Massage/Aromatherapy Massage

Massage/Aromatherapy Massage

PEP Topic 
Acute Pain
Description 

Aromatherapy is the use of fragrant oils, distilled from plants, to alter mood or improve health. Some studies have examined the effect of aromatherapy used with massage. Aromatherapy massage is massage therapy delivered by a therapist as aromatherapy oils are administered by inhalation. Massage with or without aromatherapy has been studied in patients with cancer for management of anxiety, caregiver strain and burden, constipation, CINV, depression, lymphedema, pain, sleep disturbance, and fatigue.

Effectiveness Not Established

Research Evidence Summaries

Currin, J., & Meister, E.A. (2008). A hospital-based intervention using massage to reduce distress among oncology patients. Cancer Nursing, 31(3), 214–221.

doi: 10.1097/01.NCC.0000305725.65345.f3
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Study Purpose:

To determine if 15 minutes of therapeutic massage is associated with reduction in patient-expressed levels of pain, fatigue, and emotional and physical distress during hospitalization

Intervention Characteristics/Basic Study Process:

Patients were recruited over a three-year period. The same social worker assessed the four domains of distress evaluated; assessments were done pre- and postmassage. All patients served as their own controls. Before the massage, the massage therapist asked the patient which parts of the body to massage. The most frequently chosen area was feet and legs or back, neck, and shoulders. The massage therapist provided each patient with a 10–15 minute Swedish massage. A CD player provided the same music to all patients.

Sample Characteristics:

  • The sample was composed of 251 patients.
  • Mean patient age was 59.4 years. The age range was 20–80 years.
  • The percentage of male patients was 30.3%. The percentage of female patients was 69.7%.
  • The sample included a broad distribution of cancer sites.
  • Of all patients, 68.9% were white, 29.1% were Black; 2% self-identified as belonging to an ethnic group.

Setting:

  • Single site
  • Inpatient
  • University hospital in Georgia, United States

Study Design:

Observational

Measurement Instruments/Methods:

The study used MacDonald’s scale, modified, for patient evaluation of massage therapy (rating on a 1–5 point Likert scale, Cronbach's alpha = 0.850).

Results:

Authors found significant reductions relating to each of the four dimensions measured. Mean pain scores declined (p = 0.000, effect size = 0.7270), fatigue scores declined (p = 0.000, effect size = 0.714), physical distress declined (p =.000, effect size = 0.756), and emotional distress declined (p = 0.000, effect size = 0.6810). Posthoc analysis did not reveal that the main effect was affected by interactions with possible covariates.

Conclusions:

Results demonstrated that massage therapy was associated with reduction of physical and emotional distress, pain, and fatigue in a broad range of hospitalized patients.

Limitations:

  • The study did not have an appropriate control group.
  • The authors noted that a large proportion of patients refused to participate. Males were more likely to refuse participation than females. This suggests that some patients have preconceptions about massage or privacy concerns regarding human touch. The study may have a risk of bias due to selection bias.
  • Postintervention assessments were performed immediately after the intervention. They do not reflect how long perceived benefits lasted.
  • The sample consisted of hospitalized patients, but authors provided no information about phase of care or whether patients were hospitalized for comorbid conditions.

Nursing Implications:

Nurses must consider the possibility that patients have preconceptions or privacy concerns regarding massage therapy. Authors suggested that some patients might be more comfortable with the intervention if it were called a back rub rather than a massage. Nurses in settings that offer massage should incorporate information about the intervention and allow patients to discuss their preconceptions and concerns. Findings suggest that a brief massage can relieve distress during hospitalization. Nurses should consider reinstituting the back rub as a standard nursing intervention.

Systematic Review/Meta-Analysis

Wilkinson, S., Barnes, K., & Storey, L. (2008). Massage for symptom relief in patients with cancer: Systematic review. Journal of Advanced Nursing, 63, 430–439.

doi: 10.1111/j.1365-2648.2008.04712.x
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Purpose:

To assess the evidence regarding massage as a means of improving the physical and psychological well-being of patients with cancer

Search Strategy:

  • Databases searched were Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE, Allied and Complementary Medicine (AMED), System for Information on Grey Literature (SIGLE), PsycINFO, and CancerLIT. Investigators also searched dissertation abstracts.
  • Year of publication, as defined by the search strategy, varied by database. The most recent date was September 2006.
  • Search keywords were massage, aromatherapy, therapeutic touch, essential oil, volatile oil and cancer or neoplasm or oncolog* or palliate* or terminal or hospice.
  • Studies were included in the review if they
    • Were randomized controlled trials (RCTs)
    • Involved adult patients with cancer who were receiving care in any healthcare setting
    • Included any type of massage, with a systemic goal, provided by a therapist with a recognized qualification
    • Produced patient-reported outcomes, reported by means of reliable and valid assessment tools, of physical or psychological symptoms and quality of life
    • Included the means by which the reliability and validity of assessment tools were evaluated.
  • Studies were excluded if the purpose of the massage was a specific localized physical effect without a specific systemic aim. For example, a study involving prostatic massage to obtain a semen sample was excluded.

Literature Evaluated:

After elimination of duplicates from the initial search, investigators considered 1,321 references. Of these, investigators chose 10 studies for analysis, using the Jadad scoring approach and CONSORT Statement to appraise study quality. Investigators also used sample size and duration of follow-up to evaluate studies. Given the range of massage techniques and patients, meta-analysis was impossible. Three investigators reviewed studies independently.

Sample Characteristics:

  • The review reported on 386 patients from nine studies.
  • One of the initial references was a duplicate report of a single study.
  • One study was based on personal communication, rather than a final published report.
  • Study samples included more females than males.
  • Various cancer diagnoses were represented.
  • Sample sizes ranged from 6 to 87 participants.
  • Samples included patients receiving surgery, radiotherapy, chemotherapy, and combined treatments.

Results:

  • Patients were assessed 4–16 times, with all patients assessed before and after the intervention or control period.
  • Follow-up was limited. One study assessed patients three weeks after the last massage.
  • Five trials assessed psychological outcomes, including outcomes related to anxiety and depression.
  • Seven trials assessed physical symptoms and quality of life.
  • One study found a significant post-massage decrease in pain for males only. One study found a significant reduction in pain after massage but not after the control period. One study showed pain reduction after the first and third massage, but not after the second and fourth, and a nonsignificant trend of greater pain improvement in the massage group than in the group that did not receive massage.
  • One study showed significant reduction of depression with massage, and one study showed no change.
  • Three studies demonstrated significant post-massage improvement in anxiety.
  • One study associated massage with short-term reduction in nausea.
  • One study associated massage with reduction in fatigue.
  • One study associated massage with improvement in quality of life.
  • Most studies reported decreases in anxiety and other psychological benefits; however, results relating to depression were equivocal across studies.
  • Adverse effects included a single case of skin rash in one trial and, in another trial that involved the use of essential oils, a higher incidence of digestive problems.

Conclusions:

The authors stated that results were inconclusive; however, reported results showed that massage had a preponderantly positive effect in regard to anxiety reduction.

Limitations:

  • This review did not discuss the patients' treatment phase, so effects relating to specific groups of patients were unspecified.
  • Authors did not know how and if variations in massage style affected outcomes.
  • Trials that included the use of oils used different oils, so the authors could draw no conclusions regarding the effect of aromatherapy.
  • No evidence was available to assess long-term effects of massage. Authors found that research of long-term effects, as reported in the studies, was of low quality.
  • Although inclusion criteria demanded that all studies be RCTs, results suggest that one study did not include a separate control group.

Nursing Implications:

Two studies included in the review used a crossover design, and one of these showed significant results after massage but not after the control period. This suggests that crossover design may be particularly applicable to this area of research and that the effects of massage are immediate and time sensitive.


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