Allison Mitchinson, MPH, BCTMBa; Carol E. Fletcher, PhD, RNa; and Erika Trumble, MPHb Correspondence: Allison Mitchinson (Allison.mitchinson@va.gov)
aVeterans Affairs (VA) Ann Arbor Healthcare System, Michigan bEdward Hines, Jr VA Hospital, Hines, Illinois
Author disclosures
The authors report no actual or potential conflicts of interest or outside sources of funding with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
Ethics and consent
This study was approved by the Veterans Affairs Ann Arbor Healthcare System Institutional Review Board.
Background: Female veterans experience higher rates of chronic pain, depression, and anxiety than do male veterans. Gynecologic examinations and procedures can be stressful, painful, and anxiety provoking. Research has shown that massage can help reduce pain and anxiety. The purpose of this study was to examine the relationship between massage and well-being in female veterans.
Methods: A pre- and postvisit study design was used. In advance of their clinic visit, female veterans were asked by clinic staff whether they would like a relaxation massage in conjunction with their visit. Effleurage massages were administered by licensed volunteer massage therapists in a private space and performed on the back, neck, hands/arms, legs/feet. Patients rated their pain intensity, pain unpleasantness, anxiety, shortness of breath, relaxation, and inner peace pre- and postmassage on 0 to 10 scales. Demographics and data were abstracted from the medical records.
Results: Results are based on the first massage received by 96 individuals: A majority of participants were aged ≤ 40 years (53%) and were White women (68%). Most (70%) were scheduled for an invasive procedure (eg, pelvic examination, biopsy). Seventy-nine percent had a history of chronic pain; 65% had a diagnosis of depression. Mean scores for pain intensity decreased by 1.9 points, pain unpleasantness by 2.0, and anxiety by 2.4. Relaxation increased by 4.3 points and sense of inner peace by 3.5 points. These changes were all statistically significant ( P < .001).
Conclusions: Results from this pilot study suggest massage therapy may be an effective, inexpensive, and safe treatment for pain and/or anxiety in female veterans attending a gynecology appointment. Further research should assess the effects of massage therapy in female veterans with chronic pain and coexistent mental health conditions.
There are approximately 2 million female veterans in the United States, representing about 10% of the veteran population.1 In 2015, 456,000 female veterans used the US Department of Veterans Affairs (VA) health care services. The VA predicts an increase in utilization over the next 20 years.2
Female veterans are more likely to have musculoskeletal disorder multimorbidity compared with male veterans and have higher rates of depressive and bipolar disorders, anxiety, and posttraumatic stress disorder (PTSD).3,4 Compared with male veterans, female veterans are younger, more likely to be unmarried and to have served during the wars in Iraq and Afghanistan.3 Fifty-five percent of women veterans vs 41% of men veterans have a service-connected disability, and a greater percentage of women veterans have a service connection rating > 50%.5 The top service-connected disabilities for women veterans are PTSD, major depressive disorder, migraines, and lumbosacral or cervical strain.2 In addition, one-third of women veterans using VA health care report experiencing military sexual trauma (MST).6 Military service may impact the health of female veterans both physically and mentally. Providing treatments and programs to improve their health and their health care experience are current VA priorities.
The VA is changing the way health care is conceptualized and delivered by implementing a holistic model of care known as Whole Health, which seeks to empower and equip patients to take charge of their health, blending conventional medicine with self-care and complementary and integrative health (CIH) approaches, such as massage therapy, yoga, acupuncture, and meditation.7 CIH therapies can help improve physical and mental health with little to no adverse effects.8-10
As part of the Whole Health initiative at the VA Ann Arbor Healthcare System (VAAAHS) in Michigan, the massage program was expanded in 2017 to offer relaxation massages to female veterans attending the women’s health clinic, which provides gynecologic care. Patients visiting a gynecology clinic often experience anxiety and pain related to invasive procedures and examinations. This is especially true for female veterans who experienced MST.11
VAAAHS has 1 staff massage therapist (MT). To expand the program to the women’s health clinic, volunteer licensed MTs were recruited and trained in specific procedures by the staff MT.
Several studies have demonstrated the effect of therapeutic massage on pain and anxiety in predominantly male veteran study populations, including veterans needing postsurgical and palliative care as well as those experiencing chronic pain and knee osteoarthritis.12-16 Little is known about the effects of massage therapy on female veterans. The purpose of this pilot study was to examine the effects of massage therapy among female veterans participating in the women’s health massage program.
Methods
The setting for this pre-post intervention study was VAAAHS. Veterans were called in advance by clinic staff and scheduled for 60-minute appointments either before or after their clinic appointment, depending on availability. MTs were instructed to provide relaxation massage using Swedish massage techniques with moderate pressure, avoiding deep pressure techniques. Swedish massage was selected to compare with previous veteran studies and because these techniques were approved for delivery by volunteer MTs. Massages were given in a private space on a massage table and were limited to the back, neck, head/face, and extremities.
The volunteer MTs gave the participants a survey to provide comments and to rate baseline pain and other symptoms prior to and following the massage. The MT left the room to provide privacy while completing the survey. The staff included the symptom data in the massage note as clinical outcomes and entered them into the electronic health record. Massages were given from October 1, 2017 to June 30, 2018. Data including symptom scores, demographics, the presence of chronic pain, mental health diagnoses, patient comments, and opioid use were abstracted from the electronic health record by 2 members of the study team and entered into an Excel database. This study was approved by the VAAAHS Institutional Review Board.
