A recent study published in JAMA Network Open reviews evidence to determine whether massages effectively relieve pain.

Study: Use of massage therapy for pain, 2018-2023. Image Credit: baranq / Shutterstock.com

An overview of massage therapy

Complementary and integrative medicine is a welcome alternative for many individuals who do not experience relief through or oppose the principles of modern medicine.

Massage, for example, is widely used in complementary medicine and involves manually evaluating and manipulating soft tissues on the body's surface to provide therapeutic results. These soft tissues include skin, muscle, ligaments and tendons, fascia, and structures within these tissues.

Massage therapy should be performed by trained personnel who may utilize multiple techniques performed in various styles over different durations. Despite its widespread popularity and historical use, little evidence confirming the efficacy of massage therapy in managing physical pain exists.

About the study

The current study is an evidence map, a type of systematic review. Its objective is to identify available evidence examining the efficacy of massage in pain treatment, identify knowledge gaps, and present this information in an easily understandable format.

This evidence map was requested by the United States Department of Veterans Affairs (VA) to update an earlier review covering systematic reviews through 2018. The current review included 17 of 129 earlier reviews of massage therapy for pain in adults. All included reviews were published from 2018 onwards.

Of the identified studies, only 41 evaluated the quality of evidence of their conclusions. These were categorized by the presence of one or more conclusions supported by high-certainty evidence, one or more with moderate-certainty evidence, and all findings made from poor evidence.

The efficacy of certain techniques, such as sports massage, osteopathy, needling and cupping, internal massage therapy, and foam rolling, which is considered a form of self-massage, was not examined in the current study.

What did the study show?

The 17 reviews included in the current review were rated fair or good in quality. These studies examined 13 adult health conditions with pain, including cancer pain, back pain, neck pain, fibromyalgia, plantar fasciitis, postpartum pain, and postoperative pain of various sorts.

Of the 17 studies, 14 examined a single type of massage therapy: non-specified massage therapy, acupressure, myofascial release, and tuina. Comparators included placebo, usual care, or active therapy, with either one or multiple being used, depending on the study.  

Seven conclusions with moderate certainty evidence were presented for their beneficial effects in the specified conditions. These conditions comprised chronic low back pain in three studies, pain after breast cancer surgery, labor pain, fibromyalgia, and myofascial pain. The modalities employed in these studies included myofascial release, unspecified massage therapy, and acupressure.

All remaining conclusions were based on evidence of low or very low certainty.

Conclusions

This study found that despite hundreds of randomized clinical trials and dozens of systematic reviews since 2018, there were few conclusions [regarding massage therapy] that had greater than low certainty of evidence.”

Despite the abundance of literature on massage therapy as a treatment for pain, conclusions as to its beneficial effect could be obtained with reasonable certainty for only seven conditions. These conditions included chronic and short-term low back pain, labor pain, post-breast cancer, fibromyalgia, myofascial pain, and low back pain treated with physical therapy.

In fact, massage could not be definitively considered effective in the treatment of most of the other conditions. Furthermore, the evidence regarding the adverse effects of massage therapy was of low certainty.

Sham massage is not an ideal placebo, as it involves some form of touch, which is related to better outcomes. Rather than using sham massage as a comparator, future studies may benefit from comparing the effects of massage therapy with standard treatments for each condition.

Greater precision of criteria and definition must precede truly rigorous systematic reviews. More extended follow-up periods are also crucial to exclude the effects of any unexpected or nonspecific outcomes. For example, allowing for a gap of six months before undergoing massage therapy trials in chronic pain conditions could help achieve this objective.

The most critical research need is for better evidence to increase certainty of evidence for massage therapy for pain.”