MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Chronic neck pain is common and makes the life of many sufferers a misery. Pain-killers are helpful, of course, but who wants to take such medications on the long-term? Is there anything else these patients can do?

Massage therapy has been shown to work but how often for how long? This trial was designed to evaluate the optimal dose of massage for individuals with chronic neck pain. 228 individuals with chronic non-specific neck pain were recruited and randomized them to 5 groups receiving various doses of massage:

  1. 30-minute treatments 2 or 3 times weekly
  2. 60-minute treatments once weekly
  3. 60-minutte treatments twice weekly
  4. 60-minute treatments thrice weekly
  5. a 4-week period on a wait list

Neck-related dysfunction was assessed with the Neck Disability Index (range, 0-50 points) and pain intensity with a numerical rating scale (range, 0-10 points) at baseline and at 5 weeks.

The results suggested that 30-minute treatments were not significantly better than the waiting list control condition in terms of achieving a clinically meaningful improvement in neck dysfunction or pain, regardless of the frequency of treatments. In contrast, 60-minute treatments 2 and 3 times weekly significantly increased the likelihood of such improvement compared with the control condition in terms of both neck dysfunction and pain intensity.

The authors conclude that after 4 weeks of treatment, we found multiple 60-minute massages per week more effective than fewer or shorter sessions for individuals with chronic neck pain. Clinicians recommending massage and researchers studying this therapy should ensure that patients receive a likely effective dose of treatment.

So two or three hours of massage therapy seems to be optimal as a treatment for chronic neck pain. This would cost ~£ 200-300 per week! Who can or wants to afford this? And are there other options that might be less expensive and equally or more effective? For instance, is physiotherapeutic exercise an option?

I am not sure I know the answers to these questions but, before we recommend massage therapy to the many who chronically suffer from neck pain, we should find out.

2 Responses to Massage seems effective for chronic neck pain – but what is the optimal dose?

  • My question is what happens after 5 weeks when the frequent 60 min massage sessions are over? If the persistent pain eventually returns, then have we learned anything new here? It is already well documented that massage/manual therapy has the capacity to provide with some form temporary relief to some people in pain. It is also already suggested that more repetition = increased engagement of “pain inhibitory” neurological systems (Zusman, 2011).

    Two more issues that arise here
    1. the increased frequency of a passive modality might also mean decreasing of the patients’ confidence that they can take care of their problem independently, which I think is very important for helping chronic pain patients long term.
    2. How much does it cost on average to have 60 min massage sessions x 3 per week x 4 weeks? If the effects are only temporary, is it really worth it? If there are some long term benefits on reducing pain severity/irritability (which I doubt), then what is the % improvement? 10% or 90%? I think that these are important questions.

  • Evan,

    I think results are highly dependent on the skill level of the massage therapist. I’ve been doing it 20 years and can honestly say have had great success in treating chronic pain as long as the root of it is musculoskeletal. As a matter of fact, I’ve been able to treat in 1-2 sessions and see people well on their way. I always check in with my clients afterwards to see how they are doing… On average, I see someone maybe 2-5 times a year, tops- and usually only when they hurt something… However, I am of the kind that works to get the job done in as few sessions as possible. If someone doesn’t notice an improvement after one session, it is probably not just musculoskeletal. If they have to keep coming back for the same thing, clearly a massage Tx isn’t the right tool, or the only tool they need.

    I’m no scientist, but think it’s challenging to research because there are so many causes of chronic pain from neurological to simple ergonomics to psychosomatic (which is just as real physical); and it depends on who is giving the Tx. The studies show the neck pain was “non-specific”. That is too broad and Tx can be so subjective with MT. There is no single cookie-cutter approach that will work for every single person… such as “5 strokes up, 5 strokes down, hold here 30 seconds with the pressure just so, and 3 seconds of active resistive stretching and … NEXT!”. Ah, wouldn’t that be nice! Any ideas to narrow down the study? I’m interested.

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