Massage Therapy Reducing Pain, Depression and Anxiety in Hand Osteoarthritis Patients

Abstract

This paper explores five published articles that report on results from studies conducted to explain how massage therapy reduces pain, depression and anxiety in patients with hand osteoarthritis (OA). The articles were able to describe the treatments used to reduce symptoms of pain, depression and anxiety in patients with hand (OA). Moyer et al. (2002) suggest that massage therapy may deliver beneficial outcomes in many ways, each being differently important depending on the desired effect (Moyer et al., 2002). Other articles center focus was more on the reduction of pain and explained how treatment can be helpful to relieve pain. This paper examines Moyer et al. (2002) findings in relation to four other research articles suggesting that certain treatments may help reduce pain, depression, and anxiety in patients with hand (OA) (Moyer et al., 2002). This paper included specific types of treatments associated with massage therapy to decrease pain levels indicating that patients may notice a decrease in depression and anxiety after massage therapy.
 

A significant number of patients with hand osteoarthritis use massage therapy to alleviate symptoms of pain as well as anxiety and depression (Moyer, Rounds, & Hannum, 2004). There is research that supports the evidence that massage therapy is effective. One study has shown that grip strength, a technique in massage therapy, increases muscles strength and decreases pain in hand osteoarthritis (OA) (Field, Diego, Hernandez-Reif, & Shea, 2007). This same study found a decrease in self-reported anxiety and depression following massage therapy (Field, Diego, Hernandez-Reif, & Shea, 2007). In a different study, massage therapy did not show an impact on immediate assessment on pain, but it did have a huge impact on the delayed assessment of pain. Participants who received treatment and were evaluated a few days or weeks after treatment experienced lower levels of pain (Moyer, Rounds, & Hannum, 2004).

Zwolińska et al. (2018) stated that patients with osteoarthritis (OA) may have problems in their daily activities and a decrease in well-being, which can lead to a change in mood leading to depression (Zwolińska et al., 2018). A form of therapy used for recovering from physical or mental illness is Occupational Therapy. Occupational therapy promotes rehabilitation to get back to doing daily life activities (Kjeken, et al., 2016). Another study mentions that occupational therapy interventions include joint protection and exercises that improve daily living, but their main goal is to keep up and enhance capacity of the affected areas of the hand (Stamm, et al., 2002). Stamm, et al. (2002) mentions that joint protection is intended to “strengthen muscular support, improve shock absorption around a joint, and reduce mechanical stress on the joint with different techniques or devices” in people with OA. These techniques help control pain, fatigue, inflammation and increase health and well-being (Stamm, et al., 2002). Patients with hand (OA) will see their pain reduce in random episodes if they continue to show up to their appointments and get the proper treatment needed for hand osteoarthritis.

Methods

This paper explores the question of how the use of massage therapy such as massage therapy can reduce pain, anxiety, and depression in adults with hand osteoarthritis (OA). There is evidence that massage therapy is expected to reduce symptoms of pain, anxiety, and depression. Increasing grip strength can be associated with massage therapy increasing muscle strength, which may decrease pain levels. On the other hand, once grip strength increases, pain can decrease. Patients who self-report a decrease in anxiety and depression prior to massage therapy notice a decrease in pain levels. (Field, Diego, Hernandez-Reif, & Shea, 2007).

Sample
The population in this study are adults both female and male ranging from 30-66 years old. Patients will be recruited at a hand therapy clinic. Patients must be experiencing symptoms of pain, anxiety, and depression, and must have hand osteoarthritis to participate in the study. Individuals who have these characteristics will be observed individually and asked questions about how they are feeling. These observations will allow us to see how the patient is dealing with their symptoms caused by hand (OA). In addition, they will be asked if they are interested in filling out a Pain Questionnaire based on their attitudes/opinions on the effect of massage therapy reducing the symptoms they are experiencing as well as the Beck Depression Inventory and State-Trait Anxiety Inventory. These surveys will take place during their treatment. Providing these surveys to patients will determine if the patient is really experiencing symptoms of depression and anxiety. Patients will be given the option to participate, and they will have the right to opt out at any time.
Measures

The BDI is a 21 question self-report multiple choice survey that measures depression. The scale runs from 0-3 and ranges from 0-63. The STAI inventory diagnoses anxiety and it distinguishes it from depressive symptoms. It consists of 20-item subscales that measure the state and trait anxiety. In state anxiety items, patients are asked to describe how they feel at a certain moment, and trait anxiety asks them how they usually feel. Each item in the STAI inventory is measured on a 1-4 Likert Scale and the total score of the state anxiety trait subscale ranges from 20-80.
Intervention. The patients participating in this study will mainly receive massage therapy on their hand. Some of the techniques that will be used are heat pads, transcutaneous electrical nerve stimulation (Tens), hand dynamometer, and 3 other exercises. The heat pad will be placed on their hand for 15 minutes and the Tens for 10 minutes. The hand dynamometer will be used to measure grip strength and will be done three times. The patients will have to sit with their shoulder’s in neutral position, elbow flexed at a 90-degree angle, thumb upward and outside the fist. The patient will not be allowed to rest the arm on the table. The patient will be asked to press firmly, and it will be done three times. The 3 exercises will consist of making a fist, touching the tip of each finger with the tip of the thumb, spreading the fingers as much as they can with their hand flat on a table. Each exercise will be done for 5 minutes.

The Effect of Massage Therapy for Reducing Pain. The symptoms of pain will be examined in patients participating in the study. Massage therapy is a better outcome in patients with strong pain perception.
The Effect of Massage Therapy for Reducing Anxiety and Depression. Patients having pain can develop anxiety and depression and more likely to make the symptoms more visible. One way a patient can reduce anxiety is to relax. Physiological relaxation is found to be of importance to reduce anxiety. Another way to see if the patient has reduced their anxiety would be to monitor their respiratory and heart rate after the massage. This will allow us to see whether the patient was able to relax or not. When physical contact comes into play, anxiety can be reduced. When the therapist gives the massage, he/she comes into physical contact with the patient. The patient must be okay with physical contact for the effectiveness of the treatment.
Procedures

A baseline measure of depression, anxiety, and pain would be used for the 80 participants in the study. Then you could compare these scores after you have applied the intervention (hand therapy) to see if there is a change in depression, anxiety, and pain. Quantitative data will be collected from patients who have (OA) and are experiencing symptoms of pain, anxiety, and depression. The patients will receive information that explains the purpose of the study. Participation will be voluntary, and participants are guaranteed confidentiality. The Pain Questionnaire is a self-report that will estimate the patient’s pain. Depression and anxiety will be measured using the BDI and the State-Trait Anxiety inventory. The data will be continuous since we are measuring the effect of massage therapy reducing symptoms of pain, anxiety, and depression in adults with hand osteoarthritis. The average would be calculated based on the reduction of each symptom with the help of massage therapy.
Limitations

The limitations found are the types of massages given and the setting of the clinic which can be impacting factors of the symptoms being experienced. If therapist were to indicate the type of massage whether it is gentle touch or deep tissue, it gives the patient an idea of what to expect of it. Another limitation would be the administration and the timeframe of the massage in which these would have to be relatively  consistent across patients. In addition, the position of the hand the patient was put in is another limitation. Depending on the position of the hand, it could have caused discomfort and decreased the timeframe of the massage. The massage therapist would need to come up with an approach to be flexible to complete the massage properly.Another limitation found was whether the effects of massage therapy lasted after the final day of treatment. Moyer et al. (2004) stated that therapists giving massage therapy should make assessments not only after treatment has ended, but also weeks or months later, to determine whether there were any decrease levels of anxiety, depression and other symptoms (Moyer, Rounds, & Hannum, 2004). Other limitations found in the same study was how much and what sorts of communication there was between the massage therapist and patient, whether it was verbal or nonverbal; the expectations for whether treatment will be beneficial; and if the therapist showed compassion or empathy toward the patient (Moyer, Rounds, & Hannum, 2004). Therapist having a good relationship with their patients can be beneficial for how the treatment goes. Kjeken, et al. (2016) found that occupational therapy should be applied earlier in hand (OA) to diminish functional limitations and the requirement for expensive medical procedure in secondary care (Kjeken, et al., 2016).

Study significance
Massage therapy is effective in patients if they are developing a relationship with the therapist, if they have positive experiences prior to treatments, if the therapists are warm and respectful to their patients (Moyer, Rounds, & Hannum, 2004). The effects of massage therapy are not only dependent on the interventions themselves but also on the setting of the clinic, the position in which the patient is in, the type of massage, and the time of day. This observation may support the hypothesis on how massage therapy can reduce symptoms of pain, anxiety, and depression. Some of the benefits of treating depression and anxiety in addition to pain can help the patient feel better about themselves. They can get back to their daily activities. Further studies will have to be made to guarantee the effectiveness of massage therapy reducing the symptoms in patients with hand osteoarthritis.

References

• Field, T., Diego, M., Hernandez-Reif, M., & Shea, J. (2007). Hand arthritis pain is reduced by massage therapy. Journal of Bodywork and Movement Therapies,11(1), 21-24. doi:10.1016/j.jbmt.2006.09.002
• Kjeken, I., Eide, R. E., Klokkeide, Å, Matre, K. H., Olsen, M., Mowinckel, P., . . . Nossum, R. (2016). Does occupational therapy reduce the need for surgery in carpometacarpal osteoarthritis? Protocol for a randomized controlled trial. BMC Musculoskeletal Disorders,17(1). doi:10.1186/s12891-016-1321-3
• Moyer, C. A., Rounds, J., & Hannum, J. W. (2004). A Meta-Analysis of Massage Therapy Research. Psychological Bulletin,130(1), 3-18. doi:10.1037/0033-2909.130.1.3
• Stamm, T. A., Machold, K. P., Smolen, J. S., Fischer, S., Redlich, K., Graninger, W., . . . Erlacher, L. (2002). Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: A randomized controlled trial. Arthritis & Rheumatism,47(1), 44-49. doi:10.1002/art1.10246
• Zwolińska, J., Weres, A., & Wyszyńska, J. (2018). One-Year Follow-Up of Spa Treatment in Older Patients with Osteoarthritis: A Prospective, Single Group Study. BioMed Research International,2018, 1-7. doi:10.1155/2018/7492106