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Facial Effleurage Treatment Increases Serum TNFα Levels in Patients with Acute Rhinosinusitis

Journal: Journal of Osteopathic Medicine Date: 2019/12, 119(12):Pages: e128-e129. doi: Subito , type of study: randomized controlled trial


Keywords:

facial effleurage [2]
immune response [6]
randomized controlled trial [710]
rhinosinusitis [5]
TNF-a [1]

Abstract:

Statement of Significance: Acute rhinosinusitis is a common condition affecting millions of adults annually in the United States, accounting for 21% of all outpatient antibiotic prescriptions. Estimates have been made that rhinosinusitis causes an annual health care expenditure of several billion dollars. The osteopathic manipulative treatment of facial effleurage is a potential alternative treatment that can be used on patients with suspected viral infections, or in conjugation with antibiotics in bacterial infections. Facial effleurage performed on acute rhinosinusitis patients may help relieve symptoms and expedite recovery time. Research Methods: In a parallel-arm, randomized, placebo-controlled clinical trial, patients that presented to 2 outpatient, direct primary care clinics in a mid-sized manufacturing town are asked to participate. Informed consent and enrollment eligibility is confirmed. Participants are then randomly assigned to 1 of the 8 treatment groups: healthy control (HC), HC with physical touch (PT), HC with Facial Effleurage (FE), rhinosinusitis (RS) with antibiotics (Abs), RS with PT, RS with FE, RS with Abs and PT, and RS with Abs and FE. Physical touch is the sham/placebo treatment. Peripheral blood samples are then collected. The treatment is performed and 1 hour after the initiation of facial effleurage serum samples are collected again. Peripheral blood is also collected at a follow-up appointment 7 days after treatment. Serum TNFα levels are then measured via ELISA. Data Analysis: Descriptive statistics were used to determine the mean and SD between groups. ANOVA analyses were used to determine if there are statistical differences in serum TNFα levels between treatment groups. A p-value of 0.05 was used to determine statistical significance. All analyses were performed using GraphPad Prism Software. Results: The difference between sick patients and healthy controls prior to treatment was not statistically significant, but sick patients tend to have higher levels. Patients who received facial effleurage had significantly increased TNFα levels 1 hour after treatment compared with healthy patients, patients that received only antibiotics, and patients that received the sham treatment. On follow-up 7 days after facial effleurage, TNFα is increased in sick patients, although not significantly. Conclusion: TNFα is significantly upregulated in the blood after facial effleurage 1 hour after treatment, and this increase might persist over at least a week after 1 treatment session. This might partly explain the beneficial effects of facial effleurage on patients as TNFα exodus could potentially decrease the swelling and pain the patients experience, as well as ushering in the healing response rather than prolonging the state of inflammation. This would be particularly valuable when the proinflammatory response is no longer warranted. If occurring, patients may clear the infection at a faster rate than those without treatment or those only receiving antibiotics. Through this research there is potential for an improved standard of care for acute rhinosinusitis involving facial effleurage and to decrease the reliance on antibiotics. At this time, more research is necessary to fully understand the complex relationship between FE, serum TNFα, and acute rhinosinusitis infections.


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