Effectiveness of myofascial release for adults with chronic neck pain: a meta-analysis.

BACKGROUND: Every second human will experience a phase of neck pain in their lifetime and a high rate of chronicity exists. Because of the complexity and multiple influencing factors, chronic pain conditions are associated with a long treatment and diagnostic process. This leads to a prolonged healing process and high costs. OBJECTIVE: To evaluate the effect of myofascial release on the variables of pain and range of motion in patients with chronic neck pain. METHOD: Selection criteria were set to create a search algorithm for a systematic search in the databases: PubMed, Google Scholar, EBM Reviews, Medline, CINAHL, PEDro, and Science Direct. The risk of bias and the methodological quality was analyzed with the PEDro scale. RESULT: Ten randomized controlled trials, with 549 participants met the eligibility criteria. The methodological quality was ranked from good to excellent. The myofascial release showed a significant difference in pain (p =  0.03), rotation to the right (p =  0.05), and lateral flexion to the right (p =  0.04), compared to other treatment methods. No significant effect was found for improvements in pressure pain threshold. CONCLUSION: Modest effects are observed in pain reduction, suggesting potential benefits of myofascial release in managing chronic neck pain. Further research with standardized protocols and direct comparisons to established therapies is crucial for a comprehensive understanding of myofascial release efficacy. CONTRIBUTION OF THE PAPER: What does the meta-analysis add to the current literature.

Do yoga and meditation moderate the relationship between negative life events and depressive symptoms? Analysis of a national cross-sectional survey of Australian women.

Objectives: This study aims to examine the role of yoga/meditation in the relationship between negative life events, stress and depression. Methods: The Australian Longitudinal Study on Women's Health (ALSWH) surveyed 7,186 women aged 36-43 years (mean age 39.2 years; 57.2% university degree) in 2015. Mediation and moderation analyses were conducted to examine whether yoga/meditation practice moderated those relationships. Results: Yoga/meditation was practiced by 27.5% of participants, 33.2% reported negative life events in the past 12 months, and 24% had clinical depression. Perceived stress partially mediated the association between negative life events and depressive symptoms (B = 6.28; 95%CI 5.65; 6.92). Social support (B = -0.38; 95%CI -0.54; -0.23) and optimism (B = -0.25;95%CI -0.31; -0.18) moderated the association between stress and depressive symptoms. Yoga/meditation practice moderated the direct association between negative life events and depressive symptoms (B = -0.92; 95%CI -1.67; -0.18). Conclusion: Yoga/meditation use was a significant moderator of the relationship between negative life events and depression. Yoga/mediation use did not act via reducing perceived stress, but instead was found to dampen the influence of negative life events on depression directly. More research on how yoga has an impact on depression is warranted.

[Yoga as an intervention for chronic pain]. / Yoga als Intervention bei chronischen Schmerzen.

The use of yoga, especially as an intervention for chronic pain, is increasing worldwide. Available data on chronic low back pain, within limits also for chronic neck pain and certain types of headache, show statistically significant positive effects related to pain intensity and pain-related impairments. The data provide evidence that yoga is at least equal in efficacy and safety to other exercise interventions as well as individualized physical therapy. The dose of the intervention seems to be of secondary importance, but the establishment of a long-term independent practice after initial supervision seems to be essential; however, for other pain disorders there is still a need for research.

A Randomized Controlled Trial of Fasting and Lifestyle Modification in Patients with Metabolic Syndrome: Effects on Patient-Reported Outcomes.

Lifestyle interventions can have a positive impact on quality of life and psychological parameters in patients with metabolic syndrome (MetS). In this randomized controlled trial, 145 participants with MetS (62.8% women; 59.7 ± 9.3 years) were randomized to (1) 5-day fasting followed by 10 weeks of lifestyle modification (F + LM; modified DASH diet, exercise, mindfulness; n = 73) or (2) 10 weeks of lifestyle modification only (LM; n = 72). Outcomes were assessed at weeks 0, 1, 12, and 24, and included quality of life (Short-Form 36 Health Survey Questionnaire, SF-36), anxiety/depression (Hospital Anxiety and Depression Scale, HADS), stress (Cohen Perceived Stress Scale, CPSS), mood (Profile of Mood States, POMS), self-efficacy (General Self-Efficacy Scale, GSE), mindfulness (Mindfulness Attention Awareness Scale, MAAS), and self-compassion (Self-Compassion Scale, SCS). At week 1, POMS depression and fatigue scores were significantly lower in F + LM compared to LM. At week 12, most self-report outcomes improved in both groups-only POMS vigor was significantly higher in F + LM than in LM. Most of the beneficial effects within the groups persisted at week 24. Fasting can induce mood-modulating effects in the short term. LM induced several positive effects on quality of life and psychological parameters in patients with MetS.

Effects of Fasting and Lifestyle Modification in Patients with Metabolic Syndrome: A Randomized Controlled Trial.

BACKGROUND: Lifestyle interventions, such as fasting, diet, and exercise, are increasingly used as a treatment option for patients with metabolic syndrome (MS). This study assesses the efficacy and safety of fasting followed by lifestyle modification in patients with MS compared to lifestyle modification only. METHODS: Single-blind, multicenter, parallel, randomized controlled trial in two German tertiary referral hospitals in metropolitan areas. INTERVENTIONS: (a) 5-day fasting followed by 10 weeks of lifestyle modification (modified DASH diet, exercise, mindfulness; n = 73); (b) 10 weeks of lifestyle modification only (n = 72). MAIN OUTCOMES AND MEASURES: Co-primary outcomes were ambulatory systolic blood pressure and the homeostasis model assessment (HOMA) index at week 12. Further outcomes included anthropometric, laboratory parameters, and the PROCAM score at weeks 1, 12, and 24. RESULTS: A total of 145 patients with metabolic syndrome (62.8% women; 59.7 ± 9.3 years) were included. No significant group differences occurred for the co-primary outcomes at week 12. However, compared to lifestyle modification only, fasting significantly reduced HOMA index (Δ = -0.8; 95% confidence interval [CI] = -1.7, -0.1), diastolic blood pressure (Δ = -4.8; 95% CI = -5.5, -4.1), BMI (Δ = -1.7; 95% CI = -2.0, -1.4), weight (Δ = -1.7; 95% CI = -2.0, -1.4), waist circumference (Δ = -2.6; 95% CI = -5.0, -0.2), glucose (Δ = -10.3; 95% CI = -19.0, -1.6), insulin (Δ = -2.9; 95% CI = -5.3, -0.4), HbA1c (Δ = -0.2; 95% CI = -0.4, -0.05;), triglycerides (Δ = -48.9; 95% CI = -81.0, -16.9), IL-6 (Δ = -1.2; 95% CI = -2.5, -0.005), and the 10-year risk of acute coronary events (Δ = -4.9; 95% CI = -9.5, -0.4) after week 1. Fasting increased uric acid levels (Δ = 1.0; 95% CI = 0.1, 1.9) and slightly reduced eGRF (Δ = -11.9; 95% CI = -21.8, -2.0). Group differences at week 24 were found for weight (Δ = -2, 7; 95% CI = -4.8, -0.5), BMI (Δ = -1.0; 95% CI = -1.8, -0.3), glucose (Δ = -7.7; 95% CI = -13.5, -1.8), HDL (Δ = 5.1; 95% CI = 1.5, 8.8), and CRP (Δ = 0.2; 95% CI = 0.03, 0.4). No serious adverse events occurred. CONCLUSIONS: A beneficial effect at week 24 was found on weight; fasting also induced various positive short-term effects in patients with MS. Fasting can thus be considered a treatment for initializing lifestyle modification for this patient group; however, it remains to be investigated whether and how the multilayered effects of fasting can be maintained in the medium and longer term.

Yoga for treating low back pain: a systematic review and meta-analysis.

ABSTRACT: Yoga is frequently used for back pain relief. However, the evidence was judged to be of only low to moderate certainty. To assess the efficacy and safety of yoga in patients with low back pain, a meta-analysis was performed. Therefore, MEDLINE/PubMed, Scopus, and the Cochrane Library were searched to May 26, 2020. Only randomized controlled trials comparing Yoga with passive control (usual care or wait list), or an active comparator, for patients with low back pain and that assessed pain intensity or pain-related disability as a primary outcome were considered to be eligible. Two reviewers independently extracted data on study characteristics, outcome measures, and results at short-term and long-term follow-up. Risk of bias was assessed using the Cochrane risk of bias tool. Thirty articles on 27 individual studies (2702 participants in total) proved eligible for review. Compared with passive control, yoga was associated with short-term improvements in pain intensity (15 RCTs; mean difference [MD] = -0.74 points on a numeric rating scale; 95% confidence interval [CI] = -1.04 to -0.44; standardized mean difference [SMD] = -0.37 95% CI = -0.52 to -0.22), pain-related disability (15 RCTs; MD = -2.28; 95% CI = -3.30 to -1.26; SMD = -0.38 95% CI = -0.55 to -0.21), mental health (7 RCTs; MD = 1.70; 95% CI = 0.20-3.20; SMD = 0.17 95% CI = 0.02-0.32), and physical functioning (9 RCTs; MD = 2.80; 95% CI = 1.00-4.70; SMD = 0.28 95% CI = 0.10-0.47). Except for mental health, all effects were sustained long-term. Compared with an active comparator, yoga was not associated with any significant differences in short-term or long-term outcomes.

Integrative pediatrics survey: Parents report high demand and willingness to self-pay for complementary and integrative medicine in German hospitals.

BACKGROUND: In Germany, there is hardly any institutionalization of pediatric complementary and integrative medicine (CIM) present, which is one reason why the statutory health insurance companies usually do not cover the costs. Which in turn serves as an obstacle for integrating CIM into routine pediatric care. Within the present study, we assessed existing demand for CIM methods in parents of children in clinical primary care and whether the parents would be willing to cover the costs privately. METHODS: Parents who visited the Pediatric Department of the Elisabeth Hospital, Essen, Germany and the Children's Hospital St. Marien, Landshut, Germany with their children in 2015 and 2016 were asked to take part in a paper-pencil survey. Both outpatients and inpatients were interviewed. RESULTS: 1323 parents took part in the survey. 40 % of them stated that they already use CIM for their children. Homeopathy was the most frequently mentioned with almost 60 %, followed by osteopathy and phytotherapy. More than 80 % of the participants endorsed the expansion of the CIM offers in respective hospitals. Homeopathy was the method most desired by the parents, followed by osteopathy, phytotherapy and massage therapies. The majority (88 %) of the parents stated that they would like to take advantage of an extended range of services, including extra services that they would have to pay privately for. CONCLUSION: Many parents are already using CIM for their children and are looking forward to CIM being incorporated in clinical primary care. They would also be willing to bear the costs themselves if the therapy in question is not covered by their insurance. pay for the costs themselves if the therapy is not covered by their insurance.

Yoga in women with abdominal obesity - Do lifestyle factors mediate the effect? Secondary analysis of a RCT.

INTRODUCTION: The reduction of obesity is an important challenge for health policy. Although dietary interventions are widely available, patient adherence is usually low. A promising alternative is yoga. We hypothesized that weight reduction through yoga is mediated by aspects related to eating habits as well as physical aspects. METHODS: This is an exploratory secondary analysis of a randomized controlled trial comparing the effects of yoga to waiting list in women with abdominal obesity. Body mass index (BMI) and waist circumference were assessed as outcomes; physical exercise habits, physical activity habits at leisure time, physical activity habits at work time, daily fruit and vegetable intake, nutrition self-efficacy, and physical self-efficacy were captured as mediators. Measures were assessed at weeks 0 and 12. The original trial was conducted between April and August 2015. The secondary analysis was performed December 2019. RESULTS: Forty patients were randomized to the 12 weekly yoga sessions (48.5 ± 7.9 years) and 20 patients to the waitlist group (46.4 ± 8.9 years). Physical exercise habits fully mediated the effect of yoga on BMI (B=-0.26;CI[-.56;-.07]). Daily fruit and vegetable intake partially mediated the effect of yoga on BMI (B=-0.13;CI[-.38;-.01]). No further mediation effects were found. CONCLUSIONS: Yoga supports people with overweight in eating healthier and increasing their physical activity which in turn leads to a reduced BMI. Yoga's effects on waist circumference seem to be due to other mechanisms.

Comparative efficacy of different exercise interventions in chronic non-specific low back pain: protocol of a systematic review and network meta-analysis.

INTRODUCTION: Chronic non-specific low back pain is a major public health problem. Evidence supports the effectiveness of exercise as an intervention. Due to a paucity of direct comparisons of different exercise categories, medical guidelines were unable to make specific recommendations regarding the type of exercise working best in improving chronic low back pain. This network meta-analysis (NMA) of randomised controlled trials aims to investigate the comparative efficacy of different exercise interventions in patients with chronic non-specific low back pain. METHODS AND ANALYSIS: MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, SPORTDiscus, Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform search portal were searched on November 2019 and without language restrictions. The search will be updated after data analysis. Studies on adults with non-specific low back pain of at least 12 weeks duration comparing exercise to either no specific intervention (ie, no treatment, wait-list or usual care at the treating physician's discretion) and/or functionally inert interventions (ie, sham or attention control interventions) will be eligible. Pain intensity and back-specific disability are defined as primary outcomes. Secondary outcomes will include health-related physical and mental quality of life, work disability, frequency of analgesic use and adverse events. All outcomes will be analysed short-term, intermediate-term and long-term. Data will be extracted independently by two review authors. Risk of bias will be assessed using the recommendations by the Cochrane Back and Neck Group and be based on an adaptation of the Cochrane Risk of Bias tool. ETHICS AND DISSEMINATION: This NMA will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses_NMA checklist. The results will be presented in peer-reviewed journals, implemented in existing national and international guidelines and will be presented to health care providers and decision makers. The planned completion date of the study is 1 July 2021. PROSPERO REGISTRATION NUMBER: CRD42020151472.

The effect of Echinacea spp. on the prevention or treatment of COVID-19 and other respiratory tract infections in humans: A rapid review.

BRIEF OVERVIEW: Current evidence suggests that Echinacea supplementation may decrease the duration and severity of acute respiratory tract infections; however, no studies using Echinacea in the prevention or treatment of conditions similar to COVID-19 have been identified. Few adverse events were reported, suggesting that this herbal therapy is reasonably safe. Because Echinacea can increase immune function, there is a concern that it could worsen over-activation of the immune system in cytokine storm; however, clinical trials show that Echinacea decreases levels of immune molecules involved in cytokine storm. VERDICT: Echinacea supplementation may assist with the symptoms of acute respiratory infections (ARI) and the common cold, particularly when administered at the first sign of infection; however, no studies using Echinacea in the prevention or treatment of conditions similar to COVID-19 have been identified. Previous studies have reported that Echinacea may decrease the severity and/or duration of ARI when taken at the onset of symptoms. The studies reporting benefit used E. purpurea or a combination of E. purpurea and E. angustifolia containing standardized amounts of active constituents.Few adverse events from the use of Echinacea were reported, suggesting that this herbal therapy is reasonably safe. No human trials could be located reporting evidence of cytokine storm when Echinacea was used for up to 4 months.When assessing all human trials which reported changes in cytokine levels in response to Echinacea supplementation, the results were largely consistent with a decrease in the pro-inflammatory cytokines that play a role in the progression of cytokine storm and Acute Respiratory Distress Syndrome (ARDS), factors that play a significant role in the death of COVID-19 patients. While there is currently no research on the therapeutic effects of Echinacea in the management of cytokine storm, this evidence suggests that further research is warranted.

Cupping for Patients With Chronic Pain: A Systematic Review and Meta-Analysis.

There is a growing interest in nonpharmacological pain treatment options such as cupping. This meta-analysis aimed to assess the effectiveness and safety of cupping in chronic pain. PubMed, Cochrane Library, and Scopus were searched through November 2018 for randomized controlled trials on effects of cupping on pain intensity and disability in patients with chronic pain. Risk of bias was assessed using the Cochrane risk of bias tool. Of the 18 included trials (n =1,172), most were limited by clinical heterogeneity and risk of bias. Meta-analyses found large short-term effects of cupping on pain intensity compared to no treatment (standardized mean difference [SMD] = -1.03; 95% confidence interval [CI] = -1.41, -.65), but no significant effects compared to sham cupping (SDM = -.27; 95% CI = -.58, .05) or other active treatment (SMD = -.24; 95% CI = -.57, .09). For disability, there were medium-sized short-term effects of cupping compared to no treatment (SMD = -.66; 95% CI = -.99, -.34), and compared to other active treatments (SMD = -.52; 95% CI = -1.03, -.0028), but not compared to sham cupping (SMD = -.26; 95% CI = -.57,.05). Adverse events were more frequent among patients treated with cupping compared to no treatment; differences compared to sham cupping or other active treatment were not statistically significant. Cupping might be a treatment option for chronic pain, but the evidence is still limited by the clinical heterogeneity and risk of bias. Perspective: This article presents the results of a meta-analysis aimed to assess the effectiveness and safety of cupping with chronic pain. The results suggest that cupping might be a treatment option; however, the evidence is still limited due to methodical limitations of the included trials. High-quality trials seem warranted.

Yoga for Treating Headaches: a Systematic Review and Meta-analysis.

BACKGROUND: Headache disorders are currently the sixth leading cause of disability across the globe and therefore carry a significant disease burden. This systematic review and meta-analysis aims to investigate the effects of yoga on headache disorders. METHODS: MEDLINE/PubMed, Scopus, the Cochrane Library, and PsycINFO were screened through May 2019. Randomized controlled trials (RCTs) were included when they assessed the effects of yoga in patients with a diagnosis of chronic or episodic headache (tension-type headache and/or migraine). Usual care (no specific treatment) or any active treatments were acceptable as control interventions. Primary outcome measures were headache frequency, headache duration, and pain intensity. For each outcome, standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated. RESULTS: Meta-analysis revealed a statistically significant overall effect in favor of yoga for headache frequency (5 RCTs; standardized mean difference (SMD) = - 1.97; 95% confidence interval (CI) - 2.75 to - 1.20; I2 = 63.0%, τ2 = 0.25, P = 0.03), headache duration (4 RCTs; SMD = - 1.45; 95% CI - 2.54 to - 0.37; I2 = 69.0%, τ2 = 0.33, P = 0.02), and pain intensity (5 RCTs; SMD = - 3.43; 95% CI - 6.08 to - 0.70, I2 = 95.0%, τ2 = 4.25, P < 0.01). The significant overall effect was mainly due to patients with tension-type headaches. For patients with migraine, no statistically significant effect was observed. DISCUSSION: Despite discussed limitations, this review found preliminary evidence of short-term efficacy of yoga in improving headache frequency, headache duration, and pain intensity in patients suffering from tension-type headaches. Further studies are urgently needed to draw deeper conclusions from the available results.

Integrated care for migraine and chronic tension-type headaches: A prospective observational study.

BACKGROUND AND PURPOSE: This prospective observational study aimed to investigate the effects of an interdisciplinary multimodal integrated care program in patients with chronic migraine and/or tension-type headache. MATERIALS AND METHODS: Patients (n = 158) underwent inpatient, outpatient and/or semi-stationary treatment including conventional as well as complementary headache treatment. Headache frequency was defined as the primary outcome; secondary outcomes included pain (VAS, PPS), medication use, quality of life (SF-36), function (HDI, PSFS), depression and anxiety (HADS), and pain self-efficacy (PSEQ). RESULTS: Headache frequency decreased from 17.0 ±â€¯8.8 days/month at treatment start to 11.4 ±â€¯9.2 at treatment end and to 10.6 ±â€¯9.3 at 6-month follow-up (p < 0.001). All other outcome measures also improved across the course of the study (all p < 0.001). CONCLUSIONS: An integrated care approach based on integrative medicine improved headache symptoms and functioning in patients with chronic migraine and/or tension-type headache. Interdisciplinary multimodal treatment approaches seem to adequately address the specific treatment needs of headache patients.

Complementary therapies for clinical depression: an overview of systematic reviews.

OBJECTIVES: As clinical practice guidelines vary widely in their search strategies and recommendations of complementary and alternative medicine (CAM) for depression, this overview aimed at systematically summarising the level 1 evidence on CAM for patients with a clinical diagnosis of depression. METHODS: PubMed, PsycInfo and Central were searched for meta-analyses of randomised controlled clinical trials (RCTs) until 30 June 2018. Outcomes included depression severity, response, remission, relapse and adverse events. The quality of evidence was assessed according to Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) considering the methodological quality of the RCTs and meta-analyses, inconsistency, indirectness, imprecision of the evidence and the potential risk of publication bias. RESULTS: The literature search revealed 26 meta-analyses conducted between 2002 and 2018 on 1-49 RCTs in major, minor and seasonal depression. In patients with mild to moderate major depression, moderate quality evidence suggested the efficacy of St. John's wort towards placebo and its comparative effectiveness towards standard antidepressants for the treatment for depression severity and response rates, while St. John's wort caused significant less adverse events. In patients with recurrent major depression, moderate quality evidence showed that mindfulness-based cognitive therapy was superior to standard antidepressant drug treatment for the prevention of depression relapse. Other CAM evidence was considered as having low or very low quality. CONCLUSIONS: The effects of all but two CAM treatments found in studies on clinical depressed patients based on low to very low quality of evidence. The evidence has to be downgraded mostly due to avoidable methodological flaws of both the original RCTs and meta-analyses not following the Consolidated Standards of Reporting Trials and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Further research is needed.

Mindfulness-based stress reduction for treating chronic headache: A systematic review and meta-analysis.

BACKGROUND: Mindfulness-based stress reduction/cognitive therapy are frequently used for pain-related conditions, but their effects on headache remain uncertain. This review aimed to assess the efficacy and safety of mindfulness-based stress reduction/cognitive therapy in reducing the symptoms of chronic headache. DATA SOURCES AND STUDY SELECTION: MEDLINE/PubMed, Scopus, CENTRAL, and PsychINFO were searched to 16 June 2017. Randomized controlled trials comparing mindfulness-based stress reduction/cognitive therapy with usual care or active comparators for migraine and/or tension-type headache, which assessed headache frequency, duration or intensity as a primary outcome, were eligible for inclusion. Risk of bias was assessed using the Cochrane Tool. RESULTS: Five randomized controlled trials (two on tension-type headache; one on migraine; two with mixed samples) with a total of 185 participants were included. Compared to usual care, mindfulness-based stress reduction/cognitive therapy did not improve headache frequency (three randomized controlled trials; standardized mean difference = 0.00; 95% confidence interval = -0.33,0.32) or headache duration (three randomized controlled trials; standardized mean difference = -0.08; 95% confidence interval = -1.03,0.87). Similarly, no significant difference between groups was found for pain intensity (five randomized controlled trials; standardized mean difference = -0.78; 95% confidence interval = -1.72,0.16). CONCLUSIONS: Due to the low number, small scale and often high or unclear risk of bias of included randomized controlled trials, the results are imprecise; this may be consistent with either an important or negligible effect. Therefore, more rigorous trials with larger sample sizes are needed.

Emotional release and physical symptom improvement: a qualitative analysis of self-reported outcomes and mechanisms in patients treated with neural therapy.

BACKGROUND: Neural Therapy (NT) is a common complementary treatment approach using injections with short-acting local anesthetics to treat pain and chronic diseases. However, little is known about the underlying mechanisms and the domains of treatment response. This study therefore analyzed patient experiences following NT injections with procaine. METHODS: Maximum variation sampling was used to collect data from semi-structured interviews conducted with 22 hospital inpatients aged 59.6 ± 14.9 years (81.8% female). Each had multiple (9.4 ± 6.9) diagnoses. They were undergoing two weeks of integrative treatment, which included individualized NT. The interview data were analyzed in MAXQDA using qualitative content analysis. RESULTS: With injection, patients first described local anesthetic effects including temporary blocking of pain and increased local warmth. Second, patients reported on vegetative reactions frequently leading to turmoil within the body like initial aggravation of existing symptoms or the appearance of new, concealed or phantom symptoms. This often required the need for rest to deal with the treatment stimulus. As a third step, many patients could gain physical and emotional release and relief in symptoms, mood and functioning. Emotional release was often accompanied by weeping and initially overwhelmed affected patients with dissociated memories. However, in cases where patients were able to experience those memories with a new distance, a fourth step of integration was achievable. It included reframing processes as well as a gain in pain perception and body-awareness. As a possible fifth step, patients experienced improved mood, increased pain acceptance and empowerment. Adverse events of NT included pain from the injections, vegetative complaints and emotional turmoil that lasted for minutes or hours, with a maximum of two days. CONCLUSIONS: Patients treated with procaine injections reported different psychophysiological outcomes contributing to the understanding of the mechanisms underlying NT. Further efficacy studies should separate specific NT from non-specific/placebo effects. TRIAL REGISTRATION: DRKS00004567 .

"I think you can achieve quite a lot if all of the staff stands behind it"-A qualitative study about the experience, knowledge and application of complementary therapies and integrative medicine in pediatrics.

BACKGROUND: In the United States there is an increasing use of complementary and alternative medicine (CAM) as well as integrative medicine (IM) in pediatrics. This study investigates the extent of knowledge and practical application of and attitudes towards the use and integration of CAM/IM therapies in two German pediatric clinics. METHODS: A semi-standardized qualitative interview study was conducted in a rural children's hospital in Bavaria and in a children's clinic in the metropolitan area of Ruhr. Sixteen employees (7 nurses, 9 medical doctors, 68.8% female), who had volunteered through a local contact, were questioned during their shift on CAM/IM therapies. The data collected were analyzed with MAXQDA 12 using a qualitative technique for content analysis (by Mayring). RESULTS: On average all respondents had little to superficial knowledge about the possibilities or evidence base of the therapies concerned, but did believe that CAM/IM could be an enhancement. In addition, many took interest in learning more about CAM/IM medical options. Nurses desired more practical and theoretical knowledge; while medical doctors focused on standardization and evidence base. All of them agreed that self-care strategies could enhance parental independence when treating symptoms of minor illnesses. They further agreed, that a symbiosis of conventional medicine and CAM/IM has great potential for patients and employees. It was stated that training of staff would be indispensable in order to implement standardized procedures. CONCLUSIONS: There is great potential and interest in CAM/IM among pediatric care employees. Regardless of the challenges, this investigation did find that implementing CAM/IM might be a promising extension to the daily care routine.

Integrative Pediatrics: Successful Implementation of Integrative Medicine in a German Hospital Setting-Concept and Realization.

Complementary and Alternative Medicine (CAM) has not been systematically institutionalized in pediatric hospital care in Germany so far. For the responsible implementation and systematic evaluation of CAM in pediatric care, a model project was initialized in three different pediatric hospitals in Germany, one of them being the "Kinderkrankenhaus St. Marien" in Landshut, Germany. During this project, a concept of the implementation process was developed based on clinical care, teaching, and scientific evaluation. A project group was formed in St. Marien, which included leaders of the hospital, physicians, nurses, and physiotherapists. Over a period of three years, pediatric treatment modalities of the CAM-spectrum were systematically integrated into routine pediatric care and a new integrative medicine department was established. CAM is now being applied in an inpatient as well as outpatient setting, in addition to conventional medical treatments. The modalities now applied include Traditional Chinese Medicine (TCM), relaxation, hypnosis, reflexology, wraps and poultices, aromatherapy, homeopathy, yoga, and herbal medicine. Studies were initiated in some areas. The process and concept leading up to this successful implementation will be described in this article. We show that with motivated team players and structured proceedings, implementation of integrative medicine in a children's hospital can be successful.

Yoga for anxiety: A systematic review and meta-analysis of randomized controlled trials.

Yoga has become a popular approach to improve emotional health. The aim of this review was to systematically assess and meta-analyze the effectiveness and safety of yoga for anxiety. Medline/PubMed, Scopus, the Cochrane Library, PsycINFO, and IndMED were searched through October 2016 for randomized controlled trials (RCTs) of yoga for individuals with anxiety disorders or elevated levels of anxiety. The primary outcomes were anxiety and remission rates, and secondary outcomes were depression, quality of life, and safety. Risk of bias was assessed using the Cochrane tool. Eight RCTs with 319 participants (mean age: 30.0-38.5 years) were included. Risk of selection bias was unclear for most RCTs. Meta-analyses revealed evidence for small short-term effects of yoga on anxiety compared to no treatment (standardized mean difference [SMD] = -0.43; 95% confidence interval [CI] = -0.74, -0.11; P = .008), and large effects compared to active comparators (SMD = -0.86; 95% CI = -1.56, -0.15; P = .02). Small effects on depression were found compared to no treatment (SMD = -0.35; 95% CI = -0.66, -0.04; P = .03). Effects were robust against potential methodological bias. No effects were found for patients with anxiety disorders diagnosed by Diagnostic and Statistical Manual criteria, only for patients diagnosed by other methods, and for individuals with elevated levels of anxiety without a formal diagnosis. Only three RCTs reported safety-related data but these indicated that yoga was not associated with increased injuries. In conclusion, yoga might be an effective and safe intervention for individuals with elevated levels of anxiety. There was inconclusive evidence for effects of yoga in anxiety disorders. More high-quality studies are needed and are warranted given these preliminary findings and plausible mechanisms of action.