By Neil Wagner
Massage is currently seen as a complementary or alternative treatment for back pain. It's not used as a standard treatment. A recent one-year study suggests that maybe it should be.
Ten weeks into the study, participants who had received massage were experiencing considerably less back pain than the other participants were.
The study was of 401 Seattle patients with chronic lower back pain. It set out to compare the effectiveness of two different types of back massage to that of usual care for chronic lower back pain. Usual care can include some combination of painkillers, anti-inflammatory drugs, muscle relaxants and physical therapy, or it may include very little or no treatment at all. Treatment of lower back pain is not standardized and usual care varies greatly from patient to patient.
Participants were divided into three groups. One group received usual care. The second group received 10 weeks of structural massage. The third group received 10 weeks of relaxation (Swedish) massage. Massage was given once a week. The first massage session was 75-90 minutes and all others were 50-60 minutes.
Ten weeks into the study, nearly 40% of the participants who received massage reported that their back pain was much better or gone. Only 4% of the usual care group reported this. Those who received massage were twice as likely to have spent fewer days in bed, used less anti-inflammatory medication and were also more active than the usual care group.
Massage treatment ended 10 weeks into the study. Six months after the start of the study, those who had received massage still had milder pain symptoms than the usual care group, though the difference was smaller than it had been at 10 weeks. One year after the study's start, there was essentially no difference in symptoms between the two groups.
This suggests that 10 weeks of massage gives benefits that can last at least six months.
The two types of massage were equally effective, a finding that surprised the researchers, who expected to see more benefit from structural massage. Structural massage manipulates specific back muscles and ligaments and is more complex and difficult to learn than Swedish massage is. Almost all massage therapists in the U.S. are trained in Swedish massage. The only advantage the researchers found to structural massage is that it may be more likely to be paid for by insurance plans.
Participants rated both the bothersomeness of their pain and how disabling it was, with lower scores being better. Results ten weeks into the study showed that, on a 10-point bothersomeness scale, symptoms were 1.4-1.7 points lower in the massage groups than in the usual care group. On a 23-point disability scale, scores were 2.5-2.9 points lower in the massage groups. On both scales, the higher differences were for relaxation massage, the lower differences for structural massage. The differences between the two types of massage were not statistically significant.
The study has some limitations. Participants were mostly middle-aged women recruited from a health plan that serves a white, employed population, so the results may not be generalizable to a wider population. And participants were not blinded — they knew whether or not they were receiving massage, though not what type of massage they were receiving. This may have caused some resentment in the group not receiving massage and caused them to under-report their improvement. But the study does suggest that massage improves lower back pain and makes it easier to live with.
An article on the study appears in the July 5, 2011 issue of Annals of Internal Medicine.
August 1, 2011