Idaho College of Osteopathic Medicine

PURPOSE:Transcutaneous electrical nerve stimulation (TENS) is a non-invasive, non-pharmacologic therapy with efficacy in treating chronic pain. This study evaluated the analgesic effectiveness of TENS in individuals with chronic neuropathic/nociplastic ocular pain (NOP) and explored predictors of response. DESIGN:Prospective, randomized, controlled pilot study PARTICIPANTS: Thirty-seven individuals (mean age 58 ± 12 years, 51% female) with moderate to severe chronic NOP. METHODS:Participants were randomized (2:1) to a 20-minute high-frequency TENS (hfTENS, 60 Hz) or low-frequency TENS (lfTENS, 3 Hz) intervention, delivered at the forehead three times/week, for six months. Study visits occurred at baseline, three, and six months, during which data from ocular symptom questionnaires, quantitative sensory testing (QST), and ocular examinations were collected. MAIN OUTCOME MEASURES:The primary outcome was change in ratings of pain intensity (0-10 numerical rating scale [NRS]). Secondary outcomes included changes in other measures of NOP symptom severity, QST metrics assessing evoked somatosensory sensitivity, and ocular signs (eg, corneal staining). RESULTS:Both hfTENS and lfTENS significantly reduced eye pain intensity acutely (within 24-hours of initial treatment), and hfTENS produced long-lasting improvements in the NPSI-Eye subscores of pressing pain (2.50 [5.50] to 1.50 [2.50], p = .03) and paroxysmal pain (1.50 [3.50] to 0.00 [1.50], P = .02) at three months, though without corresponding changes in NRS scores of generalized ocular pain intensity. No changes were noted at six months, and neither intervention impacted ocular exam findings at any time point. Significant baseline predictors of long-term TENS response included lower NPSI-Eye scores and lower sensitivity to noxious heat stimuli. CONCLUSIONS:Both hfTENS and lfTENS effectively reduced NOP short-term, with hfTENS also demonstrating sustained analgesia for neuropathic-like symptoms at three months. Baseline NOP severity and cutaneous sensitivity were predictive of treatment response and suggest reduced disruption of central pain modulatory mechanisms is efficacious for susceptibility to hfTENS analgesia. Together, the results from this pilot study highlight the potential of TENS as a neuromodulatory treatment for NOP, warranting future studies to guide patient selection and optimization of therapeutic benefit. CLINICAL TRIAL REGISTRATION:Pilot Study of TENS for Ocular pain; NCT05531643.

Patients with sickle cell disease (SCD) are vulnerable to acute hematologic complications due to chronic hemolysis and dependence on increased erythropoiesis. Parvovirus B19 infection can suppress erythroid progenitor cells, precipitating a transient aplastic crisis characterized by severe anemia and reticulocytopenia. Early recognition is critical to distinguish this condition from other causes of acute anemia in patients with SCD. A 22-year-old man with hemoglobin SS SCD and prior splenectomy presented with a three-day history of severe headache, non-bloody emesis, fevers, fatigue, and generalized myalgias distinct from his typical vaso-occlusive crises. On presentation, vital signs were stable, and physical examination was largely unremarkable. Laboratory evaluation demonstrated severe anemia with a hemoglobin of 4.5 g/dL (baseline: 7-10 g/dL), leukocytosis (19×10⁹/L), thrombocytopenia (94×10⁹/L), and a reticulocyte count of 2.8%. Hemolysis markers were elevated but consistent with his baseline chronic hemolysis. Peripheral smear revealed 1-3% sickled erythrocytes. Evaluation for alternative causes of acute anemia, including thrombotic microangiopathy, disseminated intravascular coagulation, autoimmune hemolytic anemia, and hemophagocytic lymphohistiocytosis, was unrevealing. Viral studies demonstrated elevated parvovirus B19 IgM and IgG antibodies, confirming acute infection. The patient received four units of packed red blood cells with improvement in hemoglobin to 6.6 g/dL. He was managed with supportive care, and hematologic parameters gradually returned toward baseline prior to discharge. This case highlights the importance of recognizing parvovirus B19-induced transient aplastic crisis as a potentially life-threatening but treatable complication in patients with SCD. Existing literature describes reticulocytopenia as a key distinguishing feature from other causes of acute anemia in SCD, yet diagnosis may be challenging when patients present with nonspecific viral symptoms or concurrent laboratory evidence of chronic hemolysis. Our case reinforces prior reports emphasizing that an inappropriately low reticulocyte response in the setting of profound anemia should prompt evaluation for parvovirus B19 infection, even in patients with baseline hemolysis and complex hematologic abnormalities. Additionally, the low percentage of sickled erythrocytes on peripheral smear despite severe anemia underscores the importance of considering aplastic crisis rather than vaso-occlusive or hyperhemolytic processes. Early recognition and supportive transfusion therapy remain essential to prevent morbidity and guide appropriate management.

CONTEXT:Depression and other mood disorders have a significant impact on patients, affecting their daily functioning, physical health, and emotional well-being. While psychopharmacological medications and psychotherapy are the most common evidence-based treatments (supported by a significant amount of scientific research), there is growing research that supports the use of complementary therapies (nonmainstream approaches utilized together with conventional medicine), including manipulative or manual therapies. OBJECTIVES:This systematic review contributes to the existing literature by evaluating published studies on the effectiveness of various manual-therapy modalities in reducing depression symptoms, and it provides a comparative examination of these modalities as complementary treatment options for depression and related mood disorders. METHODS:A comprehensive literature search was conducted from January to April 2025 utilizing PubMed, Embase, and Google Scholar. Search results were uploaded to DistillerSR to assist with the screening phase. The study selection process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria required studies to be to be peer-reviewed, published in English, assessed mood disorder symptoms as a primary variable, utilized validated depression measures pre- and postintervention, and involved manual therapies administered by qualified professionals. Selected articles were independently evaluated by authors with two metrics: a level of evidence (LOE) table and a screening criterion incorporating specific elements from the search process. The Strength of Recommendation Taxonomy (SORT) was utilized to assess the quality of the studies. RESULTS:The literature search gathered 6,661 articles that were uploaded to DistillerSR. Then 717 duplicates were removed, so 5,944 articles were screened. Ultimately, 5,810 articles were excluded during title and abstract screening. Full-text analysis was conducted on 132 articles, of which 97 met the inclusion criteria. The following modalities were studied: acupressure, acupoint massage, bone setting, chiropractic manipulation, craniosacral therapy, energetic and light touch therapies, manual therapy, osteopathic manipulative treatment/therapy (OMT/OMTh), foot reflexology, massage therapy, and other soft tissue therapies. Each modality was assigned a "B" rating based on SORT. Seventeen studies in the review included patients with specific psychiatric diagnoses, such as major depressive disorder (MDD), depression, adjustment disorder, and seasonal affective disorder, in which manipulative therapies were evaluated for their impact on managing depressive symptoms. Out of these 17 studies, 15 (88.2 %) reported that manipulative therapy led to a significant reduction in depression symptoms. The results of each modality demonstrating beneficial effects in treating depression symptoms are as follows: 6/6 (100 %) acupressure; 5/6 (83.3 %) chiropractic manipulation; 3/3 (100 %) craniosacral therapy; 8/9 (88.9 %) energetic therapies and light-touch therapies; 9/14 (64 %) manual therapy; 5/10 (50 %) OMT/OMTh; 2/3 (66.7 %) foot reflexology; 32/45 (71.1 %) massage therapy; and 2/5 (40 %) other soft tissue therapies. CONCLUSIONS:This systematic review evaluates the current literature indicating that manual therapy may be effective in reducing symptoms of depression as a complementary treatment. Research demonstrates that acupressure, craniosacral therapy, and massage therapy are consistently associated with improvements in depressive symptoms; however, further investigation into other modalities, particularly within psychiatric populations, is necessary. Ultimately, additional research is needed to substantiate the efficacy of manual therapies for individuals with psychiatric disorders.

Despite advancements in psoriasis therapeutics, biologic discontinuation and switching still happen frequently, with the most common reasons being lack of efficacy or treatment intolerance. Conventional teaching has been to switch out of the class (inter-class switching) for primary non-responders and to stay in the class (intra-class switching) for secondary non-responders. Previous real-world studies have reported success with intra-class switching within the IL-17 inhibitor class, but data have been limited to secukinumab, ixekizumab, and brodalumab. Using retrospective data from cases selected for moderate-to-severe psoriasis who failed prior IL-17 therapy, we report our real-world experience using bimekizumab in 50 patients who failed a prior IL-17 inhibitor, in which 82% achieved an IGA 0/1. By demonstrating achievement of stringent benchmarks, such as IGA 0/1 and sPGAxBSA 100 in these selected patients, we challenge the conventional teaching of primary vs secondary non-responders class switching, and have found bimekizumab to be a viable option in those who have failed IL-17 inhibitor therapy in the past.