A Simple Miracle: Treatment for Mysterious Foot Pain
Under the old ICD-9 diagnosis codes, there was actually a diagnosis for "adventures in medical mismanagement" to describe patients who had been run down the rabbit hole of poor case management and care. I encountered one of those patients in my office today.
Electrotherapy Gives Hope for Patients With Spinal Cord Injury
There has been little optimism for recovery from a spinal cord injury because the central nervous system does not repair itself well. The severity of the injury depends on the affected area.
2018 Gallup-Palmer Report: Key Findings
The fourth annual Gallup – Palmer College report is out; here are some of the key findings excerpted directly from the executive summary regarding Americans' experiences with chiropractic care relative to the management of neck and back pain:
VA Chiropractic Reduces Veterans' Use of Opioids?
Utilization of pain medication – particularly opioids – has been massively high in among veterans for decades, but Veterans Administration guidelines that recommend nonpharmacological first-line treatment options create a greater opportunity than ever for VA chiropractors to make a dent in the opioid and overall pain-management crisis.
The Top 5 Strategies to Manage Your Reputation Online
You don't need an acupuncture website anymore! Okay, maybe that statement is a little over the top. But it's not that far from the truth. A recent study on Google searches revealed that 34 percent of all searches resulted in no clicks at all.
Knocking Down the Doors: Big Media Success for F4CP
Three articles authored by a DC or a chiropractic organization and promoting the value of chiropractic care – par for the course if you're Dynamic Chiropractic, but if you're Forbes, BOSS Magazine and Becker's Spine Review, three media outlets tailored toward high-level executives and decision-makers, we're talking about an entirely different story.
A New President for AOMA: A Conversation With Mary Faria
Dr. Faria was formerly a health care executive for over 30 years, the last 17 of those years as vice president and chief operating officer of Seton Southwest Hospital in Austin. She chairs the board of Austin Mayor's Health and Fitness Council.
VA Choice Claims Denied? Here's How You Can Get Paid
The VA Choice Program (PC3 as well) indeed pays for chiropractic care including manipulation (CMT 98940-98943) and some physical medicine services.
Cynicism and Burnout: It Can Happen to You
Trying to achieve fulfillment as a doctor in today's health care environment is a "rigged game" and physicians are programmed to burn out. At least this is the opinion of Dike Drummond, MD, in his thehappymd.com blog.
News in Brief
A Comprehensive Model of Spine Care; Dr. Christine Goertz Appointed Vice Chair of PCORI Board of Governors.
Malpractice Insurance: Understanding the Cover Letter
Purchasing medical liability insurance is quick, easy and not terribly expensive. The benefits are clearly listed on a certificate—but do you really know what you are getting with that peace of mind?
Bad for the Back! Exercises That Can Prevent Healing
The questions "Who gets well? Who doesn't? Why?" prompted the following observations based on my close to 40 years of chiropractic practice.
A Guide to CBD Dosing: The Correlation Between Dose & Potency
There is an abundance of information available about the daily use of whole plant hemp CBD oil to help maintain and support a healthy lifestyle, however there remains a lack of sound guidance on CBD oil dosing.
Goodbye, Year of the Dog: Two-Thousand-Eighteen Comes to a Close
As Year of the Dog (2018) comes to a close we can look back and see the progress this profession has made. For example, the International Classification of Diseases (ICD) added traditional medicine codes, which were released in June.
The Raw Food Debate: Practitioners Discuss Nutrition & TCM
Licensed acupuncturist and fellow blogger Elissa Gonda joins this month's column for a conversation about raw food diets. She brings her perspective on the healing potential of a raw primal diet.
The Truth About Malpractice Claims Against DCs (Pt. 1)
Over the past 20 years of active practice, I have seen a number of scary case scenarios regarding signs, symptoms and patient presentations in my office. These presentations scream, This patient is going through an event or This patient does not need chiropractic care, they need emergency care.
Dietary Supplements That Help Restless Leg Syndrome
It is estimated that 7-10 percent (possibly up to 15 percent) of the U.S. population has restless leg syndrome. It is a bit more common in women than men.
Year in Review: DC's Best of the Best for 2018
As 2018 winds down, let's highlight the most popular articles in Dynamic Chiropractic by month (December – this issue – excluded, of course).
A Soy Isoflavone That Packs a Punch: Genistein
Soybeans contains unique substances called isoflavones, most notably genistein and daidzein, which have been shown to block the buildup the dangerous type of testosterone in the prostate gland linked to prostate enlargement and prostate cancer.
Reaching for Our Roots: Healing Digestion With a Simple Traditional Therapy
Are you ignoring a powerful tool in your doctor's bag? Many acupuncturists realize that Spleen Qi deficiency has reached epidemic proportions in the U.S. Yet, we don't prioritize educating our patients about the importance of warm, cooked foods.
Map It: Understanding the Customer's Journey
One of the biggest marketing mistakes most practice owners or administrators make is not putting themselves in their prospective or current patients' shoes. How do they think and feel about you and your practice? What makes them take action?
ACA Champions H.R. 7157; ICA Voices Major Concerns
While the American Chiropractic Association recently penned an open letter – signed by not only the ACA, but also the Congress of Chiropractic State Associations, Association of Chiropractic Colleges, Clinical Compass and a number of state associations.
Exercise Therapy Following Motor Vehicle Trauma (Pt. 2)
In cases of cervical spine trauma, particularly trauma related to a motor vehicle accident, my plan is to teach the patient one exercise per session and build a progression. This is an effective approach I call an "activation circuit."
Reality Check: Do We Need to Try Harder?
While waiting for a flight to a recent chiropractic event, I overheard the ticket agent at the gate next to mine on his cellphone. His side of the conversation went something like this: "Where are you now? How long before you think you can be at the gate? OK, that will work, see you soon."
When Computers Cause UCS: Adjusting Strategy
With the widespread use of mobile devices such as smartphones and tablets, the incidence of "text neck" has reached almost epidemic proportions. But there is another challenge to the spinal health and well-being of our technology-driven society.
Acupuncture in Hospital Systems: Transitioning From Tolerated to Celebrated
I've had the pleasure of working with Susan Luria, Director of University Hospitals Health Systems Connor Integrative Health Network (CIHN) for the past year on the Integrative Health Policy Consortium (IHPC) Board of Directors and Federal Policy Committee.
November, 2015, Vol. 15, Issue 11
Massage Therapy Reduces Suffering for Patients With Advanced Illness
By Massage Therapy Foundation Contributor
Contributed by Jolie Haun PhD EdS LMT; MK Brennan MS, RN, LMBT; Renee Stenbjorn MPA, LMT
Patients suffering with advanced cancer or other life-limiting illnesses often experience chronic pain, anxiety, and decreased quality of life.Medications for symptom relief are often inadequate and can result in numerous side effects. Previous studies evaluating massage have reported decreases in pain in individuals with advanced illness, such as cancer, but these studies have been limited by small sample size, lack of a control group, or randomization. This month's Massage Therapy Foundation research review focuses on recent study findings on the integration of massage therapy into a palliative care service. In this published research, Mitchinson and colleagues report on the outcomes of massage for patients with advanced illnesses.
The Study Design
Patients receiving palliative care for advanced illnesses, such as cancer, received massage at a Veterans Affairs Medical Center in Ann Arbor, Michigan. Massage therapists collected data pre and post massage to examine outcomes associated with pain, anxiety, dyspnea, relaxation, and inner peace. A retrospective chart review was conducted to collect all the data related to the patient and the massage sessions. The statistical method, analysis of covariance was used to examine changes over time.
Massage treatments were provided by a nationally certified massage therapist. Massage sessions averaged 20 minutes for inpatients and 22 minutes for outpatients and primarily consisted of effleurage with limited trigger point therapy for those patients who could tolerate the therapy. The pressure was light to moderate depending on the patient's health condition. Wounds were avoided. Patients with bony metastases often received massage to uninvolved areas. Patients who were actively dying usually received foot massage.
Of the 153 patients who received massage, 115 were able to provide data for analysis. Patients unable to do so included those who fell asleep, were delirious or confused, were very near the end of life, or who refused to answer. In total, 52% of the patients received massages in an inpatient setting; 37% received massages as outpatients and others received massages in both the inpatient and outpatient settings. In addition to their life-threatening diagnosis, 70% of patients had preexisting chronic pain. Of this sample, 69% had a primary diagnosis of cancer; the other patients were referred for non-cancer diagnoses. As is common among Veteran populations, this sample was primarily older white males.
For the sample, all short-term changes in symptoms showed improvement and all were statistically significant. Pain intensity decreased by 1.65 (0-10 scale, P < .001), anxiety decreased by 1.52 (0-10 scale, P < .001), patients' sense of relaxation increased by 2.92 (0-10 scale, P < .001), and inner peace improved by 1.80 (0-10 scale, P < .001). Unique to this study, the authors also provided individual cases to demonstrate the suffering associated with advanced illness and the impact of massage therapy (excerpts from cases).
A 55-year-old veteran with bipolar illness, a personality disorder, chronic back pain, low social support, and a history of heroin and alcohol abuse was admitted with a new diagnosis of advanced non–small-cell lung carcinoma metastatic to liver and spine. Psychiatry was consulted to help address agitation, irritability, and pacing behavior. He primarily complained of neck and shoulder pain. After the first massage, his pain intensity dropped from 10 of 10 to 8 of 10. He was initially reluctant to admit how much massage had helped relieve his pain because he feared no longer receiving opioids. Initially, he rated his sense of relaxation and inner peace as 0 of 10 prior to massage and 3 of 10 afterward. When asked about his anxiety after the second massage he commented, "I feel better than I have in a long time; that was beautiful." Later during his illness, he commented that the massages were very helpful and said, "I'm in heaven. No offense to God, but this is the only time I'm in heaven."
An 81-year-old World War II veteran with end-stage congestive heart failure and chronic back pain was followed in the clinic. He received 8 massages over an 18-month period. At his first visit, he was complaining about not being able to get his "happy breath." Prior to the massage, he rated his anxiety a 6 out of 10 and his shortness of breath 8 out of 10. He enjoyed the massage and reported a decrease in his anxiety (0 of 10) and shortness of breath (6 of 10). He commented that he felt "a little happier" because he could breathe more easily. On another occasion, he described the massage as "a little better than a piece of warm apple pie and a cup of coffee" and admitted, "I'd be lying if I said I didn't like it."
These case histories provide compelling evidence for the relief of massage experienced by patients suffering with advanced illness.
Implications for the Field of Massage
Mitchinson and colleagues conclude that "massage is a useful tool for improving symptom management and reducing suffering in palliative care patients." The most impressive aspects of this study are the sample size, the implementation of the massage program in palliative care, and the qualitative case histories exemplifying the participants' experiences with massage.
The authors' noted in their discussion that the massage program has been well accepted by professionals within the medical facility and there have been no reports of adverse events related to massage. They reported the biggest challenge was prioritizing patients by need, not having time to keep up with the requests for massage, allocating time between inpatients and outpatients, and getting access to inpatients with competing demands for the patients' time.
The authors also reported study limitations; this study used an observational method with no control group, and the sample had limited diversity. Future studies will benefit from collecting data from a diverse sample including a range of ages and ethnicities from both genders. Finally, data were self-reported and collected by the therapist, so it is possible there was reporting bias to please the therapist. Future research would benefit from data collection from someone other than the therapist; and of greater value would be to complement self-report data with objective data such as biomarkers, to support a rigorous data collection process. The use of qualitative case histories, as used in this study, provide rich data from the perspective of the participants and clearly illustrates their personal experience with massage therapy. Though the authors did not mention it as a limitation, the massage therapy protocol provided in the article was vague and would thus be difficult to replicate. The practical nature of implementing palliative care programs within a medical setting may warrant the use of a wide range of individualized massage protocols.
Practitioners, particularly those working in medical facilities now have information to support the recommendation of massage therapy within palliative care programs. As for the field of massage, this study supports the ever-expanding scope of populations and conditions for which massage therapy can be delivered as an effective treatment to alleviate pain and suffering.
Are you interested in learning more about the uses of massage therapy to alleviate pain and promote quality of life for patients with advanced illness? To learn more about the effects of massage therapy, to learn more about the effects of massage therapy, you can review the Massage Therapy Foundation review article archives, read accepted MTF Research Grant abstracts, or search PubMed for massage therapy studies.
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