Does Massage Therapy Significantly Improve Function in Patients With Post-Surgical Pain?

A systematic review and meta-analysis conducted by researchers from the Samueli Institute in Alexandria, Virginia showed relative safety and efficacy of massage therapy in relieving post-surgical pain and anxiety.¹

“While we hypothesized that our research would show some results, we were impressed by some of the findings, most notably the finding that massage therapy is associated with an average of an almost 3-point reduction on a 10 point pain scale compared to doing nothing at all,” Wayne Jonas, MD, Samueli Institute President & CEO, told Clinical Pain Advisor.

“Additionally, cancer patients who receive massage therapy as a complementary treatment for pain experience improvements, especially in pain, anxiety and fatigue. Massage therapy is associated with an average of at least a 1 point reduction on a 10-point pain scale compared to other treatments. And patients who receive massage therapy as a complementary treatment for surgical-related pain management experience improvements, especially in pain and anxiety.”^1,2

While surgical pain is primarily treated with opioids and other pharmacologic analgesics, there are significant risks associated with these treatments.^3,4 “Opioid-based analgesia, for instance, is associated with various side effects ranging from nausea and vomiting to respiratory depression and possible dependence, addiction, and/or abuse,” wrote the authors.⁵

They also noted that rather than simply managing the physical pain resulting from surgery, a more effective method would also treat pain-related fear and anxiety.

For this meta-analysis, the researchers had several goals:

• To more clearly define massage and its function relating to surgery.
• To determine the efficacy of pre- or post-operative massages in relieving pain. 
• To describe characteristics of therapeutic massage and address safety concerns.
• To formulate recommendations on massage therapy.
• To identify gaps in previous research and to address these to inform future studies.

The investigators searched PubMed, CINAHL, Embase, and PsycInfo from the study’s beginning to February 2014, and included 12 high- and 4 low-quality studies in their review.

Massage therapy was found to effectively treat pain [standardized mean difference (SMD) = −0.79] and anxiety (SMD = −0.57).

“Based on this systematic review and meta-analysis, massage therapy was found to not only be relatively safe, with infrequent adverse events, but also more efficacious than other active treatments for treating pain and anxiety in surgical populations,” the researchers wrote. None of the studies included in this analysis reported massage-related adverse events.

While most of the studies included in the analysis were of high quality, the researchers noted several issues that prevented them from formulating conclusive guidelines on massage therapy in surgery:

1. Many of the studies did not identify the specifics of massage therapy used, including:

• The type of therapy required for different surgeries
• The location of the massage and the amount of time spent in that location
• The amount of pressure applied
• The amount of time massage was administered
• Practitioner type and qualifications
• Credentialing and licensing requirements 

“These factors must be carefully considered before clinical guidelines regarding the use of massage in surgical units across hospitals can be created,” the authors wrote.

2. Optimal time to administer massage in surgical patients (ie, preceding or following surgery).

3. Appropriate placebo group to study massage. To ensure that massage “is not being given an ‘unfair advantage’ by comparing it to inappropriate controls, massage must be assessed against controls that are equally credible, acceptable, and seemingly identical to massage. Perhaps the most promising comparison group, then, would be a sham group (eg, sham massage, light touch),” the authors wrote. However, they also noted that there is disagreement about whether this would truly be a placebo; some believe that even a light touch massage would “elicit nonspecific physiological effects” and would therefore not constitute a true placebo, while others believe that because physical touch between people is common, it would be an effective placebo.

The researchers also believe that future studies should measure patients’ and practitioners’ expectations during the trial period, as it might contribute to a placebo effect.

“Once these gaps are addressed, comparative effectiveness research can be proposed, taking into account cost benefit analyses in order to determine whether massage therapy is an appropriate intervention to offer patients who are either about to undergo or are recovering from surgical procedures in hospital settings,” the authors wrote.

The researchers concluded that results from this analysis are promising, and that future research should take offered recommendations into account. “The results are clear: when properly delivered by certified massage therapists, massage is effective for the treatment of pain,” said Dr Jonas.

Disclosures

Funding for this project was provided by the Massage Therapy Foundation through the support of the American Massage Therapy Association. 

The Evidence for Massage Therapy (EMT) Working Group (diverse stakeholders making up the steering committee and subject matter experts) contributed to the protocol development and provided input throughout the entire project. All analyses were conducted independently by the Samueli Institute.

All recommendations set forth in this report were made collectively with the EMT Working Group and Samueli Institute during an expert round table and are based on the evidence revealed through the systematic review and gaps in research that emerged through the process.

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References

1. Boyd C, Crawford C, Paat CF, Price A, Xenakis L, Zhang W. The Impact of Massage Therapy on Function in Pain Populations—A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part III, Surgical Pain Populations. Pain Med. Published online May 10, 2016. doi:10.1093/pm/pnw101.
2. Crawford C, Boyd C, Paat C, et al. The impact of massage therapy on function for the general population experiencing pain—A systematic review and meta-analysis of randomized controlled trials: Part I, patients experiencing pain in the general population. Pain Med. 2016. doi:10.1093/pm/pnw099.
3. Adams R, White B, Beckett C. The effects of massage therapy on pain management in the acute care setting. Int J Ther Massage Bodywork. 2010;3(1):4–11.
4. Mitchinson AR, Kim HM, Rosenberg JM, et al. Acute postoperative pain management using massage as an adjuvant therapy: A randomized trial. Arch Surg. 2007;142(12):1158–1167.
5. Clarke H, Woodhouse LJ, Kennedy D, Stratford P, Katz J. Strategies aimed at preventing chronic post-surgical pain: Comprehensive perioperative pain management after total joint replacement surgery.Physiother Can. 2011;63(3):289–304.