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April, 2016, Vol. 16, Issue 04

Massage Therapy Impacts Client Sensation of Pain and Unpleasantness

By Massage Therapy Foundation Contributor

Contributed by Beth Barberree, BA, RMT; Jolie Haun, PhD, EdS, LMT; April Neufeld, BS, LMT

Recently claims have been made about the impact of massage therapy on pain that contradict what we massage therapists have understood to be true: that massage therapy reduces pain. But how do we know what's really going on? This month, the Massage Therapy Foundation (MTF) provides a review of an article by Martha Menard, PhD, LMT published just last year in the journal, Global Advances in Health and Medicine. We're pleased to have Dr. Menard provide guest commentary in this review.

MTF: You identified in your article that 20% of Americans experience musculoskeletal pain at a high prevalence and the profound cost resulting from lost productivity; not to mention the impact on the quality of life for those who suffer from pain. Can you tell us a bit about what inspired you to take on this research project?

Dr. Menard: I had two goals in conducting this study. One was that a previous and widely-cited meta-analysis concluded that massage therapy had no immediate effect on pain. This finding was surprising to me and contrary to my own clinical experience, so I wanted to test it. The second was to evaluate the feasibility of conducting practice-based research in a solo massage therapy practice, realizing of course that I had an advantage by virtue of previous research training. One hundred sixteen first-time clients who presented with complaint of musculoskeletal pain consented to participate in the case series.

Massage Therapy Impacts Client Sensation of Pain and Unpleasantness - Copyright – Stock Photo / Register Mark MTF: Can you share your experience around the recruitment process? Is this something we could do as individual therapists in our practice?

Dr. Menard: Every eligible client was invited to participate on the standard intake form I use, which includes a statement asking for the client's written permission to de-identify and aggregate their individual intake and progress note data for the purpose of research, which might include publication. So the intake form included the study consent. The outcome measure of the VAS [visual analogue scale] for pain sensation and unpleasantness is one that I use as a standard assessment tool in my practice, because I see a number of people with pain. Basically, I asked clients if I could use the information I normally collect anyway in my practice for research purposes, and I think that is something any individual therapist could do.

Ninety-four women and twenty-two men aged 18 to 86 years with an average age of 42 years participated, nearly all of whom were Caucasian. They were oriented to the study in a standardized fashion to garner a common understanding of what is meant by "pain sensation" and "unpleasantness."

MTF: Why was it important to distinguish between "pain sensation" and "unpleasantness?"

Dr. Menard: Pain is a complex and multidimensional phenomenon and the experience of pain can vary quite a bit depending on our emotional state. Imagine banging your shin on the coffee table just after you've had some good news and you're happy...maybe you find out that you won $1000 in the lottery...how much would that pain in your shin bother you? Then imagine that same degree of physical pain on a day when you've had some bad news and you're upset...you got fired from your job after arguing with your boss. Now how much would that same pain bother you? So, a single VAS rating may not capture the affective or emotional dimension of pain. Asking people to separate the physical sensation of the pain from how much it bothers them or how unpleasant it is and to rate these separately is a quick way to capture a slightly more nuanced measure of what is a highly subjective experience.

A single 60-minute session of individualized therapeutic massage was delivered to each participant by an experienced therapist. Techniques used during the treatment included Swedish massage, deep tissue, myofascial, positional release, passive and resisted joint mobilization, and biofield modalities. Visual Analog Scales (VAS) for pain sensation and unpleasantness were used to collect information before and then after the massage. The results showed that both pain sensation and unpleasantness were significantly reduced by a single session of therapeutic massage, suggesting that after one visit clients experience pain relieving benefits from massage. This study yields exciting outcomes given that so many people are negatively impacted by pain, both clients and their loved ones.

MTF: In the article, you state that "the results are both statistically and clinically meaningful, particularly the substantial reduction in pain unpleasantness" (p. 59, Menard, 2015). Can you explain what this means, and what opportunities therapists have to use these results to advocate for massage therapy care?

Dr. Menard: One of the comments that a number of clients spontaneously made when we were assessing their pain after the massage was typically along the lines of, "Gee, I can still feel it a little, but you know, it really doesn't bother me." While this study focused on acute musculoskeletal pain, I believe that there are important implications for pain management more widely. For example, by reducing pain unpleasantness, massage therapy could facilitate recovery in acute situations, for example, rehabilitation following joint replacement surgery. It could possibly encourage people with chronic pain conditions to be more active, which is often very helpful in increasing their ability to function. But that would require additional research using a more rigorous design. This observational study does however provide intriguing evidence to support further investigation.

In the article, Dr. Menard described some limitations of case series as a research method, which also apply to her study. These included the lack of a comparison group and risk for selection bias. She attempted to offset the latter by using a thoughtful research design, prospective with consecutive sampling, and restricting participants to those who were first time clients. Despite this, the author acknowledged that clients may have had been predisposed to expect the massage would benefit them if they had previous experience with massage therapy care. The article also mentioned that results of case series and case studies are often not as broadly generalizable as with empirical studies and that perhaps a less experienced therapist with fewer techniques to draw upon might have different outcomes.

Despite the limitations, case reports and case series provide descriptive information about massage therapists' experiences during practice, which are vital to supplement and inform empirical research. There is much we have yet to learn about client experience and massage therapy's effect on pain.

MTF: Do you have any words of advice for others who might be curious and interested in research?

Dr. Menard: A case report or case series is certainly possible for any motivated practitioner to carry out, and is really only a slightly more formalized way of documenting the same process of clinical reasoning that we use daily in our practices. My advice would be to get the support you need in planning a useful case report. The Massage Therapy Foundation website has many good resources, as does www.CaseRe3.org, especially the Learning Resources community. Writing a case report also makes you eligible to submit it to the Massage Therapy Foundation Case Report Contest, too!

To read other studies regarding massage, please view the Massage Therapy Foundation review article archives, browse accepted MTF Research Grant abstracts, or search PubMed for massage therapy research.

Case reports play an important role in scientific and professional literature. Writing a case report helps develop communication skills, critical thinking skills, and could contribute to future research and clinical practice. The Massage Therapy Foundation offers students the opportunity to advance their research skills with the Student Case Report Contest. Submissions are due by June 1st, 2016. Find out more at: www.massagetherapyfoundation.org/student-practitioner-case-report-contests.

Reference:

  1. Brown Menard, M. (2015). Immediate effect of therapeutic massage on pain sensation and unpleasantness: A consecutive case series. Global Advances in Health and Medicine 4(5), 56-60.

Registration is now open for the International Massage Therapy Research Conference in Seattle May 12-15, 2016. Visit www.massagetherapyfoundation.org for more updates and registration information.


Click here for more information about Massage Therapy Foundation Contributor.

 

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