This article reviews the complexities of the opioid epidemic, considering recent research involving the current state of the opioid epidemic; chronic pain and its role in the crisis; the properties of opioids and how they interact with human neurobiology; the effectiveness and risks of opioids as a treatment for chronic pain; opioid addiction and dependence; and pharmacological and psychological interventions for opioid addiction, opioid dependence, and chronic pain management. Opioid abuse can be reduced with the availability and access to treatment facilities for opioid detoxification; using interdisciplinary treatment models for chronic pain, opioid addiction and dependence; conducting more research in the areas of opioid addiction and opioid dependence; and shifting to an increase in nonpharmacological, less invasive treatments for pain.

A good understanding of age-dependent changes and modifications in brain networks is crucial for fully exploring the effects of aging on the human brain. Few reports have been found in studies of functional brain networks using functional near-infrared spectroscopy (fNIRS). Moreover, little is known about the feasibility of using fNIRS to assess age-related changes in brain connectomes. This study applied whole brain fNIRS measurement, combined with graph theory analysis, to assess the age-dependent changes in resting-state brain networks. Five to eight minutes of resting-state brain hemodynamic signals were recorded from 48 participants (18 young adults and 30 older adults) with 133 optical channels covering the majority of the cortical regions. Both local and global graph metrics were computed to identify the age-related changes of topographical brain networks. Older adults showed an overall decline of both global and local efficiency compared to young adults, as well as the decline of small-worldness. In addition, young adults showed the abundance of hubs in the prefrontal cortex, whereas older adults revealed the hub shifts to the sensorimotor cortex. These obvious shifts of hubs may potentially indicate decreases of the decision-making, memory, and other high-order functions as people age. Our results showed consistent findings with published literature and also demonstrated the feasibility of whole-head fNIRS measurements to assess age-dependent changes in resting-state brain networks.

This study examined the biopsychosocial characteristics of chronic low back pain (CLBP) in an understudied but increasingly larger part of the population: the elderly (i.e., 65 years and older). A new innovative physical functioning measure (postural control, which is a proxy for the common problem of slips and falls in the elderly) was part of this biopsychosocial evaluation. Also, the National Institutes of Health (NIH)-developed Patient-Reported Outcome Measurement Information System (PROMIS) was also part of this comprehensive evaluation. Two demographically-matched groups of elderly participants were evaluated: one with CLBP (n = 24); and the other without (NCLBP, n = 24). Results revealed significant differences in most of these measures between the two groups, further confirming the importance of using a biopsychosocial approach for future studies of pain and postural control in the elderly.

Chronic low back pain is a debilitating condition affecting millions of Americans annually. Older-adult populations suffer a high prevalence of this continually painful state, and further face a unique set of challenges to manage short-and long-term biopsychosocial functioning. As the population ages, and the proportion of older adults grow, it is essential to explore and develop the most effective interdisciplinary strategies to care for older adults who are chronic pain sufferers. In this Commentary, we highlight some of the special challenges that the older-adult population encounters, and their influence on pain management strategies.Keywords: Low back pain; Chronic pain; Biopsychosocial; America; Older adults CommentaryChronic low back pain (CLBP) is a widely prevalent condition affecting more than 25 million Americans [1]. In a recent 2014 report by the National Health Interview Survey (NHIS), it was noted that low back pain was the most prevalent reported pain site, exceeding joint conditions, headache/migraines, neck, and facial, or jaw pain [2]. Roughly one third (34%) of adults aged 65-74, and adults aged 75 and over (34.9%), reported low back pain in the last 3-months [2]. As the population ages, CLBP reports are expected to rise, further necessitating the need to develop interdisciplinary pain management strategies for this growing part of the population [3].In addition to CLBP, older adult populations often have multiple conditions that can complicate and limit traditional pain management therapies. As a result, they face distinctive challenges regarding healthcare regimens, including adherence, physical ability, psychological and social conditions, age-related mental decline, agerelated physical decline, and pharmacological intake concerns. Furthermore, general physical decline due to aging often limits the patient's ability to participate in physical interventions, such as exercise and more vigorous physical therapies. Often, simple stretching techniques or light exercise may not be a viable option [4]. Additionally, psychosocial status must be evaluated for adherence and well-being. Chronic pain patients often experience depression, anxiety, and sleep disorders [5], as well as dementia, Alzheimer's, and other ailments that can impede proper care.Medications are widely prescribed to help combat pain, particularly when these physical limitations are present. On average, older Americans consume multiple medications daily [6]. The large volume of prescription medication consumption certainly influences the available and appropriate treatment options to both avoid side-effects and maintain good quality-of-life. Considering these astonishing figures, it is vital to develop comprehensive, interdisciplinary preventive measures and pain management strategies in order to account for the unique concerns of the older-adult population. This Commentary aims to highlight some of the special challenges the older-adult population faces, and the importance of implementing interdisciplinary treatment strate...

Background: The results of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex for migraine have been inconsistent. However, high-frequency rTMS over the motor cortex is a treatment that may be effective in relieving symptoms of migraine with a low risk of side effects. Methods: A systematic review of high-frequency rTMS over the brain motor cortex areas in human participants was conducted to assess efficacy in treating migraine. Articles that were not looking at migraine patients, stimulation over the left motor cortex, or were not in English were excluded. Nine articles representing eight experiments using high-frequency rTMS over the motor cortex areas for migraine in human participants were extracted from the databases of PubMed, PsycINFO, MedLine, CINAHL, and BioMed Central. Results: Two-hundred and seven of 213 patients completed treatment throughout all the studies examined. High-frequency rTMS over the motor cortex areas for migraine improved migraine frequency in seven of eight studies. Two of the eight studies were randomized controlled trials at low risk for biases and found high-frequency rTMS over the motor cortex areas effective in improving migraine frequency and severity. Other details of treatment prescription and symptoms were also examined. Conclusion: High-frequency rTMS over the motor cortex areas for migraine demonstrated efficacy as a migraine treatment, had minimal side effects, and should be further investigated.

The objective of the current study was to examine the relative efficacy of two exercise techniques-a multidimensional treatment (MDT) and a traditional senior exercise therapy treatment (TET)-in older adults diagnosed with chronic low back pain (CLBP). Participants (N = 16) were randomly assigned to either the MDT (n = 8) or TET (n = 8) groups after meeting the requirements for the presence of CLBP. Participants in the MDT group received an individualized exercise program, while participants in the TET participated in a group exercise program. A Mann-Whitney test was conducted to determine differences between psychosocial and physical variables pre-and post-intervention. Statistical analyses indicated no significant differences in physical or psychosocial variables at pre-intervention assessment. However, participants in the MDT group reported a decrease in fatigue and pain interference, with an increase in physical functioning, when compared to the TET group. Additionally, the MDT group displayed a significant decrease pain interference, while the TET group had an increase grip strength. Patients who received the MDT reported less fatigue and pain interference, and an increase in their overall physical functioning.Overall, the MDT was a more efficacious method to manage CLBP.

The purpose of this review is to examine how whole-body vibration can be used as a tool in therapy to help improve common physical weaknesses in balance, bone density, gait, spasticity, and strength experienced by individuals with cerebral palsy. Cerebral palsy is the most common movement disorder in children, and whole-body vibration is quickly becoming a potential therapeutic tool with some advantages compared to traditional therapies for individuals with movement disorders. The advantages of whole-body vibration include less strain and risk of injury, more passive training activity, and reduced time to complete an effective therapeutic session, all of which are appealing for populations with physiological impairments that cause physical weakness, including individuals with cerebral palsy. This review involves a brief overview of cerebral palsy, whole-body vibration’s influence on physical performance measures, its influence on physical performance in individuals with cerebral palsy, and then discusses the future directions of whole-body vibration therapy in the cerebral palsy population.

This study examined the biopsychosocial measures related to postural control in the growing population of older adults (i.e., 60 years and older). The sample of the study consisted of 129 older adults (M = 74.45, SD = 6.95), with 34 males and 95 females; 36 were classified with chronic low-back pain (CLBP), and 93 without chronic low-back pain (NCLBP). Physical and psychosocial constructs were analyzed as predictors for postural control measures. Additionally, gender and classification of low-back pain were examined as moderators for all physical and psychosocial measures. Results demonstrated that physical and psychosocial measures were able to significantly predict composite, visual, and vestibular balance measures, but not somatosensory or preference balance measures. The chair-stand test, modified sit-and-reach test, sleep disturbance, and balance efficacy were all identified as individually significant predictors. Gender and CLBP did not moderate the utility of any predictor variables. Results of the current study re-confirm the importance of utilizing the biopsychosocial approach for future research examining postural control in older adults.