Each year, about 10 to 15 percent of adults seek treatment for lower back pain -- and few are satisfied with the results. In a new study, researchers in Seattle and Portland found that massage therapy relieved chronic back pain more effectively than the usual care offered by physicians.
The controlled clinical trial compared two types of massage -- general relaxation or structural massage targeting constricted muscles and tissues -- and found no significant difference in their effects. But both relieved pain and increased function better than usual care, which typically consists of self-care advice and prescriptions for pain medicine.
"For people who have persistent back pain, massage is a reasonable treatment option," said co-author Daniel Cherkin, a senior investigator at Group Health Research Institute in Seattle.
The findings add to the evidence base for ways to avoid invasive treatments for back pain, which have questionable effectiveness and appear to be overused. Elderly Oregonians, for instance, are about 55 percent more likely to undergo back surgery than the national average -- a sign of potentially excessive use of surgery for back pain.
Surgery is effective for treating back pain caused by herniated spinal disks or compressed spinal nerves. But such specific defects are only evident in about 5 percent of patients who seek medical attention for back pain.
"I generally tell people surgery is only helpful if you are having both back and leg pain," said Dr. Richard Deyo, a professor of evidence-based medicine at Oregon Health & Science University and study co-author. Even with herniated disks, Deyo said it's good to wait at least 6 weeks before considering surgery because pain often subsides on its own.
In the massage study, researchers enlisted more than 400 women and men from the membership of the Group Health Cooperative health system in Seattle. All of them had moderate to severe back pain lasting three months or longer. Researchers excluded people who had herniated disks or compressed spinal nerves causing leg pain. Researchers randomly assigned volunteers to receive usual care or weekly massage sessions for ten weeks.
After 10 weeks, volunteers in both massage groups fared significantly better than the usual care patients in measures of disability, symptom bothersomeness, need for pain medication, sick days, and satisfaction with care. More than 36 percent of the massage patients said their back pain was much better or gone, compared with just 4 percent of usual care patients.
After a year, however, a large fraction of people still reported significant back troubles regardless of which treatment they received. About half were taking pain medication for back symptoms, and about 5 percent said back problems forced them to miss work or school in the past month. The advantages of massage that lasted the full year were increased activity, satisfaction with care, and overall rating of improvement. The study, funded by the National Center for Complementary and Alternative Medicine, appears in the July 5 Annals of Internal Medicine.
The benefits of massage are roughly comparable to those found for exercise as a treatment for chronic back pain. "If people exercise they will have less back pain or be less bothered by it, but getting them to exercise is not that easy," Cherkin said. "Maybe the ideal for some people would be massage to get out of the chronic pain cycle and transition into a self-care program like yoga, or tai chi, or exercise."
Cost may be one of the biggest limits of massage therapy. The treatments received by the average participant in the clinical trial would have cost about $540, and health insurance often will not pay for message therapy.
-- Joe Rojas-Burke
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