Massage therapy with topical phytochemicalsin palliative care

By

Kevin KF NG, MD, PhD.Former Associate Professor of Medicine

Miller School of MedicineUniversity of Miami, Florida

Presented at The Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore Jan 22, 2016

WHO Definition of Palliative Care

Palliative care is an approach that improves the quality of life of

patients and their families facing the problem associated with life-

threating illness, through the prevention and relief of suffering by

means of early Identification and impeccable assessment and

treatment of pain and other problems, physical, psychosocial and

spiritual.

WHO Guidelines 2004

Institute of Medicine 2014

Recommendations for:• individuals• health care professionals• organizations• payers • policy makers

to achieve optimal care at the end of life,

Hospice Care in the USA 2010-2014

Total Hospice patients served per year % Of Hospice patients by AGE

http://app.jamanetwork.com/#page=issuesContainer

Hospice Home Care in USA 2010 - 2014

http://app.jamanetwork.com/#page=issuesContainer

Common physical symptoms in palliative care

pain

fatigue

loss of appetite

nausea

vomiting

shortness of breath

insomnia.

IAHPC: 34 essential medications for palliative care

http://hospicecare.com/resources/palliative-care-essentials/iahpc-essential-medicines-for-palliative-care/

Symptom management for Pain and Fatiguein Palliative Care

Drug

Analgesic

Narcotics

NSAIDS

Non-drug

Physical therapy

Occupational therapy

Massage therapy

Meditation

Yoga

Purpose of presentation: to introduce use of phytochemicals in massage oil for

palliative care.

http://www.webmd.com/

Massage therapy styles and benefitsStyles

Swedish massage

Neuro-muscular massage

Deep tissue massage

Sports massage

Chair massage

Benefits

Back pain

Headache

Osteoarthritis

Cancer

Depression

Shiatsu massage

Thai massage

Hot stone massage

Reflexology

Pregnancy massage

Neonatal massage

http://www.webmd.com/

How does massage work ?

Increase blood flow

Enhance lymphatic drainage

• Effleurage (sliding or gliding)• Petrissage (kneading)• Tapotement (rhythmic tapping)• Friction (cross fiber or with the

fibres)• Vibration/shaking

Science behind Massage

Reduce stress :

ACTH, Serotonin, Dopamine

Reduce inflammation:

CRP, TNF-α, COX-2 and 5-Lox lipid mediators, interleukins

Effect of one massage may last for one week

Function of massage oils

1. To reduce friction between

the therapist’s hand and

the skin of patient.

2. Extraction of phytochemicals

Top massage oils & their % fatty acids in USA

The story of Phytochemicals

Sheng Nong (about 4,000 years ago): tasted and classified 365 Chinese herbs.

Hippocrates (460 bc – 375 bc): used bark of white willow tree for fever and pain.

Sir John R. Vane (1927-2004): discovered how aspirin reduced fever and pain in 1971.

The word “phytochemical” was invented on April 25, 1994

Rationale of Use of Topical Phytochemicals for Palliative Care

Many patients cannot tolerate oral medications.

Most phytochemicals are metabolized in the gastro-intestinal tract and liver.

Most phytochemicals are soluble in oil.

Massage oil contains fatty acids (oleic acid, linoleic acid, linolenic acid) which are easily absorbed through the skin..

Therefore phytochemicals in massage oil may be absorbed through skin bypassing the portal circulation to enhance their beneficial effects.

Phytochemicals act on multiple targets and they act in synergy.

What are phytochemicals

Phyto = plant

Most phytochemicals work with other phytochemicals

to produce the desired effect on health: synergy

Functions of Phytochemicals

Plants

Protections from microbes and parasites.

Color

Anti-oxidant

Hormonal/signaling

Human

Ant-inflammatory

Anti-oxidant

Anti-cancer

Anti-aging

Type 2 diabetes

Eye disease

Source of Phytochemicals: fruits, vegetables, leaves, bark and roots

Classification of Dietary Phytochemicals

Molecules 2013, 18, 322-353; doi:10.3390/molecules18010322

Properties and functions of phytochemicals

Anti-oxidant

Anti-inflammatory

Anti-cancer

Immuno-stimulant

Anti-aging

Hormone-like actions

Extraction of Phytochemicals

Botanical Products (Leaves, Flowers, Fruits, Barks, Roots in carrier medium.

Homogenizer

Centrifuge

Separation of Supernatant from Residue

Tests on Subjects

Synergy= sum of parts is not equal to the whole

Part

Part

Whole

Studies performed on Phytochemical Extracts

Traditional Chinese Medicine Ginseng

Astragalus

Liquorice

Notoginseng

Dan Sheng

Discorea

Angelina sinesis

Peony

Thunder god vine

Malaysian herbs & spices Lumpuyang

Lemongrass

Galangal

Ginger

Aloe

Chive

Chilli

Tumeric

Tonkat ali

Analysis of actions of phytochemicals on molecular targets

Clinical studies to show pharmacological effects of phytochemical extracts

Dermatographia urticaia (histamine)

Psoriasis (itch)

Acute Pain (Dit Da Jow): strain, sprain, low back pain, frozen shoulder

Acute inflammation: fire ant stings

Palliative care (symptom relief)

Anti-histamine effect of phytochemical extract onDermatographia urticaria

Control Treated

10.10 am 10.17 am

Treated

Effect of phytochemcical Extract on Itch in Psoariasis

Before After 4 days

Effect of phytochemical Extract on Low back pain

Pain relief by phytochemical Extract on Gout

Before treatment 5 days after treatment

Problems: Pain, Itch, infection

Dr. Blake Layton, Extension Entomology SpecialistDepartment of Entomology, Mississippi State University

http://msucares.com/insects/fireants/sting.html

Natural history of fire ant sting from contact to resolution

Effect of Phytochemical Extract on Fire Ant Stings

Untreated for 36 hours Treated for 36 hours

Initial studies of topical phytochemicals on End of Life

Cases

Metastatic lung disease (1)

Metastatic pancreatic disease (1)

Observed Effects

Reduced cancer related fatique

Reduced stress and anxiety

Reduced analgesic usage

Reduced polypharmacy

Well tolerated

Minimal side effects

Improved overall quality of life

Grateful thanks to:

My parents who persuaded me to drink the bitter herbal mixture.

My wife and my mother-in-law who taught me Swedish massage.

My mentor Sir John R. Vane who taught me research in pharmacology.

My patients who inspired me to look for safer alternative in patient care.

Sir John R. Vane,

1982 Nobel laureate in Physiology and Medicine

(1927-2004)