In the first study of its kind, researchers in the US found real-world massage therapy to be an effective treatment for chronic low back pain.
Niki Munk, an assistant professor of health sciences in the School of Health and Rehabilitation Sciences at Indiana University-Purdue University Indianapolis and one of the co-first authors of the study, said that the study's findings are important, given the large number of people who suffer low back pain in the US.
Low back pain leads all disorders in years lost to disability in the US. Most patients improve rapidly, but one-third report persistent back pain, and 15% develop chronic low back pain with significant physical limitations.
More than 50% of those who participated in the study experienced clinically meaningful improvements in their low back pain with disability, according to Munk. "The study can give primary care providers the confidence to tell patients with chronic low back pain to try massage, if the patients can afford to do so," Munk said. Generally, massage is not covered by insurance, Medicaid or Medicare.
Previous studies of the effectiveness of massage were conducted in controlled research situations. In this study, patients were referred by a physician to a massage therapist. The massage therapist designed and provided a series of 10 massages – at no cost to the patient – in a clinical treatment environment, mimicking the experience of people who choose to seek massage therapy in the real world.
The study also looked at different characteristics associated with patients being more likely or less likely to experience clinically meaningful change from massage.
Among the study's findings: adults in the baby-boom and older generations tended to be much more likely to experience clinically meaningful changes; obese patients experienced significant improvements, but those improvements were not retained over time; and patients who were taking opioids experienced improvements in their pain from disability in some cases but were two times less likely to experience clinically meaningful change compared to those who were not taking opioids.
While the study results are promising, much more work needs to be done, Munk said: "The fact of the matter is that chronic lower back pain is very complex and often requires a maintenance-type approach versus a short-term intervention option."
Additional investigation is needed to replicate the results of the initial study and to conduct a cost-benefit analysis of massage therapy, Munk said. "Massage is an out-of-pocket cost," she said. "Generally, people wonder if it is worth it. Will it pay to provide massage to people for an extended period of time? Will it help avoid back surgeries, for example, that may or may not have great outcomes? These are the types of analyses that we hope will result from this study."
Abstract
Objective: While efficacy of massage and other nonpharmacological treatments for chronic low back pain is established, stakeholders have called for pragmatic studies of effectiveness in “real-world” primary health care. The Kentucky Pain Research and Outcomes Study evaluated massage impact on pain, disability, and health-related quality of life for primary care patients with chronic low back pain. We report effectiveness and feasibility results, and make comparisons with established minimal clinically important differences.
Methods: Primary care providers referred eligible patients for 10 massage sessions with community practicing licensed massage therapists. Oswestry Disability Index and SF-36v2 measures obtained at baseline and postintervention at 12 and 24 weeks were analyzed with mixed linear models and Tukey’s tests. Additional analyses examined clinically significant improvement and predictive patient characteristics.
Results: Of 104 enrolled patients, 85 and 76 completed 12 and 24 weeks of data collection, respectively. Group means improved at 12 weeks for all outcomes and at 24 weeks for SF-36v2’s Physical Component Summary and Bodily Pain Domain. Of those with clinically improved disability at 12 weeks, 75% were still clinically improved at 24 weeks (P < 0.01). For SF-36v2 Physical and Mental Component Summaries, 55.4% and 43.4%, respectively, showed clinically meaningful improvement at 12 weeks, 46.1% and 30.3% at 24 weeks. For Bodily Pain Domain, 49.4% were clinically improved at 12 weeks, 40% at 24 weeks. Adults older than age 49 years had better pain and disability outcomes than younger adults.
Conclusions: Results provide a meaningful signal of massage effect for primary care patients with chronic low back pain and call for further research in practice settings using pragmatic designs with control groups.
Authors
William G Elder, Niki Munk, Margaret M Love, Geza G Bruckner, Kathryn E Stewart, Kevin Pearce
[link url="https://www.sciencedaily.com/releases/2017/04/170403123315.htm"]Indiana University material[/link]
[link url="https://academic.oup.com/painmedicine/article-abstract/doi/10.1093/pm/pnw347/3069964/Real-World-Massage-Therapy-Produces-Meaningful?redirectedFrom=fulltext"]Pain Medicine abstract[/link]