Psychology, Science, and Pseudoscience: Class #12 (CAM cont.)

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In short: Like homeopathy complementary/alternative therapies such as acupuncture and chiropractic lack plausibility and efficacy, despite claims to the contrary. Placebo and other psychological effects of treatments may explain their popularity.

Education

PS409
Psychology, Science,
& Pseudoscience

Dr Brian Hughes
School of Psychology

brian.hughes@nuigalway.ie @b_m_hughes

Case Studies:
Examples of Psychology-related
Pseudoscience

Case Studies from
Outside Mainstream Psychology:
1. Complementary and alternative
medicine/therapies

CAM efficacy: Acupuncture
Plausibility issues:
Qi, yin, yang, meridians
Poor inter-rater agreement
Empirical issues:
Cochrane Library: 16 reviews
3 reviews for pain:
63 trials; 4,096 participants
No effect
1 review for smoking cessation:
24 trials
No effect

CAM efficacy: Acupuncture
Adverse effects
(Noeheim & Fonnebo, 1995; Yamashita et al., 1998)

Exaggerations?
Anaesthesia
Chinese authenticity vs. Western
romanticism
Impact on health in China

Endorsement by health insurers
Actuarial logic rather than concern for
efficacy

Endorsement by medical authorities
Populism or evidence?

CAM efficacy: Acupuncture
Ireland China India Cuba
Annual health $2,496 $278 $82 $251
spend per
capita*
Life expectancy 75/81 70/74 61/63 75/80
(M/F), yrs
Child mortality 7/5 27/36 81/89 8/7
(M/F), per 1000
Adult mortality 105/60 158/99 275/202 131/85
(M/F), per 1000
TB cases, per 11 101 168 10
100,000
Last polio case 1965 1999 2006 1962
reported

*“International Dollars” = US dollars, corrected for purchasing power parity
(i.e., figure shown refers to amount purchased in terms of US market values)
Source: WHO

CAM efficacy: Acupuncture
“Approved” by the BMA
Reasons given:
Popularity among physicians
Popularity among public
Reported efficacy for, e.g., back pain
(citing Ernst & White, 1998)

2000

CAM efficacy: Chiropractic
Plausibility issues:
Form-function relationship,
subluxations, bodily intelligence,
homuncularity

Empirical issues:
Cochrane Library: 1 review
Dysmenorrhoea
5 trials, 236 participants
No effect
Other frequently cited review:
Shekelle et al. (1992)
No chiropractic among
successful trials

CAM efficacy: Chiropractic
Other reviews
Pain: Ernst (2003); Gay et al.
(2005); Lisi et al. (2005)
50 trials
No effect
Asthma: Ernst & Harkness (2001)
2 separate studies
No effect

CAM efficacy: Chiropractic
Cost-benefit analysis?
Adverse effects of chiropractic
1 per 2 million manipulations
(Powell et al., 1993)
1 per 400,000 manipulations
(Dvorak, 1985)

Placebos
Inert substances that cause symptom relief
“My headache went away after having a sugar pill”

Substances/procedures that cause changes in a
symptom not directly attributable to specific or real
pharmacological/curative action
“My headache went away after I had my hip operation”

Any therapy that is deliberately used for its non-
specific psychological or physiological effects
“My headache went away after I had my bath”

After Ogden (2004)

Placebos

Patient characteristics
Treatment characteristics
Convincingness
e.g., ultrasound for pain (Hashish et al., 1988)
Seriousness
e.g., placebo heart surgery (Cobb et al., 1959; Diamond et al., 1960)

Patient-treatment interaction characteristics
Expectancy effects
e.g., Beta-blocker Trial (Horwitz et al., 1990)

Complementary and alternative
medicine/therapies

The document summarizes research on prolotherapy, which involves injections to repair soft tissues like ligaments and tendons. It discusses definitions of prolotherapy and focuses on dextrose prolotherapy. It provides evidence that prolotherapy is not experimental, as it is taught in postgraduate medical programs and supported by published studies. Several studies on specific conditions like Achilles tendinosis, knee osteoarthritis, and low back pain are summarized, demonstrating safety and efficacy of prolotherapy though some need further research.

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Initial promising outcomes from pilot studies in sports applications demonstrate the need for further research on DOT influence on recovering from sports injuries. Elucidation of the mechanism whereby DOT may be affecting results should also be explored. At present, from the clinical research that has been reported, fluid dynamics may be a key area for focus. DOT warrants further study as a potential treatment option that can influence clinical manifestations of pain syndromes or sports injuries.

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This document summarizes a presentation on integrating osteopathic manipulative treatment (OMT) and acupuncture for a case of low back pain. It provides background on the prevalence of complementary and alternative medicine (CAM) use in the US. It then describes OMT techniques like soft tissue work and muscle energy that were demonstrated for low back pain. It also reviews the evidence and safety of acupuncture and integrates it as a potential treatment option.

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Restorative injection therapies like prolotherapy and platelet rich plasma injections have been used for decades to treat chronic musculoskeletal pain. Prolotherapy originated from injections used to treat hernias in the 1st century AD and was developed in the 1950s to stimulate ligament repair. Studies since have shown it reduces pain and improves function in conditions like low back pain, knee pain, and groin injuries in athletes. Newer therapies involving platelet rich plasma and stem cells show promise based on studies demonstrating reduced pain and cartilage regeneration. While these therapies can cost hundreds for a typical treatment series, they provide an alternative to more invasive and costly surgeries that often only temporarily treat symptoms of chronic conditions.

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While thermal tactile stimulation remains a popular treatment for dysphagia, its effectiveness compared to other methods is debated. Studies have found it helps swallowing for some patients and conditions like cerebral palsy and stroke. However, other research indicates it only provides temporary benefits and may be less effective than electrical stimulation or VitalStim therapy. Future research is still needed to determine how and for whom thermal tactile stimulation is most effective as a treatment method.

The document summarizes a national summit on opioid safety convened to develop consensus on safer opioid prescribing practices for chronic non-cancer pain. The summit goals were to: 1) develop consensus principles for more selective, cautious opioid use; 2) share approaches to mitigate risks; 3) share how to change practice and implement guidelines. It provided background on the opioid epidemic and research showing risks increasing with higher doses and limited evidence of long-term benefits. Draft principles for safer opioid prescribing included starting with non-opioid treatments, carefully evaluating risks, limiting dose escalation, and tapering patients off opioids when risks outweigh benefits.

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The P-Stim and ANSiStim™ miniaturized device is designed to administer auricular point stimulation treatment over several days. The ear provides numerous points for stimulation within a small area. Stimulation is performed by electrical pulses emitted through strategically positioned needles. The ANSiscope device monitors the pain condition of the patient before, during and after the treatment. The P-Stim and ANSiStim™ point stimulation therapy is mainly used to treat pain. Use of the device is recommended for pre-operative, intra-operative and post-operative pain therapy as well as for the treatment of chronic pain. DyAnsys is researching the possibilities of using this concept for the treatment of depression, addiction and allergy. P-Stim and ANSiStim™ therapy allows continuous point stimulation over a period of several days while offering the patient a high degree of comfort and mobility. Use of the P-Stim and ANSiStim™ therapy provides advantages over drug therapy by minimizing possible side-effects caused by pain medications (i.e. opioid). In most cases, the patient continues to lead a normal life without side effects or any loss of quality of life.

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1) The document discusses various techniques for radiofrequency treatment of sacroiliac joint and discogenic pain, including cooled radiofrequency denervation of sacral lateral branches and dorsal rami, as well as intradiscal biacuplasty. 2) Studies show cooled radiofrequency denervation provides 50-79% pain relief in 57-64% of patients with sacroiliac joint pain at 3-6 month follow-up. Intradiscal biacuplasty uses internally cooled bipolar radiofrequency to heat the posterior disc annulus to 55-60°C to treat discogenic pain. 3) The techniques aim to denervate pain fibers while monitoring temperature to avoid excessive

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Acupuncture is one of the oldest types of therapy known to us for about five thousand years. It originated in Asia, specifically in China, was developed further and constituted a very essential part of medicine in that part of the world. In the West, acupuncture was virtually unknown until the year 1972. Professor Bischko was able to prove its mode of action using scientifically recognized methods of Western medicine. Electro-acupuncture is already used on a word-wide scale at present, but has found only limited application in auricular acupuncture, due to the currently relatively large sized equipment. For this reason, a miniature form of electro- acupuncture has been developed, in order to permit carrying out long term auricular acupuncture. The main component of the device is a micro controller (in further sequence a microchip), which allows continuous stimulation in conjunction with an integrated acupuncture needle.

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The rise and fall of RICE The RICE treatment protocol for injuries, which stands for Rest, Ice, Compression, and Elevation, was developed in the 1970s but has increasingly come under scrutiny. While ice was once considered standard treatment for pain relief, numerous studies now show ice may delay healing by reducing blood flow and inflammation needed for tissue repair. Compression and elevation also lack strong evidence of benefits. Alternatives like movement and heat are gaining support as better options for promoting healing through increased blood flow and growth factors. The traditional RICE protocol is falling out of favor as evidence demonstrates movement and inflammation are important parts of the body's natural healing response.

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SAM-now available wrs

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Delivering sustained acoustic medicine for effective, safe, drug-free pain relief and recovery, sam Professional uses ZetrOZ’s proprietary miniaturization technology to provide controlled-release, long duration ultrasound treatment, for up to four hours daily. No other medical technology is available to provide daily multi-hour therapeutic intervention to assist with conservative care and help injured patients get back to work sooner without surgical intervention. sam Professional works by providing continuous mechanical energy directly into tissue. Battery-powered, rechargeable, and comfortable to wear, the deep-penetrating ultrasonic energy reduces inflammatory pain and accelerates recovery of overuse injuries to tendons, ligaments and muscles, relieves chronic muscle spasms, and increases local circulation. Used successfully by a wide range of professional dancers, famous athletes, individuals who work in labor-intensive jobs, and others looking to more effectively manage chronic pain, sam Professional is available by prescription in the US. It is also cleared for sale in Europe, Canada, and Asia.

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This document discusses chronic pain after surgery. It begins with introducing chronic pain as persisting more than 3 months and impacting quality of life. Surgery is recognized as a common cause of chronic pain in pain clinics. The pathophysiology involves central sensitization. Risk factors include surgical technique and nerve injury. Prevention strategies encompass regional anesthesia, preemptive analgesia, and adjuvant drugs like ketamine, gabapentin, and pregabalin. The summary reiterates that perioperative pain can lead to central sensitization and chronic postsurgical pain, while regional blocks may reduce this risk for some surgeries.

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This document discusses electroanalgesia as an alternative for pain management and rehabilitation. It describes how physical pain can be caused by injury, posture, stress, illness and other factors. It then outlines various options for dealing with pain, including living with it, pharmaceuticals, injections, and electroanalgesia. Electroanalgesia works by interrupting nerve function and affecting nerve and muscle stimulation to increase local blood flow and circulation, providing pain relief. The document provides examples of diagnoses and billing codes that can be used for electroanalgesia treatment reimbursement.

Keys to Ending Fibromyalgia

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- Fibromyalgia affects 3 to 6 million Americans, with 80-90% being women who are usually diagnosed in middle age. - It is characterized by widespread pain in the muscles and soft tissues. Common symptoms include fatigue, sleep issues, headaches, and tender points in various areas of the body. - While drugs can help manage symptoms, natural therapies like exercise, stress reduction, and nutrition have shown more long-term promise for fibromyalgia sufferers. Regular exercise in particular can help reduce pain and fatigue and improve overall health.

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The document compares and contrasts traditional and alternative medicines for pain relief. It discusses the long histories of both opioids and acupuncture dating back thousands of years. While opioids provide fast relief, they are highly addictive and do not treat the underlying cause of pain. Acupuncture aims to restore balance to the body's energy flow and has milder side effects but lacks extensive research support. The document examines how each approach works, common side effects, and when each may be best suited for different types of pain treatment.

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The document summarizes research on the efficacy of spinal manipulation for treating migraines and tension headaches. It finds that spinal manipulation provides significant relief for many patients, with benefits comparable or superior to traditional drug-based treatments. It also discusses evidence that cervical spine dysfunction may cause headaches by transmitting forces to pain-sensitive dura via connective tissues. The document concludes that spinal manipulation performed by a skilled practitioner has an excellent safety record.

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1) The document discusses a study that explored the daily routines and quality of life of 10 individuals with chronic pain through interviews and assessments. 2) A grounded theory called the "Paradigm of Life" emerged from the data, which found that chronic pain disrupts individuals' occupations and impacts their quality of life. 3) The theory shows how engaging in meaningful occupations can enhance quality of life by providing distraction from pain and a sense of control.

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