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      The Impact of Massage Therapy on Function in Pain Populations—A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part I, Patients Experiencing Pain in the General Population

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          Abstract

          Purpose. Pain is multi-dimensional and may be better addressed through a holistic, biopsychosocial approach. Massage therapy is commonly practiced among patients seeking pain management; however, its efficacy is unclear. This systematic review and meta-analysis is the first to rigorously assess the quality of massage therapy research and evidence for its efficacy in treating pain, function-related and health-related quality of life outcomes across all pain populations.

          Methods. Key databases were searched from inception through February 2014. Eligible randomized controlled trials were assessed for methodological quality using SIGN 50 Checklist. Meta-analysis was applied at the outcome level. A diverse steering committee interpreted the results to develop recommendations.

          Results. Sixty high quality and seven low quality studies were included in the review. Results demonstrate massage therapy effectively treats pain compared to sham [standardized mean difference (SMD) = −.44], no treatment (SMD = −1.14), and active (SMD = −0.26) comparators. Compared to active comparators, massage therapy was also beneficial for treating anxiety (SMD = −0.57) and health-related quality of life (SMD = 0.14).

          Conclusion. Based on the evidence, massage therapy, compared to no treatment, should be strongly recommended as a pain management option. Massage therapy is weakly recommended for reducing pain, compared to other sham or active comparators, and improving mood and health-related quality of life, compared to other active comparators. Massage therapy safety, research challenges, how to address identified research gaps, and necessary next steps for implementing massage therapy as a viable pain management option are discussed.

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          Most cited references113

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          Pain catastrophizing: a critical review.

          Pain catastrophizing is conceptualized as a negative cognitive-affective response to anticipated or actual pain and has been associated with a number of important pain-related outcomes. In the present review, we first focus our efforts on the conceptualization of pain catastrophizing, highlighting its conceptual history and potential problem areas. We then focus our discussion on a number of theoretical mechanisms of action: appraisal theory, attention bias/information processing, communal coping, CNS pain processing mechanisms, psychophysiological pathways and neural pathways. We then offer evidence to suggest that pain catastrophizing represents an important process factor in pain treatment. We conclude by offering what we believe represents an integrated heuristic model for use by researchers over the next 5 years; a model we believe will advance the field most expediently.
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            A meta-analysis of massage therapy research.

            Massage therapy (MT) is an ancient form of treatment that is now gaining popularity as part of the complementary and alternative medical therapy movement. A meta-analysis was conducted of studies that used random assignment to test the effectiveness of MT. Mean effect sizes were calculated from 37 studies for 9 dependent variables. Single applications of MT reduced state anxiety, blood pressure, and heart rate but not negative mood, immediate assessment of pain, and cortisol level. Multiple applications reduced delayed assessment of pain. Reductions of trait anxiety and depression were MT's largest effects, with a course of treatment providing benefits similar in magnitude to those of psychotherapy. No moderators were statistically significant, though continued testing is needed. The limitations of a medical model of MT are discussed, and it is proposed that new MT theories and research use a psychotherapy perspective.
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              Persistent Pain and Well-being

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                Author and article information

                Journal
                Pain Med
                Pain Med
                painmedicine
                painmedicine
                Pain Medicine: The Official Journal of the American Academy of Pain Medicine
                Oxford University Press
                1526-2375
                1526-4637
                July 2016
                10 May 2016
                10 May 2016
                : 17
                : 7
                : 1353-1375
                Affiliations
                Samueli Institute, Alexandria, Virginia
                Author notes
                Correspondence to: Courtney Boyd, MA, Samueli Institute, 1737 King Street, Suite 600, Alexandria, VA 22314, USA. Tel: 703-299-4800; Fax: 703-535-6750; E-mail: cboyd@ 123456samueliinstitute.org .

                Funding sources: Funding for this project was provided by the Massage Therapy Foundation, through the generous support of the American Massage Therapy Association.

                Conflicts of interest: The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or United States Government. There are no conflicts of interest to report.

                Disclosure: The Evidence for Massage Therapy (EMT) Working Group (diverse stake-holders making up the steering committee and subject matter experts) contributed to the protocol development and provided input throughout the entire project; all analyses were conducted independently by Samueli Institute. All recommendations set forth in this report were made collectively with the EMT Working Group and Samueli Institute during an expert round table and are based on the evidence revealed through the systematic review and gaps that emerged through the process.

                Article
                pnw099
                10.1093/pm/pnw099
                4925170
                27165971
                90fac013-9046-488d-b068-02b628b7a286
                © 2016 American Academy of Pain Medicine.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Page count
                Pages: 23
                Categories
                INTEGRATIVE MEDICINE SECTION
                Review Article

                Anesthesiology & Pain management
                systematic review,meta-analysis,massage therapy,pain,function,health-related quality of life

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