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Massage offers quick pain relief for advanced cancer patients: study
Last Updated: Monday, September 15, 2008 | 7:21 PM ET
CBC
News
Massage therapy safely helps to relieve short-term pain in patients with advanced cancer, a trial suggests.
In Tuesday's issue of the Annals of Internal Medicine, researchers looked at pain and mood scores among 340
people with late stage cancer. Participants were randomly assigned to have massage therapy by a registered massage therapist,
or simple touch by someone who placed both hands on the subjects for three minutes at 10 body sites. "When patients near the
end of life, the goals of medical care change from trying to cure disease to making the patient as comfortable as possible,"
said study author Dr. Jean Kutner, a professor in the division of general internal medicine at the University of Colorado
Denver School of Medicine. "This study is important because it shows massage is a safe and effective way to provide immediate
relief to patients with advanced cancer."
Those in the massage group showed a 1.87-point decline in pain scores compared with 0.97 points for the control
group, the researchers found.
"The changes in the massage group were statistically larger than those in the simple-touch group, but all
changes were small. Over time, pain, mood, quality of life, and pain medication use were the same in both groups," the journal's
summary for patients said. While massage offered immediate relief to some patients, the beneficial effects did not last for
three weeks. "Massage may offer some immediate relief for patients with advanced cancer, but the absence of sustained effects
demonstrates the need for more effective strategies to manage pain at the end of life," the journal's editors concluded. Limitations
of the study included that many of the participants did not attend all six of the assigned treatment sessions, and that the
people measuring pain and mood knew who received which treatment, which could skew their interpretation.
It's thought that massage may help improve pain and mood through psychological effects of the therapist's
attention, as well as physical or biological effects, such as decreasing inflammation, increasing circulation and release
of mood-boosting endorphins.
R E S
E A R C H
Massage Reduces Cancer Patients' Pain, Anxiety
A seminal study of massage on cancer patients has
shown that the intervention reduces the level of pain and anxiety these patients experience during treatment for the disease.
The study, conducted over four years at the James Cancer Hospital in Columbus, Ohio, sought empirical evidence
for the efficacy of massage on cancer patients experiencing pain in the course of treatment.
"The research on the use of massage with cancer patients has been minim[al] because massage therapy schools
teach their students that massage is contraindicated with cancer patients," reported Pauline King, a mental health clinical
nurse at the hospital, who led the study.
"We are always probing, sticking and doing other invasive treatments with cancer patients who are often touch
deprived," King continued. "It was felt strongly that the patient needed caring touch as an antidote to the invasive procedures."
The study, which concluded in late 1999, was funded by a $10,000 grant from the AMTA Foundation. Its results
have been widely reported by national media.
For the study, 52 cancer patients receiving treatment at the hospital, which is affiliated with Ohio State
University, were randomly placed into either an experimental group or a control group.
On the first day of the two-day study patients in both groups had a volunteer simply sit with them for 15
minutes, but had no physical contact. On the second day patients in the experimental group received petrissage on the hands,
feet, shoulders and back of the neck for 15 minutes. Patients in the control group again sat with a volunteer for 15 minutes,
but had no physical contact.
Pain and anxiety levels were measured on both days before the intervention, directly following, and again
30 minutes later. Pain levels were measured by a Visual Analogue Scale in which patients rated the severity of their pain
on a scale from 0-10, with 0 equaling no pain and 10 equaling the worst pain possible. Anxiety, which was defined as "tension,
apprehension, nervousness and worry," was measured using the Spilberger STAIT-TRAIT Anxiety Inventory, by which patients rated
their own anxiety levels.
Data analysis showed the massage had a statistically relevant impact on pain and anxiety levels of patients
in the experimental group compared to those in the control group. Overall, patients who received massage showed a .9 difference
(drop) in pain level, versus no change in pain level for those in the control group.
"This study is a seminal study that produced empirical evidence on the efficacy of massage on cancer pain
and anxiety," the report concluded. "More hard data studies are needed in order to bring massage in the medical systems where
it is most needed."
An addendum to the study findings was the positive feedback the researchers received from the hospital's medical
staff, in regard to the massage protocol. "Even before the study was completed, doctors and nurses were consulting the primary
investigator to give their patients a massage," King reported. "The study raised the consciousness of the medical practitioners,
which was another very positive outcome of this study." - Source: Pauline King, Ohio State University.
R E S E A
R C H
Hernandez-Reif, M., Field, T., Krasnegor, J., & Theakston, H. (2001). Lower back pain is
reduced and range of motion increased after massage therapy. International Journal of Neuroscience, 106, 131-145.
METHOD: A randomized between-groups design evaluated massage therapy versus relaxation for chronic low back
pain. Treatment effects were evaluated for reducing pain, depression, anxiety and stress hormones, and sleeplessness and for
improving trunk range of motion associated with chronic low back pain.
RESULTS: By the end of the study, the massage therapy group, as compared to the relaxation group, reported
experiencing less pain, depression, anxiety and improved sleep. They also showed improved trunk and pain flexion performance,
and their serotonin and dopamine levels were higher.
R E S E A R C H
Kalauokalani, D., Cherkin, D.C., Sherman, K.J., Koepsell, T.D., & Deyo, R.A. (2001). Lessons
from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects. Spine, 26, 1418-24.
METHODS: 135 patients with chronic low back pain who received acupuncture or massage were studied. Study participants
were asked to describe their expectations regarding the helpfulness of each treatment on a scale of 0 to 10.
RESULTS: Improved function was observed for 86% of the participants with higher expectations
for the treatment they received, as compared with 68% of those with lower expectations. Patients who expected greater benefit
from massage than from acupuncture were more likely to experience better outcomes with massage than with acupuncture, and
vice versa.
RE S E A R C H
Massage Reduces Cancer Symptoms
Massage therapy significantly improved cancer patients’ symptoms, such
as pain, anxiety, nausea, fatigue and depression, according to a recent study.“Massage Therapy for Symptom Control: Outcome Study at a Major Cancer Center”
was conducted by staff of Memorial Sloan-Kettering Cancer Center (MSKCC) in New York
City.
Three
types of massage are available to patients at MSKCC: Swedish, light-touch and foot massage. Each massage lasts 20 minutes
for inpatients and one hour for outpatients. Patients may request the massage themselves, or be referred by a health professional
or family member. As a “routine part of clinical management,”
patients rate pain, fatigue, anxiety, nausea and depression before and 5-15 minutes after each massage. For this study, the
symptom with the highest score was deemed the presenting symptom.
The study’s authors analyzed before-and-after data from
the initial massage session of 1,290 cancer patients at MSKCC during a three-year period.
Swedish and foot massage were the most common interventions,
with some patients receiving a combination of both. Anxiety was the most common presenting symptom of the cancer patients,
followed by pain and fatigue.
Data analysis revealed a 54-percent mean reduction of the presenting symptom following massage therapy.
Specifically, anxiety was the symptom eased the most by massage therapy (60-percent reduction), and fatigue was the symptom
eased the least (43 percent). Outpatients showed a 10-percent greater improvement in symptoms when compared to inpatients,
perhaps due to the longer massage sessions the outpatients received.
It is clear that massage therapy achieves major reductions in
cancer patients’ pain, fatigue, nausea, anxiety and depression,” state the study’s authors.
Additional follow-up, beyond immediate post-session scores,
involved 74 outpatients and 237 inpatients. Both inpatients and outpatients were assessed two-to-five hours after the massage.
Outpatients were again assessed 24 hours and 48 hours after the massage.
Results of this extended follow-up showed that inpatients’
symptoms scores were about a half-point higher within hours of the massage. “This suggests that inpatient severity scores
returned to baseline within a day or so,” state the study’s authors.
For outpatients, there was no regression toward baseline symptom
scores throughout the follow-up period.
“Massage therapy appears to be an uncommonly non-invasive
and inexpensive means of symptom control for patients with serious chronic illness,” state the study’s authors.
“It is non-invasive, inexpensive, comforting, free of side effects and greatly appreciated by recipients.
- Source: Memorial
Sloan-Kettering Cancer Center’s
Integrative Medicine Service and Biostatistics Service, New York City.
Authors: Barrie R. Cassileth, Ph.D.; and Andrew J. Vickers,
Ph.D. Originally published in Journal of Pain and Symptom Management, September 2004, Vol. 28, No. 3, pp. 244-249.
R E S E
A R C H
Massage Improves Mood, Reduces Stress in Spouses of Cancer Patients
A 20-minute
back massage enhanced mood and reduced stress in the spouses of cancer patients, according to recent research. "The Effects of Therapeutic Back Massage
on Psychophysiologic Variables and Immune Function in Spouses of Patients With Cancer" was conducted by staff at the Duquesne
University School of Nursing in Pittsburgh, Pennsylvania.
Forty-two spouses, male and female, of patients with cancer
participated in the study. They were randomly assigned to either the massage group or the control group.
Spouses in the massage group received one 20-minute back massage,
consisting of long, slow strokes that produced a "sedative-like effect" on the subject.
Spouses in the control group read from an emotionally neutral
book for 20 minutes. They each received a back massage after the study ended.
Outcome variables were mood, perceived stress, heart rate, systolic
and diastolic blood pressure, and natural-killer-cell activity. Natural killer cells are effective against virus-infected
cells.
The outcomes were measured at three different time points: before
the back massage or reading session, immediately after the back massage or reading session, and 20 minutes after the back
massage or reading session.
Mood was evaluated on the Profile of Mood States. Stress was measured on the Visual Analogue Scale.
Natural-killer-cell activity was analyzed by blood draws.
Immediately following the massage, and 20 minutes thereafter,
spouses in the massage group showed a significant decrease in total mood disturbance on the Profile of Mood States and a significant
decrease in perceived stress on the Visual Analogue Scale.
No significant changes were found for heart rate, systolic and
diastolic blood pressure, or natural-killer-cell activity.
"It may be necessary to administer massage over several weeks
to see an increase in [natural-killer-cell activity] because relaxation-induced immune function change is more than likely
dependent on regular practice," states the study's author.
However, a correlation was made between mood and natural-killer-cell
activity. Spouses with a high score for negative mood on the Profile of Mood States had lower levels of natural-killer-cell
activity. Spouses with a lower score for negative mood had higher levels of natural-killer-cell activity. This revealed a
significant inverse relationship between mood and natural-killer-cell activity.
"This research suggests that [therapeutic back massage] may
benefit spouses of patients with cancer by enhancing positive mood and reducing perceived stress," states the study's author.
"Thus, [therapeutic back massage] may help spouses face the challenge of living with and caring for an ill partner with cancer."
- Source: Duquesne University
School of Nursing in Pittsburgh,
Pennsylvania. Author: Linda M. Goodfellow, Ph.D., R.N. Originally published in
Nursing Research, September/October 2003, Vol. 52, No. 5, pp. 318-328.
R E S E
A R C H
Massage and Healing Touch Ease Cancer
Symptoms
"The pivotal finding in this study was
the increase in natural-killer cell numbers for theMassage therapy and healing touch reduced pain, mood disturbance (anger,
anxiety, depression, confusion) and fatigue in cancer patients undergoing chemotherapy, according to a recent study.
"Therapeutic
Massage and Healing Touch Improve Symptoms in Cancer" was conducted by staff at the University
of Minnesota in Minneapolis, and United Hospital Department
of Integrative Health in St. Paul, Minnesota.
Eighty-seven
percent of the 164 subjects in the study were women. More than half of them had breast cancer; other types of cancers prevalent
in the study were gynecological or genitourinary cancer, gastro-intestinal cancer and lung cancer, among others.
Subjects
were randomly assigned to one of three groups: massage therapy, healing touch or caring presence. They received 45 minutes
of the assigned intervention per week for four weeks. All participants also received four weeks of standard cancer care alone,
which was the control condition.
In the
massage group, a standard Swedish massage was given, with modifications for tumor or surgical sites, as well as individual
tolerance.
In the healing-touch group, a protocol developed by Healing Touch International was used, involving
both touch and non-touch techniques, such as centering, unruffling, magnetic unruffling, full-body connection and mind clearing.
Subjects
in the caring-presence group laid on the massage table for 45 minutes and listened to the same relaxing music played during
the massage and healing-touch sessions, while one of the massage or healing-touch therapists was present.
Immediate
outcomes, measured before and after each intervention session, or once per control session, were heart rate, respiratory rate,
blood pressure, and self-reports of pain and nausea.
Outcomes
evaluated at the beginning and end of each four-week period were anxiety, mood, fatigue, pain, nausea, use of analgesics and
antiemetics, and overall satisfaction with care.
Both
massage therapy and healing touch reduced blood pressure, respiratory rate, heart rate, total mood disturbance and pain. Subjects
in the healing-touch group also had lower fatigue, while subjects in the massage group had lower anxiety and used less nonsteroidal
anti-inflammatory drugs (NSAIDs).
Caring
presence was found to reduce respiratory rate and heart rate, but did not differ from standard care on any other outcomes.
"[Massage
therapy] and [healing touch] were more effective than presence alone or standard care in inducing physical relaxation, reducing
pain, improving mood states and fatigue," state the study's authors. "These results clearly suggest a benefit to both massage
and [healing touch] that goes beyond the mere presence of a caring practitioner."
-
Source: University of Minnesota in Minneapolis
and United Hospital Department of Integrative Health in St. Paul, Minnesota. Authors: Janice Post-White, R.N., Ph.D.; Mary Ellen Kinney, R.N.; Kay Savik;
Joanna Bernsten Gau, R.N.; Carol Wilcox, R.N.; and Irving Lerner, M.D. Originally published in Integrative Cancer Therapies,
2003, Vol. 2, No. 4, pp. 332-344.
R E S E A R C H
Massage
Versus Relaxation for Breast Cancer
Women with breast cancer
who received massage therapy showed a significant increase in both beneficial natural-killer cells and dopamine levels, and
a significant decrease in long-term anxiety, as compared to women who received relaxation therapy, according to a recent study.
"Breast Cancer Women
Experience Increased Natural Killer Cells Following Massage Therapy" was conducted by staff at the Touch Research Institutes.
Fifty-eight women diagnosed
within the last three years with early-stage breast cancer, at least three months post-surgery and finished with radiation
and chemotherapy, were randomly assigned to either a massage-therapy group, a relaxation-therapy group or a standard-treatment
control group.
Relaxation therapy was used to discover whether massage benefits
women with breast cancer simply because it’s relaxing, or if it is the massage itself that produces positive effects.
Women assigned to the massage-therapy group received three 30-minute
massages per week for five weeks. Women in the relaxation group self-administered three 30-minute progressive-muscle-relaxation
sessions per week for five weeks. Women in the control group received standard breast-cancer treatment.
On the first and last days of the study, the women were evaluated
for both immediate and long-term effects of the sessions on depression, anger, anxiety, vigor and pain. The Profile of Mood
States, the Symptom Checklist 90 Revised (SCL-90R) Depression Subscale and the State Anxiety Inventory were used to assess
these items. Pain was evaluated with the Short-form McGill Pain Questionnaire.
Urine and blood samples were taken at the beginning and end of the study to measure dopamine and natural-killer-cell
levels. Natural-killer cells are known to be effective against virus-infected cells and various types of tumor cells.
Results of the study showed that both the massage and relaxation
groups had lower levels of depression, anxiety and pain immediately after the sessions, as compared to the standard-treatment
control group. However, it was only women in the massage group who experienced a long-term reduction in anxiety. It was also the massage-therapy group alone
that showed a significant increase in dopamine and natural-killer-cell levels from the first to last day of the study.
women with breast cancer who received massage therapy," state the study’s
authors. "Their clinical condition would be expected to improve inasmuch as natural-killer cells are noted to destroy tumor
cells." Source:
The Touch Research Institutes, with support from BIOTONE and the U.S.
Department of Defense. Authors: Maria Hernandez-Reif, Ph.D.; Tiffany Field, Ph.D.; Gail Ironson, M.D.; Julia Beutler; Yanexy
Vera; Judith Hurley, M.D.; Mary Ann Fletcher, Ph.D.; Saul Schanberg, M.D., Ph.D.; and Cynthia Kuhn, Ph.D.
R E S E A R C H
Massage
Benefits Women with Breast Cancer
Massage therapy reduced depression, anxiety and anger in women with breast cancer, and
increased their levels of dopamine, serotonin, natural killer cells and lymphocytes, according to recent research.
"Breast cancer patients have improved immune and neuroendocrine functions following massage therapy"
was conducted by the Touch Research Institutes, Department of Pediatrics, Hematology/Oncology Clinics, Sylvester Comprehensive Cancer
Center and Department of Medicine at the University of Miami School of
Medicine.
Thirty-four women with Stage 1 or 2 breast cancer were randomly assigned to either a massage-therapy
group or a standard-treatment control group. Each participant had completed radiation or chemotherapy treatment at least three
months before the study started.
Women in the massage-therapy group received three 30-minute massages per week for five weeks. The
massage involved stroking, squeezing and stretching techniques on the head, arms, legs, feet and back. Women in the control
group received standard treatment only, with the option to receive massage after the study.
The State Trait Anxiety Inventory, Profile of Mood States and the Symptom Checklist-90-R were used
to evaluate participants’ anxiety and mood at the beginning and end of the study period.
Urine samples were taken from the women on the first and last days of the study, and their blood was
drawn.
Results of the urine tests showed that serotonin and dopamine levels for the massage group increased,
and the blood tests showed that there was a significant increase in their natural killer (NK) cell numbers and lymphocytes.
"NK cells spontaneously destroy a wide variety of cancer and virus-infected cells and are involved
in eliminating metastases," state the study’s authors. "Lymphocytes are precursor cells of immunological function as
well as regulators and effectors of immunity."
Results of the questionnaires showed that women in the massage-therapy group had reduced anxiety,
depression, anger and hostility.
"In the current study, massage therapy was found to be a safe treatment, as no adverse effects were
reported, and massage was found to positively impact the psychology, immunology, and biochemistry of women with breast cancer,"
state the study’s authors.
"In summary, the self-reports of reduced stress, anxiety, anger/hostility, and improved mood, and
the corroborating findings of increased dopamine and serotonin levels and increased NK cell number (the primary outcome measure)
and lymphocytes suggest that massage therapy has positive applications for breast cancer survivors."
- Source: The Touch Research Institutes, Department
of Pediatrics, Hematology/Oncology Clinics, Sylvester Comprehensive
Cancer Center and Department of Medicine
at the University of Miami School of Medicine. Authors: Maria Hernandez-Reif,
Ph.D., Gail Ironson, M.D., Tiffany Field, Ph.D., Judith Hurley, M.D., Galia Katz, Miguel Diego, Sharlene Weiss, Ph.D., Mary
Ann Fletcher, Ph.D., Saul Schanberg, M.D., Ph.D., and Cynthia Kuhn, Ph.D. Originally published in the Journal of Psychosomatic Research.
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