Using massage and music therapy to improve postoperative outcomes

AORN Journal, Sept, 2003 by Laura D. McRee, Stacie Noble, Alice Pasvogel

Whether surgery is emergent or elective, the experience causes patient anxiety, which can be detrimental to surgical outcomes. (1) The anticipation of pain may cause increased anxiety, and, in turn, anxiety and pain cause an increase in levels of circulating catecholamines, adrenocorticotrophic hormone, growth hormone, prolactin, antidiuretic hormone, aldosterone, cortisol, glucagon, prostaglandins, and free fatty acids. (2) An increase in stress hormones and resulting metabolic responses can lead to a variety of morbid events, including myocardial and other organ ischemia, dysrhythmia, hypercoagulability, malnutrition, fluid and electrolyte imbalance, decreased wound healing, and immunocompromise. (2) Anxiety increases oxygen consumption, cardiac output, and blood pressure. (3) Furthermore, anxiety and stress can increase the need for higher doses of anesthetics and sedatives during surgical procedures, resulting in a potentially negative effect on a patient's recovery. (3) Fear of pain is a significant fear ranked second only to fear of death; (4) therefore, it is important for surgical teams to be aware of interventions that could decrease anxiety and pain.

LITERATURE REVIEW

This study was designed to determine whether massage and music therapy could decrease anxiety, resulting in positive outcomes related to cardiovascular hemostasis and decreased pain for patients. A variety of studies related to the effects of massage or music therapy on patients' anxiety have been conducted.

MASSAGE THERAPY. Massage is the art of touch and manipulation of soft tissue to achieve therapeutic results, including mental relaxation, comfort, and healing. (5) Massage has been considered a therapeutic intervention for thousands of years. There is evidence of the use and value of therapeutic massage in China more than 5,000 years ago. (6) A person's tactile needs do not change with health or aging; however, patients who are acutely ill or undergoing surgery seldom are touched other than when they are receiving necessary care. (5) Caring touch, compared to technical or mechanical touch, is an important method of communication. (7)

There are a number of theories about the mechanisms for massage's therapeutic effects on psychological and physical status. Most simply, massage nay relieve pain through muscle relaxation and the release of enkephalins. (6,8)

The gate control theory of pain also has been used to explain the effectiveness of massage in pain control. (6) According to this theory, tactile information from massage is carried on the large myelinated fibers, which may close the neurological "pain gate" at the peripheral point, thus reducing the perception of pain.

Two other mechanisms for pain relief through massage have been identified:

* soft tissue manipulation improves circulation, which reduces pain caused by the accumulation of irritants, including lactic acid and inflammatory substances; and

* the emotional contact of caring touch may induce a sense of well-being that would diminish the perception of pain. (9)

Results of previous studies have demonstrated therapeutic benefits of massage in a variety of circumstances, especially in terms of decreased anxiety, decreased stress response, and less pain. In a study of the effects of massage on 122 patients admitted to an intensive care unit (ICU), participants were assigned randomly to receive massage, aromatherapy and massage, or a period of rest. (10) Preintervention and postintervention assessments included physiological stress indicators and patients' evaluations of their anxiety level, mood, and ability to cope with the intensive care experience. No significant differences were reported in the physiological stress indicators, which included systolic and diastolic blood pressure, heart rate and rhythm, and respiratory rate. The group that received massage and aromatherapy, however, demonstrated significant improvements in mood and reported decreased anxiety after therapy.

One study evaluated the effects of massage on anxiety among older adult, institutionalized patients. (11) Participants were assigned randomly to a group that received a five-minute back massage and engaged in conversation with the massage therapist, a group that participated in a five-minute conversation only, or a group that received no interventions. Anxiety was measured using the Spielberger State-Trait Anxiety Inventory (STAI) before and after interventions and at two points in time for the group that received no interventions. The study was conducted during four consecutive days. Mean anxiety scores indicated that anxiety levels were significantly lower for the group that received massage compared to the group that received no interventions.

One group of researchers studied the effects of massage on 28 patients in a hospital burn unit. (12) Patients were assigned randomly to a massage therapy group or a standard treatment control group before undergoing a debridement procedure. The group that received massage demonstrated less anxiety, lower cortisol levels, less pain, and less depression than the group that received standard care. A limitation of this study is the lack of a comparison intervention; therefore, it cannot be determined whether an intervention other than massage would have produced the same effects.