Daniel C. Cherkin, PhD; Karen J. Sherman, PhD, MPH; Janet Kahn, PhD; Robert Wellman, MS; Andrea J. Cook, PhD; Eric Johnson, MS; Janet Erro, RN, MN; Kristin Delaney, MPH; Richard A. Deyo, MD, MPH
Cherkin DC, Sherman KJ, Kahn J, Wellman R, Cook AJ, Johnson E, et al. A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain: A Randomized, Controlled Trial. Ann Intern Med. 2011;155:1-9. doi: 10.7326/0003-4819-155-1-201107050-00002
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Published: Ann Intern Med. 2011;155(1):1-9.
Few studies have evaluated the effectiveness of massage for chronic low back pain.
To compare the effectiveness of 2 types of massage and usual care for chronic back pain.
Parallel-group randomized, controlled trial. Randomization was computer-generated, with centralized allocation concealment. Participants were blinded to massage type but not to assignment to massage versus usual care. Massage therapists were unblinded. The study personnel who assessed outcomes were blinded to treatment assignment. (ClinicalTrials.gov registration number: NCT00371384)
An integrated health care delivery system in the Seattle area.
401 persons 20 to 65 years of age with nonspecific chronic low back pain.
Structural massage (n = 132), relaxation massage (n = 136), or usual care (n = 133).
Roland Disability Questionnaire (RDQ) and symptom bothersomeness scores at 10 weeks (primary outcome) and at 26 and 52 weeks (secondary outcomes). Mean group differences of at least 2 points on the RDQ and at least 1.5 points on the symptom bothersomeness scale were considered clinically meaningful.
The massage groups had similar functional outcomes at 10 weeks. The adjusted mean RDQ score was 2.9 points (95% CI, 1.8 to 4.0 points) lower in the relaxation group and 2.5 points (CI, 1.4 to 3.5 points) lower in the structural massage group than in the usual care group, and adjusted mean symptom bothersomeness scores were 1.7 points (CI, 1.2 to 2.2 points) lower with relaxation massage and 1.4 points (CI, 0.8 to 1.9 points) lower with structural massage. The beneficial effects of relaxation massage on function (but not on symptom reduction) persisted at 52 weeks but were small.
Participants were not blinded to treatment.
Massage therapy may be effective for treatment of chronic back pain, with benefits lasting at least 6 months. No clinically meaningful difference between relaxation and structural massage was observed in terms of relieving disability or symptoms.
National Center for Complementary and Alternative Medicine.
Massage therapy is widely used for back pain.
Patients with chronic low back pain who received 10 weekly sessions of structural or relaxation massage therapy experienced clinically important improvements in symptoms and disability compared with patients who received usual care. There was no apparent difference in effect between the 2 types of massage.
Participants assigned to usual care knew that they were not receiving massage therapy and may have been more likely to report less improvement.
Massage therapy seemed to be an effective short- and longer-term treatment for chronic low back pain. There was no apparent difference between relaxation and structural massage, the latter of which may be more expensive and requires specialized techniques.
IQR = interquartile range.
Appendix Table 1.
Estimates were computed by using generalized estimating equation models with covariates set to the overall sample mean. Higher scores for both outcomes signify greater disability or symptom bothersomeness.
Estimates were computed by using generalized estimating equation models with covariates set to the overall sample mean. Higher scores for both outcomes signify greater disability or symptom bothersomeness. RDQ = Roland Disability Questionnaire.
Appendix Table 2.
Appendix Table 3.
Appendix Table 4.
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Video News Release - Massage More Effective Than Usual Care for Treating Chronic Low Back Pain
July 7, 2011
Massage, back pain, and alternative medicine.
As a rheumatologist, I would like to have a useful method of dealing with back pain but I think this article makes a very poor case.
1. Massage is always pleasant. People with and without back pain generally enjoy a massage and I have had a few myself. Ten weekly one hour massages would make most people at least transiently feel better. Two different types of massage were equally "effective", meaning at week ten patients were "improved."
2. The control group was told, "Sorry. Here's $50. Go home and tell us how you feel in ten, 26 and 52 weeks."
3. There was no control group that received even 10 minute massages, a hot tub, or some other simple P.T.
4. At ten weeks, all massage patients felt somewhat better. At 26 weeks, there was little or no significant difference and at 52 weeks, the "massage" groups were the same or even marginally worse.
5. The cost of massage was $540. One hour massages for $54 cannot be obtained in this area and insurance would usually not cover all of this.
6. Some patients might have been retreated at 52 weeks to see if a second course was even as good as the first.
7. Medical journals are frequently excited by "Complementary and Alternative Medicine" but here their standards seem to me a little low (but I am glad to have them take over my low back pain patients).
Barry L. Parnas
Associated Bodywork and Massage Professionals
August 18, 2011
Re:Massage, back pain, and alternative medicine.
This study opens up another option for low back pain sufferers with its report of positive results for massage therapy. Sufferers can confidently choose massage therapy to improve their function and, at least for a period of time, their pain. As Swedish/Relaxation massage might be the less expensive of the two massage modalities, the study also addresses cost effectiveness. As with any product or service from any provider, disclosure of costs and confidence in effectiveness is part of providing professional, competent, and effective care. Perhaps, massage professionals offering lower back treatment could offer a discounted 10- session package - good for the client and good for the provider. Massage may be expensive on a per session cost, but it may provide positive ancillary effectiveness that has not been captured statistically or compared thoroughly with other interventions. Feeling good, as pointed out by a previous comment, can have tremendously positive impact in addition to adding functionality. It is only recently that thorough life cycle cost/benefit analyses have been done even in less complex fields than human health. As the previous comment implied in its last bullet point, low back sufferers have a challenge that even the highly trained, technologically advanced medical industry finds challenging. Everyone should have clear options to try.
Rheumatology, Back Pain.
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