Cherkin, D. C., Eisenberg, D., Sherman, K. J., Barlow, W., Kaptchuk, T. J., Street, J., & Deyo, R. A. (2001). Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Arch Intern Med, 161(8), 1081-1088.

BACKGROUND

Massage therapy is being used with increasing frequency for treatment of various soft tissue complaints like low back pain. Low back pain occurs in our society with great frequency, so treatments for this problem are constantly being sought. Traditional medical approaches have not been very successful, and as a result many people have sought help from various complementary and alternative medicine (CAM) practitioners.

While there is extensive use of CAM therapies by the public, acceptance by the medical establishment has not been so fast. Due to the lack of good studies of efficacy, national evidence-based guidelines for acute low back pain have not recommended the use of either acupuncture or massage. This study attempts to contribute to the growing literature on the benefits and drawbacks of using various CAM therapies like acupuncture or massage.

This investigation used a sample group of 262 people with back pain that were randomly divided into three groups. All were members of a certain Health Maintenance Organization (HMO). The first group (94 members) received acupuncture treatment. The second group (78 members) received massage therapy treatment. The third group (90 members) was the self-care and educational materials group. They received a book and 2 videotapes on how to care for your own back. All treatments for the individuals in groups 1 and 2 were done by licensed professionals who were members of a CAM practitioner network used by the HMO that served the participants.

Each massage therapist was allowed to use techniques including Swedish, deep tissue, neuromuscular, and trigger point methods. Energy work techniques that did not involve physical contact were prohibited. Acupuncturists were allowed to do needling, electrical stimulation and manual manipulation of the needles, indirect moxibustion, infrared heat, and cupping. They were not allowed to do any form of massage so that the results of the massage would not interfere with the findings from the other group. Both acupuncturists and massage therapists were allowed to schedule up to 10 visits over a 10-week period with each patient.

RESULTS

Outcomes for these treatments were assessed at 10 weeks and at one year. The investigators were looking at a number of factors that included symptom bothersomeness, restricted activity, as well as overall satisfaction with the treatment. At the 10-week period 74% of patients rated massage as very helpful, as compared with 46% in the acupuncture group, and 17% and 26% for the book and videos respectively. At the one-year follow-up differences between the groups on these various measures were not significant. However, the massage group remained significantly lower in the use of medications.

DISCUSSION

According to this study, massage therapy appears to be very beneficial in the treatment of low back pain. The findings of this study also reflect a recent consumer survey done by Consumer Reports in May of 2000. This survey found deep tissue massage to be the most helpful treatment for back pain, and acupuncture to be among the least helpful.

The authors cited several factors that may account for the beneficial experiences of patients in the massage group. These factors should be studied much more extensively in the future. They include 1) spending an hour in a relaxed environment 2) being touched in a therapeutic context 3) receiving ongoing attention 4) specific effects of soft tissue manipulations 5) education about exercise or other lifestyle changes 6) increased body awareness.

This is one of the first studies to investigate the use of massage in an environment similar to that in which most massage therapists practice. In most studies of massage the practitioner is limited to a very strict protocol that is only administered for a few minutes in order to study the effects of that particular intervention. While convenient from a research perspective, this is not how massage therapy is practiced in the clinical environment. This study will highlight the importance of including the various factors mentioned above that play a significant role in the healing potential of massage therapy.

One of the other particularly interesting aspects of this study is the lasting effect of massage. Patients were given a maximum of 10 massage treatments within a 10-week period. Yet, the patients in the massage group had a lower usage of medication even at the one-year follow-up. This certainly indicates the need to investigate some of the long-term healing benefits of massage. The authors sum it up best when they state:

"The finding that benefits of massage persist well beyond the last treatment and the suggestion of possible reductions in subsequent health care utilization make massage a high priority for further study."

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