Does massage therapy really help alleviate pain?

Massage therapy, a widely accepted method to alleviate pain, involves the manual manipulation of soft tissues like skin, muscles, tendons, and ligaments. Despite its popularity, evidence supporting its effectiveness is still limited. To address this, the Department of Veterans Affairs (VA) conducted an updated evidence map, building on their 2018 review, to evaluate the certainty of evidence in systematic reviews of massage therapy for pain.

The VA's new evidence map follows rigorous systematic review guidelines. Researchers searched five databases—PubMed, Allied and Complementary Medicine Database, Cumulated Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, and Web of Science—from July 2018 to April 2023.

They used terms related to massage and pain management, focusing on systematic reviews that assessed the effectiveness of massage therapy for adult painful conditions. Study finding "Use of Massage Therapy for Pain, 2018-2023-A Systematic Review" are published in JAMA Network Open.

Researchers screened titles and abstracts for relevance. To qualify, reviews needed to document a systematic method for identifying and evaluating evidence. They excluded studies from low- and middle-income countries due to resource differences. Eligible studies compared massage therapy to sham treatments, usual care, or other active therapies. The final selection included 17 publications covering 13 health conditions.

The team extracted data on the health condition, number of studies, type of massage, comparators, conclusions, and the certainty of evidence. This information was presented in a visual evidence map, highlighting the number of articles, condition, intervention type, comparators, and the strength of evidence.

The review identified 1164 citations, narrowed down to 41 full-text articles. Of these, 17 systematic reviews met the criteria, covering conditions like cancer-related pain, back pain, neck pain, fibromyalgia, labor pain, and postoperative pain. Each review provided insights into the effectiveness of different massage techniques, such as acupressure, myofascial release, and nonspecified massage therapy.

The evidence map revealed that only a few conditions had moderate-certainty evidence supporting the benefits of massage therapy. For instance, reviews showed moderate-certainty evidence for back pain, neck pain, and labor pain. However, most conditions had low or very low-certainty evidence, indicating that the true effects might differ significantly from current estimates.

The quality of included reviews varied. Using criteria from the U.S. Preventive Services Task Force, ten reviews were rated as good, while seven were rated as fair. Common issues included insufficient details about the intervention, frequency, duration, and follow-up.

Approximately half of the reviews reported on adverse events. No serious adverse events were noted, and the certainty of evidence regarding adverse events was generally low. This suggests that massage therapy is relatively safe, but more research is needed to confirm these findings.

The updated evidence map shows that while massage therapy is popular and potentially beneficial, high-quality evidence supporting its effectiveness for pain relief is scarce. Most reviews reported low-certainty evidence, highlighting the need for better-designed studies.

A significant challenge in evaluating massage therapy is the ambiguity in defining what constitutes massage. For instance, acupressure is sometimes classified as acupuncture, complicating the assessment of its effectiveness. Moreover, the use of sham massage as a placebo in studies may not be entirely inactive, potentially influencing outcomes.

To improve the evidence base, future studies should compare massage therapy with other accepted pain treatments, rather than sham or placebo treatments. These studies should also have long follow-up periods to accurately measure the long-term effects of massage therapy.

This systematic review has limitations. It may have missed relevant studies not indexed in the searched databases. Additionally, the evidence map relies on the conclusions of the included systematic reviews, without independent verification. Differences in judgment regarding the most informative reviews for certain conditions also present a potential bias.

Despite the growing number of studies on massage therapy, there is still a lack of high-certainty evidence to support its use for pain relief. More high-quality randomized clinical trials are needed to build a robust evidence base. Clearer definitions and consistent methodologies are essential for future research to accurately evaluate the benefits of massage therapy.

The updated evidence map underscores the potential of massage therapy as a pain management tool, but also highlights the urgent need for more rigorous research. By addressing current limitations, the field of massage therapy can better serve those seeking relief from pain, providing a clearer understanding of its true effectiveness.

Note: Materials provided above by the The Brighter Side of News. Content may be edited for style and length.

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