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Comparison of 2 types of massage for chronic low back pain

PainSci » bibliography » Cherkin et al 2011
Tags: treatment, self-treatment, back pain, massage, biomechanics, pain problems, spine, manual therapy, etiology, pro

Four articles on PainSci cite Cherkin 2011: 1. Does Massage Therapy Work?2. The Complete Guide to Low Back Pain3. Your Back Is Not Out of Alignment4. Massage Therapy Kinda, Sorta Works for Back Pain

PainSci commentary on Cherkin 2011: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This is one of the only large, long duration studies of massage that has ever been done. Four hundred patients with chronic low back pain were split into three groups: one group got weekly hour-long relaxation massages, another got more advanced therapeutic massage, and patients in a third group got nothing. Unfortunately, the unmassaged patients knew that they were missing out — a critical flaw in the study that the authors believe made massage “seem more superior than it really is” in comparison, and so they found it “difficult to determine the true magnitude of the benefits of massage observed in this trial.” (For a good professional opinion about this problem with massage research, see Oppel regarding Preyde.)

Nevertheless, 60% of massage patients seemed to improve about 30% — about a 2-point drop on a 10-point pain scale, compared to a 1-point drop for patients who did nothing — which is just barely a large enough improvement to be clinically significant with a wee bit of wiggle room. Their gains were lost steadily after the last massage, and there were only small differences between groups after six months, and none after a year. The most useful result from this study is that there was “no clinically meaningful difference between relaxation and structural massage” whatsoever. This was a serious blow to many supposedly “advanced” massage techniques.

For an extremely detailed analysis of this research, see: Massage Therapy Kinda, Sorta Works for Back Pain: It works, but not very well, and “advanced” techniques are no better than relaxation massage.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Few studies have evaluated the effectiveness of massage for chronic low back pain.

OBJECTIVE: To compare the effectiveness of 2 types of massage and usual care for chronic back pain.

DESIGN: Parallel-group randomized, controlled trial. Randomization was computer-generated, with centralized allocation concealment. Participants were blinded to massage type but not to assignment to massage versus usual care. Massage therapists were unblinded. The study personnel who assessed outcomes were blinded to treatment assignment. ( registration number: NCT00371384)

SETTING: An integrated health care delivery system in the Seattle area.

PATIENTS: 401 persons 20 to 65 years of age with nonspecific chronic low back pain.

INTERVENTION: Structural massage (n = 132), relaxation massage (n = 136), or usual care (n = 133).

MEASUREMENTS: Roland Disability Questionnaire (RDQ) and symptom bothersomeness scores at 10 weeks (primary outcome) and at 26 and 52 weeks (secondary outcomes). Mean group differences of at least 2 points on the RDQ and at least 1.5 points on the symptom bothersomeness scale were considered clinically meaningful.

RESULTS: The massage groups had similar functional outcomes at 10 weeks. The adjusted mean RDQ score was 2.9 points (95% CI, 1.8 to 4.0 points) lower in the relaxation group and 2.5 points (CI, 1.4 to 3.5 points) lower in the structural massage group than in the usual care group, and adjusted mean symptom bothersomeness scores were 1.7 points (CI, 1.2 to 2.2 points) lower with relaxation massage and 1.4 points (CI, 0.8 to 1.9 points) lower with structural massage. The beneficial effects of relaxation massage on function (but not on symptom reduction) persisted at 52 weeks but were small.

LIMITATION: Participants were not blinded to treatment.

CONCLUSION: Massage therapy may be effective for treatment of chronic back pain, with benefits lasting at least 6 months. No clinically meaningful difference between relaxation and structural massage was observed in terms of relieving disability or symptoms.

PRIMARY FUNDING SOURCE: National Center for Complementary and Alternative Medicine.

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