In the News

Study: Use of Alternative Therapy for Pain Treatment Increases With Age and Wealth

Obesity Associated With Increased Risk of Fibromyalgia

Women Who Eat Foods With High Glycemic Index May Be at Greater Risk for Heart Disease

Study Identifies Food Combination Associated With Reduced Alzheimer’s Disease Risk

Study: Use of Alternative Therapy for Pain Treatment Increases With Age and Wealth

In a University of Michigan Health System study, one out of three patients with chronic pain reported using complementary and alternative medicine therapies such as acupuncture and chiropractic visits for pain relief.

Socioeconomic factors—primarily race and age—played a large role in the use of alternative therapy in chronic pain patients, the study showed. Whites used alternative modalities more frequently than blacks, and elderly adults had a higher frequency of using alternative therapies than younger adults.

According to the lead author, Carmen R. Green, MD, U-M professor of anesthesiology and obstetrics and gynecology and associate professor of health management and policy, this pattern may be due to alternative medicine therapies usually attracting individuals with higher education levels and income. The pattern could be a result of differences in insurance coverage.

Also, as people age, there is a greater chance that they will deal with chronic pain; therefore, as age increases, so does the likelihood that people will seek alternative therapies to deal with the pain.

The study, which appears in the journal Pain Medicine, highlights the importance of complementary and alternative medicine, its increasing usage, its economic impact, and concerns about safety and effectiveness.

To track the link between pain and alternative medicine, Green and S. Khady Ndao-Brumblay, PharmD, MSc, doctoral student in health management and policy at the U-M School of Public Health, looked at the ethnic and racial disparities in treating chronic pain in 5750 adults over a 6-year period.

Socioeconomic characteristics, medical history, physical and social health characteristics, and pain-related symptoms in both black and white adults with chronic pain were collected with the Pain Assessment Inventory Narrative to assess the treatment methods.

The types of practitioner-based alternative therapy examined included manipulation therapy such as chiropractic or physical therapy procedures, biofeedback (instruments that control the heart rate, blood pressure and brain waves for relaxation purposes) and acupuncture.

These three alternative medicine therapy services were used most often by people with chronic pain, but who uses the therapy depends on the type of modality.

Of those observed, 35% reported using at least one form of complementary and alternative medicine therapy, with 25% using manipulation techniques, 13% using biofeedback, and 8% using acupuncture.

Green, U-M pain medicine physician and anesthesiologist, says complementary and alternative medicine therapies can be beneficial in treating pain, but further studies are needed to determine just how effective they are and how great the risks and benefits are. Because alternative therapy is often used in combination with other methods, such as regular physician visits and traditional medications, she warns patients should inform their doctors when using these therapies.

Chronic pain has been found to double the odds of seeking alternative services; therefore, this along with decreased access to and negative perceptions about pain treatment may be among the primary reasons for seeking this type of therapy over conventional medicine. However, more research needs to be done to confirm this.

Obesity Associated With Increased Risk of Fibromyalgia

Researchers at the Norwegian University of Science and Technology have found an association between the level of leisure-time physical exercise and a future risk of developing fibromyalgia (FM). The research team also identified body mass index (BMI) as an independent risk factor for fibromyalgia. Details of the study appear in the May issue of Arthritis Care & Research.

Fibromyalgia is a chronic pain syndrome characterized by widespread pain lasting more than 3 months and tender point sites in the neck, shoulders, back, hips, arms, and legs. Associated features often include unexplained fatigue, sleep disturbances, headache, cognitive difficulty, and mood disturbances. The prevalence of FM increases with age and is considerably higher among women than men. Although the etiology of FM is poorly understood, many authors have suggested that a dysfunctional autonomic nervous system involving deficiencies in the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system contributes to the development of FM by altering pain perception and endogenous pain inhibition.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, FM has been linked to stressful or traumatic events, such as car accidents, repetitive injuries, illness, and certain diseases, or FM can occur spontaneously. Some scientists speculate that a gene or genes might be involved in fibromyalgia that could make a person react strongly to things that other people would not find painful.

Longitudinal studies have shown that physical exercise is associated with less musculoskeletal pain and stiff or painful joints among aging women. The Norwegian researchers, led by Paul Mork, DPhil, proposed that first, there is an association between levels of leisure-time physical exercise and future risk of FM and, second, being overweight/obese may represent an independent risk factor for future development of FM. Data for the study was collected from the Nord-Trøndelag Health (HUNT) Study, the first part conducted in 1984  (HUNT 1) and the second in 1995 (HUNT 2). During the 11 years between HUNT 1 and HUNT 2, 380 cases of incident FM were reported among 15 990 women who provided information on relevant variables at both surveys and who reported no FM or physical impairment at HUNT 1.

According to Dr Monk, women who exercised four times per week had a 29% lower risk of FM compared with inactive women. Similar results were found in analysis of the summary score, which combined information on frequency, duration, and intensity of exercise. Women with the highest exercise levels had a lower risk of FM than inactive women. The study also shows that a high BMI is a strong and independent risk factor for future development of FM. Furthermore, there are higher relative risks for the combined effect of being overweight/obese and inactive than being overweight/obese alone.

Though the causal relationship between obesity and FM remains unknown, there are some etiologic factors in common. Studies suggest that proinflammatory cytokines play a role in FM and the relationship between FM and obesity. Other studies point to dysregulation of the HPA axis, which has been observed in both FM and obesity. Finally, increased sympathetic tonus and reduced sympathetic reactivity, as recorded by heart rate variability, have been observed in patients with FM as well as in overweight and obese patients.

Women Who Eat Foods With High Glycemic Index May Be at Greater Risk for Heart Disease

Consuming carbohydrates with high glycemic index—an indicator of how quickly a food affects blood glucose levels—appears to be associated with the risk of coronary heart disease in women but not men, according to a report in a recent issue of Archives of Internal Medicine.

High-carbohydrate diets increase the levels of blood glucose and of harmful blood fats known as triglycerides while reducing levels of protective HDL or “good” cholesterol, thereby increasing heart disease risk. However, not all carbohydrates have the same effect on blood glucose levels. The glycemic index is a measure of how much a food raises blood glucose levels compared with the same amount of glucose or white bread. A related measure, the glycemic load, is calculated based on the glycemic index of a given food and also on the total amount of carbohydrates it contains.

Sabina Sieri, PhD, of Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, and colleagues studied 47 749 Italian adults—15 171 men and 32 578 women—who completed dietary questionnaires. Based on their responses, the researchers calculated their overall carbohydrate intakes as well as the average glycemic index of the foods they consumed and the glycemic loads of their diets. During a median (midpoint) of 7.9 years of follow-up, 463 participants (158 women and 305 men) developed coronary heart disease.

The one-fourth of women who consumed the most carbohydrates overall had approximately twice the risk of heart disease as the one-fourth who consumed the least. When these carbohydrates were separated into high- and low-glycemic index categories, increased intake from high-glycemic index foods was significantly associated with greater risk of coronary heart disease, whereas low-glycemic index carbohydrates were not. “Thus, a high consumption of carbohydrates from high-glycemic index foods, rather than the overall quantity of carbohydrates consumed, appears to influence the risk of developing coronary heart disease,” according to the authors.

The one-fourth of women whose diet had the highest glycemic load had 2.24 times the risk of heart disease compared with the one-fourth of women with the lowest glycemic load.

Overall carbohydrate intake, glycemic index, and glycemic load were not associated with heart disease risk in men. This could be because the adverse changes associated with carbohydrate intake, including triglyceride levels, are stronger risk factors for heart disease in women than in men.

Study Identifies Food Combination Associated With Reduced Alzheimer’s Disease Risk

Individuals whose diet includes more salad dressing, nuts, fish, poultry, and certain fruits and vegetables and fewer high-fat dairy products, red meats, organ meats, and butter appear less likely to develop Alzheimer’s disease, according to a report that will appear in the June print issue of Archives of Neurology.

Yian Gu, PhD, of Columbia University Medical Center, New York, and colleagues studied 2148 older adults (aged 65 years and older) without dementia living in New York. Participants provided information about their diets and were assessed for the development of dementia every 1.5 years for an average of 4 years. Several dietary patterns were identified with varying levels of seven nutrients previously shown to be associated with Alzheimer's disease risk: saturated fatty acids, monounsaturated fatty acids, omega-3 fatty acids, omega-6 fatty acids, vitamin E, vitamin B12 and folate.

During the follow-up, 253 individuals developed Alzheimer’s disease. One dietary pattern was significantly associated with a reduced risk of the disease. This pattern involved high intakes of salad dressing, nuts, fish, tomatoes, poultry, fruits, and cruciferous and dark and green leafy vegetables and low intakes of high-fat dairy, red meat, organ meat, and butter.

The combination of nutrients in the low-risk dietary pattern reflect multiple pathways in the development of Alzheimer’s disease. “For example, vitamin B12 and folate are homocysteine-related vitamins that may have an impact on Alzheimer's disease via their ability of reducing circulating homocysteine levels, vitamin E might prevent Alzheimer’s disease via its strong antioxidant effect and fatty acids may be related to dementia and cognitive function through atherosclerosis, thrombosis or inflammation via an effect on brain development and membrane functioning or via accumulation of beta-amyloid,” the authors write.