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PubMed2006

Implementation of neuroreflexotherapy for subacute and chronic neck and back pain within the Spanish public health system: audit results after one year.

Controlled randomized trials have demonstrated the efficacy, safety, effectiveness, and cost-effectiveness of neuroreflexotherapy (NRT) for the management of non-specific back pain. In this audit study, we describe the implementation of NRT into the routine practice of primary care within the Spanish public health service of the Balearic Islands and the results obtained after one year (2004). A referral protocol was made available to all general practitioners (GPs) who could refer eligible patients to specialized units in performing NRT interventions. A total of 1209 patients (median age 52 years, 68% women) were referred to NRT by 412 GPs (80% of all GPs), with a mean (standard deviation (S.D.)) referral rate of 1.57 (0.84) patients per month/10,000 persons affiliated to each practice, and an appropriate referral rate of 95.5%. Pain decreased from a median score (visual analog scale) of 8 at baseline to 1 at discharge, referred pain from 7 to 1, and disability (Roland-Morris Questionnaire) from 12 to 1. NRT was refused by 2.7% of patients. Adverse effects related to the procedure were only a skin reaction in 3.3% of patients. We conclude that it is feasible to implement NRT in the public health service complying with methods and application conditions used in previous randomized controlled trials (RCTs). In such conditions, implementation of this technology obtained positive audit results at one year.

Aged↗
PubMed1998

Alternative health care: its use by individuals with physical disabilities.

OBJECTIVE: This research investigated the use of alternative therapies by individuals with physical disabilities. DESIGN: A telephone survey of a cross-sectional convenience sample of people with disabilities. SETTING: An urban, outpatient rehabilitation facility specializing in vocational services. PARTICIPANTS: A convenience sample of 401 working-age individuals. MAIN OUTCOME MEASURE(S): Self-reported use of alternative therapy. RESULTS: More of this sample of individuals with physical disabilities than a randomized, national sample of the general population used alternative therapies (57.1% vs 34%) and saw providers of those therapies (22% vs 10%). Among individuals in the current sample, significant positive relationships between use of alternative therapies and education and income levels were discovered. The use of alternative therapies by this sample, however, was not associated with racial identity, gender, or age. Compared with the general population, this study's respondents reported a higher proportion of chronic pain (14% vs 8%) and depression (14% vs 8%), and a lower proportion of severe headache (9.2% vs 13%). Alternative therapies were chosen more often than conventional therapies by those with physical disabilities for pain (51.8% vs 33.9%), depression (33.9% vs 25%), anxiety (42.1% vs 13.1%), insomnia (32.3% vs 16.1%), and headaches (51.4% vs 18.9%). CONCLUSION: Physically disabled individuals are more likely to use alternative therapies than the general population and to see providers for them, have their use recommended by their physicians, and be reimbursed by their health insurance for them. A high prevalence of dysphoria is found among those with disabilities, for which a combination of alternative and conventional therapies is often used.

Adolescent↗
PubMedDate not supplied

[Implementation of neuroreflexotherapy in the treatment of back pain. Results of a pilot trial].

BACKGROUND: Previous clinical trials have demonstrated the efficacy, safety, effectiveness and efficiency of neuroreflexotherapy (NRT) in the treatment of subacute and chronic non-specific low back pain. The goal of this study was to describe the implementation of this method into the Spanish National Health System, to assess the viability of the referral protocol, and to obtain the data required for planning the widespread use of this technology. METHOD: A referral protocol was established and explained in a single clinical session in 18 health centers in Majorca (Spain). During this session, handouts of the referral protocol and a telephone number for questions were also given. After the session, the centers' physicians were authorized to refer their patients to a unit certified for NRT. Demand for this therapy, the applicability of the referral protocol, the appropriateness of referrals, and patient and physician satisfaction were quantified over a four-month period. Data were also collected on patients' clinical outcomes and on adverse effects of the treatment. RESULTS: Of the 208 physicians, 43 referred 97 patients. The mean rate of referral per 10,000 persons affiliated with each health center was 1.07 patients per month. The rate of appropriate referral was 91.8%, with no physician having to call for assistance. Most of the referred patients had chronic, intense pain, with a poor prognosis and considerable disability. None of the patients refused NRT. There were no complaints, or serious adverse effects. The degree of satisfaction was high, and 98% of patients and 87% of physicians would recommend a relative referral to. In addition, 89% of physicians believed they should be allowed to continue referring their patients. The patients' clinical outcomes were favorable and consistent with those observed in previous clinical trials. CONCLUSIONS: The method described allows NRT to be included in routine clinical practice within the Spanish National Health System under the conditions in which it was evaluated in previous randomized controlled trials. The referral protocol that was used generates a high rate of appropriate referrals, a high degree of satisfaction among patients and physicians, and clinical results that are consistent with the effectiveness and safety previously demonstrated for this technology.

Adult↗
PubMed2003

Acupuncture, electrostimulation, and reflex therapy in dermatology.

Acupuncture is an old therapeutic method that includes both needle and nonneedle acupuncture. Nonneedle acupuncture includes moxibustion, cupping, and acupressure. In the field of dermatology, acupuncture has been reported to be beneficial for the treatment of acne, postherpetic neuralgia, psoriasis, atopic dermatitis, and urticaria. In acupuncture treatment of dermal diseases, both the filiform needle and the cutaneous needle are powerful tools. In the treatment of refractory dermal diseases, cutaneous needle acupuncture is usually followed by cupping to intensify the therapeutic effect. In cases where needle acupuncture is not possible, acupuncture-like transcutaneous electrical nerve stimulation (TENS) is a good alternative. In addition, reflex therapy based on foot reflex areas may also be an alternative. A lack of controlled studies is the main drawback for the methods mentioned above. However, the experiences from experts in this field may offer us new ideas to resolve refractory disorders in dermatology.

Acupuncture Therapy↗
PubMed2003

Alternative therapy in pruritus.

Because of its multitude of origins, the symptom complex of pruritus has a plethora of purported remedies and few therapeutic indications. Very few topical and systemic FDA approved medications have the indication of pruritus. Specific therapy still awaits a better definition of the exact physiologic events in chronic pruritus. Hence most medications actually focus on the central nervous system--the peripheral receptors--and the lack of specific physiologic targets has inhibited pharmacologic development. The resulting gap has opened the door to a variety of alternative therapies.

Balneology↗
PubMed2002

Effectiveness and cost-effectiveness analysis of neuroreflexotherapy for subacute and chronic low back pain in routine general practice: a cluster randomized, controlled trial.

STUDY DESIGN: A cluster randomized, controlled trial was performed. OBJECTIVES: To assess the clinical effectiveness and cost-effectiveness of adding patients' referral to neuroreflexotherapy intervention to the usual management of subacute and chronic low back pain in routine general practice. SUMMARY OF BACKGROUND DATA: Neuroreflexotherapy consists of the temporary implantation of epidermal devices in trigger points in the back and referred tender points in the ear. The efficacy of this procedure for treating subacute and chronic low back pain has been demonstrated in previous randomized, double-blind, controlled clinical trials. METHODS: Twenty-one primary care physicians working in seven primary care centers of the Spanish National Health Service in Palma de Mallorca, Spain, were randomly assigned to the intervention group (n = 11) or the control group (n = 10). The physicians recruited patients who had low back pain that had lasted for 14 or more days despite drug treatment and who did not meet criteria for surgery. The 45 patients recruited by physicians from the control group were treated according to the standard protocol, whereas the 59 patients recruited by physicians from the intervention group were, in addition, referred to neuroreflexotherapy intervention. The analysis of variables was performed taking into account that physicians, not patients, were randomly assigned. RESULTS: Patients underwent clinical evaluations at baseline and 15, 60, and 365 days later. At baseline, median intensity of pain was higher in patients undergoing neuroreflexotherapy than in control patients (visual analogue scale, 6.07; range, 4.67-8.80 vs. 5.15, range 4.11-8.00) and median duration of pain was also higher (48.1, range 28.4-211.1 vs. 17.5, range 15.0-91.5 days). At the last follow-up visit, patients treated with neuroreflexotherapy showed greater improvement than did control patients in low back pain (visual analogue scale, 5.5; range, 3.7-8.8 vs. 1.9; range, -1.2-3.0; P < 0.001); referred pain (visual analogue scale, 3.6; range, 2.7-7.3 vs. 0.6; range, -1.5-2.0; P = 0.001); and disability (Roland-Morris scale, 8.7; range, 2.0-13.3 vs. 2.0; range, -1.5-6.7; P = 0.007). Moreover, neuroreflexotherapy intervention was associated with a significantly (P < 0.035) lower number of consultations to private or public specialists, fewer indications of radiographs by primary care physicians, lower cost of drug treatment, and less duration of sick leave throughout the follow-up period. There were also differences in favor of neuroreflexotherapy intervention in the cost-effectiveness ratio for pain, disability, and quality of life that persisted in the most optimistic, the most conservative, and the average (break-even case) assumptions. CONCLUSIONS: Referral to neuroreflexotherapy intervention improves the effectiveness and cost-effectiveness of the management of nonspecific low back pain.

Acute Disease↗
PubMed2005

Neuroreflexotherapy for nonspecific low back pain: a systematic review.

STUDY DESIGN: Systematic review. OBJECTIVE: To assess the effectiveness of neuroreflexotherapy (NRT) for low back pain (LBP). SUMMARY OF BACKGROUND DATA: Few of the alternatives for the management of LBP have a firm base of evidence for their effectiveness. Recently, a new intervention known as NRT has been developed in Spain and has been reported to have favorable results. METHODS: Searches were undertaken according to Cochrane Collaboration guidelines, and randomized controlled trials that evaluated NRT as treatment for patients with nonspecific LBP were included. A qualitative synthesis and an assessment of methodological quality were undertaken. RESULTS: Three randomized controlled trials were included, with 125 and 148 subjects in control and intervention groups, respectively. NRT was compared with sham in two trials and standard care in one. Individuals receiving active NRT showed significantly better outcomes for pain, mobility, disability, medication use, consumption of resources, and costs. No major side effects were reported by those receiving active NRT. CONCLUSIONS: NRT appears to be a safe and effective intervention for nonspecific LBP. This conclusion is limited to three trials conducted by a small number of experienced clinicians. Further trials in other settings are needed to determine whether these favorable results can be generalized.

Acute Disease↗
PubMed1999

Incidental spina bifida occulta in functional enuresis observed during laser reflexo therapy.

The etiology of persistent functional enuresis in children is ill understood. A wide range of therapeutic modalities have been tried. During investigations preceding a trial of laser reflexo therapy in functional enuretic children aged 7 to 10 years spina bifida occulta was observed in 86.6% of subjects. The lesions were predominantly at the L5-6 level. There were no cutaneous stigmata in the form of lipoma, tufts of hair, or dermal sinus at the back. Neurologic examination was unremarkable and there were no associated skeletal malformations. This strong association of spina bifida occulta with functional enuresis is higher than the reported incidence of 16.5% to 34% in normal children. This strong association hitherto unreported, raises an interesting issue in the search for the etiopathogenesis of functional enuresis.

Adolescent↗
PubMed2000

Osteoreflectory treatment of alcohol abstinence syndrome and craving for alcohol in patients with alcoholism.

Osteoreflexotherapy is used alone as a treatment used for alcohol abstinence syndrome and for alcohol craving by intraosseal stimulation of the processus styloideus ulnae of the patient's left and right hands as well as the processus spinosus of the seventh cervical vertebra and the manubrium sterni osteoreceptors. This is done by intraosseal injection of 0.5 to 1.0 ml of 0.9% NaCl solution during a period of 3 to 5 seconds. Craving for alcohol and depressed mood, strongly manifested Alcohol Abstinence Syndrome (AAS) symptoms before osteoreflexotherapy, were reduced in a most convenient and fast manner under the influence of two sessions of osteoreceptive stimulation. The withdrawal symptoms caused by alcohol abstinence decreased markedly during the first two hours after the first osteoreflexotherapy treatment, continued to decrease in the next 24 hours and by the time the second osteoreflexotherapy session was given, the withdrawal symptoms completely disappeared in 72 hours. The most slowly and least reduced AAS symptoms were asthenia and disturbances of postular equilibrium. Based on clinical observations, it is speculated that osteoreceptive stimulations destroy ethanol dependent functional systems and restore the neurophysiological and neuromediatorial integration of the brain in alcoholismpatients. Primarily because of these two cited factors, the patient can be freed of the craving for alcohol for several years, and he or she also does not suffer from depression.

Adult↗