Vaccines & Autism (Part 1)
It turns out chronic inflammation is the driver of autism expression. Unfortunately, those who emotionally embrace the vaccine issue rarely, if ever, consider this relationship, which hinders a rational view of the vaccine issue.
UnitedHealthcare Can't Seem to Keep Chiropractic Down
AA decade ago, UnitedHealthcare announced changes to its chiropractic services policy that declared manipulative therapy for headache unproven.
The Secondary Insurance Plan
I have a patient that has Medicare, but also has a secondary insurance plan that does cover acupuncture. How do I bill Medicare to get a denial so that I may bill this secondary payer?
Why Take X-Rays When You Already Have an MRI?
Let's clear up the issue regarding the efficacy of plain-film studies when an MRI study has already been performed. I review imaging studies primarily for chiropractors, and often their patients have been to other health care providers before finding their way to a DC.
The Classical Texts & Integrative Medicine
The acupuncture profession has been undergoing many changes in the past years. There has been a shift towards a more integrative approach to medicine as more hospitals include integrative departments.
"Community Care" for Vets: It's Really a Big Deal!
As a preamble, while I regrettably never served in the military, I have the highest respect for those who did and those who currently serve.
It's All About That Ki
As an industry are we shifting too much toward a Western mind set? We strive to understand how acupuncture works using imaging and extensive studies. We spend numerous hours of our training learning Western medicine and learning to speak their language. What happened to our core though?
News in Brief
WFC Among Founding Members of Global Rehab Alliance; HealthSource Selects GoChiroTV as Exclusive Digital Signage Partner; Western States' Online Degree Programs Among Best in the Nation; Logan University, University of Missouri-St. Louis Forge Partnership.
End of Life Treatment
TCM looks death in the face. We do not camouflage it as if it were poisonous. "We must allow our patients to die but we cannot allow them to perish," was my first lesson the day I met my teacher as a teenager.
Why the Automatic Denials for Modifiers 25 and 59?
Your experience is one shared by many chiropractic providers who bill through those plans. It appears to be the national trend, but by far is more prominent in Texas and Illinois.
A Resting of the Soul
In my pursuit of being a skilled health care provider, I focus on reading journals, attending classes, staying current on medicinal research, and choosing the correct billing codes. However, most of us would never have started down this career path if there wasn't something more.
Does Dairy Cause Dampness?
The topic of dairy consumption was brought up at a scalp acupuncture seminar I recently attended.
Confessions of a Former Drug Rep: Statins Are Endangering Your Overweight Patients
As I sit at my desk on the sixth anniversary of my successful liver transplant, I can't help but reflect on what caused that life-threatening ordeal. Looking back on my personal situation, I want to offer my insight into what is happening routinely to many patients.
Reducing Hip, Knee & Shoulder Replacements (Part 2)
In the first article in this series, "Early Detection Reduces Hip, Knee, & Shoulder Replacements," I described time tested screening procedures and perspectives as indicators of when to encourage your patients to seek further medical evaluation.
The Certified Practitioner
Certified Chinese herb practitioners often identify themselves with the credentials "LAc" (Licensed acupuncturist).
Doc, Are You a Social Media Holdout? Your Future Is Now
Whether you like it or not, to compete in any business, even chiropractic, you really should know and consider using social media. It is no longer a small, sleepy, local world we live in; it has become a far-reaching community.
Autoimmunity, Gut Health and Diet: Connect the Dots
According to the National Institute of Health (NIH), autoimmune disease is recognized in approximately 24 million individuals in the U.S., consisting of more than 80 various disorders that contribute to the top 10 causes of death in female children and women of all age groups.
Valuable Adjunctive Therapies
Based on the latest CDC statistics, more than 795,000 Americans have strokes per year, 140,000 of which are lethal. Approximately 87 percent of all strokes are ischemic with an estimated health care and missed work cost of $34 billion annually.1
A Bold Strategy to Take Chiropractic to New Heights
Building public awareness of an entire profession requires strategic planning – especially when it pertains to the exploration of ground-breaking marketing tactics that target new audiences with key messaging about the value of chiropractic care.
Treating Pain With Nutrition
Back in 1910, when D.D. Palmer published The Chiropractor's Adjuster and introduced the world to what he called the "triad of health" – thoughts, trauma and toxins – he explained that the body can only be made optimally healthy if all three aspects of health are addressed.
#TechPain: Causes, Solutions
For the past several decades, the science of ergonomics has blossomed. The workplace is much safer and life is generally more pleasant thanks to the application of ergonomic principles.
The Hidden Hip in LBP: Critical Screening Tests
In 1998, Harvey used this test on 117 elite athletes and found excellent interrater reliability to differentially assess iliopsoas, quadriceps or TFL/ITB tightness.
Facebook Marketing 101
Many of the health care practitioners we work with have smaller practices. The provider tends to wear many hats – office manager, salesperson and healer.
Blockchain Health Records?
Keeping data secure has become a nightmare for the average consumer. Just consider general user account hacks on Yahoo (3 billion records compromised), eBay (145 million records compromised) and Facebook (87 million records compromised), to health record breaches involving Anthem Blue Cross (78 million records compromised) and TRICARE (almost 5 million records compromised).
Art of the Associateship: It's OK to Trust, But Verify
Trust is a valuable part of any business relationship. It serves as the foundation for all business operations and ultimately long-term success for owners, employees and customers. This is especially true in the world of health care.
Trending: CBD / Hemp Oil
A recent survey of DCs regarding cannabidiol (CBD) / hemp oil provides food for thought as to the viability of CBD-based products as a component of chiropractic patient care. Here are some observations from the executive summary of the survey:
Help Shape the New Neck Pain Best Practices Guideline
The Clinical Compass (originally the Council on Guidelines and Practice Parameters – CCGPP) has issued a call for interested chiropractic clinicians to help shape a new best practices guideline for chiropractic care of neck pain.
NCCAOM: A Route to National Certification
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is offering a route to achieve national certification—without having to take any of the NCCAOM exams. This is specifically for California licensed acupuncturists that meet the eligibility requirements.
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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