Tim Brunson DCH

Welcome to The International Hypnosis Research Institute Web site. Our intention is to support and promote the further worldwide integration of comprehensive evidence-based research and clinical hypnotherapy with mainstream mental health, medicine, and coaching. We do so by disseminating, supporting, and conducting research, providing professional level education, advocating increased level of practitioner competency, and supporting the viability and success of clinical practitioners. Although currently over 80% of our membership is comprised of mental health practitioners, we fully recognize the role, support, involvement, and needs of those in the medical and coaching fields. This site is not intended as a source of medical or psychological advice. -- Tim Brunson, PhD

Hypnosis in paediatric respiratory medicine.



Hypnotherapy is an often misunderstood yet effective therapy. It has been reported to be useful within the field of paediatric respiratory medicine as both a primary and an adjunctive therapy. This article gives a brief overview of how hypnotherapy is performed followed by a review of its applications in paediatric patients with asthma, cystic fibrosis, dyspnea, habit cough, vocal cord dysfunction, and those requiring non-invasive positive pressure ventilation. As the available literature is comprised mostly of case series, retrospective studies, and only a single small randomized study, the field would be strengthened by additional randomized, controlled trials in order to better establish the effectiveness of hypnosis as a treatment, and to identify the processes leading to hypnosis-induced physiologic changes. As examples of the utility of hypnosis and how it can be taught to children with respiratory disease, the article includes videos that demonstrate its use for patients with cystic fibrosis.

Paediatr Respir Rev. 2014 Mar;15(1):82-5. doi: 10.1016/j.prrv.2013.09.002. McBride JJ(1), Vlieger AM(2), Anbar RD(3). Author information: (1)Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA. (2)Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands. (3)Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA. Electronic address: anbarr@upstate.edu.

Copyright © 2013 Elsevier Ltd. All rights reserved.

Touch, Caring, and Cancer: randomized controlled trial of a multimedia caregiver education program.



PURPOSE: A randomized controlled trial was conducted to evaluate outcomes of a multimedia instructional program for family caregivers in simple touch-based techniques to provide comfort to cancer patients at home.

METHODS: A multilingual 78-min DVD and 66-page manual were produced for homebased instruction. Content addresses attitudes and communication about touch in cancer, psychological preparation for giving and receiving touch, safety precautions, massage techniques for comfort and relaxation, acupressure for specific cancer-related symptoms, and practice in the home setting. Materials were produced in English, Spanish, and Chinese versions. A community-based multiethnic sample of 97 adult patient/caregiver dyads was randomized to experimental (massage) or attention control (reading) groups for 4 weeks. Massage dyads received the program and instructions to practice at least three times per week, while control caregivers read to their patients for the same frequency. Self-report instruments assessed change in symptom severity, quality of life, perceived stress, and caregiver attitudes.

RESULTS: Significant reductions in all symptoms occurred for patients after both activities: 12-28 % reductions after reading vs. 29-44 % after massage. Massage caregivers showed significant gains in confidence, comfort, and self-efficacy using touch and massage as forms of caregiving.

CONCLUSIONS: Multimedia instruction in touch and massage methods may offer family members a viable means of enhancing self-efficacy and satisfaction in caregiving while decreasing patient pain, depression, and other symptoms. Family members may be able to learn and apply safe and simple methods that increase patient comfort and reduce distress.

Support Care Cancer. 2012 Dec 21. Collinge W, Kahn J, Walton T, Kozak L, Bauer-Wu S, Fletcher K, Yarnold P, Soltysik R. Collinge and Associates, 3986 N Shasta Loop, Eugene, 79405, OR, USA, william@collinge.org.

Massage application for occupational low back pain in nursing staff.



This is a clinical trial which aims to evaluate the efficiency of massage in the reduction of occupational low back pain, and its influence on the performance of work and life activities for the nursing team. The sample consisted of 18 employees who received seven to eight sessions after their work period. From the Numerical Pain Rating Scale, significant improvements were found between the 3rd and 1st evaluations (p=0.000) and between the 3rd and 2nd (p=0.004), using the Wilcoxon test. Regarding the Oswestry Disability Index, the paired t test showed a statistical difference (p=0.02) between the baseline, with a mean of 21.33% and the second evaluation (18.78%), which was also seen between the second and third evaluation (16.67%). The score for the Handling and Transfer Risk Evaluation Scale was 18 points (medium risk). It is concluded that massage was effective in reducing occupational low back pain, and provided improvement in activities of work and life. Clinical Trials Identifier: NCT01315197.

Rev Lat Am Enfermagem. 2012 Jun;20(3):511-9.Borges TP, Greve JM, Monteiro AP, Silva RE, Giovani AM, Silva MJ. Escola de Enfermagem, Universidade de São Paulo, Brazil.

The Effects of Slow-Stroke Back Massage on Minutes of Nighttime Sleep in Persons With Dementia...



Full title: The Effects of Slow-Stroke Back Massage on Minutes of Nighttime Sleep in Persons With Dementia and Sleep Disturbances in the Nursing Home: A Pilot Study.

This pilot study tested the effects of a 3-minute slow-stroke back massage (SSBM) on total minutes of nighttime sleep on persons with dementia with sleep disturbances aged 65 years or older in the nursing home. Design: Pilot randomized controlled trial. Methods: Participants were randomized to an intervention group (n = 20) who received the 3-minute SSBM or a usual care control condition group (n = 20) who received usual bedtime care. Forty-eight hours of actigraphy data was recorded and analyzed on sleep variables at baseline and postintervention. Findings: Descriptive statistics showed a 36-minute increase on minutes of nighttime sleep in the SSBM intervention group (46.1 minutes) compared with the control group (10.32 minutes). Analysis of covariance did not reveal significant differences between the intervention and control groups on minutes of nighttime sleep, F(1, 37) = 1.90, p = .18, partial ?(2) = .05, or on other sleep variables. Conclusions: Dose-finding studies are needed to determine the duration of SSBM for sleep promotion. Findings from this pilot study suggest that SSBM may be an effective nursing intervention for sleep in persons with dementia in the nursing home, but further testing is needed to provide definitive results.

J Holist Nurs. 2012 Sep 24. Harris ML, Richards KC, Grando VT.

Development of a manualized protocol of massage therapy for clinical trials in osteoarthritis.



Clinical trial design of manual therapies may be especially challenging as techniques are often individualized and practitioner-dependent. This paper describes our methods in creating a standardized Swedish massage protocol tailored to subjects with osteoarthritis of the knee while respectful of the individualized nature of massage therapy, as well as implementation of this protocol in two randomized clinical trials. The manualization process involved a collaborative process between methodologic and clinical experts, with the explicit goals of creating a reproducible semi-structured protocol for massage therapy, while allowing some latitude for therapists' clinical judgment and maintaining consistency with a prior pilot study. The manualized protocol addressed identical specified body regions with distinct 30- and 60-min protocols, using standard Swedish strokes. Each protocol specifies the time allocated to each body region. The manualized 30- and 60-min protocols were implemented in a dual-site 24-week randomized dose-finding trial in patients with osteoarthritis of the knee, and is currently being implemented in a three-site 52-week efficacy trial of manualized Swedish massage therapy. In the dose-finding study, therapists adhered to the protocols and significant treatment effects were demonstrated. The massage protocol was manualized, using standard techniques, as well as made flexible for individual practitioner and subject needs. The protocol has been applied in two randomized clinical trials. This manualized Swedish massage protocol has real-world utility and can be readily utilized both in the research and clinical settings.Trial registrationClinicaltrials.gov NCT00970008 (18 August 2009).

Trials. 2012 Oct 4;13(1):185. Ali A, Kahn J, Rosenberger L, Perlman AI.

Ottawa Panel evidence-based clinical practice guidelines on therapeutic massage for low back pain.



Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; Montfort Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: Lucie.Brosseau@uottawa.ca.

To update evidence-based clinical practice guidelines (EBCPG) on massage therapy compared to control or other treatment for adults (>18 years) suffering from acute, sub-acute and chronic low back pain (LBP). A literature search was performed for relevant articles between January 1, 1948 and December 31, 2010. Eligibility criteria were then applied focussing on participants, interventions, controls, and outcomes, as well as methodological quality. Recommendations based on this evidence were then assigned a grade (A, B, C, C+, D, D+, D-) based on their strength. A total of 100 recommendations were formulated from 11 eligible articles, including 37 positive recommendations (25 grade A and 12 grade C+) and 63 neutral recommendations (49 grade C, 12 grade D, and 2 grade D+). These guidelines indicate that massage therapy is effective at providing pain relief and improving functional status. The Ottawa Panel was able to demonstrate that massage interventions are effective to provide short term improvement of sub-acute and chronic LBP symptoms and decreasing disability at immediate post treatment and short term relief when massage therapy is combined with therapeutic exercise and education.

J Bodyw Mov Ther. 2012 Oct;16(4):424-55. doi: 10.1016/j.jbmt.2012.04.002. Epub 2012 Jun 23. Brosseau L, Wells GA, Poitras S, Tugwell P, Casimiro L, Novikov M, Loew L, Sredic D, Clément S, Gravelle A, Kresic D, Hua K, Lakic A, Ménard G, Sabourin S, Bolduc MA, Ratté I, McEwan J, Furlan AD, Gross A, Dagenais S, Dryden T, Muckenheim R, Côté R, Paré V, Rouhani A, Léonard G, Finestone HM, Laferrière L, Haines-Wangda A, Russell-Doreleyers M, De Angelis G, Cohoon C.

Effects of Meridian Massage on physical growth and the infant's health as perceived by his mother.



Background: Meridian Massage is a traditional practice that manually stimulates the body's meridian system - the same network of vital energy channels used in acupuncture. The present study was to assess the effect of Meridian Massage on the physical growth and infant's health as perceived by mothers. Methods: A study was conducted in a community health center in Korea. 169 healthy infant-mother dyads were assigned to Meridian massage group (n=89) or a gentle touch massage group (n=80), based on mother's preference. All massage were conducted by their mothers for 15 minutes per session, one time daily over a course of 6 weeks. In each group, the infant's weights, heights, and the number of days with illness as perceived by mothers and related clinic visits were measured. Results: Significant differences were observed in weight and height after 6 weeks between the Meridian group and gentle touch massage group (p<.001). Infants in the Meridian massage group showed significantly different number of days with perceived clinic visits compared to those in the control group (p<.001). Conclusions: Meridian Massage may facilitate physical growth and improve infant's health outcome as perceived by mothers. A randomized controlled trial is required to further explore the effects of Meridian Massage in early infancy.

Pediatr Int. 2011 Sep 14. doi: 10.1111/j.1442-200X.2011.03477.x. Cho KJ, Ji ES, Lee MH. Post doctoral fellow, College of nursing, University of Wisconsin-Milwaukee, USA Professor, College of nursing science, Kyung Hee University, Seoul, South Korea Associate Professor, Department of Nursing, Shinsung College, Dangjin, South Korea.

Physiological and clinical changes after therapeutic massage of the neck and shoulders.



Little is known regarding the physiological and clinical effects of therapeutic massage (TM) even though it is often prescribed for musculoskeletal complaints such as chronic neck pain. This study investigated the influence of a standardized clinical neck/shoulder TM intervention on physiological measures assessing a-motoneurone pool excitability, muscle activity; and the clinical measure of range of motion (ROM) compared to a light touch and control intervention. Flexor carpi radialis (FCR) a-motoneurone pool excitability (Hoffmann reflex), electromyography (EMG) signal amplitude of the upper trapezius during maximal muscle activity, and cervical ROM were used to assess possible physiological changes and clinical effects of TM. Sixteen healthy adults participated in three, 20 min interventions: control (C), light touch (LT) and therapeutic massage (TM). Analysis of Covariance indicated a decrease in FCR a-motoneurone pool excitability after TM, compared to both the LT (p = 0.0003) or C (p = 0.0007) interventions. EMG signal amplitude decreased after TM by 13% (p <0.0001), when compared to the control, and 12% (p < 0.0001) as compared to LT intervention. The TM intervention produced increases in cervical ROM in all directions assessed: flexion (p < 0.0001), lateral flexion (p < 0.0001), extension (p < 0.0001), and rotation (p < 0.0001). TM of the neck/shoulders reduced the a-motoneurone pool excitability of the flexor carpi radialis after TM, but not after the LT or C interventions. Moreover, decreases in the normalized EMG amplitude during MVIC of the upper trapezius muscle; and increases in cervical ROM in all directions assessed occurred after TM, but not after the LT or C interventions.

Man Ther. 2011 Oct;16(5):487-94. Sefton JM, Yarar C, Carpenter DM, Berry JW. Neuromechanics Research Laboratory, Department of Kinesiology, Auburn University, Auburn, AL 36849-5323, USA. jmsefton@auburn.edu

Psychomotor re-education--movement as therapeutic method.



INTRODUCTION: Psychomotor re-education represents a multidimensional therapeutic approach in dealing with children and adults with psychomotor disorders. Therapeutic programs should be based on individual differences, abilities and capabilities, relationships, feelings and individual developmental needs as well as emotional condition of a child. BODY AND MOVEMENT AS THE BASIS OF THE TREATMENT: A movement, glance, touch, voice and word, all being an integral part of a process of psychomotor re-education, are used with a purpose of helping children to discover their own body, their feelings, needs, behaviour. When moving, children discover the space of their own bodily nature, and, subsequently, gestural space and objective space. The body represents a source of pleasure and the freedom of movement, as well as one's own existence, are soon tobe discovered. PRACTICAL APPLICATION: An adequate assessment is a precondition to design a work plan, select the best exercises for each child individually and direct the course of therapy. This is the most suitable method for treating children with slow or disharmonious development, mentally challenged children, children with speech and behaviour disorders. It is also used in the treatment of children with dyspraxic difficulties, difficulties in practognostic and gnostic development, pervasive developmental disorder and children with lateral dominance problems. CONCLUSION: Therefore, a systematic observation seems to be necessary as well as an increased number of research projects aimed at assessing results obtained by exercises in order to get a more precise insight into the process of re-education, selection of exercises, duration period and possible outcomes.

Med Pregl. 2011 Jan-Feb;64(1-2):61-3. Golubovic S, Tubic T, Markovic S. Katedra za specijalnu rehabilitaciju i edukaciju, Medicinski fakultet Novi Sad. gale@neobee.net

Effects of traditional Japanese massage therapy on gene expression: preliminary study.



Abstract Objectives: Changes in gene expression after traditional Japanese massage therapy were investigated to clarify the mechanisms of the clinical effects of traditional Japanese massage therapy. Design: This was a pilot experimental study. Settings/location: The study was conducted in a laboratory at Tsukuba University of Technology. Subjects: The subjects were 2 healthy female volunteers (58-year-old Participant A, 55-year-old Participant B). Interventions: The intervention consisted of a 40-minute full-body massage using standard traditional Japanese massage techniques through the clothing and a 40-minute rest as a control, in which participants lie on the massage table without being massaged. Outcome measures: Before and after an intervention, blood was taken and analyzed by microarray: (1) The number of genes whose expression was more than double after the intervention than before was examined; (2) For those genes, gene ontology analysis identified statistically significant gene ontology terms. Results: The gene expression count in the total of 41,000 genes was 1256 genes for Participant A and 1778 for Participant B after traditional Japanese massage, and was 157 and 82 after the control, respectively. The significant gene ontology terms selected by both Participants A and B after massage were "immune response" and "immune system," whereas no gene ontology terms were selected by them in the control. Conclusions: It is implied that traditional Japanese massage therapy may affect the immune function. Further studies with more samples are necessary.

J Altern Complement Med. 2011 Jun;17(6):553-5. Epub 2011 May 19. Donoyama N, Ohkoshi N. 1 Course of Acupuncture and Moxibustion, Department of Health, Faculty of Health Sciences, Tsukuba University of Technology , Tsukuba, Ibaraki, Japan .

A qualitative study of mindfulness-based meditation therapy in Japanese cancer patients.



PURPOSE: The primary objective of the study was to examine mindfulness-based meditation therapy qualitatively. A secondary goal was to examine the differences in themes selected by Japanese and Western patients receiving this therapy. METHODS: The subjects were 28 patients who were undergoing anti-cancer treatment. The subjects participated in two sessions of mindfulness-based meditation therapy, including breathing, yoga movement, and meditation. Each patient was taught the program in the first session, then exercised at home with a CD, and subsequently met the interviewer in a second session after 2 weeks. Primary physicians recruited the patients and interviews were conducted individually by nurses or psychologists with training in the program. Patients provided answers to pre- and post-intervention interviews about the meaning of their illness. RESULTS: Narrative data from the semi-structured interview were analyzed qualitatively. Pre-intervention, themes such as "Effort to cope," "Looking back," "Spirituality," "Personal growth," and "Suffering" were often chosen. Post-intervention, themes such as "Adapted coping," "Personal growth," "Positive meaning," "Spirituality," and "Negative recognition" were more commonly chosen. CONCLUSIONS: Mindfulness-based meditation therapy may be effective for producing adapted coping, including positive recognition and changes for an adapted lifestyle. There were some common aspects and some differences in the themes selected by patients in this study and Western patients received mindfulness therapy in other studies.

Support Care Cancer. 2011 Jul;19(7):929-33. Epub 2010 May 16. Ando M, Morita T, Akechi T, Ifuku Y. Faculty of Nursing, St. Mary's College, Tsubukuhonmachi 422, Kurume City, Fukuoka, Japan, andou@st-mary.ac.jp.

Sensorimotor interventions improve growth and motor function in preterm infants.



PURPOSE: To assess the effect of an oral (O+O), a tactile/kinesthetic (T/K+T/K), and a combined (O+T/K) intervention on preterm infants' weight gain and motor function and to determine whether the combined O+T/K intervention has an additive/synergistic effect on outcomes. DESIGN/SAMPLE: Seventy-five preterm infants were randomized into an O+O intervention consisting of oral stimulation, a T/K+T/K intervention involving whole body stimulation, an O+T/K intervention, and a control group. Interventions were administered for 15 minutes, twice a day, for ten days.

OUTCOMES: Weight gain, motor function. RESULTS: The O+O and T/K+T/K groups had greater weight gain during the intervention period than did controls (p ?.025). The T/K+T/K and O+T/K groups had better motor function than did controls (p ?.017).

CONCLUSION: Single and combined interventions improved growth and motor function. The combined intervention, because of the shorter duration of each modality, did not lead to additive/synergistic effects, suggesting that the duration of the sensorimotor input is as important as its target in achieving defined outcomes.

Neonatal Netw. 2010 Nov-Dec;29(6):359-66. Fucile S, Gisel EG. School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada. sandra.fucile@mail.mcgill.ca

Protective essential oil attenuates influenza virus infection: an in vitro study in MDCK cells.



BACKGROUND: Influenza is a significant cause of morbidity and mortality. The recent pandemic of a novel H1N1 influenza virus has stressed the importance of the search for effective treatments for this disease. Essential oils from aromatic plants have been used for a wide variety of applications, such as personal hygiene, therapeutic massage and even medical practice. In this paper, we investigate the potential role of an essential oil in antiviral activity.

METHODS: We studied a commercial essential oil blend, On Guard™, and evaluated its ability in modulating influenza virus, A/PR8/34 (PR8), infection in Madin-Darby canine kidney (MDCK) cells. Influenza virus was first incubated with the essential oil and infectivity in MDCK cells was quantified by fluorescent focus assay (FFA). In order to determine the mechanism of effects of essential oil in viral infection inhibition, we measured hemagglutination (HA) activity, binding and internalization of untreated and oil-treated virus in MDCK cells by flow cytometry and immunofluorescence microscopy. In addition, the effect of oil treatment on viral transcription and translation were assayed by relative end-point RT-PCR and western blot analysis.

RESULTS: Influenza virus infectivity was suppressed by essential oil treatment in a dose-dependent manner; the number of nascent viral particles released from MDCK cells was reduced by 90% and by 40% when virus was treated with 1:4,000 and 1:6,000 dilutions of the oil, respectively. Oil treatment of the virus also decreased direct infection of the cells as the number of infected MDCK cells decreased by 90% and 45% when virus was treated with 1:2,000 and 1:3,000 dilutions of the oil, respectively. This was not due to a decrease in HA activity, as HA was preserved despite oil treatment. In addition, oil treatment did not affect virus binding or internalization in MDCK cells. These effects did not appear to be due to cytotoxicity of the oil as MDCK cell viability was only seen with concentrations of oil that were 2 to 6 times greater than the doses that inhibited viral infectivity. RT-PCR and western blotting demonstrated that oil treatment of the virus inhibited viral NP and NS1 protein, but not mRNA expression.

CONCLUSIONS: An essential oil blend significantly attenuates influenza virus PR8 infectivity in vitro without affecting viral binding or cellular internalization in MDCK cells. Oil treated virus continued to express viral mRNAs but had minimal expression of viral proteins, suggesting that the antiviral effect may be due to inhibition of viral protein translation.

BMC Complement Altern Med. 2010 Nov 15;10:69. Wu S, Patel KB, Booth LJ, Metcalf JP, Lin HK, Wu W. Department of Respiratory Medicine, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, PR China.

Reflexology for the symptomatic treatment of breast cancer: a systematic review.



The objective of this review was to assess the effectiveness of reflexology as a symptomatic treatment for breast cancer. In all, 12 databases were searched from the time of their inception through July 2010. Prospective, controlled clinical trials of reflexology in patients with breast cancer that included an assessment of clinical outcome measures were reviewed. Study selection, data extraction, and validations were performed independently by 2 reviewers. One randomized clinical trial (RCT) and three nonrandomized controlled clinical trials (CCTs) met our inclusion criteria. One large RCT showed significant differences in quality of life and mood when reflexology was compared with self-initiated support. Three CCTs tested reflexology compared with no treatment or simple rest. All of them suggested favorable effects of reflexology on pain, nausea, and vomiting. However, they had a high risk of bias. Collectively, the existing evidence does not convincingly show that reflexology is effective for breast cancer care. Future studies seem warranted; they should be of high methodological quality, and include adequate control interventions.

Integr Cancer Ther. 2010 Dec;9(4):326-30.Kim JI, Lee MS, Kang JW, Choi do Y, Ernst E. Kyung Hee University, Seoul, South Korea.

Venous thromboembolism following vigorous deep tissue massage.



Venous thromboembolism (VTE) is an increasing public health concern, in part because of lack of awareness among patients and physicians. Nonpenetrating trauma to the legs may be an under-recognized potential risk factor for VTE. We report a case of VTE following vigorous deep tissue massage in a previously healthy 67-year-old man with no other identifiable risk factors. The etiology, risk factors, and implications for the prevention and detection of VTE are reviewed. There are few other published reports of VTE associated with massage, but under-reporting seems likely. Vigorous massage or any equivalent trauma to the legs should be considered and evaluated as a possible risk factor for VTE, especially in older adults. Additional research is needed to clarify the risks associated with nonpenetrating trauma to the legs in older adults and other susceptible groups. Improved awareness of VTE, including its risk factors and symptoms, is an urgent priority for more effective prevention, detection, and treatment.

Phys Sportsmed. 2010 Dec;38(4):136-9. Crump C, Paluska SA. Division of Family and Community Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA. kccrump@stanford.edu

Postpartum depression: an essential overview for the practitioner.



Postpartum depression (PPD) is a cross-cultural form of major depressive disorder that affects some 13% of women and can have serious health consequences for both the mother and her child. Easy-to-use, reliable, self-administered screening tools are available. PPD may have a variety of etiologies, which include changing plasma levels of estrogen and progesterone, postpartum hypothyroidism, sleep deprivation, or difficult life circumstances. Standard treatments for PPD include psychotherapy and antidepressants. However, treatment of a thyroid condition or insomnia, or even regular exercise or massage may also be beneficial. PPD is underdiagnosed, therefore more screening is needed. Obstetricians and pediatricians have a unique opportunity to test women for PPD, but general practitioners may encounter patients with undiagnosed PPD, too. These physicians could positively impact the lives of depressed mothers and their children by identifying them, then treating or providing referrals for care as appropriate.

South Med J. 2011 Feb;104(2):128-32. Breese McCoy SJ. Department of Physiology, Oklahoma State University Center for Health Sciences and College of Osteopathic Medicine and Surgery, Tulsa, OK 74107, USA. sjmccoy98@aol.com

Using massage to ease constipation.



BACKGROUND: Constipation is a painful and serious condition that patients often find difficult to talk about. It is usually treated with laxatives alone.

AIM: To determine whether abdominal massage is an effective treatment for constipation. METHOD Of 60 people with constipation, half received 15 minutes of abdominal and hand massage a day, five days a week, for eight weeks, as well as prescribed laxatives. The rest received prescribed laxatives only. Interviews with participants were also conducted.

RESULTS: Abdominal massage used with laxatives reduced abdominal pain, increased bowel movements and improved quality of life compared with laxative use alone. Patients reported positive experiences of abdominal massage but it did not reduce their laxative use.

CONCLUSION: Abdominal massage was seen as a pleasant treatment that can be offered as an option in constipation management.

Pak J Biol Sci. 2010 Oct 15;13(20):1006-10. Lämås K. Department of Nursing, Umeå University, Sweden.

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Early aggressive treatment improves prognosis in complex regional pain syndrome.



Complex regional pain syndrome (CRPS) is divided into two types. Type I occurs without obvious nerve injury. In type II, a peripheral nerve injury is present, although pain may not be limited to the distribution of that nerve. Diagnosis rests on the presence of a constellation of symptoms and signs. These include extreme sensitivity, changing skin colour and temperature, trophic changes in the skin, nails and hair, reduced range of motion and loss of function. These features are accompanied by considerable pain for which no other unifying diagnosis can be made. CRPS typically starts with an injury to an extremity which is often seemingly trivial, followed by immobilisation, such as an ankle sprain or Colles' fracture. Instead of the expected resolution of symptoms, persistent pain and dysfunction develop. CRPS usually has an early warm phase that suggests an inflammatory process, with local swelling, erythema and heat. It then progresses to a cold phase, which often goes on for months or years. It is important to keep the affected part moving as much as possible, especially in the early stages. Sensory stimulation, particularly by self-massage, is advised. Aggressive treatment in the early stages improves prognosis. Many cases, especially those with relatively minor symptoms, will resolve spontaneously. Patients who are symptomatically deteriorating, despite regular analgesia, neuropathic agents and physiotherapy, should be referred to a specialist.

Practitioner. 2011 Jan;255(1736):23-6, 3. Lee J, Nandi P. Pain Management Centre, National Hospital for Neurology & Neurosurgery, Queen Square, London.

Uterine massage to reduce postpartum hemorrhage after vaginal delivery.



OBJECTIVE: To determine the effectiveness of sustained uterine massage started before delivery of the placenta in reducing postpartum hemorrhage. METHODS: A randomized controlled trial conducted in Egypt and South Africa between September 2006 and February 2009. A total of 1964 pregnant women were randomly allocated to 1 of 3 treatment groups: intramuscular oxytocin, sustained uterine massage, or both treatments. Blood loss within 30 minutes of delivery was recorded. RESULTS: The incidence of blood loss of 300 mL or more within 30 minutes of delivery was significantly higher in the massage group than in the massage plus oxytocin (RR 1.88; 95% CI, 1.29-2.74 in Assiut, and RR 1.3; 95% CI, 1.00-1.68 in SA) and the oxytocin only group (RR 1.7; 95% CI, 1.11-2.61 in Assiut, and RR 2.24; 95% CI, 1.54-3.27 in SA). In both centers, use of additional uterotonics was significantly higher in the uterine massage group compared with the other 2 groups. CONCLUSION: Uterine massage was less effective than oxytocin for reducing blood loss after delivery. When oxytocin was used, there was no additional benefit from uterine massage. The effectiveness of uterine massage in the absence of oxytocin was not studied. ACTRN: 12609000372280.

Int J Gynaecol Obstet. 2010 Oct;111(1):32-6. Abdel-Aleem H, Singata M, Abdel-Aleem M, Mshweshwe N, Williams X, Hofmeyr GJ. Department of Obstetrics and Gynecology, Women's Health Centre, Assiut University Hospital, Assiut, Egypt. aleemh@yahoo.com

Complementary therapies for children undergoing stem cell transplantation...



FULL TITLE: Complementary therapies for children undergoing stem cell transplantation: report of a multisite trial.

BACKGROUND: Children undergoing stem cell transplant (SCT) experience high levels of somatic distress and mood disturbance. This trial evaluated the efficacy of complementary therapies (massage, humor therapy, relaxation/imagery) for reducing distress associated with pediatric SCT. METHODS: Across 4 sites, 178 pediatric patients scheduled to undergo SCT were randomized to a child-targeted intervention involving massage and humor therapy, the identical child intervention plus a parent intervention involving massage and relaxation/imagery, or standard care. Randomization was stratified by site, age, and type of transplant. The interventions began at admission and continued through SCT Week +3. Primary outcomes included patient and parent reports of somatic distress and mood disturbance obtained weekly from admission through Week +6 using the Behavioral, Affective, and Somatic Experiences Scales. Secondary outcomes included length of hospitalization, time to engraftment, and usage of narcotic analgesic and antiemetic medications. RESULTS: A mixed model approach was used to assess longitudinal trends of patient and parent report outcomes and to test differences between groups on these measures. Significant changes across time were observed on all patient and parent report outcomes. However, no significant differences between treatment arms were found on the primary outcomes. Similarly, no significant between-group differences were noted on any of the medical variables as secondary outcomes. CONCLUSIONS: Results of this multisite trial failed to document significant benefits of complementary interventions in the pediatric SCT setting.

Cancer. 2010 Aug 15;116(16):3924-33. Phipps S, Barrera M, Vannatta K, Xiong X, Doyle JJ, Alderfer MA. Department of Behavioral Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA. sean.phipps@stjude.org

Physiological responses to touch massage in healthy volunteers.



OBJECTIVES: To evaluate effects of touch massage (TM) on stress responses in healthy volunteers. METHODS: A crossover design including twenty-two (mean age=28.2) healthy volunteers (11 male and 11 female) cardiac autonomic tone was measured by heart rate (HR) and heart rate variability (HRV). Stress hormone levels (cortisol) were followed in saliva. We also measured blood glucose and serum insulin. Extracellular (ECV) levels of glucose, lactate, pyruvate and glycerol were followed using the microdialysis technique (MD). TM was performed on hands and feet for 80 min, during control, participants rested in the same setting. Data were collected before, during, and after TM and at rest. Saliva cortisol, serum glucose, and serum insulin were collected before, immediately following, and 1 h after intervention or control, respectively. RESULTS: After 5 min TM, HR decreased significantly, indicating a reduced stress response. Total HRV and all HRV components decreased during intervention. Saliva cortisol and insulin levels decreased significantly after intervention, while serum glucose levels remained stable. A similar, though less prominent, pattern was seen during the control situation. Only minor changes were observed in ECV levels of glucose (a decrease) and lactate (an increase). No significant alterations were observed in glycerol or pyruvate levels throughout the study. There were no significant differences between groups in ECV concentrations of analyzed substances. CONCLUSIONS: In healthy volunteers, TM decreased sympathetic nervous activity, leading to decreased overall autonomic activity where parasympathetic nervous activity also decreased, thereby maintaining the autonomic balance.

Auton Neurosci. 2010 Dec 8;158(1-2):105-10. Lindgren L, Rundgren S, Winsö O, Lehtipalo S, Wiklund U, Karlsson M, Stenlund H, Jacobsson C, Brulin C. Department of Nursing, Umeå University, Sweden. lenita.lindgren@nurs.umu.se

PSGR and PCA3 as biomarkers for the detection of prostate cancer in urine.



PSGR and PCA3 as biomarkers for the detection of prostate cancer in urine.

BACKGROUND: Several studies have demonstrated the usefulness of monitoring an RNA transcript in urine, such as PCA3, for prostate cancer (PCa) diagnosis. PCa screening would benefit from additional biomarkers of higher specificity and could be used in conjunction with prostate-specific antigen (PSA) testing, in order to better determine biopsy candidates. METHODS: We used urine sediments after prostate massage (PM) from 215 consecutive patients, who presented for prostate biopsy. We tested whether prostate-specific G-protein coupled receptor (PSGR), a biomarker previously described to be over-expressed in PCa tissue, could also be detected by quantitative real-time PCR in post-PM urine sediment. We combined these findings with prostate cancer gene 3 (PCA3), the current gold standard for PCa diagnosis in urine, to test if a combination of both biomarkers could improve the sensitivity of PCA3 alone. RESULTS: By univariate analysis we found that PSGR and PCA3 were significant predictors of PCa. Receiver operator characteristic curve analysis and its multivariate extension, multivariate ROC (MultiROC), were used to assess the outcome predictive values of the individual and the paired biomarkers. We obtained the following area under the curve values: PSA (0.602), PSGR (0.681), PCA3 (0.656), and PSGRvPCA3 (0.729). Then, we tested whether a combination of PSGR and PCA3 could improve specificity by fixing the sensitivity at 95%. We obtained specificities of 15% (PSGR), 17% (PCA3), and 34% (PSGRvPCA3). CONCLUSIONS: A multiplexed model including PSGR and PCA3 improves the specificity for the detection of PCa, especially in the area of high sensitivity. This could be clinically useful for determining which patients should undergo biopsy.

Prostate. 2010 Dec 1;70(16):1760-7. Rigau M, Morote J, Mir MC, Ballesteros C, Ortega I, Sanchez A, Colás E, Garcia M, Ruiz A, Abal M, Planas J, Reventós J, Doll A. Biomedical Research Unit, Research Institute, Vall d'Hebron UniversityHospital, Barcelona, Spain.

Back massage therapy promotes psychological relaxation...



FULL TITLE: Back massage therapy promotes psychological relaxation and an increase in salivary chromogranin A release.

Massage therapy promotes psychosocial relaxation, reduces stress and has been reported to improve the immune function. As such, massage therapy is currently used in palliative care for the relief of anxiety and pain. Although psychosocial status has been evaluated using subjective psychological tests, such as State-Trait Anxiety Inventory (STAI), subjective psychological tests are of limited value if the subjects fail to report reliably. Salivary biomarkers have been recently suggested as useful objective markers for assessing psychosocial status. To determine whether salivary biomarkers are useful objective indices for assessing the effects of back massage on the mental status of 25 young healthy female volunteers, we measured heart rate and salivary biomarkers (?-amylase activity, cortisol, and chromogranin A) and assessed the STAI score before and after the back massage. Back massage significantly reduced the heart rate and STAI; however, salivary amylase and cortisol levels did not change. In contrast, the level of salivary chromogranin A significantly increased. We therefore conclude that changes in the salivary biomarkers tested here may not indicate changes in psychological status following massage therapy. However, the increase in chromogranin A release may contribute to the immunologically beneficial effects of massage therapy as chromogranin A has antibacterial and antifungal activity.

J Anesth. 2010 Dec;24(6):955-8. Noto Y, Kudo M, Hirota K. Department of Nursing, Hirosaki University Graduate School of Health Sciences, Hirosaki 036-8563, Japan.

Nurses' use of non-pharmacological methods in children's postoperative pain...



FULL TITLE: Nurses' use of non-pharmacological methods in children's postoperative pain management: educational intervention study.

AIM: This paper is a report of study of the impact of an educational intervention in pain management on nurses' self-reported use of non-pharmacological methods for children's postoperative pain relief and their perceptions of barriers that limited their use of these methods. BACKGROUND: Non-pharmacological methods have been shown to be effective in relieving pain; however, many barriers, including lack of knowledge, limit nurses' use of these methods. Pain education is a promising strategy for changing nursing practice, but only a few authors have examined the effectiveness of educational interventions for nurses to help relieve children's postoperative pain. METHODS: A quasi-experimental one-group pre- and post-test design was used. Questionnaire surveys were conducted with a convenience sample of 108 Registered Nurses in two public hospitals in Singapore in 2008. RESULTS: Statistically significant increases were found in nurses' self-reported use of imagery, positive reinforcement, thermal regulation, massage and positioning in the postintervention survey. Before the intervention, these methods were less frequently used compared to other methods. Heavy workload/lack of time and the child's inability to cooperate were the most commonly reported barriers at pre- and post-test. CONCLUSION: The educational intervention had a positive effect on nurses' use of several non-pharmacological methods. Regular dissemination of updated information to nurses on these pain management methods is recommended to maintain the positive changes. Nevertheless, education alone was not sufficient to optimize nurses' use of these methods, as various barriers limited their practice.

J Adv Nurs. 2010 Nov;66(11):2398-409. doi: 10.1111/j.1365-2648.2010.05402.x. He HG, Jahja R, Lee TL, Ang EN, Sinnappan R, Vehviläinen-Julkunen K, Chan MF. Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. nurhhg@nus.edu.sg

Nurses' use of non-pharmacological methods in children's postoperative pain...



FULL TITLE: Nurses' use of non-pharmacological methods in children's postoperative pain management: educational intervention study.

AIM: This paper is a report of study of the impact of an educational intervention in pain management on nurses' self-reported use of non-pharmacological methods for children's postoperative pain relief and their perceptions of barriers that limited their use of these methods. BACKGROUND: Non-pharmacological methods have been shown to be effective in relieving pain; however, many barriers, including lack of knowledge, limit nurses' use of these methods. Pain education is a promising strategy for changing nursing practice, but only a few authors have examined the effectiveness of educational interventions for nurses to help relieve children's postoperative pain. METHODS: A quasi-experimental one-group pre- and post-test design was used. Questionnaire surveys were conducted with a convenience sample of 108 Registered Nurses in two public hospitals in Singapore in 2008. RESULTS: Statistically significant increases were found in nurses' self-reported use of imagery, positive reinforcement, thermal regulation, massage and positioning in the postintervention survey. Before the intervention, these methods were less frequently used compared to other methods. Heavy workload/lack of time and the child's inability to cooperate were the most commonly reported barriers at pre- and post-test. CONCLUSION: The educational intervention had a positive effect on nurses' use of several non-pharmacological methods. Regular dissemination of updated information to nurses on these pain management methods is recommended to maintain the positive changes. Nevertheless, education alone was not sufficient to optimize nurses' use of these methods, as various barriers limited their practice.

J Adv Nurs. 2010 Nov;66(11):2398-409. doi: 10.1111/j.1365-2648.2010.05402.x. He HG, Jahja R, Lee TL, Ang EN, Sinnappan R, Vehviläinen-Julkunen K, Chan MF. Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. nurhhg@nus.edu.sg

Piloting tailored teaching on nonpharmacologic enhancements for postoperative...



FULL TITLE: Piloting tailored teaching on nonpharmacologic enhancements for postoperative pain management in older adults.

Despite many advances in the pharmacologic treatment of pain, the issue of unresolved postoperative pain continues to plague patients and health care professionals. Little seems to be known about the reasons why nonpharmacologic methods are not more widely used, particularly as they are commonly low in cost, easy to use, and largely free of adverse side effects. A central question has to do with what patients are taught about nonpharmacologic methods and how a novel mode of teaching can be embedded in practice. A seven-step pre-posttest teaching intervention pilot study was deployed with older joint replacement patients within the context of a translational research model. Results of the teaching pilot showed significant post-teaching changes in subjects' knowledge and attitudes about nonpharmacologic methods for pain management, high satisfaction with the nonpharmacologic methods they chose, and incrementally greater use of the nonpharmacologic methods over the course of the hospital stay. A randomized controlled trial of the study is now in the early planning stages in an effort to obtain generalizable results that will help solidify evidence of the impact of music, imagery, and slow-stroke massage on pain management and confirm the value of patient teaching as an important means of offering patients more options for managing their own pain.

Pain Manag Nurs. 2010 Sep;11(3):148-58. Tracy SM. University of New Hampshire, Durham, NH, USA. s.tracy@unh.edu

Chair massage for treating anxiety in patients withdrawing from drugs...



FULL TITLE: Chair massage for treating anxiety in patients withdrawing from psychoactive drugs.

CONTEXT: Therapeutic massage has been proven to be an effective, nonpharmacologic, alternative for managing state and trait anxiety in a variety of clinical situations. However, no controlled study has investigated this effect in an addiction treatment setting. AIM: The aim of this study was to investigate the effectiveness of chair massage for reducing anxiety in persons participating in an inpatient withdrawal management program for psychoactive drugs. DESIGN: The design was a randomized, controlled clinical trial conducted from June 2008 to January 2009. SUBJECTS: Eighty-two (82) adult patients received inpatient treatment for psychoactive drug withdrawal (alcohol, cocaine, and opiates). SETTING: This study was conducted at the Withdrawal Management Services at the Capital District Health Authority, Halifax, Nova Scotia. INTERVENTIONS: Subjects were randomly assigned to receive chair massage (n?=?40) or a relaxation control condition (n?=?42). Treatments were offered for 3 consecutive days. Standard counseling and pharmacologic management were also offered concurrently to patients in all conditions. MEASUREMENTS: The primary outcome measure was anxiety assessed using the Spielberger State-Trait Anxiety Inventory (STAI). State and trait anxiety scores were determined immediately prior to and following each treatment intervention. RESULTS: Analysis of STAI scores showed a significant reduction in state and trait anxiety for both interventions (p? J Altern Complement Med. 2010 Sep;16(9):979-87. Black S, Jacques K, Webber A, Spurr K, Carey E, Hebb A, Gilbert R. Addiction Prevention and Treatment Services, Capital District Health Authority, Dartmouth, Nova Scotia, Canada.

Experimental study on mechanical vibration massage for treatment...



FULL TITLE: Experimental study on mechanical vibration massage for treatment of brachial plexus injury in rats.

OBJECTIVE: To investigate the curative effect of the self-made mechanical vibration massage instrument for treatment of brachial plexus injury in rats and to explore its mechanism. METHODS: Brachial plexus injury models were made in 144 Wistar rats and one week after natural healing of the wound, they were randomly divided into 3 groups, mechanical vibration treatment group (MV group), nerve growth factor treatment group (NGF group) and model group, 48 rats in each group. Then again, the each group was randomly divided into 4 subgroups, 7-day group, 14-day group, 21-day group and 28-day group, 12 rats in each subgroup. The MV group were treated by mechanical vibration at acupoints on three-yang and three-yin channels of the hand with the mechanical vibration massage instrument; The NGF group were treated with injection of NGF into musculus pectoralis major on the affected side; And the model group were normally fed with no treatment. After treatment for 7, 14, 21 and 28 days, the diameter of both forelimbs were measured, the electrophysiological examination on the brachial plexus in vitro and the ultrastructure observation with electron microscope on the affected side were carried out, the motor nerve conduction velocity (MNCV) and motor nerve action potential (MNAP) of the brachial plexus on the affected side, NGF content of submaxillary gland as well as muscular Na+, K(+)-ATPase activity were determined respectively. RESULTS: The different rates of the forelimb diameter in the MV group and the NGV group on the 14th d, 21st d and 28th d were better than those in the model group (P < 0.05 or P < 0.001), and in the MV group were better than those in the NGF group on the 21st d and the 28th d (P < 0.05). MNCV in the MV group and the NGV group on the 21st d and 28th d was better than that in the model group (P < 0.05 or P < 0.001), and in the MV group was better than that in the NGF group on the 28th d (P < 0.05). MNAP in the MV group and the NGV group on the 14th d, 21st d and 28th d was better than that in the model group (P < 0.05 or P < 0.001), and in the MV group was better than that in the NGF group on the 21st d and 28th d (P < 0.05). The NGF mean gray index of submaxillary gland in the model group was higher than that in the MV group and the NGF group on the 7th d (P < 0.05); in the NGF group and the model group was higher than that in the MV group on the 14th d (P < 0.05); and in the NGF group and the MV group was higher than that in the model group on the 21st d and 28th d (P < 0.05). Na+, K(+)-ATPase activity in the model group and the MV group was higher than that in the NGF group (P < 0.05) on the 14th d, and in the MV group was higher than that in the model group on the 28th d (P < 0.05). CONCLUSION: As compared with the NGF group and the model group, mechanical vibration treatment can effectively accelerate repair of injured brachial plexus, slow down atrophy of skeletal muscle, and promote secretion of NGF in submaxillary gland.

J Tradit Chin Med. 2010 Sep;30(3):190-5. Mei RJ, Xu YY, Li Q. Institute of Acupuncture and Moxibustion, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, China.

Neck pain in Hong Kong: a telephone survey on consequences and health service...



FULL TITLE: Neck pain in Hong Kong: a telephone survey on consequences and health service utilization.

STUDY DESIGN: A regionally representative telephone survey using a 2-stage randomization process. OBJECTIVE: (1) To investigate the prevalence and consequence of neck pain in terms of disability and rate of absenteeism from work. (2) To describe the health services utilization pattern of neck pain subjects and to analyse the factors associated with neck pain and health services utilization pattern. SUMMARY OF BACKGROUND DATA: There has been a lack of reliable information on the health service utilization pattern of neck pain subjects, the consequences and the patient perceived effectiveness of neck pain management in Hong Kong and Asian countries. METHODS: Subjects were interviewed on the sociodemographic characteristics, occurrence and consequences of neck pain, and the health utilization pattern. A random sample of the respondents was re-interviewed 7 to 10 days after the initial interview, by an independent interviewer for the reliability check. RESULTS: A total of 4640 subjects were interviewed. The 12-month prevalence was 64.6% (95% CI: 63.2%-66.0%). About 38.0% of these patients suffered from moderate to severe pain. Moreover, 17.7% of these subjects had to limit their social activities and 19% had to limit their work. About 25% of those subjects had consulted medical or health practitioners. Medical consultation is the majority and physiotherapy came second. Self-massage was the most preferred (83.3%) mode of self-care. Physiotherapy was regarded as the most effective health service, with 60% of the respondents' neck pain completely removed. Although most people chose self-massage to be the most effective self-care treatment, only one-third (30.2%) of them had their neck pain improved by less than a half. CONCLUSION: Neck pain is highly prevalent with an increasing impact in Hong Kong. More than one-third of neck pain patients suffered from moderate to severe pain and around 20% of them had to limit their work. About 25% of neck pain patient have consulted medical or health professionals. Physiotherapy and private medical clinic were the 2 service providers with high percentage of perceived complete improvement. There was a general trend that more neck pain patients used complementary therapies.

Spine (Phila Pa 1976). 2010 Oct 1;35(21):E1088-95. Chiu TT, Leung AS, Lam P. Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong. rstchiu@polyu.edu.hk

The role of manual therapies in equine pain management.



Manual therapy includes a diverse array of techniques, such as touch therapies, massage, physical therapy, osteopathy, and chiropractic, that were originally developed for use in humans and have been gradually applied to horses. All forms of manual therapy have variable reported levels of effectiveness for treating musculoskeletal issues in humans, but mostly only anecdotal evidence exists in horses. This article explores the scientific literature for evidence of efficacy, safety, and common mechanisms of action of the different forms of manual therapies for potential use in managing acute or chronic pain syndromes in horses. Currently, there is limited evidence supporting the effectiveness of spinal mobilization and manipulation in reducing pain and muscle hypertonicity. Further research is needed to assess the efficacy of specific manual therapy techniques and their contribution to multimodal protocols for managing specific somatic pain conditions in horses.

Vet Clin North Am Equine Pract. 2010 Dec;26(3):579-601. Haussler KK. Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523, USA. Kevin.Haussler@ColoState.edu

Integrative care for the management of low back pain...



FULL TITLE: Integrative care for the management of low back pain: use of a clinical care pathway.

BACKGROUND: For the treatment of chronic back pain, it has been theorized that integrative care plans can lead to better outcomes than those achieved by monodisciplinary care alone, especially when using a collaborative, interdisciplinary, and non-hierarchical team approach. This paper describes the use of a care pathway designed to guide treatment by an integrative group of providers within a randomized controlled trial. METHODS: A clinical care pathway was used by a multidisciplinary group of providers, which included acupuncturists, chiropractors, cognitive behavioral therapists, exercise therapists, massage therapists and primary care physicians. Treatment recommendations were based on an evidence-informed practice model, and reached by group consensus. Research study participants were empowered to select one of the treatment recommendations proposed by the integrative group. Common principles and benchmarks were established to guide treatment management throughout the study. RESULTS: Thirteen providers representing 5 healthcare professions collaborated to provide integrative care to study participants. On average, 3 to 4 treatment plans, each consisting of 2 to 3 modalities, were recommended to study participants. Exercise, massage, and acupuncture were both most commonly recommended by the team and selected by study participants. Changes to care commonly incorporated cognitive behavioral therapy into treatment plans. CONCLUSION: This clinical care pathway was a useful tool for the consistent application of evidence-based care for low back pain in the context of an integrative setting. TRIAL REGISTRATION: ClinicalTrials.gov NCT00567333.

BMC Health Serv Res. 2010 Oct 29;10:298. Maiers MJ, Westrom KK, Legendre CG, Bronfort G. Northwestern Health Sciences University, 2501 W 84th St Bloomington, MN 55431, USA. mmaiers@nwhealth.edu

The effect of chair massage on muscular discomfort...



FULL TITLE: The effect of chair massage on muscular discomfort in cardiac sonographers: a pilot study.

BACKGROUND: Cardiac sonographers frequently have work-related muscular discomfort. We aimed to assess the feasibility of having sonographers receive massages during working hours in an area adjacent to an echocardiography laboratory and to assess relief of discomfort with use of the massages with or without stretching exercises. METHODS: A group of 45 full-time sonographers was randomly assigned to receive weekly 30-minute massage sessions, massages plus stretching exercises to be performed twice a day, or no intervention. Outcome measures were scores of the QuickDASH instrument and its associated work module at baseline and at 10 weeks of intervention. Data were analyzed with standard descriptive statistics and the separation test for early-phase comparative trials. RESULTS: Forty-four participants completed the study: 15 in the control group, 14 in the massage group, and 15 in the massage plus stretches group. Some improvement was seen in work-related discomfort by the QuickDASH scores and work module scores in the 2 intervention groups. The separation test showed separation in favor of the 2 interventions. CONCLUSION: On the basis of the results of this pilot study, larger trials are warranted to evaluate the effect of massages with or without stretching on work-related discomfort in cardiac sonographers. TRIAL REGISTRATION: NCT00975026 ClinicalTrials.gov.

BMC Complement Altern Med. 2010 Sep 16;10:50. Engen DJ, Wahner-Roedler DL, Nadolny AM, Persinger CM, Oh JK, Spittell PC, Loehrer LL, Cha SS, Bauer BA. Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA. wahnerroedler.dietlind@mayo.edu.

Effect of foot massage to decrease physiological lower leg oedema...



FULL TITLE: Effect of foot massage to decrease physiological lower leg oedema in late pregnancy: a randomized controlled trial in Turkey.

This study aims to evaluate the effect of foot massage for decreasing physiological lower leg oedema in late pregnancy. Eighty pregnant women were randomly divided into two groups; study group had a 20 min foot massage daily for 5 days whereas the control group did not receive any intervention beyond standard prenatal care. The research was conducted between March and August 2007 in Manisa Province Health Ministry Central Primary Health Care Clinic 1, in Manisa, Western Turkey. Compared with the control group, women in the experimental group had a significantly smaller lower leg circumference (right and left, ankle, instep and metatarsal-phalanges joint) after 5 days of massage. The results obtained from our research show that foot massage was found to have a positive effect on decreasing normal physiological lower leg oedema in late pregnancy.

Int J Nurs Pract. 2010 Oct;16(5):454-60. doi: 10.1111/j.1440-172X.2010.01869.x. Coban A, Sirin A. Department of Midwifery, Aydin School of Health, Adnan Menderes University, Aydin, Turkey. ayden.coban@adu.edu.tr

Manipulation or microdiskectomy for sciatica?...



FULL TITLE: Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study.

OBJECTIVE: The purpose of this study was to compare the clinical efficacy of spinal manipulation against microdiskectomy in patients with sciatica secondary to lumbar disk herniation (LDH). METHODS: One hundred twenty patients presenting through elective referral by primary care physicians to neurosurgical spine surgeons were consecutively screened for symptoms of unilateral lumbar radiculopathy secondary to LDH at L3-4, L4-5, or L5-S1. Forty consecutive consenting patients who met inclusion criteria (patients must have failed at least 3 months of nonoperative management including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy, and/or acupuncture) were randomized to either surgical microdiskectomy or standardized chiropractic spinal manipulation. Crossover to the alternate treatment was allowed after 3 months. RESULTS: Significant improvement in both treatment groups compared to baseline scores over time was observed in all outcome measures. After 1 year, follow-up intent-to-treat analysis did not reveal a difference in outcome based on the original treatment received. However, 3 patients crossed over from surgery to spinal manipulation and failed to gain further improvement. Eight patients crossed from spinal manipulation to surgery and improved to the same degree as their primary surgical counterparts. CONCLUSIONS: Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.

J Manipulative Physiol Ther. 2010 Oct;33(8):576-84. McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. Chiropractor, National Spine Care, Calgary, Alberta, Canada. gmcmorland@nationalspinecare.com

Clinical efficacy of a novel sonic infusion system for periorbital rhytides.



Aging skin is a leading concern of most men and women seeking cosmetic dermatologic consultation. Various in-office procedures as well as topical at-home regimens, are generally prescribed to reduce the signs of aging, but relatively few provide immediate clinical benefit. A novel sonic infusion system that combines sonic micro-massage with an anti-aging serum was studied to determine its immediate effect on a wide range of patients with periocular rhytides. Clinical improvement of periocular rhytides was achieved after a single sonic infusion treatment (30 seconds/eye). Patients with more severe rhytides and those older than 40 years of age showed the best clinical results.

J Drugs Dermatol. 2010 Sep;9(9):1121-4. Shah S, Alster TS. Washington Institute of Dermatologic Laser Surgery, Washington, DC 20005, USA.

Masseter muscle sonographic evaluating efficacy of massage...



FULL TITLE: Masseter muscle sonographic features as indices for evaluating efficacy of massage treatment.

OBJECTIVE: The aim of this study was to clarify the sonographic features of the masseter muscle as indices for judging the efficacy of massage treatment. STUDY DESIGN: Fifteen patients with temporomandibular disorder (10 with unilateral and 5 with bilateral muscle pain) underwent massage treatment alternately on the bilateral masseter and temporal muscles with an oral rehabilitation robot. Sonography was performed before and after treatment, and the masseter thickness and existence of anechoic areas were evaluated. RESULTS: The thickness on the symptomatic side in the unilateral group significantly decreased after treatment. Anechoic areas were shown in 20 muscles (66.7%) before treatment, and disappeared or were reduced in size in 17 muscles (85.0%) after treatment. The pretreatment thickness was significantly related to visual analog scale (VAS) scores regarding posttreatment muscle pain and massage impression. The existence of anechoic areas was relevant to VAS scores regarding muscle pain. CONCLUSION: Masseter thickness and existence of anechoic areas might be related to the therapeutic efficacy regarding muscle pain.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Oct;110(4):517-26. Ariji Y, Katsumata A, Hiraiwa Y, Izumi M, Sakuma S, Shimizu M, Kurita K, Ariji E. Department of Oral and Maxillofacial Radiology, Asahi University School of Dentistry, Nagoya, Japan. yoshiko@dpc.agu.ac.jp

Massage and touch therapy in neonates: the current evidence.



Infant massage was first introduced in China in 2nd century BC. Massaging the newborn has been a tradition in India and other Asian countries since time immemorial. Various oil-based preparations have been used depending on the regional availability. There has been a recent surge in this ancient art particularly as a therapy among parents and professionals in the Western world. Evidence exists supporting the benefits of touch and massage therapy. We reviewed the literature to look at the various techniques of providing massage, its benefits, possible mechanism of action and adverse effects. The review suggests that massage has several positive effects in terms of weight gain, better sleep-wake pattern, enhanced neuromotor development, better emotional bonding, reduced rates of nosocomial infection and thereby, reduced mortality in the hospitalized patients. Many studies have described the technique and frequency of this procedure. Massage was found to be more useful when some kind of lubricant oil was used. Harmful effects like physical injury and increased risk of infection were encountered when performed inappropriately. The review also discusses the different hypotheses put forward regarding the mechanism of action. As of now there are very few studies describing the long term impact of neonatal massage.

Indian Pediatr. 2010 Sep;47(9):771-6. Kulkarni A, Kaushik JS, Gupta P, Sharma H, Agrawal RK. Division of Neonatology, Department of Pediatrics, Indraprastha Apollo Hospital, New Delhi, India.

Caring for overseas liver transplant recipients: taiwan primary family...



FULL TITLE: Caring for overseas liver transplant recipients: taiwan primary family caregivers' experiences in mainland china.

INTRODUCTION: This study explores the motivations of overseas liver transplant recipient (OLTR) families of Taiwanese OLTR who undergo the procedure in mainland China. We report the waiting time to receive the transplant in mainland China as well as the rational and service. PATIENTS AND METHODS: This exploratory qualitative method reflects guided face-to-face, semistructured interviews with families members of OLTRs. Data were subjected to content analysis. RESULTS: We interviewed 19 OLTR family members (15 females and 4 males who were between 29 and 71 years of age; mean 55.1 years) regarding 19 patients who had (17 males and 2 females who were between 36 and 71 years of age, mean, 54.6 years). The OLTR underwent transplantation in three cities in mainland China: Tianjin, Shanghai, and Guangzhou. After arrival the average waiting time was 33.1 days. Subjects reported the following reasons to help patients undergo the procedure in mainland China: (1) it is difficult to have the procedure in Taiwan; (2) the desire to extend life; and ((3)) there is no domestic living donor. Seven reasons for serving as OLTR supportive family members were identified: (1) The role and obligation in the marital relationship; (2) a close bloodline relationship; (3) insufficient manpower; (4) an individual's availability; (5) evasion of responsibility by other family members; (6) compensation for inadequate caring efforts earlier in life; and (7) an unwillingness to disturb other relatives' lives. Finally, the following support for the OLTR was reported: providing company during medical treatment/doctor visits, food preparation, massage, daily assistance, medical care, and psychological support. CONCLUSIONS: Taiwanese OLTR family members' perspectives throughout the transplant process may provide better understanding of living experiences and concerns during the stages of overseas liver transplantation.

Transplant Proc. 2010 Dec;42(10):3921-3. Chen HM, Shih FJ, Chang CL, Lai IH, Shih FJ, Hu RH. Institute of Clinical and Community Health Nursing, National Yang-Ming University Taipei, Taiwan; Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan.

Zoologic companion animal rehabilitation and physical medicine.



Injury and illness in zoologic companion animals can lead to significant pain and debilitation. Recovery can be slow and sometimes frustrating. By augmenting recovery from trauma or disease with physical medicine and rehabilitation techniques, recovery can be more rapid and complete. Physical medicine techniques, such as massage, can augment recovery from a painful injury or surgery by reducing edema, improving postoperative ileus, and decreasing anxiety. Familiarity with the tools of rehabilitation along with focus on pain management, strengthening, and proprioception improve patient care.

Vet Clin North Am Exot Anim Pract. 2011 Jan;14(1):131-40. Rychel JK, Johnston MS, Robinson NG. Department of Clinical Sciences, Center for Comparative and Integrative Pain Medicine, Colorado State University, 300 West Drake Road, Fort Collins, CO, 80523, USA. jessicarychel@gmail.com

Therapeutic massage of the neck and shoulders produces changes in peripheral...



Full Title Therapeutic massage of the neck and shoulders produces changes in peripheral blood flow when assessed with dynamic infrared thermography.

OBJECTIVE: This study's objective was to determine the effect of therapeutic massage on peripheral blood flow utilizing dynamic infrared thermography in a constant temperature/humidity thermal chamber to assess noncontact skin temperature.

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