Effectiveness of Back Massage as a Nursing Intervention for Chronic Pain in Elderly Patients with Rheumatoid Arthritis: A Case Study

Older people are likely to be managing multiple medications, multiple chronic conditions, and reduced physiological reserve, and often experience substantial symptoms from RA. While pharmacological disease-modifying agents are key to RA treatment, they are mostly directed against the underlying inflammation rather than pain. Hence, non-pharmacological add-on tools that can be incorporated into the normal nursing routine have clinical relevance and have not been well studied in the elderly RA population. The purpose of this study was to assess the clinical effectiveness of structured back massage as a type of nurse-delivered intervention for the reduction of chronic pain in an elderly patient with long-standing RA. A qualitative-quantitative single-subject case study was used that lasted for four consecutive weeks. Eight weeks of structured back massage (twice a week for 30-40 min) were conducted on a 74-year-old woman with an 11-year history of seropositive RA. The Visual Analog Scale (VAS) was used pre- and post-session for the assessment of pain intensity. Secondary outcomes were the duration of morning stiffness, as-needed (PRN) analgesic use, and patient-reported functional domain ratings, which were assessed at weeks two and four using structured interviews. The overall reduction in VAS pain scores, from a baseline of 7.8 to a post-intervention VAS of 2.6, was 66.7%. The duration of morning stiffness decreased from 87 minutes to 31 minutes (64.4% reduction). The number of doses of PRN analgesics was halved —from five doses per week to one. The use of PRN analgesics was halved, from five to one dose per week. The results showed improvements reported by the patients in six functional domains, the most prominent being the decrease in pain intensity perception, improvement in mood, and increase in activity tolerance. This elderly patient with RA had clinically significant decreases in pain and stiffness after receiving massage without any adverse effects. The results of this study suggest that massage therapy should be included in individualized care plans for older adults with RA. There is need for larger controlled trials to determine generalizability and optimum protocol parameters.