Five-Week Outcomes From a Dosing Trial of Therapeutic Massage for Chronic Neck Pain

Karen J. Sherman; Andrea J. Cook; Robert D. Wellman; Rene J. Hawkes; Janet R. Kahn; Richard A. Deyo; Daniel C. Cherkin

doi:10.1370/afm.1602

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Re:Another Option for Chronic Neck Pain, but is it Practical?
Carlos A Selmonosky

Published on: 08 May 2014
question re: protocol
Robin S Barnett

Published on: 01 April 2014
Author response: Is massage practical for neck pain?
Karen Sherman

Published on: 20 March 2014
Another Option for Chronic Neck Pain, but is it Practical?
Suzanna M. Zick

Published on: 19 March 2014

Published on: (8 May 2014)

Re:Another Option for Chronic Neck Pain, but is it Practical?
Carlos A Selmonosky, Physician
The paper has a very short follow up and has a spectrum bias that make the findings difficult to apply in general practice. Another bias is to treat unspecific neck pain as a disease, when obviously this term implies an undiagnosed etiology. Thoracic Outlet Syndrome, a common cause of neck pain, was not ruled out. A Diagnostic Triad and at least the weakness of the fifth finger was not reported as if it was present or not...
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The paper has a very short follow up and has a spectrum bias that make the findings difficult to apply in general practice. Another bias is to treat unspecific neck pain as a disease, when obviously this term implies an undiagnosed etiology. Thoracic Outlet Syndrome, a common cause of neck pain, was not ruled out. A Diagnostic Triad and at least the weakness of the fifth finger was not reported as if it was present or not. (see www.tos-syndrome.com)
Competing interests: None declared
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Competing Interests: None declared.
Published on: (1 April 2014)

question re: protocol
Robin S Barnett, Massage therapist
Thank you for this research study. I was wondering if you could elaborate on the protocol used (i.e.how much time for ROM, check-in, direct hands on to neck, to compensatory areas, and for integration) since article says you had time limits for each part of the session. Also, were they in same proportion for 30 and 60 minute sessions?
Competing interests: None declared

Competing Interests: None declared.
Published on: (20 March 2014)

Author response: Is massage practical for neck pain?
Karen Sherman, Epidemiologist
We appreciate the issues raised by Zick and Harris is their recent comment. We agree that the feasibility of therapeutic massage for neck pain may well depend on issues of costs for many patients. This is, of course, true for all medical treatments, though many are more often reimbursed than is massage. Physicians are now being asked to consider costs of care in many circumstances, and this may well be one of them. We b...
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We appreciate the issues raised by Zick and Harris is their recent comment. We agree that the feasibility of therapeutic massage for neck pain may well depend on issues of costs for many patients. This is, of course, true for all medical treatments, though many are more often reimbursed than is massage. Physicians are now being asked to consider costs of care in many circumstances, and this may well be one of them. We believe our study will help patients and physicians better understand the commitment of time and resources necessary for the best outcomes from therapeutic massage for neck pain. Our longer term follow-up will shed light on the durability of these findings.
Competing interests: I am the author of the publication.
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Competing Interests: None declared.
Published on: (19 March 2014)

Another Option for Chronic Neck Pain, but is it Practical?
Suzanna M. Zick, Research Associate Professor
Other Contributors:
When a patient with chronic neck pain seeks treatment being able to offer non-medication choices is attractive for many. One question that both patients and providers often have is how many sessions and how often would I need to receive complementary or integrative treatments such as chiropractic, acupuncture or massage to gain benefit. Until now the question of dose and frequency has been largely unexplored in a resea...
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When a patient with chronic neck pain seeks treatment being able to offer non-medication choices is attractive for many. One question that both patients and providers often have is how many sessions and how often would I need to receive complementary or integrative treatments such as chiropractic, acupuncture or massage to gain benefit. Until now the question of dose and frequency has been largely unexplored in a research setting. In Sherman et al. researchers determined that 60 minute treatments delivered two to three times weekly gave significant improvement in both pain intensity and neck dysfunction as compared to lower doses of massage and wait list control.[1] That said there are several unanswered questions that still remain. Significantly, there was no long term follow-up in the study so it is unknown how long the benefits of massage would last. Of note, the authors are conducting a follow-up study comparing the massage groups to a 9-month natural history group of patients with chronic neck pain.[2] Also, it is unclear if there is a ceiling effect and that longer or more frequent visits could lead to better outcomes. Finally and most importantly, is the dose of 60 minutes of massage two to three times weekly practical in terms of availability of trained personnel, patients' time to receive that many treatments and also cost considerations. That said, this trial provides needed informative for the design of future studies examining other manual therapies both for chronic neck pain as well as other conditions. For example, studies that do not use the optimal treatment dose may yield false negative findings. From a patient prospective this study suggests that individuals would need to have considerable money and time to receive benefit from massage for chronic neck pain. Massage is largely not covered by insurance and a one hour massage ranges from $50 and up depending on the market. Consequently, to gain benefit a patient would have to pay a minimum of $600 out-of-pocket. Despite these limitations, massage provides another option for treating chronic neck pain, which is largely safe and also leads to much higher patient satisfaction with their care.
References
1. Sherman KJ, Cook AJ, Wellman RD, et al. Five-week outcomes from a dosing trial of therapeutic massage for chronic neck pain. Ann Fam Med. 2014;12:112-20.
2. Sherman KJ, Cook AJ, Kahn JR, Hawkes RJ, Wellman RD, Cherkin DC. Dosing study of massage for chronic neck pain: protocol for the dose response evaluation and analysis of massage [DREAM] trial. BMC Complement Altern Med. 2012;12:158.
Competing interests: None declared
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Competing Interests: None declared.