In the Journals

Massage therapy alleviates chronic back pain in the ‘real world’

Massage therapy was beneficial to patients with chronic back pain, according to research recently published in Pain Management.

“A recent meta-analysis highlights methodological weaknesses in massage research, and [chronic lower back pain] treatment guideline authors and others have expressed concern that massage effectiveness has not been evaluated in primary care,” William G. Elder, MD, of the department of family and community medicine at the University of Kentucky, and colleagues wrote. “The extent to which massage treatments applied in real-world settings replicates those examined in controlled research settings would also be reasonably unknown to health care providers.”

To fill in this research gap, Elder and colleagues asked primary care physicians from 18 practices throughout Kentucky to refer patients with chronic lower back pain, defined as pain in lumbar or sacral areas for at least 3 months, for possible inclusion in the study. Eligible patients received 10 free massage sessions with community practicing, licensed massage therapists.

Eighty-five patients completed 12 weeks of data collection and 76 patients completed 24 weeks of data collection. The Oswestry Disability Index and the Physical Component Summary, Mental Component Summary, and Bodily Pain Domain aspects of the Medical Outcomes Study 36-item Short Form, version 2 were primary endpoints.

Elder and colleagues found that at 12 weeks, there was improvement in all outcomes, and at 24 weeks, there was improvement in the Bodily Pain Domain and Physical Component Summary. In addition, 75% of those with clinically improved disability at 12 weeks were still at that status at 24 weeks. Regarding the Physical Component Summary, 55.4% of patients reported clinically meaningful improvement at 12 weeks; 46.1% patients reported improvement at 24 weeks. Regarding the Mental Component Summary, 43.4% showed clinically meaningful improvement at 12 weeks; 30.3% reported improvement at 24 weeks. For Bodily Pain Domain, 49.4% of patients were clinically improved at 12 weeks; 40% of patients were improved at 24 weeks.

Elder and colleagues also found that adults older than age 49 years had better pain and disability outcomes than younger adults; obese patients experienced significant short-term improvements, but they were not retained over time; and patients taking opioids experienced improvements in pain from disability in some cases but were half as likely to experience clinically meaningful change compared with those who were not taking opioids. No adverse events were reported at any time during the study.

“While competing demands, patient preferences, and costs influence treatment decisions, clinician perception of whether a treatment works for patients in their practice likely plays a critical role in the selection of treatments,” Elder and colleagues wrote. “Our findings of statistically and clinically meaningful benefit to [chronic lower back pain] after a course of real-world massage therapy suggest the need for further study of massage when recommended by [primary care physicians]”.

According to study researcher Niki Munk, PhD, LMT, of the department of health sciences at Indiana University-Purdue University, doctors can be reassured that there is real-world data to back up the earlier studies’ claims.

“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 in a press release.

There has been a growing amount of evidence that medications may not be effective in treating back pain, suggesting the need for alternative therapies. The ACP recently advocated drug-free treatment for low back pain, citing a systematic review that evaluated noninvasive pharmacological and nonpharmacological treatments of acute or chronic nonradicular or radicular low back pain of clinical trials conducted through April 2015. Another systematic review that evaluated the effectiveness of nonsteroidal anti-inflammatory drugs vs. placebo in managing spinal pain suggested only one in six patients treated with the nonsteroidal anti-inflammatory drugs experienced any significant benefit. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.

Massage therapy was beneficial to patients with chronic back pain, according to research recently published in Pain Management.

“A recent meta-analysis highlights methodological weaknesses in massage research, and [chronic lower back pain] treatment guideline authors and others have expressed concern that massage effectiveness has not been evaluated in primary care,” William G. Elder, MD, of the department of family and community medicine at the University of Kentucky, and colleagues wrote. “The extent to which massage treatments applied in real-world settings replicates those examined in controlled research settings would also be reasonably unknown to health care providers.”

To fill in this research gap, Elder and colleagues asked primary care physicians from 18 practices throughout Kentucky to refer patients with chronic lower back pain, defined as pain in lumbar or sacral areas for at least 3 months, for possible inclusion in the study. Eligible patients received 10 free massage sessions with community practicing, licensed massage therapists.

Eighty-five patients completed 12 weeks of data collection and 76 patients completed 24 weeks of data collection. The Oswestry Disability Index and the Physical Component Summary, Mental Component Summary, and Bodily Pain Domain aspects of the Medical Outcomes Study 36-item Short Form, version 2 were primary endpoints.

Elder and colleagues found that at 12 weeks, there was improvement in all outcomes, and at 24 weeks, there was improvement in the Bodily Pain Domain and Physical Component Summary. In addition, 75% of those with clinically improved disability at 12 weeks were still at that status at 24 weeks. Regarding the Physical Component Summary, 55.4% of patients reported clinically meaningful improvement at 12 weeks; 46.1% patients reported improvement at 24 weeks. Regarding the Mental Component Summary, 43.4% showed clinically meaningful improvement at 12 weeks; 30.3% reported improvement at 24 weeks. For Bodily Pain Domain, 49.4% of patients were clinically improved at 12 weeks; 40% of patients were improved at 24 weeks.

Elder and colleagues also found that adults older than age 49 years had better pain and disability outcomes than younger adults; obese patients experienced significant short-term improvements, but they were not retained over time; and patients taking opioids experienced improvements in pain from disability in some cases but were half as likely to experience clinically meaningful change compared with those who were not taking opioids. No adverse events were reported at any time during the study.

“While competing demands, patient preferences, and costs influence treatment decisions, clinician perception of whether a treatment works for patients in their practice likely plays a critical role in the selection of treatments,” Elder and colleagues wrote. “Our findings of statistically and clinically meaningful benefit to [chronic lower back pain] after a course of real-world massage therapy suggest the need for further study of massage when recommended by [primary care physicians]”.

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According to study researcher Niki Munk, PhD, LMT, of the department of health sciences at Indiana University-Purdue University, doctors can be reassured that there is real-world data to back up the earlier studies’ claims.

“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 in a press release.

There has been a growing amount of evidence that medications may not be effective in treating back pain, suggesting the need for alternative therapies. The ACP recently advocated drug-free treatment for low back pain, citing a systematic review that evaluated noninvasive pharmacological and nonpharmacological treatments of acute or chronic nonradicular or radicular low back pain of clinical trials conducted through April 2015. Another systematic review that evaluated the effectiveness of nonsteroidal anti-inflammatory drugs vs. placebo in managing spinal pain suggested only one in six patients treated with the nonsteroidal anti-inflammatory drugs experienced any significant benefit. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.