I probably have every massage tool known to mankind at home. I think a good massage is a one of the best physical and mental stress and strain relievers, so I treat myself every few months.
The price is worth the return, times ten.
If I can’t get a massage however, this Homedics chair, a gift from husband and my daughter one Mother’s Day, is the next best thing to hands-on massage. The rollers are strong but not painful, and for the price, I like the flexibility of the easy to use options.
Many people treat their chronic pain due to injury or illness with one kind of massage therapy. Yet, integrative or medical massage may offer a more effective approach.
Medical practitioners often prescribe one type of massage therapy for patient’s with ongoing physical or emotional pain due to injury, trauma or illness. Yet the most effective massage treatment for chronic pain may be a multi-disciplinary or integrative approach, as well massage sessions that engage the patient in the healing process.
Integrative Massage Therapy
Integrative massage offers a more holistic approach to massage therapy, applying a technique according to the kind that will work on various issues in the body (and mind).
During the first session therapists generally gather detailed information about their client’s medical history and past treatments. This lets them tailor the therapy to their patient’s specific physical and emotional needs. They avoid a “one size fits all” massage approach and instead use multiple modalities, borrowing from a wide variety of cultures and practices.
Integrative massage therapists don’t try to diagnose medical conditions, nor do they rely on a client’s current diagnoses to steer the course of treatment. Instead they listen to their client’s symptoms and apply the technique(s) they feel will most effectively address the issues. The therapist serves as a kind of healing “detective,” so to speak, working to pin point the physical and potentially emotional causes behind the patient’s chronic pain.
Integrative Massage Therapy Treats A Number of Chronic Health Conditions
The cause of chronic unexplained pain is complex, yet depending on the condition, integrative massage therapy can effectively treat or alleviate symptoms in a variety of conditions such as:
- Repetitive strain injuries like carpal tunnel or tendonitis. *(I like Biofreeze for muscle pain. It gives cold therapy when you can’t bother with an ice pack.
- Poor posture issues
- Unexplained chronic pain in soft tissue/musculoskeletal system
- Accident or sports injuries
- Cancer patient pain management
Integrative Massage Therapy Empowers the Patient
Integrative massage can be very empowering to the patient and a good integrative massage therapist will explain to her patient that she is merely a facilitator to the client’s own ability to heal. Some therapists use positive words and affirmations during sessions to help “re-program” their client’s response to pain and treatment.
In addition, integrative massage therapists often teach their patients an at-home therapy plan that may include cardiovascular and targeted strengthening and stretch exercises, as well as pain and stress management tips. This approach can be quite encouraging for chronic pain sufferers who may been told for years their pain is “all in their head,” were regularly misdiagnosed or have been at the mercy of the traditional medical establishment with no relief.
Integrative Massage Therapies For Chronic Pain
Integrative massage therapists combine any of a number of techniques to relieve chronic pain depending on the patient’s symptoms and the therapist’s certification in a particular massage modality. Some of the common massage modalities used in the treatment of chronic pain include:
- Neuromuscular therapy
- CranioSacral therapy
- Myofascial release
- Trigger point therapy
- Lymphatic drainage
- Orthopedic massage
- Massage for cancer patients
Integrative Massage Therapy vs. Medical Massage
The term “medical or therapeutic massage” is sometimes used interchangeably with the term integrative massage. Integrative simply implies using a multi-disciplinary massage approach to treat medical conditions. James Waslaskin in his 2004 online article on Massage Today entitled, “Defining Medical Message,” explains that “Medical massage is performed with the intent of improving conditions or pathologies that have been diagnosed by a physician; a wide variety of modalities or procedures are utilized to focus the treatment based on the diagnosed condition.”
Match The Chronic Pain Condition With the Right Kind Of Massage
Any hands on massage work that manipulates soft tissue structures of the body in order to prevent and alleviate pain, discomfort, muscle spasm, stress and promotes health and wellness is beneficial.
If a patient is suffering with from chronic pain the may not want to limit their massage treatments to those that strictly feel good but may not have much healing or long term curative effect. Instead they should find an experienced integrative massage therapist who has the skills to assess which treatments are the most effective for their particular medical conditions.
Copyright Laura Owens. Contact the author to obtain permission for republication.
While researchers have found a relationship between insufficient vitamin D, chronic pain, anxiety and depression, the exact causality is still unknown.
Researchers in a 2007 study reported in Clinical Rheumatology that vitamin D deficiency is common in people with fibromyalgia and also occurs more frequently in those with anxiety and depression. Yet research is also emerging that may dispute the once believed link between Seasonal Affective Disorder, its depressive symptoms and D deficiency.
Regardless of the unanswered questions, patients suffering with mood issues and/or chronic muscle pain may want to consider having their 25-hydroxyvitamin D levels tested.
Fibromyalgia, Vitamin D, Anxiety & Depression May Be Linked
People with fibromyalgia often have symptoms of anxiety and depression as well as low levels of vitamin D. In the 2007 study, researchers tested serum vitamin D levels in 75 patients with fibromyalgia. The subjects completed a Fibromyalgia Impact Questionnaire (FIQ) and Hospital Anxiety and Depression Score (HADS). Results showed that patients with vitamin D deficiency scored higher on the HADS .
Research has also linked vitamin D deficiency to patients who suffer with chronic pain. While the relationship between fibromyalgia, pain, anxiety, depression and vitamin D deficiency is somewhat complex and the exact relationship remains unclear, evidence is mounting to suggest that vitamin D plays some role in chronic pain and mood imbalance.
Vitamin D Deficiency, Depression With Seasonal Affective Disorder Research Disputed
Vitamin D continues to gain worldwide attention due to emerging research linking it to more than 2,000 gene processes in the body. Yet evidence has surfaced to challenge vitamin D’s once presumed role in Seasonal Affective Disorder and the associated depressive symptoms. Researchers believe Seasonal Affective Disorder manifests during winter months as a result of lack of sunlight exposure on the skin which then results in vitamin D deficiency.
In a study published in the Journal of Affective Disorders, Dr. Oscar Franco, Assistant Clinical Professor in Public Health and his team, recruited more than 3,000 people and tested levels of vitamin D (25-hydroxyvitamin D) in the blood. Subjects completed a questionnaire to measure depressive symptoms. Researchers found no clear association between depressive symptoms and the concentration of vitamin D in the blood.
“Few studies have explored the association between blood 25-hydroxyvitamin D concentrations and depression in the general population, ” said Dr. Franco. “Previous studies into the effects of vitamin D supplementation have produced mixed results. More studies are still needed to evaluate whether vitamin D is associated with seasonal affective disorders, but our study does raise questions about the effects of taking more vitamin D to combat depressive symptoms.”
A Japanese study conducted in 2009 also found no evidence linking higher blood vitamin D levels with decreased depressive symptoms.
Vitamin D, Mood & The Brain
In a report entitled, “Vitamin D and the occurrence of depression: causal association or circumstantial evidence?” researchers concluded that based on the body of research to date, high doses of supplemental vitamin D may improve mild depressive symptoms. Yet questions persist regarding the following critical study areas of mood regulation:
- how vitamin D affects monoamine function and hypothalamic-pituitary-adrenal axis response to stress
- whether vitamin D supplementation can improve mood in individuals with moderate-to-severe depression
- whether vitamin D sufficiency is protective against incident depression and recurrence.
Investigators in the report suggest it is “premature to conclude that vitamin D status is related to the occurrence of depression. Additional prospective studies of this relationship are essential.”
While the exact relationship between mood disorders, chronic muscle pain and vitamin D deficiency has not be clearly established, evidence suggests that patients with chronic muscle pain, anxiety or depression should at least consider testing their vitamin D levels and supplementing if they are deficient.
Armstrong DJ, Meenagh GK, Bickle I, Lee AS, Curran ES, Finch MB, “Vitamin D deficiency is associated with anxiety and depression in fibromyalgia,” Clinical Rheumatology,2007 Apr.
An Pan, Ling Lu, Oscar H. Franco, Zhijie Yu, Huaixing Li, Xu Lin. “Association between depressive symptoms and 25-hydroxyvitamin D in middle-aged and elderly Chinese., “ Journal of Affective Disorders, 2009.
University of Warwick (2009, March 18). Vitamin D May Not Be The Answer To Feeling SAD. ScienceDaily. Retrieved March 3, 2010.
Bertone-Johnson ER, “Vitamin D and the occurrence of depression: causal association or circumstantial evidence?” Nutritional Review, 2009 Aug.
Copyright Laura Owens. Contact the author to obtain permission for republication.
While magnesium can reduce pain in some fibromyalgia patients, not everyone with FMS has low levels of magnesium. Yet research indicates that taking adequate doses of magnesium in combination with malic acid over an extended period of time can significantly reduce the muscle and soft tissue pain associated with fibromyalgia.
Fibromyalgia and Muscle Energy Disruption
It’s unclear how or if these two elements work synergistically, yet magnesium and malic acid are both key components in how energy is produced and transported within the cells of the muscles. Evidence suggests that one cause of fibromyalgia pain is local hypoxia in the muscles (low oxygen) which contributes to muscle tissue breakdown.
Magnesium Deficiency and Fibromyalgia Pain
Magnesium is an essential mineral for good health and is involved in a long list of critical functions in the body including: nerve signaling, muscle contraction, and as a co-factor for 350 enzymes. Some people with fibromyalgia are low in magnesium.
Magnesium activates the most important enzyme in the body, ATP (adenosine triphosphate) an energy molecule produced within a component of cells called the mitochondria, the body’s “energy furnace.” About 20 percent of the body’s production of ATP is located in the brain. As a result, diminished levels can reduce the brain’s cognitive functions, a common problem in people with fibromyalgia.
Magnesium is needed in the production of serotonin, a brain neurotransmitter involved in the perception of pain. Serotonin levels have been shown to be significantly lower in people with fibromyalgia. Magnesium is one of the many co-factors needed to release and bind serotonin in the brain to provide balanced mental functioning.
Magnesium deficiency increases a chemical in the body called substance P, a neurotransmitter and protein found in the brain and spinal cord. People with fibromyalgia have abnormally high levels of substance P. Substance P serves as a pain messenger and is associated with inflammatory processes in the joints. Excess levels can cause pain signals to be sent to the brain even when there is no actual injury or illness.
Malic Acid and Fibromyalgia Pain
Malic acid is an organic substance found in fruits (particularly apples) and plants.
Malic acid is involved in the production of energy in the body. It plays a role in the molecules involved in controlling mitochondrial, energy production, within the cells. Malic acid provides greater stamina and endurance in muscle cells.
Malic acid is particularly useful in helping remove aluminum from the body. Aluminum toxicity is thought to be one contributor to fibromyalgia symptoms. While magnesium also helps block the toxic effects of aluminum, malic acid may be even more effective.
Studies On Magnesium and Malic Acid To Reduce Fibromyalgia Pain
In a 1992 study 15 fibromylagia patients received an oral dose of 1200-2400 mg of malate (malic acid) and 300-600 mg of magnesium over a four and 8 week period. Patients reported a reduction in pain across a tender point index (TPI). Six subjects felt an improvement in 48 hours.
During another study conducted in 1995, researchers gave 24 subjects with fibromyalgia a “Supermalic” low tablet with 50 mg magnesium and 200mg malic acid. Scientists measured pain levels through patient self-assessment and the tender point index. Results showed that the low dose, short term trial was not effective to reduce fibromyalgia pain. However, higher doses over an extended duration significantly reduced subjects’ pain.
Magnesium Malate Dosage and Side Effects
Magnesium Malate has been shown to be the most effective form of magnesium to reduce fibromyalgia pain. The recommended dose is 1,500 mg, although people should adjust their dose according to their pain level and side effects.
Side effects with extended use may include headache, muscular pain, and mild gastrointestinal symptoms. The most common side effect is loose stools. Should this occur people should decrease their next dose by 50%.
Abraham GE, Glechas ID. “Management of fibromyalgia: A rationale for the use of magnesium and malic acid.” Journal of Nutritional Medicine,1992;3:49-59.
Russell IJ, et al. “Treatment of fibromyalgia syndrome with Super Malic: A randomized, double blind, placebo controlled, crossover pilot study.” Journal of Rheumatology, 1995; 22:953-958.
“The Team Value of Magnesium and Malic Acid,” Marc D. Braunstein, Oralchelation.com. Accessed 11/6/08.
Copyright Laura Owens. Contact the author to obtain permission for republication.
In 2008 the online site Pain Treatment Topics released a review of research on the potential benefits of vitamin D for patients with pain conditions, notably musculoskeletal and back issues. Although results varied, researchers agree insufficient vitamin D is an underlying factor in fibromyalgia and other chronic pain conditions.
Chronic pain and vitamin D deficiency linked long ago
Multiple studies link vitamin Ddeficiency to chronic aches and pains, muscle fatigue or weakness, and other disorders including immunity and some cancers (Holick 2003b; ODS 2008; Plotnikoff and Quigley 2003; Reginster 2005; Tavera-Mendoza and White 2007; Vieth 1999).A study presented at the American Society of Anesthesiologists 2007 Annual Meeting reported that about one in four patients with chronic pain also have inadequate blood levels of vitamin D. Patients with insufficient vitamin D also needed higher doses of morphine for longer periods of time.
According to study author W. Michael Hooten, MD, medical director and anesthesiologist at the Mayo Comprehensive Pain Rehabilitation Center in Rochester, Minn., researchers have long known that inadequate levels of vitamin D can cause pain and muscle weakness.“The implications are that in chronic pain patients, vitamin D inadequacy is not the principal cause of pain and muscle weakness,” said Hooten for a press release, “However, it could be a contributing but unrecognized factor.”
The jury is still out on the exact connection between vitamin D and chronic pain but scientists believe it may begin with lower levels of circulating calcium (hypocalcemia) due to inadequate vitamin D. A cascade of biochemical reactions then occurs that hinders bone metabolism and health. Low levels of calcium elevates parathyroid hormones which impairs proper bone mineralization causing a spongy matrix to form under periosteal membranes covering the skeleton.
This gelatin-like matrix can absorb fluid, expand, and cause outward pressure on periosteal tissues, which generates pain since these tissues are highly innervated with sensory pain fibers (Holick 2003b; Shinchuk and Holick 2007; Yew and DeMieri 2002).
Fibromyalgia and Vitamin D Deficiency
The association between low levels of 25-hydroxyvitamin D and non-specific musculoskeletal pain, including fibromyalgia syndrome remains controversial.
In one study, Israeli researchers found no association between women with fibromyalgia and low levels of vitamin D(Tandeter et al. 2009). Yet researches in an earlier study in the Middle East found a significantly greater prevalence of low D concentration in women with fibromyalgia compared to women without fibromyalgia (43% vs 19%).
Yet researchers in the Middle East found that 90% of patients diagnosed with fibromyalgia and/or non-specific musculoskeletal pain treated with vitamin D improved.(Badsha et al. 2009).
One reason for the conflicting evidence is researchers have yet to adequately measure patients’ response to different formulations, doses, and durations of vitamin D. In addition, scientists believe vitamin D receptors have different genetic make up and activity so individuals may respond differently to vitamin D therapy. (Kawaguchi et al. 2002; Videman et al. 2001).
Vitamin D Dosing
Dr. Cannell, Executive Director of The Vitamin D Council recommends supplementing with Cholecalciferol vitamin D3). D3 is the naturally occurring form of vitamin D and is made in large quantities in skin when sunlight strikes it. Dr. Cannell explains that Calcidiol is the only blood test that should be drawn. Doctors can order calcidiol levels although labs will know calcidiol as 25-hydroxyvitamin D.
Take enough vitamin D3 to get 25(OH)D levels above substrate starvation levels, 50 ng/mL or 125 nmol/L. Current recommendations for adults and children are inadequate to maintain optimal health and certainly to treat chronic pain conditions and illness.
Dr. Cannell suggests people supplement with vitamin D before getting their blood tested, then adjust their dose so their 25(OH)D level is between 50–80 ng/ml during both the summer and the winter. These are conservative dosages explains Dr. Cannell. People who avoid the sun, and nearly all dark-skinned people need to increase their dose if their blood levels are still low, even after two months of the above dosage, particularly during the winter months.
Exact levels are difficult to determine because requirements vary by age, body weight, percent of body fat, latitude, skin coloration, season of the year, use of sun block, individual variation in sun exposure, and how sick someone is.
“If you use suntan parlors once a week,” says Dr. Cannell, “or if you live in Florida and sunbathe once a week, year-round, do nothing.” However, if you receive very little UVB exposure the Council recommends the following dosing levels of D3 (maintenance level):
- healthy children under the age of two – 1,000 IU per day*
- healthy children over the age of two – 2,000 IU per day*
- adults and adolescents – 5,000 IU per day.
*The American Academy of Pediatrics recommends 400 mg per day for children.
While the exact relationship between vitamin D and chronic pain syndromes like fibromyalgia isn’t fully understood, most researchers agree that vitamin D deficiency contributes to muscuskeletal pain. Patients and practitioners should consider including vitamin D supplementation in their therapy for patients suffering with chronic pain syndromes.
Another note: Magnesium, malic acid also assist in pain relief for FMS……I use several products but Magnesium Calm is one of my favorites because it works very well, tastes good Click here for magnesium
Dr. Dean who wrote the Magnesium Miracle (Very easy to understand read on why magnesum is critical to our health yet deficient in our soil and therefore our food and often, body) turned me on to the importance of this essential mineral. I take it every night or more often if I need to. It’s a co-factor for an impressive list of functions in our body.
“Vitamin D Inadequacy May Exacerbate Pain,” American Academy of Anesthesiologists, Press Release, October 15, 2007.
Tandeter H, Grynbaum M, Zuili I, Shany S, Shvartzman P., “Serum 25-OH vitamin D levels in patients with fibromyalgia.” Israeli Medical Association Journal, 2009.
Badsha H, Daher M, Ooi Kong K. Myalgias or non-specific muscle pain in Arab or Indo-Pakistani patients may indicate vitamin D deficiency. Clinical Rheumatology. 2009.
Leavitt, Steward, B. MA, PhD., “Vitamin D: A Neglected ‘Analgesic’ for Chronic Musculoskeletal Pain: An Evidence Based Review and Clinical Practice Guideline,” June 2008, http://Pain-Topics.org/VitaminD.
“Vitamin D for Pain: Update of Research Evidence,” Pain Treatment Topics, Accessed: January 10, 2010.
Arvold DS, et al., “Correlation of symptoms with vitamin D deficiency and symptom response to cholecalciferol treatment: a randomized controlled trial,” Endocrine Practice, 2009 May-Jun.
Armstrong DJ, Meenagh GK, Bickle I, Lee AS, Curran ES, Finch MB., “Vitamin D deficiency is associated with anxiety and depression in fibromyalgia,” Clinical Rheumatology. 2006 Jul 19.