Svircev, A., Craig, L., Ansari, F.P., Juncos, J.L., and Bliwise, D.L.
Atlanta School of Massage, Atlanta, GA
Emory University Medical School, Department of Neurology, Atlanta, GA

Introduction:
Patients with Parkinson’s disease (PD) typically have markedly disturbed sleep with conventional treatments showing only minimal success. Recently neuromuscular therapy (NMT), a form of massage therapy, has been shown to offer beneficial effects on motor function in PD (UPDRS motor subscale) (Svircev and Craig, Amer Pub Hlth Assn, 2002). Massage has been identified previously as offering beneficial effects in spinal cord injury (Diego et al, Int J Neurosci 2002: 112: 133-42) and for improving sleep in hospitalized patients (Richards et al, AACN Clin Issues, 2000, 11, 77-96). The present study examined the effects of NMT on reported sleep relative to a control condition (music relaxation therapy, MRT) in PD patients.

Methods:
There were 32 participants with mild-to-moderate stage PD (mean age 63.1, 23 men, 9 women). They were randomized to receive either NMT (n=18) or MRT (n=14). NMT was administered by a certified massage therapist over a 4 week period, 2x/week (8 sessions total, 45 minutes each) at the Atlanta School of Massage Clinic. In the NMT sessions, specific attention was paid to identification of trigger points and pressured release and music was played during the session. A consistent protocol was used for each NMT session. MRT consisted of identical protocol for each participant but excluded NMT. The Pittsburgh Sleep Quality Index (PSQI) was administered at Baseline and Follow-up, and the PSQI Global Score was used as the primary outcome in this analysis. PSQI subscales served as secondary outcomes.

Results:
The NMT group (n=18) had participants with slightly more advanced PD the MRT group (n=14) (Hoehn-Yahr, 1.8 [1.0] vs 1.3 [0.5] t=1.76, p<.10) but did not differ in age or characteristic sleep quality (Baseline PSQI Global = 8.1 [3.6] vs 7.0 [3.6], t=0.81, NS). Repeated measures ANOVA indicated no group by time interactions for either the PSQI Global Score or any of the 7 subscales. With the exception of subscale 5 (subjective sleep quality), absence of even simple time effects suggest the recalcitrant nature of disturbed sleep in this population for placebo effect.

Conclusions:
Despite massage-induced improvements in PD motor function reported elsewhere (Svircev, 2002), self-reported sleep did not show improvement with this alternative treatment modality. Because of the severity of disturbed sleep in PD, possible efficacy of various massage modalities in other conditions (e.g., primary insomnia) should still be examined.

THE ACUTE EFFECTS OF MYOFASCIAL TRIGGER POINT MASSAGE THERAPY ON CARDIAC AUTONOMIC TONE IN HEALTHY SUBJECTS

Joe Delaney FIBMS PhD, King Sun Leong BMed Sci, BMBS, MRCP, MD, Alan Watkins BSc MBBS, David Brodie BSc MIBiol PhD.

Summary

Aim: To investigate the effects of myofascial trigger-point massage therapy to the head, neck and shoulder areas on cardiac autonomic tone.

Background: No studies have reported on the effect of back massage on autonomic tone as measured by heart rate variability. This is especially relevant to the nursing profession, as massage is increasingly available as a therapy complementary to conventional nursing practice.

Design : An experimental study in which subjects were initially placed in age- and sex-matched groups and then randomised to treatment or control by alternate allocation.

Methods: The study involved 30 healthy subjects (16 female and 14 male, aged 32.5 ± 8.5 years). A five-minute cardiac inter-beat interval recording, systolic and diastolic blood pressure and subjective self-evaluations of muscle tension and emotional state were taken before and after intervention. Autonomic function was measured using time and frequency domain analysis of heart rate variability.

Results: Following myofascial trigger-point massage therapy there was a significant decrease in heart rate (P < 0.0001), systolic blood pressure, (P < 0.02) and diastolic blood pressure (P < 0.01). Analysis of heart rate variability revealed a significant increase in parasympathetic activity following myofascial trigger-point massage therapy. Additionally both muscle tension and emotional state, showed significant improvement (P > 0.001).

Conclusion: In normal healthy subjects myofascial trigger-point massage therapy to the head, neck and shoulder areas is effective in increasing cardiac parasympathetic activity and improving measures of relaxation.

Keywords: Massage, heart rate variability, autonomic tone, muscle tension, relaxation.

For further information please contact Dr Joe Delaney on email: delaney@liv.ac.uk

Marcia M Piotrowski, RN MS, Cynthia Paterson, RN MSA, Allison Mitchinson, MPH, Hyungjin Myra Kim, ScD, Marvin Kirsh, MD FACS, Daniel B. Hinshaw, MD FACS

Background: Opioid analgesia alone may not fully relieve all aspects of acute postoperative pain. Complementary medicine techniques used as adjuvant therapies have the potential to improve pain management and palliate postoperative distress.

Study Design: This prospective randomized clinical trial compared pain relief after major operations in 202 patients who received one of three nursing interventions: massage, focused attention, or routine care. Interventions were performed twice daily starting 24 hours after the operation through postoperative day 7. Perceived pain was measured each morning.

Results: The rate of decline in the unpleasantness of postoperative pain was accelerated by massage (P = 0.05). Massage also accelerated the rate of decline in the intensity of postoperative pain but this effect was not statistically significant. Use of opioid analgesics was not altered significantly by the interventions.

Conclusions: Massage may be a useful adjuvant therapy for the management of acute postoperative pain. Its greatest effect appears to be on the affective component (i.e., unpleasantness) of the pain.

Published in J Am Coll Surg 2003;197:1037-1046

Authors: Jennifer Hattan BSc RN RM, Independent Midwife, The Birth Centre, London; Lindy King PhD BN RN, Senior Lecturer School of Nursing and Midwifery, Flinders University, Adelaide, Australia; Peter Griffiths BA PhD RGN, Senior Lecturer Primary and Intermediate Care, Head of Graduate Studies (taught programmes), School of Nursing and Midwifery, King’s College London

Abstract

Background: Due to the widely presumed association between heart disease and psychological wellbeing, the use of so-called ‘complementary’ therapies as adjuncts to conventional treatment modalities have been the subject of considerable debate. The present study arose from an attempt to identify a safe and effective therapeutic intervention to promote wellbeing, which could be practicably delivered by nurses to patients in the post-operative recovery period following coronary artery bypass graft (CABG) surgery.

Aim: To investigate the impact of foot massage and guided relaxation on the wellbeing of patients who had undergone CABG surgery.

Method: Twenty-five subjects were randomly assigned to either a control or one of two intervention groups. Psychological and physical variables were measured immediately before and after the intervention. A discharge questionnaire was also administered.

Results: No significant differences between physiological parameters were found. There was a significant effect of the intervention on the calm scores (ANOVA p=0.014). Dunnett’s multiple comparison showed that this was attributable to increased calm among the massage group. Although not significant the guided relaxation group also reported substantially higher levels of calm than control. There was a clear (non-significant) trend across all psychological variables for both foot massage and, to a lesser extent, guided relaxation to improve psychological wellbeing. Both interventions were well received by the subjects.

Conclusions: These interventions appear to be effective, non-invasive techniques for promoting psychological wellbeing in this patient group. Further investigation is indicated.

Authors: Jennifer Rheingans, RN, BSN, CPON; Brandi Ancrum, BS, MPH; Jodi Savell, BA; Cynthia Myers, PhD, LMT University of South Florida College of Nursing and H. Lee Moffitt Cancer Center, Tampa, FL

Purpose: To review and critically evaluate published research on complementary and alternative medicine (CAM) in patients with sickle cell disease.

Methods: A systematic review of the literature was conducted using medical index subheadings for sickle cell disease in PubMed, CINAHL, and PsycInfo from root of each database to December 2005 seeking CAM in each of the following domains: alternative medical systems, manipulative and body-based therapies, mind-body therapies, and energy therapies. Review of retrieved titles for inclusion was completed by two independent reviewers. Inclusion criteria were met by original research reporting results of controlled or uncontrolled clinical studies, including case reports and qualitative studies. Each study was critiqued by two independent reviewers.

Results: Few studies met the inclusion criteria (N=11). Alternative medical systems yielded two studies, both on acupuncture. Manipulative and body-based therapies yielded two reports, both on massage therapy. Seven studies in mind-body therapy met inclusion criteria. These included studies of hypnosis, relaxation training, and biofeedback. No studies were found on energy therapies.

Conclusions: Few studies were found on the effects of complementary therapies for sickle cell disease. Methodological weaknesses such as small sample sizes, lack of information on compliance with treatment, blinding of assessors, details of interventions, nonstandardized assessment instruments, and gaps in the reporting of outcomes limit interpretability of the studies reviewed. Several complementary therapies appear promising for patients with sickle cell disease but further study is needed. Given that severe pain is the hallmark symptom of this disease and pain is often incompletely controlled by biomedical therapies, there is a great need for more research in the use of potentially helpful adjunctive complementary therapies with minimal side effect profiles for symptom management, quality of life, and health care utilization in sickle cell disease.

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• Benjamin LJ, Dampier CD, Jacox AK, Odesina V, Phoenix D, Shapiro B, Strafford M, Treadwell M. (1999). Guideline for the
Management of Acute and Chronic Pain in Sickle Cell Disease, APS Clinical Practice Guidelines Series, No. 1. Glenview, IL:
American Pain Society.
• Bodhise PB, Dejoie M, Brandon Z, Simpkins S, Ballas SK. (2004). Non-pharmacologic management of sickle cell pain.
Hematology, 9(3), 235-237.
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for school-age children and adolescents with sickle cell disease. J Natl Black Nurses Assoc, 12(2), 6-14.
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anemia. Pain, 7, 181-185.
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C, Orne MT. (1997). Self-hypnosis training as an adjunctive treatment in the management of pain associated with sickle cell
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Authors: Tina E. Ferner, LMT, RD, Michael C. Plewa, M.D.

Background: Prior studies have demonstrated improvement in pain with massage therapy in a variety of conditions and experimental settings, though few have examined patients in a hospital setting. Objective: To describe the experience of an inpatient integrative therapy program and measure the effects of massage therapy on pain scores in hospitalized patients. Methods: This was a 23 month, retrospective, database review from an inpatient integrative therapy department of an urban tertiary care academic medical center. Age, sex, reason for referral and pain location were recorded, as were initial and final pain scores on a 0 – 10 numerical rating scale before and after a 30 minute gentle Swedish massage intervention with relaxing background music. Analgesic medications were not controlled, but were routinely prescribed to all patients. Data are expressed as median + standard deviation (with 95% confidence intervals), and groups are compared with Mann-Whitney Rank Sum Test. Results: There were 209 subjects, including 109 (52.2%) men and100 women, aged 53.5 + 17.8 years (range 13 – 89). The most common reasons for massage referral were cancer (57), post-operative (36), palliative care (17), sickle cell (9), trauma (7) and relaxation (6). The most common pain locations specified were upper back (32), shoulder (28), head (29), neck (24), abdomen (18), and lower back (15). Initial pain scores, 6.51 + 2.31 (6.19, 6.83), and final pain scores, 2.96 + 1.88 (2.70, 3.22), were significantly different, p<0.001. Pain decreased by an average of 3.56 + 1.77 (3.32, 3.80), remained unchanged in only 5 (2.4%), and did not increase in any patient. A 50% or greater pain reduction was achieved in 156 (74.6%) subjects. Conclusion: Pain scores are significantly reduced immediately following therapeutic massage for a variety of clinical conditions in hospitalized patients despite concomitant analgesic medication use. Routine use of massage therapy in hospitalized patients of all types could have potentially important implications on clinical outcome and patient satisfaction.

The purpose of this review was to investigate the current research evident to support or oppose the use of massage therapy (MT) during the stages of pregnancy, labour and delivery, and infancy.

For this review, the electronic databases, specific to health care and complementary and alternative health care were searched from 1973 to 2005. Relevant search words were used alone and in combination to find MT effectiveness trials specific to pregnancy, labour and delivery, and infant massage. The search was limited to trials in English. In total, 15 studies were included that spanned the following categories: MT and pregnancy (3), MT and labour/delivery (3), MT and infants (9).

Although other variables were included in the review, variables specific to improving maternal mood and level of anxiety, decreasing pain, decreasing obstetrical complications and improving neonatal health and development had the most significant results. All studies involving pregnant women showed that the MT group had greater or longer lasting improvements in maternal mood and anxiety when compared to the control group. This finding was further supported through the measurement of biological measures such as cortisol, dopamine and serotonin. Subjects in the MT group experienced a decrease in the level of back and leg pain. Women who received MT during labour and delivery reported decreased levels of anxiety and pain compared to women who used breathing exercises alone. When measuring obstetrical complications, the MT group had more optimal scores then the control group(s). Premature infants who received MT scored higher on the Brazelton Neonatal Behavior Assessment Scale and experienced greater daily weight gain.

The small number and mixed methodological quality of studies on the effectiveness of massage therapy for maternal and neonatal health and the absence of studies on mechanism of action, makes drawing definitive conclusions difficult. The best available, albeit limited, evidence at this time, supports the use of massage therapy for pregnant women to improve maternal mood and level of anxiety, decrease pain, decrease obstetrical complications and improve neonatal health and development.

Author: Diane Garrison

OBJECTIVE: This project was designed to determine if therapeutic massage intervention produced clinically meaningful changes in ROM, keloid size/shape, and mood variances in children ages 8-18.

DESIGN: Data collected at Camp Amigo July 2006.

PARTICIPANTS: From an initial screening of 30 children, 8 children were eventually selected for full protocol. All were burn survivors living in North Central Florida and all had thermal burns > 2 years.

RESULTS: Massage significantly increased ROM in participants with scars when comparing the first day of measurement to the last day. Circumference nor mood was significantly altered.

CONCLUSIONS: Although ROM was significantly different when comparing first and last day measurements, we are cautious to contribute this entirely to massage because of the small number of participants in the study. More research is needed.

Authors: Maria Hernandez-Reif, PhD1, Tiffany Field, PhD 1, Gail Ironson, MD, PhD2, Julia Beutler, MPH3, Yanexy Vera, BA1,
Judith Hurley, MD4, Mary Ann Fletcher, PhD5, Saul Schanberg, MD, PhD6, Cynthia Kuhn, PhD6 & Monica Fraser7

1Touch Research Institutes, University of Miami School of Medicine
2 Department of Psychology, University of Miami
3 Office of Research, University of Miami
4 Hematology/Oncology Clinics Jackson Memorial Hospital
5Department of Medicine EM Papper Laboratory, University of Miami
6Department of Pharmacology, Duke University Medical School
7BIOTONE, San Diego, CA

Summary

Fifty-eight women (mean age = 53 yrs old) with breast cancer were assigned to a massage, relaxation or standard care control group. The massage group received 30-min massages three times a week for 5 weeks by massage therapists and the relaxation group conducted progressive muscle relaxation exercises of the same duration and on the same time schedule as the mass

age group. The women were evaluated on the first and last days of the study for mood, pain, and anxiety. Blood and urine samples were also collected to assay immune measure profile and urinary hormone values. The massage and relaxation groups reported less depressive symptoms, anxiety and pain after their first and last sessions. However, by the end of the study, only the massage group reported being less depressed, anxious and angry and having more vigor. With respect to immune measures, Natural Killer cell numbers (NK cells) increased by 12% for the massage group. This may be of clinical significance given that NK cells fight tumors and viruses. Dopamine and serotonin levels, neurotransmitters associated with depression, also increased by 59% and 36% respectively, corroborating the massage group’s self-report of decreased depressive symptoms. Overall, these findings support the use of massage therapy for women with breast cancer to improve their psychological as well as their biochemical and immune profiles. Published in: International Journal of Neuroscience, 115, 495-510.

Authors: Tiffany Field, PhD 1,2, Maria Hernandez-Reif, PhD1, Miguel Diego, PhD1 & Monica Fraser3
1Touch Research Institutes, University of Miami School of Medicine
2 Fielding Graduate University
3 BIOTONE, Inc, San Diego, CA
Summary

In this study, massage therapy was compared to relaxation therapy effects for chronic low back pain. Thirty adults (mean age = 41 years old) participated with low back pain of at least 6-months duration. The participants were cleared by their primary physician for participation and met exclusion criteria of no fractured vertebrae, herniated or degenerated disks, surgery, sciatic nerve involvement or workmen’s compensation. The massage group received 30-min massages twice a week for 5 weeks by massage therapists and the relaxation group conducted progressive muscle relaxation exercises of the same duration and on the same time schedule as the massage group. Both groups were evaluated for pain, depression, anxiety, and sleep disturbances. In addition, trunk range of motion was assessed. The massage therapy group, compared to the relaxation group, reported experiencing less pain, depressed mood, anxiety and sleep disturbance. They also showed improvement in trunk and pain flexion performance. These findings support the use of massage therapy for chronic low back pain.

The findings appear in the July 2006 issue of the Journal of Bodywork and Movement Therapy and are available in the June 5, 2006 online edition.