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Conway AE, Verdi M, Shaker MS, Bernstein JA, Beamish CC, Morse R, Madan J, Lee MW, Sussman G, Al-Nimr A, Hand M, Albert DA. Beyond Confirmed Mast Cell Activation Syndrome: Approaching Patients With Dysautonomia and Related Conditions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1738-1750. [PMID: 38499084 DOI: 10.1016/j.jaip.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/23/2024] [Accepted: 03/09/2024] [Indexed: 03/20/2024]
Abstract
Allergist-immunologists face significant challenges as experts in an ever-evolving field of neuroimmunology. Among these challenges is the increasingly frequent need to counsel patients with suspected mast cell activation disorders about perceived comorbidities, which may include hypermobile Ehlers-Danlos syndrome, amplified pain syndrome, fibromyalgia, burning sensation syndromes, migraines, irritable bowel syndrome, and postural orthostatic tachycardia syndrome. Patients may experience comorbid anxiety, panic disorder, and depression associated with disturbed sleep, fatigue, and cognitive impairment that often worsen when their physical symptoms increase in severity. These conditions may mimic mast cell activation disorders and are emotionally taxing for patients and clinicians because they are often accompanied by vague diagnostic courses, perceived unmanageability, social stigma, and significant impairment in quality of life. Combined with relatively poorly researched therapies, it is no surprise that clinicians may feel overwhelmed or find it difficult to provide consistently compassionate care for this population. In this article, we review available therapies for these conditions, which run the gamut from physical therapy to antidepressants to multimodal pain control. We highlight the benefit of multidisciplinary care within the primary care home, which includes an important role by the allergist-immunologist. By outlining simple approaches to initial treatment, we hope to empower clinicians with the tools needed to curb emotional burnout and embrace this patient population with compassion.
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Affiliation(s)
| | | | - Marcus S Shaker
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Rheumatology, Allergy, and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Claire C Beamish
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Richard Morse
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Pediatric Neurology, Children's Hospital at Dartmouth, Lebanon, NH
| | - Juliette Madan
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Pediatrics, Division of Child Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Psychiatry, Division of Child Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Michael W Lee
- Department of Medical Education, Dartmouth Geisel School of Medicine, Hanover, NH
| | - Gordon Sussman
- Division of Immunology, University of Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | - Amer Al-Nimr
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Pediatric Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Matthew Hand
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Pediatric Nephrology and Integrative Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Daniel A Albert
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Rheumatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Dev P, Bavli N, Sims B, Foster J, Moscowitz A, Makris UE, Rambally S. Mindfulness and yoga therapy for acute pain in sickle cell disease. EJHAEM 2024; 5:131-135. [PMID: 38406511 PMCID: PMC10887359 DOI: 10.1002/jha2.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/28/2023] [Accepted: 10/24/2023] [Indexed: 02/27/2024]
Abstract
There is a paucity of data regarding the use of non-pharmacologic therapies for pain in sickle cell disease. The purpose of this pilot study was to assess the acceptability and feasibility of video-guided mindfulness meditation, breathing exercises, and yoga, in addition to standard of care, during admission for painful vaso-occlusive crisis. Feasibility was demonstrated by the enrollment rate of > 90% and high level of participant engagement in the intervention. Acceptability was demonstrated by positive feedback obtained in post-intervention surveys and the majority of subjects who expressed interest in participating in future mindfulness and yoga therapy sessions.
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Affiliation(s)
- Pallavi Dev
- Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
| | - Natalie Bavli
- Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
| | - Brittney Sims
- Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
| | - Jenny Foster
- Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
| | - Anna Moscowitz
- Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
| | - Una E. Makris
- Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
| | - Siayareh Rambally
- Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
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Li J, Yang H, Xiao Y, Liu X, Ma B, Ma K, Hu L, Lu X. The analgesic effects and neural oscillatory mechanisms of virtual reality scenes based on distraction and mindfulness strategies in human volunteers. Br J Anaesth 2023; 131:1082-1092. [PMID: 37798154 DOI: 10.1016/j.bja.2023.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Virtual reality (VR) has been widely used as a non-pharmacological adjunct to pain management. However, there is no consensus on what type of VR content is the best for pain alleviation and by what means VR modulates pain perception. We used three experiments to explore the analgesic effect of VR scenes in healthy adult volunteers. METHODS We first compared the effect of immersive VR on pain perception with active (i.e. non-immersive, two-dimensional video) and passive (i.e. no VR or audiovisual input) controls at both subjective perceptual (Experiment 1) and electrophysiological (electroencephalography) levels (Experiment 2), and then explored possible analgesic mechanisms responsible for VR scenes conveying different strategies (e.g. exploration or mindfulness; Experiment 3). RESULTS The multisensory experience of the VR environment lowered pain intensity and unpleasantness induced by contact heat stimuli when compared with two control conditions (P=0.001 and P<0.001, respectively). The reduced pain intensity rating correlated with decreased P2 amplitude (r=0.433, P<0.001) and increased pre-stimulus spontaneous gamma oscillations (r=-0.339, P=0.004) by 32-channel electroencephalography. A VR exploration scene induced a strong sense of immersion that was associated with increased pre-stimulus gamma oscillations (r=0.529, P<0.001), whereas a VR mindfulness meditation scene had a minor effect on immersive feelings but induced strong pre-stimulus alpha oscillations (r=-0.550, P<0.001), which led to a comparable analgesic effect. CONCLUSIONS Distinct neural mechanisms are responsible for VR-induced analgesia, deepening our understanding of the analgesic benefits of VR and its neural electrophysiological correlates. These findings support further development of digital healthcare.
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Affiliation(s)
- Jingwei Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Haoyu Yang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yian Xiao
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Xu Liu
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, Dalian, China
| | - Bingjie Ma
- Department of Pain Management, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ke Ma
- Department of Pain Management, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Li Hu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xuejing Lu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Demina A, Petit B, Meille V, Lebon F, Trojak B. Interventions combining mindfulness training with non-invasive brain stimulation and their impact on mental health outcomes: Protocol for a systematic review and meta-analysis of randomized controlled trials. PLoS One 2023; 18:e0288692. [PMID: 38015857 PMCID: PMC10684008 DOI: 10.1371/journal.pone.0288692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/03/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Mindfulness training programs and non-invasive brain stimulation are both evidence-based interventions that have applications in mental health disorders. While both have showed promising results on a range of symptoms related to mental health, their combination has more recently grabbed the attention of researchers. There is a theoretical framework for their synergistic effects, and these effects can be tested through a variety of neurophysiological and clinical outcomes. This emerging field of research, which is regularly extended with new trials, has not yet been systematically reviewed. This systematic review protocol aims to present a rationale for combining these two interventions and to document the methodical approach to our systematic review before data extraction. METHODS AND ANALYSIS Four electronic databases (Medline, EMBASE, CENTRAL, PsycINFO) and three clinical trial registries (Clinical Trials, EU Trials, WHO ICTRP) were searched. All randomized controlled trials testing the combination of mindfulness-based interventions and non-invasive brain stimulation in humans will be included. As primary outcome, data on change in anxiety and depression symptoms from baseline, and, as secondary outcomes, other mental health outcomes data will be gathered. Data will be extracted independently by two authors using a predefined extraction form. Depending on the clinical heterogeneity of the included studies, the research team will decide whether a quantitative synthesis is appropriate for each of the predefined outcomes. If there is considerable statistical heterogeneity, subgroup analyses and meta-regression will be performed. Bias will be assessed using a revised Cochrane risk-of-bias tool for randomized trials and the strength of evidence in our review will be assessed using the GRADE form in GRADEPro. We started our scoping searches in November 2022. This systematic review and meta-analysis protocol was finished and submitted before the end of the independent full-text selection process by two members of the team. ETHICS AND DISSEMINATION Ethics approval and consent to participate were not applicable to our systematic review. Our dissemination plan includes the publication of our systematic review and meta-analysis in an international peer-reviewed journal as well as international communication of our results. TRIAL REGISTRATION PROSPERO registration number CRD42022353971.
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Affiliation(s)
- Anastasia Demina
- Addiction Medicine Department, Dijon Bourgogne University Hospital, Dijon, France
- INSERM U1093, CAPS, Université de Bourgogne, UFR STAPS, Dijon, France
| | - Benjamin Petit
- Addiction Medicine Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Vincent Meille
- Addiction Medicine Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Florent Lebon
- INSERM U1093, CAPS, Université de Bourgogne, UFR STAPS, Dijon, France
| | - Benoit Trojak
- Addiction Medicine Department, Dijon Bourgogne University Hospital, Dijon, France
- INSERM U1093, CAPS, Université de Bourgogne, UFR STAPS, Dijon, France
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Dubey A, Muley PA. Meditation: A Promising Approach for Alleviating Chronic Pain. Cureus 2023; 15:e49244. [PMID: 38143667 PMCID: PMC10739252 DOI: 10.7759/cureus.49244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Chronic pain is a complex and pervasive health issue that significantly impacts the lives of millions. Various cultures have been practicing meditation for thousands of years, and it has been shown that it has many positive effects on mental and physical health. The impact of meditation on chronic pain is encouraging as it will form the base for future advancements. Meditation can improve the body's natural pain-relieving processes, lower stress levels, and boost body awareness. Patients can select from a variety of meditation techniques and include them in their treatment plans in a way that suits them best. Although it may not be a permanent solution, meditation can give patients a useful tool for managing their pain. In both clinical and experimental contexts, mindfulness meditation has been shown to lessen pain dramatically. Meditation may be used to manage chronic pain, which has several benefits, including pain alleviation, stress reduction, improved sleep, and general health. The research study provides insights into various kinds of meditation practices as well as the scientific basis of the mechanisms that are mentioned in the literature for the management of pain. Meditation practices have been scientifically shown in numerous randomized controlled studies to reduce pain intensity, enhance pain tolerance, and improve quality of life in those with chronic pain. Although more research is necessary to fully understand the mechanisms underlying the practice, the encouraging evidence is currently available.
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Affiliation(s)
- Akshay Dubey
- Physiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Nagpur, IND
| | - Parikshit A Muley
- Physiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Nagpur, IND
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