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Ng DQ, Lee S, Lee RT, Wang Y, Chan A. Real-world impact of acupuncture on analgesics and healthcare resource utilization in breast cancer survivors with pain. BMC Med 2024; 22:394. [PMID: 39285302 PMCID: PMC11406884 DOI: 10.1186/s12916-024-03626-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 09/10/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND This study evaluated the real-world impact of acupuncture on analgesics and healthcare resource utilization among breast cancer survivors. METHODS From a United States (US) commercial claims database (25% random sample of IQVIA PharMetrics® Plus for Academics), we selected 18-63 years old malignant breast cancer survivors experiencing pain and ≥ 1 year removed from cancer diagnosis. Using the difference-in-difference technique, annualized changes in analgesics [prevalence, rates of short-term (< 30-day supply) and long-term (≥ 30-day supply) prescription fills] and healthcare resource utilization (healthcare costs, hospitalizations, and emergency department visits) were compared between acupuncture-treated and non-treated patients. RESULTS Among 495 (3%) acupuncture-treated patients (median age: 55 years, stage 4: 12%, average 2.5 years post cancer diagnosis), most had commercial health insurance (92%) and experiencing musculoskeletal pain (98%). Twenty-seven percent were receiving antidepressants and 3% completed ≥ 2 long-term prescription fills of opioids. Prevalence of opioid usage reduced from 29 to 19% (P < 0.001) and NSAID usage reduced from 21 to 14% (P = 0.001) post-acupuncture. The relative prevalence of opioid and NSAID use decreased by 20% (P < 0.05) and 19% (P = 0.07), respectively, in the acupuncture-treated group compared to non-treated patients (n = 16,129). However, the reductions were not statistically significant after adjustment for confounding. Patients receiving acupuncture for pain (n = 264, 53%) were found with a relative decrease by 47% and 49% (both P < 0.05) in short-term opioid and NSAID fills compared to those treated for other conditions. High-utilization patients (≥ 10 acupuncture sessions, n = 178, 36%) were observed with a significant reduction in total healthcare costs (P < 0.001) unlike low-utilization patients. CONCLUSIONS Although adjusted results did not show that patients receiving acupuncture had better outcomes than non-treated patients, exploratory analyses revealed that patients treated specifically for pain used fewer analgesics and those with high acupuncture utilization incurred lower healthcare costs. Further studies are required to examine acupuncture effectiveness in real-world settings.
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Affiliation(s)
- Ding Quan Ng
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, 802 W Peltason Dr, Irvine, CA, 92697-4625, USA
- School of Pharmacy, Chapman University, RK 94-206, 9401 Jeronimo Road, Irvine, CA, 92618, USA
| | - Sanghoon Lee
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Richard T Lee
- Integrative Medicine Program, Departments of Supportive Care Medicine and Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Yun Wang
- School of Pharmacy, Chapman University, RK 94-206, 9401 Jeronimo Road, Irvine, CA, 92618, USA.
| | - Alexandre Chan
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, 802 W Peltason Dr, Irvine, CA, 92697-4625, USA.
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Rodgers-Melnick SN, Srinivasan R, Rivard RL, Adan F, Dusek JA. Immediate Effects of Integrative Health and Medicine Modalities Among Outpatients With Moderate-To-Severe Symptoms. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241254070. [PMID: 38737216 PMCID: PMC11088302 DOI: 10.1177/27536130241254070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/22/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Abstract
Background Patients seeking integrative health and medicine (IHM) modalities often present with multiple physical and psychological concerns. Research supports IHM's effectiveness for addressing symptoms over longer time periods. However, few studies have evaluated immediate outpatient effects. Objective This study describes pre-encounter patient-reported outcome (PRO) clusters and examines the immediate clinical effectiveness of IHM modalities on pain, stress, and anxiety among outpatients with moderate-to-severe symptoms. Methods A retrospective review was conducted of encounters among adults presenting to outpatient acupuncture, chiropractic, massage, integrative medicine consultation, or osteopathic manipulation treatment between January 2019 and July 2020. Encounters were included if patients reported pre-encounter pain, stress, or anxiety ≥4 on a numeric rating scale (NRS). Outcome analyses included random effects for patient and provider using a mixed model. Results Across 7335 clinical encounters among 2530 unique patients (mean age: 49.14 years; 81.0% female; 75.9% White; 15.8% Black/African American), the most common pre-encounter PRO clusters were pain, stress, and anxiety ≥4 (32.4%); pain ≥4 only (31.3%); and stress and anxiety ≥4 (15.6%). Clinically meaningful single-encounter mean [95% CI] changes were observed across all modalities in pain (-2.50 [-2.83, -2.17]), stress (-3.22 [-3.62, -2.82]), and anxiety (-3.05 [-3.37, -2.73]). Conclusion Patients presenting to outpatient IHM with moderate-to-severe symptoms most often presented with pain, stress, and anxiety ≥4 on the NRS. Multiple IHM modalities yielded clinically meaningful (≥2 unit) immediate reductions in these symptoms. Future research measuring immediate and longitudinal effectiveness is needed to optimize the triage and coordination of IHM modalities to meet patients' needs.
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Affiliation(s)
- Samuel N. Rodgers-Melnick
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Roshini Srinivasan
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
- Duke University School of Medicine, Durham, NC, USA
| | - Rachael L. Rivard
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
- Center for Evaluation and Survey Research, HealthPartners Institute, Minneapolis, MN, USA
| | - Francoise Adan
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jeffery A. Dusek
- Department of Medicine, University of California – Irvine, Irvine, CA, USA
- Susan Samueli Integrative Health Institute, University of California – Irvine, Irvine, CA, USA
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3
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Zabel S, Munk N. Practice-Based Research Networks and Massage Therapy: a Scoping Review. Int J Ther Massage Bodywork 2020; 13:25-34. [PMID: 33282033 PMCID: PMC7704044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Practice-based research networks (PBRNs) are means to connect practitioners with researchers and increase the body of rigorous research. PBRNs have been used in medicine for decades, but efforts to create PBRNs in massage therapy (MT) are limited. PURPOSE Examine and describe the amount of and nature of MT-related publications derived from PBRN-supported endeavors. PUBLICATION SELECTION Databases: Scopus, CINAHL, PubMed, ClinicalKey, EMBASE, Google Scholar. Keywords: massage, massage therapy, practice-based research network, PBRN. Key items: publication year, operating PBRN, article type, study design, general theme, massage therapist involvement/MT application. Inclusion Criteria: studies conducted through a PBRN using MT/massage therapists as an investigated factor; articles/editorials focused on PBRN-related MT research. RESULTS Initial database search resulted in 444 records; 40 articles included in analysis from database search, PBRN website access, and PBRN staff contacts. Publication dates ranged from 2005 to 2019, with nearly all published since 2013. Nine PBRNs published 29 articles based on 20 studies and sub-studies as research papers (n=21) or poster/oral presentation abstracts (n=8), and articles discussing the need for PBRNs in MT (n=8). Most research studies were conducted as surveys (n=21), examining practice characteristics (n=9) and patient perspectives/utilization (n=7). Three articles discussing PBRNs in MT were not connected to any specific PBRN. CONCLUSION The PBRN model holds promise to further the field of MT, but implementation needs significant development. Promoting the creation and growth of massage-specific PBRNs should be a focus of professional associations and research institutions to expand the body of scientific evidence supporting MT. While the United States has had the most PBRN-related research efforts, a sustainable implementation model is not evident as highlighted by inactivity from US-based PBRNs after initial productivity. An Australian PBRN may serve as a needed sustainability model for massage-related PBRNs in the US if their productivity trajectory continues.
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Affiliation(s)
- Samantha Zabel
- Department of Health Sciences, Indiana University School of Health and Human Sciences—IUPUI, Indianapolis, IN, USA,Corresponding author: Samantha Zabel, MA, Department of Health Sciences, Indiana University School of Health and Human Sciences—IUPUI, 901 W. New York St., PE 250, Indianapolis, IN, USA 46202,
| | - Niki Munk
- Department of Health Sciences, Indiana University School of Health and Human Sciences—IUPUI, Indianapolis, IN, USA,Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Ultimo NSW, Australia
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4
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Jong MC, Busch M, Baars EW. Integrative medicine in Dutch curative and long-term healthcare centres: Mapping the field. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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5
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Complementary and alternative medicine research in practice-based research networks: A critical review. Complement Ther Med 2019; 43:7-19. [DOI: 10.1016/j.ctim.2018.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/15/2018] [Accepted: 12/31/2018] [Indexed: 11/17/2022] Open
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Hansen KA, McKernan LC, Carter SD, Allen C, Wolever RQ. A Replicable and Sustainable Whole Person Care Model for Chronic Pain. J Altern Complement Med 2019; 25:S86-S94. [PMID: 30870025 PMCID: PMC6444891 DOI: 10.1089/acm.2018.0420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Integrative health is an expanding field that is increasingly called upon by conventional medicine to provide care for patients with chronic pain and disease. Although evidence has mounted for delivering integrative therapies individually, there is little consensus on how best to deliver these therapies in tandem as part of whole person care. While many models exist, few are financially sustainable. Methods and results: This article describes a conceptual and logistical model for providing integrative outpatient health care within an academic medical center or hospital system to patients with chronic pain and disease. In hopes that the model will be replicated, administrative details are provided to explain how the model operates and has been maintained over nine years. The details include the intentional building of a particular work culture. Conclusion: This whole person care model that addresses chronic pain and disease in an outpatient integrative clinic has been successful, sustainable and can be replicated in other academic medical centers or hospital clinics.
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Affiliation(s)
- Kathryn A Hansen
- 1 Osher Center for Integrative Medicine at Vanderbilt, Nashville, Tennessee.,2 Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee.,3 Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Lindsey C McKernan
- 1 Osher Center for Integrative Medicine at Vanderbilt, Nashville, Tennessee.,2 Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee.,4 Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Susan D Carter
- 1 Osher Center for Integrative Medicine at Vanderbilt, Nashville, Tennessee.,2 Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cynthia Allen
- 1 Osher Center for Integrative Medicine at Vanderbilt, Nashville, Tennessee.,2 Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ruth Q Wolever
- 1 Osher Center for Integrative Medicine at Vanderbilt, Nashville, Tennessee.,2 Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee.,3 Vanderbilt University School of Nursing, Nashville, Tennessee.,4 Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
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Miki K, Nakae A, Shi K, Yasuda Y, Yamamori H, Fujimoto M, Ikeda M, Shibata M, Yukioka M, Hashimoto R. Frequency of mental disorders among chronic pain patients with or without fibromyalgia in Japan. Neuropsychopharmacol Rep 2018; 38:167-174. [PMID: 30507027 PMCID: PMC7292302 DOI: 10.1002/npr2.12025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/17/2018] [Accepted: 06/18/2018] [Indexed: 01/06/2023] Open
Abstract
Aim To explore the characteristics of psychiatric morbidity in chronic pain patients who present with or without fibromyalgia. Methods Patients are referred to our chronic pain clinic from primary medical institutions, as we are a secondary medical institution. Although some patients have chronic pain, they have no clear organic disorder such as rheumatoid arthritis to account for the pain. Among the 367 new patients seen during the period from March 2009 to August 2012, 347 patients underwent psychiatric evaluation in face‐to‐face interviews with mental health specialists before a physical examination. Results Of the 347 patients examined, at least one psychiatric diagnosis was made for 94.6%. The average number of DSM‐IV‐TR diagnoses was 1.46 in the 330 chronic pain patients who had at least one psychiatric diagnosis. The breakdown of the number of psychodiagnoses was one in 60.8%, two in 27.1%, three in 4.9%, and more than three in 2.3% chronic pain patients with or without fibromyalgia. In fibromyalgia patients, the highest relative frequencies were found for somatoform disorders (76%), followed by dysthymic disorder (17%) and major depressive disorder (15%). In patients without fibromyalgia, the highest relative frequencies were found for somatoform disorders (64%), followed by major depressive disorder (15%) and dysthymic disorder (14%). Psychiatric disorders were found in 96.9% of fibromyalgia patients, and in 93.5% of chronic pain patients without fibromyalgia in Japan (no significant difference using chi‐square test). Conclusion Results show that chronic pain patients with or without fibromyalgia are extremely likely to be diagnosed with a psychiatric disorder. Psychodiagnoses of fibromyalgia patients and chronic pain patients without fibromyalgia.
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Affiliation(s)
- Kenji Miki
- Department of Pain Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.,Center for Pain Management, Hayaishi Hospital, Osaka, Japan.,Department of Rheumatology, Yukioka Hospital, Osaka, Japan
| | - Aya Nakae
- Department of Anesthesiology and Intensive Care, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kenrin Shi
- Tenjin Orthopaedics and Rheumatology, Osaka, Japan
| | - Yuka Yasuda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidenaga Yamamori
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Michiko Fujimoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masahiko Shibata
- Department of Pain Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masao Yukioka
- Department of Rheumatology, Yukioka Hospital, Osaka, Japan
| | - Ryota Hashimoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan.,Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, Osaka, Japan
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Abstract
For many years, the therapy field was dominated by a focus on the past. In this context, many clinicians were trained to use hypnosis as a tool to explore the past, and there is a rich literature documenting the use of hypnosis as a tool to induce age regression and the uncovering of traumatic memories. This article presents a therapeutic paradigm that focuses on the future. Hypnosis is used to induce creativity, flexibility, and openness to the future. In the context of health care, hypnosis is used to explore the best possible treatment outcome, which may be pharmacological, surgical, or a combination of both as well as other nonsurgical interventions. This article elaborates on the effective use of a therapeutic hypnosis strategy and technique focused on the future.
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Affiliation(s)
- Moshe S Torem
- a Cleveland Clinic-Akron General & Northeast Ohio Medical University , Akron, USA
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9
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Yang NY, Wolever RQ, Roberts R, Perlman A, Dolor RJ, Abrams DI, Ginsburg GS, Simmons LA. Integrative health care services utilization as a function of body mass index: A BraveNet practice-based research network study. ADVANCES IN INTEGRATIVE MEDICINE 2017. [DOI: 10.1016/j.aimed.2017.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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10
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Xenouli G, Xenoulis K, Sarafis P, Niakas D, Alexopoulos EC. Validation of the World Health Organization Disability Assessment Schedule (WHO-DAS II) in Greek and its added value to the Short Form 36 (SF-36) in a sample of people with or without disabilities. Disabil Health J 2016; 9:518-23. [PMID: 26996759 DOI: 10.1016/j.dhjo.2016.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/05/2016] [Accepted: 01/30/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is controversy and ongoing interest on the measurement of functionality in the personal and social level. OBJECTIVES (1) to validate the Greek version of the World Health Organization Disability Assessment Schedule (WHO DAS II) and (2) to determine its added value to the physical and psychological health subscales of the Short Form 36 (SF-36). METHODS In a cross-sectional design, data were collected between December 2014 and March 2015 by using three questionnaires (WHO DAS II, SF-36, PSS-14) in a sample of people with disabilities (n = 101) and without disabilities (n = 109) in Athens, Greece. WHO DAS II internal consistency, construct and criterion-related validity were assessed by Cronbach alpha, exploratory factor analysis and correlations; its added value by multivariable linear regression. RESULTS Cronbach Alpha's were satisfactory for the WHO DAS II, PSS-14 and SF-36 (0.85, 0.88 and 0.96 respectively). Exploratory factor analysis confirmed the existence of one or two factors in people with or without disabilities, respectively. WHO DAS II score showed significant negative correlation with the physical and mental health scale of SF-36 score, especially strong for physical health while was positively related to PSS-14 score. In multivariate analysis mental health appraisal was related to perceived stress in both groups. CONCLUSIONS This study support the validity of the Greek version of WHO DAS II and warranted its use in assessment and follow up of people with disabilities, contributing to the development of suitable policies to cover their needs and providing comparable data with other surveys using the same instrument.
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Affiliation(s)
- Georgia Xenouli
- Hellenic Open University, Parodos Aristotelous 18, GR-26 335 Patra, Greece.
| | - Kostis Xenoulis
- Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Panepistimiopolis, Ilissia, GR- 15784 Athens, Greece
| | - Pavlos Sarafis
- Hellenic Open University, Parodos Aristotelous 18, GR-26 335 Patra, Greece
| | - Dimitris Niakas
- Hellenic Open University, Parodos Aristotelous 18, GR-26 335 Patra, Greece
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