Use Of Non-pharmacological Therapies Research Articles

Trends in Utilization and Cost of Nonpharmacological Pain Therapies in the United States Under Medicare Part B, 2000-2022.

Background: Many clinical practice guidelines for management of pain disorders now favor first-line use of nonpharmacological therapies (NPT). However, Medicare coverage of NPT is limited. Methods: Using a serial cross-sectional design, we examined temporal trends in the utilization and cost of NPT procedures commonly used to treat pain under Medicare. Results: Utilization and costs for physical therapy increased while those for spinal and osteopathic manipulation declined. Discussion: Future research on NPT under Medicare should focus on equity of patient access and comparative outcomes.

Impact of Group Reality Therapy on Treatment Adherence and Health Indicators in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Trial

Background: The use of non-pharmacological therapies is important in reducing the complications and consequences of diabetes. Objectives: This study aimed to determine the effect of group reality therapy on adherence to treatment regimens and health indicators in patients with type 2 diabetes. Methods: This randomized controlled trial was performed on 60 patients with diabetes who were referred to Amir Al-Momenin Hospital in Ahvaz. Patients were randomly assigned to either the intervention group (N = 30) or the control group (N = 30). Both groups completed health indicator tests, questionnaires on demographic and clinical information, perceived adherence to the treatment regimen, and the Perceived Stress Scale. The intervention group received reality therapy training, which consisted of 10 sessions of 45 minutes each (one session per week) over 2 months, delivered through lectures and face-to-face training sessions. The control group received only routine hospital interventions. The collected data were then analyzed using a one-way t-test and one-way analysis of variance (ANOVA). Results: Twenty-seven patients in the intervention group and 27 in the control group completed the study. After analyzing the data, it was revealed that the mean age of the patients in the control group was 55.30 ± 7.95, while it was 51.96 ± 10.55 in the intervention group. Findings showed that scores for the dimensions of adherence to the treatment regimen in the intervention group significantly increased compared to the control group (P < 0.001). Additionally, the mean health indicators in the intervention group showed a significant decrease compared to the control group (P < 0.001). Moreover, the mean blood sugar level of patients in the intervention group decreased from 229.63 ± 98.76 to 123.59 ± 42.03. Likewise, the level of glycosylated hemoglobin and blood cholesterol significantly decreased from 8.19 ± 2.09 to 6.11 ± 1.86 and from 176.52 ± 51.53 to 146.22 ± 34.68, respectively. Conclusions: A reality therapy training program can be effectively used to increase treatment adherence and improve health indicators in patients with type 2 diabetes.

Patient satisfaction in the use of non-pharmacological therapies in the management of postoperative pain: a study in a tertiary hospital, Ghana

ABSTRACT Background: Non-pharmacological therapies are complementary to pharmacological therapies for managing disease symptoms, including pain, and can be integrated into a self-management program, enhancing patient independence and autonomy. It has been discovered that therapies that are non-pharmacological for pain relief are effective with minimal side effects. This study, therefore, seeks to determine how frequently non-pharmacological methods (NPMs) are used in the management of postoperative pain (POP) and the influence of these NPMs on patient satisfaction. Methods: This study had a descriptive cross-sectional design. A quantitative approach was used with a structured questionnaire based on the International Pain Outcome Questionnaire (IPO-Q) to obtain responses from patients from October 2019 to December 2019. Results: The majority of the patients, 52.2%, responded using some form of (NPM) for pain relief. The most widely used non-pharmacological method of pain relief was mobilization, representing 79.2%. The male participants were observed to use more NPMs for pain relief. Most patients (51.4%) who used NPMs for pain relief reported that their pain was not relieved. A majority (90.6%) of the participants desired more pain treatment. The type of surgery the patients underwent had a statistically significant negative correlation with using NPMs for pain relief. A higher percentage (71%) of participants were highly satisfied with their overall pain treatment. Conclusion: Pain is subjective, and it would be appropriate if patients were allowed to describe the location and intensity of their pain and choose their preferred NPMs which would be of help.

PENGARUH PEMBERIAN AIR REBUSAN DAUN SAMBUNG NYAWA TERHADAP PENURUNAN TEKANAN DARAH PADA PENDERITA HIPERTENSI DI WILAYAH KERJA PUSKESMAS BINANGA KECAMATAN BARUMUN TENGAH

Hypertension cannot be cured but can be controlled so that it does not appear for a long time (years to decades) but still be watched out for. One of the medicinal plants that can be used as a herbal medicine for hypertension is the life-saving plant. The aim of this research is to determine the effect of giving boiled water from Sambung Nyawa leaves on reducing blood pressure in hypertension sufferers in the working area of the Binanga Community Health Center, Barumun Tengah District. This research design uses a quasi-experimental method. The population in this study were residents suffering from hypertension in the Binanga Community Health Center working area from January-December 2021, namely 198 people. The sampling technique in this research was a purposive sampling technique with a sample size of 22 people. The results of the research using the Wilcoxon statistical test showed that there was a significant influence between the effect of giving boiled water from splicing life leaves on reducing blood pressure in hypertension sufferers in the working area of the Binanga Community Health Center, Barumun Tengah District with a p-value = 0.000 (<0.05). The results of this study recommend that hypertension sufferers and their families are able to understand and comprehend the use of non-pharmacological therapy, namely boiled life-giving leaves as an alternative treatment for lowering blood pressure in hypertension sufferers. Keywords: life-giving leaves, blood pressure, hypertension

Pengaruh Air Rebusan Daun Salam Terhadap Pasien Penderita Hipertensi

Hypertension is an increase in systolic blood pressure of more than 140 mmHg and 90mmHg diastolic. Hypertension is often referred to as the "silent killer" because it rarely shows signs and if it is suffered for a long time, it can cause various complications. Hypertension requires appropriate treatment, both from a pharmacological and non-pharmacological. The literature search used a strategy with keywords the effect of bay leaf boiled water on patients with hypertension. From 10 articles it is described that there is a relationship between the effect of bay leaf boiled water on patients with hypertension by drinking it every day. Based on the results of the study that the use of non-pharmacological therapy by giving bay leaf boiled water to hypertensive patients is considered effective for lowering blood pressure. Bay leaves are proven to have various pharmacological activities as antifungal, antibacterial, anti-inflammatory, antioxidant, anti cholesterol, antidiabetic, antimalarial, anti-hyperuricemia antidiarrheal.

Patient, Caregiver, and Healthcare Provider Perspectives on Pharmacologic and Non-Pharmacologic Therapies for Pain in Sickle Cell Disease

Background: Pain is the main cause of poor quality of life among patients with sickle cell disease (SCD). While opioid therapy is the mainstay of treatment for acute SCD pain, it can be complicated by side effects and toxicities. A multimodal, multidisciplinary approach to pain management that promotes non-pharmacologic therapies can improve the quality of care for patients with SCD by addressing biopsychosocial components of the pain experience. Guided by the Consolidated Framework for Implementation Research (CFIR), this study utilized qualitative interviews with patients, caregivers, and healthcare providers at our institution to assess barriers to the use of non-pharmacologic and pharmacologic therapies for pain in SCD. Methods: Semi-structured qualitative interviews were conducted with adolescents and young adults (AYAs; ages 13-21) with SCD, caregivers of AYAs with SCD, and healthcare providers at our institution. AYAs had either a documented history of chronic pain and/or ≥1 admission/year for vaso-occlusive crises (VOCs) for at least one year from 2016-2022. After informed assent and/or consent were obtained, individual semi-structured interviews were conducted. Open-ended interview questions explored existing knowledge, perceptions, and barriers to pharmacologic and non-pharmacologic therapies for pain in SCD. Interviews proceeded until no new themes emerged in each group (i.e., thematic saturation). Interviews were analyzed using descriptive content analysis facilitated by Dedoose software. The CFIR and prior research informed a preliminary codebook, which was revised as new themes emerged. The coders independently coded transcripts and then met to discuss and resolve any discrepancies in coding. Results: Demographics: Eighteen AYAs, 17 caregivers, and 22 healthcare providers were interviewed. Of the AYAs, 61% were female, mean age was 17 years, and the most common SCD genotype was HgbSS (56%). Of the caregivers, 88% were mothers, with a mean age of 43 years. There were 15 AYA/caregiver dyads who participated. The following healthcare providers who care for patients with SCD were interviewed: physicians (31%), nurse practitioners (14%), nurses (14%), child life specialists (14%), psychologists (9%), art therapists (4.5%), healing touch providers (4.5%), physical therapists (4.5%), and social work (4.5%). Themes: Barriers to the use of non-pharmacologic therapies for pain management in SCD can broadly be grouped into two major themes: lack of knowledge about options and lack of access to non-pharmacologic options. Regarding lack of knowledge, most AYAs and caregivers endorsed a lack of knowledge about specific non-pharmacologic therapies (e.g., yoga therapy, healing touch, acupuncture), including their benefits, risks, and their abilities to reduce pain. Like AYAs and caregivers, many healthcare providers had limited knowledge about specific non-pharmacologic therapies and the evidence in support of their usage. Regarding lack of access to specific options, the majority of participants questioned the ability of patients to access non-pharmacologic options for pain management including availability of options and cost of access. Additional themes included a desire for more education about pain and pain management options. AYAs and caregivers were particularly interested in more information about yoga. Additionally, AYAs and caregivers were interested in education early in life before pain episodes occurred. Conclusions: Emerging themes among all groups include an interest in non-pharmacologic therapies for pain in SCD, but with limited knowledge on benefits, risks, options, and access to these therapies. As the American Society of Hematology (ASH) guidelines recommend non-pharmacologic therapies for sickle cell pain, it is crucial to implement these therapies into the management of pain in SCD. Education about different options paired with implementation options for ways to incorporate non-pharmacologic therapies is necessary to optimize pain control and improve quality of life. A particular focus on yoga therapy, with availability of a yoga therapist in medical settings, and organized yoga education events specific for SCD may be beneficial to engage individuals in yoga therapy with a trained yoga-therapist. As a next step, evaluation of these potential implementation strategies will occur within our health system.

Utilization of Pharmacologic and Non-Pharmacologic Therapies for Pain in Sickle Cell Disease: A Cross-Sectional Study

Background: The sickling deformity of red blood cells in sickle cell disease (SCD) results in multisystem sequelae, including severe, acute pain from vaso-occlusive crises (VOCs) and chronic pain from central sensitization. Pain is the main cause of poor quality of life and hospital admissions among patients with SCD. While opioid therapy is an important component of treatment for acute SCD pain, it can be complicated by side effects and toxicities. In contrast, chronic SCD pain is best managed with non-pharmacologic therapies. A multimodal, multidisciplinary approach to pain management that promotes non-pharmacologic therapies can improve the quality of care for patients with SCD by addressing biopsychosocial components of the pain experience and is recommended by the American Society of Hematology (ASH). This study examines current usage of pharmacologic and non-pharmacologic therapies among Adolescents and Young Adults (AYAs) with SCD receiving care at our institution. Methods: The electronic medical record and Sickle Cell Knowledgebase, a customized data visualization platform unique to our institution, were utilized to conduct a retrospective chart review of AYAs, ages 13-21 years of age, with SCD from 2016-2021. Data collected included demographic information, diagnosis of chronic pain, emergency department (ED) visits and inpatient admissions for VOCs, as well as pharmacologic and non-pharmacologic therapies utilized in the ED, inpatient setting, and, for patients with chronic pain, in the outpatient setting. Results: The cohort included 90 AYAs with SCD (73% were 13-17 years old). The most common SCD genotypes were HbSS (n=47, 52%) and HbSC (n=32, 36%). The majority were female (n=53, 49%), Black (n=85, 94%), and non-Hispanic (n=86, 96%). There were 95 ED visits for VOC, where the patient was subsequently discharged home, and 246 admissions for VOC during the study period. There was a high frequency of opioid interventions for VOCs during the 95 extracted ED visits (81.8% in 2016, 91.7% in 2021). During VOC admissions, there was consistent use of opioids in 100% of admissions from 2016-2021 with increasing utilization of patient-controlled analgesia (7.7% in 2016, 45.1% in 2021) and subanesthetic ketamine (0% in 2016, 18.3% in 2021) each year during the study period. Compared to pharmacologic measures, non-pharmacologic therapies (i.e., healing touch, massage, art therapy, child life, music therapy, occupational therapy, physical therapy, psychology) were less utilized during VOC admissions. While healing touch and child life therapy were ordered during approximately 85% of VOC admissions, they occurred <50% of the time. All other integrative therapies were ordered between 5-55% of admissions each year and occurred <50% of the time. There was no correlation between length of hospital stay and use of integrative therapies. Seven patients with a diagnosis of chronic pain were identified. All 7 received non-pharmacologic therapies in the outpatient setting, including cognitive behavioral therapy, guided imagery, and psychology consultation. Six received either a gabapentinoid, serotonin and norepinephrine reuptake inhibitor (SNRI), or tricyclic antidepressant (TCA). Conclusion: Per the ASH SCD guidelines, non-pharmacologic therapies are recommended for SCD-related pain. In our cohort, we found that non-pharmacologic therapies occurred in <50% of VOC admissions and were underutilized for SCD-related pain in AYAs when compared to pharmacologic therapies at our institution. Though we speculate that healing touch and child life were frequently ordered as a default within our admission order set, utilization rates were still low. To better understand barriers to non-pharmacologic therapies in SCD, we are conducting qualitative interviews of patients, caregivers, and healthcare providers using the Consolidated Framework for Implementation Research (CFIR) as a theoretical model. Understanding barriers to the use of non-pharmacologic therapies will be essential to maximizing their implementation and hence maximizing pain control, improving quality of life, and increasing self-efficacy.

Abstract 13915: Comparison of Proteomic CV Risk to Established ASCVD 10-year Risk Decision Points

Introduction: The ASCVD pooled cohort equation (PCE) is well-established for CV risk assessment. Decision points for determining treatment plans are low, intermediate and high risk over 10 years, however this approach over and underestimates risk in certain subgroups. The validated CV Risk SomaSignal® Test (SST) provides 4-year risk probability of MACE allowing for timely assessment of risk, but the shorter timescale makes comparison to 10-year PCE risk less intuitive. Hypothesis: Using a previously described metacohort (n=5,575) of patients with increased CV risk, we hypothesized that PCE would stratify patients differently than the CV Risk SST, and that CV Risk score scaled to 10 years would yield an improved net reclassification index (NRI). Methods: CV Risk SST and PCE scores were calculated on metacohort plasma samples. CV risk score was scaled to 10 years by parameterizing the model for a 10-year score, and then calculating a quadratic equation for the conversion. CV risk score was stratified by four established risk bins, whereas the PCE was stratified similarly using <7.5%, 7.5%-15%, 15%-20%, and > 20% risks based on literature and practice-derived cutoffs. Event rates were compared between scores, and NRI was calculated. Results: We observed total NRI of 11.4% for the 10-year CV Risk SST vs. PCE, with up-classification (positive NRI=83.7%) mitigating down-classification (negative NRI=-0.723). Event rates for the high-risk group in the CV Risk test were higher than the PCE, and lower in the low-risk group (p < 0.05). Conclusions: The CV Risk SST stratifies patients by identifying low- and high-risk groups using thresholds that are more discriminatory than low-risk and high-risk thresholds in the PCE. For comparison, the CV risk SST can be scaled to 10-year risk, with CV risk SST having a positive NRI for identifying MACE. This reclassification can allow targeted therapies in patients at greater risk and use of non-pharmacological therapies in the low-risk patients.

The effectiveness of "ILU" massage in infants as a complementary therapy reduce constipation in the Public Health Center

Abstract
 Background: Giving MP-ASI is one of the supporting factors for growth and development, but nutritional intake is one of the factors that affect constipation. One alternative to the use of non-pharmacological therapy, which is administration to reduce constipation, is the "I L U" massage.
 Research methods : This research is a descriptive type of research, 5 babies who experience constipation were studied for 2 weeks using the bristol stool chart and Rome IV criteria instruments before and after giving the "I L U" massage.
 Results and Discussion : Babies who experience constipation are given "I L U" massage for 2 weeks with massage every 1 week 3 times which is observed based on the bristol stool chart and rome IV. Before the massage, the Bristol stool chart was 1-2 while Rome IV was 2-3 which indicates constipation. After 1 week after the massage, there was an increase in the Bristol stool chart and a decrease in Rome IV, and even 2 weeks after the “I L U” massage, the Bristol stool chart was 2,3,4 and Rome IV 0, indicating reduced constipation.
 Conclusion : There is an effect of giving "I L U" massage for 2 weeks on a decrease in the type of Bristol stool chart and a decrease in the value of Rome IV.
 Keywords: Complementary,Massage "I L U", constipation

Experience of treating patients with mixed hypertriglyceridemia in a lipid center (clinical case)

Lipid metabolism disorders remain a significant medical and social problem associated with mortality, disability, morbidity and pathologies of the circulatory system. According to international and Russian epidemiological studies, hypertriglyceridemia is a common risk factor for coronary heart disease. Isolated use of non-pharmacological therapy and statin monotherapy is not effective enough, and therefore it is necessary to propagate the experience of combined treatment, supported by modern recommendations. This work shows the possibilities of effective use of combined therapy of lipid metabolism disorders (statin, ezetimibe, alirocumab, fenofibrate) in patients with mixed hypertriglyceridemia.

Non-pharmacological therapies for cancer patients in Portugal and Brazil: an experience report.

To describe the experience of nurses from a center in Portugal and two in Brazil regarding the use of non-pharmacological therapies in cancer patients. This is a professional experience report. In the Portuguese institution, a group of nurses has been performing massage therapy, reflexology, postural teaching, thermotherapy, relaxation, guided imagery, Reiki, music therapy, aromatherapy, among others, for 17 years, with significant results in pain and vital signs with satisfactory perceptions. In Brazil, the clinical application is incipient, clinical studies with auriculotherapy, relaxation with guided imagery and floral therapy are taking place, with significant results for physical symptoms, anxiety, and quality of life improvement. In both countries, nurses have made efforts to implement non-pharmacological therapies. While in the Portuguese reality they have been formally institutionalized in care, in Brazil the therapies take place with voluntary work and through intervention research. This report can encourage the translation of autonomous practice to clinical studies for proposing evidence of therapies in Integrative Oncology.

Nonpharmacologic management of chronic pain in the United States' Medicare population: a scoping review protocol.

ABSTRACTObjective:This objective of this review is to describe the scope of the literature on the access to and use of nonpharmacologic therapies to manage chronic pain among people with disabilities and older adults.Introduction:Clinical guidelines recommend nonpharmacologic interventions as first-line therapy for chronic pain management. The importance of nonpharmacologic management is magnified in populations with a high pain burden and multiple chronic conditions, such as people living with a disability and/or older adults, many of whom are enrolled in Medicare. Understanding the utilization of nonpharmacologic therapies for pain is critical to guide effective pain management delivery and policy.Inclusion criteria:This scoping review will consider studies of Medicare beneficiaries and Medicare-eligible individuals who have chronic pain. Noninvasive and nonpharmacologic treatments for pain identified in clinical guidelines will be included. We will exclude studies exclusively focused on acute pain, cancer pain, palliative care and hospice settings, cannabis-based treatment, and pharmacologic therapies. Studies conducted outside the United States will be excluded.Methods:The proposed scoping review will be conducted in accordance with JBI methodology. The search strategy has been developed in consultation with a public health librarian and will be carried out in MEDLINE, CINAHL, and SocINDEX, Web of Science, and the Cochrane Library. The search will be limited to results published in English since January 1, 1990. Two independent reviewers will screen all titles and abstracts and then full-text articles. Data will be extracted and summarized in diagrammatic, tabular, and narrative formats.Scoping review registration:Open Science Framework (https://osf.io/h7bwc/)

Use of Non-pharmacological Therapies in Individuals With Migraine Eligible for Treatment With Monoclonal Antibodies Targeting Calcitonin Gene-Related Peptide (CGRP)-Signaling: A Single-Center Cross-Sectional Observational Study.

IntroductionAccessibility of treatment with monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) signaling pathway is impeded by regulatory restrictions. Affected individuals may seek out other services including non-pharmacological therapies. Thus, we found it timely to ascertain the use of non-pharmacological therapies in individuals with treatment-resistant migraine eligible for and naïve to treatment with CGRP-signaling targeting monoclonal antibodies.MethodsWe conducted a single-center cross-sectional observational study of patients eligible for and naïve to treatment with monoclonal antibodies targeting CGRP or its receptor. We recorded demographical information (gender, age, educational level, employment status, and income), disease burden (frequency of headache days and migraine days), previous use of preventive pharmacological medications for migraine, and use of non-pharmacological therapies over the past 3 months including frequency of interventions, costs, and patient-reported assessment of efficacy on a 6-point scale (0: no efficacy, 5: best possible efficacy).ResultsWe included 122 patients between 17 June 2019 and 6 January 2020; 101 (83%) were women and the mean age was 45.2 ± 13.3 years. One-third (n = 41 [34%]) had used non-pharmacological therapy within the past 3 months. Among these participants, the median frequency of different interventions was 1 (IQR: 1–2), the median number of monthly visits was 2.3 (IQR: 1.3–4), mean and median monthly costs were 1,086 ± 1471, and 600 (IQR: 0–1200) DKK (1 EUR = ~7.5 DKK), respectively, and median patient-reported assessment of the efficacy of interventions was 2 (IQR: 0–3).ConclusionEven in a high-income country with freely accessible headache services and universal healthcare coverage, there was a non-negligible direct cost in parallel with low satisfaction for non-pharmacological therapies among patients at a tertiary headache center.

Non-pharmacologic therapies in treatment of childhood-onset systemic lupus erythematosus: A systematic review.

Childhood-onset systemic lupus erythematosus (cSLE) is a complex multisystem autoimmune disease often associated with pain, fatigue, and mood-related disturbances. cSLE is associated with increased disease severity and higher rates of mortality as compared to adult onset SLE. Therefore, a multi-faceted approach to care, including the use of non-pharmacologic therapies, is essential to ensure optimal patient outcomes. The use of non-pharmacologic therapies as adjunctive treatments has been shown to be beneficial in adults with SLE, yet, their use and effect is less well understood in cSLE. This is the first systematic review to explore the use and quality of evidence of non-pharmacologic approaches to treat cSLE. A literature review was performed using PRISMA guidelines. Studies until March 2021 with participants diagnosed with cSLE were included. The quality of the evidence was graded via OCEBM levels of evidence guidelines and bias assessed using Cochrane guidelines. Completed clinical trials (via clinicaltrials.gov) were also searched to identify unpublished results. Eleven published studies consisting of 1152 patients met inclusion criteria for this review, as well as three additional studies with unpublished data on clinicaltrial.gov. Of the published trials, four studies used patient education/support, three studies used dietary supplementation, three used forms of psychotherapy (e.g., Cognitive behavioral therapy), and 1 used aerobic exercise to target the following issues: treatment adherence (n = 3), quality of life (n = 3), fatigue (n = 2), pain (n = 2), depressive symptoms (n = 1), anxiety (n = 1), and health-related outcomes including disease severity (n = 3), cardiovascular disease risk (Cardiovascular disease; n = 3), and muscle function (n = 1). Across investigations, the quality of the evidence based on study design was moderate/low. In terms of potential outcomes, dietary supplementation methods were successful in 2 of 3 studies and were associated with improvements in disease activity and fatigue. Aerobic exercise was effective in decreasing resting heart rate and increasing cardiorespiratory capacity. Patient education/support was related to significantly increased treatment adherence and decreased cardiovascular risk markers. Two of the three studies examining the impact of psychotherapy showed improvements (e.g., in treatment adherence, depression and fatigue). This review identifies several promising non-pharmacologic therapies to use as adjunctive treatments to traditional pharmacologic regimens in health and mental health-related outcomes in patients with cSLE. Future well controlled clinical trials would be beneficial to more rigorously evaluate the effects of non-pharmacologic therapies in pediatric populations.

Retrospective Series of Burning Mouth Syndrome Patients Treated with a Protective Mouthguard: An Effective Non-Pharmacologic Treatment Modality

<h3>Background</h3> Burning mouth syndrome (BMS) is a relatively common condition defined as a relentless, idiopathic burning sensation of the oral mucosa after exclusion of other underlying causes of burning. Currently effective treatment is limited mostly to pharmacologic interventions. The use of non-pharmacologic therapy, specifically the use of protective mouthguards has not been well studied. This study evaluates effectiveness of mouthguards in patients treated for BMS at University of Florida College of Dentistry (UFCD). <h3>Material and Methods</h3> Following IRB approval, the clinical database was retrospectively searched for patients diagnosed with BMS and treated with mouthguard between 2014-2019. Inclusion criteria included a minimum of 6-month follow-up and patients were excluded if treatment records were incomplete. Demographics, clinical data, medical history, and other treatment modalities were recorded and analyzed. <h3>Results</h3> A total of 16 cases were included and a mean age of 67 years (range of 50-82) and a female: male ratio of 4.3:1 was identified. The average duration of burning symptoms prior to the first visit was 43 months. The location of symptoms involved tongue only (n=11, 69%); tongue, palate, and lips (n=2, 12.5%); tongue and palate (n=2, 12.5%); and tongue and lips (n=1, 6%). The most common concurrent medical conditions were hypothyroidism (n=7, 43.7%), hypertension (n=6, 37.5%), and diabetes (n=3, 18.7%). Study patients took a median of 6.5 concurrent medications. Six patients (37.5%) had symptomatic relief with mouthguard ther- apy in conjunction to concurrent standard BMS pharmacologic therapy, 37.5% of patients (n=6) had symptomatic relief with the mouthguard alone, and 25% of patients (n=4) reported no relief from the mouthguard. <h3>Conclusion</h3> In this study a total of 75% of BMS patients reported improvement of subjective symptoms with the use of a pro- tective mouthguard, demonstrating the potential effectiveness of mouthguard as a non-pharmacologic therapeutic modality for BMS patients.

Efficacy of acupuncture at ghost points combined with fluoxetine in treating depression: A randomized study.

BACKGROUNDDepression affects more than 350 million people worldwide. In China, 4.2% (54 million people) of the total population suffers from depression. Psychotherapy has been shown to change cognition, improve personality, and enhance the ability to cope with difficulties and setbacks. While pharmacotherapy can reduce symptoms, it is also associated with adverse reactions and relapse after drug withdrawal. Therefore, there has been an increasing emphasis placed on the use of non-pharmacological therapies for depression. The hypothesis of this study was that acupuncture at ghost points combined with fluoxetine would be more effective than fluoxetine alone for the treatment of depression. AIMTo investigate the efficacy of acupuncture at ghost points combined with fluoxetine for the treatment of patients with depression.METHODSThis randomized controlled trial included patients with mild to moderate depression (n = 160). Patients received either acupuncture at ghost points combined with fluoxetine (n = 80) or fluoxetine alone (control group, n = 80). Needles were retained in place for 30 min, 5 times a week; three treatment cycles were administered. The Mann–Whitney U test was used to compare functional magnet resonance imaging parameters, Hamilton depression rating scale (HAMD) scores, and self-rating depression scale (SDS) scores between the acupuncture group and control group.RESULTSThere were no significant differences in HAMD or SDS scores between the acupuncture group and control group, before or after 4 wk of treatment. The acupuncture group exhibited significantly lower HAMD and SDS scores than the control group after 8 wk of treatment (P < 0.05). The acupuncture group had significantly lower fractional Amplitude of Low Frequency Fluctuations values for the left anterior wedge leaf, left posterior cingulate gyrus, left middle occipital gyrus, and left inferior occipital gyrus after 8 wk. The acupuncture group also had significantly higher values for the right inferior frontal gyrus, right insula, and right hippocampus (P < 0.05). After 8 wk of treatment, the effective rates of the acupuncture and control groups were 51.25% and 36.25%, respectively (P < 0.05).CONCLUSIONThe study results suggest that acupuncture at ghost points combined with fluoxetine is more effective than fluoxetine alone for the treatment of patients with mild to moderate depression.

Efficiency of primary spine care as compared to conventional primary care: a retrospective observational study at an Academic Medical Center

BackgroundPrimary Spine Care (PSC) is an innovative model for the primary management of patients with spine-related disorders (SRDs), with a focus on the use of non-pharmacological therapies which now constitute the recommended first-line approach to back pain. PSC clinicians serve as the initial or early point of contact for spine patients and utilize evidence-based spine care pathways to improve outcomes and reduce escalation of care (EoC; e.g., spinal injections, diagnostic imaging, hospitalizations, referrals to a specialist). The present study examined 6-month outcomes to evaluate the efficiency of care for patients who received PSC as compared to conventional primary care. We hypothesized that patients seen by a PSC clinician would have lower rates of EoC compared to patients who received usual care by a primary care (PC) clinician.MethodsThis was a retrospective observational study. We evaluated 6-month outcomes for two groups seen and treated for an SRD between February 01, 2017 and January 31, 2020. Patient groups were comprised of N = 1363 PSC patients (Group A) and N = 1329 PC patients (Group B). We conducted Pearson chi-square and logistic regression (adjusting for patient characteristics that were unbalanced between the two groups) to determine associations between the two groups and 6-month outcomes.ResultsWithin six months of an initial visit for an SRD, a statistically significantly smaller proportion of PSC patients utilized healthcare resources for spine care as compared to the PC patients. When adjusting for patient characteristics, those who received care from the PSC clinician were less likely within 6 months of an initial visit to be hospitalized (OR = .47, 95% CI .23–.97), fill a prescription for an opioid analgesic (OR = .43; 95% CI .29–.65), receive a spinal injection (OR = .56, 95% CI .33–.95), or have a visit with a specialist (OR = .48, 95% CI .35–.67) as compared to those who received usual primary care.ConclusionsPatients who received PSC in an academic primary care clinic experienced significantly less escalation of their spine care within 6 months of their initial visit. The PSC model may offer a more efficient approach to the primary care of spine problems for patients with SRDs, as compared to usual primary care.

Substitution of Nonpharmacologic Therapy With Opioid Prescribing for Pain During the COVID-19 Pandemic

During the pandemic, access to medical care unrelated to COVID-19 was limited because of concerns about viral spread and corresponding policies. It is critical to assess how these conditions affected modes of pain treatment, given the addiction risks of prescription opioids. To assess the trends in opioid prescription and nonpharmacologic therapy (ie, physical therapy and complementary medicine) for pain management during the COVID-19 pandemic in 2020 compared with the patterns in 2019. This retrospective, cross-sectional study used weekly claims data from 24 million US patients in a nationwide commercial insurance database (Optum's deidentified Clinformatics Data Mart Database) from January 1, 2019, to September 31, 2020. Among patients with diagnoses of limb, extremity, or joint pain, back pain, and neck pain for each week, patterns of treatment use were identified and evaluated. Data analysis was performed from April 1, 2021, to September 31, 2021. The main outcomes of interest were weekly rates of opioid prescriptions, the strength and duration of related opioid prescriptions, and the use of nonpharmacologic therapy. Transition rates between different treatment options before the outbreak and during the early months of the pandemic were also assessed. A total of 21 430 339 patients (mean [SD] age, 48.6 [24.0] years; 10 960 507 [51.1%] female; 909 061 [4.2%] Asian, 1 688 690 [7.9%] Black, 2 276 075 [10.6%] Hispanic, 11 192 789 [52.2%] White, and 5 363 724 [25.0%] unknown) were enrolled during the first 3 quarters in 2019 and 20 759 788 (mean [SD] age, 47.0 [23.8] years; 10 695 690 [51.5%] female; 798 037 [3.8%] Asian; 1 508 023 [7.3%] Black, 1 976 248 [9.5%] Hispanic, 10 059 597 [48.5%] White, and 6 417 883 [30.9%] unknown) in the first 3 quarters of 2020. During the COVID-19 pandemic, the proportion of patients receiving a pain diagnosis was smaller than that for the same period in 2019 (mean difference, -15.9%; 95% CI, -16.1% to -15.8%). Patients with pain were more likely to receive opioids (mean difference, 3.5%; 95% CI, 3.3%-3.7%) and less likely to receive nonpharmacologic therapy (mean difference, -6.0%; 95% CI, -6.3% to -5.8%), and opioid prescriptions were longer and more potent during the early pandemic in 2020 relative to 2019 (mean difference, 1.07 days; 95% CI, 1.02-1.17 days; mean difference, 0.96 morphine milligram equivalents; 95% CI, 0.76-1.20). Analysis of individuals' transitions between treatment options for pain found that patients were more likely to transition out of nonpharmacologic therapy, replacing it with opioid prescriptions for pain management during the COVID-19 pandemic than in the year before. Nonpharmacologic therapy is a benign treatment for pain often recommended instead of opioid therapy. The decrease in nonpharmacologic therapy and increase in opioid prescription during the COVID-19 pandemic found in this cross-sectional study, especially given longer days of prescription and more potent doses, may exacerbate the US opioid epidemic. These findings suggest that it is imperative to investigate the implications of limited medical access on treatment substitution, which may increase patient risk, and implement policies and guidelines to prevent those substitutions.

Romanian Guidelines for Nonpharmacological Therapy of IBS.

The nonpharmacological therapy in irritable bowel syndrome (IBS) is expanding rapidly. Practitioners and medical educators need to be aware of progress and changes in knowledge of this topic. The Romanian Society of Neurogastroenterology aimed to create guidelines based on best evidence on the use of nonpharmacological therapy in IBS. A group of experts was constituted. This was divided in eleven subgroups dedicated to eleven categories of nonpharmacological therapy. The subgroups searched the literature and formulated statements and recommendations. These were submitted to vote in order to obtain consensus. The outcome of this activity is represented by the guidelines of the Romanian Society of Neurogastroenterology, presented in this paper. The recommendations are seen as complementary to the pharmacological therapy and are not intended to recommend avoiding pharmacological drugs. These guidelines were elaborated by a Delphi process and represent a useful tool for physicians managing patients with IBS.

Association of Chiropractic Colleges Research Agenda Conference 2021 Abstracts of Proceedings.

Association of Chiropractic Colleges Research Agenda Conference 2021 Abstracts of Proceedings.