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F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 49 The self-rated numeric pain rating scale did not demonstrate a significant difference between the two groups after the first massage; however, there was a trend toward statistically significant differences between the groups after the second massage. The third massage demonstrated a statistically significant difference in pain favoring the massage group. In terms of pain behaviors measured by the CPOT, such as facial expression and body movements, there were statistically significant differences between the groups 30 minutes after the first intervention with massage leading to better scores. The massage group again trended toward improvement compared to the hand-holding group after the second massage. After the third massage, there was no difference in pain behaviors between groups. Muscle tension was significantly less in the massage group compared to the hand-holding group after the third massage, with the massage group demonstrating more relaxed muscles 30 minutes after the massage. This difference did not occur after the first or second massage. No other outcome measures demonstrated significant differences between the two groups. Overall, this study demonstrated that pain and pain behaviors were significantly improved in the hand-massage group compared to the hand-holding group. Interestingly, the differences in pain behaviors were seen during the first and second interventions, whereas the differences in measured pain were seen during the third intervention, indicating that change in behavior might occur before a noticeable decrease of measured pain occurs. One limitation in this pilot study was the small sample size. This small number further decreased by the third intervention due to the subjects transferring out of the ICU. A second limitation was the higher baseline pain level in the massage group (an average of 3.6 out of 10) compared to the hand-holding group (2.4 out of 10). These differences might have affected the amount of pain reduction measured because lower levels of pain are less likely to decrease at the same rate as higher levels of pain. A third limitation is that the duration and frequency of treatment might not be adequate for optimal benefits. Patients at higher risk of postoperative complications were excluded, as well as those with abnormalities to one or both hands. Specific exclusion criteria included: documented diagnosis of cognitive or psychiatric disorder, pulmonary artery pressure >50mm Hg, right ventricular failure, and body mass index >30. Subjects were randomized to receive either hand massage intervention (n=21) or the control intervention of holding hands (n=19). The same research nurse performed both interventions. This nurse was trained to do hand massage during a 10-hour workshop. All subjects received their intervention 30 minutes after a dose of morphine, and each intervention was repeated two to three times within 24 hours after admission to the ICU. The massage intervention started with closing the curtains, placing a "do not disturb" sign on the door, and reducing other intrusions that might affect relaxation. Next, the nurse applied lavender cream to the right hand and wrist followed by 5 minutes of massage on the palm and back of the right hand. The same procedure was repeated on the left hand. The research nurse remained silent during the massage intervention. The total time spent with the subject was 15 minutes followed by 30 minutes of rest. The control group included the same process of initiating a relaxing environment and applying lavender cream to the hand. But, instead of performing hand massage, the research nurse held the subject's right hand and then left hand in her hands for 5 minutes each without performing massage. The total time spent with the subject was 15 minutes followed by 30 minutes of rest. The main outcome measured in this study was pain. Pain was measured using three validated scales: a 0–10 numeric rating scale called the Faces Pain Thermometer (FPT), the Critical Care Pain Observation Tool (CPOT) for pain behaviors, and the Brief Pain Inventory for global experience of pain after ICU discharge. Secondary outcomes included muscle tension (assessed by the research nurse) and the subject's vital signs such as changes in blood pressure, heart rate, respiratory (breathing) rate, and pulse oximetry (amount of oxygen in the blood). Patients in the ICU and cardiac ward who underwent cardiac surgery appeared to have a reduction in pain with massage therapy.

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