K30 Introductory Presentation. Marc Brodsky, MD UCLA Center for East-West Medicine January 31, 2007

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1 K30 Introductory Presentation Marc Brodsky, MD UCLA Center for East-West Medicine January 31, 2007

2 Patient presentation 24 yo female medical student with a one- year h/o neck pain that began during a time of intense stress during a visit with her parents Dyspepsia Constipation Dysmenorrhea Dry, red eyes Cold intolerance Insomnia

3 Mechanistic (parts, objects, contents) Problems in isolation Holistic (whole, relationships, patterns) Problems of the system Analytical thinking Treatment aims to block, stimulate, or replace Principles of organization Treatment emphasizes self-healing

4 How is CAM classified? ttp://nccam.nhih.gov/

5 Integrative Medicine Healing oriented medicine that takes account of the whole person (body, mind and spirit) including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative. Curriculum in Integrative Medicine: A Guide for Medical Educators , Consortium of Academic Health Centers for Integrative Medicine

6 Wellness treatment plan

7 What is quality of life The World Health Organization defined "quality of life" in its constitution in 1948 to include physical, mental, and social well-being, and not just the absence of disease or illness.

8 SF-36: Physical health Physical Health Physical function (10) Role physica l (4) Pain (2) General Health (5)

9 SF-36: Mental health Mental Health Emotional Well- Being (5) Roleemotional (3) Energy/ fatigue (4) Social function (2)

10 Change in SF-36 scores for group of 52 consecutive patients PF Role-P Pain Gen H Energy Social Role-E EWB PCS MCS Baseline Followup Hays RD, Brodsky M, Johnston MF, Hui KK: Evaluating health-related quality of life change in individual patients. Evaluation & the Health Professions, 2005 Jun;28(2):

11 Statistical significance of Statistical significance of group change group change MCS MCS PCS PCS EWB-5 EWB RE-3 RE SF-2 SF EN-4 EN GH-5 GH BP-2 BP RP-4 RP PF-10 PF-10 prob. prob. t-test t-test Delta Delta

12 Integrative approach to patients with neck pain Pilot data from a cohort of 50 consecutive patients with neck pain recruited for Neck Pain Task Force Compare change in health-related quality of life (HRQOL) at baseline and after 6 weeks of treatment

13 Change in SF-36 scores Score Baseline Followup 34 PF Role-P Pain Gen H Energy Social Role-E EWB Multi-item scales

14 Statistical significance Statistical significance EWB-5 EWB RE-3 RE SF-2 SF EN-4 EN GH-5 GH BP-2 BP RP-4 RP PF-10 PF-10 prob. prob. t-test t-test Delta Delta

15 Change in SF-36 scores for individuals (improved) PF-10 RP-4 BP-2 GH-5 EN-4 SF-2 RE-3 EWB-5 SEp 90 8% 16% 16% 16% 16% 14% 8% 22%

16 Fibromyalgia diagnosis and treatment Low dose tricyclic +/- cyclobenzaprine and analgesics during the day, if necessary SSRI can be considered Stimulation of tender points Lifestyle modifications

17 Research interest: FMS treatment Natural, topical preparation to stimulate tender points Effective Safe Affordable Easy to use

18 Capsaicin and VR1 receptor Capsaicin binds to a vanilloid type I receptor (VR1) on a trigeminal non- myelinated group C fiber Influx of sodium and calcium ions results in depolarization

19 Capsaicin: CNS mechanism Depolarization opens voltage gated sodium channels (VGSC) and generates an action potential along the nerve fiber Transmitter substances including glutamate, Substance P (SP) und Calcitonin Gene Related Peptide (CGRP) transfers the signal to central neurons responsible for the perception of irritation and pain

20 Capsaicin: PNS mechanism Peripherally, tachykinins such as SP, CGRP and Neurokinin A (NKA) are released Mediate mediate hypersecretion, vasodilation and inflammatory cell infiltration

21 Topical capsaicin and analgesia Diabetic and post- herpetic neuropathy Osteoarthritis Rheumatoid arthritis Post-mastectomy pain (Whittaker AL, Kennedy DT, Small RE. Adjuvant agents for managing chronic pain. APS Bulletin. 1999:9)

22 Evaluation question and standard Evaluation Question Does topical capsaicin 0.025% applied to tender points 4 times a day for a period of 1 month improve quality of life in patients with fibromyalgia relative to a matched sample that uses a placebo Standard Statistically significant in post- intervention scores on quality of life instrument (global as well as fibromyalgia- specific) relative to placebo