Hospice-driver-photo

by Ann Catlin, O.T.R., L.M.T.,

To complement the MASSAGE Magazine article, Expert Advice, in which Irene Smith discusses the benefits of hospice massage, in the April 2014 issue. Article summary: Focused, or intentional, touch can convey a message of being cared for, safe and worthwhile, as well as feeling connected to oneself, one’s environment, and a greater whole or community. This is the oxytocin factor: Oxytocin is a hormone released through the pituitary gland during touch that mediates trusting behaviors in living beings.

I believe the essence of hospice care is 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 disregard a significant part of the pain experience that may have as much impact on the quality of life as any physical discomfort. The dimensions of pain include the physical, but psychological, emotional, social and spiritual dimensions equally impact the quality of life. 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 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.

Massage stimulates production of endorphins. Endorphins are opiate-like compounds produced by the body that relieve pain and produce feelings of euphoria.

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.

Behavioral Effect: Physical Tasks are Performed with Greater Comfort

Physical tasks include transfers, dressing and 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 are Enhanced 

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

Cognitive Effect: The Cycle of Pain and Fear are Interrupted 

This results in more positive thought patterns. One hypothesis 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: Enhanced Relationships

Touch enhances the relationship between the ill person and caregivers. Studies indicate substantial evidence points to the experiences of touch being are laden with psychosocial as well as physiologic implications. It is a viable means of improving both verbal and nonverbal communication Human touch creates a way for the dying person to interact and connect with others, decreasing feelings of isolation and loneliness.

Spiritual Effect: Greater Sense of Well-Being

One study indicates 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.

Ann Catlin, O.T.R., L.M.T., is a recognized educator and author in the field of massage for those in later life stages. She draws upon 30 years of experience to guide health care professionals in reclaiming human touch in eldercare and hospice. She founded and directs the Center for Compassionate Touch LLC (www.compassionate-touch.org), an organization that offers Compassionate Touch training internationally

Resources:

• Jaffe, Carolyn and Ehrlich, Carol. All Kinds of Love: Experiencing Hospice. 1997 Baywood Publishing Co., Inc., Amityville, New York

• Ruzicka, S et al (2007) Holistic Assessment of Chronic Pain Among Elders. American Journal of Hospice and Palliative Medicine Vol. 24 291-299

• Fritz, S (2000) Fundamentals of Therapeutic Massage. Mosby Inc. St. Louis, MO

• Field, T et al (2005) Cortisol decreases and serotonin and dopamine increase following massage therapy. International Journal of Neuroscience Vol. 115 (10)

• Duggleby, W (2000) Elderly Hospice Cancer Patients’ Descriptions of their Pain Experiences. American Journal of Hospice and Palliative Care Vol 17 (2) 111-117

• Bush, E (2001) The Use of Human Touch to Improve the Well-Being of Older Adults. Journal of Holistic Nursing Vol. 19 No.3 256-270

• Nelson, J (2006) Being in Tune with Life- Complementary Therapy Use and Well-being in Residential Hospice Residents. Journal of Holistic Nursing. Vol. 24 (3) 152-161

 

 

 

 

 

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