Journal of Integrative and Complementary Medicine最新文献

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.

Background: Nonpharmacologic interventions have known benefits for managing chronic pain, particularly for conditions such as fibromyalgia, and are included in clinical guidelines. However, eye movement desensitization and reprocessing (EMDR) has not been established as a routine clinical practice for pain management. Objective: To systematically review the efficacy of EMDR for managing chronic pain. Methods: A search was conducted to identify randomized clinical trials (RCTs) and observational studies by using the keywords "EMDR" and "chronic pain." Information was collected on the study population, EMDR protocol, methods for pain assessment, and outcomes. Risk of bias was evaluated, and intervention effect sizes were determined by calculating Hedges g values for long-term follow-up data in RCTs. Results: A total of nine studies, including seven RCTs, were reviewed. The studies used various diverse pain measurement tools and EMDR protocols. All reported significant improvements in pain symptoms with EMDR. Most of the studies reported statistically significant improvements in associated mental health issues, notably in psychological distress (four out of four studies), anxiety (three out of three studies), and depression (three out of four studies). Effect sizes varied among the studies, with three RCTs reporting large effects, two RCTs reporting moderate effects, and one RCT reporting small or nonsignificant effects. Conclusion: EMDR shows promise for managing chronic pain and addressing associated mental health symptoms. Despite study differences and limitations, the findings of this systematic review support the potential use of EMDR for chronic pain management.

Background: Chronic liver diseases (CLDs) are major contributors to hepatic disorder-related morbidity and mortality worldwide. LIV-52, a herbo-mineral product, has demonstrated anti-inflammatory and immunomodulatory properties. Objective: Several randomized controlled trials (RCTs) have been conducted to verify its hepatoprotective effects across diverse patient groups with CLDs. This study aims to perform a meta-analysis to evaluate the therapeutic efficacy of LIV-52 in liver diseases. Data Sources: PubMed, the Cochrane Library, EMBASE, and Web of Science were searched to identify eligible RCTs published through March 10, 2025, where the efficacy of LIV-52 was compared with usual treatments for liver diseases. Meta-analysis was performed using RevMan and GRADEPro software. Eligibility Criteria: RCTs comparing LIV-52 with or without standard care in patients with CLDs. Data Collection and Analysis: Data were extracted independently by two reviewers. Meta-analysis was performed using a random-effects model. Results: From the 10 RCTs involving 758 patients, the hepatoprotective effects of LIV-52 treatment were examined. Benefits were noted in the areas of appetite loss (odds ratio = 0.25, confidence interval [CI] = 0.06 to 1.00, p-value = 0.05), renormalization of the liver enzyme serum-glutamic-pyruvic transaminase (SGPT; mean difference [MD] = -16.37, CI = -30.87 to -1.88, p-value <0.03), and improvement in fat metabolism in patients with liver cirrhosis (zinc sulfate [ZnS] turbidity [MD = 6.76, CI = 2.4 to 11.12, p-value <0.002] and fecal fat secretion [MD = -1.66, CI = -2.53 to -0.75, p-value <0.0001]). However, no significant effects of LIV-52 were observed for liver enzymes such as serum-glutamic-oxaloacetic transaminase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), bilirubin, and the hematological parameters. The overall quality of evidence (QoE) as assessed using GRADEPro ranged from very low to moderate, with the majority of comparisons supported by low or very low due to small sample sizes and high bias risks, while the findings for some outcomes, hemoglobin and prothrombin time outcomes, supported moderate-quality evidence. Adverse events (AEs) were assessed in three RCTs; no intervention-related AEs were reported. Conclusion: The findings of this meta-analysis suggest that LIV-52 offers certain hepatoprotective benefits, particularly in improving appetite, normalizing SGPT levels, and enhancing fat metabolism in patients with liver diseases. The broader efficacy of LIV-52 is limited, and the low QoE warrants cautious interpretation. Further high-quality, large-scale studies are needed to enhance the certainty of evidence and confirm the LIV-52 efficacy and safety across all outcomes.

Introduction: Musculoskeletal pain (MSP) is prevalent and a major cause of disability, highlighting the need for nonpharmacologic treatments. Low-level laser therapy auriculotherapy (LLLT-AT) is emerging as a promising noninvasive approach for MSP management. Objective: This systematic review aimed to evaluate the effects of LLLT-AT on MSP patients. Method: A comprehensive electronic search of PubMed, Web of Science, Scopus, Cochrane Library, CINAHL, ScienceDirect, PEDro, and Google Scholar (updated on May 3, 2025) identified randomized clinical trials (RCTs) comparing LLLT-AT with sham, no intervention, or other therapies. Pain intensity was the primary outcome, and disability and pain pressure threshold were secondary. Methodological quality was assessed using the PEDro scale. The risk of bias among the included RCTs was assessed using the Cochrane Risk of Bias 2.0 (RoB 2) tool, and the meta-analysis was performed using the mean difference (MD) or standardized mean difference (SMD), as appropriate. The Grading of Recommendation, Assessment, Development, and Evaluation framework guided evidence certainty. Results: Five RCTs were included, with a mean PEDro score of 7 (standard deviation [SD] 0.7). According to Domain 6 of the RoB 2 tool, 80% of trials demonstrated a low overall risk of bias, with evaluators blinding being the primary concern. LLLT-AT significantly reduced pain intensity post-treatment compared with placebo (SMD = 1.31; 95% confidence interval [CI]: 0.40-2.30; p < 0.01) and no treatment (SMD = 1.12; 95% CI: 0.00-2.20; p < 0.01), reflecting a large effect size. An increase in the pressure pain threshold was also observed (MD = 0.64; 95% CI: 0.00-1.30; p < 0.01), although this result was limited by small sample sizes. However, the certainty of the evidence was judged as very low-deemed critical for pain intensity outcomes and not important for pressure pain threshold. No adverse events were reported. Conclusion: LLLT-AT shows potential for effectively managing MSP, reducing pain intensity, and improving pressure pain threshold. However, further research is needed to strengthen the evidence base due to the limited number of studies and to explore its applicability to other conditions. Dosage recommendations were provided to inform future research and clinical practice.