nonpharmacological treatments
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2021 ◽  
Vol 23 ◽  
Author(s):  
Grace Miranda Hansen

Fibromyalgia (FM) patients usually are resistant to conventional single mode therapy. Therefore, the efficacy of combined pharmacological and nonpharmacological treatments for the management of FM symptoms in a clinical population was assessed. Participants were injected with 4x5 mL 1% lidocaine HCl solution and given education materials and support on increasing their daily steps walked and to engage in mindfulness techniques to reduce their overall pain and accompanying symptoms of their condition. Participants self-reported pain intensity, unpleasantness, anxiety, fatigue, and depression three days prior to and after each injection. Overall ratings of pain intensity and unpleasantness showed statistically significant reductions of 34.7 and 47.2 percent respectively with the combined use of treatments. Additionally, fatigue levels had a significant decrease but depression and anxiety ratings were not significantly modified by this treatment modality. Patients who had a greater adherence to their protocol had an improved pain relief when compared to others. These results suggest that the use of a combination treatment method for FM in a clinical setting and when used in combination is effective. This pilot study can be used as a model for future randomized controlled studies on comprehensive treatments for FM. 


2021 ◽  
pp. 026988112110135
Author(s):  
Gustavo H. Vázquez ◽  
Anees Bahji ◽  
Juan Undurraga ◽  
Leonardo Tondo ◽  
Ross J. Baldessarini

Background: Successful treatment of major depressive disorder (MDD) can be challenging, and failures ("treatment-resistant depression" [TRD]) are frequent. Steps to address TRD include increasing antidepressant dose, combining antidepressants, adding adjunctive agents, or using nonpharmacological treatments. Their relative efficacy and tolerability remain inadequately tested. In particular, the value and safety of increasingly employed second-generation antipsychotics (SGAs) and new esketamine, compared to lithium as antidepressant adjuncts remain unclear. Methods: We reviewed randomized, placebo-controlled trials and used random-effects meta-analysis to compare odds ratio (OR) versus placebo, as well as numbers-needed-to-treat (NNT) and to-harm (NNH), for adding SGAs, esketamine, or lithium to antidepressants for major depressive episodes. Results: Analyses involved 49 drug-placebo pairs. By NNT, SGAs were more effective than placebo (NNT = 11 [CI: 9–15]); esketamine (7 [5–10]) and lithium (5 [4–10]) were even more effective. Individually, aripiprazole, olanzapine+fluoxetine, risperidone, and ziprasidone all were more effective (all NNT < 10) than quetiapine (NNT = 13), brexpiprazole (16), or cariprazine (16), with overlapping NNT CIs. Risk of adverse effects, as NNH for most-frequently reported effects, among SGAs versus placebo was 5 [4–6] overall, and highest with quetiapine (NNH = 3), lowest with brexpiprazole (19), 5 (4–6) for esketamine, and 9 (5–106) with lithium. The risk/benefit ratio (NNH/NNT) was 1.80 (1.25–10.60) for lithium and much less favorable for esketamine (0.71 [0.60–0.80]) or SGAs (0.45 [0.17–0.77]). Conclusions: Several modern antipsychotics and esketamine appeared to be useful adjuncts to antidepressants for acute major depressive episodes, but lithium was somewhat more effective and better tolerated. Limitations: Most trials of adding lithium involved older, mainly tricyclic, antidepressants, and the dosing of adjunctive treatments were not optimized.


Medicine ◽  
2021 ◽  
Vol 100 (19) ◽  
pp. e25741
Author(s):  
Hyo-Weon Suh ◽  
Chan-Young Kwon ◽  
Sunggyu Hong ◽  
Hyun Woo Lee ◽  
Misun Lee ◽  
...  

Pain ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Julie M. Fritz ◽  
Alison F. Davis ◽  
Diana J. Burgess ◽  
Brian Coleman ◽  
Chad Cook ◽  
...  

2020 ◽  
Vol 9 (7) ◽  
pp. 2272
Author(s):  
Linda Kerkemeyer ◽  
Katharina Achtert ◽  
Inga Claus ◽  
Svenja Happe ◽  
Jeannette Overbeck ◽  
...  

Interdisciplinary care has been shown to be effective at optimizing the treatment of patients with Parkinson’s disease. An optimized collaboration between the various healthcare providers involved in the treatment process facilitates successful care. One of the main shortcomings in the German healthcare system is the limited and unstandardized communication between practitioners. The Parkinson’s network Münsterland+ (PNM+) is an interdisciplinary network of medical and non-medical experts involved in the treatment of Parkinson’s patients: neurologists, physiotherapists, occupational therapists, speech therapists, psychologists, Parkinson’s nurses, pharmacists, patients, and relatives. The PNM+ elaborates guideline-based therapy recommendations, provided as so-called “Quickcards”. Thereby, the communication of the treating neurologist and therapists is based on a coordinated feedback system and suggestions to adequately select and, if necessary, adjust the therapy. In the German healthcare system, with its fragmented structures, the PNM+ and its activities have been shown to enhance integration of the healthcare providers and thereby optimize the care of Parkinson’s disease patients. Future research should evaluate the effects and cost-effectiveness.


Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3574-3584
Author(s):  
Cheryl Bernstein ◽  
Andrea G Gillman ◽  
Di Zhang ◽  
Anna E Bartman ◽  
Jong-Hyeon Jeong ◽  
...  

Abstract Objective High-quality chronic pain care emphasizes multimodal treatments that include medication and nonpharmacological treatments. But it is not clear which patients will participate in nonpharmacological treatments, such as physical therapy or mental health care, and previous research has shown conflicting evidence. Methods We used the Patient Outcomes Repository for Treatment (PORT) registry, which combines patient-reported outcomes data with electronic medical records. In this retrospective observational study, we performed two separate multinomial regression analyses with feature selection to identify PORT variables that were predictive of 1) recommendation of a nonpharmacological treatment by the provider and 2) patient participation in nonpharmacological treatments. Two hundred thirty-six patients were recommended (REC) or not recommended (NO REC) a nonpharmacological treatment, and all REC patients were classified as participating (YES) or not participating (NO) in the recommendations. Results Female gender and a diagnosis of Z79 “Opioid drug therapy” were significant positive and negative predictors of nonpharmacological treatment recommendations, respectively. Schedule II opioid use at initial presentation and recommendations for rehabilitation therapy were significant predictors of nonparticipation. Conclusions Patients using opioids are less likely to be recommended nonpharmacological treatments as part of multimodal chronic pain care and are less likely to participate in nonpharmacological treatments once recommended. Males are also less likely to be recommended nonpharmacological treatments. Patients referred for rehabilitation therapies are less likely to comply with those recommendations. We have identified patients in vulnerable subgroups who may require additional resources and/or encouragement to comply with multimodal chronic pain treatment recommendations.


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