Massage improves function in patients with chronic low back pain

A randomized controlled trial published in the Annals of Internal Medicine comparing two techniques of massage therapy showed a significant short- and long-term improvement using either technique, compared to usual care.

Weekly massage for 10 weeks, either a general relaxation massage or one aimed specifically at addressing musculoskeletal contributions to low back pain, produces a clinically meaningful reduction in dysfunction and symptoms as compared with usual care. The effect diminishes but functional improvement persists for up to one year after the start of treatment.

Although therapeutic massage is not a covered procedure under MediCal or Medicare, low-cost options are available in many communities. Training a family member in basic massage techniques is another option for patients with chronic pain. Some modalities of physical therapy probably share some of the underlying mechanism of benefit of therapeutic massage, and short term PT is covered by MediCal and Medicare.

Many cultures consider massage an integral part of medical care and many countries pay for massage services as part of universal health care. Health care providers tend to focus on the therapies that are most discussed (medications, epidural or facet joint injections), that may also be the most expensive options, because they are covered benefits. Consider evidence-based complementary medicine options for appropriate patients with low back pain.

 Robert Moore, MD, MPH

Reference:

Cherkin DC, Sherman KJ, Kahn J, et al. A comparison of the effects of 2 types of massage and usual care on chronic low back pain. Ann Intern Med 2011;155(1):1-9.

These investigators invited adults with chronic (at least 3 months), nonspecific low back pain to participate in this study. A total of 401 patients were randomized, using concealed allocation, to receive 1 of 3 treatments: either of two different types of massage or usual care. Massage consisted of 10 weekly sessions using either relaxation or structural massage, the latter consisting of myofascial, neuromuscular, and other soft-tissue techniques. The usual care group received no specific care. At the end of 10 weeks, dysfunction, measured by the Roland Disability Questionnaire, improved an average of 2.5 and 2.9 points out of a possible 23 points with the 2 types of massage as compared with usual care. A difference of 2 points on this scale is considered clinically meaningful. Improvements were similar with either type of massage. “Bothersomeness” of pain, rated 5.6 to 5.8 on a scale of 1 to 10, decreased an average 1.4 and 1.7 points as compared with usual care. Differences in function scores diminished over time but were still present 1 year after the start of the study.

Taken from InfoPOEM

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