April 17, 2001

Study shows massage works well for persistent low back pain

Seattle—In a study comparing three treatments for persistent low back pain—therapeutic massage, traditional Chinese acupuncture, and self-care—researchers at Group Health Center for Health Studies found therapeutic massage to be most effective for improving function.

The study, published in the April 23 issue of the Archives of Internal Medicine, is the first to evaluate the effectiveness of therapeutic massage for chronic back pain—one of America's most prevalent health problems.

"Alternative therapies for back pain are growing in popularity," said Dan Cherkin, PhD, acting director of the Center, and the study's principal investigator. "Many doctors, health plans, and people with back pain are wondering: Which treatments are really helpful and worth the cost? This study shows that therapeutic massage may be one of the best options for treating chronic back pain."

There have been few, if any, good studies of massage or acupuncture for persistent back pain, explains Cherkin. Consequently, health care organizations have had no clear scientific basis for recommending either treatment for back pain. This Group Health study—done in collaboration with Harvard Medical School's Center for Alternative Medicine Research and Education, the Northwest Institute of Acupuncture and Oriental Medicine, and the University of Washington—may help to change all that.

The study involved 262 Group Health members, ages 20 to 70, all of whom had seen their doctor in the past six weeks for persistent back pain. Each was randomly assigned to receive therapeutic massage, traditional Chinese medical acupuncture, or self-care educational materials. Patients were then interviewed regarding their symptoms and ability to function after four weeks, ten weeks, and one year.

Researchers found that, after ten weeks, massage was superior to self-care and acupuncture on measures of function. After one year, massage was no better than self-care, but it was better than acupuncture. The massage group used the least medications and had the lowest costs of subsequent back care.

The study was funded by grants from Group Health Cooperative, the Group Health Community Foundation, the John E. Fetzer Institute, and the Agency for Health Care Policy and Research.

It is one of several ongoing investigations into alternative and complementary medicine being conducted at Group Health Center for Health Studies. Studies of alternative treatments for menopausal symptoms and of the effectiveness of tai chi and meditation-based stress reduction for chronic back pain are currently in progress.

Funded primarily through government and private research grants, Group Health Center for Health Studies is located in Seattle, Washington. Group Health Cooperative is the nation's largest consumer-governed health care system, serving nearly 600,000 people in Washington and Idaho.

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Questions & Answers
Group Health's study on alternative care for low back pain

What's the most important new information from this study?

In a comparison of three treatments for persistent low back pain, therapeutic massage was found to be the most effective in terms of:

The study compared therapeutic massage, traditional Chinese medical acupuncture, and self-care-oriented educational materials.

Why is this information important?

How was the study was conducted?

The study involved 262 Group Health members, ages 20 to 70, who had seen their doctor in the past six weeks for persistent back pain. Each was randomly assigned to one of three interventions—massage, acupuncture, or self-care.

Patients assigned to massage or acupuncture received up to ten visits over a ten-week period. Providers included licensed massage therapists and acupuncturists in Group Health's network of alternative-care providers. Patients assigned to self-care received a book and two videotapes. Patients were interviewed regarding their symptoms and ability to function after four weeks, ten weeks, and one year.

What were the findings?

Researchers found that, after ten weeks, massage was superior to self-care and acupuncture on measures of function. After one year, massage was no better than self-care, but it was better than acupuncture. The massage group used the least medications and had the lowest costs of subsequent back care.

What does the study tell us about the effectiveness of acupuncture?

Acupuncture did not appear as effective as massage after ten weeks, but this finding may be related to limitations of the study:

What does the study tell us about the effectiveness of self-care?

After ten weeks, patients in the study who got self-care materials did not do as well as patients who got massage, and they did about the same as people who got acupuncture. After a year, however, patients who got the self-care materials were doing almost as well as the people who got massage. This may indicate that although self-care materials have little short-term benefit, they do have a long-term benefit.

What are Group Health's current policies regarding massage and acupuncture for members with persistent back pain?

Group Health currently provides massage and acupuncture to its enrollees through an outside network of licensed practitioners.

Coverage for these services varies according to plan. Those with alternative-care benefits must meet certain clinical criteria to get coverage for back pain. For example, the condition must:

To qualify for coverage for acupuncture, the back pain needs to have been present for more than three months. For massage, it needs to have been present for no less than two months, but no more than six months.

Will Group Health's policies about massage and acupuncture change as a result of this study?

Group Health is currently re-evaluating how it administers its alternative care benefits, looking at ways to ensure appropriate access for people with persistent back pain. Policies may be revised based on this review. The organization's policies on coverage for alternative treatments will continue to evolve as research provides new evidence about their effectiveness.

Who conducted the study?

Dan Cherkin, Ph.D, acting director of Group Health Center for Health Studies, was the principal investigator. His collaborators included David Eisenberg, MD, of the Beth Israel–Deaconess Center for Alternative Medicine Research and Education at Harvard Medical School; Karen Sherman, PhD, formerly of the Northwest Institute of Acupuncture and Oriental Medicine, and now a member of the scientific staff at Group Health;
and Richard A. Deyo, MD, MPH, professor of medicine at the University of Washington.

Who funded the study?

The study was funded by grants from Group Health Cooperative, the Group Health Community Foundation, the John E. Fetzer Institute, and the Agency for Health Care Policy and Research.

Group Health Center for Health Studies
Founded in 1947, Group Health Cooperative is a Seattle-based, consumer-governed, nonprofit health care system. The Group Health Center for Health Studies is Group Health’s research institute. For 25 years, the Center has conducted nonproprietary public-interest research on preventing, diagnosing, and treating major health problems. Government and private research grants provide its main funding.

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