Page 276 Acute Pain Management

8.4 OTHER PHYSICAL THERAPIES

8.4.1 Manual and massage therapies
Most publications relating to manual (eg physiotherapy, osteopathy and chiropractic) and
massage therapies involve the use of these treatments in low back pain and other
musculoskeletal pain. The evidence for these therapies is covered in detail in Evidence‐based
Management of Musculoskeletal Pain, published by the Australian Acute Musculoskeletal Pain
Guidelines Group (2003) and endorsed by the NHMRC. For a summary of some of the key
messages from this document see Sections 9.4 and 9.5.
There is little consistent evidence of any benefit for the use of massage in the treatment
of postoperative pain. Foot massage and guided relaxation did not lower pain scores after
cardiac surgery (Hattan et al, 2002 Level II). Similarly, massage after abdominal or thoracic
(via a sternotomy) surgery did not reduce pain scores or analgesic use, although a significant
reduction in the unpleasantness of pain (the affective component of pain) was reported
(Piotrowski et al, 2003 Level II). However, after a variety of major operations, massage therapy
reduced postoperative pain intensity and unpleasantness (Mitchinson et al, 2007 Level II). In
patients after abdominal surgery, the use of a mechanical massage device which leads to
intermittent negative pressure on the abdominal wall resulted in significantly lower pain
scores and analgesic use on the second and third days after surgery as well as reduced time
to first flatus (Le Blanc‐Louvry et al, 2002 Level II).

8.4.2 Heat and cold
Evidence for any benefits from postoperative local cooling is mixed. Significant reductions in
opioid consumption and pain scores after a variety of orthopaedic operations have been
reported (Brandner et al, 1996 Level II; Barber et al, 1998 Level II; Saito et al, 2004 Level II); other
studies have shown no such reductions (Leutz & Harris, 1995 Level II; Edwards et al, 1996 Level II;
Konrath et al, 1996 Level II). Similarly, no benefit in terms of pain relief or opioid requirements
CHAPTER 8 was seen after total abdominal hysterectomy (Finan et al, 1993 Level II) or Caesarean section

(Amin‐Hanjani et al, 1992 Level II).
There was limited evidence to support the use of local cooling for pain relief from perineal
trauma after childbirth (East et al, 2007 Level I) and no good quality evidence for its use in the
treatment in low back pain (French et al, 2006 Level I).
There is moderate evidence from four trials that heat wrap therapy results in a small short‐
term reduction in pain in patients with acute or sub‐acute low‐back pain (French et al, 2006
Level I).

8.4.3 Other therapies
There is no evidence to support the use of static magnet therapy for the treatment of pain
generally (Pittler et al, 2007 Level I) and the use of this therapy had no effect on postoperative
pain or analgesic requirements (Cepeda et al, 2007 Level II).
Postoperative transcranial magnetic stimulation used in patients after gastric bypass surgery
led to significant lower PCA opioid requirements (Borckardt et al, 2006 Level II).
There was no difference in postoperative analgesic requirements following use of millimetre
wave therapy after total knee arthroplasty (Usichenko, Edinger et al, 2008 Level II) or healing
touch after coronary artery bypass surgery (MacIntyre et al, 2008 Level II), although
postoperative anxiety was significant reduced in the latter study.

228 Acute Pain Management: Scientific Evidence