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IIR 01-197 – HSR&D Study

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IIR 01-197
Acute Post-Operative Pain Management Using Massage As Adjuvant Therapy
Daniel B. Hinshaw MD
VA Ann Arbor Healthcare System, Ann Arbor, MI
Ann Arbor, MI
Funding Period: September 2002 - November 2005

BACKGROUND/RATIONALE:
Postoperative pain is often undertreated. Although studies have demonstrated that many patients experience a substantial degree of unrelieved pain following operative procedures and that this pain can increase the incidence of serious complications, the management of discomfort continues to be suboptimal. Narcotic analgesia is the mainstay of acute postoperative pain management but patient, clinician, and institutional barriers often limit the effectiveness of drug treatment. Furthermore, pharmacologic interventions alone may not address all the factors involved in the conscious experience of pain. Massage is a complementary or adjunctive medical technique that has been used for thousands of years. Yet there is scant research related to the use of massage therapy in postoperative pain management. Used in tandem with pharmacologic treatments, massage may have the potential to substantially improve acute pain relief.

OBJECTIVE(S):
The proposed research will test the hypotheses that: 1) perceived post-operative pain and anxiety decrease over time (5 days) more rapidly in the massage group compared with the focused attention and routine care groups; 2) perceived post-operative pain and anxiety are immediately reduced in the massage group compared with the focused attention and routine care groups. (differences in pre/post daily scores); 3) post-operative complication rate is reduced and function is improved by the adjuvant use of massage compared to the control groups; 4) the adjuvant use of massage reduces postoperative length of stay and cost of care; and 5) patient satisfaction with postoperative pain relief is enhanced by the adjuvant use of massage.

METHODS:
The study is a prospective, randomized clinical trial conducted at the Ann Arbor and Indianapolis VA medical centers. Patients undergoing operative procedures involving either a sternotomy or an abdominal incision at least 8 cm in length will be randomly assigned to one of three parallel treatment groups: 1) routine postoperative care, 2) focused attention where a massage therapist spends dedicated time (but no massage is given) with the patient once a day (20 min) during post-operative days 1 through 5; or 3) effleurage massage (20 min) performed by a massage therapist once per day on post-op days 1 through 5. The anticipated sample size is 582 patients. Postoperatively patients will be asked to rate their intensity of pain, well-being, function (ability to cough, deep breathe, sleep and activity level) daily for up to five days (less if discharged prior to day five). Data will be collected on all aspects of narcotic analgesia use including the name of each drug, dose, route, and time of administration. On day six patients will complete a survey to assess their satisfaction with pain management. Using the Department of Veterans Affairs National Surgical Quality Improvement Program (NSQIP) format, data will be collected on postoperative complications during the first 30 days after the procedure. Other factors relevant to the veteran population that may affect pain control will be assessed in relationship to pain management.

FINDINGS/RESULTS:
This randomized controlled clinical trial was conducted between Feb, 2003 and January, 2005 in Department of Veterans Affairs (DVA) medical centers in Ann Arbor, Michigan and Indianapolis, Indiana. Patients were 605 veterans with a mean age of 64 who underwent major thoracic or abdominal surgery

Compared with the control group, patients in the massage group experienced short term (pre- vs. post-intervention) decreases in pain intensity (p=0.001), pain unpleasantness (p<0.001) and anxiety (p=0.007). In addition, patients in the massage group experienced a faster rate of decrease in pain intensity (p=0.02) and unpleasantness (p=0.01) over the first four post-operative days (long-term) compared with the control group. There were no differences in rate of decrease in long term anxiety, length of stay, opiate use and post-operative complications across the three intervention groups.

IMPACT:
Although pharmacologic agents have the ability to effectively limit pain, acute postoperative pain is often poorly managed with analgesic drugs alone. Massage is an effective and safe adjuvant therapy for the relief of acute post-operative pain in patients undergoing major abdominal and thoracic operations.

PUBLICATIONS:
None at this time.


DRA: Health Systems, Acute and Combat-Related Injury
DRE: Epidemiology, Treatment - Observational
Keywords: Complementary & alternative therapy, Education (patient), Education (provider), Pain, Surgery
MeSH Terms: none

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