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The effect of applying reflexology massage on Nitroglycerin Induced Migraine Type Headache

Authors:
Department of Nursing and Midwifery, Urmia University of Medical Sciences, Urmıa, Iran
Submitted (Başvuru tarihi) 02.10.2017 Accepted after revision (Düzeltme sonrası kabul tarihi) 13.04.2018 Available online date (Online yayımlanma tarihi) 26.06.2018
Correspondence: Dr. Haleh Ghavami. Urmia University of Medical Sciences, Urmıa, Iran.
Phone: +98 - 914 - 341 6092 e-mail: haleh_ghavami@yahoo.co.uk
© 2018 Turkish Society of Algology
Effect of applying reflexology massage on nitroglycerin-induced
migraine-type headache: A placebo-controlled clinical trial
Nitrogliserine bağlı migren tipi baş ağrısı üzerine refleksoloji masajının etkisi:
Plasebo kontrollü bir klinik çalışma
Nma IMANİ, Shams Aldn SHAMS, Moloud RADFAR, Haleh GHAVAMİ, Hamd Reza KHALKHALİ
Agri 2018;30(3):116-122
doi: 10.5505/agri.2018.43815
O R I G I N A L A R T I C L E
PAIN
ARI
Summary
Objectives: Nitroglycerin (NTG)-induced migraine-type headache is the most prominent side eect of nitrate therapy. There-
fore, the aim of this study was to clarify the eectiveness of reexology massage on intravenous NTG-induced headache in
coronary care unit (CCU) inpatients.
Methods: This was a randomized clinical trial. The study sample included 75 patients that were randomly divided into three
groups: control, intervention, and placebo groups. The intensity of baseline headache in patients who received NTG was mea-
sured by the numeric rating scale for pain (NRS Pain). Patients in the intervention group received reexology massage two times
for 20 min (at 3-h interval), wherein the upper part of patient’s both foot thumbs, which is the reection point of the head, was
massaged. In the placebo group, an unspecied point on the foot (heel), which was not related to the head, was massaged.
Patients in the control group did not receive any massage.
Results: No baseline dierences existed among the three groups for the mean pain scale score (p=0.66) before the study; but
the dierence between the groups after the application was statistically signicant (p=0.000).
Conclusion: Reexology massage can reduce the intensity of NTG-induced headache.
Keywords: Migraine; nitroglycerin-induced headache; reflexology massage.
Özet
Amaç: Ntroglsern (NTG) le oluan mgren tp ba ağrısı, ntrat tedavsnn en belrgn yan etksdr. Bu nedenle, bu çalıma-
nın amacı, koroner yoğun bakım üntesnde tedav gören hastalarda reeksoloj masajının, ntravenöz ntroglserne bağlı ba
ağrısı üzerne etksn aratırmaktır.
Gereç ve Yöntem: Bu çalıma randomze br klnk aratırmadır. Çalıma örnekler rastgele yöntem le üç gruba ayrıldı ve 75
hasta; kontrol grubunu, plasebo grubunu ve müdahale grubunu oluturdu.Ntroglsern alan hastalarda ba ağrısı yoğunluğu
Ağrı çn Sayısal Değerlendrme Ölçeğ (NRS) le ölçüldü. Müdahale grubundak hastalara 20 dakka boyunca k kez reeksoloj
masajı yapıldı. (İknc masaj, brncden 3 saat sonra yapıldı.), ayak baparmağının üst kısmı baın reeksoloj noktası olarak
belrlenm bunun çn reeksoloj masaj grubunda hastaların her k ayak ba parmaklarının ust kısmına masaj uygulandı. Pla-
sebo grubunda ba ağrısı le lkl olmayan br noktaya (ayak topuğuna) masaj yapıldı. Kontrol grubundak hastalara herhang
br masaj yapılmadı.
Bulgular: Çalıma önces ağrı skalası ortalamaları açısından üç grup arasında balangıç farkı yoktu (p=0.66); ancak uygulama
sonrası gruplar arasındak fark statstksel olarak yüksekt (p=0.000).
Sonuç: Reeksoloj masajı, ntroglserne bağlı ba ağrısının yoğunluğunu azaltablr.
Anahtar sözcükler: Migren; nitrogliserine bağlı baş ağrısı; refleksoloji masajı.
Introduction
Organic nitrates, such as nitroglycerin (NTG), are still
widely used for the treatment of acute and chronic
angina and congestive heart failure.[1] NTG-induced
headache is the most prominent side eect of nitrate
therapy in patients with chest pain and has a detri-
mental eect on the quality of life.[2, 3] NTG-induced
headache may be associated with vasodilation of the
cerebral arteries due to direct activation of the nitric
oxide-cyclic guanosine monophosphate pathway.[4]
Nitrate-induced severe headache occurs in over 80%
of patients. Indeed, approximately 10% of patients
116 JULY 2018
cannot tolerate nitrate therapies due to unbearable
headache.[5]
Reexology is considered to be a type of comple-
mentary and alternative medicine (CAM). CAM
refers to treatments used either as an adjunct to or
instead of conventional medical care. The House of
Lords Select Committee for Science and Technology
has placed reexology in group two, categorized as
therapies used mostly to complement conventional
medicine. Its popularity has increased in recent years
because people are seeking more holistic ways to
maintain good health and improve their well-being.
[6, 7] Reexology is categorized as a system based on
the massage of the feet which purports to have in-
visible lines connected vertically throughout the
body to all organs, and that each organ has a cor-
responding place on the foot. Reexology incorpo-
rates the use of specic pressure techniques to the
feet, hands, or ears. It is one of the complementary
therapies, which has been more commonly used in
healthcare.[8]
Accordingly, this study evaluated the eectiveness
of reexology massage on intravenous NTG-induced
headache in coronary care unit (CCU) inpatients.
We hypothesized that reexology massage reduces
NTG-induced headache intensity.
Material and Methods
Research setting and sample
This was a randomized clinical trial study, and
its Iranian Registry of Clinical Trials (IRCT) code
is IRCT2015042922010N1. The study subjects in-
cluded 75 males who were admitted in CCU of Ur-
mia University of Medical Sciences, Urmia, Iran. The
subjects were randomly divided into three groups:
control, intervention, and placebo groups. We used
a random numbers table to assign the participants
who met all the criteria into the intervention, con-
trol, or placebo group in equal numbers.
Details of power calculations and sample size
As there is no study on the eects of reexology
massage on migraine-type headache in CCU inpa-
tients, the appropriate information was not available
to calculate it. However, in the study on the eect of
foot reexology on sternotomy pain after coronary
artery bypass graft surgery,[9] the mean intensity of
pain after reexology massage was 3.34±1.5 in the
intervention group and 5±1.9 in the control group.
Our sample size was calculated using the following
formula:
n = (1/96+0/84)2 (1/52+1/92)
(5-3/34)2
Finally, we recruited 25 patients in each group for
achieving 90% power to detect a dierence in the
intensity of headache at α level of 0.05. Thus, we reg-
istered a total of 75 patients (25 for each group).
Patient inclusion criteria
CCU male inpatients on intravenous NTG, having full
consciousness, not having any problems in their feet
(especially in the ngers), not having any movement
disorders, not received any reexology massage to
date, not using any neuromuscular blocking drug,
and not consuming alcohol, opioids, or analgesics
were included. Patients willing to and able to partic-
ipate in reexology massage were included. Further-
more, they were adult (age, 19–49 years) and were
able to express their headache intensity based on
the numeric rating scale for pain (NRS Pain).
Patient exclusion criteria
Patients with diabetes (as diabetic neuropathy can
led to bias in this study), those with physical/psychi-
atric impairment that would seriously impair their
physical mobility, those who were suering from
severe diseases aecting their health (e.g., arthritis
and multiple sclerosis), those who were unable to
continue to participate in this study due to other
reasons, and those with head trauma, migraine, or
allergy to NTG were excluded.
Data collection and measures
The data were obtained from the patient informa-
tion form (a researcher-made form) and NRS Pain.
The NRS is a measure of pain intensity in adults.
Although various iterations exist, the most com-
monly used is the 11-item NRS. It is a segmented
numeric version of the visual analog scale (VAS) in
which a respondent selects a whole number (0–10)
117JULY 2018
Effect of applying reflexology massage on nitroglycerin-induced migraine-type headache: A placebo-controlled clinical trial
that best reects the intensity of his/her pain. It is an-
chored by terms describing pain severity. NRS Pain is
a single 11-point numeric scale, with 0 representing
no pain and 10 representing severe pain (“as bad as
you can imagine” and “worst pain imaginable”).[10]
All the patients were asked to complete the patient
information questionnaire before the intervention.
NRS was administered three times: just before the in-
tervention and two times after the reexology mas-
sage in the intervention group.
Ethical considerations and procedures
The study was approved by the Urmia University of
Medical Sciences Ethics Committee (Ethical code
of this study is IR.UMSU.REC 1394028). Participants
were informed of the study, and consents were ob-
tained. Also, the researcher had received a reexol-
ogy certication from an international reexology
academy before this study.
Initially, a total of 75males (according to the inclusion
and exclusion criteria of the study) were randomized
into three groups: the reexology massage, placebo,
and control groups. For randomization in this study,
an independent researcher prepared random alloca-
tion cards using computer-generated random num-
bers. The allocator kept the original random alloca-
tion sequences at an inaccessible place and worked
with a copy. Instead of the letters A, B, and C, he used
the codes I, P, and C (I for intervention, P for placebo,
and C for control) to avoid further confusion. He then
continued randomization until 25 samples were allo-
cated to each group of the study.
The patients in the placebo group received an in-
eective massage (not reexology massage) by the
researcher to avoid any bias in the research related
to researcher attendance at the study environment.
Patients in the control group did not receive any
massage. Patients in the reexology massage group
received the following manipulations: rst, their feet
were cleaned with a wet towel. Then, foot reexol-
ogy massage based on the Ingham method of reex-
ology was applied by the researcher. The patients’
heel was held with the left hand by the researcher,
and reexology massage was given on points known
as brain points (upper part of the thumb) for 10 min
on each foot. The researcher applied continuous and
uniform pressure in the upper part of the thumb of
the patients’ foot using his right hand thumb.
In the placebo group, all the above procedures were
performed, but instead of patients’ thumb of the
foot, an unspecied point on the foot (heel), which
is not related to the head, was pressured by the re-
searcher.
As reexology massage is a process for achieving
better outcomes, it has to be repeated. Therefore, for
better results in headache management, the second
intervention was performed 3 h after the rst inter-
vention, and the massage was repeated again in the
same way mentioned above for both the reexology
and placebo groups.
The data were obtained from the patient informa-
tion form and NRS Pain which was completed three
times, just before the intervention and two times af-
ter the intervention in all the groups. The data were
calculated and analyzed.
Statistical procedures
The Statistical Package for Social Sciences (SPSS) soft-
ware, version 21, was used for statistical analysis. The
numbers are shown as percentage and average for
identifying characteristics of patients. The chi-square,
one-way ANOVA, and repeated measurement tests
were used for evaluating the statistical signicance in
the sociodemographic data, medical characteristics,
and headache intensity in the three groups before the
study and two times after the intervention. Results
were accepted at the condence interval of 95% and
statistical signicance level of p<0.05.
Results
Demographic or medical characteristics
Patients included in the study were compared for
variables, such as age, marital status, education level,
employment status, smoking, and chronic headache
that might aect the results of the research. No base-
line dierences existed between the three groups
for either demographic or medical characteristics
(p>0.05, Table1).
Headache intensity
Headache intensity was statistically similar (p=0.66)
between the three groups just before the inter-
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Effect of applying reflexology massage on nitroglycerin-induced migraine-type headache: A placebo-controlled clinical trial
vention (after receiving intravenous NTG; Table 2),
but the dierences were statistically signicant af-
ter the intervention (p=0.000; Table 4). The results
showed reduced intensity of headache in the reex-
ology massage group comparted with the two other
groups after the intervention (Tables 3 and 4).
In Table 4 (on the intensity of headache), three ef-
fects have been tested:
A. Interaction between time and intervention:
The statistical test indicated that the interaction
between time and intervention from the rst to
second intervention was signicant on the mean of
headache intensity (p=0.000), and pain intensity de-
creased with time.
B. Main eect of time: There was a statistically sig-
nicant dierence in the mean of headache intensity
at dierent times (p=0.000).
C. Main eect of intervention: The main purpose
of this research was to investigate this eect. ANOVA
results showed that the mean headache intensity in
the rst to second intervention signicantly diered
between the reexology massage, placebo, and con-
119JULY 2018
Table 1. Socodemographc and medcal characterstcs of the groups (n=75)
Characterstcs n % n % n %
F=0.01
df1=2
df2=72
p=0.98
Age (Mean ±SD) 62±1.2 62.6±1.2 62.1±1.2
Martal status
Sngle 3 12 5 20 3 12 X2=0.85
df=2
p=0.68
Marred 22 88 20 80 22 88
Level of educaton
Illterate 6 24 5 20 6 24 X2=0.66
Hgh school 16 64 15 60 15 60 df=4
Unversty 3 12 5 20 4 16 p=0.95
Workng Status
Goverment 11 44 10 40 10 40
employee X2=1.16
Retred 4 16 3 12 5 20 df=6
Workless 4 16 5 20 3 12 p=0.97
Prvate sector employee 6 24 7 28 7 28
Smokng hstory
Yes 11 44 8 32 10 40 X2=0.78
No 14 56 17 68 15 60 df=2
p=0.67
Hstory of chronc headache
Yes 1 4 2 8 1 4 X2=0.52
No 24 96 23 92 24 96 df=2
p=0.76
F=F test n the analyss of varance (ANOVA); d.f=degree of freedom; X²=Ch-square test.
Reexology massage (n=25) Placebo (n=25) Control (n=25)
trol groups (p=0.000), indicating that reexology mas-
sage was eective in reducing headache intensity.
Discussion
This randomized controlled trial study was planned
to clarify the eectiveness of reexology massage
on intravenous NTG-induced headache in CCU male
inpatients. Our study ndings supported our priori
hypothesis that reexology massage reduces NTG-
induced headache intensity.
Numerous studies have indicated that reexology
massage can improve physical functioning, quality
of life, and disease-related symptoms, such as back
pain, seizure frequency, fatigue, anxiety, nausea,
vomiting, and retching.[9, 11-19]
In our study, headache intensity after receiving in-
travenous NTG was statistically similar between the
three groups before the reexology intervention,
but the dierences were statistically signicant after
Table 4. Analyss of measured headache ntensty
Headache ntensty Total squared Degree of Average F p Partal
error freedom squared error Eta Squared
Man eect of tme 80.88 2 40.44 28.92 0.001 0.287
Interacton of tme wth 149.11 4 37.27 26.66 0.000 0.425
reexology nterventon
Component of tme 201.33 144 1.39
eect error
Man eect of nterventon 58.74 2 29.37 27.5 0.001 0.423
Component of nterventon 76.88 72 1.068 -
eect error
F= F test n the analyss of varance (ANOVA).
Table 2. Comparson of mean and standard devaton of headache ntensty n each of the studed groups just before the
nterventon (after ntravenous NTG njecton)
Headache ntensty Reexology Placebo Group Control Group One-way ANOVA
Massage Group (Mean ±SD) (Mean±SD) Results
(Mean±SD)
Just before the nterventon 7.2±1.7 7±1.4 6.8±1.5 F=0.41
df1=2
df2=72
p=0.66
F= F test n the analyss of varance (ANOVA); d.f = degree of freedom.
Table 3. Comparson of mean and standard devaton of headache ntensty n each of the studed groups n the frst,
second, and thrd measurements
Group Mean and standard devaton of headache ntensty
Frst measurement Second measurement Thrd measurement
(before the nterventon) (frst tme after nterventon) (second tme after nterventon)
Reexology 7.2±1.7 5±1.4 3±1.2
Placebo 7±1.4 6.6±1.3 6.4±1.2
Control 6.8±1.5 7.4±1.1 7.2±1.5
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120 JULY 2018
the intervention. The results showed reduced inten-
sity of headache in the reexology massage group
compared with the other two groups after the reex-
ology intervention. Headache intensity in the reex-
ology group was decreased to 5±1.4 at the rst mea-
surement and to 3±1.2 at the second measurement
from the baseline score of 7.2±1.7. The headache in-
tensity in the control group was 6.8±1.5 at baseline
and increased to 7.4±1.1 at the rst measurement
and 7.2±1.5 at the second measurement. On the
other hand, headache intensity in the placebo group
was 7±1.4 at baseline, 6.6±1.3 at the rst measure-
ment, and 6.4±1.2 at the second measurement.
Similar to our study, as a nonpharmacological treat-
ment for headache, NICE has published guidelines
regarding the use of vagus nerve stimulation for the
management of cluster headache and migraine in
March 2016. The aim was to stimulate the cervical
branch of the vagus nerve to relieve pain and reduce
the frequency of attacks of migraine and cluster
headache. A handheld device is used, and two stimu-
lators are placed in front of the sternocleidomastoid
muscle over the carotid artery. The patient is able to
control the stimulation strength and should increase
it slowly until he feels muscle contractions under the
skin and continue stimulation for approximately 90s.
It has been found to be eective in treating acute at-
tacks and as prophylaxis between attacks.[20]
Furthermore, our study was consistent with the re-
search carried out by Launsø et al.[21] on the appli-
cation of reexology massage for headache in 220
patients with migraine and/or tension headache
from 1993 to 1994 to evaluate which patients with
headache underwent a course of reexology mas-
sage, why patients sought reexology massage,
what were the previous experiences of patients on
medications for headache, and whether patients
achieved favorable outcomes from reexology mas-
sage. Their results showed that at 3-month follow-
up, 81% of patients reported that they beneted
from reexology massage or that their headache
problems were cured. Also, 19% of those who had
formerly taken drugs to manage their headaches
were able to discontinue the drugs following re-
exology massage. The study concluded that reex-
ology massage results in the improvement of the
general well-being, energy level, ability to interpret
their own body signals, and ability to understand the
reasons for headache.
Limitations
It is important to note the limitations of this study,
such as relatively small sample size.
Conclusion
This study showed that CCU male inpatients with
intravenous NTG-induced migraine-type headache
may show reduction in their headache intensity by
participating in reexology massage programs. Fur-
thermore, this simple, eective, comfortable, and
low-cost program may be used for other types of mi-
graine. Additional research in reexology massage
along with natural aromatherapy may be benecial.
The results of this study may contribute to the grow-
ing knowledge which will support the feasibility and
eectiveness of reexology massage as a nonphar-
macological option for enhancing headache man-
agement in patients.
Conict-of-interest issues regarding the authorship or
article: None declared.
Peer-rewiew: Externally peer-reviewed.
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PAIN
ARI
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... The benefits of reflexology include its capability to stimulate nerve function, increase energy, boost circulation, and induce a deep state of relaxation (37)(38)(39)(40)(41)(42)(43)(44). Furthermore, it helps stimulate the central nervous system and avoid migraines (45)(46)(47)(48)(49)(50). This sort of massage speeds up recovery after an injury or surgery, decreases sleep disorders, and relieves depression and pain. ...
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Aim: this study was conducted to review the related articles and draw a final conclusion regarding the application of reflexology for delivery (labor and cesarean section) pain management in woman all over the world. Methodology: In this systematic review, relevant articles were searched in Google Scholar, PubMed, Cochrane Library, Science Direct, and Scopus databases from the year 2000 to 2018. All the human clinical trials that examined the effects of reflexology methods on delivery pain (labor or Cesarean section) were included and others excluded from the study. Results: All the 18 included original articles (with 1391 patients) reported that reflexology significantly reduces the pain of delivery, confirming its decreasing effect on labor, Cesarean section, and post-delivery pain. Results of all articles showed that, if true reflexology is performed on the right location of the body and at the appropriate time, the pain of delivery can be significantly decreased Conclusion: Reflexology is an appropriate pain relief and prophylaxis for any kind of pain, especially delivery and post-delivery pain. It is a safe remedy with no adverse effects reported so far.
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Nitrates, such as cardiac therapeutics and food additives, are common headache triggers, with nitric oxide playing an important role. Facultative anaerobic bacteria in the oral cavity may contribute migraine-triggering levels of nitric oxide through the salivary nitrate-nitrite-nitric oxide pathway. Using high-throughput sequencing technologies, we detected observable and significantly higher abundances of nitrate, nitrite, and nitric oxide reductase genes in migraineurs versus nonmigraineurs in samples collected from the oral cavity and a slight but significant difference in fecal samples. IMPORTANCE Recent work has demonstrated a potentially symbiotic relationship between oral commensal bacteria and humans through the salivary nitrate-nitrite-nitric oxide pathway (C. Duncan et al., Nat Med 1:546–551, 1995, http://dx.doi.org/10.1038/nm0695-546 ). Oral nitrate-reducing bacteria contribute physiologically relevant levels of nitrite and nitric oxide to the human host that may have positive downstream effects on cardiovascular health (V. Kapil et al., Free Radic Biol Med 55:93–100, 2013, http://dx.doi.org/10.1016/j.freeradbiomed.2012.11.013 ). In the work presented here, we used 16S rRNA Illumina sequencing to determine whether a connection exists between oral nitrate-reducing bacteria, nitrates for cardiovascular disease, and migraines, which are a common side effect of nitrate medications (U. Thadani and T. Rodgers, Expert Opin Drug Saf 5:667–674, 2006, http://dx.doi.org/10.1517/14740338.5.5.667 ).
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The aim of the present study was to investigate the association between nitrate-induced headache (NIH) and the complexity of coronary artery lesions in patients with stable coronary artery disease (CAD). Two hundred and seventy-five patients with anginal chest pain who underwent coronary angiography were enrolled in the present study. NIH was defined as the presence of headache due to nitrate treatment (isosorbide mononitrate 40 mg) after excluding confounding factors. Coronary artery lesion complexity was assessed by the SYNTAX score (SXscore) using a dedicated computer software system. The mean SXscore was lower in the patients with NIH than in patients without NIH (7.3 ± 5.2 vs. 14.4 ± 8.5, respectively; p < 0.001). Additionally, patients with NIH had a lower rate of multivessel disease compared with those without NIH (the mean number of diseased vessels was 1.5 ± 0.7 and 2.0 ± 07, respectively; p < 0.001). In multivariate analysis, increasing age (p = 0.02) and headache (p = 0.001) were found to be independent determinants of SXscore. The present study demonstrated an independent inverse association between NIH and SXscore. The NIH could provide important predictive information about coronary artery lesion complexity in patients with stable CAD. © 2015 S. Karger AG, Basel.
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Background: Reflexology is one of the top forms of Complementary and Alternative Medicine in the UK and is used for healthcare by a diverse range of people. However, it is offered by few healthcare providers as little scientific evidence is available explaining how it works or any health benefits it may confer. The aim of this review was to assess the current evidence available from reflexology randomised controlled trials (RCTs) that have investigated changes in physiological or biochemical outcomes. Methods: Guidelines from the Cochrane Handbook of Systematic Reviews of Interventions were followed: the following databases were searched from inception-December 2013: AMED, CAM Quest, CINAHL Plus, Cochrane Central Register of Controlled Trials, Embase, Medline Ovid, Proquest and Pubmed. Risk of bias was assessed independently by two members of the review team and overall strength of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation guidelines. Results: Seventeen eligible RCT’s met all inclusion criteria. A total of 34 objective outcome measures were analysed. Although twelve studies showed significant changes within the reflexology group, only three studies investigating blood pressure, cardiac index and salivary amylase resulted in significant between group changes in favour of reflexology. The overall quality of the studies was low. Keywords: Biochemistry, physiology, reflexology, systematic review.
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Objective: Complementary and alternative medicine (CAM) is increasingly being used as adjunctive treatment in primary headache syndromes in many countries. In the Turkish population, no epidemiologic data have been reported about awareness and usage of these treatments in patients with headache. Methods: One hundred and ten primary headache patients attending three headache clinics completed a questionnaire regarding their headaches, the known modalities and the use and effect of CAM procedures for their headaches. Results: The mean age of the patients was 34.7±9.6 years (32.8-36.5). Almost two-thirds of patients had completed high school and university, and one-third of patients were housewives. Migraine without aura (45.5%) was the most frequently diagnosed type of headache followed by migraine with aura (19.1%) and tension-type headache (18.2%). In 43.6% of the patients, headache frequency was 5-10 per month. The most frequently known CAM modalities were massage (74.5%), acupuncture (44.5%), yoga (31.8%), exercise (28.2%), psychotherapy (25.5%), and rosemary (23.6%). The most frequently used CAM treatments were massage (51%) and exercise (11%). Only massage was reported to be beneficial in one-third of the primary headache patients; the other modalities were not. Conclusion: Our findings suggest that the subgroup of primary headache patients in Turkey seek and use alternative treatments, frequently in combination with standard treatments. Neurologists should become more knowledgeable regarding CAM therapies; further randomized and controlled clinical researches with large sample sizes are needed.
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Purpose/Objectives: To evaluate the safety and efficacy of reflexology, a complementary therapy that applies pressure to specific areas of the feet. Design: Longitudinal, randomized clinical trial. Setting: Thirteen community-based medical oncology clinics across the midwestern United States. Sample: A convenience sample of 385 predominantly Caucasian women with advanced-stage breast cancer receiving chemotherapy and/or hormonal therapy. Methods: Following the baseline interview, women were randomized into three primary groups: reflexology (n = 95), lay foot manipulation (LFM) (n = 95), or conventional care (n = 96). Two preliminary reflexology (n = 51) and LFM (n = 48) test groups were used to establish the protocols. Participants were interviewed again postintervention at study weeks 5 and 11. Main Research Variables: Breast cancer-specific health-related quality of life (HRQOL), physical functioning, and symptoms. Findings: No adverse events were reported. A longitudinal comparison revealed significant improvements in physical functioning for the reflexology group compared to the control group (p = 0.04). Severity of dyspnea was reduced in the reflexology group compared to the control group (p < 0.01) and the LFM group (p = 0.02). No differences were found on breast cancer-specific HRQOL, depressive symptomatology, state anxiety, pain, and nausea. Conclusions: Reflexology may be added to existing evidence-based supportive care to improve HRQOL for patients with advanced-stage breast cancer during chemotherapy and/or hormonal therapy. Implications for Nursing: Reflexology can be recommended for safety and usefulness in relieving dyspnea and enhancing functional status among women with advanced-stage breast cancer.
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The purpose of the present study was to clarify the possible relationship between nitroglycerin (NTG)-induced headache and both vascular functional and organic atherosclerosis. The study included 96 patients with NTG-induced headache (group I: 54.7±9.5 years, 52 males) and 204 patients without headache (group II: 58.1±9.1 years, 127 males) who suffered from new-onset chest pain. Flow-mediated dilation and nitroglycerin-mediated dilation were significantly greater in group I than in group II (8.8±4.1% vs. 7.1±3.5%, p=0.001, and 23.1±7.3% vs. 17.1±11.8%, p<0.001, respectively). The carotid intima-media thickness was significantly smaller in group I than in group II (0.55±0.15 mm vs. 0.67±0.22 mm, p=0.001). Heart-carotid pulse wave velocity was significantly lower in group I than in group II (784.5±160.1 m/s vs. 979.1±215.6 m/s, p=0.003). In the multiple regression analysis, the absence of NTG-induced headache was a predictor of coronary artery disease (CAD) (odds ratio: 17.89, 95% confidence interval: 7.89-40.02, p<0.001). NTG-induced headache developed more frequently in patients with normal coronary arteries or minimal CAD than in patients with obstructive CAD. The presence of NTG-induced headache might be helpful and provide additional information in evaluating patients with chest pain syndrome.
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Background and purpose: Pain and fatigue are among the complications after coronary artery bypass graft surgery (CABG). Non- pharmacological methods are more favorable than pharmacological agents. This study assessed the effects of foot reflexology massage on pain and fatigue in patients after CABG. Materials and methods: A randomized controlled clinical trial was conducted in 80 patients hospitalized in Mazandaran Heart Center, 2011. The samples were allocated based on their accessibility. They were age and gender matched and then divided randomly into two groups of case and control. The case group received reflexology massage on left foot for 20 minutes from the second day after surgery for four consecutive days. In control group, the left foot of the patients was moisturized for one minute without applying any pressure. The intensity of pain and fatigue were recorded before and after the intervention using visual analogue scale. Descriptive and inferential statistics were used to analyze the data. Results: Results showed significant differences in pain and fatigue levels after the intervention among both groups (P= 0.0001). Conclusion: According to this study, foot reflexology massage, is a useful nursing intervention to relieve fatigue and pain in CABG patients. Since this low-cost method is easy to apply we recommend it to ease the pain and fatigue in patients after CABG. Keywords: Foot reflexology massage, pain, fatigue, coronary artery bypass graft (CABG). © 2012, Mazandaran University of Medical Sciences. All rights reserved.
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Background: This report is based on the results of a randomized parallel controlled trial conducted to determine the efficacy of reflexology therapy in managing intractable epilepsy. Methods: Subjects who failed epilepsy surgery or were not candidates for epilepsy surgery or were non-responders of antiepileptic drugs (AEDs) took part in this study. The trial was completed by 77 subjects randomly assigned to 2 arms: control (AEDs) and reflexology (AEDs + reflexology therapy). The hypothesis was that hand reflexology therapy could produce results similar to those of vagus nerve stimulation, and foot reflexology therapy could maintain homeostasis in the functional status of individual body parts. Reflexology therapy was applied by family members. The follow-up period was 1.5 years. Quality of life in epilepsy patients was assessed with the QOLIE-31 instrument. Results: In the reflexology group, the median baseline seizure frequency decreased from 9.5 (range 2-120) to 2 (range 0-110) with statistical significance (p < 0.001). In the control arm, the decrease was less than 25% with a baseline value of 16 (range 2-150). The pretherapy QOLIE-31 scores in the control group and the reflexology group were 41.05 ± 7 and 43.6 ± 8, respectively. Posttherapy data were 49.07 ± 6 and 65.4 ± 9, respectively (p < 0.002). The reflexology method allowed detection of knee pain in 85% of the reflexology group patients (p < 0.001), and 85.3% of patients derived 81% relief from it (p < 0.001). 4 reflexology group patients reported nausea/vomiting (n = 1), change in voice (n = 2), and hoarseness (n = 1). Conclusion: Reflexology therapy together with AEDs may help reducing seizure frequency and improving quality of life in individuals with epilepsy.
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Multiple sclerosis (MS) results in pain and other symptoms which may be modified by conventional treatment, however, MS is still not curable. Several studies have reported positive effects of reflexology in the treatment of pain, however, no randomised controlled clinical trials for the treatment of pain have been conducted within this population. The objective of this study was to investigate the effectiveness of reflexology on pain in and MS population. We randomly allocated 73 participants to receive either precision or sham reflexology weekly for 10 weeks. Outcome measures were taken pre-and post-treatment with follow-up at 6 and 12 weeks by a researcher blinded to group allocation. The primary outcome measure recorded pain using a Visual Analogue Scale (VAS). A significant (p < 0.0001) and clinically important decrease in pain intensity was observed in both groups compared with baseline. Median VAS scores were reduced by 50% following treatment, and maintained for up to 12 weeks. Significant decreases were also observed for fatigue, depression, disability, spasm and quality of life. In conclusion, precision reflexology was not superior to sham, however, both treatments offer clinically significant improvements for MS symptoms via a possible placebo effect or stimulation of reflex points in the feet using non-specific massage.