The authors are Jacqueline Tibbett, PhD, LMT; John Paradiso, LMT; and Natalie Lorick, LMT.

These findings suggest that massage use in this setting is both highly desired by patients and has great potential to improve quality of life for hospitalized patients.

The Pain Problem

Pain management is a serious issue in the United States. More than 116 million Americans suffer from chronic pain conditions; and use of opioids to treat pain has led to an addiction epidemic. As massage therapists, we know that massage reduces pain and relaxes our clients. Still, the hospital setting presents some unique challenges that makes fully realizing the potential for massage to benefit patients more difficult.

Today, however, many therapies once considered “alternative”—including massage—are gaining ground in health care environments, especially for people who need help managing pain. One of the primary reasons more health care professionals are taking notice of integrative approaches is the amount and quality of research describing the benefits of massage therapy.

A Prospective Study at Mayo Clinic

A 2019 report by Clark et al, in EXPLORE: The Journal of Science & Healing, examined whether integrative medical services reduced pain in hospitalized patients. The authors looked at recent data from a major hospital system, Mayo Clinic, where integrative services are offered. This report is important because it presents new information about the strong positive effect that integrative services like massage can provide.

The main goal of the study was to determine change in pain levels before and after an integrative therapy session. The study was a prospective study, meaning the authors looked at outcomes for a group of people with similar attributes (a cohort) over a period of time. Participants were comprised of 578 patients at two Mayo Clinic sites in late 2017. Data presented in this study came from patient medical charts and were not collected specifically for this study. As standard practice in these hospital units, patients are given brochures listing available inpatient integrative medicine services. When services are administered, data (such as pain scores) are collected.

The integrative services offered included massage, acupuncture, and Reiki, as well as relaxation and other services offered by nurses specializing in integrative health. All the providers were highly trained in their respective disciplines. For massage services, Swedish massage was the most common modality performed, followed by reflexology, craniosacral therapy and acupressure, in no particular order.

The main outcomes measured were pain ratings, number of services requested, and whether patients fell asleep. Pain scores were collected by the integrative service provider who asked participants to rate their pain numerically, both before and after the patients received the service. In cases where patients requested more than one service, true for 43 percent of the participants, repeated pain scores were averaged for each individual. The authors of this study compared scores for the pain levels before and after treatments using t-tests.

The results were highly favorable for massage and acupuncture, and a full 87 percent of services requested were for massage therapy, followed by acupuncture at 9 percent and relaxation services at 3 percent. Services to address pain, with or without other indications like anxiety, tension or edema, accounted for 56 percent of the patient requests.

Both massage therapy and acupuncture reduced pain in patients, and the reduction was found to be highly significant. Integrative relaxation services administered by nurses were not significantly effective at reducing pain. In addition to reducing pain, the services provided an opportunity for rest: 34 percent of the patients fell asleep during their treatment.

The authors conclude that use of acupuncture and massage could help reduce pain for hospitalized patients and can be used as a source of non-pharmacological pain management. Additionally, these services have the added potential benefit of inducing sleep in hospitalized patients, for whom sleep deprivation is a big concern. Sleep affects mood, pain, and physiological function and therefore improved sleep quality may generally aid in the healing process.

The study does have limitations, such as lack of control of factors that can bias results. For example, the provider giving the service also asked the patients to rate their pain before and after. Additionally, the study did not have a patient control group to compare change in pain.

Unblinded treatment and data collection, as done here, have been associated with exaggeration of a treatment effect. In addition, details about the services, including duration, were not available in the charts. This limits the conclusions that can be drawn about these services.

Main Implications of the Prospective Study

The main implications of the study by Clark et al are that massage and acupuncture can be effective in reducing pain and potentially improving other symptoms such as insomnia, sleeplessness and anxiety. This study is important because it demonstrates that in real-life scenarios, hospitalized patients benefit from integrative services. Additionally, massage can be a way to manage pain without additional opioid prescriptions.

While the results here are impressive, randomized controlled trials are still needed for massage therapy. Randomized trials provide the highest-quality evidence that becomes the basis for policy. Organizations such as the American College of Physicians and the Centers for Disease Control already recommend massage therapy for certain conditions, and this study provides support for using massage in pain management in hospitals.

It is valuable for massage therapists to know that a strong drive for massage therapy exists among hospitalized patients. The evidence presented here that massage therapy is both highly desired and highly effective provides justification for hospitals to create full-time jobs for massage therapists and for massage therapists to take these positions to help improve people’s lives.

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