Massage Therapy May Relieve Chronic Back Pain

Massage therapy may effectively reduce or relieve chronic back pain for 6 months or more, according to the results of a parallel-group, randomized controlled trial reported in the July 5 issue of the Annals of Internal Medicine.

“Recent reviews have found limited evidence that massage is an effective treatment for chronic back pain, and no studies have compared relaxation massage with structural massage, which focuses on correcting soft-tissue abnormalities,” write Daniel C. Cherkin, PhD, from the Group Health Research Institute, Seattle, Washington, and colleagues. “We therefore conducted a trial to determine whether relaxation massage reduces pain and improves function in patients with chronic low back pain and compared relaxation and structural massage for treating this condition.”

Computer-generated randomization and centralized allocation concealment were used, with blinding of participants to massage type, but not to assignment to massage vs usual care. Although the massage therapists could not be blinded, the study personnel who evaluated outcomes were blinded to treatment allocation.

At an integrated healthcare delivery system in Seattle, 401 participants were randomly assigned to receive structural massage (n = 132), relaxation massage (n = 136), or usual care (n = 133). Participants had nonspecific chronic low back pain and were aged 20 to 65 years. The main study endpoint was Roland Disability Questionnaire (RDQ) and symptom bothersomeness scores at 10 weeks, and secondary endpoints were these scores at 26 and 52 weeks. Clinically meaningful differences were defined as mean group differences of 2 or more points on the RDQ and 1.5 or more points on the symptom bothersomeness scale.

At 10 weeks, functional outcomes were similar in both massage groups. Compared with the usual care group, the relaxation group had an adjusted mean RDQ score that was 2.9 points lower (95% confidence interval [CI], 1.8 – 4.0 points), and the structural massage group had an adjusted mean RDQ score that was 2.5 points lower (95% CI, 1.4 – 3.5 points). Adjusted mean symptom bothersomeness scores were 1.7 points lower with relaxation massage (95% CI, 1.2 – 2.2 points ) and 1.4 points lower with structural massage (95% CI, 0.8 – 1.9 points).

At 52 weeks, there were persistent but small benefits of relaxation massage for function, but not for symptom reduction.

“We found that patients receiving massage were twice as likely as those receiving usual care to report significant improvements in both their pain and function,” Dr. Cherkin said in a news release. “After 10 weeks, about two-thirds of those receiving massage improved substantially, versus only about one-third in the usual care group.”

A study limitation was the lack of blinding of massage therapists and the only partial blinding of participants to treatment assignment. In addition, the exercises recommended in the 2 massage groups differed slightly, and the massage therapists were atypical, in that they had practiced for at least 5 years and had learned structural massage techniques. Generalizability of the findings is limited because the trial included mostly women with nonspecific chronic low back pain who were enrolled in a single healthcare system that serves a mostly white and employed population.

“Massage therapy may be effective for treatment of chronic back pain, with benefits lasting at least 6 months,” the study authors conclude. “No clinically meaningful difference between relaxation and structural massage was observed in terms of relieving disability or symptoms.”

~Laurie Barclay, MD

Study: Medicaid Recipients Better Off Than Uninsured

The New York Times Share to FacebookShare to Twitter (7/7, A14, Kolata, Subscription Publication) reports, “When poor people are given medical insurance, they not only find regular doctors and see doctors more often, but they also feel better, are less depressed and are better able to maintain financial stability, according to a new, large-scale study that provides the first rigorously controlled assessment of the impact of Medicaid.” Even though these “findings may seem obvious, health economists and policy makers have long questioned whether it would make any difference to provide health insurance to poor people.” In fact, this “has become part of the debate on Medicaid, at a time when states are cutting back on this insurance program for the poor.” Richard M. Suzman, of the National Institute on Aging, which funded the study, “said it was ‘one of the most important studies that our division has funded since I’ve been at the NIA.'”

The AP Share to FacebookShare to Twitter (7/7, Alonso-Zaldivar) reports, “The study looked at 10,000 Oregonians who won a state-sponsored lottery for Medicaid in 2008, and compared them to those who applied but weren’t picked and remained uninsured.” Researchers “found that people with Medicaid were 70 percent more likely to have a regular medical office or clinic for their basic care, and 55 percent more likely to have a personal doctor. Medicaid enrollees were also more likely to get preventive care, such as mammograms and cholesterol screening.” Notably, they found “no real difference between the two groups in emergency room use,” although “people with Medicaid were significantly more likely to use inpatient and outpatient services, as well as prescription drugs.”

Ezra Klein writes in a Bloomberg News Share to FacebookShare to Twitter (7/7) column that the study’s findings underscore “a point that is frequently obscured in a debate that’s often concerned more with cost curves than with treating heart disease. Part of health-care reform is about making care cheaper. But the more important part is about making Americans healthier.”

The Oregonian Share to FacebookShare to Twitter (7/7, Rojas-Burke) reports that these results “are bound to play a role in the political controversy over federal health reform, which calls for expanding Medicaid coverage to 16 million uninsured Americans in 2014.” Notably, the extent to which “Medicaid coverage improves health has remained an open question, in part because of the difficulty of performing controlled experiments. Researchers consider it unethical, for example, to force subjects to go without health insurance just to test the result.” The decision by Oregon officials “to use a random lottery presented a happenstance opportunity.”