Sep. 27, 2000 GAINESVILLE, Fla.---Thoughts of massage might conjure up images of an indulgence enjoyed by those fortunate enough to frequent a spa or by the athletic elite. But a little scientific scrutiny is showing it not only kneads away stress and soothes sore muscles - it can ease pain, tension and fatigue for those suffering from several medical conditions, including cancer and low-back problems.
Now University of Florida researchers say massage could wind up helping patients with sickle cell anemia, an inherited disorder of hemoglobin, the oxygen-carrying molecule in red blood cells. Results from a small UF pilot study that compared massage and relaxation therapy show both techniques safely and effectively reduced pain.
Sickle cell anemia is especially prevalent among black Americans: About 1 in 600 has a form of the disease, characterized by distorted, sickle-shaped red blood cells that logjam in vessels. The clogging decreases blood flow to various organs, causing intense, debilitating pain. Patients report recurrent, unpredictable episodes of sudden severe pain in the legs, arms or back, as well as chronic aching pain. Medical management of acute pain includes the use of potent painkillers and hydration, and many people end up hospitalized until the episode subsides.
Doctors would like to find alternative methods of pain control for people with sickle cell anemia because they are concerned about the long-term use of heavy-duty medication such as opiates. These medicines are sedating and can cause several side effects.
"Previous research has shown that massage is associated with pain reduction," said Cynthia Myers, a postdoctoral research associate in the UF College of Dentistry's division of public health services and research. "We thought it made sense to try it, both for the relaxation response it would evoke as well as the mechanical effects of working on muscles and applying pressure to increase circulation."
Myers presented findings from the UF study, conducted through the colleges of Health Professions and Medicine, during a poster session at the American Massage Therapy Association's annual conference Sept. 22-23 in Phoenix. UF researchers also published results from the pilot study in the journal Alternative Health Practitioner last winter.
Relaxation is a physiological reaction that causes blood vessels to dilate, improving blood flow, and researchers speculated that this might keep sickled cells from blocking vessels.
"We hypothesized that a second component of massage, which might add an effect over and above the relaxation effect, is the mechanical aspect of actually moving blood through vessels by the stroking involved in the massage itself," said Michael Robinson, a clinical psychologist at UF's College of Health Professions.
UF researcher Dr. Richard Lottenberg, a professor in the division of hematology and oncology at UF's College of Medicine, said the treatments are worthy of study because sickle cell pain largely stems from the musculoskeletal system.
Sixteen people with sickle cell anemia, all older than 18, participated in the study, which was funded by a $10,000 grant from the American Massage Therapy Association Foundation. They completed standardized pain assessment questionnaires. They then were randomly assigned to attend six 30-minute massage sessions or to learn relaxation techniques during weekly meetings to help them cope with their pain. Myers and Scott P. Lamp, both licensed massage therapists, administered the treatments.
They used a toned down version of the Swedish massage techniques of effleurage and petrissage -- soothing, rhythmic strokes and some kneading, but no tapping or pounding. Patients continued to take medications to ease their pain.
Relaxation training consisted of a series of exercises that required participants to tense and relax muscles in a specified sequence throughout the body. Patients also engaged in a five-minute visualization exercise at the end of each session that encouraged them to enjoy the sensation of being relaxed. Relaxation is defined by decreased muscle tension and respiration, lower blood pressure and heart rate, and improved circulation.
"The focus of our study was on the daily background chronic pain that affects all facets of their lives, from their ability to work to their avocational interests to their activities of daily living," Robinson said. "That pain can be to varying degrees and can be quite debilitating."
Researchers recorded pain levels and participants' ability to function before and after the study. Both massage and relaxation appeared to help: Participants reported significant reductions in the amount of pain they were in, even after the first session - in some cases cutting their ratings of pain unpleasantness and intensity nearly in half.
Researchers cautioned that sickle cell anemia patients should only receive massage therapy administered by trained, licensed massage therapists or nurses. "These people have a serious illness and anyone working with them needs to work very closely with their medical providers," Myers said.
Robinson and Myers said the findings highlight the need for further research of a disease that historically has been underfunded, undertreated and underinvestigated. "I think clearly we don't know which components worked," Robinson said. "We don't know if it was relaxation. We don't know if it was the interaction and attention from a therapist."
Massage might increase the body's natural production of the brain chemical serotonin, which is associated with pain-relieving effects, said Tiffany Field, director of the Touch Research Institute at the University of Miami School of Medicine. Field recently began a study of massage therapy for the treatment of children with sickle cell anemia.
"There is also this theory called the gate theory," she added. "We know that the nerve receptors that are detecting pain are shorter and less insulated than the receptors that detect pressure, so what may happen during massage is the message to the brain from the pressure receptors gets there faster than the message from the pain receptors, and it 'closes the gate' (to the pain). It's all biochemical but that's a metaphor for what's happening."
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