2050. Massage as Adjuvant
Therapy in the Management of Acute Postoperative Pain:
A Pilot Study
AR Mitchinson, Ann Arbor VA, MM Piotrowski, Ann Arbor
VA, C Paterson, Ann Arbor VA, HM Kim, University of Michigan, DB
Hinshaw, Ann Arbor VA, University of Michigan
Objectives: Reduction of
pain has become a national priority. Although studies have demonstrated that many patients
experience a substantial degree of unrelieved pain post-operatively and that
this pain can increase the incidence of serious complications, pain management
continues to be suboptimal. Narcotic analgesia is the mainstay of acute
postoperative pain management but patient, clinician, and institutional barriers
often limit their effectiveness. Furthermore, pharmacologic interventions may
not address all the factors involved in the conscious experience of pain. Massage used along with pharmacologic treatments, may improve
acute pain relief.
The primary objective of this
prospective, randomized trial was to test the hypothesis that massage used in
conjunction with narcotic analgesia is more effective than narcotics alone in
the relief of acute postoperative pain.
Methods: VA patients
(N=202) undergoing surgery, between April 2000 and February 2001, involving
either a sternotomy or an abdominal incision >= 8 cm in length were randomly
assigned to three treatment groups: (a) routine care, (b) individualized
attention where a nurse spent dedicated time with the patient twice a day (10
min each) or (c) effleurage massage performed by a nurse twice per day (10 min).
Treatments started 24 hours after surgery and were given mid-morning and
late-afternoon through post-operative day 7. Patients rated pain intensity and
unpleasantness each morning using a Visual Analogue Scale. Narcotic use and
satisfaction with pain management were collected. Random effect growth-curve
models were used in the analysis.
Results: After
controlling for narcotic use, the rate of decline in the unpleasantness of
post-operative pain was accelerated by massage (p=.05). Massage also accelerated
the rate of decline in the intensity of pain but this effect did not achieve
statistical significance. Use of narcotic analgesics was not altered
significantly by the intervention. 77% of patients in the “massage” group
and 64% of patients in the “individualized attention group” felt that
massage helped them with their pain.
Conclusions: This
preliminary study suggests that massage may be a useful adjuvant therapy for
post-operative pain management.
Impact: The VA is committed to improving pain management. Non-pharmacologic treatments that may potentially improve pain, enhance post-operative function, and increase patient satisfaction need further study.