Nov. 5, 2007 A new Mayo Clinic study shows that massage therapy decreases pain levels for patients after heart surgery. During a five-month period in 2005, 58 patients undergoing surgery participated in a pilot study to examine the effect of massage on pain after surgery. Of the 30 who received massage, the mean pain scores were less than 1 on a scale of 1 to 10, with 10 as the most painful. Before the massage therapy, these patients rated their pain at an average of 3 on a 10-point scale.
In the control group of 28, pain levels remained the same over the same period, according to findings published in Complementary Therapies in Clinical Practice.
Mayo Clinic's cardiovascular surgery group began looking at complementary therapies in 2004. "In surveys, we started to hear from patients that tension, stress, pain and anxiety hampered their recovery," says Susanne Cutshall, a registered nurse in Mayo Clinic¡¦s cardiovascular surgery group and lead author of the study.
A team of nurses, surgeons, anesthesiologists, pharmacists and hospital administrators listened to patients' concerns, searched the literature and visited other hospitals. The result was the Healing Enhancement Program for cardiac surgery patients. It offers massage, music and guided imagery. The program combines evidence-based conventional care and evidence-based complementary and alternative medicine (CAM), Cutshall says.
"Our goal was to look at the patient's mind, body and spirit experience," Cutshall says. "We knew long ago that our patients had stress and pain, but it had been seen as a normal part of the process. Today, patients speak up more, and we recognize it¡¦s not enough to fix the heart; we have to treat the whole patient. These therapies don't take the place of medications but are seen as an important addition that makes a difference to patients."
As team members examined potential complementary therapies, they discovered little information specific to helping heart surgery patients, particularly after surgery. Therefore, they used the following criteria to incorporate methods that had been studied for complementary therapies in general: previous studies documented good results, the therapy coincided specifically to concerns of patients needing heart surgery, and the method could be used with relative ease and low risk for the patient. Based on their research, the team created pilot studies and research protocols for massage therapy, music therapy and guided imagery for patients, as well as stress education classes for patients and family members.
The team bought CD players for each room and a selection of CDs. The team endorsed relaxation music based on numerous studies that show music's positive effects on hospital patients. In addition, the team began a partnership with Chip Davis, founder and leader of the 18th century-style classical rock group Mannheim Steamroller, to include Ambient Therapy: specially created relaxation music combined with nature sounds for patients at Mayo. A randomized controlled trial is under way.
This complementary health method teaches patients to use their imaginations -- along with music and spoken messages -- to help guide them through recovery. Using a stress- and wellness-trained nurse, patients were instructed about stress management and given a portable CD player and imagery CDs. This pilot didn't show a significant decrease in pain and anxiety, possibly because, in the pilot phase, there was limited time prior to surgery to explain this method to patients and encourage them to practice it, Cutshall says. However, guided imagery CDs are now distributed to patients when they are informed of the need for surgery, so they can use them prior to surgery, she says.
Stress education classes
The team partnered with the Mayo Clinic Patient Education Center to offer pilot stress management skill classes to inpatients and their family members. The classes work well because patients often are in the hospital for several days following surgery, Cutshall says. Classes are conducted twice a week on the cardiac surgery units.
"These services are outside the realm of what surgeons are typically taught in medical school; we tend to always want to see the evidence," says Thoralf Sundt, M.D., co-author and a cardiovascular surgeon at Mayo Clinic. "But we quickly could see the benefits to patients and that's the bottom line for us. We see this as looking out for all the needs of our patients."
As a result of the pilot study, Mayo now has a full-time massage therapist available for patients after heart surgery, and a larger, randomized study is under way.
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