Effect of Tuina Massage on Pain during Orogastric Tube Insertion in Premature Neonates: A Randomized Controlled Trial

Document Type : Original Article

Authors

1 Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

2 Department of Pediatric Nursing, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

3 School of Medicine, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

4 Department of Psychiatric Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran

10.22038/ijn.2025.84200.2621

Abstract

Background: Orogastric tube insertion is a painful procedure for neonates, particularly premature infants who are more vulnerable to pain and its consequences. Non-pharmacological, safe, and cost-effective pain management methods are essential in neonatal care. Tuina, a traditional Chinese massage technique, may reduce procedural pain in this population. This study aimed to evaluate the effect of Tuina massage on pain during orogastric tube insertion in premature neonates.
Methods: A randomized controlled trial was conducted on 70 premature neonates admitted to a maternal and neonatal hospital in Ahvaz, Iran. Participants were randomly assigned into intervention (Tuina massage) and control (routine care) groups (n=35 each) using block randomization with R software. Pain levels, heart rate, and oxygen saturation were assessed using the Premature Infant Pain Profile (PIPP) at three time points: five minutes before, during, and five minutes after tube insertion. The intervention group received Tuina massage three times, each lasting one minute with 30-second intervals during these phases.
Results: The intervention group showed a significant reduction in pain scores during and after tube insertion compared to the control group (p = 0.001, Cohen’s d = 0.927). Heart rate decreased and oxygen saturation increased significantly post-intervention in the Tuina group (p = 0.029).
Conclusion: Tuina massage is an effective, accessible, and low-cost method for reducing procedural pain and improving physiological parameters in premature neonates, supporting its use as a valuable non-pharmacological intervention in NICU settings.
 

Keywords

References

  1. Pereira FL, Gaspardo CM. Neonatal pain and developmental outcomes in children born preterm: An updated systematic review. Psychol Neurosci. 2024;17(1):1.
  2. Breton-Piette A, De Clifford-Faugère G, Aita M. Prolonged pain in premature neonates hospitalized in neonatal intensive care units: A scoping review. Int J Nurs Stud. 2024;155:104773. 
  3. Eissler AB, Stoffel L, Nelle M, Hahn S, Zwakhalen S. Pain responses in preterm infants and parental stress over repeated painful procedures: a randomized pilot trial. J Matern Fetal Neonatal Med. 2023;36(1):2183753.
  4. Merter ÖS, Dertli S, Koç Ö. Reasons and Frequency of Orogastric Tube Change in Preterm Infants by Nurses Working in Neonatal Intensive Care Units. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2023;10(4):381–386.
  5. Bharadwaj SK, Devi R, Somanath SH, Pullattayil AK, Dhyani VS. Effectiveness of nasogastric versus orogastric tube feeding in preterm infants: A systematic review and meta‐analysis. J Pediatr Gastroenterol Nutr. 2025;80(4):723-732.
  6. Shirdel M, Pouraboli B, Sagheb S, Sabagh VG, Haghani S. The effect of the four-handed method on the pain caused by gastric tube insertion in premature infants: A randomized clinical trial. 2024.
  7. Kirli C, Kisacik ÖG, Gürel S. The effects of white noise and swaddling methods on orogastric tube insertion‐related pain in preterm infants: A randomized controlled trial. Int J Nurs Pract. 2024;30(6):e13275.
  8. Nuseir K, Alzoubi KH, Altarifi A, Kassab M, Khabour OF, Al-Ghraiybah NF, et al. Long-term effects of neonatal pain and sucrose treatment. Curr Res Pharmacol Drug Discov. 2024;6:100176.
  9. Sobol-Kwapińska M, Sobol M, Woźnica-Niesobska E. Parental behavior and child distress and pain during pediatric medical procedures: Systematic review and meta-analysis. Health Psychol. 2020;39(7):558-572.
  10. Nasimi F, Zeraati H, Shahinfar J, Safdari M, Esmaeili A, Ghorbanzadeh M. Effect of multi-sensory stimulation on physiological parameters in preterm infants: Randomized clinical trial. Tehran Univ Med J. 2020;78(2):80–87.
  11. Selvanathan T, Miller SP. Brain health in preterm infants: importance of early-life pain and analgesia exposure. Pediatr Res. 2024;96(6):1397-1403.
  12. Al-Maaitah EI, Razeq NMA, Obeidat HM. Nurses' improved provision of infants’ procedural pain assessment and management with non-pharmacological interventions following a training program in Jordan. J Neonatal Nurs. 2023; 29(2):356–360.
  13. Duru P, Akkoca Z, Örsal Ö. Comparison of the efficacy of non-pharmacological interventions during the heel stick procedure on pain level, duration of crying, and voice decibel of newborns:
    A randomized controlled trial. Perinat J. 2023;31(1):31-40.
  14. Semnani N, Hojjati H, Akhoundzadeh G. The effect of Yakson touch on pain control due to nasogastric intubation in premature infants admitted to the neonatal intensive care unit of Taleghani Gonbad hospital in 2019. J Health Care. 2020;22(2):93-101.
  15. Özkan TK, Küçükkelepçe DŞ, Özkan SA. The effects of acupressure and foot massage on pain during heel lancing in neonates: A randomized controlled trial. Complement Ther Med. 2019;46:103-108.
  16. Zhang X, Guo T, Zhu B, Gao Q, Wang H, Tai X, et al. Pediatric Tuina for promoting growth and development of preterm infants: A protocol for the systematic review of randomized controlled trail. Medicine (Baltimore). 2018;97(18):e0574.
  17. Liu HC, Zhu HM, Li M, Chen BR, Yang ZY, Wang Y, et al. Chinese Tuina ameliorates muscle damage by regulating endoplasmic reticulum stress and autophagy in a rat model of skeletal muscle contusion. Tissue Cell. 2025;95:102874.
  18. Zhang P, Zhang Q, Zhu B, Xia S, Tai X, Tai X, et al. Chinese Tuina protects against neonatal hypoxia-ischemia through inhibiting the neuroinflammatory reaction. Neural Plast. 2020;2020:8828826.
  19. Gao T, Wang Y, Li M, Yang L, Chen S, Gao L, et al. Enhancing the development and growth of infant cerebral palsy rats using selective spinal manipulations. J Vis Exp. 2024(204):e65659.
  20. Geng L, Yang Y. Retrospective study of Rougan Tongdu Tuina combined with point-pressing massage therapy on neurodevelopment in children with delayed motor development at very early stage. Transl Pediatr. 2021;10(12):3202-3210.
  21. Tang W, Li Z, Xu W, Ye Y, Wang H, Wang Y, et al. Effect of massage therapy on infants with congenital muscular torticollis: A retrospective comparative study. Front Pediatr. 2023;10:984675.
  22. Landgren K, Hallström I. Effect of minimal acupuncture for infantile colic: a multicentre, three-armed, single-blind, randomised controlled trial (ACU-COL). Acupunct Med. 2017;35(3):171-179. 
  23. Liaw JJ, Zeng WP, Yang L, Yuh YS, Yin T, Yang MH. Nonnutritive sucking and oral sucrose relieve neonatal pain during intramuscular injection of hepatitis vaccine. J Pain Symptom Manage. 2011;42(6):918-930.
  24. Bagheri F, Vashani HB, Baskabadi H, Tabriz ER. An investigation of the effects of massage therapy on pain caused by umbilical vein catheter insertion in premature neonates: a clinical trial. Pak J Med Health Sci. 2020;14:1600–1603.
  25. Harrison TM, Brown R, Duffey T, Frey C, Bailey J, Nist MD, et al. Effects of massage on postoperative pain in infants with complex congenital heart disease. Nurs Res. 2020;69(5S Suppl 1):S36-S46.
  26. Yang M, Feng Y, Pei H, Deng S, Wang M, Xiao X, et al. Effectiveness of Chinese massage therapy (Tui Na) for chronic low back pain: study protocol for a randomized controlled trial. 2014;15:418.
  27. Bezgin S, Atici A, Celikkaya ME, Cicek I, Cicekli F, Aslan N, et al. An investigation of the effects of abdominal massage on the severity of functional constipation in preschool children and the quality of life of their mothers: A randomized controlled study. J Soc Anal Health. 2023;3(1):69–76.
  28. Jain S, Kumar P, McMillan DD. Prior leg massage decreases pain responses to heel stick in preterm babies. J Paediatr Child Health. 2006;42(9):505-508.
  29. Axelin A, Salanterä S, Lehtonen L. 'Facilitated tucking by parents' in pain management of preterm infants-a randomized crossover trial. Early Hum Dev. 2006;82(4):241-247.
  30. Hauck AG, van der Vaart M, Adams E, Baxter L, Bhatt A, Crankshaw D, et al. Effect of parental touch on relieving acute procedural pain in neonates and parental anxiety (Petal): A multicentre, randomised controlled trial in the UK. Lancet Child Adolesc Health. 2024;8(4):259-269. 
  31. Alinejad-Naeini M, Heidari-Beni F, Mohagheghi P, Sohrabi S. The effect of M technique massage on behavioral state and weight gain in preterm neonates: A randomized controlled trial. J Child Health Care. 2024;28(3):551-564.

 

 

 

 

Iranian Journal of Neonatology
Volume 17, Issue 1
January 2026
Pages 20-26

Files

Share

How to cite

Statistics