Importance Fibromyalgia is characterized by chronic widespread pain that is often exacerbated by movement that interferes with daily activities. Development of effective treatments for movement-evoked pain is essential for improving function for individuals with fibromyalgia. Objective To evaluate whether the addition of transcutaneous electrical nerve stimulation (TENS) to outpatient physical therapy improves fibromyalgia-associated movement-evoked pain. Design, Setting, and Participants The Fibromyalgia TENS in Physical Therapy (FM-TIPS) study was a cluster-randomized clinical trial of participants with fibromyalgia at 28 outpatient PT clinics from 6 health care systems. Between February 1, 2021, and September 31, 2024, 958 participants were screened, 459 participants enrolled, and 384 completed baseline data collection, with final data collected in March 2025. Intervention Clinics were randomized to PT plus TENS (PT-TENS) and PT-only groups. Data were captured on days 1, 30, 60 (primary end point, randomized phase), 90, and 180. Participants in the PT-only group received TENS after day 60 (extension phase). TENS was applied to the upper and lower back with instructions to use 2 hours daily with parameters of modulating frequency of 2 to 125 Hz for 100 to 180 microseconds at a strong but comfortable intensity. Main Outcomes and Measures The primary outcome was a change in movement-evoked pain (scale of 0-10, with 0 indicating no pain and 10 indicating worst pain imaginable) from baseline to day 60 rated during a 5-times sit-and-stand task using a linear mixed-effects model. In addition, patient-reported improvement based on the Patient Global Impression of Change score and patient-reported adverse events were assessed. Results A total of 384 FM-TIPS participants (mean [SD] age, 53 [15] years; 351 [91%] female) completed baseline data collection (modified intention-to-treat), with 191 individuals in PT-TENS group and 193 in PT-only group. Movement-evoked pain at day 60 during TENS treatment was significantly lower in the PT-TENS group compared with the PT-only group (group mean difference, −1.2; 95 CI, −1.6 to −0.7; d = 0.46). A dose-response effect for TENS was observed, with more participants in the PT-TENS group reporting improvement on the Patient Global Impression of Change (120 [72%] vs 86 [51%], P = .001) and a 30% or greater reduction in movement-evoked pain in responder analysis (66 of 161 [41%] vs 22 of 169 [13%]; P < .001). At day 180, 217 respondents (81%) found TENS helpful and 147 (55%) used TENS daily. There were no serious adverse events, and 109 of 358 (30%) experienced minor adverse events during the entire 6 months of the study. Conclusions and Relevance In this cluster randomized clinical trial of TENS in fibromyalgia, TENS meaningfully reduced movement-evoked pain and remained effective for 6 months. This study’s results suggest that TENS is a safe, inexpensive, and readily available treatment for fibromyalgia. Trial Registration ClinicalTrials.gov Identifier: NCT04683042
John Buchanan reveals the “wider spiritual landscape” opened up by integrations of Whitehead’s philosophical cosmology and Stanislav Grof’s cartographic work on transpersonal experience and psychedelic states of awareness. In answering the plea of William James that discussions of such phenomena “be broadened and thickened up” and related to the nature of reality as a whole, Buchanan argues that Whitehead’s cosmology, by virtue of its “panexperientialism” and “panentheism,” is implicitly (if not explicitly) open to varieties of evidence surrounding psycho-spiritual existence and experience. Buchanan leverages relevant comparative dimensions inherent in the research and theories of Grof across exceptional or nonordinary experiences. In particular, Grof’s work erects striking parallels between descriptions of powerful transpersonal encounters and Whitehead’s own explication of God’s dipolar nature as “primordial” and “consequent.”
Digital Cartography, Inc., a leader in providing comprehensive, current and seamless geographic digital data for the whole earth, is pleased to announce the release of ADC WorldMap Digital Atlas v7.1.The ADC WorldMap upgrade features two new layers: World Seas and World Coastlines.The World Seas layer represents seas for the entire world represented as polygons.The World Coastlines layer contains coastlines for the entire world, differentiated by country.With the addition of these two new layers, this release of ADC WorldMap will con tain a total of 42 detail-rich layers and tables.Along with the two new layers, ADC WorldMap Digital Atlas v7.1 includes current country and first level political boundaries for the entire world and over 37 000 second level political boundaries in 123 countries.The population data has also been updated in many cities across 112 countries.This release also adds over 2 300 parks to the Parks and Protected Areas layers.Joe Roehl, Vice President of ADCi, says, "We continually look to enhance the features included in ADC WorldMap by staying current with market needs."Roehl adds, "Version 7.1 adds two new layers-World Seas and World Coastlines-which further enhances the best available worldwide data at this scale."ADC WorldMap Digital Atlas v7.1 is available in Esri, MapInfo and Oracle Spatial formats.
This white paper, prepared by a working group of the Catholic Medical Association, provides a commentary on a new type of end-of-life document called a POLST form (Physician Orders for Life-Sustaining Treatment) as well as on its model (or “paradigm”) for implementation across the United States. After an introductory section reviewing the origin, goals, and standard defenses of the POLST paradigm and form, the paper offers a critical analysis of POLST, including an analysis of the risks that POLST poses to sound clinical and ethical decision-making. The paper ends with several recommendations to help Catholic healthcare professionals and institutions better address the challenges of end-of-life care with alternatives to POLST.
