Safety

• Do not perform massage over bruised, swollen, or inflamed areas or bones of the spine.
• Massage is contraindicated in patients with muscle, bone, or joint injury.
• A patient with an epidural infusion cannot receive a back massage.
• Know the patient’s medical history, type of therapies used, and medications, including over-the-counter (OTC) products. Many patients do not mention using such products for fear of being criticized, or because they do not want them to be taken away.
• Know your agency policy for how often pain should be assessed and when follow-up assessments should be done. During the first 24 hours a patient is on opioids, an assessment must be done at least every 4 hours.
• While a level of zero pain is an ideal goal, in some patients with chronic/persistent pain, it is not a realistic one.
• Respiratory depression can be a side effect of any opioid, whether it is administered through the oral, intravenous, or epidural route, especially in an opioid-naïve patient. Using a standard sedation scale can prevent respiratory depression by allowing observation of and intervention for oversedation.

Equipment

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Music: radio, MP3 player, or relaxation tape and tape player

Folded sheet

Bath towel

Pain scale

Lotion or oil (consider aromatherapy lotion)

Delegation

Assessment of the patient’s pain cannot be delegated to nursing assistive personnel (NAP). The skill of the nonpharmacological pain management strategy of massage, however, can be delegated to NAP. Be sure to inform NAP of the following:

• Identify and explain which nonpharmacological measures work best for the patient.
• Explain the importance of eliminating environmental conditions that intensify pain.
• Identify the need to adapt strategies to the patient’s restrictions, such as massaging a patient in the side-lying position instead of the prone position.

Preparation

• Using a pain rating scale, have the patient identify his or her level of pain intensity or discomfort.
• Assess the patient’s physiological, behavioral, and emotional signs and symptoms of pain, including the patient self-reporting of having pain.
• Assess the characteristics of the patient’s pain and the possible underlying cause.
• Administer an analgesic before implementing a nonpharmacological strategy so that the patient is more comfortable during the back massage.
• Examine the site of the patient’s pain or discomfort. Include the following techniques:
  • Inspection: discoloration, swelling, or drainage
  • Palpation: change in temperature, area of altered sensation, painful areas, or areas that trigger pain
  • Range of motion of involved joints, if applicable
• Review the health care provider’s orders for pain relief.
• Assess the patient’s understanding of pain and his or her willingness to receive nonpharmacological pain-relief measures.
• Assess the patient’s language level, and identify descriptive terms to use when employing nonpharmacological pain-relieving strategies.
• Gather all necessary equipment and supplies.

Follow-up

• Observe the character of the patient’s respiration, body position, facial expression, tone of voice, mood, mannerisms, and verbalization of discomfort.
• Ask the patient to use a pain rating scale to rate his or her current comfort level.

Documentation

• Record the effectiveness of the procedure, including the massage technique used, preparation given to the patient, the patient’s response to the massage (his or her pain rating and comfort level), change in the patient’s overall condition, and further comfort needs after the massage. Incorporate pain relief techniques into your nursing care plan.
• Report the patient’s response to nonpharmacological interventions to the staff in your shift-change report or in a care plan meeting.
• If the patient has any unusual responses to the massage, such as muscle spasms or uncontrolled or aggravated pain, report them to the nurse in charge or to the health care provider.