PALLIATIVE CARE Massage as Adjuvant Therapy in the Management of Acute Postoperative Pain: A Preliminary Study in Men Marcia M Piotrowski, RN, MS, Cynthia Paterson, RN, MSA, Allison Mitchinson, MPH, Hyungjin Myra Kim, ScD, Marvin Kirsh, MD, FACS, Daniel B Hinshaw, MD, FACS BACKGROUND: Opioid analgesia alone may not fully relieve all aspects of acute postoperative pain. Comple- mentary medicine techniques used as adjuvant therapies have the potential to improve pain management and palliate postoperative distress. STUDY DESIGN: This prospective randomized clinical trial compared pain relief after major operations in 202 patients who received one of three nursing interventions: massage, focused attention, or routine care. Interventions were performed twice daily starting 24 hours after the operation through postoperative day 7. Perceived pain was measured each morning. RESULTS: The rate of decline in the unpleasantness of postoperative pain was accelerated by massage (p = 0.05). Massage also accelerated the rate of decline in the intensity of postoperative pain but this effect was not statistically significant. Use of opioid analgesics was not altered signifi- cantly by the interventions. CONCLUSIONS: Massage may be a useful adjuvant therapy for the management of acute postoperative pain. Its greatest effect appears to be on the affective component (ie, unpleasantness) of the pain. ( J Am Coll Surg 2003;197:1037–1046. © 2003 by the American College of Surgeons) Acute postoperative pain is a nearly universal experience after major surgical procedures. Studies have demon- strated that many patients have a substantial degree of unrelieved discomfort after an operation. 1-8 Pain limits physical functioning, including the ability to cough and deep breathe, move, sleep, and perform self-care activi- ties. This may contribute to unintended and serious postoperative complications including fever, atelectasis, pneumonia, and ileus. 1,9-13 Ineffective relief may result in significant psychologic distress, potentially leading to sensory overload, confusion, and even delirium. 4-16 Sur- gical patients report that pain is one of the highest envi- ronmental stressors they encounter. 17–18 Pain has both sensory and affective components. The sensory experience is conveyed by neurohumoral mech- anisms arising locally at the surgical incision. Ultimately, by transmission through the dorsal horn of the spinal cord, discomfort is consciously perceived at the cortical level as a well-localized undesirable sensation. Sensory qualities are described in relationship to time, intensity, and location of pain as well as other properties such as pressure and thermal gradients. The affective compo- nent of pain relates to the patient’s experience or percep- tion of the pain within an emotional context, often de- scribed in terms of unpleasantness. The unpleasantness of the pain is further defined relative to tension, fear, and autonomic responses that accompany the pain. 19-22 The affective component is related closely to suffering. 23 Al- though opioid analgesia is the mainstay of acute postop- erative pain management, pharmacologic interventions alone may not effectively address all the sensory and affective factors involved in experiencing pain. Patient and clinician barriers often limit the effective- ness of drug treatment. These barriers are complex, may be poorly defined, and have proved to be resistant to No competing interests declared. This research was supported by a grant from the Department of Veterans Affairs, Veterans Integrated Service Network (VISN 11), Ann Arbor, MI. Received July 16, 2003; Accepted July 16, 2003. From the Performance Improvement Department (Piotrowski, Paterson), the Center for Practice Management and Outcomes Research, Health Services Research and Development (Mitchinson), the Department of Surgery (Kirsh, Hinshaw), and the Palliative Care Program(Hinshaw), VA Ann Arbor Health- care System, and the Center for Statistical Consultation and Research (Kim), the Department of Surgery (Kirsh, Hinshaw), and the Palliative Care Pro- gram (Hinshaw), University of Michigan, Ann Arbor, MI. Correspondence address: Daniel B Hinshaw, MD, FACS, Department of Surgery and Palliative Care Program, VA Ann Arbor Healthcare System and University of Michigan, 2215 Fuller Rd, Ann Arbor, MI 48105. 1037 © 2003 by the American College of Surgeons ISSN 1072-7515/03/$21.00 Published by Elsevier Inc. doi:10.1016/j.jamcollsurg.2003.07.020