#Non-pharmacological approach

[failtosucceedlife-blog]

12 Tips To Lower Your Blood Pressure Naturally

Learn 12 effective natural remedies to reduce high blood pressure without medication. Discover lifestyle changes, stress-reducing techniques, and healthy habits that can help manage hypertension in this informative blog post. High blood pressure or hypertension is a common health issue that affects millions of people around the world. It is often called the “silent killer” as it can cause severe…

[lifewithchronicpain]

New research shows that there’s not much evidence that antidepressants actually work at treating pain in people over 65 years old.

The study, which comes out of the University of Sydney in Australia, is concerning because older adults are often prescribed antidepressants for pain.

However, in a frustrating conclusion, the authors still do not recommend the one medication that is proven to treat pain in older adults: Opioids.

Instead, they suggest that doctors use a “multidimensional approach using non-pharmacological strategies, such as physical exercise and cognitive behavior therapy.”

In other words, they essentially conclude that pain patients should get no medications.

However, I am glad that more research is coming out to expose how ineffective antidepressants usually are at treating pain. That class of medication has long been held up as an opioid alternative, despite the fact that many patients don’t get much relief from them. (Read more at link)

Doctors just refuse to admit there is no good alternative right now to opioids. Honestly if you can find a pain reliever that works as well without the side effects of opioids, I’d be all over that. Until then, I will keep taking mine.

[jcsmicasereports]

Use of acupressure to reduce nausea and vomiting in cancer patients receiving chemotherapy (literature study) by Maher Battat in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Nausea and vomiting are distressing and serious problems for cancer patients receiving chemotherapy despite the fact that they are receiving antiemetics according to the standard guidelines which this problem is a huge challenge to nurses involved in cancer care.

Purpose: To explore and assess the effectiveness of using acupressure as a non-pharmacological intervention in addition to pharmacological interventions in reducing nausea and vomiting in cancer patients receiving chemotherapy.

Method: A literature review was conducted of 8 articles published between 2006 and 2014. These included one study of a randomized, double-blind, placebo controlled trial; one quasi-experimental model with a control group; four articles reporting on randomized control trials (RCTs); one systematic review study; and one review study. Key Findings: Seven of the articles we read supported the effect of an acupressure P6 Wristband in reducing chemotherapy induced nausea and vomiting in cancer patients and other databases also supported that finding. The one article with neutral results showed that there was no difference between a combination of acupuncture and acupressure treatment at P6 and at the sham point for the nausea score, but the level of nausea was very low in both groups.

Conclusion: We conclude that the acupressure P6 wrist band when applied to acupuncture point P6 is effective, safe, convenient, cost effective, and provides an easy, self-administrated, non-pharmacological intervention that can be used to reduce chemotherapy induced nausea and vomiting.

Keywords: Acupressure, Chemotherapy, Nausea and Vomiting, Cancer patients, Chemotherapy-induced nausea and vomiting.

Introduction

Nausea and vomiting are serious and troublesome side effects of cancer therapy. We chose this research topic in order to become familiar with the topic of the nausea and vomiting facing cancer patients during their chemotherapy treatment, which we have observed during our experience in the Oncology departments.

As nurses, we normally use updated and standard guidelines for managing clinical challenges. We reviewed the literature to explore whether there are alternative approaches to pharmacological management that might reduce or eliminate this problem. We found there are many interventions, such as music, acupuncture, acupressure, and yoga. We decided to assess the effectiveness of using acupressure to reduce the nausea and vomiting in cancer patients receiving chemotherapy. Acupressure is a type of complementary and alternative medicine which the National Cancer Institute (NCI Dictionary of Cancer Terms) defines as follows: “Acupressure is the application of pressure or localized massage to specific sites on the body to control symptoms such as pain or nausea".

The Research Question

Can acupressure reduce nausea and vomiting in cancer patients receiving chemotherapy?

We have chosen to use the definitions of the NCI Dictionary of Cancer Terms:

“Nausea is an unpleasant wavelike feeling in the back of the throat and/or stomach that may lead to vomiting", and “Vomiting is throwing up the contents of the stomach through the mouth”.

Nausea and vomiting affect the patient’s whole life. These side effects lead to metabolic imbalance, fatigue, distress, and lowered quality of life. We would like to fine a simple, effective and cost effective way to manage these problems so we can put it to use in our hospital.

Method

A literature study is, “A critical presentation of knowledge from various academic written sources, and a discussion of the sources in view of a particular research question" (Synnes 2014). There are many challenges when doing a literature study. There are many databases and much literature and our search process had to find the correct, scientific and relevant databases. It required a lot of time and effort to find the full text of all relevant articles. Fortunately, we received excellent help from the librarian at the Betanien University High school.

We started the search process by making a PICO outline to narrow down the search and to find the correct key words and mesh terms.

P: (Population or participants) Cancer patients experiencing chemotherapy-induced nausea and vomiting.

I:  (Intervention or indicator) Acupressure.

C: (Comparator or control) No comparison or placebo.

O: (Outcome) Reduce nausea and vomiting.

We used PUBMED, Google scholar, scholar.najah.edu and other search engines. When we used Acupressure as a search word we found more than 800 studies. When we added chemotherapy, cancer patients, and nausea and vomiting, we brought this down to 14 articles. We read these and decided to use 8 articles only, one of which was a systematic review. We also used an unpublished Master’s thesis from An Najah National University. This thesis was cited in one of the articles that we decided to review. The key words used were: Acupressure, Chemotherapy, Nausea and Vomiting, Cancer patients, Chemotherapy-induced nausea and vomiting, with Acupressure as a mesh term.

We then critically appraised all the articles according to our checklist. We included only those articles that followed the IMRAD style (i.e. those including an introduction, method, results and discussion section). We excluded all articles that were more than ten years old (i.e. published before 2004), except for two articles: one was about the mechanism of acupressure, which seemed to be directly relevant to our research topic, while the second article was used in the discussion section to discuss certain factors related to the topic. We also excluded one of the review articles because its method appeared to be weak. One of the Cochran reviews was also dropped because it had not been updated.

Despite applying these strict criteria, we were still concerned lest we had left out some important articles or included an inappropriate one. However, we were reassured by the fact that the librarian at Betanien had guided us in our search.

Theoretical part

Nursing Need Theory and basic human needs

The Nursing Need Theory was developed by Virginia A. Henderson to define the unique focus of nursing practice. The theory focuses on the importance of increasing the patients’ independence to hasten their progress in the hospital. Henderson’s theory emphasizes the basic human needs and how nurses can assist in meeting those needs.

The 14 components of Need Theory present a holistic approach to nursing that covers the patient’s physiological, psychological, spiritual and social needs.

Physiological components

Breathe normally.

Eat and drink adequately.

Eliminate body wastes.

Move and maintain desirable postures.

Sleep and rest.

Select suitable clothes – dress and undress.

Maintain body temperature within normal range by adjusting clothing and modifying the environment.

Keep the body clean and well groomed and protect the integument.

Avoid dangers in the environment and avoid injuring others.

Psychological aspects of communicating and learning

Communicate with others in expressing emotions, needs, fears, or opinions. Spiritual and moral

Worship according to one’s faith. Sociologically oriented to occupation and recreation

Work in such a way that there is sense of accomplishment.

Play or participate in various forms of recreation.

Learn, discover, or satisfy the curiosity that leads to normal development and health, and use the available health facilities.

There is much similarity between Henderson’s 14 components and Abraham Maslow’s Hierarchy of Needs. Henderson’s Components 1 to 9 are comparable to Maslow’s physiological needs, with the 9th component also being a safety need. Henderson’s 10th and 11th components are similar to Maslow’s love and belonging needs, while her 12th, 13th and 14th components match Maslow’s self-esteem needs (Vera 2014).

The second of Henderson’s physiological needs is the need to “Eat and drink adequately”. Only the need to breathe is given a higher priority than the need for adequate nutrition. For cancer patients receiving chemotherapy and suffering from chemotherapy-induced nausea and vomiting, this need is the most critical.

Cancer prevalence and treatment

Cancer is a group of diseases characterized by uncontrolled growth and the spread of abnormal cells. It may be caused by internal factors, such as an inherited mutation, or a hormonal or immune condition, or it may result from a mutation from metabolism, or from external sources, such as tobacco use, radiation, chemicals and infectious organisms. Cancer is prevalent all over the world, in both developed and developing nations; it affects both sexes at all ages (Said 2009). The American Cancer Society (2010) estimated that 1,529,560 new cases of cancer were diagnosed in 2010 and that 80 % would be treated with chemotherapy; this means more than 1 million patients will be undergoing chemotherapy in any given year (Lee et al. 2010).

Cancer treatment may be based on chemotherapy, radiotherapy and surgical interventions. Chemotherapy is an important treatment in cancer care but it is associated with several side effects, such as bone marrow suppression, increased susceptibility to infection, diarrhea, hair loss, appetite changes, nausea and vomiting, among others (NCI Chemotherapy Side Effects Series, 2014).

Chemotherapy-induced nausea and vomiting (CINV) is the most prevalent and one of the hardest side effects to manage (Suh 2012).

Nausea and vomiting

Nausea and vomiting (N&V) can be acute or delayed. The incidence of acute and delayed N&V was investigated in highly and moderately emetogenic chemotherapy treatment regimens. Patients were recruited from 14 oncology practices in six countries. Overall, more than 35% of patients experienced acute nausea, and 13% experienced acute emesis. In patients receiving highly emetogenic chemotherapy, 60% experienced delayed nausea and 50% experienced delayed emesis. In patients receiving moderately emetogenic chemotherapy, 52% experienced delayed nausea and 28% experienced delayed emesis. CINV was a substantial problem for patients receiving moderately emetogenic chemotherapy in ten community oncology clinics. Thirty-six percent of patients developed acute CINV, and 59% developed delayed CINV (NCI, Nausea and Vomiting, 2015).

Chemotherapy is the most common treatment-related cause of N&V. The incidence and severity of acute emesis in persons receiving chemotherapy varies according to many factors, including the particular drug, dose, schedule of administration, route, and individual patient variables.

Risk factors for acute emesis include:

Poor control with prior chemotherapy

Female gender

Younger age

Emetic classification:

The American Society of Clinical Oncology has developed a rating system for chemotherapeutic agents with their respective risk for acute and delayed emesis.

High risk: Emesis has been documented to occur in more than 90% of patients on the following chemotherapeutic agents:

Cisplatin (Platinol).

Mechlorethamine (Mustargen).

Streptozotocin (Zanosar).

Cyclophosphamide (Cytoxan), 1,500 mg/m2 or more.

Carmustine (BiCNU).

Dacarbazine (DTIC-Dome).

Moderate risk: Emesis has been documented to occur in 30% to 90% of patients on the following chemotherapeutic agents:

Carboplatin (Paraplatin).

Cyclophosphamide (Cytoxan), less than 1,500 mg/m2.

Daunorubicin (DaunoXome).

Doxorubicin (Adriamycin).

Epirubicin (Pharmorubicin).

Idarubicin (Idamycin).

Oxaliplatin (Eloxatin).

Cytarabine (Cytosar), more than 1 g/m2.

Ifosfamide (Ifex).

Irinotecan (Camptosar).

Low risk: Emesis that has been documented to occur in 10% to 30% of patients on the following chemotherapeutic agents:

Mitoxantrone (Novantrone).

Paclitaxel (Taxol).

Docetaxel (Taxotere).

Mitomycin (Mutamycin).

Topotecan (Hycamtin).

Gemcitabine (Gemzar).

Etoposide (Vepesid).

Pemetrexed (Alimta).

Methotrexate (Rheumatrex).

Cytarabine (Cytosar), less than 1,000 mg/m2.

Fluorouracil (Efudex).

Bortezomib (Velcade).

Cetuximab (Erbitux).

Trastuzumab (Herceptin).

Minimal risk: Emesis that has been documented to occur in fewer than 10% of patients on the following chemotherapeutic agents:

Vinorelbine (Navelbine).

Bevacizumab (Avastin).

Rituximab (Rituxan).

Bleomycin (Blenoxane).

Vinblastine (Velban).

Vincristine (Oncovin).

Busulphan (Myleran).

Fludarabine (Fludara).

2-Chlorodeoxyadenosine (Leustatin).

In addition to the emetogenic potential of the agent, the dose and schedule used are also extremely important factors. For example, prescribing a drug with a low emetogenic potential to be given in high doses may cause a dramatic increase in its potential to induce N&V. For example, standard doses of cytarabine rarely produce N&V, but these often occur with high doses of this drug. Another factor to consider is the use of drug combinations. Because most patients receive combination chemotherapy, the emetogenic potential of all of the drugs combined needs to be considered, and not only that of individual drug doses.

Delayed (or late) N&V is that which occurs more than 24 hours after chemotherapy administration. Delayed N&V is associated with cisplatin and cyclophosphamide, and with other drugs (e.g., doxorubicin and ifosfamide) when given at high doses, or if given on 2 or more consecutive days.

Delayed emesis: Patients who experience acute emesis with chemotherapy are significantly more likely to have delayed emesis as well.

Risk factors: All the predicative characteristics for acute emesis are also considered risk factors for delayed emesis (NCI, Nausea and Vomiting, 2015).

The nausea and vomiting that are often associated with chemotherapy are a serious problem for cancer patients. Despite recent improvements in pharmaceutical technology, about 60% of cancer patients who receive antiemetic medications with their chemotherapy still suffer from nausea and vomiting, and as many as 20% of patients refuse to continue chemotherapy due to the severity of the nausea and vomiting (Shin et al. 2004). Early studies reported that patients cited nausea and vomiting as the most distressing symptoms when receiving chemotherapy. The distressing effect of severe nausea and vomiting can lead to nutritional deficiencies, dehydration, electrolyte imbalance, fatigue, depression and anxiety; they can also disrupt the activities of daily living and cause a lot of work time to be lost (Said 2009).

Uncontrolled nausea and vomiting can interfere with adherence to treatment regimens, and may cause the oncologists to reduce chemotherapy doses. Chemotherapy-induced nausea and vomiting is classified as being either “acute” if it happens within 24 hours post chemotherapy, or “delayed” if it occurs on days 2–5 of the chemotherapy cycle. The latter is particularly troublesome because there is no reliable pharmacological treatment for this problem. The American Society of Clinical Oncology’s (ASCO) recommendations include giving 5-HT3 (5-hydroxytryptamine, or serotonin) receptor antagonists plus corticosteroids before chemotherapy to patients who are at high risk for emesis. Nevertheless, many patients still experience nausea and vomiting related to chemotherapy, and approximately one-third of patients have nausea of at least moderate intensity, resulting in a significant reduced quality of life (QOL). Therefore, the experts emphasize the need for an evaluation of additional ways to reduce these symptoms (Said 2009).

Pharmacological interventions for the management of nausea and vomiting

Historically, antiemetic treatment has steadily improved since the introduction, in 1981, of high-dose metoclopramide which reduced the amount of emesis. This was followed by the development of serotonin (5-HT3) antagonist in the early 1990s, and the 5-HT3 antagonists proved to be more effective than the prior medications in preventing CINV. The concomitant use of corticosteroids was found to further improve the control of emesis. Despite these improvements, nausea and vomiting still remain a problem for many patients. Recently, a new drug, the neurokinin NK (1) receptor antagonist has been shown to be more effective at preventing both acute and delayed CINV for patients treated with highly emetogenic chemotherapy (Said 2009).

Non-pharmacological intervention for management of nausea and vomiting

Traditional Chinese medicine offers a possible intervention for the non-pharmacological treatment of nausea and vomiting in cancer patients. Traditional Chinese medicine (TCM) is a system of medical care that was developed in China over thousands of years. It looks at the interaction between mind, body and environment, and aims to both prevent and cure illness and disease.

TCM is based on Chinese views and beliefs about the universe and the natural world. It is a very complex system. In this essay we can only give a brief overview of what TCM involves. It is very different from Western medicine; Chinese medicine practitioners believe there is no separation between the mind and body and that illness of every kind can be treated through the body. They use a combination of various practices that may include:

Herbal remedies (traditional Chinese medicines).

Acupuncture or acupressure.

Moxibustion (burning moxa – a cone or stick of dried herb).

Massage therapy.

Feng shui.

Breathing and movement exercises called qi gong (pronounced chee goong).

Movement exercises called tai chi (pronounced tie chee).

TCM practitioners say that TCM can help to:

Prevent and heal illness.

Enhance the immune system.

Improve creativity.

Improve the ability to enjoy life and work in general.

Beliefs behind TCM

According to traditional Chinese belief, humans are interconnected with nature and affected by its forces. The human body is seen as an organic whole in which the organs, tissues, and other parts have distinct functions but are all interdependent. In this view, health and disease relate to the balance or imbalance between the various functions. TCM treatments aim to cure problems by restoring the balance of energies.

There are important components that underlie the basis of TCM:

Yin-yang theory is the concept of two opposing but complementary forces that shape the world and all life. A balance of yin and yang maintains harmony in the body, the mind and the universe.

Qi (pronounced chee) energy or vital life force flows through the body along pathways known as meridians, and it is affected by the balance of yin and yang. It regulates spiritual, emotional, mental, and physical health. If there is a blockage or an imbalance in the energy flow, the individual becomes ill. TCM aims to restore the balance of qi energy.

The five elements – fire, earth, metal, water, and wood – is a concept that explains how the body works, with the elements corresponding to particular organs and tissues in the body.

The TCM approach uses 8 principles to analyse symptoms and puts particular conditions into groups: cold and heat, inside and outside, too much and not enough, and yin and yang (Cancer Research, UK, 2015).

In summary, chemotherapy related nausea is not well controlled by pharmacological agents and identifying methods to prevent and alleviate treatment-related nausea remains a major clinical challenge. Non-pharmacological interventions such as music, progressive muscle relaxation (Said 2009), and ginger herbal therapy (Montazeri A et al. 2013) have all been shown to reduce CINV. Among the non-pharmacological interventions that reduce CINV are acupuncture and acupressure, based on the assumption that the individual’s welfare depends on a balance of energy in the body and their overall energy level (Said 2009). Yarbro et al. (2011, p. 645) also indicate in Cancer nursing: principles and practice book that acupuncture and acupuncture-related interventions (electroacupoint stimulation, acupressure, acustimulation wrist bands, and electroacupuncture) can be used to control nausea and vomiting in cancer patients.

Molassiotis et al. (2007) claim that the need for additional relief has led to the interest in non-pharmacological adjuncts to drugs, such as acupuncture or acupressure, since combining anti-emetics with other non-pharmacological treatments may prove to be more effective, safe and convenient in decreasing nausea than antiemetics alone.

From the National Cancer Institute website we found that acupressure is recognised as one of the non-pharmacologic strategies used to manage nausea and vomiting (Nausea and Vomiting, 3 September 2014). We used this website to get up to date, relevant information.

Acupressure

Acupressure involves putting pressure with the fingers, or with bands, on the body’s acupoints and is easy to perform, painless, inexpensive, and is effective. The P6 (Pericardium 6) point (Nei-Guan) refers to a point located on the anterior surface of the forearm, 3-finger widths up from the first wrist crease and between the tendons of flexor carpiradialis and Palmaris longus (figure1). P6 can be stimulated by various methods. The most well-known technique is manual stimulation by the insertion and manual rotation of a very fine needle (manual acupuncture). An electrical current can be passed through the inserted needle (electroacupuncture). Electrical stimulation can also be applied via electrodes on the skin surface or by a ReliefBand, a wristwatch-like device providing non-invasive electrostimulation. Pressure can be applied either by pressing the acupoint with the fingers or by wearing an elastic wristband with an embedded stud (acupressure).

Acupressure is based on the ancient Eastern concept that Chi energy travels through pathways known as meridians. Along the meridians are acu-points, which are controlling points for the Chi energy flow. If the energy flow in meridians is slowed, blocked, or hyper-stimulated, it can be rebalanced or re-stimulated either by applying pressure (acupressure) or by inserting a needle (acupuncture) into one or more of these acupoints. Two points are known for relieving nausea and vomiting: the Nei-Guan point (P6) and the Joksamly point (ST36, located at 4-finger breadths below the knee depression lateral to the tibia).

Patients tend to prefer the P6 point over the ST36 point, Because of its ease of access and the freedom from restriction. When these points are correctly located and pressure applied, either through acupressure or acupuncture, the Chi energy flow is rebalanced, resulting in relief from nausea and vomiting.

The practice of acupressure requires some training and experience, but the technique is widely accessible to any healthcare professionals, particularly to clinical nurses. This acupressure technique is an approach that should be tried not only by healthcare professionals but also by family members or the patients themselves (Shin et al. 2004).

According to the teaching of traditional Chinese medicine, illness results from an imbalance in the flow of energy through the body. This energy or Qi (chee) is restored through the use of acupuncture and acupressure at certain points on the body that have been identified through critical observation and testing over 4000 years. In scientific terms, the neurochemicals that are released after needling or pressure at a specific point may be responsible for this effect. The most commonly used point for nausea and vomiting is Pericardium 6 (Neiguan or P6), located above the wrist (Molassiotis et al. 2007).

The literature review on acupressure

Acupressure for chemotherapy-induced nausea and vomiting in breast cancer patients: a multicentre, randomised, double-blind, placebo-controlled clinical trial. (Said 2009)

For a master degree in public health from An-najah National University, Said (2009) described a randomized, double-blind, placebo controlled trial that was done in Palestine with 126 women on chemotherapy for breast cancer. In this study the researcher divided the patients into 3 groups: the first group (n=42) received acupressure with bilateral stimulation of P6, the second group (n=42) received bilateral placebo stimulation, and the third group (n=42), which served as a control group, received no acupressure wrist band, but all groups received pharmacological management of their nausea and vomiting. Acupressure was applied using a Sea-Band (Sea-Band UK Ltd, Leicestershire, England) that patients had to wear for five days following the administration of chemotherapy. Assessment of acute and delayed nausea and emesis, quality of life, patients’ satisfaction, recommendation of treatment and requests for a rescue antiemetic were obtained. Said (2009) concluded that the acupressure showed benefits for delayed nausea and the mean number of delayed emetic episodes. Acupressure may therefore offer an inexpensive, convenient, and self-administered intervention for patients on chemotherapy to reduce nausea and vomiting at home during days 2-5 after chemotherapy. In addition, the percentage of patients who were satisfied with the treatment (≥ 3 on a 0-6 scale) was 81% (35/42) in the P6-acupressure group, and 64% (27/42) in the placebo group (p= 0.0471). The percentage of patients who would recommend acupressure treatment was 79% (34/42) in the P6-acupressure group, and 62% (26/42) in the placebo group (p= 0.0533). We used this study because it had a lot of essential information, it used the IMRAD system and was also mentioned in the literature (Genç and Tan 2014). This study demonstrated that the mean scores for the acupressure group were lower for both acute and delayed nausea.

Review of Acupressure Studies for Chemotherapy-Induced Nausea and Vomiting Control. (Lee et al. 2008)

In the Journal of Pain and Symptom Management Jiyeon Lee et al. (2008) reviewed ten controlled studies on acupressure in order to evaluate the effects of a non-invasive intervention, acupressure, when combined with antiemetics for the control of CINV. The review evaluated one quasi-experimental and nine randomized clinical trials, which included two specific acupressure modalities, namely, an acupressure band and finger acupressure. The effects of the acupressure modalities were compared study by study. Four of the seven acupressure band trials supported the positive effects of acupressure, whereas three acupressure band trials did not support the effects of acupressure. However, all the studies with negative results had methodological issues. In contrast, the one quasi-experimental and two of the randomized finger acupressure trials all supported the positive effects of acupressure on CINV control. The reported effects of the two acupressure modalities produced variable results at each stage of CINV. Acupressure bands were most effective in controlling acute nausea, whereas finger acupressure controlled delayed nausea and vomiting. The overall effect of acupressure was strongly indicative but not conclusive. We used this article because it is relevant, a review study, and is from a known journal.

The effects of P6 acupressure in the prophylaxis of chemotherapy-related nausea and vomiting in breast cancer patients. (Molassiotis et al. 2007)

As reported in the journal Complementary Therapies in Medicine, acupressure was applied using wristbands (Sea-Band™) in a randomized controlled trial conducted in two centres in the UK. Patients in the experimental group had to wear these bands for the five days following their chemotherapy administration. Assessments of nausea, retching and vomiting were obtained from all patients, daily, for five days. Molassiotis et al. (2007) evaluated the effectiveness of using acupressure on the Pericardium 6 (Neiguan) acupoint in managing CINV. Thirty-six patients took part in the study, with 19 patients allocated to the control group and 17 to the experimental group. The results showed that nausea with retching, nausea, and vomiting with retching, and the accompanying distress were all significantly lower in the experimental group as compared to the control group (p < 0.05). The only exception was the vomiting, where the difference was close to significance (p = 0.06). We used this article because it had a strong study design and also used an IMRAD system.

Acupuncture and acupressure for the prevention of chemotherapy-induced nausea- a randomized cross-over pilot study. (Melchart et al. 2006)

In a randomized, cross-over trial, Melchart et al. (2006) studied 28 patients receiving moderately or highly emetogenic chemotherapy and a conventional standard antiemetic for one chemotherapy cycle, followed by a combination of acupuncture and acupressure at point P6 for one cycle, and for another cycle a combination of acupuncture and acupressure at a close sham point. The results showed that there was no difference in the nausea score between the combined acupuncture treatment at P6 and at the sham point, but the level of nausea was very low in both cases. We used this study because the article had neutral results and because we trusted the source of article, coming as it did from a cancer support care journal.

The efficacy of acupoint stimulation for the management of therapy adverse events in patients with breast cancer: a systematic review. (Chao et al. 2009)

This is a systematic review of 26 articles published between 1999 to 2008 examining the efficacy of acupressure, acupuncture or acupoint stimulation (APS) for the management of adverse events due to the treatment of breast cancer. Published online on 17 September 2009 in the Breast Cancer Research and Treatment journal, 23 trials reported revealed that APS on P6 was beneficial in treating CINV. Chao et al. (2009) also presented the findings from three high quality studies comparing APS groups with control groups, which indicated that APS is beneficial in the management of CINV and especially in the acute phase, even with the non-invasive intervention. Health care professionals should consider using APS, and in particular acupressure on the P6 acupoint, as an option for the management of CINV. Furthermore, as a cost effective intervention, it warrants further investigation. We used this article because it used the IMRAD structure.

'Until the trial is complete you can’t really say whether it helped you or not, can you?’: exploring cancer patients’ perceptions of taking part in a trial of acupressure wristbands. (Hughes et al. 2013)

In Complementary and Alternative Medicine, Hughes et al. report on qualitative research undertaken with patients receiving chemotherapy in the UK. A convenience sample of 26 patients volunteered to participate in the clinical trial and to explore their experiences of using acupressure wristbands. Participants were recruited from three geographical sites: nine were recruited from Manchester, nine from Liverpool, and eight from Plymouth and the surrounding regions. Ten of the participating patients received true acupressure during the trial, 9 received sham acupressure, and 7 received no acupressure. Hughes et al. (2013) concluded that the research provided insights into cancer patients’ motivations and experience of taking part in a clinical trial for a complementary alternative medicine intervention, in which the participants perceived acupressure wristbands to reduce the level of nausea and vomiting experienced during their chemotherapy treatment. This article is important because it includes the benefits experienced by the patients taking part in the trial. This is also the first qualitative study to explore patients’ experiences of using acupressure wristbands and their perceptions of the effects. In the study, the patients perceived the wristbands as reducing their level of nausea and vomiting experienced due to their chemotherapy treatment. The study was an RCT.

The effect of acupressure application on chemotherapy-induced nausea, vomiting, and anxiety in patients with breast cancer. (Genç and Tan 2014)

Genç and Tan (2014) reported on a quasi-experimental study in Turkey with 64 patients with stages 1–3 breast cancer who received two or more cycles of advanced chemotherapy. Thirty two patients were in the experimental group, and thirty two in the control group. To determine the effect of acupressure P6 on CINV and anxiety in these patients, the P6 acupressure wristband was applied to the experimental group. Genç and Tan (2014) concluded that the total mean scores for patients in the experimental group, for nausea, vomiting and retching, were lower than those of the patients in the control group over the five days of application. We used this article because it is a recent and quasi-experimental study and used the IMRAD system.

The effects of P6 acupressure and nurse-provided counselling on chemotherapy-induced nausea and vomiting in patients with breast cancer. (Suh 2012)

Suh (2012) reported in the Oncology Nursing Forum on a RCT in South Korea with 120 women who were receiving chemotherapy for breast cancer. These patients had all had more than mild levels of nausea and vomiting during their first cycle of chemotherapy. The participants were assigned randomly to one of four groups: a control group (a placebo on a specific location on the hand); a counselling only group; a P6 acupressure only group; and a P6 acupressure plus nurse-provided counselling group. The purpose of the study was to evaluate the effects of pericardium 6 (P6) acupressure and nurse-provided counselling on CINV in patients with breast cancer. Suh (2012) concluded that nurse-provided counselling and P6 acupressure were together the most effective in reducing CINV in patients with breast cancer. We used this article because it is the first RCT evaluating the isolated and combined effects of P6 acupressure and counselling in reducing CINV among non-Western patients. The findings of the study support the use of P6 acupressure together with counselling that is focused on cognitive awareness, affective readiness, symptom acceptance, and the use of available resources as an adjunct to antiemetic medicine for the control of CINV. The article used the IMRAD system.

Discussion

Can acupressure reduce nausea and vomiting in cancer patients receiving chemotherapy?

In our experience, we have usually used metoclopramide (pramin) plus serotonin (5-HT3) antagonist (as Ondansetron and Granisetron), plus Dexamethasone plus neurokinin NK (1) (as Emend - aprepitant) for moderate to high ematogenic chemotherapy, yet some of the patients have still suffered from nausea and vomiting. After reviewing the literature we would like to use the acupressure P6 wrist band to solve this problem as the findings of our literature review confirm that the acupressure P6 wrist band reduces CINV in cancer patients receiving chemotherapy. This result is corroborated by 7 of the articles reviewed.

The National Cancer Institute website supports the finding that acupressure is one of the non-pharmacologic strategies that may be used to manage nausea and vomiting (NCI Dictionary of Cancer Terms). Said (2009) adds that acupressure may offer an inexpensive, convenient, and self-administered intervention for patients on chemotherapy, helping to reduce nausea and vomiting at home on days 2-5 of chemotherapy. Genç and Tan (2014) conclude that the total mean scores for CINV in patients in the experimental group to whom they applied the P6 acupressure wristband were lower compared to patients in the control group over the five days of application. Lee et al. (2008) found that the two acupressure modalities produced variable results in each phase of CINV: acupressure bands were effective in controlling acute nausea, whereas acupressure controlled delayed nausea and vomiting. Molassiotis et al. (2007) showed that the experience of nausea and vomiting was significantly lower in the experimental group than in the control group. Chao et al. (2009) found that P6 acupoint stimulation was an option for the management of CINV. In the study reported by Hughes et al. (2013) the participants perceived that acupressure wristbands reduced the levels of nausea and vomiting experienced during chemotherapy treatment. Suh (2012) concluded that the synergistic effects of P6 acupressure together with nurse-provided counselling appeared to be effective in reducing CINV in patients with breast cancer.

Five of the seven articles investigating breast cancer patients, namely Said (2009), Chao et al.( 2009), Molassiotis et al. (2007), Suh (2012) and Genç and Tan (2014), involved breast cancer patients receiving highly ematogenic chemotherapy (e.g. Cisplatin and cyclophosphamide), and moderate risk ematogenic chemotherapy (like doxorubicin).

It is necessary to mention other therapeutic regimens that can also be used in cancer treatment that contain other types of chemotherapy that cause nausea and vomiting, for example, doxorubicin-containing regimens like ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine), CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisone) and FAC (5-Fluorouracil, Adriamycin, Cyclophosphamide), and ACT (Adriamycin, Cyclophosphamide, Taxol) (Said 2009) and from our experience cisplatin-containing regimens which that classified as highly ematogenic chemotherapy we noticed the patients still experienced nausea and vomiting after they received the antiemitecs. We think it is necessary to use additional intervention like acupressure to be included in the nausea and vomiting management.

Based on the reviewed findings we plan to use acupressure for cancer patients receiving chemotherapy, because the acupressure in the studies conducted in breast cancer patients reported was used with highly ematogenic chemotherapy in addition to the standard antiemetic treatment, so it is reasonable to conclude that it will work equally well with other less ematogenic types of chemotherapy.

We prefer the use of the acupressure wrist band at P6 acupoint because it is an inexpensive, convenient, and self-administered intervention involving pressure instead of needles at the same point as that used in acupuncture. Furthermore it is safer than acupuncture and patients can easily learn to put pressure on their own wrists, whereas the acupuncture involves using needles that are about the diameter of a hair and can cause temporary discomfort during insertion (Said 2009; Molassiotis et al. 2007). Acupressure seems to be a good way to complement antiemetic pharmacotherapy as it is safe and convenient, with minimal (with bands) or no (finger acupressure) costs involved. It is thus an easy to use, cost-effective, non-invasive intervention (Lee et al. 2008; Melchart et al. 2006).

There was no study result that showed any negative effect from the acupressure wrist band at P6 point, except the review by Lee et al. (2008), which mentioned that three of the ten reported acupressure band trials did not support the possible positive effects of acupressure, but these studies all had methodological issues, such as a small sample size, no true control group, and a concern about the sham acupressure band having a possible antiemetic effect. Melchart et al. (2006) said that no difference was detected in the nausea score between the acupuncture treatment at P6 acupoint, and that at the sham point. Said (2009) mentioned that the acupressure showed no benefit in relation to the incidence of delayed vomiting, early vomiting, or acute nausea, but Melchart and Said’s studies were done with breast cancer patients and it could be that the acupressure benefits were not evident due to the breast cancer patients having had axillary lymph node resection that may have affected the meridian pathway or caused damage to the median nerve as mentioned by Roscoe et al. (2003). Consequently, we think that the evidence suggesting that there is no benefit from the acupressure method for reducing CINV is weak.

Regarding the placebo effect in the articles reviewed here, Melchart et al. (2006) indicated that there was no difference in the nausea score for the combined acupuncture treatment at p6 or that at the sham point, although the level of nausea was very low in both cases. Molassiotis et al. (2007), Said (2009) and Roscoe et al. (2003) all suggested that the placebo effect may be the result of psychological factors.

Application of acupressure in clinical practice

It is important to put this theory into practice, and health care professionals could consider using APS, in particular acupressure on the P6 acupoint, as an option in the management of CINV (Chao et al. 2009). Melchart et al. (2006) said acupressure bands can easily be used in busy oncological wards, while Suh (2012) supported the use of P6 acupressure with counselling focused on cognitive awareness, affective readiness, symptom acceptance, and the use of available resources as an adjunct to antiemetic medications for the control of CINV. Hughes et al. (2013) concluded that the research provides an insight into cancer patients’ motivations for and experiences of taking part in a clinical trial for a complementary alternative medical intervention in which the participants perceived the acupressure wristbands as reducing their level of CINV. Said (2009) suggests that oncology nurses should include acupressure in their list of options for the management of CINV, and especially delayed nausea and vomiting. Special recommendations by oncology nurses are not only useful but are also much appreciated by patients as shown in a study in which the patients were satisfied with the antiemetic treatment given by both P6-acupressure, and placebo-acupressure. The percentage of patients who were satisfied (≥ 3 on 0-6 scale) with their treatment was 81% (35/42) in the P6-acupressure group, which was in agreement with Roscoe et al. (2003), and 64% (27/42) in the placebo group (p= 0.0471). The percentage of the patients who would recommend acupressure treatment was 79% (34/42) in the P6-acupressure group, which again was in agreement with the results of Roscoe et al. (2003) and Hughes et al. (2013), compared to 62% (26/42) in the placebo group (p= 0.0533). This study presented the patients’ compliance with the use of acupressure. Acupressure is easily learnt and taught and patients should be informed about its potential role and taught how to apply it. Leaflets about acupressure for the management of nausea and vomiting could be available in chemotherapy units so that patients who are interested to use such a technique would be encouraged to come forward and learn more from nurses or other health professionals. This could add to the patients’ options for antiemetic approaches and empower them to be involved in the management of these distressing side effects. Acupressure offers a no-cost, convenient, self-administered intervention for chemotherapy patients to reduce acute nausea. Acupressure devices (i.e. Wrist Bands, travel bands, and acupressure bands) have been developed to provide passive acupressure on P6. Acupressure can be administered by healthcare providers, family members, or patients themselves, and does not involve puncture of the skin.

We therefore found that the acupressure wristband is a good way to reduce nausea and vomiting for cancer patients receiving chemotherapy by applying it in the correct position with the stud over the pericardium 6 acupoint located on the anterior surface of the forearm, 3-finger widths up from the first wrist crease, and between the tendons of flexor carpiradialis and Palmaris longus.

Lee et al. (2008) encourage the application of acupressure bilaterally, rather than unilaterally, in CINV control. They recommend three minutes of finger acupressure once daily, with additional acupressure as needed, as the optimal intervention, because both three and five minute trials have succeeded in achieving positive effects. On the other hand, Molassiotis et al. (2007) claimed that there is no correlation between the frequency of pressing the studs and the level of nausea and vomiting. Lee et al. (2008) and Molassiotis et al. (2007) therefore claim opposite results in the relationship between CINV and the frequency of pressing the stud of an acupressure P6 wrist band. But when applying the acupressure P6 wrist band bilaterally, Lee et al. (2008), Said (2009), Molassiotis et al. (2007), Suh (2012), and Genç and Tan (2014) all reported a positive effect with P6 stimulation in reducing CINV.

We would like to discuss some factors related to CINV in relation to nausea and vomiting: expectancy and gender: Roscoe et al. (2003) argued that patients who received the acustimulation bands and expected them to be effective did report having a higher quality of life and less nausea, and in relation to gender, that women are more likely to experience nausea when receiving chemotherapy. Lee et al. (2008) say this may be caused by classical conditioning and also that breast cancer patients may have had a damaged median nerve due to axillary lymph node removal, but Lee et al. (2008) also mention that P6 acupressure in younger women had a significantly greater positive effect on delayed nausea than those on a placebo or those in the no-intervention control group. On the other hand, Molassiotis et al. (2007) mentioned that younger age is associated with greater nausea. We think that men may have tolerated greater stimulation of the acupressure points, and therefore experienced greater symptom relief, so it may be that the acupressure is more effective for men than for women, but these questions of gender, age and the frequency of pressing the studs would need further investigation.

Based on the reported studies, we support the belief that acupressure on P6 is applicable in clinical practice for CINV for cancer patients provided the required education, training and counselling is given to maintain the acupressure benefits.

Acupressure side effects

The study by Molassiotis et al. (2007) found that there were no side effects from the use of the wristbands, but one patient reported that she had to take the bands off because they were too tight and left her with marks for a few days. Chao et al. (2009) also mentioned that very few minor adverse events were observed.

Melchart et al. (2006) did report adverse effects from the treatment in five cases. One suffered a hematoma when wearing the acupressure band at P6. In the sham group, one hematoma was reported after acupuncture, and another three adverse effects from the acupressure band were reported (one hematoma, one skin irritation, one eczema). Hughes et al. (2013) also reported that participants had not experienced any restrictions from wearing the wristbands in terms of everyday activities, other than when washing and bathing. As one female participant commented, for most participants the wristbands were found to be comfortable to wear. However, a few participants reported that they had experienced minor irritation, such as the wristbands feeling tight or painful, or their wrists becoming itchy. Reported adverse side effects were generally deemed minor and acceptable. In the study by Said (2009), no side effect or discomfort was noticed from wearing the acupressure wristband. Said told the patients that if the bands caused discomfort, they could be removed for 30 minutes every two hours. In this way, by taking it off for regular periods, we can prevent the side effects of acupressure, even its minor and rare effects.

Acupressure reduces CINV in cancer patients, in addition it reduces anxiety (Genç and Tan 2014) and that affects overall quality of life (Said 2009). Quality of life is defined by the NCI Dictionary of Cancer Terms as “The overall enjoyment of life and the individual’s sense of well-being and ability to carry out various activities”. Based on the physiological components of the Virginia Henderson’s theory of basic human needs and Abraham Maslow’s Hierarchy of Needs, the patient needs to eat and drink adequately, and sleep and rest (Vera, 2014). This means that when we are providing the required management for distressing symptoms, such as nausea and vomiting, by including the acupressure wrist band in addition to standard antiemetics, the patient’s appetite will improve, leading the patient to eat and drink adequately and improve their sleeping pattern. These may then also improve other aspects of the cancer patient’s life. According to the Henderson Nursing Need Theory, when we meet a patient’s needs, it results in an improved quality of life for the cancer patient receiving chemotherapy. Another way of expressing this is that it restores the balance of Yin and Yang energy that leads to reduced nausea and vomiting and improves the patient’s ability to enjoy life and work in general through a maintaining of the harmony of body and mind, as described in traditional Chinese medicine (Cancer Research UK, 2015).

We believe that it is essential for cancer patients undergoing chemotherapy treatment to have adequate nutrition to maintain their strength to fight the cancer. Different nursing actions are necessary to maintain adequate nutrition including the relieving of CINV. From this we extrapolate that using the acupressure P6 wrist band to reduce CINV improves the patient’s quality of life.

Conclusion

Chemotherapy-induced nausea and vomiting may be life threatening and is therefore a huge challenge to nurses involved in cancer care. Even with the best pharmacological management of CINV, patients continue to experience nausea and vomiting.

From a review of eight articles with strong methodology, seven supported the positive effect of an acupressure P6 wristband in reducing CINV for cancer patients. This was also supported by other databases. The one article with neutral results showed that there was no difference between a combined acupuncture and acupressure treatment at P6 and at a sham point in relation to the nausea score, but the level of nausea was very low in both groups. We conclude that the acupressure wrist band applied to acupuncture point P6 is effective, safe, convenient, cost effective, an easy and self-administrated non-pharmacological intervention from traditional Chinese medicine that reduces CINV. Solving the problem of CINV is a fundamental nursing task that can lead to improved quality of life and nutritional status, reduced anxiety and increases patient compliance. In the light of these results, and due to the effectiveness and inexpensiveness of acupressure, together with its ease of use, we suggest that it should be used in conjunction with pharmacological agents for CINV prophylaxis. To maintain the effectiveness of the acupressure, special education and training is needed to reassure the patient that the acupressure is at the correct point (P6) and counselling by the nurse is required.

We recommend the use of acupressure P6 in oncology departments and that future research should be conducted to include cancer patients receiving radiotherapy, and to investigate more about the relationship between the frequency of pressing the stud on the wrist band for acupressure P6 and CINV, and the relationship between gender and CINV, and whether it is better to apply it unilaterally or bilaterally.

[twofacedtrickery]

Delta-?? Unnamed and Delta-5 "The Professor" Character Profiles

Unnamed Delta

Name: Formally, none

Aliases: Lasho Femi [name from Professor], Daina Fisher [current legal alias], Janus [former name], DJ [by others], Ten [former designation], Emery Lavinia Jonaitis [pre-Overseer name]

Gender: Non Binary, Unexplored

Pronouns: Any, it/its only when it is in a bad way

Orientation: Queer Asexual, accepts the labels bi and pan but feels no strong draw to them

Departments: Mission Control, Chemical Development

Birth Date: August 13, 1874

Promotion Date: July 2, 1936

Defection Date: Unknown Date, 2019 [officially]

Site of Residence: Moves between various cells

Appearance:

It had long, dark hair that has started to gray quite a bit, the dark parts have a greenish tinge when the light hits it, but this hair has been shaved off and is currently being grown back out. Its eyes are relatively large, deep brown, and frequently a little bloodshot. Its left eye is typically covered with a gauze patch, heavier materials are used but sparingly, but under it, the skin and eye appear to have been burned with lye, yellowed and completely bloodshot. It stands at 6'5", though struggles to stand to its full height for extended periods. It used to have a fairly muscular build, but that had atrophied slightly since its defection. Brightly colored makeup is a common feature, but the styles are often ones requiring minimal time and effort. Clothing-wise, it tends toward looser fitting clothing where possible, all very colorful, and work boots. It has arachnodactyly and its hands are fairly scarred, its nails are also somewhat unkempt.

Personality:

The unnamed Delta member is a bit of a doormat in many regards and very devoted to those it has chosen. It has forsaken its prior detachment from emotions, going all in on the ability to feel again. It often extends a high degree of compassion and attempts to give the benefit of the doubt in all ways to those around it. However, it has not truly overwritten its formerly severe, even harsh, nature, resulting in a fairly short fuse with those it considers to be lower risk targets for its ire. It does not mind being hated, but hates when that hate is inaccurate to what it knows to be true, and it doesn't want to let others down. It is incredibly protective of those in its life, no matter how those others treat it. It has consistently had a high degree of self-criticism and high standards, these are reinforced in its life resulting in an incredibly low self image, it struggles to trust itself even about its own wants and needs. Under this all, it is fundamentally an idealist who, while willing to self-sacrifice, wants to learn how to allow itself to exist again.

History:

The unnamed Delta's body had been a researcher in pharmacology at the Foundation, prior to events that stirred within it a desire to climb the ranks and effect change. Eventually, once they became department head, O5 Command took notice and gave it a chance it never anticipated.

For decades, it handled recordkeeping at the Foundation as O5-10. During that time it witnessed five of the Overseer positions changing hands, achieved the goal its former self had set out with, faced an instance of harsh reprimanding that shook its internal perception of itself as well as its approach to life, and took on a role handling internal PR in an attempt to draw the ire toward itself and away from its colleagues. Over the years, it got worn down and increasingly isolated.

In 2018, the Chaos Insurgency launched a targeted assassination attempt against it, intended to aggravate its known psychological features and exaggerate them to the point where it could no longer function in its role. The one orchestrating this plan arranged to meet it partway through the ordeal, and, over time, they built up rapport with each other, leading to the former O5-10's defection and a romantic involvement between them.

At some point after its defection to the Insurgency, it was handed a role on Delta Command, which it happily accepted, working as mission control at times alongside contributions toward chemistry-related endeavors. Over time, due largely to its status as the Professor's partner, many within the rank and file of the Insurgency have had their initial suspicions and reservations grow into an active resentment and disdain for it, though it is in denial of this fact.

In mid 2023, the unnamed Delta got caught in a Foundation raid on the base it had been stationed at and surrendered. It was held as a prisoner and used as an attempt at PR and proving a point for over seven months before being extracted. The entire experience has left it incredibly rattled in ways it cannot bring itself to acknowledge.

The Professor

Name: The Professor, The Heretic

Aliases: Rene Fisher [current legal alias], Liam Dekker [former legal alias], Delta-5, Seven [former designation], Isaac Laurens Beck [pre-Overseer name]

Gender: Cis Male, unexplored

Pronouns: He/him

Orientation: Bisexual, recently made aware of the term

Departments: Sociology, Morale, Recruitment

Birth Date: February 6, 1791

Promotion Date: July 20, 1854

Defection Date: Unknown Date, 1924

Site of Residence: Moves between various cells

Appearance:

The Professor has ear length hair that has gone completely white that he keeps well-kept at all times. His eyes are light blue and he wears glasses to correct fairly severe myopia and mild astigmatism. He stands at 5'11" and has perfect posture. Typically, he wears full suits in blues and grays, and his casual clothing is still fairly formal while remaining relatively simple and nondescript. While his clothing for most public appearances is incredibly well-tailored, when he is wearing other clothing, it becomes apparent that he has what most would call a dad bod. He is incredibly well kept and it is apparent that he has a fairly in-depth routine for skin care.

Personality:

The Professor is a fairly subdued individual in a lot of respects. While he is self-aggrandizing, egocentric, and laps up the accolades those around him see fit to give him, he tends to be fairly reserved in other areas. When he speaks, he has the tendency to go on at length, though he will temper this if he feels the situation calls for it. He tends toward guiding others to reach their own conclusions, with subtle nudges toward the conclusions he wants them to reach, as opposed to making more direct arguments until he knows his audience is receptive, as he knows not all battles are worth engaging in. He lacks an internal sense of self, though he has a good grasp on his motives and emotions, something that he hates to be confronted with and covers for with lofty goals and the praises of others. He needs to be needed and loved and adored and believes he can achieve this. His understanding of how to care for others is skewed and his altruism and self interest are very intertwined, making it hard to tell where one ends and the other begins. His emotions are genuine, but not very strong, and when he is met with stronger emotions, he tends to downplay his expression, sometimes coming off as insincere. He also has the tendency to spin negative situations in order to reap benefit from them.

History:

The Professor had formerly been an employee at the Foundation, largely handling issues around morale and later training and similar. Over time, his skill was noticed by O5 Command and he received a promotion.

In his new position, he helped draft training protocols and recruitment tactics for the Foundation while balancing new studies. Over the decades, he began to get the idea in his head that protecting the world wasn't enough. He had to save it.

By 1924, he and 4 colleagues with similar end goals had grown so dissatisfied with the status quo that they left alongside many employees, bringing multiple items of interest with them. Many did not make it out, including one of those colleagues, but he did and brought his God Engine with him.

In the 1940s, he and the other Delta members began recruiting for rapid expansion before they had any real infrastructure in place to handle that number of operatives.

Somewhere along the way, some of these disaffected people, sold on the vision of the founding members, began to project their hopes and dreams onto the most visible member of Delta Command, him. It started as hero worship based on things he actually did, but over 70 years, the message drifted and by the 2010s, many had begun to view him as some divine being to varying degrees, a fact he isn't fully aware of.

[abhinavayu21]

PMS Relief: Find What Works for You

Introduction:

PMS is a state experienced by many women whose symptoms show up within 1 to 2 weeks before the start of menstruation, and they revolve mostly around hormonal changes affecting physical, mental and emotional conditions. Identifying ideal therapies for PMS that would improve daily functioning, is also useful. This blog will address: natural and non-pharmacological approaches to treating PMS symptoms, which will be explained through recommendations on lifestyle modifications, dietary changes, and other medicine for premenstrual syndrome.

What is PMS?

PMS is a hormonal disease that focuses on the fluctuations in levels of estrogen and progesterone hormones. Such hormonal changes have several effects on the body, including tender breasts, weight gain, mood swings, irritability, and constant fatigue. As for the present article, it is important to understand the origins of these symptoms in order to find the cure.

Symptoms of PMS:

PMS symptoms can vary widely but often include:

Mood swings

Irritability

Fatigue

Bloating

Breast tenderness

Headaches

Anxiety

Depression

These symptoms are due to alterations in interact function between steroids and hormones such as dopamine, serotonin, and oxytocin.

Natural Ways to Manage PMS:

1. Increase Serotonin Levels Naturally:

Serotonin is a neurotransmitter which has an impact on person’s feelings. It has been preceded that inositol enhances serotonin signaling and that low levels of serotonin are associated with mood swings and depression, both of which are symptoms of PMS. Here are some types of foods that directly enhance serotonin:

Diet Tips:

Make sure to consume products containing complex carbohydrates such as rice, fruits and vegetables.

One should take products rich in lean protein for instance chicken fish and beans.

Take monounsaturated fats in nuts, seeds and avocados since they help reduce cholesterol levels.

This means that one should refrain from consuming foods in boxes, sugary foods, and foods that contain caffeine.

2. Stop Being a Night Owl:

Another crucial principle of daily life and hormonal balance is wake-sleep cycling or rhythmicity. It was also found that lack of sleep would lead to aggravation of PMS.

Sleep Tips:

The recommended amount of hours for sleep is between seven and nine hours for a competent level of functioning.

Stay on a regular sleep-wake schedule and avoid sleeping during the day hours.

Ponder on the creation of a relaxing bedtime regimen of reading or bathing with warm water.

This means that activities that involve use of screens or anything that would stimulate the brain should be avoided just before sleeping.

3. Take Sun Baths and Engage in Physical Activity:

In addition to affected mental health conditions, natural sunlight exposure and subsequent physical activities can improve many PMS symptoms. It assists the body in the synthesis of vitamin D, which plays a critical role in mood as well as in the body’s general wellbeing.

Activity Tips:

Get 15 to 20 minutes of sunlight exposure per day.

Perform activities such as yoga, exercise, Surya Namaskar or morning walking which enhances the secretion of endorphin thus helping to calm the nerves.

Physical activity contributes to the regulation of hormonal levels, elevates one’s spirits, and combats bloating.

Understanding the Role of Neurotransmitters:

Neurotransmitters like dopamine, serotonin, and oxytocin are known to cause or exacerbate PMS symptoms.

Dopamine: Associated with pleasure and reward system. Whereas, low levels can cause depression and lack of aspiration or motivation. The levels of dopamine can be increased through exercises as well as fun activities.

Serotonin: Closely related to mood control and modulation. Tasty foods, drinks, and regular exercise help to enhance the serotonin level in the human body.

Oxytocin: It is popularly referred to as the ‘cuddle hormone’ since it aids in the bond formation and the calming effect. Oxytocin level can be boosted through participation in activities such as those involving yoga, interpersonal communication, and touching.

Finding the Right Medicine for Premenstrual Syndrome:

While lifestyle changes can manage PMS, some may need medication. Consult a healthcare professional to explore options like these:

Over-the-counter pain relievers such as ibuprofen and aspirin.

Hormonal treatments like birth control pills to regulate hormone levels.

Antidepressants, mainly selective serotonin reuptake inhibitors (SSRIs), for severe mood-related symptoms.

Moreover, “Upasham Tablets” by Abhinav Healthcare are natural remedies that have shown fairly promising results for PMT patients. This Ayurvedic medicine effectively helps in treating various PMS symptoms through the use of natural ingredients that balance hormones and reduce discomforts.

Conclusion:

Effectively managing premenstrual syndrome necessitates a holistic approach including dietary improvements, changes in lifestyle and medical interventions when necessary. Appreciating the hormonal and neurotransmitter aspects of PMS enables one to make decisions on how to minimize these symptoms and improve quality of life. Importantly, what works for one person may not work for another; therefore it is important to find the right combination of approaches that will suit you best.

Upasham Tablets from Abhinav Healthcare could be worth considering by anyone searching for Ayurvedic medicine for premenstrual syndrome and menstrual irregularities. The right blend of dietary modifications along with an appropriate drug regimen can go a long way towards managing PMS effectively while also enhancing physical issues.

Resource:

[unwelcome-ozian]

From a military perspective, the goal would be to improve the capability of military personnel to meet the many challenges of today’s, and anticipated, battlefields, and thereby to gain a measure of mastery over their opponents. This report analyzes some approaches that have been suggested for optimizing individual performance, in the context of potential actions of an adversary who may not be guided by the same cultural or ethical concerns that govern US military operations. The measures considered include medical supplements; non-invasive modifications of brain effectiveness, for example by training and sleep optimization; neuro-pharmacology; and neural implants. In pursuing understanding on this subject one needs to measure the value of the proposed behavioral changes or medical actions relative to what can be gained by organizing and training our military to utilize the unique characteristics, and strengths, of American society and culture, that emphasize individual choice.

[mynetpharmas]

Empowering Men: Understanding Cenforce 100mg Impacts on Erectile Dysfunction

In a world where sexual health is often considered a taboo subject, it's important to shed light on issues that affect millions of men worldwide. One such issue is erectile dysfunction (ED), which can have a significant impact on a man's self-esteem and quality of life. But there's hope, and its name is Cenforce. Cenforce 100, commonly known by its brand name Viagra, is a medication that has revolutionized the treatment of ED. By improving blood flow to the penis, it helps men achieve and maintain an erection that's firm enough for sexual intercourse. But there's more to it than just that.

The impact of erectile dysfunction on men's mental health

Erectile dysfunction can have a profound impact on a man's mental health and overall well-being. It can lead to feelings of inadequacy, low self-esteem, and even depression. The inability to perform sexually can strain relationships and create a sense of frustration and disappointment. Many men struggle in silence, feeling embarrassed or ashamed to seek help.

Understanding Cenforce and how it works

Cenforce tablet is a phosphodiesterase type 5 (PDE5) inhibitor. It works by relaxing the blood vessels in the penis, allowing for increased blood flow. This improved blood flow helps men with erectile dysfunction achieve and maintain an erection during sexual stimulation. Cenforce 100mg medication is most effective when taken on an empty stomach, about 30 minutes to an hour before sexual activity.

Benefits of Cenforce tablet for treating erectile dysfunction

Cenforce 100 online has been proven to be highly effective in treating erectile dysfunction. Studies have shown that it improves erectile function in approximately 70% of men with ED. It not only helps men achieve and maintain an erection but also enhances the quality of their sexual experiences. Buy cenforce 100 provides a safe and reliable solution for men looking to regain their sexual confidence and intimacy.

How to use Cenforce safely and effectively

To use Cenforce safely and effectively, it's important to follow the prescribed dosage and instructions provided by a healthcare professional. It's recommended to start with the lowest effective dose and adjust as necessary. Cenforce should only be taken once a day, and it's important to avoid excessive alcohol consumption, as it may decrease the effectiveness of the medication. It's also essential to be aware of potential drug interactions and disclose all medications and health conditions to a healthcare provider.

Alternative treatments for erectile dysfunction

While Cenforce 100mg is a highly effective treatment for erectile dysfunction, it's not the only option available. There are alternative treatments that may be suitable for some individuals, including other PDE5 inhibitors like tadalafil and vardenafil. Additionally, there are non-pharmacological approaches, such as vacuum erection devices, penile injections, and surgery that can be considered in consultation with a healthcare professional.

Erectile dysfunction is a common and treatable condition that affects many men worldwide. Cenforce, with its ability to improve blood flow to the penis, has revolutionized the treatment of ED and provided hope for men seeking a fulfilling and satisfying sex life. By understanding how Cenforce 100 works, its benefits, and potential side effects, men can make informed decisions about their sexual health. It's important to remember that erectile dysfunction does not define a man, and with the right support and treatment, it's possible to reclaim confidence and vitality in the bedroom. Don't let ED hold you back – take control of your sexual health and empower yourself with Cenforce.

[eclipsecrowned]

something about how like. danae tries to be a good person. her future arcs largely involve her playing sugar mama to chris' cause and eventually driving out other investors with interests non-compliant to his group's basic morals. she opposes evil in-setting and does her best to combat it with the privilege she possesses to spare further innocent lives from ruin.

the initial outbreak never should never have happened, let alone repeat, and so long as she is able, she will try to ensure that.

however.

there is also the edge that if a villain pre-2006 approached her with genuine intent to kill her rat bastard father and tear down his pharmacological reign of terror, she's absolutely going to be the team's anti-villain. tag her in coach she's ready. you have her checkbook her connections and she's not much of a combatant but damn she looks pretty.

[goedmedicine]

Therapy techniques for the treatment of erectile dysfunction

Erectile dysfunction (ED) is a common condition affecting millions of men worldwide. While it can be a source of frustration and embarrassment, the good news is that ED is treatable. Medications like Viagra and Cenforce are widely used, but there are also various therapy techniques that can complement or serve as an alternative to pharmacological treatments. These non-medical treatments address the underlying causes of ED, including psychological, emotional, and physical factors, and provide a holistic approach to restoring sexual health.

Generally, there are two forms of cure one of them is an allopathic cure which h occurs with the use of medicines such as Vidalista 20mg and the other one is by way of surgeries that user penile implants into your penis.

In this blog, we will explore different therapy techniques for the treatment of erectile dysfunction, discussing their effectiveness, benefits, and how they can be integrated into a treatment plan.

1. Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is a form of talk therapy that focuses on identifying and changing negative thought patterns and behaviors. For men with ED caused by psychological factors, such as performance anxiety, stress, or depression, CBT can be a highly effective treatment.

ED is often linked to anxiety about sexual performance, relationship problems, or low self-esteem, which can create a cycle of stress and further exacerbating the condition. CBT helps patients address these issues by:

Changing negative beliefs about sex and performance.

Reducing anxiety and stress that might be affecting sexual function.

Improving communication with a partner, which is often key to overcoming relationship-related issues.

Studies have shown that CBT can be particularly helpful for men whose ED is not primarily caused by physical health conditions but is instead driven by emotional or psychological factors. By addressing the root cause of anxiety, CBT can often lead to lasting improvements in erectile function.

2. Couples Therapy

Erectile dysfunction doesn’t just affect the individual; it can also impact relationships. Emotional intimacy, communication, and sexual satisfaction can be significantly affected by ED, leading to frustration or tension between partners. Couples therapy is designed to help partners navigate these challenges together.

In couples therapy for ED, the therapist works with both partners to:

Open communication about sexual desires, fears, and frustrations.

Address relationship issues that may be contributing to ED, such as unresolved conflicts or emotional disconnect.

Build trust and emotional closeness, which can reduce stress and anxiety during sexual encounters.

Many men find that couples therapy not only helps resolve their ED but also improves their overall relationship, creating a deeper bond and enhancing sexual satisfaction.

3. Sex Therapy

Sex therapy is another therapeutic approach specifically aimed at improving sexual function. This type of therapy involves working with a sex therapist to address the physical, emotional, and psychological aspects of sexual health. It is particularly beneficial for men who experience ED due to stress, anxiety, or relationship issues.

Sex therapy can involve:

Educational support to understand sexual health and how the body functions.

Practical exercises to improve intimacy, increase communication, and build sexual confidence.

Overcoming sexual myths or fears related to performance or body image.

A sex therapist may also recommend specific techniques or tools, such as mindfulness practices or erotic exercises, to help reduce anxiety and enhance the sexual experience. This therapy can be especially effective when ED has emotional or interpersonal roots.

4. Pelvic Floor Exercises (Kegel Exercises)

Pelvic floor exercises, commonly known as Kegel exercises, are often recommended for men suffering from ED, especially when the condition is related to weak pelvic muscles or poor circulation. These exercises involve contracting and relaxing the muscles of the pelvic floor, which support the bladder, bowel, and sexual organs.

Kegel exercises can:

Strengthen the pelvic floor muscles, which can help improve erectile function.

Increase blood flow to the penis, promoting better erections.

Enhance control over ejaculation, which can address issues like premature ejaculation alongside ED.

Regular practice of Kegel exercises can significantly improve erectile function over time. Many men see improvement in their sexual performance and quality of erections after consistently performing pelvic floor exercises.

5. Vacuum Erection Devices (VED)

A Vacuum Erection Device (VED) is a non-invasive medical device that can help men with ED achieve an erection. The device consists of a plastic cylinder that fits over the penis, a pump to create a vacuum, and a constriction ring to maintain the erection.

How it works:

The cylinder is placed over the penis, and the pump creates a vacuum, drawing blood into the penis.

Once an erection is achieved, a constriction ring is placed around the base of the penis to maintain the erection.

The device helps men achieve a firm erection without the need for medications or injections.

VEDs are an effective solution for men with ED, especially for those who prefer non-pharmacological treatments. The device can be used regularly or as needed and is a good alternative for men who cannot take oral medications due to health conditions.

6. Shockwave Therapy

Low-intensity shockwave therapy is a newer and innovative treatment for ED. This non-invasive therapy uses acoustic waves to stimulate blood flow and promote healing in the tissues of the penis. The goal is to improve circulation, which can help men achieve better erections.

Shockwave therapy works by:

Stimulating the growth of new blood vessels (angiogenesis) in the penile tissues.

Improving blood flow to the penis, which is crucial for achieving and maintaining an erection.

Reversing some of the vascular damage caused by conditions like diabetes or high blood pressure that may contribute to ED.

While research is still ongoing, shockwave therapy has shown promising results in improving erectile function, particularly for men with vascular-related ED. It is typically performed in a series of sessions by a trained specialist.

7. Lifestyle Modifications

While not a specific therapy technique, making positive lifestyle changes can have a significant impact on treating erectile dysfunction. A holistic approach to ED treatment should include:

Regular exercise to improve cardiovascular health and circulation.

Eating a balanced diet rich in fruits, vegetables, and whole grains to improve overall health.

Quitting smoking and reducing alcohol consumption, both of which can negatively affect erectile function.

Managing stress through relaxation techniques like yoga, meditation, or mindfulness.

By making these lifestyle changes, men can improve their general health, which can, in turn, enhance erectile function and help reduce the severity of ED.

Conclusion

Erectile dysfunction is a multifaceted condition that can be influenced by physical, psychological, and emotional factors. Fortunately, there are a variety of therapy techniques available that can help men treat ED and improve their sexual health.

Cognitive behavioral therapy, couples therapy, and sex therapy provide emotional and psychological support, helping men overcome performance anxiety, relationship stress, and low self-esteem. Meanwhile, pelvic floor exercises, shockwave therapy, and vacuum devices target the physical aspects of ED. Additionally, lifestyle changes like regular exercise and a balanced diet play a crucial role in improving overall health and supporting erectile function.

Choosing the right therapy technique depends on the individual’s unique situation, and a combination of treatments may be the most effective approach. Consulting with a healthcare provider or specialist is essential to determine the best plan of action based on your health needs and goals. With the right therapy, it is possible to overcome erectile dysfunction and restore a satisfying and fulfilling sexual life.

[own-adhd]

Can Qelbree Be Taken at Night? A Comprehensive Guide

Qelbree (viloxazine extended-release) is a non-stimulant medication commonly prescribed to manage Attention-Deficit/Hyperactivity Disorder (ADHD) in children, adolescents, and adults. A key question often raised by patients and caregivers is whether Qelbree can be taken at night. This article delves into the medication's pharmacological profile, clinical recommendations, and considerations regarding its administration timing.

Understanding Qelbree: Viloxazine Extended-Release Capsules

Qelbree is a once-daily, extended-release capsule designed to treat ADHD symptoms without the stimulant properties associated with traditional treatments. This medication works by modulating norepinephrine levels in the brain, which helps regulate attention, focus, and impulsivity.

For an in-depth look at Qelbree's effects and its influence on social and peer interactions, refer to the article, Response of peer relations and social activities to treatment with viloxazine extended-release capsules (Qelbree®), which analyzes findings from clinical trials on the medication.

Pharmacokinetics and Timing of Qelbree Administration

The extended-release formulation ensures a gradual release of the active ingredient, viloxazine, over 24 hours. This mechanism provides sustained symptom management but also raises questions about the best time to take the medication.

Benefits of Taking Qelbree in the Morning

Symptom Coverage: Morning administration aligns the medication's peak efficacy with daytime hours when ADHD symptoms are most disruptive.

Sleep Patterns: ADHD medications can influence sleep. Taking Qelbree earlier in the day minimizes the risk of insomnia or sleep disturbances caused by its pharmacological effects.

Considerations for Nighttime Administration

Some individuals report increased sedation as a side effect of Qelbree, which might make nighttime dosing appealing. However, this should be approached cautiously:

Delayed Effectiveness: Administering Qelbree at night may result in peak plasma concentrations during sleep, potentially diminishing its daytime benefits.

Clinical Guidance Needed: Always consult a healthcare provider to determine the optimal dosing time based on individual needs.

To explore further guidance on this topic, visit the detailed article, Can Qelbree Be Taken at Night? Here's What You Need to Know.

Side Effects and Their Impact on Timing

Qelbree's side effects play a crucial role in determining its administration schedule. Common side effects include:

Drowsiness or Fatigue: Sedative effects may prompt some users to prefer nighttime dosing.

Insomnia or Restlessness: In contrast, some individuals experience heightened alertness, making morning or midday dosing more suitable.

Clinical trials and post hoc analyses have shown variability in how patients respond to Qelbree, emphasizing the importance of personalized medical advice.

Case Studies and Clinical Trials

In a series of randomized clinical trials discussed in the Response of peer relations and social activities to treatment with viloxazine extended-release capsules (Qelbree®), researchers noted that while Qelbree effectively improved social interactions and attention spans, the timing of administration influenced individual outcomes. These findings underscore the significance of tailoring the dosing schedule to each patient's unique response and lifestyle.

FAQs on Qelbree Timing

1. Can I take Qelbree at night?

Yes, Qelbree can be taken at night if advised by a healthcare provider. Nighttime dosing may benefit individuals experiencing daytime drowsiness from the medication.

2. Will Qelbree affect my sleep?

Qelbree may cause drowsiness or, conversely, insomnia in some patients. Monitoring your sleep patterns and reporting changes to your doctor is essential.

3. How should I decide when to take Qelbree?

Consult your healthcare provider to assess your symptoms, lifestyle, and response to the medication to determine the best timing.

4. Does nighttime dosing reduce daytime effectiveness?

Potentially, as the medication's peak efficacy might occur during sleep hours, reducing its impact on daytime ADHD symptoms.

5. Can Qelbree help with sleep issues?

While some patients report improved sleep due to reduced hyperactivity, Qelbree is not a sleep aid. If sleep issues persist, consult your physician.

6. Can children take Qelbree at night?

Children may benefit from morning dosing to align symptom control with school hours. Nighttime administration should only be considered under medical supervision.

Conclusion

Qelbree is a versatile and effective treatment for ADHD, but its timing requires careful consideration. While morning administration is generally recommended to maximize daytime benefits, individual responses to the medication may warrant nighttime dosing. Always seek guidance from a healthcare professional to determine the most suitable dosing schedule for your unique needs.

For further insights, explore Can Qelbree Be Taken at Night? Here's What You Need to Know and related research on Response of peer relations and social activities to treatment with viloxazine extended-release capsules (Qelbree®).

[alchemyofazeroth]

Human Alchemy & Medical Practice

The alchemical practices developed by the humans of Stormwind represent a fascinating blend of arcane magic and scientific methodology. Through centuries of experimentation and scholarly pursuits, Stormwind's alchemists have devised a systematic approach to transmuting matter and harnessing the latent energies found within organic and inorganic substances.

Their work often focuses on the distillation and recombination of herbs, minerals, and exotic reagents gathered from across Azeroth. By carefully controlling factors such as heat, pressure, and the precise ratio of ingredients, they are able to concoct an impressive array of potions, oils, salves and other alchemical creations imbued with restorative, enhancing or transmutative properties.

Stormwind's alchemists follow strict procedures and maintain meticulous records in bound ledgers, ensuring consistent results and allowing for incremental improvements to their formulas. Their most prized secrets and recipes are jealously guarded, passed down from master to apprentice only after years of tutelage and trust-building.

The potions and elixirs produced by human alchemists are highly sought after commodities, with the most potent commanding premium prices from discerning buyers like adventurers, nobles, and military leaders. Although the craft is often shrouded in an air of mystery, the dedicated practice of alchemy remains a well-respected intellectual and commercial pursuit among the learned citizenry of Stormwind.

Human Medical Practice

The medical practices employed by humans in the city of Stormwind are both sophisticated and highly advanced, reflecting centuries of accumulated knowledge and continuous refinement.

Stormwind's healers and physicians undergo extensive training in anatomy, herbalism, alchemy, and the magical healing arts in order to provide comprehensive care to the city's residents. The Stormwind Cathedral serves as a central hub for healing, with priests and paladins channeling the Light's power to mend wounds, cure diseases, and alleviate suffering. The city's apothecaries work in tandem with the healers, concocting potent elixirs, salves, and potions using exotic herbs and reagents to supplement the healing arts.

Stormwind's medical practitioners also emphasize preventative care, educating the populace on proper hygiene, nutrition, and healthy living to stave off illness. In cases of severe injury or disease resistant to conventional treatment, the city's most skilled healers may employ powerful magic, calling upon the Light to regenerate damaged tissue, purge corruption, or even resurrect the recently deceased. Through a combination of mundane medicine and divine magic, Stormwind's medical professionals maintain the health and well-being of the city's inhabitants, combating everything from common ailments to the most grievous of battlefield injuries.

Adaptations of Stormwind Medicine

The evolution of standard medical practice in Stormwind to accommodate the diverse physiology of the various races comprising the Alliance has been a gradual yet crucial development.

In the early days of the Alliance, medical knowledge was primarily focused on treating humans, as they made up the majority of Stormwind's population. However, as more races joined the Alliance, bringing their unique anatomical structures, metabolic processes, and susceptibilities to different diseases, it became clear that a one-size-fits-all approach to medicine was inadequate. Over time, medical practitioners in Stormwind began to study and document the specific healthcare needs of their non-human patients. This included analyzing anatomical differences, such as the heightened hearing sensitivity of night elves and the high-density musculature of dwarves, to tailor diagnostic techniques and treatment plans.

Pharmacological research expanded to explore how different races responded to medications, leading to customized dosing guidelines and specialized formulations. Medical training programs in Stormwind also adapted, incorporating comparative anatomy and physiology to ensure healthcare providers were equipped to treat patients from all walks of life.

As a result of these efforts, contemporary medical practice in Stormwind is characterized by a deep understanding and respect for the physiological diversity within the Alliance. Hospitals and clinics now boast specialists trained in the nuances of treating various races, ensuring that all citizens of the Alliance receive the highest standard of care.

[pulsealign]

Neuromodulation : engaging the body in a positive dynamic

IN BRIEF Neuromodulation is an innovative approach that positively engages the body in managing pain and enhancing overall well-being. It utilizes targeted electrical currents or pharmacological agents to modulate nervous system activity in a non-invasive manner, making it particularly effective for conditions such as chronic back pain and migraines. This method offers numerous benefits,…

[snehalblog]

Drug-Free Depression Treatment Market: Analyzing the Role of Cognitive and Behavioral Therapies - UnivDatos

According to a new report by UnivDatos Market Insights, Drug Free Depression Treatment Market is expected to reach USD 16.9 Billion in 2030 by growing at a CAGR of 10.1%. Depression, also known as major depressive disorder (MDD), is a prevalent and debilitating mental health condition characterized by persistent feelings of sadness, hopelessness, and a loss of interest or pleasure in activities. It significantly impacts an individual's ability to function in daily life and can lead to various emotional and physical symptoms which makes depression treatments a necessity for such individuals. Drug-free treatments for depression encompass a range of approaches, including therapy, lifestyle changes, and alternative therapies. By fostering a supportive and empathetic therapeutic alliance, individuals affected by depression can regain a sense of control over their lives and work towards achieving improved mental and emotional well-being. Several factors are contributing to the growth of drug free depression treatments including the rising number of depression cases, the surge in awareness programs regarding mental health, the rising geriatric population, and rising investments in psychology departments are driving the growth of drug free depression treatment. For instance, in July 2023, Flow Neuroscience, a small Swedish company treating depression with brain-stimulating headsets, claimed that their device relieved depressive symptoms in clinical trials. Apart from these factors, the rising mortality rate due to anxiety and depression is further leading the market in this forecast period.

Request To Download Sample of This Strategic Report - https://univdatos.com/get-a-free-sample-form-php/?product_id=55092&utm_source=LinkSJ&utm_medium=Snehal&utm_campaign=Snehal&utm_id=snehal

The report suggests that the Rising Number of Cases of Depression is one of the major factors driving the growth of the drug free depression treatment market during the forthcoming years. For instance, according to the World Health Organization, an estimated 3.8% of the population experience depression, including 5% of adults -4% among men and 6% among women, and 5.7% of adults older than 60 years. Also, according to Statistics Canada’s report in September 2023, the percentage of Canadians aged 15 years and older suffering from major depressive episodes, bipolar disorder, and generalized anxiety disorder has increased in the past 10 years. As the incidence of depression continues to rise, there is a greater demand for effective treatment options, driving the growth of the drug free depression treatment market. Additionally, ongoing research and development efforts aimed at discovering new drug free depression treatments with improved efficacy further contribute to the expansion of this market.

Cognitive Behavioural Therapy Segment Gaining Traction in the Market:

Cognitive therapy, or cognitive-behavioral therapy (CBT), plays a significant role in the drug-free depression treatment market. It offers an effective alternative or complement to medication by addressing the underlying thought patterns and behaviors contributing to depression. In the drug-free depression treatment market, cognitive therapy is utilized as a primary intervention, offering patients a non-pharmacological approach to managing their symptoms. This approach appeals to individuals who prefer non-drug treatments or who may experience side effects or resistance to medication. Cognitive therapy's evidence-based effectiveness and focus on empowering patients to develop coping skills make it a valuable option in the drug-free depression treatment landscape.

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Conclusion

The global drug free depression treatment market is a rapidly growing field, with advancements in mental health therapeutics leading to improved outcomes for patients facing psychiatric problems. The global drug free depression treatment market is expected to continue to grow in the coming years, as new therapies are developed. Overall, the global drug free depression treatments market represents a significant opportunity for mental health organizations, which are making strategic alliances to design an effective drug free depression treatment. With continued research and development, even more effective treatments will likely become available in the future, leading to improved outcomes for patients and doctors through drug free depression treatments.

[roshankumar7904800]

Brazil Veterinary Pain Management Devices Market

Brazil Veterinary Pain Management Devices Market Size, Share, Trends: DJO Global Leads

Growing Adoption of Multi-Modal Pain Management Approaches Drives Demand for Diverse Therapeutic Devices

Market Overview:

The Brazil Veterinary Pain Management Devices Market is projected to grow at a CAGR of 8.5% from 2024 to 2031, reaching YY million by 2031. The Southeast region dominates the market, accounting for 45% of the national share. Key metrics include increasing pet ownership, rising awareness about animal health, growing livestock industry, and advancements in veterinary healthcare technologies. The veterinary pain management equipment market in Brazil is expanding rapidly due to increased pet humanisation, the rising prevalence of chronic pain illnesses in animals, and a growing emphasis on animal welfare. The industry is shifting away from pharmacological pain management treatments in favour of innovative technology to improve treatment outcomes in companion and livestock animals.

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Market Trends:

Brazil's veterinary pain management market is rapidly evolving towards multi-modal therapy solutions that include pharmacological and non-pharmacological treatments. This trend is increasing demand for a variety of pain management devices that can be used with traditional drugs. Veterinary practitioners are increasingly integrating laser therapy, electromagnetic field therapy, and acoustic wave therapy with analgesics to provide more complete pain management. According to the Brazilian Association of Veterinary Anaesthesiology and Pain Management (ABRAVET), the usage of complementary pain management approaches has increased by 30% in large metropolitan veterinary practices.

Market Segmentation:

Laser therapy devices dominate the Brazil veterinary pain management devices market, accounting for a significant share. This segment leads the market due to its adaptability, non-invasive nature, and demonstrated efficacy in treating various types of pain in animals. Laser treatment devices are commonly used in the companion animal industry to ease osteoarthritis pain, promote wound healing, and reduce inflammation in disorders including otitis and dermatitis. According to the Brazilian Small Animal Veterinary Association (ANCLIVEPA), laser therapy is currently available in more than 60% of big metropolitan veterinary clinics, with treatment volume increasing by 25% annually.

Market Key Players:

DJO Global (Chattanooga)

PetinDoor

Bioset

Zoetis

MR Equipamentos Veterinários

Ouro Fino Saúde Animal

Contact Us:

Name: Hari Krishna

Email us: hari.krishna@aurorawaveintellects.com

Website: https://aurorawaveintellects.com/

[pshychiatrysummit]

Depression, Anxiety and stress Management

Depression, Anxiety, and Stress Management

International Conference on Depression, Anxiety, and Stress Management

Theme: Integrative Approaches to Mental Health: Bridging Psychiatry, Psychology, and Holistic Care Date: July 21-22, 2025 | Venue: Vancouver, Canada

Conference Highlights

The event aims to connect the latest advancements in psychiatry, psychology, and holistic therapies under one roof. Delegates will gain insights into the intersection of these disciplines and their practical applications in managing emotional and psychological challenges. Key sessions include:

Anxiety Conferences These sessions will focus on innovative research and clinical strategies for diagnosing and managing anxiety disorders. Topics such as generalized anxiety disorder, social anxiety, and post-traumatic stress will be explored in depth.

Depression Summit With depression being one of the most widespread mental health challenges globally, the summit will present groundbreaking research, therapies, and interventions to combat depressive syndromes and their impacts.

Stress Management Event Stress is a major contributor to various mental and physical health issues. This event will highlight evidence-based stress reduction techniques, mindfulness practices, and resilience-building tools to help individuals manage stress effectively.

Psychiatry Congress A dedicated segment for psychiatrists and mental health professionals to discuss advancements in psychopharmacology, neuropsychiatry, and psychotherapy. This congress will also address the role of emerging technologies in psychiatry.

Stress Management Conference This conference will focus on workplace stress, burnout, and the importance of a healthy work-life balance. Attendees will learn about organizational strategies for fostering mental well-being among employees.

Specialized Workshops and Symposia

The event will feature several focused workshops and symposia aimed at tackling specific mental health concerns:

Anxiety Management Workshop 2025 An interactive workshop designed to equip professionals and individuals with practical tools for managing anxiety through cognitive-behavioral techniques, relaxation strategies, and holistic approaches.

Depressive Syndrome Meetings This meeting will delve into the complexities of depressive disorders, their diagnosis, and treatment, including both pharmacological and non-pharmacological options.

Depression Research Events A showcase of the latest studies and clinical trials in depression research, aiming to uncover novel therapies and predictive models for better treatment outcomes.

Insomnia Disorder Conference Exploring the intricate relationship between sleep disorders and mental health, this session will provide insights into managing insomnia and its associated emotional disturbances.

Emotional Illness Symposium 2025 This symposium will address a range of emotional disorders, including mood dysregulation, bipolar disorder, and adjustment disorders, fostering a deeper understanding of their underlying mechanisms and therapeutic approaches.

Why Attend?

This conference is a must-attend for professionals, students, and advocates passionate about mental health. It provides:

A global platform for networking with leading experts in psychiatry, psychology, and holistic care.

Cutting-edge insights into innovative treatments and research in mental health.

Hands-on learning through interactive workshops and symposiums.

Related Conferences:

Anxiety Conferences Canada | Depression summit Canada | Stress management event Canada | Psychiatry congress | Depressive syndrome meetings | Anxiety Management Workshop 2025 | Depression Research Events | Insomnia Disorder conference | Emotional illness Symposium 2025 | Depression and anxiety conferences 2025 | Emotional illness Meetings | Mental imbalance conferences 2025 | Abnormal psychology disorders summits | Psychological syndromes symposiums | Depression Research Events | Neurobiology Depression conferences 2025 | Neurobiology Depression Seminars | Anxiety Management Workshop 2025 | Psychological syndromes Congress 2025 | Stress Management Seminar 2025 | Psychiatry Summit | Psychology Events 2025 | Psychiatry Symposiums | Psychology Conferences | Mental Health Meeting | Psychiatry Workshops 2025|Stress Management Conference

Register Now

Join us at the International Conference on Depression, Anxiety, and Stress Management to be part of a transformative dialogue on mental health. Discover integrative solutions, share your expertise, and make a difference in the lives of individuals worldwide.

Reserve your spot now and become a catalyst for change in mental health care. See you in Vancouver, Canada, on July 21-22, 2025!

For More Details:

www.pshychiatrysummit.com +1 630 768 1199 support@stripeconferences.com 16192 Coastal Highway Lewes, Delaware, USA 19958

[generationfertility]

Comprehensive Guide to Understanding Fibroids: Insights from the Fertility Centre Don Mills

Fibroids, medically known as uterine myomas or leiomyomas, represent a prevalent non-cancerous tumor condition within the female reproductive system, specifically the uterus. This detailed exposition, courtesy of the Fertility Centre Don Mills, is designed to furnish you with an all-encompassing overview of fibroids, elucidating their nature, implications on health, and their relationship to fertility.

Definition and Classification of Fibroids

Fibroids are benign growths that emerge from the muscular tissue of the uterus. Their sizes are highly variable, ranging from minute, almost undetectable forms to large, bulky masses. A significant portion of women, with estimations reaching up to 80% by age 50, may develop fibroids, though not all will encounter symptomatic experiences or necessitate therapeutic interventions.

Categories of Fibroids

Fibroids are categorized according to their location in the uterus:

Intramural fibroids: Predominantly located within the uterine wall, these are the most frequently encountered type.

Subserosal fibroids: These develop on the outer surface of the uterus and may extend outward on a stalk.

Submucosal fibroids: Less common yet notably impactful, these fibroids form just beneath the uterine lining and are often associated with significant menstrual disruptions.

Symptomatology Associated with Fibroids

A substantial number of women bearing fibroids may not exhibit any symptoms. However, symptomatic individuals might report:

Increased menstrual volume or extended menstrual periods.

Pelvic discomfort or a sensation of pressure.

An increased urgency or frequency of urination.

Constipation.

Pain in the lower back or legs.

It is imperative to recognize that these symptoms could also signify other health conditions, making professional consultation essential for differential diagnosis.

Impact of Fibroids on Fertility

Fibroids can influence fertility and the course of pregnancy in various manners. Particularly, submucosal fibroids pose considerable challenges to embryo implantation and fetal development. Additionally, fibroids might obstruct the fallopian tubes, thereby inhibiting the sperm's capacity to fertilize an egg.

Treatment strategies for fibroid-afflicted women desiring pregnancy typically revolve around the fibroids' characteristics such as size and location. Therapeutic avenues may encompass pharmacological interventions to reduce fibroid size or surgical procedures for their removal. Engaging with a fertility specialist at the Fertility Centre Don Mills is crucial to tailor a treatment plan that aligns with individual reproductive goals.

Diagnostic Measures for Fibroids

The initial suspicion of fibroids often arises during a routine pelvic examination, where the physician may detect uterine irregularities. Subsequent confirmatory diagnostics commonly involve:

Ultrasound: This is the standard imaging technique for identifying fibroids.

MRI: Offers detailed imaging that assists in the comprehensive assessment and management planning of fibroids.

Therapeutic Approaches

The choice of treatment for fibroids depends on various factors including the severity of symptoms, fibroid size, and personal health objectives such as fertility preservation. Available treatments range from:

Medications: Aimed at symptom management rather than fibroid resolution.

Surgical interventions: Such as myomectomy (fibroid excision while preserving the uterus), hysterectomy (uterine removal), and minimally invasive procedures like Uterine Fibroid Embolization (UFE), which obstructs blood flow to the fibroid, causing it to shrink.

Managing Life with Fibroids

Despite the potential discomfort associated with fibroids, many women manage to maintain a normal life by adhering to regular medical evaluations and modifying lifestyle factors such as diet, exercise, and weight management.

Fibroids, while common, necessitate nuanced understanding and management, accessible through specialized healthcare providers like the Fertility Centre Don Mills. For those affected, informed decisions and proactive management can mitigate the impact of fibroids on life and fertility, ensuring comprehensive care and support.