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.