Journal of Integrative and Complementary Medicine最新文献

Introduction: Chronic pain is a major public health problem. Due to the persistent, costly, and complex nature of chronic pain, there is a need for new safe and effective treatments. Integrative breathwork interventions, or therapeutic styles of conscious breathing, have promise as novel treatments for chronic pain. The primary objective of this proof-of-concept study was to examine the feasibility, acceptability, and clinical significance of an integrative breathwork intervention for adults with chronic pain. Methods: Participants with chronic pain and without prior breathwork experience were eligible for this study. Participants completed online surveys at baseline, 2-week, and 6-week follow-ups as well as a brief survey immediately before and after the single group breathwork session. Guided Respiration Mindfulness Therapy (GRMT) was the integrative breathwork intervention that involved 1 hour of conscious connected breathing while engaging in somatically focused mindfulness and relaxation. Results: A total of 11 participants were enrolled into this study, and 10 completed the breathwork session. The intervention was rated as highly acceptable (M = 9.3, standard deviation [SD] = 1.9) and satisfying (M = 9.7, SD = 0.5). All participants recommended the intervention to someone else suffering from chronic pain. There were large, clinically meaningful improvements in pain intensity and pain interference from baseline to the 2-week (mean difference [MD] = -2.9) and 6-week (MD = -3.5) follow-ups. Conclusion: A single group session of GRMT was shown to be highly acceptable, satisfying, and potentially helpful to individuals with chronic pain. The findings demonstrated proof of concept, with most participants reporting a clinically meaningful improvement in pain outcomes through the follow-ups. Additional research on integrative breathwork interventions for chronic pain is warranted.

Objects: The purpose of this study is to investigate whether (1) acupuncture is effective in improving insulin resistance (IR) in patients with diabetes mellitus (DM) and (2) the effect of acupuncture varies depending on the type and dosage of acupuncture. Methods: PubMed, Embase, Web of Science, Cochrane Library, OpenGrey, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry were searched from their inception up to April 26, 2025. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. The Grading of Recommendations Assessment, Development and Evaluation approach was used to evaluate the credibility of findings from each outcome. Systematic review and pairwise and exploratory network meta-analysis (NMA) of randomized controlled trials (RCTs) were conducted to investigate the effectiveness and safety of acupuncture on IR in patients with DM. Results: We included 16 RCTs from 2328 citations with 1087 participants. When compared with usual care, acupuncture had a significant effect on the homeostatic model assessment of IR (HOMA-IR; standardized mean difference [SMD] = -1.13, 95% confidence interval [CI]: -1.61 to -0.64), fasting blood sugar (FBS; SMD = -0.90, 95% CI: -1.45 to -0.35), and glycated hemoglobin (HbA1c; SMD = -0.66, 95% CI: -1.11 to -0.20) but not on 2-h blood glucose (2hBG; SMD = -1.32, 95% CI -2.83 to 0.19). When compared with sham acupuncture, acupuncture had a significant effect on FBS (SMD = -0.71, 95% CI: -1.18 to -0.25) but not on HbA1c (SMD = -0.14, 95% CI: -0.48 to 0.19). Subgroup analysis revealed that high-dose acupuncture had a more beneficial effect on HOMA-IR and 2hBG. According to the NMA, electroacupuncture (EA) might be the most promising acupuncture type for improving IR. However, we failed to analyze safety outcomes due to the inadequate data across the included studies. Conclusion: The findings suggested that acupuncture could be an effective therapy to improve IR in patients with diabetes. EA and high-dose acupuncture are two potential contributing factors.

Objective: We synthesized the effects of mindfulness-based interventions (MBIs) on anxiety symptoms in adults with cancer. Method: We searched 11 electronic databases from inception to February 2024. We included studies comparing MBIs with usual care, waitlist controls, or no intervention for the improvement of patients with anxiety in cancer (CA). We only reviewed studies written in English. We used a random-effects model to compute the effect size. Funnel plot, Q statistics, and I² were used to test the heterogeneity across studies. We examined moderators to explore sources of heterogeneity. Results: Across 26 included studies, 1431 adults with cancer participated in MBIs; 1289 served as controls. Mean age ranged from 42.8 to 70.7 years. Most patients were females (56%), and patients with breast cancer and mixed cancer (55.53% and 26.20%, respectively). Overall, MBIs reduced anxiety in the experimental groups compared to control groups (Hedges' g = 0.977, 95% confidence interval = 0.61, 1.34, I² = 95%), but with substantial heterogeneity. In subgroup analysis, funding, setting, a priori power analysis, providing MBIs in adults with cancer and anxiety disorders, and measuring anxiety after postintervention were moderators affecting the pooled effect size. No other quality indicators moderated the effect sizes of MBIs on anxiety. Conclusion: MBIs appear efficacious in improving patients with CA, especially for those with mild-to-moderate anxiety symptoms. Clinicians and health providers might consider using MBIs as an alternative complementary treatment for improving or preventing anxiety disorders in adults living with cancer. With heterogeneity of studies, a large number of primary studies is needed to explore the source of heterogeneity.

Introduction: Many health care professionals are struggling to cope with high stress and burnout in the workplace. To support these professionals, several strategies have been proposed, including meditation and breathing exercises. This pilot study aimed to determine the feasibility of yogic breathing as a strategy for managing stress and burnout for anesthesia professionals. Feasibility was assessed as recruitment rate, retention rate, and adherence. Secondary efficacy outcomes included changes in stress using validated questionnaires and measures of hair cortisol concentration. Methods: A total of 57 out of 300 eligible anesthesia professionals at the Medical University of South Carolina were recruited. Participants attended a class on yogic breathing practices and were given access to the recorded class and other pre-recorded modules on yogic breathing during the study. At baseline and every 3 months, participants completed a one-question Mini Z survey and the Holmes-Rahe Life Stress Inventory. At those time points, a 3-cm clipping of 50-100 strands of hair was collected for cortisol analysis. Participants reported their time spent meditating each week. Results: This study had poor feasibility, with only 63.2% of participants still reporting on yogic breathing at week 52, including those who recorded no practice of yogic breathing. The median percentage of weeks that participants engaged in some form of yogic breathing was only 13.5% (7/52 weeks), likely due to 31.5% of participants (18/57) who performed no yogic breathing during the study period. Discussion: Although this approach of self-guided yogic breathing was not feasible, these findings can influence future programs that aim to reduce stress in anesthesia professionals.

Context: Safe, effective treatment for chronic pain is needed. Prolotherapy is an injection-based complementary and integrative therapy supported by emerging peer-reviewed evidence. It is anecdotally used in clinical care, yet it is not part of medical society practice guidelines. It is unclear how many medical training programs practice and teach prolotherapy, limiting research and clinical optimization. Objective: To assess the use and teaching of prolotherapy in U.S. medical training programs (residencies and fellowships) in specialties that treat chronic pain. Design and Analysis: A mixed-methods, 21-item cross-sectional anonymized survey was sent to directors of the Accreditation Council for Graduate Medical Education (ACGME) residency and fellowship programs in 11 specialties treating chronic pain. Analysis was by descriptive statistics, ANOVA, and qualitative inductive content analysis. Results: From 1852 mailed surveys, we received 854 responses (46.1%). Two-hundred eleven (24.7%) programs reported prolotherapy use, and 119 (13.9%) reported prolotherapy-focused education. Prolotherapy use was most frequently reported by Osteopathic Manipulative Medicine/Neuromusculoskeletal Medicine (OMM/NMM) and Physical Medicine and Rehabilitation (PM&R) residencies and by Sports Medicine and Musculoskeletal Radiology fellowships. Prolotherapy-focused teaching was most frequently provided by OMM/NMM and PM&R residencies and Sports Medicine Fellowships. Among the 119 programs teaching prolotherapy, educational efforts most commonly addressed knee (91; 76.5%), shoulder (86; 72.3%), and elbow (80; 67.2%) pathology, and most (97; 81.5%) include ultrasound guidance at least some of the time. Qualitative analysis revealed mixed perspectives about the use and teaching of prolotherapy. Non-adopters cited limited peer-reviewed evidence and awareness, while adopters noted supportive evidence, a favorable safety profile, and appreciation of alternative treatment options. Conclusions: This is the first study to assess the practice and teaching of prolotherapy for chronic pain in U.S. ACGME-accredited medical training programs. Prolotherapy appears to be used and taught by a substantial minority of responding programs; results should be interpreted with caution due to potential self-selection bias. Findings suggest more research about the use and training, and the efficacy and effectiveness, of prolotherapy is warranted.

Background: Yoga is increasingly recognized for its therapeutic benefits in managing chronic medical and psychiatric conditions, including substance use disorders. Despite its growing clinical acceptance, challenges remain regarding its real-world feasibility, particularly in medically oriented settings. Objectives: This analysis aimed to explore reasons for nonparticipation in a randomized controlled trial evaluating the efficacy of add-on yoga (dhyana meditation) in patients with opioid dependence who were stable on pharmacological treatment. Design, Setting, Participants, and Interventions: This sub-analysis was part of a larger randomized controlled trial of add-on yoga conducted at a tertiary care addiction treatment center in north India. Patients on stable doses of medications for opioid use disorder treatment were approached for participation in yoga that included 7 consecutive days of training followed by yoga practice or wait list control. Main Outcome Measures: The main outcome measures for the present analysis were the reasons for nonparticipation. Results: Only 24% (n = 120) of approached participants consented to join the trial. The most common reason for refusal was lack of time (73.2%), followed by logistical challenges and lack of familiarity with yoga. Education level was significantly associated with participation (p = 0.018). While 80.3% of nonparticipants believed yoga could be beneficial, few expressed interest in online formats or reduced-frequency visits, indicating limited practical feasibility. Conclusion: Despite a general belief in yoga's benefits, participation was limited by time and logistical constraints. Future interventions should consider hybrid or digital formats, flexible scheduling, and tailored recruitment strategies. Understanding nonparticipation reasons can enhance engagement and guide future yoga-based trials in clinical populations.