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In t e r n a t I o n a l Jo u r n a l o f th e r a p e u t I c Ma s s a g e a n d Bo d y w o r k —Vo l u M e 3, nu M B e r 1, Ma r c h 2010
RESEARCH
The Effects of Massage Therapy
on Pain Management in the
Acute Care Setting
Rose Adams, MHA, BSW, LMT,1,2 Barb White, MS, LMT,1,3,5 and Cynthia Beckett, PhD, RNC-OB, LCCE4,6
1Therapy Services, Massage Therapy; 2Member, Evidence-Based Practice Research Committee; 3Member, Ethics Committee;
and 4Director, Pediatrics/Perinatal Services and Evidence-Based Practice, Flagstaff Medical Center, Flagstaff; 5Adjunct
Faculty, Women’s and Gender Studies, Northern Arizona University, Flagstaff; and 6Faculty Associate, College of Nursing and
Healthcare Innovation, Arizona State University, Tempe, AZ, USA
Background: Pain management remains a criti-
cal issue for hospitals and is receiving the attention
of hospital accreditation organizations. The acute
care setting of the hospital provides an excellent
opportunity for the integration of massage therapy
for pain management into the team-centered ap-
proach of patient care.
Purpose and Setting: This preliminary study
evaluated the effect of the use of massage therapy
on inpatient pain levels in the acute care setting. The
study was conducted at Flagstaff Medical Center in
Flagstaff, Arizona—a nonprot community hospital
serving a large rural area of northern Arizona.
Method: A convenience sample was used to identi-
fy research participants. Pain levels before and after
massage therapy were recorded using a 0 – 10 visual
analog scale. Quantitative and qualitative methods
were used for analysis of this descriptive study.
Participants: Hospital inpatients (n = 53) from
medical, surgical, and obstetrics units partici-
pated in the current research by each receiving
one or more massage therapy sessions averaging
30 minutes each. The number of sessions received
depended on the length of the hospital stay.
Result: Before massage, the mean pain level
recorded by the patients was 5.18 [standard de-
viation (SD): 2.01]. After massage, the mean pain
level was 2.33 (SD: 2.10). The observed reduction
in pain was statistically signicant: paired samples
t52 = 12.43, r = .67, d = 1.38, p < .001. Qualitative
data illustrated improvement in all areas, with the
most signicant areas of impact reported being
overall pain level, emotional well-being, relaxation,
and ability to sleep.
Conclusions: This study shows that integration
of massage therapy into the acute care setting
creates overall positive results in the patient’s
ability to deal with the challenging physical and
psychological aspects of their health condition. The
study demonstrated not only signicant reduction
in pain levels, but also the interrelatedness of pain,
relaxation, sleep, emotions, recovery, and nally,
the healing process.
KEYWORDS: Massage therapy, acute care, hos-
pital, pain management, research, inpatients, patient
care management, postoperative pain, anxiety, reex-
ology, craniosacral, acupressure, Swedish efeurage,
pregnancy, cancer, bromyalgia, relaxation
INTRODUCTION
Pain management within the acute care setting is
a concern that is being carefully examined not only
by individual hospitals, but also by accreditation
organizations across the United States(1). Massage
therapy is one of the complementary and integrative
medicine (CIM) therapies most often prescribed by
physicians, and it is noted to be the most likely to be
benecial and the least likely to be harmful(2). Studies
have examined the experience of hospitalized patients
and found that high levels of stress and anxiety can
increase pain(3,4) and slow a patient’s recovery by
limiting “physical functioning, including the ability to
cough and breathe deeply, move, sleep, and perform
self-care activities”(5).
The Mayo Clinic of Rochester, Minnesota, con-
ducted a systematic evaluation of the patient hospital
experience and found that “tension, stress, pain, and
anxiety were key challenges for patients”(6). The inte-
gration of massage therapy into the team approach in
patient care constitutes a move forward that recognizes
pain as the fth vital sign after pulse, blood pressure,
temperature, and respiratory rate(5). Although each
patient’s healing process is unique(7), common themes
of healing recognized in the present study underlie the
signicance of a holistic approach to patient care.
Research has documented the use of massage
therapy as an effective tool for pain management(8–10),
with the added benet of producing few adverse
reactions(11–13). When, with cardiac surgery patients,
opioid medications are initially necessary, the contin-
ued use of large doses can delay the recovery process
and lead to prolonged hospitalization(11). Patients with
increased blood pressure because of stress may also
benet from massage therapy(14,15). A study at the
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In t e r n a t I o n a l Jo u r n a l o f th e r a p e u t I c Ma s s a g e a n d Bo d y w o r k —Vo l u M e 3, nu M B e r 1, Ma r c h 2010
ADAMS ET AL.: PAIN MANAGEMENT IN THE ACUTE CARE SETTING
Mayo Clinic, in which 58 cardiac surgery patients
postoperatively received 1 – 3 massage therapy ses-
sions of 20 minutes each, created evidence compelling
enough for the Mayo Clinic to hire a full-time massage
therapist to be available on the inpatient unit(6).
Cardiac surgery patients often complain of back,
shoulder, and neck pain from manipulation of the
body during the surgical procedure and from physical
manifestations of tension and stress(11). When mas-
sage therapy is incorporated as part of the postsurgical
protocol, fewer medications may be needed, provid-
ing an added advantage of fewer adverse side effects
and acting as an effective adjunct or alternative to
pharmaceuticals(10).
The gate-control theory of pain postulates that
massage may be effective in “closing the gate”—that
is, inhibiting the transmission of noxious stimuli by
stimulating large nerve bers that have been shown
to alter pain perception(13). In the acute care setting,
health care professionals have a tendency to touch
patients only when performing procedures, which can
be uncomfortable and even painful. As White wrote,
“Touch is often the most neglected or assaulted sense
of the hospitalized patient”(16).
The relaxation response (RR) is the body’s mecha-
nism to decrease the level of psycho-physiologic
arousal produced by stress(17). Massage therapy can
produce a RR that creates a calm state and enhances
the ability to rest, qualities that are so essential for
healing to occur(4). In addition, the RR elicits physi-
ological changes, including lower blood pressure
and heart rate, decreased oxygen consumption and
muscle tension, and lower levels of cortisol and
noradrenaline(15). “The majority of studies show that
back massage induces a physiological or psychologi-
cal relaxation response and that it is not injurious for
critically ill patients with heart disease”(17).
Stressors experienced by hospital patients include
excessive noise, lack of sleep, social isolation, en-
forced immobility, and pain from procedures. Anxiety
and stress during cardiac catheterization can lengthen
the hospital stay and increase the use of sedative medi-
cation before and during the procedure(3). Hamel’s
research using a randomized clinical trial design with
46 participants demonstrated that a 20-minute back
massage successfully reduced blood pressure before
cardiac catheterization(3). Studies note that fear and
anxiety are common emotions felt by cardiac surgery
patients(6), and as Moyer suggests, “There is much
agreement that how a person feels, emotionally, is at
least partly a function of that person’s bodily state”(18).
When patients have higher postoperative mobil-
ity, they may also have fewer serious postoperative
complications, as demonstrated by Mitchinson and
his colleagues in a randomized controlled trial of 605
veterans undergoing major surgery at Department of
Veterans Affairs hospitals(5).
Lack of sleep in the hospital environment is a
well-known phenomenon and can delay a patient’s
recovery(4,9,17). Hospital-induced sleep deprivation is
generally remedied with medications(17). Critically ill
and elderly patients are a vulnerable population and may
benet from non-pharmacologic methods to promote
sleep(17). By studying the amount of REM and NREM
sleep in 69 elderly men, Richards found that sleep ef-
ciency was 14.7% higher in patients who received
a 6-minute back massage than in a control group(17).
That study is comparable with another that followed
30 patients with bromyalgia who received 30 minutes
of massage therapy twice weekly for 5 weeks. The
patients experienced decreased depression, improved
sleep (a greater number of sleep hours and fewer sleep
movements) and decreased symptoms, including pain,
fatigue, and stiffness(8). Another study of 41 hospitalized
oncology patients illustrated that sleep quality, pain,
symptom distress, and anxiety all improved when mas-
sage therapy was given during the hospital stay(19).
Egnew concludes that healing may be dened as
“the personal experience of the transcendence of
suffering”(7), and therefore each individual will have
a personal concept of what “healing” means to them.
Some aspects of healing are subjective and intensely
personal, with different meanings for each person(7).
Integration of massage therapy may improve the
healing environment for the patient, thus allowing
the deeper aspects of psychological healing to occur
along with physical healing.
As authors, we felt that it was important to include
both quantitative and qualitative investigation. The
value of including qualitative research is reected
by Kania and her colleagues in an article that de-
scribes how the use of the mixed methods approach
“can provide highly valuable insights and a more
complete understanding of the effectiveness of an
intervention”(20). Using the mixed methods approach,
the present study tests the research hypothesis “Does
the use of massage therapy in an inpatient setting
improve patient perception of pain management?”
PARTICIPANTS AND METHODS
This preliminary study enrolled a convenience
sample of 65 inpatients admitted between October 1,
2006, and March 31, 2007, at a nonprot community
hospital serving a large rural area in the southwestern
region of the United States. Criteria for inclusion in
the study were a physician order for massage therapy,
the patient’s (or a family member’s) ability to com-
plete and sign a consent form, and willingness on the
part of the patient to give feedback on the experience
of hospital massage therapy and to return the qualita-
tive survey after hospital discharge. Table 1 presents
demographic data for the research participants.
The plan for the current study was submitted and
approved by the hospital’s institutional review board.
Participation in the research project was voluntary.
Informed consent, including condentiality and the
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In t e r n a t I o n a l Jo u r n a l o f th e r a p e u t I c Ma s s a g e a n d Bo d y w o r k —Vo l u M e 3, nu M B e r 1, Ma r c h 2010
ADAMS ET AL.: PAIN MANAGEMENT IN THE ACUTE CARE SETTING
right to withdraw from the study at any time, was ob-
tained, and forms were completed before the initiation
of any session for the research project. Participants
were told that, whether they chose to partake or not to
partake in the research, their regular treatment would
continue unaffected. Standardization was assured by
having each of the massage therapists use the same
scripted dialogue when approaching potential subjects
for the study. Visual analog scale (VAS) scores were
obtained by the therapists before and after therapy.
Participants were given the post-hospitalization sur-
vey at the end of their last session.
Three licensed massage therapists employed by the
hospital provided the therapy sessions. The experi-
ence in massage therapy of the therapists (all female)
ranged from 2 years to more than 20 years. Each had
received additional training for working with hospital-
ized or medically frail patients, and all had worked
in the acute care setting for 1 to 3 years.
Massage interventions consisted of 15-minute to
45-minute therapeutic massage sessions given at the
bedside. Because of the disruptive nature of the hos-
pital environment, the length of the sessions varied
based on each participant’s energy level and avail-
ability. Treatments included gentle Swedish efeurage
or petrissage, acupressure, craniosacral therapy, or
cross-ber myotherapy with light-pressure efeurage
and pressure points being the most commonly used
modalities. The treatment area on the body varied
according to participant need or concern, taking into
consideration any contraindications, including but
not limited to areas of acute injury and surgical and
intravenous sites. Head, neck, shoulders, back, and
feet were the areas most commonly chosen, with par-
ticipants in either supine or side-lying positions. Par-
ticipants were given a choice of unscented or lightly
scented oils, and relaxing music was offered.
The survey used in this research project (Patient
Survey for Massage Therapy Research) was adapted
from a survey used by Motsinger in her Capstone
Project, titled Development of an Inpatient Massage
Therapy Program in an Allopathic Hospital.a The
survey asked about length of hospital stay, number
of massages received, and whether massage therapy
had improved, had had no effect, or had worsened
the participant’s overall pain levels, emotional
well-being, ability to move, ability to participate in
therapies, relaxation, ability to sleep, and recovery.
Additionally, participants were asked if they felt
that massage therapy had had an effect on their
need for pain medication, how long the effects of
the massage had lasted, and whether they planned
to continue using massage therapy as part of their
healing process. An open-ended inquiry at the end
of the survey encouraged participants to comment
freely about massage.
Quantitative and qualitative methods were used for
analysis of this descriptive study. Demographic data,
number of massage sessions, before-and-after pain
levels using the VAS scale, survey data, and nurs-
ing comments were analyzed. Inferential statistical
analysis was conducted using the paired t-test, with
the signicance level preset at p < .05.
Qualitative data drawn from nursing comments in a
retrospective chart review and participant comments
from the post-hospitalization survey were analyzed
using the grounded theory method to code and label
categories. “Grounded theory” can be described as
a method of analysis that aims to develop middle-
range theories from qualitative data. The founders
of grounded theory, Glaser and Strauss, not only
intended to conceptualize qualitative data, but also
planned to demonstrate relationships between concep-
tual categories and to specify conditions within which
theoretical relationships emerge(21) (pp. 311–312). We
used the grounded theory method to group qualitative
responses into several categories to guide the analysis.
These categories reected responses by the partici-
pants and nurses regarding reactions to the massage
therapy session or sessions the participant received
while hospitalized. The themes generated demonstrate
an interrelationship between categories and an overall
theoretical sensitivity that supports the overriding
theme that “massage therapy promotes recovery.” Fi-
nally, all data were triangulated to determine whether
massage therapy improves patient perception of pain
management while in hospital.
RESULTS
Quantitative Data
From the initial sample of 65 participants, 53 com-
pleted the research project. Pain levels reported by the
a Motsinger S. Unpublished report for the Capstone Project for
DPT. Flagstaff, AZ: Northern Arizona University; 2003.
Ta b l e 1. Demographic Data of Research Participants
Characteristic Value
Participants (n)65
Mean age (years) 45
Sex [% (women/men)] 87/13
Ethnicity (%)
White 82
Native American 12
Hispanic 2.3
African American 1
Asian 1
Hospital unit (%)
Medical 42
Surgical 31
Obstetrics 26
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person felt no effect. The response to the question “Do
you plan to continue using massage therapy in your
healing process?” was yes in an impressive 67.2% of
participants. Another 14.1% responded no, and 18.8%
didn’t know if they would continue with massage
therapy after their hospitalization.
The survey reported participant perceptions con-
cerning the effects of massage therapy on overall pain
level, emotional well-being, ability to move, ability
to participate in therapies, relaxation after massage,
ability to sleep, contribution to faster recovery,
and less need for pain medication after massage.
Participants were asked if there was improvement,
no change, or a worsening in the foregoing factors
because of the massage. In all areas surveyed, a
majority of participants reported an improvement,
although some participants stated that they could
not remember. Notably, no participant indicated a
negative effect from massage therapy. The most
signicant areas of reported effect were overall pain
level, emotional well-being, relaxation, and ability
to sleep (Fig. 2).
Findings from the current preliminary study paral-
lel existing research showing that pain levels signi-
cantly improved with a massage intervention as an
adjunct to conventional treatments(5,19). Other note-
worthy observations included improved relaxation,
emotional well-being, ability to sleep, and a reduction
in the perception of use of pain medications.
Qualitative Data
Using the grounded theory method, “massage
therapy promotes recovery” was the main theme
identied. Within that theme, several subthemes
emerged, including pain management (Table 3),
ability to sleep, relaxation, emotional well-being, and
healing. Each category is represented with comments
from nurses or participants or both. Of the 65 par-
ticipants in the study, 45 (72.3%) returned surveys.
At the end of the survey, an open-ended question
encouraged participants to comment freely about
participants using the VAS ranged from 0 – 10. The
mean score before massage was 5.18 [standard devia-
tion (SD): 2.01]. The mean score after massage was
2.33 (SD: 2.10). A comparison of pain levels before
and after massage shows the individual responses by
massage session (Fig. 1). The observed reduction in
pain was statistically signicant: paired samples t52 =
12.43, r = .67, d = 1.38, p < .001 (Table 2).
The data show that most participants in the survey
received 1 massage (50.8%). Another 40% received
2 – 3 massage sessions, and 6 participants (9.2%)
received more than 3 massage sessions. Most sessions
(83.9%) lasted 30 minutes, 14 sessions lasted 45 min-
utes (14.9%), and 1 session lasted 15 minutes.
The effects of massage therapy were felt to last
1 – 4 hours by 34 participants (53.1%), and 4 –
8 hours, by 13 participants (20.3%). According to 9
participants (14.1%), the effects lasted 8 – 24 hours,
and according to 7 (10.9%), more than 24 hours. One
Ta b l e 2. Analysis of Pain Level Before and After Massage Therapy
Variable Value
Mean pain score (±SD)
Before 5.18 (2.01)
After 2.33 (2.10)
Correlation .67
Standard mean error 0.23
95% condence limits (1.88, 2.78)a
Signicance (2-tailed) <.001a
Cohen’s d1.38
a Statistically signicant.
SD = standard deviation.
fI g . 1. Pain level on a 1 – 10 visual analog scale before and after
massage therapy in 65 inpatient research participants. Of the 65
charts reviewed, 53 charts contained complete data (before/after
pain levels) and are shown here.
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In t e r n a t I o n a l Jo u r n a l o f th e r a p e u t I c Ma s s a g e a n d Bo d y w o r k —Vo l u M e 3, nu M B e r 1, Ma r c h 2010
ADAMS ET AL.: PAIN MANAGEMENT IN THE ACUTE CARE SETTING
their experience of massage therapy. Qualitative
responses were received from 33 participants.
In the medical charts of participants, 25 nurs-
ing comments relevant to the research project
were found. All comments were categorized into
themes and subthemes. Interrelating themes were
also acknowledged.
Pain Management
Of the 33 qualitative responses from participants,
16 were related directly to pain management. Partici-
pants mentioned improved pain levels after surgery
(n = 9), lessening of breast engorgement after a cesar-
ean section (n = 1), decreased body and headache pain
and intensity (n = 4), and decreased pain associated
with cancer (n = 2). One cancer patient commented,
“I looked forward to the massages I received while in
ICU—each helped to reduce the pain.” Another patient
commented, “After three days in the hospital I was
suffering a migraine, nausea, and a lot of body pain.
After the massage my headache was lessened and my
body pain was greatly reduced.” While still hospital-
ized, one patient noted that “I’ve never had anything
take this pain away completely.” Still another noted
that “I’m very much supportive of massage therapy
as a healing and pain relief procedure.” Not only was
perception of pain lowered, but also perception of the
need for pain medication. Signicantly, more than half
the participants (52.7%) felt that they needed less pain
medication after receiving massage therapy.
The responsibility of nurses for pain manage-
ment plays a signicant role in quality health care.
Managing pain is a team effort between physicians,
nurses, and other health care providers. Of the 25
comments by nursing staff, 16 referred to decreased
pain levels or decreased necessity for pain medications
after massage therapy. Nursing comments included
“Patient states his neck pain lessened with massage,”
“Denies pain or needs ... had massage therapy this
am, in no apparent distress,” and “Massage therapy
ordered and given with good relief.”
Sleep
Comments about ability to sleep were often as-
sociated with pain relief. One patient noted that
“massage brought dramatic pain relief and ability to
sleep and an overall sense of well-being in a stressful
fI g . 2. Patient survey results. Black bars = improved; white bars = no change; gray bar = cannot remember.
Ta b l e 3. Qualitative Theme of Pain Management with Massage for
Hospitalized Patients
Hospital inpatient
“After three days in the hospital I was
suffering a migraine, nausea, and a lot of
body pain. After the massage my head-
ache was lessened and my body pain was
greatly reduced.”
Nurse “Patient reports relaxation and pain relief
after massage—slept for three hours”
Cancer patient in
ICU
“I looked forward to the massages I
received while in ICU—each helped to
reduce the pain.”
ICU = intensive care unit.
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environment.” Another commented that “I fell asleep
almost immediately after [the massage therapist] left.”
Nursing observations conrmed what patients stated
on the survey. Nursing comments included “Patient
reports relaxation and pain relief after massage—slept
for three hours” and “Patient stated the massage was
a big help in decreasing his pain and allowed him to
relax enough to get a good nap today.”
Relaxation
Relaxation can play a signicant role in a patient’s
healing and recovery process. More than half the
participants surveyed mentioned relaxation in their
qualitative responses (n = 17). Patients mentioned
relaxation, relief from muscle tension, and increased
feelings of well-being and calm. Overall nervous
tension and the stressful environment of the hospital
were also mentioned. Remarks from patients relating
to relaxation included “[massage therapy] was very
helpful, soothing, comforting, and relaxing,” and “this
was very helpful to me, in that this is so pleasurable
during an unpleasurable experience.” A quadriplegic
patient who received massage therapy commented
that “overall well-being (emotional, physical, spiri-
tual, patience, decreased anxiety, and decreased pain
and spasticity) was improved immeasurably by mas-
sage therapy and subsequent relaxation.”
In 10 comments from the nursing staff, the ben-
ets of relaxation for their patients were mentioned.
Nursing notes reflecting the benefits included
“Patient seemed calmer tonight,” “Patient reports
improved muscle relaxation post massage therapy,”
and “Massage made her relaxed, resting comfortably,
no distress.”
Emotional Well-being
The interrelatedness of themes becomes apparent
in how patient and nursing comments alike reect
the connection between emotional well-being and
relaxation, pain relief, and ability to sleep. Par-
ticipants mentioned emotional well-being 8 times
in connection with decreased anxiety, state of mind,
attitude improvement, and human contact. One pa-
tient commented “[massage therapy] was one of the
few times I could look forward to human contact
without the potential for pain (as opposed to shots,
IV’s ...).” Another patient described her experience
with massage therapy this way: “I was so relieved
and grateful. I was no longer crying and felt much
better. I was so grateful for the body and mind relief.”
One of the participants in the research project was in
advanced stages of cancer. Although she died, her
husband returned the survey, commenting that his
“wife appreciated the pain relief, and that ‘the mas-
sage brought a smile to her face’,” also noting his
own appreciation of the therapy.
Although nursing comments focused mainly on
pain management and relaxation, 2 nursing notes
articulated improved emotional well-being. A nurse
in the Women’s and Infant Center noted that “patient
has been teary about infant in special care nursery,
had a massage, now coping a little better.” Another
nurse commented “Patient seemed calmer tonight,
not agitated, or hostile.”
Healing
References to healing and subthemes of healing in-
cluding spirituality, recovery, and therapeutic benets
were found in responses from 10 participants. One
participant noted that “I feel massage is very impor-
tant to helping patients heal, in so many ways,” and
another commented that “[massage therapy] was a
very healing experience emotionally and physically.”
Other participant comments included “Reduction of
stress also was very helpful in recovery,” “It was
very therapeutic,” and “It is such a healing process
and denitely relaxing.” No nursing comments on the
theme of healing were found.
DISCUSSION
The experience of hospitalization creates pain and
anxiety for many people, regardless of their underly-
ing medical condition. The goal of the present study
was to explore how massage therapy would affect a
patient’s perception of pain in the acute care setting.
Previous studies have established the benets of mas-
sage therapy for patients suffering from particular
illnesses—for example, cancer(19)—and cardiac sur-
gery or procedures(3,6,17). Other studies have focused
on patient experiences within particular hospital
units including transplantation, neuroscience, and
rehabilitation(4). By selecting research participants
in units throughout the hospital, with a wide variety
of diagnoses and reasons for hospitalization, our
project provides a unique picture of how massage
therapy may benet any patient coping with the pain
and stress associated with hospitalization, offering a
strong argument that massage is an effective adjunct
therapy for pain management.
The primary ndings of this preliminary study show
a strong correlation between reduction of pain levels
after massage therapy and statistically signicant
differences in pain scores before and after massage.
The perception among participants of improved pain
levels and less need for pain medication underscore
the promise of massage therapy’s positive effect on
pain management protocols. In addition, a majority
of patients felt that massage therapy contributed to
increased relaxation, emotional well-being, ability
to sleep, ability to move and to participate in other
therapies, and faster recovery. For most patients, the
effects of the session lasted 1 – 4 hours, with some
participants experiencing benefits for more than
24 hours.
Reports of improved levels of relaxation after mas-
sage therapy were received from 98% of the research
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study participants. The fact that patients throughout
the various hospital units, with a wide variety of
pre-massage pain levels, experienced relaxation
through massage therapy indicates the true potential
for massage to support healing for hospitalized pa-
tients. This nding was reiterated in comments from
patients and nurses alike. By accessing a patient’s
ability to relax, massage therapy addresses a variety
of needs. Indeed, the RR may be the most profound
mechanism through which massage therapy helps the
hospitalized patient.
In addition to relaxation, massage therapy also
counters another fundamental aspect of hospitaliza-
tion, the sense of isolation experienced by many
patients. In the present research study, participants re-
ported an improvement in emotional well-being—an
aspect of healing that may speak to the need for human
touch. More and more hospitals are recognizing the
importance of touch for the hospitalized patient(4,6).
As the face of health care changes in the coming years,
it is a hopeful sign that safe, skillful touch is being
recognized as a mechanism of healing for patients in
the acute care setting.
Participation in our research study was limited
to adults whose medical circumstances allowed
them to receive massage therapy and to complete
the study paperwork. The study does not reect the
perceptions of patients whose energy or pain levels
precluded them from participation. Patients whose
level of pain did not allow for participation may have
found less benet from massage therapy, revealing
the need for fully integrative services in which mas-
sage is merely one component of a comprehensive
pain management protocol.
Another limitation of the present study is the lack
of collection of physiological data, including heart
rate, blood pressure, and oxygen levels. The absence
of data on the physiological indicators of pain and
the RR means that the study relied on participant
perceptions without additional external measures to
verify participant responses to massage therapy. Pain
is an inherently subjective experience that includes
physical and emotional elements. Within the hospi-
tal environment, health care workers rely on patient
perceptions for pain management. The present study
thus reects current standards for assessing the ef-
fectiveness of various interventions to address pain
in patients.
The current project, designed to gather prelimi-
nary data on the research hypothesis, did not use a
control group. The selection of additional patients
in units throughout the hospital, combined with
randomization to groups, would have required sub-
stantial additional resources. However, future stud-
ies on massage therapy in an acute care setting may
benet from the addition of a control group. Such
research may also help to identify specic types of
massage therapy that are most effective in the acute
care setting.
CONCLUSIONS
Evidence-based research continues to conrm
the importance of human touch to balance the
high technology of today’s health care practices.
The further integration of CIM therapies such as
massage into the hospital offers the possibility
to improve the experience for patients who face
physical, psychological, and social challenges in an
unfamiliar environment. A large and growing body
of research, including the current project, justies
the use of massage therapy for pain management
in the acute care setting. Massage therapy can
provide pain relief and relaxation, can support a
patient’s emotional well-being and recovery, and
can ultimately aid in the healing process for hos-
pitalized patients.
ACKNOWLEDGMENTS
This research was conducted at Flagstaff Medical
Center, Flagstaff, Arizona, from October 2006 to
March 2007.
The authors thank Alisha Witcomb, LMT, for her
contribution as one of the three massage therapists
involved in this study and as an integral collaborator
in the data collection process. The authors also ex-
press their gratitude to Lori Pearlmutter, PT, MPH.
Lori was inspirational and supportive throughout the
process, as a co-investigator and a mentor.
CONFLICT OF INTEREST NOTIFICATION
The authors declare that no conicts of interest are
associated with this research project or publication
of ndings.
COPYRIGHT
Published under the CreativeCommons Attribu-
tion-NonCommercial-NoDerivs 3.0 License.
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Corresponding author: Rose Adams, Flagstaff
Medical Center, Therapy Services, Massage Therapy,
1215 N. Beaver Street, Flagstaff, Arizona 86001
U.S.A.
E-mail: rose.adams@nahealth.com
