Non-pharmacological therapeutic needs in people with Dravet syndrome.

Dravet syndrome (DS) is a genetic rare disease, which is usually caused by a mutation in the SCN1A gene. DS is characterised by a drug-resistant epilepsy and by cognitive and behavioural disturbances. Thus, DS patients require both pharmacological and non-pharmacological treatments. However, there is a paucity of studies on non-pharmacological therapies and their potential benefits. The main aim of this study was to describe the non-pharmacological therapy modalities received by DS patients and their socio-economic impact on the family. Thus, we designed an online survey addressed to caregivers of DS patients. Our results indicated that up to 91.9% of the surveyed patients required non-pharmacological therapies, which were mainly directed to treat cognitive, sensory and motor impairments. In many cases, the economic costs of these therapies were borne entirely by the families. Nevertheless, patients required a deployment of resources not only at a health care level, but also at an educational level.

Perceived health and working life in caregivers from nursing homes that used or did not use nighttime personalized non-pharmacological therapies to address residents' behavioral and psychological symptoms of dementia.

Dementia is frequent in nursing home (NH), affecting between 40 and 50 % of the residents and is associated in 90 % of the cases with behavioral and psychological symptoms (BPSD) which are detrimental to caregivers' working life and perceived health. We compared perceived health and working life between NHs that used or did not use nighttime personalized non-pharmacological therapies (PNPT) to address BPSD. This anonymous survey included 96 caregivers from 25 NHs which used (n = 69) or not (n = 27) nighttime PNPT. Perceived health, nursing and medical care, quality of care and internal motivation were significantly higher, stress symptoms and workload were significantly lower and there was a tendency to enhanced satisfaction with work in caregivers from NHs which used nighttime PNPT. Our present data open a new window on the benefits of PNPT.

Multimodal non-invasive non-pharmacological therapies for chronic pain: mechanisms and progress.

BACKGROUND: Chronic pain conditions impose significant burdens worldwide. Pharmacological treatments like opioids have limitations. Non-invasive non-pharmacological therapies (NINPT) encompass diverse interventions including physical, psychological, complementary and alternative approaches, and other innovative techniques that provide analgesic options for chronic pain without medications. MAIN BODY: This review elucidates the mechanisms of major NINPT modalities and synthesizes evidence for their clinical potential across chronic pain populations. NINPT leverages peripheral, spinal, and supraspinal mechanisms to restore normal pain processing and limit central sensitization. However, heterogeneity in treatment protocols and individual responses warrants optimization through precision medicine approaches. CONCLUSION: Future adoption of NINPT requires addressing limitations in standardization and accessibility as well as synergistic combination with emerging therapies. Overall, this review highlights the promise of NINPT as a valuable complementary option ready for integration into contemporary pain medicine paradigms to improve patient care and outcomes.

Prevalence of and factors associated with unmanageable pain levels in people with knee or hip osteoarthritis: a cross-sectional population-based study.

BACKGROUND: Pain due to knee and / or hip osteoarthritis (HKOA) is the most common symptom for seeking healthcare. Pain interferes on daily activities, social and occupational participation in people with HKOA. The goal of this study is to estimate the prevalence of unmanageable pain levels (UPL) among people with HKOA), characterize this population and identify factors associated with UPL, and compare therapeutic strategies used by people with UPL versus manageable pain levels (MPL). METHODS: We analysed data from the EpiReumaPt study (n = 10,661), that included a representative sample of the Portuguese population. Among these, 1081 participants had a validated diagnosis of HKOA by a rheumatologist.. Sociodemographic, lifestyle and health-related data were collected in a structured interview. Pain intensity (NPRS) data were collected in a medical appointment. Painmedication (last month), physiotherapy and surgery were considered as therapies for pain management. UPL was defined as a mean pain intensity in the previous week of ≥5 points on 11-point numeric pain rating scale. The factors associated with UPL were analyzed with logistic regression (p < 0.05, 95%CI). The effect of unmanageable pain levels was assessed by the HOOS/KOOS activities of daily living and quality of life subscales. Symptoms of anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Analysis was completed with linear and logistic regression. All analysis were weighted. RESULTS: The estimated prevalence of UPL among people with HKOA was 68.8%. UPL was associated with being female (odds ratio (OR) = 2.36, p < 0.001), being overweight (OR = 1.84, p = 0.035) or obese (OR = 2.26, p = 0.006), and having multimorbidity (OR = 2.08, p = 0.002). People with UPL reported worse performance in activities of daily living and lower quality of life (ß = - 21.28, p < 0.001 and ß = - 21.19, p < 0.001, respectively) than people with MPL. People with UPL consumed more NSAIDs (22.0%, p = 0.003), opioids (4.8%, p = 0.008), paracetamol (2.7%, p = 0.033), and overall analgesics (7.3%, p = 0.013) than people with MPL. A higher proportion of people with UPL underwent physiotherapy (17.5%, p = 0.002) than people with MPL. CONCLUSION: Two-thirds of people with HKOA in Portugal have poor management of their pain levels. Clinical and lifestyle factors, that are highly presented in individuals with HKOA, are associated with unmanageable pain. Our results highlighting the need for further research and implementation of effective interventions to improve pain, function and quality of life in people with HKOA.

Interdisciplinary Occupational and Physical Therapy Approach to Treating Constipation and Fecal Incontinence in Children.

AIMS: This case series was completed to determine the effectiveness of an interdisciplinary (occupational and physical therapy) approach to treating constipation and fecal incontinence in children. Non-pharmacological therapies for treating constipation and incontinence are showing potential benefits, especially for children not responding to standard medical treatment, which involves oral laxatives for fecal dis-impaction (cleanout) and maintenance dosing to prevent further impaction. METHODS: A retrospective chart review, surface electromyography (sEMG) biofeedback, and parent and child reports of progress was completed for two children ages 4 and 10 years old. Progress toward goals was measured using a therapy plan of care and progress updates every 60 days. Focus of goals included, pelvic floor muscle coordination and activation, education of anatomy and physiology of digestive system, emotional regulation, functional training in the bathroom, and hygiene. RESULTS: Notable improvements in pelvic floor function, emotional regulation, and defecation dynamics contributed to decreased constipation and fecal incontinence as well as improved emotional regulation and confidence in both participants over a 6-month period. CONCLUSION: A coordinated physical therapy and occupational therapy approach to treating children with constipation and fecal incontinence can be successful in reaching full continence and support children have not responded to standard medical treatment.

Discomfort improvement for critically ill patients using electronic relaxation devices: results of the cross-over randomized controlled trial E-CHOISIR (Electronic-CHOIce of a System for Intensive care Relaxation).

PURPOSE: To assess the impact of different electronic relaxation devices on common stressful patient symptoms experienced in intensive care unit (ICU). METHODS: Sixty critically ill patients were enrolled in four relaxation sessions using a randomized cross-over design: standard relaxation (TV/radio), music therapy (MUSIC-CARE©), and two virtual reality systems using either real motion pictures (DEEPSEN©) or synthetic motion pictures (HEALTHY-MIND©). The goal was to determine which device was the best to reduce overall patient discomfort intensity (0-10 Numeric Rating Scale (NRS); primary endpoint). Secondary endpoints were specific stressful symptoms (pain, anxiety, dyspnea, thirst, and lack of rest feeling) and stress response measured by Analgesia/Nociception Index (ANI). Multivariate mixed-effect analysis was used, taking into account patient characteristics and multiple measurements. RESULTS: Fifty patients followed the full research protocol, and ten patients did at least one research planned session of relaxation. HEALTHY-MIND© was associated with a significant decrease in overall discomfort, the primary endpoint (median NRS = 4[2-6] vs. 2[0-5]; p = 0.01, mixed-effect model), accompanied by a significant decrease in stress response (increase in ANI, secondary endpoint; p < 0.01). Regarding other secondary endpoints, each of the two virtual reality systems was associated with a decrease in anxiety (p < 0.01), while HEALTHY-MIND© was associated also with a decrease in pain (p = 0.001) and DEEPSEN© with a decrease in lack of rest (p = 0.01). Three incidents (claustrophobia/dyspnea/agitation) were reported among 109 virtual reality sessions. Cybersickness was rare (NRS = 0[0-0]). CONCLUSION: Electronic relaxation therapy is a promising, safe, and effective non-pharmacological solution that can be used to improve overall discomfort in alert and non-delirious ICU patients. Its effectiveness depends on technical characteristics (virtual reality using a synthetic imagined world versus a real world or music therapy alone without virtual reality), as well as the type of symptoms.

A pragmatic trial testing a tailored non pharmacologic therapies on nocturnal behavioral and psychological symptoms associated with dementia.

We compared the efficacy of tailored non pharmacological therapies (NPT) on specific nocturnal behavioral and psychological symptoms of dementia (BPSD). This retrospective 1-year study included 84 older dependent patients institutionalized in 7 long-term care home. Dedicated assistants, who were taught by experts how to use NPT, were asked to record the occurrence of each BPSD episode, to choose a given NPT on the basis of their knowledge of the patient and the type of BPSD and to estimate its efficacy. Wandering was the most prevalent BPSD followed by agitation/aggression and screaming. The most used therapy was cognitive stimulation, followed by multisensory stimulation, reminiscence and Montessori-based. Regarding wandering, multisensory stimulation was found to be the most efficacious NPT significantly different from Montessori-based, cognitive stimulation or reminiscence. With regards to agitation/aggression or screaming, Montessori-based was found to be the most efficacious NPT significantly different from multisensory stimulation, reminiscence and cognitive stimulation.

Opioid sparing strategies for perioperative pain management other than regional anaesthesia: A narrative review.

Opioids play a crucial role in pain management in spite of causing increased hospital morbidity and related costs. It may also cause significant risks such as postoperative nausea and vomiting (PONV), sedation, sleep disturbances, urinary retention and respiratory depression (commonly referred to as opioid related adverse effects) in postoperative patients. In order to evade these opioid related side effects and also improve pain management, multimodal analgesia i.e., combination of different analgesics, was introduced more than a decade ago. Both pharmacological and non-pharmacological techniques are available as opioid sparing analgesia. Research from around the world have proved pharmacological techniques ranging from acetaminophen, NSAIDs (non-steroidal anti-inflammatory drugs), N-methyl-D-aspartate receptor antagonists (NDMA), alpha-2 agonists, anticonvulsants such as gamma aminobutyric acid analogues, beta-blockers, capsaicin, lignocaine infusion to glucocorticoids to be effective. On the other hand, non-pharmacological methods include techniques such as cognitive behavioral therapy, transcutaneous electrical nerve stimulation (TENS), electroanalgesia, acupuncture and hypnosis. However, research regarding the effect of these non-pharmacological techniques on pain management is still needed.

Management of multiple trichoepithelioma: A review of pharmacological therapies.

Trichoepithelioma is a rare benign adnexal neoplasm that can occur in various forms including solitary, multiple, familial or nonfamilial. Multiple facial trichoepithelioma can be associated with significant psychosocial burden. Conventional treatment modalities such as surgical excision and ablative laser have variable results and can be associated with unacceptable complications and tumour regrowth. Pharmacological interventions such as topical and systemic agents are potentially effective but clinical data are limited and treatments are poorly standardised. We review the available evidence to determine the role of pharmacological therapies in the management of multiple trichoepithelioma. Demographic and clinical data were retrospectively collected from the available English literature. Majority of cases treated with pharmacological therapies (93.75%) had a positive treatment outcome, achieving partial lesion response. Adverse effects associated with pharmacological therapies were generally well tolerated and did not interrupt treatment. There are limitations as to how our results can be interpreted owing to the paucity of good quality evidence, spectrum of disease severity, and diversity of study designs utilised in the included articles. Nonetheless, the results of our study indicate that while most pharmacological interventions for multiple trichoepithelioma produce a partial response, they can be employed as effective suppressive therapies, either alone or in conjunction with conventional treatments. The current evidence for pharmacological therapies remains largely anecdotal justifying the need for further clinical studies in this area.

Lighting and Alzheimer's Disease and Related Dementias: Spotlight on Sleep and Depression.

Alzheimer's disease and related dementias is the collective term for a progressive neurodegenerative disease for which there is presently no cure. This paper focuses on two symptoms of the disease, sleep disturbances and depression, and discusses how light can be used as a non-pharmacological intervention to mitigate their negative effects. Bright days and dark nights are needed for health and well-being, but the present components of the built environment, especially those places where older adults spend most of their days, are too dimly illuminated during the day and too bright at night. To be effective light needs to be correctly specified, implemented, and measured. Yet without the appropriate specification and measurement of the stimulus, researchers will not be able to successfully demonstrate positive results in the field, nor will lighting designers and specifiers have the confidence to implement lighting solutions for promoting better sleep and mood in this population.

[Long-term effect analysis of a cognitive stimulation program in mild cognitive impairment elderly in Primary Care: A randomized controlled trial]. / Análisis del efecto a largo plazo de un programa de estimulación cognitiva en mayores con deterioro cognitivo leve en Atención Primaria: ensayo controlado aleatorizado.

OBJECTIVE: To provide evidence about the efficacy of a community health intervention through a cognitive stimulation program at long term in older people with mild cognitive impairment. DESIGN: Randomized controlled trial (CONSORT group norms). LOCATION: San José Norte-Centro Primary Care Center and La Caridad Foundation (Zaragoza, Spain). PARTICIPANTS: Twenty-nine people over 65 years old with a 24-27 MEC score that completed 48 months follow up. They were randomized between the intervention group (15) and the control group (14). INTERVENTIONS: The intervention was applied in 10 sessions of 45min for 10 weeks using the red notebook tool for mental activation that works memory, orientation, language, praxis, gnosis, calculation, perception, logical reasoning, attention and executive functions. MAIN MEASUREMENTS: The main outcome variables were MEC-35, Set-test, Barthel index, Lawton-Brody scale, Goldberg anxiety scale and Yesavage geriatric depression scale short form. RESULTS: Increases of the main result variable over the baseline level of MEC-35 were analyzed. On average, the intervention group obtained higher scores than control: 3.14 points post intervention, 3.76 points after 6 months and 2.26 points more than control group after 12 months. All the differences were statistically significant. After 48 months the intervention group obtained 2 points more than control group. The intervention did not improve verbal fluency, activity daily living and mood. CONCLUSIONS: Our cognitive stimulation program seems to improve cognitive performance, measured with the variable MEC-35 at post intervention, 6, 12 and 48 months. There is no evidence of improvement in verbal fluency, activity daily livings and mood. Clinicaltrials.gov Identifier: NCT03831061.

A systematic review of pharmacological therapies and their effectiveness on health-related quality of life outcomes in patients with juvenile-onset systemic lupus erythematosus.

Juvenile-onset systemic lupus erythematosus (JSLE) presents with an aggressive course and high morbidity associated with disease and treatment. JSLE patients have a poorer health-related quality of life (HRQoL) when compared with age-matched patients with other rheumatologic disorders. We aim to summarize the impact of current pharmacological therapies on the HRQoL of JSLE patients. Search strategies were developed across seven databases. Randomized clinical trials (RCTs) and cohort studies comparing interventions to standard therapy, placebo or pre-post cohort comparisons for more than 4 weeks were included. The outcome included self-reported scales compared at baseline and a therapeutic time point. Risk of bias was evaluated by using the Cochrane risk of bias tool and the Newcastle-Ottawa quality assessment scale. A total of 2812 articles were narrowed down to 309 for full-text screening. Four RCTs and one prospective cohort study, with a total of 634 JSLE patients, met the inclusion criteria. Four of the studies had a controlled intervention plus standard therapy compared with standard therapy alone or placebo. Multiple indices were used to evaluate HRQoL. These included the Pediatric Quality of Life Inventory, Childhood Health Assessment Questionnaire, Simple Measure of Impact of Lupus Erythematosus in Youngsters tool, Kids Fatigue Severity Scale and Child Depression Inventory. A single study reported a significant improvement while remaining studies reported no difference or failed to report the statistical analysis. Although HRQoL is significantly impaired in JSLE, evidence regarding its improvement is limited due to the small number of eligible studies, heterogeneity in scales, and HRQoL domains. A universal HRQoL questionnaire for JSLE needs to be established and used in both the research and clinical setting. All studies should adhere to reporting guidelines.

The "CHROME criteria": Tool to optimize and audit prescription quality of psychotropic medications in institutionalized people with dementia.

OBJECTIVE: Describe and validate the CHROME (CHemical Restraints avOidance MEthodology) criteria. DESIGN: Observational prospective longitudinal study. SETTING: Single nursing home in Las Palmas de Gran Canaria, Spain. PARTICIPANTS: 288 residents; mean age: 81.6 (SD 10.6). 77.4% had dementia. INTERVENTION: Multicomponent training and consultancy program to eliminate physical and chemical restraints and promote overall quality care. Clinicians were trained in stringent diagnostic criteria of neuropsychiatric syndromes and adequate psychotropic prescription. MEASUREMENTS: Psychotropic prescription (primary study target), neuropsychiatric syndromes, physical restraints, falls, and emergency room visits were semi-annually collected from December 2015 to December 2017. Results are presented for all residents and for those who had dementia and participated in the five study waves (completer analysis, n=107). RESULTS: For the study completers, atypical neuroleptic prescription dropped from 42.7% to 18.7%, long half-life benzodiazepines dropped from 25.2% to 6.5%, and hypnotic medications from 47.7% to 12.1% (p<0.0005). Any kind of fall evolved from 67.3 to 32.7 (number of falls by 100 residents per year). Physicians' diagnostic confidence increased, while the frequency of diagnoses of neuropsychiatric syndromes decreased (p<0.0005). CONCLUSIONS: Implementing the CHROME criteria reduced the prescription of the most dangerous medications in institutionalized people with dementia. Two independent audits found no physical or chemical restraint and confirmed prescription quality of psychotropic drugs. Adequate diagnosis and independent audits appear to be the keys to help and motivate professionals to optimize and reduce the use of psychotropic medication. The CHROME criteria unify, in a single compendium, neuropsychiatric diagnostic criteria, prescription guidelines, independent audit methodology, and minimum legal standards. These criteria can be easily adapted to other countries.

[Analysis of the effect of a program of cognitive stimulation in elderly people with normal aging in primary care: Randomized clinical trial]. / Análisis del efecto de un programa de estimulación cognitiva en personas con envejecimiento normal en Atención Primaria: ensayo clínico aleatorizado.

OBJECTIVE: To provide evidence of the effectiveness of a community health intervention, that includes a cognitive stimulation program, to prevent the deterioration of cognitive abilities in our population of elderly people with normal cognition that are living in the community. DESIGN: Randomized clinical trial (CONSORT group norms) LOCATION: San José Norte-Centro Health Center and La Caridad Foundation (Zaragoza, Spain). PARTICIPANTS: 201 people aged 65 or older, with a MEC score of at least 28 points, which were randomized between the Intervention group (101) and the Control group (100). INTERVENTION: The intervention was applied in 10 sessions of 45minutes, one per week. It used materials designed by one of the authors, which addressed the following areas: memory, orientation, language, praxis, gnosis, calculation, perception, logical reasoning, attention-concentration and programming. MAIN MEASUREMENTS: The main outcome variables were MEC, Set-Test, Barthel and Lawton-Brody. RESULTS: Increases of the main result variables over their baseline level were analized. For MEC variable, the Intervention group obtained, on average, 1.58 points more than the Control group in the evaluation performed immediately after the intervention. After 6months, the improvement was 1.51 points and after a year, it was of 2.04 points. All these differences were statistically significant. For Set-Test, Barthel and Lawton-Brody variables, no statistically significant differences were observed between Intervention group and Control group. CONCLUSIONS: Cognitive stimulation with our program is effective to maintain or improve cognitive performance, measured with the variable MEC, our population of elderly people with normal cognition that are living in the community. There is no evidence that this improvement is transferred to the activities of daily life measured with Barthel and Lawton-Brody variables.

Pulmonary function and clinical correlation in DMD.

Duchenne muscular dystrophy [DMD] is the most common inherited myopathy and is caused by a defect in the dystrophin gene on the X chromosome causing production of a dysfunctional dystrophin protein. Over the last decade there have been advances in disease modifying pharmacotherapy beyond the widely used strategy of corticosteroids into products to impact both dystrophin production itself and also some of the downstream effects of absent of dysfunctional dystrophin. This manuscript will explore the respiratory progression of DMD including some proposed functional and clinical correlations and the overlap between loss of function in different muscle groups. Options for symptomatic treatment and support are presented and direction as to when the different options should be considered is provided. The manuscript will also review the currently available and late phase developmental pharmacotherapies for DMD.

Tendinopathy: Pathophysiology, Therapeutic Options, and Role of Nutraceutics. A Narrative Literature Review.

Tendinopathies are very common in general population and a huge number of tendon-related procedures take place annually worldwide, with significant socio-economic repercussions. Numerous treatment options are commonly used for tendon disorders. Besides pharmacological and physical therapy, nutrition could represent an additional tool for preventing and treating this complex pathology that deserve a multidisciplinary approach. In recent years, nutraceutical products are growing up in popularity since these seem to favor the prevention and the healing processes of tendon injuries. This narrative literature review aims to summarize current understanding and the areas of ongoing research about the management of tendinopathies with the help of oral supplementation.

Patterns of conventional and complementary non-pharmacological health practice use by US military veterans: a cross-sectional latent class analysis.

BACKGROUND: Non-pharmacological therapies and practices are commonly used for both health maintenance and management of chronic disease. Patterns and reasons for use of health practices may identify clinically meaningful subgroups of users. The objectives of this study were to identify classes of self-reported use of conventional and complementary non-pharmacological health practices using latent class analysis and estimate associations of participant characteristics with class membership. METHODS: A mailed survey (October 2015 to September 2016) of Minnesota National Guard Veterans from a longitudinal cohort (n = 1850) assessed current pain, self-reported overall health, mental health, substance use, personality traits, and health practice use. We developed the Health Practices Inventory, a self-report instrument assessing use of 19 common conventional and complementary non-pharmacological health-related practices. Latent class analysis was used to identify subgroups of health practice users, based on responses to the HPI. Participants were assigned to their maximum-likelihood class, which was used as the outcome in multinomial logistic regression to examine associations of participant characteristics with latent class membership. RESULTS: Half of the sample used non-pharmacological health practices. Six classes of users were identified. "Low use" (50%) had low rates of health practice use. "Exercise" (23%) had high exercise use. "Psychotherapy" (6%) had high use of psychotherapy and support groups. "Manual therapies" (12%) had high use of chiropractic, physical therapy, and massage. "Mindfulness" (5%) had high use of mindfulness and relaxation practice. "Multimodal" (4%) had high use of most practices. Use of manual therapies (chiropractic, acupuncture, physical therapy, massage) was associated with chronic pain and female sex. Characteristics that predict use patterns varied by class. Use of self-directed practices (e.g., aerobic exercise, yoga) was associated with the personality trait of absorption (openness to experience). Use of psychotherapy was associated with higher rates of psychological distress. CONCLUSIONS: These observed patterns of use of non-pharmacological health practices show that functionally similar practices are being used together and suggest a meaningful classification of health practices based on self-directed/active and practitioner-delivered. Notably, there is considerable overlap in users of complementary and conventional practices.

Lipoprotein(a): the revenant.

In the mid-1990s, the days of lipoprotein(a) [Lp(a)] were numbered and many people would not have placed a bet on this lipid particle making it to the next century. However, genetic studies brought Lp(a) back to the front-stage after a Mendelian randomization approach used for the first time provided strong support for a causal role of high Lp(a) concentrations in cardiovascular disease and later also for aortic valve stenosis. This encouraged the use of therapeutic interventions to lower Lp(a) as well numerous drug developments, although these approaches mainly targeted LDL cholesterol, while the Lp(a)-lowering effect was only a 'side-effect'. Several drug developments did show a potent Lp(a)-lowering effect but did not make it to endpoint studies, mainly for safety reasons. Currently, three therapeutic approaches are either already in place or look highly promising: (i) lipid apheresis (specific or unspecific for Lp(a)) markedly decreases Lp(a) concentrations as well as cardiovascular endpoints; (ii) PCSK9 inhibitors which, besides lowering LDL cholesterol also decrease Lp(a) by roughly 30%; and (iii) antisense therapy targeting apolipoprotein(a) which has shown to specifically lower Lp(a) concentrations by up to 90% in phase 1 and 2 trials without influencing other lipids. Until the results of phase 3 outcome studies are available for antisense therapy, we will have to exercise patience, but with optimism since never before have we had the tools we have now to prove Koch's extrapolated postulate that lowering high Lp(a) concentrations might be protective against cardiovascular disease.

Effects of non-pharmacological supportive care for hot flushes in breast cancer: a meta-analysis.

PURPOSE: To assess the efficacy of non-pharmacological therapies for hot flushes (HFs) in women with breast cancer (BC). METHODS: Nine databases (MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, CINAHL, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), China Biology Medicine (CBM), and Wan Fang Database) were searched from their inceptions to October 2016. We also hand-searched reference lists of reviews and included articles, reviewed conference proceedings, and contacted experts. Finally, randomized controlled trials (RCTs) were aggregated to evaluate the therapeutic effect of acupuncture for HFs in women with BC. RESULTS: Sixteen trials were included in the meta-analysis. Significant combined effects of non-pharmacological therapies were observed in reducing frequency and severity of HFs after treatment (d = -0.57, P < 0.001). These effects were sustained, albeit reduced in part, during follow-up (d = -0.36, P < 0.001), with the exception of frequency (P = 0.41). Meta-analysis according to therapy types showed that for hypnosis, HFs scores instead of scores of HFs-related daily interference scale (HFRDIS) were significantly lowered at the post-treatment time point (d = -13.19, P < 0.001); for acupuncture, a small but significant effect on HFRDIS was found at the post-treatment time point (d = -3.34, P < 0.001). The effect was sustained during follow-up; however, no effect was evident for HFs frequency; for cognitive behavioral therapy (CBT), at the post-treatment time point, but not during follow-up, a small but significant effect was documented for HFs score (d = -0.88, P < 0.01). No serious adverse effect was reported in the included studies. CONCLUSIONS: Various types of non-pharmacological therapies were associated with significant effects on HFs in women with BC.