By Narda Robinson, DO, DVM If you perform surgery, consider a massage for your patients postoperatively. If you do not have the time or educational background to practice massage, you would be wise to either learn how to perform bodywork or hire someone who can. Gentle, careful, scientific and evidence-informed massage can work wonders for those patients who accept touch and need help recovering from surgery, trauma or a variety of medical conditions. Even with animals that don’t at first welcome hands-on healing, many can learn to relax and appreciate massage when it is delivered with care and respect for the patient’s individual physical and emotional receptivity. More veterinarians are learning and reading about massage for cats and dogs.1-3 Evidence-informed clinicians are introducing massage at the veterinary clinic to increase comfort and reduce recovery time for patients suffering from acute or chronic disease. After surgery, massage assists the body in reducing inflammation and pain. It can neuromodulate the sensory and autonomic limbs of the nervous system with the effect of lowering blood pressure, normalizing respiration and restoring healthful digestion and motility.4 It also can decrease stress, anxiety and maladaptive behaviors. Who wouldn’t want this for their patients? Sadly, many practitioners remain mired in the old mindset of relying solely on surgery, drugs and tincture of time. They may eschew integrative therapies based on ignorance, prejudice or unsupported bias against anything they didn’t learn in school, whether that was five or 50 years ago. On the other hand, many new and recent graduates readily embrace and thrive upon integrative and rehabilitative medicine. Clients who find themselves fortunate enough to work with a progressive veterinarian appreciate the range of options presented to them, spanning integrative, pharmacologic and surgical methods. Even when a client opts for surgery, her animal may benefit significantly by the inclusion of integrative medicine postoperatively. Pain and tension hamper the body’s ability to recover and extend hospital stays. Reducing pain and improving comfort is thus in both the patient’s and client’s best interests. While there is limited veterinary clinical research on massage, several studies have been done in humans recovering from surgery. For example, five minutes of massage to each hand and foot significantly lowered the perception and distress resulting from incisional pain along with sympathetic responses in patients after various surgical interventions.5 The reduction in pain from foot and hand massage was 53 percent; for those patients that also require analgesic medications, adding in massage may reduce the amount of drugs needed and thereby lessen the risk and intensity of adverse effects. Research on massage after cesarean section indicated that massage offered an economical and effective method of providing statistically significant reductions in pain intensity and requests for analgesic medications.6 Certain massage techniques, such as foot and hand massage for humans, can be learned readily and practiced by family members and nursing staff.7 Similarly, veterinary clients motivated to support their animal companion after surgery could learn a handy repertoire of low-risk maneuvers appropriate for the veterinary patient that encourage recovery and improve comfort. Researchers have evaluated the impact of massage for patients undergoing more intensive operations. Heart surgery patients, in particular, tend to experience longer intraoperative periods and complain of sometimes severe chest wall and upper back pain. A variety of massage techniques may be required in these instances, including myofascial and connective tissue release, trigger point deactivation, deep tissue massage, cross fiber friction and manual lymphatic drainage of the face and scalp.8 A pilot study examined the effects of a multiplicity of techniques for cardiac surgery patients; it revealed a statistically and clinically significant reduction in scores assessing pain, anxiety and tension, compared to those receiving standard care alone.9 Massage for cardiac patients also has been shown to be safe,10 although each clinical condition and individual receiving such care should be approached carefully and vital signs should be monitored during treatment if needed. Recognizing that more needs to be done to control pain in the postoperative period beyond drugs and anesthesia, researchers at the Mayo Clinic performed a randomized controlled trial to evaluate the effects of postoperative massage for patients after abdominal colorectal surgery. They monitored vital signs and evaluated psychological well-being before and after surgery, looking at measures such as pain, tension, anxiety, relaxation and satisfaction with care.11 They found that 20 minutes of postoperative massage provided patients substantial relief from both pain and anxiety. This positive impact on patients led to changes in practice in the hospital. The study’s authors wrote: “Since the completion of this study, massage therapy has been made available to all patients at the medical center. It is now a valued part of the standard offerings to address pain and anxiety. In addition, massage therapists from other institutions have attended training programs at Mayo Clinic to enable them to create best practices for massage therapy at their own hospitals.” At what point will veterinary teaching hospitals and private practices consider routinely offering massage for our postsurgical patients as well? References Drum MG, Bockstahler B, Levine D, et al. Feline rehabilitation. Vet Clin Small Anim. 2015; 45:175-201. Robinson NG and Sheets S. Canine Medical Massage. AAHA Press, 2015. Corti L. Massage therapy for dogs and cats. Topics in Compan An Med. 2014; 29:54-57. Corti L. Massage therapy for dogs and cats. Topics in Compan An Med. 2014; 29:54-57. Wang H-L and Keck JF. Foot and hand massage as an intervention for postoperative pain. Pain Management Nursing. 2004; 5(2):59-65. Abbaspoor Z, Akbari M, and Najar S. Effect of foot and hand massage in post-cesarean section pain control: a randomized clinical trial. Pain Management Nursing. 2014; 15(1):132-136. Ucuzal M and Kanan N. Foot massage: effectiveness on postoperative pain in breast surgery patients. Pain Management Nursing. 2014; 15(2):458-465. Cutshall SM, Wentworth LJ, Engen D, et al. Effect of massage therapy on pain, anxiety, and tension in cardiac surgical patients: a pilot study. Complementary Therapies in Clinical Practice. 2010; 16:92-95. Cutshall SM, Wentworth LJ, Engen D, et al. Effect of massage therapy on pain, anxiety, and tension in cardiac surgical patients: a pilot study. Complementary Therapies in Clinical Practice. 2010; 16:92-95. Boitor M, Martorella G, Arbour C, et al. Evaluation of the preliminary effectiveness of hand massage therapy on postoperative pain of adults in the intensive care unit after cardiac surgery: a pilot randomized controlled trial. Pain Management Nursing. 2015; 16(3):354-366. Dreyer NE, Cutshall SM, Huebner, M, et al. Effect of massage therapy on pain, anxiety, relaxation and tension after colorectal surgery: a randomized study. Complementary Therapies in Clinical Practice. 2015; 21:154-159. Originally published in the December 2015 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!
