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12 Articles in Volume 13, Issue #1
A Modest Proposal (Thanks to Jonathan Swift—1667-1745)
Chronic Pain: Study of Complementary and Alternative Treatments
Decompression Surgery to Reduce Diabetic Peripheral Neuropathy
Extracorporeal Shock Wave Therapy—Application for Trigger Points
Improving a Practice Model for Prescribing Opioids
Interpretations and Actions Following Cytochrome P450 Testing
Is It Safe to Restart an NSAID Following an Endoscopically Confirmed NSAID-Induced GI Bleed?
January/February 2013 Pain Research Updates
Massage Therapy in an Ambulatory Pain Clinic
Practical Tips in the Treatment of Osteoarthritis of the Hip
Quantum Theory Underpins Electromagnetic Therapies for Pain Management
When a Pain Patient Insists on Alternative Treatments Alone

Massage Therapy in an Ambulatory Pain Clinic

When added to standard pain treatments, massage therapy can improve outcomes.

Chronic low back pain is one of the most common types of pain experienced by patients. It is defined as pain in the lower back that does not resolve within 3 to 6 months. The most common causes of low back pain are osteoarthritis, muscular pain, herniated disc, fractures, spinal stenosis, scoliosis, and compression fractures.1 Chronic low back pain that results from these conditions interferes with essential activities of daily living such as sleeping, socializing, and doing household chores; furthermore, chronic pain impedes an individual’s ability to exercise.

Opioids, despite potential complications and side effects, are widely used as effective analgesics in the treatment of moderate-to-severe chronic low back pain.2,3 With regard to mild, chronic low back pain, Astin stated that alternative therapies have been proven a safe and effective alternative for pain control and can potentially decrease reliance on opioid prescriptions.4 Massage therapy is an ancient therapy used to mobilize soft tissue. Tissue mobilization is thought to elicit a number of beneficial physiological effects, which might modulate pain. Massage can also relax the body, aid in tissue repair, improve blood flow in superficial vessels, and elevate mood.5 It is believed that pain reduction might occur through activation of segmental inhibitory pain pathways and by the production of endorphins.5 Recently, the use of massage technique for chronic low back pain sufferers has shown promising results in the treatment of chronic low back pain, especially when combined with exercise and education.5

Massage therapy has proven to be a valuable adjunct in pain management, leading to significant benefits with reports of decreasing pain levels. These interventions can also lead to decreased anxiety as an added benefit.1 The main objective of alternative therapies is to reduce chronic low back pain levels, which in turn may help decrease opioid utilization.

Study of Massage Therapy

A review of the literature reveals that the subject of alternative therapy for patients with chronic pain has been receiving more attention from providers; these modalities focus on pain management, primarily as a tool to reduce pain levels, opioid abuse, and addiction.6 The phrases “alternative medicine” and “alternative therapies” lack clear definitions. There are no widely accepted phrases for practices grouped under the terms of alternative, unconventional, unorthodox, or complementary therapies.6 However, any treatment or therapy such as massage therapy that does not fall under the umbrella of conventional medicine would be termed an alternative therapy.6 Furthermore, the number of patients with chronic pain who use alternative therapies is increasing, largely due to the increase in doubts, skepticism, and dissatisfaction with conventional medicine.7

Table 1. Demographics Information

Study Protocol

The authors conducted a comparative trial to study the effect of massage therapy on pain. The setting for this study was a pain management clinic in Western New York. The clinic is located in a suburban setting and is directed by one nurse practitioner and ancillary staff. As recommended by the New York State Department of Health for pain providers, the clinic does not take self-referrals; all patients are referred to the clinic by their primary care physicians.

Sixty chronic low back pain patients were included in the study and were randomized into two groups: a treatment group (30 patients) and control group (30 patients). All participants in the study continued to receive their usual care, which included monthly clinic visits focusing on pain and medication management (ie, opioids, non-steroidal anti-inflammatory drugs, muscle relaxants), trigger point injections (muscular injections) as indicated, and nutritional counseling. The treatment group also received the addition of massage therapy.

Pain levels before and after the massage therapy were recorded using a 0-10 numeric pain rating scale. Demographic data was obtained from all participants, and each participant signed an informed consent document. In addition, functional status and disability ratings were obtained from participants before and after treatment. The Oswestry Disability Index, an assessment tool often used to measure a patient’s permanent functional disability, was used in this study.

One licensed massage therapist, employed by the clinic, provided the therapy sessions. Massage interventions consisted of 15-minute therapeutic massage sessions given twice per week for 4 weeks. Treatments included gentle massage in the lower lumbar spine. Levels of pain and disability were assessed before treatment sessions began, and at the completion of the 4-week massage treatment session.

Table 2.  Past Alternative Therapies

Study Results

Table 1 illustrates the participants’ demographic characteristics and pain medications. A variety of opioids were used for pain control. Of the control group, 46.7% was taking hydrocodone (Lortab), while 20.0% were using morphine-based products to treat their pain. Of the treatment group, 58.1% of the participants were prescribed hydrocodone or its derivatives, while 19.4% were prescribed oxycodone (Percocet) or its derivative to treat their chronic low back pain. Table 2 illustrates the overall use of alternative therapies. Eighty percent of the control group had considered using alternative therapies in the past to help their chronic low back pain, compared with 74.2% of the treatment group. Interestingly, 83.3% of the control group and 87.1% of the treatment group had at least one health care professional recommend alternative therapies for treatment of chronic low back pain.

Table 3 shows pre- and post-treatment pain scores. There was a significant difference between the pre- and post-treatment pain rating in the treatment group (6.73 vs 5.33—a decrease of 1.4). The control group’s pre-treatment and post-treatment scores remained unchanged. In addition, the control group reported a mean pre-treatment disability rating of 17.67 (moderate disability), which remained unchanged at the end of the study. By comparison, there was a decrease in disability scores for the treatment group (15.40 to 14.45).

Discussion

As stated earlier, the majority of the participants had at least one health care provider recommend alternative therapies for the treatment of their chronic pain. In addition, >50% of both the treatment and control group had considered using alternative therapies for their treatment of chronic pain. It is unclear as to why there was no follow through with the participants in the utilization of alternative therapy.

The study results suggest that massage therapy reduces pain ratings and disability scores in those who suffer from chronic low back pain. This study found that 64.5% of the treatment group participants had a pre-treatment pain rating score between 6 and 7, while 61.3% of post-treatment scores were between 5 and 6. The treatment group also had an average disability decrease of 1.00. Additionally, participants in the treatment group had an overall decrease in both measures of pain and disability, but this decrease was small, possibly due to the short duration of the treatment or small sample sizes, but results were in the desired direction and were significant. In view of these findings, the evidence supports adjunctive use of massage in the treatment of chronic low back pain when attempting to achieve lower levels of pain and disability. It is hopeful that use of massage therapy will help diminish opioid use in chronic low back pain sufferers.

Table 3. Pre-Post Treatment Scores

Limitations

One limitation of the research study is the fact that it was only 1 month in duration. In addition, the study had a relatively small sample size of 60; thus, it may be difficult for the results to be considered representative of the entire population suffering from low back pain, and may not be generalizable to those suffering from other types of pain such as cervical pain and abdominal pain.

Conclusions

Large controlled trials should be undertaken in future studies, directly comparing the impact of massage therapy for chronic low back pain sufferers. In addition, research should focus on concomitant use of massage and its potential impact on concomitant conventional treatments such as opioid therapy. With continued research, alternative therapies could be integrated into mainstream treatment of chronic low back pain to ease suffering and disability. Massage therapy shows promise in the treatment of chronic pain in terms of reducing the level of pain and disability in patients.

Last updated on: April 2, 2013
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