Prior research has reported that integrative medicine (IM) therapies reduce pain in inpatients, but without controlling for important variables. Here, the authors extend prior research by assessing pain reduction while accounting for each patient's pain medication status and clinical population. The initial data set consisted of 7,106 inpatient admissions, aged ≥18 years, between July 16, 2012, and December 15, 2014. Patients' electronic health records were used to obtain data on demographic, clinical measures, and pain medication status during IM. The final data set included first IM therapies delivered during 3,635 admissions. Unadjusted average pre-IM pain was 5.33 (95% confidence interval [CI]: 5.26 to 5.41) and post-IM pain was 3.31 (95% CI: 3.23 to 3.40) on a 0-10 scale. Pain change adjusted for severity of illness, clinical population, sex, treatment, and pain medication status during IM was significant and clinically meaningful with an average reduction of -1.97 points (95% CI: -2.06 to -1.86) following IM. Adjusted average pain was reduced in all clinical populations, with largest and smallest pain reductions in maternity care (-2.34 points [95% CI: -2.56 to -2.14]) and orthopedic (-1.71 points [95% CI: -1.98 to -1.44]) populations. Pain medication status did not have a statistically significant association on pain change. Decreases were observed regardless of whether patients were taking narcotic medications and/or nonsteroidal anti-inflammatory drugs versus no pain medications. For the first time, inpatients receiving IM reported significant and clinically meaningful pain reductions during a first IM session while accounting for pain medications and across clinical populations. Future implementation research should be conducted to optimize identification/referral/delivery of IM therapies within hospitals. Clinical Trials.gov #NCT02190240.
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http://dx.doi.org/10.1089/acm.2021.0051 | DOI Listing |
JAMA Netw Open
January 2025
Center for OCD and Related Disorders, Massachusetts General Hospital, Boston.
Importance: Obsessive-compulsive and related disorders (OCRDs) encompass various neuropsychiatric conditions that cause significant distress and impair daily functioning. Although standard treatments are often effective, approximately 60% of patients may not respond adequately, underscoring the need for novel therapeutic approaches.
Objective: To evaluate improvement in OCRD symptoms associated with glutamatergic medications as monotherapy or as augmentation to selective serotonin reuptake inhibitors, with a focus on double-blind, placebo-controlled randomized clinical trials (RCTs).
Neurol Sci
January 2025
International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan.
Objectives: Fibromyalgia imposes a considerable burden of disability worldwide, and its therapies include rehabilitation interventions. However, the overall brain modulatory effects of rehabilitation interventions and their effects on clinical improvements in patients with fibromyalgia remain unclear. This systematic review of magnetic resonance imaging studies synthesised evidence for the brain modulatory effects of rehabilitation in patients with fibromyalgia.
View Article and Find Full Text PDFChronic fracture-related infection is a complex, costly clinical problem with a wide spectrum of clinical presentations. The goals of treatment are infection control with a healed fracture covered by well-vascularized soft tissue and improvement of patient pain and function. Management is both medical, with culture-targeted antimicrobial agents, and surgical, requiring meticulous irrigation and débridement.
View Article and Find Full Text PDFMultimodal analgesia and anesthesia have become the gold standard in total joint arthroplasty to reduce postoperative pain and opioid consumption and minimize complications associated with opioid use. There are several elements in an effective multimodal protocol, including oral medications, periarticular injection, regional nerve blocks, and spinal and general anesthesia. Many nonopioid medications are often used, such as acetaminophen and NSAIDs.
View Article and Find Full Text PDFIntroduction: Recently, a three-step endoscopic scale, known as the Diverticular Inflammation and Complication Assessment (DICA), was introduced to predict the course of diverticular disease (DD), yielding some promising outcomes. However, analyses were performed only for symptomatic individuals.
Objectives: The aim of our study was to prospectively evaluate the predictive value of DICA in asymptomatic individuals with no previous diagnosis of DD who underwent colorectal cancer screening colonoscopy.
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