"Statistics show that nearly 80% of adults suffer from at least one episode of back pain in their lives. If you're not a believer in statistics and averages, you probably don't have to look too far to find tangible, real-life examples of back pain - perhaps even from personal experience.

The economic and physical consequences of back pain are fairly clear: billions of dollars in lost workdays, insurance resources, and health care costs each year, coupled with significant disability and dysfunction. However, pinning down the source of the pain, and doing something about it, can be an entirely different matter. Muscle strain; normal wear-and tear; overexertion; poor posture; improper lifting; organ dysfunction; disease; and stress are just some of the potential causes of back pain. Even the so-called health care "experts" rarely agree on what causes back pain, or on the most effective approach to managing the condition.

Consumer utilization of complementary and alternative medicine (CAM) has risen dramatically in the past 10 years, and with it, the number of back pain patients seeking massage. In 1997, one in three U.S. adults with low back pain sought the services of a CAM provider, particularly massage therapists, chiropractors and acupuncturists.

Despite the common-sense notion that massage therapy can help ease back pain, few scientific studies have confirmed beneficial results - until recently. Since 1999, four major randomized, controlled trials and one systematic literature review have evaluated the efficacy of massage for treating back pain. The most recent (and perhaps most convincing) of the five appeared in the April 23, 2001 issue of the Archives of Internal Medicine, a publication of the American Medical Association.

This randomized trial compared therapeutic massage with traditional Chinese medical acupuncture and self-care education for chronic low back pain (LBP). Two hundred and sixty-two patients, 20-70 years old and with persistent LBP, were randomly selected from a local HMO to receive one of the three interventions for 10 weeks. Most patients had received initial treatment for their pain at least one year earlier, and most reported continuous pain in the year leading up to the study. Most were using pain medication (non-steroidal anti-inflammatory drugs). Acupuncture and massage were provided by licensed therapists (12 massage therapists, 7 acupuncturists) with at least three years of experience in their respective fields.

Patients in the massage group (N=78) received up to 10 massage visits, consisting of various massage techniques, including Swedish, movement re-education; deep tissue; moist heat or cold; trigger or pressure point; and neuromuscular. The massage therapists also recommended stretching exercises and educated patients on "body awareness" techniques to help recognize early warning signs of injury.

Patients in the acupuncture group (N=94) received up to 10 treatments in the form of basic needling techniques; moxibustion; infrared lamp heat; cupping; and needle electrostimulation. As with the massage group, the acupuncture group was given exercise recommendations.

Patients in the self-care group (N=90) received a book and two videotapes that discussed management and prevention strategies for chronic back pain.

Patients in all three groups retained access to their HMO medical provider during the study period. Phone interviews served to assess outcomes at 4, 10 and 52 weeks after randomization; results are presented as follows:

• "Significant treatment effects favoring massage" were evident at 10 weeks. Specifically, the massage group reported less severe symptoms than the self-care group and less dysfunction than the self-care group and the acupuncture group.
   
• At 10 weeks, only five percent of massage patients reported more than one week of restricted activity, compared with 19% total in the acupuncture and self-care groups. Even more impressive, only three percent of the massage group reported spending one or more days in bed because of back pain during the study period, compared to 13% in the acupuncture group and 12% in the self-care group.
   
• Patients reported decreases in medication use during the study period, more significantly in the massage group (73% using medication at baseline, only 47% at 10 weeks) than the acupuncture group (69% at baseline, 51% at 10-week follow-up). Medication use in the self-care group remained relatively unchanged (63% at baseline, 62% after 10 weeks).
   
• At one-year follow-up, massage remained superior to acupuncture in terms of symptoms and function. Use of medications also remained lower in the massage group than in both other groups.
   
• Far less patients (10%) in the massage group made visits to their HMO physician for their pain during the study period, compared with 18% and 21%, respectively, in the acupuncture and self-care groups.

In their conclusion, lead author Daniel Cherkin and colleagues note: "Therapeutic massage was effective for persistent low back pain, apparently providing long-lasting benefits. Traditional Chinese Medical acupuncture was relatively ineffective. Massage might be an effective alternative to conventional medical care for persistent back pain."

Is massage an effective therapeutic treatment for back pain? No doubt your patients think so, especially after months or years of receiving your care. It's good to see that, slowly but surely, the research is proving what the massage community, and the people it serves, have always known."