Friday, September 27, 2002

This presentation is part of : Supporting Pain Management Across the Lifespan

A Test of Foot and Hand Massage to Decrease Pain Among Post-Operative Patients

Hsiao-Lan Wang, RN, MSN and Juanita F Keck, RN, DSN, associate professor. Adult Health, Indiana University School of Nursing, Indianapolis, IN, USA

Objective: Post-operative pain is routinely poorly controlled by pharmaceutical means. Complementary strategies based on sound research findings are needed to aid in post-operative pain relief. Foot and hand massage has the potential to aid in pain relief. The Massage stimulates cutaneous mechanoreceptors that activate large primary afferents. They release GABA and endorphins, which inhibit neurotransmitters discharged from the primary nociceptive neurons and evoke depressive reactions within the receptive field in the pain pathway. As a result, receptor activation of second transmission neurons is blocked preventing nociceptive information from reaching consciousness. The purpose of the study was to investigate whether a 20-minute foot and hand massage (5 minutes to each extremity), an intervention expected to stimulate the inhibitory pain pathway, could produce reductions of pain perception (intensity and distress) and sympathetic responses (heart rate, respiratory rate, and blood pressure) among post-operative patients.

Design: The study utilized a pretest-posttest single group design with participants serving as their own controls. The pain intensity and distress scores in the modified Brief Pain Inventory (mBPI) and the measures of heart rate (HR), respiratory rate (RR), and blood pressure (BP) were obtained before and immediately after the massage intervention.

Population, Sample, Setting, Years: The accessible population included patients who were 20 years old or older who had undergone gastrointestinal, gynecological, head and neck, plastic, or urological surgery and were hospitalized on a 39-bed unit at a large teaching hospital in the Midwest between May 1, 2000 and May 1, 2001. The study was conducted on the first full post-operative day. Patients were excluded if they had damaged tissue or damaged skin on feet or hands from any cause, cardiovascular or respiratory diagnoses, medications to regulate their cardiovascular and the respiratory systems, or PCA for pain management. Patients reported pain even though pain medications had been administered from1 to 4 hours before the intervention. A total of 25 eligible patients were approached, and 18 accepted the invitation to participate in the study.

Intervention and Outcome Variable(s): The intervention was a 20-minute foot and hand massage (5 minutes to each extremity). The foot massage procedure was simulated from massage skills proposed by Joachim (1983). The hand massage procedure was designed by the first author. Pain intensity and distress were measured by 0-10 numerical scales in the Brief Pain Inventory modified for this patient population. Heart rate and blood pressure were detected by a Dinamap 8100 portable monitor. Respiratory rate was quantified by visual inspection of the chest movement.

Findings: The subjects reported a 56% decrease in pain intensity from 4.65 to 2.35 (t=8.154, p<0.001). Pain distress decreased from 4.00 to 1.88 (t=5.683, p<0.001). The sympathetic responses to pain including heart rate and respiratory rate also significantly decreased (p < 0.05), although blood pressure remained unchanged. The subjects experienced moderate pain although they had received pain medications before the intervention, which was reduced by the intervention supporting the effectiveness of the massage to decrease post-operative pain.

Conclusions: Foot and hand massage appears to be an effective, inexpensive, low risk, flexible, and easily applied strategy for pain management.

Implications: The massage skills used in the study can easily be taught to family members or unlicensed personnel in order to relieve nursing time. Subjects in the study have reported moderate pain in the period of 1 to 4 hours after pain medications. Nurses must evaluate patients°¦ pain levels after pharmacological pain treatment in the practice. Foot and hand massage has worked effectively with analgesics. Therefore, this strategy would be a beneficial non-invasive means of pain management for the nurses when their patients°¦ pain is not controlled well by medications.

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