Genomic and Clinical Effects Associated with a Relaxation Response Mind-Body Intervention in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disease

Kuo, Braden; Bhasin, Manoj; Jacquart, Jolene; Scult, Matthew A.; Slipp, Lauren E.; Riklin, Eric; Lepoutre, Veronique; Comosa, Nicole; Norton, Beth-Ann; Dassatti, Allison; Rosenblum, Jessica; Thurler, Andrea H.; Surjanhata, Brian; Hasheminejad, Nicole; Kagan, Leslee; Slawsby, Ellen; Rao, Sowmya R.; Macklin, Eric A.; Fricchione, Gregory L.; Benson, Herbert; Libermann, Towia A.; Korzenik, Joshua R.; Denninger, John W.

doi:10.1371/journal.pone.0123861

Cited by 71 publications

(57 citation statements)

References 60 publications

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“…The intervention-associated decrease in pain is consistent with previous reports 28, [43][44][45] of relaxationinducing interventions in critical and noncritical care settings. The decrease in pain did not correspond to use of analgesics, which remained almost stable, in line with previous results.…”

Section: Discussionsupporting

confidence: 91%

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Effects of an Integrative Nursing Intervention on Pain in Critically Ill Patients: A Pilot Clinical Trial

Papathanassoglou¹,

Hadjibalassi²,

Miltiadous³

et al. 2018

Am J Crit Care

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Background Pain, a persistent problem in critically ill patients, adversely affects outcomes. Despite recommendations, no evidence-based nonpharmacological approaches for pain treatment in critically ill patients have been developed. Objectives To investigate the effects of a multimodal integrative intervention on the incidence of pain and on secondary outcomes: intensity of pain, hemodynamic indices (systolic and mean arterial pressure, heart rate), anxiety, fear, relaxation, optimism, and sleep quality. Methods A randomized, controlled, double-blinded repeated-measures trial with predetermined eligibility criteria was conducted. The intervention included relaxation, guided imagery, moderate pressure massage, and listening to music. The primary outcome was incidence of pain (score on Critical Care Pain Observation Tool > 2). Other outcomes included pain ratings, hemodynamic measurements, self-reported psychological outcomes, and quality of sleep. Repeated-measures models with adjustments (baseline levels, confounders) were used. Results Among the 60 randomized critically ill adults in the sample, the intervention group experienced significant decreases in the incidence (P = .003) and ratings of pain (P < .001). Adjusted models revealed a significant trend for lower incidence (P = .002) and ratings (P < .001) of pain, systolic arterial pressure (P < .001), anxiety (P = .01), and improved quality of sleep (P = .02). Conclusion A multimodal integrative intervention may be effective in decreasing pain and improving painrelated outcomes in critically ill patients. (American Journal of Critical Care. 2018; 27:172-185) EFFECTS OF Unrelieved pain is common among ICU patients and may compromise outcomes, by contributing to unstable hemodynamic parameters, hypercatabolism, hyperglycemia, infections, delirium, and posttraumatic stress. 2 Pain in ICU patients may also be part of a vicious circle implicating anxiety 3 and insomnia. 4 Moreover, pain has been linked to the post-ICU syndrome 5 and may become chronic in survivors, a situation associated with poor quality of life and poor psychological and physiological outcomes. 6Management of pain in patients with a critical illness is challenging.7 Opioids, the drug class of choice, are associated with marked side effects, including respiratory depression, hypotension, decreased gastrointestinal motility, delirium, and higher costs due to increased use of resources and prolonged stay in the ICU.8 Nociception, the perception of painful stimuli, entails a complex interaction among sensory, affective, and social components.9 Moreover, anxiety, fear, and negative expectations are common in critically ill patients and may contribute to heightened perception of pain.10 Thus, the multifactorial nature of ICU pain calls for approaches that address both physiological and psychosocial responses to pain. Current guidelines highlight the need to test and implement nonpharmacological strategies for pain treatment in critically ill patients.2 Interventions that elicit a relaxation ...

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Section: Discussionsupporting

confidence: 91%

“…9 The intervention-associated decrease in anxiety is in line with previous reports on relaxation, 28,[44][45][46]54 music, 48,49,55 and touch-massage. 21,55,56 We also found some effect of the intervention on patients' fear, which is an important outcome because fear is involved in pain perception.…”

Section: Discussionsupporting

confidence: 87%

Effects of an Integrative Nursing Intervention on Pain in Critically Ill Patients: A Pilot Clinical Trial

Papathanassoglou¹,

Hadjibalassi²,

Miltiadous³

et al. 2018

Am J Crit Care

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“…Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are major intestinal disorders and both IBD and IBS are characterized by having inflammation and the co-occurring intestinal dysmotility in different extent [910]. Diarrhea, constipation and intestinal inflammation are the main symptoms of the patients with IBD and IBS [1112].…”

Section: Introductionmentioning

confidence: 99%

Ameliorative effects of atractylodin on intestinal inflammation and co-occurring dysmotility in both constipation and diarrhea prominent rats

Xiong

Chen

et al. 2017

Korean J Physiol Pharmacol

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Intestinal disorders often co-occur with inflammation and dysmotility. However, drugs which simultaneously improve intestinal inflammation and co-occurring dysmotility are rarely reported. Atractylodin, a widely used herbal medicine, is used to treat digestive disorders. The present study was designed to characterize the effects of atractylodin on amelioration of both jejunal inflammation and the co-occurring dysmotility in both constipation-prominent (CP) and diarrhea-prominent (DP) rats. The results indicated that atractylodin reduced proinflammatory cytokines TNF-α, IL-1β, and IL-6 in the plasma and inhibited the expression of inflammatory mediators iNOS and NF-kappa B in jejunal segments in both CP and DP rats. The results indicated that atractylodin exerted stimulatory effects and inhibitory effects on the contractility of jejunal segments isolated from CP and DP rats respectively, showing a contractile-state-dependent regulation. Atractylodin-induced contractile-state-dependent regulation was also observed by using rat jejunal segments in low and high contractile states respectively (5 pairs of low/high contractile states). Atractylodin up-regulated the decreased phosphorylation of 20 kDa myosin light chain, protein contents of myosin light chain kinase (MLCK), and MLCK mRNA expression in jejunal segments of CP rats and down-regulated those increased parameters in DP rats. Taken together, atractylodin alleviated rat jejunal inflammation and exerted contractile-state-dependent regulation on the contractility of jejunal segments isolated from CP and DP rats respectively, suggesting the potential clinical implication for ameliorating intestinal inflammation and co-occurring dysmotility.

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“…Several bodies of clinical research support this association including: (a) studies of anxiety, depression and stressful life events in GI disorders (1,3); (b) the prevalence of physical and emotional abuse and neglect in these disorders (4); and (c) benefits of stress management (5,6). Nonetheless, how much of an impact stress has on overall quality of life (QOL) and GI symptoms in GERD, IBS and IBD is not well understood.…”

Section: Introductionmentioning

confidence: 99%

Perceived Stress in Patients with Common Gastrointestinal Disorders: Associations with Quality of Life, Symptoms and Disease Management

Edman

Greeson

Roberts

et al. 2017

EXPLORE

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Objective and Methods: Given associations between stress, and gastrointestinal (GI) symptoms and disorders, this pilot study assesses relationships between perceived stress, quality of life (QOL) and self-reported pain ratings as an indicator of symptom management in patients who self-reported gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Results: In a sample of GI patients (n=402), perceived stress positively correlated with depression (r=0.76, p<0.0001), fatigue (r=0.38, p< 0.0001), sleep disturbance (r=0.40, p<0.0001), average pain (r=0.26, p<0.0001) and worst pain (r=0.25, p< 0.0001). Higher perceived stress also correlated with lower mental health-related QOL. Assessed in subgroups, similar correlations were found for the participants with GERD (n=188), IBS (n=132) and IBD (n=82). Finally, there were significant correlations within both the GERD and IBD cohorts between perceived stress, and average pain (r=0.34, p<0.0001; r=0.32, p<0.0001respectively) and worst pain (r=0.29, p<0.0001; r=0.35, p<0.01respectively). Conclusions: Perceived stress broadly correlated with QOL characteristics in patients with GERD, IBS, and IBD, and their overall QOL was significantly lower than that of the general population. Perceived stress also appeared to be an indicator of symptom management (self-reported pain ratings) in GERD and IBD, but not IBS. Future research is needed using objective measures of stress and symptom/disease management to confirm these associations, and to prospectively evaluate the ability of stress reduction interventions to improve perceived stress, QOL and disease management in these GI disorders; integrative medicine treatment programs that simultaneously target such multiple symptoms may be particularly beneficial to study.

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Genomic and Clinical Effects Associated with a Relaxation Response Mind-Body Intervention in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disease

Cited by 71 publications

References 60 publications

Effects of an Integrative Nursing Intervention on Pain in Critically Ill Patients: A Pilot Clinical Trial

Effects of an Integrative Nursing Intervention on Pain in Critically Ill Patients: A Pilot Clinical Trial

Ameliorative effects of atractylodin on intestinal inflammation and co-occurring dysmotility in both constipation and diarrhea prominent rats

Perceived Stress in Patients with Common Gastrointestinal Disorders: Associations with Quality of Life, Symptoms and Disease Management

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