Clinical Question: Can massage improve disability and decrease symptoms in patients with chronic low back pain?

Bottom Line: Weekly massage for 10 weeks, either a general relaxation massage or one aimed specifically at addressing musculoskeletal contributions to low back pain, produces a clinically meaningful reduction in dysfunction and symptoms as compared with usual care. The effect diminishes but functional improvement persists for up to 1 year after the start of treatment. (Level of Evidence: 1b)

Reference: Cherkin DC, Sherman KJ, Kahn J, et al. A comparison of the effects of 2 types of massage and usual care on chronic low back pain. Ann Intern Med 2011;155(1):1-9.

Study Design: Randomized controlled trial (single-blinded)

Funding Source: Government

Allocation: Concealed

Setting: Outpatient (primary care)

Synopsis: These investigators invited adults with chronic (at least 3 months), nonspecific low back pain to participate in this study. A total of 401 patients were randomized, using concealed allocation, to receive 1 of 3 treatments: either of 2 different types of massage or usual care. Massage consisted of 10 weekly sessions using either relaxation or structural massage, the latter consisting of myofascial, neuromuscular, and other soft-tissue techniques. The usual care group received no specific care. At the end of 10 weeks, dysfunction, measured by the Roland Disability Questionnaire, improved an average of 2.5 and 2.9 points out of a possible 23 points with the 2 types of massage as compared with usual care. A difference of 2 points on this scale is considered clinically meaningful. Improvements were similar with either type of massage. "Bothersomeness" of pain, rated 5.6 to 5.8 on a scale of 1 to 10, decreased an average 1.4 and 1.7 points as compared with usual care. Differences in function scores diminished over time but were still present 1 year after the start of the study.