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Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
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.
Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
Acupuncture and Oriental Medicine in the West
We know acupuncture and Oriental medicine as the indigenous medicine of East Asia; in particular China, Korea and Japan are the countries of origin of this wonderful healing system.
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
Dietary Fat and Prostate Cancer: An Important Update
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
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.
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