Clinical Briefs

With Comments from John La Puma, MD, FACP

Acupuncture and Massage Therapies for Low Back Pain

August 2001; Volume 4; 96

Source: Cherkin DC, et al. Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Arch Intern Med 2001;161:1081-1088.

"Because the value of popular forms of alternative care for chronic back pain remains uncertain, we compared the effectiveness of acupuncture, therapeutic massage, and self-care education for persistent back pain.

"We randomized 262 patients aged 20 to 70 years who had persistent back pain to receive traditional Chinese medical acupuncture (n = 94), therapeutic massage (n = 78), or self-care educational materials (n = 90). Up to 10 massage or acupuncture visits were permitted over 10 weeks. Symptoms (0-10 scale) and dysfunction (0-23 scale) were assessed by telephone interviewers masked to treatment group. Follow-up was available for 95% of patients after four, 10, and 52 weeks, and none withdrew for adverse effects.

"Treatment groups were compared after adjustment for prerandomization covariates using an intent-to-treat analysis. At 10 weeks, massage was superior to self-care on the symptom scale (3.41 vs. 4.71, respectively; P = 0.01) and the disability scale (5.88 vs. 8.92, respectively; P < 0.001). Massage was also superior to acupuncture on the disability scale (5.89 vs. 8.25, respectively; P = 0.01). After one year, massage was not better than self-care but was better than acupuncture (symptom scale: 3.08 vs. 4.74, respectively; P = 0.002; dysfunction scale: 6.29 vs. 8.21, respectively; P = 0.05). The massage group used the least medications (P < 0.05) and had the lowest costs of subsequent care.

"Therapeutic massage was effective for persistent low back pain, apparently providing long-lasting benefits. Traditional Chinese medical acupuncture was relatively ineffective. Massage might be an effective alternative to conventional medical care for persistent back pain."

Comment

The senior investigator in this trial, Dr. Rick Deyo, has contributed greatly to the back pain literature for nearly two decades, and his other colleagues in Seattle—Drs. Cherkin and Barlow, and Ms. Street—all have contributed significantly as well. They teamed up with Eisenberg and Kaptchuk at Harvard to answer questions that are common in clinical practice about treatment of chronic low back pain.

They surveyed nearly 4,000 HMO enrollees six weeks after a primary care visit for back pain, not knowing how many still had pain, and enrolled the first 262 to respond, with 95% follow-up after one year. Typically, their patients were white, well-educated, and employed; 58% were women. Sixteen percent had massage previously for low back pain, but only 3% had acupuncture.

These data are the first that I know of to suggest strongly that massage is an effective short-term treatment for chronic low back pain. To find a licensed massage therapist, contact the American Massage Therapy Association, phone: (847) 864-0123, or web site: www.amtamassage.org.

In addition, Cherkin and colleagues present data to suggest cost-effectiveness as well, noting the use of massage therapists, treatment protocols, and long-term follow-up. The reason for the superior outcomes was not ascertained, but possibilities range from spending an hour in a relaxed environment to increased body awareness.

Recommendation

Massage therapy should be strongly considered, together with mobilization, exercise, and short-term analgesics, in the treatment of chronic low back pain, at least in an educated, employed population. Patients prefer it, these excellent data support it, and it appears to be cost-effective as well.