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Research With Massage Therapy Foundation

By Massage Therapy Foundation Contributor

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Cancer Pain, Function & Massage: Findings of Meta-Analysis

Contributed by Jolie Haun PhD EdS LMT, Jacqueline Tibbett PhD LMT, Drew Rowe LMT

The pain and impaired function patients with cancer experience is well documented. Palliative efforts have long been promoted as a means of coping with these adverse effects, so commonly associated with cancer and its treatment. There is an abundance of published work on the palliative treatment of cancer pain with the use of massage. However, the efficacy of massage on outcomes such as pain and function for patients with cancer is inconclusive.

In an attempt to make some determination of efficacy, Boyd and colleagues conducted a systematic review and meta-analysis in the Pain Medicine journal. In a systematic review, authors compile relevant studies on a research topic using a pre-planned methodology. A meta-analysis pools the numeric data from the studies included in the systematic review in order to answer a research question in a large sample.

The authors suggest this comprehensive review was the first to critically assess evidence for the efficacy of massage in treating pain, function-related and health-related quality of life in patients with cancer.

The systematic review and meta-analysis

The authors identified relevant studies using key literature databases (i.e., PubMed, CINAHL, Embase, PsycInfo). Upon review, studies were assessed for quality and eligibility using pre-determined criteria. A diverse and expert steering committee, identified as the Evidence for Massage Therapy (EMT) Working Group, defined the eligibility criteria. Note that in this review article, massage therapy was defined by the EMT as “The systematic manipulation of soft tissue with the hands that positively affects and promotes healing, reduces stress, enhances muscle relaxation, improves local circulation, and creates a sense of well-being.”

Articles were included if they met all criteria: (a) cancer patients experiencing pain; (b) massage therapy administered as pre-defined by the EMT Working Group (interventions performed by tools (e.g., chair massage) only were excluded; (c) presence of sham, no treatment, or active comparator; (d) assessment of at least one relevant function outcome; and (e) randomized controlled trial (RCT) study design published in the English language.

To conduct the meta-analysis, outcomes of the interventions from multiple studies were combined. Those outcomes were then interpreted by the authors to make recommendations for the field regarding the efficacy of massage.

Cancer Pain, Function & Massage: Findings of Meta-Analysis - Copyright – Stock Photo / Register Mark What does the research show?

The database searches yielded 3,678 articles. Sixteen articles met the eligibility for inclusion in the analysis; twelve high-quality and four low-quality studies. Results of these studies cumulatively indicate massage therapy is effective in people with cancer for treating pain compared to no treatment and active comparators (for example, physical therapy, acupuncture, conventional medical treatment).

It is very important to heed these findings with an informed perspective. The demonstration of “weak” recommendations is not entirely a function of the effects of massage demonstrated in the literature but rather function of the state of the science represented in the body of literature.

In other words, the authors’ recommendations are based on the few studies that met the rigorous but important inclusion criteria. For example, much research done historically in massage did not adequately address protocol requirements. This is evident when only 16 studies were eligible from a sample of several thousand articles. As such, to conclusively determine the impact of massage on pain and functional outcomes associated with cancer, the field must take actions to conduct rigorous research with robust methods in future projects.

What’s next in massage research with patients with cancer & pain?

A considerable contribution of this work was its review in addressing massage therapy safety, research challenges, how to address research gaps, and steps for implementing massage therapy to address pain in patients with cancer. The authors cited these next steps for research conducted in the future:

  1. Use the CONSORT checklist when developing protocols and reporting trial findings.
  2. Use the STRICT-M checklist; focus on practitioner qualifications and credentialing, and special considerations for this population.
  3. Consider using PROMIS patient-reported outcome measures.
  4. Address heterogeneity and make recommendations regarding standard criteria for protocol development.
  5. Conduct comparative effectiveness research, incorporating cost benefit analyses.

Are you interested in learning more about the uses of massage therapy to alleviate pain and promote quality of life for patients and conducting rigorous research to demonstrate impact? To learn more about the effects of massage therapy and research, you can review the Massage Therapy Foundation article archives, read accepted MTF Research Grant abstracts, check out the Massage Therapy Foundation’s tools for research, or search PubMed for massage therapy studies.

Resource

  • Boyd C, Crawford C, et al. The Impact of Massage Therapy on Function in Pain Populations—A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part II, Cancer Pain Populations. Pain Med, 2016; 17(8): 1553–1568.

Editor’s Note: The preceding research synopsis is authored by volunteers from MTF’s Writing Workgroup. To learn more please visit their columnist page.

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