Massage Therapy Reduces Suffering for Patients With Advanced Illness

Massage Therapy Reduces Suffering for Patients With Advanced Illness

Contributed by Jolie Haun PhD EdS LMT; MK Brennan MS, RN, LMBT; Renee Stenbjorn MPA, LMT

Patients suffering with advanced cancer or other life-limiting illnesses often experience chronic pain, anxiety, and decreased quality of life. Medications for symptom relief are often inadequate and can result in numerous side effects. Previous studies evaluating massage have reported decreases in pain in individuals with advanced illness, such as cancer, but these studies have been limited by small sample size, lack of a control group, or randomization. This month's Massage Therapy Foundation research review focuses on recent study findings on the integration of massage therapy into a palliative care service. In this published research, Mitchinson and colleagues report on the outcomes of massage for patients with advanced illnesses.

The Study Design

Patients receiving palliative care for advanced illnesses, such as cancer, received massage at a Veterans Affairs Medical Center in Ann Arbor, Michigan. Massage therapists collected data pre and post massage to examine outcomes associated with pain, anxiety, dyspnea, relaxation, and inner peace. A retrospective chart review was conducted to collect all the data related to the patient and the massage sessions. The statistical method, analysis of covariance was used to examine changes over time.

The Treatments

Massage treatments were provided by a nationally certified massage therapist. Massage sessions averaged 20 minutes for inpatients and 22 minutes for outpatients and primarily consisted of effleurage with limited trigger point therapy for those patients who could tolerate the therapy. The pressure was light to moderate depending on the patient's health condition. Wounds were avoided. Patients with bony metastases often received massage to uninvolved areas. Patients who were actively dying usually received foot massage.

The Results

Of the 153 patients who received massage, 115 were able to provide data for analysis. Patients unable to do so included those who fell asleep, were delirious or confused, were very near the end of life, or who refused to answer. In total, 52% of the patients received massages in an inpatient setting; 37% received massages as outpatients and others received massages in both the inpatient and outpatient settings. In addition to their life-threatening diagnosis, 70% of patients had preexisting chronic pain. Of this sample, 69% had a primary diagnosis of cancer; the other patients were referred for non-cancer diagnoses. As is common among Veteran populations, this sample was primarily older white males.

For the sample, all short-term changes in symptoms showed improvement and all were statistically significant. Pain intensity decreased by 1.65 (0-10 scale, P < .001), anxiety decreased by 1.52 (0-10 scale, P < .001), patients' sense of relaxation increased by 2.92 (0-10 scale, P < .001), and inner peace improved by 1.80 (0-10 scale, P < .001). Unique to this study, the authors also provided individual cases to demonstrate the suffering associated with advanced illness and the impact of massage therapy (excerpts from cases).

Case 1

A 55-year-old veteran with bipolar illness, a personality disorder, chronic back pain, low social support, and a history of heroin and alcohol abuse was admitted with a new diagnosis of advanced non–small-cell lung carcinoma metastatic to liver and spine. Psychiatry was consulted to help address agitation, irritability, and pacing behavior. He primarily complained of neck and shoulder pain. After the first massage, his pain intensity dropped from 10 of 10 to 8 of 10. He was initially reluctant to admit how much massage had helped relieve his pain because he feared no longer receiving opioids. Initially, he rated his sense of relaxation and inner peace as 0 of 10 prior to massage and 3 of 10 afterward. When asked about his anxiety after the second massage he commented, "I feel better than I have in a long time; that was beautiful." Later during his illness, he commented that the massages were very helpful and said, "I'm in heaven. No offense to God, but this is the only time I'm in heaven."

Case 2

An 81-year-old World War II veteran with end-stage congestive heart failure and chronic back pain was followed in the clinic. He received 8 massages over an 18-month period. At his first visit, he was complaining about not being able to get his "happy breath." Prior to the massage, he rated his anxiety a 6 out of 10 and his shortness of breath 8 out of 10. He enjoyed the massage and reported a decrease in his anxiety (0 of 10) and shortness of breath (6 of 10). He commented that he felt "a little happier" because he could breathe more easily. On another occasion, he described the massage as "a little better than a piece of warm apple pie and a cup of coffee" and admitted, "I'd be lying if I said I didn't like it."

These case histories provide compelling evidence for the relief of massage experienced by patients suffering with advanced illness.

Implications for the Field of Massage

Mitchinson and colleagues conclude that "massage is a useful tool for improving symptom management and reducing suffering in palliative care patients." The most impressive aspects of this study are the sample size, the implementation of the massage program in palliative care, and the qualitative case histories exemplifying the participants' experiences with massage.

The authors' noted in their discussion that the massage program has been well accepted by professionals within the medical facility and there have been no reports of adverse events related to massage. They reported the biggest challenge was prioritizing patients by need, not having time to keep up with the requests for massage, allocating time between inpatients and outpatients, and getting access to inpatients with competing demands for the patients' time.

The authors also reported study limitations; this study used an observational method with no control group, and the sample had limited diversity. Future studies will benefit from collecting data from a diverse sample including a range of ages and ethnicities from both genders. Finally, data were self-reported and collected by the therapist, so it is possible there was reporting bias to please the therapist. Future research would benefit from data collection from someone other than the therapist; and of greater value would be to complement self-report data with objective data such as biomarkers, to support a rigorous data collection process. The use of qualitative case histories, as used in this study, provide rich data from the perspective of the participants  and clearly illustrates their personal experience with massage therapy. Though the authors did not mention it as a limitation, the massage therapy protocol provided in the article was vague and would thus be difficult to replicate. The practical nature of implementing palliative care programs within a medical setting may warrant the use of a wide range of individualized massage protocols.

Practitioners, particularly those working in medical facilities now have information to support the recommendation of massage therapy within palliative care programs. As for the field of massage, this study supports the ever-expanding scope of populations and conditions for which massage therapy can be delivered as an effective treatment to alleviate pain and suffering.

Are you interested in learning more about the uses of massage therapy to alleviate pain and promote quality of life for patients with advanced illness? To learn more about the effects of massage therapy, to learn more about the effects of massage therapy, you can review the Massage Therapy Foundation review article archives, read accepted MTF Research Grant abstracts, or search PubMed for massage therapy studies.


  • Mitchinson A, Fletcher C E, Kim HM, Montagnini M, Hinshaw DB. 2014. Integrating Massage Therapy within the Palliative Care of Veterans with Advanced Illnesses: An Outcome Study. American Journal of Hospice & Palliative Medicine. 31(1): 6-12.