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OBJECTIVE:Yoga positively affects health-related quality of life and disease activity in ulcerative colitis. The underlying modes of action remain unclear. Within the present study we hypothesized that patients´ perceived stress mediates the effects of yoga on health-related quality of life and disease activity. METHODS:This is a secondary analysis of a randomized controlled trial comparing the effects of yoga to written self-care advice in patients with inactive ulcerative colitis and impaired quality of life. Perceived stress was assessed using the Perceived Stress Questionnaire, health-related quality of life using the Inflammatory Bowel Disease Questionnaire and disease activity using the Clinical Activity Index. Outcomes were assessed at weeks 0, 12 and 24. RESULTS:Seventy-seven patients participated. Thirty-nine patients attended the 12 supervised weekly yoga sessions (71.8% women; 45.0 ± 13.3 years) and 38 patients written self-care advice (78.9% women; 46.1 ± 10.4 years). Perceived stress correlated significantly with health-related quality of life and disease activity at week 24. Perceived stress at week 12 fully mediated the effects of yoga on health-related quality of life (B = 16.23; 95% Confidence interval [6.73; 28.40]) and disease activity (B = -0.28; 95% Confidence interval [-0.56; -0.06]) at week 24. CONCLUSION:Our findings confirm the importance of perceived stress in reducing disease activity and increasing health-related quality of life in patients with ulcerative colitis and impaired quality of life. Practitioners should keep psychosocial risk in mind as a risk factor for disease exacerbation, and consider yoga as an adjunct intervention for highly stressed patients with ulcerative colitis. CLINICALTRIALS. GOV REGISTRATION NUMBER:The trial was registered at clinicaltrials.gov prior to patient recruitment (registration number NCT02043600).

© 2017 Elsevier Inc. Objectives The aim of this review was to systematically assess and meta-analyze the effects of a low fermentable, oligo-, di-, mono-saccharides and polyol (FODMAP) diet (LFD) on the severity of symptoms, quality of life, and safety in patients with irritable bowel syndrome (IBS). Methods The MEDLINE/PubMed, Scopus, and Cochrane Library databases were screened through January 19, 2016. Randomized controlled trials (RCTs) that compared LFD to other diets were included if they assessed symptoms of IBS or abdominal pain in patients with IBS. Safety, quality of life, anxiety, depression, and effect on gut microbiota were defined as secondary outcomes. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated. Results Nine RCTs with a total of 596 subjects were included. Three RCTs compared LFD with a habitual diet, two RCTs provided all meals and compared LFD with a western diet, one RCT each compared LFD with a diet high in FODMAPs or a sham diet, and two RCTs compared with other diet recommendations for IBS. A meta-analysis revealed significant group differences for LFD compared with other diets with regard to gastrointestinal symptoms (SMD = −0.62; 95% CI = −0.93 to −0.31; P = 0.0001), abdominal pain (SMD = −0.50; 95% CI = −0.77 to −0.22; P = 0.008), and health-related quality of life (SMD = 0.36; 95% CI = 0.10–0.62; P = 0.007). Three studies reported a significant reduction in luminal bifidobacteria after LFD. Adverse events were assessed in three RCTs only and no intervention-related adverse events were reported. Conclusions This meta-analysis found evidence of the short-term efficacy and safety of LFD in patients with IBS. However, only a preliminary recommendation for LFD can be made until long-term effects are investigated.

© 2017 Elsevier Ltd Aim: The aim of this cross-sectional analysis was to identify sociodemographic, and health related predictors for fasting use among patients of a large integrative internal medicine ward. Methods: A cross-sectional analysis was conducted among patients being referred to a hospital for internal and integrative medicine. Patients’ ever-use of fasting for their primary medical complaint and their perceptions of benefit and harm were assessed. The potential predictors of fasting use included sociodemographic characteristics, health behaviour, internal medicine diagnosis, health, satisfaction with health, and health locus of control; and they were analysed using multiple logistic regression analysis. Results: Of 2144 respondents, 15.8% reported having used fasting, with 61.2% reporting perceived benefits and 3.9% harms due to use. Fasting use was positively associated with higher education, being diagnosed with osteoarthritis or fibromyalgia and regular fast food use, while patients with inflammatory bowel diseases, smokers, alcohol abstinent people and those with a high external social health locus of control were less likely to use fasting. A good health status and high internal locus of control were positively associated with the perception of fasting as helpful, while part-time employment, being diagnosed with inflammatory bowel diseases and being alcohol abstinent were negatively associated with perceived helpfulness. Conclusion: There is significant use of therapeutic fasting by integrative medicine patients in Germany, with high self-reported benefit and low self-reported harms. Use of fasting by patients was not related to evidence of efficacy of fasting for their condition, with other factors being more predictive of fasting use.

Copyright © 2017 by the American Academy of Pediatrics. Context: Gastrointestinal disorders are common childhood complaints. Particular types of complementary and alternative medicine, such as herbal medicine, are commonly used among children. Research information on efficacy, safety, or dosage forms is still lacking. ObjectiveS: To systematically summarize effectiveness and safety of different herbal treatment options for gastrointestinal disorders in children. Data Sources: Medline/PubMed, Scopus, and the Cochrane Library were searched through July 15, 2016. Study Selection: Randomized controlled trials comparing herbal therapy with no treatment, placebo, or any pharmaceutical medication in children and adolescents (aged 0-18 years) with gastrointestinal disorders were eligible. Data Extraction: Two authors extracted data on study design, patients, interventions, control interventions, results, adverse events, and risk of bias. Results: Fourteen trials with 1927 participants suffering from different acute and functional gastrointestinal disorders were included in this review. Promising evidence for effectiveness was found for Potentilla erecta, carob bean juice, and an herbal compound preparation including Matricaria chamomilla in treating diarrhea. Moreover, evidence was found for peppermint oil in decreasing duration, frequency, and severity of pain in children suffering from undifferentiated functional abdominal pain. Furthermore, evidence for effectiveness was found for different fennel preparations (eg, oil, tea, herbal compound) in treating children with infantile colic. No serious adverse events were reported. Limitations: Few studies on specific indications, single herbs, or herbal preparations could be identified. Conclusions: Because of the limited number of studies, results have to be interpreted carefully. To underpin evidence outlined in this review, more rigorous clinical trials are needed.

This paper is the first in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the diagnosis and management of Crohn's disease and concerns the methodology of the consensus process, and the classification, diagnosis and medical management of active and quiescent Crohn's disease. Surgical management as well as special situations including management of perianal Crohn's disease of this ECCO Consensus are covered in a subsequent second paper [Gionchetti et al JCC 2016].

© 2017 S. Karger GmbH, Freiburg. Background: Chronic neck pain is a major public health burden with only limited evidence for the effectiveness of complementary therapies. This study aimed to test the efficacy of cupping massage in patients with neck pain. Patients and Methods: Patients with chronic non-specific neck pain were randomly assigned to cupping massage or a wait list control. The intervention group received 5 cupping massages on a twice-weekly basis while the control patients continued their usual treatments. The primary outcome measure was neck pain intensity (0-100 mm visual analogue scale (VAS)) after 3 weeks. Secondary outcomes included pain on movement, functional disability, health-related quality of life, mechanical detection and pain thresholds and adverse events. Results: 50 patients (52.6 ± 10.3 years, 92% female) were randomised to either cupping massage or a wait list (N = 25 each). Patients in the cupping group reported significantly less neck pain post intervention (difference per protocol -14.3 mm, 95% confidence interval (CI) -27.7 to -1.0, p = 0.037; difference intention-to-treat -10.8 mm, 95% CI -21.5 to -0.1, p = 0.047). Significant group differences in favour of the intervention were further found for pain on movement (p = 0.019) and functional disability (p < 0.001), the quality-of-life subscales pain (p = 0.002) and mental health (p = 0.003) and the mental component summary (p = 0.036). Changes were also found for pressure pain sensitivity at the site of maximal pain (p = 0.022). Five adverse events were reported. Conclusions: Cupping massage appears to be effective in reducing pain and increasing function and quality of life in patients with chronic non-specific neck pain. More rigorous studies are needed to confirm and extend these results.

© 2017 The Cochrane Collaboration. Background: Breast cancer is the cancer most frequently diagnosed in women worldwide. Even though survival rates are continually increasing, breast cancer is often associated with long-term psychological distress, chronic pain, fatigue and impaired quality of life. Yoga comprises advice for an ethical lifestyle, spiritual practice, physical activity, breathing exercises and meditation. It is a complementary therapy that is commonly recommended for breast cancer-related impairments and has been shown to improve physical and mental health in people with different cancer types. Objectives: To assess effects of yoga on health-related quality of life, mental health and cancer-related symptoms among women with a diagnosis of breast cancer who are receiving active treatment or have completed treatment. Search methods: We searched the Cochrane Breast Cancer Specialised Register, MEDLINE (via PubMed), Embase, the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 1), Indexing of Indian Medical Journals (IndMED), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal and Clinicaltrials.gov on 29 January 2016. We also searched reference lists of identified relevant trials or reviews, as well as conference proceedings of the International Congress on Complementary Medicine Research (ICCMR), the European Congress for Integrative Medicine (ECIM) and the American Society of Clinical Oncology (ASCO). We applied no language restrictions. Selection criteria: Randomised controlled trials were eligible when they (1) compared yoga interventions versus no therapy or versus any other active therapy in women with a diagnosis of non-metastatic or metastatic breast cancer, and (2) assessed at least one of the primary outcomes on patient-reported instruments, including health-related quality of life, depression, anxiety, fatigue or sleep disturbances. Data collection and analysis: Two revie

© 2017 Elsevier B.V. Objectives Previous research has found that yoga can enhance quality of life and ease menopausal symptoms of breast cancer survivors. The study examined whether self-esteem mediated the effects of yoga on quality of life, fatigue and menopausal symptoms, utilizing validated outcome measures. Study design This is a secondary analysis of a randomized controlled trial comparing the effects of yoga with those of usual care in 40 breast cancer survivors who suffered from menopausal symptoms. All participants completed all 3 assessments (week 0, week 12, and week 24) and provided full data. Main outcome measures Outcomes were measured using self-rating instruments. Mediation analyses were performed using SPSS. Results Self-esteem mediated the effect of yoga on total menopausal symptoms (B = −2.11, 95% BCI [−5.40 to −0.37]), psychological menopausal symptoms (B = −0.94, 95% BCI [−2.30 to −0.01]), and urogenital menopausal symptoms (B = −0.66, 95% BCI [−1.65 to −0.15]), quality of life (B = 8.04, 95% BCI [3.15–17.03]), social well-being (B = 1.80, 95% BCI [0.54–4.21]), emotional well-being (B = 1.62, 95% BCI [0.70–3.34]), functional well-being (B = 1.84, 95% BCI [0.59–4.13]), and fatigue (B = 4.34, 95% BCI [1.28–9.55]). Self-esteem had no effect on somatovegetative menopausal symptoms (B = −0.50, 95% BCI n.s.) or on physical well-being (B = 0.79, 95% BCI n.s.). Conclusions Findings support the assumption that self-esteem plays a vital role in the beneficial effect of yoga and that yoga can have long-term benefits for women diagnosed with breast cancer and undergoing menopausal transition.

© 2017 Elsevier GmbH Background: Herbal medicine is among the most frequently used complementary medicines. This study aims to identify the socio-demographic and health-related predictors of herbal medicine utilisation among patients with chronic internal medicine conditions admitted to inpatient care. Methods: Patients referred to a German integrative medicine clinic were asked whether they had ever used herbal medicine for their primary medical diagnosis, and whether they experienced benefits or harm. Socio-demographic characteristics, health behaviour, medical diagnosis, health status, mental health, satisfaction with health, and health locus of control were determined as potential predictors of herbal medicine use. Results: Of 2105 respondents, 41.9% reported herbal medicine use for their primary medical complaint, with 57.4% of them reporting perceived benefits and no harm due to use. Herbal medicine use was positively associated with female gender, at least high school education, a diagnosis of fibromyalgia, lung disease or sub-threshold depression, high internal health locus of control and avoidance of fast food, and was negatively associated with spinal pain. High satisfaction with life and high internal health locus of control were positively associated with perceiving herbal medicine as helpful. Whilst, being a smoker and diagnosed with headaches or irritable bowel syndrome had a negative association with the use of herbal medicine. Conclusion: Herbal medicine utilisation among patients admitted to integrative inpatient care is common. While predictors of herbal medicine use appear to be in line with previous findings, there is a need for more in-depth examination of patients’ motivations for the use of herbal medicine to further the understanding of their health behaviours and needs.

Herbal medicine is a promising alternative in the treatment of acute rhinosinusitis (ARS). We performed a systematic review for phytopharmaceutical treatments of ARS. A computerized search of databases (Cochrane Library, PubMed, and Scopus) up to 16 September 2015 was performed. Randomized controlled trials (RCTs) and controlled trials (CTs) were included and assessed using the Cochrane risk of bias tool. Seven trials on Pelargonium sidoides (EPs 7630, Umckaloabo®), Myrtol (Gelo- Myrtol® forte), BNO 1016 (Sinupret® extract), BNO 101 (Sinupret®), Cyclamen europaeum (Nasodren®), and Esberitox ® were included. Risk of bias was heterogeneous. EPs 7630 appeared to be useful in the treatment of ARS. Myrtol showed benefits against a placebo compound, and BNO 1016 and BNO 101 might be helpful; however, there was little evidence for the effectiveness of Cyclamen europaeum and Esberitox®. Herbal medicine might be effective for the treatment of ARS, but given the low number of clinical trials and the heterogeneous methodological quality, further research is necessary.

Herbal remedies have a long history in the medical care of the German-speaking regions but they are rarely taken into account in the development of medical guidelines. In a prestudy, our working group analyzed as to how far herbal remedies were taken into consideration in the current interdisciplinary evidence- and consensus-based S3 medical guidelines established by the Association of the Scientific Medical Societies (AWMF) in Germany. The aim of this study was to analyze to what extent possible side effects and interactions of herbal remedies are mentioned in the S3 medical guidelines. In January 2015, 134 S3 guidelines were counted and analyzed. 27.6% (n = 37) of them show 194 statements summarized under the term ‘phytotherapy’. References to side effects and interactions can be found in 28.4% of the statements (n = 55); 13.9% (n = 27) of these references are backed by the literature. 14 of the statements deal with nutritional supplements, 11 are statements about phytotherapy in general, and 7 summarize at least 2 medical plants in 1 statement. Hence, only 23 statements pay attention to side effects and interactions of individual medical plants; 14 of these are backed by the literature. These results do not correspond to the standards required by the AWMF, which is due to imprecise terms as well as to the insufficiently systematic approach in the search for scientific evidence for the safety of medical plants. Here, the Association for Phytotherapy may achieve an important contribution to quality improvement.

© 2016 Elsevier Inc. Introduction Overweight and obesity are among the most important modifiable risk factors for chronic diseases and premature death. The aim of this review was to systematically assess and analyze the effects of yoga on weight-related outcomes. Methods Medline/PubMed, Scopus, and the Cochrane Library were screened through March 2015 for randomized controlled trials on yoga for weight-related outcomes in the general population or overweight/obese individuals. Risk of bias was assessed using the Cochrane risk of bias tool on the following domains: selection bias, performance bias, detection bias, attrition bias, reporting bias, and other bias. Results Out of 445 records identified during literature search, 30 trials with a total of 2173 participants were included. No effects on weight, body mass index, body fat percentage or waist circumference were found. In studies with healthy adult participants an effect of yoga compared to usual care was found regarding waist/hip ratio (SMD =‐ − 1.00; 95% CI =‐ − 1.44, − 0.55; p < 0.001). In studies with overweight/obese participants only, effects relative to usual care were found for body mass index (SMD = − 0.99; 95% CI = − 1.67, − 0.31; p = 0.004). Effects however were not robust against selection bias; and publication bias could not be ruled out. No intervention-related adverse events were reported. Conclusions Despite methodological drawbacks, yoga can be preliminarily considered a safe and effective intervention to reduce body mass index in overweight or obese individuals.

© 2016 S. Karger GmbH, Freiburg. Background: Homeopathy use continues to grow in many European countries, and some studies have examined the characteristics of patients using homeopathy within the general population. The aim of this study was to identify predictors for homeopathy use among internal medicine patients. Patients and Methods: A cross-sectional analysis was conducted among all patients being referred to the Department of Internal and Integrative Medicine at Essen, Germany, over a 3-year period. The analysis examined whether patients had used homeopathy for their primary medical complaint before, the perceived benefit, and the perceived harm of homeopathy use. Odds ratios with 95% confidence intervals were calculated using multiple logistic regression analysis. Results: Of 2,045 respondents, 715 (35.0%) reported having used homeopathy for their primary medical complaint (diagnosis according to the International Statistical Classification of Diseases and Related Health Problems), with 359 (50.2%) reporting perceived benefits and 15 (2.1%) reporting harm. Homeopathy use was positively associated with female gender, high school level education, suffering from fibromyalgia or subthreshold depression, and being fast food abstinent, while patients with osteoarthritis, spinal or other pain, smokers, and patients with a high external-social health locus of control were less likely to use homeopathy. Conclusion: Personal characteristics and health status may impact on the use and the perceived helpfulness of homeopathy.

© 2016 Elsevier Ltd. Objective: To determine whether the odds of positive conclusions in randomized controlled trials (RCTs) of yoga, differ between yoga styles. Design: Systematic review of yoga RCTs. Medline/PubMed, Scopus, the Cochrane Library, IndMED and the tables of content of specialist yoga journals, not listed in medical databases, were screened up to 12 February, 2014 for RCTs comparing yoga interventions to non-yoga interventions. The RCTs' conclusions were classified as positive (yoga is helpful for a respective condition) or not positive; and these were compared between different yoga styles using the Chi squared test and multiple logistic regression analysis. Results: A total of 306 RCTs were included. These applied 52 different yoga styles, the most commonly used of which were: hatha yoga (36 RCTs), Iyengar yoga (31 RCTs), pranayama (26 RCTs), and the integrated approach to yoga therapy (15 RCTs). Positive conclusions were reached in 277 RCTs (91%); the proportion of positive conclusions did not differ between yoga styles (p = 0.191). Conclusion: RCTs with different yoga styles do not differ in their odds of reaching positive conclusions. Given that most RCTs were positive, the choice of an individual yoga style can be based on personal preferences and availability.

© 2016 American Pain Society This study aimed to test the efficacy of Tai Chi for treating chronic neck pain. Subjects with chronic nonspecific neck pain were randomly assigned to 12 weeks of group Tai Chi or conventional neck exercises with weekly sessions of 75 to 90 minutes, or a wait-list control. The primary outcome measure was pain intensity (visual analogue scale). Secondary outcomes included pain on movement, functional disability, quality of life, well-being and perceived stress, postural and interoceptive awareness, satisfaction, and safety. Altogether, 114 participants were included (91 women, 49.4 ± 11.7 years of age). After 12 weeks Tai Chi participants reported significantly less pain compared with the wait list group (average difference in mm on the visual analogue scale: −10.5; 95% confidence interval, −20.3 to −.9; P = .033). Group differences were also found for pain on movement, functional disability, and quality of life compared with the wait list group. No differences were found for Tai Chi compared with neck exercises. Patients’ satisfaction with both exercise interventions was high, and only minor side effects were observed. Tai Chi was more effective than no treatment in improving pain in subjects with chronic nonspecific neck pain. Because Tai Chi is probably as effective as neck exercises it may be considered a suitable alternative to conventional exercises for those with a preference toward Tai Chi. Perspective This article presents results of a randomized controlled trial comparing Tai Chi, conventional neck exercises, and no treatment for chronic nonspecific neck pain. Results indicate that Tai Chi exercises and conventional neck exercises are equally effective in improving pain and quality of life therefore representing beneficial interventions for neck pain.

© 2016 AGA Institute Background & Aims This review aims to systematically survey the effects of yoga on symptoms of irritable bowel syndrome (IBS), pain, quality of life, mood, stress, and safety in patients with IBS. Methods MEDLINE/Pubmed, Scopus, the Cochrane Library, CAM-QUEST, CAMbase, and IndMED were screened through November 2015. Randomized controlled trials comparing yoga with usual care, nonpharmacologic, or pharmacologic interventions were analyzed for patients with IBS. Primary outcomes included gastrointestinal symptoms, quality of life, and pain. Anxiety, mood, and safety were defined as secondary outcomes. Risk of bias was assessed according to the Cochrane Collaboration recommendations. Results Six randomized controlled trials with a total of 273 patients were included in the qualitative analysis. There was evidence for a beneficial effect of a yogic intervention over conventional treatment in IBS, with significantly decreased bowel symptoms, IBS severity, and anxiety. Furthermore, there were significant improvements in quality of life, global improvement, and physical functioning after yoga compared with no treatment. Two randomized controlled trials reported safety data stating that no adverse events occurred. Overall, risk of bias of the included studies was unclear. Conclusions The findings of this systematic review suggest that yoga might be a feasible and safe adjunctive treatment for people with IBS. Nevertheless, no recommendation can be made regarding yoga as a routine intervention for patients with IBS because of major flaws in study methods. More research is needed with respect to a high-quality study design and consensus in clinical outcome measurements in IBS. ClinicalTrials.gov number, NCT02721836.

Purpose: Tai Chi seems effective for many musculoskeletal conditions. This study aimed to test the efficacy of Tai Chi and neck exercises for treating chronic non-specific neck pain. Methods: Patients suffering from chronic non-specific neck pain were randomly assigned to 12 weeks of group Tai Chi or neck exercises, or usual care. Patients attended weekly sessions of 75–90 minutes, and were advised to practice 15 minutes daily. The primary outcome measure was pain intensity (visual analog scale). Secondary outcomes included pain on movement, functional disability, quality of life, psychological well-being and perceived stress, postural and interoceptive awareness, satisfaction and safety. Results: A total of 114 patients were included in this study (91 females, 49.4 ± 11.7 years). After 12 weeks patients practicing Tai Chi reported significantly less pain compared to usual care (difference: −10.5; 95% CI: −20.3, −0.9; p = 0.033). Significant effects were also found for pain on movement, functional disability and quality of life compared to usual care. No group differences were found for Tai Chi compared to neck exercises. Changes in pain intensity were predicted by age and baseline pain intensity, changes in postural awareness and the number of attended classes. Patients were satisfied with both active interventions and only minor side effects were observed. Conclusion: Twelve weeks of Tai Chi were more effective than usual care to improve pain, disability, quality of life and postural control in patients with chronic non-specific neck pain. Since Tai Chi was equally efficacious, it may be considered a suitable alternative for conventional neck exercises.

© 2016 the Author(s). Introduction: Integrative medicine inpatient treatment has been shown to improve physical and mental health in patients with internal medicine conditions. The aim of this study was to investigate the effectiveness of a 2-week integrative medicine inpatient treatment in patients with chronic pain syndromes and the association of treatment success with patient-related process variables. Methods: Inpatients with chronic pain syndromes participating in a 2-week integrative medicine inpatient program were included. Patients' pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were measured on admission, discharge, and 6 months after discharge. Likewise process variables including ability and will to change, emotional/rational disease acceptance, mindfulness, life and health satisfaction, and easiness of life were assessed. Results: A total of 310 inpatients (91% female, mean age 50.7 ± 12.4 year, 26.5% low back pain, and 22.9% fibromyalgia) were included. Using mixed linear models, significant improvements in pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress were found (all P < 0.05). Ability to change and implementation, disease acceptance, mindfulness, life and health satisfaction, and light heartedness/easiness likewise improved (all P < 0.05). Improved outcomes were associated with increases in process variables, mainly ability to change and implementation, disease acceptance, life and health satisfaction, and light heartedness/easiness (R 2 = 0.03-0.40). Conclusions: Results of this study suggest that a 2-week integrative medicine inpatient treatment can benefit patients with chronic pain conditions. Functional improvements are associated with improved ability to change and implementation, disease acceptance, and satisfaction.

© 2016 The Author(s). This study aimed to test the efficacy of cupping therapy to improve symptoms and quality of life in patients diagnosed with the fibromyalgia syndrome. Participants were randomly assigned to cupping therapy, sham or usual care. Cupping was administered five times at twice weekly intervals on the upper and lower back. The primary outcome measure was pain intensity at day 18. Secondary outcomes included functional disability, quality of life, fatigue and sleep quality as well as pressure pain sensitivity, satisfaction and safety at day 18 and 6 months. Altogether 141 patients were included in this study (139 females, 55.8 ± 9.1 years). After 18 days patients reported significant less pain after cupping compared to usual care (difference-12.4; 95% CI:-18.9;-5.9, p < 0.001) but not compared to sham (difference-3.0; 95% CI:-9.9, 3.9, p = 0.396). Further effects were found for quality of life compared to usual care. Patients were mildly satisfied with cupping and sham cupping; and only minor side effects were observed. Despite cupping therapy being more effective than usual care to improve pain intensity and quality of life, effects of cupping therapy were small and comparable to those of a sham treatment, and as such cupping cannot be recommended for fibromyalgia at the current time.

© Haug Verlag in MVS Medizinverlage Stuttgart GmbH & Co.KG. Background. In order to present recent findings on the effectiveness and safety of phytotherapy for treatment of osteoarthritis (OA) we summarized the two latest Cochrane reviews (Cameron & Chrubasik, 2013; Cameron & Chrubasik, 2014). One of them included oral and the other topical herbal treatment options as a treatment for OA. Methods. We conducted a thorough evaluation of the Cochrane reviews. We assessed methodological quality of the reviews and extracted evidence. Results. Meta-analyses found evidence for effects of the oral herbal products Boswellia serrata and only partially for avocado-soybean unsaponifiable (ASU). However, they included only a small number of primary studies. The systematic review on topical herbal treatments included fewer trials and did not include a meta-analysis. Discussion. Based on the qualitative synthesis Boswellia serrata can be applied in the treatment of OA. It is not clear if ASU can be recommended. No valid recommendation can be given for or against other herbal therapies due to a lack of randomized clinical trials in the field.

© 2016 Elsevier Ltd. Objective: Herbal medicines have been used widely for the treatment of irritable bowel syndrome (IBS) patients. The aim of this study is to investigate efficacy and safety of an Ayurvedic herbal compound preparation made from: Murraya koenigii (curry), Punica granatum (pomegranate) and Curcuma longa (turmeric), compared to a placebo in patients with diarrhoea predominant IBS. Material and methods: This trial was conducted as a randomised placebo-controlled crossover trial with randomised sequence of verum and placebo for each patient. Verum and placebo were provided as ground powders and delivered in sealed containers. Patients and outcome assessors were blinded. Patients were advised to ingest the decoction twice daily for 4 weeks. The primary outcome measure was IBS symptom intensity; secondary outcomes included: quality of life, anxiety and depression, compliance and safety. Results: 32 IBS patients were included in the trial (19 females, mean age 50.3 ± 11.9 years). Eleven people dropped out during the trial resulting in 37 complete verum and 35 complete placebo phases. No group differences were found between verum and placebo for IBS symptom intensity (difference 24.10; 95% CI: -17.12; 65.32, p = 0.26). The same was true for secondary outcomes. Compliance was satisfactory to good and the preparation appeared to be safe, but one third of the patients registered at least one minor adverse event that might be related to the study interventions. Conclusion: An Ayurvedic herbal preparation made from Murraya koenigii, Punica granatum and Curcuma longa appeared to be no more effective in improving diarrhoea predominant irritable bowel symptoms than placebo.

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 acceptancebased 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.

© European Society of Cardiology. Background Metabolic syndrome is the most important risk factor for developing cardiovascular disease and type 2 diabetes. The aim of this review was to systematically assess and perform a meta-analysis of the effects of yoga on the parameters of metabolic syndrome. Methods MEDLINE/PubMed, Scopus, the Cochrane Central Register of Controlled Trials and IndMED were searched and screened from their inception through to 8 March 2016 for randomised controlled trials on yoga for patients with metabolic syndrome. Risk of bias was assessed using the Cochrane risk of bias tool. Results Seven trials with a total of 794 participants were included. No effects of yoga on resolution of metabolic syndrome, diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol and fasting plasma glucose were found, but yoga was superior to usual care for waist circumference (standardised mean difference (SMD) = '0.35; 95% confidence interval (CI) = '0.57 to '0.13; p < 0.01) and systolic blood pressure (SMD = '0.29; 95% CI = '0.51 to '0.07; p = 0.01). However, these effects were not robust against selection bias. No intervention-related adverse events were reported. Conclusion Based on the results of this meta-analysis, no recommendation can be made for or against yoga in order to influence the parameters of metabolic syndrome. Despite methodological drawbacks, and until further research is undertaken, yoga can be preliminarily considered as a safe and effective intervention for reducing waist circumference and systolic blood pressure in individuals with metabolic syndrome who are not adhering to conventional forms of exercise.