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Research With Massage Therapy Foundation

By Massage Therapy Foundation Contributor

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Chronic Pain and Opioid Dependency

Is there a benefit to providing massage therapy?

Contributed by Jolie Haun, PhD, EdS, LMT; Natalie Lorick, LMT; MK Brennan, MS, RN, LMBT

For many individuals, chronic pain impacts activities of daily living, results in increased health care utilization, and contributes to opioid addiction. Massage therapy has demonstrated chronic pain symptom relief however, there is little evidence published about the use of massage as an adjunctive therapy during opioid-replacement treatment despite its demonstrated use in relieving chronic pain symptoms in other populations.

This month's Massage Therapy Foundation article review focuses on a recent publication in the International Journal of Therapeutic Massage and Bodywork by Adams et al, which evaluated the efficacy of Swedish massage in pain reduction with a cohort of opioid-dependent patients with chronic pain undergoing methadone treatment.

Chronic Pain and Opioid Dependency - Copyright – Stock Photo / Register Mark The clinical trial was conducted at a nonprofit methadone treatment center serving low-income patients. A two group randomized clinical trial was conducted to test the study outcomes. Twenty-seven patients were selected to be in a group that received massage plus treatment-as-usual and 24 patients were randomized to a control group (treatment-as-usual only) for eight weeks, with a follow-up visit four weeks after completing the intervention. Those randomized to the massage plus treatment-as-usual group received a weekly 50-minute Swedish massage session. Eligibility criteria included a requirement that participants receive methadone treatment for at least 90 days since more than one third of patients at the clinic withdraw within the first 90 days. The chronic pain assessment done when new patients started at the clinic was used during the participant selection process and baseline data was collected before randomization.

The main outcome measures included pain, anxiety, depression, physical functioning, decreased substance use, and improvement in treatment engagement. Assessments were done weekly or monthly depending on the outcome being measured. All assessments were repeated at week 12 to evaluate the durability of the massage effect.

Participants from both groups were comparable at baseline for demographic, pain, physical, and emotional variables. The massage group reported improved pain scores with worst pain showing a clinically significant 2-point improvement while the other pain scores did not. Overall improvements were not observed in treatment engagement or levels of anxiety, depression, or physical functioning. A subgroup of the participants, who felt they could be pain-free, consistently reported improvements in pain from baseline to week 8, and this was most pronounced and clinically significant in the massage group. By week 12, this improvement was diminished and the massage participants reported the highest levels of being worse.

The findings of this study do not indicate a clinically significant positive effect of massage in pain reduction or improvement in anxiety, depression, or treatment engagement in a substance-using, opioid-dependent population with chronic pain. However, study limitations should be noted when interpreting the study findings, such as small sample size, absence of a true placebo, variation in types of chronic pain, restriction to one massage type, the role of belief in being pain-free, and potential self-activation characteristics. Authors suggest as future research efforts are planned the challenges and limitations faced in this project should be considered.

These study findings contribute to the field of massage therapy and practice. Massage therapists and bodyworkers should note the potential limitations of using Swedish massage when working with opioid-dependent patients with chronic pain. The study results also indicate the need to examine the use of massage in conjunction with other adjunctive therapies when addressing pain symptom management in an opioid-dependent population with chronic pain.

Are you interested in learning more about the uses of manual therapies to alleviate pain and promote quality of life for patients? To learn more about the effects of massage therapy, you can read the Massage Therapy Foundation review article archives, review accepted MTF Research Grant abstracts, or search PubMed for massage therapy studies.

The Massage Therapy Foundation Student and Practitioner Case Report Contests are intended to enhance professional development and research skills. The deadline to submit to the Practitioner Case Report Contest is October 3, 2016. Find out more information and who has won past case report competitions by visiting www.massagetherapyfoundation.org/student-practitioner-case-report-contests/.

Reference:

  1. 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.
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