Massage therapy after surgery can reduce pain when combined with routine pain medication according to a study among patients in  two Veterans Administration hospitals.  the patients, all men, were recovering from chest or abdominal surgery.

They were randomly assigned to receive:

• Routine care
• Twenty minutes of personal attention, but no massage, from a massage therapist each day in addition to routine care,
• A five minute back massage from a massage therapist each evening plus routine care.

Measures of pain intensity, pain unpleasantness, and anxiety were assessed every morning and evening.

Over four days of post-operative recovery, all three groups had less pain intensity, pain unpleasantness, and anxiety.  But the massage group had a significantly greater decreases of three measures.  They also had more rapid reduction in pain intensity and unpleasantness.

There were no differences in the use of opiate pain medicine, complications, or the average length of time each group remained in the hospital.

When asked if massage made their pain worse (1) or better (10), the average response was 8.3.

Researchers caution that only men were part of the study and if patients were reluctant to be touched, they were not included.

Allison R. Mitchinson MPH, NCTMB. a certified therapeutic massage therapist, and her team concluded,

Massage is an effective and safe adjuvant therapy for the relief of acute postoperative pain in patients undergoing major operations.

Massage may potentially be a safer alternative as-needed form of pain relief. With proper training, health care providers at the bedside (especially nurses) may now have a powerful non-pharmacologic tool to directly address their patients’ pain and anxiety.

SOURCE: Mitchinson et al. Archives of Surgery, Volume 142, Number 12, December 2007.

An another article about the research study appeared on MedPage Today on December 17, 2007.

A Personal Point of View

After my surgery this summer, I was in extra pain because I couldn’t lie on my back because of rectal surgery.  Turning was difficult., and I ached in addition to the pain from surgery.  Massage therapists from Memorial Sloan Kettering’s Integrative Medicine Department eased both pain and stress with massage. 

Kate

A study in the United Kingdom compared cancer in people diagnosed with schizophrenia and bipolar disorder compared to matched controls.  They found almost triple the risk for colon cancer among schizophrenics compared to controls.  There was no similar increase in risk for people diagnosed with bipolar disorder.

Nearly 41, 000 people were included in the study that matched cases of breast, colon, rectal, esophageal, prostate, and respiratory cancers to similar people without cancer.  Patients in the study were treated in more than 450 general practices contributing to the QRESEARCH database.

There were 5,100 cases of colon cancer which were matched to 24,500 cases without colon cancer.   After adjusting for smoking, body mass index, socioeconomic status, other illnesses, and medicines, people with schizophrenia has 190 percent increased risk of also having colon cancer.  Odds ratio, after adjustment, was 2.90.

Antipsychotic medications increased the risk.  Patients taking antipsychotics had nearly four times the risk of having colon cancer than controls. (Adjusted odds ratio 4.08.)

However, no similar  colon cancer risk increase was found in people diagnosed with bipolar disorder.

There was also a small increased risk for breast cancer and a decreased risk for lung cancer among schizophrenics.

Julia Hippisley-Cox, MD and her team concluded,

Patients with schizophrenia have a significantly higher risk of colon cancer and a lower risk of respiratory cancer compared with patients without schizophrenia after adjustment for confounders. In contrast, the risks of cancer in patients with and without bipolar disorder are similar, suggesting that residual confounding is unlikely to explain the findings. The increased risk of colon cancer is particularly marked in patients with schizophrenia who take antipsychotic medications.

SOURCE: Hippisley-Cox et al, Archives of General Psychiatry, Volume 64, Number 2, December, 2007.

What This Means for Patients

People who have been diagnosed with schizophrenia have a greatly increased risk for colon cancer and should be certain to be screened for colorectal cancer, probably using the most sensitive method available.

Patients, with schizophrenia and their doctors and caregivers should make colorectal screening a priority.

The House voted 272-142 for a $555 billion spending package Wednesday, including $70 billion in unfettered funding for Iraq, sending Congress home for the year (The Hill).

The House of Representatives passed its Omnibus spending bill Monday night in two separate votes. The first was a vote of 253-154, to pass the omnibus’ spending measure; and the second was 206-201 to add $31 billion for the troops in Afghanistan.

Democrats caved to pressure from the White House and cut their original spending bill.

The bill includes cuts to appropriations for the National Institutes of Health (NIH) and the National Cancer Institute (NCI). When the cut is applied, however, it is more or less flat funding. The Senate is expected to add additional war funds to this bill when it reaches the Senate floor. If they are required to come up with spending cuts to pay for the additional funds, the across the board percentage will be higher, and there will likely be a cut to NIH/NCI.

Even though it looks like the Administration prevailed in this fight, Republicans were still critical of the bill claiming multiple earmarks were attached at the last minute.

I urge everyone to contact their elected official and express their disappointment.

Based a report from a single hospital in France, having a second surgery to remove colorectal cancer that has spread to the liver can provide good long-term outcomes.  In this study about one in four patients who had a second liver surgery were alive and cancer free five years after their surgery.

Surgeons at the University Hospital of Bordeaux in France reviewed records of forty patients who had a second operation to remove tumors in their liver that had spread from a colon or rectal cancer.

They found that complications after surgery were not significantly higher than complications during a first liver resection.  Blood transfusions and time in the hospital were not different.

After three years, 55 percent of patients were alive and 49 percent were free of cancer.  After five years, 31 percent were still living and 27 percent were disease free.

The length of time between the first and second surgery and whether or not there was cancer outside of the liver independently predicted survival.

Antonio Sa Cunha, MD and his colleagues concluded

A second liver resection because of recurrent liver metastases from colorectal cancer is safe and provides a survival benefit similar to that with single hepatectomy. Our analysis suggests that the benefit of treatment is limited in patients who undergo a second hepatectomy within 1 year of the first operation and in those with extrahepatic disease.

SOURCE: Cunha et al, Archives of Surgery, Volume 142, Number 12, December 2007.

WHAT THIS MEANS FOR PATIENTS

Although this is a small study in a single hospital, it confirms other reports of successful removal of liver mets that have returned after an initial resection.  More than one in four patients in this study were still alive and cancer free after five years.

Patients with second liver mets should feel confident about talking to a surgeon about their removal.

Not having cancer outside of the liver contributed to survival, as well as needing the second operation more than a year after the first one.