This meta-analysis of randomized clinical trials (RCTs) was aimed at evaluating the effects of massage therapy in the treatment of postoperative pain.

Three databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) were searched for RCTs published from database inception through January 26, 2021. The primary outcome was pain relief. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. The random-effect model was used to calculate the effect sizes and standardized mean difference (SMD) with 95% confidential intervals (CIs) as a summary effect. The heterogeneity test was conducted through I2. Subgroup and sensitivity analyses were used to explore the source of heterogeneity. Possible publication bias was assessed using visual inspection of funnel plot asymmetry.

The analysis included 33 RCTs and showed that MT is effective in reducing postoperative pain (SMD, -1.32; 95% CI, −2.01 to −0.63; p = 0.0002; I2 = 98.67%). A similarly positive effect was found for both short (immediate assessment) and long terms (assessment performed 4 to 6 weeks after the MT). Neither the duration per session nor the dose had a significant impact on the effect of MT, and there was no difference in the effects of different MT types. In addition, MT seemed to be more effective for adults. Furthermore, MT had better analgesic effects on cesarean section and heart surgery than orthopedic surgery.

The authors concluded that MT may be effective for postoperative pain relief. We also found a high level of heterogeneity among existing studies, most of which were compromised in the methodological quality. Thus, more high-quality RCTs with a low risk of bias, longer follow-up, and a sufficient sample size are needed to demonstrate the true usefulness of MT.

The authors discuss that publication bias might be possible due to the exclusion of all studies not published in English. Additionally, the included RCTs were extremely heterogeneous. None of the included studies was double-blind (which is, of course, not easy to do for MT). There was evidence of publication bias in the included data. In addition, there is no uniform evaluation standard for the operation level of massage practitioners, which may lead to research implementation bias.

Patients who have just had an operation and are in pain are usually thankful for the attention provided by carers. It might thus not matter whether it is provided by a massage or other therapist. The question is: does it matter? For the patient, it probably doesn’t; However, for making progress, it does, in my view.

In the end, we have to realize that, with clinical trials of certain treatments, scientific rigor can reach its limits. It is not possible to conduct double-blind, placebo-controlled studies of MT. Thus we can only conclude that, for some indications, massage seems to be helpful (and almost free of adverse effects).

This is also the conclusion that has been drawn long ago in some countries. In Germany, for instance, where I trained and practiced in my younger years, Swedish massage therapy has always been an accepted, conventional form of treatment (while exotic or alternative versions of massage therapy had no place in routine care). And in Vienna where I was chair of rehab medicine I employed about 8 massage therapists in my department.

13 Responses to Massage therapy for postoperative pain?

  • A better trial design would have been to compare massage therapy with additional empathetic attention. Even hand holding might be an informative comparison.

    I suspect that any additional quality contact/connection would demonstrate beneficial outcomes in average. I really doubt any actual effect of the massage itself.

    • I really doubt any actual effect of the massage itself.

      The immediate natural reaction to sustaining a minor injury is to rub the affected area, which is very effective in relieving the pain. Melzac and Wall came up with the gate theory of pain to explain this, which in essence is that secondary afferent neurones act as a gate, restricting the information reaching the brain from primary sensory neurones in the periphery, so that stimulating a (fast, wide-diameter myelinated) sensory nerve that is not involved in transmitting pain will close the gate to signals from the (slow, narrow-diameter unmyelinated) nerves that carry pain. This effect is used therapeutically for treating pain, for instance by stimulating the nerves with electric currents (transcutaneous nerve stimulation or TNS) or with sprays and creams such as Deep Heat which contain an irritant (capsaicin?) that produces a sensation of heat in the skin. I would expect that there is a similar effect from massage.

      Injuries are often accompanied by muscle spasm, a reflex that can help to immobilise the area and reduce further injury, but which is itself painful and increases any pain that is already there. Massage is an effective way to reduce muscle spasm as anybody who has experienced cramp will testify.

      Ultimately pain is experienced in the brain, and is very strongly influenced by mood and expectations. Massage is usually pleasant and relaxing and helps to engender a state in which pain is less distressing.

      These are three mechanisms that immediately come to mind that are specific to massage, though I would think there are other beneficial effects over and above placebo, such as increasing joint mobility. There is a degree of overlap between massage and physiotherapy, and indeed massage therapists were the forerunners of physiotherapists.

      • Plus, there is some evidence that massage – like many agreeable things – elevates endorphin levels in the brain.

        • Rubbing a sore spot is a momentary distraction from pain, not a treatment for pain. If the injury is minor, the pain may even be gone by the time we stop rubbing.

          But no-one rubs a broken arm, and massage, although some may find it pleasant, is not treatment and has zero enduring effect.

  • Rubbing a sore spot is a momentary distraction from pain, not a treatment for pain.

    It is not a distraction. It prevents the pain signals from reaching the brain in the first place.

    • That is exactly what distractions do.

      • Is that what opioids are considered, a distraction?

        • The analgesic effect of opioids continue long after the pill is swallowed and can be considered a pain treatment.

          Massage is not a pain treatment.

          • The peak effect of most opioids is 0.5-1 hours and the duration of action is 3-6 hours, depending on the opioid of course.

            So according to you, to determine if an approach is a distraction or not is based upon the duration of action?

          • No, according to evidence basis. But don’t bother educating yourself. No point.

          • I think you need to study the research regarding massage therapy and it’s suspected analgesic effects as well as look up the definition of distraction. You look silly.

      • I would regard a distraction as something that acted centrally by diverting attention away from the pain. Preventing the signals from reaching the brain in the first place is what rubbing the affected part does, as does TENS (which is a treatment often used by pain clinics) and local anaesthesia. Are these all distractions?

        For that matter, distracting attention away from pain can be very effective treatment.

        • Yes, there are some that who are in chronic pain where reading a book can be a distraction from the pain as it diverts one’s attention elsewhere at least temporarily.

          Massage can have a therapeutic benefits, albeit sometimes it may be short-term. But there are many types of massages and they all don’t work on the same neurophysiological mechanisms and it also depends on many individual and condition factors.

          For example, I injured my shoulder in a fall from six feet. After some months the pain became progressive to being almost unbearable (yes I had imaging done). I sought massage therapy. Was the massage a distraction from the pain? Heck no, it hurt worse during the massage (as I expected it would when dealing with a chronic injury). But after a few sessions the pain was minimal and now I am pain free. Aneddotal, of course. Point is, the massage certainly wasn’t a distraction from my pain.

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