A seminal study of massage on cancer patients has shown that the intervention reduces the level of pain and anxiety these patients experience during treatment for the disease.

The study, conducted over four years at the James Cancer Hospital in Columbus, Ohio, sought empirical evidence for the efficacy of massage on cancer patients experiencing pain in the course of treatment.

“The research on the use of massage with cancer patients has been minim[al] because massage therapy schools teach their students that massage is contraindicated with cancer patients,” reported Pauline King, a mental health clinical nurse at the hospital, who led the study.

“We are always probing, sticking and doing other invasive treatments with cancer patients who are often touch deprived,” King continued. “It was felt strongly that the patient needed caring touch as an antidote to the invasive procedures.”

The study, which concluded in late 1999, was funded by a $10,000 grant from the AMTA Foundation. Its results have been widely reported by national media.

For the study, 52 cancer patients receiving treatment at the hospital, which is affiliated with Ohio State University, were randomly placed into either an experimental group or a control group.
On the first day of the two-day study patients in both groups had a volunteer simply sit with them for 15 minutes, but had no physical contact. On the second day patients in the experimental group received petrissage on the hands, feet, shoulders and back of the neck for 15 minutes. Patients in the control group again sat with a volunteer for 15 minutes, but had no physical contact.

Pain and anxiety levels were measured on both days before the intervention, directly following, and again 30 minutes later. Pain levels were measured by a Visual Analogue Scale in which patients rated the severity of their pain on a scale from 0-10, with 0 equaling no pain and 10 equaling the worst pain possible. Anxiety, which was defined as “tension, apprehension, nervousness and worry,” was measured using the Spilberger STAIT-TRAIT Anxiety Inventory, by which patients rated their own anxiety levels.

Data analysis showed the massage had a statistically relevant impact on pain and anxiety levels of patients in the experimental group compared to those in the control group. Overall, patients who received massage showed a .9 difference (drop) in pain level, versus no change in pain level for those in the control group.

“This study is a seminal study that produced empirical evidence on the efficacy of massage on cancer pain and anxiety,” the report concluded. “More hard data studies are needed in order to bring massage in the medical systems where it is most needed.”

An addendum to the study findings was the positive feedback the researchers received from the hospital’s medical staff, in regard to the massage protocol. “Even before the study was completed, doctors and nurses were consulting the primary investigator to give their patients a massage,” King reported. “The study raised the consciousness of the medical practitioners, which was another very positive outcome of this study.”

- Source: Pauline King, Ohio State University.

Massage lowers anxiety, improves mood and increases range of motion among dance students, according to a recent study.

Researchers at the Touch Research Institute showed that twice-weekly massage lowered the stress hormone cortisol, eased neck, shoulder and back pain, and helped range of motion, including neck extension and shoulder abduction.

Thirty female dance students were randomly assigned to a massage or relaxation therapy group. Both groups otherwise continued the same daily dance and school regime.

Those in the massage group received 30-minute sessions twice weekly for five weeks. The massage was focused on the upper body and consisted of moderate to firm pressure, stroking, stretching and rocking. With a prone dancer, the therapist began the session with firm strokes to stretch and warm the neck, back and shoulders. Next, friction and then squeezing were applied to both sides of the spine and then along the sides of the body.

This was followed with a sequence of up-and-down and side-to-side strokes along the collar bone and scapula. Firm pressure was applied, moving muscles away from vertebral column. Firm gliding motions were made down the neck, shoulder and upper back, finishing at the bottom of the scapula.

Continuing with the dancer lying on her side, massage was applied with firm pressure on the muscles along the rib cage, releasing tension before continuing. The chest muscles were then lifted, squeezed and stretched. The arms were circled up by the head and behind the back and down again while applying gentle pressure to the chest and side. The lateral neck muscles were then pressed. Lastly, the arm was circled in reverse, using its own weight to stretch the middle back and chest muscles.
In the relaxation group, dancers listened via earphones to instructions on a series of guided muscle relaxation exercises while lying on a mat. Sessions lasted 30 minutes and consisted of tensing and relaxing muscles, starting with the feet and moving up the body, ending at the face. These sessions also occurred twice weekly for five weeks.

To assess the effects of the massage and relaxation sessions, researchers used five measurements: a State Anxiety Inventory (a questionnaire that assesses anxiety levels), a Profile of Mood States questionnaire; pre- and post-session pain scales to measure perception of pain in the neck, shoulders and back; pre- and post session saliva samples to measure cortisol levels; and measurements of range of motion, including neck extension and shoulder abduction.

Results showed that both groups had less anxiety, better mood, and less pain in the neck, shoulder and back. Only the massage group experienced a decrease in cortisol and an improvement in range of motion, including neck extension and shoulder abduction.

“Perhaps massage therapy stretched the dancers more than relaxation therapy, thus leading to the improved range of motion for the massage therapy group,” the study authors wrote.

The authors stated that further study should be devoted to the effects of massage therapy for preventing and treating dance injuries.

- Source: Touch Research Institute. Originally reported in the Journal of Dance Medicine & Science, 1999, Vol. 3, No. 3, pp. 108-112.

Hypertensive adults who received regular biweekly massage sessions experienced less depression and hostility and showed a decrease in measured stress-hormone levels, according to a recent research study.

The study titled “High blood pressure and associated symptoms were reduced by massage therapy” was completed in May 1999, and was conducted in conjunction with the Touch Research Institute, the University of Miami School of Medicine and Nova Southeastern University in Florida.

Thirty adults with controlled hypertension (for at least the last six months) were randomly assigned to either a massage therapy group or a progressive relaxation group.

Those in the massage group were given twice-weekly 30-minute massage sessions in the afternoon or early evening for five weeks. Massages were given on a rotating basis by various therapists. With the subject in a supine position, the therapist would massage the head and neck, arms, torso and legs with stroking, squeezing, pressing and pulling motions. With the subject in a prone position, the therapist would massage the back of the legs, and would then massage the back.

Participants in the progressive muscle relaxation group received instructions on completing self-administered, twice-weekly 30-minute exercises for five weeks. Researchers instructed subjects to only perform their session in the afternoon or early evening on assigned days to ensure compatibility with the massage group’s schedule. Relaxation sessions began with participants breathing deeply for several minutes while in a supine position with the hands alongside the body. They then followed instructions to tighten and then relax different muscles, moving upward from the feet to the head. Muscle groups included were of the feet, calves, thighs, hands, arms, back and face.
Pre- and post-treatment assessments included: a state anxiety inventory (STAI) to assess current emotions; a salivary sample to measure the levels of the stress hormone cortisol; systolic blood pressure and diastolic blood pressure measures; the Center for Epidemiological Studies Depression Scale (CES-D) questionnaire to rate depressive symptoms; Symptom Checklist-90-Revised (SCL-90-R) self-report symptom inventory of depression, anxiety and hostility; and urinary catecholamines (biologically active amines which affect the nervous and cardiovascular systems) and cortisol measurement.

Results showed that while both groups had lower anxiety levels (STAI) and lower levels of depression (CES-D), only the massage therapy group showed decreases in sitting diastolic and systolic blood pressure; decreases in salivary and urinary cortisol stress-hormone levels; and lower scores for depression, anxiety and hostility.

Researchers suggested that future studies be long-term, and examine the effects of massage on individuals who have high levels of stress.

“Longer-term follow-up might also help determine whether the results reflected short-term effects or whether the results would have persisted beyond the treatment sessions,” researchers wrote. “If massage therapy can effectively reduce symptoms associated with hypertension, then it might reduce life-threatening complications, such as the risk of stroke or heart attack.”

- Source: Touch Research Institute. Originally reported in the Journal of Bodywork and Movement Therapies, January 2000, Vol. 4, No. 1.

Massage reduces physical and emotional stress, and reduces pain and insomnia among primary caregivers for terminally ill family members, according to a study, “Massage as a respite intervention for primary caregivers.”

The study was administered by The Oregon Hospice Association and East-West College of the Healing Arts, and funded by a community outreach grant from the American Massage Therapy Association Foundation in 1998. The grant initiated a massage respite project that provided massage as an intervention for primary caregivers, who often experience fatigue and stress.

Massage was offered to a group of 13 caregivers between the ages of 35 and 82, who had been referred by a volunteer coordinator or social worker. Most participants were women, usually wives, caring for men. They received 75-minute sessions of Swedish massage and other techniques, including shiatsu, Reiki, polarity, jostling, compression, myofascial release, trigger-point therapy and gentle stretching, weekly or biweekly at a hospice or at their home. Half of the participants had never had massage before. On the intake form, caregivers primarily asked to have their necks, shoulders or backs massaged. The average number of massages received was six (the caregivers were often too busy to take time for massage).

Assessments included a pre- and post-massage list of questions that rated emotional stress, physical stress, physical pain and sleep difficulty on a 1-5 scale. Physical stress measurements included things such as stamina and energy level, while physical pain referred to specifics such as headaches, back pain and knotted muscles.
Results showed that 85 percent of the caregivers reported a decrease in emotional and physical stress. Physical pain was relieved for 77 percent of the caregivers. Difficulty sleeping was eased for 54 percent. The few caregivers who reported contradictory results also commented on having so much stress (due to daily duties or a recent death) that they were unable to feel the benefits of massage beyond the immediate session.

The study concluded that participants experienced an overall decrease in stress, and that by offering massage as a respite intervention, hospice agencies would benefit both caregivers and the patients under their care.

“Perhaps the hospice team of the future will include a massage therapist who will work side-by-side with the nurse, clergy, social worker, and physical therapist,” study author Gayle MacDonald stated. “Not only do they have the training to work with sore muscles and stiff necks, massage therapists bring with them qualities such as restfulness, tranquility, deep compassion, and the ability to listen with their entire being. Through their hands these attributes are transmitted, momentarily easing the burden and nourishing the caregiver’s body, mind and heart.”

- Source: Gayle MacDonald, LMT. Originally reported in The American Journal of Hospice & Palliative Care, January/February 1998 pp. 43-47.

Women suffering from symptoms of premenstrual syndrome (PMS), such as irritability, headaches, anxiety and weight gain, felt relief from regular massage sessions, according to results from a recent research study.

The study, “Premenstrual symptoms are relieved by massage therapy,” was conducted by the Touch Research Institute in conjunction with the University of Miami Medical School.

Twenty-four women, aged 19 to 45, with premenstrual dysphoric disorder (a severe form of PMS) were selected from gynecological practices. The women were randomly assigned to a massage therapy group or a relaxation group. Those in the massage therapy group received twice-weekly, 30-minute massage sessions for five weeks. The sessions started during a premenstrual week to establish a baseline measure.

Sessions began with the woman supine, and included 1premenstrual5 minutes of: kneading the neck; stroking the forehead; pressing down on the tops of the shoulders; stroking on the hands, arms and shoulders; circular stroking on the stomach; stroking of the feet and legs; and kneading of the thighs. The remaining 15 minutes of the session, the woman was prone while the therapist stretched her ankles; compressed her calf muscles; kneaded her thigh muscles; gave gliding strokes to her legs; and massaged her low back, shoulders and neck.

The relaxation group was given progressive muscle relaxation therapy. For 30 minutes twice a week, participants were instructed to tense and relax major muscle groups, starting with the feet and moving up.
Treatment assessments included the following self-rating scales: the Center for Epidemiological Depression Scale (CES-D) to rate depressive symptoms; the Menstrual Distress Questionnaire (MDQ) to rank premenstrual symptoms; the State Trait Anxiety Inventory (STAI) to measure anxiety; the Profile of Mood States (POMS) to rate the level of depression; and a visual analog scale (VAS) to rate perceived pain.

At the end of the study, results indicated that the massage therapy group experienced a decrease in anxiety (STAI), a decrease in depression (POMS), a reduction in perceived pain (VAS), and an overall reduction in PMS symptoms including pain and water retention (MDQ).

Researchers wrote that future studies might focus on the effects of a longer-term massage therapy program.

“Overall, the present findings suggest that massage therapy may be an effective long-term aid for pain reduction and water retention, and short-term for decreasing anxiety and improving mood for women with premenstrual dysphoric disorder. Based on these findings, massage therapy benefits would be expected to generalize to the milder PMS.”

- Source: Touch Research Institute. Originally reported in the Journal of Psychosomatic Obstetrics & Gynecology, March 2000, Vol. 21, pp. 9-15.

Adults with chronic low-back pain found relief from massage therapy, according to a research study. Massage eased pain, reduced depression and anxiety, and improved sleep and range of motion.

The study, “Lower Back Pain is Reduced and Range of Motion Increased After Massage Therapy,” was completed in January 2000 by the Touch Research Institute in conjunction with the University of Miami School of Medicine and Iris Burman of Educating Hands, and was first published in the International Journal of Neuroscience.

Twenty-four adults who had experienced low-back pain for at least six months were randomly assigned to either a massage therapy group or a relaxation therapy group.

The massage therapy group received twice-weekly, 30-minute massages for five weeks. Starting in the prone position, the following techniques were used: kneading and pressing the back muscles, stroking both sides of the spine and hips, gliding strokes to the legs, and kneading and pressing the thighs. Continuing in the supine position, participants received: gliding strokes to the neck and abdomen, kneading of the rectus and oblique muscles that help bend the trunk of the body forward, stroking of the legs, kneading of the anterior thighs, flexing of the thighs and knees, and gentle pulling on both legs.

Those in the relaxation group were instructed in progressive muscle relaxation techniques to tense and relax muscles in the feet, calves, thighs, hands, arms, back and face. Participants performed these exercises at home twice weekly for 30 minutes.
Assessments taken before and after the first and last sessions included: the Profile of Mood States Depression Scale to rate depression; the State Anxiety Inventory to rate feelings at the present moment; the McGill Pain Questionnaire to measure pain; the Visual Analogue Scale to measure present level of pain; the Range of Motion Measures test to rate the level of ability to bend; a Symptom Checklist-90 Revised to measure moods; a sleep scale to measure quality of sleep; and urine samples to measure levels of the stress hormone cortisol, serotonin and catecholamines (amino acid derivatives that affect the nervous system, cardiovascular system, metabolic rate, temperature and muscles).

Results showed that both groups experienced a decrease in stress and long-term pain, but only the massage group experienced less pain directly after the session, fewer depressive symptoms, better sleep, improved range of motion and an increase in serotonin and the catecholamine dopamine biochemical levels.

“The findings from the present study are compelling and if the effects can be replicated and persist, these data suggest that massage therapy effectively reduces pain, positively impacts on the biochemical system, and attenuates psychological symptoms associated with lower back pain,” the study authors wrote.

The authors also wrote that future studies might “examine the impact of massage therapy on job productivity and absenteeism for individuals with chronic low back problems.”

- Source: Touch Research Institute. Originally reported in International Journal of Neuroscience, 2001, Vol. 106, pp. 131-145.

HIV-positive adolescents who received twice-weekly massage experienced decreased depression and an improvement in immune system function, according to a recent study.

The study, “HIV adolescents show improved immune function following massage therapy,” was completed in March 2000 by the Touch Research Institute in conjunction with the University of Miami School of Medicine and was originally reported in the International Journal of Neuroscience.

Twenty-four HIV-positive adolescents aged 13 to 19 were recruited from a health-care service center and randomly assigned to either a massage group or a relaxation group. All participants were undergoing similar anti-HIV drug regimens. For both groups, the first day of either massage or relaxation therapy was within one week of a scheduled blood draw, and the last day of therapy was within one week of the next scheduled blood draw.

Participants in the massage group received a 20-minute seated massage twice a week for 12 weeks. The massage therapist gave a standard seated massage, working on the back, arms, hands and neck of each participant. The back massage consisted of long, moderate-pressure strokes to the back parallel to the spine; gentle rocking; squeezing of shoulders and arms; finger pressure applied along the spine; and circular strokes to the hips. Massage to the arms included kneading and pressing from shoulder to lower arm. Work on the hands included massage of the entire hand, pulling of fingers, pressure to the palm for 15-20 seconds, and gentle pulling of the arms. The neck massage consisted of kneading, finger pressure along the skull and neck, scalp massage, and pressing and squeezing from the trapezius down to the arms.

The relaxation group participants were led through 20 minutes of progressive muscle relaxation twice weekly for the 12 weeks. A research assistant or a massage therapist would instruct the participants to tense and relax the same muscles that were massaged in the massage group: the back, arms, hands and neck.
Pre- and post-treatment research assessments included: a demographic questionnaire; the Center for Epidemiological Studies Depression Scale (CES-D) questionnaire to rate depression; a blood draw to measure T-lymphocytes (HIV disease progression markers) and natural killer cells (cells that provide protection against opportunistic disease); and a state anxiety inventory to assess feelings.

Results showed that natural killer cell numbers increased only for the massage therapy group. The massage therapy group also reported feeling less depressed than those in the relaxation group, and experienced an improvement in immune function at the end of the 12 weeks, as compared to the relaxation group.

Researchers suggested that a future study could look at the effects of massage therapy on HIV-positive adolescents who are not depressed.

- Source: Touch Research Institute. Originally reported in International Journal of Neuroscience, 2000, Vol. 106, pp. 35-45.

Preschoolers showed enhanced cognitive performance after receiving massage therapy, as evidenced by greater accuracy on skills tests than those in a control group.

The research study “Preschooler’s Cognitive Performance Improves Following Massage,” was conducted by researchers at the Touch Research Institute in conjunction with Texas Tech University, Nova Southeastern University and the University of Miami School of Medicine. It was originally published in the journal Early Child Development and Care.

Twenty preschoolers ages 3 to 5 were randomly assigned to either a massage therapy group or a story-reading group. The children were given a temperament rating based on how their behavior was seen by their teachers, along a scale that ranged from calm and easygoing to anxious and high-strung.

Those in the massage group were given one 15-minute massage. Beginning in the supine position, the children were massaged along their faces, including circular strokes on the nose, cheeks, jaw and chin; their stomachs, including paddlewheel-fashion hand strokes; their legs, including massage of the feet and toes and stroking the legs up toward the heart; and their arms, including strokes from shoulders to hands. Finishing in the prone position, each child was massaged along the back, hands, sides, shoulders and neck, ending with strokes from the head to the feet.
Children in the control group were read a Dr. Seuss story for 15 minutes, while sitting close together in a carpeted area.

The skills pre-test was given to both groups prior to the reading or massage. Following the reading or massage, a skills post-test was given. Assessment included the Wechsler Preschool and Primary Scale of Intelligence-Revised, which measured the children’s performance on three timed skill and abstract reasoning tests: block design, animal pegs and mazes.

Results showed that children who received massage were more accurate on the tests, in contrast to those in the control group, whose scores either stayed the same or decreased in each post-test. Researchers reasoned that the children were more alert following massage, and thus showed improved performance on the tests. The children who had been rated by teachers as anxious and high-strung showed the greatest improvement in scores following the massage. Massage possibly alleviated stress among these children, the study authors concluded.

Researchers noted that little touch takes place in preschools. “Whether touch deprivation is a source of stress among preschoolers is an important question for future research,” the study authors wrote. “Since the long-term effects of massage therapy have not yet been established, further studies are needed to determine the extent to which touch therapy needs to be incorporated in the preschool curriculum.”

- Source: The Touch Research Institute. Originally published in Early Child Development, 1998, Vol. 143, pp. 59-64.

Massage is an effective treatment for chronic low back pain, according to a research study conducted by the Center for Health Studies in Seattle, Washington. In a comparison of massage, acupuncture and self-care, a 10-week program of massage therapy was found to be most effective of the three.

The study, “A Randomized Trial Comparing Acupuncture, Therapeutic Massage and Self-Care Education for Chronic Low Back Pain,” was completed in late 2000.

Researchers compared the effects of acupuncture, massage and self-care education on 262 adults, aged 20 to 70. Participants in the massage group and the acupuncture group could have up to 10 sessions during the 10-week study period.

Those in the acupuncture group received acupuncture, electrical stimulation, heat, cupping, herbs and exercise suggestions.

Those in the massage-therapy group received a treatment protocol of therapies including Swedish and deep-tissue massage, trigger-point therapy, neuromuscular therapy and movement education.
Self-care participants were given two videos and a book with information about back pain, techniques to control and prevent pain, and suggestions for dealing with emotional problems that can accompany chronic pain.

Pre- and post-treatment assessments included: a Roland Disability Scale (a questionnaire that measures ability to function); SF-12 physical and mental health summary scales; exercise and worry level assessments; and estimates on care costs. Assessments were taken at intervals of four, 10 and 52 weeks.

Massage was found to be the most helpful therapy at the end of the 10-week treatment period, in all assessment criteria. Acupuncture ranked higher than self-care only in higher satisfaction with care and less use of pain medication at the end of 10 weeks.

After one year, those who had participated in the massage group still reported the greatest benefit from the 10-week treatment period, as compared to those who were in the acupuncture or self-care groups. Researchers also said there were noted improvements at the end of one year in the self-care group, in the areas of symptom, function and decreased worry about back problems.

“This study suggests that massage has benefits that become apparent within 10 weeks and persist at least one year,” the researchers wrote. As well, those in the massage group had 40 percent fewer back-pain-related visits to a physician and 40 percent fewer medication refills than those in the other two groups.

“The finding that the benefits of massage persist well beyond the last treatment, and the suggestion of possible reductions in subsequent health care utilization, make massage a high priority for further study,” the authors wrote.

- Source: Group Health Cooperative of Puget Sound Center for Health Studies, Seattle, Washington. Authors: Daniel C. Cherkin, Ph.D.; David Eisenberg, M.D.; Karen J. Sherman, Ph.D.; William Barlow, Ph.D.; Ted J. Kaptchuk, O.M.D.; Janet Street, R.N., Richard A. Deyo, M.D. Originally published in Archives of Internal Medicine, April 23, 2001, Vol. 161, No.8.

Burn patients reported less itching, pain and anxiety, and an improvement in mood after receiving massage, according to a research study. The study, “Postburn Itching, Pain, and Psychological Symptoms Are Reduced With Massage Therapy,” was conducted by researchers at the Touch Research Institute at the University of Miami School of Medicine and published in the Journal of Burn Care and Rehabilitation.

Twenty adult burn patients were recruited from a university outpatient center to participate in the study. Individuals were in the remodeling (the reconstruction or reshaping of the wound as it heals) phase of wound healing, approximately 118 days after injury. They had moderate-sized wounds and complained of severe itching. They were randomly placed in either a control group or a massage group. Both groups received standard medical care that consisted of an examination by a doctor, medication and physical therapy.

Those in the massage group received twice-weekly, 30-minute massage sessions for five weeks. Massage therapists massaged the wound area with moderate pressure, using cocoa butter as a lubricant. Cocoa butter was applied to the wound area in a stroking manner, and therapists pressed along the wound edges and stroked toward the center of the wound. Massage therapists also used circular, transverse and vertical strokes for 10 minutes on the wound. The skin was rolled in all directions and then long, gliding strokes to the entire affected area were used to end the massage.

Measurements taken included an itching and pain rating based on the McGill Pain Questionnaire; the State Trait Anxiety Inventory (STAI), which measures feelings at the present moment; and the Profile of Mood States that measures depression. Results showed that those in the massage therapy group experienced a reduction in pain and itching, a decrease in anxiety and improved mood, as compared to those in the control group. The measures showed long-term improvement from the beginning to the end of the study.
“Our findings are encouraging because massage therapy provides a natural and effective alternative for the reduction of itching, pain, and psychological symptoms that are commonly experienced by patients with burns after they are discharged from the hospital,” the study authors wrote. “Future and long-term studies might examine enduring effects of massage therapy for scar tissue healing, including reduction of the height of the scar and improvement in vascularity, pliability, and pigmentation.”

- Source: The Touch Research Institute. Originally published in the Journal of Burn Care and Rehabilitation, 2000, Vol. 21, pp. 189-93.