Communication through Touch: Using Massage in Palliative Care

1. Communication through Touch: Using Massage in Palliative Care J. D. Elder, MA, LMT Hertzberg Palliative Care Institute Mount Sinai School of Medicine, 2011

2. Objectives • Explain and define Massage Therapy • Demonstrate and contrast Swedish massage techniques with other common and modified massage techniques • Recognize massage as an approach to touch, and a way of communicating that can be incorporated as part of routine patient care and interaction

3. “Touch is the earliest sense to develop and provides a fundamental means of interacting with the environment and others” (Sims, 1988).

4. What is Massage Therapy • Ancient health and healing practice. References to massage found across cultures--China, Japan, India, Egypt, Rome and Greece • Variety of approaches to clinical touch and palpation • Hippocrates defined medicine as "the art of rubbing." http://nccam.nih.gov/health/massage/massageintroduction.htm • >80 documented massage therapy styles

5. What is massage therapy? • Massage therapists press, rub, and otherwise manipulate muscles and other soft tissues of the body. Most often use their hands and fingers. http://nccam.nih.gov/health/massage/massageintroduction.htm#defining • Speed, pressure/intensity, depth and direction of the massage stroke varies based on the technique, goals and conditions of patient

6. Massage Therapy in United States • Used for a variety of health-related purposes, including pain relief, anxiety and depression, injury rehabilitation, stress management, and to support wellness. http://nccam.nih.gov/health/massage/massageintroduction.htm#use

7. Popularity and Cost An estimated 18 million U.S. adults and 700,000 children received massage therapy in 2006 at an estimated cost of 4.2 billion dollars (2007 NIH health survey). http://nccam.nih.gov/news/camstats/costs/costdatafs.htm

8. Contraindications • Caution must be exercised in event of blood clots, cancer, infection, osteoporosis and spinal fractures. • This does not mean that a patient cannot receive massage; massage therapist must select or modify massage techniques so that they can be safely, appropriately and effectively used.

9. What is the evidence? • Improves neck and back pain (Sherman et al, 2009; Cherkin et al, 2011) • Helps relieve anxiety and depression (Moyer et al, 2004) • Improves pain, mood and fatigue in patients receiving chemotherapy (Post-White et al, 2003)

10. What is the evidence? (con’t) • Older adults who used manipulative and body-based techniques reported less functional impairment” (Nguyen et al, 2010) • Patients who received touch during routine MD visits, “resulted in lower pulse and anxiety” and “lower blood pressure” (Salzmann-Erikson & Erikson, 2005)

11. Common Massage Techniques • Swedish Massage Therapy: a Five-stroke massage system based anatomy and circulation flow. Method can be used to meet a number of specific goals (depending on treatment intent). • Medical Massage: more specific massage application to treat physical conditions (e.g., structural injuries) and complement rehabilitation.

12. Massage Therapy (cont) • MyoFascial Release: Slow, stretching of the myofascia capsule to release contractures. • Micro-Holding/Mindful Massage: a firm yet slow and gentle holding techniqueused to encourage physical and mental relaxation. Is often sleep inducing. • Lymphatic Drainage: gentle pumping technique used to manually reduce edema by moving lymph toward working lymphatic ducts.

13. Swedish Massage: 5 basic strokes • Effleurage: light evaluative and often broad *flushing stroke. * i.e., blood and lymph flow • Petrissage: deeper--more vigorous movement of circulation and muscles. • Friction: finger pressures used to reduce adhesions and loosen muscle attachments and joints (usually small circular movements) • Vibration: vibrating/shaking stroke used to loosen muscle and joints • Tapoment: more vigorous, percussive strokes used to loosen tight muscles

14. Massage Therapy as Palliative Intervention • Intervention goals change from aggressive rehabilitation to symptom relief, relaxation and comfort. • Collapse of massage technique into two strokes.* • Evaluative • Micro-holding stroke * This is done to avoid flushing strokes (e.g., effleurage/petrissage), to reduce excessive moving of patient and to induce a relaxation response and aid sleep.

15. Our Experience • Symptom management and comfort • Pain, anxiety, depression, • Often receive requests for MT for bone marrow transplant patients (less anxiety medication) • positional considerations for pt physical comfort • Meditation/mindfulness-based stress reduction • Environment considerations, noise, lighting, music

16. Our Experience • Caregiver and staff support • Additional eyes and ears on patients and families (e.g., patient’s status and symptom changes, skin rash or skin breakdown, pt and/or family distress) • The way that touch is administered always communicates more than just a physical sensation

17. Our Experience “When you touch a body, you touch the whole person, the intellect, the spirit, and the emotions.” Jane Harrington • The way that touch is administered always communicates more than just a physical sensation

18. The Massage Therapy Program is made possible through the generous support of The Balm Foundation

19. Thank You This presentation was produced by and is owned by Mount Sinai School of Medicine. Any copying or distribution is prohibited without our express written consent. Any presentation of this video or its accompanying audio may be made solely for educational purposes. The information presented, although dealing with health-care and patient issues, is not medical advice. Anyone who needs specific medical assistance, consultation or advice should consult his/her physician. Any questions concerning the content of this video may be directed to Mount Sinai School of Medicine at webfeedback@mssm.edu

20. Works Cited Cherkin, Daniel C., Karen J. Sherman, Janet Kahn, Robert Wellman, Andrea Cook, Eric Johnson, Janet Erro, Kristin Delaney and Richard A. Deyo. “A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial.” Annals of internal Medicine 155 (2011): 1-9. Moyer, Christopher A., James Rounds and James W. Hannum. “A Meta-analysis of massage therapy research.” Psychological Bulletin 130.1 (2004): 3-18. Nguyen, Ha T., Joseph G. Grzywacz, Wei Lang, Michael Walkup and Thomas A. Arcury. “Effects of Complementary Therapy on Health in National U.S. Sample of Older Adults.” Journal of Alternative and Complementary Medicine 16.7 (2010): 701-706). Post-White, Janice., Mary Ellen Kinney, Kay Savik, Joanna Berntsen Gau, Carol Wilcox and Irving Lerner. “Therapeutic massage and healing touch inprove symptoms in cancer.” Integrative Cancer Therapies 2.4 (2003): 332-344.

21. Works Cited Salzmann-Erikson, Martin and Henrik Erikson. “Encountering Touch: a path to affinity in psychiatric care.” Issues in Mental Health Nursing. 26 (2995): 843-852) Sherman, Karen J., Daniel C. Cherkin, Rene J. Hawkes, Diana L. Miglioretti and Richard A. Deyo. “Randomized trial of therapeutic massage for chronic neck pain.” Clinical Journal of Pain 25.3 (2009):233-238. Sims, Sally., “The Significance of Touch in Palliative Care.” Palliative Medicine 2 (1988): 58-61