Chiropractic + Naturopathic Doctor • April 2016 • Roundup

University of Georgia researchers are announcing a study addressing ways to reduce the stigma surrounding concussions, an injury so commonly associated with football.

Funded by a three-year, $400,000-grant from the NCAA and the U.S. Department of Defense, Julianne Schmidt, an assistant professor in the UGA College of Education’s kinesiology department, and Welch Suggs, an associate professor in the Grady College of Journalism and Mass Communication, are creating intervention methods to help athletes seek assistance after they have suffered a concussion.

“The goal is to change the culture in sport to one of reporting rather than one of concealing,” said Schmidt, who has led several studies involving concussions and the recovery process associated with them.

Suggs, who studies how media images affect individual attitudes about health and sports issues, will help examine how in-person seminars and multimedia presentations affect athletes’ attitudes toward reporting concussions.

“The problem is, athletes are unwilling to report concussions because they’re worried about compromising their status on the team,” he said. “We’re trying to work with the athletes and the people surrounding them to make concussion reporting less of a threat.”

A survey will be conducted to determine athletes’ knowledge and attitudes toward concussions, and the results will be used to create an intervention strategy delivered in multiple platforms. Parents and coaches will be involved in the process as well, which will help reinforce among the athletes the importance of reporting a concussion. While there are no military participants in the research, the Department of Defense plans to use the study to address similar concussion-reporting issues among soldiers.

The research team also includes Ron Courson, director of sports medicine for the UGA Athletic Department; Fred Reifsteck, UGA’s head team physician; coaches and athletes at Division II and III schools in Georgia; and Laura Bierema, associate dean for academic programs in the College of Education.

Schmidt said at the end of the study the team plans to present guidelines to be distributed throughout the NCAA to encourage reporting concussions derived from scientific evidence. This dives deeper than current concussion information given to athletes, which focuses on simply knowing the facts about a concussion.

This new program would address questions elite student athletes ask, such as, “What will my parents think?” and “What will my coaches think?”

Acupuncture may be a safe and effective adjunctive integrative medicine treatment for chronic pain in pediatric patients, according to a new study published in the December 2015 issue of Alternative and Complementary Therapies.

The study was conducted at Rush University Medical Center’s Cancer Integrative Medicine Program in Chicago and led by Angela Johnson, a Chinese medicine practitioner at Rush.

“Effective treatment of pain can be particularly difficult because it’s subjective; but with children, it is increasingly difficult because a child may not be able to communicate effectively depending on the age and accurate recognition of pain,” says Johnson.

While acupuncture has been shown to reduce pain in adults, there’s very little data on it’s effectiveness in children. “This study looked at the effect of acupuncture in children directly, rather than examining data collected from adults. This focus is especially important, since children experience pain in different ways than adults,” Johnson says.

Chronic pain affects 20 to 35 per cent of children under age 18 worldwide. Conditions that can cause chronic pain in children include headaches, abdominal pain, back pain, musculoskeletal pain, scoliosis, leukemia, sports injuries and Crohn’s disease.

The Rush study included 55 children and adolescents between age seven and 20 who experienced chronic pain conditions. Each patient received up to eight individually tailored acupuncture treatments lasting 30 minutes.

All patients reported significant and progressive declines across all levels of pain throughout the eight-session treatment, with stronger pain reductions during early treatment. Participants also reported substantial pain reductions from the start to the end of each session. Additionally, patients reported significant reductions in health, emotional, social and educational problems. These findings were corroborated by similar reductions in parent- reported observations of the same issues.

“Acupuncture provides an amazing alternative to chronic pain medication. This is especially true for patients who may have to cope with pain for most of their life, including those who have sickle cell anemia and aftereffects of cancer. In addition it helps with anxiety and depression,” says Dr. Paul Kent, co-principal investigator of the study and pediatric oncologist at Rush. “I’ve had patients completely weaned off all their pain medications when receiving acupuncture therapy. It has also benefited patients who struggle with chronic nausea.”

To measure self-reported intensity, location and quality of pain, the study used the Adolescent Pediatric Pain Tool, which assesses pain using the following criteria:

• A pain-intensity score measured on a 10-centimeter line anchored by the words “no pain,” “little,” “medium,” “large” and “worst possible pain.”

• A number of pain-quality descriptors, yielding both a tallied score indicating number of words circled (circle scores), and tallied scores for sensory, affective, temporal and evaluative pain quality sub scales Higher circle scores indicate a greater subjective experience of pain, higher measurement scores indicate higher levels of pain intensity, and pain-quality descriptors (sensory, affective, temporal and evaluative) help describe the pain experience.

This study contributes to the sparse literature on the use of acupuncture in a pediatric population, and supports acupuncture’s feasibility as an effective strategy for managing chronic pain.

“The results of this study suggest that acupuncture can have a profound positive impact on the health and well-being of children who experience the disabling effects of chronic pain,” Johnson says.

She hopes to expand her research to larger groups of children in order to understand more about how acupuncture can help relieve their chronic pain.

Federal Health Minister Jane Philpott HAS announced more than $4 million in funding for research aimed at improving the health of people who abuse prescription drugs.

More and more Canadians are putting their health at risk by intentionally taking medication, such as opioids, in a way that hasn’t been recommended by a doctor. The Government of Canada, through the Canadian Institutes of Health Research (CIHR), is investing $4.4 million to support four large regional teams comprised of researchers, service providers and decision makers to tackle this public health issue, a statement from the CIHR said.

“Our government is committed to investing in collaborative research projects aimed at improving the health and lives of thousands of Canadians and their families struggling with prescription drug abuse. We commend the regional teams for undertaking a study that has tremendous potential to provide the necessary information to ultimately offer the right treatment to the right patient,” Philpott said.

The teams, based in British Columbia, the Prairies, Ontario, Québec and the Maritimes, collaboratively developed the first national study, Optimizing patient centered-care: a pragmatic randomized control trial comparing models of care in the management of prescription opioid misuse (OPTIMA), conducted through the Canadian Research Initiative in Substance Misuse (CRISM).

“Prescription opioid dependence is now the most frequent opioid problem encountered in our addiction treatment facilities In Canada,” according to Dr. Julie Bruneau, principal investigator, Quebec and Maritimes Node, University of Montreal Hospital Research Centre. “This pan-Canadian study will test specific interventions that have the potential to increase our ability to attract, retain and successfully treat these patients.”

The OPTIMA study will compare and evaluate two treatments for prescription opioid dependence, methadone, which is the current standard of care in Canada, and buprenorphine/naloxone, often the therapy of choice in the United States. The study will address real world treatment conditions, including patient preference for short-term versus long-term treatment with medication, and support pat i e n t-centered approaches informing decisionmaking processes.

The comparison of the effectiveness of the two treatment models in reducing prescription opioid use will generate practice-based evidence that will be extremely valuable for informing patient care and improving overall health outcomes in Canada, the CIHR said.

The teams highlighted today were established under CRISM, which was launched in 2015 to support national collaborative research on reducing negative effects of prescription drug abuse, substance misuse and addiction, including overdose and death.

This investment is part of a $44.9 million investment over five years to expand the National Anti-Drug Strategy to not only include research on illicit drugs, but also prescription drug abuse in Canada.

Prescription drug abuse is a growing public health and safety problem in Canada, particularly among youth. In the 2012 Canadian Alcohol and Drug Use Monitoring Survey, approximately 410,000 Canadians reported abusing prescription drugs like opioid pain relievers. The most common types of prescription drugs abused include: opioids, benzodiazepines, and stimulants.

Mindfulness programs may help alleviate chronic low-back pain among older adults, according to a new study published in JAMA Internal Medicine.

The study, involving 282 participants with an average age of 74 years, compared a mind-body program with a health education program in a single-blind, randomized clinical trial. Eligible participants were people aged 65 years or older, with functional limitations due to chronic low-back pain and moderate chronic pain.

“Treatment of chronic low-back pain (LBP) in older adults is limited by the adverse effects of analgesics,” study authors commented on the importance of the study. “Effective nonpharmacologic treatment options are needed.”

Participants in both the intervention and controlled groups underwent an eight week program followed by monthly sessions for six months. The intervention group program was based on the Mindfulness-based Stress Reduction program model, which included methods of meditation, “using directed breathing and mindful awareness of thoughts and sensations in sitting, walking or lying down positions. They also learned mindful stretching during the initial eight weeks,” a news report from Reuters Health said.

The control group, on the other hand, was given the “10 Keys to health aging” education program.

Based on the Roland and Morris Disability Questionnaire, the study found the mindfulness group had more improvements on their pain after the eight-week program period compared to the control group. Disability scores between the two groups, however, were similar after the six-month follow up sessions.

“Compared with the control group, intervention participants improved an additional -1.1 (mean, 12.1 vs 13.1) points at eight weeks and -0.04 (mean, 12. 2 vs 12.6) points at 6 months (effect sizes, -0.23 and -0.08, respectively) on the Roland and Morris Disability Questionnaire. By six months, the intervention participants improved on the Numeric Pain Rating Scale current and most severe pain measures an additional - 1.8 points (95% CI, - 3.1 to -0.05 points; effect size, -0.33) and -1.0 points (95% CI, -2.1 to 0.2 points; effect size, -0.19), respectively. The changes in Numeric Pain Rating Scale mean pain measure after the intervention were not significant (-0.1 [95% CI, - 1.1 to 1.0] at 8 weeks and - 1.1 [95% CI, -2.2 to - 0.01] at 6 months; effect size, -0.01 and -0.22, respectively),” the study said.

Based on the results of the study, researchers found that a mind-body program can improve short-term function with chronic-low back pain, and long-term for current and most severe pain in older adults.

“The functional improvement was not sustained, suggesting that future development of the intervention could focus on durability,” the study said.