Massage therapy reduces anxiety and enhances EEG pattern of alertness and math computations

The brain under pressure: Exploring neurophysiological responses to cognitive stress

Stress is an increasingly dominating part of our daily lives and higher performance requirements at work or to ourselves influence the physiological reaction of our body. Elevated stress levels can be reliably identified through electroencephalogram (EEG) and heart rate (HR) measurements. In this study, we examined how an arithmetic stress-inducing task impacted EEG and HR, establishing meaningful correlations between behavioral data and physiological recordings. Thirty-one healthy participants (15 females, 16 males, aged 20 to 37) willingly participated. Under time pressure, participants completed arithmetic calculations and filled out stress questionnaires before and after the task. Linear mixed effects (LME) allowed us to generate topographical association maps showing significant relations between EEG features (delta, theta, alpha, beta, and gamma power) and factors such as task difficulty, error rate, response time, stress scores, and HR. With task difficulty, we observed left centroparietal and parieto-occipital theta power decreases, and alpha power increases. Furthermore, frontal alpha, delta and theta activity increased with error rate and relative response time, while parieto-temporo-occipital alpha power decreased. Practice effects on EEG power included increases in temporal, parietal, and parieto-occipital theta and alpha activity. HR was positively associated with frontal delta, theta and alpha power whereas frontal gamma power decreases. Significant alpha laterality scores were observed for all factors except task difficulty and relative response time, showing overall increases in left parietal regions. Significant frontal alpha asymmetries emerged with increases in error rate, sex, run number, and HR and occipital alpha asymmetries were also found with run number and HR. Additionally we explored practice effects and noted sex-related differences in EEG features, HR, and questionnaire scores. Overall, our study enhances the understanding of EEG/ECG-based mental stress detection, crucial for early interventions, personalized treatment and objective stress assessment towards the development of a neuroadaptive system.

A systematic review of manual therapy modalities and anxiety

CONTEXT

Anxiety disorders have a far-reaching impact on society, with profound implications on both mental and physical health. In response, there is growing interest in manual therapy modalities, with emerging research suggesting their potential to alleviate related symptoms.

OBJECTIVES

To establish a consensus regarding manual therapy modalities for addressing anxiety symptoms, a systematic review of current literature was conducted.

METHODS

A literature search was conducted between May and August 2023, utilizing a systematic search on both PubMed and Google Scholar, adhering to the defined inclusion criteria. In addition, information was gathered utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Both authors (KLW and TH) conducted the literature review. The inclusion criteria include articles written in English, peer-reviewed, anxiety conditions documented, and manual therapy delivered by a respectfully qualified professional. Manual therapy modalities include massage therapy, osteopathic manipulative treatment (OMT), foot reflexology, acupressure, manual therapy, healing touch, therapeutic touch, and gentle touch. After initial data collection, both researchers independently screened articles utilizing two metrics: a level of evidence (LOE) table and a screening criterion incorporating unique elements from the search process. The quality of the included articles was assessed utilizing Strength of Recommendation Taxonomy (SORT). When reviewer discrepancies arose, authors reread full-text studies and discussed the inclusion and exclusion criteria to achieve consensus.

RESULTS

The data searches identified 8,979 articles, with 239 articles remaining after duplicates and nonapplicable articles were removed. A total of 42 articles met the inclusion criteria, with only 40 articles able to be obtained for full-article review. After full review and the exclusion of articles with invalid author conclusions, meta-analysis, or systematic reviews, 34 articles were included in the review. All articles received an LOE rating of 2 or better and aligned with our specific screening criteria. Based on SORT, each modality was assigned a "B" rating. Among the included articles, n=27 demonstrated statistical significance in favor of manual therapy modalities as an anxiety treatment. The positive results for the aforementioned manual therapies on anxiety symptom improvement are shown: 15/18 (83 %) massage therapy, 2/6 (33 %) OMT, 5/5 (100 %) foot reflexology, 1/1 (100 %) acupressure, 1/1 (100 %) manual therapy, 0/2 (0 %) healing touch, 1/1 (100 %) therapeutic touch, and 1/1 (100 %) gentle touch.

CONCLUSIONS

A pattern emerged, wherein individuals receiving manual therapy interventions displayed a statistically significant reduction in anxiety intensity. Considering the positive results, manual therapy should be considered an effective strategy for anxiety management.

Exploring the physiological response differences of β-caryophyllene, linalool and citral inhalation and their anxiolytic potential

Essential oils with β-caryophyllene, citral, and linalool as key compounds often exhibit some anti-anxiety like effects in aromatherapy. However, evidence of the effect of these three compounds through human inhalation remains limited. It is worth exploring their potential anxiolytic effect through the olfactory pathway, and finding out whether the three compounds lead to different physiological responses. A total of 48 subjects were randomly assigned to three odor (β-caryophyllene, citral, and linalool) inhalation groups and one control (odorless jojoba oil) group. Stress stimulation was induced using n-back and mental arithmetic tasks. The odor was administered before the task test session. Assessments including the State-Trait Anxiety Inventory (STAI), electroencephalogram (EEG) activities, facial expressions, several physiological indicators, and a self-report scale of subjective perception of the odor environments were carried out. The changes before and after inhalation, as well as the inter-group differences, were analyzed. Both β-caryophyllene and citral inhalation led to a significant decrease in anxiety levels, while only β-caryophyllene resulted in a notable reduction across both sub-scales of STAI. Following the odor inhalation, heart rate significantly decreased in all three groups, with the β-caryophyllene group exhibiting the most pronounced decline. While the systolic blood pressure of the linalool group demonstrated a statistically significant difference. Regarding facial expressions, β-caryophyllene significantly increased the ratio of 'Happiness' and decreased the ratio of 'Fear'. In the non-task state, citral reduced the power of frontal alpha, delta, and theta waves while β-caryophyllene had a similar effect. All odor inhalation groups showed increased delta and theta waves after the task compared with the control group, with the β-caryophyllene group having notably lower frontal beta waves. β-Caryophyllene and citral exhibited good anti-anxiety effects. Subjects receiving different odors showed different EEG and physiological responses, indicating the differences in emotional regulation ways among the three compounds.

Comparative Efficacy of Robotic and Manual Massage Interventions on Performance and Well-Being: A Randomized Crossover Trial

BACKGROUND

Manual massage (MM) interventions can improve psychophysiological states of relaxation and well-being. In this context, robotic massage (RM) represents a promising, but currently understudied, solution.

HYPOTHESIS

Both MM and RM would improve flexibility of the hamstrings and lumbopelvic muscles and promote a psychophysiological state of relaxation through decreased sympathetic activity.

STUDY DESIGN

Single-blind randomized crossover trial.

LEVEL OF EVIDENCE

Level 2.

METHODS

A total of 21 participants experienced 2 massage interventions targeting back soft tissues. During a first condition, the intervention was performed by a physical therapist, whereas during a second condition the intervention was performed by a robot. We collected objective and subjective indexes of performances and well-being before and after each massage intervention. We also collected physical therapists' self-reports of perceived fatigue, tension, and ability to maintain the massage routine.

RESULTS

Skin conductance decreased from the pretest to the posttest in both conditions (partial R2 = 0.44, 95% CI [0.30, 1.00], P < 0.01), although the decrease was more pronounced after MM. Whereas both interventions were associated with improved subjective sensations, eg, pain, warmth, well-being (partial R2 = 0.08, 95% CI [0.06, 1.00], P < 0.01), MM yielded additional benefits compared with RM. The physical therapist reported greater fatigue and tension and reduced perceived massage efficiency along with repeated massage interventions. MM outperformed RM to elicit a psychophysiological state of relaxation.

CONCLUSION

RM exhibited a pattern of changes comparable with that of MM, for both objective and subjective indexes of relaxation and well-being.

CLINICAL RELEVANCE

RM could represent a prophylactic option to prevent the onset of counterproductive fatigability in physical therapists.

Bridging the Gap between Psychophysiological and Audiological Factors in the Assessment of Tinnitus: An EEG Investigation in the Beta Band

BACKGROUND

Despite substantial progress in investigating its psychophysical complexity, tinnitus remains a scientific and clinical enigma. The present study, through an ecological and multidisciplinary approach, aims to identify associations between electroencephalographic (EEG) and psycho-audiological variables.

METHODS

EEG beta activity, often related to stress and anxiety, was acquired from 12 tinnitus patients (TIN group) and 7 controls (CONT group) during an audio cognitive task and at rest. We also investigated psychological (SCL-90-R; STAI-Y; BFI-10) and audiological (THI; TQ12-I; Hyperacusis) variables using non-parametric statistics to assess differences and relationships between and within groups.

RESULTS

In the TIN group, frontal beta activity positively correlated with hyperacusis, parietal activity, and trait anxiety; the latter is also associated with depression in CONT. Significant differences in paranoid ideation and openness were found between groups.

CONCLUSIONS

The connection between anxiety trait, beta activity in the fronto-parietal cortices and hyperacusis provides insights into brain functioning in tinnitus patients, offering quantitative descriptions for clinicians and new multidisciplinary treatment hypotheses.

A systematic review and multivariate meta-analysis of the physical and mental health benefits of touch interventions

Receiving touch is of critical importance, as many studies have shown that touch promotes mental and physical well-being. We conducted a pre-registered (PROSPERO: CRD42022304281) systematic review and multilevel meta-analysis encompassing 137 studies in the meta-analysis and 75 additional studies in the systematic review (n = 12,966 individuals, search via Google Scholar, PubMed and Web of Science until 1 October 2022) to identify critical factors moderating touch intervention efficacy. Included studies always featured a touch versus no touch control intervention with diverse health outcomes as dependent variables. Risk of bias was assessed via small study, randomization, sequencing, performance and attrition bias. Touch interventions were especially effective in regulating cortisol levels (Hedges' g = 0.78, 95% confidence interval (CI) 0.24 to 1.31) and increasing weight (0.65, 95% CI 0.37 to 0.94) in newborns as well as in reducing pain (0.69, 95% CI 0.48 to 0.89), feelings of depression (0.59, 95% CI 0.40 to 0.78) and state (0.64, 95% CI 0.44 to 0.84) or trait anxiety (0.59, 95% CI 0.40 to 0.77) for adults. Comparing touch interventions involving objects or robots resulted in similar physical (0.56, 95% CI 0.24 to 0.88 versus 0.51, 95% CI 0.38 to 0.64) but lower mental health benefits (0.34, 95% CI 0.19 to 0.49 versus 0.58, 95% CI 0.43 to 0.73). Adult clinical cohorts profited more strongly in mental health domains compared with healthy individuals (0.63, 95% CI 0.46 to 0.80 versus 0.37, 95% CI 0.20 to 0.55). We found no difference in health benefits in adults when comparing touch applied by a familiar person or a health care professional (0.51, 95% CI 0.29 to 0.73 versus 0.50, 95% CI 0.38 to 0.61), but parental touch was more beneficial in newborns (0.69, 95% CI 0.50 to 0.88 versus 0.39, 95% CI 0.18 to 0.61). Small but significant small study bias and the impossibility to blind experimental conditions need to be considered. Leveraging factors that influence touch intervention efficacy will help maximize the benefits of future interventions and focus research in this field.

The Multisystem effects of Long COVID Syndrome and Potential Benefits of Massage Therapy in Long COVID Care

Background

A major complication of infection with Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, is the potential for Long COVID Syndrome. While the pathophysiology of Long COVID Syndrome has yet to be described, the disease presentation is characterized by long-term symptoms with debilitating effects on human health. A better understanding of Long COVID symptomology may open up new avenues for patient treatment such as massage therapy.

Methods

From the PubMed database, cohort studies that examined post-infection COVID sequelae published between January 1st, 2021 and April 30th, 2021 were selected to investigate patient demographics and symptoms. A review of massage therapy literature since 2000 in conjunction with identified Long COVID symptoms was performed.

Results

This systematic review identified 17 cohort studies across the world that investigated the symptomatology of patients suffering from post-COVID sequelae in multiple organ systems. We identified the pulmonary and nervous systems to be the organ systems most affected with post-COVID sequelae, with PTSD, fatigue, dyspnea, cough, sleep disturbances, loss of smell, abdominal pain, and decreased appetite as the most common symptoms reported by >20% of Long COVID patients. Massage therapy was historically found to provide benefits to patients experiencing similar symptoms to those identified in Long COVID.

Conclusions

Recognizing the need for new approaches to treatment for Long COVID Syndrome, we identify massage therapy as a potential therapeutic treatment to positively impact the organ systems affected by Long COVID, especially the high-incident symptoms, and improve patient quality of life.

Current evidence for non-pharmaceutical, non-surgical treatments of canine osteoarthritis

Osteoarthritis is a progressive degenerative disease process that affects a significant proportion of the canine population, impacting these animals' quality of life. Currently, there is no cure and treatment consists of managing the clinical signs of pain and reduced mobility. There are many treatments for canine osteoarthritis and in this review we discuss the evidence base behind non-pharmaceutical, non-surgical treatments of this disease. These treatments include weight management, nutraceuticals, acupuncture, physiotherapies such as therapeutic exercise, hydrotherapy as well as other therapeutic modalities including photobiomodulation therapy, electromagnetic field therapy and others.

Brief Myofascial Intervention Modulates Visual Event-Related Potential Response to Emotional Photographic Contents: A Pilot Study

The use of touch for the treatment of psychiatric disorders is increasingly investigated, as it is shown that cognitive symptoms can be improved by various forms of massage. To investigate if the effect of massage is measurable using classical visual event-related potential components (P1, P2, late positive potential (LPP)), we performed a preliminary study on six participants using myofascial induction massage. Participants were shown emotionally valenced or neutral images before and after a 20 min myofascial massage. We found general increases in P2 amplitude following the intervention across all conditions (both neutral and affective), indicating increased attention or salience to visual stimuli. The magnitude of change was visibly larger for unpleasant stimuli, suggesting that visual perception and attention were modulated specifically in response to unpleasant visual images. The LPP showed reductions in amplitude after myofascial massage, suggesting increased emotional modulation following intervention, as a result of possible DMN alterations, consistent with region and function. We conclude that brief myofascial intervention supports other research in the field, finding that physical touch and massage techniques can alter cognition and perception. We posit further research to investigate its future use as an intervention for both physical and cognitive modulation. Importantly, we provide preliminary evidence that the neural processes that resonate with this type of massage involve complex feedforward and backward cortical pathways, of which a significant portion participate in modulating the visual perception of external stimuli.

Foam Rolling Elicits Neuronal Relaxation Patterns Distinct from Manual Massage: A Randomized Controlled Trial

The present double-blinded, randomized controlled study sought to compare the effects of a full-body manual massage (MM) and a foam rolling (FR) intervention on subjective and objective indexes of performance and well-being. A total of 65 healthy individuals were randomly allocated to an FR, MM, or a control group who received a cognitively oriented relaxation routine. Self-report ratings of perceived anxiety, muscle relaxation, and muscle pain were used to index changes in affect and physical sensations. The sit-and-reach and toe-touch tests, as well as a mental calculation task, were used to index motor and cognitive performances, respectively. We also conducted resting-state electroencephalography and continuous skin conductance recordings before and after the experimental intervention. Both FR and MM groups exhibited neural synchronization of alpha and beta oscillations during the posttest. Skin conductance increased from the pretest to the posttest in the relaxation group, but decreased in the FR group. All interventions improved range of motion, although only the MM group outperformed the relaxation group for the toe-touch performance. MM was associated with reduced muscle pain and increased muscle relaxation. Reduced perceived anxiety after the intervention was observed in the FR group only. Overall, MM and FR both improved objective and subjective indexes of performance and well-being. Differences between the two massage interventions are discussed in relation to the effects of pressure stimulation on autonomic regulations and the proactive vs. retroactive nature of FR, compared to MM.

A Strategic Program for Risk Assessment and Intervention to Mitigate Environmental Stressor-Related Adverse Pregnancy Outcomes in the Indian Population

The Problem: Global environmental stressors of human health include, but are not limited to, conflict, migration, war, natural disasters, climate change, pollution, trauma, and pandemics. In combination with other factors, these stressors influence physical and mental as well as reproductive health. Maternal stress is a known factor for adverse pregnancy outcomes such as preterm birth (PTB); however, environmental stressors are less well-understood in this context and the problem is relatively under-researched. According to the WHO, major Indian cities including New Delhi are among the world's 20 most polluted cities. It is known that maternal exposure to environmental pollution increases the risk of premature births and other adverse pregnancy outcomes which is evident in this population.

Response to the Problem: Considering the seriousness of this problem, an international and interdisciplinary group of researchers, physicians, and organizations dedicated to the welfare of women at risk of adverse pregnancy outcomes launched an international program named Optimal Pregnancy Environment Risk Assessment (OPERA). The program aims to discover and disseminate inexpensive, accessible tools to diagnose women at risk for PTB and other adverse pregnancy outcomes due to risky environmental factors as early as possible and to promote effective interventions to mitigate these risks. OPERA has been supported by the Worldwide Universities Network, World Health Organization (WHO) and March of Dimes USA.

Addressing the Problem: This review article addresses the influence of environmental stressors on maternal-fetal health focusing on India as a model population and describes the role of OPERA in helping local practitioners by sharing with them the latest risk prediction and mitigation tools. The consequences of these environmental stressors can be partially mitigated by experience-based interventions that build resilience and break the cycle of inter- and-transgenerational transmission. The shared knowledge and experience from this collaboration are intended to guide and facilitate efforts at the local level in India and other LMIC to develop strategies appropriate for the jurisdiction for improving pregnancy outcomes in vulnerable populations.

Massage Therapy's Effectiveness on the Decoding EEG Rhythms of Left/Right Motor Imagery and Motion Execution in Patients With Skeletal Muscle Pain

Objective: Most of effectiveness assessments of the widely-used Massage therapy were based on subjective routine clinical assessment tools, such as Visual Analogue Scale (VAS) score. However, few studies demonstrated the impact of massage on the Electroencephalograph (EEG) rhythm decoding of Motor imagery (MI) and motion execution (ME) with trunk left/right bending in patients with skeletal muscle pain. Method: We used the sample entropy (SampEn), permutation entropy (PermuEn), common spatial pattern (CSP) features, support vector machine (SVM) and logic regression (LR) classifiers. We also used the convolutional neural network (CNN) and attention-based bi-directional long short-term memory (BiLSTM) for classification. Results: The averaged SampEn and PermuEn values of alpha rhythm decreased in almost fourteen channels for five statuses (quiet, MI with left/right bending, ME with left/right bending). It indicated that massage alleviates the pain for the patients of skeletal pain. Furthermore, compared with the SVM and LR classifiers, the BiLSTM method achieved a better area under curve (AUC) of 0.89 for the classification of MI with trunk left/right bending before massage. The AUC became smaller after massage than that before massage for the classification of MI with trunk left/right bending using CNN and BiLSTM methods. The Permutation direct indicator (PDI) score showed the significant difference for patients in different statuses (before vs after massage, and MI vs ME). Conclusions: Massage not only affects the quiet status, but also affects the MI and ME. Clinical Impact: Massage therapy may affect a bit on the accuracy of MI with trunk left/right bending and it change the topography of MI and ME with trunk left/right bending for the patients with skeletal muscle pain.

Frequency-Dependent Light Stimulation Effects on Performance During Vigilance Tasks on a Laptop

Students, office workers, or other computer and mobile device users can suffer from decrements in alertness or productivity, but many intervention methods on these can be too distracting or even affect daily routines. Using heart rate (HR) to determine a fast and slow target frequency at which to oscillate light brightness stimulation on a laptop, thirty-six participants joined a cognitive task where we hypothesized that fast frequency stimulation would increase alertness and decrease relaxation, while slow frequency stimulation would have the opposite effects. We found that slow frequency stimulation produces a statistically significant delay in response time, users react more slowly (3.8e2 ± 5.5e1 ms), when compared to the no stimulation (3.7e2 ± 4.1e1 ms) (p = 9.0e-3) conditions. The (Slow - No Stimulation) response time (1.7e1 ± 2.7e2 ms) produced a statistically significant delay in response time versus the (Fast - No Stimulation) response time (-0.74 ± 2.4e1 ms) (p = .016). These delays due to slow stimulation occurred without influencing accuracy or subjective sleepiness ratings. We observed that frequency-dependent light stimulation can potentially influence HRV metrics such as the mean normal-to-normal intervals and mean HR. Future work will target breathing rate to determine light stimulation oscillations as we further investigate the potential of using the slow-frequency domain to unobtrusively influence user performance and physiology.

Bifidobacterium longum 1714™ Strain Modulates Brain Activity of Healthy Volunteers During Social Stress

OBJECTIVES

Accumulating evidence indicates that the gut microbiota communicates with the central nervous system, possibly through neural, endocrine, and immune pathways, and influences brain function. B. longum 1714™ has previously been shown to attenuate cortisol output and stress responses in healthy subjects exposed to an acute stressor. However, the ability of B. longum 1714™ to modulate brain function in humans is unclear.

METHODS

In a randomized, double-blinded, placebo-controlled trial, the effects of B. longum 1714™ on neural responses to social stress, induced by the "Cyberball game," a standardized social stress paradigm, were studied. Forty healthy volunteers received either B. longum 1714™ or placebo for 4 weeks at a dose of 1 × 10 cfu/d. Brain activity was measured using magnetoencephalography and health status using the 36-item short-form health survey.

RESULTS

B. longum 1714™ altered resting-state neural oscillations, with an increase in theta band power in the frontal and cingulate cortex (P < 0.05) and a decrease in beta-3 band in the hippocampus, fusiform, and temporal cortex (P < 0.05), both of which were associated with subjective vitality changes. All groups showed increased social stress after a 4-week intervention without an effect at behavioral level due to small sample numbers. However, only B. longum 1714™ altered neural oscillation after social stress, with increased theta and alpha band power in the frontal and cingulate cortex (P < 0.05) and supramarginal gyrus (P < 0.05).

DISCUSSION

B. longum 1714™ modulated resting neural activity that correlated with enhanced vitality and reduced mental fatigue. Furthermore, B. longum 1714™ modulated neural responses during social stress, which may be involved in the activation of brain coping centers to counter-regulate negative emotions.

Pediatric Massage Therapy Research: A Narrative Review

This narrative review on pediatric massage literature from the last decade suggests that massage therapy has positive effects on several pediatric conditions. These include preterm infant growth, psychological problems including aggression, gastrointestinal problems including constipation and diarrhea, painful conditions including burns and sickle cell, muscle tone disorders including cerebral palsy and Down syndrome, and chronic illnesses including diabetes, asthma cancer, and HIV. Potential underlying mechanisms for the massage therapy effects include increased vagal activity and decreased stress hormones. Limitations of the literature include the need for more randomized controlled trials, longitudinal studies, and underlying mechanism studies.

EEG captures affective touch: CT-optimal touch and neural oscillations

Tactile interactions are of developmental importance to social and emotional interactions across species. In beginning to understand the affective component of tactile stimulation, research has begun to elucidate the neural mechanisms that underscore slow, affective touch. Here, we extended this emerging body of work and examined whether affective touch (C tactile [CT]-optimal speed), as compared to nonaffective touch (non-CT-optimal speed) and no touch conditions, modulated EEG oscillations. We report an attenuation in alpha and beta activity to affective and nonaffective touch relative to the no touch condition. Further, we found an attenuation in theta activity specific to the affective, as compared to the nonaffective touch and no touch conditions. Similar to theta, we also observed an attenuation of beta oscillations during the affective touch condition, although only in parietal scalp sites. Decreased activity in theta and parietal-beta ranges may reflect attentional-emotional regulatory mechanisms; however, future work is needed to provide insight into the potential neural coupling between theta and beta and their specific role in encoding slow, tactile stimulation.

Interpersonal touch interventions for patients in intensive care: A design-oriented realist review

AIM

To develop a theoretical framework to inform the design of interpersonal touch interventions intended to reduce stress in adult intensive care unit patients.

DESIGN

Realist review with an intervention design-oriented approach.

METHODS

We searched CINAHL, MEDLINE, EMBASE, CENTRAL, Web of Science and grey literature sources without date restrictions. Subject experts suggested additional articles. Evidence synthesis drew on diverse sources of literature and was conducted iteratively with theory testing. We consulted stakeholders to focus the review. We performed systematic searches to corroborate our developing theoretical framework.

RESULTS

We present a theoretical framework based around six intervention construction principles. Theory testing provided some evidence in favour of treatment repetition, dynamic over static touch and lightening sedation. A lack of empirical evidence was identified for construction principles relating to intensity and positive/negative evaluation of emotional experience, moderate pressure touch for sedated patients and intervention delivery by relatives versus healthcare practitioners.

Effect of Hand and Foot Massage Therapy on Psychological Factors and EEG Activity in Elderly People Requiring Long-Term Care: A Randomized Cross-Over Study

Massage therapy is widely used as a complementary therapy in the elderly. Here, we investigate the effect of hand and foot massage therapy on psychological factors and electroencephalographic (EEG) activity in elderly people requiring long-term care. We included 12 elderly people requiring long-term care, who were randomly divided into two groups (A and B). Group A received hand massage and group B received foot massage, both for 15 min each. After 1 week, group A received foot massage and group B received hand massage, both for 15 min each. We assessed emotions and mood states with a Likert scale after each massage and resting-state EEG activity was measured before and after each massage. Our results showed that both hand and foot massage led to a high degree of pleasant, relaxed, and refreshed feelings. Moreover, resting-state alpha activity significantly increased in the left insular cortex after hand massage (p < 0.05), and in the right and left posterior cingulate cortex after foot massage (p < 0.05). This study suggests that hand and foot massage therapy modulate psychological factors and EEG activity in elderly people requiring long-term care.

Neurophysiology of human touch and eye gaze in therapeutic relationships and healing: a scoping review

OBJECTIVE

The primary objective of this scoping review was to examine and map the range of neurophysiological impacts of human touch and eye gaze, and consider their potential relevance to the therapeutic relationship and to healing.

INTRODUCTION

Clinicians, and many patients and their relatives, have no doubt as to the efficacy of a positive therapeutic relationship; however, much evidence is based on self-reporting by the patient or observation by the researcher. There has been little formal exploration into what is happening in the body to elicit efficacious reactions in patients. There is, however, a growing body of work on the neurophysiological impact of human interaction. Physical touch and face-to-face interaction are two central elements of this interaction that produce neurophysiological effects on the body.

INCLUSION CRITERIA

This scoping review considered studies that included cognitively intact human subjects in any setting. This review investigated the neurophysiology of human interaction including touch and eye gaze. It considered studies that have examined, in a variety of settings, the neurophysiological impacts of touch and eye gaze. Quantitative studies were included as the aim was to examine objective measures of neurophysiological changes as a result of human touch and gaze.

METHODS

An extensive search of multiple databases was undertaken to identify published research in the English language with no date restriction. Data extraction was undertaken using an extraction tool developed specifically for the scoping review objectives.

RESULTS

The results of the review are presented in narrative form supported by tables and concept maps. Sixty-four studies were included and the majority were related to touch with various types of massage predominating. Only seven studies investigated gaze with three of these utilizing both touch and gaze. Interventions were delivered by a variety of providers including nurses, significant others and masseuses. The main neurophysiological measures were cortisol, oxytocin and noradrenaline.

CONCLUSIONS

The aim of this review was to map the neurophysiological impact of human touch and gaze. Although our interest was in studies that might have implications for the therapeutic relationship, we accepted studies that explored phenomena outside of the context of a nurse-patient relationship. This allowed exploration of the boundary of what might be relevant in any therapeutic relationship. Indeed, only a small number of studies included in the review involved clinicians (all nurses) and patients. There was sufficient consistency in trends evident across many studies in regard to the beneficial impact of touch and eye gaze to warrant further investigation in the clinical setting. There is a balance between tightly controlled studies conducted in an artificial (laboratory) setting and/or using artificial stimuli and those of a more pragmatic nature that are contextually closer to the reality of providing nursing care. The latter should be encouraged.

[Achtsame Massage und Achtsamkeitsschulung (Insightouch®) bei Depressionen, psychosomatischen und Bindungsstörungen]

Hintergrund: Bindungsstörungen können das Auftreten von Angst und Depression begünstigen, lassen sich aber durch korrigierende emotionale Erfahrungen verändern. Eine Massage - insbesondere wenn beide, Masseur (m/w) und Klient, sich in einem Zustand der Achtsamkeit befinden - kann eine solche korrigierende Erfahrung vermitteln. In der vorliegenden Interventionsstudie wurden die Auswirkungen von Insightouch® - einer Kombination von achtsamkeitsbasierter Massage mit Achtsamkeitsschulung - untersucht. Teilnehmer und Methoden: Wir rekrutierten 36 Personen mit psychischen Beschwerden, geringer Bindungsfähigkeit und geringer Achtsamkeit. In Intervallen von 8 Wochen wurden mittels validierter Fragebögen Parameter wie psychosomatische Symptome (Brief Symptom Inventory), Bindungsqualitäten (Adult Attachment Scale) und Achtsamkeit (Freiburger Achtsamkeitsfragebogen) erhoben. Die Hälfte der Teilnehmer (Gruppe A) startete mit der 8-wöchigen Behandlungsphase; nach weiteren 8 Wochen ohne Behandlung wurde die Nachhaltigkeit der Behandlungswirkung dokumentiert. Die Teilnehmer der Gruppe B starteten mit einer 8-wöchigen Wartephase (Kontrollphase ohne Behandlung), gefolgt von der Behandlungsphase. Ergebnisse: Während sich nach der Kontrollphase keine signifikanten Änderungen zeigten, bewirkte die aktive Behandlung statistisch signifikante Besserungen der 1) Symptomatik, 2) Bindungsdefizite und 3) Achtsamkeit. Nach der 8-wöchigen Nachbeobachtungsphase waren die psychischen und die bindungsbezogenen Symptome weiter verbessert; die behandlungsbedingt erhöhte Fähigkeit zur Achtsamkeit blieb hoch. Schlussfolgerung: Insightouch als primär nonverbale Intervention erhöht die Bindungsfähigkeit, verbessert psychosomatische Symptome und erhöht nachhaltig die Fähigkeit zur Achtsamkeit.

Construction and Validation of the Touch Experiences and Attitudes Questionnaire (TEAQ): A Self-report Measure to Determine Attitudes Toward and Experiences of Positive Touch

Despite growing interest in the beneficial effects of positive touch experiences throughout our lives, and individual differences in how these experiences are perceived, there is not yet available a contemporary self-report measure of touch experiences and attitudes, for which the factor structure has been validated. This article describes four studies carried out during the construction and validation of the Touch Experiences and Attitudes Questionnaire (TEAQ). The original TEAQ, containing 117 items relating to positive touch experiences was systematically constructed. Principal component analysis reduced this measure to 57 items and identified six components relating to touch experiences during childhood and adult experiences relating to current intimate touch and touch with friends and family. Three attitudinal components were identified relating to attitude to intimate touch, touch with unfamiliar people, and self-care. The structure of this questionnaire was confirmed through confirmatory factor analysis carried out on data obtained from a second sample. Good concurrent and predictive validity of the TEAQ compared to other physical touch measures currently available was identified. Known-group validity in terms of gender, marital status and age was determined, with expected group differences identified. This study demonstrates the TEAQ to have good face validity, internal consistency, construct validity in terms of discriminant validity, known-group validity and convergent validity, and criterion-related validity in terms of predictive validity and concurrent validity. We anticipate this questionnaire will be a valuable tool for the field of physical touch research.

Effects of Rifaximin on Central Responses to Social Stress-a Pilot Experiment

Probiotics that promote the gut microbiota have been reported to reduce stress responses, and improve memory and mood. Whether and how antibiotics that eliminate or inhibit pathogenic and commensal gut bacteria also affect central nervous system functions in humans is so far unknown. In a double-blinded randomized study, 16 healthy volunteers (27.00 ± 1.60 years; 9 males) received either rifaximin (600 mg/day) (a poorly absorbable antibiotic) or placebo for 7 days. Before and after the drug intervention, brain activities during rest and during a social stressor inducing feelings of exclusion (Cyberball game) were measured using magnetoencephalography. Social exclusion significantly affected (p < 0.001) mood and increased exclusion perception. Magnetoencephalography showed brain regions with higher activations during exclusion as compared to inclusion, in different frequency bands. Seven days of rifaximin increased prefrontal and right cingulate alpha power during resting state. Low beta power showed an interaction of intervention (rifaximin, placebo) × condition (inclusion, exclusion) during the Cyberball game in the bilateral prefrontal and left anterior cingulate cortex. Only in the rifaximin group, a decrease (p = 0.004) in power was seen comparing exclusion to inclusion; the reduced beta-1 power was negatively correlated with a change in the subjective exclusion perception score. Social stress affecting brain functioning in a specific manner is modulated by rifaximin. Contrary to our hypothesis that antibiotics have advert effects on mood, the antibiotic exhibited stress-reducing effects similar to reported effects of probiotics (supported by NeuroGUT, a EU 7th Framework Programme ITN no. 607652; ClinicalTrials.gov identifier number NCT02793193).

A Mechanism-Based Approach to Physical Therapist Management of Pain

Pain reduction is a primary goal of physical therapy for patients who present with acute or persistent pain conditions. The purpose of this review is to describe a mechanism-based approach to physical therapy pain management. It is increasingly clear that patients need to be evaluated for changes in peripheral tissues and nociceptors, neuropathic pain signs and symptoms, reduced central inhibition and enhanced central excitability, psychosocial factors, and alterations of the movement system. In this Perspective, 5 categories of pain mechanisms (nociceptive, central, neuropathic, psychosocial, and movement system) are defined, and principles on how to evaluate signs and symptoms for each mechanism are provided. In addition, the underlying mechanisms targeted by common physical therapist treatments and how they affect each of the 5 categories are described. Several different mechanisms can simultaneously contribute to a patient's pain; alternatively, 1 or 2 primary mechanisms may cause a patient's pain. Further, within a single pain mechanism, there are likely many possible subgroups. For example, reduced central inhibition does not necessarily correlate with enhanced central excitability. To individualize care, common physical therapist interventions, such as education, exercise, manual therapy, and transcutaneous electrical nerve stimulation, can be used to target specific pain mechanisms. Although the evidence elucidating these pain mechanisms will continue to evolve, the approach outlined here provides a conceptual framework for applying new knowledge as advances are made.

The effects on mental fatigue and the cognitive function of mechanical massage and binaural beats (brain massage) provided by massage chairs

OBJECTIVE

To verify whether the mechanical massage using massage chairs and binaural beats (brain massage) affect the mental fatigue recovery and cognitive enhancements.

METHODS

25 healthy adults used massage chairs that could provide mechanical massage and binaural beats (brain massage) for 20 min. Mental fatigue and cognitive function were assessed before and after receiving brain massage using electroencephalogram (EEG) and 5 prolonged cognitive tests.

RESULTS

When a person received a brain massage on the massage chair, the decrease in mental fatigue was statistically significant compared to taking a rest or receiving a mechanical massage only on the massage chair. In addition, sustained attention, verbal short-term and long-term memory and non-verbal long-term memory were statistically significantly increased after using brain massage.

CONCLUSION

Brain massage (mechanical massage and binaural beats) are effective in reducing mental fatigue and improving the cognitive function.

The effects of unilateral Swedish massage on the neural activities measured by quantitative electroencephalography (EEG)

Purpose

It is generally accepted that massage can provide a lot of benefits to human health, especially for the brain functions. Little is known about the effect of unilateral massage on the brain activities. Nowadays, Swedish massage is a modern massage technique that is popular in both treatment and research fields. The purpose of this paper is to investigate the effect of unilateral Swedish massage on brain activities with electroencephalography (EEG) recording.

Design/methodology/approach

In total, 18 healthy adult participants (5 men, 13 women) aged between 22 and 36 years were massaged over one side of arm, forearm, hand, neck and face. Then the same procedures were repeated to another side of the body. EEG was recorded before (baseline) and during each massage condition. The absolute power of four common brain waves consisting of δ (0.5-4 Hz), θ (4-8 Hz), α (8-13 Hz), and β activities (13-30 Hz) from the quantitative EEG analysis between baseline and each massage condition were used to compare with the paired t-test.

Findings

The study found the reduction of δ and θ powers over bilateral frontal, fronto-central, and central areas. The increments of α power over the similar brain areas were also observed. These findings indicated the generalized effect of unilateral Swedish massage for inducing relaxation. Moreover, the significant reduction of β power was also found over right central area when left-arm massage was applied. This finding revealed the initial inhibitory effect of Swedish massage over right somatosensory cortex that received sensory stimulation through massage from left side of the body.

Originality/value

Unilateral Swedish massage induced the inhibitory effect at the contralateral somatosensory cortex and then produced the generalized effect which is compatible with relaxation.

A comparison of four stress reduction modalities on measures of stress among university students

Purpose

High levels of stress reported at college campuses has led to the need for stress management interventions. College students often do not know how to deal with the increase in stress during college which may lead to ineffective ways to manage stress, such as drugs, alcohol, and under the worst circumstance, suicide. Several universities have implemented stress relieving centers where students can participate in various modalities to relax and reduce symptoms of stress. The purpose of this paper is to compare four stress reduction modalities on the amount of physiologic and perceived stress (PS) reduction in a stress relief center.

Design/methodology/approach

Archival information of 5,526 students (2,759 female, 2,767 male) were analyzed. During their time at the relaxation center, these students would participate in one of four relaxation modalities (massage chair, chi machine, rejuvenation lounger, or sitting meditation). Upon entering and exiting the center, PS, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were measured. The dependent variables were compared from pre- to post-relaxation with paired tests. Gain scores were calculated for each dependent variable and compared between modalities with an ANOVA and post hoc independent t-tests. The α was set at=0.05 for statistical significance.

Findings

Results indicated that all four modalities showed an overall decrease in stress-related symptoms for both men and women (p<0.05). There was no statistical difference in dependent variable gain scores between the relaxation modalities (p>0.05) for men. There was no statistical difference in dependent variable gain scores between the relaxation modalities (p>0.05) for women except for SBP and DBP where the massage chair, chi machine, and sitting meditation all reduced SBP and DBP to a greater degree than the rejuvenation lounger (p<0.05).

Originality/value

The results of this study suggest that the use of these stress reduction modalities (massage chair, chi machine, rejuvenation lounger, or sitting meditation) is effective at transiently reducing physiologic and perceived measures of stress of college students. Universities should recognize the importance of stress relief centers in order to help students manage stress symptoms and effectively manage their daily stress levels.

Massage Therapy for Psychiatric Disorders

This article reviews the current state of knowledge of the role of massage therapy in the treatment of common psychiatric disorders and symptoms. It briefly discusses the prevalence of psychiatric disorders and the popularity of complementary and integrative treatments in the general population. The authors touch on the growing literature describing the biology and neurobiology of massage therapy. The impact of massage as both a therapy for major psychiatric disorders and a treatment for psychiatric symptoms is reviewed, and how massage therapists conceptualize and treat their patients with psychiatric complaints is discussed. If psychiatrists are going to partner with massage therapists, they need to understand how massage therapists' perspectives differ from those of traditional practitioners of allopathic medicine. A model of how psychiatrists and other mental health professionals can work with massage therapists to care for patients is proposed, followed by a summary of the article's key points.

How the brain codes intimacy: The neurobiological substrates of romantic touch

Humans belong to a minority of mammalian species that exhibit monogamous pair-bonds, thereby enabling biparental care of offspring. The high reward value of interpersonal closeness and touch in couples is a key proximate mechanism facilitating the maintenance of enduring romantic bonds. However, surprisingly, the neurobiological underpinnings mediating the unique experience of a romantic partner's touch remain unknown. In this randomized placebo (PLC)-controlled, between-group, pharmacofunctional magnetic resonance imaging (fMRI) study involving 192 healthy volunteers (96 heterosexual couples), we intranasally administered 24 IU of the hypothalamic peptide oxytocin (OXT) to either the man or the woman. Subsequently, we scanned the subjects while they assumed that they were being touched by their romantic partners or by an unfamiliar person of the opposite sex, although in reality an identical pattern of touch was always given by the same experimenter. Our results show that intranasal OXT compared to PLC selectively enhanced the subjective pleasantness of the partner's touch. Importantly, intranasal OXT selectively increased responses to partner touch in the nucleus accumbens (NAcc) and anterior cingulate cortex. Under OXT, NAcc activations to partner touch positively correlated with the subjects' evaluation of their relationship quality. Collectively, our results suggest that OXT may contribute to the maintenance of monogamous relationships in humans by concomitantly increasing the reward value of partner touch and diminishing the hedonic quality of stranger touch. Hum Brain Mapp 38:4525-4534, 2017. © 2017 Wiley Periodicals, Inc.

Effects of manual lymph drainage for abdomen on the brain activity of subjects with psychological stress

[Purpose] The present study investigated the effects of manual lymph drainage for abdomen on electroencephalography in subjects with psychological stress. [Subjects and Methods] Twenty-eight subjects were randomly allocated to undergo a 20-min session of either manual lymph drainage or abdominal massage on a bed. [Results] Analysis of electroencephalograms from the manual lymph drainage group showed a significant increase in relaxation, manifested as an increase in average absolute, relative alpha activity and a decrease in relative gamma activity. [Conclusion] Our results suggest that the application of manual lymph drainage from the abdomen provides acute neural effects that increase relaxation in subjects with psychological stress.

Integrative Evaluation of Automated Massage Combined with Thermotherapy: Physical, Physiological, and Psychological Viewpoints

Various types of massages are reported to relieve stress, pain, and anxiety which are beneficial for rehabilitation; however, more comprehensive studies are needed to understand the mechanism of massage therapy. In this study, we investigated the effect of massage therapy, alone or in combination with infrared heating, on 3 different aspects: physical, physiological, and psychological. Twenty-eight healthy university students were subjected to 3 different treatment conditions on separate days, one condition per day: control, massage only, or massage with infrared heating. Physical (trunk extension [TE]; maximum power of erector spinae), physiological (heart-rate variability [HRV]; electroencephalogram [EEG]), and psychological (state-trait anxiety inventory [STAI]; visual analogue scale [VAS]) measurements were evaluated and recorded before and after each treatment condition. The results showed that massage therapy, especially when combined with infrared heating, significantly improved physical functioning, increased parasympathetic response, and decreased psychological stress and anxiety. In the current study, we observed that massage therapy contributes to various physical, physiological, and psychological changes, where the effect increases with thermotherapy.

The need of dermatologists, psychiatrists and psychologists joint care in psychodermatology

The mind-skin connection has been studied since the nineteenth century. The last 40 years have set the development of new research areas which allowed the clarifying of how these two dimensions interact. The diseases that involve skin and mind constitute the field of psychodermatology and require that specialists in dermatology, psychiatry and psychology together and integrated take part in it, since skin, nervous system and mind are simultaneously affected. This paper aims to expose how psychodermatoses are currently conceptualized and the need of integration of these three specialties for conveniently treating the patients.

The Effect of Therapeutic Back Massage in Hypertensive Persons: A Preliminary Study

Hypertension, one of the most pervasive disease processes in the United States, can lead to target organ damage. Although there is no one cause of primary hypertension, the theory of an unchecked long-term stress response continues to be a valid argument. Conversely, eliciting the relaxation response may alter the course of the unchecked stress response. Massage therapists have suggested that their therapy elicits the relaxation response and therefore can decrease blood pressure (BP) and hypertension. This preliminary study tested the effects of a regularly applied back massage on the BP of patients with clinically diagnosed hypertension. In this experimental, pretest-posttest study, a 10-min back massage was given to the experimental group (n = 8), three times a week for 10 sessions. The control group (n = 6) relaxed in the same environment for 10 min, three times a week for 10 sessions. Analysis of variance determined systolic BP changed significantly, F (1, 12) = 17.90, p = .001, between groups over time as did the diastolic BP, F (1, 12) = 8.34, p = .014. Effect size was 2.25 for systolic pressure and 1.56 for diastolic pressure (alpha of .05 and power at .80). This preliminary study suggests that regular massage may lower BP in hypertensive persons.

Touch Therapy Effects on Development

In this review empirical data are presented on the use of touch therapy, specifically massage therapy for improving the clinical course of several conditions including growth and development of pre-term infants, reducing pain, increasing attentiveness, diminishing depression, and enhancing immune function. Potential underlying mechanisms for the massage therapy effects are proposed for each of these conditions. The general effect appears to derive from the stimulation of pressure receptors and the ensuing increase in vagal activity and slowing physiology which in turn facilitates a more relaxed behavioural state, effects a decrease in stress hormones, most particularly cortisol, and an increase in immune function, particularly natural killer cells.

Evaluating the use of gas discharge visualization to measure massage therapy outcomes

BACKGROUND

The purpose of this study was to evaluate the short-term effects of massage therapy using gas discharge visualization (GDV), a computerized biophysical electrophoton capture (EPC), in tandem with traditional self-report measures to evaluate the use of GDV measurement to assess the bioenergetic whole-person effects of massage therapy.

METHODS

This study used a single treatment group, pre-post-repeated measures design with a sample of 23 healthy adults. This study utilized a single 50-min full-body relaxation massage with participants. GDV measurement method, an EPC, and traditional paper-based measures evaluating pain, stress, muscle tension, and well-being were used to assess intervention outcomes.

RESULTS

Significant differences were found between pre- and post-measures of well-being, pain, stress, muscle tension, and GDV parameters. Pearson correlations indicate the GDV measure is correlated with pain and stress, variables that impact the whole person.

CONCLUSIONS

This study demonstrates that GDV parameters may be used to indicate significant bioenergetic change from pre- to post-massage. Findings warrant further investigation with a larger diverse sample size and control group to further explore GDV as a measure of whole-person bioenergetic effects associated with massage.

Massage therapy research review

Moderate pressure massage has contributed to many positive effects including increased weight gain in preterm infants, reduced pain in different syndromes including fibromyalgia and rheumatoid arthritis, enhanced attentiveness, reduced depression and enhanced immune function (increased natural killer cells and natural killer cell activity).Surprisingly, these recent studies have not been reviewed, highlighting the need for the current review. When moderate and light pressure massage have been compared in laboratory studies, moderate pressure massage reduced depression, anxiety and heart rate, and it altered EEG patterns, as in a relaxation response. Moderate pressure massage has also led to increased vagal activity and decreased cortisol levels. Functional magnetic resonance imaging data have suggested that moderate pressure massage was represented in several brain regions including the amygdala, the hypothalamus and the anterior cingulate cortex, all areas involved in stress and emotion regulation. Further research is needed to identify underlying neurophysiological and biochemical mechanisms associated with moderate pressure massage.

Manual lymph drainage attenuates frontal EEG asymmetry in subjects with psychological stress: a preliminary study

[Purpose] The purpose of this preliminary study was to investigate the effect of manual lymph drainage (MLD) of the neck on frontal electroencephalogram (EEG) asymmetry in subjects with psychological stress. [Subjects] Thirteen subjects with psychological stress participated in the study. [Methods] Subjects received MLD of the neck for 15 min. [Results] Analysis of the frontal asymmetry index showed that the energy shift in the alpha frequency band from the left hemisphere to the right hemisphere after MLD resulted in greater left-side activation (positive asymmetry values), which could be related to the positive emotional state observed particularly in the F7-F8 area. [Conclusion] These preliminary findings suggest that frontal EEG asymmetry was significantly attenuated after MLD.

Lifetime stress cumulatively programs brain transcriptome and impedes stroke recovery: benefit of sensory stimulation

Prenatal stress (PS) represents a critical variable affecting lifetime health trajectories, metabolic and vascular functions. Beneficial experiences may attenuate the effects of PS and its programming of health outcomes in later life. Here we investigated in a rat model (1) if PS modulates recovery following cortical ischemia in adulthood; (2) if a second hit by adult stress (AS) exaggerates stress responses and ischemic damage; and (3) if tactile stimulation (TS) attenuates the cumulative effects of PS and AS. Prenatally stressed and non-stressed adult male rats underwent focal ischemic motor cortex lesion and were tested in skilled reaching and skilled walking tasks. Two groups of rats experienced recurrent restraint stress in adulthood and one of these groups also underwent daily TS therapy. Animals that experienced both PS and AS displayed the most severe motor disabilities after lesion. By contrast, TS promoted recovery from ischemic lesion and reduced hypothalamic-pituitary-adrenal axis activity. The data also showed that cumulative effects of adverse and beneficial lifespan experiences interact with disease outcomes and brain plasticity through the modulation of gene expression. Microarray analysis of the lesion motor cortex revealed that cumulative PS and AS interact with genes related to growth factors and transcription factors, which were not affected by PS or lesion alone. TS in PS+AS animals reverted these changes, suggesting a critical role for these factors in activity-dependent motor cortical reorganization after ischemic lesion. These findings suggest that beneficial experience later in life can moderate adverse consequences of early programming to improve cerebrovascular health.

Effects of manual lymph drainage of the neck on EEG in subjects with psychological stress

[Purpose] The present study investigated the effect of manual lymph drainage (MLD) of the neck on electroencephalography (EEG) in subjects with psychological stress. [Methods] Twenty-six subjects were randomly allocated to receive one 15-min session of either MLD or resting on a bed (control). [Results] Analysis of EEG in the MLD group showed a significant increase in relaxation, manifested as an increase in average absolute and relative delta and alpha activity. [Conclusion] It is suggested that MLD provides acute neural effects that increase relaxation in subjects with psychological stress.

Effect of preoperative anxiety on spectral entropy during induction with propofol

Background

Anxiety influences brain wave activity. E-Entropy module-derived spectral entropy is an electroencephalographic derivative used to monitor the depth of sedation. This study assessed the effect of preoperative anxiety on the spectral entropy parameters of response entrophy (RE) and state entrophy (SE).

Methods

Trait anxiety was measured in 92 American Society of Anesthesiologists physical status I-II patients with the Spielberger State-Trait Anxiety Inventory (STAI) form X2 and state anxiety with STAI-X1 just before anesthesia. RE, SE, blood pressure and heart rate were measured before induction. Propofol was infused via a target controlled infusion pump. At loss of consciousness (LOC), the effect-site concentration (Ce), RE, SE and total amount of propofol were recorded. Patients were stratified into three groups based on their state and trait anxiety scores to evaluate the effect of anxiety level on entropy values.

Results

STAI-X1 was significantly correlated with RE and SE for LOC (ρ = 0.230, P = 0.028 and ρ = 0.308, P = 0.003, respectively) and also with STAI-X2 (ρ = 0.411, P = 0.001, respectively). SE was higher in the high state anxiety group than in the low state anxiety group (P = 0.017). The other measured variables were not correlated with any anxiety scales.

Conclusions

The state of anxiety increases RE and SE values at LOC induced with propofol. High state anxiety is associated with higher SE than apparent at low state anxiety. When determining the propofol-induced LOC by spectral entropy, anxiety levels should be considered.

A preliminary study of the effects of repeated massage on hypothalamic-pituitary-adrenal and immune function in healthy individuals: a study of mechanisms of action and dosage

OBJECTIVES

This study gathers preliminary data about the biologic effects of repeated Swedish massage therapy compared to a light-touch control condition.

DESIGN

The study design was a 5-week comparison of repeated Swedish massage and light touch on oxytocin (OT), arginine-vasopressin (AVP), adrenal corticotropin hormone (ACTH), cortisol (CORT), circulating phenotypic lymphocyte markers, and mitogen-stimulated cytokine function.

SETTING

The setting was an outpatient research unit in an academic medical center.

PARTICIPANTS

The study subjects were medically and psychiatrically healthy young adults.

INTERVENTION

The study comprised 45 minutes of Swedish massage or light touch, using highly specified and identical protocols, either weekly or twice weekly for 5 weeks.

OUTCOME MEASURES

The outcome measures were mean differences between massage and light touch on OT, AVP, ACTH, CORT, lymphocyte markers, and cytokine levels.

RESULTS

Compared to the touch control condition, weekly Swedish massage stimulated a sustained pattern of increased circulating phenotypic lymphocyte markers and decreased mitogen-stimulated cytokine production, similar to what was previously reported for a single massage session, while having minimal effect on hypothalamic-pituitary-adrenal function. Twice-weekly massage produced a different response pattern with increased OT levels, decreased AVP, and decreased CORT but little effect on circulating lymphocyte phenotypic markers and a slight increase in mitogen-stimulated interferon-γ, tumor necrosis factor-α, interleukin (IL)-1b and IL-2 levels, suggesting increased production of pro-inflammatory cytokines.

CONCLUSIONS

There are sustained cumulative biologic actions for the massage and touch interventions that persist for several days or a week, and these differ profoundly depending on the dosage (frequency) of sessions. Confirmatory studies in larger samples are needed.

Interpersonal touch: physiological effects in critical care

INTRODUCTION

Nurses use several forms of touch in patient encounters. Interpersonal touch elicits specific physiological and psychological responses, including neuroendocrine effects and reduction of stress. Critical illness is a state of excessive physiological and psychological stress.

AIMS

To critically review evidence on the effect of touch on physiological outcomes in critically ill individuals. Results of intervention studies in adult critical care settings were reviewed along with supportive evidence from studies in other populations.

METHODS

Critical literature review based on studies published in MEDLINE, PubMed, Cinahl, Embase, and Cochrane databases.

RESULTS

Eleven studies were reviewed. Significant effects of interpersonal touch included lower systolic and diastolic blood pressure and respiratory rate, improved sleep, and decreased pain. Almost no results were replicated owing to discrepancies among studies. Although the effect of touch on cardiovascular autonomic status appears considerable, several confounders must be considered. In noncritically ill populations, replicable findings included increased urinary dopamine and serotonin, natural killer cytotoxic activity, and salivary chromogranin. Effects on plasma cortisol and immune cells were variable. Effects appear to vary according to amount of pressure, body site, duration, and timing: Moderate pressure touch may elicit a parasympathetic response in contrast to light touch, which may elicit a sympathetic response. Moreover, touch effects may be mediated by the density of autonomic innervation received by the body areas involved and repetition of sessions.

CONCLUSION

The physiological pathway mediating the effects of touch is unclear. Although no concrete conclusions can be drawn, research evidence suggests that touch interventions may benefit critically ill individuals.

Tactile skin stimulation increases dopamine release in the nucleus accumbens in rats

We investigated the effect of mild (non-noxious) tactile stimulation (stroking) of skin on dopamine (DA) release in the nucleus accumbens (NAc) of rats. A coaxial microdialysis probe was stereotaxically implanted in the NAc and perfused with modified Ringer's solution. Dialysate output from consecutive 5-min periods was injected into a high-performance liquid chromatograph and DA was measured using an electrochemical detector. Bilateral tactile stimulation of the back for 5 min significantly increased DA release in conscious and anesthetized animals. Increased DA release was observed by stimulation of the contralateral, but not ipsilateral, back. DA secretion was also increased with stimulation of the forelimb, hindlimb, and abdomen. These effects were abolished after lesioning the ventral tegmental area (VTA). In contrast, noxious stimulation (pinching) of these areas had no effect on DA secretion. In conclusion, innocuous mechanical stimulation of the skin increases DA release in the contralateral NAc via the VTA.

Body massage performance investigation by brain activity analysis

Massage has been widely applied to improve health and reduce stress. However, the performance difference between hands-on treatment and treatment by mechanical devices has been little mentioned. Therefore, the main aim of this paper is to investigate a subject's EEG performance under massage treatment applied by hand and treatment applied by mechanical devices. Massage was applied to four acupoints for three minutes each. The massage acupoint sequence was from left Jian-wai-yu, right Jian-wai-yu, left Zuo-fei-yu, and finally right Zuo-fei-yu. An EEG system of 32 channels was used. Twenty-four volunteers, mainly college students, were enrolled. EEG rhythm powers of each massage sessions were derived. Two-way ANOVA revealed that there were also significant interactions between the massage stage and the massage type on delta (P < 0.01), theta (P < 0.05), and beta rhythms (P < 0.01), and there were significant differences at different stages for the mechanical massage group (F = 5.557, P < 0.01). The mechanical massage group had more significant differences than the hands-on group for stage coherence of around coherence on alpha rhythm. Further rhythm power scalp topography between two massage methods is also investigated.