In the latest study comparing the benefits of adding massage to usual care for lower back pain, researchers report that massage improved pain symptoms and allowed patients to function better than those who didn't get massage.
That's good news for the eight out of 10 Americans who will, at some point in their lifetimes, experience the excruciating spasms of back pain that can send people to bed for days, if not weeks.
It's also helpful news for doctors. Even though it's common knowledge that an old-fashioned muscle-kneading is a great way to relax and reduce pain, the new findings give that notion some clinical teeth. Having such data in hand is critical for doctors who are discussing options for pain relief with their patients. "We have a huge number of people who get medical tests and treatments for back pain, and we have a huge problem with opioids," says Dan Cherkin, senior research investigator at Group Health Research Institute in Seattle and lead author of the study. "In spite of all that, we're not better off in terms of addressing back pain. In fact, the problem is getting worse."
In the study, published in the Annals of Internal Medicine, Cherkin and his group recruited 400 people with chronic back pain. The participants' pain was typical of the kind that most of us experience: the result of wear and tear on muscles, or from being tensed up in front of a computer for too long. The researchers excluded those whose back pain was due to injury or a disease like cancer, in order to study more everyday types of back problems.
The participants were then randomly assigned to one of three treatment groups: relaxation massage; structural massage, which is more akin to physical therapy and focuses specifically on problem areas; and usual care only. The usual care group simply continued on whatever treatments they were already receiving, whether that included painkilling drugs, back exercises, yoga or any other therapy except massage. The other two groups also continued with usual care, but added massage on top of it.
Participants received massage once a week for at least an hour. After 10 weeks, both massage groups reported lower disability scores, as measured with a questionnaire that asked participants about how much pain and impairment they experienced during their daily activities like climbing stairs or getting up from a chair. Participants filled out the questionnaires at 10, 26 and 52 weeks.
On average, the massage groups recorded disability scores that were 2.7 points lower than the usual-care group. The massage patients also said they functioned better than those who weren't massaged at 10 weeks. Six months after the treatments, the difference between the massage and non-massage groups had shrunk, but those who received the treatment still reported feeling slightly better than the controls.
Was it massage that really helped, or did the mere anticipation of a relaxing massage confer some type of placebo benefit? That's possible, but Cherkin notes that whatever the mechanism, massage appears to work. "We need alternatives to what isn't working in treating back pain," he says. "Massage is one of those alternatives."
The participants in the study had all tried existing therapies but couldn't find relief for their pain. The fact that massage made a difference when added to existing treatments may shift the way back pain is currently treated. And it couldn't happen sooner: a recent report by the Institute of Medicine found that untreated or inadequately treated pain affects 116 million Americans and is a "public health crisis."
"The important thing isn't so much that massage is an effective treatment," says Cherkin, "but that the study illustrates that a variety of things are safe and helpful for people who haven't gotten help from other treatments. So rather than telling patients after the usual things don't work, 'Sorry, there's nothing we can do for you,' we should tell them that there are a lot of things available to treat their pain, 'Let's talk about which one you think might be most helpful to try next.'"
For doctors, having a controlled trial that documents the benefits of massage — this one was funded by the National Institutes of Health's National Center for Complementary and Alternative Medicine — can help inform discussions about pain-relieving options. "There are always options, and there is always hope," says Cherkin.