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Teach Your Patients About External Healing Applications
Since the skin is the body's largest organ, and is able to respond to both internal and external stimulations, communicate sensations to the brain, protect the body, breathe and even excrete toxins, it can be an excellent source of healing.
Functional Impingement of the Hip (Part 2): Rehab Exercises
I find functionally impinged hips that don't move properly on so many of my patients. (See part 1 of this article for a description of the condition.)
If Your Pro-Chiropractic Governor Resigned, Would You Be Prepared?
John Kitzhaber, MD, recently re-elected to a historic fourth term as Oregon governor, has resigned among alleged ethics violations by his fiancée' and first lady, Cylvia Hayes. I developed a personal friendship with John and consider him a good friend.
Applauding a Legacy of Leadership
Founding Palmer West President, John Miller, DC, HCD (Hon.), FICA (Hon.), a 1954 graduate of Palmer College of Chiropractic, passed away March 8, 2015 at age 83.
Talking to Patients About Medial Branch Neurotomy (Part 2)
Even when lumbar facet denervation (medial branch neurotomy) is successful, relief is rarely complete or permanent. Smuck, et al., reviewed 16 articles and found the average duration of >50 percent pain relief for an initial procedure was nine months.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
Apple Takes a Bite Out of Research
The more than 700 million iPhone users have just been given the opportunity to "do their part to advance medical research."
News in Brief
Dr. Frank Nicchi Receives Award at ACC-RAC; Sherman College Expands International Influence.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
Trouble in the Wellness Waters?
Call me old-fashioned, paranoid or just old, but I do remember graduating from chiropractic college in the late '70s in the midst of the Wilk v AMA lawsuit.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
Make Every Day Mother's Day
May is a special month for many reasons. After a long, harsh winter, spring is at last in full swing. Memorial Day helps us honor those who have fought and fallen in the name of freedom.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
December, 2010, Vol. 10, Issue 12
Pediatric Massage Study Finds Surprising Results
By Tracy Walton, LMT, MS
I had the great pleasure of attending the American Massage Therapy Association National Convention in Minneapolis this year, and hearing a panel discuss pediatric massage research. Among the presenters was Dr. Sean Phipps, a psychologist and researcher at St. Jude Children's Research Hospital in Memphis.He presented a large study of massage and humor therapy in children undergoing stem cell transplant (SCT).1 Stem cell transplant is typically used to treat certain types of cancer and blood diseases. It is a rigorous procedure, with multiple medical risks to the patient.
This is an important and useful study for a number of reasons:
I'll leave the explanation and importance of the first two points to the various resources in massage research literacy.2 Instead, I want to focus here on the last point, that the study observed NO effect from massage or humor therapy in pediatric SCT patients. The audience was understandably surprised, and some of us were stunned. What happened?
The study staff recruited 178 pediatric SCT patients. Because stem cell transplant is notoriously strong treatment, associated with high degrees of distress for patients and families, the study looked at both patient- and parent-targeted interventions. This was not the first time the group attempted research in this area; Previous, smaller studies had documented the feasibility and appeal of massage and humor therapy,3 and had even suggested some benefit to warrant this further study, which was a larger scale, NIH-funded controlled trial.
The patients, aged 6-18, were randomized into three arms. One was a child-targeted intervention composed of massage and humor therapy. Another group received the child-targeted intervention in addition to a parent-targeted intervention that involved massage and relaxation/imagery. The third group, the control group, received only standard medical care.
A standard massage routine was provided by professional massage therapists, with the intended dose set at three half-hour sessions per week for 4 weeks, beginning at 1 week before transplant. The actual average massage dose turned out to be 8.8 sessions over the course of the study, as timing and other logistics often affect the actual amount delivered. The researchers measured somatic distress, mood disturbance, length of hospitalization, the time to engraftment (for the transplant to "take") and the use of opioid pain relievers and antiemetics (antinausea drugs).
As stated above, the investigators found that massage therapy and humor therapy made no difference in any of the outcomes. The patients' experiences of SCT appeared to be unchanged by these two complementary therapies. Even the addition of the parent-targeted therapy, in which the designated parent received massage on the same schedule as the child, along with relaxation therapy, seemed to make no difference. In fact, Dr. Phipps showed graphs of the three groups that were almost identical. Changes in mood and distress measures did occur in all three groups over the course of 4 weeks, but they were typical ups and downs over the course of the procedure. During SCT, the mood and distress measures get worse before they get better, and the patterns were the same in all three groups.
There were no differences in the medical outcomes, either. The time to engraftment, length of hospital stay, and use of pain relievers and antiemetics were surprisingly similar across the three groups.
What Do We Make Of This?
The study authors admitted being surprised by the results, and even disappointed. One important quality in a research paper is humility, and the authors were quick to point out possible limitations in the study design: perhaps they weren't measuring exactly the right outcomes, or the timing of the measurements was not perfect. The age range of 6-18 years in their patient may have been too broad to fully standardize the treatments. They also report that the results of a single study--theirs--is not sufficient for firm conclusions. More studies, from additional researchers, are needed before we can determine whether to advise massage for this population.
One of the most potent observations in this paper, and in the talk that I heard, was that the standard medical care during SCT has improved much in the past years, and that patient distress is so well-managed that it is difficult to improve upon it with massage. In fact, levels of distress in the study sample were quite low to begin with, and throughout the study. While SCT-related distress still exists, it may be that standard medical care is already reducing it to the lowest levels possible, and massage cannot be expected to take it any further.
I was impressed by the care taken in this project, by the findings, and by the reflections of the investigator. I have a few of my own thoughts to add to discussion:
First, it is important for researchers to publish work like this, when the outcomes do not meet the researcher's hypothesis. If we reported only the "good" or "bad" news in massage research (a problem called publication bias), then it would hold back the science of massage, and take longer to learn its true impact. I hope that other massage therapy trade publications also report on these findings, as disappointing as they are, so that the news is balanced.
Second, as much as I might wish for massage to have an effect in this population, the science and my own wishful thinking are two separate things. Massage is powerful therapy, but it is unlikely to be a cure-all. If it really is true that massage has no significant effect on a given population, we need to know that. As a profession, it's important to know if massage is less effective in some populations than in others. If it is, we can direct our study and practice where we know it is effective. Perhaps other patient populations are more responsive to massage, or there are places where the medical management of a condition falls short, and massage could play a larger role. If so, perhaps we should focus our efforts there. This would not mean denying massage to people undergoing SCT. Instead, it would mean that we continue to study the impact of massage, learn where it's most effective, and make sure we act on that information.
Finally, I am interested in the massage design and dose. I have to ask, in this and other studies, whether the massage dose is sufficient to bring about a change? Do we need to schedule daily massage in some populations, so that after logistics have taken their toll, the participants end up receiving 4-5 sessions per week? If so, would 4-5 sessions per week be sufficient, or too much? Does scheduling massage at certain points compromise its effectiveness, and, instead, it should be provided on demand the way some pain medications are administered? Are certain massage strokes, or body areas of focus essential for massage to be effective?
As disappointing as these results were, the study offers an important contribution to the body of research. I am not ready to abandon massage of SCT patients, nor do the investigators suggest that we should. But the study asks good questions. I am grateful to the investigators for their care, expertise, and clear reporting. As good research, this study invites further reflection, discussion, and, of course, more research.
Click here for more information about Tracy Walton, LMT, MS.
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