SHSSR Diabetes Oral and Non-Insulin Injectable Medication Overview Revision 5.17.2013 References OnlineTM, Pediatric Lexi-Drugs OnlineTM , Hudson, Ohio: Lexi-Comp, Inc.; Facts & Comparisons. Facts & Comparisons Web site. http://online.factsandcomparisons.com.ezproxy.samford.edu/. Clinical Pharmacology Web site. http://cpip.gsm.com.ezproxy.samford.edu/. Pharmacist’s Letter. Drugs
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Original article: applied kinesiology for treatment of women with mastalgiaThe Breast (2001) 10, 15–19# 2001 Harcourt Publishers Ltddoi:10.1054/brst.2000.0176, available online at http://www.idealibrary.com on Applied kinesiology for treatment of women with mastalgia W. M. Gregory,1 S. P. Mills,2 H. H. Hamed1 and I. S. Fentiman11Hedley Atkins Breast Unit, Guy’s Hospital, London, UK; 2Association of Systematic Kinesiology, Surbiton,Surrey, UK S U M M A R Y. To determine whether an applied kinesiology technique was of benefit to women with breast pain,an open pilot study was conducted in which 88 newly presenting women with self-rated moderate or severe mastalgiawere treated by applied kinesiology. This involved a hands-on technique consisting of rubbing a series of ‘lymphaticreflex points’ while touching painful areas of the breasts. The women were predominantly pre-menopausal, andpatients with both cyclical and non-cyclical pain were included in the study. Patients’ self-rated pain scores, bothbefore and immediately after applied kinesiology were compared, together with a further score 2 months later.
Immediately after treatment there was considerable reduction in breast pain in 60% of patients with completeresolution in 18%. At the visit after 2 months, there was a reduction in severity, duration and frequency of pain of50% or more in about 60% of cases (P50.0001). This preliminary study suggests that applied kinesiology may be aneffective treatment for mastalgia, without side-effects and merits testing against standard drug therapies. # 2001Harcourt Publishers Ltd similarities with both chiropractic and acupuncture. Asimple physical technique has been developed, which is Mastalgia, either cyclical or non-cyclical is a common suitable for application to women with breast pain.
problem, which is usually-limiting and often responds to This involves the kinesiologist touching the painful area reassurance that there is no underlying serious pathology.
of the breast with one hand while massaging a series of Nevertheless there is a small proportion of women who points on the outside of the upper leg (from the knee to have pain of such severity that it interferes with their the hip) with the other hand.These points were first personal, sexual and worklife. For this reason some are described by Chapman in the 1930s, and he claimed to given endocrine treatments such as bromocriptine, have correlated these reflex points with specific organs.
danazol and tamoxifen, all of which have been shown in Chapman’s reflex points are found mostly on the torso double-blind placebo-controlled studies to be effective. and legs. Those used to relieve breast pain run along a A wide variety of side-effects has been reported and line in the centre of the outside of the thigh, sometimes these can be of such severity that treatment approximately where the seam would lie on pair of has to be stopped. After cessation of treatment there is trousers. These points may be very tender and the usually relapse of pain, often within 3 months.Dietary kinesiologist usually massages them only briefly at first, factors may also contribute to breast pain and reduction returning to rub more firmly until the tenderness of fat intake has been shown to reduce mastas has diminishes. The massaging is done with a rotary-type the use of evening primrose oil (gamma linolenic action of the fingertips, beginning at the knee and This latter treatment appears to be effective mostly in working up the leg to the hip. Once pain in this area of the breast has reduced the kinesiologist moves on to Applied kinesiology is a multifaceted complimentary touch any other painful areas of the breast. This process medical approach, which has developed recently and has usually takes 20–30 min to complete. Subsequently thepatient can use this technique herself. To test thiskinesiological approach in women with mastalgia, a trial Address correspondence to: I. S. Fentiman, Hedley Atkins Breast Unit,Guy’s Hospital, London SE1 GRT, UK.
was initiated at Guy’s Hospital Breast unit.
participating was 37 years (range 17–64). Of thepatients, 68 were pre-menopausal, two were perimeno- All cases had self-rated moderate or severe mastalgia pausal, six had undergone hysterectomies, and 10 were with no discrete masses on clinical examination. They were aged 20–70 years with either cyclical or non- The patients were seen by just two kinesiologists cyclical breast pain, and with no evidence of malignancy (SPM or WMG). The pain evaluation forms were on mammograms for those aged over 40 years. None handed out by the kinesiologist and the women were receiving any other treatment for mastalgia apart evaluated their pain before and after the treatment.
from mild analgesics, nor had any been treated with Ideally, to avoid bias, it would have been better to have endocrine therapy in the previous 3 months. Three the patients fill out the questionnaires at their leisure, applied kinesiology treatments were given at 1 monthly and post the completed forms directly to the statistician.
intervals and after 2 months a self-assessment form was However, with the before and after evaluations being so close together, this would have been inadvisable. It is a Two assessment forms were used in the study, and difficult task, and prone to error, to evaluate a prior pain that has since changed some time after this change has completed by women at their initial visit and compared pain before and after the first treatment, rated on a0–10 scale. The second form, completed 2 months later,asked patients to rate their pain over this period andconsidered four aspects: severity, frequency, duration The t-test was used to test the significance of thedifference between the before and after pain scores on the first questionnaire, and to test for whether changesin pain score for the four different attributes listed in Between May 1995 and March 1997, 88 sequential the second questionnaire were significant. As a second patients were entered into the study. All were seen in a and more conservative check on these results, a dedicated Mastalgia Clinic and had self-rated moderate non-parametric test was also used. For this test, or severe breast pain. After the initial consultation and observed changes in scores were coded as 0 (no change), examination/tests with the doctor, those women who 1 (improvement) or –1 (deterioration). The Wilcoxon were reassured and no longer appeared worried by their signed rank test was then used to evaluate the pain, were not randomized. The study was explained by probability that there was no overall change (median the surgeon conducting the clinic and if the patient score=0). Correlations were quantified using Spear- agreed to participate, she was treated immediately man’s correlation coefficient. P values 50.05 were taken by the kinesiologist. The mean age of the patients Applied kinesiology for treatment of women patient experienced an increase of pain after appliedkinesiology.
To ensure that the significance of this result is not based merely on the women showing small improve- Of the 88 completed forms, 20 showed that the patient ments, we re-coded one-point improvements as 0 (i.e. no had no pain on the day of the visit and these were change). This still gave a mean improvement of 2.1, and therefore not evaluable when analyzing improvement in a t-statistic of 8.21 (P50.00001). Furthermore, re-coding pain score. One patient had an initial pain score but no 1- and 2-point improvements as 0 gave a mean improve- post-treatment score and was also unevaluable, leaving ment of 1.6, and a t-statistic of 5.64 (P50.00001). Thus 67 evaluable cases. As is shown in after the first the improvements in pain score are still significant, even treatment there was a rapid and highly significant when discounting small improvements.
reduction in pain. The mean improvement in pain was2.3, with a standard error for this mean of 23, and at-statistic of 10.1 (P50.00001). The mean starting value (on a scale of 10) was 4.0, with a standard deviation of3.1. The mean improvement in pain score was 51%. The This evaluation was carried out at 2 months, after three Wilcoxon statistic also gave a highly significant result; applied kinesiology treatments. Patients were asked to W = 1770, P50.00001. There was a 5 50% reduction rate severity, duration, frequency and area of extent of in pain score in 40 out of 67 (60%). There was complete mastalgia. Forty out of 88 women (45%) did not resolution of pain in 18%, no change in 12% and no return for the second evaluation so that results were available for 48 out of 88 women (55%). The showing 550% improvement (x2 [trend] = 6.0, P = 0.01).
There was also some correlation with age – older women worsening of symptoms. There were highly significant were more likely to return for the last two visits reductions in all aspects of breast pain (P50.0001). Of (r = 0.26, P = 0.007); 47% of women under 45 returned those completing the second questionnaire, 18 (37%) for the last two visits compared with 80% of women reported that they carried out the technique themselves on a regular basis, 27 (56%) occasionally, and 3 (6%) As measured by the second questionnaire, improve- ments were still highly significant in all four categories The reasons for patients not returning for follow-up describing degree of response to treatment at the initial could not be determined. One woman cancelled because visit (see There was a correlation between the of complete eradication of pain but others either final pain scores on the second questionnaire and the cancelled without giving a reason or simply did not initial % improvements on the first visit rank correla- turn up. Those who failed to return for the last two visits tions for severity, duration, area of extent and frequency were less likely to have reported improvement after the being respectively 0.42 (P= 0.005), 0.39 (P = 0.009), first treatment. Of those who had complete resolution of 0.25 (P = 0.07) and 0.31 (P = 0.03). None of the pain pain at the first visit, 83% returned for the subsequent scores were correlated with age or menstrual status.
two treatments compared with 57% of those who had Again, as with the first questionnaire the improvements pain relief of between 50% and 99%, and 41% of those were not of a minor degree. For the different categories,namely severity, duration, area, and frequency of pain65%, 58%, 31%, and 69% respectively of women had Change in pain score after first treatment This preliminary study has shown that women treated with an applied kinesiological technique report signifi- cant reduction in mastalgia. Immediately after treatment Changes in pain scores on questionnaire at 2 months after three applied kinesiology treatments Cases with 550% improvement at first visit (n = 11)*Severity Cases with 50–99% improvement at first visit (n = 16)*Severity Cases with 100% improvement at first visit (n = 10)*Severity Cases with no pain at first visit (n = 10)*Severity *One case had a pain score of 8 at their initial visit before kinesiology but no pain score following kinesiology at their first visit and so is notincluded in this breakdown.
Applied kinesiology for treatment of women about 90% had improvement in pain score, with an Applied kinesiology is a relatively new development average reduction of approximately 50%. This pain used by chiropractors, which dates back to 1964.
relief persisted at 2 months. In comparison with other Holistic and eclectic in approach, it embraces concepts forms of treatment, such as danazol, bromocriptine and from other disciplines like nutrition, osteopathy and tamoxifen, this is achieved with no side-effects and it is acupunture. Applied kinesiologists have also used a possible that the benefit may be longer lasting. The whole range of specialized techniques to deal with such technique appeared to be equally effective in women common conditions as physical injuries, backache and with both moderate and severe mastalgia and in no cases neck pain, learning difficulties, constipation, mental stress and emotional problems. This study may pave the Reassurance alone often improves the lot of women way for future trials of applied kinesiology for a variety with breast pain, so it might be argued that the improvements seen were not a result of the kinesiology.
The long-term effects of applied kinesiology were not Two factors suggest that this is not the case. Firstly, the addressed in this study but those cases seen after a women included in this study had relatively intractable longer time of follow-up reported continued benefit.
moderate to severe pain. This group might be expected This study did not compare standard drug treatments to have a limited response to reassurance alone.
for mastalgia with applied kinesiology. The clear and Secondly, in this study, the kinesiology treatment immediate effects of the intervention, together with produced dramatic improvements in a few minutes at evidence of continued relief after 2 months suggests that the first treatment. The women had already seen the this is a contender for a place in the management of doctor, and received whatever reassurance he or she had breast pain. Of course, it is possible that the intervention to offer. They then came to the kinesiologist and may work through a complex placebo mechanism. This documented their pain. After the kinesiology treatment study did not have a control group, and so this cannot they documented their pain again, and in the vast be ruled out, although the rapid improvements in pain majority there were large improvements, including score following treatment suggests that this is not the complete eradication of pain. In addition there was a case. There is a pressing need to carry out a prospective correlation between this intial improvement and the randomized trial, albeit with the proviso that this could overall improvement documented at the second evalua- not be a double-blind study. It may however be possible tion after three treatments. This suggests that the overall to have one control group where a different area of the improvements were related to the intial treatment, body is rubbed, making the treatment effectively blind to namely the kinesiology. These big and immediate improvements were therefore not simply a result ofreassurance.
The current authors are sure, although it is difficult to prove, that the dropouts are a result of many factors 1. Mansel R E, Preece P E, Hughes L E. A double-blind trial of the prolactin inhibitor bromocriptine in benign breast disease. Br J Surg operating in these women. As mentioned in the text, one woman dropped out as a result of her pain having 2. Mansel R E, Wisbey J R, Hughes L E. Controlled trial of the anti- completely resolved, and others may well also have gonadotrophin danazol in painful nodular benign breast disease.
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some women didn’t return because the improvements Double-blind trial of tamoxifen therapy for mastalgia. Lancet 1986; and/or reassurance that they experienced were suffi- 4. Hamed H, Fogelman I, Smith P, Gregory W, Fenitman I S. Effect ciently great that they no longer considered their pain an of a GnRH analogue on bone mass in premenopausal patients with issue. Elderly women were more likely to return for mastalgia. The Breast: 1993; 2: 79–82.
subsequent visits, although the reason for this is 5. Boyd N, McGuire V, Shannon P, Fish E, Lickley L. A randomized trial of low-fat, high carbohydrate diet in patients with cyclical unclear. They may perhaps be more motivated as mastopathy. Lancet 1988; ii: 128–132.
they get older. The negative correlation between 6. Preece P, Hanslip J I, Gilbert L et al. Evening primrose oil (Efamol) returning for their final visit and improvement an initial for mastalgia. In: Horrobin DF. Clinical Uses of Essential FattyAcids. Montreal: Eden Press 1982.
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Title: The effect of immediate feedback: Evaluation of an occupational health web- based intervention tool (ISAT – Interactive Self-Assessment Tool) Liliana Dias, PHD Student KULEUVEN Sofie Taeymans & Yasmin Handaja, ISW Limits Debora Vansteenwegen, PhD KULeuven and ISW Limits Theoretical background: Given the increasing interest in positive occupational health interventions in th