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Trial of therapeutic massage for neck pain

updated

Tags: neck, good news, head/neck, spine

One article on PainSci cites Sherman 2014: The Complete Guide to Neck Pain & Cricks

PainSci summary of Sherman 2014: ?This page is one of thousands in the PainScience.com 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 at the bottom of the page, as often as possible.

This study compared different doses of massage therapy for 228 patients with chronic neck pain with no obvious cause.

It showed that more massage therapy helped neck pain, and suggested that perhaps other studies showing lackluster effects on neck pain “may have not administered adequate doses.” Interesting. It’s a pretty nice study, with actual good news.

But! (There’s always a but, eh?) Among other limitations, there was this one (and kudos to them for acknowledging it, I was really hoping they would): “inability to control for nonspecific effects of attention with the use of a wait list control design.” Ayuh. In other words, it’s not exactly a shocker that just spending a lot of pleasant time with a therapist might produce better outcomes than waiting for treatment. I mean, duh! The massage itself may well not have been the mechanism.

Or it may well have been. The problem is that this study can’t really tell us. Can it tell us anything? Yes: if massage helps neck pain, more massage probably helps neck pain more.

~ 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.

PURPOSE: This trial was designed to evaluate the optimal dose of massage for individuals with chronic neck pain.

METHODS: We recruited 228 individuals with chronic nonspecific neck pain from an integrated health care system and the general population, and randomized them to 5 groups receiving various doses of massage (a 4-week course consisting of 30-minute visits 2 or 3 times weekly or 60-minute visits 1, 2, or 3 times weekly) or to a single control group (a 4-week period on a wait list). We assessed neck-related dysfunction with the Neck Disability Index (range, 0-50 points) and pain intensity with a numerical rating scale (range, 0-10 points) at baseline and 5 weeks. We used log-linear regression to assess the likelihood of clinically meaningful improvement in neck-related dysfunction (≥5 points on Neck Disability Index) or pain intensity (≥30% improvement) by treatment group.

RESULTS: After adjustment for baseline age, outcome measures, and imbalanced covariates, 30-minute treatments were not significantly better than the wait list control condition in terms of achieving a clinically meaningful improvement in neck dysfunction or pain, regardless of the frequency of treatments. In contrast, 60-minute treatments 2 and 3 times weekly significantly increased the likelihood of such improvement compared with the control condition in terms of both neck dysfunction (relative risk = 3.41 and 4.98, P = .04 and .005, respectively) and pain intensity (relative risk = 2.30 and 2.73; P = .007 and .001, respectively).

CONCLUSIONS: After 4 weeks of treatment, we found multiple 60-minute massages per week more effective than fewer or shorter sessions for individuals with chronic neck pain. Clinicians recommending massage and researchers studying this therapy should ensure that patients receive a likely effective dose of treatment.

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