רפואה משלימה ואינטגרטיבית לחולים אונקולוגיים
רפואה משלימה לאנשים שאובחנו כחולים אונקולוגיים בהווה או בעבר ורפואה משלימה לתחזוקה לאחר סיום הטיפול.
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הרפואה המשלימה והאינטגרטיבית עשויה לתרום רבות לאיכות החיים של מטופלים אונקולוגיים החל משלב גילוי המחלה, דרך אבחנה, מהלך הטיפול והתקופה שלאחר הטיפולים.
מחקרים וניסיון קליני מראים כי רפואה משלימה עשויה לסייע באופן משמעותי למגוון תופעות לואי ייחודיות לטיפולים הקונבנציונאליים במחלת הסרטן.
טיפולים בדיקור סיני, שיאצו טווי נא, צמחי מרפא יכולים לסייע רבות בחיזוק מערכות הגוף השונות, ובהתפתחות לחץ מתח וחרדה.
עייפות וחולשה:
הטיפולים השונים בסרטן מלווים בעייפות מצטברת ובחולשה רבה. חולשה של מערכות שונות עשויה להוביל לתסמינים שונים כגון: ספיגה נמוכה של חומרים חיוניים במערכת העיכול, פצעים בריריות שונות – מוקוזיטיס, ספירות דם נמוכות בשל פגיעה במח העצם, לאות והרגשת חוסר חיוניות.
טיפול בצמחי מרפא ותוספי תזונה, כמו גם דיקור ושיאצו באופן רציף לאורך תקופת הטיפולים ולאחריהם, יחד עם התאמות תזונתיות, תורמים לחיזוק משק האנרגיה ולהפחתת העייפות וחולשה.
כאב ונוירופטיות:
מערכת העצבים של המטופלים בסרטן סופגת רעילות רבה ומגיבה באופנים שונים. תופעות כמו כאב, ירידה בתחושה, תחושת נימול, תחושת שריפה וצריבה. הכאב יופיע לרוב בגפיים אך לעיתים גם באיברי הגוף הפנימיים. כאב יכול לנבוע מלחץ המופעל על החוליות ועל המפרקים השונים. טיפול בדיקור שיאצו ותוספי תזונה שונים באופן רציף לאורך תקופת הטיפולים ולאחריהם, תורמים להקלה על כאב ועל נוירופטיות.
מתח ועומס רגשי:
מחלת הסרטן מלווה בעומס רגשי, עשוי להתבטא בחרדה, עצב, נטייה למצב רוח ירוד, פחדים ואשמה. מתח עלול להוביל לאיכות חיים ירודה, לבעיות שינה, בעיות עיכול וקושי בתפקודים שונים בבית או בעבודה. טיפול בדיקור, שיאצו, צמחי מרפא באופן רציף לאורך תקופת הטיפולים ולאחריהם, תורמים להקלה ברמות המתח והעומס הרגשי ולכן עשויים לשפר את איכות החיים.
תסמינים במערכת העיכול:
תסמינים כמו כיבים בפה, יובש בפה, בחילה, הקאה, שלשול, עצירות, כאבי בטן, חוסר תיאבון וירידה במשקל יכולים להיות חלק ממחלה, או תופעות לוואי של טיפולים. דיקור סיני, צמחי מרפא ותוספי תזונה, טיפולי מגע וטיפולי רפואה משלימה אחרים, עשויים להועיל בהתמודדות עם תסמינים אלו.
מה עושים כדי להתחיל טיפול?
הטיפול בפגישת יעוץ. הפגישה כוללת תשאול, סקירת רקע רפואי, בדיקה רפואית במקרה הצורך והתאמת תוכנית טיפול אישית ברפואה משלימה.
הרפואה המשלימה והאינטגרטיבית עשויה לתרום רבות לאיכות החיים של מטופלים אונקולוגיים החל משלב גילוי המחלה, דרך אבחנה, מהלך הטיפול והתקופה שלאחר הטיפולים.
מחקרים וניסיון קליני מראים כי רפואה משלימה עשויה לסייע באופן משמעותי למגוון תופעות לואי ייחודיות לטיפולים הקונבנציונאליים במחלת הסרטן.
מחקרים בתחום רפואה הסינית
הרפואה המשלימה והאינטגרטיבית מבוססת על ניסיון קליני ומחקר מקצועי בארץ ובעולם.
להלן מחקרים ועבודות שפורסמו בשנים האחרונות ומוכיחים יעילות מובהקת הקיימת לטיפולי רפואה משלימה בתחומים השונים: כאב גב, צוואר | כאב מפרקים | פיברומיאלגיה | מעי רגיש | אלרגיות | עור | מתח וחרדה | סרטן | ילדים- קשב וריכוז, אסטמה | נשים – פריון גיל מעבר
כאב
נמצא יתרון מובהק לטיפולי דיקור במצבים של כאב כרוני
קישור למחקר: https://pubmed.ncbi.nlm.nih.gov/22965186
שם המחקר:
Arch Intern Med. 2012 Oct 22;172(19):1444-53. doi: 10.1001/archinternmed.2012.3654.
Acupuncture for chronic pain: individual patient data meta-analysis.
Vickers AJ1, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, Sherman KJ, Witt CM, Linde K; Acupuncture Trialists' Collaboration.
תקציר המחקר:
Abstract
BACKGROUND:
Although acupuncture is widely used for chronic pain, there remains considerable controversy as to its value. We aimed to determine the effect size of acupuncture for 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain.
METHODS:
We conducted a systematic review to identify randomized controlled trials (RCTs) of acupuncture for chronic pain in which allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible RCTs, with a total of 17 922 patients analyzed.
RESULTS:
In the primary analysis, including all eligible RCTs, acupuncture was superior to both sham and no-acupuncture control for each pain condition (P < .001 for all comparisons). After exclusion of an outlying set of RCTs that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI, 0.13-0.33), 0.16 (95% CI, 0.07-0.25), and 0.15 (95% CI, 0.07-0.24) SDs lower than sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively; the effect sizes in comparison to no-acupuncture controls were 0.55 (95% CI, 0.51-0.58), 0.57 (95% CI, 0.50-0.64), and 0.42 (95% CI, 0.37-0.46) SDs. These results were robust to a variety of sensitivity analyses, including those related to publication bias.
CONCLUSIONS:
Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.
ראומטולוגיה
GOUT - נימצא יתרון משמעותי לטיפולי דיקור
http://www.ncbi.nlm.nih.gov/pubmed/?term=Acupuncture+for+gouty+arthritis+a+concise
שם המחקר:
Rheumatology (Oxford). 2013 Jul;52(7):1225-32. doi: 10.1093/rheumatology/ket013. Epub 2013 Feb 18.
Acupuncture for gouty arthritis: a concise report of a systematic and meta-analysis approach.
Lee WB1, Woo SH, Min BI, Cho SH.
תקציר המחקר:
Abstract
OBJECTIVE:
To assess the effectiveness of acupuncture as complementary therapy for gouty arthritis from randomized controlled trials (RCTs).
METHODS:
Five electronic databases, including English and Chinese, were systematically searched until August 2012. All RCTs involving acupuncture in combination with conventional therapy for gouty arthritis were included.
RESULTS:
Ten RCTs involving 852 gouty arthritis patients were systematically reviewed. Among them six studies of 512 patients reported a significant decrease in uric acid in the treatment group compared with a control group, while two studies of 120 patients reported no significant decrease in uric acid in the treatment group compared with the control group. The remaining four studies of 380 patients reported a significant decrease in visual analogue scale score in the treatment group.
CONCLUSION:
The results of the studies included here suggest that acupuncture is efficacious as complementary therapy for gouty arthritis patients. More research and well-designed, rigorous and large clinical trials are necessary to address these issues.
ריאות
COPD - שיפור מובהק בקוצר נשימה במאמץ
קישור למחקר: http://www.ncbi.nlm.nih.gov/pubmed/22905352
שם המחקר:
Arch Intern Med. 2012 Jun 11;172(11):878-86.
A randomized, placebo-controlled trial of acupuncture in patients with chronic obstructive pulmonary disease (COPD): the COPD-acupuncture trial (CAT).
Suzuki M1, Muro S, Ando Y, Omori T, Shiota T, Endo K, Sato S, Aihara K, Matsumoto M, Suzuki S, Itotani R, Ishitoko M, Hara Y, Takemura M, Ueda T, Kagioka H, Hirabayashi M, Fukui M, Mishima M.
תקציר המחקר:
Abstract
BACKGROUND:
Dyspnea on exertion (DOE) is a major symptom of chronic obstructive pulmonary disease (COPD) and is difficult to control. This study was performed to determine whether acupuncture is superior to placebo needling in improving DOE in patients with COPD who are receiving standard medication.
METHODS:
Sixty-eight of 111 patients from the Kansai region of Japan who were diagnosed as having COPD and were receiving standard medication participated in a randomized, parallel-group, placebo-controlled trial (July 1, 2006, through March 31, 2009) in which the patients, evaluators, and statistician were unaware of the random allocation. Participants were randomly assigned to traditional acupuncture (real acupuncture group, n=34) or placebo needling (placebo acupuncture group, n=34). Both groups received real or placebo needling at the same acupoints once a week for 12 weeks. The primary end point was the modified Borg scale score evaluated immediately after the 6-minute walk test. Measurements were obtained at baseline and after 12 weeks of treatment.
RESULT:
After 12 weeks, the Borg scale score after the 6-minute walk test was significantly better in the real acupuncture group compared with the placebo acupuncture group (mean [SD] difference from baseline by analysis of covariance, -3.6 [1.9] vs 0.4 [1.2]; mean difference between groups by analysis of covariance, -3.58; 95% CI, -4.27 to -2.90). Patients with COPD who received real acupuncture also experienced improvement in the 6-minute walk distance during exercise, indicating better exercise tolerance and reduced DOE.
CONCLUSION:
This study clearly demonstrates that acupuncture is a useful adjunctive therapy in reducing DOE in patients with COPD.
אונקולוגיה
שילוב של צמחי מרפא סיניים עם כימותרפיה שיפר באופן מובהק הישרדות של שנה אח בחולי סרטן ריאות (מסוג NSCLC).
קישור למחקר:
שם המחקר:
PLoS One. 2013;8(2):e57604. doi: 10.1371/journal.pone.0057604. Epub 2013 Feb 28.
The efficacy of Chinese herbal medicine as an adjunctive therapy for advanced non-small cell lung cancer: a systematic review and meta-analysis.
Li SG1, Chen HY, Ou-Yang CS, Wang XX, Yang ZJ, Tong Y, Cho WC.
תקציר
Abstract
Many published studies reflect the growing application of complementary and alternative medicine, particularly Chinese herbal medicine (CHM) use in combination with conventional cancer therapy for advanced non-small cell lung cancer (NSCLC), but its efficacy remains largely unexplored. The purpose of this study is to evaluate the efficacy of CHM combined with conventional chemotherapy (CT) in the treatment of advanced NSCLC. Publications in 11 electronic databases were extensively searched, and 24 trials were included for analysis. A sum of 2,109 patients was enrolled in these studies, at which 1,064 patients participated in CT combined CHM and 1,039 in CT (six patients dropped out and were not reported the group enrolled). Compared to using CT alone, CHM combined with CT significantly increase one-year survival rate (RR = 1.36, 95% CI = 1.15-1.60, p = 0.0003). Besides, the combined therapy significantly increased immediate tumor response (RR = 1.36, 95% CI = 1.19-1.56, p<1.0E-5) and improved Karnofsky performance score (KPS) (RR = 2.90, 95% CI = 1.62-5.18, p = 0.0003). Combined therapy remarkably reduced the nausea and vomiting at toxicity grade of III-IV (RR = 0.24, 95% CI = 0.12-0.50, p = 0.0001) and prevented the decline of hemoglobin and platelet in patients under CT at toxicity grade of I-IV (RR = 0.64, 95% CI = 0.51-0.80, p<0.0001). Moreover, the herbs that are frequently used in NSCLC patients were identified. This systematic review suggests that CHM as an adjuvant therapy can reduce CT toxicity, prolong survival rate, enhance immediate tumor response, and improve KPS in advanced NSCLC patients. However, due to the lack of large-scale randomized clinical trials in the included studies, further larger scale trials are needed.
מעי רגיש
רפואה סינית יעילה בטיפול במעי רגיש
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342906
World J Gastroenterol. 2015 Feb 28; 21(8): 2315–2322.
Published online 2015 Feb 28. doi: 10.3748/wjg. v21.i8.2315
PMCID: PMC4342906
Treatment of irritable bowel syndrome in China: A review
World J Gastroenterol. 2015 Feb 28;21(8):2315-22. doi: 10.3748/wjg. v21.i8.2315.
Abstract
Irritable bowel syndrome (IBS) is a common, chronic, functional gastrointestinal disorder with a high incidence rate in the general population, and it is common among the Chinese population. The pathophysiology, etiology and pathogenesis of IBS are poorly understood, with no evidence of inflammatory, anatomic, metabolic, or neoplastic factors to explain the symptoms. Treatment approaches are mainly focused on symptom management to maintain everyday functioning and to improve quality of life for patients with IBS. However, prescribed medications often result in significant side effects, and many IBS sufferers (particularly Chinese) do not improve. Instead of taking a variety of conventional medications, many have turned to taking traditional Chinese medicine or integrated Chinese and Western medicine for remedy. A number of clinical trials have shown that Chinese herbal, acupuncture or integrative therapies presented improved treatment outcomes and reduced side effects in IBS patients. The purpose of this review article is to examine the treatment approaches of IBS that have been published in recent years, especially in China, to assess the possible differences in treating IBS between China and other countries. This would provide some useful information of unique treatment approach in clinical practice for physicians in the management of IBS in China, thus offering more treatment options for IBS patients with potentially better treatment outcomes while reducing the medical cost burden.
אלרגיות
נזלת אלרגית-שיפור מובהק בטיפול בדיקור סיני
http://www.ncbi.nlm.nih.gov/pubmed/23420231
Ann Intern Med. 2013 Feb 19;158(4):225-34. doi: 10.7326/0003-4819-158-4-201302190-00002.
Acupuncture in patients with seasonal allergic rhinitis: a randomized trial.
Brinkhaus B1, Ortiz M, Witt CM, Roll S, Linde K, Pfab F, Niggemann B, Hummelsberger J, Treszl A, Ring J, Zuberbier T, Wegscheider K, Willich SN.
Abstract
Chinese translation
BACKGROUND:
Acupuncture is frequently used to treat seasonal allergic rhinitis (SAR) despite limited scientific evidence.
OBJECTIVE:
To evaluate the effects of acupuncture in patients with SAR.
DESIGN:
Randomized, controlled multicenter trial. (ClinicalTrials.gov: NCT00610584)
SETTING:
46 specialized physicians in 6 hospital clinics and 32 private outpatient clinics.
PATIENTS:
422 persons with SAR and IgE sensitization to birch and grass pollen.
INTERVENTION:
Acupuncture plus rescue medication (RM) (cetirizine) (n = 212), sham acupuncture plus RM (n = 102), or RM alone (n = 108). Twelve treatments were provided over 8 weeks in the first year.
MEASUREMENTS:
Changes in the Rhinitis Quality of Life Questionnaire (RQLQ) overall score and the RM score (RMS) from baseline to weeks 7 and 8 and week 16 in the first year and week 8 in the second year after randomization, with predefined noninferiority margins of -0.5 point (RQLQ) and -1.5 points (RMS).
RESULTS:
Compared with sham acupuncture and with RM, acupuncture was associated with improvement in RQLQ score (sham vs. acupuncture mean difference, 0.5 point [97.5% CI, 0.2 to 0.8 point; P < 0.001]; RM vs. acupuncture mean difference, 0.7 point [97.5% CI, 0.4 to 1.0 point; P < 0.001]) and RMS (sham vs. acupuncture mean difference, 1.1 points [97.5% CI, 0.4 to 1.9 points; P < 0.001]; RM vs. acupuncture mean difference, 1.5 points [97.5% CI, 0.8 to 2.2 points; P < 0.001]). There were no differences after 16 weeks in the first year. After the 8-week follow-up phase in the second year, small improvements favoring real acupuncture over the sham procedure were noted (RQLQ mean difference, 0.3 point [95% CI, 0.03 to 0.6 point; P = 0.032]; RMS mean difference, 1.0 point [95% CI, 0.2 to 1.9 points; P = 0.018]).
LIMITATION:
The study was not powered to detect rare adverse events, and the RQLQ and RMS values were low at baseline.
CONCLUSION:
Acupuncture led to statistically significant improvements in disease-specific quality of life and antihistamine use measures after 8 weeks of treatment compared with sham acupuncture and with RM alone, but the improvements may not be clinically significant.
פריון וגניקולוגיה
דיקור שיפר תוצאות כשניתן במקביל לטיפולי הפריה חוץ גופית (IVF)
http://www.ncbi.nlm.nih.gov/pubmed/21376483
Maturitas. 2011 Apr;68(4):346-54. doi: 10.1016/j.maturitas.2011.02.001. Epub 2011 Mar 3.
The use of acupuncture for managing gynaecologic conditions: An overview of systematic reviews.
Kang HS1, Jeong D, Kim DI, Lee MS.
Abstract
Acupuncture is increasingly popular for the treatment of many medical complaints, including gynaecologic conditions. The aim of this study was to summarise the evidence from systematic reviews (SRs) and meta-analyses assessing the efficacy of acupuncture in treating common gynaecologic conditions. Six electronic databases, including two major English-language databases (PubMed and the Cochrane Library) and four Korean databases, were systematically searched for SRs and meta-analyses concerned with acupuncture and common gynaecologic diseases. The following English search terms were used: (gynaecologic disease in MeSH terms) AND (acupuncture or acup*) AND (systematic review OR meta-analysis). In addition, three Korean traditional medicine journals (The Journal of the Korean Acupuncture and Moxibustion Society, The Journal of Korean Oriental Medicine and The Journal of Oriental Obstetrics and Gynaecology) were searched. The quality of the included studies was assessed using the Overview Quality Assessment Questionnaire. Of the 55 potentially relevant studies that were found, 16 SRs were included in this report. These reviews evaluated the efficacy of acupuncture for treating the side effects of breast cancer chemotherapy, menstrual disturbances, menopausal symptoms, female infertility, uterine fibroids and polycystic ovary syndrome. Acupuncture was clearly beneficial in the management of chemotherapy-induced nausea and vomiting. In addition, current evidence suggests that acupuncture administered close to embryo transfer during in vitro fertilisation treatment improves the rates of pregnancy and live birth. In conclusion, there is no convincing evidence of the efficacy of acupuncture except for specific conditions, which include acupuncture administered with embryo transfer to improve the outcome of in vitro fertilisation and acupuncture for the management of chemotherapy-induced nausea and vomiting. More well-designed trials using rigorous methodology are required to evaluate the efficacy of acupuncture in treating gynaecologic conditions.
רפואה סינית מקלה על סימנים קלימקטריים במנופאוזה
http://www.ncbi.nlm.nih.gov/pubmed/25017715
Climacteric. 2015 Apr;18(2):142-56. doi: 10.3109/13697137.2014.937687. Epub 2014 Oct 18.
Effects of traditional Chinese medicine on symptom clusters during the menopausal transition.
Taylor-Swanson L1, Thomas A, Ismail R, Schnall JG, Cray L, Mitchell ES, Woods NF.
Abstract
AIMS:
To review controlled clinical trials of traditional Chinese medicine (TCM) therapies for hot flushes and at least one other co-occurring symptom among sleep, cognitive function, mood, and pain.
METHODS:
An experienced reference librarian performed an extensive search of PubMed/Medline, CINAHL Plus, PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, AMED, and Alt-Health Watch for randomized, controlled trials reported in English between 2004 and July 2011. Of 1193 abstracts identified, 58 trials examined effectiveness of therapies for hot flushes and at least one additional co-occurring symptom.
RESULTS:
Eleven trials (13 publications) examined TCM therapeutics of acupuncture, Chinese herbal medicine (CHM) or moxibustion. Acupuncture trials (eight) yielded mixed results; five trials significantly reduced hot flushes. Of those five trials, one also showed benefit for sleep and pain and two trials found benefit for mood symptoms. Of three CHM trials, three trials had significant findings: one for hot flushes and mood, one for hot flushes and pain, and one for hot flushes, sleep, mood symptoms and pain. Moxibustion and counseling (one trial) significantly reduced hot flushes, mood symptoms and pain. None of the trials reported any serious adverse events.
CONCLUSIONS:
TCM therapeutics of acupuncture, CHM and moxibustion show promising results for the treatment of mood and pain symptoms co-occurring with hot flushes. Although the controlled clinical trials of TCM therapeutics reviewed here measured multiple symptom outcomes, few report treatment effects in ways that allow clinicians to consider symptom clusters when prescribing therapies. Future studies need to measure and report results for individual symptoms or group like symptoms together into subscales. Controlled clinical trials with larger numbers of participants are essential to allow evaluation of these therapies on hot flushes and multiple co-occurring symptoms.
רפואה סינית מסורתית בטיפול בהפרעת קשב וריכוז
http://www.ncbi.nlm.nih.gov/pubmed/25220091
Child Adolesc Psychiatr Clin N Am. 2014 Oct;23(4):853-81. doi: 10.1016/j.chc.2014.05.011.
Traditional Chinese medicine in the treatment of ADHD: a review.