Cherkin DC et al. A Comparison of effects of 2 types of massage and usual care on chronic low back pain. Ann of Int Med. 2011;155:1-9.

Subjects – patients with “uncomplicated”, chronic low back pain (LBP) of 3 months with an intensity of at least 3 on a scale of 0 to 10.  Many types of patients were excluded including those with an identified cause of LBP such as fracture or spinal stenosis, complicated LBP such as sciatica or post surgical, and severe fibromyalgia.  These exclusions were listed as a limitation to the study and do limit its applicability to the general PT LBP patient. 

401 subjects were included (mostly white, female, and employed) average age mid 60. Subjects were randomized and fairly good blinding was done.  Blinding was compromised in less that 10% of cases.

Interventions – three groups: relaxation massage (general massage taught in most massage therapy schools), structured massage (myofascial release to a specific tissue, this is usually learned in post graduate classes and not all massage therapists have these skills), and usual care (nothing).

Massage patients received 10 weekly one hour sessions (adherence 93% and 88%). Therapists could suggest any of 7 specified exercises.  Not sure why this was included.  Analysis shows no difference among massage groups as to the exercises suggested. Relaxation patients were offered a massage CD.  This seems to make the groups significantly different. 

Outcomes were based on the Roland Disability Questionnaire (RDQ) (valid and reliable tool) at 10 weeks (the end of the active treatments), 26 weeks and 52 weeks.  Participants were also asked to rate the bothersomeness of their pain on a scale of 0 to 10.  Statistical analysis was extensive.

Results

At 10 weeks (end of active treatment)	Massage subjects	Control subjects
Clinically significant improvement in RDQ	62% and 65%	38%
Patient who claimed their back pain was “much better”	36% and 39%	4%

No significant difference between the groups at 26 weeks and 52 weeks

No significant difference in medication use or reduction in heath care costs among groups.

Adverse events – mostly pain  4% relaxation massage, 7% structured massage.

Limitations – at 10 weeks subjects who reported visiting a provider for back pain: 33% usual care, 20% massage subjects.  Also 8% of the usual care subjects reported seeing a massage therapist within the 10 week study time.  As noted above patients with known causes of LBP were excluded.  These patients may benefit from structured massage. 

Comments – This is a fairly well done study on an intervention that is difficult to study.  Seems many of the subjects included may have had stress related or centralized pain syndromes which seem to response best to global relaxation strategies.  The results of the study point to the benefits of massage as an adjunct to therapy or in cases were the patient’s pain persists after therapy.  Unfortunately, carry over is not evident and patients will need to continue long term weekly massage for continued benefits.  Although some can afford the time and cost, it is not possible for all patients.  I fine many of my chronic pelvic pain and fibromyalgia patient benefit from maintenance massage.

Beth Shelly, PT, DPT, WCS, BCB PMD