Chronic Pain

What is chronic pain?

The International Association for the Study of Pain defines it as:  An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage 1. Chronic pain differs from acute pain, which generally results from injury, disease, or inflammation and is confined to a given period of time and severity (ibid.).

Chronic pain is believed to represent a disease itself and may be worsened by environmental and psychological factors (ibid.). Chronic pain lasts longer than acute pain and is resistant to many medical treatment. Chronic pain frequently causes severe problems for patients, and individuals may have multiple chronic pain conditions. Pain is the number one complaint of older Americans, and one in five older Americans takes a painkiller regularly (ibid.).

Chronic pain is a broad conditions including several others, including:

General/Specific Body Pains:

Back, Knee, Growing Pains, Injury, Leg, Lower Back, Musculoskeletal, Myofascial, Neck, Pelvic, PMS, Whiplash

Joint/Skeletal Pain:

Arthritis, Osteoarthritis, TMJD

Autoimmune Disease Related Pain:

Diabetes Type I, IBD, Lupus, MS, Rheumatoid Arthritis

Nervous System Damage:

Carpal Tunnel Syndrome, Central Pain Syndrome, Pinched Nerve, Neuropathic, Sciatica, Thoracic Outlet Syndrome

Psychological Conditions:

Depression, Post-Traumatic Stress Disorder

Other Chronic Illness:

Cancer, Chronic Fatigue Syndome, Fibromyalgia, HIV/AIDS

 

The research

Research provides good support that massage therapy is generally effective at reducing pain 2 5(p. 16). Moderately strong and fairly robust clinical evidence suggests that massage therapy may effectively improve chronic and subacute low back pain 1. A recent meta-analysis concluded that massage therapy did effectively reduce pain in the neck and low-back 2.

More limited and conflicting evidence exists for the efficacy of massage therapy in complaints of neck, arm and shoulder pain, 3 as well as in myofascial pain 4. Insufficient evidence exists for the effectiveness of massage therapy for knee pain 5, as well as for neck pain in association with disorders, including whiplash 6.

 

Examples of Types of Chronic Pain:  Arthritis and Chronic Fatigue Syndrome

Limited but increasingly strong research has demonstrated that massage therapy may be effective as a treatment for ranging types of arthritis, including juvenile rheumatoid arthritis, as well as hip and knee osteoarthritis 7 . One study rates the level of research on hip and knee OA as “silver level” such that there is demonstrated but inconclusive support, 8 though the short-term efficacy of massage therapy for short-term improvements in OA knee was found by one meta-analysis to suggest general effectiveness 8. Most recently, a study has suggested that a 60-minute “dose” of Swedish massage therapy may be optimal for treatment of knee OA, though they suggest that more definitive research is needed on massage for osteoarthritis of the knee, in terms of efficacy, how it may work in the body, and its cost-effectiveness for patients 9 .

If you consider the research on Chronic Fatigue Syndrome, for example, research is fairly robust.Chronic fatigue syndrome (CFS) is a debilitating and complex disorder characterized by profound fatigue that is not improved by bed rest but may be worsened by physical or mental activity 10. Symptoms affect several body systems and may include weakness, muscle pain, impaired memory and/or mental concentration, and insomnia, which can result in reduced participation in daily activities 11.

Research suggests that massage therapy may be an effective treatment for increasing overall wellness in individuals experiencing chronic fatigue syndrome, including: a short-term reduction in reported depression, anxiety, and pain; a longer term reduction in fatigue symptoms; as well as a longer-term reduction in other somatic symptoms occurring with CFS 12. Another RCT has demonstrated that a specific modality of massage therapy may yield positive effects on physical symptoms and the immune functions in individuals with chronic fatigue syndrome 13. A systematic review assessed the status of research as limited and therefore inconclusive though massage generally did have positive effects in the limited number of RCTs 14.

massage-therapy-for-pain5eeeImage courtesy of Ryan Hoyme, Hoyme Consulting

References

1 National Institutes of Health. 9/19/2012. Accessed at http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm on September 20, 2012.Cherkin DC, Eisenberg D, Sherman KJ, Barlow W, Kaptchuck TJ, Street J, Deyo RA. 2001. “Randomized Trial Comparing Traditional Chinese Medical Acupuncture, Therapeutic Massage, and Self-care Education for Chronic Low Back Pain.” Archives of Internal Medicine 161(8): 1080-88. Cherkin D, Sherman K, Deyo R, Shekelle P. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Intern Med 2003; 138(11): 898-906; Chou R, Huffman L. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med 2007; 147(7): 492-504; Dryden T, Baskwill A, Preyde M. Massage therapy for the orthopaedic patient: a review. Orthop Nurs 2004; 23(5): 327-34; Furlan A, Brosseau L, Imamura M, Irvin E. Massage for low-back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 2002; 27(17): 1896-910; Imamura M, Furlan A, Dryden T, Irvin E. Evidence-informed management of chronic low back pain with massage. Spine J 2008; 8(1): 121-33; Tsao J. Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review. Evid Based Complement Alternat Med 2007; 4(2): 165-79; van Tulder M, Furlan A, Gagnier J. Complementary and alternative therapies for low back pain. Best Pract Res Clin Rheumatol 2005; 19(4): 639-54. Plews-Ogan, Margaret, Owens, Justine E., Goodman, Matthew, Wolfe, Pamela, and John Schorling. 2005. “A Pilot Study Evaluating Mindfulness-Based Stress Reduction and Massage for the Management of Chronic Pain.” Journal of General Internal Medicine 20(12): 1136-38.

2Furlan, A.D., Yazdi F., Tsertsvadze A., Gross A., Van Tulder M., Santaguida L., Gagnier J., Ammendolia C., Dryden T., Doucette S., Skidmore B., Daniel, R., Ostermann, T., and S. Tsouros. 2012. “A systematic review and meta-analysis of efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine for neck and low-back pain.” Evidence-based Complementary and Alternative Medicine 2010:953139.

3Tsao J. Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review. Evid Based Complement Alternat Med 2007; 4(2): 165-79; Verhagen A, Karels C, Bierma-Zeinstra S, Burdorf L, Feleus A, Dahaghin S, et al. Ergonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder in adults. Cochrane Database of Systematic Reviews 2006(3); Verhagen A, Karels C, Bierma-Zeinstra S, Feleus A, Dahaghin S, Burdorf A, et al. Exercise proves effective in a systematic review of work-related complaints of the arm, neck, or shoulder. J Clin Epidemiol 2007; 60(2): 110-17; Karjalainen K, Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H, et al. Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults. Cochrane Database of Systematic Reviews 2003(3).

4Rickards L. The effectiveness of non-invasive treatments for active myofascial trigger point pain: a systematic review of the literature [corrected] [published erratum appears in Int J Osteopath Med 2007; 10(1): 32]. Int J Osteopath Med 2006; 9(4): 120-36.

5Philadelphia panel evidence-based clinical practice guidelines on selected rehabilitation interventions for knee pain. Phys Ther 2001; 81(10): 1675-700.

6Ezzo J, Haraldsson B, Gross A, Myers C, Morien A, Goldsmith C, et al. Massage for Mechanical Neck Disorders: A Systematic Review. Spine 2007; 32(3): 353-62; Graham N, Gross A, Goldsmith C, Klaber Moffett J, Haines T, Burnie S, et al. Mechanical traction for neck pain with or without radiculopathy. Cochrane Database of Systematic Reviews 2008(3); Gross A, Kay T, Hondras M, Goldsmith C, Haines T, Peloso P, et al. Manual therapy for mechanical neck disorders: a systematic review. Man Ther 2002; 7(3): 131-49; Committee GD. Chiropractic clinical practice guideline: Evidence-based treatment of adult neck pain not due to whiplash. Journal – Canadian Chiropractic Association 2005; 49(3): 158-209; Philadelphia panel evidence-based clinical practice guidelines on selected rehabilitation interventions for neck pain. Phys Ther 2001; 81(10): 1701-17; Verhagen A, Scholten-Peeters G, van Wijngaarden S, de Bie R, Bierma-Zeinstra S. Conservative treatments for whiplash. Cochrane Database of Systematic Reviews 2007(3).

7 Beider S, Mahrer N, Gold, G. Pediatric massage therapy: An overview for clinicians. Pediatr Clin N Am 2007; 54(6): 1025-41;; Zhang W, Moskowitz R, Nuki G, Abramson S, Altman R, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage 2007; 15(9): 981-1000.

8 French HP, Brennan A, White B, Cusack. “Manual therapy for osteoarthritis of the hip or knee: A systematic review.” Man Ther. 2011;16(2):109-17.

9 Bjordal JM, Johnson MI, Lopes-Martins RAB, Bogen B, Chow R, Ljunggren AE. “Short-term efficacy of physical interventions in osteoarthritis knee pain. A systematic review and meta-analysis of randomized placebo-controlled trials.” BMC Musculoskeletal Disorders 2007, 8:51, available online at http://www.biomedcentral.com/1471-2474/8/51/.

10 Perlman, A., Ali, A., Nijke, V., Horn, D., Davidi, A., Gould-Fogerite, S., Milak, C., and D. Katz. 2012. “Massage therapy for osteoarthritis of the knee: a randomized dose-finding trial. BMC Complementary and Alternative Medicine 12(Suppl 1):O33.

11 Centers for Disease Control and Prevention. “Chronic Fatigue Syndrome (CFS).” Lasted Updated on May 16, 2012. Accessed at <http://www.cdc.gov/cfs/> on 8/15/2012.

12 Field TM, Sunshine W, Hernandez-Reif M, Quintino O, Schanberg S, Kuhn C, Burman I: Massage therapy effects on depression and somatic symptoms in chronic fatigue syndrome. J Chronic Fatigue Syndr 1997;3:43-51.

13 Wang JH, Chai TQ, Lin GH, Luo L: Effects of the intelligent-turtle massage on the physical symptoms and immune functions in patients with chronic fatigue syndrome. J Tradit Chin Med 2009 ;29(1):24-28.

14 Alraek T, Lee MS, Choi TY, Cao H, Liu J. “Complementary and alternative medicine for patients with chronic fatigue syndrome: A systematic review.” BMC Compl and Alt Med . 2011;11:87. Accessed on 8/15/12 at persistent link: <http://www.biomedcentral.com/content/pdf/1472-6882-11-87.pdf>.