Pain Management

Massage

Massage are used primarily to treat musculoskeletal pain. Their benefit is well known in a number of musculoskeletal pain disorders, although there are significant differences among therapists as to how treatment is delivered.

Table 6. Massage in Post-SCI Pain

Author Year Country PEDro Score Research Design Total Sample Size	Methods	Outcome
Lovas et al. 2017 Australia RCT PEDro=4 N=40	Population: Mean age=46.0±11.6 yr; Gender: males=34, females=6; Time since injury=18.4±12.1 yr; Level of injury: paraplegia=30, tetraplegia=9; Severity of injury: complete=20, incomplete=19; Type of pain=neuropathic and musculoskeletal. Intervention: Participants were randomized to either a Swedish upper body massage group (MT) or n active concurrent control guided imagery (GI) relaxation group for 5 wks with one session per wk. Outcome Measures: Short-form McGill pain questionnaire (MPQ) and Chalder’s fatigue scale (CFS).	1. No significant differences between groups for pain severity scores (p>0.05). 2. Pain scores reduced significantly over time from pre-treatment to post-treatment in both groups (p<0.01). 3. No significant interaction effect between groups and intervention over time (p<0.05). 4. No significant between-group differences in overall CFS scores (p>0.05). 5. Fatigue scores reduced significantly over time (p<0.01). 6. No significant interaction effect between groups and intervention over time (p>0.05).
Chase et al. 2013 USA RCT PEDro=5 N=40	Population: Age=40.24 yr. Sex: Males=33, Females=7; Mean time since injury was 69.35days. Severity of injury: complete=23. Incomplete=17. Type of pain=neuropathic and musculoskeletal. Intervention: SCI individuals in rehabilitation facility were randomly assigned to receive broad compression massage (BCM) or light contact touch (LCT) 3 times a week for 2 weeks and then crossed over to the alternative treatment after a 1 week wash-out period. Outcome Measures: Brief Pain Inventory (BPI); PHQ9.	1. Pain intensity reduced significantly more in the individuals receiving LCT first compared to the BCM group, p=0.01). 2. No significant difference between the groups was seen in PHQ9.
Norrbrink & Lundeberg 2011 Sweden Prospective Controlled Trial N=30	Population: Age=47.1 yr. Mean time since injury was 11.9 yr. Type of pain=neuropathic. Intervention: Participants were placed in one of two groups to receive acupuncture or massage therapy. Both groups consisted of 6 weeks with treatment twice a week. Outcome Measures: Visual Analogue Scale.	1. Worst pain intensity and pain unpleasantness improved significantly in the acupuncture group compared to the massage group. 2. However, no significant differences were seen in pain intensity between the two groups.

Author Year

Country

PEDro Score

Research Design

Total Sample Size

Methods

Outcome

Lovas et al. 2017

Australia

RCT

PEDro=4

N=40

Population: Mean age=46.0±11.6 yr; Gender: males=34, females=6; Time since injury=18.4±12.1 yr; Level of injury: paraplegia=30, tetraplegia=9; Severity of injury: complete=20, incomplete=19; Type of pain=neuropathic and musculoskeletal.

Intervention: Participants were randomized to either a Swedish upper body massage group (MT) or n active concurrent control guided imagery (GI) relaxation group for 5 wks with one session per wk.

Outcome Measures: Short-form McGill pain questionnaire (MPQ) and Chalder’s fatigue scale (CFS).

1. No significant differences between groups for pain severity scores (p>0.05).

2. Pain scores reduced significantly over time from pre-treatment to post-treatment in both groups (p<0.01).

3. No significant interaction effect between groups and intervention over time (p<0.05).

4. No significant between-group differences in overall CFS scores (p>0.05).

5. Fatigue scores reduced significantly over time (p<0.01).

6. No significant interaction effect between groups and intervention over time (p>0.05).

Chase et al. 2013

USA

RCT

PEDro=5

N=40

Population: Age=40.24 yr. Sex: Males=33, Females=7; Mean time since injury was 69.35days. Severity of injury: complete=23. Incomplete=17. Type of pain=neuropathic and musculoskeletal.

Intervention: SCI individuals in rehabilitation facility were randomly assigned to receive broad compression massage (BCM) or light contact touch (LCT) 3 times a week for 2 weeks and then crossed over to the alternative treatment after a 1 week wash-out period.

Outcome Measures: Brief Pain Inventory (BPI); PHQ9.

1. Pain intensity reduced significantly more in the individuals receiving LCT first compared to the BCM group, p=0.01).

2. No significant difference between the groups was seen in PHQ9.

Norrbrink & Lundeberg 2011

Sweden

Prospective Controlled Trial

N=30

Population: Age=47.1 yr. Mean time since injury was 11.9 yr. Type of pain=neuropathic.

Intervention: Participants were placed in one of two groups to receive acupuncture or massage therapy. Both groups consisted of 6 weeks with treatment twice a week.

Outcome Measures: Visual Analogue Scale.

1. Worst pain intensity and pain unpleasantness improved significantly in the acupuncture group compared to the massage group.

2. However, no significant differences were seen in pain intensity between the two groups.

No significant difference in pain intensity reduction post SCI was seen among those that received massage compared to guided imagery (Lovas et al. 2017) or acupuncture (Norrbrink & Lundeberg 2011). In a crossover RCT, Chase et al. (2013) found that patients that received light touch and then massage were more likely report reduction in pain intensity than those that received massage and then light touch. The study did not examine the effectiveness of either treatment compared to the alternative; hence, it is difficult to examine if one treatment itself is more effective than the other.