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PURPOSE OF REVIEW: This review assesses the effectiveness and safety of light therapy, particularly green light therapy, as an emerging non-pharmacological treatment for chronic migraine (CM). It aims to highlight alternative or complementary approaches to traditional pharmacological remedies, focusing the need for diverse treatment options. RECENT FINDINGS: Despite sensitivity to light being a defining feature of migraine, light therapy has shown promising signs in providing substantial symptom relief. Studies have provided insights into green light therapy's role in managing CM. These studies consistently demonstrate its efficacy in reducing the frequency, severity, and symptoms of migraines. Additional benefits observed include improvements in sleep quality and reductions in anxiety. Importantly, green light therapy has been associated with minimal side effects, indicating its potential as a suitable option for migraine sufferers. In addition to green light, other forms of light therapy, such as infrared polarized light, low-level laser therapy (LLLT), and intravascular irradiation of blood (ILIB), are also being explored with potential therapeutic effects. Light therapies, especially green light therapy, are recognized as promising, safe, and non-pharmacological interventions for treating CM. They have been shown to be effective in decreasing headache frequency and enhancing the overall quality of life. However, current studies, often limited by small sample sizes, prompt more extensive clinical trials to better understand the full impact of light therapies. The exploration of other light-based treatments, such as LLLT and ILIB, warrants further research to broaden the scope of effective migraine management strategies.
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Trastornos Migrañosos , Fototerapia , Humanos , Trastornos Migrañosos/terapia , Fototerapia/métodos , Enfermedad Crónica , Resultado del TratamientoRESUMEN
Huntington's disease (HD) is an autosomal dominant inherited disease, which leads to motor, cognitive and psychiatric symptoms. The diagnosis can be confirmed by genetic testing for extended CAG repeats in the Huntingtin gene. Mental and behavioral symptoms are common in HD and can appear several years before the onset of motor symptoms. The psychiatric symptoms include apathy, depression, anxiety, obsessive-compulsive symptoms and, in some cases, psychoses and aggression. These are currently restricted to symptomatic treatment as disease-modifying treatment approaches are still under investigation. The current clinical practice is based on expert opinions as well as experience with the treatment of similar symptoms in other neurological and mental health diseases. This article provides an overview of the complex psychiatric manifestations of HD, the diagnostic options and the established pharmacological and nonpharmacological treatment approaches.
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Enfermedad de Huntington , Enfermedad de Huntington/diagnóstico , Enfermedad de Huntington/genética , Enfermedad de Huntington/psicología , Enfermedad de Huntington/terapia , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Trastornos Mentales/psicología , Diagnóstico DiferencialRESUMEN
OBJECTIVES: To investigate the effectiveness of family caregiver-administered home-based manual massages in managing dementia symptoms and reducing caregiver stress. METHODS: Thirty-eight pairs of participants-patients with dementia and their family caregivers-were randomly allocated to the experimental or the control group. The caregivers underwent 3-h-long massage training. Subsequently, the patients received a 30-min-long, home-based massage from their caregivers thrice a week for 8 consecutive weeks. The Cornell Scale for Depression in Dementia (CSDD), Cohen-Mansfield Agitation Inventory (CMAI), and Perceived Stress Scale (PSS) were assessed before and after the interventions. RESULTS: After intervention, the experimental group exhibited significant improvements in CSDD and CMAI scores compared with the scores of the control group (all p < .001). Furthermore, the experimental group obtained more favorable PSS scores than did the control group (p = .013). CONCLUSIONS: Family caregiver-administered home-based massage therapy is recommended for managing dementia symptoms and reducing caregiver stress.
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Cuidadores , Demencia , Humanos , Cuidadores/educación , Demencia/terapia , Escalas de Valoración Psiquiátrica , MasajeRESUMEN
This study examined the effects of dog-assisted therapy (DAT) on social behaviors, emotional manifestations, and experience during the activity of 3 people with dementia residing in a specialized dementia unit. The study used an A-B-A-B withdrawal single-case experimental design with two 5-session phases, baseline and DAT, replicating the same activities in each phase. The sessions were recorded and 2 independent coders quantified the frequency of social behaviors along with an assessment of the emotional manifestations and experience during the activity. Comparing with baseline sessions, DAT sessions showed an increase in prosocial behaviors (leans, looks, and verbalizations) and a significant impact on emotional manifestations with heightened pleasure. Dog-assisted therapy sessions also led to a better experience, with higher participation, pleasure, and relationship with others, together with lower rejection and displeasure than in the baseline sessions. Dog-assisted therapy seems to be a nonpharmacological therapy with potential to improve quality of life of people with dementia through promoting social behaviors and positive emotional manifestations.
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Demencia/rehabilitación , Emociones/fisiología , Calidad de Vida/psicología , Conducta Social , Anciano de 80 o más Años , Animales , Demencia/psicología , Perros , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Therapy of patients with spondylarthritis (SA) remains one of the most difficult problems of modern rheumatology. Its relevance is due to the high frequency of damage to people of working age, the progressive course of the disease and early disability. The basis of SA therapy is a combination of pharmacological and non-pharmacological methods. The article published studies on the use of physiotherapy in patients with SA. An analysis of the literature data indicates the existence of a sufficiently large number of publications confirming the feasibility of using physical factors in the treatment of patients with SA. It is shown that an integrated approach to the treatment of this group of patients provides the greatest efficiency. However, studies on the use of physiotherapy in patients with SA with a high level of evidence are clearly not enough. Still unresolved issues related to the approval of clinical recommendations for therapy with physical factors, the features of the use of physiotherapy depending on the degree of activity and the stage of medical rehabilitation. The development and approval of clinical recommendations for the use of physical factors in the complex therapy of patients with SA is one of the urgent tasks of modern rheumatology and medical rehabilitation.
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Espondilitis Anquilosante , Humanos , Modalidades de Fisioterapia , ReumatologíaRESUMEN
BACKGROUND: Tai Chi (TC) is a Chinese mind-body exercise with proven physical and psychological benefits. A modified TC via virtual reality (VR) may be suitable for the elderly owing to the immediate guidance and feedback regarding movement accuracy. This study explored the cognitive and physical effects of a VR-based TC (VRTC) exercise program on older adults with cognitive impairment (CI). METHODS: Sixty older adults with CI were cluster-assigned to either the VRTC or the control group; the intervention was conducted twice weekly for 6 months. Outcomes included cognitive and physical functions. The movement accuracy score and attendance were recorded. Generalized estimating equation (GEE) and multiple regression analyses were performed. RESULTS: Adjusted GEE analysis showed significant interaction effects in the 6-min walk test, 30-s sit-to-stand test, functional reach, 5-m gait speed, and abstract thinking and judgment. Overall, medium to large effect sizes (d = 0.50-0.82) were found in favor of the VRTC group. The average movement accuracy score in the first 3 months significantly predicted improvement in cognitive performance (p = 0.011). CONCLUSIONS: The VRTC exercise posed a protective effect for some cognitive and physical functions in older adults with CI. The more engaging the program, the greater the improvement in the cognitive performance.
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Cognición/fisiología , Disfunción Cognitiva , Taichi Chuan , Realidad Virtual , Anciano , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/psicología , Disfunción Cognitiva/terapia , Ejercicio Físico/fisiología , Ejercicio Físico/psicología , Femenino , Humanos , Masculino , Rendimiento Físico Funcional , Taichi Chuan/métodos , Taichi Chuan/psicología , Taiwán , Resultado del TratamientoRESUMEN
OBJECTIVE: Evaluate the effects of a novel autonomic regulation therapy (ART) via vagus nerve stimulation (VNS) in patients with chronic heart failure (HF) and reduced left ventricular ejection fraction during a 12-month follow-up period. METHODS: The Autonomic Regulation Therapy for the Improvement of Left Ventricular Function and Heart Failure Symptoms (ANTHEM-HF) study enrolled 60 subjects with New York Heart Association class II-III HF and low left ventricular ejection fraction (≤40%), who received open-loop ART using VNS randomized to left or right cervical vagus nerve placement and followed for 6 months after titration to a therapeutic output current (2.0 ± 0.6 mA). Patients received chronic stimulation at a frequency of 10 Hz and pulse duration of 250 µsec. Forty-nine subjects consented to participate in an extended follow-up study for an additional 6 months (12 months total posttitration) to determine whether the effects of therapy were maintained. RESULTS: During the 6-month extended follow-up period, there were no device malfunctions or device-related serious adverse effects. There were 7 serious adverse effects unrelated to the device, including 3 deaths (2 sudden cardiac deaths, 1 worsening HF death). There were 5 nonserious adverse events that were adjudicated to be device-related. Safety and tolerability were similar, and there were no significant differences in efficacy between left- and right-sided ART. Overall, mean efficacy measure values at 12 months were not significantly different from mean values at 6 months. CONCLUSIONS: Chronic open-loop ART via left- or right-sided VNS continued to be feasible and well-tolerated in patients with HF with reduced EF. Improvements in cardiac function and HF symptoms seen after 6 months of ART were maintained at 12 months.
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Sistema Nervioso Autónomo/fisiopatología , Insuficiencia Cardíaca/terapia , Volumen Sistólico/fisiología , Estimulación del Nervio Vago/métodos , Función Ventricular Izquierda/fisiología , Remodelación Ventricular , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Hypnosis has been used in medicine for nearly 250 years. Yet, emergency clinicians rarely use it in emergency departments or prehospital settings. OBJECTIVE: This review describes hypnosis, its historical use in medicine, several neurophysiologic studies of the procedure, its uses and potential uses in emergency care, and a simple technique for inducing hypnosis. It also discusses reasons why the technique has not been widely adopted, and suggests methods of increasing its use in emergency care, including some potential research areas. DISCUSSION: A limited number of clinical studies and case reports suggest that hypnosis may be effective in a wide variety of conditions applicable to emergency medical care. These include providing analgesia for existing pain (e.g., fractures, burns, and lacerations), providing analgesia and sedation for painful procedures (e.g., needle sticks, laceration repair, and fracture and joint reductions), reducing acute anxiety, increasing children's cooperation for procedures, facilitating the diagnosis and treatment of acute psychiatric conditions, and providing analgesia and anxiolysis for obstetric/gynecologic problems. CONCLUSIONS: Although it is safe, fast, and cost-effective, emergency clinicians rarely use hypnosis. This is due, in part, to the myths surrounding hypnosis and its association with alternative-complementary medicine. Genuine barriers to its increased clinical use include a lack of assured effectiveness and a lack of training and training requirements. Based on the results of further research, hypnosis could become a powerful and safe nonpharmacologic addition to the emergency clinician's armamentarium, with the potential to enhance patient care in emergency medicine, prehospital care, and remote medical settings.
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Medicina de Emergencia , Hipnosis , Ansiedad/terapia , Humanos , Hipnosis/métodos , Hipnosis Anestésica , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Manejo del Dolor , Cooperación del PacienteRESUMEN
Most patients with schizophrenia need life-long treatment. There is therefore a continued need for effective and tolerable treatment options. A 2-monthly LAI formulation of aripiprazole, Aripiprazole 2-Month Ready-to-Use 960 mg (Ari 2MRTU 960) has recently been approved in the US. Here, the possible role in therapy for this new treatment option is discussed in a narrative review. PubMed was searched for literature on long-acting injectables with a focus on patient-reported outcomes and real-world evidence on extended injection intervals (2-3 months). Dopamine D2 partial agonists, one of which is aripiprazole, exhibit favorable tolerability and safety properties. Additionally, there are many advantages in using long-acting injectable formulations such as enhanced treatment persistence and stability of patients as well as reduced rates of relapses, hospitalizations, and death. Some of these advantages become more pronounced with longer injection intervals. Additional advantages of longer injection intervals are more room for non-medication-related communication between healthcare professionals and patients, patient and physician preferences, reduced caregiver burden, and easier transitioning from inpatient to outpatient treatment. Taken together, since aripiprazole may be a good treatment choice for many patients based on its favorable safety and tolerability profile, and given the advantages of LAI treatment over oral treatment and the advantages of reduced dosing frequency, Ari 2MRTU 960 may become an important treatment option for many clinically stable patients with schizophrenia.
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Antipsicóticos , Esquizofrenia , Humanos , Aripiprazol/efectos adversos , Esquizofrenia/tratamiento farmacológico , Antipsicóticos/efectos adversos , Inyecciones , Agonistas de Dopamina/uso terapéutico , Preparaciones de Acción Retardada/uso terapéuticoRESUMEN
Idiopathic pulmonary fibrosis (IPF) is a continuous, progressive, and lethal age-related respiratory disease. It is characterized by condensed and rigid lung tissue, which leads to a decline in the normal functioning of the lungs. The pathophysiology of IPF has still not been completely elucidated, so current strategies are lagging behind with respect to improving the condition of patients with IPF and increasing their survival rate. The desire for a better understanding of the pathobiology of IPF and its early detection has led to the identification of various biomarkers associated with IPF. The use of drugs such as pirfenidone and nintedanib as a safe and effective treatment alternative have marked a new chapter in the treatment of IPF. However, nonpharmacological therapies, involving long-term oxygen therapy, transplantation of the lungs, pulmonary rehabilitation, ventilation, and palliative care for cough and dyspnea, are still considered to be beneficial as supplementary methods for IPF therapy. A major risk factor for IPF is aging, with associated hallmarks such as telomere attrition, senescence, epigenetic drift, stem cell exhaustion, loss of proteostasis, and mitochondrial dysfunction. These are promising earmarks for the development of potential therapy for the disease. In this review, we have discussed current and emerging novel therapeutic strategies for IPF, especially for targets associated with age-related mechanisms.
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Fibrosis Pulmonar Idiopática , Humanos , Fibrosis Pulmonar Idiopática/terapia , Fibrosis Pulmonar Idiopática/tratamiento farmacológico , Fibrosis Pulmonar Idiopática/fisiopatología , Indoles/uso terapéutico , Animales , Piridonas/uso terapéutico , Envejecimiento/fisiologíaRESUMEN
Background: Constipation is an uncomfortable symptom experienced by many patients with advanced cancer, and it decreases the quality of life. Several studies have advised pharmacological therapies for constipation management, whereas others have promoted nonpharmacological approaches that promote changes in the patient's lifestyle. However, constipation management by nurses has not yet been systematically reviewed in patients with cancer. Therefore, this study conducted a scoping review of nursing support focused on nonpharmacological therapies offered to relieve constipation in patients with cancer. Methods: The review was guided by Arksey and O'Malley's five-stage scoping review framework. We searched the databases of PubMed, Cumulative Index to Nursing and Allied Health Literature, CENTRAL in the Cochrane Library, and Ichushi-Web of the Japan Medical Abstract Society from the databases' inceptions to August 31, 2023, using various search terms such as "cancer," "constipation," and "nursing care." Results: A total of 1501 articles that met the eligibility criteria were identified; of these, 5 articles were selected, and 1 additional article was found via handsearching. The final sample included six articles. We categorized the articles into three major nursing support types: acupressure, aroma massage to the abdomen, and self-management education. Five studies used a randomized controlled trial (RCT) design, including one with a randomized, waiting-list controlled trial, and one used a non-RCT design. All included studies showed the effectiveness of nonpharmacological interventions to improve constipation. Conclusion: This study also identified three types of nursing support for patients with cancer to relieve constipation. However, because of the small sample size, further evidence is required.
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Telomeres are nanoscale DNA-protein complexes to protect and stabilize chromosomes. The reexpression of telomerase in cancer cells is a key determinant crucial for the infinite proliferation and long-term survival of most cancer cells. However, the use of telomerase inhibitors for cancer treatment may cause problems such as poor specificity, drug resistance, and cytotoxicity. Here, we discovered a nondrug and noninvasive terahertz modulation strategy capable of the long-term suppression of cancer cells by inhibiting telomerase activity. First, we found that an optimized frequency of 33 THz photon irradiation effectively inhibited the telomerase activity by molecular dynamics simulation and frequency filtering experiments. Moreover, in vitro experiments showed that telomerase activity in 4T1 and MCF-7 cells significantly decreased by 77% and 80% respectively, after 21 days of regular 33 THz irradiation. Furthermore, two kinds of cells were found to undergo aging, apoptosis, and DNA double-strand breaks caused by telomere crisis, which seriously affected the survival of cancer cells. In addition, the tumorigenicity of 4T1 cells irradiated with 33 THz waves for 21 days in in vivo mice decreased by 70%. In summary, this study demonstrates the potential application of THz modulation in nano therapy for cancer.
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Neoplasias , Telomerasa , Animales , Ratones , Telomerasa/metabolismo , Inhibidores Enzimáticos/farmacología , Telómero , Apoptosis , ADNRESUMEN
BACKGROUND: Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder characterized by abdominal pain, bloating, and changes in bowel habits. Various dietary factors have been implicated in the pathogenesis and management of IBS symptoms. This systematic review aims to evaluate the effects of polyphenols, minerals, fibers, and fruits on the symptoms and overall well-being of individuals with IBS. MATERIALS AND METHODS: A comprehensive literature search was conducted in several electronic databases, including PubMed, Scopus, and Web of Science. Studies published up until July 2023 were included. RESULTS: The selected studies varied in terms of study design, participant characteristics, intervention duration, and outcome measures. Overall, the findings suggest that dietary interventions involving polyphenols, minerals, fibers, and fruits can have a positive impact on IBS symptoms. Dietary fiber supplementation, particularly soluble fiber, has been associated with reduced bloating and enhanced stool consistency. CONCLUSIONS: This systematic review provides evidence supporting the beneficial effects of polyphenols, minerals, fibers, and fruits in IBS patients. These dietary components hold promise as complementary approaches for managing IBS symptoms. However, due to the heterogeneity of the included studies and the limited number of high-quality randomized controlled trials, further well-designed trials are warranted to establish the optimal dosages, duration, and long-term effects of these interventions. Understanding the role of specific dietary components in IBS management may pave the way for personalized dietary recommendations and improve the quality of life for individuals suffering from this complex disorder.
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Frutas , Síndrome del Colon Irritable , Humanos , Polifenoles/farmacología , Calidad de Vida , Minerales , FlatulenciaRESUMEN
Physical exercise is of great significance for maintaining human health. Exercise can provide varying degrees of benefits to cognitive function at all stages of life cycle. Currently, with the aging of the world's population and increase of life expectancy, cognitive dysfunction has gradually become a disease of high incidence, which is accompanied by neurodegenerative diseases in elderly individuals. Patients often exhibit memory loss, aphasia and weakening of orientation once diagnosed, and are unable to have a normal life. Cognitive dysfunction largely affects the physical and mental health, reduces the quality of life, and causes a great economic burden to the society. At present, most of the interventions are aimed to maintain the current cognitive level and delay deterioration of cognition. In contrast, exercise as a nonpharmacological therapy has great advantages in its nontoxicity, low cost and universal application. The molecular mechanisms underlying the effect of exercise on cognition are complex, and studies have been extensively centered on neural plasticity, the direct target of exercise in the brain. In addition, mitochondrial stability and energy metabolism are essential for brain status. Meanwhile, the organ-brain axis responds to exercise and induces release of cytokines related to cognition. In this review, we summarize the latest evidence on the molecular mechanisms underlying the effects of exercise on cognition, and point out directions for future research.
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Disfunción Cognitiva , Calidad de Vida , Anciano , Humanos , Disfunción Cognitiva/genética , Disfunción Cognitiva/terapia , Cognición , Encéfalo , EnvejecimientoRESUMEN
Background: Alzheimer's disease (AD) is a crippling epidemic that is predicted to affect over 15 million people worldwide by the year 2050. Symptoms such as refusal to cooperate, impaired communication and cognition, and agitation and anxiety can play a large part in the difficulties that surround caring for an AD patient. There are medications that are marketed to treat AD symptoms, but many have harmful side effects. Holistic methods, such as music therapy, are gaining attention for their ease of implementation and limited side effects. Aim: The purpose of this project was to implement a music therapy intervention for people with AD in hospice and evaluate the levels of agitation experienced by the patient. Method: The study was conducted over a period of eight weeks. Music therapy was administered nightly for 20 minutes by caregivers and the Pittsburgh Agitation Scale was completed at the beginning of the study, at four weeks into the study, and at the completion of the study. Results: The intervention was found to be significant in reducing aberrant vocalization, motor agitation, aggressiveness, and resisting care. Conclusion: Based on the findings, music therapy may be useful as a holistic intervention for decreasing agitation in individuals with AD.
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BACKGROUND: The cost of pain to society is high, not only in dollars but in physical and emotional suffering. Undertreated pain in the geriatric population can lead to functional impairments and diminished quality of life. A transitional care unit (TCU) described having higher levels of moderate to severe pain than state and national levels in like facilities. OBJECTIVE: A team of university faculty and students, and staff members from the TCU developed a quality improvement project to examine the feasibility of integrating complementary therapies to treat pain into clinical practice. METHODS: The team integrated three evidence-based complementary therapies into staff workflow. RESULTS: The nursing and therapy staff reported minimal to no interruption to their workflow when patients used the complementary therapies. Staff expressed satisfaction with an expanded menu of pain management options. Patients reported statistically significant lower (p = 0.002) pain levels after using the complementary therapies and benefits beyond pain relief, including relaxation, stress reduction, and improved sleep. CONCLUSION: Adding complementary therapies to the pain management program was feasible and the patients had less pain along with other benefits when using the therapies with standard care. IMPLICATIONS FOR NURSING: Having additional methods for managing pain is beneficial and vital.
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Terapias Complementarias , Cuidado de Transición , Anciano , Humanos , Dolor , Manejo del Dolor/métodos , Mejoramiento de la Calidad , Calidad de Vida/psicologíaRESUMEN
Alzheimer's disease (AD) is a progressive neurodegenerative disease associated with cognitive decline. Memory problems are typically among the first signs of cognitive impairment in AD, and they worsen considerably as the disease progresses. However, musical memory is partially spared in patients with AD, despite severe deficits in episodic (and partly semantic) memory. AD patients can learn new songs, encode novel verbal information, and react emotionally to music. These effects of music have encouraged the use and development of music therapy (MT) for AD management. MT is easy to implement and well-tolerated by most patients and their caregivers. Effects of MT in patients with AD include improved mood, reduced depressive scores and trait anxiety, enhanced autobiographical recall, verbal fluency, and cognition. Here, we review musical memory in AD, therapeutic effects of studies using MT on AD, and potential mechanisms underlying those therapeutic effects. We argue that, because AD begins decades before the presentation of clinical symptoms, music interventions might be a promising means to delay and decelerate the neurodegeneration in individuals at risk for AD, such as individuals with genetic risk or subjective cognitive decline.
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Enfermedad de Alzheimer , Memoria Episódica , Musicoterapia , Música , Enfermedades Neurodegenerativas , Enfermedad de Alzheimer/terapia , Humanos , Recuerdo Mental , Música/psicología , Pruebas NeuropsicológicasRESUMEN
BACKGROUND: Music-based intervention has been used as first-line non-pharmacological treatment to improve cognitive function for people with mild cognitive impairment (MCI) or dementia in clinical practice. However, evidence regarding the effect of music-based intervention on general cognitive function as well as subdomains of cognitive functions in these individuals is scarce. OBJECTIVE: To evaluate the efficacy of music-based interventions on a wide range of cognitive functions in people with MCI or dementia. METHOD: We searched the effect of various music therapies using randomized controlled trials on cognitive function using several databases. Studies based on any type of dementia or MCI were combined. The effects of music-based intervention on each cognitive function were pooled by meta-analysis. RESULTS: A total of 19 studies involving n = 1024 participants (mean age ranged from 60 to 87 years old) were included. We found statistically significant improvements in MMSE (general cognitive function), the Frontal Assessment Battery (executive function), and the Auditory Verbal Learning Test (episodic memory). CONCLUSIONS: This study provides positive evidence to support music-based interventions for improving a wide range of cognitive functions in older adults with MCI and dementia. Therefore, we recommend increased use of music in people's homes, day care centers and nursing homes. This study was registered with PROSPERO, number 250383.
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CONTEXT: The novel coronavirus 2019 (COVID-19) pandemic has impacted the delivery of health care services throughout the United States, including those for patients with chronic pain. OBJECTIVES: To measure changes in patients' utilization of nonpharmacological and pharmacological treatments for chronic low back pain and related outcomes during the COVID-19 pandemic. METHODS: A pre-post study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry) using data in the 3 months before and 3-6 months after the declaration of a national emergency related to COVID-19. Participants 21-79 years old with chronic low back pain were included in the study and provided self reported data at relevant quarterly encounters. Use of exercise therapy, yoga, massage therapy, spinal manipulation, acupuncture, cognitive behavioral therapy, nonsteroidal antiinflammatory drugs, and opioids for low back pain was measured. The primary outcomes were low back pain intensity and back related functioning measured with a numerical rating scale and the Roland Morris Disability Questionnaire, respectively. Secondary outcomes included health related quality of life scales measured with the Patient Reported Outcomes Measurement Information System, including scales for physical function, anxiety, depression, low energy/fatigue, sleep disturbance, participation in social roles and activities, and pain interference with activities. RESULTS: A total of 476 participants were included in this study. The mean age of participants at baseline was 54.0 years (standard deviation, ±13.2 years; range, 22-81 years). There were 349 (73.3%) female participants and 127 (26.7%) male participants in the study. Utilization of exercise therapy (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.23-0.57), massage therapy (OR, 0.46; 95% CI, 0.25-0.83), and spinal manipulation (OR, 0.53; 95% CI, 0.29-0.93) decreased during the pandemic. A reduction in NSAID use was also observed (OR, 0.67; 95% CI, 0.45-0.99). Participants reported a significant, but not clinically relevant, improvement in low back pain intensity during the pandemic (mean improvement, 0.19; 95% CI, 0.03-0.34; Cohen's d, 0.11). However, White participants reported a significant improvement in low back pain intensity (mean improvement, 0.28; 95% CI, 0.10-0.46), whereas Black participants did not (mean improvement, -0.13; 95% CI, -0.46 to 0.19; p for interaction=0.03). Overall, there was a significant and clinically relevant improvement in pain interference with activities (mean improvement, 1.11; 95% CI, 0.20-2.02; Cohen's d, 0.20). The use of NSAIDs during the pandemic was associated with marginal increases in low back pain intensity. CONCLUSIONS: Overall, decreased utilization of treatments for chronic low back pain did not adversely impact pain and functioning outcomes during the first 6 months of the pandemic. However, Black participants experienced significantly worse pain outcomes than their White counterparts.
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COVID-19/epidemiología , Dolor Crónico/terapia , Dolor de la Región Lumbar/terapia , Terapia por Acupuntura/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , COVID-19/prevención & control , COVID-19/transmisión , Terapia Cognitivo-Conductual/estadística & datos numéricos , Terapia por Ejercicio/estadística & datos numéricos , Femenino , Humanos , Masculino , Manipulación Espinal/estadística & datos numéricos , Masaje/estadística & datos numéricos , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Dimensión del Dolor , Utilización de Procedimientos y Técnicas , Calidad de Vida , Estados Unidos , Yoga , Adulto JovenRESUMEN
A PURPOSE OF REVIEW: Interstitial lung diseases (ILDs) cause unpredictable degrees of fibrosis and inflammation in the lungs leading to functional decline and varying symptom burden for patients. Some patients may live for years and be responsive to therapy and others disease trajectory may be shorter and similar to patients with lung cancer. This ultimately affects the patient's quality of life as well as their caregiver(s). B RECENT FINDINGS: Nonpharmacological therapies play an important role in treatment of interstitial lung disease. These include symptom management, pulmonary rehabilitation, oxygen therapy, and palliative care. While ILDs are associated with high morbidity and mortality, different models of care exist globally. New tools help clinicians identify and address palliative care needs in daily practice and specialty nurses and ILD centers can optimize care. C SUMMARY: This paper provides an overview of nonpharmacological therapies available for patients with interstitial lung disease.