Articles
16 September 2008

Massage Therapy versus Simple Touch to Improve Pain and Mood in Patients with Advanced Cancer: A Randomized Trial

Publication: Annals of Internal Medicine
Volume 149, Number 6

Abstract

Background:

Small studies of variable quality suggest that massage therapy may relieve pain and other symptoms.

Objective:

To evaluate the efficacy of massage for decreasing pain and symptom distress and improving quality of life among persons with advanced cancer.

Design:

Multisite, randomized clinical trial.

Setting:

Population-based Palliative Care Research Network.

Patients:

380 adults with advanced cancer who were experiencing moderate-to-severe pain; 90% were enrolled in hospice.

Intervention:

Six 30-minute massage or simple-touch sessions over 2 weeks.

Measurements:

Primary outcomes were immediate (Memorial Pain Assessment Card, 0- to 10-point scale) and sustained (Brief Pain Inventory [BPI], 0- to 10-point scale) change in pain. Secondary outcomes were immediate change in mood (Memorial Pain Assessment Card) and 60-second heart and respiratory rates and sustained change in quality of life (McGill Quality of Life Questionnaire, 0- to 10-point scale), symptom distress (Memorial Symptom Assessment Scale, 0- to 4-point scale), and analgesic medication use (parenteral morphine equivalents [mg/d]). Immediate outcomes were obtained just before and after each treatment session. Sustained outcomes were obtained at baseline and weekly for 3 weeks.

Results:

298 persons were included in the immediate outcome analysis and 348 in the sustained outcome analysis. A total of 82 persons did not receive any allocated study treatments (37 massage patients, 45 control participants). Both groups demonstrated immediate improvement in pain (massage, −1.87 points [95% CI, −2.07 to −1.67 points]; control, −0.97 point [CI, −1.18 to −0.76 points]) and mood (massage, 1.58 points [CI, 1.40 to 1.76 points]; control, 0.97 point [CI, 0.78 to 1.16 points]). Massage was superior for both immediate pain and mood (mean difference, 0.90 and 0.61 points, respectively; P < 0.001). No between-group mean differences occurred over time in sustained pain (BPI mean pain, 0.07 point [CI, −0.23 to 0.37 points]; BPI worst pain, −0.14 point [CI, −0.59 to 0.31 points]), quality of life (McGill Quality of Life Questionnaire overall, 0.08 point [CI, −0.37 to 0.53 points]), symptom distress (Memorial Symptom Assessment Scale global distress index, −0.002 point [CI, −0.12 to 0.12 points]), or analgesic medication use (parenteral morphine equivalents, −0.10 mg/d [CI, −0.25 to 0.05 mg/d]).

Limitations:

The immediate outcome measures were obtained by unblinded study therapists, possibly leading to reporting bias and the overestimation of a beneficial effect. The generalizability to all patients with advanced cancer is uncertain. The differential beneficial effect of massage therapy over simple touch is not conclusive without a usual care control group.

Conclusion:

Massage may have immediately beneficial effects on pain and mood among patients with advanced cancer. Given the lack of sustained effects and the observed improvements in both study groups, the potential benefits of attention and simple touch should also be considered in this patient population.

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Supplemental Material

Supplement. Appendix: REST Study Procedures Manual

References

1.
Singer PAMartin DKKelner M. Quality end-of-life care: patients' perspectives. JAMA. 1999;281:163-8. [PMID: 9917120]
2.
Kutner JSKassner CTNowels DE. Symptom burden at the end of life: hospice providers' perceptions. J Pain Symptom Manage. 2001;21:473-80. [PMID: 11397605]
3.
Bruera E. Research into symptoms other than pain. In: Doyle D, Hanks GW, MacDonald N, eds. Oxford Textbook of Palliative Medicine. 2nd ed. New York: Oxford Univ Pr; 1998:179-85.
4.
Kutner JSBryant LLBeaty BLFairclough DL. Time course and characteristics of symptom distress and quality of life at the end of life. J Pain Symptom Manage. 2007;34:227-36. [PMID: 17572055]
5.
National Institutes of Health. National Institutes of Health State-of-the-Science Conference Statement on Improving End-of-Life Care. Bethesda, MD: National Institutes of Health; 2004.
6.
Committee on Care at the End of Life. Approaching Death: Improving Care at the End of Life. Washington, DC: National Academies Pr; 1997.
7.
Field TM. Massage therapy effects. Am Psychol. 1998;53:1270-81. [PMID: 9872050]
8.
Ferrell-Torry ATGlick OJ. The use of therapeutic massage as a nursing intervention to modify anxiety and the perception of cancer pain. Cancer Nurs. 1993;16:93-101. [PMID: 8477405]
9.
Longworth JC. Psychophysiological effects of slow stroke back massage in normotensive females. ANS Adv Nurs Sci. 1982;4:44-61. [PMID: 6808905]
10.
Owens MKEhrenreich D. Literature review of nonpharmacologic methods for the treatment of chronic pain. Holist Nurs Pract. 1991;6:24-31. [PMID: 1918182]
11.
Wilkie DJKampbell JCutshall SHalabisky HHarmon HJohnson LPet al. Effects of massage on pain intensity, analgesics and quality of life in patients with cancer pain: a pilot study of a randomized clinical trial conducted within hospice care delivery. Hosp J. 2000;15:31-53. [PMID: 11315685]
12.
Westcombe AMGambles MAWilkinson SMBarnes KFellowes DMaher EJet al. Learning the hard way! Setting up an RCT of aromatherapy massage for patients with advanced cancer. Palliat Med. 2003;17:300-7. [PMID: 12822844]
13.
Evans CMcCarthy M. Prognostic uncertainty in terminal care: can the Karnofsky index help? Lancet. 1985;1:1204-6. [PMID: 2860399]
14.
Kutner JSMain DSWestfall JMPace W. The practice-based research network as a model for end-of-life care research: challenges and opportunities. Cancer Control. 2005;12:186-95. [PMID: 16062166]
15.
American Massage Therapy Association. Glossary of Massage Terms. Accessed at www.amtamassage.org/infocenter/home.html on 17 July 2008.
16.
Goldstone LA. Massage as an orthodox medical treatment past and future. Complement Ther Nurs Midwifery. 2000;6:169-75. [PMID: 11858299]
17.
Smith MCKutner JSHemphill LYamashita TFelton S. Developing control and treatment conditions in a clinical trial of massage therapy for advanced cancer. J Soc Integr Oncol. 2007;5:139-46.
18.
Quinn JF. Therapeutic touch as energy exchange: testing the theory. ANS Adv Nurs Sci. 1984;6:42-9. [PMID: 6322674]
19.
Keller EBzdek VM. Effects of therapeutic touch on tension headache pain. Nurs Res. 1986;35:101-6. [PMID: 3633503]
20.
Galer BSJensen MP. Development and preliminary validation of a pain measure specific to neuropathic pain: the Neuropathic Pain Scale. Neurology. 1997;48:332-8. [PMID: 9040716]
21.
Jensen TSGottrup HSindrup SHBach FW. The clinical picture of neuropathic pain. Eur J Pharmacol. 2001;429:1-11. [PMID: 11698022]
22.
Fishman BPasternak SWallenstein SLHoude RWHolland JCFoley KM. The Memorial Pain Assessment Card. A valid instrument for the evaluation of cancer pain. Cancer. 1987;60:1151-8. [PMID: 3300951]
23.
Cleeland CSRyan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23:129-38. [PMID: 8080219]
24.
Philip JSmith WBCraft PLickiss N. Concurrent validity of the modified Edmonton Symptom Assessment System with the Rotterdam Symptom Checklist and the Brief Pain Inventory. Support Care Cancer. 1998;6:539-41. [PMID: 9833305]
25.
Todd KHFunk KGFunk JPBonacci R. Clinical significance of reported changes in pain severity. Ann Emerg Med. 1996;27:485-9. [PMID: 8604867]
26.
Jensen MPChen CBrugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain. 2003;4:407-14. [PMID: 14622683]
27.
Cohen SRBoston PMount BMPorterfield P. Changes in quality of life following admission to palliative care units. Palliat Med. 2001;15:363-71. [PMID: 11591087]
28.
Cohen SRMount BMBruera EProvost MRowe JTong K. Validity of the McGill Quality of Life Questionnaire in the palliative care setting: a multi-centre Canadian study demonstrating the importance of the existential domain. Palliat Med. 1997;11:3-20. [PMID: 9068681]
29.
Cohen SRMount BM. Living with cancer: “good” days and “bad” days—what produces them? Can the McGill quality of life questionnaire distinguish between them? Cancer. 2000;89:1854-65. [PMID: 11042583]
30.
Chang VTHwang SSFeuerman MKasimis BSThaler HT. The memorial symptom assessment scale short form (MSAS-SF). Cancer. 2000;89:1162-71. [PMID: 10964347]
31.
Chang VTHwang SSKasimis BThaler HT. Shorter symptom assessment instruments: the Condensed Memorial Symptom Assessment Scale (CMSAS). Cancer Invest. 2004;22:526-36. [PMID: 15565810]
32.
Chang VT, Hwang SS, Thaler HT, Kasimis BS, Portenoy RK. Memorial Symptom Assessment Scale. Expert Review of Pharmacoeconomics & Outcomes Research. 2004;4:171-8.
33.
Hwang SSScott CBChang VTCogswell JSrinivas SKasimis B. Prediction of survival for advanced cancer patients by recursive partitioning analysis: role of Karnofsky performance status, quality of life, and symptom distress. Cancer Invest. 2004;22:678-87. [PMID: 15581048]
34.
Chang VTThaler HTPolyak TAKornblith ABLepore JMPortenoy RK. Quality of life and survival: the role of multidimensional symptom assessment. Cancer. 1998;83:173-9. [PMID: 9655308]
35.
World Health Organization Expert Committee. Cancer Pain Relief and Palliative Care. WHO Technical Report Series no. 804. Geneva: World Health Organization; 1990.
36.
Fitzmaurice GMLaird NMShneyer L. An alternative parameterization of the general linear mixture model for longitudinal data with non-ignorable drop-outs. Stat Med. 2001;20:1009-21. [PMID: 11276032]
37.
Ernst EWhite AR. Acupuncture may be associated with serious adverse events [Letter]. BMJ. 2000;320:513-4. [PMID: 10678876]
38.
Portenoy RKThaler HTKornblith ABLepore JMFriedlander-Klar HKiyasu Eet al. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer. 1994;30A:1326-36. [PMID: 7999421]
39.
Ingham JPortenoy RK. The measurement of pain and other symptoms. In: Doyle D, Hanks GW, MacDonald N, eds. Oxford Textbook of Palliative Medicine. 2nd ed. New York: Oxford Univ Pr; 1998:203-19.
40.
Miller MGMcCarthy NO'Boyle CAKearney M. Continuous subcutaneous infusion of morphine vs. hydromorphone: a controlled trial. J Pain Symptom Manage. 1999;18:9-16. [PMID: 10439568]
41.
Portenoy RKPayne DJacobsen P. Breakthrough pain: characteristics and impact in patients with cancer pain. Pain. 1999;81:129-34. [PMID: 10353500]
42.
Ahmedzai SBrooks D. Transdermal fentanyl versus sustained-release oral morphine in cancer pain: preference, efficacy, and quality of life. The TTS-Fentanyl Comparative Trial Group. J Pain Symptom Manage. 1997;13:254-61. [PMID: 9185430]
43.
Serlin RCMendoza TRNakamura YEdwards KRCleeland CS. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain. 1995;61:277-84. [PMID: 7659438]
44.
Du Pen SLDu Pen ARPolissar NHansberry JKraybill BMStillman Met al. Implementing guidelines for cancer pain management: results of a randomized, controlled clinical trial. J Clin Oncol. 1999;17:361-70. [PMID: 10458255]
45.
Elliott BAElliott TEMurray DMBraun BLJohnson KM. Patients and family members: the role of knowledge and attitudes in cancer pain. J Pain Symptom Manage. 1996;12:209-20. [PMID: 8898504]
46.
Twycross RHarcourt JBergl S. A survey of pain in patients with advanced cancer. J Pain Symptom Manage. 1996;12:273-82. [PMID: 8942122]
47.
Portenoy RKThaler HTKornblith ABLepore JMFriedlander-Klar HCoyle Net al. Symptom prevalence, characteristics and distress in a cancer population. Qual Life Res. 1994;3:183-9. [PMID: 7920492]
48.
McMillan SCTittle MHagan SLaughlin J. Management of pain and pain-related symptoms in hospitalized veterans with cancer. Cancer Nurs. 2000;23:327-36. [PMID: 11037952]
49.
Boutron IMoher DAltman DGSchulz KFRavaud PCONSORT Group. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008;148:295-309. [PMID: 18283207]
50.
Boutron IMoher DAltman DGSchulz KFRavaud PCONSORT Group. Methods and processes of the CONSORT Group: example of an extension for trials assessing nonpharmacologic treatments. Ann Intern Med. 2008;148:W60-6. [PMID: 18283201]
51.
Kelly AM. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J. 2001;18:205-7. [PMID: 11354213]
52.
Diehr PLafferty WEPatrick DLDowney LDevlin SMStandish LJ. Quality of life at the end of life. Health Qual Life Outcomes. 2007;5:51. [PMID: 17683554]
53.
Kutner JSNowels DEKassner CTHouser JBryant LLMain DS. Confirmation of the “disability paradox” among hospice patients: preservation of quality of life despite physical ailments and psychosocial concerns. Palliat Support Care. 2003;1:231-7. [PMID: 16594423]
54.
Pan CXMorrison RSNess JFugh-Berman ALeipzig RM. Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life. A systematic review. J Pain Symptom Manage. 2000;20:374-87. [PMID: 11068159]
55.
Sagar SMDryden TWong RK. Massage therapy for cancer patients: a reciprocal relationship between body and mind. Curr Oncol. 2007;14:45-56. [PMID: 17576465]
56.
Myers CDWalton TBratsman LWilson JSmall B. Massage modalities and symptoms reported by cancer patients: narrative review. J Soc Integr Oncol. 2008;6:19-28. [PMID: 18302907]
57.
Hernandez-Reif MIronson GField THurley JKatz GDiego Met al. Breast cancer patients have improved immune and neuroendocrine functions following massage therapy. J Psychosom Res. 2004;57:45-52. [PMID: 15256294]
58.
Post-White JKinney MESavik KGau JBWilcox CLerner I. Therapeutic massage and healing touch improve symptoms in cancer. Integr Cancer Ther. 2003;2:332-44. [PMID: 14713325]
59.
Cassileth BRVickers AJ. Massage therapy for symptom control: outcome study at a major cancer center. J Pain Symptom Manage. 2004;28:244-9. [PMID: 15336336]
60.
Billhult A, Stener-Victorin E, Bergbom I. The experience of massage during chemotherapy treatment in breast cancer patients. Clin Nurs Res. 2007;16:85-99; discussion 100-2. [ 17452429]
61.
Soden KVincent KCraske SLucas CAshley S. A randomized, controlled trial of aromatherapy massage in a hospice setting. Palliat Med. 2004;18:87-92. [PMID: 15046404]
62.
Fellowes DBarnes KWilkinson S. Aromatherapy and massage for symptom relief in patients with cancer. Cochrane Database Syst Rev. 2004;:CD002287. [PMID: 15106172]
63.
Richards KCGibson ROverton-McCoy AL. Effects of massage in acute and critical care. AACN Clin Issues. 2000;11:77-96. [PMID: 11040555]
64.
Billhult ADahlberg K. A meaningful relief from suffering experiences of massage in cancer care. Cancer Nurs. 2001;24:180-4. [PMID: 11409061]
65.
Nelson JP. Being in tune with life: complementary therapy use and well-being in residential hospice residents. J Holist Nurs. 2006;24:152-61. [PMID: 16880409]
66.
Buss MKArnold RM. Challenges in palliative care research: one experience. J Palliat Med. 2004;7:405-7. [PMID: 15265348]
67.
Casarett DJKarlawish JHirschman KB. Are hospices ready to participate in palliative care research? Results of a national survey. J Palliat Med. 2002;5:397-406. [PMID: 12133244]

Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 149Number 616 September 2008
Pages: 369 - 379

History

Published online: 16 September 2008
Published in issue: 16 September 2008

Keywords

Authors

Affiliations

Jean S. Kutner, MD, MSPH
From the School of Medicine, College of Nursing, and School of Public Health, University of Colorado Denver, Denver and Aurora, Colorado, and Florida Atlantic University, Boca Raton, Florida.
Marlaine C. Smith, RN, PhD
From the School of Medicine, College of Nursing, and School of Public Health, University of Colorado Denver, Denver and Aurora, Colorado, and Florida Atlantic University, Boca Raton, Florida.
Lisa Corbin, MD
From the School of Medicine, College of Nursing, and School of Public Health, University of Colorado Denver, Denver and Aurora, Colorado, and Florida Atlantic University, Boca Raton, Florida.
Linnea Hemphill, APRN, BC, MSN
From the School of Medicine, College of Nursing, and School of Public Health, University of Colorado Denver, Denver and Aurora, Colorado, and Florida Atlantic University, Boca Raton, Florida.
Kathryn Benton, MSPH
From the School of Medicine, College of Nursing, and School of Public Health, University of Colorado Denver, Denver and Aurora, Colorado, and Florida Atlantic University, Boca Raton, Florida.
B. Karen Mellis, BS
From the School of Medicine, College of Nursing, and School of Public Health, University of Colorado Denver, Denver and Aurora, Colorado, and Florida Atlantic University, Boca Raton, Florida.
Brenda Beaty, MSPH
From the School of Medicine, College of Nursing, and School of Public Health, University of Colorado Denver, Denver and Aurora, Colorado, and Florida Atlantic University, Boca Raton, Florida.
Sue Felton, MA
From the School of Medicine, College of Nursing, and School of Public Health, University of Colorado Denver, Denver and Aurora, Colorado, and Florida Atlantic University, Boca Raton, Florida.
Traci E. Yamashita, MS
From the School of Medicine, College of Nursing, and School of Public Health, University of Colorado Denver, Denver and Aurora, Colorado, and Florida Atlantic University, Boca Raton, Florida.
Lucinda L. Bryant, PhD, MSHA
From the School of Medicine, College of Nursing, and School of Public Health, University of Colorado Denver, Denver and Aurora, Colorado, and Florida Atlantic University, Boca Raton, Florida.
Diane L. Fairclough, DrPH
From the School of Medicine, College of Nursing, and School of Public Health, University of Colorado Denver, Denver and Aurora, Colorado, and Florida Atlantic University, Boca Raton, Florida.
Acknowledgment: The authors thank the on-site study teams, staff, patients and families at the study sites: Catholic Hospice, Miami, Florida; Circle of Life Hospice & Palliative Care, Springdale, Arkansas; Hope Hospice and Community Services, Fort Myers, Florida; HospiceCare in the Berkshires, Pittsfield, Massachusetts; Hospice & Palliative CareCenter, Winston-Salem, North Carolina; Hospice & Palliative Care of Cape Cod, Cape Cod, Massachusetts; Hospice & Palliative Care of the Charlotte Region, Charlotte, North Carolina; Hospice of Saint John, Lakewood, Colorado; Hospice Partners, Hillside, Illinois; LifePath Hospice, Tampa, Florida; Midwest Palliative & Hospice CareCenter, Glenview, Illinois; Pikes Peak Hospice, Colorado Springs, Colorado; San Diego Hospice, San Diego, California; The Denver Hospice, Pathways Program, Denver, Colorado; The Washington Home, Washington, DC; and the University of Colorado Cancer Center, Aurora, Colorado.
Grant Support: By the National Institutes of Health and National Center for Complementary and Alternative Medicine (1R01AT01006-01A2), Mendel/Asarch Lung Cancer Family Foundation Grants Program, Paul Beeson Physician Faculty Scholars in Aging Research Award, and Robert Wood Johnson Generalist Physician Faculty Scholars Program (Dr. Kutner).
Disclosures: None disclosed.
Reproducible Research Statement: Study protocol and data set: Available from Dr. Kutner (e-mail, [email protected]). Massage and simple touch protocols are available online at www.annals.org (Appendix). Statistical code: Available from Dr. Fairclough (e-mail, [email protected]).
Corresponding Author: Jean S. Kutner, MD, MSPH, Division of General Internal Medicine, B180, University of Colorado Denver School of Medicine, PO Box 6511, Academic Office 1, Aurora, CO 80045; e-mail, [email protected].
Current Author Addresses: Dr. Kutner, Ms. Mellis, Ms. Felton, and Ms. Yamashita: Division of General Internal Medicine, University of Colorado Denver School of Medicine, Mail Stop B180, PO Box 6511, Aurora, CO 80045.
Dr. Smith: Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431.
Dr. Corbin: Division of General Internal Medicine, University of Colorado Denver School of Medicine, Mail Stop F743, PO Box 6510, Aurora, CO 80045.
Ms. Hemphill: 10061 East Mexico Avenue, Denver, CO 80247.
Ms. Benton, Ms. Beaty, and Dr. Fairclough: Colorado Health Outcomes Program, University of Colorado Denver School of Medicine, Mail Stop F443, PO Box 6508, Aurora, CO 80045.
Dr. Bryant: University of Colorado Denver School of Public Health, 4200 East 9th Avenue, Box C245, Denver, CO 80262.
Author Contributions: Conception and design: J.S. Kutner, M.C. Smith, L. Corbin, L. Hemphill, D.L. Fairclough.
Analysis and interpretation of the data: J.S. Kutner, M.C. Smith, L. Corbin, K. Benton, B. Beaty, T.E. Yamashita, L.L. Bryant, D.L. Fairclough.
Drafting of the article: J.S. Kutner, M.C. Smith, L. Corbin, L. Hemphill, K. Benton, D.L. Fairclough.
Critical revision of the article for important intellectual content: J.S. Kutner, M.C. Smith, L. Corbin, K. Benton, B.K. Mellis, B. Beaty, T.E. Yamashita, L.L. Bryant.
Final approval of the article: J.S. Kutner, M.C. Smith, L. Corbin, K. Benton, L.L. Bryant, D.L. Fairclough.
Provision of study materials or patients: B.K. Mellis.
Statistical expertise: K. Benton, D.L. Fairclough.
Obtaining of funding: J.S. Kutner, M.C. Smith.
Administrative, technical, or logistic support: M.C. Smith, B.K. Mellis, S. Felton, T.E. Yamashita.
Collection and assembly of data: J.S. Kutner, M.C. Smith, L. Hemphill, K. Benton, B.K. Mellis, S. Felton, T.E. Yamashita.
ClinicalTrials.gov registration number: NCT00065195.

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Jean S. Kutner, Marlaine C. Smith, Lisa Corbin, et al. Massage Therapy versus Simple Touch to Improve Pain and Mood in Patients with Advanced Cancer: A Randomized Trial. Ann Intern Med.2008;149:369-379. [Epub 16 September 2008]. doi:10.7326/0003-4819-149-6-200809160-00003

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