For a range of conditions, therapies based on complementary or alternative medicine are gaining acceptance in the medical community, although few have been rigorously evaluated. In Great Britain, an estimated 20 percent of physicians use such therapies, and more than 70 percent of physicians have referred patients for such treatments. Stress management is one of the most frequently cited reasons for use of complementary therapies. Therapeutic massage is one of several relaxation techniques available, but its effectiveness has not been clearly demonstrated. Hanley and colleagues compared the outcome of six sessions of therapeutic massage to outcomes associated with use of stress reduction programs that used relaxation tapes.

They recruited patients from a stress reduction clinic held once per week in a Scottish general practice. Eligible adult patients who had General Health Questionnaire (GHQ-30) scores of five or more (indicating significant stress levels) were invited for a screening interview to obtain baseline data and exclude patients with medical or psychiatric conditions. Eligible patients were randomly assigned to therapeutic massage (29 patients), use of a relaxation tape at home (28 patients), and use of relaxation tapes in the physician's office during weekly sessions (22 patients). The outcome measures were changes in scores on the GHQ-30, the Adapted Well Being Index (AWBI) and the Sleep Index, and the number of physician consultations during treatment and for six weeks after treatment.

Complete data were available for 69 patients who completed the treatments. Patients in all treatment groups had significant improvements in each of the three indexes of stress and a significant drop in the frequency of consultation with their physician in the six weeks after treatment. There was little change in the use of medication to relieve stress. The levels of improvement were almost identical in each group at three-week and six-week follow-ups. At the beginning of the study, 36 percent of the patients were taking medication to relieve stress. At follow-up, no new patients had started taking medication, four had decreased their dosage or stopped, and two had increased their dosage. Patient satisfaction with treatment was quite high. In each group, 84 to 91 percent of patients reported benefit, and 63 to 100 percent said they would have the same treatment again. The highest patient satisfaction scores were for therapeutic massage.

The authors conclude that therapeutic massage was no more effective than relaxation tapes in reducing stress in primary care patients. Although patients preferred therapeutic massage, it is an expensive intervention, requiring significant resources and equipment. Relaxation tapes, either used at home or during clinic sessions, are an equally effective intervention for significant stress reduction.