Systematic Reviews Highlights Limited Certainty in Massage Therapy for Pain Management

This study, published in JAMA Network Open, revealed that despite the abundance of randomized clinical trials, systematic reviews on massage therapy for painful adult health conditions only rated a small portion of their conclusions as moderate-certainty evidence. Additionally, instances where massage therapy was found to be superior to other active treatments with moderate or high-certainty evidence were uncommon.

The systematic review uncovered 129 systematic reviews published since 2018, with 41 evaluating the certainty or quality of their conclusions. In total, 17 of these reviews focused on 13 different health conditions, and the majority determined that the evidence quality was low or very low.

Massage therapy has gained popularity as a complementary approach, especially in the context of musculoskeletal pain, which remains a prevalent health concern worldwide. It has been advocated for many painful adult health conditions and has a large evidence base. Selene Mak, Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California, and colleagues aimed to map systematic reviews, conclusions, and certainty or quality of evidence for outcomes of massage therapy for painful adult health conditions.

For this purpose, the researchers conducted a computerized search of PubMed, the Allied and Complementary Medicine Database, the Cumulated Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews, and the Web of Science from 2018 to 2023.

Included studies were systematic reviews of massage therapy aimed at pain management in adult health conditions that formally assessed the certainty, quality, or strength of the conclusions. Studies focusing on sports massage, osteopathy, dry cupping or needling, and internal massage therapies (such as those for pelvic floor pain) were excluded, along with self-administered techniques like foam rolling. Reviews were classified based on their conclusions: those with at least one conclusion rated as high-certainty evidence, those with at least one rated as moderate-certainty evidence, and those where all conclusions were rated as low or very low certainty. A comprehensive list of these conclusions and their evidence certainty was compiled.

The researchers reported the following findings:

• There were 129 systematic reviews of massage therapy for painful adult health conditions; of these, 41 reviews used a formal method to rate certainty or quality of evidence of their conclusions, and 17 reviews were mapped, covering 13 health conditions.
• Across these reviews, no conclusions were rated as high certainty of evidence.
• Seven conclusions were rated as moderate-certainty evidence; all remaining conclusions were of low- or very low–certainty evidence.
• All conclusions rated as moderate certainty were that massage therapy had a beneficial association with pain.

The findings showed that the number of conclusions about the effectiveness of massage therapy that were judged to have at least moderate certainty of evidence was greater now than in 2018, but it was still small relative to the need. It stresses the need for more high-quality randomized clinical trials to provide a stronger evidence base to assess the effect of massage therapy on pain.

"For painful conditions lacking at least moderate-certainty evidence supporting the use of massage therapy, new studies are essential to address the limitations of current research. Advancing the field of massage therapy will require educating the broader research community on clearer definitions of massage therapy and assessing the appropriateness of including multiple modalities within the same systematic review," the researchers concluded.

Reference:

Mak S, Allen J, Begashaw M, et al. Use of Massage Therapy for Pain, 2018-2023: A Systematic Review. JAMA Netw Open. 2024;7(7):e2422259. doi:10.1001/jamanetworkopen.2024.22259