Nabilone — Clinical Experience at the James Paget Hospital

The dose per capsule is 1 mg but we found that this could be excessive for some patients. Therefore, some were started at 0.25 mg by opening the capsule and dividing the resultant powder into four. The initial time for nabilone use has been at night to reduce the potential discomfort of any side effects. Once the patient’s confidence has been developed, the dosage has been increased where appropriate. Those patients who have benefited from nabilone have been through a period of discontinuation to help evaluate the benefits of this drug. The age range of the 43 patients who have used nabilone is from 25–82 years with 75% between the ages of 30 and 50. More women than men were treated, mainly reflecting a large sex difference in the group with multiple sclerosis. The diagnoses of the patients were categorised into 6 groups as the most convenient method of presenting the information from such an heterogeneous group. No attempt has been made to do anything more than describe the effects of using nabilone on each individual patient and thereby evaluate whether it might be of value in pain control. Multiple Sclerosis Multiple Sclerosis is characterised by widespread and varied damage to the central nervous Read more […]

Africa

Very little information about plant use in Africa has been written down. In African thought, all living things are believed to be connected to each other, to the gods, and to ancestral spirits. If harmony exists between all of these, then good health is enjoyed, but if not, misfortune or ill health will result. Forces can be directed at humans by displeased gods, ancestors, and witches, resulting in disharmony which must be resolved before good health can be restored. Treatment may also involve much more than medicine. Practices such as divination and incantation maybe carried out to help with diagnosis, and sacrifices may need to be made in order to placate the supernatural entity. The traditional healer is also likely to be a religious leader, since health and spirituality are closely intertwined in Africa. Traditional healers have existed throughout Africa since prehistoric times, for example, the ifas and juju men of West Africa or the inyanga (sangoma is the term used for diviners) of South Africa. Various methods have been used to identify “healing plants,” such as trying to find a plant that possesses a stronger spirit than the one causing the disease, or by using the “law of signatures.” This system existed Read more […]

Why Are HIV / AIDS Patients Turning To Complementary And Alternative Medicine Therapies?

Most people with HIV / AIDS report using complementary and alternative medicine therapies to manage health complications, especially control of conventional medication side effects, which can be significant enough to reduce compliance with conventional therapy. Many also report using complementary and alternative medicine to cope with emotional issues, such as depression and stress. Pain management is a significant reason for complementary and alternative medicine use among HIV / AIDS patients. Pain may result from direct effects of HIV on the peripheral or central nervous system, immune suppression, and resulting opportunistic infections, antiretroviral medications, and common problems unrelated to HIV disease or treatment, such as low back pain. Additional reasons for complementary and alternative medicine use among those with HIV / AIDS include symptom management, as a way to prevent disease progression, forestall beginning the use of conventional therapies (often while monitoring for disease progression), gain freedom from medical regimens; and avoid stigmas associated with the use of conventional therapy, for example, the self-perception of “being diseased,” feeling dependent on conventional medications, or Read more […]

Chronic Pelvic Pain

Chronic pelvic pain (CPP) is defined as pelvic pain lasting more than 6 months. Some authors add the additional criteria that the pain be noncyclic. It is one of the most common presenting complaints in gynecologic practice, affecting as many as one in seven American women. Chronic pelvic pain comprises up to 10% of outpatient gynecologic visits, accounts for 20% of laparoscopies, and results in 12% (75,000 / year) of all hysterectomies performed annually in the United States. Estimated annual direct medical costs for outpatient visits for chronic pelvic pain in the United States among women 18 to 50 years old is estimated to be $881.5 million. It is often an extremely frustrating condition for both patient and care provider because in many cases an etiology cannot be identified and there is no apparent pathology. Treatment of presumed underlying conditions is frequently ineffective, and the “pain itself becomes the illness.” Because the cause often cannot be identified, chronic pelvic pain is frequently attributed to psychogenic causes. Although these may play a role in chronic pelvic pain for some women with lack of an identifiable cause, this does not necessarily equate with a psychosomatic origin for this complaint. Common Read more […]

Pregnancy Care

Pregnancy Care And Prenatal Wellness The state of a woman’s health is indeed completely tied up with the culture in which she lives and her position in it, as well as in the way she lives her life as an individual. We cannot hope to reclaim our bodily wisdom and inherent ability to create health without first understanding the influence of our society on how we think and care for our bodies. — Dr. Christiane Northrup, obstetrician / gynecologist The past decades have tremendously improved the outcomes of high-risk pregnancies and birth, yet with these improvements have come the ubiquitous presence of technological intervention in nearly all aspects of normal childbearing as well. Yet, the safety and efficacy of the routine use of many interventions is not clear, with a striking lack of an evidence base for many. Nonetheless, the number and frequency of interventions has risen steadily since the 1950s. Since 2003, cesarean section has been the most common hospital surgical procedure performed in the United States, with 1.2 million of these major abdominal surgeries each year, accounting for more than 25% of all US births at a national cost $14.6 billion in total charges. In spite of spending more money and using Read more […]

Endometriosis

Endometriosis is one of the most common gynecologic problems in the United States and a leading gynecologic cause of both hospitalization and hysterectomy. Women with symptomatic endometriosis face chronic and sometimes debilitating pain; asymptomatic and symptomatic women alike may experience significant fertility problems due to this condition. The least-biased estimate for the overall prevalence of endometriosis in reproductive-age women is about 10%. Endometriosis is defined as the presence and growth of endometrial tissue in locations outside of the uterus. These cells may appear on the ovaries, fallopian tubes, bowel, bladder, peritoneal tissue, ligaments, or other structures in the abdominal cavity, and rarely may occur at other sites, including the nasal and respiratory passages leading to nosebleeds or pink frothy sputum at the time of the menses. Displaced endometrial tissue responds to cyclic hormonal changes, proliferating and shedding outside of the uterus. The bleeding is accompanied by inflammation caused by irritation of local tissue, such as, the peritoneum. Recurrent inflammation can cause scarring and adhesions that can cause pain and dysfunction of other affected sites. Endometriosis is common in Read more […]

Uterine Fibroids: Treatment Summary

• Achieve a healthy body weight and distribution. • Promote hormonal regulation and elimination of excess estrogen. Avoid excess environmental (and dietary) estrogen exposure. • Encourage an anti-inflammatory diet low in red meat and dairy products and high in fresh fish, green vegetables, and fresh fruit. • Improve uterine tone and circulation with herbs and exercise (e.g., specific yoga postures, belly dancing). • Treat / prevent symptoms, such as, bleeding and pain, with appropriate botanicals for acute and chronic problems. • Treat anemia if necessary. • Supplement with vitamins A, C, and E, and the minerals zinc and selenium. What to expect with treatment • Expect an immediate reduction in acute pain within 1 to 2 hours of the onset of treatment with analgesic, antispasmodic, and sedative herbs, and a reduction in bleeding within 1 to 4 hours with the use of herbal astringents and antihemorrhagic herbs. • Expect an overall reduction in symptom occurrence within two menstrual cycles after the onset of treatment. • Expect to begin to see reduction in fibroid size within 3 to 6 months of onset of treatment. • Fibroids may not be eliminated entirely but can be Read more […]

Diseases of the Musculoskeletal System

Herbs For Diseases Of The Musculoskeletal System Disorders of the musculoskeletal system — including arthritis, hip and elbow dysplasia, ligament conditions such as anterior cruciate / luxating patellas, and spinal arthritis / spondylosis — generally present as altered gait or lameness caused by pain. These conditions benefit from physical therapies including acupuncture, chiropractics, physiotherapy, and massage, as well as weight reduction where appropriate. Chondroprotective agents should always be considered and conventional antiinflammatory agents should be considered for acute injuries. Alternatives to nonsteroidal antiinflammatories are often sought because of concerns over side effects of medications including continued degeneration of joints and gastrointestinal, hepatic, or renal effects. Musculoskeletal conditions affect the whole body. Pain in one area leads to biomechanical changes elsewhere due to shifts in weight bearing and movement. The whole body must be evaluated, not just the affected limb or back. Frequently, muscle spasm, trigger points, myofascial pain, and joint pain are detected elsewhere in the body. Similarly, herbalists take a systemic approach to treating musculoskeletal disorders. Read more […]

Anti-Inflammatory Herbs

Withania (Withania somnifera) Withania is a useful component of any musculoskeletal formula as both an adaptogen and an herb. It was traditionally recognized in Ayurvedic medicine for musculoskeletal disorders. Although the mechanism of action is not fully understood, it appears that Withania may involve cyclooxygenase inhibition and a direct musculotropic action that accounts for the antispasmodic effects of Withania. Devil’s claw (Harpagophyturn procumbens) Devil’s claw is a threatened plant species used in traditional African medicine for arthritis. In humans it has been investigated for the treatment of nonspecific lower back pain, arthritis, and rheumatism, and has been shown to be effective for pain relief when the extract provides more than 50 mg of harpagoside daily. However, the effects of Devil’s claw are not just due to the constituent harpagoside. In one in vitro study it was shown to suppress prostaglandin (PG)E2 synthesis and nitric oxide production by inhibiting lipopolysaccharide-stimulated enhancement of cox2 and inducible nitric oxide synthase mRNA expression. It has been included in a formula with Black currant (Ribes nigrum), Horsetail (Equisetum arvense), and White willow (Salix alba) and compared Read more […]

Herb-Drug Interactions: Devil’s claw

Harpagophytum procumbens (Burch.) DC. (Pedaliaceae) Synonym(s) and related species Grapple plant, Harpagophytum, Wood spider. Harpagophytum burchellii Decne. Pharmacopoeias Devil’s Claw (British Pharmacopoeia 2009); Devil’s Claw Dry Extract (British Ph 2009, European Ph 2008); Devil’s Claw Root (European Ph, 6th ed., 2008 and Supplements 6.1, 6.2, 6.3 and 6.4). Constituents Devil’s claw is usually standardised to the content of the iridoid glycoside, harpagoside. Other iridoid glycosides include harpagide and procumbide, and other constituents include diterpenes, the phenolic glycosides 6-acetylacteoside and 2,6-diacetylacteoside, flavonoids (including kaemp-ferol), triterpenes and harpagoquinone. Use and indications The dried secondary root tuber is used as a stomachic and bitter tonic, and for inflammatory disorders including arthritis, gout, myalgia, fibrositis, lumbago and rheumatic disease. Pharmacokinetics In vitro, a Devil’s claw extract moderately inhibited the activity of the cytochrome P450 isoenzymes, CYP2C8, CYP2C9, CYP2C19, and CYP3A4. Devil’s claw had the greatest effect on CYP2C9, but this was still, at best, a modest effect. For information on the pharmacokinetics of individual flavonoids Read more […]