Assessing the impact of preferred web app-based music-listening on pain processing at the central nervous level in older black adults with low back pain: An fNIRS study.

BACKGROUND: Low back pain (LBP) disproportionately affects older black adults, often leading to inadequate treatment due to clinician biases. Objective pain measures are imperative, and Functional Near-Infrared Spectroscopy (fNIRS) shows promise for pain detection. AIM: To determine the impact of listening to home-based preferred web app-based music on underlying pain processing mechanisms at the central nervous level in older black adults aged ≥65 with LBP. METHODS: Twenty older black adults with LBP listened to preferred music twice daily for four days using the MUSIC CARE® app. Neuroimaging data were collected using fNIRS. Data were transformed to changes in oxy-hemoglobin and deoxy-hemoglobin concentrations and analyzed. RESULTS: Significant cortical activation pattern differences were observed between pre-and post-intervention scans, particularly in somatosensory regions. Post-intervention scans showed significantly reduced hemodynamic activities. CONCLUSION: Preferred music listening has the potential to alleviate pain, and fNIRS emerges as a promising tool for exploring cortical-level pain-related neural circuits.

Transcranial Direct Current Stimulation in Nicotine Use: Nursing Implications for Patient Outcomes.

ABSTRACT: Tobacco use is a leading cause of cancer, cardiovascular and respiratory disease, and preventable death in the United States. The brains of individuals with nicotine dependence are characterized by damaged mesolimbic pathways in the medial portion of the limbic and frontal lobes, creating positive reinforcing mechanisms. Transcranial direct current stimulation (tDCS) targets this neuroadaptation to improve smokers' nicotine-related outcomes, such as craving and smoking behavior, by depolarizing or hyperpolarizing the neurons of the brain. Recent literature reported promising outcomes in smokers after tDCS treatment interventions. tDCS has great potential for clinical nursing research for tobacco control given its multiple methodological advantages and few disadvantages. Nurse researchers can consider individualized and home-based tDCS interventions for community-based tobacco control research and may need to consider objective outcome measures (e.g., cotinine in urine) and addiction-related cognitive variables (e.g., self-regulation). Users of electronic nicotine delivery systems also need to be considered as participants in tDCS interventions. Additional considerations for nursing research are discussed.

Pain sensation and gut microbiota profiles in older adults with heart failure.

Objectives: Patients with heart failure (HF) experience severe pain and may have altered pain sensation; however, the underlying mechanisms of these symptoms are not yet fully understood. Identifying pain sensation and genomic biomarkers of pain in older adults with HF is a critical step toward developing personalized interventions to improve pain management and outcomes. This study aimed to investigate the differences in pain sensation, gut microbiota, self-reported pain, and symptoms in older adults with and without HF. Methods: Twenty older adults with HF and age-matched healthy controls (HCs) were recruited in the Northeastern United States. Quantitative sensory testing and conditioned pain modulation were performed on the nondominant upper arm to detect the mechanical, thermal, and pressure pain thresholds and pain modulations. Stool samples were collected, and the 16S rRNA V4 gene region of stool samples was sequenced and processed using the Mothur 1.42.3 pipeline. Self-reported pain and symptoms were measured by the Brief Pain Inventory and the NIH Patient-reported Outcomes Measurement Information System. The associations between pain sensation, gut microbiota α-diversity indices, and pain and symptoms were explored using the Spearman correlations. Results: The HF and HC subjects' mean ages were 73.50 (SD = 8.33) and 67.10 (SD = 7.64), respectively. The HF subjects reported significantly higher pain intensity and interference, sleep disturbance, fatigue, anxiety, and depression than the HCs. The HF subjects also had a significantly lower level of physical function and participation in social roles and activities. Compared with the HCs, the HF subjects had significantly altered conditioned pain modulation heat effect and gut microbiota compositions and predicted metabolic functions. The Statistical Analysis Of Metagenomic Profiles indicated that the HF subjects had a significantly decreased cardiac muscle contraction pathway compared with the HCs. The correlation analysis showed that the quantitative sensory testing profiles and gut microbiota diversity index were significantly associated with pain and symptoms in older adults with HF. Conclusions: Older adults with HF had more severe self-reported pain and symptoms, altered pain sensation, and different gut microbiota composition and function compared with age-matched HCs. Pain sensation and gut microbiota may contribute to pain and symptoms in older adults with HF and could serve as biomarkers of pain and symptoms of HF. Further research with a larger sample size is warranted to confirm these findings.

Listening to Remotely Monitored Home-based Preferred Music for Pain in Older Black Adults with Low Back Pain: A Pilot Study of Feasibility and Acceptability.

BACKGROUND: Low back pain (LBP) is a complex condition that is widespread among older Black adults. Nonpharmacologic interventions are recommended as first-line therapy, but their use in practice is limited, possibly due to misunderstanding of their analgesic characteristics. AIM: To determine the feasibility and acceptability of listening to preferred music at home to relieve pain in older Black adults aged 65 years or older with LBP. METHOD: We recruited 20 community-dwelling older adults (≥65 years) with LBP to use noise-isolating headphones to listen to their preferred music for 20 minutes twice daily for four days via the MUSIC CARE® app. Feasibility was determined using enrollment, adherence, and attrition rates, and acceptability was determined using the Treatment Acceptance and Preference (TAP) scale. Average pain scores were self-reported using the Numeric Rating Scale (NRS) after the second intervention of the day. Pain scores were evaluated using paired sample t test and repeated-measures ANOVA. RESULTS: Enrollment, adherence, and attrition rates were 95.25%, 100.00%, and 0.00%, respectively. Most participants rated the TAP scale at ≥3, indicating acceptance. Pain scores decreased significantly from baseline (M = 46.90, SD = 21.47) to post-intervention (M = 35.70, SD = 16.57), t (19) = 2.29, p = .03. Repeated measures ANOVA showed a significant decrease in mean pain scores over time [F (2.36, 44.88) = 5.61, p = .004, η2 = .23]. CONCLUSIONS: Listening to preferred music for 20 minutes twice a day is a feasible and acceptable intervention that can considerably reduce pain in older Black adults with LBP.

Home-based tDCS for apathy in Alzheimer's disease: a protocol for a randomized double-blinded controlled pilot study.

BACKGROUND: Apathy is among the most common behavioral symptoms in dementia and is consistently associated with negative outcomes in Alzheimer's disease (AD). Despite its prevalence and clinical relevance, available pharmacological and non-pharmacological strategies to treat apathy in AD have been marked, respectively, by potentially severe side effects and/or limited efficacy. Transcranial direct current stimulation (tDCS) is a relatively novel non-pharmacological method of neuromodulation with promising results. Compared to previous tDCS formats, recent technological advances have increased the portability of tDCS, which creates the potential for caregiver-administered, home use. Our study aims to evaluate the feasibility, safety, and efficacy of home-based tDCS for the treatment of apathy in AD. METHODS/DESIGN: This is an experimenter- and participant-blinded, randomized, sham-controlled, parallel-group (1:1 for two groups) pilot clinical trial, involving 40 subjects with AD. After a brief training, caregivers will administer tDCS for participants at home under remote televideo supervision by research staff to ensure the use of proper technique. Participants will be assessed at baseline, during treatment (week 2, week 4, and week 6), and 6 weeks post-treatment. Dependent measures will cover cognitive performance, apathy, and other behavioral symptoms. Data about side effects and acceptability will also be collected. DISCUSSION: Our study will address apathy, an overlooked clinical problem in AD. Our findings will advance the field of non-pharmacological strategies for neuropsychiatric symptoms, presenting a great potential for clinical translation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04855643.

Self-administered transcranial direct current stimulation treatment of knee osteoarthritis alters pain-related fNIRS connectivity networks.

Significance: Knee osteoarthritis (OA) is a disease that causes chronic pain in the elderly population. Currently, OA is mainly treated pharmacologically with analgesics, although research has shown that neuromodulation via transcranial direct current stimulation (tDCS) may be beneficial in reducing pain in clinical settings. However, no studies have reported the effects of home-based self-administered tDCS on functional brain networks in older adults with knee OA. Aim: We used functional near-infrared spectroscopy (fNIRS) to investigate the functional connectivity effects of tDCS on underlying pain processing mechanisms at the central nervous level in older adults with knee OA. Approach: Pain-related brain connectivity networks were extracted using fNIRS at baseline and for three consecutive weeks of treatment from 120 subjects randomly assigned to two groups undergoing active tDCS and sham tDCS. Results: Our results showed that the tDCS intervention significantly modulated pain-related connectivity correlation only in the group receiving active treatment. We also found that only the active treatment group showed a significantly reduced number and strength of functional connections evoked during nociception in the prefrontal cortex, primary motor (M1), and primary somatosensory (S1) cortices. To our knowledge, this is the first study in which the effect of tDCS on pain-related connectivity networks is investigated using fNIRS. Conclusions: fNIRS-based functional connectivity can be effectively used to investigate neural circuits of pain at the cortical level in association with nonpharmacological, self-administered tDCS treatment.

Impact of ChatGPT on Interdisciplinary Nursing Education and Research.

ChatGPT, a trending artificial intelligence tool developed by OpenAI, was launched in November 2022. The impact of ChatGPT on the nursing and interdisciplinary research ecosystem is profound.

Non-Invasive Neuromodulation Methods to Alleviate Symptoms of Huntington's Disease: A Systematic Review of the Literature.

Huntington's disease (HD) is a progressive and debilitating neurodegenerative disease. There is growing evidence for non-invasive neuromodulation tools as therapeutic strategies in neurodegenerative diseases. This systematic review aims to investigate the effectiveness of noninvasive neuromodulation in HD-associated motor, cognitive, and behavioral symptoms. A comprehensive literature search was conducted in Ovid MEDLINE, Cochrane Central Register of Clinical Trials, Embase, and PsycINFO from inception to 13 July 2021. Case reports, case series, and clinical trials were included while screening/diagnostic tests involving non-invasive neuromodulation, review papers, experimental studies on animal models, other systematic reviews, and meta-analyses were excluded. We have identified 19 studies in the literature investigating the use of ECT, TMS, and tDCS in the treatment of HD. Quality assessments were performed using Joanna Briggs Institute's (JBI's) critical appraisal tools. Eighteen studies showed improvement of HD symptoms, but the results were very heterogeneous considering different intervention techniques and protocols, and domains of symptoms. The most noticeable improvement involved depression and psychosis after ECT protocols. The impact on cognitive and motor symptoms is more controversial. Further investigations are required to determine the therapeutic role of distinct neuromodulation techniques for HD-related symptoms.

Feasibility, Acceptability, and Efficacy of Home-Based Transcranial Direct Current Stimulation on Pain in Older Adults with Alzheimer's Disease and Related Dementias: A Randomized Sham-Controlled Pilot Clinical Trial.

Although transcranial direct current stimulation (tDCS) is emerging as a convenient pain relief modality for several chronic pain conditions, its feasibility, acceptability, and preliminary efficacy on pain in patients with Alzheimer's disease and related dementias (ADRD) have not been investigated. The purpose of this pilot study was to assess the feasibility, acceptability, and preliminary efficacy of 5, 20-min home-based tDCS sessions on chronic pain in older adults with ADRD. We randomly assigned 40 participants to active (n = 20) or sham (n = 20) tDCS. Clinical pain intensity was assessed using a numeric rating scale (NRS) with patients and a proxy measure (MOBID-2) with caregivers. We observed significant reductions of pain intensity for patients in the active tDCS group as reflected by both pain measures (NRS: Cohen's d = 0.69, p-value = 0.02); MOBID-2: Cohen's d = 1.12, p-value = 0.001). Moreover, we found home-based tDCS was feasible and acceptable intervention approach for pain in ADRD. These findings suggest the need for large-scale randomized controlled studies with larger samples and extended versions of tDCS to relieve chronic pain on the long-term for individuals with ADRD.

Management of Chronic Pain and PTSD in Veterans With tDCS+Prolonged Exposure: A Pilot Study.

INTRODUCTION: Chronic pain and posttraumatic stress disorder (PTSD) are prevalent comorbid conditions, particularly in Veterans; however, there are few integrated treatments for chronic pain and PTSD. Instead, interventions are typically implemented separately and may involve addictive opioids. Although there are highly effective, non-pharmacological treatments for PTSD, they are plagued by high dropout, which may be exacerbated by comorbid pain, as these PTSD treatments typically require increased activity. Importantly, a noninvasive pain treatment, tDCS (transcranial direct current stimulation) shows indications of effectiveness and may be integrated with psychological treatments, even when delivered via telehealth. This study examines the feasibility and initial efficacy of integrating home telehealth tDCS with prolonged exposure (PE), an evidence-based PTSD treatment. MATERIALS AND METHODS: Thirty-nine Veterans were contacted, 31 consented to evaluation, 21 were enrolled, and 16 completed treatment and provided pre- and post-treatment data at one of two Veterans Affairs Medical Centers. Transcranial direct current stimulation sessions corresponded with PE exposure assignments, as there is theoretical reason to believe that tDCS may potentiate extinction learning featured in PE. RESULTS: Patients evinced significant improvement in both pain interference and PTSD symptoms and a trend toward improvement in depression symptoms. However, a significant change in pain intensity was not observed, likely because of the small sample size. DISCUSSION: The findings provide initial support for the feasibility of an entirely home-based, integrated treatment for comorbid PTSD and pain.

The Influence of the BDNF Val66Met Variant on the Association Between Physical Activity/Grip Strength and Depressive Symptoms in Persons With Diabetes.

The rs6265 in the brain-derived neurotrophic factor (BDNF) is associated with depression in people with diabetes. Both physical activity (PA) and grip strength are negatively associated with depression. We conducted cross-sectional analyses of the wave 10 survey data for a nationally representative sample of 1,051 diabetes participants of the Health and Retirement Study. Both greater PA (ß = -.15) and stronger grip strength (ß = -.02) were independently associated with depression. Although the interaction between BDNF rs6265 and PA on depressive symptoms was not significant, the negative PA-depression association was stronger among female non-Met carriers (ß = -.19) and male Met carriers (ß = -.14). Meanwhile, grip strength was associated with depression only in Met carriers (ß = -.04), and similar association was observed in both males and females. In conclusion, female non-Met carriers and male Met carriers may benefit from PA.

Efficacy of Home-Based Transcranial Direct Current Stimulation on Experimental Pain Sensitivity in Older Adults with Knee Osteoarthritis: A Randomized, Sham-Controlled Clinical Trial.

Although transcranial direct current stimulation (tDCS) is encouraging regarding clinical pain intensity for individuals with knee osteoarthritis, very few studies have explored its impact on experimental pain sensitivity, which may hinder our understanding of underlying therapeutic mechanisms. The purpose of this study was to assess the efficacy of 15 home-based tDCS sessions on experimental pain sensitivity and explore its relationships with clinical pain intensity. We randomly assigned 120 participants to active tDCS (n = 60) and sham tDCS (n = 60). Quantitative sensory testing (QST) was used, including heat pain threshold and tolerance, pressure pain threshold, and conditioned pain modulation. Patients in the active tDCS group exhibited reduced experimental pain sensitivity as reflected by all QST measures at the end of treatment. Furthermore, correlations were observed between changes in clinical pain intensity and experimental pain sensitivity. These findings warrant further studies on tDCS and experimental pain sensitivity in patients with knee osteoarthritis and exploring the magnitude and sustainability of effects on a longer term.

Self-administered transcranial direct current stimulation for pain in older adults with knee osteoarthritis: A randomized controlled study.

BACKGROUND: Knee osteoarthritis (OA) is a leading cause of pain in older adults. Previous studies indicated clinic-based transcranial direct current stimulation (tDCS) was effective to reduce pain in various populations, but no published studies have reported the efficacy of home-based self-administered tDCS in older adults with knee OA using a randomized clinical study. OBJECTIVE: The purpose of this study was to evaluate the efficacy and feasibility of tDCS on clinical pain intensity in adults with knee OA pain. METHODS: One hundred twenty participants aged 50-85 years with knee OA pain were randomly assigned to receive fifteen daily sessions of 2 mA tDCS for 20 min (n = 60) or sham tDCS (n = 60) over 3 weeks with remote supervision via telehealth. Clinical pain intensity was measured by the Numeric Rating Scale and Western Ontario and McMaster Universities Osteoarthritis Index. Also, we collected data on the tDCS experience via a questionnaire. RESULTS: Participants (68% female) had a mean age of 66 years. Active tDCS significantly reduced pain intensity compared to sham tDCS after completion of the fifteen daily sessions (Cohen's d = 1.20; p-value < 0.0001). Participants showed high levels of satisfaction with their tDCS experience, and there have been no adverse events. CONCLUSION: We demonstrated that home-based self-administered tDCS was feasible and reduced clinical pain intensity in older adults with knee OA, which can increase its accessibility. Future studies with multi-site randomized controlled trials are needed to validate our findings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT04016272.

Remotely supervised home-based online chair yoga intervention for older adults with dementia: Feasibility study.

BACKGROUND: and Purpose: Social isolation and caregiver burden call for an innovative way to deliver a chair yoga (CY) intervention to older adults with dementia who cannot travel to a community center. During a remotely supervised CY session, the yoga instructor can monitor each participant's pose and correct poses to optimize efficacy of CY and reduce chances of injury. This study assessed the feasibility of a remotely supervised online CY intervention for older adults with dementia and explored the relationship between CY and clinical outcomes: pain interference, mobility, risk of falling, sleep disturbance, autonomic reactivity, and loneliness. METHODS: Using a one-group pretest/posttest design, a home-based CY intervention was delivered remotely to 10 older adults with dementia twice weekly in 60-minute sessions for 8 weeks. Psychosocial and physiological (i.e., cardiac) data were collected remotely at baseline, mid-intervention, and post-intervention. RESULTS: The results indicated that remotely supervised online CY is a feasible approach for managing physical and psychological symptoms in socially isolated older adults with dementia, based on retention (70%) and adherence (87.5%), with no injury or other adverse events. While there were no significant findings for pain interference, mobility, sleep, or social loneliness longitudinally, emotional loneliness showed a significant increase, F(1.838, 11.029) = 6.293, p = .016, η2 = 0.512, from baseline to post-intervention. Although participants were socially connected to other participants via a videoconferencing platform, emotional loneliness increased during the pandemic period. CONCLUSION: A home-based remotely supervised online CY is a feasible approach for socially isolated older adults with dementia who are unable to travel to a facility.

Health Literacy and Access to Care in Cancer Screening Among Korean Americans.

BACKGROUND: Health literacy and access to care are critical facilitators for preventive health behaviors. After the passage of the Affordable Care Act in March 2010, little has been studied about how improved health insurance coverage has impacted the use of preventive health services among Korean Americans. OBJECTIVE: The study assessed the impact of access to care, use of services, and health literacy on cancer screening among Korean Americans. METHODS: A descriptive cross-sectional study of 377 Korean Americans age 18 years and older was conducted with a survey and convenient sampling in Texas. KEY RESULTS: Although 79% of the sample had health insurance, 32% had never visited a health care provider, and 14% were delayed in care in the past 12 months. Only 11.6% were confident to complete medical forms, and 69.5% had limited levels of confidence. Cancer screening compliance rates were: mammography (50.4% at age 40-54 years; 46.6% at age 55 years and older), a Pap smear (29.4% at age 21-29 years; 78.4% at age 30-65 years; 72.2% at age 66 years and older), and colorectal cancer screening at age 45 years and older (stool tests 15.1%; sigmoidoscopy 27%; colonoscopy 51.3%). Multiple logistic regression analyses revealed that household income, gender, health insurance, and health literacy were significantly associated with self-reported cancer screening. CONCLUSIONS: Korean Americans who participated in this study are characterized by marginalized health literacy, underused health care services, and significantly lower cancer screening compliance than the goals of Healthy People 2020. The following interventions are suggested to improve health literacy and health insurance literacy on cancer screening: culturally sensitive and linguistically appropriate education for the guidelines concordant with cancer screening, effective communication skills with health care providers, support for navigating the health care system, and development of internet- or social media-based health education programs to meet the preferred communication methods of this population. [HLRP: Health Literacy Research and Practice. 2021;5(4):e310-e318.] Plain Language Summary: Despite having improved health insurance coverage, Korean Americans of this study have marginalized health literacy, limited health insurance literacy, low cancer screening compliance, and underused health care services. The results of this study suggest several strategies to improve health literacy and health insurance literacy for Korean Americans, which may also apply to other groups with similar barriers.