The Role of Acupuncture in Pain Management.

Acupuncture is a traditional Chinese practice of medicine that has gained popularity in Western culture and around the world. It involves the insertion of thin needles into the skin to stimulate nerves, muscles, and connective tissues throughout the body with the goal of alleviating pain, tension, and stress. More broadly, acupuncture is actually a family of different procedures. Conceptually, it is believed to stimulate the body's meridians, or energy-carrying channels, in an attempt to correct imbalances and to restore health. These benefits are thought to be derived from the proximity of acupoints with nerves through intracellular calcium ions. This lesson outlines a brief history of acupuncture and how it may be used to treat various types of physical and emotional pain and specific conditions, including overactive bladder and psoriasis. Acupuncture has been demonstrated to enhance endogenous opiates, such as dynorphin, endorphin, encephalin, and release corticosteroids, relieving pain and enhancing the healing process. There are associated risks; however, serious side effects are rare. When compared to traditional methods of pain management, more studies are warranted in order to establish the efficacy of acupuncture and its place in pain management.

Macrolide and fluoroquinolone mediated cardiac arrhythmias: clinical considerations and comprehensive review.

While there is evidence for cardiac arrhythmias associated with macrolide and fluoroquinolone antibiotics, there is still debate among health care providers as to whether this risk of arrhythmia is overstated. A joint panel of the US Food and Drug Administration suggested that macrolide and fluoroquinolone labels need much stronger warnings regarding the possible serious adverse cardiac effects associated with these antibiotics, especially since they are so widely prescribed. And while health care providers may differ on the pertinence of the cardiac risks associated with antibiotic use, they can undoubtedly minimize the cardiac effects that are associated with these antibiotics by paying attention to the cardiac risk factors and drug history associated with the patient. Relevant studies for our review were identified from a PubMed search using keywords and combined word searches involving macrolides, fluoroquinolones, and cardiac arrhythmias. We attempted to include as many recent (>2015) articles as possible. We included case reports, randomized, controlled trials, observational studies, case-control studies, systematic reviews, and retrospective studies. Underlying cardiac issues can predispose patients to harmful cardiac side effects that can be exacerbated in the presence of antibiotics. The health care provider should rule out any risk factor associated with antibiotic-induced cardiac arrhythmia in the event that a patient does need a macrolide or fluoroquinolone antibiotic. Rigorous patient evaluation and a detailed patient history, including short and long term medication use, is the likely key to reducing any risk of cardiac arrhythmias associated with macrolides and fluoroquinolones. Clinicians should be cautious when prescribing macrolide and fluoroquinolone medications to patients with risk factors that may lead to antibiotic-induced cardiac arrhythmias, including a slow heart rate and those that are taking medications to treat arrhythmias.