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In the Unlikely Event of an FDA Recall ... No News Has Been Good News
East Asian herb product manufacturers have practiced impeccable diligence by complying with current Good Manufacturing Practices (cGMP) and providing the practitioner community certificates of analyses that detail laboratory testing results for things like heavy metals and toxic elements.
Safety First, Protecting the Patient: A Herbal Certification Program by the NCCAOM
The acceptance of acupuncture and Oriental (East Asian) medicine in the U.S. has made tremendous strides over the last 30-plus years. AOM/TCM is no longer "alternative or complementary" medicine. Yet, as acupuncture has become more mainstream, acceptance of herbal medicine has lagged behind.
The Opioid Crisis: "Let's Roll!"
Sept. 11, 2018 will mark the 17th anniversary of the horrific terroristic attack on the U.S. Whenever I think about that day, I am reminded of the heroes on Flight 93 who took action to keep the airliner away from Washington, D.C., by making it crash into the ground near Shanksville, Pa.
A Functional Approach to Type 2 Diabetes
Diabetes is recognized as one of the top chronic illnesses plaguing our society today. Here are some quick statistics on the prevalence of both diagnosed and undiagnosed diabetes:
News in Brief
Chiropractic Takes Leap Forward in France; New ACA President Named; Sherman College Responds To "Choosing Wisely" Recommendations; R.I. DCs Speak at Medical CE Event.
The Veteran's Choice Program & Your Claims
Q: I have recently begun treating veterans under the Veteran's Choice program. I am getting paid just fine for acupuncture codes and evaluation and management services but have been denied all physical medicine codes including infra-red heat 97026, massage 97124 and manual therapy 97140.
Preparing for the Opioid Patient: The Future of the Acupuncture Profession
In the future there will be many more clients with opioid addictions in acupuncture practices. Acupuncture is being promoted as an excellent resource to help with recovery from opioid addiction.
Fixing a Major Practice Hurdle in Wisconsin
Wisconsin Gov. Scott Walker has signed Assembly Bill 834, legislation repealing the requirement that DCs wishing to practice in Wisconsin score higher on Part III and Part IV of the NBCE examination than is required in most other states.
Lancet LBP Series: Relevance to the Chiropractic Profession
The Lancet Low Back Pain Working Group consists of a team of leading international experts on back pain from different professional backgrounds and from countries around the globe. The group published a series of three papers in The Lancet on March 21, 2018, and have subsequently received significant media attention. Here is a summary of the relevant data from these three important papers.
The Pain of Chemotherapy: A Case Study
The primary reason for presenting this case study and patient is to review the pain relief response she experienced from micro-current electro-acupuncture for taxane induced neuropathy.
Standard Process Unveils Nutrition Innovation Center
The North Carolina Research Campus, a 350-acre research center in Kannapolis, North Carolina, just north of Charlotte, is a research collaborative that includes university, corporate and community partners.
Renew Your Passion: The National
It's another August day in Florida with temperatures reaching almost 90 degrees. The sun is shining through the tall windows of the Hyatt Regency Orlando on all the attendees at The National by the Florida Chiropractic Association.
Corporate Chiropractic (Pt. 2): The Dark Side
In a previous DC article (May issue), I tried to make the case that the trend of corporations and franchises delivering chiropractic care might actually be positive.
Practicing Tai Chi Between the Seasons: Balancing the External and Internal Environments
Each morning for the past week, I have found myself to be a bit more tired than usual. There were nights when I went to bed a little late and nights I went to bed early, but it didn't make a difference.
The Spirit of the Points: The Pericardium Meridian (Part 2)
As indicated in part one of this series, the vast majority of our patients, regardless of the presence of physical symptoms, are also imbalanced at the levels of mind and spirit. The ancient Chinese knew that to treat the whole person, all levels must be taken into account so that complete balance and harmony can be achieved.
Leave Acupuncture to Acupuncturists
Colorado acupuncturists are desperately fighting to reverse a recent decision — the passing of HB18-1155 — that adds dry needling to physical therapists' scope of practice. You can support Colorado acupuncturists by signing their Change.org petition here.
Mineral Nutrition for Athletic Performance and Recovery
Research on sports, exercise, and mineral nutrition has been ongoing for decades. It is widely held that strenuous exercise can increase the need for minerals.
VA and Medicare Billing: Case of the Missing Modifier
Indeed, the Veterans Administration is paying directly to chiropractors for care under the VA Choice or PC3 Program. There are currently two administrators for this program: Health Net for the northeast and TriWest for the southwest (approximate geographic regions).
Text Neck: Assess and Adjust
A common presentation in a chiropractic clinical practice is the patient with neck pain and stiffness. Patients usually report limited range of motion on rotation of the head and neck.
Legos Lead to New Patients
It's time to examine a different way of envisioning the marketing and promotional flows in your office. This 10,000-foot perspective I like to call your practice's "marketing Legos." Much like the Legos we all played with as kids – now you get to sort them out in practice!
A Report From the 3rd Annual ASA Council Congress
This past March the American Society of Acupuncturists (ASA) was proud to hold its third annual ASA Council Congress in Denver, Colorado.
The Gut/Brain Relationship: Exploring Brain Diseases
Several thousand years ago ancient Chinese doctors stressed the importance of a healthy diet, and leading a healthy lifestyle as the primary ingredient to maintaining health.
Art of the Associateship: Success Is in the Finances
Finances are an important part of any business relationship. Money serves as the fuel for all business operations and ultimately the long-term success of owners, employees and customers. This is especially true in the world of health care.
Give Obesity the Attention It Deserves: Practice Pointers
During my earlier years in practice, I first became aware of the obesity problem in New Mexico because of an offer to star in a movie.
Low Back Rehab: Hip Mobility
The strength of chiropractic physical rehabilitation is first and foremost CMT, closely followed by our appreciation of a whole-body approach to balancing the entire kinetic chain.
K2: The Supplement for Your Anti-Aging Treatments
While aging as a whole is inevitable, some aspects of aging may actually be caused by a simple vitamin deficiency. That's right – wrinkles, stiff muscles and decreased athletic performance can all be symptoms of just one micronutrient deficiency: vitamin K2.
NIH Agenda: How Will More Drugs Help?
National Institutes of Health (NIH) Director Francis Collins announced in April that his agency will be partnering with drug manufacturers to address the opioid and pain crisis. The project is known as the Helping to End Addiction Long-Term (HEAL) Initiative.
A Five-Step Plan for Marketing the Sale of Your Practice
We spend so much time and energy educating ourselves to be successful practitioners that many of us never stop to consider what comes next. What happens if you have a great practice but you need to move, are getting burned out, or are simply ready to retire and try something else?
A Model for Integrative Health in the U.S.
This past March I met Dr. Benjamin Kligler, national director for the Integrative Health Coordinating Center of the Veterans Administration (VA), at an Integrative Health and Wellness Congressional Caucus briefing, where he presented on the VA health care system.
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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