Complementary Health Practices for U.S. Military, Veterans, and Families

 

From the NCCAM Web page

 

Many military personnel and veterans experience chronic pain, a condition that can be debilitating and is often difficult to treat. Post-traumatic stress, traumatic brain injury, depression, and substance use are other conditions that tend to co-occur in these same service members and are also challenging to treat. Opioid medications are often prescribed for chronic pain conditions, but use and misuse of opioids resulting in hospitalizations and death has been on the rise. A study published in the journal JAMA Internal Medicine examined the prevalence of chronic pain and opioid use among U.S. soldiers following deployment. The researchers found that of the more than 2,500 participants surveyed, 44 percent had chronic pain and 15 percent regularly used opioids—rates much higher than the general population.

Many military, veterans, and their families turn to complementary and integrative health approaches such as mindfulness meditation and other practices in an effort to enhance the options for the management of pain and associated problems. This page provides resources and information on health conditions of special concern to military, veterans, and their families and the complementary and integrative health practices being studied for this population.

PAIN IN THE MILITARY IS OUR FEATURED TOPIC

• Press Release: NIH and VA address pain and related conditions in U.S. military personnel, veterans, and their families: Research will focus on nondrug approaches
• Infographic: Fighting Pain in the U.S. Military, Veterans, and Their Families

For Consumers

General Information

• Message From the Director: Exploring Nondrug Approaches to Managing Pain and Related Conditions in the Military

   (09/25/14)

• NIH and VA address pain and related conditions in U.S. military personnel, veterans, and their families: Research will focus on nondrug approaches

  (09/25/14)
• Chronic Pain and Complementary Health Approaches: What You Need To Know
• Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research  (Institute of Medicine)  [444KB PDF]
• The Imperative for Integrative Medicine in the Military: A Personal and System Perspective – Eric Schoomaker, M.D., Ph.D.  (IRCIMH)

Research Spotlights

• Acupuncture May Help Symptoms of Posttraumatic Stress Disorder

  (06/01/07)

Ongoing Medical Studies

• Find Active Medical Research Studies on Military (ClinicalTrials.gov)

Multimedia

• Fighting Pain in the U.S. Military, Veterans, and Their Families

For Health Professionals

General Information

• Lecture: Building Resilience in High Stress Cohorts With Mindfulness Training

  (05/05/14)

Clinical Practice Guideline

• Pain Management Task Force Final Report  (Office of The Army Surgeon General)  [5MB PDF]

Scientific Literature

Military Personnel

• Systematic Reviews/Reviews/Meta-analysis (PubMed®)
• Randomized Controlled Trials (PubMed®)

[Research summary] New Research Review Looks at Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain

From the AHRQ Web site

A new research review from AHRQ’s Effective Health Care Program  found that while the evidence on the effectiveness and harms of opioid therapy for chronic pain treatment is limited, there is an increased risk of serious harms based on the opioid dose given. The research review assesses observational studies that suggest that use of long-term opioids for chronic pain is associated with increased risk of abuse, overdose, fractures and heart attack, when compared with patients who are not being prescribed opioids. The review noted that more research is needed to understand the long-term benefits, risk of abuse and related outcomes, and effectiveness of different opioid prescribing methods and strategies. The review is titled, “The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain.” AHRQ has also released a statistical brief from the Healthcare Cost and Utilization Project titled, “Hospital Inpatient Utilization Related to Opioid Overuse Among Adults, 1993-2012.” According to the brief, hospitalization rates for opioid overuse more than doubled from 1993 to 2012 and increased at a faster rate for people age 45 and older. In addition, AHRQ Director Rick Kronick, Ph.D., has published a blog about opioids.

Related articles

• AHRQ: Little Evidence for Opioids in Managing Long-term Chronic Pain
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• Risks of Opioids Outweigh Gains for Many Patients
• National study of discontinuation of long-term opioid therapy among veterans
• Heroin overdose deaths increased in many states through 2012
• Risks of opioids outweigh benefits for headache, low back pain, other conditions

New study shows that yoga and meditation may help train the brain

http://www.eurekalert.org/pub_releases/2014-10/ws-nss100314.php

From the October 2014 EurkAlert!

New research by biomedical engineers at the University of Minnesota shows that people who practice yoga and meditation long term can learn to control a computer with their minds faster and better than people with little or no yoga or meditation experience. The research could have major implications for treatments of people who are paralyzed or have neurodegenerative diseases.

The research is published online in Technology, a new scientific journal featuring cutting-edge new technologies in emerging fields of science and engineering.

In the study, researchers involved a total of 36 participants. One group of 12 had at least one year of experience in yoga or meditation at least two times per week for one hour. The second group included 24 healthy participants who had little or no yoga or meditation experience. Both groups were new to systems using the brain to control a computer. Both groups participated in three, two-hour experiments over four weeks in which they wore a high tech, non-invasive cap over the scalp that picked up brain activity. The participants were asked to move a computer cursor across the screen by imaging left or right hand movements.

The participants with yoga or meditation experience were twice as likely to complete the brain-computer interface task by the end of 30 trials and learned three times faster than their counterparts for the left-right cursor movement experiments.

“In recent years, there has been a lot of attention on improving the computer side of the brain-computer interface but very little attention to the brain side,” said lead researcher Bin He, a biomedical engineering professor in the University of Minnesota’s College of Science and Engineering and director of the University’s Institute for Engineering in Medicine. “This comprehensive study shows for the first time that looking closer at the brain side may provide a valuable tool for reducing obstacles for brain-computer interface success in early stages.”

Researchers have been increasingly focused on finding ways to help physically disabled individuals who are paralyzed, have lost limbs, or suffer from diseases such as ALS or cerebral palsy. In these cases, brain function remains intact, but these people have to find a way to bypass muscular control to move a wheelchair, control an artificial limb, or control other devices.

Professor He gained international attention in 2013 when members of his research team were able to demonstrate flying a robot with only their minds. However, they found that not everyone can easily learn to control a computer with their brains. Many people are unsuccessful in controlling the computer after multiple attempts. A consistent and reliable EEG brain signal may depend on an undistracted mind and sustained attention. Meditators have shown more distinctive EEG patterns than untrained participants, which may explain their success.

Professor He said he got the idea for the study more than five years ago when he began his brain-computer interface research and noticed one woman participant who was much more successful than other participants at controlling the computer with her brain. The woman had extensive experience with yoga and mediation, referred to by researchers as Mind-Body Awareness Training (MBAT).

The next step for He and his team is to study a group of participants over time who are participating in yoga or meditation for the first time to see if their performance on the brain-computer interface improves.

“Our ultimate goal is to help people who are paralyzed or have brain diseases regain mobility and independence,” He said. “We need to look at all possibilities to improve the number of people who could benefit from our research.”

###

This research was funded by the National Science Foundation, the National Institutes of Health, and the University of Minnesota’s Institute for Engineering in Medicine. In addition to He, the University of Minnesota research team included research lab technician Kaitlin Cassady, biomedical engineering undergraduate student Albert You, and biomedical engineering master’s and medical student Alex Doud.

Corresponding author for this study in Technology is Professor Bin He, Ph.D., binhe@umn.edu. This study can be found at http://www.worldscientific.com/doi/abs/10.1142/S233954781450023X.

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[Journal article]Pollution from drug manufacturing: review and perspectives

Pollution from drug manufacturing: review and perspectives.

From the article at Philosophical Society of the Royal Society

As long ago as the sixteenth century, Paracelsus recognized that ‘the dose makes the poison’. Indeed, environmental concentrations of pharmaceuticals excreted by humans are limited, most importantly because a defined dose is given to just a fraction of the population. By contrast, recent studies have identified direct emission from drug manufacturing as a source of much higher environmental discharges that, in some cases, greatly exceed toxic threshold concentrations. Because production is concentrated in specific locations, the risks are not linked to usage patterns. Furthermore, as the drugs are not consumed, metabolism in the human body does not reduce concentrations. The environmental risks associated with manufacturing therefore comprise a different, wider set of pharmaceuticals compared with those associated with risks from excretion. Although pollution from manufacturing is less widespread, discharges that promote the development of drug-resistant microorganisms can still have global consequences. Risk management also differs between production and excretion in terms of accountability, incentive creation, legal opportunities, substitution possibilities and costs. Herein, I review studies about industrial emissions of pharmaceuticals and the effects associated with exposure to such effluents. I contrast environmental pollution due to manufacturing with that due to excretion in terms of their risks and management and highlight some recent initiatives.

…

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[News article]NerdWallet Health Study: Medical Debt Crisis Worsening Despite Policy Advances – Health

NerdWallet Health Study: Medical Debt Crisis Worsening Despite Policy Advances – Health.

From the 8 October 2014 article

Despite recent advances in health care policy, American households continue to struggle with medical debt, and it’s only getting worse. Americans are putting more of their take-home pay toward medical costs than ever before.

• NerdWallet Health has found that Americans pay three times more in third-party collections of medical debt each year than they pay for bank and credit card debt combined. In 2014, roughly one in five American adults will be contacted by a debt collection agency about medical bills, but they may be overpaying – NerdWallet found rampant hospital billing errors resulting in overcharges of up to 26%.

• NerdWallet found 63% of American adults indicate they have received medical bills that cost more than they expected. At the same time, 73% of consumers agree they could make better health decisions if they knew the cost of medical care before receiving it.

• Between 2010 and 2013, American households lost $2,300 in median income, but their health care expenses increased by $1,814.[1] Out-of-pocket spending is expected to accelerate to a 5.5% annual growth rate by 2023 – double the growth of real GDP.

In a follow-up to last year’s study that found medical debt is the largest cause of personal bankruptcy, NerdWallet Health investigated the mounting financial obstacles facing the American patient.

Download a printer-friendly version of the study here.

#88296230 / gettyimages.com

Psychiatrist appointments hard to get, even for insured, study shows — ScienceDaily

Psychiatrist appointments hard to get, even for insured, study shows — ScienceDaily.

Obtaining access to private outpatient psychiatric care in the Boston, Chicago and Houston metropolitan areas is difficult, even for those with private insurance or those willing to pay out of pocket. Researchers, who posed on the phone as patients seeking appointments with individual psychiatrists, encountered numerous obstacles, including unreturned calls, and met with success only 26 percent of the time.

…

[News article] Corruption of health care delivery system? — ScienceDaily

Corruption of health care delivery system? — ScienceDaily.

From the 14 October 2014 article

he foundation of evidence-based research has eroded and the trend must be reversed so patients and clinicians can make wise shared decisions about their health, say Dartmouth researchers in the journal Circulation: Cardiovascular Quality and Outcomes.

Drs. Glyn Elwyn and Elliott Fisher of The Dartmouth Institute for Health Policy & Clinical Practice are authors of the report in which they highlight five major problems set against a backdrop of “obvious corruption.” There is a dearth of transparent research and a low quality of evidence synthesis. The difficulty of obtaining research funding for comparative effectiveness studies is directly related to the prominence of industry-supported trials: “finance dictates the activity.”

The pharmaceutical industry has influenced medical research in its favor by selective reporting, targeted educational efforts, and incentivizing prescriber behavior that influences how medicine is practiced, the researchers say. The pharmaceutical industry has also spent billions of dollars in direct-to-consumer advertising and has created new disease labels, so-called disease-mongering, and by promoting the use of drugs to address spurious predictions.

Another problem with such studies is publication bias, where results of trials that fail to demonstrate an effect remain unpublished, but trials where the results are demonstrated are quickly published and promoted.

…

English: Example of promotional “freebies” given to physicians by pharmaceutical companies (Photo credit: Wikipedia)

 

The authors offer possible solutions:

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• Corruption of the health care delivery system
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[News article] New approaches needed for people with serious mental illnesses in criminal justice system — ScienceDaily

New approaches needed for people with serious mental illnesses in criminal justice system — ScienceDaily.

From the 14 October 2014 article

esponding to the large number of people with serious mental illnesses in the criminal justice system will require more than mental health services, according to a new report.

In many ways, the criminal justice system is the largest provider of mental health services in the country. Estimates vary, but previous research has found that about 14 percent of persons in the criminal justice system have a serious mental illness, and that number is as high as 31 percent for female inmates. Researchers are defining serious mental illnesses to include such things as schizophrenia, bipolar spectrum disorders and major depressive disorders.

“It has been assumed that untreated symptoms of mental illness caused criminal justice involvement, but now we’re seeing that there is little evidence to support that claim,” said Matthew Epperson, assistant professor at the University of Chicago School of Social Service Administration. Specialized interventions for people with mental illness in the criminal justice system have been developed over the past 20 years, such as mental health courts and jail diversion programs, Epperson said.

“But we need a new generation of interventions for people with serious mental health issues who are involved in the criminal justice system, whether it be interactions with police, jails, probation programs and courts,” he said. “Research shows that people with serious mental illnesses, in general, display many of the same risk factors for criminal involvement as persons without these conditions.”

…

: Criminal Justice Center (Photo credit: Wikipedia)

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[News Article] Take note: Jazz and silence help reduce heart rate after surgery, study shows — ScienceDaily

Showing 13.5φEX Headphone with noise cancellation from Sony Walkman Series NW-S705F (Photo credit: Wikipedia)

Take note: Jazz and silence help reduce heart rate after surgery, study shows — ScienceDaily.

 

From the 13 October 2014 article

Jazz is good for you. Patients undergoing elective hysterectomies who listened to jazz music during their recovery experienced significantly lower heart rates, suggests a study presented at the ANESTHESIOLOGY™ 2014 annual meeting.

But the research also found that silence is golden. Patients who wore noise-cancelling headphones also had lower heart rates, as well as less pain.

The results provide hope that patients who listen to music or experience silence while recovering from surgery might need less pain medication, and may be more relaxed and satisfied, note the researchers.

“The thought of having a surgical procedure — in addition to the fears associated with anesthesia — creates emotional stress and anxiety for many patients,” said Flower Austin, D.O., anesthesiology resident, Penn State Milton S. Hershey Medical Center, Hershey, Pa., and lead study author. “Physician anesthesiologists provide patients with pain relief medication right after surgery. But some of these medications can cause significant side effects.”

 

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[Journal Supplement] Public health in the 21st century

Public health in the 21st century.

From the 16 October 2014 press release

 

American Journal of Preventive Medicine supplement addresses critical challenges to public health

Ann Arbor, MI, October 16, 2014 – Although disease outbreaks and epidemics drawing worldwide attention emphasize the importance and acute need for public health professionals, the world faces a longer-term challenge—a public health workforce that is truly effective in the 21st century. In a new supplement to the American Journal of Preventive Medicine, ***experts address critical challenges to public health, from workforce development, capacity building, partnership and collaborations, and changes and needs in workforce composition.

As the U.S. healthcare system evolves and communities gain more access to care, diverse forces are driving change, and the practice of public health is adapting. Given the challenges to the public health system and those faced as a nation—including urgent health threats (e.g., antibiotic resistance, prescription drug use and overdose, global health security) and decreased funding for addressing public health concerns—having trust in public health practitioners, their scientific knowledge, and particularly the public health system, has never been more important.

“The public health workforce is now not only required to take a lead in protecting citizens’ health, but it also must provide the evidence base needed for linking public health information with clinical services and activities; offer targeted, scalable public health interventions; and support clinical services in a way that affects populations at large,” notes Guest Editor Fátima Coronado, MD, MPH, Deputy Associate Director for Science, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. “This supplement is both timely and important because it reviews some of the critical challenges faced by the public health workforce, discusses selected changes under way, and highlights data-driven research to advance the field of public health services and systems research.”

This groundbreaking supplement, The Public Health Workforce, includes 22 articles from more than 30 institutions, agencies, foundations and public companies and covers two major areas: public health workforce capacity building and public health workforce size and composition.

Key topics in the Supplement include:

• How to clearly define the public health workforce challenges using cause-and-effect diagrams and a concise roadmap.
• Use of Massive Open Online Courses (MOOCs) by the School of Public Health at Harvard and concerns about retention of the knowledge gained using that method of instruction.
• How the CDC conducts workforce development within its own organization.
• Do students who receive adequate training in Public Health and Community Medicine tend to practice in areas with physician shortages?
• How do we count public health workers? In the first study since 2000, 50% of all public health workers are employed at the local level, with 30% and 20% at the state and federal levels, respectively.
• How can we define public health workers properly? A taxonomy has been developed which is a necessary step to continuously monitor the size and composition of the workforce to ensure sufficient capacity to deliver essential public health services.
• Data show that part-time public health workers are a low percentage of the total workforce and the percentage has decreased over the last 5 years.
• Despite relatively uncompetitive pay, local health departments experience lower rates of employee turnover than state health agencies and lower rates than state and local government in general.
• How can we align public health workforce competencies with population health improvement goals?
• How the Public Health Accreditation Board (PHAB) developed the standards and measures to encourage health departments to strengthen the current public health workforce and strategically develop the workforce of tomorrow.
• Do Internal Medicine Residency Programs develop public health competencies?
• How a training program for racial and ethnic minorities for careers in public health sciences has resulted in 60% of the students entering public health careers.
• Will epidemiology education change rapidly enough to keep up with trends in communications and computing?
• How the growth of cities, “Big Data,” and cognitive computing will change the public health workforce.
• Building a Culture of Health – How the public health workforce will not only provide medical care but will help to establish a Culture of Health.
• Nursing as a critical driver of the Culture of Health.

Guest Editors Dr. Coronado and Denise Koo, MD, MPH, Office of Public Health Scientific Services, CDC, Atlanta, GA, and Kristine Gebbie, DrPH, RN, Faculty of Health Sciences, Flinders University, Adelaide, South Australia, write that “we are buoyed by the increased efforts to meet workforce challenges and the valuable contribution of researchers and practitioners to strengthen the public health workforce. Efforts to strengthen the public health workforce should be a continuing priority involving well-planned, evidence based, and coordinated actions from decision makers undaunted by the mission of transforming public health and improving the population’s health while facing the complex landscape of the 21st century.”

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***The article may be available for free or low cost at your local public, academic, or hospital/medical center library. Call ahead and ask for a reference librarian.

BBC – Future – Should we diagnose rare diseases with smartphones?

English: Biosafety level 4 hazmat suit: researcher is working with the Ebola virus (Photo credit: Wikipedia)

BBC – Future – Should we diagnose rare diseases with smartphones?.

From the 17 October 2014 BBC article

s fear of the Ebola virus escalates, Eric Topol thinks that we’re missing an important weapon. And you just need to reach into your pocket to find it. “Most communicable diseases can be diagnosed with a smartphone,” he says. “Rather than putting people into quarantine for three weeks – how about seeing if they harbour it in their blood?” A quicker response could also help prevent mistakes, such as the patient in Dallas who was sent home from hospital with a high fever, only to later die from the infection.

It’s a provocative claim, but Topol is not shy about calling for a revolution in the way we deal with Ebola – or any other health issue for that matter. A professor of genomics at the Scripps Research Institute in California, his last book heralded “the creative destruction of medicine” through new technology. Smartphones are already helping to do away with many of the least pleasant aspects of sickness – including the long hospital visits and agonising wait for treatment. An easier way to diagnose Ebola is just one example of these sweeping changes.

…

[Press release] Do no harm: Pediatrician calls for safely cutting back on tests, treatments





http://www.portaldemisterios.com/videos/yt-MyfqSZg3RLw


http://www.eurekalert.org/pub_releases/2014-10/aaop-dnh100314.php

From the October 2014 press release

SAN DIEGO – When parents take a sick or injured child to the doctor or emergency room, they often expect tests to be done and treatments given. So if the physician sends them on their way with the reassurance that their child will get better in a few days, they might ask: “Shouldn’t you do a CT scan?” or “Can you prescribe an antibiotic?”

What families — and even doctors — may not understand is that many medical interventions done “just to be safe” not only are unnecessary and costly but they also can harm patients, said Alan R. Schroeder, MD, FAAP, who will present a plenary session at the American Academy of Pediatrics (AAP) National Conference & Exhibition. Titled “Safely Doing Less: A Solution to the Epidemic of Overuse in Healthcare,” the session will be held from 11:30-11:50 a.m. PDT Monday, Oct. 13 in Ballroom 20 of the San Diego Convention Center.

Dr. Schroeder, chief of pediatric inpatient services and medical director of the pediatric intensive care unit at Santa Clara Valley Medical Center in San Jose, Calif., will discuss some of the reasons why doctors provide unnecessary care (i.e., barriers to safely doing less), including pressure from parents and a fear of missing something.

“We all have cases where we’re haunted by something bad happening to a patient. Those tend to be cases where we missed something,” he said. “We tend to react by doing more and overtreating similar patients.”

He also will give examples of where overuse commonly occurs in pediatrics, such as performing a CT scan on a child with a minor head injury, and the negative consequences.

“You may find a tiny bleed or a tiny skull fracture, and once you’ve found that you’re compelled to act on it. And generally acting on it means at a minimum admitting the child to an intensive care unit for observation even if the child looks perfectly fine,” Dr. Schroeder said. “The term for that is overdiagnosis. You detect an abnormality that will never cause harm.”

Finally, he will suggest ways to minimize overtesting and overtreatment, highlighting the Choosing Wisely campaign. More than 60 medical societies including the AAP have joined the initiative and have identified more than 250 tests and procedures that are considered overused or inappropriate in their fields.

“I’ve devoted much of my research to identify areas in inpatient pediatrics where we can safely do less — which therapies that we are doing now are unnecessary or overkill,” Dr. Schroeder said.

###

The American Academy of Pediatrics is an organization of 62,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.

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Infection Report 5: What you really should be worried about | The Pediatric Insider

Infection Report 5: What you really should be worried about | The Pediatric Insider.

From the 10 October 2014 posting by Roy Benaroch, MD

This week’s posts have all been about infections, new and old—infections newly found, and infections sneaking back. On the one hand, the media is agog with news of Ebola and the mysterious paralysis virus; on the other hand, threats that are far more likely to kill us are being largely ignored.

One infection is on the verge of sneaking back, which is a shame. We had it beaten, and now we’re allowing it to gain a foothold. We’ve got a great way to eradicate measles, but fear and misinformation have led to pro-disease, anti-vaccine sentiment, especially among those white, elite, and wealthy. As we’ve seen, we’re all in this together—so those anti-vaccine enclaves are going to affect all of us.

Measles, itself, is just about the most contagious disease out there.

…..

English: This is the skin of a patient after 3 days of measles infection; treated at the New York – Presbyterian Hospital. Prior to widespread immunization, measles was common in childhood, with more than 90% of infants and children infected by age 12. Recently, fewer than 1,000 measles cases have been reported annually since 1993. 日本語: 麻疹患者の発疹. 中文: 感染了痲疹的皮膚. Українська: Як кір поражає шкіру. עברית: פריחה על עורו של חולה חצבת. (Photo credit: Wikipedia)

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[Press release] Results of study of the human mind and consciousness at the time of death available

Artist’s depiction of the separation stage of an out-of-body experience, which often precedes free movement. (Photo credit: Wikipedia)

http://www.eurekalert.org/pub_releases/2014-10/e-ros100714.php

From the 7 October 2014 EurkAlert!

he results of a four-year international study of 2060 cardiac arrest cases across 15 hospitals published and available now on ScienceDirect. The study concludes:

• The themes relating to the experience of death appear far broader than what has been understood so far, or what has been described as so called near-death experiences.
• In some cases of cardiac arrest, memories of visual awareness compatible with so called out-of-body experiences may correspond with actual events.
• A higher proportion of people may have vivid death experiences, but do not recall them due to the effects of brain injury or sedative drugs on memory circuits.
• Widely used yet scientifically imprecise terms such as near-death and out-of-body experiences may not be sufficient to describe the actual experience of death. Future studies should focus on cardiac arrest, which is biologically synonymous with death, rather than ill-defined medical states sometimes referred to as ‘near-death’.
• The recalled experience surrounding death merits a genuine investigation without prejudice.

Recollections in relation to death, so-called out-of-body experiences (OBEs) or near-death experiences (NDEs), are an often spoken about phenomenon which have frequently been considered hallucinatory or illusory in nature; however, objective studies on these experiences are limited.

In 2008, a large-scale study involving 2060 patients from 15 hospitals in the United Kingdom, United States and Austria was launched. The AWARE (AWAreness during REsuscitation) study, sponsored by the University of Southampton in the UK, examined the broad range of mental experiences in relation to death. Researchers also tested the validity of conscious experiences using objective markers for the first time in a large study to determine whether claims of awareness compatible with out-of-body experiences correspond with real or hallucinatory events.

Results of the study have been published in the journal Resuscitation and are now available online on ScienceDirect.

Dr Sam Parnia, Assistant Professor of Critical Care Medicine and Director of Resuscitation Research at The State University of New York at Stony Brook, USA, and the study’s lead author, explained: “Contrary to perception, death is not a specific moment but a potentially reversible process that occurs after any severe illness or accident causes the heart, lungs and brain to cease functioning. If attempts are made to reverse this process, it is referred to as ‘cardiac arrest’; however, if these attempts do not succeed it is called ‘death’. In this study we wanted to go beyond the emotionally charged yet poorly defined term of NDEs to explore objectively what happens when we die.”

Thirty-nine per cent of patients who survived cardiac arrest and were able to undergo structured interviews described a perception of awareness, but interestingly did not have any explicit recall of events.

“This suggests more people may have mental activity initially but then lose their memories after recovery, either due to the effects of brain injury or sedative drugs on memory recall”, explained Dr Parnia, who was an Honorary Research Fellow at the University of Southampton when he started the AWARE study.

Among those who reported a perception of awareness and completed further interviews, 46 per cent experienced a broad range of mental recollections in relation to death that were not compatible with the commonly used term of NDE’s. These included fearful and persecutory experiences. Only 9 per cent had experiences compatible with NDEs and 2 per cent exhibited full awareness compatible with OBE’s with explicit recall of ‘seeing’ and ‘hearing’ events.

One case was validated and timed using auditory stimuli during cardiac arrest. Dr Parnia concluded: “This is significant, since it has often been assumed that experiences in relation to death are likely hallucinations or illusions, occurring either before the heart stops or after the heart has been successfully restarted, but not an experience corresponding with ‘real’ events when the heart isn’t beating. In this case, consciousness and awareness appeared to occur during a three-minute period when there was no heartbeat. This is paradoxical, since the brain typically ceases functioning within 20-30 seconds of the heart stopping and doesn’t resume again until the heart has been restarted. Furthermore, the detailed recollections of visual awareness in this case were consistent with verified events.

“Thus, while it was not possible to absolutely prove the reality or meaning of patients’ experiences and claims of awareness, (due to the very low incidence (2 per cent) of explicit recall of visual awareness or so called OBE’s), it was impossible to disclaim them either and more work is needed in this area. Clearly, the recalled experience surrounding death now merits further genuine investigation without prejudice.”

Further studies are also needed to explore whether awareness (explicit or implicit) may lead to long term adverse psychological outcomes including post-traumatic stress disorder.

Dr Jerry Nolan, Editor-in-Chief of Resuscitation, stated: “The AWARE study researchers are to be congratulated on the completion of a fascinating study that will open the door to more extensive research into what happens when we die.”

###

Notes to editors:

The paper is, “AWARE—AWAreness during REsuscitation—A prospective study” (http://dx.doi.org/10.1016/j.resuscitation.2014.09.004), Resuscitation, published by Elsevier. Available on ScienceDirect: http://www.sciencedirect.com/science/article/pii/S0300957214007394

[Full text of this article may be available at your local public, academic, or hospital library. Call ahead and ask for a reference librarian. Many academic and hospital libraries have at least some services for the public]

 

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[Free ebook] Pain: Considering Complementary Approaches

 

From the National Center for Complementary and Alternative Medicine

Pain is the most common reason for seeking medical care. It is also a common reason why people turn to complementary health approaches.

We have collected our information on pain into an eBook you can download to your computer or mobile device.

If you have a Web-enabled device:

• Download the eBook as an ePub (for Nook, iPad, and more) (1MB EPUB)
• Download the eBook for Kindle (1.2MB MOBI)