July 4, 2011, 5:00 pm
Stubborn Back Pain? Try MassageBy NICHOLAS BAKALAR
Massage is a common alternative treatment for chronic low back pain, but most recent studies have found little evidence that it works. A group of researchers designed a study to see if they could find a difference between back pain sufferers who got massage and those who did not.
The scientists recruited 401 members of a large group health plan who had moderately severe back pain unconnected with any disease and generally related to strains and sprains. Three quarters of the volunteers had had pain for more than a year.
The volunteers, average age 46, two-thirds of them women, were randomly assigned to one of three groups. Some got relaxation massage, a full-body technique intended to induce a generalized sense of relaxation to ease low back pain. Others got structural massage, which aims to identify specific musculoskeletal contributors to pain and to release restrictions on muscles causing the distress. The third group received no special care and served as controls.
The three groups were similar in the other kinds and frequency of treatments they used, including painkillers or sedatives, back exercises and bed rest.
Each of the massage groups received 10 weeks of treatment, and at the end of that period, all three groups had some improvement, as measured by their answers to 23 questions about performing routine activities without help — for example, climbing stairs without using a handrail or getting out of an easy chair by themselves. They were also asked to rate the degree of their back pain symptoms on a 10-point scale.
Those who received massage scored significantly better on both symptom and function tests, and they spent less time in bed, used less medicine and were more satisfied with their current level of back pain.
At 26 weeks after treatment, those in the usual care group continued to function less well than those who had gotten massage. But there were no significant differences in the pain scores in the three groups, either at 26 or at 52 weeks.
Daniel C. Cherkin, the lead author and an epidemiologist with the Group Health Research Institute in Seattle, mentioned some of the study’s considerable strengths. It had a randomized design, a high follow-up rate, good adherence to the treatment and a large sample size. Still, he said, the study was done on a mostly white, middle-class population in otherwise good health, which may limit its applicability to other groups. The study appeared online Monday in Annals of Internal Medicine.
It is unclear how massage eases back pain, but the researchers suggest it may stimulate tissue locally or cause a more generalized central nervous system response. It is also possible that just spending time in a relaxing environment or being touched and cared for by a sympathetic therapist could have led to improvement. Also, those in the control group knew that the other groups were getting massage, and the knowledge that others were getting the treatment while they got none may have led them to underestimate their own progress.
Still, the researchers conclude that massage has few adverse effects and is a reasonable treatment for low back pain. There is no evidence, though, that it lowers the cost of health services related to back pain.
“We tested this on people who had not been getting better from the usual medical approaches, Dr. Cherkin said. “If you’ve tried other things and you’re not getting adequate relief, then massage is a reasonable thing to try.”