Massage eases low back pain in randomized controlled trial

Annals of Internal Medicine trial compared massage types at Group Health

Seattle, WA—Massage therapy helps ease chronic low back pain and improve function, according to a randomized controlled trial in the July 5 Annals of Internal Medicine. The first study to compare structural and relaxation (Swedish) massage, the trial found that both types of massage worked well, with few side effects. Here is the journal's summary for patients.

“We found that massage helps people with back pain to function even after six months,” said trial leader Daniel C. Cherkin, PhD, a senior investigator at Group Health Research Institute. Better function means they are more able to work, take care of themselves, and be active.

“This is important because chronic back pain is among the most common reasons people see doctors and alternative practitioners, including massage therapists,” Dr. Cherkin added. “It’s also a common cause of disability, absenteeism, and ‘presenteeism,’ when people are at work but can’t perform well.”

The trial enrolled 400 Group Health Cooperative patients who had had low back pain for at least three months. Their pain was “nonspecific,” meaning with no identified cause. They were randomly assigned to one of three treatments: structural massage, relaxation massage, or usual care. Usual care was what they would have received anyway, most often medications. The hour-long massage treatments were given weekly for 10 weeks.

At 10 weeks, more than one in three patients who received either type of massage—but only one in 25 patients who got usual care—said their back pain was much better or gone. Also at 10 weeks, a questionnaire showed nearly twice as many massage patients (around two thirds) as usual-care patients (more than one third) were functioning significantly better than at the trial’s outset. Patients in the massage groups spent fewer days in bed, were more active, and used less anti-inflammatory medication than did those with usual care.

“As expected with most treatments, the benefits of massage declined over time,” Dr. Cherkin said. “But at six months after the trial started, both types of massage were still associated with improved function.” After one year, the benefits of massage were no longer significant.

The bottom line: “We found the benefits of massage are about as strong as those reported for other effective treatments: medications, acupuncture, exercise, and yoga,” Dr. Cherkin said. “And massage is at least as safe as other treatment options. So people who have persistent back pain may want to consider massage as an option.”

Prior studies of massage for back pain had tested only structural forms of massage, not relaxation massage. But relaxation (also called Swedish) massage is the most widely available and is taught in massage schools. It aims to promote a feeling of relaxation throughout the body. By contrast, structural massage involves identifying and focusing on specific pain-related “soft tissues” (like muscles and ligaments). It requires extra training and may be more expensive than relaxation massage.

“The massage therapists assumed structural massage would prove more effective than relaxation massage,” said Dr. Cherkin’s colleague Karen J. Sherman, PhD, MPH, a senior investigator at Group Health Research Institute. “They were surprised when patients in the relaxation group got so much relief from their back pain.”

Next steps include figuring out whether the structural and relaxation massages were equally effective for the same—or for different—reasons:

• Structural or relaxation massage, or both, might have specific effects, such as stimulating tissue or calming the central nervous system.
• Either or both might work through “nonspecific effects” that may promote a person’s ability to play an active role in their own healing. Possible nonspecific effects include: being touched; spending time in a relaxing environment; receiving care from a therapist who seems caring; getting advice on caring for yourself, such as exercises to do on your own; or becoming more aware of your own body, so you’re better able to avoid triggers for your back pain.
• Some combination of specific and nonspecific effects might be at play.

Drs. Cherkin and Sherman’s co-authors are Assistant Investigator Andrea J. Cook, PhD, of Group Health Research Institute and the University of Washington; Biostatisticians Robert Wellman, MS, and Eric A. Johnson, MS, Project Manager Janet Erro, RN, MN, and Analyst/Programmer Kristin Delaney, MPH, of Group Health Research Institute; Janet Kahn, PhD, of the University of Vermont School of Medicine in Burlington; and Richard A. Deyo, MD, MPH, of Oregon Health and Science University in Portland, OR.

The National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, funded this study.

Annals of Internal Medicine

Established in 1927 by the American College of Physicians, Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12.4 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.

Annals of Internal Medicine trial compared massage types at Group Health

Seattle, WA—Massage therapy helps ease chronic low back pain and improve function, according to a randomized controlled trial in the July 5 Annals of Internal Medicine. The first study to compare structural and relaxation (Swedish) massage, the trial found that both types of massage worked well, with few side effects. Here is the journal's summary for patients.

“We found that massage helps people with back pain to function even after six months,” said trial leader Daniel C. Cherkin, PhD, a senior investigator at Group Health Research Institute. Better function means they are more able to work, take care of themselves, and be active.

“This is important because chronic back pain is among the most common reasons people see doctors and alternative practitioners, including massage therapists,” Dr. Cherkin added. “It’s also a common cause of disability, absenteeism, and ‘presenteeism,’ when people are at work but can’t perform well.”

The trial enrolled 400 Group Health Cooperative patients who had had low back pain for at least three months. Their pain was “nonspecific,” meaning with no identified cause. They were randomly assigned to one of three treatments: structural massage, relaxation massage, or usual care. Usual care was what they would have received anyway, most often medications. The hour-long massage treatments were given weekly for 10 weeks.

At 10 weeks, more than one in three patients who received either type of massage—but only one in 25 patients who got usual care—said their back pain was much better or gone. Also at 10 weeks, a questionnaire showed nearly twice as many massage patients (around two thirds) as usual-care patients (more than one third) were functioning significantly better than at the trial’s outset. Patients in the massage groups spent fewer days in bed, were more active, and used less anti-inflammatory medication than did those with usual care.

“As expected with most treatments, the benefits of massage declined over time,” Dr. Cherkin said. “But at six months after the trial started, both types of massage were still associated with improved function.” After one year, the benefits of massage were no longer significant.

The bottom line: “We found the benefits of massage are about as strong as those reported for other effective treatments: medications, acupuncture, exercise, and yoga,” Dr. Cherkin said. “And massage is at least as safe as other treatment options. So people who have persistent back pain may want to consider massage as an option.”

Prior studies of massage for back pain had tested only structural forms of massage, not relaxation massage. But relaxation (also called Swedish) massage is the most widely available and is taught in massage schools. It aims to promote a feeling of relaxation throughout the body. By contrast, structural massage involves identifying and focusing on specific pain-related “soft tissues” (like muscles and ligaments). It requires extra training and may be more expensive than relaxation massage.

“The massage therapists assumed structural massage would prove more effective than relaxation massage,” said Dr. Cherkin’s colleague Karen J. Sherman, PhD, MPH, a senior investigator at Group Health Research Institute. “They were surprised when patients in the relaxation group got so much relief from their back pain.”

Next steps include figuring out whether the structural and relaxation massages were equally effective for the same—or for different—reasons:

• Structural or relaxation massage, or both, might have specific effects, such as stimulating tissue or calming the central nervous system.
• Either or both might work through “nonspecific effects” that may promote a person’s ability to play an active role in their own healing. Possible nonspecific effects include: being touched; spending time in a relaxing environment; receiving care from a therapist who seems caring; getting advice on caring for yourself, such as exercises to do on your own; or becoming more aware of your own body, so you’re better able to avoid triggers for your back pain.
• Some combination of specific and nonspecific effects might be at play.

Drs. Cherkin and Sherman’s co-authors are Assistant Investigator Andrea J. Cook, PhD, of Group Health Research Institute and the University of Washington; Biostatisticians Robert Wellman, MS, and Eric A. Johnson, MS, Project Manager Janet Erro, RN, MN, and Analyst/Programmer Kristin Delaney, MPH, of Group Health Research Institute; Janet Kahn, PhD, of the University of Vermont School of Medicine in Burlington; and Richard A. Deyo, MD, MPH, of Oregon Health and Science University in Portland, OR.

The National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, funded this study.

Annals of Internal Medicine

Established in 1927 by the American College of Physicians, Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12.4 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.