Our Research:

Complementary treatments for osteoarthritis (OA) are sought by patients for symptomatic relief and to avoid the iatrogenic effects of non-steroidal antiinflammatories

This systematic review evaluates the efficacy of the nutritional supplement Perna Canaliculus (green-lipped mussel, GLM) in the treatment of OA and substantially adds to previous work by focussing solely on GLM use in OA as well providing a re-analysis of the original trial data.
Randomized or quasi-randomized controlled trials (comparative, placebo-controlled or crossover) were considered for inclusion from Cochrane Library, Medline, Embase, Amed, Cinahl, Scopus and NeLH databases where adults with OA of any joint were randomized to receive either GLM vs. placebo, no additional intervention (usual care), or an active intervention. The methodological quality of the trials was assessed using the JADAD scale. Four RCTs were included, three placebo controlled, the fourth a comparative trial of GLM lipid extract vs. stabilized powder extract. No RCTs comparing GLM to conventional treatment were identified. All four studies assessed GLM as an adjunctive treatment to conventional medication for a clinically relevant time in mild to moderate OA. All trials reported clinical benefits in the GLM treatment group but the findings from two studies cannot be included in this review because of possible un-blinding and inappropriate statistical analysis. The data from the two more rigorous trials, in conjunction with our re-analysis of original data suggests that GLM may be superior to placebo for the treatment of mild to moderate OA. As a credible biological mechanism exists for this treatment, further rigorous investigations are required to assess efficacy and optimal dosage.

Objective Conventional treatment of osteoarthritis (OA) with non-steroidal anti-inflammatory drugs is associated with serious gastrointestinal side effects and in view of the recent withdrawal of some cyclo-oxygenase-2 inhibitors, identifying safer alternative treatment options is needed. The objective of this systematic review is to evaluate the existing evidence from randomised controlled trials of two chemically related nutritional supplements, dimethyl sulfoxide (DMSO) and methylsulfonylmethane (MSM) in the treatment of OA to determine their efficacy and safety profile.

Methods The electronic databases [Cochrane Library, Medline, Embase, Amed, Cinahl and NeLH (1950 to November 2007)] were searched. The search strategy combined terms: osteoarthritis, degenerative joint disorder, dimethyl sulfoxide, DMSO, methylsulfonylmethane, MSM, clinical trial; double-blind, single blind, RCT, placebo, randomized, comparative study, evaluation study, control. Inclusion and exclusion criteria were applied. Data were extracted and quality was assessed using the JADAD scale.
Results Six studies were included [evaluating a total of 681 patients with OA of the knee for DMSO (N = 297 on active treatment); 168 patients for MSM (N = 52 on active treatment)]. Two of the four DMSO trials, and both MSM trials reported significant improvement in pain outcomes in the treatment group compared to comparator treatments, however, methodological issues and concerns over optimal dosage and treatment period, were highlighted.
Conclusion No definitive conclusion can currently be drawn for either supplement. The findings from all the DMSO studies need to be viewed with caution because of poor methodology including; possible unblinding, and questionable treatment duration and dose. The data from the more rigorous MSM trials provide positive but not definitive evidence that MSM is superior to placebo in the treatment of mild to moderate OA of the knee. Further studies are now required to identify both the optimum dosage and longer-term safety of MSM and DMSO, and definitive efficacy trials.

Objective: The specific sensations (deqi) generated during acupuncture are thought to be important for a positive clinical outcome, particularly when treating pain. It is important to be able to measure these sensations and discriminate between deqi and pain. A greater understanding of this will greatly aid researchers who wish to conduct mechanistic studies of acupuncture. Previous questionnaire designs failed to consider patient experience and, hence, may have been flawed. The aim of this study was to generate and validate a new sensation questionnaire, that was able to discriminate between pain and deqi, taking into account patient experience and expert opinions.
Design: The questionnaire was designed following qualitative interviews with patients, literature review, and consultation with experts. The questionnaire was piloted and then validated. It was successfully completed by 227 patients and analyzed using factor analysis and partial correlation.
Setting: Patients were recruited via the physical therapy department at Southampton General Hospital and from private practice clinics in and around the Southampton area.
Subjects: The subjects were patients receiving acupuncture for any condition.
Results Two (2) factors were clearly demonstrated: “Aching deqi” (7 items) which suggested deqi with pain and “Tingling deqi” (7 items) suggesting deqi only. One (1) item related solely to pain and 2 further items did not load into any factor.
Conclusions The final questionnaire is presented containing 17 items and is shown to be a valid, rigorous, soundly grounded, and patient-centered measure, capable of accurately recording deqi. We suggest that analysis should include a partial correlation of certain sensations against a pain visual analogue scale to ascertain how painful each sensation was, particularly if the questionnaire is to be used in a context in which pain and deqi need to be separated or their relationship clarified.

Background The hypothesis that hypersensitivity to Candida yeasts, present in the gastrointestinal tract, causes a diffuse collection of multi-system symptoms is not generally accepted within conventional medicine. A questionnaire (FRDQ-7) was previously developed and used to identify patients for a randomised, placebo-controlled trial of the non-absorbed antifungal drug nystatin. Nystatin was superior to placebo in relieving these symptoms. This provides some support for the hypotheses that underpin the ‘Candida syndrome’1.
Aim To identify a population with a high (>9) FRDQ-7 score and symptom-free controls and subsequently to explore the relationship between FRDQ-7 and Candida IgA, IgG and IgM levels.
Design A case controlled study.
Methods Santelmann has suggested that the FRDQ-7 describes people with ‘Candida syndrome’ if the score is > 9; 35 patients with medically unexplained symptoms, aged between 18 and 64, were selected for study if they scored >9 on the FRDQ-7 questionnaire. Serum Candida IgA, IgG and IgM measurements were undertaken both for this group and a group of forty five healthy age and sex-matched controls and the immunoglobulin  concentrations compared.
Results Candida IgG concentration was significantly higher in the subject group than in the control group (p<0.001). No significant difference was found for Candida IgA or IgM concentrations.
Conclusions Further studies are requires to identify if there is a causal link for the elevation of serum IgG found in this sub-group of patients with increased FRDQ-7 scores, or whether these 2 observations are parallel manifestations of a common underlying disorder.

Background Insomnia is the most common of all sleep complaints and is under-researched. The current treatments of choice are conventional hypnotics agents, but these have potential for serious adverse reactions. Uncontrolled and anecdotal evidence suggests that lavender oil is an effective treatment for insomnia, but this has not been formally investigated.
Objectives The aims of this study were to evaluate the proposed trial methodology and the efficacy of Lavandula augustifolia (lavender) on insomnia.
Interventions: Interventions consisted of Lavandula augustifolia (treatment) and sweet almond oil as placebo/control. The aroma was supplied via an Aromastream device (Tisserand Aromatherapy, Sussex, UK).
Design This was a pilot study with randomized, single-blind, cross-over design (baseline, two treatment periods, and a washout period, each of 1 week duration).
Subjects and setting Volunteers with defined insomnia treated on a domiciliary basis participated in the study.
Outcome measures Outcomes were assessed with the following: Pittsburgh Sleep Quality Index (PSQI) indicating insomnia (score 5 at entry); Borkovec and Nau (B&N) Questionnaire evaluating treatment credibility; and Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ) assessing attitudes to CAM and health beliefs.
Results Ten (10) volunteers (5 male and 5 female) were entered and completed the 4 week study. Lavender created an improvement of 2.5 points in PSQI (p  0.07, 95% CI 4.95 to 0.4). Each intervention was equally credible and belief in CAM did not predict outcome. Women and younger volunteers with a milder insomnia improved more than others. No period or carry-over effect was observed.
Conclusion The methodology for this pilot study appeared to be appropriate. Outcomes favor lavender, and a larger trial is required to draw definitive conclusions.