Massage oil fortified with phytochemicals for relief of symptoms such as pain, fatigue, anxiety and insomnia in palliative care

1. Massage therapy with topical phytochemicals
in palliative care
By
Kevin KF NG, MD, PhD.
Former Associate Professor of Medicine
Miller School of Medicine
University of Miami, Florida
Presented at The Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore Jan 22, 2016

2. WHO Definition of Palliative Care
Palliative care is an approach that improves the quality of life of
patients and their families facing the problem associated with life-
threating illness, through the prevention and relief of suffering by
means of early Identification and impeccable assessment and
treatment of pain and other problems, physical, psychosocial and
spiritual.

3. WHO Guidelines 2004

4. Institute of Medicine 2014
Recommendations for:
• individuals
• health care professionals
• organizations
• payers
• policy makers
to achieve optimal care at the end of life,

5. Hospice Care in the USA 2010-2014
Total Hospice patients served per year % Of Hospice patients by AGE
http://app.jamanetwork.com/#page=issuesContainer

6. Hospice Home Care in USA 2010 - 2014
http://app.jamanetwork.com/#page=issuesContainer

7. Common physical symptoms in palliative care
 pain
 fatigue
 loss of appetite
 nausea
 vomiting
 shortness of breath
 insomnia.

8. IAHPC: 34 essential medications for palliative care
http://hospicecare.com/resources/palliative-care-essentials/iahpc-essential-medicines-for-palliative-care/

9. Symptom management for Pain and Fatigue
in Palliative Care
Drug
 Analgesic
 Narcotics
 NSAIDS
Non-drug
 Physical therapy
 Occupational therapy
 Massage therapy
 Meditation
 Yoga

11. Purpose of presentation: to introduce use
of phytochemicals in massage oil for
palliative care.

12. http://www.webmd.com/

14. Massage therapy styles and benefits
Styles
 Swedish massage
 Neuro-muscular massage
 Deep tissue massage
 Sports massage
 Chair massage
Benefits
 Back pain
 Headache
 Osteoarthritis
 Cancer
 Depression
 Shiatsu massage
 Thai massage
 Hot stone massage
 Reflexology
 Pregnancy massage
 Neonatal massage
http://www.webmd.com/

15. How does massage work ?
 Increase blood flow
 Enhance lymphatic drainage
• Effleurage (sliding or gliding)
• Petrissage (kneading)
• Tapotement (rhythmic tapping)
• Friction (cross fiber or with the
fibres)
• Vibration/shaking

16. Science behind Massage
 Reduce stress :
ACTH, Serotonin, Dopamine
 Reduce inflammation:
CRP, TNF-α, COX-2 and 5-Lox lipid mediators, interleukins
 Effect of one massage may last for one week

17. Function of massage oils
1. To reduce friction between
the therapist’s hand and
the skin of patient.
2. Extraction of phytochemicals

18. Top massage oils & their % fatty acids in USA

19. The story of Phytochemicals
 Sheng Nong (about 4,000 years ago): tasted and classified 365 Chinese herbs.
 Hippocrates (460 bc – 375 bc): used bark of white willow tree for fever and pain.
 Sir John R. Vane (1927-2004): discovered how aspirin reduced fever and pain in 1971.
 The word “phytochemical” was invented on April 25, 1994

20. Rationale of Use of Topical Phytochemicals for Palliative Care
 Many patients cannot tolerate oral medications.
 Most phytochemicals are metabolized in the gastro-intestinal tract and liver.
 Most phytochemicals are soluble in oil.
 Massage oil contains fatty acids (oleic acid, linoleic acid, linolenic acid) which are easily
absorbed through the skin..
 Therefore phytochemicals in massage oil may be absorbed through skin bypassing the portal
circulation to enhance their beneficial effects.
 Phytochemicals act on multiple targets and they act in synergy.

21. What are phytochemicals
 Phyto = plant
 Most phytochemicals work with other phytochemicals
to produce the desired effect on health: synergy

22. Functions of Phytochemicals
Plants
 Protections from microbes and parasites.
 Color
 Anti-oxidant
 Hormonal/signaling
Human
 Ant-inflammatory
 Anti-oxidant
 Anti-cancer
 Anti-aging
 Type 2 diabetes
 Eye disease

23. Source of Phytochemicals: fruits, vegetables, leaves, bark and roots

24. Classification of Dietary Phytochemicals
Molecules 2013, 18, 322-353; doi:10.3390/molecules18010322

25. Properties and functions of phytochemicals
 Anti-oxidant
 Anti-inflammatory
 Anti-cancer
 Immuno-stimulant
 Anti-aging
 Hormone-like actions

26. Extraction of Phytochemicals
Botanical Products (Leaves, Flowers, Fruits, Barks, Roots in carrier medium.
Homogenizer
Centrifuge
Separation of Supernatant from Residue
Tests on Subjects

27. Synergy= sum of parts is not equal to the whole
Part
Part
Whole

28. Studies performed on Phytochemical Extracts
Traditional Chinese Medicine
 Ginseng
 Astragalus
 Liquorice
 Notoginseng
 Dan Sheng
 Discorea
 Angelina sinesis
 Peony
 Thunder god vine
Malaysian herbs & spices
 Lumpuyang
 Lemongrass
 Galangal
 Ginger
 Aloe
 Chive
 Chilli
 Tumeric
 Tonkat ali

29. Analysis of actions of phytochemicals on molecular targets

30. Clinical studies to show pharmacological effects of phytochemical extracts
 Dermatographia urticaia (histamine)
 Psoriasis (itch)
 Acute Pain (Dit Da Jow): strain, sprain, low back pain, frozen shoulder
 Acute inflammation: fire ant stings
 Palliative care (symptom relief)

31. Anti-histamine effect of phytochemical extract on
Dermatographia urticaria
Control Treated
10.10 am 10.17 am
Treated

32. Effect of phytochemcical Extract on Itch in Psoariasis
Before After 4 days

33. Effect of phytochemical Extract on Low back pain

34. Pain relief by phytochemical Extract on Gout
Before treatment 5 days after treatment

35. Problems: Pain, Itch, infection
Dr. Blake Layton, Extension Entomology Specialist
Department of Entomology, Mississippi State University
http://msucares.com/insects/fireants/sting.html
Natural history of fire ant sting from contact to resolution

36. Effect of Phytochemical Extract on Fire Ant Stings
Untreated for 36 hours Treated for 36 hours

37. Initial studies of topical phytochemicals on End of Life
Cases
 Metastatic lung disease (1)
 Metastatic pancreatic disease (1)
Observed Effects
 Reduced cancer related fatique
 Reduced stress and anxiety
 Reduced analgesic usage
 Reduced polypharmacy
 Well tolerated
 Minimal side effects
 Improved overall quality of life

38. Grateful thanks to:
 My parents who persuaded me to drink the bitter herbal mixture.
 My wife and my mother-in-law who taught me Swedish massage.
 My mentor Sir John R. Vane who taught me research in pharmacology.
 My patients who inspired me to look for safer alternative in patient care.
Sir John R. Vane,
1982 Nobel laureate in Physiology and Medicine
(1927-2004)