In the News
Massage Therapy and Multiple Sclerosis
By Martha Brown Menard, PhD, CMT
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system. Instead of its normal activity of targeting and destroying foreign substances such as bacteria, with MS the body’s immune system mistakenly attacks the myelin sheath that surrounds the nerve. Like many chronic illnesses, MS affects quality of life and activities of daily living. Major symptoms include pain, fatigue, spasticity, paresthesias (loss of sensation) and bladder dysfunction. People with MS frequently use complementary and alternative (CAM) therapies—including massage—to manage symptoms. A 2005 survey1 estimates that 50 percent to 75 percent of MS patients use CAM therapies, while another noted that 66 percent of respondents reported improvement in their symptoms2.
Relatively little research has been conducted specifically on the use of massage or bodywork therapies for symptom relief in MS. Three recent studies, however, have examined the use of reflexology in MS. Two of these are randomized controlled trials (RCT) for symptom relief; the third investigated the nature of the interaction between clients and therapists through an analysis of the conversations that occurred during sessions.
Reflexology treatment relieves symptoms of multiple sclerosis: a randomized controlled study
The earlier of the two RCTs was conducted in Israel3. Seventy-one MS patients suffering from spasticity and/ or paresthesias, or both, were recruited and randomly assigned to receive a full reflexology treatment of the feet and massage of the lower legs or a nonspecific massage of the lower legs alone, for 45 minutes per week for 11 weeks. Patients with an acute relapse of their MS during the preceding three months or during the study were excluded, as were patients who had recently started or stopped physical therapy, massage therapy or another manual treatment. All patients continued their current medications, and no changes were recorded during the study and follow-up period. Of the 71 participants who entered the study, only 53 completed it.
Thirty-six reflexologists provided the interventions, with each therapist treating one patient assigned to the true reflexology and one assigned to the control condition, so that patients in both groups were exposed to the same therapists. All patients received an equal number of sessions that lasted the same amount of time. Outcome measures included an average weekly score for paresthesias, measured using a visual analog scale (VAS). Spasticity was evaluated in a similar fashion, using separate scales for muscle strength and muscle tone. Urinary symptoms, such as frequency and urgency, were assessed using the American Urological Association symptom checklist, a 1–5 scale of how often patients experience each symptom, with a global measure of quality of life. Outcomes were assessed at baseline, six weeks, 11 weeks (end of the treatments) and at three-months follow-up. Participants and investigators who measured the outcomes were blinded.
Because of the relatively small sample size (in relation to the number of outcomes), a nonparametric analysis was performed, looking at differences between the two study groups at the various time points of the study. Significant differences were observed for spasticity, paresthesias and urinary symptoms in the treatment group, while muscle strength showed borderline improvement (p=.6). The authors noted that the improvement in muscle strength was especially remarkable considering that many of the medications patients continued to use for spasticity are associated with muscle weakness.
There are two potential issues with this study. One is the high rate of dropouts. However, there were no statistically significant differences between those who dropped out of the study and those who completed it. A second issue is that the study included patients with all forms of MS, so some participants may have had different degrees of severity of their symptoms. There were no statistically significant differences between the treatment and control groups in the initial severity of their symptoms, the duration of their illness, or in terms of common demographic variables, such as age or sex.
Reflexology for the treatment of pain in people with multiple sclerosis: a double-blind randomized sham-controlled clinical trial
The second RCT took place in Northern Ireland and was published in 20094. The investigators randomly assigned 73 MS patients with a VAS rating greater than 4 for at least two months, and without previous experience of reflexology, or a relapse requiring steroid medication or hospitalization within the past two months, to receive either a true or a sham reflexology treatment. Both the participants and the investigator who conducted the outcomes measured were blinded as to group assignment. Blinding was assessed by the use of a questionnaire at weeks two and 16 (follow-up).
The true reflexology group received a precise massage of all the key refl ex points on the feet associated with the major organs, while the sham refl exology group received a standardized massage, using the same sequence but with less pressure over the same general areas.
The sham intervention was designed to control for personal contact and, according to the theory of reflexology, should have had no specific effects. Both groups received a 45-minute treatment for 10 weeks. The primary outcome measured was pain, using the VAS with a 0–10 scale, with fatigue and depression as secondary outcomes. Outcomes were measured at baseline, 10 weeks, 16 weeks and 22 weeks. Nonparametric tests were again used for statistical analysis.
Both groups showed significant reductions in all three outcomes compared to baseline measures at the end of the 10-week intervention period. Pain reduction was maintained at weeks 16 and 22, while reduction in fatigue and depression was maintained until week 16. However, there were no significant differences between the two groups.
One explanation for this result may have been that the reflex points are not located as precisely as suggested, and that the sham intervention was equally as effective. Rather than an active and inactive treatment being compared to each other, the investigators in this study may have been comparing two active interventions that were quite similar to each other. In that case it would not be surprising that both were similarly effective; this situation illustrates why sham interventions in many complementary therapies are difficult to design well, and are sometimes controversial.
What do people talk about during reflexology? Analysis of worries and concerns expressed during sessions for patients with multiple sclerosis
The third paper discussed here investigated what MS patients talk about with their therapists during reflexology sessions, through analyzing audiotapes from a previously conducted study5. In that study, which used a crossover design, 50 participants with MS received six sessions each of reflexology and progressive muscle relaxation (PMR), provided by nurses. The order of the six sessions of reflexology or PMR was randomly assigned, with a four-week washout period inbetween. Of those participants, 48 made some type of personal disclosure during their reflexology sessions.
Themes discussed by participants included their distress about their MS symptoms and treatment; psychological concerns such as feeling frustrated about the ability to participate in everyday social activities; and concerns for the future regarding increasing disability, inability to work, and being able to keep up family and personal relationships. While many of the disclosures occurred spontaneously, therapists also facilitated discussions about diet, health worries, and practical or social concerns. There was also a good deal of dialog regarding social activities, such watching television and current events in the news.
Interestingly, the rate of personal disclosure showed a gradual reduction over the length of the study. The investigators speculate that one possible reason for this result is therapists may have asked more questions to get to know their patients in the initial weeks of the study, or that patients may have had more concerns to share early on in the study.
A limitation of this study was that audio taping proved to be a less than reliable method of data collection; out of 245 tapes, 55 were inaudible or blank because of technical problems, and seven to 12 tapes each week had some missing data. Audiotaping also failed to record visual cues that may have been given by therapists, and the authors recommended videotaping as a more reliable and informative source of data for future studies.
Reflexology appears to show some promise for relieving symptoms of multiple sclerosis. General massage may also help to reduce pain, fatigue and depression, although more research is needed. Patients with MS do disclose personal concerns to their therapists during sessions; it will be interesting if future studies investigate how common an occurrence such disclosure is more generally and with other specific populations, such as people living with cancer or other chronic conditions.
1. Apel A, Greim B, Zettl UK. How frequently do patients with multiple sclerosis use complementary and alternative medicine? Comp Ther Med 2005; 13: 258-263. Murray TJ. Complementary and alternative medicine for MS. Int MS J 2006; 13: 3.
2. Siev-Ner I, Gamus D, Lerner-Geva L, and Achiron A. Reflexology treatment relieves symptoms of multiple sclerosis: a randomized controlled study. Mult Scler 2003; 9: 356-361.
3. Hughes CM, Smuth S, and Lowe-Strong AS. Refl exology for the treatment of pain in people with multiple sclerosis: a double-blind randomized sham-controlled clinical trial. Mult Scler 2009; 15: 1329-1338.
4. Mackereth PA, Booth K, Hillier VF, and Caress A. What do people talk about during reflexology? Analysis of worries and concerns expressed during sessions for patients with multiple sclerosis. Comp Ther Clin Prac 2009; 15: 85-90.
Source: this article was from excerpted from mtj® (Massage Therapy Journal®) Summer 2010. Subscribe to read the entire article.