Saturday, April 6, 2013

Patients reported outcome: "There Will Be Blood"



It was said that ability of the mind to re-evaluate existing convictions upon acquiring new information is the sign of intellect.  In other words a human being has to always strive to doubt existing authoritative opinions, push the envelope, and get outside the box to be on the winning team of progress.

Unfortunately, the physical implication of this approach is not always cut and dry and often people, accustomed to the black and white mindset, instead of going out of the box attempt to break it.

In one of the online discussion I came across an opinion that doubted the good old scientifically and clinically proven fact, that massage increases arterial blood flow supply to the tissue. Having raised an objection to defend the view that I go by in my daily practice, I offered a scientific explanation on why the studies supporting the idea that “massage therapy disturbing blood supply” are incompetent and why using such study as a reference is invalid.
Oh boy, I was accused of being retrograde, was drowned with buzz words and pepper sprayed with rhapsody of "out of the box" thinking.  

This incident brought to mind a recent case of a patient with severe pain in the left side of lower back.  The patient was a young female, who experienced severe pain at the left side lower back in sitting position or while standing up.
She was referred to our clinic by a physician who was Board Certified in Physical Medicine, and who had been invited to consult the patient when she was hospitalized. Her physician informed me that all necessary tests, including CT and MRI, had found no significant spinal abnormalities.

Yet she endured quite an Odyssey of pain.  She couldn't work and her day-today life was greatly affected.  The patient became depressed, anxious, and mentally exhausted.

In a desperate attempt to help, her primary care physician referred her to the Multidiscipline Pain Management Center in hope of addressing her condition with a combination of acupuncture, chiropractic adjustments and physical therapy. This approach failed and her pain and disability increased. The pain became so intolerable that she was hospitalized.

After an intense flair up her pain management physician recommended surgery of electrodes insertion in the spinal cord to prevent pain stimuli reaching the brain. However, the Pain Management center's psychiatrist insisted that such treatment should be postponed and antipsychotic medications, as well as psychotherapy, should be attempted first.

Patient was practically disabled for four months prior to her visit to our clinic.
These symptoms could have been the result of many different abnormalities, including spinal disorders, muscular syndromes, and abdominal disorders accompanied by adhesions.  By having lower back MRI Drs. excluded spinal disorders and various blood tests excluded significant inner organ disorders that could produce this type of symptoms.

Thinking over her case, because of absence of trigger point in lower back region, I suspected that her problem lies in the abdomen area and decided to start with abdominal massage in order to accelerate venous blood and lymph drainage. These techniques are gentle and always feel pleasant. After a few minutes of applying the drainage techniques she began to cry. My first thought was that my therapy had increased intensity of pain. As I asked her about it, she replied, "No, it didn't increase my pain." At this moment, it was obvious to me that she had released psychological tension and suppressed emotions. This is very common in patients who suffer from intense chronic pain, and such a reaction ignited hope for a successful rehabilitation.

After application of abdominal drainage techniques she reported a significant decrease of pain intensity in lower back region. I asked her to sit up. Since for many months, prior to this treatment, she couldn't sit for 10 minutes experiencing excruciating pain, it was to our great surprise, the pain didn't come back as she sat still for more than 10 minutes. At this moment, my suspicion that her severe back pain was the result of significant venous stasis and lymphedema in the abdominal cavity grew into assurance. Acceleration of venous blood drainage means increase of arterial blood supply. If, God forbid, massage therapy disturbs blood supply, we would make people sick.

In the last 20 years evidence-based medicine was “redirected“ to draw its conclusions from research papers exclusively, disregarding clinical outcome as evidence-based proof. Therefore, ignoring critical evidence, my opponents supported the conclusion that ”massage therapy disturbs blood supply.”

Incidentally, this approach of evidence based medicine recently was denied by FDA. Today, in order for product to be approved, not only research paper is needed, but also patients reported outcome should be positive. Massage therapy is about results or clinical outcome. Any methodology, being it oriental massage therapy or conventional scientifically developed methods, has to be clinically tested as safe and effective. The essence of abdominal massage is to replace large amounts of venous blood in the abdomen area with the fresh arterial blood rich with nutrients and oxygen, thus letting the body to heal itself. Considering that 30 to 35% of all blood supply is delivered to abdominal cavity, it's hard to imagine that massage somehow doesn't increase the flow of arterial blood.  In other words if it weren't for massage than what did it?

When trying to get out of the box, one should remember that this is a considerable mental and spiritual effort, which cannot be undertaken by bluntly undermining everything that was done by the previous generations of exceptional human minds, who, perhaps, also stepped out of their boxes in attaining this knowledge.

To review the full protocol for abdominal/visceral massage please click here.

Please click this link to get familiar with the scientific review of the studies that concluded that ”massage therapy disturbs blood supply” 

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