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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. © 2013, Mary Ann Liebert, Inc.

Objective. To evaluate the quality of evidence and the strength of recommendation for yoga as an ancillary intervention in rheumatic diseases. Methods. Medline/PubMed, Scopus, the Cochrane Library and IndMED were searched through February 2013. Randomized controlled trials (RCTs) comparing yoga with control interventions in patients with rheumatic diseases were included. Two authors independently assessed the risk of bias using the Cochrane Back Review Group risk of bias tool. The quality of evidence and the strength of the recommendation for or against yoga were graded according to the GRADE recommendations. Results. Eight RCTs with a total of 559 subjects were included; two RCTs had a low risk of bias. In two RCTs on FM syndrome, there was very low evidence for effects on pain and low evidence for effects on disability. In three RCTs on OA, there was very low evidence for effects on pain and disability. Based on two RCTs, very low evidence was found for effects on pain in RA. No evidence for effects on pain was found in one RCT on CTS. No RCT explicitly reported safety data. Conclusion. Based on the results of this review, only weak recommendations can be made for the ancillary use of yoga in the management of FM syndrome, OA and RA at this point. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.

Introduction. Cancer diagnosis and treatment are often associated with physical and psychosocial impairments. Many cancer patients request complementary and alternative therapies such as mind-body medicine. Concept. The department of internal and integrative medicine at the Essen-Mitte Clinics offer a mind-body medicine day care clinic for cancer patients that is based on the Mindfulness-Based Stress Reduction Program and the mind-body medicine cancer program of the Harvard Mind/Body Medical Institute. The program encompasses mindfulness training, yoga, mindful exercise, nutrition, naturopathic self-help strategies, and cognitive restructuring. Cases. Two patients who had participated in the day care clinic program are presented here. One patient presented with anxiety and depression after recently diagnosed breast cancer and the other with psychological impairments as a result of multiple nevi excision after malignant melanoma surgery. Both patients improved in terms of anxiety and further psychological symptoms. Conclusions. The Essen-Mitte Clinics mind-body medicine day care clinic appears to alleviate psychological consequences of cancer and its treatment. Further studies and randomized controlled trials are necessary to confirm these results. © The Author(s) 2013.

Objectives: This paper presents a systematic review and meta-analysis of the effectiveness of mindfulness-based stress reduction (MBSR) for FMS. Methods: The PubMed/MEDLINE, Cochrane Library, EMBASE, PsychINFO and CAMBASE databases were screened in September 2013 to identify randomized and non-randomized controlled trials comparing MBSR to control interventions. Major outcome measures were quality of life and pain; secondary outcomes included sleep quality, fatigue, depression and safety. Standardized mean differences and 95% confidence intervals were calculated. Results: Six trials were located with a total of 674 FMS patients. Analyses revealed low quality evidence for short-term improvement of quality of life (SMD. = -0.35; 95% CI - 0.57 to - 0.12; P. = 0.002) and pain (SMD. = - 0.23; 95% CI - 0.46 to - 0.01; P. = 0.04) after MBSR, when compared to usual care; and for short-term improvement of quality of life (SMD. = - 0.32; 95% CI - 0.59 to - 0.04; P. = 0.02) and pain (SMD. = - 0.44; 95% CI - 0.73 to - 0.16; P. = 0.002) after MBSR, when compared to active control interventions. Effects were not robust against bias. No evidence was further found for secondary outcomes or long-term effects of MBSR. Safety data were not reported in any trial. Conclusions: This systematic review found that MBSR might be a useful approach for FMS patients. According to the quality of evidence only a weak recommendation for MBSR can be made at this point. Further high quality RCTs are required for a conclusive judgment of its effects. © 2013 Elsevier Inc.

While clinical trials have shown evidence of efficacy of yoga in different chronic diseases, subjective health benefits associated with yoga practice under naturalistic conditions have not yet been investigated. The aim of this study was to investigate associations of regular yoga practice with quality of life and mental health in patients with chronic diseases. Using a case-control design, patients with chronic diseases who regularly practiced yoga were selected from a large observational study and compared to controls who did not regularly practice yoga and who were matched individually to each case on gender, main diagnosis, education, and age (within 5 years). Patients' quality of life (SF-36 questionnaire), mental health (Hospital Anxiety and Depression Scale), life satisfaction, and health satisfaction (Questionnaire for Life Satisfaction) were assessed. Patients who regularly practiced yoga (n=186) had a better general health status (P=0.012), a higher physical functioning (P=0.001), and physical component score (P=0.029) on the SF-36 than those who did not (n=186). No group differences were found for the mental scales of the SF-36, anxiety, depression, life satisfaction, or health satisfaction. In conclusion, practicing yoga under naturalistic conditions seems to be associated with increased physical health but not mental health in chronically diseased patients. © 2013 Holger Cramer et al.

Objectives: The assessment of clinically meaningful differences in patients' self-reported outcomes has become increasingly important when interpreting the results of clinical studies. Although these assessments have become quite common there are hardly any data for nonspecific neck pain, especially in the context of complementary and alternative medicine. The aim of this analysis is the determination of minimal clinically important differences (MCID) and substantial clinical benefits (SCB) in patients with chronic nonspecific neck pain after cupping treatment. Methods: The data set comprised a total of 200 patients with chronic nonspecific neck pain participating in clinical trials on cupping therapy. The MCID and SCB for pain intensity (VAS), neck disability index (NDI) and the subscale bodily pain (SF-36-BP) as well as physical component summary (SF-36-PCS) of the SF-36 were determined using receiver operating characteristic (ROC) curve analysis with an adapted assessment of change in health status (SF-36), i.e. a 5-point Likert scale ranging from "much better" to "much worse", as anchor. MCID derived from the ROC was the score to distinguish "somewhat better" from "about the same", and the SCB was the score to distinguish "much better" from "somewhat better". Results: The calculated MCIDs were: -8. mm (-21%) for VAS, -3 points (-10.2%) for NDI, +10 points (+20.5%) for SF-36-BP and +2.6 points (+7.7%) for SF-36-PCS. The SCBs were: -26.5. mm (-66.8%) for VAS, -8.4 points (-29%) for NDI, +15.5 points (+43.1%) for SF-36-BP and +5.1 points (+12.9%) for SF-36-PCS. Accuracy of the estimations was good for MCID in general and for SCB regarding VAS and NDI. Conclusions: The results support the assumption that patients' perceptions of treatment benefits measured by VAS in these trials might be comparable to others in conventional therapies. For NDI and SF-36-PCS the estimated differences were smaller than in previous reports indicating that context factors such as patient

Background: Several trials have shown that cupping might be an effective treatment for chronic nonspecific neck pain, but little is known about the long-term effectiveness. This study aimed to investigate long-term effects of a short series of cupping; therefore additional follow-up measurements were conducted 2 years after completion of 3 studies. Patients and Methods: Participants from 3 randomized waitlist controlled trials on cupping for chronic nonspecific neck pain were followed 2 years after treatment. Outcome measures included neck pain intensity (100 mm Visual Analog Scale; VAS), functional disability (Neck Disability Index, NDI), and health-related quality of life (Short Form 36 Health Survey Questionnaire; SF-36). Results: 133 of 150 patients had received cupping treatment and were contacted; 82 of them (61.7%) returned the follow-up questionnaires. No effect was found for neck pain intensity, but for physical function ( NDI: -3.15; 95% CI: -5.89; -0.41; p = 0.025) and quality of life ( physical component summary: 2.97; 95% CI: 0.97; 4.97; p = 0.004; bodily pain: 14.53; 95 % CI: 9.67; 19.39; p < 0.001). Mean duration of cupping effect was 8.9 ± 8.7 months with 16 patients reporting that neck pain had not yet reached the level before cupping. The majority of the patients did not continue cupping therapy, mostly due to lack of providers, costs or loss of interest. Conclusions: A series of cupping treatments did not influence neck pain intensity on the longer term, however significant increases were found for physical function and quality of life in patients with chronic nonspecific neck pain. Due to the considerable drop-out rate conclusions are limited. There is evidence suggesting that cupping treatment might have sustainable effects in some patients. Further randomized controlled trials with long-term follow-up are urgently needed for conclusive judgment of long-term effectiveness. © 2013 S. Karger GmbH, Freiburg.

Background: Yoga seems to be an effective means to cope with a variety of internal medicine conditions. While characteristics of yoga users have been investigated in the general population, little is known about predictors of yoga use and barriers to yoga use in internal medicine patients. The aim of this cross-sectional analysis was to identify sociodemographic, clinical, and psychological predictors of yoga use among internal medicine patients.Methods: A cross-sectional analysis was conducted among all patients being referred to a Department of Internal and Integrative Medicine during a 3-year period. It was assessed whether patients had ever used yoga for their primary medical complaint, the perceived benefit, and the perceived harm of yoga practice. Potential predictors of yoga use including sociodemographic characteristics, health behavior, internal medicine diagnosis, general health status, mental health, satisfaction with health, and health locus of control were assessed; and associations with yoga use were tested using multiple logistic regression analysis. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for significant predictors.Results: Of 2486 participants, 303 (12.19%) reported having used yoga for their primary medical complaint. Of those, 184 (60.73%) reported benefits and 12 (3.96%) reported harms due to yoga practice. Compared to yoga non-users, yoga users were more likely to be 50-64 years old (OR = 1.45; 95%CI = 1.05-2.01; P = 0.025); female (OR = 2.45; 95%CI = 1.45-4.02; P < 0.001); and college graduates (OR = 1.61; 95%CI = 1.14-2.27; P = 0.007); and less likely to currently smoke (OR = 0.61; 95%CI = 0.39-0.96; P = 0.031). Manifest anxiety (OR = 1.47; 95%CI = 1.06-2.04; P = 0.020); and high internal health locus of control (OR = 1.92; 95%CI = 1.38-2.67; P < 0.001) were positively associated with yoga use, while high external-fatalistic health locus of control (OR = 0.66; 95%CI = 0.47-0.92; P = 0.014) was negatively associated

Objectives. The fibromyalgia syndrome (FMS) is a chronic condition with only few evidence-based complementary and alternative therapies available. This paper presents a systematic review and meta-analysis of the effectiveness of Qigong for fibromyalgia syndrome. Methods. The PubMed/MEDLINE, Cochrane Library, Embase, PsycINFO, and Cambase databases were screened in December 2012 to identify randomized controlled trials comparing Qigong to control interventions. Major outcome measures were pain and quality of life; and secondary outcomes included sleep quality, fatigue, depression, and safety. Standardized mean differences (SMD) and 95% confidence intervals were calculated. Results. Seven trials were located with a total of 395 FMS patients. Analyses revealed low quality evidence for short-term improvement of pain, quality of life, and sleep quality and very low quality evidence for improvement of fatigue after Qigong for FMS, when compared to usual care. No evidence was found for superiority of Qigong compared to active treatments. No serious adverse events were reported. Discussion. This systematic review found that Qigong may be a useful approach for FMS patients. According to the quality of evidence, only a weak recommendation for Qigong can be made at this point. Further high quality RCTs are required for the conclusive judgment of its long-term effects. © 2013 Romy Lauche et al.

Objectives: To assess sociodemographic, clinical, and psychological characteristics of patients with internal diseases who use relaxation techniques as a coping strategy. Design: Cross-sectional analysis among patients with internal diseases. Setting: Department of Internal and Integrative Medicine at an academic teaching hospital in Germany. Main outcome measures: Prior use of relaxation techniques (e.g. meditation, autogenic training), perceived benefit, and perceived harm. Potential predictors of relaxation techniques use (sociodemographic characteristics, health behavior, internal medicine diagnosis, general health status, mental health, satisfaction, and health locus of control) were tested using multiple logistic regression analysis. Results: Of 2486 participants, 1075 (43.2%) reported to have used relaxation techniques, 648 (60.3%) reported benefits, and 11 (1.0%) reported harms. Use of relaxation techniques was independently associated with female gender (Odds ratio [OR] = 1.43; 95% confidence interval [CI] = 1.08-1.89), higher education (OR = 1.32; 95%CI = 1.03-1.71), fibromyalgia (OR = 1.78; 95%CI = 1.22-2.61), and internal health locus of control (OR = 1.27; 95%CI = 1.01-1.60). Use of relaxation techniques was negatively associated with age below 30 (OR = 0.32; 95%CI = 0.20-0.52) or above 64 (OR = 0.65; 95%CI = 0.49-0.88), full-time employment (OR = 0.75; 95%CI = 0.57-0.98), current smoking (OR = 0.72; 95%CI = 0.54-0.95), osteoarthritis (OR = 0.51; 95%CI = 0.34-0.77), rheumatic arthritis (OR = 0.59; 95%CI = 0.37-0.93), good to excellent health status (OR = 0.70; 95%CI = 0.52-0.96), and high life satisfaction (OR = 0.78; 95%CI = 0.62-0.98). Conclusion: In a German sample of patients with internal diseases, relaxation techniques were used as a coping strategy by about 43%. Users were more likely to be middle-aged, female, well-educated, diagnosed with fibromyalgia, not smoking, not full-time employed, and not to have a good health status or high life satisf

Introduction: Integrative medicine inpatient treatment can improve health-related quality of life and mental health in chronically ill patients. This study aimed to explore the potential effect of a 14-day integrative inpatient treatment on chronically ill patients' self-management skills and resources; also focusing on gender specific effects. Materials and methods: A longitudinal prospective cohort study without a control group was conducted at the Department for Complementary and Integrative Medicine. The intervention consisted of individualized conventional and complementary medical treatments; the latter including mind/body techniques. The main outcomes were patients' self-management skills and resources according to the FERUS-questionnaire which measures motivation-to-change, coping, self-observation, self-efficacy, self-verbalization, hope and social support. FERUS data were compared before and after 14 days of hospital inpatient treatment, using repeated measurement ANOVA, with time as within-subject and gender as well as the amount of received mind/body interventions as between-subject factors. Results: Data from 73 patients between September and October 2007 (55 female, 51.5. ±. 13.5 years) were available. Statistical analyses showed significant overall increases in patients' self-management skills on the coping, self-observation, self-verbalization and social support FERUS sub-scales (. p<. 0.05). Significant interactions were also found for the subscales self-efficacy, hope and their FERUS total scores; with increases in these scores for women only (. p<. 0.05). No effects were found for the numbers of mind/body therapies. Conclusion: Participants' self-management skills significantly increased after a resource-oriented approach to treating chronic disease. These results suggest that further research into the use of integrative treatment approaches for patients with chronic illness is warranted. © 2012 Elsevier GmbH.

Objectives. This study aimed to determine patient-related predictors of treatment satisfaction in fibromyalgia syndrome (FMS)-patients. Methods. In a cross-sectional survey, participants with self-reported diagnosis of FMS were recruited by FMS-self help organisations and clinical institutions. The patients answered demographic and medical questionnaires, the Fibromyalgia Survey Questionnaire (FSQ) including the Somatic Severity Score (SSS) and Widespread Pain Index (WPI), the Patient Health Questionnaire (PHQ-4), and rated their treatment satisfaction on an 11-point Likert scale. The impact of patient-related variables (age, gender, partnership, educational level, time since onset of pain, time since FMS-diagnosis, health status since diagnosis, membership in FMS self-help organisations, polysymptomatic distress, anxiety and depression) and types of treatment on treatment satisfaction were tested by a multiple regression analysis. Results. The study sample (n=1651 patients) was composed mainly of middle-aged women with a long disease history, and 83.9% fulfilled the American College of Rheumatology diagnostic criteria of 2010. There was considerate variety regarding treatment satisfaction in FMS-patients, 14.8% reported no, 31.7% low, 40.8% moderate and 12.7% high satisfaction. Higher satisfaction was predicted by longer time since FMS diagnosis (p=0.03), improved health status since FMS-diagnosis (p<0.0001), lower depression score (p=0.005) and higher amount of active therapies (p<0.0001). Other sociodemographic (age, gender etc.) and disease-related variables (polysymptomatic distress intensity) did not influence treatment satisfaction. Conclusion. The results of the study illustrate the influence of patient-related factors on treatment satisfaction. Treating comorbid depression and enabling patients to actively cope with the disease might prove successful in improving treatment satisfaction of FMS-patients. © Clinical and Experimental Rheumatology 2013.

Objectives: This paper aimed to systematically review and meta-analyze the effectiveness of Tai Chi for osteoarthritis of the knee. Methods: MEDLINE, the Cochrane Library, EMBASE, Scopus, PsycInfo and CAMBASE were screened through April 2013. Randomized controlled trials (RCTs) comparing Tai Chi to control conditions were included. Two authors independently assessed risk of bias using the risk of bias tool recommended by the Cochrane Back Review Group. Outcome measures included pain, physical functional, joint stiffness, quality of life, and safety. For each outcome, standardized mean differences and 95% confidence intervals were calculated. Results: 5 RCTs with a total of 252 patients were included. Four studies had a low risk of bias. Analysis showed moderate overall evidence for short-term effectiveness for pain, physical function, and stiffness. Strong evidence was found for short-term improvement of the physical component of quality of life. No long-term effects were observed. Tai Chi therapy was not associated with serious adverse events. Conclusion: This systematic review found moderate evidence for short-term improvement of pain, physical function and stiffness in patients with osteoarthritis of the knee practicing Tai Chi. Assuming that Tai Chi is at least short-term effective and safe it might be preliminarily recommended as an adjuvant treatment for patients with osteoarthritis of the knee. More high quality RCTs are urgently needed to confirm these results. © 2013 Elsevier Ltd.

Introduction. The Department for Internal and Integrative Medicine in Essen utilizes mind/body medical elements in order to empower patients with chronic diseases to better cope with their symptoms and to adopt a healthy lifestyle. This study explored the influence and predictors of a 2-week integrative treatment program on patients' quality of life. Methods. This observational study was conducted with inpatients as part of the quality assurance program. Patients' quality of life, psychological symptoms, and health locus of control were measured on admission and discharge and again 3, 6, and 12 months after discharge. Regression analyses were conducted to determine the factors predicting improved quality of life. Results. Data from 2486 inpatients treated in 2001-2004 were included (80 female, mean age 53.9 ± 14.3 years). Response rates decreased to 50 at 12 months. Small-to-moderate effects were found on patients' quality of life, anxiety, and depression. Patients' internal locus of control significantly increased. Improved quality of life was mainly predicted by lower baseline scores. Conclusion. Results of this study suggest that a 2-week inpatient treatment might sustainably reduce patients' symptoms and increase their quality of life; however, conclusions are only preliminary. More research is needed to enable the effectiveness to be judged conclusively. © 2012 Romy Lauche et al.

Objectives. To systematically review and meta-analyze the effectiveness of yoga for menopausal symptoms. Methods. Medline, Scopus, the Cochrane Library, and PsycINFO were screened through April 2012. Randomized controlled trials (RCTs) were included if they assessed the effect of yoga on major menopausal symptoms, namely, (1) psychological symptoms, (2) somatic symptoms, (3) vasomotor symptoms, and/or (4) urogenital symptoms. For each outcome, standardized mean differences (SMDs) and 95 confidence intervals (CIs) were calculated. Two authors independently assessed risk of bias using the risk of bias tool recommended by the Cochrane Back Review Group. Results. Five RCTs with 582 participants were included in the qualitative review, and 4 RCTs with 545 participants were included in the meta-analysis. There was moderate evidence for short-term effects on psychological symptoms (SMD = - 0.37; 95 CI -0.67 to -0.07; P = 0.02). No evidence was found for total menopausal symptoms, somatic symptoms, vasomotor symptoms, or urogenital symptoms. Yoga was not associated with serious adverse events. Conclusion. This systematic review found moderate evidence for short-term effectiveness of yoga for psychological symptoms in menopausal women. While more rigorous research is needed to underpin these results, yoga can be preliminarily recommended as an additional intervention for women who suffer from psychological complaints associated with menopause. © 2012 Holger Cramer et al.

Introduction: Chronic diseases are one of the biggest challenges for future medicine. Empowering patients to adopt a health promoting lifestyle and to learn effective coping strategies seems essential for successful therapy. Integrative medicine might provide such strategies to promote healthy lifestyle changes by means of Mind/Body therapies. Concept: The Department for Internal and Integrative Medicine at Kliniken Essen-Mitte, academic teaching Hospital of the University Duisburg-Essen, offers an Integrative Day Care Clinic with the focus on lifestyle management as part of standard care. The program utilizes Mind/Body therapies and components from cognitive therapy to increase patient's coping. Case reports: Three cases, attending the Integrative Day Care Clinic, are presented here. Cases reveal that the Integrative Day Care Clinic may be effective for all patients who do contribute to the program and make necessary lifestyle changes. The most frequently reported changes do not concern symptom severity, but acceptance, coping and self-efficacy, especially in stressful situations. Satisfaction with the therapy is high. Conclusion: An Integrative Day Care Clinic group program appears to indicate positive effects for patients with chronic diseases. These results are supported by the results of several randomized controlled trials in patients with chronic diseases. Further superior quality trials and qualitative approaches are necessary to provide reliable results and more insight into the nature of the effects. © 2012 Elsevier GmbH.

Objectives. The objective was to investigate whether a treatment with a needle stimulation pad (NSP) changes perceived pain and/or sensory thresholds in patients with chronic neck (NP) and lower back pain (BP). Methods. 40 patients with chronic NP and 42 patients with chronic BP were equally randomized to either treatment or waiting list control group. The treatment group self-administered a NSP over a period of 14 days. Pain ratings were recorded on numerical rating scales (NRSs). Mechanical detection thresholds (MDTs) and pressure pain thresholds (PPTs) were determined at the site of maximal pain and in the adjacent region, vibration detection thresholds (VDT) were measured at close spinal processes. The Northwick Park Neck Pain Questionnaire (NPQ) and the Oswestry Disability Index (ODI) were utilized for the NP and BP study, respectively. Results. NRS ratings were significantly reduced for the treatment groups compared to the control groups (NP: P =. 021 and BP: P . 001), accompanied by a significant increase of PPT at pain maximum (NP: P =. 032 and BP: P =. 013). There was no effect on VDT and MDT. The NPQ showed also a significant improvement, but not the ODI. Conclusions. The mechanical NSP seems to be an effective treatment method for chronic NP and BP. © 2012 Claudia Hohmann et al.

Introduction. Cupping has been used since antiquity in the treatment of pain conditions. In this pilot study, we investigated the effect of traditional cupping therapy on chronic nonspecific neck pain (CNP) and mechanical sensory thresholds. Methods. Fifty CNP patients were randomly assigned to treatment (TG, n = 25) or waiting list control group (WL, n = 25). TG received a single cupping treatment. Pain at rest (PR), pain related to movement (PM), quality of life (SF-36), Neck Disability Index (NDI), mechanical detection (MDT), vibration detection (MDT), and pressure pain thresholds (PPT) were measured before and three days after a single cupping treatment. Patients also kept a pain and medication diary (PaDi, MeDi) during the study. Results. Baseline characteristics were similar in the two groups. After cupping TG reported significantly less pain (PR: -17.9mm VAS, 95CI -29.2 to -6.6; PM: -19.7, 95CI -32.2 to -7.2; PaDi: -1.5 points on NRS, 95CI -2.5 to -0.4; all P < 0.05) and higher quality of life than WL (SF-36, Physical Functioning: 7.5, 95CI 1.4 to 13.5; Bodily Pain: 14.9, 95CI 4.4 to 25.4; Physical Component Score: 5.0, 95CI 1.4 to 8.5; all P < 0.05). No significant effect was found for NDI, MDT, or VDT, but TG showed significantly higher PPT at pain-areas than WL (in lg(kPa); pain-maximum: 0.088, 95CI 0.029 to 0.148, pain-adjacent: 0.118, 95CI 0.038 to 0.199; both P < 0.01). Conclusion. A single application of traditional cupping might be an effective treatment for improving pain, quality of life, and hyperalgesia in CNP. Copyright © 2012 Romy Lauche et al.

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. © 2012 S. Karger GmbH, Freiburg.

Gua Sha is a traditional East Asian healing technique where the body surface is "press-stroked" with a smooth-edged instrument to raise therapeutic petechiae that last 25 days. The technique is traditionally used in the treatment of both acute and chronic neck and back pain. This study aimed to measure the effects of Gua Sha therapy on the pain ratings and pressure pain thresholds of patients with chronic neck pain (CNP) and chronic low back pain (CLBP). A total of 40 patients with either CNP or CLBP (mean age 49.23 ± 10.96 years) were randomized to either a treatment group (TG) or a waiting list control group (WLC). At baseline assessment (T1), all patients rated their pain on a 10 cm visual analog scale (VAS). Patients' pressure pain thresholds (PPT) at a site of maximal pain (pain-maximum) and an adjacent (pain-adjacent) site were also established. The treatment group then received a single Gua Sha treatment. Post-intervention measurements were taken for both groups at T2, seven days after baseline assessment (T1), using the same VAS and PPT measurements in precisely the same locations as at T1. Final analysis were conducted with 21 patients with CNP and 18 patients with CLBP. The study groups were equally distributed with regard to randomization. Patients in both the CNP and the CLBP treatment groups reported pain reduction (p < 0.05) and improved health status from their one Gua Sha treatment, as compared to the waiting list group. Pain sensitivity improved in the TG in CNP, but not in CLBP patients, possibly due to higher pressure sensitivity in the neck area. No adverse events were reported. These results suggest that Gua Sha may be an effective treatment for patients with chronic neck and low back pain. Further study of Gua Sha is warranted. © 2012 World Scientific Publishing Company & Institute for Advanced Research in Asian Science and Medicine.