalhos existentes. Por ser a tecnica "duplo- cego cruzado placebo-controlada" aquela de maior validade no meio cientifico oficial e por termos participado do unico grupo de pesquisadores no mundo todo que trabalhou com esta tecnica em ensaio clinico com medicamento homeopatico, pretendemos, a partir desta experiencia pessoal, discutir a aplicabilidade do metodo num ensaio clinico homeopatico