Healey talks Hospital-Based Massage Therapy in Pain Medicine News

Mounting Evidence Backs Massage Therapy’s Reduction in Postoperative Pain
By Inayah Entzmeinger at Pain Medicine News

With growing amounts of data showing the benefits of hospital-based massage therapy (HBMT), complementary and alternative medicine (CAM) professionals are recommending increased use of the integrative health practice in hospital settings to treat patients’ postsurgical pain, as well as anxiety, stress and insomnia related to their hospital stay.

Nonpharmacologic and nonopioid pain management solutions are used more frequently for patients with postsurgical pain to understand the progression from acute to chronic pain after surgery, and to reduce the over prescription of opioids after surgery (Lancet 2019;393[10180]:1537-1546).

Massage therapy and other methods of CAM also are gaining popularity in U.S. hospitals. According to statistics from the 2019 American Hospital Association Annual Survey, of the 4,167 responding hospitals (68% of 6,090 hospitals in the United States), more than 22% offer CAM services including massage therapy, along with services such as acupuncture, chiropractic, and diet and lifestyle changes. This number has increased from 7.7% in 1999 to 18.3% in 2004.

Massage therapy reduces anxiety and pain in the pre- and postoperative phases of surgery, as well as during nonsurgical hospital visits. A study of nontherapeutic hand massage on surgical outpatients found that anxiety scores had a –2.1 (±1.3) difference after massage therapy (Explore [NY] 2020;S1550-8307[20]30302-5). Patients who received massages after undergoing thoracic surgery experienced a –3.49 (±1.72) difference in pain scores after massage (Int J Ther Massage Bodywork 2011;4[2]:2-6).

In the same hospital-wide study containing a mixture of surgical and nonsurgical patients, mean pain scores before HBMT were 5.18 (±2.01), decreasing to 2.33 (±2.10) immediately afterward. Participants also reported feeling better for up to eight hours after the massage session concluded, with a few patients reporting beneficial effects 24 hours later.

Many patients report positive effects on their overall pain levels and emotional well-being, Dale Healey, DC, PhD, told Pain Medicine News. “For massage therapy, I think touch is at the core,” said Healey, the dean of the College of Health and Wellness at Northwestern Health Sciences University, in Bloomington, Minn. “Patients have a different relationship with the massage therapist than with other health care providers.”

Often, results are best observed when massage therapy is used in concert with other treatments. An analysis of studies using the American College of Physicians grading system suggests that massage in combination with other treatments including exercise therapy shows improved effects on subacute to chronic low back pain more than other treatments alone (Ann Intern Med 2017;166[7]:514-530). A study on postsurgical rehabilitation from hip arthroplasty showed that kinesitherapy including therapeutic massage, along with occupational exercises and performed physical factors, also can significantly shorten recovery time (Folia Med [Plovdiv] 2017;59[2]:217-221).

The application of massage and other CAM therapies can reduce the need for pharmacologic intervention. “No one is claiming that massage therapy is the panacea,” said Healey, who is also the vice chair of the Commission on Massage Therapy Accreditation, the vice chair of the Academic Collaborative for Integrative Health, and a board member of the Academy of Integrative Health and Medicine. However, if the level of opioid addiction and long-term opioid use could decrease in any way using CAM in hospitals, “that would be dramatic,” Healey said.

Unlike massage therapy performed at private practices, HBMT requires specialized knowledge of hospital culture and patient needs, Healey explained. Special considerations for HBMT are almost all concerning the unfamiliar setting of massage application and not the massage therapist’s previous training.

Hospital-based “massage therapists have to adapt their approach to account for physical space,” Healey said. “The hospital bed, … catheters, breathing tubes and apparatus. The competencies are mostly about adapting to the unique elements of that environment.”

To address the need for specific competencies that must be adhered to for performing massage therapy in a hospital setting, the Academic Collaborative for Integrative Health, an organization for integrative health accreditation and education, created the HBMT Task Force in 2012 (J Bodyw Mov Ther 2019;23[2]:291-294).

The preliminary competencies outlined are hospital environment, which includes working with patients and hospital staff to maintain mutual respect and safety within the hospital environment; massage protocols, which focus on the ability to work around medical equipment and recognizing therapist and patient limitations; and therapeutic presence, which focuses on communication, identifying signs of patient stress and anxiety, and maintaining self-care practices.

The study self-identifies as a pilot project that can and should be updated to align with each hospital that chooses to apply it. “There may be [hospital] environments that do not deal with a certain specificity,” Healey said. “We wanted these competencies to be broad enough that they could be embraced by any hospital system or any clinical environment. There is nothing prohibiting a hospital from adding competencies that they expect of their therapists in their unique environment.”