Sherman KJ, Cherkin DC, Hawkes RJ, Miglioretti DL, Deyo RA.

Randomized trial of therapeutic massage vs self-care book for chronic neck pain.

Center for Health Studies, Group Health Cooperative, 1730 Minor Ave, Ste 1600, Seattle, WA 98101. Sherman.k@ghc.org

PURPOSE: While therapeutic massage is one of the most popular CAM treatments for neck pain, little is known about its effectiveness. This study was designed to obtain preliminary estimates of the effectiveness and safety of therapeutic massage compared with and a book about self-management of neck pain.

METHODS: Patients aged 20 to 64 years with neck pain for at least 3 months were recruited from Group Health Cooperative and randomized to receive either up to 10 massages over a 10 week period (n=32) or a self-care book (n=32). The primary outcomes measures were dysfunction (Neck Disability Index-NDI) and symptom bothersomeness (0 to 10 scale), while secondary outcomes included patient global rating of improvement and medication usage. Follow-up telephone interviews were conducted after 4, 10, and 26 weeks. Relative risks and 95% confidence intervals (CI) were computed to assess the difference in clinically meaningful responses between groups (i.e., > 5 point improvement on the NDI; > 30% improvement from baseline on the bothersomeness scale).

RESULTS: All of the participants randomized to massage made at least one visit, with a median of 8 visits. One massage participant dropped out because of increased pain after the first visit, but no serious adverse events were reported. Follow-up rates exceeded 90% at all time points. At 10 weeks, participants in the massage group were more likely to experience a clinically significant improvement on the NDI (48% vs. 18% of controls; RR= 2.7; 95% CI=1.2-6.5) and on the bothersomeness scale (55% vs. 25% of controls; RR=2.2; 95% CI=1.1-4.5). At 26 weeks, the differences in function had attenuated slightly but still favored massage (RR=1.8; 95% CI=1.1-3.3). However, no group difference was seen in symptom bothersomeness (RR=1.1 ; 95% CI=0.6-2.0). Using the patient global rating of improvement, participants in the massage group rated themselves as "better or much better" twice as often as those in the control group (10 weeks: 55% vs. 25%, RR=2.2, 95% CI=1.1-4.5; 26 weeks: 43% vs. 25%; RR=1.7; 95% CI=0.8-3.7). Medication usage in the massage group remained similar throughout the trial (56% at baseline, 53% at 10 and 26 weeks), while medication usage in the book group increased slightly from 63% at baseline to 77% at 26 weeks.

CONCLUSION: These data demonstrate that clinical trials comparing therapeutic neck massage to a self-care intervention are feasible, that massage is a safe treatment for neck pain and that further trials of massage for neck pain are warranted.

 

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