Massage therapy more effective for patients with chronic low back pain

Annals of Internal Medicine trial compared massage types at Group Health

Massage therapy helps ease chronic low back pain and improve function, according to a randomized controlled trial that the Annals of Internal Medicine will publish in its July 5 issue. The first study to compare structural and relaxation (Swedish) massage, the trial found that both types of massage worked well, with few side effects.

"We found that massage helps people with back pain to function even after six months," said trial leader Daniel C. Cherkin, PhD, a senior investigator at Group Health Research Institute. Better function means they are more able to work, take care of themselves, and be active.

"This is important because chronic back pain is among the most common reasons people see doctors and alternative practitioners, including massage therapists," Dr. Cherkin added. "It's also a common cause of disability, absenteeism, and 'presenteeism,' when people are at work but can't perform well."

The trial enrolled 400 Group Health Cooperative patients who had had low back pain for at least three months. Their pain was "nonspecific," meaning with no identified cause. They were randomly assigned to one of three treatments: structural massage, relaxation massage, or usual care. Usual care was what they would have received anyway, most often medications. The hour-long massage treatments were given weekly for 10 weeks.

At 10 weeks, more than one in three patients who received either type of massage-but only one in 25 patients who got usual care-said their back pain was much better or gone. Also at 10 weeks, a questionnaire showed nearly twice as many massage patients (around two thirds) as usual-care patients (more than one third) were functioning significantly better than at the trial's outset. Patients in the massage groups spent fewer days in bed, were more active, and used less anti-inflammatory medication than did those with usual care.

"As expected with most treatments, the benefits of massage declined over time," Dr. Cherkin said. "But at six months after the trial started, both types of massage were still associated with improved function." After one year, the benefits of massage were no longer significant.

The bottom line: "We found the benefits of massage are about as strong as those reported for other effective treatments: medications, acupuncture, exercise, and yoga," Dr. Cherkin said. "And massage is at least as safe as other treatment options. So people who have persistent back pain may want to consider massage as an option."

Prior studies of massage for back pain had tested only structural forms of massage, not relaxation massage. But relaxation (also called Swedish) massage is the most widely available and is taught in massage schools. It aims to promote a feeling of relaxation throughout the body. By contrast, structural massage involves identifying and focusing on specific pain-related "soft tissues" (like muscles and ligaments). It requires extra training and may be more expensive-but more likely to be covered by health insurance plans-than relaxation massage.

"The massage therapists assumed structural massage would prove more effective than relaxation massage," said Dr. Cherkin's colleague Karen J. Sherman, PhD, MPH, a senior investigator at Group Health Research Institute. "They were surprised when patients in the relaxation group got so much relief from their back pain."

Next steps include figuring out whether the structural and relaxation massages were equally effective for the same-or for different-reasons:

• Structural or relaxation massage, or both, might have specific effects, such as stimulating tissue or calming the central nervous system.
• Either or both might work through "nonspecific effects" that may promote a person's ability to play an active role in their own healing. Possible nonspecific effects include: being touched; spending time in a relaxing environment; receiving care from a therapist who seems caring; getting advice on caring for yourself, such as exercises to do on your own; or becoming more aware of your own body, so you're better able to avoid triggers for your back pain.
• Some combination of specific and nonspecific effects might be at play.