Non-pharmacological Therapies Research Articles

Painful Realities: Navigating the Complexities of Head and Neck Cancer Pain.

Head and neck cancer (HNC) and its treatments can cause significant pain, which can profoundly impact patients' quality of life and treatment outcomes. Understanding the full scope of HNC pain is essential for effective management and improved patient care. This review aims to comprehensively analyze the multifaceted nature of pain experienced by individuals with HNC, including its various etiologies and management strategies. HNC pain can arise from tumor extent, treatment-related toxicity, or comorbid conditions. The pathophysiology involves complex interactions between nociceptive, neuropathic, and inflammatory mechanisms. Optimal pain control requires a multimodal patient-tailored approach utilizing both pharmacological and non-pharmacological therapies. Enhancing our understanding of HNC pain and optimizing its management is imperative for improving the overall well-being and treatment outcomes of affected individuals. Future research should focus on understanding detailed pain mechanisms, with the goal of developing personalized pain management strategies and exploring novel therapeutic targets. By implementing comprehensive approaches to HNC pain management, healthcare providers can better support patients through their cancer treatment journey.

Effects of Combined Visual-Motor Response Training on Cognitive Function and Brain Plasticity Mechanisms in Various Populations: Protocol for a Single-Center, Open-Label, Controlled Clinical Trial.

Cognitive impairment is one of the major diseases facing the aging population. The progressive decline of cognitive function can lead to declining health or even the loss of life, work, and social ability. Exercise and behavioral stimulation can increase neurotransmitters in the brain and improve overall health and cognitive function. Reactivity training can mobilize neuromuscular function and induce changes in brain plasticity, which may effectively improve cognitive dysfunction and delay the occurrence and development of Alzheimer disease; however, the evidence supporting its effectiveness is still limited. This study aims to explore the effectiveness and reliability of visual-motor reaction training in improving cognitive function, thereby promoting the application of novel nonpharmacological therapies. This study is a single-center, open-label, controlled clinical trial. A total of 78 participants will be recruited for the study, including an equal number of athletes, ordinary healthy college students, and ordinary older adults in the community. Participants will receive 2 weeks of visual-motor response training. The primary outcome of this study is to assess differences in functional magnetic resonance imaging (fMRI) at 2 weeks. The secondary outcomes were the following: acousto-optic response time, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Mini Mental State Examination (MMSE), Activity of Daily Living (ADL) Scale, Subjective Cognitive Decline Questionnaire-9 (SCD-Q9), a 10-word memory test, and safety. The study was approved by the Shanghai Clinical Research Ethics Committee on January 2, 2024 (SECCR/2023-162-01). As of September 11, 2024, we have completed the recruitment of all 3 groups of volunteers. We expect to complete data collection and analysis by February 2025. The purpose of this study is to compare improvements in brain perceptual motor functions and cognitive levels across different populations through response ability training and to explore the efficacy and safety of exercise-based nonpharmacological therapies in improving cognitive function. Other potential benefits include understanding the functional differences and perceptual characteristics of the brain's perceptual-motor system between athletes and the general population and exploring the adaptability of the brain in acquiring skills during competitive sports training. This could provide an evidence base for early sports talent development and broader youth development. Chinese Clinical Trial Registry ChiCTR2400079602; https://tinyurl.com/23fbbndw. DERR1-10.2196/56424.

Lipoprotein Apheresis: Utility, Outcomes, and Implementation in Clinical Practice: A Scientific Statement From the American Heart Association.

Despite the availability of multiple classes of lipoprotein-lowering medications, some high-risk patients have persistent hypercholesterolemia and may require nonpharmacologic therapy. Lipoprotein apheresis (LA) is a valuable but underused adjunctive therapeutic option for low-density lipoprotein cholesterol and lipoprotein(a) lowering, particularly in children and adults with familial hypercholesterolemia. In addition to lipid lowering, LA reduces serum levels of proinflammatory and prothrombotic factors, reduces blood viscosity, increases microvascular myocardial perfusion, and may provide beneficial effects on endothelial function. Multiple observational studies demonstrate strong evidence for improved cardiovascular outcomes with LA; however, use in the United States is limited to a fraction of its Food and Drug Administration-approved indications. In addition, there are limited data regarding LA benefit for refractory focal segmental glomerulosclerosis. In this scientific statement, we review the history of LA, mechanisms of action, cardiovascular and renal outcomes data, indications, and options for treatment.

Acupuncture’s Emergence as A Promising Non-Pharmacological Therapy for Appetite Management in Cancer Chemotherapy

Objective The primary objective of this investigation was to assess the impact of acupuncture intervention and explore the intricacies of acupoint selection as a therapeutic strategy for chemotherapy-induced Anorexia (CIA). Method Eight electronic databases were searched to identify relevant studies on the use of acupuncture for the treatment of CIA to conduct a comprehensive meta-analysis. Following this, the Apriori algorithm, correlation analysis, and cluster analysis were performed to identify correlations between the selection of acupoints. Results Acupuncture significantly reduced the incidence of anorexia (RR = 0.76, 95%CI: 0.65, 0.90; I 2=63%; p = 0.001; n = 503) and anorexia score (SMD=-0.33, 95%CI: −0.53, −0.14; I 2=22%; p = 0.0008; n = 419), as well as preserved body mass (MD = 2.70, 95%CI: 1.08, 4.32; I 2=0%; p = 0.001; n = 187) and enhanced physical strength (MD = 4.23, 95%CI: 1.90, 6.55; I 2=58%; p = 0.0004; n = 377). Moreover, subgroup analysis highlighted its efficacy in managing anorexia associated with non-gastrointestinal tumors and mitigating the severity of cisplatin-induced anorexia. Meanwhile, Zusanli (ST36), Neiguan (PC6), Tianshu (ST25), Zhongwan (RN12), and Qihai (RN6) were identified as crucial acupoints in CIA management. Conclusion Acupuncture holds promise as a potential non-pharmacological approach for managing anorexia during cancer chemotherapy. To provide robust evidence of its effectiveness, well-designed Randomized Controlled Trials (RCTs) with larger participant cohorts, and consistent core outcome measures are essential.

Pulmonary Hypertension: Pharmacological and Non-Pharmacological Therapies.

Pulmonary hypertension (PH) is a severe and chronic disease characterized by increased pulmonary vascular resistance and remodeling, often precipitating right-sided heart dysfunction and death. Although the condition is progressive and incurable, current therapies for the disease focus on multiple different drugs and general supportive therapies to manage symptoms and prolong survival, ranging from medications more specific to pulmonary arterial hypertension (PAH) to exercise training. Moreover, there are multiple studies exploring novel experimental drugs and therapies including unique neurostimulation, to help better manage the disease. Here, we provide a narrative review focusing on current PH treatments that target multiple underlying biochemical mechanisms, including imbalances in vasoconstrictor-vasodilator and autonomic nervous system function, inflammation, and bone morphogenic protein (BMP) signaling. We also focus on the potential of novel therapies for managing PH, focusing on multiple types of neurostimulation including acupuncture. Lastly, we also touch upon the disease's different subgroups, clinical presentations and prognosis, diagnostics, demographics, and cost.

Health Literacy and Adherence to Therapy in Type 2 Diabetes: A Cross-Sectional Study in Portugal.

Therapy adherence is a key factor in the control of type 2 diabetes mellitus (T2DM). Optimal self-care requires skills in health literacy (HL). This study aims to analyze the relationship between HL and adherence to therapy and to understand the possible influence of other sociodemographic and disease variables. A multicenter, cross-sectional study was conducted in Portuguese in 13 different primary health care units in both rural and urban environments. A sociodemographic questionnaire and two validated instruments, "Medical Term Recognition Test" and "Summary of Diabetes Self-Care Activities," were applied. The last value of hemoglobin A1c (HbA1c) and the number of chronic medications were collected from clinical records. Descriptive statistics and bivariate correlations were performed as well as multivariable linear regression to assess the association between HL and adherence to therapy. Participants (n = 354) were on average age 63.67 ± 10.39 years, 57.1% male and 42.9% female, 68.4% with inadequate HL and an average HbA1c of 7 ± 1.18%. Better HL was correlated with higher adherence to the total of self-care activities, nonpharmacological therapy, and foot care. In multivariable linear regression analyses, better HL (β = 0.176, p = .003), less than minimum wage (β = -0.197, p = .001) and insulin therapy (β = 0.272, p = .001) were independently associated with increased adherence to overall self-care activities. In a representative sample of people with T2DM in Portugal, HL was a key factor for greater adherence to demanding self-care activities. [HLRP: Health Literacy Research and Practice. 2024;8(4):e194-e203.].

Evaluation of comparative efficacy of Hijama bila shart (dry cupping) and Bukhoor (steam application) in the management of low back pain

IntroductionLow back pain is an important cause of disability. The aim of treatment is to reduce the pain and minimize its consequences. Management includes counseling and reassurance, use of analgesics, non-pharmacological therapies, and regular review. MethodAn open-label, randomized, and parallel-group clinical trial was conducted in which Group A patients received Hijama bila Shart (dry cupping) while group B patients received Bukhoor (medicated steam application); both therapies were given for 5 min in 3 sittings (day 1, 4 and 8). ResultOswestry LBP Total Scores in Group A decreased from 20.70 ± 0.49 to 6.77 ± 0.37, while in Group B it decreased from 20.07 ± 3.63 to 5.83 ± 2.36. The pain intensity also decreased from 3.10 ± 0.55 to 1.57 ± 0.57 in group A, while from 2.97 ± 0.61 to 1.30 ± 0.75 in group B. Improvement in disability was also found statistically significant. On comparing the improvement in disability between the group, the difference was significant (p < 0.05), and improvement in group A was a little better as compared to group B. DiscussionThe effect of dry cupping may be due to increased blood circulation; lymphatic channelization and dispersion of inflammatory chemicals from the site of pain. The effect of medicated steam application may be due to the anti-inflammatory and muscle relaxing effects of steam and heat of the steam itself; the drugs used for steam application are reported to reduce inflammation on local application. ConclusionDry cupping and Medicated Steam application both are beneficial, safe, and cost effective treatment modalities for the Low back pain.

Recent advances in acupuncture for pain relief.

Acupuncture therapy has achieved global expansion and shown promise for health promotion and treatment of acute/chronic pain. To present an update on the existing evidence base for research and clinical practice supporting acupuncture analgesia. This Clinical Update elaborates on the 2023 International Association for the Study of Pain Global Year for Integrative Pain Care "Factsheet Acupuncture for Pain Relief" and reviews best evidence and practice. Acupuncture is supported by a large research evidence base and growing utilization. Mechanisms of acupuncture analgesia include local physiological response at the needling site, suppression of nociceptive signaling at spinal and supraspinal levels, and peripheral/central release of endogenous opioids and other biochemical mediators. Acupuncture also produces pain relief by modulating specific brain networks, integral for sensory, affective, and cognitive processing, as demonstrated by neuroimaging research. Importantly, acupuncture does not just manage pain symptoms but may target the sources that drive pain, such as inflammation, partially by modulating autonomic pathways. Contextual factors are important for acupuncture analgesia, which is a complex multifaceted intervention. In clinical practice, historical records and many providers believe that acupuncture efficacy depends on specific acupoints used, the technique of needle placement and stimulation, and the person who delivers the procedure. Clinical research has supported the safety and effectiveness of acupuncture for various pain disorders, including acupuncture as a complementary/integrative therapy with other pain interventions. Although the quality of supportive evidence is heterogeneous, acupuncture's potential cost-effectiveness and low risk profile under standardized techniques suggest consideration as a neuromodulatory and practical nonpharmacological pain therapy.

Research trends of traditional Chinese non-pharmacological therapy in the management of overweight and obesity from 2004 to 2023: a bibliometric study

ObjectiveTraditional Chinese non-pharmacological therapy has gained popularity in the management of overweight and obesity. This study aims to reveal trends and hotspots of global research on traditional Chinese non-pharmacological therapies for overweight and obesity. MethodsPublications on traditional Chinese non-pharmacological therapies for overweight and obesity between 2004 and 2023 were searched from the Web of Science Core Collection. Bibliometric analyses and visualization were performed using VOSviewer, CiteSpace, and R software. ResultsA total of 566 publications from 246 journals were included in this study. Annual number of publications and cited times in the field were generally increasing. China contributed the most publications, followed by the United States and Republic of Korea, and Chengdu University of Traditional Chinese Medicine from China had the highest number of publications among institutions. Stener-Victorin E was not only the most productive author but also, along with Cabioglu MT, the most cited authors. Evidence-Based Complementary and Alternative Medicine was both the largest source journal and the most cited journal. The highly cited references mainly consists of clinical trials, narrative reviews and systematic reviews focusing on acupuncture therapy. Keywords analysis indicated that acupuncture therapy and traditional Chinese exercise constituted the main components of traditional Chinese non-pharmacological therapy in weight management. ConclusionsThis study revealed a growing interest in traditional Chinese non-pharmacological therapies for managing overweight and obesity, with acupuncture therapies and traditional Chinese exercises as the main research focuses. This study offers insights into traditional Chinese non-pharmacological therapies in weight management, and may benefit further research.

Beyond Guideline-Directed MedicalTherapy: Nonpharmacologic Management for Patients With HeartFailure.

Heart failure (HF) is a leading cause of cardiovascular morbidity, mortality, and health care expenditure. Guideline-directed medical therapy and device-based therapy in HF are well established. However, the role of nonpharmacologic modalities to improve HF care remains underappreciated, is underused, and requires multimodal approaches to care. Diet,exercise and cardiac rehabilitation, sleep-disordered breathing, mood disorders, and substance use disorders are potential targets to reduce morbidity and improve function of patients with HF. Addressing these factors may improve symptoms and quality of life, reduce hospitalizations, and improve mortality in heart failure. This state-of-the-art reviewdiscusses dietary interventions, exercise programs, and the management of sleep-disordered breathing, mood disorders, and substance use in individuals with heart failure. The authors review the latest data and provide optimal lifestyle recommendations and recommended prescriptions for nonpharmacologic therapies.

Non-Pharmacological Management of Insomnia in Cancer Patients

Abstract Introduction. Insomnia is a common sleep disorder in cancer patients, characterized by a reduction in the quality or quantity of sleep. It can lead to fatigue, mood disturbances, and may contribute to immunosuppression, affecting both disease progression and quality of life. Materials and methods. In an attempt to answer the question: “Does non-pharmacological treatment of insomnia improve the quality of life in cancer patients?”, we conducted a systematic search in the international databases PubMed and ScienceDirect, following the PRISMA guidelines. The search keywords were “insomnia,” “sleep disorders,” “cancer,” and “quality of life.” Results. The systematic review included eight randomized trials that evaluated the effect of non-pharmacological therapies on insomnia and quality of life in oncology patients. Cognitive-behavioral therapy (CBT) is the first-line treatment with proven efficacy. Variants of CBT delivered through online platforms were found to be non-inferior in studies involving small patient groups. Another alternative treatment is acupuncture, which, while not as effective as CBT, improves sleep quality and enhances quality of life. Physical exercise, dance, nutrition programs, and psychological counseling also improve sleep and enhance quality of life compared to the usual hospital approaches. Conclusions. Non-pharmacological treatment of insomnia improves the quality of life in cancer patients.

Impact of a Nutrition and Diabetes Continuing Education Program on Primary Care Provider's Knowledge, Attitude, and Clinical Practice.

Diet/nutrition is the first-line non-pharmacological therapy in the treatment of diabetes. Diet/nutrition counseling is infrequently provided by primary care providers (PCPs), who have limited nutrition education in both medical and advanced practice provider curricula. This quality improvement project aimed to improve knowledge and attitude, and frequency of diet/nutrition counseling by PCPs among patients with uncontrolled diabetes (glycosylated hemoglobin A1c ≥8%), by providing an online continuing medical education (CME) program on diabetes diet/nutrition. At a community health center in New England, PCPs attended a live 50-minute online CME program that was developed internally, which taught PCPs current diet/nutrition guidelines and recommendations related to diabetes. Knowledge was assessed prior to and two weeks following the program, utilizing a 10-question tool, the Nutrition Management of Diabetes Assessment (NMDA). Similarly, attitude was evaluated using two subscales of the Nutrition in Patient Care Survey (NIPS): Nutrition in routine care and Physician efficacy. Chart audits of patients with uncontrolled diabetes were evaluated to assess PCPs documentation of diet/nutrition counseling four weeks prior to and six weeks following the CME program. In September 2023, PCPs (n = 29) completed the CME program. There was an improvement in knowledge in the NMDA amongst PCPs (36% difference, p < 0.001). Attitude scores from two subscales of the NIPS were evaluated and both showed improvement, however only physician efficacy was significant (15% difference, p < 0.01). There was a positive difference in the trend of diet/nutrition counseling after the education program (p < 0.05). An online CME program improved diabetes diet/nutrition knowledge and attitude of PCPs and improved counseling practices for patients living with uncontrolled diabetes. The education program provided PCPs current standards of care guidelines/recommendations, which they can utilize when counseling patients with diabetes. PCPs would benefit from dedicated continuing education programs regarding diet/nutrition therapy for chronic illnesses.

Understanding Non-Pharmacological Treatments for Fibromyalgia Functional and Well-Being Status: The Role of Literacy

Background/Objectives: Fibromyalgia (FM) affects up to 5% of the global population and is a leading cause of significant social and economic consequences. Higher health literacy leads to better understanding of treatment plans, improved self-care, and adherence to recommendations, enhancing overall quality of life. This study aims to determine whether different aspects of the disease are influenced by patients’ education level and literacy when applying the same therapy and to assess how patients’ perceptions of therapy outcomes vary over time based on their educational level. Methods: This study involved 140 fibromyalgia (FM) patients diagnosed using the 2016 ACR criteria, with 128 completing the study. Participants attended three visits over 28 weeks and were stratified into four groups based on educational level: Group 1—secondary school or less; Group 2—high school graduates; Group 3—college graduates; Group 4—university graduates. Patients were assigned to groups (n = 32, 32, 30, and 34, respectively) after the initial evaluation (T0). The treatment was assessed (T1) and followed up three months later (T2) to evaluate changes in functional status and quality of life. All patients underwent the same rehabilitation program, cognitive therapy, and kinesiotherapy. Results: Significant differences in disease impact on the patient’s life (FIQ total score) were observed between groups from the initial evaluation (p = 0.000). The overall FIQ score was notably affected by non-pharmacological therapy in patients with higher education. These differences continued to be significant even three months after the treatment ended (p = 0.000). Functional limitations were evident from the start (p = 0.000) and improved significantly post-treatment in patients with higher education (p = 0.000). However, subjective evaluations of disease impact (assessed by the first item of FIQ) did not consistently align with objective findings (hand grip strength). Functional limitations did not significantly differ in subjective evaluations (F1Q1) across educational levels (p = 0.045), and inverse correlations were noted between functional status and SF-12 well-being components. Conclusions: This study underscores that higher education enhances fibromyalgia management and functional outcomes, particularly when combined with non-pharmacological therapies. However, subjective perceptions may not always align with objective improvements, indicating that factors beyond education, such as personal and external influences, also impact disease management. Thus, improving health literacy through educational interventions could further benefit FM patients’ quality of life.

Etodolac utility in osteoarthritis: drug delivery challenges, topical nanotherapeutic strategies and potential synergies.

Osteoarthritis (OSA) is a prevalent joint disorder characterized by losing articular cartilage, primarily affecting the hip, knee and spine joints. The impact of OSA offers a major challenge to health systems globally. Therapeutic approaches encompass surgical interventions, non-pharmacological therapies (exercise, rehabilitation, behavioral interventions) and pharmacological treatments. Inflammatory processes within OSA joints are regulated by pro-inflammatory and anti-inflammatory cytokines. Etodolac, a COX-2-selective inhibitor, is the gold standard for OSA management and uniquely does not inhibit gastric prostaglandins. This comprehensive review offers insights into OSA's pathophysiology, genetic factors and biological determinants influencing disease progression. Emphasis is placed on the pivotal role of etodolac in OSA management, supported by both preclinical and clinical evidences in topical drug delivery. Notably, in-silico docking studies suggested potential synergies between etodolac and baicalein, considering ADAMTS-4, COX-2, MMP-3 and MMP-13 as essential therapeutic targets. Integration of artificial neural network (ANN) techniques with nanotechnology approaches emerges as a promising strategy for optimizing and personalizing topical etodolac delivery. Furthermore, the synergistic potential of etodolac and baicalein warrants in-depth exploration. Hence, by embracing cutting-edge technologies like ANN and nanomedicine, the optimization of topical etodolac delivery could guide a new era of OSA treatment.

The Impact of Uric Acid-Lowering Therapy on the Progression of Non-dialysis Chronic Kidney Disease: A Prospective Cohort Study.

Background Hyperuricemia treatment can positively influence the progression of chronic kidney disease (CKD). This study aimed to evaluate the impact of uric acid-lowering therapy on the progression of CKD after three months. Materials and methods A prospective cohort study was conducted on 126 patients with non-dialysis CKD in Can Tho Central General Hospital, Vietnam, from December 2018 to December 2019. Adopting a questionnaire survey method to collect information, including demographic characteristics, body mass index (BMI), personal history, previous medical history, diet, and use of drugs with the potential to affect the uric acid levels in the blood. Participants also underwent necessary tests, such as serum uric acid, serum creatinine, and blood lipids. Data were analyzed using SPSS software version 26.0(IBM Corp., Armonk, NY). Results The prevalence of hyperuricemia in patients with non-dialysis CKD was 77.8%, and the average serum uric acid was 494.21 ± 131.57 µmol/L. Patients with a high-purine diet were about 18.85 times as likely to have hyperuricemia as those with a low-purine diet (p < 0.001, OR = 18.85, 95%CI: 4.233-83.938). BMI, stages of CKD, and hypertension were associated with the hyperuricemia rate (p < 0.05). After three months of treatment, 46.2% of patients achieved the serum uric acid target, and the patient group combined allopurinol with changing diet had a higher rate than the patient group changing diet only (p = 0.02). There was a moderate inverse correlation between the difference in serum uric acid and the difference in estimated glomerular filtration rate (eGFR) after treatment (r = -0.5, p = 0.001). Conclusions The effective management of hyperuricemia by combining nonpharmacological (changing diet) and/or pharmacological (allopurinol) therapies may meaningfully improve the glomerular filtration rate in non-dialysis CKD patients with hyperuricemia.

The Effectiveness of Familiar Auditory Sensory Training (FAST) in Increasing Consciousness Levels among Stroke Patients

Stroke is a leading cause of death worldwide, along with myocardial infarction and cancer. Stroke often results in loss of consciousness and neurological deficits that affect sensory perception. To support recovery, non-pharmacological therapies like auditory sensory stimulation are crucial. Familiar Auditory Sensory Training (FAST) is one such intervention. This study assessed the effectiveness of FAST in improving consciousness levels in stroke patients using a one-group pretest-posttest design. It involved 35 stroke patients aged 35-75, who were selected through purposive sampling and underwent three FAST sessions. Consciousness levels were measured using the Glasgow Coma Scale (GCS) before and after the intervention. Data analysis with the Wilcoxon rank test at α=0.05 revealed a significant increase in consciousness from a mean of 6.77 to 10.83 post-intervention (p=0.001), demonstrating FAST's effectiveness in enhancing consciousness in ICU stroke patients.

Effect of Taichi Exercise on Blood Pressure in a Family with Hypertension in Banjarsengon Village: A Case Study

Hypertension is a critical global health issue that affects quality of life and increases the risk of cardiovascular disease. The purpose of this case study is to assess the efficacy of Taichi exercise as a nonpharmacological therapy for decreasing blood pressure in the family with hypertension. Mrs. H, a 49-year-old single mother with a history of hypertension lived in Banjarsengon Village, Jember. The Taichi exercise intervention was performed twice a week for three weeks. Following six sessions of Taichi exercise, total systolic blood pressure decreased by 10 mmHg and diastolic by 6 mmHg. Family empowerment through the participation of Mrs. H's children in supporting the implementation of Taichi exercise is key in this therapeutic approach. The results of this study suggest that Taichi exercise has potential as a safe and effective alternative therapy for the management of hypertension. In order for the hypertension management program in families to have maximum impact, it is very necessary to increase family empowerment through health workers in community health centers who are monitored periodically.

Advancements in Pharmacological Interventions and Novel Therapeutic Approaches for Amyotrophic Lateral Sclerosis.

(1) Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease in which the patient suffers from an affection of both upper and lower motor neurons at the spinal and brainstem level, causing a progressive paralysis that leads to the patient's demise. Gender is also considered a predisposing risk factor for developing the disease. A brief review of the pathophysiological mechanisms of the disease is also described in this work. Despite the fact that a cure for ALS is currently unknown, there exists a variety of pharmacological and non-pharmacological therapies that can help reduce the progression of the disease over a certain period of time and alleviate symptoms. (2) We aim to analyze these pharmacological and non-pharmacological therapies through a systematic review. A comprehensive, multidisciplinary approach to treatment is necessary. (3) Drugs such as riluzole, edaravone, and sodium phenylbutyrate, among others, have been investigated. Additionally, it is important to stay updated on research on new drugs, such as masitinib, from which very good results have been obtained. (4) Therapies aimed at psychological support, speech and language, and physical therapy for the patient are also available, which increase the quality of life of the patients.

Biomarkers and Novel Therapies of Diabetic Neuropathy: An Updated Review.

Diabetic neuropathy is a persistent consequence of the biochemical condition known as diabetes mellitus. As of now, the identification and management of diabetic neuropathy continue to be problematic due to problems related to the safety and efficacy of existing therapies. This study examines biomarkers, molecular and cellular events associated with the advancement of diabetic neuropathy, as well as the existing pharmacological and non-pharmacological treatments employed. Furthermore, a holistic and mechanism-centric drug repurposing approach, antioxidant therapy, Gene and Cell therapies, Capsaicin and other spinal cord stimulators and lifestyle interventions are pursued for the identification, treatment and management of diabetic neuropathy. An extensive literature survey was done on databases like PubMed, Elsevier, Science Direct and Springer using the keywords "Diabetic Neuropathy", "Biomarkers", "Cellular and Molecular Mechanisms", and "Novel Therapeutic Targets".Thus, we may conclude that non-pharmacological therapies along with palliative treatment, may prove to be crucial in halting the onset of neuropathic symptoms and in lessening those symptoms once they have occurred.

Time to revisit the enigma of mastalgia management

Mastalgia (breast pain) also known as mastodynia, is one of the most common causes of breast issues for which a female visits a medical practitioner. It is divided into cyclical mastalgia, which is associated with menstruation, or can be noncyclical mastalgia which can present premenopausal or postmenopausal. The incidence of breast cancer associated with mastalgia is extremely low and reassurance plays a major role in the treatment of patients. Hormonal changes have been associated with the pathogenesis of cyclical mastalgia. Outdated treatment modalities are still being followed even though newer and more effective treatment options have been established. Objective assessment of breast pain should be done with the visual analog scale. Non-pharmacological therapy should be encouraged in every patient of mastalgia such as counseling and reassurance, sports bra, yoga, and relaxation therapy. Tamoxifen and ormeloxifene are now the drug of choice in severe mastalgia and care should be taken to counsel the patients about use and common and detrimental side effects. The available treatment modalities and their directions to use are discussed in this review.