Meditation and other mind-body therapies could help relieve pain and reduce opioid use, according to a new review.

Opioids are a class of drugs that doctors sometimes prescribe for the treatment of acute chronic pain.

While effective, opioids can also be highly addictive. This has led to what many specialists refer to as the “opioid crisis,” as many people end up misusing or overusing opioid prescription drugs.

In previous years, opioid use disorder — in which people compulsively overuse opioids — has led to approximately 118,000 annual deaths worldwide and about 47,600 deaths in the United States alone.

Increasingly, specialists are turning toward soothing, nonpharmacological methods of pain management to try to address the opioid crisis. These include mind-body therapies (MBTs), such as meditation, hypnosis, relaxation techniques, and cognitive behavioral therapy (CBT).

“To help combat the opioid crisis, guidelines encourage practitioners to consider nonopioid pain management options, including [MBTs],” write Prof. Eric Garland — from the University of Utah in Salt Lake City — and colleagues in their new systematic review and meta-analysis, which features in JAMA Internal Medicine.

Prof. Garland and team sought to find out whether and to what extent MBTs can help relieve chronic pain and prevent individuals who use or have used opioids from developing opioid-related health problems, including opioid use disorder.

‘Significant’ link with lower opioid use

The researchers analyzed the data from 60 reports, which included a total of 6,404 participants. These reports featured a range of MBTs, including meditation, hypnosis, relaxation, guided imagery, therapeutic suggestion, and CBT.

“Overall meta-analytic results revealed that MBTs had a statistically significant, moderate association with reduced pain intensity and a statistically significant, small association with reduced opioid dosing,” the authors report.

Different MBTs, however, showed various levels of effectiveness when it came to relieving pain and reducing individuals’ need for opioids.

More specifically, of the five studies looking at the effects of meditation, all five suggested that this intervention was associated with “significant improvements in pain severity,” while four found that it also had a link with “significant improvements in opioid misuse, opioid craving, time to opioid cessation, and/or opioid use.”

When it came to hypnosis, 15 out of 23 studies suggested that this intervention could significantly alleviate pain, and 12 out of 23 said that it significantly reduced opioid use and cravings for these substances.

Other interventions that were helpful in these regards were relaxation and CBT. Of the 16 studies looking at the effectiveness of relaxation, 12 found that it helped lower pain intensity. However, only three of the relaxation studies reported a link between this intervention and lower opioid use.

In addition, two studies reported possible side effects of using relaxation. Some individuals, these studies found, reported “significantly worsened opioid dosing outcomes” following relaxation interventions.

Three of the seven studies investigating CBT found that this form of therapy led to “statistically significant improvements in pain intensity,” and four of the studies reported that CBT helped reduce opioid use or misuse.

Guided imagery and therapeutic suggestion did not appear to be significantly associated with improvements in pain or opioid use.

Doctors should take MBTs into consideration

The review authors admit that the data that they worked with were not ideal. For one, they explain, they would have welcomed having access to a higher number of studies that had collected more specific information on opioid dosing, drug type, dose frequency, and duration of use.

For another, they emphasize that the studies that they analyzed relied on self-reported data, which can be unreliable. Yet the researchers still argue that their findings are encouraging — most MBTs, they say, appear to have no side effects, and people could really find them helpful. They conclude:

“Practitioners should consider presenting MBTs as nonpharmacologic adjuncts to opioid analgesic therapy. […] Behavioral healthcare professionals working alongside physicians could feasibly integrate MBTs into standard medical practice through coordinated care management.”

“Insofar as MBTs are associated with pain relief and opioid use reduction among patients prescribed opioids for a range of pain conditions,” they add, “MBTs may help alleviate the opioid crisis.”

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People’s interest in CBD products is skyrocketing, according to a new study.

Acne, pain, menstrual problems, and opioid addiction — the range of conditions that cannabidiol (CBD) can apparently treat seems endless. But does the compound really work? The answer remains unclear.

Nonetheless, CBD is having a moment, says a research letter that JAMA Network Open has published.

The analysis of online searches by the population of the United States reveals that millions are equally or more interested in CBD than they are in any other health products and topics.

Dr. Davey Smith, chief of infectious diseases and global public health at the University of California (UC), San Diego, says: “At this time there are no known benefits for taking CBD over the counter. CBD is this generation’s snake oil, where millions are engaging with the product without evidence of any benefit.”

CBD takes the stage

CBD is not new, with people having first extracted it from the cannabis plant in 1940. However, it has recently become available in an array of products, from gummies to ice cream, in the form of massage oil, and as droplets.

It is fair to say that public interest in CBD is high. Study co-author John W. Ayers notes that “3 years ago, there was essentially no one searching about CBD online, but now there are an estimated 6.4 million unique searches each month.”

CBD’s value as a health supplement remains indeterminate, with few major health authorities weighing in on its benefits or potential side effects.

The authors of the study believe that this is because they may not understand the extent to which people are interested in the substance. The team hopes to remedy this with hard data that prompt experts to prioritize more research.

Online curiosity about CBD

Health scientists from UC San Diego analyzed the frequency of U.S. Google searches for either “CBD” or “cannabidiol” from January 2004 through to April 2019.

Next, using this data, they extrapolated search traffic out through December 2019.

“Rather than relying on self-reports where some might not be willing to discuss CBD openly, we directly observed millions of instances of people seeking out information or even shopping for CBD online.”

Lead study author Dr. Eric Leas

During the last 3 years, the increase in CBD searches has been particularly pronounced. It increased by 125% during 2017 and then 160% during 2018. Experts expect it to be up by 180% again in 2019.

The researchers noted increased interest in CBD throughout the U.S. In some places, interest was especially strong. For instance, searches grew by 605% in Alabama.

The booming number of inquiries that the team recorded in other states — Vermont, Wisconsin, Tennessee, Colorado, New Hampshire, and Oregon — demonstrates that CBD is a nationwide topic of interest.

The interest in CBD may be partly due to the increased destigmatization of marijuana.

Indeed, states with legalized recreational marijuana use had the greatest number of CBD searches. States allowing medicinal uses of cannabis followed, and then states in which marijuana is illegal.

In comparison with other searches

To ascertain the significance of their findings, the researchers also tracked searches for other health-related topics, products, and alternative therapies.

“When talking to colleagues about our study,” says co-author and research fellow Alicia Nobles, “we often play a game we call ‘CBD or,’ and almost every time, experts are shocked to learn that CBD is more popular or nearly as popular.”

Nobels cites an example: “For every two internet searches for dieting in the U.S., we found there is one for CBD!”

While the number of searches for CBD was roughly equal to those for yoga and e-cigarettes, CBD queries swamped the search numbers for other popular health topics, exceeding the number of searches for:

• veganism by 112%
• marijuana by 113%
• exercise by 159%
• vaccination by 163%
• meditation by 338%
• apple cider vinegar by 517%
• acupuncture by 749%.

What to do as interest in CBD accelerates

This longitudinal cross-sectional study did not address actual purchases of CBD-based products. However, the rapid increase of interest in CBD that the study has documented suggests that the substance’s popularity is outpacing scientific research into the benefits and hazards of its use.

The study’s authors assert that “investigation into CBD should become a public health priority to catch up with the public’s interest.”

They conclude their paper by proposing a four-phase plan of action going forward:

1. “Studies should focus on the epidemiology of CBD use, characterizing who uses CBD products and for what purposes.”
2. Researchers should evaluate the effects and potential drug interactions of CBD.
3. There is a need to develop product safety standards because the mislabeling of CBD products is common, and adulterated products have led to mass poisonings.
4. “Marketing practices around CBD should be standardized, as marketing that misleads the public could erode trust in evidence-based medicine.”

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The FDA caution against the potential risks of homeopathic products.

According to some estimates, a third of adults and more than 11% of children in the United States are using complementary health approaches.

In 2012, the Centers for Disease Control and Prevention (CDC) analyzed a sample of almost 89,000 adults.

They found that over 40,000 of these were taking “nonvitamin, nonmineral dietary supplements,” and that over 5,000 were using homeopathic treatments.

According to some sources, homeopathy is a $1.2 billion industry in the U.S. As more and more people start to purchase these products, the risk of unsafe products reaching consumers is also rising.

To prevent this, in 2017, the FDA issued a draft guidance document wherein they explained how they assess the risks of homeopathic products.

Now, they have revised this document and are asking the public for feedback and input on the new version.

The FDA are also withdrawing a previous compliance policy guide — entitled “Conditions Under Which Homeopathic Drugs May be Marketed” — which they issued in 1988, as the policy no longer reflects their current thinking.

Dr. Norman E. Sharpless, the acting commissioner of food and drugs, and Dr. Janet Woodcock, the director of the Center for Drug Evaluation and Research, authored the FDA statement that details these two new steps.

FDA urge public to review draft guidance

In their statement, the FDA explain the need for safeguarding the public from the potential risks of homeopathic products.

Homeopathic drugs, they say, “are made from a wide range of substances, including ingredients derived from plants, healthy or diseased animal or human sources, minerals and chemicals, including known poisons.”

“These products have the potential to cause significant and even permanent harm if they are poorly manufactured,” they claim.

As part of the revision of the 2017 draft guidance, the FDA have now detailed which categories of homeopathic products pose a higher risk to public health, and which particular ingredients and methods of administration are less likely to be safe.

They are also planning to give details on “products for vulnerable populations, and products with significant quality issues.”

The FDA call for the public’s help in revising this draft before it is final. In their statement, they say, “We encourage the public to review this revised draft guidance and comment before it is finalized.”

“We will consider feedback gathered through this new public comment period, the more than 4,500 comments interested stakeholders submitted on the original 2017 draft guidance, and information gleaned from a 2015 public hearing on the current use of homeopathic [drugs].”

The final version of the document will “provide transparency regarding the categories of homeopathic drug products that [the FDA] intend to prioritize.”

Withdrawing compliance policy guide

The FDA have also withdrawn their compliance policy guide (CPG) entitled “Conditions Under Which Homeopathic Drugs May be Marketed.”

The main reason for this withdrawal is that since issuing the CPG, the FDA have encountered several situations in which homeopathic drugs posed a significant risk to human health — even though the products, as labeled, appeared to meet the conditions described in the policy. The FDA write on their website:

“CPG 400.400 is inconsistent with our risk based approach to regulatory and enforcement action generally and therefore does not reflect our current thinking. Therefore, it is appropriate to withdraw [it].”

These two steps are part of a larger effort to protect the public from potentially harmful homeopathic products.

As part of this effort, the FDA have issued over 10 warning letters to homeopathic drug producers, with recent recipients including Kadesh Inc., U.S. Continental Marketing Inc., Fill It Pack It Inc., and Bershtel Enterprises LLC dba WePackItAll.

According to the FDA, these companies have worked together to produce and package eye drops in nonsterile conditions, which could cause serious eye infections.

The FDA also encourage consumers and healthcare professionals alike to report any adverse health effects or problems with homeopathic products to their MedWatch Adverse Event Reporting program.

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Could Chinese herbal remedies relieve hot flashes?

Hot flashes affect up to 90% of women during menopause.

They have an association with poor sleep, depressed mood, and reduced quality of life.

Eventually, hot flashes will stop without medical intervention, but for some people, they can last more than a decade.

Scientists know that peripheral vasodilation plays a role in hot flashes, but they do not know precisely why they occur.

One theory is that the reduction in estrogen that occurs during menopause might be a factor. Changes in the levels of serotonin and norepinephrine might also play a part.

Currently, doctors treat hot flashes with either hormone replacement therapy or low dosages of paroxetine, which is an antidepressant medication.

Although these treatments work well for many people, they can produce unpleasant side effects. Also, doctors advise those with certain conditions, such as breast cancer, against hormone replacement therapy.

Complementary and alternative medicine

As current treatment options are not ideal for everyone, many people investigate complementary and alternative medicine (CAM) for hot flashes. In fact, one study found that 80% of women tried CAM during menopause.

CAM comes in many forms, one of which is traditional Chinese medicine. Recently, researchers carried out a review and meta-analysis of studies testing Chinese herbal treatments against hot flashes. They published their findings in PLOS ONE.

Following a literature search, the authors found 19 randomized controlled trials that investigated the clinical effects and safety of Chinese herbal medicine on hot flashes. In total, the trials included 2,469 participants.

Of the 19 studies in the review, the team included just 16 in the meta-analysis because the remaining three did not have adequate data. Overall, the authors conclude:

“This review indicated that [Chinese herbal medicine] formulae were safe to be applied in [females with menopausal hot flashes] and able to improve [menopausal hot flash]-related symptom scores as well as the peripheral blood flow.”

Importantly, the herbal interventions appeared to cause few adverse events.

How might Chinese herbs help?

The authors believe that Chinese herbal medicine might relieve hot flashes due to estrogen-like effects.

For instance, some of the herbs that the researchers used in the trials, including bai shao, dang gui, zhi mu, chai hu, huang qin, and yin yang huo, contain phytoestrogens.

Phytoestrogens, which people sometimes call dietary estrogens, are structurally similar to estrogen. If reduced estrogen plays a part in hot flashes, perhaps phytoestrogens could relieve this symptom.

The authors caution that if the benefits of Chinese herbs rely on estrogen or estrogen-like effects, “they should be used with caution when prescribed to patients with hormone-dependent conditions, such as breast cancer.”

Alternatively, calcitonin gene-related peptide might mediate the effects. This peptide affects peripheral circulation, and some research suggests that certain Chinese herbs reduce the levels of calcitonin gene-related peptide in the blood.

Not enough evidence by far

Although the authors’ overall conclusions are positive, their work has significant limitations.

For instance, the authors report substantial differences between each study in the review, which makes it difficult to compare them and collate the findings. Some studies used Chinese herbs in the form of granules, while others used them in capsule, decoction, tablet, or “honey pill” form.

The studies also varied in their design, with some comparing Chinese herbal medicines with a placebo and others comparing them with hormone replacement therapy.

Each study used different cocktails of herbs, too. For instance, one study tested a mix of just two herbs, and another study investigated a blend of 31 herbs.

In all, the 19 studies used 18 different formulations of herbs. This variation, in itself, makes it difficult to generalize the results and pool data together.

Perhaps more worrying is that in almost half of the studies, the authors detected a “high risk of bias.” This bias took different forms; for instance, “four studies investigated the herbal formulae supplied by drug manufacturers.”

In 10 of the studies, the “blinding” was inadequate. In other words, the participants may have known that they were receiving the “treatment” rather than the placebo, which could have influenced the results.

Public interest in CAM is at an all time high. Currently, the existing evidence in support of Chinese herbal remedies is relatively weak. However, because these types of treatments are cost-effective and often relatively safe, it is worth investigating them further.

Scientists need to carry out many more well-controlled, large-scale studies before they can uncover the true benefits, if any, of Chinese herbal remedies.