EXAMINING THE EFFECTS OF CONNECTIVE TISSUE MASSAGE ON PAIN AFTER THORACOTOMY - RANDOMIZED CONTROLLED TRIAL

Abstract

Purpose: The objective was evaluate the effect of a connective tissue massage on pain, applied analgesic amounts and length of hospitalization of the patients. Method: The study was a prospective, randomized, controlled clinical trial and conducted at a thoracic surgery department of university hospital. The patients were randomly allocated to 1 of 2 groups: a control group (n=27) and the experimental group (n=27). Standard medical treatment, care and pulmonary rehabilitation program were applied to both groups. In addition, a total of 5 sessions of connective tissue massage were applied to the experimental group. Pain level of the patients was evaluated at every 24 hours as of the zeroth postoperative day. VAS was used as a one-dimensional scale for pain assessment. Totally applied analgesic amounts and length of hospitalization of the patients were recorded. Results: There was no statistically significant difference between the experimental and control groups on the postoperative 0th and 1st days. A statistically significant difference was found between VAS averages on postoperative 2nd, 3rd, 4th, 5th, 6th and 7th days (p<0.001). Totally applied analgesic amounts of the the patients decreased significantly from the postoperative 2nd day (p<0.05). The length of hospital stay in the experimental group was short. Conclusions: The pain of the experimental group decreased significantly and their pain on the postoperative 7th day was quite low and therefore the need for analgesic drugs decreased significantly.

Keywords

• pain
• thoracotomy
• connective tissue massage
• quality of life

TORAKOTOMİ SONRASI KONNEKTİF DOKU MASAJININ AĞRI ÜZERİNDEKİ ETKİSİNİN İNCELENMESİ - RANDOMİZE KONTROLLÜ ÇALIŞMA

Abstract

Amaç: Konnektif doku masajının hastaların ağrılarına, uygulanan analjezik miktarlarına ve hastanede kalış sürelerine etkisinin değerlendirilmesi amaçlandı. Yöntem: Çalışma prospektif, randomize, kontrollü bir klinik çalışmaydı ve bir üniversite hastanesinin göğüs cerrahisi bölümünde yürütüldü. Hastalar rastgele 2 gruptan 1'ine ayrıldı: bir kontrol grubu (n=27) ve çalışma grubu (n=27). Her iki gruba da standart medikal tedavi, bakım ve pulmoner rehabilitasyon programı uygulandı. Ayrıca çalışma grubuna toplam 5 seans konnektif doku masajı uygulandı. Hastaların ağrı düzeyi postoperatif 0. günden itibaren 24 saatte bir değerlendirildi. Ağrı değerlendirmesi için tek boyutlu bir ölçek olarak VAS kullanıldı. Hastaların toplam uygulanan analjezik miktarları ve hastanede kalış süreleri kaydedildi. Sonuçlar: Cerrahi sonrası 0. ve 1. günlerde çalışma ve kontrol grupları arasında istatistiksel olarak anlamlı fark yoktu. Postoperatif 2., 3., 4., 5., 6. ve 7. günlerde VAS ortalamaları arasında istatistiksel olarak anlamlı fark bulundu (p<0,001). Hastaların toplam uygulanan analjezik miktarları postoperatif 2. günden itibaren anlamlı olarak azaldı (p<0,05). Çalışma grubunda hastanede kalış süresi kısaydı. Tartışma: Çalışma grubunun ağrıları anlamlı olarak azaldı ve postoperatif 7. gün ağrıları oldukça azdı ve bu nedenle analjezik ilaç ihtiyacı önemli ölçüde azaldı.

Keywords

• ağrı
• konnektif doku masajı
• torakotomi
• yaşam kalitesi

References

1. Marshall K, McLaughlin K. Pain Management in Thoracic Surgery. Thorac Surg Clin. 2020;30(3):339-346. https://doi.org/10.1016/j.thorsurg.2020.03.001
2. Singh P, Chaturvedi A. Complementary and alternative medicine in cancer pain management: a systematic review. Indian J Palliat Care. 2015;21(1):105-115. https://doi.org/10.4103/0973-1075.150202
3. McCaffery M. Nursing approaches to nonpharmacological pain control. Int J Nurs Stud. 1990;27:1-5. https://doi.org/10.1016/0020-7489(90)90018-e
4. Hsu HC, Lin MH, Lee HF, Wu CY, Chou CT, Lin SF. Effects of aromatherapy with essential oil massage on the sleep quality of critical care nurses: A randomized controlled trial. Complement Ther Clin Pract. 2021;43:101358. https://doi.org/10.1016/j.ctcp.2021.101358
5. Liu C, Chen X, Wu S. The effect of massage therapy on pain after surgery: A comprehensive meta-analysis. Complement Ther Med. 2022;71:102892. https://doi.org/10.1016/j.ctim.2022.102892
6. Holey LA, Dixon J. Connective tissue manipulation: a review of theory and clinical evidence. J Body Mov Ther. 2014;18:112-118. . https://doi.org/10.1016/j.jbmt.2013.08.003
7. Yüksel I, Akbayrak T, Tuğay N, et al. Masaj teknikleri. In: Yüksel I, Akbayrak T, editors. Klasik masaj teknikleri, Konnektif doku masajı. Ankara: Alp Publishers; 2007.
8. Ekici G, Bakar Y, Akbayrak T, Yuksel I. Comparison of manual lymph drainage therapy and connective tissue massage in women with fıbromyalgia: a randomized controlled trial. J Manipulative Physiol Ther. 2009;32:127-33. https://doi.org/10.1016/j.jmpt.2008.12.001

9. Vernon H, Humphreys K, Hagino C. Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials. J Manipulative Physiol Ther. 2007;30:215-27. https://doi.org/10.1016/j.jmpt.2007.01.014
10. Celenay ST, Kaya DO, Akbayrak T. Cervical and scapulothoracic stabilization exercises with and without connective tissue massage for chronic mechanical neck pain: a prospective, randomized controlled trial. Man Ther. 2016;21:144-150. https://doi.org/10.1016/j.math.2015.07.003
11. Biswas S, Verma R, Bhatia VK, et al. Comparison between thoracic epidural block and thoracic paravertebral block for post thoracotomy pain relief. JCDR. 2016; 10(9):UC08-UC12. https://doi.org/10.7860/JCDR/2016/19159.8489
12. Brattberg G. Connective tissue massage in the treatment of fibromyalgia. Eur J Pain. 1999;3:235-244. https://doi.org/10.1053/eujp.1999.0123
13. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17:45-56. https://doi.org/10.1016/0304-3959(83)90126-4
14. Eti-Aslan F. Postoperatif Ağrı Değerlendirmesinde Görsel Kıyaslama ve Basit Tanımlayıcı Ölçeklerin Duyarlılık ve Seçiciliklerinin Karşılaştırılması. VI. Ulusal Hemşirelik Kongresi, Ankara. 1998; 178-186.
15. Ozturk R, Sevil U, Sargın A, Yucebilgin MS. The effects of reflexology on anxiety and pain in patients after abdominal hysterectomy: a randomized controlled trial. Complement Ther Med. 2018;36:107-112. https://doi.org/10.1016/j.ctim.2017.12.005
16. Bakar Y, Sertel M, Öztürk A, et al. Short term effects of classic massage compared to connective tissue massage on pressure pain threshold and muscle relaxation response in women with chronic neck pain: a preliminary study. J Manipulative Physiol Ther. 2014;37:415-421. https://doi.org/10.1016/j.jmpt.2014.05.004
17. Demirtürk F, Erkek ZY, Alparslan Ö, et al. Comparison of Reflexology and Connective Tissue Manipulation in Participants with Primary Dysmenorrhea. J Altern Complement Med. 2016;22(1):38-44. https://doi.org/10.1089/acm.2015.0050
18. Celenay ST, Kaya DO, Ucurum SG. Adding connective tissue manipulation to physiotherapy for chronic low back pain improves pain, mobility, and well-being: a randomized controlled trial. J Exerc Rehabil. 2019;15(2):308-315. https://10.12965/jer.1836634.317
19. Gad-Allah ASEF, Abdelfattah KAM, Badawy FA, et al. Post-thoracotomy pain. Egypt J Hosp Med. 2021;85(2):3519-3523.
20. Elmore B, Nguyen V, Blank R, Yount K, Lau C. Pain Management Following Thoracic Surgery. Thorac Surg Clin. 2015;25(4):393-409. https://doi.org/10.1016/j.thorsurg.2015.07.005
21. Wang H, Li S, Liang N, Liu W, Liu H, Liu H. Postoperative pain experiences in Chinese adult patients after thoracotomy and video-assisted thoracic surgery. J Clin Nurs. 2017;26(17-18):2744-2754. https://doi.org/10.1111/jocn.13789
22. Bottiger BA, Esper SA, Stafford-Smith M. Pain management strategies for thoracotomy and thoracic pain syndromes. Semin Cardiothorac Vasc Anesth. 2014;18(1):45-56. https://doi.org/10.1177/1089253213514484
23. Gupta R, Van De Ven T, Pyati S. Post-thoracotomy pain: current strategies for prevention and treatment. Drugs. 2020;80(16):1677-84. https://doi.org/10.1007/s40265-020-01390-0
24. Choi EJ, Yoon JP, Choi YM, Park JY, Kim HY, Byeon GJ. Intravenous infusion of dexmedetomidine amplifies thoracic epidural analgesic effect after open thoracotomy: A prospective, double-blind, randomized controlled trial. Medicine (Baltimore). 2019;98(48):e17983. https://doi.org/10.1097/MD.0000000000017983
25. Zengin M, Baldemir R, Ülger G, et al. Comparison of thoracic epidural analgesia and thoracic paravertebral block in pain management after thoracotomy. ACMJ. 2022;4(1):70-5. https://doi.org/10.38053/acmj.1034690
26. Dion L, Rodgers N, Cutshall SM, et al. Effect of massage on pain management for thoracic surgery patients. Int J Ther Massage Bodywork. 2011;4(2):2-6. https://doi.org/10.3822/ijtmb.v4i2.100
27. Boitor M, Gélinas C, Richard-Lalonde M, Thombs BD. The Effect of Massage on Acute Postoperative Pain in Critically and Acutely Ill Adults Post-thoracic Surgery: Systematic Review and Meta-analysis of Randomized Controlled Trials. Heart Lung. 2017;46(5):339-346. https://doi.org/10.1016/j.hrtlng.2017.05.005
28. Denault A, Lamarche Y, Rochon A, et al. Innovative approaches in the perioperative care of the cardiac surgical patient in the operating room and intensive care unit. Can J Cardiol. 2014;30:459-477. https://doi.org/10.1016/j.cjca.2014.09.029
29. Braun LA, Stanguts C, Casanelia L, et al. Massage therapy for cardiac surgery patients-a randomized trial. J Thorac Cardiovasc Surg. 2012;144:1453-9. https://doi.org/10.1016/j.jtcvs.2012.04.027
30. Fazlollah A, Darzi HB, Heidaranlu E, Moradian ST. The effect of foot reflexology massage on delirium and sleep quality following cardiac surgery: a randomized clinical trial. Complement Ther Med. 2021;60:102738. https://doi.org/10.1016/j.ctim.2021.102738
31. Tembhare V, SP M. Assess the effects of back massage to improve sleeping pattern of the postoperative cardiothoracic patients among the selected hospitals. Indian J Forensic Med Toxicol. 2021;15(2). https://doi.org/10.37506/ijfmt.v15i2.14478
32. Saatsaz S, Rezaei R, Alipour A, Beheshti Z. Massage as adjuvant therapy in the management of post-cesarean pain and anxiety: a randomized clinical trial. Complement Ther Clin Pract. 2016;24:92-8. https://doi.org/10.1016/j.ctcp.2016.05.014
33. Dreyer NE, Cutshall SM, Huebner M, et al. Effect of massage therapy on pain, anxiety, relaxation, and tension after colorectal surgery: a randomized study. Complement Ther Clin Pract. 2015;21(3):154-9. https://doi.org/10.1016/j.ctcp.2015.06.004
34. Lee SH, Kim JY, Yeo S, et al. Meta-analysis of massage therapy on cancer pain. Integr Cancer Ther. 2015;14:297-304. https://doi.org/10.1177/1534735415572885
35. Bahceli PZ, Arslan S, Ilik Y. The effect of slow-stroke back massage on chemotherapy-related fatigue in women with breast cancer: an assessor blinded, parallel group, randomized control trial. Complement Ther Clin Pract. 2022;46:101518. https://doi.org/10.1016/j.ctcp.2021.101518
36. Kaur A, Ray G, Mitra M. Comparing the effectiveness of connective tissue mobilisation and kinesio-taping on females with primary dysmenorrhea. Indian J Physiother Occup Ther. 2017;11(3):70-5.