A 20-minute evening back massage may help relieve pain and reduce anxiety following major surgery when given in addition to pain medications, according to a report in the December issue of Archives of Surgery, one of the JAMA/Archives journals.

Many patients still experience pain following major surgery despite the availability of pain-relieving medications, according to background information in the article. Pain may be under-treated because patients fear becoming dependent on medications, are concerned about side effects, believe that they should endure pain without complaining or worry about bothering nurses.

Physicians and nurses may administer ineffective doses of pain relievers because of personal biases, cultural attitudes or a lack of knowledge.

Allison R. Mitchinson, M.P.H., N.C.T.M.B., of the Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, Mich., and colleagues conducted a randomized controlled trial involving 605 veterans (average age 64) undergoing major surgery (chest or abdominal operations) between 2003 and 2005. Patients were randomly assigned to one of three groups for the five days following surgery: 203 received routine care; 200 received a daily 20-minute back massage; and 202 received 20 minutes of individual attention each day from a massage therapist, but no massage. “The purpose of this group was to assess the effect of emotional support independent of massage,” the authors write. Patients were asked daily to rate the intensity and unpleasantness of their pain, plus their level of anxiety, on scales of one to 10.

“Compared with the control group, patients in the massage group experienced short-term (preintervention vs. postintervention) decreases in pain intensity, pain unpleasantness and anxiety,” the authors write. “In addition, patients in the massage group experienced a faster rate of decrease in pain intensity and unpleasantness during the first four postoperative days compared with the control group.” There were no differences in long-term anxiety, length of hospital stay or the amount of pain-relieving medications used among the three groups.

“The effectiveness of massage in reducing both the intensity and unpleasantness of pain suggests that it may act through more than one mechanism,” the authors write. “Massage may ameliorate suffering by helping to relieve the anxiety that so effectively synergizes with pain to create distress.” It could also generate mood-boosting endorphins or create a competing sensation that blocks pain, they note.

“Historically, massage was a common experience for postsurgical patients,” the authors write. “As health care systems have become more complex and administrative demands on nursing time have increased, the tradition of nurse-administered massage has been largely lost. With the recent emphasis on assessing pain as the fifth vital sign tempered by renewed concerns for patient safety, it is time to reintegrate the use of effective and less dangerous approaches to relieve patient distress.”

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(Arch Surg. 2007;142(12):1158-1167. Available pre-embargo to the media at www. jamamedia.org.)

Editor’s Note: This study was supported by a grant from the Department of Veterans Affairs Health Services Research and Development. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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