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Massage Today
March, 2009, Vol. 09, Issue 03

Hospice Massage: Easing the Pain of a Life-Limiting Illness, Part 1

By Ann Catlin, LMT, NCTMB, OTR

A couple of years ago, I had the privilege of spending a few days at a residential hospice in Washington, D.C. called Joseph's House; I was there to conduct a workshop for the staff. While I was there to teach, in the process I learned so much about dying with dignity. You see, Joseph's House takes in and cares for homeless men and women with terminal illness. Witnessing the impact of touch on the lives of these men and women was profound and has stayed with me ever since. Anxiety was eased, relationships were deepened and spirits were lifted for those receiving the touch and those giving it. I recall gently massaging the legs and arms of a young man who, it was believed, was only days away from dying. As I watched him fully receive my touch with a look of peace, I felt blessed to be doing this humble work. Those who entered the doors of Joseph's House were given the gift of living well with dignity in their final days.

I believe that is the essence of hospice care to help the dying person live well and to support quality of life. A paramount concern in hospice care is alleviating pain. As massage practitioners, we have much to contribute to easing pain and suffering on many levels. The complex nature of pain is holistic, meaning it is related to the whole person: the body mind and spirit. By acknowledging only the physical component of pain, we are disregarding a significant part of the pain experience that may have as much impact on the quality of life as the physical discomfort. The dimensions of pain obviously include the physical, however the psychological, emotional, social and spiritual dimensions equally impact the quality of life as well.

Dimensions of Pain

The dimensions of pain include:1

  • Physiological dimension focuses on the physical sensation in the body along with accompanying physiological responses such as heart rate or shortness of breath.
  • Behavioral dimension is related to how pain affects the activity level and function such as mobility and daily activities.
  • Emotional dimension is how the individual's feeling and mood is affected.
  • Cognitive dimension deals with the person's belief system about pain and his or her past experiences. It is related to the thoughts one has about the circumstances.
  • Social dimension is centered on how pain changes relationships with family, friends or caregivers.
  • Spiritual well-being dimension arises from a sense of meaning and purpose in one's life; hope; feelings and thoughts about a higher being.

Massage: Why it Works

 - Copyright – Stock Photo / Register Mark The American Massage Therapy Association (AMTA) defines massage as "a manual soft tissue manipulation, and includes holding, causing movement, and/or applying pressure to the body." The intention of applying massage is, according to the AMTA to positively affect the health and well-being of the client.

A hands-on complementary approach for those in eldercare, hospice and palliative care enhances quality of life. Combining sensitive massage techniques, focused touch, one-on-one attention and specialized communication skills can be highly effective for those in later life stages. The concepts and techniques of this hands-on approach are effective as a non-pharmacological tool in alleviating discomfort associated with the dimensions of pain. What follows is an exploration of the effects of massage along with some of the rationale for why massage may be important tools in alleviating pain for individuals with life-limiting illness.

Physiological Effect: Physical sensation of pain is reduced. Massage has been shown to affect the nervous system through stimulation of sensory receptors. The gate control theory refers to the idea that pain impulses pass through a "gate" to reach the nerve fibers leading from the spinal cord to the thalamus in the brain. Pain impulses are transmitted by large and small diameter nerve fibers. Massage stimulates the large-diameter fibers, preventing the small diameter fibers from transmitting signals, suppressing the sensation of pain.2

Massage stimulates production of endorphins. Endorphins are opiate-like compounds produced by the body that relieve pain and produce feelings of euphoria.2 Massage decreases cortisol levels. Cortisol is a stress hormone that is produced by the adrenal glands during prolonged stress. When cortisol levels are lowered it enhances sleep quality and the immune system.2

Behavioral Effect: Physical tasks are performed with greater comfort (i.e. transfers, dressing, ambulating). When the burden of pain is eased the individual may increase his or her involvement in self-care and participate more actively in daily life and level of function is improved.

Emotional Effect: Positive feelings and mood is enhanced. Massage has a generalized effect on the autonomic nervous system, resulting in changes in mood and an induced relaxation response.2 Massage seems to increase serotonin levels. Serotonin is a neurochemical that regulates mood; feelings of calm; and subdues anxiety and irritability.3

Cognitive Effect: The cycle of pain and fear may be interrupted, resulting in more positive thought patterns. One hypothesis4 states that pain has three phases: the anticipation phase; the sensation phase; and the aftermath phase. The person suffering from chronic or intermittent pain may experience fear in the anticipation phase stemming from unpleasant past painful experiences. When the pain experience is eased with massage and one-on-one focused attention, those associations may lose their grip on the belief system of the person.

Social Effect: Touch and massage is a medium that enhances the relationship between the ill person and caregivers.

Bush5 reports that substantial evidence points to the fact that the experiences of touch are laden with psychosocial as well as physiologic implications. It is a viable means of improving both verbal and non-verbal communication. Human touch creates a way for the dying person to interact and connect with others, decreasing feelings of isolation and loneliness.

Spiritual Effect: Human touch enhances spiritual well-being. Nelson6 reports that when individual felt cared for by staff during and after receiving complementary approaches, the burden of disease (i.e. physical, emotional) seemed less and allowed them to feel like they had more of a desire to participate in life.

The unconditional gift of touch acknowledges the individual's worth regardless of the condition of the body or mind easing suffering on all levels. Hospice organizations are offering massage therapy as a complementary service more than ever before. We truly hold within our hands the means to make a meaningful difference in the quality of life at life's end.

Hospice is:7

  • A professional holistic service to patients with terminal illness and their families. Hospice service can be given at home or in a dedicated hospice program within a hospital or nursing home or in a free standing hospice facility.
  • Care that is based on an attitude of acceptance of death as a part of life.
  • Care that is guided by the patient and his or her goals rather than by others' rules or prescriptions.
  • Care that preserves dignity and is given with respect and compassion. It is the outcome of warm human relationships between the care provider and the patient and family.
  • A caring, dedicated effort to encourage the patient and his family to recognize and express their feelings about dying, both before and after death.
  • Care that uses a creative flexible approach to control of distressing symptoms (especially pain) and whatever other problems the patients and family may encounter.

References

  1. Ruzicka S, et al. Holistic Assessment of Chronic Pain Among Elders. American Journal of Hospice and Palliative Medicine, 2007;24:291-9.
  2. Fritz S. Fundamentals of Therapeutic Massage. St. Louis, Mo.: Mosby, Inc, 2000.
  3. Field T, et al. Cortisol decreases and serotonin and dopamine increase following massage therapy. International Journal of Neuroscience, 2005;115(10).
  4. Duggleby W. Elderly Hospice Cancer Patients' Descriptions of their Pain Experiences. American Journal of Hospice and Palliative Care, 2000;17(2):111-7.
  5. Bush E. The Use of Human Touch to Improve the Well-Being of Older Adults. Journal of Holistic Nursing, 2001;19(3):256-70.
  6. Nelson J. Being in Tune with Life- Complementary Therapy Use and Well-being in Residential Hospice Residents. Journal of Holistic Nursing, 2006;24(3):152-61.
  7. Jaffe C, Ehrlich C. All Kinds of Love: Experiencing Hospice.  Amityville, New York: Baywood Publishing Co Inc., 1997.

Click here for more information about Ann Catlin, LMT, NCTMB, OTR.

 

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