Thai Massage Effective in Relieving Chronic Pain
Massage Therapy Foundation Contributor
Thai Massage Effective in Relieving Chronic Pain
Massage Therapy Foundation Contributor
Contributed by Derek R. Austin, PT, DPT, MS, BCTMB, CSCS; April Neufeld, BS, LMT, BCTMB; S. Pualani Gillespie, LMT, MSN, RN, BCMTB
Traditional Thai Massage (TTM) is an ancient healing art that has been researched in several high-quality studies. A 2015 research review published in the peer-reviewed journal Complementary Therapies in Clinical Practice systematically identified these research articles. The authors attempted to quantify the studies' findings regarding decreases in pain and perceived muscle tension resulting from TTM. The researchers also explored whether TTM may be more effective than Swedish massage.
Using specific inclusion criteria, the authors found six research articles that they judged to be of high-quality research evidence, except one rated as moderate-quality. All six studies had random allocation of subjects and included an intention-to-treat analysis, which reduces biased. The studies found evidence that TTM decreases pain, reduces tension, and improves flexibility.
A study of 180 patients with chronic myofascial pain syndrome compared six 30-minute sessions of either TTM or Swedish massage (SM) over three to four weeks. Both groups reported significant reductions in pain relief and reduction in sensitivity to pressure after the first treatment session, post-treatment, and at a one month follow-up. Especially striking were the high levels of pain relief reported immediately post-treatment (62% for TTM and 63% for SM), as well as the levels of pain relief at a one month follow-up (56% for TTM and 52% for SM). The only significant difference between groups regarding pain relief showed SM to be superior after the first treatment session (25% for TTM and 35% for SM).
TTM was compared with joint mobilization in a group of 67 patients with non-specific low back pain. Patients randomly received either a 10-min session of TTM or lumbar joint mobilization, and they rated their pain levels using a Visual Analogue Scale before the treatment and five minutes after the session. TTM led to an average of 40% reduction in pain, while joint mobilization caused an average of 20% reduction in pain. There was a statistically significant difference between these findings in favor of TTM.
A randomized controlled trial (RCT) compared TTM to a resting condition of lying prone. A sample of 36 individuals with chronic myofascial pain received a single 30-minute session of either TTM or rest. TTM led to an immediate 56% reduction in pain intensity and 46% improvement in pressure pain threshold compared to baseline. Resting led to no change in either pain measure. These findings were highly statistically significant (p < 0.001).
A small study of 20 individuals with scapulocostal pain syndrome compared TTM to the physical therapy (PT) modalities of ultrasound therapy and hot packs. This study had amazingly large results, indicating that TTM was very effective in treating this condition. Participants received nine 30-minute sessions of either TTM or ultrasound therapy and hot packs. Individuals in the TTM group reported an average of 56% reduction in pain intensity after the first treatment (vs. 21% for modalities). The TTM group had an incredible 86% reduction in pain intensity pre- to post-treatment (vs. 36% for modalities). This result remained, and the subjects in the TTM group reported an 86% reduction in pain levels vs. baseline at a two-week follow-up (vs. 23% for modalities). The TTM group had similar findings for the reductions in pressure pain threshold and was statistically superior to the control group at all time points for both pain measures.
A similar study of 40 patients with scapulocostal pain syndrome also compared the immediate results of a single 30-minute session of TTM compared to PT modalities of ultrasound therapy and hot packs. Strong statistical significance (p < 0.001) showed TTM to be superior to modalities. Subjects in the TTM group reported an average of 35% reduction in pain intensity compared to only a 17% reduction in pain following modalities.
TTM was also compared to Swedish massage in relation to chronic low back pain. A study randomized 140 individuals to receive ten 30-minute sessions of either TTM or SM over five weeks. The outcome of pain intensity was assessed using three separate pain measures. The researchers found significant improvements for both groups from baseline following the treatment sessions and at a 10-week follow-up. SM was statistically superior to TTM by one outcome measure, the Visual Analogue Scale – the SM group showed a 71% reduction post-treatment (vs. 56% for TTM) and a 60% reduction at 10-week follow-up (vs. 39% for TTM). There were no significant differences between the groups on the other two measures of pain, meaning that TTM and SM appeared to be equally effective at relieving pain.
Other results identified in the reviewed studies showed that both TTM and SM are effective in improving body flexibility and reducing perceived muscle tension. For example, in the study comparing nine 30-minute sessions of either TTM or PT modalities, muscle tension was reduced at the two-week follow-up by 87% following TTM compared to only a 22% reduction in muscle tension for modalities. Secondary outcome measures in some studies showed TTM relieved anxiety and decreased arousal as measured by brain wave activity. There was also evidence that TTM and SM both reduced disability in individuals with chronic low back pain.
The authors conclude that TTM results in significant and substantial reductions in pain and should be included as part of multidisciplinary pain care. There are some limitations to the research from this review article, chiefly the inclusion of only six research articles. Unfortunately, more high-quality research is not yet available regarding TTM, especially for more conditions. That said, the conditions researched all included chronic musculoskeletal pain, which is the most common condition treated by nearly all massage therapists. The researchers go on to identify the major limitation of all the studies reviewed as being the lack of long-term follow-up, with the longest follow-up period being only ten weeks after treatment. There were no also studies that included TTM in an interdisciplinary pain care setting. These limitations are minor, and the research strongly suggests massage therapists practicing TTM or SM are highly effective in treating pain, especially when utilizing multiple 30-minute sessions either once or twice weekly.
Don't forget that you likely have Continuing Education credits (CEs) to earn by the end of the year 2016! Not everyone can travel to Thailand to learn Traditional Thai Massage. If an educational vacation is not on the agenda this year, you can earn 8 CEs online with the Basics of Research Literacy course from the Massage Therapy Foundation (MTF). After learning how to interpret research like the article summarized in this column, you will receive 8 hours of NCBTMB-approved continuing education credits. More details are available at www.massagetherapyfoundation.org/research-literacy-courses/.
Did you know November is American diabetes month? Massage may have some effects on diabetes and promising research is already being done in this area. As stress or mental fatigue can be harmful to the diabetic patient by increasing blood glucose level, a massage could reduce the production of stress hormones and thereby maintain blood sugar at normal levels. Several institutions have and are conducting research about various forms of relaxation therapy (such as massage) and their effects in lowering blood sugar levels. The MTF helps to support massage research, and we encourage interested researchers to apply for an MTF research grant to study the effects of massage for diabetes.
- Keeratitanont K, Jensen MP, Chatchawan U, Auvichayapat P. The efficacy of traditional Thai massage for the treatment of chronic pain: A systematic review. Complement Ther Clin Pract. 2015 Feb;21(1):26-32. doi: 10.1016/j.ctcp.2015.01.006. Epub 2015 Jan 31. Review. PubMed PMID: 25682523.
Editor's Note: In memory of S. Pualani (Pua) Gillespie. Pua was a former Massage Therapy Foundation Trustee, current Massage Therapy Foundtion Community Service committee member and writing work group volunteer. She has contributed to the Foundation research review articles for Massage Today since 2014. Her blessed and giving spirit will always be remembered.