Soothing touch helps lessen patients’ pain.  Volunteers give massages to seriously ill at hospitals.

By Nancy Burns, Globe Correspondent | January 1, 2004

Louis Pepin looked up from his recliner with a grin as the massage therapist approached. “Great to see you, Barbara,” said the 61-year-old Pepin, who comes to the Cancer Center at Saints Memorial Medical Center in Lowell four times a week to receive intravenous treatments for a liver condition.

His visits usually last an hour, but when a massage therapist works on his feet during the treatments, the time seems to go by quicker. So now Pepin tries to schedule his sessions for times when a massage therapist will be there.

When Pepin arrived on this particular day, he rated his discomfort level as a 6 on the hospital’s 10-point pain scale. But that plummeted to zero by the end of his 15-minute foot massage.

“It takes the tension and pain away from my ankles and feet,” said Pepin, who added that the relief can last several days. “I try to keep a little active, so I’m on my feet doing some walking, but the pain gets strong.” Because massage promotes the flow of blood, he said, “It takes the pain away that’s in my feet, and probably in my bone structure, too.”

The majority of patients treated in the infusion room are cancer patients receiving chemotherapy. A smaller number, about 30 to 40 percent, are those like Louis who are “hematology” patients getting blood treatments. Many cancer patients are also hematology patients. All of them come in regularly, to sit in their recliners and wait while their IV solutions drip into their systems.

Barbara Petricone, the massage therapist, noted that the level and duration of pain relief varies from one patient to another. But she has found that a wide variety of cancer and other patients have benefited from the foot massages that have been provided by her volunteer organization since the fall at Saints Memorial and St. Joseph’s Hospital in Nashua.

Although once consider controversial as a treatment for cancer patients, therapeutic massage for such patients is starting to get a foothold in mainstream medicine. In a 2003 survey of 219 hospitals that offer massage therapy, the American Hospital Association found that 17 percent provided the therapy for cancer patients. The Dana- Farber Cancer Institute in Boston provides massage for its patients, through a practitioner on staff.

A number of preliminary studies indicate that foot, back, and general massage can be helpful for pain relief, anxiety and depression, said Dr. Russell Phillips, chief of the division of general internal medicine at Beth Israel Deaconess Medical Center in Boston. In a study done at Beth Israel in which 17 patients at the end of their lives recounted their experience with massage, five of the six patients who had received the treatment said it relieved pain and helped them to relax.

“These numbers are small, but the survey suggests it’s worth investigating using more rigorous research methods,” he said.

“We’re setting up to do some randomized control trials, to study the effects of massage on a variety of outcomes for patients with cancer,” said Phillips. “The mechanisms are uncertain, but may be related to increases in endorphins that are released by massage.” Endorphins are the natural pain relievers released within the body, which are stimulated by massage.

“The risks I’d be concerned about for hospital patients would be issues of infection control,” said Phillips, especially for open wounds, though the risks can be minimized through hand-washing and the use of gloves. Untrained providers could also cause harm, as the techniques are highly specialized.

According to Sandy Creamer, a nurse practitioner at Saints, the Oncology Nursing Society has done numerous studies on relaxation, meditation, and massage therapy. The results have shown that when patients are more relaxed through these methods, the side effects of chemotherapy are reduced and “they help the whole body accept treatment, so it will do what it needs to do.”

Petricone became interested in launching a massage therapy program a year ago, when her sister was diagnosed with cancer. Petricone owns a private practice with four other therapists, Massage: The Balance of Healing, in Chelmsford, and has been in the field for 10 years. She also has specialized training in massage for oncology.

As Petricone saw positive effects from the massage she was providing to her sister during treatments, she felt other cancer patients might benefit as well.

“Their anxiety level was very high, and they were bored and depressed, simply because of the length of time they were there,” she observed. Most noteworthy, said Petricone, “None of the touch that these patients receive is positive. Everything being done to them is poking, jabbing, and stabbing. As nicely as their providers try to do things, it still hurts! Plain and simple, none of it feels good, and they needed to receive positive touch.”

Petricone said her sister found that massage allowed her to reduce her pain medication. Other patients have considered it helpful in reducing nausea and promoting better sleep.

When she approached St. Joseph’s in August, the staff was intrigued. They were already having success with complementary therapies, and were open to trying massage. Petricone started working on patients in September and by November had brought the program to Saints in Lowell as well.

“I always stop at the nurses’ station first, to ask which patients might be receptive to massage,” said Petricone. Then she asks those patients, “We’re giving foot massages today; do you think you’d like one?” Petricone estimates that she’s worked with over 50 patients this fall, some more than once. Those patients simply wave her over as soon as they make eye contact. The therapists usually massage from four to seven patients in their two-hour visits at the hospital.

While there are no national standards for massage, many training programs and professional organizations are nationally recognized, such as the American Massage Therapy Association, of which Petricone is a member. Practitioners for each community in Massachusetts must adhere to individual town ordinances. Petricone's volunteers -- who currently consist of Michelle Gendron, Jack Ogden, Ami Hughes, Linda Murphy, and Misti Severini -- are professional massage therapists with specialized training.

Petricone received training in the use of massage for cancer patients with Tracy Walton, a Cambridge-based author and lecturer who travels the nation teaching massage for cancer. “It is very important for the therapist to have a solid foundation in work with cancer patients,” said Walton, who has a master’s degree in biology from Northeastern University.

Walton said a therapist needs to find out details such as where the tumor sites are, and whether there are solid or liquid tumors, to avoid delicate areas. If platelet counts are compromised, making the patient more vulnerable to bruising or bleeding, therapists would know to lighten the pressure of their massage. “The most important decision a massage therapist makes in designing a safe session for a cancer patient is how to adapt the massage to cancer treatment,” Walton said.

Because massage of the feet and hands is generally considered benign by medical professionals, Petricone opted to focus strictly on those areas when she offered a program to hospitals. Because patients often have an IV inserted into their arms during treatment, massage of their feet is done more often.

While some patients are shy about having their feet rubbed, they are frequently coaxed on by other patients. According to Paula Drake, a registered nurse at St. Joseph’s, “We’ve never had anyone who doesn’t like it. The patients look forward to their foot massage. And when therapists aren’t here, they ask for them.” Patients often become so relaxed during their foot rubs that they fall asleep.

“We’re all in favor of anything that will help patients,” said Drake. “You can see the patients relax, and the massage makes them feel good. It’s a wonderful service.”