Biomedical subjects

Joseph F Audette

Publications and source records attributed to Joseph F Audette.

7 recordsLinked to original sources

PubMed2007

Somatosensory cortical plasticity in carpal tunnel syndrome treated by acupuncture.

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the median nerve characterized by paresthesias and pain in the first through fourth digits. We hypothesize that aberrant afferent input from CTS will lead to maladaptive cortical plasticity, which may be corrected by appropriate therapy. Functional MRI (fMRI) scanning and clinical testing was performed on CTS patients at baseline and after 5 weeks of acupuncture treatment. As a control, healthy adults were also tested 5 weeks apart. During fMRI, sensory stimulation was performed for median nerve innervated digit 2 (D2) and digit 3 (D3), and ulnar nerve innervated digit 5 (D5). Surface-based and region of interest (ROI)-based analyses demonstrated that while the extent of fMRI activity in contralateral Brodmann Area 1 (BA 1) and BA 4 was increased in CTS compared to healthy adults, after acupuncture there was a significant decrease in contralateral BA 1 (P < 0.005) and BA 4 (P < 0.05) activity during D3 sensory stimulation. Healthy adults demonstrated no significant test-retest differences for any digit tested. While D3/D2 separation was contracted or blurred in CTS patients compared to healthy adults, the D2 SI representation shifted laterally after acupuncture treatment, leading to increased D3/D2 separation. Increasing D3/D2 separation correlated with decreasing paresthesias in CTS patients (P < 0.05). As CTS-induced paresthesias constitute diffuse, synchronized, multidigit symptomatology, our results for maladaptive change and correction are consistent with Hebbian plasticity mechanisms. Acupuncture, a somatosensory conditioning stimulus, shows promise in inducing beneficial cortical plasticity manifested by more focused digital representations.

Acupuncture Therapy↗

PubMed2007

Complementary and alternative medicine for noncancer pain.

In summary, the past several years have shown an increase in the quality of trials examining the clinical efficacy of various CAM modalities for pain conditions. There is still need to raise the quality of the studies from a scientific and methodological point of view in many areas of CAM research by randomization, appropriate sample size, blinding, and developing more sophisticated sham procedures. However, much work still has to be done to find ways to preserve the clinical authenticity of CAM treatment methods when brought into the light of a research protocol. Recent attempts have been made to find a method of maintaining the standardization and reproducibility of research protocols while allowing the kind of flexible treatment that would normally be applied in a clinical setting. Other questions that should be answered with future studies include understanding how treatment length influences outcome, if maintenance treatments are needed for chronic conditions, and cost and risk comparisons with standard pharmacological treatment. Providing this kind of detail will assist both with reproducibility as well as help us gain a better understanding about whether certain treatment paradigms are superior to others for specific clinical conditions. Finally, physicians who have an interest in pursuing CAM research should educate themselves both about the methodological issues inherent with the particular area of interest as well as about ways to maintain the authenticity of the CAM treatment protocols so that the literature is not populated with more poorly designed studies. With the emerging interest in integrative medicine, there is a growing interest in collaboration and a greater number of physicians are interested in obtaining training in CAM modalities to help bridge this gap between CAM and conventional clinicians. For example, the American Academy of Medical Acupuncturists (AAMA) has been formed to help as both an educational and research forum for physician acupuncturists and the American Holistic Medical Association provides educational exposure in a broad range of Integrative and CAM modalities. The future of medicine will likely be Integrative and the more health care providers can educate themselves about this area of medicine, the better they will be able to provide the highest quality of care to their patients.

Complementary Therapies↗

PubMed2006

Tai Chi versus brisk walking in elderly women.

PURPOSE: to compare the effects of a short style of Tai Chi versus brisk walking training programme on aerobic capacity, heart rate variability (HRV), strength, flexibility, balance, psychological status and quality of life in elderly women. METHODS: nineteen community-dwelling, sedentary women (aged 71.4 +/- 4.5 years) were randomly assigned to Tai Chi Chuan (TCC; n = 11) or brisk walking group (BWG; n = 8). A separate group of elderly women was recruited from the same population to act as a sedentary comparison group (SCG; n = 8). The exercise groups met for 1 h, three days per week for 12 weeks. Outcomes measured before and after training included estimated VO2max, spectral analysis of HRV (high-frequency, low-frequency power as well as high- and low-frequency power in normalised units) as a measure of autonomic control of the heart, isometric knee extension and handgrip muscle strength, single-leg stance time, the State Trait Anxiety Inventory (STAI), Profile of Mood States (POMS) and Short Form-36 (SF-36) questionnaires. RESULTS: significant improvement was seen in estimated VO(2)max in the TCC group (TCC versus SCG P = 0.003, TCC versus BWG P = 0.08). The mean within-person change of high-frequency power in normalised units (HFnu) increased [8.2 (0.14-16.3)], representing increased parasympathetic activity, and low-frequency power in normalised units (LFnu) decreased [-8.7 (-16.8-0.5)], representing decreased sympathetic activity, in the TCC group only. Significant gains were also seen in the non-dominant knee extensor strength and single-leg stance time (TCC versus BWG P < 0.05). CONCLUSIONS: a short style of TCC was found to be an effective way to improve many fitness measures in elderly women over a 3-month period. TCC was also found to be significantly better than brisk walking in enhancing certain measures of fitness including lower extremity strength, balance and flexibility.

Aged↗

PubMed2005

Neuropathic low back pain.

In this discussion, we hope to advance a clinical approach to low back pain that is more in line with our modern understanding of neuropathic pain. We review the current understanding of normal and pathologic neuroanatomy of the lumbar spine and then outline how pathology in the different structures can lead to neuropathic pain and cause common pain patterns seen in clinical practice. We also detail the available treatments for neuropathic low back pain.

Animals↗

PubMed2004

The role of acupuncture in pain management.

This article reviews the theories and applications of acupuncture to musculoskeletal pain management. First, Chinese theories of acupuncture are discussed briefly. Next, current understanding of nociception and central pain modulation is discussed in detail,followed by discussion of the physiologic effect of acupuncture analgesia. Other theories of acupuncture analgesia are presented based on neuromodulation of the central nervous system. Finally,the efficacy of acupuncture for many musculoskeletal pain syndromes,including spine-related pain, soft tissue pain, neuropathic pain, arthritis of the knee, and upper extremity tendinitis, is reviewed. The article concludes with a discussion of methodologic issues related to conducting randomized, placebo-controlled trials of acupuncture and goals for future research in this area of pain management.

Acupuncture Therapy↗

PubMed2004

Bilateral activation of motor unit potentials with unilateral needle stimulation of active myofascial trigger points.

OBJECTIVE: The objective of this study was to determine if there are electromyographic differences between active and latent myofascial trigger points (MTrPs) during trigger point needling. DESIGN: A total of 21 subjects were recruited prospectively. The experimental group consisted of 13 subjects who had active myofascial pain in the neck for >6 mos. The age-matched, control group consisted of eight subjects without neck pain but with taut bands in the cervical musculature. The active MTrPs (or latent MTrPs in the control group) were identified in the trapezius or levator scapulae muscles, then needle electrodes were inserted ipsilaterally into the muscle with the MTrPs and into the same muscle on the contralateral side. Electromyographic activity was recorded bilaterally with a dual-channel electromyographic machine, and local twitch responses were obtainedusinganacupuncturedryneedlingtechniqueonlyonthesideoftheactiveMTrPs. RESULTS: We demonstrated that in subjects with active MTrPs, bilateral motor unit activation could be obtained with unilateral needle stimulation of the trigger point. In contrast, in all the subjects with latent MTrPs, only unilateral motor unit activation could be obtained in the muscle on the same side of the needle stimulation. The motor unit potentials seen on the electromyograph were similar in morphology to a fasciculation potential but more complex. CONCLUSION: We demonstrated bilateral or mirror-image electromyographic activity associated with unilateral needle stimulation of active MTrPs. We have found no previous mention of this phenomenon in the literature. Our study supports the concept that the perpetuation of pain and muscle dysfunction in active MTrPs may be related to abnormal central nervous system processing of sensory input at the level of the spinal cord.

Acupuncture Points↗

PubMed2003

Acupuncture in the management of myofascial pain and headache.

Acupuncture encompasses a host of healing techniques that have been practiced for more than 2000 years. Many different techniques and styles are in use in the West. The scientific study of acupuncture regarding its effectiveness has proven to be problematic and definitive studies are few. This is partly because of the difficulty in studying a dynamic, patient-centered system whose practice paradigms often are artificially limited by the application of a reductionist methodology, which is dictated by the standards of scientific enquiry. However, acupuncture, unlike many indigent medical practices in the world, has withstood the test of time in China and in the West, with many practitioners and patients reporting real benefits for the conditions of headache and myofascial pain when treated by acupuncture. This review provides a brief overview of acupuncture and what is known of its effectiveness in treating headache and myofascial pain.

Acupuncture Therapy↗