Kutner, J.S., Smith, M.C., Corbin, L. Hemphill, L., Benton, K., Mellis, B.K., . . . Fairclough, D.L. (2008). Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: A randomized trial. Annals of Internal Medicine, 149, 369–379.

To test the hypothesis that massage would decrease pain and analgesic medicine use

Patients were randomly assigned to a massage treatment group or to a control group in which patients received simple touch controlled for time and attention. Individual baseline data for disease characteristics, pain, symptom distress, quality of life, functional status, expectations from massage, and concurrent interventions were collected within 72 hours of study inclusion and at three weekly visits over the three to four weeks of study participation for measurement of sustained effects. Data collectors were blinded to study group assignment. Participants received up to three 30-minute treatments over two weeks, with at least 24 hours between treatment sessions, according to a schedule jointly determined by the patient and the treatment provider. Treatment providers obtained immediate outcome data prior to and following each treatment. All participants received routine care in addition to study interventions. Massage intervention included gentle effleurage, petrissage, and myofascial trigger point release. Most frequently massaged areas were neck and upper back, arms, hands, lower legs, and feet. Massages were performed by licensed massage therapists who had at least six months’ experience working with patients with advanced cancer. Control touch included placement of both hands on the participant bilaterally on the neck, shoulder blades, lower back, calves, heels, clavicles, lower arms, hands, patellae, and feet with light and consistent pressure. All treatment providers had standardized hands-on training and were evaluated for competency.

• The study had 348 participants.
• Mean participant age was 65.2 ±14.4 in the experimental group and 64.2 ±14.4 in the control group.
• The sample was 61% female and 39% male.
• The most common diagnoses were breast and lung cancers; 100% had metastatic disease, and 27% had bone metastasis.
• Fifty-four percent had constant pain, and 26% of participants’ pain was neuropathic.
• Forty-four percent were married or in a committed relationship, 39%–42% had a college education level or higher, and 86% were non-Hispanic white.
• In the experimental group, 77% were receiving care at home; in the control group, 81% were receiving care at home.
• Mean worst pain in 24 hours in both groups was 6.4 or greater at baseline.

• Multisite
• Other setting
• 15 U.S. hospices and the University of Colorado Cancer Center

• End-of-life care phase
• End of life and palliative care

A randomized, single-blind, controlled trial design was used.

• Memorial Pain Assessment Card (MPAC): 0–10 point scale for immediate effect
• Brief Pain Inventory (BPI): For sustained measure
• MPAC Mood Scale
• McGill Quality of Life Questionnaire
• Memorial Symptom Assessment Scale (MSAS)
• Recording of name, dose, and frequency of medication for symptom management

Both massage and touch were associated with significant improvements in immediate and sustained pain outcomes. Massage was superior to touch, but the difference was not statistically significant. Both groups demonstrated statistical, but not clinically significant, improvement in BPI scores. Both massage and simple touch were reported to be associated with statistically significant immediate improvement in mood, with massage showing statistically superior effect compared to touch. Confidence intervals were provided but significance levels were not reported. Both groups demonstrated improvement in physical and emotional symptom distress and quality of life across weekly evaluations, but there were no differences between groups. There were no adverse effects associated with the interventions, and no differences in general adverse events or mortality between groups. Differences in pain medication use were not reported.

Both massage and simple touch appeared to have immediate beneficial effects on pain and mood in these patients. Both groups experienced slight improvement in pain, quality of life, and symptom distress over time. These changes were minimal, showing statistical significance but not clinical relevance.

• Findings are limited to patients with very advanced cancer, the majority of whom were in hospice programs, and may not be applicable to other patient groups.
• There was no usual care control group. Having an appropriate attentional control group was useful, but given the findings that both study groups experienced benefits, the attention itself may be the most relevant factor in changes seen.

Simple touch appeared to have a short-term positive effect on patient mood and pain experience. This is an intervention that should be easy to provide for patients, and could be something that caregivers could also be educated to provide. This intervention could be useful for intermittent use as an adjunct to other interventions for pain management. Formal massage did not provide significantly greater effects. Given findings of simple touch in the population studied here, evaluation of this approach in other patient groups can be useful.