Complementary Medical Therapies for Pain Management

Massage Therapy in Pediatric Pain Management

By Mary C. McLellan, MPH, BSN, RN, CMT
Integrative Therapies Team
Boston Children’s Hospital
Boston, MA

Massage therapy is defined as the “systematic and scientific manipulation of the soft tissues of the body”1. Soft tissue includes muscles, lymphatic and circulatory vessels, connective tissue and fascia. There are many styles, approaches and applications of massage therapy (See Table 1) but they all have five basic techniques to treat the body:

  • Effleurage – long, broad strokes which stimulate the parasympathetic response and  passively stretches broad muscle groups
  • Petrissage – kneading and compression to relax and stretch muscles and connective tissue
  • Friction – deep pressure applied to the muscles and connective tissues in a cross-fiber direction
  • Tapotement – percussion techniques  to relax spastic  muscles
  • Vibration – gentle, rhythmic movement of large muscle groups to induce a  parasympathetic  response

Table 1
Table 1

The massage therapist integrates these techniques based upon the treatment needs, massage modality and the patient’s goals.

There are many therapeutic effects of massage therapy in relation to pain management and pain reduction. Following the Gate Control theory, pressure applied to trigger points may override transmission of pain stimuli along the large diameter nerve fibers 2–4. The mechanical effects of massage may warm and stretch the soft tissues, decrease fibrous adhesions, and activate either the parasympathetic or sympathetic system (dependent upon massage approach) which may influence muscle tone. Utilizing massage therapy prior to physical therapy (PT) is a helpful adjunct to improve comfort of the patient and prepare the tissues for PT interventions5,6. Controlled studies have demonstrated massage to be more effective than relaxation techniques for reducing musculoskeletal pain7–9. Studies have demonstrated massage therapy to be effective in reducing reported pain6,7,16–25,8,26,27,9–15, post-operative analgesic usage21,28–30, cancer related pain and symptoms10,11,31,12,13,16–19,22,24, chronic pain9,32, back pain and related disability6,8,23,25,26,33,34, tension headaches7, and other musculoskeletal pain4,7–9,18,25,26.

Massage should not be performed over areas of skin or tissue integrity loss, acute injury or inflammation, pitting edema, or locations that have indwelling devices such as central venous lines or shunts. Massage should not be done in the setting of circulatory disorders that are associated with increased thrombus risk such as varicosities, phlebitis, and/or  thrombophlebitis. Massage should be deferred if the patient has an active infectious condition that could be spread along the skin, the circulation or lymphatic system. Caution should be observed in areas with abnormal or absent skin sensation as the sensory feedback of the applied massage pressure and put the patient at risk for injury. Caution should be used in patients with prolonged bleeding times from either anti-coagulation, low platelets (<50,000K) or coagulopathies.

To date, 45 states have licensure for massage therapists; however, the training qualifications and requirements vary greatly.  The American Massage Therapy Association (AMTA) is a professional organization of massage therapists that pledge to uphold a Code of Ethics and professional standards35. AMTA members must have completed at least 500 in-class hours from an accredited massage therapy school, state licensure or certification from the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). The AMTA has a free “Find a Therapist” feature on their website which is available to the public. The NCBTMB provides national certification for professional massage therapists and bodyworkers for professionals that have graduated from a NCBTMB assigned school. Therapists obtain CBTMB certification after passing a NCBTMB board certification exam, pass a NCMTMN-run criminal background check, have state licensure and agree to uphold to the NCBTMB Standards of Practice and Code of Ethics36,37. Professionals must reapply every two years after completing 24 continuing education credits. The NCBTMB has a free provider search for the public to find a qualified therapist. Similar to the AMTA, the American Organization for Bodywork Therapies of Asia (AOBTA) is a professional organization for therapists trained in Asian Bodywork Therapies (ABT) that have completed 500 hours of AOBTA training38. The AOBTA has a free search for the public to find an ABT therapist. Patients may look for therapists with membership or credentialing from any of the mentioned professional organizations to ensure they are receiving treatment from a professionally trained and qualified massage therapist.

Massage is an effective therapy for a variety of pain conditions and should be considered for inclusion in a patient’s pain management plan.

References

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