Research Update June 2017

Real-world massage is effective for treating Lower Back Pain

A common research design evaluating the effectiveness of massage involved treatment with standardized massage sessions, rarely found in the real-world. A new study from Indiana University-Purdue University published in the journal Pain Medicine tackled this deficiency, therapists were free to design massage programs according to the patients. The researchers recruited 104 people with persistent back pain who were referred by their doctors to licensed massage therapists. Modalities used by therapists varied including Swedish massage, active isolated stretching, myofascial techniques, lymphatic drainage, trigger point therapy, neuromuscular therapy, craniosacral therapy, reflexology, Reiki, acupressure, and positional release. The treatment was 10 sessions over 12 weeks.

After 12 weeks, more than half of the patients reported improved outcomes in terms of pain reduction, and meaningful physical and mental improvement. In addition, the improvement still lasts after 24 weeks. Several people improved so much that their scores on a standard screening test dropped below the threshold for disability.

While improvement was observed across the board, there were few demographic trends. Adults older than age 49 years had better pain and disability outcomes than younger adults. People with obesity tended to improve, but those gains didn’t last. People taking opioids were two times less likely to experience meaningful changes, compared to those not taking them.

The study has a limitation as it does not have a control. However as noted by Prof. Aaron E. Carroll from Indiana University School of Medicine “given the natural course of back pain — that most of it go away no matter what you do — the ideal approach is to treat the symptoms and let the body heal. Non-invasive therapies seem to do that well enough.”

Massage therapy effective for the health and well-being of older people 

The proportion of people over 65 years is rapidly rising in Australia and many parts of the world. These issues potentially place an increased demand for quality long-term care for the older person. A critical review undertaken by researchers from Riverland General Hospital in Berri, SA, explored the potential benefits of massage within the daily routine care of the older person in residential care settings.

Fourteen studies dated 1993–2012 were critically evaluated and the authors found that massage may be advantageous from client and nursing perspectives. Clients’ perceive massage to positively influence factors such as pain, sleep, emotional status and psychosocial health. Evidence also demonstrates massage to benefit the client and organization by reducing the necessity for restraint and pharmacological intervention.

The authors concluded that massage offers benefit for promoting health and well-being of the older person along with potentially increased engagement of family in care provision. Integration of massage into daily care activities of the older person requires ongoing promotion and implementation. The study was published in International Journal of Older People Nursing.

Evidence of both systemic inflammation and neuroinflammation in fibromyalgia patients

Researchers have expected that chronic inflammation probably plays a role in the pathophysiology of fibromyalgia (FM). Neuroinflammatory is considered to be central to the pathophysiology of many chronic pain conditions. Proving this hypothesis appears to be challenging. Previous studies on fibromyalgia on human plasma/serum and/or cerebrospinal fluid (CSF)’s protein only looked at a few cytokine candidates and the results are inconclusive.

Instead of analyzing only a few substances at a time, a new research from Sweden analyzed 92 inflammation-related proteins simultaneously. The research was published in Journal of Pain Research. The researchers investigated the CSF and plasma inflammatory profiles of 40 FM patients compared with CSF from healthy controls (n=10) and plasma from blood donor controls (n=46). The authors found evidence of both neuroinflammation (as assessed in CSF) and chronic systemic inflammation (as assessed in plasma). This study provides a concrete evidence for an extensive inflammatory profile in FM patients. This dispels the myth that it is all in the head or Idiopathic or even psychogenic.

The authors also clearly stated the limitation of this study (FM patients were all female and the control is limited). The authors further hypothesize possible mechanism, include (1) central sensitization due to neuroinflammation, (2) an inflammatory risk factor that was present prior to the development of chronic pain (e.g., a genetic susceptibility), (3)  a consequence of the chronic pain condition, e.g. pain-related stress, inactivity , depression, etc.

Interestingly, inflammatory profiles similar to those now found in FM have been previously observed in studies of both chronic pain and neuropathic pain. Til Luchau, author, and instructor of myofascial therapy commented: “FM seems to respond to manual therapy similarly to chronic pain conditions. Empirically, both FM and chronic pain can, in many cases, be easily aggravated by too-direct, too-fast, too-long, or too-frequent work; or can show symptoms that seem to move around; or seem linked with mental or emotional agitation, depression, inactivity, and poor sleep. Manual therapists who have worked with FM and chronic pain have learned that the best results seem to come when their treatment takes into account the entire nervous system’s (or entire person’s) level of sensitivity, activation, resource, and resilience; and that duration, pressure, pace, and frequency all need to carefully be tuned to the individual’s response (which can be different every time).”

“Personally, my ears perk whenever there’s a new development in the immune system’s relationship to pain; we have a lot to learn about inflammation, and are still elaborating the larger principles of how and when our work can be most effective with inflammatory and conditions; and of course, how our approach might need to adapt or expand in order to best help clients and patients with either chronic pain and FM.”

This news update was published in Massage & Myotherapy magazine July 2017 issue.