Effectiveness of Ayurvedic Massage (Sahacharadi Taila) in Patients with Chronic Low Back Pain: A Randomized Controlled Trial

Integrative Approaches for Cancer Pain Management

PURPOSE OF REVIEW

The goal of this review is to summarize updates to the broad array of complementary therapies available for cancer pain. This paper will serve as a reference for clinicians managing pain in cancer patients.

RECENT FINDINGS

Patients are embracing integrative therapies in growing numbers; clinicians must be prepared to incorporate these therapies into patients' existing treatment regimens. This requires knowledge regarding risks, benefits, and potential interactions with existing cancer therapies. Integrative cancer pain management strategies have shown promise, with several proven effective for the management of cancer pain. Energy therapies, including acupuncture, and biologicals and nutraceuticals including overall diet and vitamin D, have the highest level of evidence for efficacy. The remaining therapies discussed in this chapter may be beneficial for patients on a case-by-case basis; risks and benefits of each individual therapy as described in the text must be further assessed in future rigorous trials to further clarify the role of these complementary therapies in cancer pain management.

Comparative effectiveness of nonpharmacological interventions in reducing psychological symptoms among patients with chronic low back pain

OBJECTIVES

Chronic low back pain (CLBP) can seriously impair the quality of life of patients and has a remarkable comorbidity with psychological symptoms, which, in turn, can further exacerbate the symptoms of CLBP. Psychological treatments are critical and nonnegligent for the management of CLBP, and thus, should attract sufficient attention. However, current evidence does not suggest the superiority and effectiveness of nonpharmacological interventions in reducing psychological symptoms among patients with CLBP.Thus, this study was designed to compare the effectiveness of nonpharmacological interventions for depression, anxiety, and mental health among patients with CLBP and to recommend preferred strategies for attenuating psychological symptoms in clinical practice.

METHODS

In this systematic review and network meta-analysis (NMA), PubMed, Embase Database, Web of Science, and Cochrane Library were searched from database inception until March 2022. Randomized clinical trials (RCTs) that compare different nonpharmacological interventions for depression, anxiety, and mental health among patients with CLBP were eligible. The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was used. Four reviewers in pairs and divided into two groups independently performed literature selection, data extraction, and risk of bias, and certainty of evidence assessments. This NMA was conducted with a random effects model under a frequentist framework. The major outcomes were depression, anxiety, and mental health presented as the standardized mean difference (SMD) with the corresponding 95% CI.

RESULTS

A total of 66 RCTs that randomized 4806 patients with CLBP met the inclusion criteria. The quality of evidence was typically low or some risks of bias (47 out of 66 trials, 71.3%), and the precision of summary estimates for effectiveness varied substantially. In addition, 7 categories of interventions with 26 specific treatments were evaluated. For depression, mind body therapy (pooled SMD = -1.20, 95% CI: -1.63 to -0.78), biopsychosocial approach (pooled SMD = -0.41, 95% CI: -0.70 to -0.12), and physical therapy (pooled SMD = -0.26, 95% CI: -0.50 to -0.02) exhibited remarkable effectiveness in reducing depression compared with the control group. For managing anxiety, mind body therapy (pooled SMD = -1.35, 95% CI: -1.90 to -0.80), multicomponent intervention (pooled SMD = -0.47, 95% CI: -0.88 to -0.06), and a biopsychosocial approach (pooled SMD = -0.46, 95% CI: -0.79 to -0.14) were substantially superior to the control group. For improving mental health, multicomponent intervention (pooled SMD = 0.77, 95% CI: 0.14 to 1.39), exercise (pooled SMD = 0.60, 95% CI: 0.08 to 1.11), and physical therapy (pooled SMD = 0.47, 95% CI: 0.02-0.92) demonstrated statistically substantial effectiveness compared with the control group. The rank probability indicated that mind body therapy achieved the highest effectiveness in reducing depression and anxiety among patients with CLBP. Besides, the combined results should be interpreted cautiously based on the results of analyses evaluating the inconsistency and certainty of the evidence.

CONCLUSION

This systemic review and NMA suggested that nonpharmacological interventions show promise for reducing psychological symptoms among patients with CLBP. In particular, mind body therapy and a biopsychosocial approach show considerable promise, and mind body therapy can be considered a priority choice in reducing depression and anxiety. These findings can aid clinicians in assessing the potential risks and benefits of available treatments for CLBP comorbidity with psychological symptoms and provide evidence for selecting interventions in clinical practice. More RCTs involving different interventions with rigorous methodology and an adequate sample size should be conducted in future research.

Effect of mindfulness-based mind-body therapies in patients with non-specific low back pain-A network meta-analysis of randomized controlled trials

Background/objectives

Although mindfulness-based mind-body therapy (MBMBT) is an effective non-surgical treatment for patients with non-specific low back pain (NLBP), the best MBMBT mode of treatment for NLBP patients has not been identified. Therefore, a network meta-analysis (NMA) was conducted to compare the effects of different MBMBTs in the treatment of NLBP patients.

Methods

PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched for randomized controlled trials (RCTs) applying MBMBT for the treatment of NLBP patients, with all of the searches ranging from the time of database creation to January 2023. After 2 researchers independently screened the literature, extracted information, and evaluated the risks of biases in the included studies, the data were analyzed by using Stata 16.0 software.

Results

A total of 46 RCTs were included, including 3,886 NLBP patients and 9 MBMBT (Yoga, Ayurvedic Massage, Pilates, Craniosacral Therapy, Meditation, Meditation + Yoga, Qigong, Tai Chi, and Dance). The results of the NMA showed that Craniosacral Therapy [surface under the cumulative ranking (SUCRA): 99.2 and 99.5%] ranked the highest in terms of improving pain and disability, followed by Other Manipulations (SUCRA: 80.6 and 90.8%) and Pilates (SUCRA: 54.5 and 71.2%). In terms of improving physical health, Craniosacral Therapy (SUCRA: 100%) ranked the highest, followed by Pilates (SUCRA: 72.3%) and Meditation (SUCRA: 55.9%). In terms of improving mental health, Craniosacral Therapy (SUCRA: 100%) ranked the highest, followed by Meditation (SUCRA: 70.7%) and Pilates (SUCRA: 63.2%). However, in terms of improving pain, physical health, and mental health, Usual Care (SUCRA: 7.0, 14.2, and 11.8%, respectively) ranked lowest. Moreover, in terms of improving disability, Dance (SUCRA: 11.3%) ranked lowest.

Conclusion

This NMA shows that Craniosacral Therapy may be the most effective MBMBT in treating NLBP patients and deserves to be promoted for clinical use.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, PROSPERO [CRD42023389369].

The Effect of Thai Massage on the Severity of Pain in Patients with Unstable Angina: A Randomized Controlled Clinical Trial

Introduction: Chest pain is an unpleasant and the most common symptom in patients suffering from unstable angina. This study was implemented to investigate the effect of Thai massage on severity of pain in patients with unstable angina. Methods: This study was a randomized controlled clinical trial that carried out on 70 patients with unstable angina who had been hospitalized in hospital affiliated to Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran. The participants were allocated randomly to either the intervention (n=35) or control group (n=35) between August 1, 2016 and April 30, 2017. The patients in the intervention group received routine care beside and Thai massage with the duration of 30 minutes in two consecutive days. The patients in the control group received routine care. The intensity of pain was assessed by using the numeric rating scale, five minutes before and immediately, 15, 30 and 60 minutes after the intervention. The independent t-test and repeated measures analysis of variance (ANOVA) were used to analysis data through SPSS 13. Results: After the intervention, the severity of pain was significantly diminished by about four measurement points (P=0.001) with the linear pattern of pain reduction. Nonetheless, in the control group, no statistically significant difference in the intensity of pain was found. Conclusion: This study showed that Thai massage as non-invasive approach, concomitant with standard nursing care, has the potential to decrease chest pain. Nurses should be taught about pain relief methods for improving the quality of patient care.

Ayurveda in Knee Osteoarthritis-Secondary Analyses of a Randomized Controlled Trial

Background: Ayurveda is widely practiced in South Asia in the treatment of osteoarthritis (OA). The aim of these secondary data analyses were to identify the most relevant variables for treatment response and group differences between Ayurvedic therapy compared to conventional therapy in knee OA patients. Methods: A total of 151 patients (Ayurveda n = 77, conventional care n = 74) were analyzed according to the intention-to-treat principle in a randomized controlled trial. Different statistical approaches including generalized linear models, a radial basis function (RBF) network, exhausted CHAID, classification and regression trees (CART), and C5.0 with adaptive boosting were applied. Results: The RBF network implicated that the therapy arm and the baseline values of the WOMAC Index subscales might be the most important variables for the significant between-group differences of the WOMAC Index from baseline to 12 weeks in favor of Ayurveda. The intake of nutritional supplements in the Ayurveda group did not seem to be a significant factor in changes in the WOMAC Index. Ayurveda patients with functional limitations > 60 points and pain > 25 points at baseline showed the greatest improvements in the WOMAC Index from baseline to 12 weeks (mean value 107.8 ± 27.4). A C5.0 model with nine predictors had a predictive accuracy of 89.4% for a change in the WOMAC Index after 12 weeks > 10. With adaptive boosting, the accuracy rose to 98%. Conclusions: These secondary analyses suggested that therapeutic effects cannot be explained by the therapies themselves alone, although they were the most important factors in the applied models.

Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021

Low back pain (LBP) remains a musculoskeletal condition with an adverse societal impact. Globally, LBP is highly prevalent and a leading cause of disability. This is an update to the 2012 Academy of Orthopaedic Physical Therapy (AOPT), formerly the Orthopaedic Section of the American Physical Therapy Association (APTA), clinical practice guideline (CPG) for LBP. The overall objective of this update was to provide recommendations on interventions delivered by physical therapists or studied in care settings that included physical therapy providers. It also focused on synthesizing new evidence, with the purpose of making recommendations for specific nonpharmacologic treatments. J Orthop Sports Phys Ther 2021;51(11):CPG1-CPG60. doi:10.2519/jospt.2021.0304.

Knowledge of osteopathic manipulative medicine and osteopathic physicians in a New York South Asian community

CONTEXT

Research regarding patient awareness of osteopathic manipulative medicine (OMM) can help identify barriers and factors limiting patient knowledge. Levels of knowledge about OMM and osteopathic physicians have been studied in New York's Chinese and Korean populations, but have not previously been investigated in the South Asian population.

OBJECTIVES

To assess the knowledge of OMM and osteopathic physicians within a South Asian community of New York.

METHODS

A cross-sectional study was designed in which a culturally appropriate survey, provided in both English and Hindi, was administered to study participants in order to measure knowledge of osteopathic medicine. The study utilized convenience sampling and distributed surveys to individuals who identified themselves of South Asian descent at high traffic sites in Hicksville, New York. The survey contained 10 questions, assessing the individual's knowledge of osteopathic medicine. The Kruskal-Wallis and Chi-Square tests were employed to determine statistical significance of the data obtained from the surveys.

RESULTS

The survey was conducted on 100 participants in Hicksville, New York. The respondent demographics included 53 males and 47 females with an average age of 41.2 ± 16.3 years old. There were 34 (34%) participants who had heard of osteopathic manipulative medicine (OMM) and 26 (26%) participants who had knowledge of doctor of osteopathic medicine (DO) physicians. Respondents were found more likely to have knowledge of DOs if they were born in the United States (US) vs. other countries (US, 8 of 14 [57.1%] vs. others, 18 of 86 [20.9%]; p=0.006) or lived longer in the US (11 of 26 [42.3%], p=0.039). Participants who spoke a non-English primary language were also found less likely to have knowledge of DOs as they made up 46 of the 58 respondents who indicated no knowledge (79.3%, p=0.042).

CONCLUSIONS

A general lack of knowledge of DOs and OMM exists within the South Asian community of Hicksville, New York and lower levels of awareness were found among participants who were male, born outside the US, had a language other than English as their primary language, and had spent less time in the US. Additional educational resources may be implemented to increase awareness of DOs and OMM among this and similar communities.

Massage Therapy's Effectiveness on the Decoding EEG Rhythms of Left/Right Motor Imagery and Motion Execution in Patients With Skeletal Muscle Pain

Objective: Most of effectiveness assessments of the widely-used Massage therapy were based on subjective routine clinical assessment tools, such as Visual Analogue Scale (VAS) score. However, few studies demonstrated the impact of massage on the Electroencephalograph (EEG) rhythm decoding of Motor imagery (MI) and motion execution (ME) with trunk left/right bending in patients with skeletal muscle pain. Method: We used the sample entropy (SampEn), permutation entropy (PermuEn), common spatial pattern (CSP) features, support vector machine (SVM) and logic regression (LR) classifiers. We also used the convolutional neural network (CNN) and attention-based bi-directional long short-term memory (BiLSTM) for classification. Results: The averaged SampEn and PermuEn values of alpha rhythm decreased in almost fourteen channels for five statuses (quiet, MI with left/right bending, ME with left/right bending). It indicated that massage alleviates the pain for the patients of skeletal pain. Furthermore, compared with the SVM and LR classifiers, the BiLSTM method achieved a better area under curve (AUC) of 0.89 for the classification of MI with trunk left/right bending before massage. The AUC became smaller after massage than that before massage for the classification of MI with trunk left/right bending using CNN and BiLSTM methods. The Permutation direct indicator (PDI) score showed the significant difference for patients in different statuses (before vs after massage, and MI vs ME). Conclusions: Massage not only affects the quiet status, but also affects the MI and ME. Clinical Impact: Massage therapy may affect a bit on the accuracy of MI with trunk left/right bending and it change the topography of MI and ME with trunk left/right bending for the patients with skeletal muscle pain.

Comparative morbidity profile of patients attending an Ayurveda clinic and a modern medicine clinic of a primary health center in rural Haryana, India

Context:

There is a paucity of data on the profile of patients accessing traditional systems of medicine. A comparison of profile of patients attending an Ayurveda clinic with that of modern medicine clinic will help in better understanding of utilization of services and preference for system of medicine by the patients seeking health care.

Aim:

The aim was to study the morbidity profile of patients who attended the Ayurveda clinic of a primary health center (PHC) in rural Haryana over 1 year and compared it with that of the modern medicine clinic attendees at the same facility.

Materials and Methods:

The study site was PHC, Dayalpur in block Ballabgarh, district Faridabad, Haryana, India. All new patients who attended the Ayurveda clinic of PHC Dayalpur in the year 2012 were included in the study. New attendees of modern medicine clinic of the same PHC in the year 2012 were used for comparison of profile of patients.

Results:

In year 2012, of the total new patients registered at PHC, 26% attended Ayurveda clinic. The male-to-female ratio (0.8:1) was similar in both clinics. The representation of children up to 5 years and elderly was significantly higher (12.0% vs. 6.7% and 19.5% vs. 11.0%) in modern medicine clinic as compared to Ayurveda clinic. The most common morbidities seen in Ayurveda clinic were twak vikar or skin disease (12.3%), sandhivata or osteoarthritis (10.3%), and kasa or cough (8.5%). Three most common morbidities in modern medicine clinic were acute respiratory infection (35.7%), hypertension (10.6%), and acute febrile illness (9.2%).

Conclusions:

The study provided evidence that Ayurveda was popular among rural population in North India. Therefore, the Government of India's initiative of setting up Ayurveda clinic in PHCs is well founded.