Medicine is Changing

We are missing a lot of signals about the future of our health and our determinants of health.  In a journal article written by Asch et al. (2012) the evolution of healthcare and what determines our health is discussed.  Three specific signals are mentioned in the article and include the often overlooked social determinants of health such as social circumstances.  Second, healthcare institutions and insurance are no longer producing outcomes consumers’ desire.  There is a trend showing that there is interest in what happens to the population and the individual.  The third signal we are missing is that reimbursement for services is changing, and eventually the successful healthcare providers will offer a broad range of services to deliver health.

See the entire article in The New England Journal of Medicine

Asch, A.D., Volpp K. (2012). What business are we in? The Emergence of Health as

the business of Health Care.  The New England Journal of Medicine, 367; 10. pp. 888-889.

The Clinical Applications of Hawthorn (Crataegus Oxyacantha)

Crataegus Oxyacantha, also known as hawthorn, can be used in the treatment of hypertension.  The leaf, berry, and flower extracts have been researched for active constituents, which can be found in lengthy monographs. Actions of this botanical include increasing diuresis, improving coronary circulation, and acts as a hypotensive.

Isolating the active constituents appears to have little effect when tested in the lab. Research suggests utilizing the entire plant extracts for clinical use. A large review completed by Rastogi et al. (2015) examines Crataegus as a remedy for cardiovascular disorders.  The review suggests that there is abundant evidence to support the use of Crataegus in cardiovascular conditions, and further well-designed research is needed to evaluate drug-herb interactions and adverse side effects to incorporate this botanical in standards of care.

1.     Li L, Zhou X, Li N, Sun M, Lv J, Xu Z. Herbal drugs against cardiovascular disease : traditional medicine and modern development. 2015;20(9). doi:10.1016/j.drudis.2015.04.009.

2.     Rastogi S, Pandey MM, Rawat AKS. Traditional herbs : a remedy for cardiovascular disorders. Phytomedicine. 2015;000:1-8. doi:10.1016/j.phymed.2015.10.012.

Chronic Pain, Fibromyalgia, & Depression Research

Fibromyalgia is a widespread non-inflammatory pain syndrome with multi-system manifestations, and occurs primarily in females between the ages of 20-65 years old. Fibromyalgia in the adult US population prevalence is between 1-2%.1 The condition appears to be a primary disorder of pain processing, or central sensitization. Risk factors include female sex, poor functional status, stressful life events and low socioeconomic status.  Comorbid conditions that frequently occur with fibromyalgia include depression, rheumatologic conditions, and both inflammatory and non-inflammatory disorders. 

Chronic pain symptoms are often experienced for many years, if not indefinitely, for most patients experiencing chronic pain, which is economically exhaustive to the patient and population. Long-term treatment outcomes from a multi-disciplinary care approach shows evidence of a significant decrease in the psychological symptoms of depression, anxiety, and physical pain.2 Determinants of extended duration of treatment outcome appear to be a result of the environment in which treatment occurs, such as individual versus group treatment.  This treatment approach supports the idea that a multi-disciplinary care offers an improved treatment outcome compared to standard of care for chronic pain. Research suggests that the physician or practitioner-patient relationship is central to treatment success and is reflected in an international case conference of integrative medicine for the treatment of chronic pain.3 

Mindfulness and meditative practices have demonstrated improvement in quality of life, including depression in patients diagnosed with fibromyalgia.3 Research demonstrated that mindfulness had a greater benefit than the control interventions (mindfulness-based stress reduction without training), and the intervention had long lasting effects for females with fibromyalgia.4

 

1. Domino, Frank J. The 5-minute Clinical Consult Standard. Philadelphia, PA: Wolters Kluwer Health; 2015. 444-445 p.

2.Meineche-Schmidet V, Jensen N.H, Sjogren P.  Long-term outcome of multidisciplinary intervention of chronic pain patients in a private setting.  Scandinavian Journal of Pain.  2012; 3: 99-105.

3.Benno Rehberg.  Evidence-Based integrative pain medicine.  European Journal of Integrative Medicine. 2010; 3:109-113.

4.Grossman P, Tiefenthaler-Gilmer U, Raysz A, Kesper U. Mindfulness training as an intervention for fibromyalgia: Evidence of postintervention and 3-year follow-up benefits in well-being. Psychother Psychosom. 2007;76:226–33.