A Systematic Review and Meta-Analysis of Efficacy, Cost-Effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-Back Pain

doi:10.1155/2012/953139

PMC full text:

Evid Based Complement Alternat Med. 2012; 2012: 953139.

Published online 2011 Nov 24. doi: 10.1155/2012/953139

Copyright/License ►Request permission to reuse: Copyright © 2012 Andrea D. Furlan et al.
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Table 8

Summary of findings of massage for low-back pain (only pain and functional outcomes).

Duration and cause of pain	Outcomes	GRADE*	Findings
Massage versus no treatment

Acute/subacute nonspecific	Pain intensity score (VAS)	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	One trial showed significant short-term posttreatment benefit with massage (VAS: 37.0 ± 19.0 versus 52.0 ± 21.0, P < 0.001) [139].
Acute/subacute nonspecific	Oswestry Disability Index	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	One trial showed significant short-term posttreatment benefit with massage (Oswestry: 16.0 ± 5.0 versus 31.0 ± 12.0, P < 0.001) [139].

Acute/subacute, specific	NA	Insufficient No trial	NA

Chronic nonspecific	Pain intensity score (SF-36 pain scale)	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial, massage (reflexology) was not significantly different from no treatment immediately posttreatment (mean score: 50.0 ± 25.7 versus 41.8 ± 25.6) and in the intermediate-term followup (mean score: 50.7 ± 27.1 versus 44.4 ± 28.5) [140].
Chronic nonspecific	Oswestry Disability Index	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial, massage (reflexology) was not significantly different from no treatment immediately posttreatment (mean score: 29.8 ± 19.6 versus 36.7 ± 19.9) and in the intermediate-term followup (mean score: 29.0 ± 20.2 versus 32.9 ± 17.6) [140].

Chronic specific	NA	Insufficient No trial	NA

Mixed/unknown (specific, nonspecific)	NA	Insufficient No trial	NA

Massage versus placebo

Acute/subacute, nonspecific	Pain intensity score (VAS, MPQ)	Moderate Design: RCT ROB: Medium Consistency: yes Directness: yes	In two trials massage produced significantly lower immediate and short-term posttreatment pain intensity compared to placebo [139, 141].
	Oswestry Disability Index	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In two trials massage produced significantly better disability scores compared to placebo [139, 141].
	Roland-Morris Disability Questionnaire	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes

Acute/subacute, specific	NA	Insufficient No trial	NA

Chronic nonspecific	Pain intensity score (VAS, MPQ)	Low Design: RCT ROB: High Consistency: NA (one trial) Directness: yes	In one trial, massage (reflexology) had numerically similar degree of improvement in intermediate-term pain intensity (VAS: 2.2 versus 3.3, MPQ: 6.0 versus 7.5), compared to subjects in the placebo group [142].
Chronic nonspecific	Roland-Morris Disability Questionnaire	Low Design: RCT ROB: High Consistency: NA (one trial) Directness: yes	In one trial, massage (reflexology) had numerically similar degree of improvement in intermediate-term disability (RMDQ: 4 versus 3.5) compared to subjects in the placebo group [142].

Chronic specific	NA	Insufficient No trial	NA

Mixed/unknown (specific, nonspecific)	NA	Insufficient No trial	NA

Massage versus physiotherapy

Acute/subacute, mixed, and unknown (specific, nonspecific)	NA	Insufficient No trial	NA

Chronic nonspecific	Pain intensity score (VAS, MPQ)	Moderate Design: RCT ROB: Medium Consistency: yes Directness: yes	The meta-analysis of two trials showed a statistically significant difference in favour of massage over physical therapy in reducing pain intensity immediately posttreatment (pooled mean difference on VAS score: −2.11, 95% CI: −3.15, −1.07) [143, 144].
Chronic nonspecific	Roland-Morris Disability Questionnaire and modified Oswestry Disability Index	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	The mean total RMDQ score immediately posttreatment was significantly lower in the acupressure group than in the physical therapy group (−3.8, 95% CI: −5.7, −1.9) [143]. The mean total ODI score immediately posttreatment was significantly lower in the acupressure group than in the physical therapy group, (− 5.34, 95% CI: −7.62, −3.05) [143].

Chronic specific	NA	Insufficient No trial	NA

Massage versus relaxation

Acute/subacute, mixed, and unknown (specific, nonspecific)	NA	Insufficient No trial	NA

Chronic nonspecific	Pain intensity score (VAS)	Low Design: RCT ROB: High Consistency: yes Directness: yes	The meta-analysis of two trials showed a significantly lower pain intensity with massage compared to relaxation (mean difference: −1.27, 95% CI: −2.46, −0.08) [145, 146]. A third trial not pooled in the meta-analysis [140] did not demonstrate any significant immediate (or intermediate-term) posttreatment differences in pain (immediate posttreatment score: 50.0 ± 25.7 versus 47.2 ± 26.3).
Chronic nonspecific	Oswestry Disability Index	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial, massage (reflexology) was not significantly different from relaxation immediately posttreatment (mean score: 29.8 ± 19.6 versus 33.4 ± 23.3) and in the intermediate-term followup (mean score: 29.0 ± 20.2 versus 31.3 ± 21.1) [140].

Chronic specific	NA	Insufficient No trial	NA

Massage versus usual care

Acute/subacute, mixed, and unknown (specific, nonspecific)	NA	Insufficient No trial	NA

Chronic nonspecific	Pain intensity score (VAS)	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial, there was no significant difference between massage and usual care (prescription by physician and behavioural counselling with practice nurse) measured in the intermediate-term followup, mean change scores −0.41 (95% CI: −0.91, 0.09) and −0.32 (95% CI: −0.66, 0.03) for massage and usual care respectively [147].
Chronic nonspecific	Roland-Morris Disability Questionnaire	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial, there was no significant difference between massage and usual care (prescription by physician and behavioural counselling with practice nurse) measured in the intermediate-term followup, mean change score −1.96 (95% CI: −0.74, 3.18) and −0.90 (95% CI: −1.76, 0.04) for massage and usual care respectively [147].

Chronic specific	NA	Insufficient No trial	NA

Massage versus exercise

Acute/subacute, nonspecific	Pain intensity score (VAS)	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial, comprehensive massage was significantly better than exercise. Mean scores in the massage and exercise group at the immediate posttreatment were 0.44 (95% CI: 0.17, 0.71) versus 1.64 (95% CI: 1.3, 2.0) and short-term posttreatment followups 0.42 (95% CI: 0.17, 0.66) versus 1.33 (95% CI: 0.97, 1.7) respectively [140].
Acute/subacute, nonspecific	Roland-Morris Disability Questionnaire	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	In one trial, comprehensive massage was significantly better than exercise. Mean scores in the massage and exercise group at the immediate posttreatment were 2.36 (95% CI: 1.2, 3.5) versus 6.82 (95% CI: 4.3, 9.3) and short-term posttreatment followups 1.54 (95% CI: 0.69, 2.4) versus 5.71 (95% CI: 3.5, 7.9) respectively [140].

Acute/subacute, specific	NA	Insufficient No trial	NA

Chronic nonspecific	Pain intensity score (VAS)	Moderate Design: RCT ROB: Medium Consistency: yes Directness: yes	Two trials showed no significant difference between massage and exercise [29, 147].
Chronic nonspecific	Roland-Morris Disability Questionnaire	Low Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes	One trial showed no significant difference between massage and exercise [147].

Chronic specific	NA	Insufficient No trial	NA

Mixed or unknown (specific and nonspecific)	NA	Insufficient No trial	NA

*Precision in formal grading was applied only to pooled results.

VAS: visual analog scale; RMDQ: Roland-Morris disability scale; MPQ: McGill pain questionnaire; PDI: pain disability index; NPQ: neck pain questionnaire; NA: not applicable; ROB: risk of bias; RCT: randomized controlled trial.