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Saadoun M, Bauer MR, Adams RS, Highland KB, Larson MJ. Opioid and Nonpharmacologic Treatments Among Soldiers With Chronic Pain and Posttraumatic Stress Disorder. Psychiatr Serv 2021; 72:264-272. [PMID: 33467870 PMCID: PMC8127998 DOI: 10.1176/appi.ps.201900303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study examined the prevalence of chronic pain alone, posttraumatic stress disorder (PTSD) alone, and both chronic pain and PTSD among U.S. Army soldiers during the postdeployment year. METHODS The sample was 576,425 active duty soldiers returning from deployment in Afghanistan or Iraq between October 1, 2008, and September 30, 2014. Bivariate statistics were used to compare health care utilization among subgroups. Multivariate logistic regression with additional covariates was used to identify predictors of receiving an opioid days' supply of >30 days in the postdeployment year among soldiers with chronic pain, focusing on the effect of PTSD alone and on an interaction of PTSD with nonpharmacologic treatments (including therapeutic exercise, chiropractic treatment, acupuncture, and biofeedback). RESULTS In total, 12.2% of the soldiers received a chronic pain diagnosis, 5.1% a PTSD diagnosis, and 1.8% had both. Among soldiers with both conditions, 80.3% received nonpharmacologic treatment, and 31.4% received an opioid days' supply of >30 days. Among soldiers with chronic pain, comorbid PTSD and lack of nonpharmacologic treatment was associated with increased odds of receiving an opioid days' supply of >30 days (odds ratio [OR]=1.4, 95% confidence interval [CI]=1.3-1.6). PTSD combined with specific nonpharmacologic treatment modalities had a variable relationship with opioid receipt, and only PTSD with acupuncture or biofeedback was associated with reduced odds (OR=0.8, 95% CI=0.7-0.9). CONCLUSIONS Soldiers having both chronic pain and PTSD have significant health care needs. Although these soldiers accessed mental health care and received nonpharmacologic treatment, additional interventions are needed to mitigate protracted opioid utilization.
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Affiliation(s)
- Mayada Saadoun
- Schneider Institutes for Health Policy and Research, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Saadoun, Bauer, Adams, Larson); Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, and the Henry M. Jackson Foundation, Bethesda, Maryland (Highland)
| | - Mark R Bauer
- Schneider Institutes for Health Policy and Research, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Saadoun, Bauer, Adams, Larson); Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, and the Henry M. Jackson Foundation, Bethesda, Maryland (Highland)
| | - Rachel Sayko Adams
- Schneider Institutes for Health Policy and Research, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Saadoun, Bauer, Adams, Larson); Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, and the Henry M. Jackson Foundation, Bethesda, Maryland (Highland)
| | - Krista Beth Highland
- Schneider Institutes for Health Policy and Research, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Saadoun, Bauer, Adams, Larson); Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, and the Henry M. Jackson Foundation, Bethesda, Maryland (Highland)
| | - Mary Jo Larson
- Schneider Institutes for Health Policy and Research, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Saadoun, Bauer, Adams, Larson); Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, and the Henry M. Jackson Foundation, Bethesda, Maryland (Highland)
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Arvidsdotter T, Kylén S, Bäck-Pettersson S. Experiences of Living with Stress-Related Exhaustion Disorder and Participating in a Tailor-Made AntiStress Program in Primary Care. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/psych.2019.1011096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bishop FL, Salmon C. Advertising, Expectations and Informed Consent: The Contents and Functions of Acupuncture Leaflets. Acupunct Med 2018; 31:351-7. [DOI: 10.1136/acupmed-2013-010416] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the content of patient information leaflets about acupuncture. Methods 401 patient information leaflets were obtained from practising UK acupuncturists and subjected to content and thematic analysis. Results 59% of included leaflets were from NHS physiotherapists. Almost all the leaflets defined acupuncture and the majority explained how it might work, described the treatment process and placed it in a historical context. Most described possible benefits and risks of acupuncture and discussed contraindications and safety. Just under a third of leaflets (120, 30%) suggested conditions that might be helped by acupuncture, most commonly musculoskeletal pain, arthritis and injuries. By emphasising differences between individuals in acupuncture treatments and responsiveness, the leaflets fostered hope for positive effects without making any guarantees. Conclusions Information leaflets are broadly consistent with the evidence for acupuncture, but some claims are inconsistent with official advice from advertising regulators. An ethically sound, scientifically grounded and psychologically effective leaflet should accurately convey both benefits and risks of treatment, optimise patients’ expectations and allay concerns about needling. This study suggests that acupuncture leaflets might achieve these multiple functions but care should be taken to ensure adequate coverage of risks.
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Affiliation(s)
- Felicity L Bishop
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Cathy Salmon
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
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Dusek JA, Griffin KH, Finch MD, Rivard RL, Watson D. Cost Savings from Reducing Pain Through the Delivery of Integrative Medicine Program to Hospitalized Patients. J Altern Complement Med 2018; 24:557-563. [PMID: 29474095 PMCID: PMC6006422 DOI: 10.1089/acm.2017.0203] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES An important task facing hospitals is improving pain management without raising costs. Integrative medicine (IM), a promising nonpharmacologic pain management strategy, is yet to be examined for its cost implications in an inpatient setting. This institution has had an inpatient IM department for over a decade. The purpose was to examine the relationship between changes in patients' pain, as a result of receiving IM therapy, and total cost of care during an inpatient hospital admission. DESIGN In this retrospective analysis, data from an EPIC-based electronic health record (EHR) patient demographics, length of stay (LOS), and All Patient Refined Diagnosis Related Groups (APR-DRG) severity of illness measures were utilized. IM practitioners collected and entered patient-reported pain scores into the EHR. The authors regressed the demographic, change in pain, LOS, and APR-DRG variables with changes in pain on total cost for the hospital admission. To estimate cost savings to the hospital, they computed the average reduction in cost associated with reduction in pain by multiplying the coefficient for change in pain by average total cost. SETTING/LOCATION A large, tertiary care hospital in Minneapolis, MN. SUBJECTS Adult inpatient admissions, 2730, during the study period where patients received IM for pain and met eligibility criteria. INTERVENTION IM services provided to inpatients. OUTCOME MEASURES Change in pain on an 11-point numeric rating scale before and after initial IM sessions; total costs for hospital admissions. RESULTS Both LOS and age were found to increase cost, as did being white, male, married, and having APR-DRG severity coded as extreme. For patients receiving IM therapies, pain was reduced by an average of 2.05 points and this pain reduction was associated with a cost savings of $898 per hospital admission. CONCLUSIONS For patients receiving IM therapies, pain was significantly reduced and costs were lowered by about 4%.
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Affiliation(s)
- Jeffery A Dusek
- 1 Allina Health, Integrative Health Research Center, Penny George Institute for Health and Healing , Minneapolis, MN
| | - Kristen H Griffin
- 1 Allina Health, Integrative Health Research Center, Penny George Institute for Health and Healing , Minneapolis, MN
| | - Michael D Finch
- 2 Children's Minnesota, Children's Minnesota Research Institute , Minneapolis, MN
| | - Rachael L Rivard
- 1 Allina Health, Integrative Health Research Center, Penny George Institute for Health and Healing , Minneapolis, MN
| | - David Watson
- 2 Children's Minnesota, Children's Minnesota Research Institute , Minneapolis, MN
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Is Hyperbaric Oxygen Therapy Effective for Traumatic Brain Injury? A Rapid Evidence Assessment of the Literature and Recommendations for the Field. J Head Trauma Rehabil 2018; 32:E27-E37. [PMID: 27603765 PMCID: PMC5426690 DOI: 10.1097/htr.0000000000000256] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Supplemental Digital Content is Available in the Text. Objective: This systematic review examines the efficacy of hyperbaric oxygen (HBO2) for traumatic brain injury (TBI) to make evidence-based recommendations for its application and future research. Methods: A comprehensive search was conducted to identify studies through 2014. Methodological quality was assessed and synthesis and interpretation of relevant data was performed. Results: Twelve randomized trials were included. All mild TBI studies demonstrated minimal bias and no statistically significant differences between HBO2 and sham arms. Statistically significant improvement occurred over time within both groups. Moderate-to-severe TBI studies were of mixed quality, with majority of results favoring HBO2 compared with “standard care.” The placebo analysis conducted was limited by lack of details. Conclusions: For mild TBI, results indicate HBO2 is no better than sham treatment. Improvements within both HBO2 and sham groups cannot be ignored. For acute treatment of moderate-to-severe TBI, although methodology appears flawed across some studies, because of the complexity of brain injury, HBO2 may be beneficial as a relatively safe adjunctive therapy if feasible. Further research should be considered to resolve the controversy surrounding this field, but only if methodological flaws are avoided and bias minimized.
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Goyatá SLT, Avelino CCV, Santos SVMD, Souza Junior DID, Gurgel MDSL, Terra FDS. Effects from acupuncture in treating anxiety: integrative review. Rev Bras Enferm 2017; 69:602-9. [PMID: 27355312 DOI: 10.1590/0034-7167.2016690325i] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 11/01/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to evaluate the scientific evidence that is available in the literature on the effects of acupuncture for treating anxiety and on the quality of such studies. METHOD the study is an integrative review of CINAHL, LILACS, PUBMED-PICO, SciELO, and The Cochrane Library between 2001 and 2014. Keywords anxiety, acupuncture therapy, acupuncture, and anxiety disorders were combined among themselves to ensure a wide search of primary studies. RESULTS among 514 articles, 67 were selected to be fully read and 19 were included. Among these, 11 were found to have strong evidence levels. Among the six articles about randomized clinical studies, five were found to be of reasonable quality. Two studies used acupuncturist nurses to perform their interventions. Its results showed positive and statistically significant effects from using acupuncture for treating subjects with anxiety. CONCLUSION acupuncture seems to be a promising treatment for anxiety; however, there is a need for improving the methodological quality of the research on this field.
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Affiliation(s)
| | | | - Sérgio Valverde Marques Dos Santos
- Programa de Pós-Graduação Enfermagem Fundamental, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Sornborger J, Fann A, Serpa JG, Ventrelle J, R D N MS, Ming Foynes M, Carleton M, Sherrill AM, Kao LK, Jakubovic R, Bui E, Normand P, Sylvia LG. Integrative Therapy Approaches for Posttraumatic Stress Disorder: A Special Focus on Treating Veterans. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2017; 15:390-398. [PMID: 31975869 PMCID: PMC6519541 DOI: 10.1176/appi.focus.20170026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Over the past decade, the use of integrative health modalities, such as mind-body interventions, art therapy, nutrition, and exercise, to treat stress-related mental health conditions, including posttraumatic stress disorder (PTSD), in military and veteran populations has been increasing. The use of integrative therapies for PTSD provides options for veterans who are not interested in traditional modalities, have limited access to traditional treatments, or are seeking a more comprehensive approach to managing their PTSD or subthreshold symptoms. These therapies show promise for improving overall well-being and comorbid conditions with PTSD, such as pain or migraines, but yield mixed data for PTSD symptoms. The aim of this article is to review the evidence for the most promising integrative health modalities for treating PTSD, with a special focus on the treatment of veterans, as well as to offer recommendations and suggestions for clinicians.
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Affiliation(s)
- Jo Sornborger
- Drs. Sornborger and Serpa and Ms. Kao are with the University of California at Los Angeles Health System and the Semel Institute for Neuroscience and Human Behavior, Los Angeles, California. Drs. Fann and Sherrill are with Emory University School of Medicine, Atlanta, Georgia. Ms. Ventrelle and Dr. Normand are with Rush University Medical Center, Chicago. Dr. Foynes is with the National Center for PTSD, Veterans Administration Boston Healthcare System and Boston University School of Medicine, Boston. Ms. Carleton and Ms. Jakubovic are with Massachusetts General Hospital. Drs. Bui and Sylvia are with Massachusetts General Hospital and Harvard Medical School, Boston
| | - Alice Fann
- Drs. Sornborger and Serpa and Ms. Kao are with the University of California at Los Angeles Health System and the Semel Institute for Neuroscience and Human Behavior, Los Angeles, California. Drs. Fann and Sherrill are with Emory University School of Medicine, Atlanta, Georgia. Ms. Ventrelle and Dr. Normand are with Rush University Medical Center, Chicago. Dr. Foynes is with the National Center for PTSD, Veterans Administration Boston Healthcare System and Boston University School of Medicine, Boston. Ms. Carleton and Ms. Jakubovic are with Massachusetts General Hospital. Drs. Bui and Sylvia are with Massachusetts General Hospital and Harvard Medical School, Boston
| | - J Greg Serpa
- Drs. Sornborger and Serpa and Ms. Kao are with the University of California at Los Angeles Health System and the Semel Institute for Neuroscience and Human Behavior, Los Angeles, California. Drs. Fann and Sherrill are with Emory University School of Medicine, Atlanta, Georgia. Ms. Ventrelle and Dr. Normand are with Rush University Medical Center, Chicago. Dr. Foynes is with the National Center for PTSD, Veterans Administration Boston Healthcare System and Boston University School of Medicine, Boston. Ms. Carleton and Ms. Jakubovic are with Massachusetts General Hospital. Drs. Bui and Sylvia are with Massachusetts General Hospital and Harvard Medical School, Boston
| | - Jennifer Ventrelle
- Drs. Sornborger and Serpa and Ms. Kao are with the University of California at Los Angeles Health System and the Semel Institute for Neuroscience and Human Behavior, Los Angeles, California. Drs. Fann and Sherrill are with Emory University School of Medicine, Atlanta, Georgia. Ms. Ventrelle and Dr. Normand are with Rush University Medical Center, Chicago. Dr. Foynes is with the National Center for PTSD, Veterans Administration Boston Healthcare System and Boston University School of Medicine, Boston. Ms. Carleton and Ms. Jakubovic are with Massachusetts General Hospital. Drs. Bui and Sylvia are with Massachusetts General Hospital and Harvard Medical School, Boston
| | - M S R D N
- Drs. Sornborger and Serpa and Ms. Kao are with the University of California at Los Angeles Health System and the Semel Institute for Neuroscience and Human Behavior, Los Angeles, California. Drs. Fann and Sherrill are with Emory University School of Medicine, Atlanta, Georgia. Ms. Ventrelle and Dr. Normand are with Rush University Medical Center, Chicago. Dr. Foynes is with the National Center for PTSD, Veterans Administration Boston Healthcare System and Boston University School of Medicine, Boston. Ms. Carleton and Ms. Jakubovic are with Massachusetts General Hospital. Drs. Bui and Sylvia are with Massachusetts General Hospital and Harvard Medical School, Boston
| | - Melissa Ming Foynes
- Drs. Sornborger and Serpa and Ms. Kao are with the University of California at Los Angeles Health System and the Semel Institute for Neuroscience and Human Behavior, Los Angeles, California. Drs. Fann and Sherrill are with Emory University School of Medicine, Atlanta, Georgia. Ms. Ventrelle and Dr. Normand are with Rush University Medical Center, Chicago. Dr. Foynes is with the National Center for PTSD, Veterans Administration Boston Healthcare System and Boston University School of Medicine, Boston. Ms. Carleton and Ms. Jakubovic are with Massachusetts General Hospital. Drs. Bui and Sylvia are with Massachusetts General Hospital and Harvard Medical School, Boston
| | - Megan Carleton
- Drs. Sornborger and Serpa and Ms. Kao are with the University of California at Los Angeles Health System and the Semel Institute for Neuroscience and Human Behavior, Los Angeles, California. Drs. Fann and Sherrill are with Emory University School of Medicine, Atlanta, Georgia. Ms. Ventrelle and Dr. Normand are with Rush University Medical Center, Chicago. Dr. Foynes is with the National Center for PTSD, Veterans Administration Boston Healthcare System and Boston University School of Medicine, Boston. Ms. Carleton and Ms. Jakubovic are with Massachusetts General Hospital. Drs. Bui and Sylvia are with Massachusetts General Hospital and Harvard Medical School, Boston
| | - Andrew M Sherrill
- Drs. Sornborger and Serpa and Ms. Kao are with the University of California at Los Angeles Health System and the Semel Institute for Neuroscience and Human Behavior, Los Angeles, California. Drs. Fann and Sherrill are with Emory University School of Medicine, Atlanta, Georgia. Ms. Ventrelle and Dr. Normand are with Rush University Medical Center, Chicago. Dr. Foynes is with the National Center for PTSD, Veterans Administration Boston Healthcare System and Boston University School of Medicine, Boston. Ms. Carleton and Ms. Jakubovic are with Massachusetts General Hospital. Drs. Bui and Sylvia are with Massachusetts General Hospital and Harvard Medical School, Boston
| | - Lan K Kao
- Drs. Sornborger and Serpa and Ms. Kao are with the University of California at Los Angeles Health System and the Semel Institute for Neuroscience and Human Behavior, Los Angeles, California. Drs. Fann and Sherrill are with Emory University School of Medicine, Atlanta, Georgia. Ms. Ventrelle and Dr. Normand are with Rush University Medical Center, Chicago. Dr. Foynes is with the National Center for PTSD, Veterans Administration Boston Healthcare System and Boston University School of Medicine, Boston. Ms. Carleton and Ms. Jakubovic are with Massachusetts General Hospital. Drs. Bui and Sylvia are with Massachusetts General Hospital and Harvard Medical School, Boston
| | - Rafaella Jakubovic
- Drs. Sornborger and Serpa and Ms. Kao are with the University of California at Los Angeles Health System and the Semel Institute for Neuroscience and Human Behavior, Los Angeles, California. Drs. Fann and Sherrill are with Emory University School of Medicine, Atlanta, Georgia. Ms. Ventrelle and Dr. Normand are with Rush University Medical Center, Chicago. Dr. Foynes is with the National Center for PTSD, Veterans Administration Boston Healthcare System and Boston University School of Medicine, Boston. Ms. Carleton and Ms. Jakubovic are with Massachusetts General Hospital. Drs. Bui and Sylvia are with Massachusetts General Hospital and Harvard Medical School, Boston
| | - Eric Bui
- Drs. Sornborger and Serpa and Ms. Kao are with the University of California at Los Angeles Health System and the Semel Institute for Neuroscience and Human Behavior, Los Angeles, California. Drs. Fann and Sherrill are with Emory University School of Medicine, Atlanta, Georgia. Ms. Ventrelle and Dr. Normand are with Rush University Medical Center, Chicago. Dr. Foynes is with the National Center for PTSD, Veterans Administration Boston Healthcare System and Boston University School of Medicine, Boston. Ms. Carleton and Ms. Jakubovic are with Massachusetts General Hospital. Drs. Bui and Sylvia are with Massachusetts General Hospital and Harvard Medical School, Boston
| | - Patricia Normand
- Drs. Sornborger and Serpa and Ms. Kao are with the University of California at Los Angeles Health System and the Semel Institute for Neuroscience and Human Behavior, Los Angeles, California. Drs. Fann and Sherrill are with Emory University School of Medicine, Atlanta, Georgia. Ms. Ventrelle and Dr. Normand are with Rush University Medical Center, Chicago. Dr. Foynes is with the National Center for PTSD, Veterans Administration Boston Healthcare System and Boston University School of Medicine, Boston. Ms. Carleton and Ms. Jakubovic are with Massachusetts General Hospital. Drs. Bui and Sylvia are with Massachusetts General Hospital and Harvard Medical School, Boston
| | - Louisa G Sylvia
- Drs. Sornborger and Serpa and Ms. Kao are with the University of California at Los Angeles Health System and the Semel Institute for Neuroscience and Human Behavior, Los Angeles, California. Drs. Fann and Sherrill are with Emory University School of Medicine, Atlanta, Georgia. Ms. Ventrelle and Dr. Normand are with Rush University Medical Center, Chicago. Dr. Foynes is with the National Center for PTSD, Veterans Administration Boston Healthcare System and Boston University School of Medicine, Boston. Ms. Carleton and Ms. Jakubovic are with Massachusetts General Hospital. Drs. Bui and Sylvia are with Massachusetts General Hospital and Harvard Medical School, Boston
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Prince C, Bruhns ME. Evaluation and Treatment of Mild Traumatic Brain Injury: The Role of Neuropsychology. Brain Sci 2017; 7:brainsci7080105. [PMID: 28817065 PMCID: PMC5575625 DOI: 10.3390/brainsci7080105] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 11/04/2022] Open
Abstract
Awareness of mild traumatic brain injury (mTBI) and persisting post-concussive syndrome (PCS) has increased substantially in the past few decades, with a corresponding increase in research on diagnosis, management, and treatment of patients with mTBI. The purpose of this article is to provide a narrative review of the current literature on behavioral assessment and management of patients presenting with mTBI/PCS, and to detail the potential role of neuropsychologists and rehabilitation psychologists in interdisciplinary care for this population during the acute, subacute, and chronic phases of recovery.
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Affiliation(s)
- Carolyn Prince
- JFK Johnson Rehabilitation Institute, Center for Brain Injuries, Edison, NJ 08820, USA.
| | - Maya E Bruhns
- Alta Bates Summit Medical Center, Oakland, CA 94609, USA.
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Kameyama A, Toda K. SURVEY OF DENTAL STUDENTS' ATTITUDE REGARDING ORIENTAL MEDICINE/COMPLEMENTARY AND ALTERNATIVE MEDICINE: COMPARISON BETWEEN TWO JAPANESE DENTAL SCHOOLS. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES 2017; 14:287-295. [PMID: 28480440 PMCID: PMC5412235 DOI: 10.21010/ajtcam.v14i3.30] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: The present study aimed to examine the impact of “curricula for undergraduate education in oriental medicine (OM)/complementary and alternative medicine (CAM)” on student awareness of OM. A questionnaire survey was conducted involving the Nagasaki University School of Dentistry (NUSD), a university that implements education in OM as part of its undergraduate curriculum, and Tokyo Dental College (TDC), which does not teach OM. Materials and methods: The third- and fifth-year students of both NUSD and TDC underwent the anonymous questionnaire survey, which included questions regarding their knowledge of OM and CAM, interests in these subjects, and their opinions on the necessity of teaching OM in the undergraduate dental education, and the results were collected for analysis. Results: Whereas 33% of 5th year NUSD students had knowledge of OM/CAM was 33%, only 10% of 5th year TDC students reported knowledge on the subject. 69% of 5th year NUSD students interested in OM/CAM, while 5th year TDC students who interest them were only 45%. Although 77% of 5th year NUSD students were in favor of OM education implemented in the Faculty of Dentistry, the percentages of TDC students of that were smaller (46% in 3rd year and 48% in 5th year). Whereas 26% of 5th year TDC students did not recognize the necessity of oriental medicine education, only one 5th year NUSD student (2%) did not so. Conclusion: Introduction of education in OM in the undergraduate dental education program helps students to increase their interests in dental clinical applications.
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Affiliation(s)
- Atsushi Kameyama
- Department of Endodontics and Clinical Cariology, Tokyo Dental College, Chiba, JAPAN
| | - Kazuo Toda
- Department of Integrative Sensory Physiology, Unit of Basic Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JAPAN
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Hong C, Efferth T. Systematic Review on Post-Traumatic Stress Disorder Among Survivors of the Wenchuan Earthquake. TRAUMA, VIOLENCE & ABUSE 2016; 17:542-561. [PMID: 26028651 DOI: 10.1177/1524838015585313] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Post-traumatic stress disorder (PTSD) widely occurs among victims or witness of disasters. With flashbacks, hyperarousal, and avoidance being the typical symptoms, PTSD became a focus of psychological research. The earthquake in Wenchuan, China, on May 12, 2008, was without precedent in magnitude and aftermath and caused huge damage, which drew scientists' attention to mental health of the survivors. We conducted a systematic overview by collecting published articles from the PubMed database and classifying them into five points: epidemiology, neuropathology, biochemistry, genetics and epigenetics, and treatment. The large body of research during the past 6 years showed that adolescents and adults were among the most studied populations with high prevalence rates for PTSD. Genomic and transcriptomic studies focusing on gene × environment studies as well as epigenetics are still rare, although a few available data showed great potential to better understand the pathophysiology of PTSD as multifactorial disease. Phytotherapy with Chinese herbs and acupuncture are rarely reported as of yet, although the first published data indicated promising therapy effects. Future studies should focus on the following points: (1) The affected populations under observation should be better defined concerning individual risk factor, time of observation, spatial movement, and individual disease courses of patients. (2) The role of social support for prevalence rates of PTSD should be observed in more detail. (3) Efficacy and safety of Chinese medicine should be studied to find potential interventions and effective treatments of PTSD.
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Affiliation(s)
- Chunlan Hong
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Mainz, Germany
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Boyd C, Crawford C, Paat CF, Price A, Xenakis L, Zhang W. The Impact of Massage Therapy on Function in Pain Populations-A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part III, Surgical Pain Populations. PAIN MEDICINE (MALDEN, MASS.) 2016; 17:1757-1772. [PMID: 27165970 PMCID: PMC5013820 DOI: 10.1093/pm/pnw101] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Pain is multi-dimensional and may be better addressed through a holistic, biopsychosocial approach. Massage therapy is commonly practiced among patients seeking pain management; however, its efficacy is unclear. This systematic review and meta-analysis is the first to rigorously assess the quality of the evidence for massage therapy's efficacy in treating pain, function-related, and health-related quality of life outcomes in surgical pain populations. METHODS Key databases were searched from inception through February 2014. Eligible randomized controlled trials were assessed for methodological quality using SIGN 50 Checklist. Meta-analysis was applied at the outcome level. A professionally diverse steering committee interpreted the results to develop recommendations. RESULTS Twelve high quality and four low quality studies were included in the review. Results indicate massage therapy is effective for treating pain [standardized mean difference (SMD) = -0.79] and anxiety (SMD = -0.57) compared to active comparators. CONCLUSION Based on the available evidence, weak recommendations are suggested for massage therapy, compared to active comparators for reducing pain intensity/severity and anxiety in patients undergoing surgical procedures. This review also discusses massage therapy safety, challenges within this research field, how to address identified research gaps, and next steps for future research.
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Affiliation(s)
| | | | | | | | - Lea Xenakis
- Samueli Institute, Alexandria, Virginia, USA
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Boyd C, Crawford C, Paat CF, Price A, Xenakis L, Zhang W. The Impact of Massage Therapy on Function in Pain Populations-A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part II, Cancer Pain Populations. PAIN MEDICINE (MALDEN, MASS.) 2016; 17:1553-1568. [PMID: 27165967 PMCID: PMC4975018 DOI: 10.1093/pm/pnw100] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Pain is multi-dimensional and may be better addressed through a holistic, biopsychosocial approach. Massage therapy is commonly practiced among patients seeking pain management; however, its efficacy is unclear. This systematic review and meta-analysis is the first to rigorously assess the quality of massage therapy research and evidence for its efficacy in treating pain, function-related and health-related quality of life in cancer populations. METHODS Key databases were searched from inception through February 2014. Eligible randomized controlled trials were assessed for methodological quality using the SIGN 50 Checklist. Meta-analysis was applied at the outcome level. A diverse steering committee interpreted the results to develop recommendations. RESULTS Twelve high quality and four low quality studies were subsequently included in the review. Results demonstrate massage therapy is effective for treating pain compared to no treatment [standardized mean difference (SMD) = -.20] and active (SMD = -0.55) comparators. Compared to active comparators, massage therapy was also found to be beneficial for treating fatigue (SMD = -1.06) and anxiety (SMD = -1.24). CONCLUSION Based on the evidence, weak recommendations are suggested for massage therapy, compared to an active comparator, for the treatment of pain, fatigue, and anxiety. No recommendations were suggested for massage therapy compared to no treatment or sham control based on the available literature to date. This review addresses massage therapy safety, research challenges, how to address identified research gaps, and necessary next steps for implementing massage therapy as a viable pain management option for cancer pain populations.
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Affiliation(s)
| | | | | | | | - Lea Xenakis
- Samueli Institute, Alexandria, Virginia, USA
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Crawford C, Boyd C, Paat CF, Price A, Xenakis L, Yang E, Zhang W. The Impact of Massage Therapy on Function in Pain Populations-A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part I, Patients Experiencing Pain in the General Population. PAIN MEDICINE (MALDEN, MASS.) 2016; 17:1353-1375. [PMID: 27165971 PMCID: PMC4925170 DOI: 10.1093/pm/pnw099] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Pain is multi-dimensional and may be better addressed through a holistic, biopsychosocial approach. Massage therapy is commonly practiced among patients seeking pain management; however, its efficacy is unclear. This systematic review and meta-analysis is the first to rigorously assess the quality of massage therapy research and evidence for its efficacy in treating pain, function-related and health-related quality of life outcomes across all pain populations. METHODS Key databases were searched from inception through February 2014. Eligible randomized controlled trials were assessed for methodological quality using SIGN 50 Checklist. Meta-analysis was applied at the outcome level. A diverse steering committee interpreted the results to develop recommendations. RESULTS Sixty high quality and seven low quality studies were included in the review. Results demonstrate massage therapy effectively treats pain compared to sham [standardized mean difference (SMD) = -.44], no treatment (SMD = -1.14), and active (SMD = -0.26) comparators. Compared to active comparators, massage therapy was also beneficial for treating anxiety (SMD = -0.57) and health-related quality of life (SMD = 0.14). CONCLUSION Based on the evidence, massage therapy, compared to no treatment, should be strongly recommended as a pain management option. Massage therapy is weakly recommended for reducing pain, compared to other sham or active comparators, and improving mood and health-related quality of life, compared to other active comparators. Massage therapy safety, research challenges, how to address identified research gaps, and necessary next steps for implementing massage therapy as a viable pain management option are discussed.
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Jonas WB, Bellanti DM, Paat CF, Boyd CC, Duncan A, Price A, Zhang W, French LM, Chae H. A Randomized Exploratory Study to Evaluate Two Acupuncture Methods for the Treatment of Headaches Associated with Traumatic Brain Injury. Med Acupunct 2016; 28:113-130. [PMID: 27458496 PMCID: PMC4926228 DOI: 10.1089/acu.2016.1183] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Headaches are prevalent among Service members with traumatic brain injury (TBI); 80% report chronic or recurrent headache. Evidence for nonpharmacologic treatments, such as acupuncture, are needed. Objective: The aim of this research was to determine if two types of acupuncture (auricular acupuncture [AA] and traditional Chinese acupuncture [TCA]) were feasible and more effective than usual care (UC) alone for TBI-related headache. Materials and Methods:Design: This was a three-armed, parallel, randomized exploratory study. Setting: The research took place at three military treatment facilities in the Washington, DC, metropolitan area. Patients: The subjects were previously deployed Service members (18-69 years old) with mild-to-moderate TBI and headaches. Intervention: The interventions explored were UC alone or with the addition of AA or TCA. Outcome Measures: The primary outcome was the Headache Impact Test (HIT). Secondary outcomes were the Numerical Rating Scale (NRS), Pittsburgh Sleep Quality Index, Post-Traumatic Stress Checklist, Symptom Checklist-90-R, Medical Outcome Study Quality of Life (QoL), Beck Depression Inventory, State-Trait Anxiety Inventory, the Automated Neuropsychological Assessment Metrics, and expectancy of outcome and acupuncture efficacy. Results: Mean HIT scores decreased in the AA and TCA groups but increased slightly in the UC-only group from baseline to week 6 [AA, -10.2% (-6.4 points); TCA, -4.6% (-2.9 points); UC, +0.8% (+0.6 points)]. Both acupuncture groups had sizable decreases in NRS (Pain Best), compared to UC (TCA versus UC: P = 0.0008, d = 1.70; AA versus UC: P = 0.0127, d = 1.6). No statistically significant results were found for any other secondary outcome measures. Conclusions: Both AA and TCA improved headache-related QoL more than UC did in Service members with TBI.
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Affiliation(s)
| | | | | | | | | | | | | | - Louis M. French
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
| | - Heechin Chae
- Defense and Veterans Brain Injury Center Clinic, Fort Belvoir Community Hospital, Fort Belvoir, VA
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King CHC, Moore LC, Spence CDL. Exploring Self-Reported Benefits of Auricular Acupuncture Among Veterans With Posttraumatic Stress Disorder. J Holist Nurs 2015; 34:291-9. [PMID: 26530240 DOI: 10.1177/0898010115610050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Auricular acupuncture treatments are becoming increasingly available within military treatment facilities, resulting in an expansion of nonpharmacologic treatment options available to veterans with posttraumatic stress disorder (PTSD). This study aimed to explore the self-reported benefits of auricular acupuncture treatments for veterans living with PTSD. DESIGN A qualitative research methodology, thematic content analysis, was used to analyze data. METHOD Seventeen active duty veterans with PTSD provided written comments to describe their experiences and perceptions after receiving a standardized auricular acupuncture regimen for a 3-week period as part of a pilot feasibility study. FINDINGS A variety of symptoms experienced by veterans with PTSD were improved after receiving auricular acupuncture treatments. Additionally, veterans with PTSD were extremely receptive to auricular acupuncture treatments. Four themes emerged from the data: (1) improved sleep quality, (2) increased relaxation, (3) decreased pain, and (4) veterans liked/loved the auricular acupuncture treatments. CONCLUSIONS Veterans with PTSD reported numerous benefits following auricular acupuncture treatments. These treatments may facilitate healing and recovery for veterans with combat-related PTSD, although further investigations are warranted into the mechanisms of action for auricular acupuncture in this population.
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Crawford C, Boyd C, Jain S, Khorsan R, Jonas W. Rapid Evidence Assessment of the Literature (REAL(©)): streamlining the systematic review process and creating utility for evidence-based health care. BMC Res Notes 2015; 8:631. [PMID: 26525982 PMCID: PMC4630849 DOI: 10.1186/s13104-015-1604-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 10/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic reviews (SRs) are widely recognized as the best means of synthesizing clinical research. However, traditional approaches can be costly and time-consuming and can be subject to selection and judgment bias. It can also be difficult to interpret the results of a SR in a meaningful way in order to make research recommendations, clinical or policy decisions, or practice guidelines. Samueli Institute has developed the Rapid Evidence Assessment of the Literature (REAL) SR process to address these issues. REAL provides up-to-date, rigorous, high quality SR information on health care practices, products, or programs in a streamlined, efficient and reliable manner. This process is a component of the Scientific Evaluation and Review of Claims in Health Care (SEaRCH™) program developed by Samueli Institute, which aims at answering the question of "What works?" in health care. METHODS/DESIGN The REAL process (1) tailors a standardized search strategy to a specific and relevant research question developed with various stakeholders to survey the available literature; (2) evaluates the quantity and quality of the literature using structured tools and rulebooks to ensure objectivity, reliability and reproducibility of reviewer ratings in an independent fashion and; (3) obtains formalized, balanced input from trained subject matter experts on the implications of the evidence for future research and current practice. RESULTS Online tools and quality assurance processes are utilized for each step of the review to ensure a rapid, rigorous, reliable, transparent and reproducible SR process. CONCLUSIONS The REAL is a rapid SR process developed to streamline and aid in the rigorous and reliable evaluation and review of claims in health care in order to make evidence-based, informed decisions, and has been used by a variety of organizations aiming to gain insight into "what works" in health care. Using the REAL system allows for the facilitation of recommendations on appropriate next steps in policy, funding, and research and for making clinical and field decisions in a timely, transparent, and cost-effective manner.
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Affiliation(s)
- Cindy Crawford
- Samueli Institute, 1737 King Street, Suite 600, Alexandria, VA, 22314, USA.
| | - Courtney Boyd
- Samueli Institute, 1737 King Street, Suite 600, Alexandria, VA, 22314, USA.
| | - Shamini Jain
- Samueli Institute, 2101 East Coast Hwy., Suite 300, Corona del Mar, CA, 92625, USA.
| | - Raheleh Khorsan
- Samueli Institute, 2101 East Coast Hwy., Suite 300, Corona del Mar, CA, 92625, USA.
| | - Wayne Jonas
- Samueli Institute, 1737 King Street, Suite 600, Alexandria, VA, 22314, USA.
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Consumer Information and Treatment Resources for Posttraumatic Stress Disorder: Within Reach but Not Grasp. Harv Rev Psychiatry 2015; 23:426-37. [PMID: 26544093 DOI: 10.1097/hrp.0000000000000056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In the context of multiple treatment options for posttraumatic stress disorder (PTSD) and a large, growing need for consumer information regarding accessible and effective treatments, this article identifies and reviews available information and treatment resources. Multiple search strategies identified a suite of information sources, including meta-analyses and systematic reviews of PTSD treatments, the program evaluation and implementation literature, the economics literature, Internet sites, and other resources for veteran and civilian consumers. Resources were evaluated with regard to their target audiences, depth and breadth of treatment options covered, nature of the information provided, and accessibility to consumers. A large body of research covers the various treatments and sets of treatment guidelines for PTSD. Despite the extensive scientific information targeted at providers and researchers, the quality, accessibility, and usability of the published research varies widely. The Veterans Health Administration provides the most extensive information on various treatment options and where to obtain treatment within that system. Publicly available websites provide information on multiple treatment options, but information to help nonveterans navigate treatment choices is limited. Published reports of PTSD program-evaluation and implementation studies are sparse. Information on PTSD treatment options available to consumers can be overwhelming and confusing, which places an unnecessary burden on an already vulnerable group of patients and their families. Exacerbating the situation is the shortage of program-evaluation and implementation research. The dearth of centralized and accessible information related to nonveteran PTSD patient groups needs to be addressed.
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Jonas W, Walter J, Petri RP. Integrative Medicine and the Trauma Spectrum Response. Med Acupunct 2015. [DOI: 10.1089/acu.2014.1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Wayne Jonas
- President and Chief Executive Officer, Samueli Institute, Alexandria, VA
| | - Joan Walter
- Chief Operating Officer, Samueli Institute, Alexandria, VA
| | - Richard P. Petri
- United States Army, Chairman, NATO HFM-195 Task Force, Integrative Medicine Interventions for Military Personnel, El Paso, TX
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Jain S, Boyd C, Fiorentino L, Khorsan R, Crawford C. Are there efficacious treatments for treating the fatigue-sleep disturbance-depression symptom cluster in breast cancer patients? A Rapid Evidence Assessment of the Literature (REAL(©)). BREAST CANCER-TARGETS AND THERAPY 2015; 7:267-91. [PMID: 26379445 PMCID: PMC4567232 DOI: 10.2147/bctt.s25014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose While fatigue, sleep disturbance, and depression often co-occur in breast cancer patients, treatment efficacy for this symptom cluster is unknown. A systematic review was conducted to determine whether there are specific interventions (ie, medical, pharmacological, behavioral, psychological, and complementary medicine approaches) that are effective in mitigating the fatigue–sleep disturbance–depression symptom cluster in breast cancer patients, using the Rapid Evidence Assessment of the Literature (REAL©) process. Methods Peer-reviewed literature was searched across multiple databases; from database inception – October 2011, using keywords pre-identified to capture randomized controlled trials (RCT) relevant to the research question. Methodological bias was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) 50 checklist. Confidence in the estimate of effect and assessment of safety were also evaluated across the categories of included interventions via the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. Results The initial search yielded 531 citations, of which 41 met the inclusion criteria. Of these, twelve RCTs reported on all three symptoms, and eight of these were able to be included in the GRADE analysis. The remaining 29 RCTs reported on two symptoms. Studies were of mixed quality and many were underpowered. Overall, results suggest that there is: 1) promising evidence for the effectiveness of various treatment types in mitigating sleep disturbance in breast cancer patients; 2) mixed evidence for fatigue; 3) little evidence for treating depression; and 4) no clear evidence that treatment of one symptom results in effective treatment for other symptoms. Conclusion More high-quality studies are needed to determine the impact of varied treatments in mitigating the fatigue–sleep disturbance–depression symptom cluster in breast cancer patients. Furthermore, we encourage future studies to examine the psychometric and clinical validity of the hypothesized relationship between the symptoms in the fatigue–sleep disturbance–depression symptom cluster.
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Affiliation(s)
- Shamini Jain
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Lavinia Fiorentino
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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Gergen DM. Management of Mild Traumatic Brain Injury Symptoms in a 31-Year-Old Woman Using Cervical Manipulation and Acupuncture: A Case Report. J Chiropr Med 2015; 14:220-4. [PMID: 26778936 PMCID: PMC4685187 DOI: 10.1016/j.jcm.2015.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/05/2015] [Accepted: 08/05/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The objective was to describe chiropractic and acupuncture care of a patient with acute mild traumatic brain injury (mTBI) symptoms. CLINICAL FEATURES A 31-year-old woman had acute neck pain, headache, dizziness, nausea, tinnitus, difficulty concentrating, and fatigue following a fall. She was diagnosed at an urgent care facility with mTBI immediately following the fall. Pharmaceutical intervention had been ineffective for her symptoms. INTERVENTION AND OUTCOME The patient was treated with chiropractic adjustments characterized as high velocity, low amplitude thrusts directed to the cervical spine and local acupuncture points in the cervical and cranial regions. The patient received care for a total of 8 visits over 2.5 weeks with resolution of concussive symptoms. CONCLUSION This patient with mTBI responded favorably to a conservative treatment protocol with the combination of chiropractic and acupuncture care.
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Arvidsdotter T, Marklund B, Taft C, Kylén S. Quality of life, sense of coherence and experiences with three different treatments in patients with psychological distress in primary care: a mixed-methods study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:132. [PMID: 25928131 PMCID: PMC4467206 DOI: 10.1186/s12906-015-0654-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/17/2015] [Indexed: 12/14/2022]
Abstract
Background Psychological distress is associated with impaired health-related quality of life (HRQL) and poor sense of coherence (SOC). In a previous study, we found that therapeutic acupuncture (TA) and an integrative treatment that combined TA with person-centred approach in a salutogenic dialogue (IT) alleviated anxiety and depression significantly more than conventional treatment (CT) in primary care patients. Here, we report on secondary analyses regarding the HRQL and SOC from that previous pragmatic randomised controlled trial (RCT). Method Quantitative and qualitative design. One hundred twenty patients were referred for psychological distress. Quantitative analyses were performed at baseline and after 8 weeks of treatment using the SF-36 mental component summary (MCS), physical component summary (PCS) and the Sense of Coherence-13 (SOC) questionnaires. Qualitative manifest content analyses were based on open-ended questions—“Have you experienced any changes since the start of the treatment? Will you describe these changes?” Results No baseline differences were found. At 8 weeks, both the IT and TA groups had statistically better scores and greater improvement from baseline on the MCS and SOC than the CT group. The effect sizes were large. No significant differences were found between the IT and TA groups or in relation to the PCS. SOC was highly correlated with the MCS but not with the PCS. Dropout rates were low. The experiences of the intervention resulted in four categories: Being heading back; Status quo; Feeling confirmed; and Feeling abandoned, with 13 related subcategories. Conclusion IT and TA seem to improve sense of coherence and mental health status in primary care patients with psychological distress, whereas CT appears to be less beneficial. IT and TA appear to be well-accepted and may serve as useful adjunct treatment modalities to standard primary care. Our results are consistent with much of the previous research in highlighting a strong relationship between SOC and mental health status. The written qualitative data described feeling confirmed and feeling increased self-efficacy, self-care and faith in the future. Those in the CT group, however, described feeling abandoned, missing treatment and experiencing increased emotional and physical problems. More research is needed. Trial registration ISRCTN trial number NCT01631500.
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Lake J. The integrative management of PTSD: A review of conventional and CAM approaches used to prevent and treat PTSD with emphasis on military personnel. ADVANCES IN INTEGRATIVE MEDICINE 2015. [DOI: 10.1016/j.aimed.2014.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schulenburg J. Considerations for Complementary and Alternative Interventions for Pain. AORN J 2015; 101:319-26. [DOI: 10.1016/j.aorn.2015.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 09/14/2014] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
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Randomized effectiveness trial of a brief course of acupuncture for posttraumatic stress disorder. Med Care 2015; 52:S57-64. [PMID: 25397825 DOI: 10.1097/mlr.0000000000000237] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Initial posttraumatic stress disorder (PTSD) care is often delayed and many with PTSD go untreated. Acupuncture appears to be a safe, potentially nonstigmatizing treatment that reduces symptoms of anxiety, depression, and chronic pain, but little is known about its effect on PTSD. METHODS Fifty-five service members meeting research diagnostic criteria for PTSD were randomized to usual PTSD care (UPC) plus eight 60-minute sessions of acupuncture conducted twice weekly or to UPC alone. Outcomes were assessed at baseline and 4, 8, and 12 weeks postrandomization. The primary study outcomes were difference in PTSD symptom improvement on the PTSD Checklist (PCL) and the Clinician-administered PTSD Scale (CAPS) from baseline to 12-week follow-up between the 2 treatment groups. Secondary outcomes were depression, pain severity, and mental and physical health functioning. Mixed model regression and t test analyses were applied to the data. RESULTS Mean improvement in PTSD severity was significantly greater among those receiving acupuncture than in those receiving UPC (PCLΔ=19.8±13.3 vs. 9.7±12.9, P<0.001; CAPSΔ=35.0±20.26 vs. 10.9±20.8, P<0.0001). Acupuncture was also associated with significantly greater improvements in depression, pain, and physical and mental health functioning. Pre-post effect-sizes for these outcomes were large and robust. CONCLUSIONS Acupuncture was effective for reducing PTSD symptoms. Limitations included small sample size and inability to parse specific treatment mechanisms. Larger multisite trials with longer follow-up, comparisons to standard PTSD treatments, and assessments of treatment acceptability are needed. Acupuncture is a novel therapeutic option that may help to improve population reach of PTSD treatment.
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Lee C, Crawford C, Swann S. Multimodal, Integrative Therapies for the Self-Management of Chronic Pain Symptoms. PAIN MEDICINE 2014; 15 Suppl 1:S76-85. [DOI: 10.1111/pme.12408] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Delgado R, York A, Lee C, Crawford C, Buckenmaier C, Schoomaker E, Crawford P. Assessing the Quality, Efficacy, and Effectiveness of the Current Evidence Base of Active Self-Care Complementary and Integrative Medicine Therapies for the Management of Chronic Pain: A Rapid Evidence Assessment of the Literature. PAIN MEDICINE 2014; 15 Suppl 1:S9-20. [DOI: 10.1111/pme.12412] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Crawford C, Lee C, May T. Physically Oriented Therapies for the Self-Management of Chronic Pain Symptoms. PAIN MEDICINE 2014; 15 Suppl 1:S54-65. [DOI: 10.1111/pme.12410] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ralevski E, Olivera-Figueroa LA, Petrakis I. PTSD and comorbid AUD: a review of pharmacological and alternative treatment options. Subst Abuse Rehabil 2014; 5:25-36. [PMID: 24648794 PMCID: PMC3953034 DOI: 10.2147/sar.s37399] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Although posttraumatic stress disorder (PTSD) and alcohol use disorders (AUD) frequently co-occur there are no specific treatments for individuals diagnosed with these comorbid conditions. The main objectives of this paper are to review the literature on pharmacological options for PTSD and comorbid AUD, and to summarize promising behavioral and alternative interventions for those with these dual diagnoses. METHODS We conducted a comprehensive search on PsycINFO and MEDLINE/PubMed databases using Medical Subject Headings terms in various combinations to identify articles that used pharmacotherapy for individuals with dual diagnoses of PTSD and AUD. Similar strategies were used to identify articles on behavioral and alternative treatments for AUD and PTSD. We identified and reviewed six studies that tested pharmacological treatments for patients with PTSD and comorbid AUD. RESULTS The literature on treatment with US Food and Drug Administration approved medications for patients with dual diagnosis of PTSD and AUD is very limited and inconclusive. Promising evidence indicates that topiramate and prazosin may be effective in reducing PTSD and AUD symptoms in individuals with comorbidity. Seeking safety has had mixed efficacy in clinical trials. The efficacy of other behavioral and alternative treatments (mindfulness-based, yoga, and acupuncture) is more difficult to evaluate since the evidence comes from small, single studies without comparison groups. CONCLUSION There is a clear need for more systematic and rigorous study of pharmacological, behavioral, and alternative treatments for patients with dual diagnoses of PTSD and AUD.
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Affiliation(s)
- Elizabeth Ralevski
- Yale University School of Medicine, Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Lening A Olivera-Figueroa
- Yale University School of Medicine, Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ismene Petrakis
- Yale University School of Medicine, Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
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How to assess the external validity and model validity of therapeutic trials: a conceptual approach to systematic review methodology. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:694804. [PMID: 24734111 PMCID: PMC3963220 DOI: 10.1155/2014/694804] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 11/14/2013] [Accepted: 11/17/2013] [Indexed: 01/21/2023]
Abstract
Background. Evidence rankings do not consider equally internal (IV), external (EV), and model validity (MV) for clinical studies including complementary and alternative medicine/integrative medicine (CAM/IM) research. This paper describe this model and offers an EV assessment tool (EVAT©) for weighing studies according to EV and MV in addition to IV. Methods. An abbreviated systematic review methodology was employed to search, assemble, and evaluate the literature that has been published on EV/MV criteria. Standard databases were searched for keywords relating to EV, MV, and bias-scoring from inception to Jan 2013. Tools identified and concepts described were pooled to assemble a robust tool for evaluating these quality criteria. Results. This study assembled a streamlined, objective tool to incorporate for the evaluation of quality of EV/MV research that is more sensitive to CAM/IM research. Conclusion. Improved reporting on EV can help produce and provide information that will help guide policy makers, public health researchers, and other scientists in their selection, development, and improvement in their research-tested intervention. Overall, clinical studies with high EV have the potential to provide the most useful information about “real-world” consequences of health interventions. It is hoped that this novel tool which considers IV, EV, and MV on equal footing will better guide clinical decision making.
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Effects of an integrative treatment, therapeutic acupuncture and conventional treatment in alleviating psychological distress in primary care patients--a pragmatic randomized controlled trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 13:308. [PMID: 24200100 PMCID: PMC4226264 DOI: 10.1186/1472-6882-13-308] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 11/01/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND To evaluate and compare effects of an integrative treatment (IT), therapeutic acupuncture (TA), and conventional treatment (CT) in alleviating symptoms of anxiety and depression in psychologically distressed primary care patients. METHODS An open, pragmatic randomized controlled trial comparing the three treatment regimens at four and eight weeks after treatment. The study sample consisted of 120 adults (40 per treatment arm) aged 20 to 55 years referred from four different primary health care centres in western Sweden for psychological distress. Psychological distress was evaluated at baseline, and after 4 and 8 weeks of treatment using the Hospital Anxiety and Depression scale (HAD). Treatment sessions lasted about 60 minutes in IT and 45 minutes in TA. RESULTS No baseline differences were found between groups on HAD depression or anxiety. HAD anxiety and depression decreased significantly more in the IT and TA groups than in the CT group both after 4 and 8 weeks of treatment, but not between IT and TA. Improvements in the TA and IT groups were large and clinically significant, whereas CT effects were small and clinically non-significant. CONCLUSIONS Both IT and TA appear to be beneficial in reducing anxiety and depression in primary care patients referred for psychological distress, whereas CT does not. These results need to be confirmed in larger, longer-term studies addressing potentially confounding design issues in the present study. TRIAL REGISTRATION ISRCTN trial number NCT01631500.
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