Massage Therapists as Part of the Pain and Palliative Care Team


Imagine being diagnosed with a life limiting illness, one that has left you in pain and wondering where to turn next. Whether it be a terminal illness that might have a six-month diagnosis or an illness that has severely diminished your quality of life, where would you turn?

Marion B, a grandmother of eight dealing with stage IV breast cancer and the pain and depression that can follow the treatment, was facing this exact challenge. In their Living Well Series, Get Palliative Care described Marion’s experience of transitioning to palliative care.

Marion worked with her oncologist to treat her cancer through radiation and targeted drug therapy. Although the treatment was helping, she felt that she needed more help to deal with the difficult pain she felt in her lower back. This caused fatigue and kept her from doing normal tasks. She also couldn’t shake the feelings of depression. Eventually, Marion’s oncologist referred her to palliative care.

In her first palliative care visit, Marion met Dr. Krivitsky as well as the entire palliative care team at the Levine Cancer Institute in Charlotte. Dr. Krivitsky’s team sees over 2,000 patients a year as they deal with various illnesses. He says it all comes down to building a real relationship with each patient.

“I try to learn about them. I listen to their story as much as they’re willing to share, and that typically leads to a lot of sharing that they’ve really never done before with any other clinician. It can become very emotional, and by default, that creates an emotional connection between the clinician and the patient, which hopefully leads to a better understanding of the human aspect of their suffering and their journey,” says Dr. Krivitsky.

Marion’s story illustrates the need for a professional team to care for patients dealing with the pain and depression of a life limiting illness.

Palliative care is specialized medical care that focuses on providing relief from the symptoms and stress of a serious or chronic illness. It is provided by a specially-trained team of doctors, nurses and other specialists who work together with your other doctors to provide an extra layer of support. The goal is to improve your quality of life.

The palliative care team focuses on:

  • Depression

  • Relieve your symptoms and distress

  • Help you better understand your disease and diagnosis

  • Help clarify your treatment goals and options

  • Understand and support your ability to cope with your illness

  • Assist you with making medical decision

  • Coordinate with your other doctors

Palliative Care on the Rise

Though not all hospitals offer palliative care services, Diane E. Meier at the Department of Geriatrics and Palliative Medicine in New York, addressed the need for increased access to palliative care due to the increase of individuals dealing with chronic, life limiting illnesses.

In May 2017, the Center to Advance Palliative Care (CAPC) release a report that states, “palliative care in U.S. hospitals has increased yet again this year. The prevalence of hospitals (50 or more beds) with a palliative care team increased from 658 to 1,744 — a 165% increase from 2000 to 2013.

The rise in prevalence of palliative care in U.S. hospitals has been steady over the last 13 years. In 2000, less than one-quarter of U.S. hospitals (658) had a palliative care program, compared with nearly three-quarters (1,744) in 2013. If current trends continue, by 2017, eight in ten U.S. hospitals with 50 or more beds will have a palliative care program.”

Massage Therapy in Pain and Palliative Care

Research has shown that massage therapy has been found to decrease pain, relieve fatigue, and provide meaning and respite to palliative-care patients.

A.) Massage Therapy can help with emotional/spiritual stress and physical pain.

Massage Therapy can improve mood and reduce depression:

  • in those with chronic pain

  • in those with chronic pain over time

  • in hospice patients

  • in children with cancer

  • in children with HIV

  • in women with breast cancer

  • in people with chronic disease

  • in those with chronic fatigue syndrome

  • in those with fibromyalgia

  • in adults with multiple sclerosis

B.) Massage Therapy for Pain

In a May 2016 Pain Medicine Journal, Crawford,et al, did a systematic review and meta-analysis of The Impact of Massage Therapy on Function in Pain Populations. The analysis showed the efficacy of massage therapy specifically for pain was unclear but concluded that because “pain is multi-dimensional and may be better addressed through a holistic, biopsychosocial approach, … “massage should be strongly recommended as a pain management option.”

The Role of the Massage Therapist on the Pain and Palliative Care Interdisciplinary Team

In Marion’s case, we do not know whether she sought out massage for her depression and pain, we do know that massage may have helped relieve her symptoms.

The American Society of Clinical Oncology has established a position statement regarding outpatient palliative care services. It recommends increased integration of palliative care with goals to achieve high-quality comprehensive cancer care by 2020.

As the need for more integrative approaches to palliative care, a professionally trained Pain and Palliative Massage Therapist will play an important role in giving patients a choice in incorporating non-pharmaceutical strategies into their treatment plan.

A professionally training massage therapist needs to have a firm grasp of the following concepts when treating a pain and palliative care patient.

  • Complexities of Pain

  • How to Assess and Categorize Pain

  • Medications used for Pain Management

  • Adjuvant Medication in Palliative Care

  • Common Diseases, Conditions & Symptoms in Palliative Care

  • Evaluating Pressure Modification and Site Restrictions

  • Special Ethical Issues in Palliative Care

  • Palliative Care vs Hospice Care

  • How to be a part of an Interdisciplinary Team

Though Medicare does not cover massage therapy in palliative care, there is strong evidence that massage therapy is “becoming the most frequently offered complementary therapy in hospice and palliative care.”

Massage therapists interested in exploring being part of palliative care can contact the Heart Touch Project. A non-profit with over 22 years of experience of bringing touch to health care.

If you would like more information on becoming a professionally trained pain and palliative massage therapist, please contact Hannah Hall hannah@hearttouch.org.

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