Stress Reduction and Massage for Chronic Pain

Stress Reduction and Massage for Chronic Pain The primary purpose of this study was to determine whether patients with chronic musculoskeletal pain who were of largely lower socioeconomic status would participate in a randomized trial that includes 2 alternative therapies. We specifically targeted patients who were likely to have the most barriers to participation. Even with this "worst-case scenario" the completion rate was 76%. We conclude that it is feasible to study these therapies in this patient group. There were 32 patients who were eligible for the study who decided not to participate and future studies should address issues such as distance, transportation, and timing of the MBSR classes to improve the participation rate. Although the completion rate differences in treatment group was not significant, there was a trend for more participants in the massage group to complete the study (90%) compared with the MBSR group (60%). This may be because of differences in the commitment required by the different modalities, or it may be merely chance.

The secondary aim of the study was to provide estimates of the treatment effects of the 2 therapies studied, in comparison with standard care. There were statistically significant differences noted between the treatment groups which have important implications for clinical care and future research. First, the massage group had statistically significant improvements in pain unpleasantness and mental health ratings on the SF-12 at week 8 compared with the standard care group. Pain sensation ratings showed a similar trend but did not reach statistical significance. Interestingly, this benefit was attenuated at week 12. It appears that massage was effective in improving pain but that benefit was lost when the massage sessions were ended.

Second, among the MBSR completers, there was a statistically significant improvement in mental health ratings on the SF-12 at week 12 compared with baseline, indicating this effect may be more durable than the pain effects seen with massage. With MBSR, patients learn a life skill, and the beneficial effects of this can conceivably grow rather than diminish over time.

The 2 interventions had different effects on the complex components of chronic pain. Understanding which modalities are most effective at improving which component will help us design treatment programs with the highest likelihood of success.

There were several limitations of this study, including the small sample size and that more patients dropped out of the MBSR arm. Other limitations include a limited duration follow-up and that the massage therapists used no music or massage oils which may not mimic actual practice. Finally, differences in contact time between the therapies may be a confounder.

In conclusion, MBSR and massage appear promising for the treatment of chronic musculoskeletal pain and even socioeconomically disadvantaged patients will participate in trials of these modalities. In addition, massage therapy can have a positive impact on pain unpleasantness, but this impact attenuates over time. Mindfulness-based stress reduction may have a positive impact on mental health in these patients, an effect that seems to persist after the classes are completed. Together, these findings provide support for conducting larger studies to more definitively establish the optimal role of massage and MBSR in the treatment of chronic musculoskeletal pain. In the meantime, it is both feasible and promising to offer these therapies to chronic pain patients in the ambulatory setting.

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