Massage Continuing Education Workshops - And then let me quickly describe some of the studies that we've done for massage therapy for back pain, and you're going to see results that look strikingly similar once again. Here, we randomized 400 patients who again had chronic low-back pain and were treated by one of 27 licensed massage therapists, and they were randomized to three groups.
One group got so-called structural massage, which in the massage therapy world refers to a particular type of massage that they call myofascial and neuromuscular techniques that are intended to focus on particularly tense muscles or adhesions that the therapist perceives beneath the skin. And the structural massage requires some special additional training over the usual training for massage therapy.
The second group got relaxation massage, which is the conventional Swedish massage. The musculoskeletal massage therapists will sometimes refer to this sort of disparagingly as a "spa massage, and both of those groups got up to 10 weekly treatments, and then there was the usual care arm again. And we followed these patients out to a year, again with better than 90 percent followup at every time point. And as with the two real acupuncture groups, these two real massage groups had virtually indistinguishable results, and so in some of the results that I'll show you, these groups have been combined.
Here again is a similar sort of display of the results. This is just the Roland Morris disability score in this case, and you see the same pattern in the short term here at 10 weeks of followup. All three groups are improving. Usual care improves the least. The two massage groups both improve somewhat more but are indistinguishable from each other. There's again some convergence out here by a year of followup so that all three groups look similar, although the Swedish massage group seems to sort of stay down here with a little less dysfunction, if you will.
And here's a different way of presenting the same results, again asking what fraction of patients actually had a clinically important improvement. So these are percentages now rather than scores, and you can see the two massage groups at 10 weeks of followup are substantially more likely to have that clinically important improvement than the usual care group. And, again, there's some convergence over the span of the year. So if we look just numerically at that 3-point difference, you see this. In the massage group at that 8-week followup --or 10 weeks rather, 10-week followup-- you see 63 percent have that clinically important improvement in the massage group versus just 38 percent in the usual care group.
And another way of asking about a clinically important effect that we tried was asking what fraction of patients reported that their pain was completely gone or much better. And there, the answer was 37 percent in the massage group versus just 4 percent in the usual care group. At one year, no statistically significant difference in these primary outcomes. And again, if you look at the systematic reviews, they're pretty consistent with our findings.
The Cochrane Review found some 13 randomized trials, five of which had a low risk of bias, and the conclusion there was that massage might be beneficial for subacute and chronic low-back pain, especially if they're combined with exercise and education. And again, a comment that there's very little information in these trials about return to work or cost-effectiveness. And a review of systematic reviews concluded that there's an emerging body of evidence that supports the effectiveness of massage therapy for non-specific low-back pain.
So if you step back then and take a higher level view of all treatments for low-back pain, where does this fit in? Where do these complementary and alternative treatments fit in? It turns out that the American College of Physicians and the American Pain Society teamed up back in 2007 to write a set of clinical guidelines based on a very thorough systematic review.
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And in those guidelines for treating low-back pain, they concluded that spinal manipulation and acupuncture and massage therapy could all be recommended for patients with chronic low-back pain. They called that a weak recommendation because it was based on only moderate-quality evidence rather than high-quality evidence. And another, similar review --somewhat more recent-- concluded that CAM treatments are more effective than no treatment or placebo or usual care in reducing pain in the short term, but probably not in the long term, and perhaps are no better than sham therapy for reducing functional disability..
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Massage Continuing Education Workshops
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Massage Continuing Education Workshops
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