MASSAGE THERAPY TO REDUCE THE PAIN OF

CHEMOTHERAPY PATIENTS

(Siti Rahmawati)

Introduction

Cancer is a disease that begins with the presence of cells whose

growth is uncontrolled and causes damage to healthy cells in the body.

Cancer is one of the leading causes of death worldwide in both developed

and developing countries (Ministry of Data and Information Center, 2015).

In Indonesia today cancer has become a health problem that must be

addressed thoroughly, integratedly, effectively, efficiently, and ecnomisally.

Cancer can potentially affect all walks of life, although in the data it is still

dominated by the elderly but the latest data shows an increase in cancer

occurring in the age range of children, adolescents, and adults (Society

&Asco, n.d.). The prevalence of cancer patients in Indonesia is 1.4% with a

total of 347,792 patients (Ministry of Health, 2017). In 2018, approximately

8.2 million deaths were caused by cancer. Global Cancer Observatory 2018

data from the World Health Organization (WHO) illustrates the most

common cancer cases in Indonesia are cases of breast cancer, namely 58,256

cases or 16.7% of the total 348,809 cases of cancer. Cervical cancer (cervix)

is the second most common type of cancer in Indonesia as many as 32,469

cases or 9.3% of the total cases (Ministry of Health, 2017). For data on the

overall cases of cancer that occur in Indonesia can be seen in the following

figure below.

Cancer is a disease caused by abnormal growth and growth of cells in

the body (Kristanti et al., 2017). The growth and growth of these cancer cells
can be destructive or damage healthy cells by infiltrating other tissues

through lymph vessels or blood vessels. The suppression of cancerous tissue

on healthy nerves and also the side effects of chemotherapy drugs cause

patients to experience pain (Ricevuto et al., 2010).

Pain is an unpleasant experience physically and emotionally due to

tissue damage (Thomas, 1997). Pain in cancer patients is chronic. Chronic

pain is a pain that occurs suddenly or slowly from low intensity to severe that

occurs more than 3 months (Munawaroh, 2017). Pain can be affected by

several things such as the type of cancer and the condition of the body,

gender, culture and clinical condition of the patient (Nurmalisa, 2020).

Pain due to chemotherapy drug side effects namely neuropathy with

symptoms of tingling and pain in the hands and feet (Neris et al., 2016).

Factors that resulted in increased pain were climbing stairs (34.8%), walking

(30.4%), lifting (21.7%), heavy work (17.4%), standing (13%), urination

(8.7%), sleep (8.7%), and other things such as diet, stress and weather (39%).

The average pain range of patients is 4-9 or in the moderate to severe pain

range (Farastuti &Windiastuti, 2016).

Cancer pain has an impact on the physical, psychological, social, and

spiritual. Physical impacts include; fatigue, decreased appetite, vomiting,

decreased muscle strength. The psychological impact is; difficulty

concentrating, fear, depression and also anxiety. Social impacts are decreased

social relationships and impaired appearance. The spiritual impact is;

increased feelings of suffering, disruption of meaning and purpose of life,

disorders in religious beliefs (Romdhoni, 2017). Pain in cancer patients can

be overcome by 2 techniques, namely pharmacological and

nonpharmacological techniques. Pharmacological management guidelines

according to the Health Organization (WHO) based on the pain rate of cancer

patients are for mild pain with non-opioids e.g. acetaminofen, moderate pain

with opioids such as codeine, and severe pain with powerful opioids such as

morphine and fentanyl (Jara et al., 2018). In addition to pharmacological

techniques, the use of non-pharmacological techniques to reduce the patient's

pain levels can be done with the use of complementary therapies.

Complementary Alternative Medecine (CAM) can be used as an alternative

option for cancer patients in reducing pain such as music therapy, massage,

acupuncture and guided imagery. The selection of therapy types is tailored to

the patient's choice by considering various aspects such as culture, duration

of administration, therapeutic techniques, and other aspects (Köhler et al.,

2020).

Cancer pain management can effectively be influenced by several

things, among others, pain detection capabilities, proper prescribing,

availability of medications, the ability of patients to perform pain

management in daily life, and the patient's desire to adhere to treatment

(Kristanti et al., 2017). The obstacles to pain management of chemotherapy

patients are not optimally influenced in terms of cognitive, affective and

sensory. The cognitive barriers of the patient are difficulty in communication

with the doctor regarding the pain experienced, knowledge of drug use, and

pessimism about the ability to control cancer. Affective barriers are closely

related to emotional changes in patients such as anxiety and depression.

Sensory barriers are related to the effects of ongoing analgesic therapy (Nuwa

&Kiik, 2020). The patient's inability to cope with pain causes the patient to

have difficulty in carrying out daily activities such as eating, dressing,

bathing and mobilization so as to impact the quality of life of patients who

continue to decline (Romdhoni, 2017).

To reduce the pain level of chemotherapy patients one of them is by

administering complementary massage therapy (Lee et al., 2015). Massage is

the most effective step to improve relaxation and is used as palliative therapy.

Massage means to provide stimulation under the skin tissue by giving a soft

touch and pressure to provide a sense of comfort. Massage is given to cause

a pleasant effect for cancer patients undergoing chemotherapy (Bao et al.,

2014). If the patient with chemotherapy perceives touch as a stimulus to

relax, then a relaxation response will appear. Relaxation can also reduce

anxiety due to pain, thus preventing pain from gaining weight. Massage can

be an option to provide a sensation of comfort that can relieve tension and

make the patient relax due to pain (AMT, 2016). The workings of this

massage cause the release of endorphins, thus blocking the transmission of

pain stimulus. Techniques for performing massage can be done with several

approaches, one of the methods performed is to apply gentle pressure and

friction to the client (Falkensteiner et al., 2011). Gentle touch efforts can

provide pleasure and comfort for patients. This technique is simple and easy

to do, so it can be applied to anyone who experiences pain, especially in

cancer patients who are undergoing chemotherapy therapy. The effect of

massage is to reduce tension, as well as increase physical and psychological

relaxation (Bao et al., 2014). Massage can help the independence of clients

and families in managing pain, especially for patients who do not want to

overcome pain by using pharmacological therapy. In addition, in giving

massage there is no need to use special tools that require large costs so that

this stimulus can be given to clients with any economic strata (Nur Fadilah

&Astuti, 2018).
 Library Overview

1. Cancer

Cancer or malignant tumors occur due to abnormal growth of body

tissue cells, caused by neoplasia, dysplasia, and hyperplasia. Neoplasia is a

condition of cells found in tissues proliferating abnormally and invasively,

dysplasia is a condition of cells that do not develop normally with indications

of changes in the nucleus (nucleus of cells), hyperplasia is a condition of

normal cells in tissues experiencing excessive growth. Cancer is a disease

caused by abnormal growth of body tissue cells, developing rapidly, not

being constrained and continuing to divide. Cancer is a disease that can attack

and arise as a result of abnormal growth of body tissue cells that turn into

cancer cells in their development (Kristanti et al., 2017).

Types or Locations of Cancer

a. Breast

It is a pathological disorder that begins due to changes in genetic

disorders in a single cell and takes several years to be acquired. Risk factors

that affect the occurrence of breast cancer are gender (women) and old age,

the presence of previous breast cancer, family history: having relatives who

have a degree of breast (mother, sister, daughter) (NARESWARI et al.,

2017).

B. Rectal colon

It is the second most visceral neoplasm. Risk factors that affect him

over 40 years of age, food (excessive animal fat, especially cows, and low

fiber), other diseases of the gastrointestinal tract (Ministry of Health, 2017).

c. Larynx
 Tumors are in the true vocal cords and are less likely to spread due to

the underlying connective tissue lack of lymph nodes, which are

characterized by a rau sound that lasts more than 3 days (Nuwa &Kiik, 2020).

d. Lungs

This cancer usually develops in the wall or epithelium of the bronchial

tree. There is no early stage, while in the advanced stages of chest pain,

cough, fever, parau, shoulder pain, weight loss, shrinking sound (Ricevuto et

al., 2010).

e. Leukemia

It is a malignant polyferation of white blood cell (WBC) of bone

marrow and accumulation of peripheral blood vessels, bone marrow, and

body tissues.

f. Pancreas

It is a deadly gastrointestinal disorder that develops rapidly. Caused

by smoking and risk factors that affect diabetes mellitus, acute pangkreatitis,

alkhohol abuse.

g. Prostate

It is the second most common neoplasm found in men aged 50 and

over. Most sarcoma comes from the posterior prostate gland, while others are

from the ureter, which is lined with difficulty urinating, hematuria, anuria,

urinary retention.

h. Prostate

It is the second most common neoplasm found in men aged 50 and

over. Most sarcoma comes from the posterior prostate gland, while others are

from the ureter, which is lined with difficulty urinating, hematuria, anuria,

urinary retention.
 i. Gaster

It happened to a man over the age of 40. Caused by gastritis, chronic

gastric inflammation, ulcer gastritis, gastric atrophy. And patched with

abdominal distention, chronic gastric discomfort, dysphagia, blood being

pierced, heavy vomiting, weight gain, anorexia, feeling full after meals,

anemia, and fatigue.

j. Ovaries

It is the leading cause of death from gynecological cancer. Risk

factors that affect it are a history of breast cancer, a family history of ovarian

cancer, old age, low perity and obesity. That is preceded by increased

abdominal circumference, pelvic pressure, bloating, back pain, constipation,

abdominal pain, urinary urgency, increased waist size, limb pain, and pelvic

pain.

k. Cervix

It is the third most common cancer in the female reproductive system

and is classified as preinvasive or invasive, which is pre-staged in the early

stdium, namely the possibility of abnormal vaginal bleeding, persistent

discharge from the vagina, and pain in the advanced stages of pelvic pain,

vaginal leakage in the form of urine and feces from fistulas, anorexia, weight

loss, and anemia.

l. Bladder, etc.

Occurs in patients over the age of 55 years who are experienced by

many men. It usually appears at the base of the bladder and pierces the ureter

hole as well as the neck of the bladder. The encested hematuria and painless,

urinary tract infections occur and urgency / urge urination, changes in urine,

pelvic or back pain due to the presence of metastases (Malki, 2014).

 1. Etiology

a. Environmental, social

b. Physical: radiation, need/ blisters

c. Chemistry: food, industry, pharmaceuticals, cigarettes

d. Genetic: breast, uterus

e. Viruses: common in animals.

The cause of cancer is a healthy body is not able to defend itself

against cancer, this occurs because of the complex interaction between

exposure to carcinogens and mutations that have accumulated in several

genes called oncogenes, thus activating cell division that affects embryonic

development. Another cancer gene is the tumor suppressor gene, this will

stop cell division. The causes of gene damage obtained are: viruses, radiance,

environmental carcinogens as well as food and hormones. Other factors that

affect the occurrence of cancer are age, nutritional status, hormonal balance

and response to stress (Lacy &Becker, 2013).

2. Pathophysiology

Abnormal cells form a group and begin to proliferate abnormally,

allowing growth regulatory signals in the surrounding cell environment. Cells

get invasive characteristics so that changes in surrounding tissues occur.

Cells infiltrate tissues and gain access to kelimfe and blood vessels, which

carry cells to other areas of the body. this event is called metastasis (cancer

spread to other parts of the body) (Galluzzi et al., 2020).

Cancer cells are called malignant neoplasms and are classified and

named after where the tissues grow. The failure of the immune system to

destroy abnormal cells quickly and precisely causes cells to grow into large
to be treated using normal immune system. Certain categories of agents or

factors that play a role in carcinomagenesis (maligna transportation) include

viruses and bacteria, physical agents, chemical agents, genetic or familial

factors, dietary factors, and hormonal agents (Galluzzi et al., 2020).

Neoplasms are new growths. According to an anecdologist from the

United Kingdom, neoplasms are abnormal tissue mass, excess plants, and are

not coordinated with normal tissues, and always grow even if the stimuli that

cause them are gone. Neoplastic proliferation causes a mass of neoplasms

causing swelling or lumps in the body's tissues, resulting in the formation of

tumors. The term tumor is used for swelling by tissue sembaban or bleeding.

Tumors are distinguished into two, namely benign and malignant. If a

malignant tumor is called cancer (McAdam Eccles, 1917).

3. Clinical Manifestations

a. Cancer cells spread from one organ or part of the body to another through

invasion and metastasized. So that the manifestation is as appropriate as the

affected organ or body.

b. Cancer causes anemia, weakness, weight loss (dysphagia (difficulty

swallowing), anorexia, blockages), and pain (often late distadium) (Fan,

2009).

4. Symptoms are caused by tissue destruction and replacement by

nonfunctional cancerous tissue or highly productive tissues (e.g. bone

marrow disorders and anemia or overproduction of adrenal steroids), pressure

on surrounding structures, increased metabolic needs, and impaired

production of blood cells (Oláh, 2005).

5. Cancer Treatment

a. Surgery
It is very effective when done in people with early stage cancer so that it has

a chance of recovery.

b. Combination

The combination treatment combines radiotherapy chemotherapy and

surgery.

c. Radiation

Radiation aims to destroy cancerous tissue.

d. Chemotherapy

Chemotherapy treatment aims to reach cancer cells that spread to

other parts of the body by inhibiting and controlling the growth of cancer

cells (Smith &Saiki, 2015).

1. Chemotherapy

a. Understanding

Chemotherapy is a therapy that involves the use of chemicals or drugs in the

use of cancer. Conventional chemotherapy works by destroying the structure

or metabolism of cancer cells (Sataloff et al., n.d.).

Chemotherapy is the treatment of cancer using drugs / hormones.

Chemotherapy can be used effectively in both spreading and localized

diseases. Chemotherapy is a systemic therapy, which means the drug spreads

throughout the body and can reach cancer cells that have spread far or

metastasized elsewhere (Alam, 2018).

B. Various chemotherapy

In conducting chemotherapy, clinically should be considered the following:

1. Determine the purpose of therapy

Chemotherapy has several different purposes, namely curative

chemotherapy, adjuvant chemotherapy, neoadjuvan chemotherapy,

investigative chemotherapy.

2. Rational use of drugs

Under normal circumstances, systemic chemotherapy using intravenous

pathways, according to Hryniuk and Evin the intensity of the drug dose is the

most important factor of the effectiveness of the drug, increased dose

intensity in addition to increasing effectiveness also brings greater toxic

effects (such as: severe vomiting nausea, fever and bleeding).

3. Overcoming drug resistance

Drug resistance is the main cause of chemotherapy, the causes of drug

resistance vary, different drugs have different mechanisms (Pavlidis et al.,

2015).

c. Types of Chemotherapy Therapy

1. Neoadjuvan therapy is chemotherapy given before surgery or radiotherapy,

the goal is to reduce the mass of the tumor so that after the tumor shrinks it

will be easier to deal with radiation. Neoadjuvan therapy is administered in

2-3 cycles given every 3 weeks provided that there is a response to

chemotherapy. In recent studies, neoadjuvan chemotherapy showed increased

opeative chances for neck head cancer, lung small cell cancer, osteosarcoma,

reduced surgical performance that led to defects in certain cancers (larynx,

bladder, canalist analyst) improved the quality of life of some patients.

2. Primary chemotherapy is used alone in the treatment of tumors, which are

less likely to be treated, and chemotherapy is used to control the symptoms.

3. Investigative chemotherapy is a clinical trial with a new chemotherapy

regimen, to find a new drug or regimen with high effectiveness, low toxicity.

4. Combination chemotherapy using two or more chemotherapy agents.

Chemotherapy as a palliative therapy, which is only controlling the growth

of tumors and not to cure or eradicate cancer cells. This therapy is usually

done in advanced patients where the cancer has spread to other organs in the

body. Palliative chemotherapy is administered to cancer patients in the

advanced stage, and can only play a role in reducing symptoms, prolonging

survival time. In this case the doctor should consider the advantages and

disadvantages that chemotherapy brings to the patient, avoid chemotherapy

that is too strong until the patient's quality of life decreases or worsens the

development of the disease.

5. Curative chemotherapy is given to patients with curative ssensitive tumors

(such as: acute lymphostic leukemia, malignant lymphoma, testicular cancer,

small cell carcinoma of the lungs), curative chemotherapy should use a

combination chemotherapy formula consisting of drugs with different

mechanisms of action, different toxic effects and each effective when used

individually, given with many cycles for each drug in the formula is

attempted using a dose of maksimun that can be tolerated by the body. The

interval period is agreed to be shortened in order to achieve total eradication

of cancer cells in the body (Ruth Hettler, 2011).

1. Pain

a. The definition of pain is an unpleasant sensory and emotional

experience related to potential tissue damage or disruption of tissue

metabolism. Neuropathic (chronic) pain occurs due to abnormal processing

of sensory inputs by the central or peripheral nervous system. There are a

large number of neuropathic pain syndromes that are often difficult to

overcome such as: cancer pain, lower back pain, diabetic neuropathy, wounds

on the spinal cord (Munawaroh, 2017).

 B. Factors That Cause Pain Factors that can be the cause of the onset

of cancer pain in general are

1. Pain caused directly by tumors that cause compression of central

and peripheral nerves.

2. Pain due to cancer treatment such as chemotherapy causes

neuropathy and tissue necrosis to cause pain.

3. Pain that is not related to tumors usually depends on the condition

of patients experiencing gastric distention, infection, musculoskeletal pain

(Farastuti &Windiastuti, 2016).

c. Types of Pain

1. Nociceptive Pain. Nociceptive pain is pain stimulated by pain

receptors. This type of pain usually comes from the response that occurs due

to damage to the body. Nociceptive Pain Treatment may use common or

common analgesic groups such as paracetamol, NSAIDs, or the opioid group.

2. Neuropathic Pain. Neuropathic pain is caused by the presence of

wounds or dysfunction of the nervous system. This type of pain cannot be

treated with the usual analgetics, so commonly used medications such as

antidepressants, anticonvulsants, and some other types of drugs. Neuropathic

pain is also commonly caused by nerve pressure or infiltration by cancer (Jara

et al., 2018).

d. Measurement of Pain Levels in Cancer

1. Analog Visual Scale and Numerical Rating Scale.

2. The Face Pain Rating Scale (Neris et al., 2016)

2. Complementary Massage Therapy

Massage is a nursing action that has been recognized as an additional

treatment in reducing pain levels in chemotherapy patients. Massage is

 defined as "hand movements practiced on the surface of an individual's body

with therapeutic purposes" and reduce the severity of pain in patients.

Massage is done by giving systematic movement and little pressure with the

movement of rubbing and rolling soft tissues or muscles of the patient (Bao

et al., 2014).

The physical and psychological impacts of Massage to reduce the pain

of chemotherapy patients are:

- Significantly lower blood pressure and heart rate

- Improves blood circulation and lymph, reduces edema, relieves muscle

spasms and pain, and promotes relaxation

- In western countries, more than 70% of hospices offer massage services and

26% of cancer patients receive massage therapy as one of their management

of cancer pain. Since most analgesics have high doses, the use of massage

therapy can reduce the use of analgesic drugs and also the possibility of using

powerful opioids.

- Some studies have shown beneficial and potential effects of massage therapy

to reduce pain in advanced cancer patients undergoing chemotherapy

therapy.

- It is recommended that massage can relieve 40% of cancer pain in cancer

patients at various stages.

- Other studies also indicate massage therapy can be effective, especially in

short-term effects.

- It is believed that massage therapy is safe, non-invasive, cheap in pain

management (Cassileth et al., 2007).

The ideal way to integrate nurse-led massage therapy into nursing practice
to improve the quality of life of chemotherapy patients is to provide

massage training to nurses in the cancer treatment room, this aims to ensure

all hospitalized cancer patients have safe and effective care that is useful to

alleviate the patient's pain symptoms. Not all cancer patients with

chemotherapy can be given interventions with massage, such as conditions

in patients with advanced osteoporosis, birth fractures, burns, deep vein

thrombosis, eczema, open wounds, phlegm and skin infections

(Falkensteiner et al., 2011).

Intervention

Five out of six studies provide full-body massage therapy with a duration

of between 15 to 60 minutes as the main intervention in addition to foot

massage and massage with a light touch. Massage is most often applied to

the head, neck, back, gluteus muscles, arms, hands, lower legs and legs in

a full body massage intervention. In addition, a 10-minute massage can also

be applied to the lower extremities or feet of the patient.

Swedish/classical massage is performed with the principle of gentle

effleurage administration, mild petrissage, compression, release of

myofascial trigger points and pressure at nerve points., gentle pressure

slowly, rhythmic and squeeze removal and circular movements around the

joints are applied to the ankles, feet and lower legs. The position for

massage therapy is mentioned in the two RCTs there are more than 50% of

massage sessions reserved for patients in supine, and the rest are in a prone

position and lying on the side (Kulsum et al., 1970).

Contraindications of massage

Patients are restricted to massage therapy if they have platelet counts below

10,000 or on anticoagulant therapy, active spinal cord compression

syndrome, deep vein thrombosis, areas of the body with inflammation or

infection, identifying open wounds or bruises, or undergoing surgery on the

day of massage intervention (Nur Fadilah &Astuti, 2018).

Massage will be avoided on top of metastatic sites that have been marked

before intervention is performed.

Effects of massage therapy to reduce the pain of chemotherapy patients

Direct ▪ on pain control

Four RCTs showed a decrease in pain intensity immediately after half or at

the end of a full body massage (p< 0.05). Three studies showed significant

direct effects for patients with a baseline pain score of ≥ 4 on a VAS 0-10

and MPAC scale.

Pain decreased immediately by 1.87 points decreased on a pain scale of 0-

10 MPAC, which is clinically significant (p<0.0001).

Swedish massage is also referred to as a classic massage used as the main

type of massage in all studies reviewed. Standardized massage techniques

and the use of acupressure points should be clearly mentioned in the

proposed guidelines. However, areas of the body that are given

interventions of pressure intensity, rhythm, rate/frequency of each massage

must be personalized and modified according to the patient's actionability,

skin fragility/edema and postural limitations (Jackson, T., Van Teijlingen,

E., &Bruce, 2012).

Duration of massage

Massage therapy is given with an average duration of 30 minutes. The

frequency of massage therapy is performed two to three times per week or

administered according to the patient's request (Lee et al., 2015).

Patient position
A comfortable position for massage therapy is important for patients due to

their weakness and advanced stages of the disease. Supine position, prone,

and lying on the side are the most preferred in cancer patients. Positioning

the patient into a comfortable posture before a massage is administered can

improve relaxation and therefore optimize the effects of pain reduction

(Miladinia et al., 2016).

Swedish massage training for nurses

Nurses are the most ideal people to provide massage therapy in a clinical

setting as they are quite experienced in treating patients with different

stages of the disease. They are more competent in managing complaints of

advanced cancer patients (Miladinia et al., 2016).

Evidence-based guidelines for the use of massage therapy in pain control

for advanced cancer patients undergoing chemotherapy therapy are one of

the steps that need to be developed to help improve the quality of life of

patients with chemotherapy.

Based on evidence taken from systematic reviews and analysis, guidelines

for the use of massage therapy in advanced cancer patients need to be

developed (Gentile et al., 2021).

Massage therapy based on the results of a review of several journals found

that 4 journals discuss about the effect of massage therapy on pain reduction

in palliative patients. All four journals prove that massage therapy can

reduce pain in palliative patients. Massage therapy is a therapy that involves

manipulation of the soft tissues of the body using a variety of manual

techniques and applying emphasis and withdrawal. Peripher receptors are

stimulated which reaches the brain through the spinal cord. Massage can
reduce stress and levels of anxiety and pain. On the other hand, massage

can improve symptom management and quality of life of cancer patients

but evidence is not proven that this massage increases the spread of cancer.

16 Systematic review of 27 clinical trials that tested massage interventions

against pain in cancer patients showed that 26 research journals proved

significantly that massage therapy can reduce anxiety, emotional distress,

pain, nausea as well as improve comfort. 17 Randomized control trial study

involving 1290 cancer patients and 12 certified massage therapists,

evaluating score changes in pain, fatigue, stess, nausea, and depression.

Three types of massage therapy are swedish, light touch, and foot massage.

There is a 50% reduction in pain symptoms. 18 Randomized control trial

study in which 4 sessions of massage intervention for 2 weeks to cancer

patients who experienced pain which was shown to experience a reduction

in pain when compared to the group that was not given massage therapy.

19 Randomized control trial research comparing massage therapy, touch

and standard treatments showed that massage therapy can reduce the pain

of patients undergoing chemotherapy. 20 Massage therapy can reduce pain

by inhibiting the distress delivery cycle through suppression performed by

the therapist (presence, communication, and desire to produce an

therapeutic response), stimulate the relaxation response, increase blood

flow and spleen, have analgesic effects, reduce inflammation and edema,

reduce muscle spasm, increase endogenous endorphin release and inhibit

sensory stimulus that plays a role in the delivery of pain response. 21 The

sensation of relaxation caused by massage therapy can trigger skeletal

muscle activity, reduced blood pressure and heart rate, peripher blood

vessels can circulate and trigger a warm feeling in the body. Massage
(vibration) can stimulate some receptors on parts of the body. For example,

pacini cells that exist on the surface of the body and mekanoresptor that are

in the body. The body's mekanoreceptor cells will measure the intensity of

relaxation of body tissues and the most accurate cells will inform the body

to cause a relaxing and warming effect of the body caused by better blood

circulation by massage. The relaxing effect is related to the limbic system.

In this process, massage decreases the activation of the sympathetic nervous

system and the distribution and transmission of adrenaline and

noradrenaline will be reduced. Therefore, the intensity of the pain is also

reduced. Massage therapy needs to be done by a nurse who is already an

expert so that the nurse does have to take certain training to be able to do

massage therapy that has a therapeutic effect.

 Conclusion

Complementary Massage therapy is the most effective step to improve relaxation and reduce

pain in cancer patients undergoing chemotherapy therapy.

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