Massage as adjuvant therapy in the management of post-cesarean pain and anxiety: A randomized clinical trial Sussan Saatsaz, Rozita Rezaei, Abbas Alipour * , Zahra Beheshti Thalassemia Research Center, Mazandaran University of Medical Sciences, Sari, Iran article info Article history: Received 11 November 2015 Received in revised form 24 May 2016 Accepted 24 May 2016 Keywords: Massage Pain Cesarean section Anxiety abstract Objective: The present study was conducted to determine the effect of massage on post-cesarean pain and anxiety. Methods: The present single-blind clinical trial was conducted on 156 primiparous women undergone elective cesarean section. The participants were randomly divided into three groups, including a hand and foot massage group, a foot massage group and a control group (n ¼ 52 per group). The patients' intensity of pain, vital signs and anxiety level were measured before, immediately after and 90 min after the massage. Results: A significant reduction was observed in the intensity of pain immediately and 90 min after massage (P < 0.001). Moreover, changes in some of the physiological parameters, including blood pressure and respiration rate, were significant after massage (P < 0.001); however, this change was not significant for pulse rate. A significant reduction was also observed in the level of anxiety (P < 0.001) and a significant increase in the frequency of breastfeeding (P < 0.001) after massage. Conclusion: As an effective nursing intervention presenting no side-effects, hand and foot massage can be helpful in the management of postoperative pain and stress. © 2016 Elsevier Ltd. All rights reserved. 1. Introduction Childbirth through cesarean section is among the most common surgical procedures in the world, and comprised 60% of childbirths [1]. In Iran, cesarean section is also highly prevalent, and research shows that 47.9% of childbirths are performed in this way [2]. Ce- sarean birth imposes physiological stresses of anesthesia, surgical procedure, physical recovery, and postoperative complications [3] such as pain and stress [4]. Many other researchers reported an increased anxiety in women who undergo cesarean section for childbirth. Hospitalization, undergoing surgical operation, an incomplete pain relief, fear of abdominal wound infection and the administration of analgesics and other drugs affect the patient's breast milk and are commonly experienced as situations that cause anxiety [5e7]. Through a neuroendocrine reflex and an increased sympathetic tone, postoperative pain can lead to such complications as compromising the immune system, reactive hypoglycemia (delay- ing wound healing), increased myocardial oxygen consumption, paralytic ileus and reduced respiratory function [8]. Postoperative pain relief is a highly important issue in midwifery, because pain- induced endocrine changes can lead to anxiety. Moreover, the pain caused by the abdominal scar interferes with the mother's proper positioning for breastfeeding and an effective breastfeeding as a result [9]. The management of postoperative anxiety and pain reduces the patient's discomfort, enables early walking, reduces hospital stay and hospital costs and increases patient satisfaction [10]. In addition, an adequate and rapid pain control scheme following cesarean section contributes to an earlier beginning of breastfeeding, which itself aids the postpartum uterine contraction [11]. A wide range of postoperative pain management methods are available, including the use of opioid analgesics, which are considered the most common pain relief intervention [9]. Opioid pain relief causes complications such as nausea and vomiting, overdose, mood disorders and delayed return to normal life after discharge from the hospital, which then increase the financial costs incurred by the patient [12,13]. The use of opioid reduces the mother's level of consciousness and subsequently her attention to the newborn and prevents the development of an effective mother- * Corresponding author. E-mail addresses: s.saatsaz@mazums.ac.ir (S. Saatsaz), r.rezaei@mazums.ac.ir (R. Rezaei), alipour.abbas59@gmail.com (A. Alipour), z.beheshti@mazums.ac.ir (Z. Beheshti). Contents lists available at ScienceDirect Complementary Therapies in Clinical Practice journal homepage: www.elsevier.com/locate/ctcp http://dx.doi.org/10.1016/j.ctcp.2016.05.014 1744-3881/© 2016 Elsevier Ltd. All rights reserved. Complementary Therapies in Clinical Practice 24 (2016) 92e98