The effect of topical arnica on muscle pain.

BACKGROUND: The herb Arnica montana, in topical formulations, has been reputed to decrease bruising and muscle pain. This claim has been inadequately and incompletely addressed. OBJECTIVE: To determine whether topical A. montana cream could decrease subjective leg pain following calf raises. Secondary outcomes were effects on ankle range of motion and muscle tenderness. METHODS: A randomized, double-blind, placebo-controlled trial was conducted in 53 subjects. Active range of motion was measured in both ankles, and then a series of calf-raises were completed according to a standardized protocol. Each participant received 2 tubes of cream, 1 with active arnica and 1 with placebo. The creams were applied to the lower legs immediately after the exercise, and again at 24 and 48 hours postexercise according to the "RIGHT" or "LEFT" labels. At 48 hours postexercise, subjects had their ankle range of motion and muscle tenderness measured. Subjects used the analog scale to rate pain in each leg at baseline, 24 hours, 48 hours, and 72 hours. RESULTS: No significant differences in pain scores were seen before exercise (arnica: 0.07 vs placebo: 0.09, p = 0.32). Pain scores on legs treated with arnica were higher than scores on those receiving placebo 24 hours after exercise (3.04 vs 2.36, respectively; p < 0.005). Pain scores on day 3 (arnica: 3.44 vs placebo: 3.20, p = 0.66) and day 4 (arnica: 2.36 vs placebo: 2.31, p = 0.62) were not significantly different. There was no difference in muscle tenderness (arnica: 1.05 vs placebo: 1.05, p = 1.0). Ankle range of motion did not differ significantly on either day 1 (arnica: 64.70 degrees vs placebo: 66.15, p = 0.352 or day 3 (arnica: 63.32 degrees vs placebo: 65.94, p = 0.058). CONCLUSIONS: Rather than decreasing leg pain, arnica was found to increase leg pain 24 hours after eccentric calf exercises. This effect did not extend to the 48-hour measurement.

The placebo effect and homeopathy.

BACKGROUND: Like other forms of medicine, including Complementary and Alternative Medicine (CAM), homeopathy elicits expectations in patients. The physician-patient relationship, personal and comprehensive treatment and lack of adverse effects are elements in creating positive expectations. Other elements may be associated with negative expectations. METHODS: We conducted a systematic literature review on placebo and nocebo effects in acupuncture and homeopathy using Medline. RESULTS: Findings on the psychophysiological and neuromediating mechanisms of the placebo-nocebo phenomenon are reviewed. Studies of these effects reveal how expectations and unconscious conditioning can be measured by imaging and EEG methods. They result in significant, non-specific therapeutic effects, which may confuse the evaluation of the specific therapeutic effects treatment, hampering selection of the simillimum. CONCLUSIONS: Directions for future research on non-specific therapeutic effects of homeopathy to improve clinical practice and clinical research are discussed.

Complementary and alternative pain therapy in the emergency department.

One primary reason patients go to emergency departments is for pain relief. Understanding the physiologic dynamics of pain, pharmacologic methods for treatment of pain, as well CAM therapies used in treatment of pain is important to all providers in emergency care. Asking patients about self-care and treatments used outside of the emergency department is an important part of the patient history. Complementary and alternative therapies are very popular for painful conditions despite the lack of strong research supporting some of their use. Even though evidenced-based studies that are double blinded and show a high degree of interrater observer reliability do not exist, patients will likely continue to seek out CAM therapies as a means of self-treatment and a way to maintain additional life control. Regardless of absolute validity of a therapy for some patients, it is the bottom line: "it seems to help my pain." Pain management distills down to a very simple endpoint, patient relief, and comfort. Sham or science, if the patient feels better, feels comforted, feels less stressed, and more functional in life and their practices pose no health risk, then supporting their CAM therapy creates a true wholistic partnership in their health care.CAM should be relatively inexpensive and extremely safe. Such is not always the case, as some patients have discovered with the use of botanicals. It becomes an imperative that all providers be aware of CAM therapies and informed about potential interactions and side effects when helping patients manage pain and explore adding CAM strategies for pain relief. The use of regulated breathing, meditation, guided imagery, or a massage for a pain sufferer are simple but potentially beneficial inexpensive aids to care that can be easily employed in the emergency department. Some CAM therapies covered here, while not easily practiced in the emergency department, exist as possibilities for exploration of patients after they leave, and may offer an improved sense of well-being and empowerment in the face of suffering and despair. The foundations of good nutrition, exercise, stress reduction, and reengagement in life can contribute much to restoring the quality of life to a pain patient. Adding nondrug therapies of physical therapy, cognitive-behavioral therapy, TENS, hypnosis, biofeedback, psychoanalysis, and others can complete the conventional picture. Adding in simple mind/body therapies, touch therapies, acupuncture, or others may be appropriate in select cases, and depending on the circumstances, may effect and enhance a conventional pain management program. Armed with an understanding of pain dynamics and treatments, practitioners can better meet patient needs, avoid serious side effects, and improve care when addressing pain management in the emergency department.

[Analgesic anti-inflammatory effects of moschus bone-setting liquor in local traumatic ecchymosis].

Moschus Bone-setting liquor, ip, 1 ml/kg significantly decreases the rate and frequency of body twisting reaction induced by ip acetic acid, and markedly increases the pain threshold of thermal stimulation in mice. The liquor also reduces apparently the inflammation of mice ear induced by the oil of Fructus Crotonis, and rapidly relieves the traumatic ecchymosis in guinea pigs. Dose response relationship was obtained in the experiment. These results provide evidences for the clinical application of Moschus Bone-setting liquor in the treatment of many traumatic diseases.

Human narcotic use emulator.

Last year the author extended his modular, open-systems, computerized human nervous system function emulator (HNSFE) by adding simulated hormone action. This year he extends the HNSFE with a related capability: emulation of the effects of therapeutic and non-therapeutic drug use. The opioid narcotic drug model was chosen because of its importance in medicine and because of its potential for misuse. For this research the author utilized a frequency-to-voltage converter (FVC) as an analog calculational element to simulate the effects of drug binding to neural cell membrane receptors. The resulting voltages are utilized in this human narcotic use emulator (HNUE) to represent the level of opioid drug activity at the cellular level which initiates high level somatic and behavioral responses in the HNSFE artificial intelligence system. The HNUE is compatible with the computerized postoperative pain / narcotic dosing model of Liu and Northrop. Some effects of long-term drug use (the development of tolerance, physical and psychological dependence, addiction and the withdrawal syndrome) are emulated.

Homoeopathy for delayed onset muscle soreness: a randomised double blind placebo controlled trial.

OBJECTIVE: To pilot a model for determining whether a homoeopathic medicine is superior to placebo for delayed onset muscle soreness (DOMS). DESIGN: Randomised double blind placebo controlled trial. SETTING: Physiotherapy department of a homoeopathic hospital. SUBJECTS: Sixty eight healthy volunteers (average age 30; 41% men) undertook a 10 minute period of bench stepping carrying a small weight and were randomised to a homoeopathic medicine or placebo. OUTCOME MEASURES: Mean muscle soreness in the five day period after the exercise test, symptom free days, maximum soreness score, days to no soreness, days on medication. RESULTS: The difference between group means was 0.17 in favour of placebo with 95% confidence intervals +/- 0.50. Similar results were found for other outcome measures. CONCLUSION: The study did not find benefit of the homoeopathic remedy in DOMS. Bench stepping may not be an appropriate model to evaluate the effects of a treatment on DOMS because of wide variation between subject soreness scores.

Demographic and therapeutic determinants of pain reactivity in very low birth weight neonates at 32 Weeks' postconceptional Age.

BACKGROUND: Management of pain in very low birth weight infants is limited by a lack of empiric knowledge about the multiple determinants of biobehavioral reactivity in infants receiving neonatal intensive care. OBJECTIVE: To examine relationship of early neonatal factors and previous medication exposure to subsequent biobehavioral reactivity to acute pain of blood collection. DESIGN: Prospective cohort study. Methods. One hundred thirty-six very low birth weight (

Bases anatomofisiologicas del dolor para un enfoque homeopatico / Anatomophisiologic basis of the pain for an homeopathic analisis

Se trata de una revision de las bases anatomofisiologicas del dolor. Se hace un recuento neuroanatomico relacionando la estructura con las caracteristicas sintomaticas base de la medicina homeopatica; se determina que la medicina homeopatica tiene mejor efecto en la condicion de dolor cronico. Se establecen algunas sugerencias para la investigacion en este campo.(AU)

Receptores opioides a la luz de la biología molecular: explican mas de 6.000 años de farmacología empírica / Opioid receptors in the era of molecular biology: explain more than 6.000 years of empiric pharmacology

The medicinal use of opium and of morphine in different cultures and ancient civilizations is described. Research within the past 40 years have demonstrated the existence of brain opiate receptors. Morphine and related opioid analgetic interact at these sites in the nervous system to produce the characteristic pharmacological effects of these drugs. The opiate receptors have structural homologies with a variety of other cell membrane recpetors; they activate second messenger-based chemical transduction systems in the cell embrane and are endowed with several regulation mechanisms. These opiate receptors are presumably activated under specific physiological conditions by endogenous ligands (opiopeptins). It is currently thought thar morphine mimicks the opiopeptins by interacting with these receptors either at different molecular subsites or with a different mode of action

Bases anatomofisiológicas del dolor para un enfoque homeopático / Anatomo-phisiological bases of pain

Se trata de una revisión de las bases anatomofisiológicas del dolor. Se hace un recuento neuroanatómico relacionando la estructura con las características sintomáticas base de las medicina homeopática; se determina que la medicina homeopática tiene mejor efecto en la condición de dolor crónico. Se establecen algunas sugerencias para la investigación en este campo