Background: Opioid-dependent women have an 80% to 90% unintended pregnancy rate, almost double the overall unintended pregnancy rate: 40% globally and 51% in north America. The escalating prescription drug abuse milieu increases the possibility that a laboring patient has a history of opioid abuse. In 2012, neonatal abstinence syndrome occurred in 5.8 per 1,000 hospital births. In addition to regional analgesia as needed, nonpharmacologic labor pain management (NPLPM) is recommended for all laboring patients, and especially those with a history of substance abuse. NPLPM user ratings of somewhat effective or very effective can reach 72% to 100%. Purpose: To elucidate the efficacy and safety of acupuncture, noninvasive electro-acupuncture, and acupressure in labor pain management. Methods: The Academic One Search, Cumulative Index to Nursing and Allied Health Literature, and PubMed databases were searched on June 23, 2016 using the terms “acupuncture treatment labor pain,” with human subjects, English language, free full text, and publication from 2012 onward as parameters. Seven randomized controlled trials (RCTs), one systematic review, and one meta-analysis were found. Results: Compared to standard intrapartum care controls, bilateral electro-acupuncture at JiaJi or Sanyinjiao significantly reduced visual analog scale (VAS) pain scores 30-minutes post intervention (p < .01) and Stage 1 active phase labor length (p < .05). Bilateral Sanyinjiao acupressure reduced average labor duration by 160.4 minutes, p = .0047, without affecting cesarean delivery (CD) rate, or 1- and 5-minute APGAR scores. At the cost of the longest Stage 2 labor, pruritus, neonatal asphyxia, and urinary retention, patient-controlled epidural analgesia (PCEA) achieved greater analgesic effect than electro-acupuncture at JiaJi and CiLiao, p = .05. However, electro-acupuncture achieved shorter Stage 2 labor duration than PCEA (p = .05), as well as, 10-point lower VAS pain scores and reduced CD rate than no-analgesia controls, p < .05. Conclusions: In 2011, the Cochrane Review found that acupuncture and acupressure may have a role in reducing labor pain. Current evidence indicates that electro-acupuncture and acupressure should have a role in NPLPM. Nevertheless, future RCTs could strengthen the argument for increased use of electro-acupuncture and acupressure in NPLPM.

Objectives: Chronic pain, often defined as pain lasting longer than three months, can lead to significant medical, social, and economic consequences, lost productivity, and larger health care costs. Chronic pain patients increasingly seek treatment through mindfulness meditation. Our aim was to synthesize evidence on efficacy and safety of mindfulness meditation interventions for the treatment of chronic pain. Methods: We searched electronic databases and systematic review bibliographies for randomized controlled trials (RCTs) on mindfulness for adults with chronic pain. We dually abstracted data and conducted efficacy meta-analyses. Quality of evidence was assessed using the GRADE approach. Results: 28 RCTs met inclusion criteria; only three reported on safety. We found low quality evidence that mindfulness meditation is associated with a decrease in pain compared to control in 24 RCTs. Mindfulness meditation significantly reduced pain scores compared to treatment as usual, but not compared to passive controls or education/support groups. The efficacy of mindfulness meditation on pain did not differ systematically by type of intervention, medical condition, length or frequency of intervention, or whether offered as mono- or adjunctive therapy. Statistically significant effects were also found for depression, and health-related quality of life. Conclusions: Mindfulness meditation improves pain symptoms, depression, and quality of life; however, quality of evidence for pain outcomes is low due to substantial heterogeneity and mixed quality of included RCTs. Additional trials with adequate power, greater efforts to prevent attrition, monitoring of adherence to meditation practice, active collection of adverse events, and better reporting of methods are suggested.

Background Chronic diseases are among the most common and costly of all health problems. Practicing Yan Xin Qigong (YXQG) has been found to be associated with self-reported improvement in health status, including mental health, sleeping quality, work performance, and chronic pain. The purpose of study is to explore its potential in managing chronic diseases. Methods Using data from a population-level survey that was collected on a voluntary basis at the 5th Canadian Yan Xin Qigong Festival in 2001, we conducted quantitative analysis on the association between YXQG practice and self-reported conditions on arthritis, chronic fatigue, heart diseases, hypertension, and obesity. The sample size for this study was 505. To test the robustness of the results, we constructed two types of outcome variables: the first type included five dichotomous indicators on whether there was a significant improvement in the condition of each of the five diseases; and the second was a dichotomous variable indicating whether there was any significant improvement in at least one condition of these five diseases. We also constructed two exposure variables regarding YXQG practice time: a dichotomous variable indicating either less or more than one year of YXQG practice; and a categorical variable indicating less than a year, between one and three years, and above three years of YXQG practice. Other covariates included age, gender, race, and education level. We used logistic regression with robust variance estimator in analysis. Results High proportions of YXQG practitioners reported significant improvement in arthritis (57%), chronic fatigue (57%), heart disease (67%), hypertension (51%), and obesity (49%). Except for hypertension, the length of practicing YXQG was positively associated with the likelihood of improved conditions. Those who practiced YXQG for more than one year were more likely to have improvement in arthritis (odds ratio 3.69 with 95% CI 1.44-9.42), chronic fatigue (odds ratio 3.71 with 95% CI 1.73-7.96), heart diseases (odds ratio 14.14 with 95% CI 1.44-138.97), and obesity (odds ratio 4.92, 95% CI 2.04-11.88). Conclusion Findings about the positive association between YXQG practice and improved chronic disease conditions are robust to various model specifications and consistent with previous studies.

background/purpose Mounting evidence demonstrates how trauma resides in the body (Levine, 2010; Ogden, Pain, Fisher, 2006; van der Kolk, 2014) and that yoga may be particularly effective in the treatment of trauma-related disorders (van der Kolk et al., 2014). However, a dearth remains of evidence-based yoga-protocols for use with diverse populations (Hagins & Khalsa, 2012; van der Kolk & Najavits, 2013), especially in the realm of trauma work. This study sought to develop the evidence base to develop a trauma-sensitive yoga protocol for veterans, building upon a standardized protocol developed by Brems (2015). methods Key informants were selected based on literature review and referral. After informed consent, we inquired about trauma-informed yoga interventions, general considerations, common adaptations, contraindications, and challenges. Special emphasis was based on collecting information about trauma-informed yoga on a military population. results/outcomes To date, 10 interviews have been conducted in person or by phone. Informants were aged 29 to 69; included two men and eight women; were located throughout the US; held a range of positions (yoga therapists/teachers, health professionals, mental health professionals); specialized in yoga for individuals with trauma histories; taught yoga 4 to 25 years. Emerging themes for trauma-informed yoga included the need to emphasize: • interventions that engage the parasympathetic nervous system • modified practice • invitational language • breathing practices to reduce hyperarousal • special attention to the environment and room setup (placement of students, accessibility of exits, lighting, props that could be triggering) Recommendations included cautions against: • breath retention • indiscriminate touch • use of sanskrit • backbends, postures that position hips in vulnerable ways • sustained engagement of the sympathetic nervous system Recommendations for instructors teaching yoga to trauma populations included in-depth knowledge of: • range of trauma experiences • adaptations for poses • additional training in trauma-informed practices • power in student-instructor relationships • self-care Considerations for veterans included awareness of: • range of physical, mental, and medication-related health concerns in students • language adaptation for military culture • alienation experienced by veterans • finding safe, accessible spaces for teaching veterans • cultural barriers conclusions Findings emphasize the necessity of adaptations of yoga classes for specialized populations, especially those with trauma history and histories of military service. To increase informed access to specialized yoga interventions, additional education and standardized approaches are needed that heed appropriate cautions and recommendations of experts.

Background Previous research demonstrates an association between adoption of Integrative, Complementary and Traditional Health Practices (ICTHP) and demographic factors such as income. Less is known about the aggregate effects of income, health insurance coverage, and health care expenditures on ICTHP uptake. Our main objectives were to 1) compare patterns of utilization of ICTHP by insurance status, health expenditures, and income; and 2) compare trends in utilization of ICTHP by level of insurance coverage. Methods We analyzed data contained in the 2007 National Health Interview Survey (NHIS) Complementary and Alternative Medicine (CAM) supplement and the 2008 Medical Expenditure Panel Survey (MEPS). These survey results were linked in order to more precisely examine fiscal impacts of insurance coverage and health care spending on ICTHP utilization. In our study, ICTHP includes adoption of mind and body practices as well as herbal supplementation. Utilization of ICTHP was treated as a dichotomous outcome with either adoption of at least one, or no recognized practice. Insurance coverage was categorized as private, Medicaid / Medicare, or uninsured. Respondents whose medical expenditures accounted for greater than 10% of their annual income were measured as underinsured. We utilized logistic regression to measure effects of study variables on adoption of ICTHP practices. Results were weighted and standardized to represent the U.S. adult, non-institutionalized population. Results Among subjects (N=17,764), we found that 23% of respondents reported engaging in at least one form of CAM in the preceding twelve-month period. The most common CAM modalities reported were utilization of vitamin supplementation (16%), prayer (16%), herbal supplementation (5%), deep breathing techniques (5%), and meditation (4%). Vitamin supplementation (p=0.002) and prayer (p<0.0001) were most common among insured respondents. Although not statistically significant, there was a slight effect of insurance status on uptake of acupuncture (p=0.12) and massage therapies (p=0.12). Adoption of ICTHP varied significantly based on total household health care expenditures (p=0.002), total family income (p<0.0001) and insurance status (p<0.0001). Individuals with private insurance were 1.53 [1.21, 1.94] times more likely to adopt at least one ICTHP modality than their uninsured counterparts. Fully insured respondents were 1.73 [1.42, 2.12] times as likely to adopt at least one ICTHP modality relative to underinsured respondents. Respondents who adopted at least one ICTHP modality were 30 percent less likely (p=0.01) to report poor general health. Conclusion Our results suggest adoption of many forms of integrative, complementary and traditional health practices may be influenced by level of insurance coverage and net health care expenditures rather than solely by income. Importantly, those who adopted at least one ICTHP were significantly less likely to report poor overall health. With recent expansion of health benefits to millions of previously uninsured, health policy researchers should evaluate ways to increase coverage, and thereby decrease out of pocket expenditures for ICTHP modalities with demonstrated efficacy for management of many health conditions.