Back pain is one of the most common medical complaints in the world, and too often it is very difficult for us family doctors to find the best treatment. We will take the occasional x-ray which never shows anything; prescribe pain pills we hope won’t over-sedate them, and pray that their body’s natural healing process kicks in. Unfortunately, a small percentage’s pain never completely goes away, and back pain becomes an irritating/debilitating part of their life. It’s frustrating for patients and their doctors.
Perhaps there’s a very simple answer to every doctor’s treatment plans: massage! This may seem obvious to many people, but most docs thought that massage’s effects were very short-lived. Now, I’m happy to report that perhaps massage does have long-lasting effects on people with chronic back pains. This is due to a new study, just published in the Annals of Internal Medicine, which studied three groups: a control group; one group getting relaxing massage; and a third getting more aggressive “structural massage”. The NY Times Health Section, as usual, does such a good job that I’ll just quote them:
Those who received massage scored significantly better on both symptom and function tests, and they spent less time in bed, used less medicine and were more satisfied with their current level of back pain.
At 26 weeks after treatment, those in the usual care group continued to function less well than those who had gotten massage. But there were no significant differences in the pain scores in the three groups, either at 26 or at 52 weeks.
Daniel C. Cherkin, the lead author and an epidemiologist with the Group Health Research Institute in Seattle, mentioned some of the study’s considerable strengths. It had a randomized design, a high follow-up rate, good adherence to the treatment and a large sample size. Still, he said, the study was done on a mostly white, middle-class population in otherwise good health, which may limit its applicability to other groups. The study appeared online Monday in Annals of Internal Medicine.
It is unclear how massage eases back pain, but the researchers suggest it may stimulate tissue locally or cause a more generalized central nervous system response. It is also possible that just spending time in a relaxing environment or being touched and cared for by a sympathetic therapist could have led to improvement. Also, those in the control group knew that the other groups were getting massage, and the knowledge that others were getting the treatment while they got none may have led them to underestimate their own progress.
Still, the researchers conclude that massage has few adverse effects and is a reasonable treatment for low back pain. There is no evidence, though, that it lowers the cost of health services related to back pain.
“We tested this on people who had not been getting better from the usual medical approaches, Dr. Cherkin said. “If you’ve tried other things and you’re not getting adequate relief, then massage is a reasonable thing to try.”
So there you have it; a simple massage once a week can help your overall quality of life with chronic back pain. Note how while there was no major difference in pain levels, the patient’s satisfaction rates were higher — as well as medication use.
Another good take-home message is that a more aggressive, Chinese-style massage was as effective as the more sleepy, Swedish-oil relaxation style massage. I vastly prefer the invigorating Chinese massages but actually wasn’t sure if it would make back pains worse or better — and now I know.
In my practice, I will no longer be hesitant when recommending massage to my back pain patients. Such is the power of good studies; they can quickly change medical practice.
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How many studies do we need to prove that the best treatment for soft tissue injury is chiropractic adjustment and deep tissue massage with PT modalities if necessary. After treating over 1000 patients I can tell you – it works and works well.
You’re more than welcome to share with us the best, randomized placebo-controlled and blinded studies showing specifically where chiropractic is the best treatment versus other treatments.
So here is a brand new review of spinal manipulation and back pain:
“CONCLUSIONS:
High-quality evidence suggests that there is no clinically relevant difference between SMT and other interventions for reducing pain and improving function in patients with chronic low-back pain. Determining cost-effectiveness of care has high priority.” From Rubinstein SM, van Middelkoop M, Assendelft WJ, et al. Spinal manipulative therapy for chronic low-back pain: an update of a Cochrane review. Spine (Phila Pa 1976). 2011 Jun;36(13):E825-46. (Review) PMID: 21593658
Older reviews:
“REVIEWER’S CONCLUSIONS:
There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low-back pain.” From Cochrane Database Syst Rev. 2004;(1):CD000447. Spinal manipulative therapy for low back pain.
Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG.
“CONCLUSIONS:
Therapies with good evidence of moderate efficacy for chronic or subacute low back pain are cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation. For acute low back pain, the only therapy with good evidence of efficacy is superficial heat.” From Ann Intern Med. 2007 Oct 2;147(7):492-504.
Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline.
Chou R, Huffman LH; American Pain Society; American College of Physicians.
Massage feels really,really good. Combining massage therapy and chiropractic treatment we can get beneficial benefits, such as improve flexibility, reduce pain and may even improve sleep.