Ucuzal, M., & Kanan, N. (2014). Foot massage: Effectiveness on postoperative pain in breast surgery patients. Pain Management Nursing , 15, 458–465. 

DOI Link

Study Purpose

To determine the effect of foot massage on pain after breast surgery and to provide guidance for nurses in nonpharmacologic interventions for pain relief

Intervention Characteristics/Basic Study Process

Patients were placed in the control or experimental group. The control group only received pain medications. In addition to receiving pain medications, the experimental group was given a 20-minute foot massage at the first complaint of pain. Pain and vital signs were assessed 5, 30, 60, 90, and 120 minutes after the first complaint of pain in both groups. The time periods were in sync between groups in regard to the first complaint of pain.

Sample Characteristics

  • N = 70 (sample size was calculated by power analysis)
  • AGE = ≤ 18 years (40% between 41–60 years)
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Breast surgery patients (included were excision of mass with either SLNBx or ALND, simple mastectomy, or modified radical mastectomy without surgical complications)
  • OTHER KEY SAMPLE CHARACTERISTICS: No communication or mental disabilities; no expanders were placed during surgery; had at least one drain placed during surgery; no history of hypertension or need to take blood pressure on the foot;  had to express a pain level of four or higher

Setting

  • SITE: Single site    
  • SETTING TYPE: Inpatient    
  • LOCATION: General department of breast surgery at a University Hospital in Istanbul Turkey between February 2007 and April 2008

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment

Study Design

Quasi-experimental, nonrandomized, controlled, comparison study

Measurement Instruments/Methods

  • McGill Pain Questionnaire Short Form (MPQ-SF) including the visual assessment scale (0–10 cm line)

Results

In regard to the demographic information, there were no significant differences between the two groups. 77% of all patients were using NSIADs to control pain. Patients in the experimental group had less pain five minutes after the foot massage. This effect has been demonstrated in several other studies. After 60 minutes, there was a slight increase in pain that never reached the initial pain rating prior to any treatments. Both groups experienced a decrease in pain with a larger decrease in the experimental group (p < 0.001).
 
Vital sign changes were transient. Blood pressure, pulse, and respirations decreased during foot massages and five minutes after treatment. Systolic and diastolic blood pressure and respirations did not reach their premassage levels, even after 120 minutes. Pulse only decreased at the five-minute mark. It was increased at all other time intervals. This study's results supported past research studies.

Conclusions

Foot massages with conventional pain medications can be effective in decreasing pain in patients after breast surgery. Nurses can easily use foot massage in patients without risk factors to decrease their pain. Nurses should provide nonpharmacologic techniques such as foot massage to decrease pain in patients after breast surgery.

Limitations

  • Small sample (< 100)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Unintended interventions or applicable interventions not described that would influence results: Placebo effect of positive expectations that pain will be eliminated by an intervention can itself decrease pain
  • Key sample group differences that could influence results: Four different types of surgery were included.
  • Findings not generalizable
  • Other limitations/explanation: The assessment of pain is very subjective.

Nursing Implications

Foot massage could be a practical addition to conventional pain management strategies to assist nurses in controlling postoperative pain. Foot massage is efficient, taking little time and costing little money. The initial cost of training could be quickly off set by the increase in patient satisfaction and better pain control. Including massage training in nursing schools would decrease the cost to institutions. Additional research in the use of massage in other patient populations is needed to help quantify massage as a pain management technique and nursing standard.