Transforming Exam Delivery
The NBCE Board of Directors has never wavered on its promise to deliver an excellent, on-campus computerized testing experience to students. Likewise, there has never been a compromise to the delivery of fair, valid and legally defensible exams.
Acupuncture's Standard of Care
Both a concern and critique of acupuncture, frequently espoused by the bio-medical community is, "there is no standard of care in acupuncture." The following is why I believe this statement is disingenuous at best.
Missed Causes of LBP: It's the Syndrome, Not the Subluxation
When I read the chart notes of other chiropractors, I am usually disappointed. They list what vertebrae are fixated or misaligned. They may describe the involved fascia and muscles.
A Novel Way to Prevent Elderly Falls: Toe Strength
In any given year, nearly 40 percent of senior citizens ages 70 and older will fall at least once. Each fall significantly increases the risk of not only sprains, strains and contusions, but also fractures.
Better With Chiropractic
While chiropractic care is receiving high levels of exposure these days, most pain patients who consult with a health provider still do so with their primary-care MD. And of course, that means in most cases, they're receiving standard medical care, not chiropractic.
New Opportunities for DCs
For decades, the model chiropractic practice has been the single-doctor practice. Recent surveys have found that approximately two-thirds of U.S. doctors of chiropractic still practice this way, with another 20 percent practicing in multiple-chiropractor practices.
Bastyr University: On the Front Lines of the Pain Epidemic
At University of Washington's Harborview Medical Center, the Seattle region's only Level I Trauma and Burn Center, the demands for in-patient care are dramatically different from a private clinic environment.
Practice Pearls: There's More to ROM Than Meets the Eye
As part of my neuromusculoskeletal examination, I perform range-of-motion (ROM) evaluations. I can "eyeball" the range and measure, I can use a goniometer and measure, I can use my phone app and measure, or I can use various other instruments to help determine degrees of motion.
Regenerative Medicine: How to Do It by the Books
The "lay of the land" for regenerative therapies, including but certainly not limited to adult stem-cell treatments, seems to change almost daily.
Prompting Memory: How to Stimulate Cognition
Recently I gave a talk titled, The Art of Memoir – Tapping the Past to Sharpen the Present at a senior lunch event in Austin, Texas.
It's Time for a Functional Approach to Chronic Illness
It seems one of the more modern buzzwords is chronic, referring to diseases – that is to say, "ongoing and incurable." However, we can take a different perspective and recognize that, although the body may have been traumatized and injured, healing should always be viewed in the realm of possibility.
Reducing Allostatic Load & Stress Through Heightened Awareness
Your contemporary mental health and psychotherapy colleagues may often approach the treatment of allostatic load as a mental health condition and use prescription psycho-pharmaceutical medicine to affect general and specific central nervous system (CNS) pathways and brain neuro-chemistry medicine to alleviate the associated symptoms.
NBCE to Reinstitute Computer-Based Exams
The National Board of Chiropractic Examiners (NBCE) has announced it will reinstate computer-based testing in January 2019 courtesy of a partnership with testing and assessment solutions provider Prometric.
Dropping Insurance: 4 Steps
My office manager just got off the phone with the secretary of a long-standing patient. I have treated this woman and 10 members of her family for more than a decade. She has, as have all of my patients, paid my fee at the time of service since I dropped insurance in 1997.
First World Spine Care Graduate: Hildah Molate
Hildah Molate, the first World Spine Care (WSC) scholarship student, graduated from Palmer College of Chiropractic earlier this year and is now working at the WSC community spine clinic in Shoshong, Botswana.
TCM Codes for the World
I just received an email concerning the ICD-TM11 codes. The World Health Organization (WHO) will be presenting the new ICD-11 codes to World Health Assembly very soon.
Multi-Dimensional Acupuncture: 3D, 4D & 5D
Maggie is an intuitive healer and workshop leader who I met on a recent hike. While we were talking she told me how she had to take it easy because of her knees. She said that her doctor told her that she has the early signs of arthritis.
News in Brief
Parker University Launches New Open-Access Research Journal for Chiropractic; Western States, Cleveland-KC Name New Deans of Chiropractic Colleges; Sherman College Goes Tobacco-Free; Life University Wins 11 Awards.
Official NCCAOM Practice Tests
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is excited to announce the launch of the new NCCAOM Exam Preparation Center.
Prevention: Stop Recurrent Urinary Tract Infections
The recurrent urinary tract infection (UTI) is one of those nuisance conditions that can play havoc with quality of life, and this particular infection is much more common than most people realize.
Chiropractic's Next Frontier: Adjusting the Microbiome
Restoring a healthy microbiome to help treat disease may be the next frontier in chiropractic offices around the country.
Diagnosing & Treating Aggressive Energy
Recently, there has been an article, and subsequent discussion, about the subject of Aggressive Energy (AKA "AE"), including ways to detect its presence and an alternative method of treating it.
Old Trend, New Risks: Heavy Weight Training
With more opportunities to exercise than ever, a greater selection of exercise options, and the subsequent opinions supporting and challenging their merits, it's easy to be confused as to which approach is best.
Catch the Workplace Wellness Wave
Do you offer workplace wellness services to local businesses? If not, you might want to consider this lucrative channel for expanding your practice. Workplace wellness programs and wellness-related benefits have grown in popularity over the past several decades.
Is Primary Spine Care the Answer for Chiropractic?
Recently, we sat down with Mark Studin, DC, FASBE(C), DAAPM, DAAMLP, to discuss the state of chiropractic and why primary spine care may hold the key to chiropractic's future. Read what he had to share in this exclusive interview.
State by State: Chiropractic Leads Changes in Health Care
Monumental legislative bills in support of the chiropractic profession were passed recently in Washington, West Virginia and Oregon. Here is a review of this important legislation, state by state...
Paving the Way to Integrative Health & Wellness
Jared Polis (D-Colorado) and Mike Coffman (R-Colorado) launched the integrative health and wellness (IHW) caucus in October, 2018.
Cyber Threat Checklist: Defend Your Business With These 10 Steps
Living in an internet connected society brings many conveniences and benefits. The power of the internet to connect us with customers, store data, and find information has opened the door for many small business owners to grow and flourish.
The Acupuncturist and the Opioid Crisis: Conquering Pain & Addiction in the U.S.
The current opioid epidemic dominates the discussion among national health leaders, recovery advocates and families nationwide. Opioids include heroin as well as prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.
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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