Integrative Therapy Approaches for Posttraumatic Stress Disorder: A Special Focus on Treating Veterans.

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.

Enthesitis of biceps brachii short head and coracobrachialis at the coracoid process: a generator of shoulder and neck pain.

This series describes the outcome of diagnostic block at the coracoid process's common origin of the biceps brachii short head and coracobrachialis for anterior shoulder pain and cervical myofascial pain syndrome in six patients. All showed significant tenderness over the tip of the coracoid process. All underwent diagnostic injection with Marcaine at the coracoid process, followed by therapeutic injection with Marcaine and DepoMedrol. All reported complete relief of pain after local injection. Enthesitis at the coracoid process needs to be considered as a causative or contributing factor in patients presenting with shoulder and neck symptoms. No study was found in the literature describing this association. Whether tendonitis of the common origin is a primary cause or result of chronic neck and shoulder dysfunction remains to be established.

Modulation of the sleep state-dependent P50 midlatency auditory-evoked potential by electric stimulation of acupuncture points.

OBJECTIVE: To determine if the P50 midlatency auditory evoked potential, a sleep state-dependent waveform thought to be generated by the reticular activating system, is modulated after surface stimulation of acupuncture points (ie, electroacupuncture). DESIGN: P50 potential recordings were carried out before, during, and after electroacupuncture. SETTING: A clinical research center. PARTICIPANTS: Eighty healthy subjects ages 25 to 55 were recorded in 7 investigations. INTERVENTIONS: Stimulation of 3 specific acupuncture points (Pericardium 6, Heart 3, Liver 3) was compared with no stimulation or with stimulation of control points (Gall Bladder 34, Large Intestine 11, Small Intestine 3). We compared different frequencies of stimulation (5, 60, 100 Hz), unilateral versus bilateral stimulation, and the effects of repeated episodes of stimulation. MAIN OUTCOME MEASURES: P50 auditory evoked potential latency, amplitude (measure of level of arousal), and habituation (measure of sensory gait) at interstimulus interval of 250 ms. RESULTS: Electroacupuncture at specific points decreased P50 potential amplitude versus electroacupuncture at control points (P=.006) or versus no stimulation (P<.001). The optimal effective frequency was 5 Hz (P<.05 at 5 Hz, P>.05 at 60 and 100 Hz), and unilateral electroacupuncture was not as effective as bilateral electroacupuncture (P=.007). Repeated episodes of bilateral electroacupuncture showed additive effects (P<.05). There were no differences in responsiveness across sexes (P=.79), and electroacupuncture did not affect P50 potential habituation (P>.05). CONCLUSIONS: Electroacupuncture may be effectively used to decrease arousal levels, perhaps as adjunct therapy for disorders of hypervigilance.

Validation of postural radiographs as a way to measure change in pelvic obliquity.

OBJECTIVE: To evaluate the validity of using postural radiographs to assess change in pelvic obliquity. DESIGN: Blinded comparison of reference lines and instrument development of postural radiographs. SETTING: Veterans Administration hospital. PARTICIPANTS: Thirty-nine subjects with no history of low back pain. INTERVENTION: Repeated postural radiographs without heel lifts and with (1/4)-in (6.35-mm) and (1/2)-in (12.7-mm) heel lifts. MAIN OUTCOME MEASURE: The change of pelvic obliquity as measured by the intersulcate, interalar, and sacral surface lines on postural radiographs. RESULTS: A (1/4)-in heel lift resulted in changes of 4.6+/-4.0mm, 3.6+/-3.1mm, and 5.8+/-3.9mm and a (1/2)-in heel lift in changes of 7.8+/-4.3mm, 7.8+/-4.6mm, and 5.2+/-3.8mm for the intersulcate, interalar, and sacral surface lines, respectively. Pearson correlation coefficients were used to correlate the change in pelvic obliquity with the corresponding heights of heel lifts; for the (1/4)-in heel lift, they were.67,.88, and.71, and for (1/2)-in heel lift they were.73,.79, and.87 for the intersulcate, interalar, and sacral surface lines, respectively (all P<.001). CONCLUSION: All the reference lines seem to be valid measures of change of pelvic obliquity relative to the size of the lifts (ie, the changes in pelvic obliquity seem to be causally related and correlated with the lifts). These results also suggest that postural radiographs can be used to determine the magnitude of pelvic obliquity.

The prevalence of postural asymmetry in people with and without chronic low back pain.

OBJECTIVE: To determine the extent of pelvic obliquity and lateral sacral base angle in subjects with and without chronic low back pain (LBP) by using postural radiographs. DESIGN: Cross-sectional, controlled. SETTING: A Veterans Administration hospital. PARTICIPANTS: Veterans and employees with (n=93) and without (n=76) chronic LBP. INTERVENTION: Postural radiographs. MAIN OUTCOME MEASURE: Differences between the mean extent of pelvic obliquity and the lateral sacral base angle in subjects with and without chronic LBP. RESULTS: The z scores showed no significant statistical differences in the extent of pelvic obliquity or lateral sacral angle in subjects with and without chronic LBP. CONCLUSION: Correction of pelvic obliquity by the use of heel lifts has been used as a modality of treatment for patients with chronic LBP. The majority of the patients in our clinics for whom this modality is used report at least some improvement in their pain symptoms. Because the extent of pelvic obliquity is similar in the subjects with and without chronic LBP, other factors must account for those who benefit from correction of their pelvic obliquity.