CAM and Oncology Research

Two great articles about studies regarding cancer patients and alternative care:

Can therapeutic massage alleviate cancer fatigue?

This article talks about a recent massage-specific study that’s exploring how massage therapy can help reduce cancer-related fatigue. There’s already a lot of research regarding pain, anxiety, and depression relief in the cancer population, but cancer fatigue has often been overlooked.

Closer details of the study can be found here.

Attitudes and beliefs drive use of complementary and alternative medicine (CAM) among cancer patients

Another recent article talks about a study exploring what drives the use of CAM among cancer patients. They found that attitudes and beliefs about the benefits of complementary and alternative care are the biggest factor determining use, as opposed to clinical and demographic characteristics.

While this may seem like just a small finding, I think this is actually really important. This means that the biggest reason cancer patients aren’t using CAM is because they don’t know about it, or aren’t sure whether it can help. This is not an insurmountable problem – the best way to tackle it is by more outreach, by explaining to patients (and physicians) all of the ways that CAM can help with cancer symptoms.

Have you read my Oncology blog series yet? Check it out if you haven’t yet:
Part One: Introduction
Part Two: Benefits
Part Three: Adjustments
Part Four: Hospice

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Evidence of Massage Therapy Benefits

Check out Dr. Brent Bauer of the Mayo Clinic talk about the research-supported benefits of massage therapy:

Source: AMTA

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Important Announcement: Office Relocation

Image courtesy of Baitong333 at FreeDigitalPhotos.netI have some exciting news to announce: I just signed a lease on a new office space!

I’ll be relocating at the beginning of October, but don’t worry – I’m not going far. Only four blocks, in fact. Specifically, I’m moving to the Electric Building at 621 SW Alder (suite 630).

It’s a beautiful building (and also historic, like my current space), and I’m really looking forward to moving into a new, ever-so-slightly larger, space. Added bonus: no current construction!

If you’re coming to see me in September, there’s no change. I’ll still be at 510 SW 3rd Ave #425. However! If you have an appointment in October or later, it will be at my new space.


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Massage Therapy for Veterans

Promoting reintegration of National Guard veterans and their partners using a self-directed program of integrative therapies: a pilot study.

This study reports on a self-directed intervention program for National Guard personnel and their significant relationship partners. The intervention program was a multimedia package: a guided mediation CD and a massage technique DVD, so that the veterans and their partners would do meditation and give each other massages. Significant improvements were seen in PTSD symptoms, depression, and self-compassion for veterans, and in stress symptoms for their partners.

While this was just a pilot study with a small sample size, the finding are encouraging and more research is warranted.

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Oregon Medicaid’s Solution for Chronic Pain

[Originally posted on IHPC Massage]

Image courtesy of Ambro at FreeDigitalPhotos.netWhen the EHB Advisory Committee met earlier this year to discuss what Oregon’s 2017 Benchmark plan should look like, someone brought up the very good point that it should include the benefits found on the Oregon Health Plan (OHP), the state’s Medicaid program.

The reason behind this suggestion was that a huge number of people who will be on the exchange plans are constantly bouncing between OHP and private insurance, depending on their work situation and financial situation on any given month. Thus, having an identical scope of benefits between the two would provide a more-or-less seamless transition whenever the consumer qualified for Medicaid or had to purchase a private plan. If not the exact same providers (since not all providers work with OHP), then at least the same types of providers.

Alas, that was not to be. CAM providers were (yet again) not accounted for in the benchmark plan.

But were CAM providers really in a better position on OHP plans? Funny you should ask. In fact, back in March, the Health Evidence Review Commission (HERC), released a paper that suggested OHP take a very different approach:

Until now, the OHP has limited [back condition] treatment to patients who have muscle weakness or other signs of nerve damage. Beginning in 2016, treatments will be available for all back conditions. Before treatment begins, providers will assess patients to determine their level of risk for chronic back pain, and whether they meet criteria for a surgical consultation. Based on the results, one or more of the following covered treatments may be appropriate:

  • Acupuncture
  • Chiropractic manipulation
  • Cognitive behavioral therapy (a form of talk therapy)
  • Medications (including short-term opiate drugs, but not long-term prescriptions)
  • Office visits
  • Osteopathic manipulation
  • Physical and occupational therapy
  • Surgery (only for a limited number of conditions where evidence shows surgery is more effective than other treatment options)

In addition, yoga, intensive rehabilitation, massage, and/or supervised exercise therapy are recommended to be included in the comprehensive treatment plans. These services, which also have evidence of effectiveness, will be provided where available as determined by each Coordinated Care Organization (CCO). [emphasis mine]

Massage! Yoga! Manipulations! I love it. It feels like the people in charge are finally trying to figure out what actually helps reduce or manage chronic pain. This is a great development, and it has the power to change a lot of lives.

How do we solve the problem of chronic pain? For so long, the answer has been prescription medication. Hydrocodonebtibu75200However, as I wrote about earlier, many people and organizations are starting to realize that these medications have drawbacks and limitations. Indeed, one of the reasons alternative care has taken hold in this country recently is because of the need to find another way to treat chronic pain.

Having options is nice, but it’s a luxury that people with limited means can barely afford. When your health insurance covers prescription medicine but not alternative care treatments, what can you do? In such cases, the choice between painkillers and CAM isn’t really a choice.

And the long-term use of painkillers can become a problem. As illustrated in this article, “In 2012, more than 900,000 Oregonians received an opioid prescription…About one third of hospitalizations related to drug abuse here are due to opioids.” Indeed, the HERC document points out that, “OHP has spent a great deal of public money on treatments such as surgery and medications, without good evidence that they improve patient’s lives. At the same time, narcotics also carry risks of dependency, misuse and overdose.”

Starting in January, OHP patients will have a real choice in how they want to manage their chronic back pain.

The weird tangent to all of this, however, is that Oregon’s Medicaid will soon have a wider scope of provider types and covered services than most of the plans on Oregon’s Exchange. Even in private plans that do cover certain CAM services, the insurance companies will still be allowed to discriminate against providers until 2017. Whereas, if a provider wanted to work with a Medicaid patient, he or she would only have to talk to the patient’s CCO to make it happen. It seems to me that the state is actually invested in making people’s lives better, while the insurance companies are focused only on the short-term gains.

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Massage for Good Health

freedigitalphotos.net

5 Ways Massage Can Improve Your Health

This link is pretty straightforward, but lists like this are especially nice to share with friends and family who don’t think much about the benefits of massage. Feel free to pass it on!

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Trigger Point Article

From AMTA: Massage + Trigger Points

You know, of course, that I love writing my own blog posts about Trigger Points and Trigger Point Massage, but I also love it when other people write about them! Check out this very informative article on the AMTA website about trigger points and how massage can help alleviate them.

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Under Construction

My building – The Postal Building – is currently under quite a bit of construction.

What’s going on? On the first floor (lobby), they’re adding a room for bike storage, as well as bathrooms/showers. On the other floors, they’re replacing the railings and updating the bathrooms.

Construction is expected to last through October. It isn’t very noisy day-to-day, thankfully, and hopefully it won’t be too bad as it continues. The worst part was when they put up the scaffolding last week, but that’s already done.

Also – related, although it’s probably a different construction company handling this – Garden Bar is opening another location in the previously empty retail space below. Come for the massage, stay for the salad!

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The Evolution of Alternative Medicine

The Atlantic just published a really great article about how attitudes towards and acceptance of CAM treatments and integrative care has changed over the years.

The article touches on research being done about the placebo effect and the power of one’s own body to heal, something I’ve written about elsewhere. It talks about how modern medicine has evolved since the 1960s to focus more on overall wellness, instead of just acute disease treatment:

The actual treatments they use vary, but what ties integrative doctors together is their focus on chronic disease and their effort to create an abstract condition called wellness. In the process, they’re scrutinizing many therapies that were once considered alternative, subjecting them to the scientific method and then using them the same way they’d incorporate any other evidence-based medicine.

This approach is forcing the entire medical community to grapple with certain questions: How has the role of a doctor changed over the years? Are there better ways to treat the kinds of health problems that can usually only be managed, not cured? And how do you gather evidence on therapies that involve not only the body but also the mind?

The article does a great job discussing chronic pain, both how widespread it is and how difficult it is to treatment with modern medicine. There’s a lot of research being done at NIH and its newly named NCCIH (National Center for Complementary and Integrative Health) about how best to manage pain (eg, how does yoga affect health?), and I can’t wait to read more about their findings.

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Massage Therapy and PT

[Originally posted on IHPC Massage]

Since well before the Affordable Care Act, massage therapists have been struggling for recognition in the medical community. Alternative care in general suffered from a pretty low opinion, but massage was often lower still. So many insurance policies covered chiropractic and acupuncture treatments without covering massage. Somehow the fact that a massage made you “feel good”, as opposed to having your joints forcibly popped or getting needles stuck into your back, disqualified it from being a part of Serious Medical Care.

And so we fought with insurers and lawmakers about how massage should be treated like the CAM service it already was. The professions already went hand-in-hand, with so many massage therapists working in chiropractic offices, and with LMTs, LAcs, LCs, and NDs so often found under the same roof. Complementary and alternative care in general has such a broad variety of uses, and no single modality should be excluded.

Even though I knew that the changes would not happen immediately, when the Affordable Care Act took effect I assumed that before too long massage would gain its proper place alongside other CAM treatments. Alternative care of all kinds for everyone!

What’s happening with more and more insurance plans, however, is that massage is being thrown in an entirely different category than its CAM brethren. Massage is considered by these insurers to be a type of rehabilitative care, akin to physical therapy.

On the one hand, that’s pretty cool. Physical therapy is undeniably a medical treatment. If massage is like PT, that means massage has earned recognition as a medical treatment. Nice!

On the other hand, being a “rehabilitative therapy” instead of a “CAM therapy” means that massage is not as accessible as its companion modalities. In these insurance plans, chiropractic care and acupuncture treatments are available without needing to meet any deductible first, making them perfect for wellness and preventative care. Massage, however, is trapped behind (sometimes unreachable) deductibles, forcing the client to pay out of pocket for treatment or forego treatment entirely.

I get why they’ve done this, I suppose. The code I use to bill for massage (CPT 97140) is identical to one of the codes that physical therapists use. It’s actually considered a PT code by many insurance companies. And since Section 2706 mandates that insurers cover services based on the type of treatment as opposed to the type of practitioner, this is, in a way, less discriminatory.

But it still leaves me with a very bad taste in my mouth. Because by treating massage therapists in this way, insurers have declared that massage has no place in wellness or preventative care. We shouldn’t be giving massages that feel good (and help prevent future issues); we should only give massages that solve immediate problems.

If that’s the case, then where does rehabilitation end and relaxation begin? What a loaded question.

More and more – and this is true for providers in all physical medicine modalities – I have had to justify to insurers why my treatments are medically necessary. I find myself constantly trying to convince insurance companies that my massages are rehabilitative and purposeful even if the treatment has gone on “too long” (their words) and my client should be completely healed by now.

I was denied coverage for a treatment last week because the insurance company didn’t understand why I haven’t fixed all of my client’s muscle problems completely and forever such that he’ll never be in pain ever again. When I say it like that, it’s easy to see why this is foolish.

You know what should define a medical need? A doctor’s referral. If a doctor writes that his or her client needs massages, those massages are – almost by definition – a medical necessity. And yet, in practice, they don’t make a difference. Somehow insurance companies have convinced themselves (and the public) that they know best, even through they’re driven by profit over anything else.

Going back to my original point, I can’t say that I can see a clear resolution for this mess. The two billing codes* that massage therapists use are considered to be physical therapy codes, and therefore subject to physical therapy reimbursement requirements. It’s not just LMTs – if a chiropractor gives a pre-adjustment massage, this is also treated as rehabilitative treatment. The difference, of course, is that a spinal adjustment is a chiropractic code, and covered like a CAM treatment.

Should CPT 97124 and 97140 be considered the domain of LMTs, and covered in the same way that other CAM care is covered? Or maybe physical therapy should be available without a deductible? Some insurance companies already do that, and I’d be interested to see if it makes a difference in spending. If the insurance companies are all about the money, that might be our only chance of getting the point across.

* Depending on the insurer, sometimes both CPT 97140 and 97124 are considered PT codes, and sometimes only 97140 is. In the latter case, 97124 is either not covered at all or reimbursed at a lower rate.

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