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Moderate Pressure Massage Therapy
Abstract
This chapter is a review of representative data (not an exhaustive review) on moderate pressure massage therapy effects and potential underlying mechanisms for those effects. They include (1) weight gain in preterm infants, (2) pain reduction and potential underlying mechanisms for pain reduction following massage, (3) enhanced attention, (4) reduced depression and its EEG correlates, and (5) enhanced immune function. Moderate pressure massage is necessary for these effects which, in turn, may be mediated by increased vagal activity and reduced cortisol. The fMRI data from one study suggest that touch when combined with movement simulates findings on other rewarding pleasant touch.
... O grupo de massagem com pressão leve apresentou aumento do sono superficial, da agitação, do choro, de movimentos e comportamento de estresse (como o soluço). Já o grupo de massagem com pressão moderada parece estar mais relaxado e menos excitado, o que pode contribuir para o maior ganho de peso 58 . ...
Introdução: O prematuro é um bebê biologicamente mais vulnerável do que o bebê nascido a termo devido à sua imaturidade orgânica, necessitando de cuidados especiais logo ao seu nascimento. A massagem terapêutica em prematuros tem trazido efeitos positivos para o desenvolvimento global destes bebês. Objetivo: Revisar na literatura atual os estudos sobre os efeitos da massagem terapêutica em bebês prematuros. Métodos: Revisão integrativa da literatura de ensaios clínicos randomizados que utilizaram a massagem em bebês prematuros. Buscou-se nas bases de dados MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SciELO) e Physiotherapy Evidence Database (PEDro), estudos publicados de 2008 até 2019, utilizando os descritores: “preterm”, “massage in premature”, “infant massage” e seus equivalentes em português. Resultados: Foram incluídos 39 estudos que preencheram os critérios de elegibilidade, totalizando 4,883 participantes. Os maiores achados foram o ganho de peso (51,3%), a diminuição do tempo de internação e consequente diminuição nos gastos hospitalares (16,2%) e diminuição dos hormônios do estresse (13,5%). Outros achados também foram encontrados como: melhora do desenvolvimento cognitivo/motor, hidratação da pele, do sono, da mineração óssea, entre outros. Conclusão: A massagem produz estabilidade ao bebê prematuro. Os familiares também podem ser treinados para realizar a massagem; fortalecendo o vínculo entre eles. A massagem com óleo é efetiva, sobretudo, quando associada à massagem tátil com a cinestésica, e a pressão deve ser do tipo moderada.
... Massage is associated with pain reduction in children and adolescents [144][145][146][147]. It is postulated that this works through either the Gate control theory [148], stimulation of pressure receptors impacting vagal tone and serotonin [149], decreased substance P from decreased stress responses, and/or increased oxytocin release [150]. It is our clinical experience that massage is particularly effective in children and adolescents with a confirmed myofascial component to their pain. ...
Chronic pain is a complex biopsychosocial phenomenon, which confers significant distress and poor quality of life to at least 6% of the pediatric population. Biological constituents of chronic pain arise from various sources: nociceptive, inflammatory, neuropathic, myofascial, as well as peripheral and central sensitization. Chronic myofascial pain arises from dysfunction related to skeletal muscles, fascia and scars. This may be related to a sedentary lifestyle, Western diet, myofascial injury but also musculoskeletal overuse. Chronic myofascial pain is often unrecognized and misdiagnosed, especially in children.
myoActivation is a novel structured process of assessment and treatment designed to recognize and treat myofascial components of chronic pain. myoActivation includes: a comprehensive timeline of trauma history, and a unique, quick and reproducible assessment followed by therapeutic intervention. myoActivation combines effective myofascial pain therapies, including trigger point injections, fascial release and subcision (scar release). myoActivation can be used as one component in the biopsychosocial approach to chronic pain management. The adult process will often need to be adapted to accommodate pediatric developmental and psychological profiles.
This review outlines the importance of diet and exercise on skeletal muscle health and some other strategies important in managing pediatric chronic myofascial pain. myoActivation provides an effective, low-cost, non-pharmacological tool to diagnose and treat the myofascial components of pediatric chronic pain. Case studies will demonstrate how to adapt the adult myoActivation process to the pediatric population. The conservative strategies and myoActivation process described require appropriately controlled research studies to fully demonstrate the benefits highlighted in this case series.
... In the light of evidence that cortical processing may be a key mechanism underlying the benefits of gentle, medium-velocity touch (Table 1, Figure 2b), gentle touch may have limited effectiveness for sedated patients due to reduced corticocortical and subcorticocortical connectivity (MacDonald, Naci, MacDonald, & Owen, 2015). In contrast, moderate pressure touch is suggested to elicit a relaxation response by increasing parasympathetic activity and/or reducing sympathetic activity (Field, 2016b;Watanabe & Hotta, 2017 ...
Aim
To develop a theoretical framework to inform the design of interpersonal touch interventions intended to reduce stress in adult intensive care unit patients.
Design
Realist review with an intervention design‐oriented approach.
Methods
We searched CINAHL, MEDLINE, EMBASE, CENTRAL, Web of Science and grey literature sources without date restrictions. Subject experts suggested additional articles. Evidence synthesis drew on diverse sources of literature and was conducted iteratively with theory testing. We consulted stakeholders to focus the review. We performed systematic searches to corroborate our developing theoretical framework.
Results
We present a theoretical framework based around six intervention construction principles. Theory testing provided some evidence in favour of treatment repetition, dynamic over static touch and lightening sedation. A lack of empirical evidence was identified for construction principles relating to intensity and positive/negative evaluation of emotional experience, moderate pressure touch for sedated patients and intervention delivery by relatives versus healthcare practitioners.
... Speichel als Korrelat eines Anti-Stress-Effektes öfters beschrieben worden [1]. Field vertritt die Meinung, dass hierfür insbesondere Einflüsse auf die vagale Aktivität zu diskutieren seien, deren Voraussetzung wiederum die Anwendung moderaten Drucks bei der Massage sei um damit myofasziale Druckrezeptoren zu stimulieren [28]. Auf der anderen Seite existieren Befunde, wonach gerade sanfte, rhythmische Berührung, wie sie auch der Säugling an der Mutterbrust erprobt, zu einer vermehrten Ausschüttung von Oxytocin führt, das sowohl biologisches Korrelat von zwischenmenschlichem Vertrauen z. ...
Background and objective Multiple types of massage gain increasing interest as complimentary treatment for various indications. Whereas evidence exists for antidepressant or pain reducing effects in subjects with defined disorders or complaints or in laboring women little is known about the subjective psychophysical effects of massage given to “normal” clients of massage therapists or other specialists in physical therapy. Methods The subjective effects of a single application of a 1 hour lasting relaxing (psychoactive) massage (“Vasana”) were explored in 100 volunteers recruited in a practice of physiotherapists. Three successive measurements based on various questionnaires and VAS were performed within an open, one-armed, naturalistic study. Results The recruited cohort differed somewhat from the German general population: higher rate of women and of people with various psychosomatic complaints. A significant increase of the feeling of well-being was observed immediately after the massage, not however 14 days later. Most documented psychophysical dimensions (13 VAS items) showed significant improvement after the intervention such as less anxiety, improved mood, less myofascial pain etc. Approx. one third of the subjects reported on various changes even after 2 weeks such as changed bodily awareness, improved sleep etc. The underlying potential neurobiological mechanisms are discussed. Conclusion A 1 hour lasting relaxing psychoactive massage improves the global feeling of well-being. The intervention exerted mood elevating, anti-stress and analgetic effects, partly persisting over two weeks, which should be integrated in the multi-dimensional treatment of various psychosomatic/psychiatric disorders and particularly in the medical and psychological management of chronic pain. The latter indication, however, against the background of existing scientific evidence will probably require multiple massage sessions.
Recebido em: 4 abr. 2018. Aprovado em: 26 set. 2019. Publicado em: 4 set. 2020. Abstract: Context: The term "Well-being" [WB] has many different meanings in scientific literature. Objectives: To search specific situations and related semantics for feelings of well-being [WB] associated to oxytocin [OT] release. Data sources: A systematic review using PRISMA guidelines in PubMed, BVS Virtual (Medline, Lilacs) and SIBI-USP Portal de Busca Integrada (1970-1999 & 2014-2018). Study selection: Reviews and clinical trials (PICOS) on OT, & WB and similar concepts in humans. Data extraction: Independent selection of articles by two reviewers; selection of articles by one reviewer, using predefined criteria. Data synthesis: 46 articles were selected out of 339, with 26 additional articles. Main data referred to social situations, sensorial stimuli, trust and psychiatric and health studies. Conclusions: The identified variables involved brain-body-mind interactions, and health/disease; translational neuroscience seems to be the best theoretical reference to investigate it.
Mothers' and fathers' touch were investigated during their first naturalistic interaction with their newborns, and maternal touch was predicted from newborn to 3-months postpartum during the Still-Face (SF) procedure. Both parents displayed more nurturing types of touch when interacting with their infants for the first time. Maternal touch at newborn predicted maternal touch after, but not before, the SF 3-months later; more touch after birth was associated with more soothing, regulating, types of maternal touch following the SF, suggesting that the nature of these interactive contexts (post-birth, post-SF) may be parallel. To our knowledge, this is the first study to investigate the full range of maternal and paternal touching behaviors during the first hour after birth. It is also one of the only investigations that considers how mothers' very first touch and physical contact relate to their later touch at 3-months. Our results uniquely contribute by revealing the nurturing and predictive quality of parents' touch, and underscore touch as a primary means of early contact and communication.
Human beings are highly social creatures who often touch each other during social interactions. Although the physiologic effects of touch are not understood fully, it appears to sustain social bonds and to increase cooperative behaviors. Oxytocin (OT) is a hormone known to facilitate social bonding, and touch may affect OT release. Previous studies seeking to relate massage and oxytocin in humans have been inconsistent in their findings.
This study examined the effect of massage on oxytocin and also measured its effect on other physiologic factors, including adrenocorticotropin hormone (ACTH), nitric oxide (NO), and beta-endorphin (BE).
The research team advertised that the trial would study relaxation and assigned participants randomly to the intervention or the control group. A lab administrator assigned a random numeric code to participants to mask their identities.
The study took place at the University of California Los Angeles (UCLA), Los Angeles, CA.
Ninety-five people from UCLA gave written informed consent for participation in the study, with the team paying them to participate. The intervention group included 65 participants and the control group 30 participants.
For the intervention (massage) group, the research team drew participants' blood and followed the blood draw with 15 minutes of moderate-pressure massage of the upper back. The control (rest) group rested quietly for 15 minutes after the blood draw. A second blood draw followed for both groups.
The research team assayed OT, ACTH, NO, and BE. The team used four survey instruments to examine the relationship between personality factors and the physiologic measures of interest. The team analyzed data using SPSS 15.0 for Windows.
Massage was associated with an increase in OT and reductions in ACTH, NO, and BE. Comparing the effects of massage for the massage group with those for the rest group, the research team found significant differences between groups for changes in OT, ACTH, NO, and BE.
This study is the first using a large sample of mixed gender that demonstrates that massage increases OT and decreases ACTH, NO, and BE. These findings may help explain the mechanisms through which social connections reduce morbidity and mortality.
Baseline resting electroencephalogram activity was recorded with 3 different reference montages from 15 clinically depressed and 13 control subjects. Power in all frequency bands was extracted by fast Fourier transformation. There was a significant Group × Hemisphere interaction in the midfrontal region, for the alpha band power only. Depressed subjects had less left-sided activation (i.e., more alpha activity) than did normal control subjects. This pattern of diminished left-sided frontal activation is interpreted as indicating a deficit in approach mechanisms in depressed subjects.
Twenty-six adults were given a chair massage and 24 control group adults were asked to relax in the massage chair for 15 minutes, two times per week for five weeks. On the first and last days of the study they were monitored for EEG, before, during and after the sessions. In addition, before and after the sessions they performed math computations, they completed POMS Depression and State Anxiety Scales and they provided a saliva sample for Cortisol. At the beginning of the sessions they completed Life Events, Job Stress and Chronic POMS Depression Scales. Group by repeated measures and post hoc analyses revealed the following: 1) frontal delta power increased for both groups, suggesting relaxation; 2) the massage group showed decreased frontal alpha and beta power (suggesting enhanced alertness); while the control group showed increased alpha and beta power; 3) the massage group showed increased speed and accuracy on math computations while the control group did not change; 4) anxiety levels were lower following the massage but not the control sessions, although mood state was less depressed following both the massage and control sessions; 5) salivary Cortisol levels were lower following the massage but not the control sessions but only on the first day; and 6) at the end of the 5 week period depression scores were lower for both groups but job stress scores were lower only for the massage group.
Small studies of variable quality suggest that massage therapy may relieve pain and other symptoms.
To evaluate the efficacy of massage for decreasing pain and symptom distress and improving quality of life among persons with advanced cancer.
Multisite, randomized clinical trial.
Population-based Palliative Care Research Network.
380 adults with advanced cancer who were experiencing moderate-to-severe pain; 90% were enrolled in hospice.
Six 30-minute massage or simple-touch sessions over 2 weeks.
Primary outcomes were immediate (Memorial Pain Assessment Card, 0- to 10-point scale) and sustained (Brief Pain Inventory [BPI], 0- to 10-point scale) change in pain. Secondary outcomes were immediate change in mood (Memorial Pain Assessment Card) and 60-second heart and respiratory rates and sustained change in quality of life (McGill Quality of Life Questionnaire, 0- to 10-point scale), symptom distress (Memorial Symptom Assessment Scale, 0- to 4-point scale), and analgesic medication use (parenteral morphine equivalents [mg/d]). Immediate outcomes were obtained just before and after each treatment session. Sustained outcomes were obtained at baseline and weekly for 3 weeks.
298 persons were included in the immediate outcome analysis and 348 in the sustained outcome analysis. A total of 82 persons did not receive any allocated study treatments (37 massage patients, 45 control participants). Both groups demonstrated immediate improvement in pain (massage, -1.87 points [95% CI, -2.07 to -1.67 points]; control, -0.97 point [CI, -1.18 to -0.76 points]) and mood (massage, 1.58 points [CI, 1.40 to 1.76 points]; control, 0.97 point [CI, 0.78 to 1.16 points]). Massage was superior for both immediate pain and mood (mean difference, 0.90 and 0.61 points, respectively; P < 0.001). No between-group mean differences occurred over time in sustained pain (BPI mean pain, 0.07 point [CI, -0.23 to 0.37 points]; BPI worst pain, -0.14 point [CI, -0.59 to 0.31 points]), quality of life (McGill Quality of Life Questionnaire overall, 0.08 point [CI, -0.37 to 0.53 points]), symptom distress (Memorial Symptom Assessment Scale global distress index, -0.002 point [CI, -0.12 to 0.12 points]), or analgesic medication use (parenteral morphine equivalents, -0.10 mg/d [CI, -0.25 to 0.05 mg/d]).
The immediate outcome measures were obtained by unblinded study therapists, possibly leading to reporting bias and the overestimation of a beneficial effect. The generalizability to all patients with advanced cancer is uncertain. The differential beneficial effect of massage therapy over simple touch is not conclusive without a usual care control group.
Massage may have immediately beneficial effects on pain and mood among patients with advanced cancer. Given the lack of sustained effects and the observed improvements in both study groups, the potential benefits of attention and simple touch should also be considered in this patient population.
Baseline resting electroencephalogram activity was recorded with 3 different reference montages from 15 clinically depressed and 13 control subjects. Power in all frequency bands was extracted by fast Fourier transformation. There was a significant Group X Hemisphere interaction in the mid-frontal region, for the alpha band power only. Depressed subjects had less left-sided activation (i.e., more alpha activity) than did normal control subjects. This pattern of diminished left-sided frontal activation is interpreted as indicating a deficit in approach mechanisms in depressed subjects.
Recent investigations of dysfunctional pain processing in the central nervous system have contributed much knowledge about the development of chronic musculoskeletal pain. Many common chronic musculoskeletal pain syndromes - including regional myofascial pain syndromes, whiplash pain syndromes, refractory work-related neck-shoulder pain, certain types of chronic low back pain, fibromyalgia and others - may essentially be explained by abnormalities in central pain modulation. The growing awareness of dysfunctional central pain modulation may be a conceptual breakthrough leading to a better understanding of common chronic pain disorders. A new paradigm will have multiple clinical implications, including re-evaluation of clinical practice routines and rehabilitation methods, and will focus on controversial issues of medicolegal concern. The concept of dysfunctional central pain processing will also necessitate a mechanism-based classification of pain for the selection of individual treatment and rehabilitation programs for subgroups of patients with chronic musculoskeletal pain due to different pathophysiological mechanisms.
Three types of commonly used massage therapy techniques were assessed in a sample of 36 healthy adults, randomly assigned to: (1) moderate massage, (2) light massage, or (3) vibratory stimulation group (n = 12 per group). Changes in anxiety and stress were assessed, and EEG and EKG were recorded. Anxiety scores decreased for all groups, but the moderate pressure massage group reported the greatest decrease in stress. The moderate massage group also experienced a decrease in heart rate and EEG changes including an increase in delta and a decrease in alpha and beta activity, suggesting a relaxation response. Finally, this group showed increased positive affect, as indicated by a shift toward left frontal EEG activation. The light massage group showed increased arousal, as indicated by decreased delta and increased deta activity and increased heart rate. The vibratory stimulation group also showed increased arousal, as indicated by increased heart rate and increased theta, alpha, and beta activity.
Women diagnosed with breast cancer received massage therapy or practiced progressive muscle relaxation (PMR) for 30-min sessions 3 times a week for 5 weeks or received standard treatment. The massage therapy and relaxation groups reported less depressed mood, anxiety, and pain immediately after their first and last sessions. By the end of the study, however, only the massage therapy group reported being less depressed and less angry and having more vigor. Dopamine levels, Natural Killer cells, and lymphocytes also increased from the first to the last day of the study for the massage therapy group. These findings highlight the benefit of these complementary therapies, most particularly massage therapy, for women with breast cancer.
The mechanisms by which vibrotactile stimuli relieve pain are not well understood, especially in humans. We recorded cortical magnetic responses to paired noxious (intra-epidermal electrical stimulation, IES) and innocuous (transcutaneous electrical stimulation, TS) stimuli applied to the back at a conditioning-test interval (CTI) of -500 to 500 ms. Results showed that IES-induced responses were remarkably attenuated when TS was applied 20-60 ms later and 0-500 ms earlier than IES (CTI = -60 to 500 ms). Since the signals evoked by IES reached the spinal cord (CTI = -60 to -20 ms conditions) and the cortex (-60 and -40 ms condition) earlier than those evoked by TS, the present results indicate that cortical responses to noxious stimuli can be inhibited by innocuous tactile stimuli at the cortical level, with minimal contribution at the spinal level.
In this article the positive effects of massage therapy on biochemistry are reviewed including decreased levels of cortisol and increased levels of serotonin and dopamine. The research reviewed includes studies on depression (including sex abuse and eating disorder studies), pain syndrome studies, research on auto-immune conditions (including asthma and chronic fatigue), immune studies (including HIV and breast cancer), and studies on the reduction of stress on the job, the stress of aging, and pregnancy stress. In studies in which cortisol was assayed either in saliva or in urine, significant decreases were noted in cortisol levels (averaging decreases 31%). In studies in which the activating neurotransmitters (serotonin and dopamine) were assayed in urine, an average increase of 28% was noted for serotonin and an average increase of 31% was noted for dopamine. These studies combined suggest the stress-alleviating effects (decreased cortisol) and the activating effects (increased serotonin and dopamine) of massage therapy on a variety of medical conditions and stressful experiences.
Why we need a daily dose of touch: an investigation of the effects of touch on our physical and mental well-being.
Although the therapeutic benefits of touch have become increasingly clear, American society, claims Tiffany Field, is dangerously touch-deprived. Many schools have “no touch” policies; the isolating effects of Internet-driven work and life can leave us hungry for tactile experience. In this book Field explains why we may need a daily dose of touch.
The first sensory input in life comes from the sense of touch while a baby is still in the womb, and touch continues to be the primary means of learning about the world throughout infancy and well into childhood. Touch is critical, too, for adults' physical and mental health. Field describes studies showing that touch therapy can benefit everyone, from premature infants to children with asthma to patients with conditions that range from cancer to eating disorders.
This second edition of Touch, revised and updated with the latest research, reports on new studies that show the role of touch in early development, in communication (including the reading of others' emotions), in personal relationships, and even in sports. It describes the physiological and biological effects of touch, including areas of the brain affected by touch, and the effects of massage therapy on prematurity, attentiveness, depression, pain, and immune functions. Touch has been shown to have positive effects on growth, brain waves, breathing, and heart rate, and to decrease stress and anxiety. As Field makes clear, we enforce our society's touch taboo at our peril.
Bradford Books imprint
The multimodal properties of the human somatosensory system continue to be unravelled. There is mounting evidence that one of these submodalities-touch-has another dimension, providing not only its well-recognized discriminative input to the brain, but also an affective input. It has long been recognized that touch plays an important role in many forms of social communication and a number of theories have been proposed to explain observations and beliefs about the "power of touch." Here, we propose that a class of low-threshold mechanosensitive C fibers that innervate the hairy skin represent the neurobiological substrate for the affective and rewarding properties of touch.
High blood pressure is associated with elevated anxiety, stress and stress hormones, hostility, depression and catecholamines. Massage therapy and progressive muscle relaxation were evaluated as treatments for reducing blood pressure and these associated symptoms. Adults who had been diagnosed as hypertensive received ten 30 min massage sessions over five weeks or they were given progressive muscle relaxation instructions (control group). Sitting diastolic blood pressure decreased after the first and last massage therapy sessions and reclining diastolic blood pressure decreased from the first to the last day of the study. Although both groups reported less anxiety, only the massage therapy group reported less depression and hostility and showed decreased urinary and salivary stress hormone levels (cortisol). Massage therapy may be effective in reducing diastolic blood pressure and symptoms associated with hypertension.
Methods:
Forty-two adults with rheumatoid arthritis in the upper limbs were randomly assigned to a moderate pressure or a light pressure massage therapy group. A therapist massaged the affected arm and shoulder once a week for a 4-week period and also taught the participant self-massage to be done once daily.
Results:
The moderate pressure vs. the light pressure massage therapy group had less pain and perceived greater grip strength following the first and last massage sessions. By the end of the one month period the moderate pressure massage group had less pain, greater grip strength and greater range of motion in their wrist and large upper joints (elbows and shoulders).
A review of the research on infant vagal tone suggests that vagal activity is associated with both infant growth and infant socioemotional development. Vagal activity has been noted to increase following the stimulation of pressure receptors as in massage therapy. Vagal activity, in turn, stimulates gastric motility which mediates weight gain in infants. Vagal activity has also been notably elevated during synchronous mother–infant interactions and positive affect, providing confirmatory data for the Porges “social engagement system” model. In contrast, low vagal activity has been noted in prenatally depressed mothers (and prenatally angry and anxious mothers) and their infants, as well as in children with autism. These studies highlight the relations between vagal activity and the social behaviors of attentiveness, facial expressions and vocalizations.
Massage therapy has been notably effective in preventing prematurity, enhancing growth of infants, increasing attentiveness, decreasing depression and aggression, alleviating motor problems, reducing pain, and enhancing immune function. This review covers massage therapy research from the last decade, as an update to the American Psychologist 1998 review paper. Models are presented for potential biochemical and physiological mechanisms underlying the massage therapy effects.
Prenatal mood and biochemistry levels were assessed in women with (N=70) and without (N=70) depressive symptoms during their second trimester of pregnancy. At the neonatal period maternal and neonatal biochemistry, EEG and vagal tone levels were assessed, neonatal behavioral states were observed and the Brazelton neurobehavioral assessment was conducted. The mothers with depressive symptoms had higher prenatal cortisol levels and lower dopamine and serotonin levels. Mothers with depressive symptoms were also more likely to deliver prematurely and have low birthweight babies. The newborns of mothers with depressive symptoms had higher cortisol levels and lower dopamine and serotonin levels, thus mimicking their mothers prenatal levels. On the Brazelton Scale, the newborns of depressed mothers had less optimal habituation, orientation, motor, range of state, autonomic stability and depressed scores. A path analysis was conducted to assess the effects of prenatal depression and the mothers’ prepartum biochemistry on gestational age and birthweight. As predicted in the model proposed, prenatal depression was related to prepartum cortisol and norepinephrine levels, and cortisol levels were in turn negatively related to prematurity, and norepinephrine levels were positively related to low birthweight.
Context:
The problem of unrelieved pain in Emergency Department (ED) patients as well as contraindications to analgesics and narcotics due to masking of symptoms during the diagnostic period, presents itself as a unique opportunity for ED nurses to utilize non-pharmacological and non-invasive interventions such as cutaneous stimulation (CS) to relieve pain.
Objective:
To evaluate the effectiveness of a specific protocol of CS, developed by the researchers, in reducing pain levels in ED patients. Another objective was to determine the effect of CS on blood pressure and heart rate. Potential factors that could influence the dependent variables such as age, gender, educational level, location of pain, and site of CS were tested.
Design:
A one group pre-test post-test experimental design measured variables before and after intervention in all subjects.
Sample:
After being screened for inclusion, 50 patients (38 adults, 12 children) were admitted to the study and were treated with CS to relieve pain.
Results:
Following CS, subjects reported significantly reduced pain, and demonstrated reduced heart rate, and blood pressure readings. The location of pain significancy influenced heart rate and diastolic blood pressure but not pain level. The most effective site of CS was contralateral to the pain. Age, gender and educational level had no significant affect.
Conclusions:
The results of this study provide empirical evidence that CS effectively reduces pain, heart rate, and blood pressure in ED patients. The intervention of CS has solid utilization potential and could be easily incorporated into standard ED procedure. Further research is needed to identify threats to internal validity especially that of the caring presence of the nurse.
This study assessed the effects of moderate and light pressure massage on the growth and development of young infants. A recent study by Diego, Field, Sanders, and Hernandez-Reif (2004) showed that persons who were given moderate pressure massage, as compared with persons who received light massage or vibratory stimulation, experienced a decrease in heart rate, EEG changes associated with a relaxation response and positive affect, and the greatest decrease in stress. In the present study, mothers were instructed to massage their newborn infants once per day using either light or moderate pressure. The infants’ growth (i.e., weight, length, head circumference), sleep behavior, and performance on the Brazelton scale were assessed soon after birth and at one month of age. As compared to infants who received a light pressure massage, infants in the moderate pressure group gained more weight, were greater length, performed better on the orientation scale of the Brazelton, had lower Brazelton excitability and depression scores, and exhibited less agitated behavior during sleep.
Touch massage (TM) is a form of pleasant touch stimulation used as treatment in clinical settings and found to improve well-being and decrease anxiety, stress, and pain. Emotional responses reported during and after TM have been studied, but the underlying mechanisms are still largely unexplored. In this study, we used functional magnetic resonance (fMRI) to test the hypothesis that the combination of human touch (i.e. skin-to-skin contact) with movement is eliciting a specific response in brain areas coding for pleasant sensations. The design included four different touch conditions; human touch with or without movement and rubber glove with or without movement. Force (2.5 N) and velocity (1.5 cm/s) were held constant across conditions. The pleasantness of the four different touch stimulations was rated on a visual analog scale (VAS-scale) and human touch was rated as most pleasant, particularly in combination with movement. The fMRI results revealed that TM stimulation most strongly activated the pregenual anterior cingulate cortex (pgACC). These results are consistent with findings showing pgACC activation during various rewarding pleasant stimulations. This area is also known to be activated by both opioid analgesia and placebo. Together with these prior results, our finding furthers the understanding of the basis for positive TM treatment effects.
To study the effect of maternal massage therapy on hospital stay in very-low-birth-weight infants who were already submitted to skin-to-skin care.
A randomized study was performed including infants of birth weight >or=750 and <or=1500 g and gestational age <or=32 weeks. The exclusion criteria were as follows: death before completing 48 h and presence of major malformations. Neonates were divided into intervention group (IG) (standard care plus maternal massage) and control group (CG). Anthropometric data were always verified by a person blind to the group to which the newborn belonged. Maternal massage was performed four times a day on the face and limbs. Passive exercises of upper and lower limbs were also done by the mothers.
A total of 104 newborns were included, 52 in each group. Both groups were similar in gestational age (IG: 29.7+/-1.6; CG: 29.4+/-1.6 weeks), birth weight (IG: 1186+/-194; CG: 1156+/-198 g), gender, number of small-for-gestational-age infants, SNAPPE-II, deaths, gains in weight, length and head circumference. Incidence of late-onset sepsis was significantly lower in the intervention group (IG: 10.8%, n=5; CG: 38.3%, n=18; P=0.005). IG was discharged from the hospital 7 days before CG (IG: 42, confidence interval (CI) 95%: 38 to 46; CG: 49, CI 95%: 42 to 56), and presented 1.85 hazard ratio (CI 95%: 1.09 to 3.13; P=0.023) for early discharge.
Maternal massage therapy in very-low-birth-weight infants decreases the length of hospital stay and the incidence of late-onset neonatal sepsis.
Previous studies in our laboratory have shown that even short-term separation of preweanling rat pups from the mother produces adverse effects in the pup. These include alterations in ornithine decarboxylase activity and in the secretion of growth hormone and corticosterone. The present study demonstrates that while intermittent heavy stroking effectively reverses or prevents all the changes associated with maternal deprivation neither kinesthetic nor vestibular stimulation affects these responses. The results verify earlier findings from this laboratory indicating that tactile interactions between rat pups and their mother modulate pup physiology and provide experimental support for the hypothesized role of tactile stimuli on early infant development.
In this paper, potential underlying mechanisms for massage therapy effects on preterm infant weight gain are reviewed. Path analyses are presented suggesting that: (1) increased vagal activity was associated with (2) increased gastric motility, which, in turn, was related to (3) greater weight gain; and (4) increased IGF-1 was related to greater weight gain. The change in vagal activity during the massage explained 49% of the variance in the change in gastric activity. And, the change in vagal activity during the massage explained 62% of the variance in the change in insulin. That the change in gastric activity was not related to the change in insulin suggests two parallel pathways via which massage therapy leads to increased weight gain: (1) insulin release via the celiac branch of the vagus; and (2) increased gastric activity via the gastric branch of the vagus.
Moderate pressure appears to be necessary for massage therapy effects. Studies comparing moderate and light pressure massage are reviewed and they suggest that growth and development are enhanced in infants and stress is reduced in adults, but only by moderate pressure massage. The stimulation of pressure receptors leads to increased vagal activity which, in turn, seems to mediate the diverse benefits noted for massage therapy.
In this paper, preterm infant massage therapy studies are reviewed. Massage therapy has led to weight gain in preterm infants when moderate pressure massage was provided. In studies on passive movement of the limbs, preterm infants also gained significantly more weight, and their bone density also increased. Research on ways of delivering the massage is also explored including using mothers versus therapists and the added effects of using oils. The use of mothers as therapists was effective in at least one study. The use of oils including coconut oil and safflower oil enhanced the average weight gain, and the transcutaneous absorption of oil also increased triglycerides. In addition, the use of synthetic oil increased vagal activity, which may indirectly contribute to weight gain. The weight gain was associated with shorter hospital stays and, thereby, significant hospital cost savings. Despite these benefits, preterm infant massage is only practiced in 38% of neonatal intensive care units. This may relate to the underlying mechanisms not being well understood. The increases noted in vagal activity, gastric motility, insulin and IGF-1 levels following moderate pressure massage are potential underlying mechanisms. However, those variables combined do not explain all of the variance in weight gain, highlighting the need for additional mechanism studies.
Twenty healthy adults were randomly assigned to a moderate pressure or a light pressure massage therapy group, and EKGs were recorded during a 3-min baseline, during the 15-min massage period and during a 3-min postmassage period. EKG data were then used to derive the high frequency (HF), low frequency (LF) components of heart rate variability and the low to high frequency ratio (LF/HF) as noninvasive markers of autonomic nervous system activity. The participants who received the moderate pressure massage exhibited a parasympathetic nervous system response characterized by an increase in HF, suggesting increased vagal efferent activity and a decrease in the LF/HF ratio, suggesting a shift from sympathetic to parasympathetic activity that peaked during the first half of the massage period. On the other hand, those who received the light pressure massage exhibited a sympathetic nervous system response characterized by decreased HF and increased LF/HF.
This pilot study aimed to determine the feasibility of providing massage to children with cancer to reduce symptoms in children and anxiety in parents. Twenty-three children/parent dyads were enrolled; 17 completed all data points. Children with cancer, ages 1 to 18 years, received at least 2 identical cycles of chemotherapy, and one parent, participated in the 2-period crossover design in which 4 weekly massage sessions alternated with 4 weekly quiet-time control sessions. Changes in relaxation (heart and respiratory rates, blood pressure, and salivary cortisol level) and symptoms (pain, nausea, anxiety, and fatigue) were assessed in children; anxiety and fatigue were measured in parents. Massage was more effective than quiet time at reducing heart rate in children, anxiety in children less than age 14 years, and parent anxiety. There were no significant changes in blood pressure, cortisol, pain, nausea, or fatigue. Children reported that massage helped them feel better, lessened their anxiety and worries, and had longer lasting effects than quiet time. Massage in children with cancer is feasible and appears to decrease anxiety in parents and younger children.
This study was designed to look at the efficacy of adjuvant massage therapy in children and adolescents who presented to a chronic pediatric pain clinic for management.
After Institutional Review Board approval and informed consent and assent was obtained, all pediatric patients who presented to the outpatient chronic pain clinic at Children's Memorial Hospital from July 2006 to May 2007 were invited to participate in a study that offered massage therapy as an adjunct to conventional pain treatment. Patients (n = 80 sessions, 57 patients) were asked to rate their levels of distress, pain, tension, discomfort, and degree of upset mood on a scale of 1-5 (e.g. for distress 1 = very calm; 5 = very distressed) before and after massage therapy. Paired t-tests were used to compare pre- and postmassage ratings and probability values were corrected for multiple comparisons using the Bonferroni procedure.
After massage therapy, patients reported highly significant improvement in their levels of distress, pain, tension, discomfort, and mood compared with their premassage ratings (all t-values >6.1, ****P < 1 x 10(-8). To control for the possible effects of patients reporting improvements simply as a result of rating their symptoms, we collected control ratings before and after a comparable 'no intervention' time period in a subset of 25 patients. The 'no intervention' time period typically took place in the treatment room with the therapist present. Approximately 60% of the control ratings were obtained before the intervention and 40% were obtained after the massage therapy. None of the differences between the pre- and postratings associated with the 'no intervention' control time period were significant. In these same patients, the difference between the pre- and postmassage ratings were significant, all t-values >3.8, **P < 0.001.
To determine if massage therapy increased serum insulin and insulin-like growth factor-1 (IGF-1) in preterm neonates.
Forty-two preterm neonates who averaged 34.6 weeks (M = 29.5 wk gestational age; M birth weight = 1237 g) and were in the "grower" (step-down) nursery were randomly assigned to a massage therapy group (body stroking and passive limb movements for three, 15-minute periods per day for 5 days) or a control group that received the standard nursery care without massage therapy. On Days 1 and 5, the serum collected by clinical heelsticks was also assayed for insulin and IGF-1, and weight gain and kilocalories consumed were recorded daily.
Despite similar formula intake, the massaged preterm neonates showed greater increases during the 5-day period in (1) weight gain; (2) serum levels of insulin; and (3) IGF-1. Increased weight gain was significantly correlated with insulin and IGF-1.
Previous data suggested that preterm infant weight gain following massage therapy related to increased vagal activity, which suggests decreased stress and gastric motility, which may contribute to more efficient food absorption. The data from this study suggest for the first time that weight gain was also related to increased serum insulin and IGF-1 levels following massage therapy.
Preterm infants who received massage therapy not only showed greater weight gain but also a greater increase in serum insulin and IGF-1 levels, suggesting that massage therapy might be prescribed for all growing neonates.
A 30-minute back massage was given daily for a 5-day period to 52 hospitalized depressed and adjustment disorder children and adolescents. Compared with a control group who viewed relaxing videotapes, the massaged subjects were less depressed and anxious and had lower saliva cortisol levels after the massage. In addition, nurses rated the subjects as being less anxious and more cooperative on the last day of the study, and nighttime sleep increased over this period. Finally, urinary cortisol and norepinephrine levels decreased, but only for the depressed subjects.
This article reviews the literature and presents data from our laboratories on sensory deprivation stress and supplemental stimulation of the rat pup and the preterm neonate. The data suggest that the effects of maternal deprivation in the rat pup (suppression of growth hormone release and protein synthesis) are regulated by a specific form of tactile stimulation: only brush stroking of maternally deprived rat pups returned growth parameters to normal; other forms of stimulation, including kinesthetic and vestibular stimulation, were ineffective in restoring normal functions. Other data are presented demonstrating that very small preterm neonates given tactile-kinesthetic stimulation gain more weight per day, spend more time awake and active, and show more mature habituation, orientation, motor, and range of state behaviors on the Brazelton assessment.
Natural cytotoxicity, mediated by natural killer (NK) cells and cell with lymphokine-activated killer (LAK) activity, is believed to play an important role in host anti-cancer mechanisms.
The authors critically review recent publications on the role of natural cytotoxicity in patients with cancer.
In patients with cancer, several studies have noted variations in the numbers and activity of NK and cells with LAK activity in different body compartments. NK cell activity in the peripheral blood lymphocytes (PBLs) is higher than that found in lymph nodes and within tumors, and this appears to be due to the presence of suppressor factors. The natural cytotoxicity of PBLs in patients with different types of cancers varies. However, there appears to be a trend for natural cytotoxicity to be reduced in certain cancer patients, possibly related to tumor volume or dissemination. Anti-cancer treatments (e.g., surgery, hormonal modulation, radiotherapy and chemotherapy) can also result in suppression of natural cytotoxicity, although the long-term effect on response to treatment and development of metastases is at present unknown.
NK and LAK cells, through the use of immune biologic modifiers, have been demonstrated to have a therapeutic role in the treatment of human cancers. Further studies are required to determine the optimal dosages and combinations of chemotherapeutic agents, the timing of surgery, and the adjuvant use of immune biologic response modifiers. An increasing awareness and understanding of this field, may allow for the future development of anti-cancer therapies.
The aim of the study was to compare emotional and physiological responses to real and control examinations and to assess their relation to personality characteristics. Emotional responses were assessed by state anxiety and perceived stress. The assessment of physiological responses included the activity of the cardiac system (heart periods, vagal tone), the adrenocortical system (cortisol) and the immune system (immune globulin A, sIgA). Emotional and physiological responses of 23 students (12 males, 11 females) were assessed during an oral exam at the end of a basic course in psychology which was a prerequisite for the students' final exams. For the control condition physiological responses were assessed one week before the examination during a memory test. The findings of the study demonstrate different emotional and physiological response patterns to examinations as compared to the control condition. Heightened anxiety was observed only before the exam. Whereas within-situation physiological responses (higher heart periods, cortisol, and sIgA; lower vagal tone) were observed both under the exam and control condition, responses to exam condition indicated pre-exam anticipatory activation and post-exam restricted recovery responses. With regard to personality characteristics subjects with high ego-resiliency showed more flexible adaptation than subjects with low ego-resiliency both on the emotional level (anxiety down-regulation after exam) and on the physiological level (situation-specific responses, quick recovery). Subjects with high ego-control exhibited a lower physiological reactivity under both conditions, i.e. they seemed to maintain longer their control also on a physiological level independent of the type of situation.
The evolution of the autonomic nervous system provides an organizing principle to interpret the adaptive significance of mammalian affective processes including courting, sexual arousal, copulation, and the establishment of enduring social bonds. According to the Polyvagal Theory (Porges, 1995, 1996, 1997), the well-documented phylogenetic shift in the neural regulation of the autonomic nervous system passes through three stages, each with an associated behavioral strategy. The first stage is characterized by a primitive unmyelinated visceral vagus that fosters digestion and responds to threat by depressing metabolic activity. Behaviorally, the first stage is associated with immobilization behaviors. The second stage is characterized by the sympathetic nervous system that is capable of increasing metabolic output and inhibiting the visceral vagus to foster mobilization behaviors necessary for 'fight or flight'. The third stage, unique to mammals, is characterized by a myelinated vagus that can rapidly regulate cardiac output to foster engagement and disengagement with the environment. The mammalian vagus is neuroanatomically linked to the cranial nerves that regulate social engagement via facial expression and vocalization. The Polyvagal Theory provides neurobiological explanations for two dimensions of intimacy: courting and the establishment of enduring pair-bonds. Courting is dependent upon the social engagement strategies associated with the mammalian vagus. The establishment of enduring pair-bonds is dependent upon a co-opting of the visceral vagus from an immobilization system associated with fear and avoidance to an immobilization system associated with safety and trust. The theory proposes that the phylogenetic development of the mammalian vagus is paralleled by a specialized communication, via oxytocin and vasopressin, between the hypothalamus and the medullary source nuclei of the viscera vagus, which facilitates sexual arousal, copulation, and the development of enduring pair-bonds.
The purpose of the current study was to examine the impact of massage therapy on psychological, physical, and psychophysiological measures in patients undergoing autologous bone marrow transplantation (BMT). Patients scheduled to undergo BMT were randomly assigned to receive either (a) massage therapy, consisting of 20-minute sessions of shoulder, neck, head, and facial massage, or (b) standard treatment. Overall effects of massage therapy on anxiety, depression, and mood were assessed pretreatment, midtreatment, and prior to discharge using the State-Trait Anxiety Inventory, Beck Depression Inventory, and Brief Profile of Mood States, respectively. The immediate effects of massage were measured via the State Anxiety Inventory, Numerical Scales of Distress, Fatigue, Nausea, and Pain and indices of psychophysiological arousal (heart rate, blood pressure, and respiration rate), collected prior to and following patients' first, fifth, and final massage (on Days--7, midtreatment, and predischarge). Analysis of the data evaluating the immediate effects of massage showed that patients in the massage therapy group demonstrated significantly larger reductions in distress, fatigue, nausea, and State Anxiety than the standard treatment group at Day-7, in State Anxiety at midtreatment, and in fatigue at the predischarge assessment. The overall measures of psychological symptoms measured at pretreatment, midtreatment, and prior to discharge showed no overall group differences, although the massage group scored significantly lower on the State Anxiety Inventory than the standard care group at the midtreatment assessment. The two groups together showed significant declines through time on scores from the Profile of Mood States and State and Trait Anxiety Inventories.
EEG asymmetry, specifically greater relative right frontal activation, is associated with negative affect. Depressed adults show stable patterns of this asymmetry. The present study assessed the effects of massage therapy and music therapy on frontal EEG asymmetry in depressed adolescents. Thirty adolescents with greater relative right frontal EEG activation and symptoms of depression were given either massage therapy (n = 14) or music therapy (n = 16). EEG was recorded for three-minute periods before, during, and after therapy. Frontal EEG asymmetry was significantly attenuated during and after the massage and music sessions.
HIV+adolescents (M CD4=466 mm3) recruited from a large urban university hospital's outpatient clinic were randomly assigned to receive massage therapy (n=12) or progressive muscle relaxation (n=12) two-times per week for 12 weeks. To assess treatment effects, participants were assessed for depression, anxiety and immune changes before and after treatment the 12 weeks treatment period. Adolescents who received massage therapy versus those who experienced relaxation therapy reported feeling less anxious and they were less depressed, and showed enhanced immune function by the end of the 12 week study. Immune changes included increased Natural Killer cell number (CD56) and CD56+CD3-. In addition, the HIV disease progression markers CD4/CD8 ratio and CD4 number showed an increase for the massage therapy group only.
To evaluate the effects of hand massage on patient anxiety during cataract surgery.
Kangnam St. Mary's Hospital, Seoul, Korea.
This study comprised 59 patients having cataract surgery from December 11, 1996, to February 12, 1997. The patients were divided into those having a hand massage 5 minutes before surgery (experimental group, n = 29) and those not receiving a hand massage (control group, n = 30). Patients' anxiety levels were measured using the Visual Analog Scale and by assessing the systolic blood pressure, diastolic blood pressure, and pulse rate before and after the hand massage and 5 minutes before the end of surgery. Epinephrine, norepinephrine, cortisol, blood sugar levels, neutrophil, and lymphocyte percentages in white blood cells were also measured.
After the hand massage, the psychological anxiety levels, systolic and diastolic blood pressures, and pulse rate were significantly lower than before the massage. The hand massage significantly decreased epinephrine and norepinephrine levels in the experimental group. Epinephrine, norepinephrine, and cortisol levels increased in the control group. The differences between groups were significant. There were no significant between-group differences in blood sugar levels or neutrophil and lymphocyte percentages in white blood cells.
The findings indicate that hand massage decreases the psychological and physiological anxiety levels in patients having cataract surgery under local anesthesia.
The problem of unrelieved pain in Emergency Department (ED) patients as well as contraindications to analgesics and narcotics due to masking of symptoms during the diagnostic period, presents itself as a unique opportunity for ED nurses to utilize non-pharmacological and non-invasive interventions such as cutaneous stimulation (CS) to relieve pain.
To evaluate the effectiveness of a specific protocol of CS, developed by the researchers, in reducing pain levels in ED patients. Another objective was to determine the effect of CS on blood pressure and heart rate. Potential factors that could influence the dependent variables such as age, gender, educational level, location of pain, and site of CS were tested.
A one group pre-test post-test experimental design measured variables before and after intervention in all subjects.
After being screened for inclusion, 50 patients (38 adults, 12 children) were admitted to the study and were treated with CS to relieve pain.
Following CS, subjects reported significantly reduced pain, and demonstrated reduced heart rate, and blood pressure readings. The location of pain significantly influenced heart rate and diastolic blood pressure but not pain level. The most effective site of CS was contralateral to the pain. Age, gender and educational level had no significant affect.
The results of this study provide empirical evidence that CS effectively reduces pain, heart rate, and blood pressure in ED patients. The intervention of CS has solid utilization potential and could be easily incorporated into standard ED procedure. Further research is needed to identify threats to internal validity especially that of the caring presence of the nurse.
The issue of whether pain is represented by specific neural elements or by patterned activity within a convergent somatosensory subsystem has been debated for over a century. The gate control theory introduced in 1965 denied central specificity, and since then most authors have endorsed convergent wide-dynamic-range neurons. Recent functional and anatomical findings provide compelling support for a new perspective that views pain in humans as a homeostatic emotion that integrates both specific labeled lines and convergent somatic activity.
Women with breast cancer are at risk for elevated depression, anxiety, and decreased natural killer (NK) cell number. Stress has been linked to increased tumor development by decreasing NK cell activity. The objectives of this study included examining massage therapy for women with breast cancer for (1) improving mood and biological measures associated with mood enhancement (serotonin, dopamine), (2) reducing stress and stress hormone levels, and (3) boosting immune measures.
Thirty-four women (M age=53) diagnosed with Stage 1 or 2 breast cancer were randomly assigned postsurgery to a massage therapy group (to receive 30-min massages three times per week for 5 weeks) or a control group. The massage consisted of stroking, squeezing, and stretching techniques to the head, arms, legs/feet, and back. On the first and last day of the study, the women were assessed on (1) immediate effects measures of anxiety, depressed mood, and vigor and (2) longer term effects on depression, anxiety and hostility, functioning, body image, and avoidant versus intrusive coping style, in addition to urinary catecholamines (norepinephrine, epinephrine, and dopamine) and serotonin levels. A subset of 27 women (n=15 massage) had blood drawn to assay immune measures.
The immediate massage therapy effects included reduced anxiety, depressed mood, and anger. The longer term massage effects included reduced depression and hostility and increased urinary dopamine, serotonin values, NK cell number, and lymphocytes.
Women with Stage 1 and 2 breast cancer may benefit from thrice-weekly massage therapy for reducing depressed mood, anxiety, and anger and for enhancing dopamine, serotonin, and NK cell number and lymphocytes.
Little is known about the hypothalamic-pituitary-adrenal (HPA) axis stress system in chronic depression. This study examined the corticotropin-releasing hormone (CRH) challenge test in a group of patients with chronic depression, before and after 3 months of treatment with vagus nerve stimulation (VNS) therapy, and a matched group of healthy control subjects.
Key inclusion criteria were DSM-IV-defined major depressive disorder, a history of a current episode lasting for at least 2 years, and unresponsiveness to at least two classes of antidepressant medications. Eleven test subjects and 11 matched control subjects underwent a CRH challenge.
There were significant reductions in depression scores over the study period. The CRH/ACTH (adrenocorticotropic hormone) responses in the depressed group before VNS implantation were significantly higher than in the healthy group and were reduced to normal values after VNS treatment. Some measures of cortisol response were elevated before treatment and were reduced to normal over the study period. The only clinical measure correlated with HPA axis alterations was reduction in atypical depressive symptom scores.
These preliminary results suggest that chronic depression, in contrast to acute melancholic depression, might be characterized by increased ACTH response to CRH challenge. Short-term treatment with VNS therapy was associated with normalization of this response.
To investigate changes in regional cerebral blood flow (rCBF) under the prone condition with and without light massage on the back, we measured rCBF quantitatively in healthy human subjects using positron emission tomography with H(2)15O. Biochemical tests showed that the light massage (palm-pressure) reduced levels of stress-related serum cortisol and salivary stress protein chromogranin-A measured after the PET examination. Absolute rCBF significantly increased in the parietal cortex (precuneus) under the prone condition compared with the supine condition, and this rCBF increase was in parallel with comfortable sensation and slowing heart rate during the massage. Correlation analysis in statistical parametric mapping showed that the amygdalar and basal forebrain rCBF correlated with parasympathetic function (heart rate reduction), indicating involvement of the forebrain-amygdala system in mediating activities in the autonomic nervous system in the presence of comfortable sensation. To conclude, prone posture itself can stimulate the precuneus region to raise awareness, and the light massage on the back may help accommodate the brain to comfortable stimulation.
Massage therapy has been observed to be helpful in some patients with fibromyalgia. This study was designed to examine the effects of massage therapy versus relaxation therapy on sleep, substance P, and pain in fibromyalgia patients. Twenty-four adult fibromyalgia patients were assigned randomly to a massage therapy or relaxation therapy group. They received 30-minute treatments twice weekly for 5 weeks. Both groups showed a decrease in anxiety and depressed mood immediately after the first and last therapy sessions. However, across the course of the study, only the massage therapy group reported an increase in the number of sleep hours and a decrease in their sleep movements. In addition, substance P levels decreased, and the patients' physicians assigned lower disease and pain ratings and rated fewer tender points in the massage therapy group.