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1.  A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain: A Randomized, Controlled Trial 
Annals of internal medicine  2011;155(1):1-9.
Background
Few studies have evaluated the effectiveness of massage for back pain.
Objective
To evaluate the effectiveness of two types of massage for chronic back pain.
Design
Single-blind parallel group randomized controlled trial.
Setting
Integrated health care delivery system in Seattle area.
Patients
401 persons 20 to 65 years of age with non-specific chronic low back pain.
Interventions
Ten treatments over 10 weeks of Structural Massage (intended to identify and alleviate musculoskeletal contributors to pain through focused soft-tissue manipulation) (n=132) or Relaxation Massage (intended to decrease pain and dysfunction by inducing relaxation) (n=136). Treatments provided by 27 experienced licensed massage therapists. Comparison group received continued usual care (n=133). Study presented as comparison of usual care with two types of massage.
Measurements
Primary outcomes were the Roland Disability Questionnaire (RDQ) and the Symptom Bothersomeness scale measured at 10 weeks. Outcomes also measured after 26 and 52 weeks.
Results
At 10 weeks, the massage groups had similar functional outcomes that were superior to those for usual care. The adjusted mean RDQ scores were 2.9 and 2.4 points lower for the relaxation and structural massage groups, respectively, compared to usual care (95% CIs: [1.8, 4.0] and [1.4, 3.5]). Adjusted mean symptom bothersomeness scores were 1.7 points and 1.4 points lower with relaxation and structural massage, respectively, versus usual care (95% CIs: [1.2, 2.2] and [0.8, 1.9]). The beneficial effects of relaxation massage on function (but not on symptom reduction) persisted at 52 weeks, but were small.
Limitations
Restricted to single site; therapists and patients not blinded to treatment.
Conclusions
This study confirms the results of smaller trials that massage is an effective treatment for chronic back pain with benefits lasting at least 6 months, and also finds no evidence of a clinically-meaningful difference in the effectiveness of two distinct types of massage.
Primary Funding Source
National Center for Complementary and Alternative Medicine
doi:10.1059/0003-4819-155-1-201107050-00002
PMCID: PMC3570565  PMID: 21727288
2.  Changes in Clinical Parameters in Patients with Tension-type Headache Following Massage Therapy: A Pilot Study 
Complementary and alternative medicine approaches to treatment for tension-type headache are increasingly popular among patients, but evidence supporting its efficacy is limited. The objective of this study was to assess short term changes on primary and secondary headache pain measures in patients with tension-type headache (TTH) receiving a structured massage therapy program with a focus on myofascial trigger point therapy. Participants were enrolled in an open label trial using a baseline control with four 3-week phases: baseline, massage (two 3-week phases) and follow-up. Twice weekly, 45-minute massage sessions commenced following the baseline phase. A daily headache diary was maintained throughout the study in which participants recorded headache incidence, intensity, and duration. The Headache Disability Index was administered upon study entry and at 3-week intervals thereafter. 18 subjects were enrolled with 16 completing all headache diary, evaluation, and massage assignments. Study participants reported a median of 7.5 years with TTH. Headache frequency decreased from 4.7±0.7 episodes per week during baseline to 3.7±0.9 during treatment period 2 (P<0.001); reduction was also noted during the follow-up phase (3.2±1.0). Secondary measures of headache also decreased across the study phases with headache intensity decreasing by 30% (P<0.01) and headache duration from 4.0±1.3 to 2.8±0.5 hours (P<0.05). A corresponding improvement in Headache Disability Index was found with massage (P<0.001). This pilot study provides preliminary evidence for reduction in headache pain and disability with massage therapy that targets myofascial trigger points, suggesting the need for more rigorously controlled studies.
PMCID: PMC2565109  PMID: 19119396
Complementary and Alternative Medicine; Headache Disability Index; Manual Therapy; Myofasical Pain; Myofascial Trigger Points
3.  Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain 
Objective To determine the effectiveness of lessons in the Alexander technique, massage therapy, and advice from a doctor to take exercise (exercise prescription) along with nurse delivered behavioural counselling for patients with chronic or recurrent back pain.
Design Factorial randomised trial.
Setting 64 general practices in England.
Participants 579 patients with chronic or recurrent low back pain; 144 were randomised to normal care, 147 to massage, 144 to six Alexander technique lessons, and 144 to 24 Alexander technique lessons; half of each of these groups were randomised to exercise prescription.
Interventions Normal care (control), six sessions of massage, six or 24 lessons on the Alexander technique, and prescription for exercise from a doctor with nurse delivered behavioural counselling.
Main outcome measures Roland Morris disability score (number of activities impaired by pain) and number of days in pain.
Results Exercise and lessons in the Alexander technique, but not massage, remained effective at one year (compared with control Roland disability score 8.1: massage -0.58, 95% confidence interval -1.94 to 0.77, six lessons -1.40, -2.77 to -0.03, 24 lessons -3.4, -4.76 to -2.03, and exercise -1.29, -2.25 to -0.34). Exercise after six lessons achieved 72% of the effect of 24 lessons alone (Roland disability score -2.98 and -4.14, respectively). Number of days with back pain in the past four weeks was lower after lessons (compared with control median 21 days: 24 lessons -18, six lessons -10, massage -7) and quality of life improved significantly. No significant harms were reported.
Conclusions One to one lessons in the Alexander technique from registered teachers have long term benefits for patients with chronic back pain. Six lessons followed by exercise prescription were nearly as effective as 24 lessons.
Trial registration National Research Register N0028108728.
doi:10.1136/bmj.a884
PMCID: PMC3272681  PMID: 18713809
4.  The effect of chair massage on muscular discomfort in cardiac sonographers: a pilot study 
Background
Cardiac sonographers frequently have work-related muscular discomfort. We aimed to assess the feasibility of having sonographers receive massages during working hours in an area adjacent to an echocardiography laboratory and to assess relief of discomfort with use of the massages with or without stretching exercises.
Methods
A group of 45 full-time sonographers was randomly assigned to receive weekly 30-minute massage sessions, massages plus stretching exercises to be performed twice a day, or no intervention. Outcome measures were scores of the QuickDASH instrument and its associated work module at baseline and at 10 weeks of intervention. Data were analyzed with standard descriptive statistics and the separation test for early-phase comparative trials.
Results
Forty-four participants completed the study: 15 in the control group, 14 in the massage group, and 15 in the massage plus stretches group. Some improvement was seen in work-related discomfort by the QuickDASH scores and work module scores in the 2 intervention groups. The separation test showed separation in favor of the 2 interventions.
Conclusion
On the basis of the results of this pilot study, larger trials are warranted to evaluate the effect of massages with or without stretching on work-related discomfort in cardiac sonographers.
Trial Registration
NCT00975026 ClinicalTrials.gov
doi:10.1186/1472-6882-10-50
PMCID: PMC2949737  PMID: 20846441
5.  Dosing study of massage for chronic neck pain: protocol for the dose response evaluation and analysis of massage [DREAM] trial 
Background
Despite the growing popularity of massage, its effectiveness for treating neck pain remains unclear, largely because of the poor quality of research. A major deficiency of previous studies has been their use of low “doses” of massage that massage therapists consider inadequate. Unfortunately, the number of minutes per massage session, sessions per week, or weeks of treatment necessary for massage to have beneficial or optimal effects are not known. This study is designed to address these gaps in our knowledge by determining, for persons with chronic neck pain: 1) the optimal combination of number of treatments per week and length of individual treatment session, and 2) the optimal number of weeks of treatment.
Methods/design
In this study, 228 persons with chronic non-specific neck pain will be recruited from primary health care clinics in a large health care system in the Seattle area. Participants will be randomized to a wait list control group or 4 weeks of treatment with one of 5 different dosing combinations (2 or 3 30-min treatments per week or 1, 2, or 3 60-min treatments per week). At the end of this 4-week primary treatment period, participants initially receiving each of the 5 dosing combinations will be randomized to a secondary treatment period of either no additional treatment or 6 weekly 60-min massages. The primary outcomes, neck-related dysfunction and pain, will be assessed by blinded telephone interviewers 5, 12, and 26 weeks post-randomization. To better characterize the trajectory of treatment effects, these interview data will be supplemented with outcomes data collected by internet questionnaire at 10, 16, 20 and 39 weeks. Comparisons of outcomes for the 6 groups during the primary treatment period will identify the optimal weekly dose, while comparisons of outcomes during the secondary treatment period will determine if 10 weeks of treatment is superior to 4 weeks.
Discussion
A broad dosing schedule was included in this trial. If adherence to any of these doses is poor, those doses will be discontinued.
Trial registration
This trial is registered in ClinicalTrials.gov, with the ID number of NCT01122836
doi:10.1186/1472-6882-12-158
PMCID: PMC3546891  PMID: 22985134
Therapeutic massage; Optimal dose; Chronic neck pain
6.  Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review 
Previous reviews of massage therapy for chronic, non-malignant pain have focused on discrete pain conditions. This article aims to provide a broad overview of the literature on the effectiveness of massage for a variety of chronic, non-malignant pain complaints to identify gaps in the research and to inform future clinical trials. Computerized databases were searched for relevant studies including prior reviews and primary trials of massage therapy for chronic, non-malignant pain. Existing research provides fairly robust support for the analgesic effects of massage for non-specific low back pain, but only moderate support for such effects on shoulder pain and headache pain. There is only modest, preliminary support for massage in the treatment of fibromyalgia, mixed chronic pain conditions, neck pain and carpal tunnel syndrome. Thus, research to date provides varying levels of evidence for the benefits of massage therapy for different chronic pain conditions. Future studies should employ rigorous study designs and include follow-up assessments for additional quantification of the longer-term effects of massage on chronic pain.
doi:10.1093/ecam/nel109
PMCID: PMC1876616  PMID: 17549233
Fibroymalgia; headache pain; low back pain; musculoskeletal pain; recurrent pain
7.  Changes in Psychological Parameters in Patients with Tension-type Headache Following Massage Therapy: A Pilot Study 
Investigations into complementary and alternative medicine (CAM) approaches to address stress, depression, and anxiety of those experiencing chronic pain are rare. The objective of this pilot study was to assess the value of a structured massage therapy program, with a focus on myofascial trigger points, on psychological measures associated with tension-type headache. Participants were enrolled in an open-label trial using a baseline control with four 3-week phases: baseline, massage (two 3-week periods) and a follow-up phase. Eighteen subjects with episodic or chronic tension-type headache were enrolled and evaluated at 3-week intervals using the State-Trait Anxiety Inventory, Beck Depression Inventory, and the Perceived Stress Scale. The Daily Stress Inventory was administered over 7-day periods during baseline and the final week of massage. Twice weekly, 45-minute massage therapy sessions commenced following the baseline phase and continued for 6 weeks. A significant improvement in all psychological measures was detected over the timeframe of the study. Post hoc evaluation indicated improvement over baseline for depression and trait anxiety following 6 weeks of massage, but not 3 weeks. A reduction in the number of events deemed stressful as well as their respective impact was detected. This pilot study provides evidence for reduction of affective distress in a chronic pain population, suggesting the need for more rigorously controlled studies using massage therapy to address psychological measures associated with TTH.
PMCID: PMC2700492  PMID: 20046550
Beck Depression Inventory; Complementary and Alternative Medicine; Daily Stress Inventory; Myofascial Pain; State-Trait Anxiety Inventory
8.  Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome 
Gastroenterology  2010;138(4):1321-1329.
Background & Aims
Levator ani syndrome (LAS) might be treated using biofeedback to teach pelvic floor relaxation, electrogalvanic stimulation (EGS), or massage of levator muscles. We performed a prospective, randomized controlled trial to compare the effectiveness of these techniques and assess physiological mechanisms for treatment.
Methods
Inclusion criteria were Rome II symptoms plus weekly pain. Patients were categorized as “highly likely” to have LAS if they reported tenderness with traction on the levator muscles, or as “possible” LAS if they did not. All 157 patients received 9 sessions including psychological counseling plus biofeedback, EGS, or massage. Outcomes were reassessed at 1, 3, 6, and 12 months.
Results
Among patients with “highly likely” LAS, adequate relief was reported by 87% for biofeedback, 45% for EGS, and 22% for massage. Pain days per month decreased from 14.7 at baseline to 3.3 after biofeedback, 8.9 after EGS, and 13.3 after massage. Pain intensity decreased from 6.8 (0–10 scale) at baseline to 1.8 after biofeedback, 4.7 after EGS, and 6.0 after massage. Improvements were maintained for 12 months. Patients with only a “possible” diagnosis of LAS did not benefit from any treatment. Biofeedback and EGS improved LAS by increasing the ability to relax pelvic floor muscles and evacuate a water-filled balloon, and by reducing the urge and pain thresholds.
Conclusions
Biofeedback is the most effective of these treatments, and EGS is somewhat effective. Only patients with tenderness on rectal examination benefit. The pathophysiology of LAS is similar to that of dyssynergic defecation.
doi:10.1053/j.gastro.2009.12.040
PMCID: PMC2847007  PMID: 20044997
Proctalgia; Biofeedback; Electrogalvanic stimulation; Dyssynergic defecation
9.  The effect of massage therapy on blood pressure of women with pre-hypertension 
BACKGROUND:
Prehypertension is considered as a cardiovascular disease predicator. Management of prehypertension is an appropriate objective for clinicians in a wide range of medical centers. Treatment of prehypertension is primarily non-pharmacological, one of which is massage therapy that is used to control the blood pressure. This study aimed to evaluate the effect of Swedish massage (face, neck, shoulders and chest) on blood pressure (BP) of the women with prehypertension.
METHODS:
This was a single-blind clinical trial study. Fifty prehypertensive women selected by simple random sampling which divided into control and test groups. The test group (25 patients) received Swedish massage 10-15 min, three times a week for 10 sessions and the control groups (25 patients) also were relaxed at the same environment with receiving no massage. Their BP was measured before and after each session. Analyzing the data was done using descriptive and inferential statistical methods (chi square, Mann-Whitney, paired t-test and student t-test) through SPSS software.
RESULTS:
The results indicated that mean systolic and diastolic blood pressure in the massage group was significantly lower in comparison with the control group (p < 0.001).
CONCLUSIONS:
Findings of the study indicated that massage therapy was a safe, effective, applicable and cost-effective intervention in controlling BP of the prehypertension women and it can be used in the health care centers and even at home.
PMCID: PMC3203301  PMID: 22039381
Massage therapy; prehypertension; women
10.  Durability of Effect of Massage Therapy on Blood Pressure 
Background:
Pre-hypertension is considered as a cardiovascular disease predicator. Management of pre-hypertension is an appropriate objective for clinicians in a wide range of medical centers. Treatment of pre-hypertension is primarily non-pharmacological, one of which is massage therapy that is used to control the BP. This study aimed to evaluate the survival effect of Swedish massage (face, neck, shoulders, and chest) on BP of the women with pre-hypertension.
Methods:
This was a single-blind clinical trial study. Fifty pre-hypertensive women selected by simple random sampling which divided into control and test groups. The test group (25 patients) received Swedish massage 10-15 min, 3 times a week for 10 sessions and the control groups (25 patients) also were relaxed at the same environment with receiving no massage. Their BP was measured before and after each session and 72 h after finishing the massage therapy. Analyzing the data was done using descriptive and inferential statistical methods (Chi- square, Mann-Whitney, paired t-test and Student t-test) through SPSS software.
Results:
The results indicated that mean systolic and diastolic BP in the massage group was significantly lower in comparison with the control group (P < 0.001). Evaluation of durability of the massage effects on BP also indicated that 72 h after finishing the study, still there was a significant difference between the test and control groups in systolic and diastolic BP (P < 0.001).
Conclusions:
Findings of the study indicated that massage therapy was a safe, effective, applicable and cost-effective intervention in controlling BP of the pre-hypertension women and it can be used in the health care centers and even at home.
PMCID: PMC3733180  PMID: 23930160
Durability; massage therapy; pre-hypertension
11.  Effectiveness of focused structural massage and relaxation massage for chronic low back pain: protocol for a randomized controlled trial 
Trials  2009;10:96.
Background
Chronic back pain is a major public health problem and the primary reason patients seek massage treatment. Despite the growing use of massage for chronic low back pain, there have been few studies of its effectiveness. This trial will be the first evaluation of the effectiveness of relaxation massage for chronic back pain and the first large trial of a focused structural form of massage for this condition.
Methods and Design
A total of 399 participants (133 in each of three arms) between the ages of 20 and 65 years of age who have low back pain lasting at least 3 months will be recruited from an integrated health care delivery system. They will be randomized to one of two types of massage ("focused structural massage" or "relaxation massage"), or continued usual medical care. Ten massage treatments will be provided over 10 weeks. The primary outcomes, standard measures of dysfunction and bothersomeness of low back pain, will be assessed at baseline and after 10, 26, and 52 weeks by telephone interviewers masked to treatment assignment. General health status, satisfaction with back care, days of back-related disability, perceived stress, and use and costs of healthcare services for back pain will also be measured. Outcomes across assigned treatment groups will be compared using generalized estimating equations, accounting for participant correlation and adjusted for baseline value, age, and sex. For both primary outcome measures, this trial will have at least 85% power to detect the presence of a minimal clinically significant difference among the three treatment groups and 91% power for pairwise comparisons. Secondary analyses will compare the proportions of participants in each group that improve by a clinically meaningful amount.
Conclusion
Results of this trial will help clarify the value of two types of massage therapy for chronic low back pain.
Trial registration
Clinical Trials.gov NCT 00371384.
doi:10.1186/1745-6215-10-96
PMCID: PMC2774684  PMID: 19843340
12.  Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain: economic evaluation 
Objective An economic evaluation of therapeutic massage, exercise, and lessons in the Alexander technique for treating persistent back pain.
Design Cost consequences study and cost effectiveness analysis at 12 month follow-up of a factorial randomised controlled trial.
Participants 579 patients with chronic or recurrent low back pain recruited from primary care.
Interventions Normal care (control), massage, and six or 24 lessons in the Alexander technique. Half of each group were randomised to a prescription for exercise from a doctor plus behavioural counselling from a nurse.
Main outcome measures Costs to the NHS and to participants. Comparison of costs with Roland-Morris disability score (number of activities impaired by pain), days in pain, and quality adjusted life years (QALYs). Comparison of NHS costs with QALY gain, using incremental cost effectiveness ratios and cost effectiveness acceptability curves.
Results Intervention costs ranged from £30 for exercise prescription to £596 for 24 lessons in Alexander technique plus exercise. Cost of health services ranged from £50 for 24 lessons in Alexander technique to £124 for exercise. Incremental cost effectiveness analysis of single therapies showed that exercise offered best value (£61 per point on disability score, £9 per additional pain-free day, £2847 per QALY gain). For two-stage therapy, six lessons in Alexander technique combined with exercise was the best value (additional £64 per point on disability score, £43 per additional pain-free day, £5332 per QALY gain).
Conclusions An exercise prescription and six lessons in Alexander technique alone were both more than 85% likely to be cost effective at values above £20 000 per QALY, but the Alexander technique performed better than exercise on the full range of outcomes. A combination of six lessons in Alexander technique lessons followed by exercise was the most effective and cost effective option.
doi:10.1136/bmj.a2656
PMCID: PMC3272680  PMID: 19074232
13.  Massage for Children Undergoing Hematopoietic Cell Transplantation: A Qualitative Report 
Background. No in-depth qualitative research exists about the effects of therapeutic massage with children hospitalized to undergo hematopoietic cell transplantation (HCT). The objective of this study is to describe parent caregivers' experience of the effects of massage/acupressure for their children undergoing HCT. Methods. We conducted a qualitative analysis of open-ended interviews with 15 parents of children in the intervention arm of a massage/acupressure trial. Children received both practitioner and parent-provided massage/acupressure. Results. Parents reported that their child experienced relief from pain and nausea, relaxation, and greater ease falling asleep. They also reported increased caregiver competence and closeness with their child as a result of learning and performing massage/acupressure. Parents supported a semistandardized massage protocol. Conclusion. Massage/acupressure may support symptom relief and promote relaxation and sleep among pediatric HCT patients if administered with attention to individual patients' needs and hospital routines and may relieve stress among parents, improve caregiver competence, and enhance the sense of connection between parent and child.
doi:10.1155/2012/792042
PMCID: PMC3296156  PMID: 22474526
14.  Spinal manipulative therapy versus Graston Technique in the treatment of non-specific thoracic spine pain: Design of a randomised controlled trial 
Background
The one year prevalence of thoracic back pain has been estimated as 17% compared to 64% for neck pain and 67% for low back pain. At present only one randomised controlled trial has been performed assessing the efficacy of spinal manipulative therapy (SMT) for thoracic spine pain. In addition no high quality trials have been performed to test the efficacy and effectiveness of Graston Technique® (GT), a soft tissue massage therapy using hand-held stainless steel instruments. The objective of this trial is to determine the efficacy of SMT and GT compared to a placebo for the treatment of non specific thoracic spine pain.
Methods
Eighty four eligible people with non specific thoracic pain mid back pain of six weeks or more will be randomised to one of three groups, either SMT, GT, or a placebo (de-tuned ultrasound). Each group will receive up to 10 supervised treatment sessions at the Murdoch University Chiropractic student clinic over a 4-week period. Treatment outcomes will be measured at baseline, one week after their first treatment, upon completion of the 4-week intervention period and at three, six and twelve months post randomisation. Outcome measures will include the Oswestry Back Pain Disability Index and the Visual Analogue Scale (VAS). Intention to treat analysis will be utilised in the statistical analysis of any group treatment effects.
Trial Registration
This trial was registered with the Australia and New Zealand Clinical Trials Registry on the 7th February 2008. Trial number: ACTRN12608000070336
doi:10.1186/1746-1340-16-12
PMCID: PMC2584064  PMID: 18959807
15.  Is soft tissue massage an effective treatment for mechanical shoulder pain? A study protocol 
Very little research has been conducted into the effectiveness of soft tissue massage as an intervention for the treatment of mechanical shoulder pain. Studies that have been conducted suffer from methodological issues, poor long-term follow-up and have conflicting results. The aim of this study, therefore, is to provide treating clinicians with improved evidence regarding the effectiveness of soft tissue massage for shoulder pain of local mechanical origin. Participants referred to the trial with mechanical shoulder pain will be assessed for range of motion, functional ability, and pain by a blinded assessor. Participants will then be randomly allocated to either an exercise-only group or an exercise and soft tissue massage group. Both groups will receive seven treatment sessions from a physical therapist over a period of 4 weeks. One week after the cessation of treatment, all participants will be reassessed by the same blinded assessor. Three months after cessation of treatment, subjects will again be reassessed. The primary outcome will be pain measured on a visual analogue scale (VAS) 1 week following the cessation of treatment. Secondary analyses will be pain at 3 months, the descriptive and present pain index sections of the short form McGill pain questionnaire, patient specific functional scale, and percentage improvement in pain scores and range of motion at 1 week following the cessation of treatment and at 3 month follow-up. Analysis of data will be carried out by a statistician who is blinded to group membership. Primary analyses will by intention-to-treat.
doi:10.1179/106698110X12595770849687
PMCID: PMC3103116  PMID: 21655424
Clinical trial; Function; Massage; Pain; Shoulder
16.  Massage Therapy vs. Simple Touch to Improve Pain and Mood in Patients with Advanced Cancer: A Randomized Trial 
Annals of internal medicine  2008;149(6):369-379.
BACKGROUND
Small studies of variable quality suggest that massage therapy may relieve pain and other symptoms.
OBJECTIVE
Evaluate efficacy of massage for decreasing pain and symptom distress and improving quality of life among persons with advanced cancer.
DESIGN
Multi-site randomized clinical trial.
SETTING
Population-based Palliative Care Research Network (PoPCRN).
PATIENTS
380 adults with advanced cancer experiencing moderate-severe pain; 90% were enrolled in hospice.
INTERVENTION
Six 30-minute massage or simple touch sessions over two weeks.
MEASUREMENTS
Primary outcomes were immediate (Memorial Pain Assessment Card, MPAC, 0 – 10 scale) and sustained (Brief Pain Inventory, BPI, 0 – 10 scales) change in pain. Secondary outcomes were immediate change in mood (MPAC 0 – 10 scale) and 60-second heart and respiratory rates and sustained change in quality of life (McGill Quality of Life Questionnaire, MQOL, 0 – 10 scale), symptom distress (Memorial Symptom Assessment Scale, MSAS, 0 – 4 scale), and analgesic medication use (parenteral morphine equivalents (milligrams/24 hours). Immediate outcomes were obtained just prior to and following each treatment session. Sustained outcomes were obtained at baseline and weekly for 3 weeks.
RESULTS
298 were included in the immediate outcome analysis and 348 in the sustained outcome analysis. 82 did not receive any allocated study treatments (37 massage, 45 control). Both groups demonstrated immediate improvement in pain (massage -1.87 points (CI, -2.07, -1.67), control -0.97 points (CI, -1.18, -0.76)) and mood (massage 1.58 points (CI, 1.40, 1.76), control 0.97 points (CI, 0.78, 1.16)). Massage was superior for both pain and mood (mean difference 0.90 and 0.61 points, respectively, P<0.001). There were no between group mean differences over time in pain (BPI Mean 0.07 (CI, -0.23, 0.37), BPI Worst -0.14 (CI, -0.59, 0.31)), quality of life (MQOL Overall 0.08 (CI, -0.37, 0.53)), symptom distress (MSAS Global Distress Index -0.002 (CI, -0.12, 0.12)), or analgesic medication use (parenteral morphine equivalents -0.10 (CI, -0.25, 0.05).
LIMITATIONS
The immediate outcome measures were obtained by unblinded study therapists, possibly leading to reporting bias and the overestimation of beneficial effect. The generalizability to all advanced cancer patients is uncertain. The differential beneficial effect of massage therapy over simple touch is not conclusive in the absence of a “usual care” control arm.
CONCLUSIONS
Massage may have immediately beneficial effects on pain and mood among patients with advanced cancer. Given the lack of sustained effects and the observed improvements in both study arms, the potential benefits of attention and simple touch should also be considered in this population.
PMCID: PMC2631433  PMID: 18794556
17.  A Pilot Study Evaluating Mindfulness-Based Stress Reduction and Massage for the Management of Chronic Pain 
Journal of General Internal Medicine  2005;20(12):1136-1138.
Background
Mindfulness-based stress reduction (MBSR) and massage may be useful adjunctive therapies for chronic musculoskeletal pain.
Objective
To evaluate the feasibility of studying MBSR and massage for the management of chronic pain and estimate their effects on pain and mood.
Design
Randomized trial comparing MBSR or massage with standard care.
Participants
Thirty patients with chronic musculoskeletal pain.
Measurements
Pain was assessed with 0 to 10 numeric rating scales. Physical and mental health status was measured with the SF-12.
Results
The study completion rate was 76.7%. At week 8, the massage group had average difference scores for pain unpleasantness of 2.9 and mental health status of 13.6 compared with 0.13 (P<.05) and 3.9 (P<.04), respectively, for the standard care group. These differences were no longer significant at week 12. There were no significant differences in the pain outcomes for the MBSR group. At week 12, the mean change in mental health status for the MBSR group was 10.2 compared with −1.7 in the standard care group (P<.04).
Conclusions
It is feasible to study MBSR and massage in patients with chronic musculoskeletal pain. Mindfulness-based stress reduction may be more effective and longer-lasting for mood improvement while massage may be more effective for reducing pain.
doi:10.1111/j.1525-1497.2005.0247.x
PMCID: PMC1490272  PMID: 16423104
mindfulness-based stress reduction; massage; chronic pain; mental health; integrative medicine
18.  Benefits of Massage-Myofascial Release Therapy on Pain, Anxiety, Quality of Sleep, Depression, and Quality of Life in Patients with Fibromyalgia 
Fibromyalgia is a chronic syndrome characterized by generalized pain, joint rigidity, intense fatigue, sleep alterations, headache, spastic colon, craniomandibular dysfunction, anxiety, and depression. The purpose of the present study was to determine whether massage-myofascial release therapy can improve pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. A randomized controlled clinical trial was performed. Seventy-four fibromyalgia patients were randomly assigned to experimental (massage-myofascial release therapy) and placebo (sham treatment with disconnected magnotherapy device) groups. The intervention period was 20 weeks. Pain, anxiety, quality of sleep, depression, and quality of life were determined at baseline, after the last treatment session, and at 1 month and 6 months. Immediately after treatment and at 1 month, anxiety levels, quality of sleep, pain, and quality of life were improved in the experimental group over the placebo group. However, at 6 months postintervention, there were only significant differences in the quality of sleep index. Myofascial release techniques improved pain and quality of life in patients with fibromyalgia.
doi:10.1155/2011/561753
PMCID: PMC3018656  PMID: 21234327
19.  The effect of massage therapy on chemotherapy-induced nausea and vomiting in pediatric cancer 
Background:
Nausea and vomiting are the most common and unpleasant side effects of chemotherapy, and they may prevent successful treatment completion. Antiemetics not only cannot control nausea and vomiting completely but also have numerous side effects. So it is necessary to find other methods for a better control. This study aimed to assess the effect of massage therapy on chemotherapy-induced nausea and vomiting in pediatric cancer.
Materials and Methods:
In this randomized controlled clinical trial study, 70 patients (4-18 years of age) under chemotherapy were divided into two (massage therapy and control) groups randomly. In the massage group at 0.5 h and 24 h before and 24 h after chemotherapy, the patients were massaged (Swedish massage) for 20 min, respectively. All indices of nausea and vomiting (incidence, severity, time, and length) were assessed by Visual Analogue Scale (VAS) and BARF scales and other questionnaires and documented.
Results:
The results of Mann–Whitney and chi-squire tests indicated that in the massage group, the incidence of nausea was 25.7%, the severity, length, and times of nausea were 20%, 54 min, and 0.35 times, respectively, and the severity and times of vomiting were 0.24 scores and 0.31 times lower than those of the control group (P < 0.05), respectively. But vomiting incidence in the two groups showed no significant difference (P = 0.192).
Conclusions:
Massage therapy reduced chemotherapy-induced nausea and vomiting. So, nurses can use it and educate it to the patients’ families. Nurses, besides using it clinically, can provide instructions to families for involving them in the treatment process and they feel they are more efficate in care of their suffering children.
PMCID: PMC3872861  PMID: 24403922
Cancer; chemotherapy; massage; nausea; vomiting; paediatrics; Iran
20.  Study on effect of massage therapy on pain severity in orthopedic patients 
BACKGROUND:
Pain as a main social problem has involved millions of people. Usually pharmaceutical methods use for treating pain but they have side effects which make them less effective. Massage is one of the effective ways for reducing pain after surgery. The aim of this study was to evaluate the effect of massage therapy on pain severity in orthopedic patients.
METHODS:
This is a clinical trial study on 60 arthroscopic knee surgery patients who were hospitalized in men's orthopedic ward of Al-Zahra and Kashani hospitals. A two part questionnaire was used for collecting data. Samples were selected using easy continuity method and then they were randomly divided into two groups. In intervention group, besides routine treatments, patients were massaged by the researcher for 20 minutes each day and pain severity was evaluated before and after the massage. Data was analyzed using descriptive and inferential statistics and SPSS software.
RESULTS:
Results showed that there was a meaningful different between mean score of pain severity before and after the massage in intervention group (p < 0.001) but this difference wasn′t meaningful in control group (p = 0.32). Also comparing the mean score of pain severity in both groups before any interventions showed that there were no meaningful differences (p = 0.34) but this difference was meaningful after interventions (p = 0.001).
CONCLUSIONS:
Considering massage as a safe and effective intervention, it could be used as an easy, cheap and executable method for treating pain in all medical health care centers and even at patient's home.
PMCID: PMC3093031  PMID: 21589747
Massage; pain; orthopedics; patients
21.  Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials 
PLoS ONE  2014;9(2):e89304.
Background
Although some studies evaluated the effectiveness of massage therapy for fibromyalgia (FM), the role of massage therapy in the management of FM remained controversial.
Objective
The purpose of this systematic review is to evaluate the evidence of massage therapy for patients with FM.
Methods
Electronic databases (up to June 2013) were searched to identify relevant studies. The main outcome measures were pain, anxiety, depression, and sleep disturbance. Two reviewers independently abstracted data and appraised risk of bias. The risk of bias of eligible studies was assessed based on Cochrane tools. Standardised mean difference (SMD) and 95% confidence intervals (CI) were calculated by more conservative random-effects model. And heterogeneity was assessed based on the I2 statistic.
Results
Nine randomized controlled trials involving 404 patients met the inclusion criteria. The meta-analyses showed that massage therapy with duration ≥5 weeks significantly improved pain (SMD, 0.62; 95% CI 0.05 to 1.20; p = 0.03), anxiety (SMD, 0.44; 95% CI 0.09 to 0.78; p = 0.01), and depression (SMD, 0.49; 95% CI 0.15 to 0.84; p = 0.005) in patients with FM, but not on sleep disturbance (SMD, 0.19; 95% CI −0.38 to 0.75; p = 0.52).
Conclusion
Massage therapy with duration ≥5 weeks had beneficial immediate effects on improving pain, anxiety, and depression in patients with FM. Massage therapy should be one of the viable complementary and alternative treatments for FM. However, given fewer eligible studies in subgroup meta-analyses and no evidence on follow-up effects, large-scale randomized controlled trials with long follow-up are warrant to confirm the current findings.
doi:10.1371/journal.pone.0089304
PMCID: PMC3930706  PMID: 24586677
22.  Aromatherapy Massage on the Abdomen for Alleviating Menstrual Pain in High School Girls: A Preliminary Controlled Clinical Study 
This study investigated the alleviating effects of aromatherapy massage and acetaminophen on menstrual pain in Korean high school girls. Subjects were divided into two groups: the aromatherapy massage (treatment) group (n = 32) and the acetaminophen (control) group (n = 23). Aromatherapy massage was performed on subjects in the treatment group. The abdomen was massaged once using clary sage, marjoram, cinnamon, ginger, and geranium in a base of almond oil. The level of menstrual pain was assessed using a visual analogue scale at baseline and twenty-four hours afterward. The reduction of menstrual pain was significantly higher in the aromatherapy group than in the acetaminophen group. Using multiple regression, aromatherapy massage was found to be more highly associated with reduction in the level of menstrual pain than acetaminophen. These finding suggest that aromatherapy massage may be an effective treatment for menstrual pain in high school girls. However, it could not be verified whether the positive effects derived from the aromatherapy, the massage, or both. Further rigorous studies should be conducted using more objective measures.
doi:10.1155/2012/187163
PMCID: PMC3178179  PMID: 21949670
23.  Effects and predictors of shoulder muscle massage for patients with posterior shoulder tightness 
Background
Clinical approaches like mobilization, stretching, and/or massage may decrease shoulder tightness and improve symptoms in subjects with stiff shoulders. We investigated the effect and predictors of effectiveness of massage in the treatment of patients with posterior shoulder tightness.
Methods
A randomized controlled trial was conducted in a hospital-based outpatient practice (orthopedic and rehabilitation). Forty-three women and 17 men (mean age = 54 years, range 43-73 years) with posterior shoulder tightness participated and were randomized into massage and control groups (n = 30 per group). A physical therapist provided the massage on the posterior deltoid, infraspinatus, and teres minor of the involved shoulder for 18 minutes [about 6 minutes for each muscle] two times a week for 4 weeks. For the control group, one therapist applied light hand touch on the muscles 10 minutes two times a week for 4 weeks. Glenohumeral internal rotation ROM, functional status, and muscle tightness were the main outcomes. Additionally, the potential factors on the effectiveness of massage were analyzed by multivariate logistic regression. For this analysis, patients with functional score improvement at least 20% after massage were considered responsive, and the others were considered nonresponsive.
Results
Fifty-two patients completed the study (29 for the massage and 23 for the control). The overall mean internal rotation ROM increased significantly in the massage group compared to the control (54.9° v.s. 34.9°; P ≤ 0.001). There were 21 patients in the responsive group and 8 in the nonresponsive group. Among the factors, duration of symptoms, functional score, and posterior deltoid tightness were significant predictors of effectiveness of massage.
Conclusions
Massage was an effective treatment for patients with posterior shoulder tightness, but was less effective in patients with longer duration of symptoms, higher functional limitation, and less posterior deltoid tightness.
Trial registration
This clinical trial is registered at Trial Registration "Trial registration: Clinicaltrials.gov NCT01022827".
doi:10.1186/1471-2474-13-46
PMCID: PMC3339516  PMID: 22449170
Massage; Stiff shoulder; Range of motion
24.  Randomised trial of acupuncture compared with conventional massage and “sham” laser acupuncture for treatment of chronic neck pain 
BMJ : British Medical Journal  2001;322(7302):1574.
Objectives
To compare the efficacy of acupuncture and conventional massage for the treatment of chronic neck pain.
Design
Prospective, randomised, placebo controlled trial.
Setting
Three outpatient departments in Germany.
Participants
177 patients aged 18-85 years with chronic neck pain.
Interventions
Patients were randomly allocated to five treatments over three weeks with acupuncture (56), massage (60), or “sham” laser acupuncture (61).
Main outcome measures
Primary outcome measure: maximum pain related to motion (visual analogue scale) irrespective of direction of movement one week after treatment. Secondary outcome measures: range of motion (3D ultrasound real time motion analyser), pain related to movement in six directions (visual analogue scale), pressure pain threshold (pressure algometer), changes of spontaneous pain, motion related pain, global complaints (seven point scale), and quality of life (SF-36). Assessments were performed before, during, and one week and three months after treatment. Patients' beliefs in treatment were assessed.
Results
One week after five treatments the acupuncture group showed a significantly greater improvement in motion related pain compared with massage (difference 24.22 (95% confidence interval 16.5 to 31.9), P=0.0052) but not compared with sham laser (17.28 (10.0 to 24.6), P=0.327). Differences between acupuncture and massage or sham laser were greater in the subgroup who had had pain for longer than five years (n=75) and in patients with myofascial pain syndrome (n=129). The acupuncture group had the best results in most secondary outcome measures. There were no differences in patients' beliefs in treatment.
Conclusions
Acupuncture is an effective short term treatment for patients with chronic neck pain, but there is only limited evidence for long term effects after five treatments.
What is already known on this topicAcupuncture is a widespread complementary treatmentEvidence from trials have given conflicting results on its use in the treatment of neck pain because of methodological shortcomings and because effects were compared either with alternative treatments or with different sham procedures imitating acupuncture, but not bothWhat this study addsCompared with sham laser acupuncture and massage, needle acupuncture has beneficial effects on mobility and pain related to motion in patients with chronic neck painAcupuncture was clearly more effective than massage, but differences were not always significant compared with sham laser acupunctureAcupuncture was the best treatment for patients with the myofascial syndrome and those who had had pain for longer than five years
PMCID: PMC33515  PMID: 11431299
25.  A comparative study on vaccination pain in the methods of massage therapy and mothers’ breast feeding during injection of infants referring to Navabsafavi Health Care Center in Isfahan 
Background:
Vaccination is one of the most common painful procedures in infants. The irreversible consequences due to pain experiences in infants are enormous. Breast feeding and massage therapy methods are the non-drug methods of pain relief. Therefore, this research aimed to compare the vaccination-related pain in infants who underwent massage therapy or breast feeding during injection.
Materials and Methods:
This study is a randomized clinical trial. Ninety-six infants were allocated randomly and systematically to three groups (breast feeding, massage, and control groups). The study population comprised all infants, accompanied by their mothers, referring to one of the health centers in Isfahan for vaccination of hepatitis B and DPT at 6 months of age and for MMR at 12 months of age. Data gathering was done using questionnaire and checklist [neonatal infant pain scale (NIPS)]. Data analysis was done using descriptive and inferential statistical methods with SPSS software.
Results:
Findings of the study showed that the three groups had no statistically significant difference in terms of demographic characteristics (P > 0/05). The mean pain scores in the breast feeding group, massage therapy, and control group were 3.4, 3.9, and 4.8, respectively (P < 0.05). Then the least significant difference (LSD) post hoc test was performed. Differences between the groups, i.e. massage therapy and breast feeding (P = 0.041), breast feeding group and control (P < 0.001), and massage therapy and control groups (P = 0.002) were statistically significant.
Conclusion:
Considering the results of the study, it seems that breast feeding during vaccination has more analgesic effect than massage therapy. Therefore, it is suggested as a noninvasive, safe, and accessible method without any side effects for reducing vaccination-related pain.
PMCID: PMC3917134  PMID: 24554949
Breast feeding; Iran; massage therapy; pain; vaccination

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