The Effects of Nursing Back Rub on Pain and Wound Cytokines and The Relationship Between Pre-CABG Mood and Post-CABG Wound Cytokines

This study, guided by psychoneuroimmunology theory, examined the effects of a 10-minute nursing back rub in 20 coronary artery bypass graft (CABG) patients on pain and four proinflammatory wound cytokines (IL-1β, IL-6, IL-8, and TNF-α). It also examined the relationships between the Profile of Mood States (POMS) and the proinflammatory cytokines. A control group (n = 8) received time with the researcher, and an experimental group (n = 12) received a slow stroke effleurage back rub. All participants initially completed the POMS and after surgery, wound fluid was collected from the mediastinal chest tube before and after the intervention. Analysis showed the experimental group had a significant decrease in pain (df 11, p=0.001). Pretest mean levels of cytokines one hour before the back rub were: IL-1β, 15.1 pg/ml; IL-6, 104,680pg/ml; IL-8, 6,953 pg/m, and TNF-α, 3.5 pg/ml. Posttest cytokine mean levels were: IL-1β, 13.71 pg/ml; IL-6, 94,658.5 pg/ml; IL-8, 22,431 pg/ml; and TNF-α, 3.6 pg/ml. There were no significant changes in any cytokine levels in either group from pretest to posttest. Great variability in cytokine concentrations was noted in both the experimental and the control group. No significant relationships were found between the POMS Total Mood Disturbance Score (TMDS) and cytokine levels. There was a significant inverse relationship (r = -.560, p=.016) between the POMS score of tension-anxiety and IL-6. There was a significant positive correlation (r = .475, p=.034) between IL1-β and weight. This study has contributed support to a nursing intervention that appears to reduce pain perception, to the understanding of wound cytokine levels in CABG patients, and to psychoneuroimmunology research in that wound fluid IL-6 levels in were lower in patients who were tense/anxious before surgery. Further research needs to be done on wound healing and stress reducing interventions.