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     Nurse Media Journal of Nursing, 3, 1, 2013,   483-497    483   Does Foot Massage Relieve Acute Postoperative Pain? A Literature Review Chanif  1 , Wongchan Petpichetchian 2 , Wimonrat Chongchareon 3   Purpose:  This study aimed to examine the current state of knowledge regarding foot massage to determine if foot massage has an effect on relieving acute postoperative pain. Method:  The following questions were used to guide this review: How does pain occur? What is the pain management modalities used in relieving acute postoperative pain? Does foot massage relieve acute postoperative pain? A comprehensive systematic search of published literature and journal articles from Science Direct, CINAHL, PubMed, ProQuest and from relevant textbooks was conducted. The universal case entry website, Google-scholar was used as well. The following keywords were used: foot massage, pain management, and  postoperative pain. Eight studies on foot massage and more than thirty related articles were reviewed. Result:  Postoperative pain is caused by tissue damage that induces release of chemical mediators from the surgical wound. The four processes of pain are transduction, transmission,  perception and modulation. Pain medication is the goal standard for acute postoperative pain relief. In addition, foot massage is a modality that can be used in relieving acute postoperative  pain. Massage stimulates large nerve fibers and dermatome layers which contain tactile and  pressure receptors. The receptors subsequently transmit the nerve impulse to the central nervous system. The gate control system in the dorsal horn is activated through the inhibitory interneuron, thus closing the gate. Subsequently, the brain does not receive the pain message. Eight reviewed studies demonstrated that foot massage relieves acute postoperative pain. However, there were some methodological limitations of these studies. Conclusion:  It is recommended to examine the effect of foot massage on acute postoperative  pain with high homogenous samples using various duration of massage and range of time for  pain measurement at different settings.  Key words : foot massage, pain management and postoperative pain. 1   Faculty of Nursing and Health Science, The Muhammadiyah of Semarang University, Indonesia   2   Faculty of Nursing, The Prince of Songkla University, Thailand   3   Faculty of Nursing, The Prince of Songkla University, Thailand  Does Foot Massage Relieve Acute Postoperative Pain?    Nurse Media Journal of Nursing, 3, 1, 2013,   483- 497 484   Background   Pain is a common symptom found in patients with acute and chronic illness. Pain is also the main reason encountered by hospitalized patients in general and surgical patients in  particular. Tranmer et al. (2003)   reported that 74 % of 69 patients including postoperative  patients experienced pain. Despite the drugs and anesthetic techniques available, the  prevalence of post operative pain is still high (Apfelbaum, Chen, & Mehta, 2003; Power, 2005). A study found that patients after surgery expressed moderate to severe pain. Among them 41% expressed moderate or severe pain (Sommer, de-Rijke, van-Kleef, Kessel & Peters, 2008). Similarly Ignatavicus and Workman (2002) reported that 20% of patients who underwent surgery experienced severe pain, 20% to 40 % experienced moderate pain, and 40% to 70% experienced severe pain. Apfelbaum et al. (2003) reported that the  prevalence of acute postoperative pain was approximately 80%. Among them, 86% had moderate, severe, or extreme pain.  Nurse has a role to control and relieve acute postoperative pain by using both  pharmacologic and nonpharmacologic approaches. Pharmacological management includes non-opioids, opioids and anesthesia. Opioid analgesia alone may not fully relieve all aspects of acute postoperative pain. Complementary therapy as an adjuvant therapy may potentially relieve acute postoperative pain (Piotrowski, Paterson, Mitchinson, Myra, Kirsh, & Hinshaw, 2003). In recent years, many complementary therapies such as massage, soothing music, relaxation, mind  –   body techniques, reflexology, herbal medicines, hypnosis, and therapeutic touch have proved decrease pain level to help manage pain (Smith, Collins, Cyna, & Crowther, 2003). Foot massage is independent nursing intervention that can be applied to patients who are pain. Foot massage is easy to apply, costless and no need special equipment. It could  Does Foot Massage Relieve Acute Postoperative Pain?    Nurse Media Journal of Nursing, 3, 1, 2013,   483- 497 485    be added in to daily nursing activities. However, a pertinent question is whether foot massage relieves acute postoperative pain. It needs a critical analysis to determine if foot massage has an effect on relieving acute postoperative pain. Objectives   This study aimed to examine the current state of knowledge regarding foot massage to determine if foot massage has an effect on relieving acute postoperative pain. Method   The authors conducted a comprehensive systematic search of published literature, articles, journals related to foot massage in relieving acute postoperative pain. The articles were searched and retrieved from Science Direct, CINAHL, PubMed, and ProQuest from year 2000 to 2011, also from relevant textbooks. The universal case entry website, Google scholar was used as well. To facilitate search of the literature, the authors used keywords including foot massage, pain management and postoperative pain. The inclusion criteria of the literature review were the articles and textbooks investigating about foot massage, postoperative pain, and pain management in English language. The data were extracted, validated among the authors, and then categorized. The major findings are presented in the following sections.  Nature of Postoperative Pain and its Management Postoperative pain is a consequence of tissue damage from surgical incision. Immediately after tissue damage, sensory nerve endings are suddenly exposed to a variety of cellular breakdown products and inflammatory mediators that trigger acute nociceptive activity. These chemical mediators  generate local pain sensation. The pain message will reach the brain through dorsal horn. Furthermore the pain sensation is recognized and interpreted.  Does Foot Massage Relieve Acute Postoperative Pain?    Nurse Media Journal of Nursing, 3, 1, 2013,   483- 497 486   Perception of pain is the end result of the neural activity of pain transmission, that is a conscious experience, and the reticular system is responsible for the emotional and behavioral response to pain (Copstead & Ba nasik, 2005; Lewis, Heitkemper, Dirksen, O’Brien, & Bucher, 2007). Acute postoperative pain needs to be managed. The modalities used in relieving acute postoperative pain include both pharmacologic and non pharmacologic management. Pharmacological pain management needs collaboration with the physician. The physician  prescribes specific medications for pain or may establish an intravenous (IV) or epidural route for administering analgesics medications (Smeltzer & Bare, 2004). Pharmacologic pain management is divided into three categories: non-opioids, opioids, and anesthetic agents (Aschenbrenner & Venable, 2010; Black & Hawks, 2005, Jacques, 2009). Practically these medications have side effects that can be life threatening. The common side effects include respiratory depression, hypotension, constipation, urinary retention, decrease urinary output, dizziness, nausea, and vomiting (Aschenbrenner & Venable, 2010; Black & Hawks, 2005). Therefore, it needs management of these side effects. Pharmacologic management alone may not fully relieve acute postoperative pain (Piotrowski, Paterson, Mitchinson, Myra, Kirsh, & Hinshaw, 2003). Complementary therapy as a non-pharmacological pain management has the  potential to palliate acute postoperative pain (Piotrowski et al., 2003). There is some evidence supporting use of non-pharmacologic interventions in relieving acute postoperative pain. These include relaxation (Good et al., 2001), guided imagery (Albert, 2001), zikr meditation (Sitepu, 2009), and music therapy (Good et al., 2002). These interventions had been proved to relieve postoperative pain. Foot massage is another alternative non-pharmacologic pain management may have potential to improve outcome of pain management. Foot massage can be applied independently by the nurse and
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