Do Relaxation Exercises Decrease Pain After Arthroscopic Rotator Cuff Repair? A Randomized Controlled Trial.

BACKGROUND: Pain after rotator cuff repair is commonly managed with opioid medications; however, these medications are associated with serious adverse effects. Relaxation exercises represent a potential nonpharmacologic method of pain management that can be easily implemented without substantial adverse effects; however, the effects of relaxation exercises have not been studied in a practical, reproducible protocol after arthroscopic rotator cuff repair. QUESTIONS/PURPOSES: (1) Does performing relaxation exercises after arthroscopic rotator cuff repair (ARCR) decrease pain compared with standard pain management medication? (2) Does performing relaxation exercises after ARCR decrease opioid consumption? (3) What proportion of patients who used the relaxation techniques believed they decreased their pain level, and what proportion continued using these techniques at 2 weeks? (4) Does performing relaxation exercises after ARCR affect shoulder function? METHODS: During the study period, 563 patients were eligible for inclusion; however, only 146 were enrolled, randomized, and postoperatively followed (relaxation group: 74, control group: 72); 68% (384 of 563) of patients were not contacted due to patient and research staff availability. Thirty-three patients were unenrolled preoperatively or immediately postoperatively due to change in operative procedure (such as, only debridement) or patient request; no postoperative data were collected from these patients. Follow-up proportions were similar between the relaxation and control groups (relaxation: 80%, control: 81%; p = 0.90). The relaxation group received and reviewed educational materials consisting of a 5-minute video and an educational pamphlet explaining relaxation breathing techniques, while the control group did not receive relaxation education materials. Patients recorded their pain levels and opioid consumption during the 5 days after ARCR. Patients also completed the American Shoulder and Elbow Surgeons shoulder score preoperatively and 2, 6, 13, 18, and 26 weeks postoperatively. Linear mixed models were created to analyze postoperative pain, opioid consumption measured in morphine milligram equivalents (MMEs), and shoulder function outcomes. A per-protocol approach was used to correct for patients who were enrolled but subsequently underwent other procedures. RESULTS: There was no difference in pain scores between the relaxation and control groups during the first 5 days postoperatively. There was no difference in pain scores at 2 weeks postoperatively between the relaxation and control groups (3.3 ± 3 versus 3.5 ± 2, mean difference -0.22 [95% CI -1.06 to 0.62]; p = 0.60). There was no difference in opioid consumption during the first 5 days postoperatively between the relaxation and control groups. The use of relaxation exercises resulted in lower 2-week narcotics consumption in the relaxation group than in the control group (309 ± 241 MMEs versus 442 ± 307 MMEs, mean difference -133 [95% CI -225 to -42]; p < 0.01). Sixty-two percent (41 of 66) of patients in the relaxation group believed the relaxation exercises decreased their pain levels. Fifty-two percent (34 of 66) were still performing the exercises at 2 weeks postoperatively. During the 6-month follow-up period, there was no difference in shoulder function between the relaxation and control groups. CONCLUSION: The preoperative administration of quick, basic relaxation exercises allowed patients to use appreciably lower opioid analgesic doses over the first 2 weeks after ARCR, without any worsening of pain scores. We consider this result promising but preliminary; it is possible that a more intense mindfulness intervention-the one we studied here was disseminated using only a 5-minute video-would deliver reductions in pain and further reductions in opioid usage. LEVEL OF EVIDENCE: Level II, therapeutic study.

The paradox of relaxation training: Relaxation induced anxiety and mediation effects of negative contrast sensitivity in generalized anxiety disorder and major depressive disorder.

BACKGROUND: The Contrast Avoidance Model postulates that individuals with generalized anxiety disorder (GAD) fear a sharp spike in negative emotion, and thus, prefer to worry to maintain their negative affect rather than being in a more euthymic state, such as relaxation. Relaxation induced anxiety (RIA) is a paradoxical phenomenon wherein people experience a spike in their anxiety during relaxation training. Because these phenomena may be related and may also operate among individuals with major depressive disorder (MDD), we attempted to test whether negative contrast sensitivity was a mediator of GAD or MDD in the prediction of RIA. METHODS: Individuals with GAD (n = 32), MDD (n = 34), and healthy controls (n = 30) were exposed to a negative emotional contrast by engaging with relaxation practice and then watching a negative emotional video. This was followed by the assessment of their negative contrast sensitivity. After this, participants engaged again with relaxation and RIA was measured. We examined mediation effects of negative contrast on the relationship between diagnostic status and RIA. RESULTS: Negative contrast sensitivity fully mediated GAD and partially mediated MDD in predicting RIA. CONCLUSIONS: Our findings support the hypotheses that negative contrast sensitivity is the mediator of both GAD and MDD in predicting RIA. This may have implications for assessment and treatment of GAD and MDD.

Personalised relaxation practice to improve sleep and functioning in patients with chronic fatigue syndrome and depression: study protocol for a randomised controlled trial.

BACKGROUND: Chronic fatigue syndrome (CFS) and major depressive disorder (MDD) are both debilitating but heterogeneous conditions sharing core features of fatigue, unrefreshing sleep, and impaired functioning. The aetiology of these conditions is not fully understood, and 'best-practice' treatments are only moderately effective in relieving symptoms. Unrecognised individual differences in the response to such treatments are likely to underlie poor treatment outcomes. METHODS/DESIGN: We are undertaking a two-group, parallel, randomised controlled trial (RCT) comparing the effects of a personalised relaxation intervention on sleep quality, daytime symptoms, and functioning in patients with CFS (n = 64) and MDD (n = 64). Following identification of the method that best enhances autonomic responding (such as heart rate variability), participants randomised to the active intervention will practise their recommended method nightly for 4 weeks. All participants will keep a sleep diary and monitor symptoms during the trial period, and they will complete two face-to-face assessments, one at baseline and one at 4 weeks, and a further online assessment to evaluate lasting effects of the intervention at 2 months. Assessments include self-report measures of sleep, wellbeing, and function and monitoring of autonomic responses at rest, in response to the relaxation method and during nocturnal sleep. Treatment outcomes will be analysed using linear mixed modelling. DISCUSSION: This is the first RCT examining the effects of a personalised relaxation intervention, pre-tested to maximise the autonomic relaxation response, in patients with unrefreshing sleep and fatigue attributed to CFS or MDD. Detailed monitoring of sleep quality and symptoms will enable sensitive detection of improvements in the core symptoms of these debilitating conditions. In addition, repeated monitoring of autonomic functioning can elucidate mechanisms underlying potential benefits. The findings have translational potential, informing novel, personalised symptom management techniques for these conditions, with the potential for better clinical outcomes. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ANZCTR), ACTRN12616001671459 . Registered on 5 December 2016.

Stress Management in Patients Undergoing Carotid Endarterectomy for Carotid Artery Stenosis: A Pilot Randomized Controlled Trial.

BACKGROUND: Psychological stress is common to patients submitted to cardiovascular operations. The purpose of this pilot, single-center, open-label, randomized controlled trial was to investigate the effects of a stress management program (SMP) on patients undergoing carotid endarterectomy (CEA). METHODS: A sample of 24 patients with significant (>70%) carotid stenosis was finally randomized to SMP (intervention group; n = 12) or no-stress management intervention (control group; n = 12) before CEA. SMP consisted of 2 relaxation techniques (relaxation-breathing and guided imagery) before and 8 weeks after CEA. Measurements included Perceived Stress Scale (PSS), Hospital Anxiety and Depression Scale (HADS), Health Locus of Control Scale (HLC), and blood pressure and heart rate. RESULTS: The 2 groups did not differ in terms of demographic characteristics, vascular risk factors, and baseline psychometric measurements. No delay on the time of surgery was caused by the practice of the relaxation techniques. Both perceived stress and anxiety improved within the intervention group at the end of the program (P = 0.005 and P = 0.007, respectively). No improvement in PSS-14, HLC, and HADS scores were documented in control group at the end of the 8-week follow-up period. The intervention group had lower PSS-14 scores at 8 weeks after CEA (median PSS-14 score, 20 points; range, 10-28) compared with control group (median PSS, 25 points; range, 11-47; P = 0.026). No significant effect of SMP was found for blood pressure and heart rate measurements. CONCLUSIONS: Our results indicate that relaxation techniques appear to be beneficial in terms of stress and anxiety reduction in patients undergoing CEA. These findings require independent confirmation in the setting of a larger, double-blind randomized controlled trial.

Complementary and alternative medicine use and quality of life in pediatric diabetes.

OBJECTIVES: The objectives of this study were to explore the association between complementary and alternative medicine (CAM) use as reported by youth, and parents' and children's reported quality of life in youth with diabetes. DESIGN: The study design was a cross-sectional survey. SETTING: Youth in Washington State participated in the SEARCH for Diabetes in Youth study, a national, multisite epidemiological study designed to assess the prevalence and incidence of diabetes in U.S. youth. Surveys assessing CAM utilization were mailed in January and April 2006. PARTICIPANTS: One thousand four hundred and thirty-nine (1439) youth were mailed a CAM survey. The final sample consisted of 467 youth with both CAM survey results and quality-of-life data. OUTCOME MEASURES: Difference in mean scores on Pediatric Quality of Life Inventory (PedsQL) between CAM users and nonusers overall, and specific CAM therapies were the outcome measures. RESULTS: Of the 1439 participants approached, 587 (40.8%) returned the CAM survey. In adjusted analyses, children reported any CAM use as associated with more barriers to treatment (difference in mean scores -3.48, 95% confidence interval [CI] -6.65, -0.31). Children following a CAM diet reported higher quality of life (PedsQL Core Total difference 4.01, 95% CI [0.10-7.91]; Core Psychosocial difference was 6.45, 95% CI [1.95 to 10.95]), but those using stress-reduction activities reported poorer quality of life (Diabetes Total difference -4.19, 95% CI [-8.35 to -0.04]). Parent-reported quality of life was lower for children who used "other supplements" (Core Total difference -6.26, 95% CI [-11.29 to -1.24]; Core Psychosocial difference was -5.92, 95% CI [-11.65 to -0.19]). CONCLUSIONS: CAM diets were associated with increased quality of life in youth with diabetes, whereas supplement use and stress-reduction activities were associated with decreased quality of life. The temporal sequence between CAM use and quality of life requires further study.

Experiences of difficulty that patients with cancer faced in the learning process of progressive muscle relaxation.

AIM: The purpose of this study was to clarify the experiences of difficulty that patients with cancer faced in the learning process of progressive muscle relaxation (PMR) and to consider which kind of PMR guidance should be given to weak patients with cancer. METHODS: The participants were instructed to practise PMR for 2 weeks when they were in good condition. The interview was conducted 1 week and 2 weeks after the PMR intervention. The 21 participants who experienced difficulty were analyzed. The analysis was completed by using the content analysis method. RESULTS: Fifteen patients practised PMR by themselves one-to-two times per day. However, six patients practised PMR three-to-four times per week when they were in good condition. The interview answers fell into two categories: (i) experiences of difficulty that patients encountered in the learning process; and (ii) experiences in which patients had no feeling of change though they had practised PMR. The former category included the subcategories of experiences in which patients felt difficulty with PMR, experiences in which patients felt uncomfortable symptoms after PMR, and experiences in which patients did not feel it was good timing to learn PMR. CONCLUSION: It is easy for disease to progress in patients with cancer and those with poor strength, so it is necessary to match the functional status of individual patients. It also is important to support patients in practising PMR whenever they have the desire, by respecting their will.

Relaxation training side effects reported by seriously disturbed inpatients.

The extent to which seriously disturbed inpatients report side effects related to passive and progressive relaxation training was examined. Most reported few side effects; only 1 of 64 subjects was removed because of a negative reaction to training. There was no significant difference in side effects reported in response to the two training procedures. Comparisons were made with data from a survey of therapists who practice relaxation training.

The effect of progressive relaxation on Valsalva response in healthy adults.

The purpose of the study was to determine if the tensing portion of progressive relaxation initiates the Valsalva response in order to establish the safety of the procedure for acutely ill cardiovascular patients. Sixty healthy adult volunteers performed fist, chest, and abdominal tensing and relaxation while their heart rate was continuously monitored. Occurrence of the Valsalva response was determined by dividing peak tachycardia during tensing by maximum bradycardia during releasing the tension. A Valsalva ratio greater than 1.5 indicated presence of the Valsalva response. Forty-three percent of the sample exhibited the Valsalva response. Thus, progressive relaxation should not be used with acutely ill cardiovascular patients.

Overview: clinical and physiological comparison of meditation with other self-control strategies.

In 1977 the American Psychiatric Association called for a critical examination of the clinical effectiveness of meditation. The author provides a review of the literature bearing on clinical and physiological comparisons of meditation with other self-control strategies. He begins by providing a definition of mediation and then cites the literature comparing mediation with such self-regulation strategies as biofeedback, hypnosis, and progressive relaxation. He pays particular attention to the "uniqueness" of mediation as a clinical intervention strategy a well as the adverse effects of meditation. Finally, he offers suggestions and guidelines for future research.

[Kind, value and risks of known relaxation techniques in bronchial asthma (author's transl)]. / Wesen, Wert and Gefahren bekannter Entspannungstechniken beim Asthma bronchiale.

Therapy and prophylaxis of Bronchial Asthma and cardiopulmonary consecutive diseases are commented upon with special reference to 1. indication and expected effectivity of scientifically based relaxation techniques, 2. some methods of treatment by gymnastics and breathing exercises as well by sports therapy, 3. nature, general risks and absolute contraindications by "modern" parascientific procedures.