Hypothesis Studies indicate that menopausal symptoms are relieved by acupuncture. Additional stud... more Hypothesis Studies indicate that menopausal symptoms are relieved by acupuncture. Additional studies have suggested that acupuncture may affect heart rate variability (HRV). This paper reports a pilot study that investigated whether menopausal symptoms responded to acupuncture, and if changes in the spectral analysis of HRV, either suppression of low frequency or augmentation of high frequency bands, corresponded with symptom report. Methods/interventions 12 healthy menopausal subjects were enrolled in this feasibility study. At baseline, subjects were experiencing moderately distressing menopausal symptoms, scoring at least 22 of a possible 44 points on the Menopausal Rating Scale. 10 traditional Chinese medicine-based, protocol acupuncture treatments were administered over a 4 week period, three times a week for 2 weeks, followed by twice a week for 2 weeks. Outcome measures Menopausal Rating Scale questionnaire, 11 menopausal symptoms were evaluated on a zero to four severity sca...
Over 15 million people live with fibromyalgia (FM), a disorder with an estimated annual direct co... more Over 15 million people live with fibromyalgia (FM), a disorder with an estimated annual direct cost that exceeds $20 billion. FM is associated with a multiplicity of symptoms, such as pain (1) (2), work limitations (3), poor quality of life (4), poor coping (1), poor physical functioning (5), and multiple chronic comorbidities that make it particularly challenging to treat. Rational evidence-based treatment paradigms are emerging, but there remains a research-to-practice gap, leaving patients to seek out their own treatment options. Alternatively, patients may seek guidance from their provider about adding complementary therapies to their existing treatment plan. Therefore, patients are increasingly seeking out Traditional Chinese medicine (TCM) for answers concerning FM. Evidence-based clinical studies suggest that there are Eastern and Western interventions treat FM symptoms, provide maximization of function and enhance quality of life. However, Western educated health care provid...
BACKGROUND People with fibromyalgia (FM) have persistent widespread pain and soft tissue tenderne... more BACKGROUND People with fibromyalgia (FM) have persistent widespread pain and soft tissue tenderness. As an adjunct to drug therapies, they often seek bodywork such as massage for pain reduction. Recently the pain-generating role of the fascia in maintaining FM symptoms has been suggested [1] indicating that manual therapy that addresses the fascia may be helpful in managing FM symptoms. Two randomized controlled trials of myofascial release therapy (MFR) compared to sham ultra-sound found significant reduction in tender points and pain scores that persisted at one-month post-intervention. The study authors concluded that further research was warranted to compare outcomes obtained with MFR with those of other manual therapies. [2, 3]
ABSTRACT Purposes/Aims To establish feasibility for a larger study to gain new knowledge about th... more ABSTRACT Purposes/Aims To establish feasibility for a larger study to gain new knowledge about the physiology of acupuncture by correlating menopausal symptom experiences with the effects of acupuncture and two biomarkers: heart rate variability (HRV), which will establish cardiac autonomic nervous system reactions to acupuncture, and interleukin 6 (IL6), a proinflammatory cytokine to explore possible immune inflammatory system response to acupuncture. Rationale/Conceptual Basis/Background: Symptoms commonly seen in menopause, such as fatigue, mood disorders/depression, sleep disorders and new onset myalgias/arthralgias have been associated with elevated proinflammatory cytokines, including IL6. Recent work has linked stimulation of the vagus nerve with suppression of the immune-inflammatory response. Additionally, several small studies have indicated that acupuncture may alleviate pain and improve mood, though mechanism has not been established. Thus, theoretically, an acupuncture needle may influence the vagus nerve through peripheral nerve stimulation and affect the immune-inflammatory response. Vasomotor symptoms, such as hot flashes and sweats, experienced during the menopausal transition have been linked theoretically to autonomic instability affecting the vasculature. Heart rate variability has been shown to reflect the effects of the autonomic nervous system on cardiac activity. Roughly 14 separate, albeit small studies suggest acupuncture may effectively control these symptoms. By evaluating the effects of acupuncture on HRV we hope to correlate increased parasympathetic influences on HRV with decreased vasomotor symptoms. Methods: This study represents an innovative research design that examined each individual participant as a dynamic system. Each subject underwent ten acupuncture treatments, using a standard, traditional Chinese medicine-based acupoint protocol, over a 4-week period, with multiple, frequent measures collected. Sample: 12 healthy, non-surgically induced menopausal women with symptom scores ≥ 22 on the Menopausal Rating Scale (MRS). Data collection Daily MRS symptom scores, pre/post-acupuncture serum interleukin 6 levels at first and last treatment, continuous electrocardiogram monitoring with subsequent HRV analysis before and during each acupuncture session. Results: Preliminary results suggest improved symptoms with HRV analysis and cytokine data pending. Implications In addition to exploration of physiologic mechanism, acupuncture researchers need to consider using innovative, meaningful and individual-oriented research designs. This feasibility study illustrates one such design, and includes hypotheses for physiologic mechanisms related to the acupuncture needle. Funding: NIH T32 Grant # AT001287 Your uploaded file(s): * WIN ABSTRACT.doc (29.5KB) - Research paper
ABSTRACT People with fibromyalgia (FM) have persistent widespread pain, axial pain, and tendernes... more ABSTRACT People with fibromyalgia (FM) have persistent widespread pain, axial pain, and tenderness. As an adjunct to drug therapies, nurses often recommend bodywork such as massage to reduce symptoms and optimize physical function. Light Swedish-type massage is most commonly selected as FM patients also experience tenderness to touch. Recently, however, the pain generating role of the fascia in maintaining FM symptoms has been demonstrated. Additionally, two randomized controlled trials of myofascial release therapy compared to sham ultrasound or disconnected magnotherapy resulted in superiority of MFR in the control of most FM symptoms (Castro-SĂ¡nchez et al., 2011a; Castro-SĂ¡nchez et al., 2011b). The purpose of this study was to test the feasibility and acceptability of deep myofascial release versus an active massage condition- light Swedish massage- in women with FM. Eight subjects received either myofasical release while four subjects received Swedish massage for 90 minutes weekly x four weeks. On average, the subjects were 34.5 years of age (SD=5.5), with FM for 2.6 years (SD=0.9), with no baseline differences between groups. The Aickin separation test (2004) indicated that primary outcome, Fibromyalgia Impact Questionnaire-Revised Total Change Score for the myofascial group trended (mean = 10.14, SD = 16.2) in the hypothesized and positive direction compared to the Swedish massage group (mean = 0.33, SD = 4.93) (Aickin, 2004). Nordic Musculoskeletal Questionnaire-Revised scored pain at 7 bodily regions, with most improvement in neck/shoulder pain. Additionally qualitative interviews with the massage therapist will be conducted to further determine the tolerability of the interventions. There were no adverse events or early discontinuations by subjects indicating that both interventions were feasible and acceptable to patients despite tenderness to touch (baseline myalgic score 31.9 (SD=7.7) and 36.3 (SD=3.1) in the myofascial and Swedish massage groups respectively. Larger randomized controlled trials are supported by the separation test. Aickin, A. (2004). Separation tests for early-phase complementary and alternative medicine comparative trials. Evidence-Based Integrative Medicine, 1(4), 225-231. Castro-SĂ¡nchez A. M., MatarĂ¡n-Peñarrocha G. A., Arroyo-Morales M., Saavedra-HernĂ¡ndez M., FernĂ¡ndez-Sola C., & Moreno-Lorenzo C. (2011a). Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: A randomized controlled trial. Clinical Rehabilitation, 25(9), 800-813. Castro-SĂ¡nchez A. M., MatarĂ¡n-Peñarrocha G. A., Granero-Molina J., Aguilera-Manrique G., Quesada-Rubio J. M., & Moreno-Lorenzo C. (2011b). Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evidence-Based Complementary and alternative Medicine, 2011, 1-9.
Specific Aims: 1. To analyze extant literature that has examined various complementary and altern... more Specific Aims: 1. To analyze extant literature that has examined various complementary and alternative medicine (CAM) therapies specific for fibromyalgia symptom management. 2. Based on the literature review, to assess best practices for CAM and fibromyalgia symptom management. Method: A systematic review of empirical studies, randomized and pragmatic clinical trials, were examined for quality, grade and level of evidence in commonly used CAM therapies for fibromyalgia symptom management. Databases used: PubMed, Ovid MEDLINE 1947-2010, PsycINFO 1806-2101, EBM Reviews - Cochrane Database of Systematic Reviews 2005 to September 2010, CINAHL (EBSCO). Key words used: fibromyalgia, fibrositis, chronic muscle pain, acupuncture, balneotherapy, yoga, tai chi, electrostimluation, laser, herbal therapy, homeopathy, and massage. The literature was assessed for quality of design, statistical analyses, power and effect sizes, if available. Background and Rational A comprehensive state-of-the-sci...
People with fibromyalgia (FM) have persistent widespread pain, axial pain, and tenderness. As an ... more People with fibromyalgia (FM) have persistent widespread pain, axial pain, and tenderness. As an adjunct to drug therapies, nurses often recommend bodywork such as massage to reduce symptoms and optimize physical function. Light Swedish-type massage is most commonly selected as FM patients also experience tenderness to touch. Recently, however, the pain generating role of the fascia in maintaining FM symptoms has been demonstrated. Additionally, two randomized controlled trials of myofascial release therapy compared to sham ultrasound or disconnected magnotherapy resulted in superiority of MFR in the control of most FM symptoms (Castro-SĂ¡nchez et al., 2011a; Castro-SĂ¡nchez et al., 2011b). The purpose of this study was to test the feasibility and acceptability of deep myofascial release versus an active massage condition- light Swedish massage- in women with FM. Eight subjects received either myofasical release while four subjects received Swedish massage for 90 minutes weekly x four...
ABSTRACT: Fibromyalgia (FM) is a persistent pain state commonly diagnosed and managed by nurse pr... more ABSTRACT: Fibromyalgia (FM) is a persistent pain state commonly diagnosed and managed by nurse practitioners. This article summarizes current tenants regarding the etiology, pathophysiology, clinical presentation, diagnostic standards, and pharmacologic and non-pharmacologic treatments necessary to successfully manage FM.
ABSTRACT: Fibromyalgia (FM) is a persistent pain state commonly diagnosed and managed by nurse pr... more ABSTRACT: Fibromyalgia (FM) is a persistent pain state commonly diagnosed and managed by nurse practitioners. This article summarizes current tenants regarding the etiology, pathophysiology, clinical presentation, diagnostic standards, and pharmacologic and non-pharmacologic treatments necessary to successfully manage FM.
Examined 96 early childhood educators' level of comfort in discussing death with young childr... more Examined 96 early childhood educators' level of comfort in discussing death with young children both as a formal learning experience and as it naturally occurs. While over 80% of the teachers consider death education important, most felt academically unprepared to deal with it. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Hypothesis Studies indicate that menopausal symptoms are relieved by acupuncture. Additional stud... more Hypothesis Studies indicate that menopausal symptoms are relieved by acupuncture. Additional studies have suggested that acupuncture may affect heart rate variability (HRV). This paper reports a pilot study that investigated whether menopausal symptoms responded to acupuncture, and if changes in the spectral analysis of HRV, either suppression of low frequency or augmentation of high frequency bands, corresponded with symptom report. Methods/interventions 12 healthy menopausal subjects were enrolled in this feasibility study. At baseline, subjects were experiencing moderately distressing menopausal symptoms, scoring at least 22 of a possible 44 points on the Menopausal Rating Scale. 10 traditional Chinese medicine-based, protocol acupuncture treatments were administered over a 4 week period, three times a week for 2 weeks, followed by twice a week for 2 weeks. Outcome measures Menopausal Rating Scale questionnaire, 11 menopausal symptoms were evaluated on a zero to four severity sca...
Over 15 million people live with fibromyalgia (FM), a disorder with an estimated annual direct co... more Over 15 million people live with fibromyalgia (FM), a disorder with an estimated annual direct cost that exceeds $20 billion. FM is associated with a multiplicity of symptoms, such as pain (1) (2), work limitations (3), poor quality of life (4), poor coping (1), poor physical functioning (5), and multiple chronic comorbidities that make it particularly challenging to treat. Rational evidence-based treatment paradigms are emerging, but there remains a research-to-practice gap, leaving patients to seek out their own treatment options. Alternatively, patients may seek guidance from their provider about adding complementary therapies to their existing treatment plan. Therefore, patients are increasingly seeking out Traditional Chinese medicine (TCM) for answers concerning FM. Evidence-based clinical studies suggest that there are Eastern and Western interventions treat FM symptoms, provide maximization of function and enhance quality of life. However, Western educated health care provid...
BACKGROUND People with fibromyalgia (FM) have persistent widespread pain and soft tissue tenderne... more BACKGROUND People with fibromyalgia (FM) have persistent widespread pain and soft tissue tenderness. As an adjunct to drug therapies, they often seek bodywork such as massage for pain reduction. Recently the pain-generating role of the fascia in maintaining FM symptoms has been suggested [1] indicating that manual therapy that addresses the fascia may be helpful in managing FM symptoms. Two randomized controlled trials of myofascial release therapy (MFR) compared to sham ultra-sound found significant reduction in tender points and pain scores that persisted at one-month post-intervention. The study authors concluded that further research was warranted to compare outcomes obtained with MFR with those of other manual therapies. [2, 3]
ABSTRACT Purposes/Aims To establish feasibility for a larger study to gain new knowledge about th... more ABSTRACT Purposes/Aims To establish feasibility for a larger study to gain new knowledge about the physiology of acupuncture by correlating menopausal symptom experiences with the effects of acupuncture and two biomarkers: heart rate variability (HRV), which will establish cardiac autonomic nervous system reactions to acupuncture, and interleukin 6 (IL6), a proinflammatory cytokine to explore possible immune inflammatory system response to acupuncture. Rationale/Conceptual Basis/Background: Symptoms commonly seen in menopause, such as fatigue, mood disorders/depression, sleep disorders and new onset myalgias/arthralgias have been associated with elevated proinflammatory cytokines, including IL6. Recent work has linked stimulation of the vagus nerve with suppression of the immune-inflammatory response. Additionally, several small studies have indicated that acupuncture may alleviate pain and improve mood, though mechanism has not been established. Thus, theoretically, an acupuncture needle may influence the vagus nerve through peripheral nerve stimulation and affect the immune-inflammatory response. Vasomotor symptoms, such as hot flashes and sweats, experienced during the menopausal transition have been linked theoretically to autonomic instability affecting the vasculature. Heart rate variability has been shown to reflect the effects of the autonomic nervous system on cardiac activity. Roughly 14 separate, albeit small studies suggest acupuncture may effectively control these symptoms. By evaluating the effects of acupuncture on HRV we hope to correlate increased parasympathetic influences on HRV with decreased vasomotor symptoms. Methods: This study represents an innovative research design that examined each individual participant as a dynamic system. Each subject underwent ten acupuncture treatments, using a standard, traditional Chinese medicine-based acupoint protocol, over a 4-week period, with multiple, frequent measures collected. Sample: 12 healthy, non-surgically induced menopausal women with symptom scores ≥ 22 on the Menopausal Rating Scale (MRS). Data collection Daily MRS symptom scores, pre/post-acupuncture serum interleukin 6 levels at first and last treatment, continuous electrocardiogram monitoring with subsequent HRV analysis before and during each acupuncture session. Results: Preliminary results suggest improved symptoms with HRV analysis and cytokine data pending. Implications In addition to exploration of physiologic mechanism, acupuncture researchers need to consider using innovative, meaningful and individual-oriented research designs. This feasibility study illustrates one such design, and includes hypotheses for physiologic mechanisms related to the acupuncture needle. Funding: NIH T32 Grant # AT001287 Your uploaded file(s): * WIN ABSTRACT.doc (29.5KB) - Research paper
ABSTRACT People with fibromyalgia (FM) have persistent widespread pain, axial pain, and tendernes... more ABSTRACT People with fibromyalgia (FM) have persistent widespread pain, axial pain, and tenderness. As an adjunct to drug therapies, nurses often recommend bodywork such as massage to reduce symptoms and optimize physical function. Light Swedish-type massage is most commonly selected as FM patients also experience tenderness to touch. Recently, however, the pain generating role of the fascia in maintaining FM symptoms has been demonstrated. Additionally, two randomized controlled trials of myofascial release therapy compared to sham ultrasound or disconnected magnotherapy resulted in superiority of MFR in the control of most FM symptoms (Castro-SĂ¡nchez et al., 2011a; Castro-SĂ¡nchez et al., 2011b). The purpose of this study was to test the feasibility and acceptability of deep myofascial release versus an active massage condition- light Swedish massage- in women with FM. Eight subjects received either myofasical release while four subjects received Swedish massage for 90 minutes weekly x four weeks. On average, the subjects were 34.5 years of age (SD=5.5), with FM for 2.6 years (SD=0.9), with no baseline differences between groups. The Aickin separation test (2004) indicated that primary outcome, Fibromyalgia Impact Questionnaire-Revised Total Change Score for the myofascial group trended (mean = 10.14, SD = 16.2) in the hypothesized and positive direction compared to the Swedish massage group (mean = 0.33, SD = 4.93) (Aickin, 2004). Nordic Musculoskeletal Questionnaire-Revised scored pain at 7 bodily regions, with most improvement in neck/shoulder pain. Additionally qualitative interviews with the massage therapist will be conducted to further determine the tolerability of the interventions. There were no adverse events or early discontinuations by subjects indicating that both interventions were feasible and acceptable to patients despite tenderness to touch (baseline myalgic score 31.9 (SD=7.7) and 36.3 (SD=3.1) in the myofascial and Swedish massage groups respectively. Larger randomized controlled trials are supported by the separation test. Aickin, A. (2004). Separation tests for early-phase complementary and alternative medicine comparative trials. Evidence-Based Integrative Medicine, 1(4), 225-231. Castro-SĂ¡nchez A. M., MatarĂ¡n-Peñarrocha G. A., Arroyo-Morales M., Saavedra-HernĂ¡ndez M., FernĂ¡ndez-Sola C., & Moreno-Lorenzo C. (2011a). Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: A randomized controlled trial. Clinical Rehabilitation, 25(9), 800-813. Castro-SĂ¡nchez A. M., MatarĂ¡n-Peñarrocha G. A., Granero-Molina J., Aguilera-Manrique G., Quesada-Rubio J. M., & Moreno-Lorenzo C. (2011b). Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evidence-Based Complementary and alternative Medicine, 2011, 1-9.
Specific Aims: 1. To analyze extant literature that has examined various complementary and altern... more Specific Aims: 1. To analyze extant literature that has examined various complementary and alternative medicine (CAM) therapies specific for fibromyalgia symptom management. 2. Based on the literature review, to assess best practices for CAM and fibromyalgia symptom management. Method: A systematic review of empirical studies, randomized and pragmatic clinical trials, were examined for quality, grade and level of evidence in commonly used CAM therapies for fibromyalgia symptom management. Databases used: PubMed, Ovid MEDLINE 1947-2010, PsycINFO 1806-2101, EBM Reviews - Cochrane Database of Systematic Reviews 2005 to September 2010, CINAHL (EBSCO). Key words used: fibromyalgia, fibrositis, chronic muscle pain, acupuncture, balneotherapy, yoga, tai chi, electrostimluation, laser, herbal therapy, homeopathy, and massage. The literature was assessed for quality of design, statistical analyses, power and effect sizes, if available. Background and Rational A comprehensive state-of-the-sci...
People with fibromyalgia (FM) have persistent widespread pain, axial pain, and tenderness. As an ... more People with fibromyalgia (FM) have persistent widespread pain, axial pain, and tenderness. As an adjunct to drug therapies, nurses often recommend bodywork such as massage to reduce symptoms and optimize physical function. Light Swedish-type massage is most commonly selected as FM patients also experience tenderness to touch. Recently, however, the pain generating role of the fascia in maintaining FM symptoms has been demonstrated. Additionally, two randomized controlled trials of myofascial release therapy compared to sham ultrasound or disconnected magnotherapy resulted in superiority of MFR in the control of most FM symptoms (Castro-SĂ¡nchez et al., 2011a; Castro-SĂ¡nchez et al., 2011b). The purpose of this study was to test the feasibility and acceptability of deep myofascial release versus an active massage condition- light Swedish massage- in women with FM. Eight subjects received either myofasical release while four subjects received Swedish massage for 90 minutes weekly x four...
ABSTRACT: Fibromyalgia (FM) is a persistent pain state commonly diagnosed and managed by nurse pr... more ABSTRACT: Fibromyalgia (FM) is a persistent pain state commonly diagnosed and managed by nurse practitioners. This article summarizes current tenants regarding the etiology, pathophysiology, clinical presentation, diagnostic standards, and pharmacologic and non-pharmacologic treatments necessary to successfully manage FM.
ABSTRACT: Fibromyalgia (FM) is a persistent pain state commonly diagnosed and managed by nurse pr... more ABSTRACT: Fibromyalgia (FM) is a persistent pain state commonly diagnosed and managed by nurse practitioners. This article summarizes current tenants regarding the etiology, pathophysiology, clinical presentation, diagnostic standards, and pharmacologic and non-pharmacologic treatments necessary to successfully manage FM.
Examined 96 early childhood educators' level of comfort in discussing death with young childr... more Examined 96 early childhood educators' level of comfort in discussing death with young children both as a formal learning experience and as it naturally occurs. While over 80% of the teachers consider death education important, most felt academically unprepared to deal with it. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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