Massage Therapy versus Simple Touch to Improve Pain and Mood in Patients with Advanced Cancer

A Randomized Trial

16 September 2008 | Volume 149 Issue 6 | Pages 369-379

Background: Small studies of variable quality suggest that massage therapy may relieve pain and other symptoms.

Objective: To evaluate the efficacy of massage for decreasing pain and symptom distress and improving quality of life among persons with advanced cancer.

Design: Multisite, randomized clinical trial.

Setting: Population-based Palliative Care Research Network.

Patients: 380 adults with advanced cancer who were experiencing moderate-to-severe pain; 90% were enrolled in hospice.

Intervention: Six 30-minute massage or simple-touch sessions over 2 weeks.

Measurements: Primary outcomes were immediate (Memorial Pain Assessment Card, 0- to 10-point scale) and sustained (Brief Pain Inventory [BPI], 0- to 10-point scale) change in pain. Secondary outcomes were immediate change in mood (Memorial Pain Assessment Card) and 60-second heart and respiratory rates and sustained change in quality of life (McGill Quality of Life Questionnaire, 0- to 10-point scale), symptom distress (Memorial Symptom Assessment Scale, 0- to 4-point scale), and analgesic medication use (parenteral morphine equivalents [mg/d]). Immediate outcomes were obtained just before and after each treatment session. Sustained outcomes were obtained at baseline and weekly for 3 weeks.

Results: 298 persons were included in the immediate outcome analysis and 348 in the sustained outcome analysis. A total of 82 persons did not receive any allocated study treatments (37 massage patients, 45 control participants). Both groups demonstrated immediate improvement in pain (massage, –1.87 points [95% CI, –2.07 to –1.67 points]; control, –0.97 point [CI, –1.18 to –0.76 points]) and mood (massage, 1.58 points [CI, 1.40 to 1.76 points]; control, 0.97 point [CI, 0.78 to 1.16 points]). Massage was superior for both immediate pain and mood (mean difference, 0.90 and 0.61 points, respectively; P < 0.001). No between-group mean differences occurred over time in sustained pain (BPI mean pain, 0.07 point [CI, –0.23 to 0.37 points]; BPI worst pain, –0.14 point [CI, –0.59 to 0.31 points]), quality of life (McGill Quality of Life Questionnaire overall, 0.08 point [CI, –0.37 to 0.53 points]), symptom distress (Memorial Symptom Assessment Scale global distress index, –0.002 point [CI, –0.12 to 0.12 points]), or analgesic medication use (parenteral morphine equivalents, –0.10 mg/d [CI, –0.25 to 0.05 mg/d]).

Limitations: The immediate outcome measures were obtained by unblinded study therapists, possibly leading to reporting bias and the overestimation of a beneficial effect. The generalizability to all patients with advanced cancer is uncertain. The differential beneficial effect of massage therapy over simple touch is not conclusive without a usual care control group.

Conclusion: Massage may have immediately beneficial effects on pain and mood among patients with advanced cancer. Given the lack of sustained effects and the observed improvements in both study groups, the potential benefits of attention and simple touch should also be considered in this patient population.

Editors' Notes Context Some patients nearing death seek pain relief with massage, but little is known about the effectiveness of massage in managing pain in palliative care settings. Contribution In this randomized trial in 380 patients with advanced cancer, improvement in pain and mood immediately after treatment was greater with massage than with simple touch. Unfortunately, there were no sustained differences in pain, quality of life, or analgesic use during 3 weeks. Adverse effects were infrequent and similar in both groups. Implication 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 Editors

 

Author and Article Information

From the School of Medicine, College of Nursing, and School of Public Health, University of Colorado Denver, Denver and Aurora, Colorado, and Florida Atlantic University, Boca Raton, Florida.

Acknowledgment: The authors thank the on-site study teams, staff, patients and families at the study sites: Catholic Hospice, Miami, Florida; Circle of Life Hospice & Palliative Care, Springdale, Arkansas; Hope Hospice and Community Services, Fort Myers, Florida; HospiceCare in the Berkshires, Pittsfield, Massachusetts; Hospice & Palliative CareCenter, Winston-Salem, North Carolina; Hospice & Palliative Care of Cape Cod, Cape Cod, Massachusetts; Hospice & Palliative Care of the Charlotte Region, Charlotte, North Carolina; Hospice of Saint John, Lakewood, Colorado; Hospice Partners, Hillside, Illinois; LifePath Hospice, Tampa, Florida; Midwest Palliative & Hospice CareCenter, Glenview, Illinois; Pikes Peak Hospice, Colorado Springs, Colorado; San Diego Hospice, San Diego, California; The Denver Hospice, Pathways Program, Denver, Colorado; The Washington Home, Washington, DC; and the University of Colorado Cancer Center, Aurora, Colorado.

Grant Support: By the National Institutes of Health and National Center for Complementary and Alternative Medicine (1R01AT01006-01A2), Mendel/Asarch Lung Cancer Family Foundation Grants Program, Paul Beeson Physician Faculty Scholars in Aging Research Award, and Robert Wood Johnson Generalist Physician Faculty Scholars Program (Dr. Kutner).

Potential Financial Conflicts of Interest: None disclosed.

Reproducible Research Statement: Study protocol and data set: Available from Dr. Kutner (e-mail, jean.kutner{at}ucdenver.edu). Massage and simple touch protocols are available online at http://www.annals.org (Appendix). Statistical code: Available from Dr. Fairclough (e-mail, diane.fairclough{at}ucdenver.edu).

Requests for Single Reprints: Jean S. Kutner, MD, MSPH, Division of General Internal Medicine, B180, University of Colorado Denver School of Medicine, PO Box 6511, Academic Office 1, Aurora, CO 80045; e-mail, jean.kutner{at}ucdenver.edu.

Current Author Addresses: Dr. Kutner, Ms. Mellis, Ms. Felton, and Ms. Yamashita: Division of General Internal Medicine, University of Colorado Denver School of Medicine, Mail Stop B180, PO Box 6511, Aurora, CO 80045.

Dr. Smith: Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431.

Dr. Corbin: Division of General Internal Medicine, University of Colorado Denver School of Medicine, Mail Stop F743, PO Box 6510, Aurora, CO 80045.

Ms. Hemphill: 10061 East Mexico Avenue, Denver, CO 80247.

Ms. Benton, Ms. Beaty, and Dr. Fairclough: Colorado Health Outcomes Program, University of Colorado Denver School of Medicine, Mail Stop F443, PO Box 6508, Aurora, CO 80045.

Dr. Bryant: University of Colorado Denver School of Public Health, 4200 East 9th Avenue, Box C245, Denver, CO 80262.

Author Contributions: Conception and design: J.S. Kutner, M.C. Smith, L. Corbin, L. Hemphill, D.L. Fairclough.

Analysis and interpretation of the data: J.S. Kutner, M.C. Smith, L. Corbin, K. Benton, B. Beaty, T.E. Yamashita, L.L. Bryant, D.L. Fairclough.

Drafting of the article: J.S. Kutner, M.C. Smith, L. Corbin, L. Hemphill, K. Benton, D.L. Fairclough.

Critical revision of the article for important intellectual content: J.S. Kutner, M.C. Smith, L. Corbin, K. Benton, B.K. Mellis, B. Beaty, T.E. Yamashita, L.L. Bryant.

Final approval of the article: J.S. Kutner, M.C. Smith, L. Corbin, K. Benton, L.L. Bryant, D.L. Fairclough.

Provision of study materials or patients: B.K. Mellis.

Statistical expertise: K. Benton, D.L. Fairclough.

Obtaining of funding: J.S. Kutner, M.C. Smith.

Administrative, technical, or logistic support: M.C. Smith, B.K. Mellis, S. Felton, T.E. Yamashita.

Collection and assembly of data: J.S. Kutner, M.C. Smith, L. Hemphill, K. Benton, B.K. Mellis, S. Felton, T.E. Yamashita.

ClinicalTrials.gov registration number: NCT00065195.

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Massage Therapy improves pain and mood in advanced cancer

mark k chelmowski

Annals Online, 18 Nov 2008 [Full text]