resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Practice Policy (Gone Bad): The Sign
Every once in a while, you see something and think to yourself, That's a really bad idea. Case in point: I went to see my medical doctor the other day. Just after being "roomed," as they say, the nurse checked my vital signs. Then she left.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 1
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Harvard Health References Flawed AHA Position Paper
In its special health report, "Stroke: Diagnosing, Treating, and Recovering From a 'Brain Attack,'" Harvard Health Publications includes information from the American Heart Association's 2014 position statement on cervical manipulation and cervical dissection – a statement the American Chiropractic Association emphasized in a letter to Harvard Health mixes "scientific facts with half-truths."
News in Brief
Call for Abstracts Announced - Parker Las Vegas 2016; Logan Adds Doctorate Degree; New Role for Dr. James Edwards.
Help: A Need at Every Level
One of the great gifts of training in acupuncture is the ability to take good care of oneself. I recently had a bout of frozen shoulder — an inflammatory syndrome which can be debilitatingly painful and take years to resolve.
Improving Communication Between AOM and Biomedical Providers
How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped.
The Short Leg Dilemma
When evaluating a new patient, it is common to note a relative shortening of one leg to the other. Some patients will even tell you they have one, and then pull out the store-bought heel lift they read about online.
Do Some Good and Grow Your Business with Cause Marketing
Cause marketing is truly one of the best ways that you can promote your services as a acupuncture professional. Cause marketing refers to a type of marketing where a business partners with a non-profit organization to help bring awareness to a charitable cause.
An Acupuncturist's View of Medicinal Marijuana
The use of cannabis for medical purposes is very controversial. Use as a panacea by physicians uninitiated to the proper application of herbal medicine, as well as an excuse for recreational use have greatly confused the issue.
The Zen Art of "One Point"
We were always told in our Zen Shiatsu training (by Japanese and Japanese American instructors) that our ultimate aim was to to find that "One Point." To be so focused we could touch just one point to transform Qi throughout a client's body.
Practicing with Authenticity
To extrapolate from the above quote, patients love healthcare providers they can trust. One way to earn the trust of your patients is by practicing with authenticity. What does that mean, exactly?
Surprising Reasons for Orthotic Efficacy
Clinical outcome studies show orthotics are effective in the management of a wide range of injuries, including plantar fasciitis, Achilles tendinitis and patellofemoral pain syndrome.
Nuts Reduce Risk of Heart Disease, Cancer and Other Health Problems
Several recent studies suggest regular consumption of nuts may provide a significant degree of protection against certain types of cancer, heart disease, possibly type 2 diabetes and some neurodegenerative diseases.
Patient-Centered Care vs. Payer Restrictions: Your Ethical Obligation
Do you have an ethical obligation to evaluate your patients, make a diagnosis and provide evidence-based, patient-centered health care, irrelevant to the payer restrictions?
Getting a YES: An Effective Strategy for Overcoming Patient Objections
Patients make more excuses for declining care from an acupuncturist than perhaps any other type of doctor. Various reasons hold them back from making a commitment to care.
Modernization of Chinese Medicine
Language – written, spoken, signed, or otherwise is learned as a means to express our individualized perceptions about the world around us. Language is designed to communicate our personal experiences.
What's Chiropractic Research Worth to You?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fundraising campaign to support chiropractic research.
Dorsiflexion Dysfunction: Evaluation & Manipulation Techniques
Almost every condition from the foot to the hip can be attributed to the inability to dorsiflex the ankle mortice and other joints that participate in dorsiflexion. Let's start by understanding normal versus abnormal dorsiflexion.
Oriental Medicine on the World Stage
"Let me win. But if I cannot win, let me be brave in the attempt." This simple, yet powerful statement was lived out time and time again by so many of the athletes from around the world during the Special Olympics World Games in Los Angeles.
More Chiropractors Required
An intriguing study published in the Journal of the American Board of Family Medicine examines how "chiropractic care affects use of primary care physician (PCP) services."
Change Lives by Supporting Chiropractic Research: Are You In?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fund-raising campaign to support chiropractic research.
Fertility and Poly-Unsaturated Fatty Acids
Starting or expanding one's family is a major milestone. It's something that more and more people seek out health care advice and support for.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 2
In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing.
The Food Conversation: Nutrition and Your Practice
It's morning and your first patient rolls in with a triple espresso steaming in one hand and a frazzled, desperate look in her eye. "You gotta help me, doc, I am constipated unless I drink one of these, and I am exhausted and anxious all the time."
A Chiropractor's Guide to Yoga
"Doctor, can I continue to do yoga while undergoing your care?" "Is it OK for me to go back to yoga while I'm getting my back treated?" "It is safe to start my yoga classes again after my neck pain improves?"
Fish Oil: A Key Component of Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
February, 2007, Vol. 07, Issue 02
Learning From the Largest Study on Cancer and Massage
By Tracy Walton, LMT, MS
The body of research on cancer and massage is growing. One study often cited to support massage therapy programs for cancer patients was performed by the Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City.Authored by Barrie Cassileth and Andrew Vickers, it's titled "Massage Therapy for Symptom Control: Outcome Study at a Major Cancer Center," and is the largest published study on cancer and massage to date. MSKCC is not new to the massage arena. Therapists have provided Swedish massage, light-touch massage and foot massage since 1999, and both inpatients and outpatients receive the work.
The "Big Five" Cancer Symptoms
Health care for cancer patients focuses on what some people call "The Big Five" symptoms patients face: pain, nausea, fatigue, anxiety and depression. Medications can help somewhat, but these five symptoms still can cause much suffering along the cancer journey. Massage therapists have offered anecdotal reports of symptom relief in their clients. If their experiences turn out to be true for significant numbers of people, this indeed will be news.
So far, only small studies have suggested a link between massage and symptom relief, and it's too early to claim "proof." Cassileth and Vickers strengthen the suggested link with this observational study of their clinical offerings, documenting their patients' responses to massage in a systematic way.
In this study, symptom cards were distributed to patients. These cards asked them to rate their symptoms on a 0-10 scale at baseline (pre-massage) and post-massage, five to 15 minutes afterward. Three years' worth of patients led to a large sample size.
Cards were returned for several thousand massage sessions, and the study staff pared them down to only the initial sessions for 1,290 different patients. Because of when the cards were completed, they supplied data only on immediate effects on symptoms, if any. To see about sustained effects on symptom relief, investigators followed up with approximately one-quarter of the patients by phone, 24 to 48 hours after their massage session. A large amount of data was collected.
Control Group or No Control Group?
It's important to note the absence of a control group in this study. This was not a "randomized, controlled clinical trial (RCT)." In an RCT, patients in the study are randomized to either an intervention (massage) group or a non-intervention (control) group, the intervention is applied (or not, in the case of the control), and the same measurements are taken from both groups for comparison. A control group is a key feature of a study because, if treatment X appears to be effective for symptom Y, it's extremely important to know whether symptom Y would have improved without treatment X. Symptoms tend to come and go, and symptoms improve for all sorts of reasons. Thus, a control/comparison group is vital if you want to isolate any effects that are specific to massage.
In class, I often am asked, "Why did this group carry out such a large study without bothering to include a control group? Isn't it a lot of wasted work?" This is an important question. For the goals of the study, a control group wasn't necessary. One goal was to see whether existing clinical services seemed to be helping people. Another was to check feasibility: whether massage therapy could indeed be delivered at high volume in a major cancer center. Even though the massage program had been up and running and was theoretically feasible, because it already was happening, numbers like this make feasibility real. This observational self-study was the perfect design for these particular goals.
A controlled clinical trial of this size would be very costly. However, such an observational study lays a foundation for one, paving the way for funding. The authors mentioned their plans for an RCT in the paper, and a look at the MSKCC Web site shows that one currently is underway on massage at the end of life. Moreover, the data from this observational study support not only the researchers themselves, but also the rest of us in seeking funding and support for RCTs on cancer and massage. So, their efforts were in no way wasted.
What Did They Find?
The researchers found what you might expect − immediate, dramatic reductions in all five symptoms. Notably, in patients who initially scored a given symptom at 4 or more, the average improvements in that symptom ranged from 42.9 percent in fatigue to 59.9 percent in anxiety. Patients who had Swedish and light-touch massage had stronger responses than those who received foot massage, but there was little difference in the outcomes between Swedish and light-touch massage.
Those were the immediate, post-massage effects. Follow-up scores looking for sustained effects were obtained from inpatients two to five hours after treatment and from outpatients 24 to 48 hours later. Improvement in outpatients' symptoms persisted over that time period. In contrast, inpatient scores, which initially had improved, started to worsen in just a few hours after massage treatment. This is an interesting difference!
Although it's tempting to focus only on massage benefits, other data about the massage protocols and other factors also were interesting. For example, investigators found that Swedish massage and foot massage were more commonly administered than light-touch massage, and that foot massage was used more often for inpatients than outpatients. The latter may reflect practical issues in massage with inpatients − being able to easily reach the feet of a patient surrounded by equipment, no need for repositioning, and so on. Swedish massage and light-touch massage were balanced between in- and outpatients. Moreover, the average length of the massage session for an inpatient was just 20 minutes, while the average session for outpatients was 60 minutes in length. This is a wide range in dose, an important clinical factor. In my experience, massage therapists are good for some lively conversation about the needed, tolerated and best massage dose for any given symptoms!
These data provide rich opportunity for speculation. Why did the outpatients seem to do better than the inpatients? Is it a function of the difference in massage dose? Is it a function of the type of massage protocols or how ill the patients were in the first place? Is it harder to sustain the benefits of massage in a hospitalized patient in an acute health crisis than in an outpatient? These questions call for further study.
The investigators themselves stated, "Major, clinically relevant, immediate improvements in symptom scores were reported following massage therapy. Given the observational nature of this study, we cannot make conclusions about the cause of this effect." Their caution is well-advised. If you cite this study in support of massage therapy for this population, always mention it was an observational study, rather than a controlled trial that would establish clearer cause and effect. Use the word "suggest" rather than "prove." However, also note that this study offered clinical outcomes similar to smaller controlled trials in this population. See my summary of two such massage trials in the May 2006 and November 2006 issues of Massage Today.
Even without a control group, this study offers therapists, hospital administrators and health care providers a stronger foundation for massage. If you are building a case for a massage therapy program in your facility, note that MSKCC found it feasible for inpatients and outpatients at high volume. If your prospective client is nervous about receiving massage during cancer treatment or isn't sure it would help, a study like this suggests other people found it safe and helpful. This study gathers together 1,290 valuable, individual stories of massage into one place and offers them to us to scrutinize, learn from and appreciate. Studies such as this move the work forward. They inspire us by their example, move us to ask further questions and help us to envision a future when massage therapy is part of regular cancer care.
Author's Note: The article is indexed at www.pubmed.gov. Search the author to yield the abstract and ordering information, or request a reprint from the author in writing at MSKCC. Cassileth BA, Vickers, AJ. Massage therapy for symptom control: outcome study at a major cancer center. Journal of Pain and Symptom Management 2004;28(3):244-9. Memorial Sloan-Kettering Cancer Center, Integrative Medicine. "Our Research." Available at www.mskcc.org/mskcc/html/1990.cfm. Accessed 12-06.
Click here for more information about Tracy Walton, LMT, MS.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.