The Use of Massage

for Cancer Pain

Management
Miriam Cardenas
Azusa Pacific University
GNRS 507: Scientific Writing
Intro/ Background
In the oncology population:
Pain is the most common subjective finding
Poorly managed in 80% of oncology patients
Pharmacological interventions (Western medicine)
Many adverse effects
Massage therapy is a non-pharmacological intervention shown to decrease sensation of pain,
anxiety, and symptoms of distress
PICOT Question
In hospitalized patients with metastatic cancer, does incorporating a massage
therapy intervention compared to no massage result in decreased pain scores
using a 0-10 pain level scale?
Key Points in Literature Review
Methodology and Research
Studies taken from 2007-2017
Studies used variations of back and/or foot soft tissue massages
Participants received 15 to 45 minutes of massage per session
Tools for measurement:
Visual Analogue Scale, Brief Pain Inventory, 5-point Likert-type scale, and short-form
McGill Pain Questionnaire

Sampling
Adults (20-86 years old)
Patients with metastatic cancer
Key Points in Lit. Review Cont.
Key Findings
All studies showed that massage therapy was effective for pain management
Decreased pain levels after massage and compared to the control groups
4/6 studies showed statistically significant values to support short-term benefits
2/6 studies examined long-term benefits
Showed improvement in pain levels compared to no massage group
One study showed significant decrease in pain over time with massage

Limitations
Lack of current RCTs and single experiments
Several meta-analysis and literature reviews
Lack of consistencies in defining type and location of massage
Hierarchy of Evidence
1- Level I systematic review of RCTs
3- Level II single RCTs
1- Level III quasi-experimental and
cross-sectional study
1- Level III evidence-based
descriptive, correlational pilot study
Clinical Implications
Three part program:
Part 1- Train massage therapist
Part 2- Educate patients about complementary therapy options
Part 3- Administration of the massage and data collection
Sampling inclusions:
Adults (18 to 70 years old)
In-hospital treatment
Diagnosed with metastatic cancer
Medically stable to receive massage
Massage intervention and outcome measurements:
30 to 45 minute massage session
Administered by licensed massage therapist
Given 3 to 5 days/ week for the length of the patients hospital stay
Measurement tools: The Brief Pain Inventory and McGill Pain Questionnaire
Post-intervention pain levels compared to baseline pain level
Potential Barriers
Financial expenses
Cost of massage therapy (licensed massage therapist)
Educating massage therapist on technique
Insurance coverage for massage therapy

Staff compliance
Making referrals/requests for massage
Informing patients about massage intervention
Patient compliance
Consenting to massage therapy
Ethical Considerations
Non-maleficence (to minimize harm or risk for harm)
Specific inclusions and exclusions for patient group
In studies, no major health disparities or harm that resulted
Excluded: infants and elderly, pre-existing contraindicated health conditions

Beneficence (to do good)

Research supports that massage therapy improves symptoms of pain,
fatigue, anxiety, nausea, and satisfaction.
Expected Outcomes/ How Measured
Expected Outcomes:
Expected trends towards improved pain after massage intervention

How Measured: (Using measure tool in the Dalton et al. 2007 study)
The Brief Pain Inventory (0-10 pain level scale)
Short-Form McGill Pain Questionnaire
Conclusion
According to research, massage therapy shown to:

Reduce pain in patients with metastatic cancer who are receiving cancer
treatment.
Be most effective as a complementary therapy to pharmacological
interventions (Not a substitute)
Improve patient quality of life (Decreased levels of pain, fatigue, nausea, and
satisfaction)
References
Aghabati, N., Esmaiel, Z.P., & Mohammadi, E. (2008). The effect of therapeutic touch on pain and fatigue of cancer patients undergoing

chemotherapy. eCAM, 7(3). Doi: 10.1093/ecam/nen006.

Beauchamp, T. L. & Childress, J. F. (2009). Principles of biomedical ethics (7th ed.). New York, NY: Oxford University Press.

Boyd, C., Crawford, C., Paat, C. F., Price, A., Xenakis, L., Yang, E., & Zhang, W. (2016). The impact of massage therapy on function in pain

population-a systemic review and meta-analysis of randomized controlled trials: part I, patients experiencing pain in the general population. Pain

Medicine, 17, 1353-1375. Doi: 10.1093/pm/pnw099

Dalton, J., Engelke, M., Keefe, F.J., Stephenson, N.L., & Swanson, M. (2007). Partner-delivered reflexology: effects on cancer pain and anxiety.

Oncology Nursing Forum, 34(1), 127-132. Doi: 10.1188/07.ONF.127-132.

Davis, R.B., Kahn, J.R., Marcantonio, E.R., Phillips, R.S., Toth, M., & Walton, T. (2013). Massage therapy for patients with metastatic cancer: a

pilot randomized controlled trial. The Journal of Alternative and Complementary Medicine, 10, 650-656. Doi: 10.1089/acm.2012.0466.

Ferrell, B. R., Ferrell, B. A., Grant, M. M., & Rhiner, M. (1993). A structured nondrug intervention program for cancer pain. Cancer Practice 1(2).

137-143. Retrieved from http://prc.coh.org/pdf/NondrugIntv.pdf.

References Cont.
Karagozoglu, S. & Kahve, E. (2013). Effects of back massage on chemotherapy- related fatigue and anxiety: supportive care and therapeutic touch in

cancer nursing. Applied Nursing Research, 23, 210-217. Retrieved from http://dx.doi.org/10.1016/j.apnr.2013.07.002.

Kramlich, D. (2017). Complementary health practitioners in the acute and critical care setting: nursing considerations. Critical Care Nurse, 37, 60-

65. Doi: https://doi.org/10.4037/ccn2017181

Polubinski, J. P. & West, L. (2005). Implementation of a massage therapy program in the home hospice setting. Journal of Pain and Symptom

Management, 30(1), 104-106.

Robison, J.G., & Smith, C.L. (2016). Therapeutic massage during chemotherapy and/or

biotherapy infusions: pain perceptions of pain, fatigue, nausea, anxiety, and satisfaction. Clinical Journal of Oncology Nursing, 20, 34-40. Doi:

10.1188/16.CJON.E34-E40
Questions?