Who seeks primary care for musculoskeletal disorders (MSDs) with physicians prescribing homeopathic and other complementary medicine? Results from the EPI3-LASER survey in France.

BACKGROUND: There is a paucity of information describing patients with musculoskeletal disorders (MSDs) using complementary and alternative medicines (CAMs) and almost none distinguishing homeopathy from other CAMs. The objective of this study was to describe and compare patients with MSDs who consulted primary care physicians, either certified homeopaths (Ho) or regular prescribers of CAMs in a mixed practice (Mx), to those consulting physicians who strictly practice conventional medicine (CM), with regard to the severity of their MSD expressed as chronicity, co-morbidity and quality of life (QOL). METHODS: The EPI3-LASER study was a nationwide observational survey of a representative sample of general practitioners and their patients in France. The sampling strategy ensured a sufficient number of GPs in each of the three groups to allow comparison of their patients. Patients completed a questionnaire on socio-demographics, lifestyle and QOL using the Short Form 12 (SF-12) questionnaire. Chronicity of MSDs was defined as more than twelve weeks duration of the current episode. Diagnoses and co-morbidities were recorded by the physician. RESULTS: A total of 825 GPs included 1,692 MSD patients (predominantly back pain and osteoarthritis) were included, 21.6% in the CM group, 32.4% Ho and 45.9% Mx. Patients in the Ho group had more often a chronic MSD (62.1%) than the CM (48.6%) or Mx (50.3%) groups, a result that was statistically significant after controlling for patients' characteristics (Odds ratio = 1.43; 95% confidence interval (CI): 1.07 - 1.89). Patients seen by homeopaths or mixed practice physicians who were not the regular treating physician, had more often a chronic MSD than those seen in conventional medicine (Odds ratios were 1.75; 95% CI: 1.22 - 2.50 and 1.48; 95% CI: 1.06 - 2.12, respectively). Otherwise patients in the three groups did not differ for co-morbidities and QOL. CONCLUSION: MSD patients consulting primary care physicians who prescribed homeopathy and CAMs differed from those seen in conventional medicine. Chronic MSD patients represented a greater proportion of the clientele in physicians offering alternatives to conventional medicine. In addition, these physicians treated chronic patients as consulting rather than regular treating physicians, with potentially important impacts upon professional health care practices and organisation.

Effectiveness of the homeopathic preparation Zeel compared with carprofen in dogs with osteoarthritis.

The authors compared the symptomatic effectiveness of a complex homeopathic preparation Zeel (1-3 tablets orally per day depending on body weight) to carprofen (4 mg/kg body weight) in dogs (n=68) aged >1 yr diagnosed with osteoarthritis in a multicenter, prospective, observational open-label cohort study in 12 German veterinary clinics. The active treatment period was 56 days. Symptomatic effectiveness, lameness, stiffness of movements, and pain on palpation were evaluated by treating veterinarians and owners. Clinical signs of osteoarthritis improved significantly (P<0.05) at all time points (days 1, 28, and 56) with both therapies. At the end of the treatment period, effectiveness was comparable in both groups. Both treatment regimens were well tolerated with only three treatment-related adverse events, all in the carprofen group.

Lipid peroxidation, erythrocyte antioxidants and plasma antioxidants in osteoarthritis before and after homeopathic treatment.

OBJECTIVE: This study attempts to evaluate the status of oxidative stress in osteoarthritis (OA), by measuring some parameters of oxidant stress and antioxidant defenses in blood, before and after homeopathy treatment, and to asses the role, if any, of homeopathic treatment in modulating free radical toxicity in OA. METHODS: Erythrocyte lipid peroxidation (LP), erythrocyte antioxidants viz., glutathione (GSH), glutathione reductase (GR), superoxide dismutase (SOD), catalase (CT) and plasma antioxidants viz., ceruloplasmin, glutathione-S-transferase (GST), vitamin C, total antioxidant activity (AOA) were determined in eighty one patients with OA and fifty three normals. Forty seven patients, who were treated with homeopathic remedies were considered for the follow-up studies. LOCATION: Father Muller Homeopathic Hospital, Mangalore, South Karnataka, India. RESULTS: Erythrocyte LP (0 hour, p<0.001; 2 hours, p<0.01; and susceptibility to LP, p<0.05) and SOD (p<0.05) were significantly higher, whereas plasma vitamin C (p<0.01) and AOA (p<0.001) were significantly lower in OA patients when compared to controls. In follow-up patients the erythrocyte LP (0 hour, p<0.01; 2 hours, p<0.01; and susceptibility to LP, p<0.01) and SOD (p<0.01) were significantly lower when compared to their pretreatment values. Plasma vitamin C attained a normal range. The AOA activity after treatment was not significantly different from that observed before treatment. CONCLUSION: Oxidative stress increased in OA as indicated by increased LP, SOD, decreased vitamin C and AOA. On homeopathic treatment the LP has decreased in the erythrocytes which shows and reduced oxidative stress. This is further evidenced by returning of plasma vitamin C and erythrocyte SOD to the normal levels, but oxidant stress has not been completely overcome as plasma AOA remained low after treatment.

Osteoarthritis: an overview of the disease and its treatment strategies.

Osteoarthritis (OA) is currently defined by the American College of Rheumatology as a "heterogeneous group of conditions that leads to joint symptoms and signs which are associated with defective integrity of articular cartilage, in addition to related changes in the underlying bone at the joint margins." Its prevalence after the age of 65 years is about 60% in men and 70% in women. The etiology of OA is multifactorial, with inflammatory, metabolic, and mechanical causes. A number of environmental risk factors, such as obesity, occupation, and trauma, may initiate various pathological pathways. OA indicates the degeneration of articular cartilage together with changes in subchondral bone and mild intraarticular inflammation. The principal treatment objectives are to control pain adequately, improve function, and reduce disability. Acetaminophen is frequently used for symptomatic OA with mild to moderate pain. Nonsteroidal antiinflammatory drugs (NSAIDs) are more effective in the case of moderate-severe pain, but they have an increased risk of serious upper gastrointestinal adverse events. The newer cyclooxygenase COX-2 specific inhibitors (Coxibs) are as efficacious as traditional NSAIDs and have a better gastrointestinal safety profile. Other compounds (eg, chondroitin sulfate, diacerein, glucosamine sulfate) have a symptomatic effect that is slower and less than that of NSAIDs. The structure-modifying effects of drugs are currently being evaluated, and both glucosamine sulfate and diacerein have been shown in some trials to have a beneficial structural effect. Nonpharmacological interventions are frequently and widely used in the management of OA patients, but there is little evidence that they are effective: the best studied and most successful nonpharmacological interventions are patient education, self-management, and exercise. There is some evidence for the pain-relieving efficacy of thermotherapy and transcutaneous electrical nerve stimulation (TENS) but not of electrotherapy, acupuncture, homeopathy, or manual therapy. The value of interventions aimed at improving function and maximizing independence (occupational therapy, walking aids, workplace adaptation) is also unclear. The disease course and patient's requirements often change over time, thus requiring a periodic review and readjustment of therapy rather than the rigid continuation of a single treatment.

Homeopathy and rheumatic disease.

Despite a growing interest in uncovering the basic mechanisms of arthritis, medical treatment remains symptomatic. Current medical treatments do not consistently halt the long-term progression of these diseases, and surgery may still be needed to restore mechanical function in large joints. Patients with rheumatic syndromes often seek alternative therapies, with homeopathy being one of the most frequent. Homeopathy is one of the most frequently used complementary therapies worldwide.

Complementary and alternative therapies in occupational health. Part II--Specific therapies.

Dossey (2001) says, "The nurse serves as a facilitator and helps assist the patient and his or her significant others to be in the best state for healing to take place. Nurses are in a unique position to be instruments of healing at all times." According to Fitch (1999), "A fundamental goal of nursing is to comfort." Complementary and alternative therapies offer many self care and comforting remedies help employees prevent disease and promote healing. Occupational health nurses have the ability to educate employees and offer guidance about CAM therapies; encourage self care management of minor complaints; and encourage employees, when appropriate, to seek health care. As employees' use of CAM continues to increase, occupational health nurses need to monitor use of CAM therapies among employees. Nurses should inform the employer, case managers, and insurance companies involved about the potential increase in CAM use to promote changes in the health care system and integrate conventional and CAM therapies as needed. Further research related to CAM therapies continues as the health care system warrants safe, effective, and cost effective ways to promote health and prevent or manage illness.

Complementary or alternative therapies for osteoarthritis.

Complementary or alternative therapies for osteoarthritis are commonly used and therefore it is important that health-care providers and patients are aware of the evidence for or against these approaches. In this article, the best available evidence is reviewed. The results suggest that, for several treatments, the risk-benefit profile is encouraging: acupuncture, several herbal medicines and capsaicin cream. For other therapies the evidence is weak or contradictory: homeopathy, magnet therapy, tai chi, leech therapy, music therapy, yoga, imagery and therapeutic touch. Many other treatments have not been scientifically tested. It is concluded that some complementary or alternative therapies have generated sufficiently promising results to warrant further investigation in large-scale, definitive, randomized clinical trials.

Resultados del tratamiento homotoxicológico en pacientes con artrosis de rodilla: 5 años de experiencia / Homotoxicological therapy for knee arthritis: five years of experience

Introducción: la artrosis puede limitar las actividades cotidianas. Los tratamientos actuales están orientados a calmar el dolor, disminuir la inflamación, la rigidez articular y la limitación para la marcha. Existen tratamientos que ofrecen nuevas alternativas como los medicamentos de la homotoxicología. El propósito de esta investigación es evaluar la utilidad de estos productos frente a la artrosis de la rodilla. Materiales y métodos: se estudiaron 65 pacientes con condromalacia grado III y IV que consultaron a la clínica Medicadiz entre 2001 y 2005. Se les realizó artrocentesis para la aplicación de los medicamentos. Se realizó seguimiento con el test de Womac, evaluación de la marcha y escala visual análoga del dolor. Se realizó artroscopia de segunda mirada. Resultados: el 75,4% de los pacientes tuvo un Womac inicial con resultados regulares y pobres, contrario a lo que se observa en el Womac después del tratamiento homotoxicológico, en donde el 90,7% tuvo resultados excelentes y buenos. El 82,8% de los pacientes tuvo mejoría de la marcha después del tratamiento. La escala visual análoga del dolor tuvo un promedio inicial de 7,5. El 75% tuvo un puntaje de 2 al terminar el tratamiento. Seis pacientes (9,2%) se sometieron a artroscopia de segunda mirada mostrando mejoría de la condromalacia. Discusión: la homotoxicología puede ser una herramienta terapéutica que permita ofrecer a los pacientes soluciones definitivas que eviten el proceso destructivo articular.

La homeopatía frente a casos con tratamiento convencional / Treating patients on conventional drugs homeopathically

Durante mucho tiempo se creyó que un paciente no podía ser tratado con Homeopatía si es que, al momento de la consulta, se encontraba siguiendo un tratamiento alopático. Los doctores Morrison y Herrick establecen las pautas generales que deben seguirse al respecto y los inconvenientes que aparecen al momento de tratar de remplazar la medicina convencional por la medicina homeópata. Una parte del trabajo rescata la opinión que tienen algunos pacientes acerca de los dos sistemas clínicos terapéuticos, así como las expectativas de la familia (y de la sociedad, por extensión) en torno al método clínico configurado por Samuel Hahnemann.

For a long time it was believed that a patient could not be treated with Homeopathy if, at the time of consultation, was following an allopathic treatment. The doctorsHerrick Morrison established the general guidelines to be followed in this regard and disadvantages that appear when trying to replace the conventional medicine homeopathic medicine. Part of the work rescues the opinion they have some patients on the two treatment clinical systems as well as the expectations of the family (and society by extension) about the clinical method set by Samuel Hahnemann.

La homeopatía frente a casos con tratamiento convencional / Treating patients on conventional drugs homeopathically

Durante mucho tiempo se creyó que un paciente no podía ser tratado con Homeopatía si es que, al momento de la consulta, se encontraba siguiendo un tratamiento alopático. Los doctores Morrison y Herrick establecen las pautas generales que deben seguirse al respecto y los inconvenientes que aparecen al momento de tratar de remplazar la medicina convencional por la medicina homeópata. Una parte del trabajo rescata la opinión que tienen algunos pacientes acerca de los dos sistemas clínicos terapéuticos, así como las expectativas de la familia (y de la sociedad, por extensión) en torno al método clínico configurado por Samuel Hahnemann. (AU)

For a long time it was believed that a patient could not be treated with Homeopathy if, at the time of consultation, was following an allopathic treatment. The doctorsHerrick Morrison established the general guidelines to be followed in this regard and disadvantages that appear when trying to replace the conventional medicine homeopathic medicine. Part of the work rescues the opinion they have some patients on the two treatment clinical systems as well as the expectations of the family (and society by extension) about the clinical method set by Samuel Hahnemann. (AU)

Complementary medicine.

Complementary medicine has become an important subject for rheumatologists, not least because many patients try complementary treatments. Recent clinical trials yield promising results. In particular, evidence suggests that several herbal medicines and dietary supplements can alleviate the pain of osteoarthritis and rheumatoid arthritis. Clearly, rigorous testing of complementary treatments is possible, and considering their popularity, should be encouraged.

Homeopathic remedies for the treatment of osteoarthritis: a systematic review

Osteoarthritis is a common rheumatic disease. Limitations of conventional medical management of this condition indicate a real need for safe and effective treatment of osteoarthritic patients. The authors review the clinical evidence for and against the effectiveness of homeopathic medicines in the... (AU)

Homeopathie, biotherapie et osteoarthrite / Homeopathy, biotherapy and osteoarthritis

Les atteintes articulaires representent un stade important de ces maladies invalidantes, impliquant une degradation des conditions de vie du patient, davantage de depenses pour le diagnostic et le traitement, et... (AU)

Bloqueio do nervo obturador como proposta terapêutica analgésica para osteoartrose de coxofemoral - técnica simplificada / Obturator nerve blockage as an analgesic proposal for hip osteoarthritis - a simplified technique

Apresentar uma nova abordagem terapêutica na dor por osteartrose de quadril por meio de uma técnica simplificada de bolqueio do nervo obturador; com a vantagem de ser mais fácil, rápida e com menor risco que a técnica descrita em literatura. Será enfatizada também a necessidade de um tratamento global, nos casos de dor crônica. Sendo aqui relatado o caso clínico da primeira paciente a ser submetida a esse procedimento a qual apresentou grande melhora do quadro álgico (com base na escala visual analógica) e funcional (segundo relatos da paciente).

Treating patients on conventional drugs homeopathically

Patients on allopathic drugs at the time they present for homeopathic treatment can present unique challenges to the practitioner. Dr. Morrison and Nancy Herrick, PA discuss these challenges in detail and offer protocols for managing such cases