Article Figures & Data
Figures
- Figure 1
Trial flow.
a Most common reasons for ineligibility: 237 (32.6%) insufficient neck pain; 176 (24.6%) neck pain too complex; 74 (10.2%) prior massage; 140 (19.2%) could not attend treatment clinics.
Tables
Variable Control
(n = 37)1 × 60
Min/wk
(n = 38)2 × 30
Min/wk
(n = 38)2 × 60
Min/wk
(n = 39)3 × 30
Min/wk
(n = 37)3 × 60
Min/wk
(n = 39)Demographics Age, mean (SD), y 44.4 (12.2) 50.2 (10.9) 42.3 (11.3) 48.7 (11.5) 45.7 (11.5) 49.0 (9.9) Women, No. (%) 26 (70.3) 30 (78.9) 28 (73.7) 28 (71.8) 25 (67.6) 27 (69.2) College graduate, No. (%) 27 (73.0) 22 (57.9) 26 (68.4) 25 (64.1) 27 (73) 28 (78.1) White non-Hispanic, No. (%) 30 (81.1) 30 (78.9) 27 (71.1) 32 (84.2) 20 (54.1) 29 (76.3) Married, No. (%) 22 (59.5) 22 (57.9) 27 (71.1) 23 (59.0) 26 (70.3) 24 (61.5) Family income >$45,000/y, No. (%) 27 (73.0) 25 (65.8) 21 (55.3) 29 (74.4) 27 (73.0) 23 (59.0) Unemployed, No. (%) 6 (16.2) 9 (23.7) 6 (15.8) 8 (20.5) 8 (21.6) 7 (17.9) Work that requires lifting and carrying, No. (%) 8 (21.6) 7 (18.4) 13 (34.2) 8 (20.5) 7 (18.9) 10 (25.6) Measures of neck pain impact Neck Disability Index, mean (SD) 13.4 (4.8) 14 (4.6) 13.4 (3.8) 13.7 (5.1) 13.1 (5.6) 14.3 (5.5) Neck pain intensity, mean (SD) 5.6 (1.3) 5.9 (1.5) 5.8 (1.4) 5.6 (1.1) 6.1 (1.5) 5.7 (1.2) Duration of neck pain >5 y, No. (%) 11 (29.7) 15 (39.5) 19 (50.0) 16 (41.0) 12 (32.4) 17 (43.6) >7 Days usual activity restricted due to neck pain in the past 3 mo, No. (%) 9 (24.3) 6 (15.8) 4 (10.5) 8 (20.5) 6 (16.2) 11 (28.2) >3 Days of neck exercise in past week, No. (%) 13 (35.0) 14 (36.8) 8 (21.1) 14 (35.9) 11 (29.7) 15 (38.5) Any medications for neck pain in past week, No. (%) 21 (56.8) 22 (57.9) 23 (60.5) 25 (64.1) 18 (48.7) 28 (71.8) NSAID use for neck pain, No. (%) 19 (51.4) 15 (39.5) 17 (44.7) 20 (51.3) 11 (29.7) 15 (38.5) Opioid use for neck pain, No. (%) 1 (2.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Measures of quality of life SF-36 General health very good or excellent, No. (%) 25 (67.6) 25 (65.8) 22.0 (57.9) 26 (66.7) 23 (62.2) 29 (74.4) SF-36 Mental health,a mean (SD) 75.8 (15.2) 76.3 (16.0) 78.4 (14.3) 77.1 (16.8) 78.3 (11.7) 78.9 (13.1) SF-36 Physical health, mean (SD) 80.2 (13.7) 76.6 (19.6) 81.1 (15.4) 73.8 (17.8) 79.6 (20.2) 78.5 (16.4) Miscellaneous measures Worry, mean (SD) 4.6 (1.9) 4.3 (2.6) 3.6 (2.6) 4.1 (2.2) 4.2 (2.4) 4 (2.4) Perceived Stress Scale, mean (SD) 16.9 (6.9) 15.9 (7.2) 16.1 (5.6) 17 (6.5) 17.1 (4.9) 15.8 (6.9) Very satisfied with overall care for neck pain No. (%) 1 (4.0) 2 (7.4) 1 (3.2) 5 (17.9) 1 (3.0) 2 (6.1) Expectation of massage helpfulness, mean (SD) 7.7 (1.4) 7.4 (2.3) 7.4 (1.9) 7.4 (1.8) 7.2 (2.0) 7.7 (2.3) Expect neck pain to be much better or completely gone in 1 year, No. (%) 13 (35.1) 11 (28.9) 10 (26.3) 13 (33.3) 12 (33.3) 11 (28.2) Top treatment choice was massage, No. (%) 26 (76.5) 25 (69.4) 17 (48.6) 22 (62.9) 24 (68.6) 25 (67.6) Had prior massage for back or neck pain, No. (%) 25 (67.6) 28 (73.7) 21 (55.3) 22 (56.4) 20 (54.1) 25 (64.1) Neck-related disability days >7 Days in past 4 weeks that normal activities were cut by half a day or more because of neck pain, No. (%) 5 (13.5) 4 (10.5) 1 (2.6) 2 (5.1) 4 (10.8) 6 (15.4) ≥1 Day in the past 4 weeks that neck pain kept you in bed or lying down for all or most of the day, No. (%) 3 (8.1) 4 (10.5) 2 (5.3) 0 (0.0) 5 (13.5) 2 (5.1) ≥1 Day in past 4 weeks that neck pain kept you out of work or school, No. (%) 2 (5.7) 3 (8.6) 1 (2.7) 2 (5.4) 1 (2.9) 3 (8.1) -
NSAID = nonsteroidal anti-inflammatory drug; SF-36 = 36-Item Short Form Health Survey.
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Notes: NDI is a 0 to 50 scale; higher scores indicate worse function. Neck pain intensity is a 0 to 10 scale; higher scores indicate more pain. SF-36 scales are all scaled to a 0 to 100 scale; higher scores indicate better function. Perceived Stress Scale is a 0 to 40 scale; higher scores indicate more stress. Worry and expectations are both 0 to 10 scales; higher scores indicate more worry or higher expectations, respectively.
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↵a On the 5-item Mental Health Inventory.
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Outcome by Massage Dose Unadjusted Adjusteda % (95% CI) RR (95% CI) P Value Overall P Value RR (95% CI) P Value Overall P Value Clinically relevant improvement in NDIb Control 8.6 (2.9–25.3) 1.00 – .001 1.00 – .003 1 × 60 min/wk 18.4 (9.4–36.0) 2.15 (0.60–7.67) .24 1.96 (0.53–7.33) .32 2 × 30 min/wk 15.8 (7.6–32.9) 1.84 (0.50–6.81) .36 1.90 (0.53–6.86) .33 2 × 60 min/wk 31.6 (19.8–50.4) 3.68 (1.13–11.98) .03 3.41 (1.05–11.08) .04 3 × 30 min/wk 11.8 (4.7–29.5) 1.37 (0.33–5.68) .66 1.61 (0.40–6.46) .50 3 × 60 min/wk 47.4 (33.9–66.2) 5.53 (1.78–17.15) .003 4.98 (1.64–15.17) .005 Clinically relevant improvement in neck pain intensityc Control 25.7 (14.6–45.2) 1.00 – <.001 1.00 – <.001 1 × 60 min/wk 34.2 (22.0–53.2) 1.33 (0.65–2.72) .43 1.17 (0.58–2.37) .66 2 × 30 min/wk 42.1 (29.0–61.1) 1.64 (0.83–3.22) .15 1.61 (0.83–3.13) .16 2 × 60 min/wk 63.2 (49.5–80.5) 2.46 (1.33–4.54) .004 2.30 (1.26–4.18) .007 3 × 30 min/wk 44.1 (30.2–64.4) 1.72 (0.87–3.38) .12 1.61 (0.81–3.18) .17 3 × 60 min/wk 76.3 (63.9–91.1) 2.97 (1.64–5.36) .000 2.73 (1.52–4.91) .001 -
RR = relative risk.
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↵a Adjusted for baseline Neck Disability Index and neck pain intensity, age, sex, duration of neck pain more than 5 years, use of medications for neck pain, and race/ethnicity (white non-Hispanic vs other).
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↵b Improvement of at least 5 points from baseline at 5 weeks postrandomization.
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↵c Improvement of at least 30% from baseline at 5 weeks postrandomization.
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Outcome by Massage Dose Unadjusted Adjusteda Mean Change
(95% CI)Mean Difference
(95% CI)P Value Overall P Value Mean Difference
(95% CI)P Value Overall P Value Neck Disability Index Control 1.45 (−0.20 to 3.10) Ref – <.001 Ref – <.001 1 × 60 min/wk −0.86 (−2.09 to 0.36) −2.31 (−4.37 to −0.26) .03 −2.31 (−4.29 to −0.32) .02 2 × 30 min/wk −0.89 (−2.33 to 0.54) −2.34 (−4.53 to −0.16) .04 −2.35 (−4.51 to −0.18) .03 2 × 60 min/wk −2.06 (−3.51 to −0.62) −3.52 (−5.71 to −1.32) .002 −3.44 (−5.53 to −1.35) .001 3 × 30 min/wk 0.05 (−1.26 to 1.35) −1.41 (−3.51 to 0.70) .19 −1.73 (−3.78 to 0.33) .10 3 × 60 min/wk −4.36 (−6.25 to −2.47) −5.81 (−8.32 to −3.30) <.001 −5.63 (−7.94 to −3.32) <.001 Neck pain intensity Control −0.51 (−1.35 to 0.32) Ref – <.001 Ref – <.001 1 × 60 min/wk −1.21 (−1.84 to −0.58) −0.70 (−1.74 to 0.35) .19 −0.43 (−1.36 to 0.50) .37 2 × 30 min/wk −1.66 (−2.29 to −1.03) −1.14 (−2.19 to −0.10) .03 −1.02 (−1.93 to −0.12) .03 2 × 60 min/wk −2.21 (−2.81 to −1.61) −1.70 (−2.72 to −0.67) .001 −1.56 (−2.46 to −0.66) .001 3 × 30 min/wk −1.62 (−2.19 to −1.05) −1.10 (−2.12 to 0.09) .03 −0.83 (−1.73 to 0.07) .07 3 × 60 min/wk −2.74 (−3.22 to −2.25) −2.22 (−3.19 to −1.26) <.001 −2.07 (−2.94 to −1.20) <.001 -
Ref = reference group.
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↵a Adjusted for baseline Neck Disability Index and neck pain intensity, age, sex, duration of neck pain of more than 5 years, use of medications for neck pain, and race/ethnicity (white non-Hispanic vs other).
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Outcome Control
(n = 37)1 × 60
Min/wk
(n = 38)2 × 30
Min/wk
(n = 38)2 × 60
Min/wk
(n = 39)3 × 30
Min/wk
(n = 37)3 × 60
Min/wk
(n = 39)Overall P >7 Days in past 4 weeks that normal activities were cut by half a day or more because of neck pain, % (95% CI) 8.9
(4.0 to 19.8)5.1
(2.3 to 11.8)1.9
(0.3 to 12.2)2.8
(0.8 to 9.2)4.7
(1.6 to 13.7)7.9
(3.3 to 18.9).35 ≥1 Day in the past 4 weeks that neck pain kept you in bed or lying down for all or most of the day, % (95% CI) 6.5
(2.0 to 21.2)6.9
(2.9 to 16.7)4.3
(0.9 to 20.3)0.0a
(n/a)8.5
(3.8 to 18.7)3.5
(1.0 to 12.8).67 ≥1 Day in the past 4 weeks that neck pain kept you out of work or school, % (95% CI) 4.6
(1.1 to 19.8)6.8
(2.4 to 19.1)2.2
(0.4 to 14.1)3.6
(0.9 to 14.7)1.8
(0.4 to 7.8)4.9
(1.2 to 19.8).73 Perceived Stress Scale, mean (95% CI) −0.42
(−2.4 to 1.6)−1.1
(−2.3 to 0.1)−1.6
(−3.3 to 0.2)−1.5
(−3.1 to 0.0)−3.7
(−5.5 to −1.9)−1.5
(−3.2 to 0.3).21 Compared with when you began the study, neck pain is much better or completely gone, % (95% CI) 2.5
(0.4 to 14.8)7.1
(2.2 to 18.2)9.3
(3.6 to 23.9)18.9
(10.0 to 35.8)20.4
(10.2 to 40.6)40.6
(27.8 to 59.5)<.001 Very satisfied with care for neck pain, % (95% CI) 22.2
(11.2 to 44.0)40.0
(27.6 to 57.8)40.6
(27.8 to 59.2)54.6
(41.1 to 72.5)25.9
(16.3 to 44.3)47. 0
(33.2 to 66.5).06 -
n/a = not applicable.
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Note: All variables are adjusted for baseline Neck Disability Index and neck pain intensity. The outcomes Perceived Stress Scale, neck pain is much better/completely gone, and satisfaction with care for neck pain additionally adjusted for age, sex, duration of neck pain more than 5 years, use of medications for neck pain, and race (white non-Hispanic vs other). The Perceived Stress Scale was further adjusted for baseline score for this scale.
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↵a No participant in this group was kept in bed for most of the day because of neck pain.
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The Article in Brief
Five-Week Outcomes From a Dosing Trial of Therapeutic Massage for Chronic Neck Pain
Karen J. Sherman , and colleagues
Background Neck pain is a common and debilitating condition, and massage therapy is commonly used to treat it. This study evaluates the optimal dose of massage for persons with chronic neck pain.
What This Study Found Two hundred twenty-eight patients with chronic neck pain were randomized to 5 groups receiving various doses of massage for a 5-week period. The study found that the benefits of massage treatments for chronic neck pain increase with dose. Specifically, patients who received 30-minute treatments 2 or 3 times weekly were not significantly better than a wait-listed control group in terms of achieving a clinically meaningful improvement in neck dysfunction or pain. In contrast, patients who received 60-minute treatments 2 or 3 times weekly showed significant improvement in neck dysfunction and pain intensity compared to the control group. Compared with their control counterparts, massage participants were 3 times more likely to have clinically meaningful improvement in neck function if they received 60 minutes of massage twice a week and 5 times more likely if they received 60 minutes of massage 3 times a week.
Implications
- Patients who receive massage treatment for chronic neck pain may not be realizing benefits from treatment because they are not receiving an effective treatment dose.
