A Systematic Review and Meta-Analysis of Efficacy, Cost-Effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-Back Pain

Table 8

Summary of findings of massage for low-back pain (only pain and functional outcomes).

Duration and cause of pain	Outcomes	GRADE*	Findings
Massage versus no treatment
Acute/subacute nonspecific	Pain intensity score (VAS)	Low; Design: RCT; ROB: Medium; Consistency: NA (one trial); Directness: yes	One trial showed significant short-term posttreatment benefit with massage (VAS: 37.0±19.0 versus 52.0±21.0, 𝑃<0.001) [139].
	Oswestry Disability Index	Low; Design: RCT; ROB: Medium; Consistency: NA (one trial); Directness: yes	One trial showed significant short-term posttreatment benefit with massage (Oswestry: 16.0±5.0 versus 31.0±12.0, 𝑃<0.001) [139].
Acute/subacute, specific	NA	Insufficient; No trial	NA
Chronic nonspecific	Pain intensity score (SF-36 pain scale)	Low; Design: RCT; ROB: Medium; Consistency: NA (one trial); Directness: yes	In one trial, massage (reflexology) was not significantly different from no treatment immediately posttreatment (mean score: 50.0±25.7 versus 41.8±25.6) and in the intermediate-term followup (mean score: 50.7±27.1 versus 44.4±28.5) [140].
	Oswestry Disability Index	Low; Design: RCT; ROB: Medium; Consistency: NA (one trial); Directness: yes	In one trial, massage (reflexology) was not significantly different from no treatment immediately posttreatment (mean score: 29.8±19.6 versus 36.7±19.9) and in the intermediate-term followup (mean score: 29.0±20.2 versus 32.9±17.6) [140].
Chronic specific	NA	Insufficient; No trial	NA
Mixed/unknown (specific, nonspecific)	NA	Insufficient; No trial	NA
Massage versus placebo
Acute/subacute, nonspecific	Pain intensity score (VAS, MPQ)	Moderate; Design: RCT; ROB: Medium; Consistency: yes; Directness: yes	In two trials massage produced significantly lower immediate and short-term posttreatment pain intensity compared to placebo [139, 141].
	Oswestry Disability Index	Low; Design: RCT; ROB: Medium; Consistency: NA (one trial); Directness: yes	In two trials massage produced significantly better disability scores compared to placebo [139, 141].
	Roland-Morris Disability Questionnaire	Low; Design: RCT; ROB: Medium; Consistency: NA (one trial); Directness: yes
Acute/subacute, specific	NA	Insufficient; No trial	NA
Chronic nonspecific	Pain intensity score (VAS, MPQ)	Low; Design: RCT; ROB: High; Consistency: NA (one trial); Directness: yes	In one trial, massage (reflexology) had numerically similar degree of improvement in intermediate-term pain intensity (VAS: 2.2 versus 3.3, MPQ: 6.0 versus 7.5), compared to subjects in the placebo group [142].
	Roland-Morris Disability Questionnaire	Low; Design: RCT; ROB: High; Consistency: NA (one trial); Directness: yes	In one trial, massage (reflexology) had numerically similar degree of improvement in intermediate-term disability (RMDQ: 4 versus 3.5) compared to subjects in the placebo group [142].
Chronic specific	NA	Insufficient; No trial	NA
Mixed/unknown (specific, nonspecific)	NA	Insufficient; No trial	NA
Massage versus physiotherapy
Acute/subacute, mixed, and unknown (specific, nonspecific)	NA	Insufficient; No trial	NA
Chronic nonspecific	Pain intensity score (VAS, MPQ)	Moderate; Design: RCT; ROB: Medium; Consistency: yes; Directness: yes	The meta-analysis of two trials showed a statistically significant difference in favour of massage over physical therapy in reducing pain intensity immediately posttreatment (pooled mean difference on VAS score: −2.11, 95% CI: −3.15, −1.07) [143, 144].
	Roland-Morris Disability Questionnaire and modified Oswestry Disability Index	Low; Design: RCT; ROB: Medium; Consistency: NA (one trial); Directness: yes	The mean total RMDQ score immediately posttreatment was significantly lower in the acupressure group than in the physical therapy group (−3.8, 95% CI: −5.7, −1.9) [143].; The mean total ODI score immediately posttreatment was significantly lower in the acupressure group than in the physical therapy group, (− 5.34, 95% CI: −7.62, −3.05) [143].
Chronic specific	NA	Insufficient; No trial	NA
Massage versus relaxation
Acute/subacute, mixed, and unknown (specific, nonspecific)	NA	Insufficient; No trial	NA
Chronic nonspecific	Pain intensity score (VAS)	Low; Design: RCT; ROB: High; Consistency: yes; Directness: yes	The meta-analysis of two trials showed a significantly lower pain intensity with massage compared to relaxation (mean difference: −1.27, 95% CI: −2.46, −0.08) [145, 146].; A third trial not pooled in the meta-analysis [140] did not demonstrate any significant immediate (or intermediate-term) posttreatment differences in pain (immediate posttreatment score: 50.0±25.7 versus 47.2±26.3).
	Oswestry Disability Index	Low; Design: RCT; ROB: Medium; Consistency: NA (one trial); Directness: yes	In one trial, massage (reflexology) was not significantly different from relaxation immediately posttreatment (mean score: 29.8±19.6 versus 33.4±23.3) and in the intermediate-term followup (mean score: 29.0±20.2 versus 31.3±21.1) [140].
Chronic specific	NA	Insufficient; No trial	NA
Massage versus usual care
Acute/subacute, mixed, and unknown (specific, nonspecific)	NA	Insufficient; No trial	NA
Chronic nonspecific	Pain intensity score (VAS)	Low; Design: RCT; ROB: Medium; Consistency: NA (one trial); Directness: yes	In one trial, there was no significant difference between massage and usual care (prescription by physician and behavioural counselling with practice nurse) measured in the intermediate-term followup, mean change scores −0.41 (95% CI: −0.91, 0.09) and −0.32 (95% CI: −0.66, 0.03) for massage and usual care respectively [147].
	Roland-Morris Disability Questionnaire	Low; Design: RCT; ROB: Medium; Consistency: NA (one trial); Directness: yes	In one trial, there was no significant difference between massage and usual care (prescription by physician and behavioural counselling with practice nurse) measured in the intermediate-term followup, mean change score −1.96 (95% CI: −0.74, 3.18) and −0.90 (95% CI: −1.76, 0.04) for massage and usual care respectively [147].
Chronic specific	NA	Insufficient; No trial	NA
Massage versus exercise
Acute/subacute, nonspecific	Pain intensity score (VAS)	Low; Design: RCT; ROB: Medium; Consistency: NA (one trial); Directness: yes	In one trial, comprehensive massage was significantly better than exercise. Mean scores in the massage and exercise group at the immediate posttreatment were 0.44 (95% CI: 0.17, 0.71) versus 1.64 (95% CI: 1.3, 2.0) and short-term posttreatment followups 0.42 (95% CI: 0.17, 0.66) versus 1.33 (95% CI: 0.97, 1.7) respectively [140].
	Roland-Morris Disability Questionnaire	Low; Design: RCT; ROB: Medium; Consistency: NA (one trial); Directness: yes	In one trial, comprehensive massage was significantly better than exercise. Mean scores in the massage and exercise group at the immediate posttreatment were 2.36 (95% CI: 1.2, 3.5) versus 6.82 (95% CI: 4.3, 9.3) and short-term posttreatment followups 1.54 (95% CI: 0.69, 2.4) versus 5.71 (95% CI: 3.5, 7.9) respectively [140].
Acute/subacute, specific	NA	Insufficient; No trial	NA
Chronic nonspecific	Pain intensity score (VAS)	Moderate; Design: RCT; ROB: Medium; Consistency: yes; Directness: yes	Two trials showed no significant difference between massage and exercise [29, 147].
	Roland-Morris Disability Questionnaire	Low; Design: RCT; ROB: Medium; Consistency: NA (one trial); Directness: yes	One trial showed no significant difference between massage and exercise [147].
Chronic specific	NA	Insufficient; No trial	NA
Mixed or unknown (specific and nonspecific)	NA	Insufficient; No trial	NA

*Precision in formal grading was applied only to pooled results.
VAS: visual analog scale; RMDQ: Roland-Morris disability scale; MPQ: McGill pain questionnaire; PDI: pain disability index; NPQ: neck pain questionnaire; NA: not applicable; ROB: risk of bias; RCT: randomized controlled trial.