Weekly Full-Body Massage Improves Short-term Knee OA Pain

Janis C. Kelly

December 19, 2018

A weekly full-body massage may be an effective way to help patients with knee osteoarthritis (OA) manage pain, data from a randomized trial show.

"Osteoarthritis is a leading cause of disability and affects more than 30 million people in America," lead author Adam Perlman, MD, program director of the Leadership Program in Integrative Healthcare at Duke University School of Medicine, Durham, North Carolina, said in a press statement. "Medications are available, but many patients experience adverse side effects, raising the need for alternatives. This study demonstrates that massage has potential to be one such option."

The study, published online December 12 in the Journal of General Internal Medicine, assessed initial and long-term effects of an 8-week course of weekly 60-minute massage and the efficacy of subsequent biweekly maintenance massage. The massage was delivered in accordance with a standardized protocol. The active control arm was light-touch treatment in which the massage therapists touched the major muscle groups and joints in a specific sequence but without massaging the muscles. The passive control arm was continuation of the patient's usual care.

Perlman and colleagues at four institutions enrolled 222 adults with knee OA; 200 patients completed an assessment at 8 weeks, and 175 completed an assessment at 52 weeks. Patients were eligible if they met the American College of Rheumatology radiographic knee OA criteria and had a baseline visual analogue scale (VAS) pain score of 40 to 90. Users of nonsteroidal anti-inflammatory drugs or other analgesics were included if the doses of their medications had remained stable for 3 months. Exclusion criteria were serious comorbidities, dual knee replacements, recent use of corticosteroids or hyaluronate, knee arthroscopy or injury within the past year, or regular use of massage therapy.

At 8 weeks, patients in the massage group showed significant improvements in the WOMAC Global Score, which was the the primary outcome, compared with the light-touch group (-8.16) and with the usual-care group (-9.55). The difference between the light-touch and usual-care groups (-1.40) was not significant.

The massage group also improved significantly more than the light-touch or usual-care groups on the WOMAC subscales for pain (-10.98 and -10.83, respectively), stiffness (-7.53 and -10.53), and physical function (-6.21 and -8.15). The light-touch and usual-care groups did not differ significantly on these subscales.

Massage was not significantly better than light touch for reducing pain, as measured on a 0 to 100 VAS (-7.21; 95% confidence interval [CI], -14.93 to 0.52) but was significantly better than usual care (-11.20; 95% CI, -18.53 to -3.08). The light-touch and usual-care groups did not differ significantly on the VAS.

Similarly, massage was not significantly more effective than light touch on the NIH PROMIS Pain Interference Questionnaire (-0.79) but was more effective than usual care (-2.09). Light touch and usual care were not significantly different on this measure.

The authors note that massage was not significantly more effective than light touch for improving the 50-foot timed walk (0.13 ft/sec) but was more effective than usual care (0.16 ft/sec). Light touch and usual care were not significantly different on this measure.

Range of motion was not significantly changed by either massage or light touch.

After 8 weeks, participants in the massage and light-touch groups were randomly assigned to receive biweekly massage, biweekly light touch, or usual care, in part to test whether improvements seen in the initial phase would be increased or sustained by biweekly massage. However, the authors report that at 52 weeks, there were no significant differences in the change in WOMAC Global from baseline in any of the study groups, nor were there significant differences between any of the groups. The authors conclude that biweekly massage maintenance did not significantly improve any of the outcome scores beyond the first 8 weeks.

"Our data indicate that 8 weeks of massage provided a statistically and clinically significant improvement of osteoarthritis symptoms," the authors write. "Although mean group WOMAC for massage maintenance improved and massage followed by usual care got worse, this difference was not significant at 52 weeks with this sample size."

The authors add, "While the underlying mechanisms of massage-mediated improvements in osteoarthritis are not well-defined, preliminary studies suggest that massage may improve systemic immune and inflammatory profiles in healthy individuals."

Perlman said, "Massage therapy is one of the most popular complementary medicine interventions. At a time when people are looking for effective nonmedication options for pain, this study provides further evidence that massage has a potential role, at least for those suffering with osteoarthritis."

The study was supported by the National Center for Complementary and Integrative Health of the National Institutes of Health. The authors have disclosed no relevant financial relationships.

J Gen Intern Med. Published online December 12, 2018. Abstract

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