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A Comparison of Massage Therapy and Usual Medical Care for Chronic Low Back Pain FREE

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The full report is titled “A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain. A Randomized, Controlled Trial.” It is in the 5 July 2011 issue of Annals of Internal Medicine (volume 155, pages 1-9). The authors are D.C. Cherkin, K.J. Sherman, J. Kahn, R. Wellman, A.J. Cook, E. Johnson, J. Erro, K. Delaney, and R.A. Deyo.

Ann Intern Med. 2011;155(1):I-28. doi:10.7326/0003-4819-155-1-201107050-00001
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What is the problem and what is known about it so far?

Low back pain is very common. It often goes away after several days or weeks, but it may last for months or years or periodically recur. The main goal in treating low back pain is to decrease pain and allow people to resume their normal activities. Usual treatments for low back pain include drugs (painkillers, anti-inflammatory drugs, and muscle relaxants), physical therapy, back exercises, and education about ways to prevent back injury and deal with back pain. Some people use alternative treatments for low back pain, such as chiropractic or massage therapy.

There are at least 2 kinds of massage therapy. Relaxation massage is most common; in this technique, a variety of maneuvers is used to relax the massaged muscles and the person with back pain overall. Structural massage uses maneuvers to release tension in specific tissues and joint structures in an attempt to restore healthy functioning of the muscular and nervous systems. It is not known whether relaxation massage, which is more widely available, is as effective as structural massage.

Why did the researchers do this particular study?

To compare the short-term and long-term effects of relaxation massage, structural massage, and usual care for people with persisting low back pain.

Who was studied?

401 people with low back pain of no identified cause lasting at least 3 months.

How was the study done?

The researchers first gathered information about the participants' symptoms and how much those symptoms limited their daily activities. They then randomly assigned each participant to receive relaxation massage, structural massage, or usual medical care without massage. Participants assigned to the massage groups got about 1 hour of massage once a week for 10 weeks. The researchers remeasured participants' symptoms and ability to perform daily activities after completing the 10 massage treatments, and then at 6 months and 1 year after starting massage therapy.

What did the researchers find?

Participants who received massage had less pain and were better able to perform daily activities after 10 weeks than those who received usual care. The benefits of massage lasted for 6 months but were less clear at 1 year, when pain and function had improved about equally in all 3 groups. The type of massage did not seem to make a difference. Symptoms and ability to perform activities improved about the same in the 2 massage groups.

What were the limitations of the study?

Participants were mostly white. The findings might not apply to people of other ethnicities. Participants who received usual medical care were aware that they were not getting massage treatments and that other participants were; that might have led them to report worse symptoms than if they were unaware of what treatments other people were getting.

What are the implications of the study?

Ten sessions of massage therapy led to more rapid improvement in low back pain than usual medical care. There was no apparent difference between relaxation massage and the more specialized technique of structural massage.





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