A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain A Randomized, Controlled Trial

Background: Few studies have evaluated the effectiveness of massage for chronic low back pain. Objective: To compare the effectiveness of 2 types of massage and usual care for chronic back pain. Design: Parallel-group randomized, controlled trial. Randomization was computer-generated, with centralized allocation concealment. Participants were blinded to massage type but not to assignment to massage versus usual care. Massage therapists were unblinded. The study personnel who assessed outcomes were blinded to treatment assignment. (ClinicalTrials. gov registration number: NCT00371384) Setting: An integrated health care delivery system in the Seattle area. Patients: 401 persons 20 to 65 years of age with nonspecific chronic low back pain. Intervention: Structural massage (n = 132), relaxation massage (n = 136), or usual care (n = 133). Measurements: Roland Disability Questionnaire (RDQ) and symptom bothersomeness scores at 10 weeks (primary outcome) and at 26 and 52 weeks (secondary outcomes). Mean group differences of at least 2 points on the RDQ and at least 1.5 points on the symptom bothersomeness scale were considered clinically meaningful. Results: The massage groups had similar functional outcomes at 10 weeks. The adjusted mean RDQ score was 2.9 points (95% CI, 1.8 to 4.0 points) lower in the relaxation group and 2.5 points (CI, 1.4 to 3.5 points) lower in the structural massage group than in the usual care group, and adjusted mean symptom bothersomeness scores were 1.7 points (CI, 1.2 to 2.2 points) lower with relaxation massage and 1.4 points (CI, 0.8 to 1.9 points) lower with structural massage. The beneficial effects of relaxation massage on function (but not on symptom reduction) persisted at 52 weeks but were small. Limitation: Participants were not blinded to treatment. Conclusion: Massage therapy may be effective for treatment of chronic back pain, with benefits lasting at least 6 months. No clinically meaningful difference between relaxation and structural massage was observed in terms of relieving disability or symptoms.