Excerpt: Gavronsky, Koeniger-Donohue, Steller, and Hawkins (2012) concluded that, 48 hours after major pelvic surgeries for cancer, the women in their study experienced equivalent pain relief from either manual acupuncture or percutaneous electrical nerve stimulation. This statement was not supported by the study data because of the lack of blinding and insufficient controls. Despite the numerous strengths of the study, due to weaknesses in the study design with regard to blinding and control groups, the addition of acupuncture to percutaneous electrical nerve stimulation should not yet be ruled out as a method of obtaining enhanced pain relief.

Background: Low back pain is very common and has a tremendous economic impact. With the prevalence and incidence of low back pain on the rise, individuals are turning to alternative treatments. Yoga is the most widely used complementary and alternative medicine treatment for low back pain and it is not fully certain how effective this method is for resolving the symptoms. Objectives: The purpose of this manuscript is to systematically review the current literature for randomized controlled trials that assess the outcomes of yoga intervention in individuals with low back pain. Methods: An electronic database search was performed to analyze studies. To be included in the review, the studies were required to be a randomized controlled trial, published in English, present in a peer reviewed journal, identify yoga as the primary treatment focus for low back pain in at least one group, and included participants with at least a 12 week history of low back pain. Results: A search of the databases revealed 177 articles, of which, 8 met the inclusion criteria. Conclusions: Yoga intervention appears to be effective in alleviating symptoms brought on by low back pain. Yoga was either demonstrated to significantly improve quality of life and reduce disability, stress, depression, and medication usage associated with low back pain in 6 of the 8 analyzed trials. More research is necessary to account for the lack of between-group differences in two trials.

While chronic pain is an increasingly prevalent condition in the United States, it is twice as common among the military veteran population. As many Vietnam War era veterans are aging and experiencing comorbid medical conditions, their chronic pain is becoming increasingly complex. Policies enacted in response to the ‘opioid epidemic’ have in some ways made treatment of pain safer, but have also left remaining questions regarding how to properly provide care. There are three fields of complexity that interact within this topic: patients with a clear need for care and pain management, providers committed to helping patients, and structural barriers that unintentionally interfere with the provision of care. The lived experience of chronic pain and receiving care through the VA healthcare system combined with a common military culture exemplifies a lifeworld centered on pain—which I call a ‘painworld.’ This painworld is seen in the illness narratives of older, white, male veterans with chronic pain. Examining the way a single VA site provides pain care shows the providers are dedicated to treating veteran patients and offer a large number of treatment options. While the need for pain management services is clear from both the patient and provider perspectives, translating the lived experience of these veterans and their medical needs into a hierarchical bureaucratic structure is difficult. Furthermore, the bureaucratic nature of a large federal organization creates gaps in the healthcare system. This leads to the creation of informal systems through systems-correcting praxis to fill the gaps and attempt to prevent siloing and slippage throughout. Together, these fields of complexity are organized into three chapters, building the argument that the convergence of veteran painworlds, pain care, and bureaucracy can contribute to miscommunication, leading to unintended slippage through the system and inadequate care, despite good intentions of staff. Furthermore, the VA system and structure of providing pain care both influences and is part of the painworld, as are the interactions that occur between veteran patients and staff.

The pathomechanism of migraine attacks is not understood well, however, is currently believed to be a brain disorder. Migraine is a multifactorial disorder that needs to be investigated in multiple research areas to shed light into its mechanism and find ways to treat it effectively. Migraine episodes come from one or many things at the same time, and such vary from person to person. However, sufficient evidence in recent studies show there is a strong relationship between genetics with patients having specific genes that may be responsible for the disease or a genetic sequence passed down through generations in families, especially in the case of migraine with aura. Several genes including P/Q type calcium channel gene mutations, Na+ /K+ pump ATP1A2 malfunctions and Na+ gated voltage channel Nav 1.1 have been implicated with familial hemiplegic migraines with aura (Samsam 2012). Additionally, insulin resistance has been shown to be a very prevalent factor in migraine patients, but more research has yet to be done to support such claim. Also, many studies suggest the possibility of migraine attacks occurring due to a lack of energy in the patient´s brain. Meaning that exhaustion of the brain can also lead to a migraine episode. In this thesis, we investigated the genetic causes of migraine and reviewed the recent genes implicated in the pathomechanism of migraines. Further, we explored several articles that investigated the metabolic changes that occur in the brain during a migraine attack and looked for reasons behind such changes.

TITLE: Association of Alcohol Use, Depression, and Pain among Cancer Patients AUTHOR INFO Nneoma Ubah Manik Ahuja Eugene Annor Author(s) Affiliations: College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States Background: Cancer is often a chronic illness that evolves with pain. Studies have shown that 60% of patients with cancer are burdened with pain, and 25% to 30% have severe pain. Uncontrolled pain has been recognized as one of the significant causes of depression among cancer patients. Depression is a comorbid syndrome that affects 25% of cancer patients, but only 5% see a mental health professional. Major depressive disorders have very high rates of comorbidity, with substance use disorders ranging from 12% to 80%. However, there is limited data on the association of depression, alcohol use disorders, and pain among cancer patients. This study aims to identify this association. Methods: We used cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System, a nationally representative U.S. telephone-based survey of adults aged 18 and above. We also extracted data for cancer patients (n=8,963). Logistic regression analysis was conducted to test the association between pain associated with cancer and two outcomes, depression, and alcohol use. We controlled for income, race, educational status, health insurance status, race/ethnic minority status, and age. Results: Overall, 8.6% (n=843) of patients reported pain from their cancer, while 20.2% reported depression and 44.4% reported alcohol use. Pain from cancer was associated with significantly higher odds of depression (OR=1.75, 95% CI, 1.49, 2.05) along with low income (OR=1.93, 95% CI, 1.73, 2.16) and less than high school education (OR=1.30, 95% CI, 1.02, 1.65). Pain from cancer was not significantly associated with alcohol use, while male gender (OR=1.46, 95% CI, 1.34, 1.58) among cancer patients predicted higher odds of alcohol use. Conclusion: Depression and alcohol use have been identified as significant problems among cancer patients with pain. Among the cancer patients studied, pain from cancer was not significantly associated with alcohol use. However, cancer patients burdened with pain were more likely to suffer depression. This indicates a need to invest more effort in identifying cancer patients with depression and managing their pain appropriately to improve their outcomes. Proper pain management should also be prioritized in cancer care to prevent depression. Keywords: Pain management, Cancer Pain, Alcohol, Depression.

Effective pain management is an elusive concept in the acute care setting. Improving nurses' knowledge about optimal pain management is one way to improve the patient's pain experience. A computer-simulation game was developed as an alternative method of teaching the subject of pain management to nursing students. In the game, two patient scenarios are presented, one male and one female. Both patients present with acute pain and request help from the nurse. The player progresses through a series of nine questions as the scenarios unfold, each with one best or correct answer. The purpose of this study was to evaluate the game's potential as a teaching method compared to traditional methods of teaching, such as a lecture. A total of 30 nursing students participated in the study. After playing through the game, each student was asked to complete a post-game survey consisting of 10 standard 5-point Likert scale items and five open-ended questions. The survey was used to evaluate the students' enjoyment of the game, educational benefits, preference compared to traditional teaching methods, and perceived potential to change nursing practice. Results of the survey show that the majority of nursing students enjoyed playing the game and found it captured their attention more than traditional teaching methods. Nine out of the ten Likert scale items received universal high scores. Nursing students were receptive to the computer-simulation game as a teaching method and found it preferable to traditional methods.

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