Massage May Help Relieve Acute Postoperative Pain

Laurie Barclay
December 17, 2007 — Massage is an effective adjunct treatment to relieve acute postoperative pain in patients who had major surgery, according to the results of a randomized controlled trial published in the December issue of the Archives of Surgery.
"Adjuvant massage therapy improves pain management and postoperative anxiety among many patients who experience unrelieved postoperative pain," write Allison R. Mitchinson, MPH, NCTMB, from the Veterans Affairs Ann Arbor Healthcare System in Ann Arbor, Michigan, and colleagues. "Pharmacologic interventions alone may not address all of the factors involved in the experience of pain."
From February 1, 2003, through January 31, 2005, 605 veterans undergoing major surgery were randomized to 3 groups: control group receiving routine care, individualized attention from a massage therapist for 20 minutes, or back massage by a massage therapist every evening for up to 5 postoperative days. Mean age was 64 years. The main endpoints were visual analog scale (VAS) scores for short- and long-term (>4 days) pain intensity, pain unpleasantness, and anxiety.
Preintervention vs postintervention effects were greater in the massage group than in the control group for reduced pain intensity (P = .001), pain unpleasantness (P < .001), and anxiety (P = .007). Compared with the control group, patients in the massage group also had a faster rate of decrease in pain intensity (P = .02) and unpleasantness (P = .01) during the first 4 postoperative days.
Rates of decrease in long-term anxiety, length of stay, opiate use, and complications were similar in the 3 groups.
"Massage is an effective and safe adjuvant therapy for the relief of acute postoperative pain in patients undergoing major operations," the authors write. "With proper training, health care providers at the bedside (especially nurses) may now have a powerful nonpharmacologic tool to directly address their patients' pain and anxiety."
Study limitations include virtually all participants being elderly men; potential self-selection bias because patients who did not want to be touched refused to participate; and inability to perform dose-response interventions.
"As health care systems have become more complex and administrative demands on nursing time have increased, the tradition of nurse-administered massage has been largely lost," the authors conclude. "With the recent emphasis on assessing pain as the fifth vital sign tempered by renewed concerns for patient safety, it is time to reintegrate the use of effective and less dangerous approaches to relieve patient distress."
The Department of Veterans Affairs Health Services Research and Development supported this study. The authors have disclosed no relevant financial relationships.
Arch Surg. 2007;142:1158-1167.