Cinnarizine

Psychoneuroimmunoendocrinology is the term describing the unity of mental, neurological, hormonal and immune functions with its many potential applications. PNIE addresses the influence of the cognitive images of the mind (whatever its elusive definition) on the central nervous system and consequent interactions with the endocrine and immune systems. It encompasses several arenas, including but not limited to biofeedback and voluntary controls, the impacts of thought and belief on physiology, past and present effects of stress on mental, emotional and physical function, placebo effects, cumulative effects of social relationships on health and disease, and contiguous and remote impacts of "energy medicine" on one's own function and that of others. This column highlights the impact of cogent studies from these arenas on the understanding of holistic medicine in this new millennium.

Glaucoma and stress

The rises in intraocular pressures in 18 patients with glaucoma were shown to be highly correlated with stressful life situations and emotional reactions. The pressures increased significantly in a number of these patients on being subjected to an interview in which the topic of conversation included the personal conflicts of the patient, particularly with anxiety, anger and depression. Observations were completed in 18 women and 5 men, age 27-75.

Ripley HS, Wolfe HG. Life Situations, Emotions and Glaucoma. Psychosom Med 1950 JulAug; 12(4): 215-24

Comment: The subjects in this clinical experiment were known to have glaucoma. Intraocular pressures rose significantly in several of these subjects, increasing 50% in some patients. No statistical analysis is offered, but simply knowing that the pressures rose in a number of subjects is enough of a warning that personal stress issues should be considered by primary care physicians, optometrists and ophthalmologists in measuring intraocular tension. It would be fairly simple to introduce potential emotionally stressful topics into the conversation and repeat the readings. For those whose pressures are stress-related, therapeutic meaures need to be undertaken to help the patients manage their stress.

Color blindness

This is a case history report of a multiple personality disorder patient who was blue-green color-blind on isochromatic color plate testing, but in another personality state perfectly distinguished Ishihara blue-green color plate phenomena.

Braun BG. Psychophysiologic phenomena in multiple personality and hypnosis. Am J Clin Hypn 1983 Oct; 26(2):84-92

Comment: There is not a lot of comment one can make about these kinds of reports. Other case reports of a similar nature have been published by this author who is a psychiatrist, and by others. They include observations in multiple personality disorder patients documenting a shift in allergy to cigarette smoke, allergy to oranges, allergy to cats, in handedness, and in focal length on shifting consciousness from one personality state to another. These observations would tell us that our understanding of allergic phenomena and neurological phenomena are by no means thoroughgoing. Allergic phenomena must clearly involve the participation of the brain and the mind, even though the latter has never been satisfactorily defined. The shift in handedness also escapes explanation by our usual cognitive reason. Reported phenomena such as these cases has always prompted me to be leery of anyone who claims to have the final word on anything.

Tension and inhibition of hearing/perceptions

In an animal experiment, when a clicking sound was generated through a loudspeaker in a soundproof room and perceived by a conscious cat with an electrode previously implanted in the 8th cranial (auditory) nerve, an electrical discharge was reliably recorded and transferred to an oscilloscope screen as a sine-wave curve a few milliseconds later. Two mice were then placed in a large, clear inverted jar clearly visible to the cat. Upon giving the mice its full attention and experiencing the assumed frustration of being driven by instinct and training on the one hand and the experienced inability to get at the mice, the clicking sound at the same intensity resulted in no electrical discharge recorded from the auditory nerve, the oscillcscope registering only a straight line. This inhibition of afferent perceptive signals was called the "inhibitory nervous system." In later research Robert Galambos anatomically dissected the oligocochlear bundle, a small segment of the auditory nerve carrying efferent messages f rom the brain to the cochlea, as opposed to the hundreds of afferent fibers in the nerve carrying messages from the ear to the brain. Severing the oligocochlear bundle obliterated the inhibitory phenomenon, and the authors logically showed that the oligocochlear bundle had the capability of "turning off' or inhibiting signals from the cochlea to the auditory cortex of the brain.

Hernandez-Peon R et al. The Efferent Control of Afferent Signals Entering the Central Nervous System. Ann N YAced Sci 1961. Jan 28; 89:866-82

Comment: Little attention has been given to this important study; the tension in the cats in this experiment turned off the ability to hear an auditory signal at the same volume which previously and subsequently clearly elicited objective evidence of an auditory response without the mice present. Subsequent work showed is highly likely that human beings are similarly wired, and that the same inhibitory phenomenon is probably present in the optical system as well. Most of us can recall a time when we are lost in thought working on a tension producing situation in our mind, and we simply literally do not hear someone calling us to dinner or communicating with us about something of significant importance. The tension we experience in those situations excites the inhibitory nervous system to protect us from an excessive load of stressful information. The next time someone does not respond to you, it may be that they truly do not hear you, rather than the fact that they hear and do not choose to respond.

Positional vertigo and behavioral therapy including biofeedback

Benign positional vertigo represents a challenge to rehabilitation due to the subjective nature of the complaint of dizziness, frequent failure of pharmacological interventions, and complicating psychological factors. This is a case history of a 26-year-old woman who complained of debilitating spells of dizziness after mild head injury sustained in a motor vehicle accident. During three weeks of baseline observation before treatment, the patient reported a weekly average of 48 dizzy spells, which prevented participation in her normal independent activities and kept her homebound and psychologically distressed. Nine-weeks of behavioral treatment included biofeedback-assisted relaxation training, psychological counseling, gaze-fixation practice, desensitization exercise, and generalization training. This protocol has been used to successfully train pilots to combat vertigo and nausea in flight. The patient reported 90% reduction in dizzy spells and full resumption of independent activities including driving and athletics.

Shutty MS Jr, Dawdy L, McMahon M, Buckelew SP. Behavioral treatment of dizziness secondary to benign positional vertigo following head trauma. Arch Phys Med Rehabil 1991 Jun; 72(71:473.6

Comment: Vertigo, tinnitus and ataxia have a large subjective component which can make treatment and its evaluation more difficult. This cognitive approach assisted with biofeedback experience proved successful in this patient. Behavioral methods are widely reported successful in these balance and hearing problems, and pharmacological treatment appears to offer relatively little promise. There are few if any side effects of biofeedback and cognitive methods.

Tinnitus and biofeedback

Fifty-eight randomly selected idiopathic tinnitus patients were randomized to receive EMG biofeedback in 10 weekly 30-minute sessions (n=10); biofeedback controls (n=8); cinnarizine (an antihistamine, n=10); placebo pills (n=20), or acupuncture in 10 weekly 30-minute sessions. Cinnarizine has calcium-channel blocking and vasoconstriction antagonist properties. The biofeedback controls were "treated" for 30 minutes but the responsiveness of the device was rendered random. The sham (control) biofeedback group had 0% improvement; the acupuncture group 30% improvement (p<.08=NS); the drug group was 7% improved (NS) and the placebo pill group 2% improved. The biofeedback group was 50% improved (p<.05).

Podoshin L et al. Idiopathic subjective tinnitus treated by biofeedback, acupuncture and drug therapy. Ear Nose Throat J 1991 May; 70(5):284-89

Comment: While biofeedback in this study achieved only 50% success, it was markedly better than drugs, acupuncture, sham biofeedback and placebo. Primary care physicians would welcome 50% improvement in this condition. There was randomization in selection of these patients reported, strengthening the obvious conclusion that argues for a trial of biofeedback in this condition. Little success is reported by more conventional approaches.

Tinnitus and hypnosis

Forty-one patients, 15 women and 26 men with a mean age of 54, underwent three sessions of client-centered hypnotherapy for their tinnitus. Of these patients, 28 (68%) showed some benefit for their tinnitus 3 months after completing their hypnosis, and 13 (32%) showed no evidence of improvement. Hearing loss was associated with lack of benefit for tinnitus treated with hypnotherapy. Of the non-benefited group, 46% had a hearing loss of 30 db or more in their better-hearing ear compared to less than 15% in the beneficial group, a significant difference (p<O.O2).

Mason J, Rogerson D. Client-centered hypnotherapy for tinnitus: who is likely to benefit? Am J Clin Hypn 1995 Apr; 37(4):294-9

Comment: Client-centered hypnotherapy can be offered to anyone who wants therapy for their tinnitus; in those with significant accompanying hearing loss, therapy is unlikely to benefit. The full understanding of how hypnosis achieves its effects is yet to be explained. Hypnosis would appear to be greatly underused, and the number of physicians seeking training is not large. There is much significant overlap between relaxation training and the suggestion used by most physicians with formal hypnotherapy. The depth of the changes in the state of consciousness does appear to differ. It is helpful for primary care physicians to either have some training in hypnotherapy or have reliable resources for referral.

Robert Anderson is a retired family physician. In mid-career, his practice took on a more holistic nature as decades passed. He has authored five major books, Stress Power! (1978), Wellness Medicine (1987), The Complete Self Care Guide to Holistic Medicine (1999) (co-author), The Scientific Basis for Holistic Medicine, (5th edition) available from American Health Press, nhf@msn.com, and Clinician's Guide to Holistic Medicine (McGraw Hill, 2001). Anderson is serving as the founding president of the American Board of Holistic Medicine, is a past president of the American Holistic Medical Association, former Assistant Clinical Professor of Family Medicine at the University of Washington, and currently Adjunct Instructor in Family Medicine at Bastyr University.

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