Virtually delivered Mindfulness-Oriented Recovery Enhancement (MORE) reduces daily pain intensity in patients with lumbosacral radiculopathy: a randomized controlled trial.

Introduction: Lumbosacral radiculopathy (LR), also known as sciatica, is a common type of radiating neurologic pain involving burning, tingling, and numbness in the lower extremities. It has an estimated lifetime prevalence as high as 43%. Objectives: The objective of this randomized controlled trial was to evaluate the impact of virtually delivered Mindfulness-Oriented Recovery Enhancement (MORE) on patients with LR during the COVID-19 pandemic. Methods: Potentially eligible patients were identified using electronic health record queries and phone screenings. Participants were then randomized to MORE or treatment-as-usual (TAU) for 8 weeks, with pain intensity assessed daily. At baseline and follow-up visits, participants completed questionnaires assessing the primary outcome, disability, as well as quality of life, depression, mindful reinterpretation of pain, and trait mindfulness. Results: In our study, patients undergoing virtual delivery of MORE had greater improvements in daily pain intensity (P = 0.002) but not in disability (P = 0.09), depression (P = 0.26), or quality of life (P = 0.99 and P = 0.89, SF-12 physical and mental component scores, respectively), relative to TAU patients. In addition, patients in MORE experienced significantly greater increases in mindful reinterpretation of pain (P = 0.029) and trait mindfulness (P = 0.035). Conclusion: Among patients with lumbar radiculopathy, MORE significantly reduced daily pain intensity but did not decrease disability or depression symptoms. Given the long duration of symptoms in our sample, we hypothesize the discrepancy between changes in daily pain intensity and disability is due to fear avoidance behaviors common in patients with chronic pain. As the first trial of a mindfulness intervention in patients with LR, these findings should inform future integrative approaches to LR treatment, particularly when considering the increasing use of virtual interventions throughout the COVID-19 pandemic.

Treatment of Epstein-Barr Induced Hepatitis with High Dose Intravenous Vitamin C: A Case Report.

Introduction: Vitamin C has been previously studied for use with acute and chronic Epstein-Barr Virus (EBV) and hepatitis C. However, it has never been evaluated for its impact on EBV induced hepatitis. In this case report, we present a patient's history with EBV induced hepatitis treated with high dose vitamin C. Methods: A 36-year-old female presented to the National University of Natural Medicine Health Center with reactivated EBV-induced viral hepatitis. She reported severe fatigue, brain fog, maintenance and initiation insomnia, periocular hyperpigmentation, blurry vision, and decreased concentration. The patient's diagnosis was confirmed with a diagnostic evaluation of her EBV titers and liver enzymes, all of which were elevated. After assessing for contraindications, the patient was treated with intravenous (IV) vitamin C starting at a 10g dose and increasing weekly for 3 weeks to a dose of 25g. Results: After 12 weeks of treatment with high dose IV vitamin C, as well as other immune-supportive nutrient therapy, the patient reported a decrease in fatigue severity, brain fog, vision disturbances, exercise limitations, and insomnia severity. Discussion: We recommend that physicians consider the administration of high-dose IV vitamin C for all concurrent cases of EBV and hepatitis in both acute and chronic conditions. As recognition of reactivated viral infections grows, high-dose IV vitamin C for other latent viral infections such as COVID-19, cytomegalovirus, herpes simplex, varicella zoster, and HIV should be considered.

Intravenous Magnesium Sulfate Reduces Tremor Severity: A Case Series.

Introduction: Tremors involve involuntary muscle contractions that can occur at rest or during movement. Parkinson's disease (PD), the most common form of resting tremor, is conventionally treated with dopamine agonists, a therapy with a limited window of efficacy as the disease progresses due to levodopa tachyphylaxis. Complementary and Integrative Health (CIH) interventions represent low-cost options for a disease which is expected to double in prevalence in the next decade. Based on its use in many conditions, magnesium sulfate may have therapeutic potential for patients with tremors. This case series presents findings on the use of intravenous magnesium sulfate for the management of four patients with tremors. Methods: All four patients were seen at the National University of Natural Medicine clinic and screened for contraindications and safety considerations prior to each treatment using the acronym, ATHUMB: allergies, treatment response, health history, urinalysis, medications, and breakfast/meal timing. Magnesium sulfate is given in an initial dose of 2000 mg increasing in increments of 500 mg over the next one-to-two office visits up to a 3500 mg maximum. Results: Reductions in tremor severity were noticed for each patient during and following treatment. All patients reported a 24-48-hour window of relief and improvement in activities of daily living after each IV; 3 of 4 patients reported that window extended to 5-7 days. Conclusion: IV magnesium sulfate was effective in decreasing tremor severity. Future research should explore the impact of IV magnesium sulfate on tremors using objective and self-reported measures to quantify the size and duration of its effect.

Protocol for mindfulness-oriented recovery enhancement (MORE) in the management of lumbosacral radiculopathy/radiculitis symptoms: A randomized controlled trial.

Introduction: Lumbosacral radiculopathy/radiculitis (LR) or "sciatica" is a commonly intractable sequelae of chronic low back pain (LBP), and challenges in the treatment of LR indicate that persistent pain may have both mechanical and neuropathic origins. Mindfulness-based interventions have been demonstrated to be effective tools in mitigating self-reported pain in LBP patients. This paper describes the protocol for a randomized controlled trial (RCT) evaluating the effects of the specific mindfulness-based intervention Mindfulness-Oriented Recovery Enhancement (MORE) on LR symptoms and sequelae, including mental health and physical function. Methods: Participants recruited from the Portland, OR area are screened before completing a baseline visit that includes a series of self-report questionnaires and surface electromyography (sEMG) of the lower extremity. Upon enrollment, participants are randomly assigned to the MORE (experimental) group or treatment as usual (control) group for 8 weeks. Self-reported assessments and sEMG studies are repeated after the intervention is complete for pre/post-intervention comparisons. The outcome measures evaluate self-reported pain, physical function, quality of life, depression symptoms, trait mindfulness, and reinterpretation of pain, with surface electromyography (sEMG) findings evaluating objective physical function in patients with LR. To our knowledge, this is the first trial to date using an objective measure, sEMG, to evaluate the effects of a mindfulness-based intervention on LR symptoms. Hypotheses: We hypothesize that MORE will be effective in improving self-reported pain, physical function, quality of life, depression symptoms, mindfulness, and reinterpretation of pain scores after 8 weeks of mindfulness training as compared to treatment as usual. Additionally, we hypothesize that individuals in the MORE group with abnormal sEMG findings at baseline will have improved sEMG findings at their 8-week follow-up visit.

Meditative practices, stress and sleep among students studying complementary and integrative health: a cross-sectional analysis.

BACKGROUND: The International Cohort on Lifestyle Determinants of Health (INCLD Health) is an ongoing, prospective cohort study assessing the health behaviours and lifestyles of higher education students, including their use of specialty diets and complementary and integrative health (CIH) practices. PURPOSE: This cross-sectional analysis of the INCLD Health cohort aims to (1) evaluate the associations between perceived stress, sleep disturbance, and meditative practices with diurnal salivary free cortisol and (2) evaluate the associations of meditative practices as well as mind-body practices with perceived stress and sleep disturbance. METHODS: Serial multivariable linear regression models, adjusting for sociodemographic and lifestyle behaviours, were used to assess associations of (1) perceived stress, sleep disturbance, and meditative practices with salivary cortisol, and (2) meditative practices as well as mind-body practices with perceived stress and sleep disturbance. Meditative and mind-body practices were evaluated using a stress-management and self-care survey; perceived stress and sleep disturbance were evaluated using the 10-item Perceived Stress Scale (PSS), and the patient reported outcome measures information system-29 (PROMIS-29) sleep sub-score respectively. Salivary cortisol was collected at 4 time points over a 24-hour period and area under the curve (AUC) calculations conducted. RESULTS: 82.5% (n = 80) of participants utilized at least monthly meditative practices. Greater disturbed sleep, but not perceived-stress, meditative, nor mind-body practices was independently associated with increased AUC cortisol (b = 0.02, 95% CI: 0.002-0.05, p = 0.03) after adjusting for age, sex, race, ethnicity, and BMI. Neither meditative nor mind-body practices were associated with perceived stress or disturbed sleep. CONCLUSIONS: Among INCLD Health participants, greater sleep disturbance, but not perceived stress or meditative practices were associated with daytime cortisol.

Protocol for The International Cohort on Lifestyle Determinants of Health Study: A Longitudinal Investigation of Complementary and Integrative Health Utilization in Postsecondary Education Students.

Objectives: The specific aims are: 1) To characterize the health, wellness, and lifestyle of graduate and undergraduate students, and how these characteristics change over time; 2) To evaluate associations between lifestyle factors and gut microbiota populations and diversity; and 3) To evaluate associations between stress and stress management practices with sleep habits, quality of life, and overall health. Design: The International Cohort on Lifestyle Determinants of Health (INCLD Health) longitudinal cohort study is designed to assess health behaviors and lifestyle practices amongst adults studying complementary and integrative health (CIH) and higher-education students more generally after at least one to six years of exposure to CIH education. INCLD Health will adhere to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. Settings/Location: Colleges and universities with a CIH focus or interest with the flagship site being the National University of Natural Medicine. Participants: Adults currently enrolled in a college or university with a CIH focus or interest. Outcome Measures: Study visits will be conducted at baseline, 6 months, then every 12 months until the end of each participants' degree program. Measures include anthropometrics; serum and salivary biomarkers of cardiovascular risk, reproductive hormones, and cortisol; nutritional intake measured by a digital food frequency questionnaire; sequencing of fecal microbiota; plus validated questionnaires investigating mood, perceived stress, stress management practices, physical activity, sleep, and wellness. Conclusions: The INCLD Health Study, approved by the NUNM IRB in late 2018, will enroll a unique cohort of adults to characterize the use of CIH practices in relation to short- and long-term health. Our study design provides a breadth of information that could be implemented at multiple sites internationally allowing for comparisons across diverse student cohorts with relatively low cost and personnel.