Publications by authors named "Heidemarie Haller"

29 Publications

  • Page 1 of 1

Yoga for treating low back pain: a systematic review and meta-analysis.

Pain 2021 Jul 28. Epub 2021 Jul 28.

Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany. National Centre for Naturopathic Medicine, Southern Cross University, Lismore, Australia. Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia.

Abstract: Yoga is frequently used for back pain relief. However, evidence was judged to be of only low- or moderate. To assess the efficacy and safety of yoga in patients with low back pain a meta-analysis was performed. Therefore Medline/PubMed, Scopus, and the Cochrane Library was searched to May 26 2020. Only randomized controlled trials (RCTs) comparing Yoga with passive control (usual care or waitlist), or an active comparator, for patients with low back pain, that assessed pain intensity or pain-related disability as a primary outcome were considered to be eligible. Two reviewers independently extracted data on study characteristics, outcome measures, and results at short-term and long-term follow-up. Risk of bias was assessed using the Cochrane Risk of Bias Tool. 30 articles on 27 individual studies (2702 participants in total) proved eligible for review. Compared to passive control, yoga was associated with short-term improvements in pain intensity (15 RCTs; Mean Difference (MD)=-0.74 points on a numeric rating scale; 95%CI=-1.04,-0.44; Standardized Mean Difference (SMD)=-0.37 95%CI=-0.52,-0.22), pain-related disability (15 RCTs; MD=-2.28; 95%CI=-3.30,-1.26; SMD=-0.38 95%CI=-0.55,-0.21), mental health (7 RCTs; MD=1.70; 95%CI=0.20,3.20; SMD=0.17 95%CI=0.02,0.32) and physical functioning (9 RCTs; MD=2.80; 95%CI=1.00,4.70; SMD=0.28 95%CI=0.10,0.47). Except for mental health all effects sustained long-term. Compared to an active comparator, yoga was not associated with any significant differences in short- or long-term outcomes.In conclusion, yoga revealed robust short- and long-term effects for pain, disability, physical function and mental health, when compared to non-exercise controls. However these effects were mainly not clinically significant.
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http://dx.doi.org/10.1097/j.pain.0000000000002416DOI Listing
July 2021

The INTREST registry: protocol of a multicenter prospective cohort study of predictors of women's response to integrative breast cancer treatment.

BMC Cancer 2021 Jun 23;21(1):724. Epub 2021 Jun 23.

Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten / Herdecke University, Witten, Germany.

Background: Cancer registries usually assess data of conventional treatments and/or patient survival. Beyond that, little is known about the influence of other predictors of treatment response related to the use of complementary therapies (CM) and lifestyle factors affecting patients' quality and quantity of life.

Methods: INTREST is a prospective cohort study collecting register data at multiple German certified cancer centers, which provide individualized, integrative, in- and outpatient breast cancer care. Patient-reported outcomes and clinical cancer data of anticipated N = 715 women with pTNM stage I-III breast cancer are collected using standardized case report forms at the time of diagnosis, after completing neo-/adjuvant chemotherapy, after completing adjuvant therapy (with the exception of endocrine therapy) as well as 1, 2, 5, and 10 years after baseline. Endpoints for multivariable prediction models are quality of life, fatigue, treatment adherence, and progression-based outcomes/survival. Predictors include the study center, sociodemographic characteristics, histologic cancer and comorbidity data, performance status, stress perception, depression, anxiety, sleep quality, spirituality, social support, physical activity, diet behavior, type of conventional treatments, use of and belief in CM treatments, and participation in a clinical trial. Safety is recorded following the Common Terminology Criteria for Adverse Events.

Discussion: This trial is currently recruiting participants. Future analyses will allow to identify predictors of short- and long-term response to integrative breast cancer treatment in women, which, in turn, may improve cancer care as well as quality and quantity of life with cancer.

Trial Registration: German Clinical Trial Register DRKS00014852 . Retrospectively registered at July 4th, 2018.
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http://dx.doi.org/10.1186/s12885-021-08468-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220783PMC
June 2021

The use and benefits of Craniosacral Therapy in primary health care: A prospective cohort study.

Complement Ther Med 2021 May 26;58:102702. Epub 2021 Feb 26.

Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Background: Patients frequently use treatments complementary to standard primary care. This prospective cohort-study examined the use, benefits, and safety of Craniosacral Therapy (CST).

Methods: Consecutive out-patients utilizing CST from 2015 to 2019 were asked to provide anonymized data on symptom intensity, functional disability, and quality of life before and after treatment using an adapted 11-point numerical rating scale (NRS) version of the Measure Yourself Medical Outcome Profile (MYMOP). Treatment expectations were assessed as were concurrent therapies/medication and safety. Mean differences were analyzed using paired sample t-tests with 95 % confidence intervals (CI), predictors of treatment response using linear regression modelling.

Results: CST therapists submitted 220 patient records (71.4 % female) including 15.5 % infants and toddlers, 7.7 % children, and 76.8 % adolescents and adults. Patients received on average 7.0 ± 7.3 CST sessions to treat 114 different, acute and chronic conditions. Symptom intensity significantly decreased by -4.38 NRS (95 %CI=-4.69/-4.07), disability by -4.41 NRS (95 %CI=-4.78/-4.05), and quality of life improved by 2.94 NRS (95 %CI = 2.62/3.27). Furthermore, CST enhanced personal resources by 3.10 NRS (95 %CI = 1.99/4.21). Independent positive predictors of change in the adapted total MYMOP score included patients' expectations (p = .001) and therapists' CST experience (p = .013), negative predictors were symptom duration (p < .002) and patient age (p = .021); a final categorical predictor was CST type (p = .023). Minor but no serious adverse events occurred.

Conclusions: In primary care, patients and parents of underage children use CST for preventive and therapeutic purposes. Considering the design limitations, CST appears to be overall effective and safe in infants, children, and adults.
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http://dx.doi.org/10.1016/j.ctim.2021.102702DOI Listing
May 2021

Effects of an Integrative Mind-Body-Medicine Group Program on Breast Cancer Patients During Chemotherapy: An Observational Study.

Curr Pharm Des 2021 ;27(8):1112-1120

Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Background: Breast cancer is one of the leading cancers in women in the Western world. Cancer treatment, especially chemotherapy, is often associated with physical and psychosocial side effects.

Objective: To improve the quality of life and manage side effects, a new integrative mind-body-medicine group concept for breast cancer patients receiving chemotherapy was developed and pilot tested.

Methods: Breast cancer patients participated in a 66 hours mind-body-medicine group program tailored to the needs of cancer patients during chemotherapy. The program was integrated into standard care encompassing mindfulness training, yoga, moderate exercise, nutrition, complementary self-help strategies, cognitive restructuring, and acupuncture. Quality of life (EORTC QLQ-C30), depression and anxiety (HADS), stress (PSS-10), and fatigue (BFI) were assessed before and after the program, as well as satisfaction and safety. Analyses were carried out on exploratory basis with paired samples t-tests.

Results: Fifty-seven female patients, aged 51.3±10.5 years, with breast cancer diagnoses were enrolled. After completing the program, global EORTC quality of life was improved (D=9.5; 95%-CI=[2.9|16.1]; p=.005), although the EORTC-symptom scales assessing fatigue (D=9.9; 95%-CI=[1|18.8]; p=.030), nausea (D=7.1; 95%- CI=[0.6|13.6]; p=.031), and dyspnea (D=12.5; 95%-CI=[2.9|22.1]; p=.011) were found to be increased. Stress (D=-3.5; 95%-CI=[-5|-2.1]; p=.000), anxiety (D=-3.8; 95%-CI=[-4.9|-2.7]; p=.000) and depression (D=-3.9; 95%-CI=[-4.9|-2.8]; p=.000) were also found to be significantly reduced. Regarding the severity of (D=0.2; 95%- CI=[-0.8|0.5]; p=.644) and the impairment due to fatigue (D=0.1; 95%-CI=[-0.8|0.6]; p=.696), no significant worsening was observed. Patients were satisfied with the program. No serious adverse events were reported.

Conclusion: Breast cancer patients benefit from an integrative mind-body-medicine group program during chemotherapy regarding the quality of life and psychological symptoms. Randomized controlled trials are warranted.
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http://dx.doi.org/10.2174/1381612826666201211111122DOI Listing
May 2021

Comparative efficacy of different exercise interventions in chronic non-specific low back pain: protocol of a systematic review and network meta-analysis.

BMJ Open 2020 08 5;10(8):e036050. Epub 2020 Aug 5.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, University of Duisburg-Essen, Faculty of Medicine, Essen, Germany.

Introduction: Chronic non-specific low back pain is a major public health problem. Evidence supports the effectiveness of exercise as an intervention. Due to a paucity of direct comparisons of different exercise categories, medical guidelines were unable to make specific recommendations regarding the type of exercise working best in improving chronic low back pain. This network meta-analysis (NMA) of randomised controlled trials aims to investigate the comparative efficacy of different exercise interventions in patients with chronic non-specific low back pain.

Methods And Analysis: MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, SPORTDiscus, Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform search portal were searched on November 2019 and without language restrictions. The search will be updated after data analysis. Studies on adults with non-specific low back pain of at least 12 weeks duration comparing exercise to either no specific intervention (ie, no treatment, wait-list or usual care at the treating physician's discretion) and/or functionally inert interventions (ie, sham or attention control interventions) will be eligible. Pain intensity and back-specific disability are defined as primary outcomes. Secondary outcomes will include health-related physical and mental quality of life, work disability, frequency of analgesic use and adverse events. All outcomes will be analysed short-term, intermediate-term and long-term. Data will be extracted independently by two review authors. Risk of bias will be assessed using the recommendations by the Cochrane Back and Neck Group and be based on an adaptation of the Cochrane Risk of Bias tool.

Ethics And Dissemination: This NMA will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses_NMA checklist. The results will be presented in peer-reviewed journals, implemented in existing national and international guidelines and will be presented to health care providers and decision makers. The planned completion date of the study is 1 July 2021.

Prospero Registration Number: CRD42020151472.
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http://dx.doi.org/10.1136/bmjopen-2019-036050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409959PMC
August 2020

Craniosacral therapy for chronic pain: a systematic review and meta-analysis of randomized controlled trials.

BMC Musculoskelet Disord 2019 Dec 31;21(1). Epub 2019 Dec 31.

Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Objectives: To systematically assess the evidence of Craniosacral Therapy (CST) for the treatment of chronic pain.

Methods: PubMed, Central, Scopus, PsycInfo and Cinahl were searched up to August 2018. Randomized controlled trials (RCTs) assessing the effects of CST in chronic pain patients were eligible. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for pain intensity and functional disability (primary outcomes) using Hedges' correction for small samples. Secondary outcomes included physical/mental quality of life, global improvement, and safety. Risk of bias was assessed using the Cochrane tool.

Results: Ten RCTs of 681 patients with neck and back pain, migraine, headache, fibromyalgia, epicondylitis, and pelvic girdle pain were included. CST showed greater post intervention effects on: pain intensity (SMD = -0.32, 95%CI = [- 0.61,-0.02]) and disability (SMD = -0.58, 95%CI = [- 0.92,-0.24]) compared to treatment as usual; on pain intensity (SMD = -0.63, 95%CI = [- 0.90,-0.37]) and disability (SMD = -0.54, 95%CI = [- 0.81,-0.28]) compared to manual/non-manual sham; and on pain intensity (SMD = -0.53, 95%CI = [- 0.89,-0.16]) and disability (SMD = -0.58, 95%CI = [- 0.95,-0.21]) compared to active manual treatments. At six months, CST showed greater effects on pain intensity (SMD = -0.59, 95%CI = [- 0.99,-0.19]) and disability (SMD = -0.53, 95%CI = [- 0.87,-0.19]) versus sham. Secondary outcomes were all significantly more improved in CST patients than in other groups, except for six-month mental quality of life versus sham. Sensitivity analyses revealed robust effects of CST against most risk of bias domains. Five of the 10 RCTs reported safety data. No serious adverse events occurred. Minor adverse events were equally distributed between the groups.

Discussion: In patients with chronic pain, this meta-analysis suggests significant and robust effects of CST on pain and function lasting up to six months. More RCTs strictly following CONSORT are needed to further corroborate the effects and safety of CST on chronic pain.

Protocol Registration At Prospero: CRD42018111975.
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http://dx.doi.org/10.1186/s12891-019-3017-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937867PMC
December 2019

Complementary therapies for clinical depression: an overview of systematic reviews.

BMJ Open 2019 08 5;9(8):e028527. Epub 2019 Aug 5.

Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, Universitat Duisburg-Essen, Essen, Germany.

Objectives: As clinical practice guidelines vary widely in their search strategies and recommendations of complementary and alternative medicine (CAM) for depression, this overview aimed at systematically summarising the level 1 evidence on CAM for patients with a clinical diagnosis of depression.

Methods: PubMed, PsycInfo and Central were searched for meta-analyses of randomised controlled clinical trials (RCTs) until 30 June 2018. Outcomes included depression severity, response, remission, relapse and adverse events. The quality of evidence was assessed according to Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) considering the methodological quality of the RCTs and meta-analyses, inconsistency, indirectness, imprecision of the evidence and the potential risk of publication bias.

Results: The literature search revealed 26 meta-analyses conducted between 2002 and 2018 on 1-49 RCTs in major, minor and seasonal depression. In patients with mild to moderate major depression, moderate quality evidence suggested the efficacy of St. John's wort towards placebo and its comparative effectiveness towards standard antidepressants for the treatment for depression severity and response rates, while St. John's wort caused significant less adverse events. In patients with recurrent major depression, moderate quality evidence showed that mindfulness-based cognitive therapy was superior to standard antidepressant drug treatment for the prevention of depression relapse. Other CAM evidence was considered as having low or very low quality.

Conclusions: The effects of all but two CAM treatments found in studies on clinical depressed patients based on low to very low quality of evidence. The evidence has to be downgraded mostly due to avoidable methodological flaws of both the original RCTs and meta-analyses not following the Consolidated Standards of Reporting Trials and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Further research is needed.
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http://dx.doi.org/10.1136/bmjopen-2018-028527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686993PMC
August 2019

The risks and benefits of yoga for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.

Clin Rehabil 2019 Dec 29;33(12):1847-1862. Epub 2019 Jul 29.

Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.

Objectives: To determine the effectiveness and safety of yoga interventions on disease symptoms, quality of life and function in patients diagnosed with chronic obstructive pulmonary disease (COPD).

Data Sources: Medline/PubMed, Scopus, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched through 6 June 2019.

Review Methods: Randomized controlled trials assessing the effects of yoga on quality of life, dyspnea, exercise capacity, and pulmonary function (FEV1) in patients with COPD were included. Safety was defined as secondary outcome. Mean differences (MD) and standardized mean differences (SMD) with 95% confidence intervals (CIs) were computed. Risk of bias was assessed using the Cochrane tool.

Results: Eleven randomized controlled trials with a total of 586 patients were included. Meta-analysis revealed evidence for effects of yoga compared to no treatment on quality of life on the COPD Assessment Test (MD = 3.81; 95% CI = 0.97 to 6.65;  = 0.009,  = 70%), exercise capacity assessed by the 6-minute walk test (MD = 25.53 m; 95% CI = 12.16 m to 38.90 m;  = 0.001,  = 0%), and pulmonary function assessed by FEV1 predicted (MD  = 3.95%; 95% CI = 2.74% to 5.17%;  < 0.001,  = 0%). Only the effects on exercise capacity and pulmonary function were robust against methodological bias. Effects were only present in breathing-focused yoga interventions but not in interventions including yoga postures. Adverse events were reported infrequently.

Conclusion: This meta-analysis found robust effects of yoga on exercise capacity and pulmonary function in patients with COPD. Yoga, specifically yoga breathing techniques, can be an effective adjunct intervention for patients with COPD. Yoga's safety needs to be assessed in more depth in future studies.
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http://dx.doi.org/10.1177/0269215519860551DOI Listing
December 2019

Hypoglossal acupuncture for acute chemotherapy-induced dysgeusia in patients with breast cancer: study protocol of a randomized, sham-controlled trial.

Trials 2019 Jul 4;20(1):398. Epub 2019 Jul 4.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany.

Background: Distortion of taste sensations is a common chemotherapy-induced side effect; however, treatment evidence is limited. Pilot data indicated that acupuncture might be able to improve symptoms of dysgeusia. Thus, the aim of this study is to investigate the effects and side effects of hypoglossal acupuncture in the treatment of dysgeusia in patients with breast cancer undergoing chemotherapy.

Methods/design: The study is a randomized controlled trial comparing a single verum acupuncture treatment with two active comparators: sham acupuncture and dietary recommendations. Sample size calculation revealed a total of 75 patients pending an alpha of 0.05, a power of 0.8, and an estimated effect size of 0.80. Patients with breast cancer undergoing platinum- or taxane-based chemotherapy will be included if they present with phantogeusia (abnormal taste sensations without an external oral stimulus) with an intensity of 4 points or above on an 11-point numeric rating scale (NRS). The primary outcome is phantogeusia; secondary outcomes include parageusia (abnormal taste of food), hypogeusia (reduced taste sensations), hypergeusia (increased taste sensations), xerostomia (dry mouth), stomatitis, appetite, and functional impairment. All outcomes will be assessed at baseline and prior to the next chemotherapy administration using an 11-point NRS for each. All adverse events will be recorded.

Discussion: The results of this study will demonstrate the extent to which hypoglossal acupuncture may influence the intensity of and functional impairment due to chemotherapy-induced dysgeusia.

Trial Registration: Clinical Trials.gov, NCT02304913 . Registered on 19 November 2014.
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http://dx.doi.org/10.1186/s13063-019-3525-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610893PMC
July 2019

Emotional release and physical symptom improvement: a qualitative analysis of self-reported outcomes and mechanisms in patients treated with neural therapy.

BMC Complement Altern Med 2018 Nov 27;18(1):311. Epub 2018 Nov 27.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Background: Neural Therapy (NT) is a common complementary treatment approach using injections with short-acting local anesthetics to treat pain and chronic diseases. However, little is known about the underlying mechanisms and the domains of treatment response. This study therefore analyzed patient experiences following NT injections with procaine.

Methods: Maximum variation sampling was used to collect data from semi-structured interviews conducted with 22 hospital inpatients aged 59.6 ± 14.9 years (81.8% female). Each had multiple (9.4 ± 6.9) diagnoses. They were undergoing two weeks of integrative treatment, which included individualized NT. The interview data were analyzed in MAXQDA using qualitative content analysis.

Results: With injection, patients first described local anesthetic effects including temporary blocking of pain and increased local warmth. Second, patients reported on vegetative reactions frequently leading to turmoil within the body like initial aggravation of existing symptoms or the appearance of new, concealed or phantom symptoms. This often required the need for rest to deal with the treatment stimulus. As a third step, many patients could gain physical and emotional release and relief in symptoms, mood and functioning. Emotional release was often accompanied by weeping and initially overwhelmed affected patients with dissociated memories. However, in cases where patients were able to experience those memories with a new distance, a fourth step of integration was achievable. It included reframing processes as well as a gain in pain perception and body-awareness. As a possible fifth step, patients experienced improved mood, increased pain acceptance and empowerment. Adverse events of NT included pain from the injections, vegetative complaints and emotional turmoil that lasted for minutes or hours, with a maximum of two days.

Conclusions: Patients treated with procaine injections reported different psychophysiological outcomes contributing to the understanding of the mechanisms underlying NT. Further efficacy studies should separate specific NT from non-specific/placebo effects.

Trial Registration: DRKS00004567 .
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http://dx.doi.org/10.1186/s12906-018-2369-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258402PMC
November 2018

Mindfulness-based interventions for women with breast cancer: an updated systematic review and meta-analysis.

Acta Oncol 2017 Dec 7;56(12):1665-1676. Epub 2017 Jul 7.

a Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine , University of Duisburg-Essen , Essen , Germany.

Background: The aim of this meta-analysis was to systematically update the evidence for mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) in women with breast cancer.

Material And Methods: In October 2016, PubMed, Scopus, and Central were searched for randomized controlled trials on MBSR/MBCT in breast cancer patients. The primary outcome was health-related quality of life. Secondary outcomes were fatigue, sleep stress, depression, anxiety, and safety. For each outcome, standardized mean differences (SMD/Hedges' g) and 95% confidence intervals (CI) were calculated. Risk of bias was assessed by the Cochrane risk of bias tool.

Results: The Literature search identified 14 articles on 10 studies that included 1709 participants. The overall risk of bias was unclear, except for risk of low attrition bias and low other bias. Compared to usual care, significant post-intervention effects of MBSR/MBCT were found for health-related quality of life (SMD = .21; 95%CI = [.04-.39]), fatigue (SMD = -.28; 95%CI = [-.43 to -.14]), sleep (SMD = -.23; 95%CI = [-.40 to -.05]), stress (SMD = -.33; 95%CI = [-.61 to -.05]), anxiety (SMD = -.28; 95%CI = [-.39 to -.16]), and depression (SMD = -.34; 95%CI = [-.46 to -.21]). Up to 6 months after baseline effects were significant for: anxiety (SMD = -.28; 95%CI = [-.47 to -.09]) and depression (SMD = -.26; 95%CI = [-.47 to -.04]); and significant for anxiety (SMD = -.21; 95%CI = [-.40 to -.03]) up to 12 months after baseline. Compared to other active interventions, significant effects were only found post-intervention and only for anxiety (SMD = -.45; 95%CI = [-.71 to -.18]) and depression (SMD = -.39; 95%CI = [-.65 to -.14]). However, average effects were all below the threshold of minimal clinically important differences. Effects were robust against potential methodological bias. Adverse events were insufficiently reported.

Conclusions: This meta-analysis revealed evidence for the short-term effectiveness and safety of mindfulness-based interventions in women with breast cancer. However, their clinical relevance remains unclear. Further research is needed.
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http://dx.doi.org/10.1080/0284186X.2017.1342862DOI Listing
December 2017

Mindfulness-Based Stress Reduction for Treating Low Back Pain: A Systematic Review and Meta-analysis.

Ann Intern Med 2017 Jun 25;166(11):799-807. Epub 2017 Apr 25.

From Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany; University Hospital Zurich and University of Zurich, Zurich, Switzerland; and University of Technology Sydney, Ultimo, New South Wales, Australia.

Background: Mindfulness-based stress reduction (MBSR) is frequently used to treat pain-related conditions, but its effects on low back pain are uncertain.

Purpose: To assess the efficacy and safety of MBSR in patients with low back pain.

Data Sources: Searches of MEDLINE/PubMed, Scopus, the Cochrane Library, and PsycINFO to 15 June 2016.

Study Selection: Randomized controlled trials (RCTs) that compared MBSR with usual care or an active comparator and assessed pain intensity or pain-related disability as a primary outcome in patients with low back pain.

Data Extraction: Two reviewers independently extracted data on study characteristics, patients, interventions, outcome measures, and results at short- and long-term follow-up. Risk of bias was assessed using the Cochrane risk-of-bias tool.

Data Synthesis: Seven RCTs involving 864 patients with low back pain were eligible for review. Compared with usual care, MBSR was associated with short-term improvements in pain intensity (4 RCTs; mean difference [MD], -0.96 point on a numerical rating scale [95% CI, -1.64 to -0.34 point]; standardized mean difference [SMD], -0.48 point [CI, -0.82 to -0.14 point]) and physical functioning (2 RCTs; MD, 2.50 [CI, 0.90 to 4.10 point]; SMD, 0.25 [CI, 0.09 to 0.41 point]) that were not sustained in the long term. Between-group differences in disability, mental health, pain acceptance, and mindfulness were not significant at short- or long-term follow-up. Compared with an active comparator, MBSR was not associated with significant differences in short- or long-term outcomes. No serious adverse events were reported.

Limitation: The number of eligible RCTs was limited; only 3 evaluated MBSR against an active comparator.

Conclusion: Mindfulness-based stress reduction may be associated with short-term effects on pain intensity and physical functioning. Long-term RCTs that compare MBSR versus active treatments are needed in order to best understand the role of MBSR in the management of low back pain.

Primary Funding Source: None.
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http://dx.doi.org/10.7326/M16-1997DOI Listing
June 2017

A Systematic Review and Meta-Analysis Estimating the Expected Dropout Rates in Randomized Controlled Trials on Yoga Interventions.

Evid Based Complement Alternat Med 2016 16;2016:5859729. Epub 2016 Jun 16.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276 Essen, Germany; Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, 15 Broadway, Ultimo, Sydney, NSW 2007, Australia.

A reasonable estimation of expected dropout rates is vital for adequate sample size calculations in randomized controlled trials (RCTs). Underestimating expected dropouts rates increases the risk of false negative results while overestimating rates results in overly large sample sizes, raising both ethical and economic issues. To estimate expected dropout rates in RCTs on yoga interventions, MEDLINE/PubMed, Scopus, IndMED, and the Cochrane Library were searched through February 2014; a total of 168 RCTs were meta-analyzed. Overall dropout rate was 11.42% (95% confidence interval [CI] = 10.11%, 12.73%) in the yoga groups; rates were comparable in usual care and psychological control groups and were slightly higher in exercise control groups (rate = 14.53%; 95% CI = 11.56%, 17.50%; odds ratio = 0.82; 95% CI = 0.68, 0.98; p = 0.03). For RCTs with durations above 12 weeks, dropout rates in yoga groups increased to 15.23% (95% CI = 11.79%, 18.68%). The upper border of 95% CIs for dropout rates commonly was below 20% regardless of study origin, health condition, gender, age groups, and intervention characteristics; however, it exceeded 40% for studies on HIV patients or heterogeneous age groups. In conclusion, dropout rates can be expected to be less than 15 to 20% for most RCTs on yoga interventions. Yet dropout rates beyond 40% are possible depending on the participants' sociodemographic and health condition.
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http://dx.doi.org/10.1155/2016/5859729DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927989PMC
July 2016

Mindfulness- and Acceptance-based Interventions for Psychosis: A Systematic Review and Meta-analysis.

Glob Adv Health Med 2016 Jan 1;5(1):30-43. Epub 2016 Jan 1.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen (Dobos), Germany.

Background: Mindfulness- and acceptance-based interventions are increasingly studied as a potential treatment for a variety of mental conditions.

Objective: To assess the effects of mindfulness- and acceptance-based interventions on psychotic symptoms and hospitalization in patients with psychosis.

Methods: MEDLINE/PubMed, Embase, the Cochrane Library, and PsycINFO were screened from inception through April 2015. Randomized controlled trials (RCTs) were analyzed when they assessed psychotic symptoms or hospitalization in patients with psychosis; affect, acceptance, mindfulness, and safety were defined as secondary outcomes.

Results: Eight RCTs with a total of 434 patients comparing mindfulness-based (4 RCTs) or acceptance-based interventions (4 RCTs) to treatment as usual or attention control were included. Six RCTs had low risk of bias. Moderate evidence was found for short-term effects on total psychotic symptoms, positive symptoms, hospitalization rates, duration of hospitalization, and mindfulness and for long-term effects on total psychotic symptoms and duration of hospitalization. No evidence was found for effects on negative symptoms, affect, or acceptance. No serious adverse events were reported.

Conclusion: Mindfulness- and acceptance-based interventions can be recommended as an additional treatment for patients with psychosis.
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http://dx.doi.org/10.7453/gahmj.2015.083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756771PMC
January 2016

Craniosacral Therapy for the Treatment of Chronic Neck Pain: A Randomized Sham-controlled Trial.

Clin J Pain 2016 May;32(5):441-9

*Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen ‡Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Germany †Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney (UTS), Sydney, Australia.

Objectives: With growing evidence for the effectiveness of craniosacral therapy (CST) for pain management, the efficacy of CST remains unclear. This study therefore aimed at investigating CST in comparison with sham treatment in chronic nonspecific neck pain patients.

Materials And Methods: A total of 54 blinded patients were randomized into either 8 weekly units of CST or light-touch sham treatment. Outcomes were assessed before and after treatment (week 8) and again 3 months later (week 20). The primary outcome was the pain intensity on a visual analog scale at week 8; secondary outcomes included pain on movement, pressure pain sensitivity, functional disability, health-related quality of life, well-being, anxiety, depression, stress perception, pain acceptance, body awareness, patients' global impression of improvement, and safety.

Results: In comparison with sham, CST patients reported significant and clinically relevant effects on pain intensity at week 8 (-21 mm group difference; 95% confidence interval, -32.6 to -9.4; P=0.001; d=1.02) and at week 20 (-16.8 mm group difference; 95% confidence interval, -27.5 to -6.1; P=0.003; d=0.88). Minimal clinically important differences in pain intensity at week 20 were reported by 78% within the CST group, whereas 48% even had substantial clinical benefit. Significant between-group differences at week 20 were also found for pain on movement, functional disability, physical quality of life, anxiety and patients' global improvement. Pressure pain sensitivity and body awareness were significantly improved only at week 8. No serious adverse events were reported.

Discussion: CST was both specifically effective and safe in reducing neck pain intensity and may improve functional disability and the quality of life up to 3 months after intervention.
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http://dx.doi.org/10.1097/AJP.0000000000000290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4894825PMC
May 2016

Somatoform disorders and medically unexplained symptoms in primary care.

Dtsch Arztebl Int 2015 Apr;112(16):279-87

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen.

Background: The literature contains variable figures on the prevalence of somatoform disorders and medically unexplained symptoms in primary care.

Methods: The pertinent literature up to July 2014 was retrieved by a systematic search in the PubMed/MEDLINE, PsychInfo, Scopus, and Cochrane databases. The methodological quality and heterogeneity (I2) of the retrieved trials were analyzed. The prevalence rates of medically unexplained symptoms, somatoform disorders, and their subcategories were estimated, along with corresponding 95% confidence intervals (CI), with the aid of random-effects modeling.

Results: From a total of 992 identified publications, 32 studies from 24 countries involving a total of 70 085 patients (age range, 15-95 years) were selected for further analysis. All had been carried out between 1990 and 2012. The primary studies were more heterogeneous overall; point prevalences for the strict diagnosis of a somatization disorder ranged from 0.8% (95% CI 0.3-1.4%, I2 = 86%) to 5.9% (95% CI 2.4-9.4%, I2 = 96%), with higher estimated prevalences in studies that applied less restrictive diagnostic criteria. At least one type of somatoform disorder was diagnosable by DSM-IV and/or ICD-10 criteria in a fraction of primary-care patients that ranged from 26.2% (95% CI 19.1-33.3%, I2 = 98%) to 34.8% (95% CI 26.6-44.6%; I2 = 92%). The percentage of patients complaining of at least one medically unexplained symptom ranged from 40.2% (95% CI 0.9-79.4%; I2 = 98%) to 49% (95% CI 18-79.8%, I2 = 98%). The quality of the studies, in general, was only moderate. No relationship was found between study quality and prevalence estimates.

Conclusion: The statistical heterogeneity of the included studies is very high. Somatoform disorders and medically unexplained symptoms are more common than generally assumed. The found prevalences highlight the importance of these conditions in primary care.
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http://dx.doi.org/10.3238/arztebl.2015.0279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442550PMC
April 2015

Treating the sequelae of postoperative meningioma and traumatic brain injury: a case of implementation of craniosacral therapy in integrative inpatient care.

J Altern Complement Med 2015 Feb 21;21(2):110-2. Epub 2015 Jan 21.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen , Essen, Germany .

Background: Craniosacral therapy (CST) is a commonly used but under-researched therapeutic approach. This case study explores the implementation of CST in the integrative inpatient treatment of sequelae of postoperative meningioma and traumatic brain injury.

Case: A 50-year-old woman was admitted for 2 weeks of integrative inpatient treatment following meningioma resection and traumatic brain injury. In addition to the integrative treatment approach, which included conventional as well as complementary and alternative medicine, she received five sessions of CST for refractory headaches, vertigo, and cervicobrachial syndrome during this time. At discharge, the reported intensity of her headaches on a 10-cm visual analogue scale decreased from 6-9 cm to 2-4 cm and her level of vertigo decreased from 6-10 cm to 2 cm. Her cervical mobility and muscle tension, sleep quality, and general well-being also improved. The attending physicians saw CST as having contributed greatly to this improvement alongside use of phytotherapy and hyperthermia.

Conclusion: Implementation of CST in integrative inpatient care could benefit patients with headache and vertigo from intracranial injuries.
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http://dx.doi.org/10.1089/acm.2013.0283DOI Listing
February 2015

Credibility of a comparative sham control intervention for Craniosacral Therapy in patients with chronic neck pain.

Complement Ther Med 2014 Dec 6;22(6):1053-9. Epub 2014 Oct 6.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276 Essen, Germany.

Objectives: Determining efficacy in complementary medicine research requires valid placebo/sham control groups that are credible to patients and ensure successful blinding. Within the scope of this study, a light touch sham-control intervention for trials of Craniosacral Therapy (CST) was developed and tested for its credibility.

Methods: Patients of a randomized controlled trial on chronic non-specific neck pain (NCT01526447) obtained the Credibility/Expectancy Questionnaire and the Helping Alliance/Satisfaction Questionnaire. Treatment and sham group respectively received 8 weekly sessions of CST or light touch. Data without (N=50) and with multiple imputation (N=54) were analyzed separately using logistic regression models. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated to assess whether group outcome could be predicted from patients' credibility ratings. An additional t-test for analysis of the overall compliance/attendance was conducted.

Results: Patients' ratings of treatment expectancy, credibility and therapeutic alliance were not found to have significant power for classifying patients into CST or sham group (p≥.05). Only satisfaction with treatment revealed a significant impact (AOR: 6.83; 95% CI: [1.54|30.24]; p=.011) in the non-imputed analysis, but not in the multiple imputation analysis (AOR: 4.09; 95% CI: [0.94|17.76]; p=.060). Compliance of both groups was not significantly different (p>.05) as were reasons for non-attendance. No serious adverse events were reported.

Conclusions: Patients' expectancy, credibility and therapeutic alliance did not appear to affect study outcomes, blinding patients to group allocation was possible, and sham intervention was tolerable and safe. The design can therefore be recommended as control for non-specific treatment effects in future CST clinical trials.
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http://dx.doi.org/10.1016/j.ctim.2014.09.007DOI Listing
December 2014

The prevalence and burden of subthreshold generalized anxiety disorder: a systematic review.

BMC Psychiatry 2014 May 1;14:128. Epub 2014 May 1.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University Duisburg-Essen, Am Deimelsberg 34a, 45276 Essen, Germany.

Background: To review the prevalence and impact of generalized anxiety disorder (GAD) below the diagnostic threshold and explore its treatment needs in times of scarce healthcare resources.

Methods: A systematic literature search was conducted until January 2013 using PUBMED/MEDLINE, PSYCINFO, EMBASE and reference lists to identify epidemiological studies of subthreshold GAD, i.e. GAD symptoms that do not reach the current thresholds of DSM-III-R, DSM-IV or ICD-10. Quality of all included studies was assessed and median prevalences of subthreshold GAD were calculated for different subpopulations.

Results: Inclusion criteria led to 15 high-quality and 3 low-quality epidemiological studies with a total of 48,214 participants being reviewed. Whilst GAD proved to be a common mental health disorder, the prevalence for subthreshold GAD was twice that for the full syndrome. Subthreshold GAD is typically persistent, causing considerably more suffering and impairment in psychosocial and work functioning, benzodiazepine and primary health care use, than in non-anxious individuals. Subthreshold GAD can also increase the risk of onset and worsen the course of a range of comorbid mental health, pain and somatic disorders; further increasing costs. Results are robust against bias due to low study quality.

Conclusions: Subthreshold GAD is a common, recurrent and impairing disease with verifiable morbidity that claims significant healthcare resources. As such, it should receive additional research and clinical attention.
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http://dx.doi.org/10.1186/1471-244X-14-128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4048364PMC
May 2014

A systematic review and meta-analysis of yoga for hypertension.

Am J Hypertens 2014 Sep 2;27(9):1146-51. Epub 2014 May 2.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany;

Background: The aim of this systematic review and meta-analysis was to evaluate the quality of evidence and the strength of recommendation for yoga as a therapeutic means in the management of prehypertension and hypertension.

Methods: MEDLINE/Pubmed, Scopus, CENTRAL, and IndMED were screened through February 2014 for randomized controlled trials (RCTs) on the effects of yoga interventions (≥8 weeks) compared with usual care or any active control intervention on blood pressure in patients with prehypertension (120-139/80-89 mm Hg) or hypertension (≥140/≥90 mm Hg). Risk of bias was assessed using the Cochrane risk of bias tool; quality of evidence was assessed according to the GRADE recommendations.

Results: Seven RCTs with a total of 452 patients were included. Compared with usual care, very low-quality evidence was found for effects of yoga on systolic (6 RCTs, n = 278; mean difference (MD) = -9.65 mm Hg, 95% confidence interval (CI) = -17.23 to -2.06, P = 0.01; heterogeneity: I (2) = 90%, χ(2) = 48.21, P < 0.01) and diastolic blood pressure (6 RCTs, n = 278; MD = -7.22 mm Hg, 95% CI = -12.83 to -1.62, P = 0.01; heterogeneity: I (2) = 92%, χ(2) = 64.84, P < 0.01). Subgroup analyses revealed effects for RCTs that included hypertensive patients but not for RCTs that included both hypertensive and prehypertensive patients, as well as for RCTs that allowed antihypertensive comedication but not for those that did not. More adverse events occurred during yoga than during usual care. Compared with exercise, no evidence was found for effects of yoga on systolic or diastolic blood pressure.

Conclusions: Larger studies are required to confirm the emerging but low-quality evidence that yoga may be a useful adjunct intervention in the management of hypertension.
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http://dx.doi.org/10.1093/ajh/hpu078DOI Listing
September 2014

Effects of yoga on cardiovascular disease risk factors: a systematic review and meta-analysis.

Int J Cardiol 2014 May 25;173(2):170-83. Epub 2014 Feb 25.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Background: The aim of this review was to systematically assess and meta-analyze the effects of yoga on modifiable biological cardiovascular disease risk factors in the general population and in high-risk disease groups.

Methods: MEDLINE/PubMed, Scopus, the Cochrane Library, and IndMED were screened through August 2013 for randomized controlled trials (RCTs) on yoga for predefined cardiovascular risk factors in healthy participants, non-diabetic participants with high risk for cardiovascular disease, or participants with type 2 diabetes mellitus. Risk of bias was assessed using the Cochrane risk of bias tool.

Results: Forty-four RCTs with a total of 3168 participants were included. Risk of bias was high or unclear for most RCTs. Relative to usual care or no intervention, yoga improved systolic (mean difference (MD)=-5.85 mm Hg; 95% confidence interval (CI)=-8.81, -2.89) and diastolic blood pressure (MD=-4.12 mm Hg; 95%CI=-6.55, -1.69), heart rate (MD=-6.59 bpm; 95%CI=-12.89, -0.28), respiratory rate (MD=-0.93 breaths/min; 95%CI=-1.70, -0.15), waist circumference (MD=-1.95 cm; 95%CI=-3.01, -0.89), waist/hip ratio (MD=-0.02; 95%CI=-0.03, -0.00), total cholesterol (MD=-13.09 mg/dl; 95%CI=-19.60, -6.59), HDL (MD=2.94 mg/dl; 95%CI=0.57, 5.31), VLDL (MD=-5.70 mg/dl; 95%CI=-7.36, -4.03), triglycerides (MD=-20.97 mg/dl; 95%CI=-28.61, -13.32), HbA1c (MD=-0.45%; 95%CI=-0.87, -0.02), and insulin resistance (MD=-0.19; 95%CI=-0.30, -0.08). Relative to exercise, yoga improved HDL (MD=3.70 mg/dl; 95%CI=1.14, 6.26).

Conclusions: This meta-analysis revealed evidence for clinically important effects of yoga on most biological cardiovascular disease risk factors. Despite methodological drawbacks of the included studies, yoga can be considered as an ancillary intervention for the general population and for patients with increased risk of cardiovascular disease.
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http://dx.doi.org/10.1016/j.ijcard.2014.02.017DOI Listing
May 2014

A systematic review of yoga for heart disease.

Eur J Prev Cardiol 2015 Mar 3;22(3):284-95. Epub 2014 Feb 3.

Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany.

Background: This systematic review of randomized controlled trials (RCTs) aimed to evaluate the quality of evidence and the strength of recommendation for yoga as an ancillary intervention for heart disease.

Methods: Medline/PubMed, Scopus, the Cochrane Library, and IndMED were searched up to October 2013. Main outcome measures were mortality, nonfatal cardiac events, exercise capacity, health-related quality of life, and modifiable cardiac risk factors. Risk of bias, quality of evidence, and the strength of the recommendation for or against yoga were assessed according to the Cochrane Collaboration and GRADE recommendations.

Results: Seven RCTs with 624 patients comparing yoga to usual care were included. For coronary heart disease (four RCTs), there was very low evidence for no effect on mortality, for a reduced number of angina episodes, and for increased exercise capacity, and low evidence for reduced modifiable cardiac risk factors. For heart failure (two RCTs), there was very low evidence for no effect on mortality, and low evidence for increased exercise capacity, and for no effect on health-related quality of life. For cardiac dysrhythmias treated with implantable cardioverter-defibrillator (one RCT), there was very low evidence for no effect on mortality, and for improved quality, and low evidence for effects on nonfatal device-treated ventricular events. Three RCTs reported safety data and reported that no adverse events occurred.

Conclusions: Based on the results of this review, weak recommendations can be made for the ancillary use of yoga for patients with coronary heart disease, heart failure, and cardiac dysrhythmia at this point.
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http://dx.doi.org/10.1177/2047487314523132DOI Listing
March 2015

Effectiveness of home-based cupping massage compared to progressive muscle relaxation in patients with chronic neck pain--a randomized controlled trial.

PLoS One 2013 7;8(6):e65378. Epub 2013 Jun 7.

Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Unlabelled: Chronic neck pain is a major public health problem with very few evidence-based complementary treatment options. This study aimed to test the efficacy of 12 weeks of a partner-delivered home-based cupping massage, compared to the same period of progressive muscle relaxation in patients with chronic non-specific neck pain. Patients were randomly assigned to self-directed cupping massage or progressive muscle relaxation. They were trained and asked to undertake the assigned treatment twice weekly for 12 weeks. Primary outcome measure was the current neck pain intensity (0-100 mm visual analog scale; VAS) after 12 weeks. Secondary outcome measures included pain on motion, affective pain perception, functional disability, psychological distress, wellbeing, health-related quality of life, pressure pain thresholds and adverse events. Sixty one patients (54.1±12.7 years; 73.8%female) were randomized to cupping massage (n = 30) or progressive muscle relaxation (n = 31). After treatment, both groups showed significantly less pain compared to baseline however without significant group differences. Significant effects in favor of cupping massage were only found for wellbeing and pressure pain thresholds. In conclusion, cupping massage is no more effective than progressive muscle relaxation in reducing chronic non-specific neck pain. Both therapies can be easily used at home and can reduce pain to a minimal clinically relevant extent. Cupping massage may however be better than PMR in improving well-being and decreasing pressure pain sensitivity but more studies with larger samples and longer follow-up periods are needed to confirm these results.

Trial Registration: ClinicalTrials.gov NCT01500330.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0065378PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676414PMC
January 2014

"I'm more in balance": a qualitative study of yoga for patients with chronic neck pain.

J Altern Complement Med 2013 Jun 21;19(6):536-42. Epub 2013 Jan 21.

Department of Internal and Integrative Medicine, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.

Objectives: This study investigated the perceived influence of yoga on body perception and psychosocial aspects of life for patients with chronic neck pain.

Design: This qualitative study was conducted using semistandardized interviews.

Setting: The interventions and interviews took place in a referral center's research department.

Subjects: Eighteen (18) patients with chronic nonspecific neck pain were recruited from a larger randomized controlled trial of yoga for chronic neck pain.

Interventions: Participants attended 90 minutes of Iyengar yoga once a week for 9 weeks.

Outcome Measures: Participants completed a drawing of their neck and shoulder regions to reflect their subjective body perceptions before and after their yoga program. Semistandardized interviews were used to explore their body perception, emotional status, everyday life and coping skills, as well as any perceived changes in these dimensions postparticipation. An interdisciplinary group analyzed the study data using content analysis techniques.

Results: Participants reported change on five dimensions of human experience: physical, cognitive, emotional, behavioral, and social. Physically, most participants cited renewed body awareness, both during their yoga practice and in their daily lives. Such change was echoed in their postparticipation body drawings. Cognitively, participants reported increased perceived control over their health. Emotionally, they noted greater acceptance of their pain and life burdens. Behaviorally, they described enhanced use of active coping strategies. Finally, socially, they reported renewed participation in an active life.

Conclusions: Participants linked yoga to change on all dimensions of human experience, attributing reduced pain levels, increased coping ability, better pain acceptance and increased control to it. Body awareness appeared a key mechanism in these changes.
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http://dx.doi.org/10.1089/acm.2011.0885DOI Listing
June 2013

Randomized-controlled trial comparing yoga and home-based exercise for chronic neck pain.

Clin J Pain 2013 Mar;29(3):216-23

Chair of Complementary and Integrative Medicine, University of Duisburg-Essen, Germany.

Objectives: Chronic neck pain is a significant public health problem with only very few evidence-based treatment options. There is growing evidence for the effectiveness of yoga for relieving musculoskeletal disorders. The aim of this study was to evaluate the effect of Iyengar yoga compared with exercise on chronic nonspecific neck pain.

Methods: Patients were randomly assigned to either yoga or exercise. The yoga group attended a 9-week yoga course and the exercise group received a self-care manual on home-based exercises for neck pain relief. The main outcome measure was the present neck pain intensity (100 mm visual analog scale). Secondary outcome measures included functional disability (Neck Disability Index), pain at motion (visual analog scale), health-related quality of life (Short Form-36 questionnaire), cervical range of motion, proprioceptive acuity, and pressure pain threshold.

Results: Fifty-one patients (mean age 47.8 y ; 82.4% female) were randomized to yoga (n=25) and exercise (n=26) intervention. After the study period, patients in the yoga group reported significantly less neck pain intensity compared with the exercise group [mean difference: -13.9 mm (95% CI, -26.4 to -1.4), P=0.03]. The yoga group reported less disability and better mental quality of life. Range of motion and proprioceptive acuity were improved and the pressure pain threshold was elevated in the yoga group.

Discussion: Yoga was more effective in relieving chronic nonspecific neck pain than a home-based exercise program. Yoga reduced neck pain intensity and disability and improved health-related quality of life. Moreover, yoga seems to influence the functional status of neck muscles, as indicated by improvement of physiological measures of neck pain.
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http://dx.doi.org/10.1097/AJP.0b013e318251026cDOI Listing
March 2013

A systematic review and meta-analysis of yoga for low back pain.

Clin J Pain 2013 May;29(5):450-60

Department of Complementary and Integrative Medicine, University of Duisburg-Essen, Essen, Germany.

Objectives: To systematically review and meta-analyze the effectiveness of yoga for low back pain.

Methods: MEDLINE, the Cochrane Library, EMBASE, CAMBASE, and PsycINFO, were screened through January 2012. Randomized controlled trials comparing yoga to control conditions in patients with low back pain were included. Two authors independently assessed risk of bias using the risk of bias tool recommended by the Cochrane Back Review Group. Main outcome measures were pain, back-specific disability, generic disability, health-related quality of life, and global improvement. For each outcome, standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.

Results: Ten randomized controlled trials with a total of 967 chronic low back pain patients were included. Eight studies had low risk of bias. There was strong evidence for short-term effects on pain (SMD=-0.48; 95% CI, -0.65 to -0.31; P<0.01), back-specific disability (SMD=-0.59; 95% CI, -0.87 to -0.30; P<0.01), and global improvement (risk ratio=3.27; 95% CI, 1.89-5.66; P<0.01). There was strong evidence for a long-term effect on pain (SMD=-0.33; 95% CI, -0.59 to -0.07; P=0.01) and moderate evidence for a long-term effect on back-specific disability (SMD=-0.35; 95% CI, -0.55 to -0.15; P<0.01). There was no evidence for either short-term or long-term effects on health-related quality of life. Yoga was not associated with serious adverse events.

Discussion: This systematic review found strong evidence for short-term effectiveness and moderate evidence for long-term effectiveness of yoga for chronic low back pain in the most important patient-centered outcomes. Yoga can be recommended as an additional therapy to chronic low back pain patients.
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http://dx.doi.org/10.1097/AJP.0b013e31825e1492DOI Listing
May 2013

Mindfulness-based stress reduction for low back pain. A systematic review.

BMC Complement Altern Med 2012 Sep 25;12:162. Epub 2012 Sep 25.

University of Duisburg-Essen, Essen, Germany.

Background: Mindfulness-based stress reduction (MBSR) is frequently used for pain conditions. While systematic reviews on MBSR for chronic pain have been conducted, there are no reviews for specific pain conditions. Therefore a systematic review of the effectiveness of MBSR in low back pain was performed.

Methods: MEDLINE, the Cochrane Library, EMBASE, CAMBASE, and PsycInfo were screened through November 2011. The search strategy combined keywords for MBSR with keywords for low back pain. Randomized controlled trials (RCTs) comparing MBSR to control conditions in patients with low back pain were included. Two authors independently assessed risk of bias using the Cochrane risk of bias tool. Clinical importance of group differences was assessed for the main outcome measures pain intensity and back-specific disability.

Results: Three RCTs with a total of 117 chronic low back pain patients were included. One RCT on failed back surgery syndrome reported significant and clinically important short-term improvements in pain intensity and disability for MBSR compared to no treatment. Two RCTs on older adults (age ≥ 65 years) with chronic specific or non-specific low back pain reported no short-term or long-term improvements in pain or disability for MBSR compared to no treatment or health education. Two RCTs reported larger short-term improvements of pain acceptance for MBSR compared to no treatment.

Conclusion: This review found inconclusive evidence of effectiveness of MBSR in improving pain intensity or disability in chronic low back pain patients. However, there is limited evidence that MBSR can improve pain acceptance. Further RCTs with larger sample sizes, adequate control interventions, and longer follow-ups are needed before firm conclusions can be drawn.
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http://dx.doi.org/10.1186/1472-6882-12-162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520871PMC
September 2012

My back has shrunk: the influence of traditional cupping on body image in patients with chronic non-specific neck pain.

Forsch Komplementmed 2012 11;19(2):68-74. Epub 2012 Apr 11.

Chair of Complementary and Integrative Medicine, Alfried Krupp von Bohlen und Halbach Foundation, University of Duisburg-Essen, Germany.

Background: In conditions such as phantom limb pain and low back pain body image is distorted. This qualitative study investigates body image in patients with chronic non-specific neck pain (CNP), its influence on their everyday life and any changes linked to traditional cupping therapy.

Methods: The study was conducted with a convenience sample of 6 patients with CNP from a larger randomised controlled trial (RCT) on cupping. The data came from body image drawings and semi-structured interviews. The latter were analysed using Mayring's content analysis techniques.

Results: The patients' drawings showed apparent body image distortions with elements that were missing or deformed. The interviews showed that pain was the predominant perception, influencing patients' body perception. Patients saw their pain as beyond their control, using mostly passive strategies to cope. After cupping, patients reported less pain and improved pain perception. These changes were reflected in their drawings.

Conclusion: Patients with CNP experienced apparent body image distortions, which traditional cupping therapy appeared to improve. Additional research is needed to further explore this link.
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http://dx.doi.org/10.1159/000337688DOI Listing
October 2012
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