Massage therapy can have emotional benefit
Power of touch is often understated
Most people know massage therapy for its relaxation benefits, but its application to hospice care goes well beyond the physical. The power of therapeutic bodywork can help dying patients release pent-up emotions, such as fear and anger.
"Massage therapy is very compatible with hospice care," says Adela Basayne, LMT, a private-practice massage therapist in Portland, OR. "Massage therapists aren’t looking to change the health status of patients. Instead, their goal is to treat symptoms."
According to the National Hospice and Palliative Care Organization’s Complementary Therapies in End-of-Life Care, hospice patients and caregivers exhibiting the following signs may benefit from massage therapy as a means of physical relief and psychosocial benefit:
- anger about the diagnosis;
- anxiety about pain, finances, or other matters;
- denial of diagnosis or progression of disease;
- fear of death;
- guilt;
- mood swings caused by pain drugs or disease-related dementia;
- depression;
- thoughts of suicide.
Massage therapy’s applicability to pain management was supported in a 2000 study originally published in the Hospice Journal. Researchers studied 56 hospice patients whose average age was 64. Patients were randomly assigned to receive either massage therapy or usual care that did not include massage therapy. Those receiving massage therapy were given the therapy twice weekly for two weeks by a licensed massage therapist.
Pain decreased more in massage group
When the study began, about half of the patients had constant pain. Massage therapy and normal care both reduced patients’ pain to episodic or intermittent pain in 14% of the patients in each group. Overall, patients suffered half as much pain at the end of the study as they did at the beginning.
But pain intensity decreased more in the massage group than in the usual care group — a 42% decrease in the massage group vs. a 25% decrease in the usual care group. Nearly three-quarters of the patients receiving massage reported pain levels of 0 or otherwise lower than at the beginning of the study, compared with only 57% of the usual-care patients.
About one-third of the massage patients received massages in between the sessions scheduled as part of this study. The effect of massage on pain intensity was immediate, according to researchers, decreasing the pain scores after each massage. Pulse rate and respiratory rate also fell, indicating a relaxation response.
The therapists followed a standardized protocol for the massage, specifying full-body massage, when possible, and the types and duration of the strokes to be used, such as effleurage strokes and others. The massages lasted 30 to 45 minutes. About half of the patients could not complete the study because death intervened or their condition deteriorated to an extent that precluded their completing the study questionnaire.
Hospice patients are not the only ones who can benefit from massage therapy. Caregivers, many of whom are under relentless stress, may enjoy physical and emotional improvement as a result of massage.
A 1998 study by The Oregon Hospice Association and East-West College of the Healing Arts, both in Portland, found that massage reduces physical stress, emotional stress, pain, and insomnia among primary caregivers for terminally ill family members.
Massage was offered to a group of 13 caregivers between the ages of 35 and 82 who had been referred by a volunteer coordinator or social worker. Most participants were women, mostly wives caring for husbands. They received 75-minute sessions of Swedish massage and other techniques, including shiatsu, Reiki, polarity, jostling, compression, myofascial release, trigger-point therapy, and gentle stretching, weekly or biweekly at a hospice or at their home. Half of the participants had never had massage before. On the intake form, caregivers primarily asked to have their necks, shoulders, or backs massaged. The average number of massages received was six (the caregivers were often too busy to take time for massage).
Assessments included a pre- and post-massage list of questions that rated emotional stress, physical stress, physical pain, and sleep difficulty on a 1-5 scale. Physical stress measurements included things such as stamina and energy level, while physical pain referred to specifics such as headaches, back pain, and knotted muscles.
Results showed that 85% of the caregivers reported a decrease in emotional and physical stress. Physical pain was relieved for 77% of the caregivers. Difficulty sleeping was eased for 54% of the study group. The few caregivers who reported contradictory results also commented on having so much stress from their daily duties or as a result of a recent death that they were unable to feel the benefits of massage beyond the immediate session.
The study concluded that participants experienced an overall decrease in stress and that by offering massage as a respite intervention, hospice agencies would benefit both caregivers and the patients under their care.
The reason for the positive results, says Basayne, is that both patients and caregivers are touch-deprived as a result of their disease and the demands of caring for a loved one. Friends and family members are less inclined to embrace, caress, or even hold hands out of irrational fear of contracting the same disease or some other personal reasons. Massage therapy brings back the human touch that patients are craving, says Basayne.
The reasons why massage therapy reduces pain are well-known, Basayne says. Experts have theorized that massage therapy’s relaxation effect reduces anxiety, which in turn lowers pain intensity.
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