Massage as a therapy has different type of sessions. Swedish massage, Deep tissue massage, Tuina , Zhiya, Asian Massage, Tantric Massage , Oriental Massage, Chinese medicine massage, body to body nudist massage ( a sensual therapy) and more. Before one can enjoy massage's benefit , the safety is one of the most important thing that should not ignored.
This study aims to evaluate the efficacy of capacitive resistive monopolar radiofrequency (CRMRF) at 448 kHz as an adjunct treatment to physiotherapeutic techniques for reducing pain and improving quality of life in patients with chronic pelvic pain syndrome (CPPS). The study involves an 80-patient randomized controlled trial comparing a CRMRF activated group to a CRMRF deactivated group, both receiving physiotherapy. Outcome measures include pain levels, quality of life, kinesiophobia, and catastrophizing, which will be assessed at baseline and weeks 6 and 10. The results may show whether CRMRF provides benefits when added to physiotherapy and pain education for CPPS patients.
1) The study aimed to evaluate the effects of capacitive and resistive electric transfer (CRet) and hotpack (HP) on hemoglobin saturation and tissue temperature in the lower paraspinal muscle of 13 healthy males.
2) Total hemoglobin and oxygenated hemoglobin were significantly higher in the CRet group than the HP group for 30 minutes after intervention. Tissue temperature at 10mm and 20mm depths were also significantly higher in the CRet group than HP group from 10 to 30 minutes after intervention.
3) Both CRet and HP increased hemoglobin saturation and tissue temperature more than the sham intervention. However, the effect on hemoglobin saturation was greater with CRet, and CRet warmed
ZMPCZM016000.11.22 effect of the frequency of TENS on the postoperative opio...painezeeman
This study examined the effects of different frequencies of transcutaneous electrical nerve stimulation (TENS) on postoperative opioid requirements. 100 women undergoing gynecological surgery received patient-controlled analgesia and were assigned to receive sham TENS, low-frequency TENS, high-frequency TENS, or mixed-frequency TENS. Mixed-frequency TENS provided the greatest opioid-sparing effect, decreasing morphine requirements by 53% compared to sham TENS. Low and high frequencies also decreased requirements by 32% and 35% respectively. All active TENS groups had shorter PCA therapy duration and less nausea, dizziness, and itching than the sham group.
ZMPCZM016000.11.20 TENS can reduce postoperative analgesic consumption.A meta...painezeeman
TENS can reduce postoperative analgesic consumption according to a meta-analysis of 21 randomized controlled trials. The analysis found that TENS reduced overall analgesic use by 26.5% compared to placebo. For trials using strong, subnoxious TENS at adequate frequencies, analgesic consumption was reduced by 35.5% compared to 4.1% for trials without these optimal parameters. The difference between optimal and non-optimal TENS was statistically significant, indicating TENS can significantly reduce pain medication needs when administered optimally.
ZMPCZM016000.11.07 Analgesic effects of TENS & IFC on heat pain in healthy su...painezeeman
This study examined the analgesic effects of transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) on heat pain thresholds in healthy subjects. 48 subjects were randomly assigned to receive either TENS, IFC, or no stimulation for 30 minutes. Heat pain thresholds were measured before, during, and after stimulation. Both TENS and IFC significantly increased heat pain thresholds during stimulation compared to no stimulation. While the effect of TENS did not last long after stimulation, IFC maintained elevated heat pain thresholds for at least 30 minutes following stimulation. The study concluded that both TENS and IFC can effectively reduce heat pain sensitivity in healthy subjects, with IFC having longer-lasting effects.
This study summarizes the long-term results of 31 patients who underwent bilateral single-port endoscopic thoracic sympathectomy for primary hyperhidrosis between 2010-2014. The average follow-up time was 60.6 months. At follow-up, 10 patients (32.3%) reported their primary complaint of excessive sweating had not been resolved. 15 patients (48.4%) developed compensatory hyperhidrosis, most commonly in the dorsal region. The factors most affecting patient satisfaction were persistence of the primary complaint and development of compensatory hyperhidrosis. 6 patients (19%) reported being dissatisfied with the surgery results long-term.
ZMPCZM016000.11.09 Electrotherpay study summaries for surgeons provided by me...painezeeman
1) Several studies examined the effects of transcutaneous electrical nerve stimulation (TENS) and electrical muscle stimulation (EMS) after shoulder and knee surgeries.
2) The studies found that TENS reduced pain levels and analgesic consumption after shoulder surgery compared to placebo. EMS improved quadriceps strength and gait more than voluntary exercise alone after ACL reconstruction.
3) Home interferential current therapy also reduced pain, edema, and improved range of motion more than placebo after ACL reconstruction, meniscectomy, or knee chondroplasty procedures.
This study aims to evaluate the efficacy of capacitive resistive monopolar radiofrequency (CRMRF) at 448 kHz as an adjunct treatment to physiotherapeutic techniques for reducing pain and improving quality of life in patients with chronic pelvic pain syndrome (CPPS). The study involves an 80-patient randomized controlled trial comparing a CRMRF activated group to a CRMRF deactivated group, both receiving physiotherapy. Outcome measures include pain levels, quality of life, kinesiophobia, and catastrophizing, which will be assessed at baseline and weeks 6 and 10. The results may show whether CRMRF provides benefits when added to physiotherapy and pain education for CPPS patients.
1) The study aimed to evaluate the effects of capacitive and resistive electric transfer (CRet) and hotpack (HP) on hemoglobin saturation and tissue temperature in the lower paraspinal muscle of 13 healthy males.
2) Total hemoglobin and oxygenated hemoglobin were significantly higher in the CRet group than the HP group for 30 minutes after intervention. Tissue temperature at 10mm and 20mm depths were also significantly higher in the CRet group than HP group from 10 to 30 minutes after intervention.
3) Both CRet and HP increased hemoglobin saturation and tissue temperature more than the sham intervention. However, the effect on hemoglobin saturation was greater with CRet, and CRet warmed
ZMPCZM016000.11.22 effect of the frequency of TENS on the postoperative opio...painezeeman
This study examined the effects of different frequencies of transcutaneous electrical nerve stimulation (TENS) on postoperative opioid requirements. 100 women undergoing gynecological surgery received patient-controlled analgesia and were assigned to receive sham TENS, low-frequency TENS, high-frequency TENS, or mixed-frequency TENS. Mixed-frequency TENS provided the greatest opioid-sparing effect, decreasing morphine requirements by 53% compared to sham TENS. Low and high frequencies also decreased requirements by 32% and 35% respectively. All active TENS groups had shorter PCA therapy duration and less nausea, dizziness, and itching than the sham group.
ZMPCZM016000.11.20 TENS can reduce postoperative analgesic consumption.A meta...painezeeman
TENS can reduce postoperative analgesic consumption according to a meta-analysis of 21 randomized controlled trials. The analysis found that TENS reduced overall analgesic use by 26.5% compared to placebo. For trials using strong, subnoxious TENS at adequate frequencies, analgesic consumption was reduced by 35.5% compared to 4.1% for trials without these optimal parameters. The difference between optimal and non-optimal TENS was statistically significant, indicating TENS can significantly reduce pain medication needs when administered optimally.
ZMPCZM016000.11.07 Analgesic effects of TENS & IFC on heat pain in healthy su...painezeeman
This study examined the analgesic effects of transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) on heat pain thresholds in healthy subjects. 48 subjects were randomly assigned to receive either TENS, IFC, or no stimulation for 30 minutes. Heat pain thresholds were measured before, during, and after stimulation. Both TENS and IFC significantly increased heat pain thresholds during stimulation compared to no stimulation. While the effect of TENS did not last long after stimulation, IFC maintained elevated heat pain thresholds for at least 30 minutes following stimulation. The study concluded that both TENS and IFC can effectively reduce heat pain sensitivity in healthy subjects, with IFC having longer-lasting effects.
This study summarizes the long-term results of 31 patients who underwent bilateral single-port endoscopic thoracic sympathectomy for primary hyperhidrosis between 2010-2014. The average follow-up time was 60.6 months. At follow-up, 10 patients (32.3%) reported their primary complaint of excessive sweating had not been resolved. 15 patients (48.4%) developed compensatory hyperhidrosis, most commonly in the dorsal region. The factors most affecting patient satisfaction were persistence of the primary complaint and development of compensatory hyperhidrosis. 6 patients (19%) reported being dissatisfied with the surgery results long-term.
ZMPCZM016000.11.09 Electrotherpay study summaries for surgeons provided by me...painezeeman
1) Several studies examined the effects of transcutaneous electrical nerve stimulation (TENS) and electrical muscle stimulation (EMS) after shoulder and knee surgeries.
2) The studies found that TENS reduced pain levels and analgesic consumption after shoulder surgery compared to placebo. EMS improved quadriceps strength and gait more than voluntary exercise alone after ACL reconstruction.
3) Home interferential current therapy also reduced pain, edema, and improved range of motion more than placebo after ACL reconstruction, meniscectomy, or knee chondroplasty procedures.
The main findings of upper endoscopy in 133 patients with laryngopharyngeal reflux were:
1. Gastritis was found in 77% of patients, esophagitis in 59%, and hypofunction of the cardia in 40%.
2. Hiatal hernia was identified in 32% of patients.
3. Barrett's esophagus and neoplasms were found in 9% and 2.2% of patients respectively.
4. Only 12% of patients had a normal endoscopy.
5. Helicobacter pylori was positive in 30% of patients.
The dry needling of myofascial pain syndrome trigger points provided pain relief compared to sham needling.
A Systematic Review on the Efficacy of Iontophoresis
as a Treatment for Lateral Epicondylitis by James McKivigan*, Brent Yamashita and Derek Smith in Research & Investigations in Sports Medicine
Gabapentin reduced acute pain after mastectomy and decreased the incidence of chronic pain in two studies. A single dose of gabapentin was ineffective for reducing thoracotomy pain when an epidural was also used. Regional anesthesia and intravenous lidocaine reduced chronic pain incidence after mastectomy or thoracotomy in several studies. Ketamine and intercostal cryoanalgesia did not reduce chronic pain. Total intravenous anesthesia may reduce post-thoracotomy pain in one study.
I. Therapeutic ultrasound is used to treat musculoskeletal issues like inflammation by generating heat through sound waves. While it may help some patients, there is little scientific evidence that it is reliably effective.
II. A review of 38 studies found little evidence to support the use of ultrasound for musculoskeletal disorders. Only 2 of 10 well-designed trials found it more effective than placebo for specific conditions.
III. While ultrasound appears safe and may provide benefits for some patients, more high-quality research is still needed to scientifically validate its therapeutic effects.
This study investigated the efficacy of pulsed electromagnetic field therapy (PEMF) in reducing delayed onset muscle soreness (DOMS) in marathon runners. A double-blind randomized controlled trial assigned 133 marathon runners to either an active PEMF device or placebo device to use for 20 minutes, 4 times per day for 5 days after a marathon. The primary outcome was thigh pain assessed using a visual analog scale during squats. Subjects using the active PEMF device had significantly lower pain scores compared to the placebo group, indicating PEMF reduced DOMS in marathon runners.
Dr. Tinni T. Maskoen is the Head of Intensive Care at Hasan Sadikin Hospital in Bandung and Chair of the Intensive Care Education Program at Padjadjaran University Medical School. She discusses the importance of effective pain relief after surgery and outlines the World Health Organization analgesic ladder for treating surgical pain. She advocates for a multimodal approach using combinations of paracetamol, NSAIDs, opioids, and other adjuvants to provide enhanced pain relief with reduced side effects.
The preoperative administration of low doses of ketamine and clonidine before induction anesthesia appeared to provide benefits in morbidly obese patients undergoing open bariatric surgery. Patients receiving ketamine and clonidine required less sevoflurane, lower doses of fentanyl, and had a shorter time to tracheal extubation compared to controls. They also consumed less tramadol postoperatively and reported less pain in the first 6 hours based on visual analog scale scores. The combination of ketamine and clonidine allowed for reduced doses of anesthetic drugs while improving postoperative recovery outcomes.
1) The study examined the mechanisms underlying pain in patients with joint hypermobility syndrome/Ehlers–Danlos syndrome, hypermobility type (JHS/EDS-HT).
2) Clinical exams, questionnaires, and sensory testing found no evidence of somatosensory nervous system damage but did find signs of central sensitization such as lowered pain thresholds and increased wind-up ratio.
3) The results suggest that rather than neuropathic pain, the pain experienced by patients with JHS/EDS-HT is caused by central sensitization, sharing mechanisms with fibromyalgia.
Meta analysis of clinical efficacy of pulsed radio frequencyPainezee Specialist
This meta-analysis reviewed 25 controlled clinical trials involving 1332 patients to evaluate the efficacy of pulsed radio frequency energy (PRFE) therapy for postoperative pain and edema, nonpostoperative pain and edema, and wound healing. A vote-counting method found more positive outcomes than neutral or negative outcomes for each clinical application. A statistical combination of P-values also found statistically significant improvements in pain, edema reduction, and wound healing outcomes. The analysis provides strong statistical evidence that PRFE therapy is an effective treatment for postoperative and nonpostoperative pain and edema as well as for wound healing applications.
This document contains information about the editorial board and executive body of the M.P. State Anaesthesiology journal for 2017-2018. It lists the editor and co-editor, and provides contact information. It also lists the executive body members including the president, vice president, secretary, and treasurer. The document then continues with several articles on topics in anaesthesiology, including one on anaesthesia for thoracoscopic procedures.
This randomized, double-blind pilot study examined the effects of pulsed electromagnetic field (PEMF) therapy on pain in patients with early knee osteoarthritis. 34 patients were randomly assigned to either an active PEMF device group (n=15) or a sham device group (n=19). The PEMF signal was designed to modulate the calcium/calmodulin dependent nitric oxide signaling pathway. Results showed a 50% reduction in pain scores from baseline in the active group starting on day 1 and persisting to day 42, while no significant reduction was seen in the sham group. The overall decrease in pain was nearly threefold greater in the active group. The rapid and sustained pain relief seen with PEMF therapy suggests it may reduce inflammation
This document summarizes clinical studies and cost analyses that demonstrate the importance of maintaining perioperative normothermia. Several studies show that hypothermia can lead to increased surgical site infections, longer hospital stays, more blood loss and transfusions, prolonged drug effects, and increased mortality. Additionally, meta-analyses found that maintaining normothermia results in cost savings of $2495 to $7073 per patient in the US due to reductions in complications. Prewarming patients for 30 minutes before surgery can help prevent inadvertent perioperative hypothermia.
This document provides an overview of regional anesthesia techniques for total joint arthroplasty (TJA), including total hip arthroplasty (THA) and total knee arthroplasty (TKA). It discusses the evidence regarding general versus regional anesthesia, as well as various regional techniques for intraoperative anesthesia and postoperative analgesia. While regional anesthesia is associated with improvements in some outcomes like pain control and reduced side effects, the evidence on other outcomes like infection rates and length of stay is mixed compared to general anesthesia. A variety of regional techniques can provide effective analgesia after TJA, including neuraxial blocks, peripheral nerve blocks, and extended-release epidural morphine, but they each have specific risks and benefits to consider.
A single blind RCT to evaluate the effect of intraoperative bupivacaine infilteration fro post operative pain relief was conducted. Observations based on the VAS and mean duration for requirement of 1st analgesic dose post operatively. Results compared with other similar studies and found that the there is significant reduction in the VAS of post operative pain and increase in the duration for requirement for the 1st dose of the analgesic postoperatively
To Evaluate the Role of Inj. Ketamine (0.3mg/Kg) Intravenously, Before Skin I...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document summarizes a case study of a 63-year-old male experiencing left forearm pain and tingling following repetitive snow shoveling and chainsaw use. The symptoms were consistent with proximal median nerve entrapment. Through examination of the patient's history, symptoms, and results of special tests, the physical therapist was able to differentially diagnose the condition as pronator syndrome, where the median nerve is compressed at the pronator teres muscle. The case highlights the importance of detailed anatomical knowledge and differential diagnosis when evaluating neuropathies, as electrodiagnostic studies are often inconclusive for pronator syndrome. Accurately diagnosing the site of entrapment is critical for guiding effective treatment.
This document provides an overview of antiseizure drugs (ASDs) used to treat epilepsy. It discusses the classification of ASDs as older first-generation drugs introduced over 40 years ago and newer second- and third-generation drugs introduced in the last 30 years. The document reviews the pharmacokinetics of ASDs, including absorption, metabolism, half-lives, and drug interactions. It also discusses guidelines for selecting ASDs based on seizure type and evaluates the efficacy and tolerability of different ASDs as initial monotherapy for treating epileptic seizures.
Evaluation of safety and efficacy using venus freeze by dr neil sadickCms Dış Ticaret
This study evaluated the safety and efficacy of the Venus Freeze® system, a radiofrequency device for non-invasive wrinkle treatment. 31 subjects received 10 treatments over 3 months and were evaluated before and after by physicians. Results found significant improvement in wrinkle appearance for 96.7% of subjects with no adverse effects. Statistical analysis showed a significant reduction in wrinkle score from before to after treatment, indicating the Venus Freeze® system is an effective and safe option for non-invasive wrinkle reduction.
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The main findings of upper endoscopy in 133 patients with laryngopharyngeal reflux were:
1. Gastritis was found in 77% of patients, esophagitis in 59%, and hypofunction of the cardia in 40%.
2. Hiatal hernia was identified in 32% of patients.
3. Barrett's esophagus and neoplasms were found in 9% and 2.2% of patients respectively.
4. Only 12% of patients had a normal endoscopy.
5. Helicobacter pylori was positive in 30% of patients.
The dry needling of myofascial pain syndrome trigger points provided pain relief compared to sham needling.
A Systematic Review on the Efficacy of Iontophoresis
as a Treatment for Lateral Epicondylitis by James McKivigan*, Brent Yamashita and Derek Smith in Research & Investigations in Sports Medicine
Gabapentin reduced acute pain after mastectomy and decreased the incidence of chronic pain in two studies. A single dose of gabapentin was ineffective for reducing thoracotomy pain when an epidural was also used. Regional anesthesia and intravenous lidocaine reduced chronic pain incidence after mastectomy or thoracotomy in several studies. Ketamine and intercostal cryoanalgesia did not reduce chronic pain. Total intravenous anesthesia may reduce post-thoracotomy pain in one study.
I. Therapeutic ultrasound is used to treat musculoskeletal issues like inflammation by generating heat through sound waves. While it may help some patients, there is little scientific evidence that it is reliably effective.
II. A review of 38 studies found little evidence to support the use of ultrasound for musculoskeletal disorders. Only 2 of 10 well-designed trials found it more effective than placebo for specific conditions.
III. While ultrasound appears safe and may provide benefits for some patients, more high-quality research is still needed to scientifically validate its therapeutic effects.
This study investigated the efficacy of pulsed electromagnetic field therapy (PEMF) in reducing delayed onset muscle soreness (DOMS) in marathon runners. A double-blind randomized controlled trial assigned 133 marathon runners to either an active PEMF device or placebo device to use for 20 minutes, 4 times per day for 5 days after a marathon. The primary outcome was thigh pain assessed using a visual analog scale during squats. Subjects using the active PEMF device had significantly lower pain scores compared to the placebo group, indicating PEMF reduced DOMS in marathon runners.
Dr. Tinni T. Maskoen is the Head of Intensive Care at Hasan Sadikin Hospital in Bandung and Chair of the Intensive Care Education Program at Padjadjaran University Medical School. She discusses the importance of effective pain relief after surgery and outlines the World Health Organization analgesic ladder for treating surgical pain. She advocates for a multimodal approach using combinations of paracetamol, NSAIDs, opioids, and other adjuvants to provide enhanced pain relief with reduced side effects.
The preoperative administration of low doses of ketamine and clonidine before induction anesthesia appeared to provide benefits in morbidly obese patients undergoing open bariatric surgery. Patients receiving ketamine and clonidine required less sevoflurane, lower doses of fentanyl, and had a shorter time to tracheal extubation compared to controls. They also consumed less tramadol postoperatively and reported less pain in the first 6 hours based on visual analog scale scores. The combination of ketamine and clonidine allowed for reduced doses of anesthetic drugs while improving postoperative recovery outcomes.
1) The study examined the mechanisms underlying pain in patients with joint hypermobility syndrome/Ehlers–Danlos syndrome, hypermobility type (JHS/EDS-HT).
2) Clinical exams, questionnaires, and sensory testing found no evidence of somatosensory nervous system damage but did find signs of central sensitization such as lowered pain thresholds and increased wind-up ratio.
3) The results suggest that rather than neuropathic pain, the pain experienced by patients with JHS/EDS-HT is caused by central sensitization, sharing mechanisms with fibromyalgia.
Meta analysis of clinical efficacy of pulsed radio frequencyPainezee Specialist
This meta-analysis reviewed 25 controlled clinical trials involving 1332 patients to evaluate the efficacy of pulsed radio frequency energy (PRFE) therapy for postoperative pain and edema, nonpostoperative pain and edema, and wound healing. A vote-counting method found more positive outcomes than neutral or negative outcomes for each clinical application. A statistical combination of P-values also found statistically significant improvements in pain, edema reduction, and wound healing outcomes. The analysis provides strong statistical evidence that PRFE therapy is an effective treatment for postoperative and nonpostoperative pain and edema as well as for wound healing applications.
This document contains information about the editorial board and executive body of the M.P. State Anaesthesiology journal for 2017-2018. It lists the editor and co-editor, and provides contact information. It also lists the executive body members including the president, vice president, secretary, and treasurer. The document then continues with several articles on topics in anaesthesiology, including one on anaesthesia for thoracoscopic procedures.
This randomized, double-blind pilot study examined the effects of pulsed electromagnetic field (PEMF) therapy on pain in patients with early knee osteoarthritis. 34 patients were randomly assigned to either an active PEMF device group (n=15) or a sham device group (n=19). The PEMF signal was designed to modulate the calcium/calmodulin dependent nitric oxide signaling pathway. Results showed a 50% reduction in pain scores from baseline in the active group starting on day 1 and persisting to day 42, while no significant reduction was seen in the sham group. The overall decrease in pain was nearly threefold greater in the active group. The rapid and sustained pain relief seen with PEMF therapy suggests it may reduce inflammation
This document summarizes clinical studies and cost analyses that demonstrate the importance of maintaining perioperative normothermia. Several studies show that hypothermia can lead to increased surgical site infections, longer hospital stays, more blood loss and transfusions, prolonged drug effects, and increased mortality. Additionally, meta-analyses found that maintaining normothermia results in cost savings of $2495 to $7073 per patient in the US due to reductions in complications. Prewarming patients for 30 minutes before surgery can help prevent inadvertent perioperative hypothermia.
This document provides an overview of regional anesthesia techniques for total joint arthroplasty (TJA), including total hip arthroplasty (THA) and total knee arthroplasty (TKA). It discusses the evidence regarding general versus regional anesthesia, as well as various regional techniques for intraoperative anesthesia and postoperative analgesia. While regional anesthesia is associated with improvements in some outcomes like pain control and reduced side effects, the evidence on other outcomes like infection rates and length of stay is mixed compared to general anesthesia. A variety of regional techniques can provide effective analgesia after TJA, including neuraxial blocks, peripheral nerve blocks, and extended-release epidural morphine, but they each have specific risks and benefits to consider.
A single blind RCT to evaluate the effect of intraoperative bupivacaine infilteration fro post operative pain relief was conducted. Observations based on the VAS and mean duration for requirement of 1st analgesic dose post operatively. Results compared with other similar studies and found that the there is significant reduction in the VAS of post operative pain and increase in the duration for requirement for the 1st dose of the analgesic postoperatively
To Evaluate the Role of Inj. Ketamine (0.3mg/Kg) Intravenously, Before Skin I...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document summarizes a case study of a 63-year-old male experiencing left forearm pain and tingling following repetitive snow shoveling and chainsaw use. The symptoms were consistent with proximal median nerve entrapment. Through examination of the patient's history, symptoms, and results of special tests, the physical therapist was able to differentially diagnose the condition as pronator syndrome, where the median nerve is compressed at the pronator teres muscle. The case highlights the importance of detailed anatomical knowledge and differential diagnosis when evaluating neuropathies, as electrodiagnostic studies are often inconclusive for pronator syndrome. Accurately diagnosing the site of entrapment is critical for guiding effective treatment.
This document provides an overview of antiseizure drugs (ASDs) used to treat epilepsy. It discusses the classification of ASDs as older first-generation drugs introduced over 40 years ago and newer second- and third-generation drugs introduced in the last 30 years. The document reviews the pharmacokinetics of ASDs, including absorption, metabolism, half-lives, and drug interactions. It also discusses guidelines for selecting ASDs based on seizure type and evaluates the efficacy and tolerability of different ASDs as initial monotherapy for treating epileptic seizures.
Evaluation of safety and efficacy using venus freeze by dr neil sadickCms Dış Ticaret
This study evaluated the safety and efficacy of the Venus Freeze® system, a radiofrequency device for non-invasive wrinkle treatment. 31 subjects received 10 treatments over 3 months and were evaluated before and after by physicians. Results found significant improvement in wrinkle appearance for 96.7% of subjects with no adverse effects. Statistical analysis showed a significant reduction in wrinkle score from before to after treatment, indicating the Venus Freeze® system is an effective and safe option for non-invasive wrinkle reduction.
Casino Party Night Florida. Need an idea for a charity fundraiser or a birthday party? Look no further than A Casino Event Florida for all your casino party and charity poker events for your organization. Call (954) 533-4579
This document provides a summary of a report on spreading the benefits of digital participation in Scotland. It makes the following key points:
1. The Scottish Government must ensure universal digital inclusion and assume accountability to ensure affordable and accessible digital infrastructure and skills for all.
2. Barriers to digital participation include lack of access, motivation, and skills. Addressing these barriers equitably across groups is needed to avoid increasing inequality.
3. Recommendations are made regarding improving access through infrastructure investment, motivation through local community initiatives, and education/skills through lifelong learning opportunities.
4. Achieving widespread digital participation by 2020 will require substantial investment and a coordinated, strategic approach across sectors.
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Music therapy is an established healthcare profession that uses music to address physical, emotional, cognitive, and social needs. Music therapists use music to work on non-music goals like promoting wellness, managing stress, alleviating pain, and improving communication. The earliest writings about music as a healing influence date back to Aristotle and Plato. Modern music therapy began after World War I and II when musicians played for veterans suffering physical and emotional trauma, showing notable responses. This led to the development of music therapy as a college discipline and profession. Music therapists now work in various settings helping a wide range of populations.
Out comes of lower level laser vs ultrasonicDR.SUNIL KUMAR
De Quervain's tenosynovitis is a painful condition of the wrist caused by overuse of the thumb. This study compared the effectiveness of low-level laser therapy (LLLT) and ultrasound therapy (UST) in treating De Quervain's tenosynovitis. 30 patients were randomly assigned to receive either LLLT or UST daily for 7 sessions. Outcome measures including pain, tenderness, grip strength and tendon thickness were assessed before and after treatment. The study found that grip strength and pain improved more in the UST group compared to the LLT group. However, differences in tendon thickness changes between the groups were not statistically significant. In conclusion, UST seemed to
Application of Pstim in Clinical Practice MaxiMedRx
The P-Stim and ANSiStim™ miniaturized device is designed to administer auricular point stimulation treatment over several days. The ear provides numerous points for stimulation within a small area. Stimulation is performed by electrical pulses emitted through strategically positioned needles. The ANSiscope device monitors the pain condition of the patient before, during and after the treatment.
The P-Stim and ANSiStim™ point stimulation therapy is mainly used to treat pain. Use of the device is recommended for pre-operative, intra-operative and post-operative pain therapy as well as for the treatment of chronic pain. DyAnsys is researching the possibilities of using this concept for the treatment of depression, addiction and allergy.
P-Stim and ANSiStim™ therapy allows continuous point stimulation over a period of several days while offering the patient a high degree of comfort and mobility. Use of the P-Stim and ANSiStim™ therapy provides advantages over drug therapy by minimizing possible side-effects caused by pain medications (i.e. opioid). In most cases, the patient continues to lead a normal life without side effects or any loss of quality of life.
Wet cupping therapy was applied to 5 points on the back of 40 healthy participants. Electrocardiography recordings were taken before and after to analyze heart rate variability (HRV), a measure of sympathovagal balance. All HRV parameters, including SDNN, SDANN, RMSSD, pNN50, LF, and HF, increased after cupping therapy compared to before, indicating cupping restored sympathovagal balance. This is the first study to show in humans that cupping therapy may have cardioprotective effects by stimulating the peripheral nervous system.
Artigo - Acupuncture and physiotherapy for painful shoulderRenato Almeida
This randomized controlled trial evaluated the efficacy of single-point acupuncture combined with physiotherapy compared to physiotherapy alone for the treatment of painful shoulder. 425 patients with subacromial syndrome received 15 sessions of physiotherapy over 3 weeks along with either weekly acupuncture at point ST38 or sham TENS. Patients receiving acupuncture showed significantly greater improvement in shoulder function scores and reported less analgesic use compared to the control group receiving only physiotherapy. The study demonstrates that adding acupuncture to physiotherapy can more effectively treat painful shoulder conditions.
1) The document discusses various biophysical agents (BPAs) that can be used to treat and prevent pressure injuries, including electrical stimulation, phototherapy, ultrasound, negative pressure wound therapy, and hyperbaric oxygen.
2) Most studies show that BPAs like electrical stimulation can significantly improve wound healing and reduce wound size compared to standard wound care.
3) Common BPAs used for pressure injuries include electrical stimulation, which has strong evidence and recommendations for use, as well as phototherapy, ultrasound, negative pressure wound therapy, and hyperbaric oxygen. These modalities aid wound healing in various ways such as increasing blood flow and promoting granulation tissue formation.
Extracorporeal shockwave therapy (ESWT) has analgesic and anti-inflammatory effects. With the evolu- tion and comprehension of its biological and physical mechanisms, the application of ESWT on other pathologies has also been studied, especially in musculoskeletal diseases. Recently, studies on animal models have shown its angiogenic capacity and a higher rate of local re-epithelization. These small stud- ies led to few trials using low-energy, radial ESWT to treat problematic chronic skin ulcers. Skin ulcers have diverse etiologies, ranging from pressure ulcers, burns, venous or arterial ulcers, and even diabetic ulcers. Their treatment is usually a challenge, due to the long-term treatment and high costs.
Abin Abraham Mammen.
Background: Trigger point is a extremely irritable local spot of exquisite tenderness in the nodule
within the tangible taut muscle band. The prevalence studies have shown that the occurrence of myofascial trigger point in the general population.
Objective: The aim of the study was compare the effects of low level laser therapy( LLLT) Vs
ultrasound therapy in the management of active trapezius trigger point.
Methodology: The participants will be allocated into two groups using simple random sampling.
One group has to be given Low level laser therapy (LLLT) and Moist Heat and other group treated
with US and Moist Heat. Both group receive treatment for 3 times a week. Total number of 9
session has to be given in 21 days. The outcome measure has to be taken at the first day and end
of the day.
Conclusion: Based on the above results we conclude that Low Level Laser Therapy can be used as a therapeutic device in the management of Active Trapezius Trigger points.
1. Cancer pain affects a large percentage of cancer patients, with moderate to severe pain reported in over 33% of cases. Proper pain management is important to relieve unnecessary suffering and reduce further weakening of patients.
2. Cancer pain can be nociceptive (from tissue damage) or neuropathic (from nerve damage) in nature, with bone pain being very common. Treatment involves modifying the pathological process, elevating pain thresholds, interrupting pain pathways, and lifestyle modifications.
3. Effective cancer pain management requires a rational approach using the WHO guidelines, with an emphasis on relieving pain at all stages of disease through various pharmacological and non-pharmacological means.
Different Splinting Time for Carpal Tunnel Syndrome in Women: Comparative Studyiosrjce
Study objective: To define the best splinting wear times, night or day, in pain relief for female patients with
idiopathic chronic CTS in exacerbation phase.
Design: Quasi experimental comparative design.
Method and measurements: 24 female patients (42 wrists) from military hospital in Riyadh participated in
this study. Their CTS was diagnosed by the nerve conduction velocity (NCV). On basis of splint wear time
patients were divided into two groups; day time and night time. Thermoplastic, custom-made,neutral
wristsplints were given to both groups (21 wrists each). Patients completed 3 consecutive weeks of follow-up.
Pain (pressure) threshold through, algometer, was used to measure the pain in both groups. Four
measurements were applied; one at the initial assessment and 3 during follow-up weeks.
Results: The current study showed a statistical s i g n i f i c a n t improvement (p = 0.0001) in pain threshold
with splint wear. This was true for both groups. Patients received splint in day time showed little increase in
pain threshold when compared with night time wear instruction but without significant difference.
Conclusion: W rist splint is an effective conservative treatment for CTS. No difference was found between
night or day time splint wear. Patient should wear the splint at their most adherent time
Acupuncture has become more widely used in sports medicine to treat pain and hasten recovery from injuries. Modern acupuncture uses sterile, disposable needles inserted at specific points along "meridians" to balance the flow of life energy in the body. Treatment sessions typically involve 6-12 needles placed for 10-30 minutes. While generally safe, serious risks include infection and organ puncture. Research shows acupuncture effective for osteoarthritis knee pain and some studies find it can improve immune function after exercise. The largest trial to date found acupuncture helped reduce knee pain more than education or sham acupuncture.
This document provides an introduction to local anesthesia. It discusses that dentists, not doctors, were responsible for discovering anesthesia due to their motivation to alleviate pain from dental procedures. The first two people to introduce anesthesia were dentists - Horace Wells with nitrous oxide in 1844 and William Morton with ether. Local anesthesia works by preventing the generation and conduction of nerve impulses, setting up a chemical roadblock between the source of pain and the brain. The document then discusses the mechanism of action, factors affecting local anesthetics, and uses and contraindications of local anesthesia.
Tennis elbow, also known as lateral epicondylitis, is caused by repetitive microtrauma to the extensor tendons of the forearm. The most common source of pain is the bony origin of the extensor carpi radialis brevis tendon. Examination reveals tenderness over the lateral epicondyle that is worsened by wrist extension. Treatment initially involves rest, nonsteroidal anti-inflammatories, physical therapy, and corticosteroid injection if conservative measures fail. Differential diagnoses include radial tunnel syndrome and cervical radiculopathy.
Integrative medicine, which is also called integrated medicine and integrative health in the combines alternative medicine with evidence-based medicine. Proponents claim that it treats the "whole person," focuses on wellness and health rather than on treating disease, and emphasizes the patient-physician relationship.
Evaluating Chronic Pain Patients Using Methods from Johns Hopkins Hospital Ph...Nelson Hendler
This article describes the use of physiological testing, instead of anatomical testing, to evaluate chronic pain. The efficacy of this approach is documented by published outcome studies.,, Patient require surgery 50%-63% of the time to improve.
1) The document describes a study that examined the effectiveness of Action Potential Simulation (APS) Therapy in reducing pain for 60 people with multiple sclerosis (MS) over an 8-week period.
2) APS Therapy uses micro-currents to simulate nerve cell action potentials and is thought to help reduce pain and inflammation. In the study, participants received APS Therapy 3 times per week for 8 minutes each time.
3) Results found that APS Therapy significantly reduced usual and worst pain levels according to Visual Analogue Scale scores, with 78% of participants reporting reduced pain and 33% becoming pain-free. Common types of pain like back pain, joint pain, and neuropathic pain all saw significant reductions.
This randomized controlled trial investigated the effectiveness of pulsatile dry cupping therapy compared to no intervention for knee osteoarthritis. 40 patients were randomly assigned to receive either 8 cupping sessions over 4 weeks or no treatment. Outcome measures including pain, stiffness, physical function, and quality of life were assessed at 4 and 12 weeks. At 4 weeks, cupping resulted in significantly greater improvements in pain, physical function, and quality of life scores compared to the control group. Many benefits were still present at 12 weeks, though some scores were no longer significantly different. The study provides preliminary evidence that cupping may be an effective treatment for relieving symptoms of knee osteoarthritis.
Objective: Tennis elbow is an inflammatory condition of the common extensor origin over the lateral epicondyle. This condition does not affect tennis players only. It often follows an injury or sudden contraction of the common extensor origin.There is many treatments and approaches towards Tennis elbow but physiotherapy is the best modern conservative treatment. The aim of this study is to evaluate the effectiveness of movement with mobilization in reducing pain and increasing strength in patients with chronic lateral epicondylitis. Design and setting: A randomized controlled study design was used to examine the differences between conventional physical therapy and physical therapy with manual mobilization approach for study duration of 15 days. Subjects: Twelve subjects of both male and female gender were divided into 2 groups. Experimental group treated with ultrasound therapy, mobilization and progressive resisted exercises. Control group treated with ultrasound therapy and progressive resisted exercises only the results were analyzed. The procedure was done in Physiotherapy Department at Masterskill college of Nursing and health. Outcome Measurement: Two outcome measures were used. NPRS for the measurement of severity of pain and various weighted sand bags (0.25 kg to 2kg) were used to measure the strength. Results: The data shows a significant difference in the post test values of pain and strength between experimental group and control group. Experimental group shows much decrease in pain and increase in strength than the control group. Conclusion: The study concludes that the manual mobilization with movement along with ultrasound therapy and progressive resisted exercises is effective in reducing pain and increasing strength than that of progressive resisted exercise along with ultra sound therapy in adults with chronic lateral epicondylitis.
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Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
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5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
1. The safety of massage therapy
E. Ernst
Objectives. After many years out of the limelight, massage therapy is now
experiencing a revival. The aim of this systematic review is to evaluate its potential
for harm.
Methods. Computerized literature searches were carried out in four databases. All
articles reporting adverse effects of any type of massage therapy were retrieved.
Adverse effects relating to massage oil or ice were excluded. No language
restrictions were applied. Data were extracted and evaluated according to
predefined criteria.
Results. Sixteen case reports of adverse effects and four case series were found.
The majority of adverse effects were associated with exotic types of manual
massage or massage delivered by laymen, while massage therapists were rarely
implicated. The reported adverse events include cerebrovascular accidents, displace-
ment of a ureteral stent, embolization of a kidney, haematoma, leg ulcers, nerve
damage, posterior interosseous syndrome, pseudoaneurism, pulmonary embolism,
ruptured uterus, strangulation of neck, thyrotoxicosis and various pain syndromes.
In the majority of these instances, there can be little doubt about a cause–effect
relationship. Serious adverse effects were associated mostly with massage
techniques other than ‘Swedish’ massage.
Conclusion. Massage is not entirely risk free. However, serious adverse events are
probably true rarities.
KEY WORDS: Complementary and alternative medicine, Massage, Adverse effects, Safety, Risk.
Massage can be defined as the systematic manipulation
of soft tissues of the body for pain reduction or other
therapeutic purposes. Manual palpation involved can
also be used for diagnostic purposes. ‘Classic’ (‘Swedish’)
massage comprises effleurage (stroking and gliding),
petrissage (kneading), and tapotement (percussion) w1x.
Various forms of massage originate from different parts
of the world (Table 1).
Until the early parts of the twentieth century, massage
was widely accepted in Europe and elsewhere as an
effective treatment for a range of conditions w2x. Even
though most of its indications are still not backed up by
convincing evidence we.g. 3, 4x, massage is making a
comeback. Between 1990 and 1997, the 1-year preva-
lence of use of massage by the US general population
increased from 6 to 12% w5x and massage belongs to the
three most popular complementary therapies, both in the
US w6x and in the UK w7x. The majority of physicians
(83%) feel that massage provides a useful adjunct to their
own practice and many (71%) refer patients to massage
therapists w8–10x.
The aim of this systematic review is to evaluate all
published data about adverse effects of massage therapy.
Methods
Computerized literature searches were carried out using
Medline, Embase, The Cochrane Library and AMED (January
1995 to December 2001). The search terms used were adverse
events, complications, lymph drainage, manual therapy,
massage, risk, Rolfing, safety and shiatsu. In addition, my
own files were searched, and other experts (n=21) as well as
professional organizations of massage therapy (n=18) were
consulted. The bibliographies of articles thus located were
also searched.
All reports (irrespective of language of publication) with
original data on adverse effects following any type of massage
therapy were included. Treatments not typically carried out
by a massage therapist were excluded, for example cardiac
Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, UK.
Submitted 2 May 2002; revised version accepted 5 February 2003.
Correspondence to: E. Ernst. E-mail: Edzard.Ernst@pms.ac.uk
Rheumatology 2003;42:1101–1106
doi:10.1093/rheumatology/keg306, available online at www.rheumatology.oupjournals.org
Advance Access publication 30 May 2003
1101
Rheumatology 42 ß British Society for Rheumatology 2003; all rights reserved
Rheumatology 2003;42:1101–1106
doi:10.1093/rheumatology/keg306, available online at www.rheumatology.oupjournals.org
Advance Access publication 30 May 2003
atNanjingUniversityonMarch30,2012http://rheumatology.oxfordjournals.org/Downloadedfrom
2. massage, prostatic massage or carotid sinus massage. Adverse
events related to massage oils, such as allergies to aroma-
therapy oils, or to the use of ice in conjunction with massage
were also excluded we.g. 11, 12x. All articles were evaluated and
validated by the present author according to predefined criteria
(see headings of Table 2).
Results
Thirty-one relevant articles were located w13–43x. All
adverse effects are summarized in Table 2; exemplary
reports are also detailed below.
Massage by professionals
A 45-yr-old American man presented with acute exten-
sor paralysis of the metacarpophalangeal joints and
inability to abduct the thumb radially w25x. The problems
had occurred 15–20 min after deep tissue massage of the
forearm on the affected side. The massage included
direct pressure applied laterally with the elbow of the
therapist. The patient was diagnosed to suffer from
posterior interosseous syndrome. The cause was deemed
to be the direct and persistent pressure applied laterally,
compressing the posterior interosseous nerve against the
interosseous membrane causing neuropraxia.
A 39-yr-old healthy woman, who had no relevant
medical history and was taking no medication, had a
deep tissue massage that included the abdomen w26x.
Within 24 h, she experienced abdominal discomfort,
shoulder pain and nausea. Seventy-two hours after the
massage, she was admitted to hospital. On admission,
she was anaemic (haematocrit=23 lul), and an abdomi-
nal CT scan showed a large (14 cm318 cm) haematoma
in the right hepatic lobe. There was no evidence of
haemangioma, adenoma or other intrahepatic lesions.
A diagnosis of hepatic haematoma was made and the
most likely cause was thought to be the forceful abdo-
minal massage. Over the subsequent 6 months, the
patient received 2 units of packed red cells, lost 10.4 kg
of body weight due to persistent nausea, and developed
a low-grade fever. Eventually she made a full recovery.
German otolaryngologists published a series of four
patients with adverse reactions to conventional massage
therapy w32x. These individuals all suffered from neck
pain and were prescribed massage therapy. Subsequently
they noted an acute deterioration of hearing, which
was verified audiographically in all cases. The authors
feel that the time sequence of events renders a causal
relationship likely and report that they have seen ‘several
more cases’ of this type.
Clinical trials of massage therapy we.g. 33–35x rarely
mention adverse effects. A laudable exception is a study
of premature infant massage w36x. The authors observed
a small temperature drop after massage and noted that
‘the technique may expose the infant to a slight heat loss’.
Six normal volunteers and two patients with post-
thrombotic venous oedema were treated with manual
lymph massage with an external pressure of 70–100 mmHg
w37x. Subsequently biopsies were taken of the lymphatic
vessels. After a 10-min massage, damage of lymphatics
TABLE1.Briefexplanationsofdifferentformsofmanualmassagetherapy
Name
Countryof
originuoriginator
Description
oftechniqueTherapeuticaimPostulatedmechanism
Frictionmassage
orconnective
tissuemassage
(German:Bindegewebs
massage)
GermanyuDickeStrongandoftenpainful
mobilizationofsubcutaneous
tissuesbyspecialstrokingof
subcutaneoustissuesofthe
torsoandtheextremities
‘Neurotherapeutic’
methodaimedatloosening
adhesionsandinfluencing
distantorgans
Stimulationof
nerveendings
oftheautonomic
nervoussystem
LymphdrainageGermanyuFo¨ldiGentlestrokingtechniquealonglymph
vesselsandoverlymphnodes
IncreaselymphflowPassivemovement
oflymph
RolfingUSuRolfDeepandsometimespainful
manipulationofsofttissuestobreak
downabnormalconnectivetissue
Loosenupand
realignbody
Supportbody’s
ownenergyfield
ShiatsuJapanun.a.Massagewithstrongdigitalpressure
overacupuncturepoints
Restoreenergeticbalance
ofthebody
Stimulateenergy
flowaccordingtothe
conceptsofacupuncture
Swedishmassage
(classicmuscularmassage)
Europeun.a.Effleurage(stroking),petrissage
(kneading),tapotement
(vibrationandshaking),friction
(rubbing)
Decreasemuscletone,
increasebloodflow,
reducepain
Washoutlocalpainmediators,
reducemuscularspasm,
reducecentralpainperception
UrutMalaysiaun.a.Forcefulmassagetechniqueusedby
Malaytraditionalhealers
NotknownNotknown
n.a.,notapplicable.
1102 E. Ernst1102 E. Ernst
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3. TABLE 2. Reports of adverse events associated with massage therapy
First author
(year) Patient Type of massage Therapist Site of massage Indication Adverse event Causalityd
Outcome
Thambua
(1971) 30-yr-old Malay
pregnant woman
Urut Traditional
Malay healer
Abdomen Pregnancy Ruptured uterus Certain Surgery and
subsequent full
recovery
Warrena
(1978) 72-yr-old woman Vigorous massage
for ;10 min
Relative Calf muscle Leg pain Pulmonary embolism Likely Not mentioned
Tachia
(1990) 57-yr-old woman with
Hashimoto’s disease
Vigorous manual
massage
Not mentioned Neck Muscle pain
and stiffness
Transient destructive
thyrotoxicosis
Possible Full recovery after
6 months
Herskovitza
(1992)
61-yr-old man Shiatsu massage with
strong digital
pressure
Shiatsu therapist Base of his
palm and
thenar muscles
Not mentioned Painless weakness of
left thumb without
sensory symptoms
Certain Full recovery over
next 2 months
Sorensena
(1993)
38-yr-old diabetic man
with peripheral
neuropathy
Vacuum boot foot
massage with
mechanical device
‘Alternative
therapist’
Feet Peripheral
vascular
disease
Ulceration and infection Certain Amputation of leg
Liua
(1993) 52-yr-old man Self-massage with
‘massage balls’
Self-treatment Neck Chronic neck
pain
Tapered stenosis of the
extracranial
internal carotid artery
Possible Not mentioned
Mumma
(1993) 64-yr-old woman Shiatsu Shiatsu therapist Not mentioned Not mentioned Pain in left pericervical
and suprascapular areas
Possible Not mentioned
Rama
(1994) 1-day-old neonate ‘Traditional’ with
sand bag
Relative Testes Hydrocele Large haematoma Likely Full recovery
after surgical
intervention
Yeoa
(1994) 62-yr-old
anticoagulated
patient
Manual massagec
Relative Back Back pain Large haematoma,
slight anaemia
Likely Full recovery
within 2 weeks
Kalingaa
(1996) 16-yr-old boy with
exostosis on femur
Traditional Chinese
massagec
,
5 sessions
Practitioner of
traditional
Chinese medicine
Right thigh Pain in right
thigh
Pseudoaneurysm of
popliteal artery
Likely Full recovery
after arterial
reconstruction
Kerra
(1997) 51-yr-old women with
ureteral stent
Deep body massage
using Rolfing
technique
Rolfing therapist Abdomen,
pelvis, lower
back
Not mentioned Displacement of
ureteral
stent, a pin
Likely Full recovery after
repositioning
of stent
Mikhaila
(1997) 59-yr-old man with
aortofemoral bypass
Back massage including
walking on back
Relative Back Back pain Embolization of
the left kidney
Likely Full recovery with
anticoagulation and new
aortofemoral bypass
Giesea
(1998) 45-yr-old man Deep tissue massage
including
pressure applied with
elbow
Massage therapist Forearm Pain in
right forearm
Posterior interosseous
syndrome
Likely Near full recovery
after 3 weeks
Trottera
(1999) 39-yr-old woman Deep tissue massage Not mentioned Abdomen Not mentioned Large hepatic
haematoma
Likely Full recovery after
6 months
Safetyofmassagetherapy1103Safetyofmassagetherapy1103
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4. was verified by electron microscopy. It affected initially
the endothelial lining and subsequently also lymphatic
collectors. The pressures applied were in excess of those
used in manual lymphatic drainage w38x.
Massage by laymen
A 72-yr-old woman was admitted to hospital with
thrombosis of the right middle cerebral artery w14x. She
later complained of discomfort in the left calf and a
diagnosis of deep-vein thrombophlebitis was made. The
leg was raised and intravenous heparin was started. The
patient’s husband massaged her leg vigorously for about
10 min in an attempt to relieve her discomfort. Sub-
sequently, the patient became short of breath and a
pulmonary embolus was diagnosed.
A 62-yr-old Chinese male on warfarin with stable INR
readings was admitted for an acute swelling over his left
back w21x. His wife had given him a vigorous manual
back massage for musculoskeletal pain in that area
2 days before. The patient was diagnosed to suffer from
a large (20 cm312 cm) haematoma, orthostatic hypo-
tension and slight anaemia. Both INR and platelet count
were normal. The patient’s warfarin medication was
temporarily reduced and a blood transfusion was admini-
stered. The haematoma gradually resolved over the next
2 weeks and the patient made a full recovery. The most
likely cause for the haematoma was the vigorous manual
massage combined with the warfarin-induced bleeding
tendency.
A 59-yr-old man with an aortobifemoral bypass was
admitted after his wife had treated him for back pain
with a manual massage, which included walking on his
back w24x. The patient subsequently experienced severe
left loin pain. The bypass had been performed
18 months previously; it had initially been successful
but had occluded later. The massage had dislodged the
thrombus in the graft into the left kidney. The patient
was anticoagulated, and later a new aortobifemoral graft
was implanted. A further abdominal CT scan 4 months
postoperatively showed no defect in the left kidney.
Massage using apparatus
A 38-yr-old man was treated by an ‘alternative therapist’
with a mechanical leg massage (vacuum boot) for peri-
pheral vascular disease in the presence of peripheral
diabetic neuropathy w17x. The patient subsequently
developed an infected leg ulcer. The leg became gan-
grenous and had to be amputated. The authors warn
that ‘patients of this kind wshould notx receive treatment
from any person without medical experience’.
A 56-yr-old woman placed an electric roller massage
device on her bed under her head to treat her neck pain
before retiring for the evening w27x. Later, when her
husband went to bed he noted that she was in the supine
position and the device was apparently functioning nor-
mally. The husband was awoken early next morning by a
clicking noise and found his wife in the same position.
Her blouse had become entangled in the roller of the
massage device and was constricted around her neck.
The husband called the paramedics who verified her death.
Deidikera
(1999)56-yr-oldwomenElectricalrollermassage
devise
Self-treatmentNeckNeckpainStrangulationofneckCertainDeath
Tsuboia
(2001)80-yr-oldmanShiatsuShiatsu
practitioner
UpperneckNeckand
shoulderpain,
headache
Retinalartery
embolismwith
subsequentpartial
lossofvision
andlefthemiparesis
LikelyPermanentocular
effects
Unknownb
(1980)
167lactatingwomenTraditionalRussian
breastmassage
TraditionalhealersBreastsLactationmastitisDeteriorationof
mastitisabscesses
CertainNotmentioned
Rahmanb
(1987)3MalaywomenUrut
(traditionalmassage)
TraditionalhealersAbdomenAbdominalpainColonruptureCertainFullrecovery
aftersurgery
Becroftb
(1989)48infantsTraditionalmassageTraditionalhealersAbdomen
ofmother
PregnancyCranialhaemorrhage
infetus
ProbableNotmentioned
Bru¨gelb
(1991)4patientsSwedishmassageTrainedmassage
therapist
NeckNeckpainDeteriorationof
hearing
ProbableNotmentioned
a
Casereport.
b
Caseseries.
c
Nofurtherdetailsprovided.
d
Asestimatedbythepresentauthor.
TABLE2.Continued
Firstauthor
(year)PatientTypeofmassageTherapistSiteofmassageIndicationAdverseeventCausalityd
Outcome
1104 E. Ernst1104 E. Ernst
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5. Exotic forms of manual massage
A 61-yr-old man received a shiatsu massage from a
trained therapist with strong digital pressure in the region
of the base of his palm and the thenar muscles w16x. The
procedure was accompanied with ‘notable transient pain’.
The next day he noticed a weakness of the left thumb
without sensory symptoms. On examination, he exhibited
moderate isolated weakness of the abductor policis brevis
muscle without atrophy or sensory dysfunction. Tinel’s
and Phalen’s signs were negative and nerve conduction
studies yielded normal findings. Mild active denervation
and reduced motor unit recruitment were noticed
electromyographically. The authors diagnosed a mono-
neuropathy caused by the manual compression of the
recurrent motor branch of the median nerve. The patient
made an uneventful recovery over the next few months.
Hawaiian authors report the case of a 64-yr-old woman
admitted to hospital for suspected myocardial infarction
w19x. She complained of increasing pain in the peri-
cervical and suprascapular areas. Myocardial infarc-
tion was not confirmed but the pain increased. A typical
rash along the left eighth cervical dermatome led to the
diagnosis of herpes zoster, confirmed through antibody
titres. The patient revealed that she had been treated with
‘an overtly vigorous shiatsu massage’ 3 days before the
onset of pain. The authors speculate that ‘zoster resulted
from either direct trauma to the nerve or nerve root during
the massage, or to subsequent tissue inflammation causing
swelling or immunological injury to the nerve’.
A 51-yr-old American woman had undergone place-
ment of a left ureteral double-J stent to relieve flank pain
associated with ureteral stricture w23x. Six days later she
consulted a ‘Rolfer’ and received a deep body massage
according to the Rolfing technique, which she had
enjoyed previously on a regular basis. The massage was
applied to the abdomen, pelvis and lower back. Towards
the end of the session, the patient experienced severe
flank pain and urinary incontinence. She was admitted
to hospital where a visible protrusion of the tip of the
stent was noted 1 cm beyond the ureteral orifice. Distal
migration of the stent was confirmed by radiographic
examination. The patient’s stent was repositioned, and
she subsequently made a full recovery.
An 80-yr-old Japanese man with a history of transient
ischaemic attacks and anticoagulant therapy received a
shiatsu massage on the neck in prone position to treat a
mild headache w28x. Immediately after rising, the nasal
half of his right visual field was impaired. He also
showed slight left hemiparesis dominant in the upper
extremity. Further investigations showed multiple branch
occlusions of the central artery and multiple small
infarctions in the right frontal lobe. The patient was
treated with urikinase for 7 days. Subsequently there
was full recovery of the hemiparesis but only minimal
improvement of ocular symptoms.
Reviews
US authors reviewed the question of whether back
massages are contraindicated after an acute myocardial
infarction w39x. They found elevation of blood pressure
and decrease of heart rate following back massage in
normal volunteers. Thus they caution that ‘heart rate
and blood pressure should be monitored before and after
the procedure to identify patients at risk for sympathetic
stimulation’. Other reviews of massage therapy for
specific indications w40–42x fail to address any safety
aspects. A recent Cochrane review of massage therapy
for pre-term infants states that ‘no adverse effects of
touch or massage were reported in any study’ w43x.
Discussion
Sixteen case reports and four case series (Table 2) of
adverse events after massage therapy were found. Massage
was frequently used for rheumatological conditions. In
the majority of these cases causality is established con-
vincingly, for instance, through the sequence or nature of
events. Some of the adverse effects relate to serious
complications.
Considering the popularity of massage therapy, the
number of reported adverse events seems minute. How-
ever, this could be due to under-reporting. In a related
area (spinal manipulation) we have, for instance, shown
that under-reporting of serious adverse events is close to
100% w44x.
Clearly, one should differentiate between various
approaches. The above findings suggest that massage
by non-professional and forceful techniques like shiatsu,
urut and Rolfing are relatively often associated with
adverse events. The reports reviewed above are often
incomplete. For instance, the background of the ther-
apist and the type of massage therapy are not always
described. This further limits the conclusiveness of the
evidence.
Several systematic reviews of controlled clinical trials
testing the effectiveness of massage therapies have been
published and have arrived at cautiously positive con-
clusions we.g. 45–47x. However, too few clinical trials of
massage therapy exist and many of its claims are not
backed up by evidence w3, 4x. Thus adequate risk–benefit
evaluations are not feasible.
In conclusion, massage therapies are not totally devoid
of risks. The incidence of adverse events is unknown,
but probably low.
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