The effect of postoperative back massage on pain, sleep outcomes and serum cortisol after open-heart surgery: A randomized controlled trial.

BACKGROUND

Massage is widely recognized as an effective non-pharmacological intervention for reducing pain and anxiety after cardiac surgery. However, its effects on sleep outcomes and biological stress markers remain underexplored.

AIM: To evaluate the impact of back massage on postoperative pain, subjective and objective sleep outcomes, and serum cortisol levels in patients undergoing open-heart surgery.

METHODS

A prospective randomized controlled trial was conducted with 72 patients scheduled for elective open-heart surgery. Participants were randomized (1:1) to an intervention group (back massage) or a control group (routine care with light touch). The intervention consisted of three standardized sessions (15-20 min each) on the first postoperative day. Outcomes included pain (Numeric Rating Scale-Pain), subjective sleep quality (Richard-Campbell Sleep Scale), objective sleep duration (smartwatch measurement), and serum cortisol levels. Data were analyzed using repeated-measures analysis of variance and Brunner-Langer tests in a per-protocol population (n = 64).

RESULTS

Back massage was associated with significantly longer total sleep duration (p = 0.037) and greater reduction in pain scores, with significant group, time, and group × time effects (p = 0.002, p < 0.001, p = 0.048). Cortisol levels decreased over time in both groups (p < 0.001), but without significant between-group differences. Subjective sleep quality improved in both groups, and analgesic use declined, with no significant variation between groups. No adverse events were observed.

CONCLUSION

This randomized controlled trial demonstrates that back massage is a safe and feasible intervention after open-heart surgery, improving objectively measured sleep duration and reducing pain. By incorporating objective sleep measures and a biological stress marker (serum cortisol), this study provides novel insights that extend beyond the traditionally reported outcomes of pain and anxiety, supporting massage as a complementary strategy within multimodal nursing care.