Massage gains respect of Western medicine

[Guest guest]

November 22, 2004 Can massage cure?

As a healing aid, hands-on therapy gains credibility at leading medical

centers.

http://www.latimes.com/features/health/la-he-massage22nov22,0,6280141.story?coll\

=la-home-health

By E. MacGregor, Times Staff Writer

You lie on the crisp white sheet of the massage table in semidarkness.

The scent of almond oil fills the air. Then come the hands, gently

kneading the necklace of knots that rings your back, your neck, your

shoulders. You close your eyes, breathe deeply and let yourself relax.

Beyond the pleasures of the moment, though, are there medical benefits

to massage?

Hospitals and medical clinics around the country are beginning to

integrate massage into patient care. Massage is currently the most

common nontraditional therapy offered in U.S. hospitals, according to an

American Hospital Assn. survey in 2003. The most common uses for massage

in hospitals: helping patients cope with pain and stress, and as a

therapeutic service for cancer and maternity patients.

At Martha Jefferson Hospital in Charlottesville, Va., cancer patients

are offered therapeutic massage by one of eight trained therapists.

Longmont United Hospital in Colorado has a massage therapist on staff

around the clock for patients who need or request it. At Memorial

Sloan-Kettering Cancer Center in New York, 11 massage therapists are on

a staff team working with hundreds of patients admitted to the hospital

or seen at its various clinics.

And at the UCLA Center for East-West Medicine, a team of four therapists

use massage to alleviate pain and symptoms for patients suffering from

illnesses such as fibromyalgia, migraines and back pain.

The National Institutes of Health is funding several studies to examine

the medical benefits of massage. Previous studies by various

organizations have found that massage can help reduce chronic pain,

diminish anxiety and depression, and enhance immune function.

A new survey by the American Massage Therapy Assn., a professional

organization, shows that nearly half of Americans have used massage

therapy as a way to manage and relieve pain. The survey also found that

healthcare providers are more likely than before to discuss the possible

benefits of massage and to recommend it to their patients. And some

health insurers have begun paying for the therapy, according to the

survey.

Still, many doctors remain skeptical of the research suggesting a

medical benefit to massage, saying more rigorous studies are needed.

But doctors, nurses and patients who have seen massage in action say

that even if the benefits can't be demonstrated by large clinical

studies, the anecdotal evidence is powerful.

" Clearly there are medical benefits to massage, " said Dr. P.

Fontana, a cardiothoracic surgeon at Cedars-Sinai Medical Center in Los

Angeles who conducted a pilot study of heart patients to measure the

effectiveness of nontraditional therapies, such as massage, in helping

speed recover after surgery.

Ninety-five percent of the 50 massage patients reported that massage was

a " very important " part of their recovery, Fontana said. Dr. Ka-Kit Hui,

director of UCLA's East-West Center in Santa , goes further:

" Massage is a very important therapeutic approach which is underutilized

and underappreciated. A lot of people think massage is good for aches

and pains. But what we have found is that massage activates the body's

own healing system. "

A long history

The use of massage as a healing art dates back to about 4000 BC, when

the therapy was used in China and India. In this country, massage was

commonly used by nurses up until the 1960s and 1970s to help ease

patients' pain and help them sleep.

But the advent of powerful prescription pain medications in recent

decades has diminished the use of massage in medical settings — until

fairly recently.

Patients at UCLA'S East-West Center see a team made up of a

Western-trained doctor, an acupuncturist and a massage therapist. Often

referred by their physicians, many of the patients come to the center

because traditional Western remedies, such as prescription drugs, have

not proven effective for their ailments.

About half of the center's patients receive some massage therapy as part

of their treatment program, which may also include traditional medicine.

On a recent morning, McGuirk, 45, sat on the edge of a massage

table in a hospital gown. About five years ago she began to get

migraines so severe that doctors gave her morphine and Demerol to ease

the pain. Confined to bed three to four days a week, she was in danger

of losing her nursing job.

" The medical profession kind of pooh-poohs migraines, " she says. " And I

was losing half my life. "

Her primary care doctor sent her to a neurologist, who put her on pain

relievers and antidepressants. Nothing worked.

Finally the neurologist referred her to the East-West Center, where she

was treated by Dr. Jun Liang Yu, a Chinese-born doctor trained in

Western medicine in Asia, who practices acupuncture and massage therapy

at the center.

" That was the first time anyone had touched my neck or shoulders " in a

medical setting, McGuirk said of her massage treatments with Yu. The

UCLA therapists told her that her neck and shoulders were " as hard as

wood. "

" They told me I was getting no blood circulation to the brain. If there

is no blood circulation there is no oxygen, and if there is no oxygen,

of course you are going to get headaches. "

As McGuirk lay on the table, Yu began to work her neck, back and

shoulders. He did not press down hard on sore areas or acupressure

points. Instead, it looked almost as if he were rolling her muscles.

" We don't beat up muscles. We manipulate the muscles, " Yu explained. " We

are rolling the muscles back in place. "

Hui, the center's director, is board certified in internal medicine and

clinical pharmacology, and is also an authority on Chinese and

integrative medicine. He believes changes in the body occur because

there are neural chemical changes associated with stimulating points in

the body. " We have done it with needles, but we can do it with fingers

as well, " Hui said. " Think of the acupuncture points that are being

stimulated like the remote control of the TV. Push and the body will

react. Something is released. "

Key to improvement

McGuirk has taken prescription medication, such as muscle relaxants, and

made lifestyle changes, and now says her migraines occur only about once

every three weeks.

But she is convinced that massage had been a key factor in her

improvement. " Without it, I'd be back to migraines three to four times a

week. "

Hugo, 30, who suffers from interstitial cystitis — a chronic

inflammation of the bladder — is another patient at the East-West Center

who attributes her improvement primarily to massage. After years of

ineffective treatment with antibiotics, she was treated at UCLA with

acupuncture, a few muscle relaxants and massage. She has been off

antibiotics for two years.

" You have to be patient with natural remedies, " she said. " Natural

remedies take longer. "

Hui does not believe massage is a panacea. Nor does he believe it can

replace surgery or medications. But he does believe it is " an important

frontline approach for a lot of chronic problems, or prevention of

chronic problems. "

Those who advocate massage therapy say some hospital administrators are

wary of introducing such a " touchy-feely " element to clinical practice.

Simone Zappa, a nurse who is now director of the Integrative Medicine

Service at Memorial Sloan-Kettering, believed that massage therapists

would only be taken seriously by hospital staff if they could read a

medical chart, assess a patient and document their intervention. So the

hospital program trains its massage therapists in medical terminology

and using medical charts. Zappa also teaches them to go easy on the

touchy-feely talk around physicians.

" If you talk to massage therapists or acupuncturists, they talk about

energy, " said Zappa. " Western doctors don't believe in energy. I've told

my massage therapists, don't talk about energy. We are working in a

Western institution and we need to conform to its norms. "

While Zappa, Hui and others advocate massage for its therapeutic value,

they have had difficulty convincing insurers that it is more than a

" feel good " treatment. Massage therapy is not covered by most health

plans, so patients often must pay out of pocket.

At the East-West Center, about 80% of patients have insurance coverage,

and the massage treatments are covered as part of an overall treatment

program for claims deemed medically necessary.

When insurers question the necessity of a claim, doctors can write a

note explaining the reason for the treatment.

Memorial Sloan-Kettering requires patients at its outpatient clinics to

pay for massage services, and uses the revenue to offset the expense of

massage for patients admitted to the hospital.

Ongoing studies

Field, director of the Touch Research Institute at the

University of Miami School of Medicine, has conducted more than 100

studies on the medical benefits of massage over the last 30 years. She

has collaborated with physicians and published some studies in medical

journals.

" I think doctors think, it seems like such a pleasurable thing, how can

it be therapeutic, " said Field. " But all the effects are statistically

significant and that is what science accepts as research. "

Gayle Mac, who taught a course in medical massage at the Oregon

Health & Science University for many years, and is the author of

" Massage for the Hospital Patient and Medically Frail Client "

(Lippincott & Wilkins, 2004), says there are inherent

challenges to doing research on massage.

" Doctors only buy into the Western gold standard for research, " she

says. " It has to be a huge sample size, randomized, controlled and

double blind. Well, you can't do a double-blind massage study. It's

impossible. It is not like doing medication on cardiac patients. "

Addressing skepticism

But new studies funded by NIH's National Center for Complementary and

Alternative Medicine may help to address some of the skepticism about

the medical benefits of massage. Field is working on two NIH-funded

studies: one looking at the underlying mechanisms of the effect of

massage on premature babies; the other looking at the effect of massage

on treating depression in pregnant mothers.

At Memorial Sloan-Kettering, researchers are conducting a study, also

funded by the NIH, to measure the effectiveness of using massage in

treating pain in cancer patients.

And researchers at Cedars-Sinai just completed an eight-week study

involving 70 HIV patients to see whether the therapy was effective in

treating depression, pain and quality of life. Over eight weeks, one

group of patients received no massage, one group received a sham massage

and one group received Swedish massage twice a week.

" The results are not yet published, " said Poland, director of

research in the department of psychiatry at Cedars-Sinai, and the lead

investigator of the NIH-funded study. " But it looks very promising that

massage was better than either of the two control groups. "

With many hospitals around the country struggling with rising medical

costs and an uncertain financial future, the idea of hiring massage

therapists will continue to be a tough sell to administrators, some

health professionals say.

Over time, however, massage advocates hope that research that supports

the safety, benefit and, perhaps, even the cost-effectiveness of medical

massage will help persuade more hospitals to give it a try.

" If you can show doctors massage works as well as drugs and has no side

effects, " said Dr. Joya Favreau, an internist and specialist in

integrative medicine at Cedars-Sinai who worked on the HIV massage

study, " they will use it. "