Massage, acupuncutre ease pain after cancer surgery

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UCSF News – Massage and acupuncture are effective in decreasing pain and depression following surgery in cancer patients, according to a UCSF study.

The findings of the randomized controlled clinical trial are reported in the March 2007 issue of the “Journal of Pain and Symptom Management.”

“This pilot study confirmed that pain after surgery decreased when patients underwent a combination of massage and acupuncture. This is a significant finding because there are implications for further study to see if these therapies should be offered to hospitalized patients for symptom management,” said Wolf Mehling, MD, lead author and UCSF assistant professor of family and community medicine.

The study compared the post-operative symptoms of pain, nausea and mood and the cost of symptom-related medications in two groups of hospitalized patients during the first three days after cancer-related surgery. One group underwent a combination of massage and acupuncture in addition to usual care, and one group had usual care alone. Usual care is defined as traditional treatment through medication.

Study results showed a greater decrease in both pain and depressive mood in the group that underwent massage/acupuncture therapy along with usual care. The study was conducted at the UCSF Osher Center for Integrative Medicine.

According to Mehling, 40% of people with cancer are treated with complementary and alternative medicine therapies. Although the measurable benefits of these therapies have been promising, there have been no conclusive results, he said.

“The combination of massage and acupuncture for symptom management in perioperative cancer patients has never been studied,” said Mehling. “We know that integration of these therapies has shown short-term benefit on psychological well-being, but there has not been strong evidence to support it until now.”

In the study, cancer surgery was characterized as any surgery related to a diagnosis of malignancy: mastectomy or reconstructive surgery for breast cancer; abdominal surgery for intestinal or hepatic malignancies; pelvic surgery for ovarian, uterine or cervical malignancies; urological surgery for testicular, prostate, bladder or renal malignancies; and head and neck cancer surgery.

During the three-day post-operative period, patients used an 11-point (0-10) numeric rating scale to rank severity of current pain and of pain during the previous 24 hours.

“There was quite a variance when it came to level of pain for each patient. Patients who were very well medicated for pain and nausea still experienced dramatic ups and downs during their post-operative days,” Mehling said. “Getting up from bed for the first time after abdominal surgery or having a catheter removed probably contributed to the patient’s pain rating. For patients who received acupuncture and massage, it is possible that this personal attention contributed to a marked decrease in anxiety.”

Patients received Swedish massage, which involves kneading and applying long strokes to soft tissue and muscles, and an acupressure-type (shiatsu) foot massage for 10-30 minutes depending on their clinical needs and condition. Acupuncture treatment was based on the traditional Chinese medicine standardized core set of acupuncture points and was used to treat pain, nausea and anxiety.

“Pain decreased for those in the intervention group more than for those in the control group,” said Mehling. “Looking at an average pain baseline score, we found 1.1 point improvement in pain level on the first post-operative day for the group given massage and acupuncture, and only 0.1 point improvement in the control group that did not have intervention. Over the three days of the study, the average scores among patients reporting significant pain improved by 1.8 for the massage and acupuncture group compared to 0.3 in the control group.”

Pain ratings also differed according to the type of cancer surgery.

“We found the strongest improvement for pain among patients undergoing either prostate and testicular surgery or gastro-intestinal and gynecological cancer surgery, but therapies were not as beneficial for patients treated for kidney or bladder cancer,” he said.

Costs were compared for the entire post-operative hospital stay for all variables except medications, which were compared for the first three post-operative days only.

“Given the limited data, we could not find any cost saving benefits after application of these therapies, except for a reduction in anti-anxiety/sleep medication costs,” he said. “This preliminary data suggests looking at this further, with a larger control group and an ability to better assess individual medication usage.”

Study co-authors are Michael Acree, PhD; Leslie Wilson, PhD; Joseph Acquah, OMD; Beverly Burns, OMD; Jnani Chapman, RN, CMP; Frederick M. Hecht, MD; and Alan Bostrom, PhD, all from UCSF; and Bradly Jacobs, MD, MPH, and Jeremy West, BA, previously with UCSF.

Funding for this study was provided by the Mount Zion Health Fund, San Francisco.

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