Is Massage Therapy a Placebo?

Some review studies have found only weak evidence that massage offers pain-reducing benefits. Research on massage therapy for maternal pain and anxiety during childbirth is currently limited to four small trials. Each one used different massage techniques, with different frequencies and durations, and relaxation techniques were included in three trials. To investigate the effects of massage interventions that complement maternal neurophysiological adaptations to labor and labor pains, a randomized controlled pilot trial (RCT) was designed to evaluate the effects of a massage program practiced during physiological changes in the pain threshold, from the end of the pregnancy until birth, on pain reported by women.

The study included three arms: intervention (massage program with relaxation techniques), placebo (music with relaxation techniques) and control (regular care). The placebo offered a non-pharmacological coping strategy, to ensure that the use of massage was the only difference between the intervention and placebo groups. There was a trend toward slightly lower mean pain scores in the intervention group, but these differences were not statistically significant. No differences were found in the use of pharmacological analgesia, the need for augmentation, or the mode of administration.

There was a trend towards more positive views on preparation for childbirth and a sense of control in the intervention and placebo groups, compared to the control group. These findings suggest that regular massage with relaxation techniques from the end of pregnancy to birth is an acceptable coping strategy that deserves a large scale trial with sufficient power to detect differences in pain reported as the main outcome measure. A placebo is a substance or treatment with no active therapeutic effect. The most common types of placebos are inert tablets (such as sugar pills) or simulated treatment procedures.

Until recently, the placebo effect was mainly used as a tool to examine the clinical efficacy of new drugs. Each time a new drug is tested, its effect is compared to the baseline value of an “empty” placebo or pill, which was administered to patients randomly assigned to a control group. Craniosacral therapy is another classic example, popular for decades, it is a tactile therapy, not a “massage” per se. With the right precautions, massage therapy can be part of supportive care for cancer patients who want to try it; however, the evidence that it can alleviate pain and anxiety is not strong.

Most of the studies had almost little in common, except that they were all experimenting with some type of massage-like therapy for some type of back pain. The sad truth is that massage therapy has almost no significant proven medical benefits and is fraught with an embarrassing number of myths and an amateur research story. This makes the results of massage studies seem much more medically impressive than they would be if all that satisfaction and other “unspecific” effects were subtracted. Some come because of the “complementary benefits” of Thai massage, which generally manifest themselves as its “other” treatments, such as chiropractic, acupuncture, and even chemotherapy and pharmacy courses, which have proven to be more effective.

The argument of this study is that between 20 and 40% of all manual therapy treatments (massage, chiropractic and physical therapy) will cause some type of discomfort, side effect, or “adverse event” in medical language. Being massaged by another human being and massaging yourself with a glorified pool noodle are obviously completely different things. Not many scientists are interested in studying massages, while massage therapists have no scientific training. If scientifically unsustainable practices are surprising among ordinary medical massage therapists, they are almost universal among barely trained and untrained body workers.

Therefore, imperfect evidence shows that massage can help alleviate low back pain, and yet the world has certainly not been spared back pain. Despite all of this, massage therapists still have many reasons why they can be proud of what they do, and many ways to practice massage therapy ethically and evidence-based.

Mark Szymonik
Mark Szymonik

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