Wednesday, February 26, 2014

Painkiller Usage Reduced by 50 Percent with Homeopathy

The front page lead story of the Los Angeles Times on March 30, 2013, was the significant increase in deaths as a result of painkillers (Glover and Girion, 2013).  The good news is that there are alternatives to painkillers and safer treatments that can reduce their usage.

A large study conducted in France showed that patients with chronic musculoskeletal disorders had a 50% reduced usage of conventional pain medication by being under the care of a physician who specializes in prescribing homeopathic medicines (Rossignol, Begaud, Engel, et al, 2012).

This study of 1,153 patients with musculoskeletal disorders* compared treatments from conventional physicians (CM), physicians who specialized in homeopathic medicine (Ho), and physicians who engaged in a mixed practice of conventional and natural treatments (Mx).  Some of the musculoskeletal disorders of patients who were included in this study were: Osteoarthritis, rheumatism, fibromyalgia, muscle spasms, tendinitis, rotary cuff syndrome, ankylosing spondylitis, intervertebral disc disorders, neck pain, torticollis, and spinal stenosis.

This study was approved by the French National Data-Protection Commission and the French National Council of Physicians.  Prior to the start of the study, a higher percentage of patients who received care from a MD homeopath were found to have a "chronic" musculoskeletal disorder (61%), as compared with those going to conventional MDs (50%) or to MDs who practiced a mixed treatment (52%).

Despite the fact that the homeopathic patients were considered ill for a longer period of time, this study showed that the patients with chronic musculoskeletal pain had a 50% reduced use of conventional pain medication, while patients with acute musculoskeletal pain had a 38% reduced use.  In addition to this significant reduction in the use of painkillers, the patients who received homeopathic treatment showed a similar clinical progression of their musculoskeletal disease as assessed by standardized functional scales.

The researchers acknowledged that musculoskeletal disorders are a leading reason for medical consultation in primary care.  The researchers also noted that this nationwide observational study was conducted over one year and that long-term usage of conventional pain medications are known to have numerous minor and serious side effects, as distinct from homeopathic medicines which have a long-time history of safety.  Because homeopathic medicine in France is only practiced by MDs, the researchers asserted that maintaining the present reimbursement schedule for homeopathic treatment keeps health care costs down.

The researchers of this study were a diverse and prestigious group of professors of epidemiology, biostatistics, and medicine from the University of Paris, the Pasteur Institute, University of Bordeaux, University of Pierre and Marie Curie, McGill University, and the London School of Hygiene and Tropical Medicine.


Other Studies Confirm Homeopathic Efficacy

There have been over 200 randomized and placebo controlled clinical trials, most of which have shown therapeutic benefits to patients receiving homeopathic treatment.  It is not the purpose of this article to review all of them, but it is instructive to review some of the other studies that dealt with treating people with musculoskeletal ailments.

Fibromyalgia is a complex syndrome that includes musculoskeletal pain.  The <strong>British Medical Journal </strong>published a sophisticated study in which half of the subjects were initially given a placebo and half were given a homeopathic medicine (Fisher, Greenwood, Huskisson 1989).  Then, halfway through the study, the group that initially took the medicine was given the placebo, and those who initially took the placebo began taking the real medicine.  Instead of comparing two groups against each other, this "crossover" methodology compared each person under one treatment with him or herself under a placebo.  This type of study is considered the most sophisticated type of research design.

Researchers consider a study to have statistical significance if calculations show that there is a 5 in 100 possibility (written:  P=.05) of the result to occur simply through chance.  However, the results of this experiment were so significant that the researchers found that there was a 5 in 10,000 chance (P=.005) of this occurring from chance.  This study is therefore considered "substantially" significant, not just statistically significant.

This study concluded that homeopathic medicines are effective in reducing the pain and tender spots and in improving sleep in patients suffering from fibromyalgia.

The highly respected journal, Rheumatology (the journal of the British Society for Rheumatology), also published a very positive study on homeopathic treatment.  Researchers from the University of Arizona in collaboration with homeopaths conducted a double-blind, randomized, placebo-controlled trial with 62 fibromyalgia patients (Bell, Lewis, Brooks, et al., 2004).  Patients were randomized to receive an oral daily dose of an individually chosen homeopathic medicine in LM potency (or a placebo).  Patients were evaluated at baseline, 2 months, and 4 months.

The study discovered that 50% of patients who were given a homeopathic medicine experienced a 25% or greater improvement in tender point pain on examination, while only 15% of those who were given a placebo experienced a similar degree of improvement (P=0.008).  After 4 months, the homeopathic patients rated the "helpfulness of the treatment" significantly greater than did those patients given a placebo (P=0.004).

Even an independent group of researchers (who included one of the most ardent antagonists to homeopathy) evaluated this study and have deemed it to be of the "highest quality"(De Silva, El-Metwally, Ernst, et al 2010).

One additional feature of this study was that the first dose of medicine was given by olfaction (by smell) and that both groups of patients were monitored by EEG (electroencephalography is the recording of electrical activity along the scalp).  The scientists found that there were both significant and identifiable differences in the EEG readings in patients who were given the homeopathic medicine, as compared to those patients who were given the placebo (Bell, Lewis, Schwartz, et al, 2004a).  Each patient in this study underwent three laboratory sessions, including at baseline, at 3 months, and at 6 months after initial treatment.  The active treatment group were found to experience significant increases in the EEG relative alpha magnitude, while patients who were given a placebo experienced a decrease in this measurement (P=0.003).  Ultimately, this study showed clinical benefits from homeopathic medicine, and it showed objective measurements that verified a physiological response to treatment.

In a meta-analysis of clinical research on the homeopathic treatment of people with rheumatic disease, researchers concluded, "Overall, it appears that homeopathic remedies work better than a placebo in studies of rheumatic syndromes, but there are too few studies to make definitive conclusions about the efficacy of any one type of homeopathic treatment on any one condition" (Jonas, Linde, and Ramirez, 2000).

One early study on the homeopathic treatment of people with rheumatoid arthritis was published in the British Journal of Clinical Pharmacology.  This study found that 82% of those patients prescribed an individually chosen homeopathic medicine experienced some relief of their arthritic pain, while only 21% of patients prescribed a placebo experienced a similar degree of relief (Gibson, 1980).  

In 2007, a randomized double-blind placebo controlled trial was conducted at a University Hospital in Zurich, Switzerland, where they compared the use of ibuprofen and Arnica in external gel preparations in the treatment of 204 patients with osteoarthritis in the joints of the hands (Widrig, 2007).  The use of topical preparations for symptom relief is common in the treatment of osteoarthritis. The effects of ibuprofen (5%) and Arnica (50 g tincture/100 g, DER 1:20), as gel preparations in patients with radiologically confirmed and symptomatically active osteoarthritis of joints of hands, were evaluated in 204 patients, to ascertain differences in pain relief and hand function after 21 days treatment.

The researchers found were no differences between the two groups in pain and hand function improvements or in any secondary end points evaluated.  Their results confirmed that this preparation of Arnica is not inferior to ibuprofen when treating osteoarthritis of hands.

A more recent double blind, randomized, placebo-controlled trial was conducted in England that compared individualized homeopathic treatment (versus a placebo), homeopathic treatment with a homeopathic complex medicine (versus a placebo), and the homeopathic consultation (with prescription of a real medicine vs. a placebo) (Brien S, Lachance L, Prescott, 2010).  Participants were randomly allocated to consultation or no consultation and then further randomized to treatment type for a total of five arms in the trial.

However, because this study had five different treatment options, the researchers estimated that they needed at least 110 patients for the study.  The study ended up with only 56 subjects, with an average of only 11 patients in each arm of the study.  Predictably enough, the study did not any difference between the groups.  Although skeptics of homeopathy contend that this study "proves" that homeopathic medicines do not work, good scientists good scientists understand the severe limitations with this trial which simply did not have an adequate number of patients to evaluate properly.

Ultimately, skeptics of homeopathy insist that homeopathic medicines are placebos, and yet, the body of basic sciences research on cells, on plants, and on animals suggests a real biological action to homeopathic medicines.  Or perhaps the skeptics are right, and perhaps cells, plants, and animals have some type of profoundly wild psychic abilities, a possibility that is much more metaphysical than skeptics may want to believe.  The truth is much more likely to be the results of a homeopathic medicine.




References:

Bell, IR, Lewis, DA, Brooks, DJ, Schwartz, GE, Leis, SE, Walsh, BT, and Baldwin, DM, Improved Clinical Status in Fibromyalgia Patients Treated with Individualized Homeopathic Remedies Versus Placebo, Rheumatology, January 20, 2004:1111-7.  http://rheumatology.oxfordjournals.org/content/43/5/577.long

Bell IR, Lewis Ii DA, Lewis SE, Schwartz GE, Brooks AJ, Scott A, Baldwin CM.
EEG Alpha Sensitization in Individualized Homeopathic Treatment of Fibromyalgia.
Int J Neurosci. 2004;114(9):1195-1220.

Bell IR, et al: Electroencephalographic cordance patterns distinguish exception clinical responders with fibromyalgia to individualized homeopathic medicines. J Alt Comp Med 10,2:285-299, 2004c.

Fisher P, Greenwood A, Huskisson EC, et al., "Effect of Homoeopathic Treatment on Fibrositis (Primary Fibromyalgia)," BMJ, 299(August 5, 1989):365-6.  http://pubmedcentralcanada.ca/pmcc/articles/PMC1837216/pdf/bmj00244-0034.pdf

Glover, Scott; and Girion, Lisa.  Deaths tied to painkillers rising in the U.S. Los Angeles Times, March 30, 2013, front page.  http://articles.latimes.com/2013/mar/29/local/la-me-0330-rx-deaths-20130330

Rossignol M, Begaud B, Engel P, et al.  Impact of physician preferences for homeopathic or conventional medicines on patients with musculoskeletal disorders: results from the EPI3-MSD cohort. Pharmacoepidemiol Drug Saf. 2012 Jul 11. doi: 10.1002/pds.3316.  http://www.ncbi.nlm.nih.gov/pubmed/22782803

Widrig, R., Suter, A., Saller, R., and Melzer, J.  Choosing between NSAID and arnica for topical treatment of hand osteoarthritis in a randomised, double-blind study. Rheumatology International.  2007 Apr;27(6):585-91. http://www.ncbi.nlm.nih.gov/pubmed/17318618



66 comments:

  1. I'm afraid that when you say
    "Researchers consider a study to have statistical significance if calculations show that there is a 5 in 100 possibility (written: P=.05) of the result to occur simply through chance. However, the results of this experiment were so significant that the researchers found that there was a 5 in 10,000 chance (P=.005) of this occurring from chance. This study is therefore considered "substantially" significant, not just statistically significant."
    you are incorrect. The p-value is the probability of seeing a result or a more extreme one *given* that it has occurred by chance. P=0.005 does not mean that 'there was a 5 in 10,000 chance of this occurring from chance' - that implies that there is a 0.995 probability that something else than chance were responsible (presumably you would say homeopathy). The difference is subtle, but p-values calculated the probability of the data given the null hypothesis, not the relative probabilities of the hypotheses themselves. To do that you must apply Bayes' theorem, and I personally would argue that this p-value is not enough to outweigh the deep implausibility of homeopathy, and the poor standard of evidence elsewhere, especially when many homeopaths would have claimed a stronger expected effect beforehand. If homeopaths are going to claim any effect, even small in scale (which is different from statistically significant) ones, as supporting the homeopathic hypothesis, then the hypothesis must be downweighted in the model comparison since it is so poorly predictive.
    The p-value is a completely inappropriate tool for making a decision between hypotheses in circumstances like this, where one hypothesis is deeply implausible.

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  3. Great article. As a Homeopath myself I have found that some patients have had great results from remedies in their pain management of Osteoarthritis in particular. In particular with Rhus Tox. Thanks again. Happy to share this article on my blog if you would like that. www.villagehomeopathy.blogspot.co.uk

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