Touch Research Abstracts

Vol. 9 No. 2 Spring, 2002

Massage Therapy for Pain Syndromes

Pain Syndromes
Noting significant pain reduction following painful
procedures suggested that massage therapy might
alleviate pain in chronic conditions such as
juvenile rheumatoid arthritis, fibromyalgia, lower
back pain and migraine headaches. Although these
are very different forms of pain experience, similar
mechanisms might be operating. Research studies
on the use of massage therapy with these
conditions are summarized below.
Juvenile Rheumatoid Arthritis
Abstract
Chronic pain is a problem for children with
juvenile rheumatoid arthritis. Anti-inflammatory
agents used for their pain have ceiling effects, and
other drugs such as narcotics cannot be used due to
their addictive potential. Thus, massage therapy is
being assessed for its usefulness for pain relief. In
a study in which parents provided their children
daily massages, several positive effects were noted
(Field, Hernandez-Reif, Seligman, Krasnegor,
Sunshine, Rivas-Chacon, Schanberg & Kuhn,
1997). The massaged children (versus the control
children who received progressive muscle
relaxation), had 1) decreased anxiety and cortisol
after the first and last sessions; and 2) decreased
pain over the 1-month period.
Background
Juvenile rheumatoid arthritis (JRA) is the most
common rheumatic disease of childhood and one
of the most common chronic diseases of childhood
(Cassidy & Petty, 1995; Lovell & Walco, 1989).
The JRA diagnosis is based on the observation of
persistent arthritis (6 or more weeks in duration) in
one or more joints. The disease typically manifests
itself before 16 years of age, with peak onset in the
age groups 1 to 3 and 8 to 12 years (Varni & Jay,
1984). Common symptoms include night pain and

joint stiffness both during the morning and

following long periods of inactivity.
Treatment regimens for JRA have included
medications, exercise and devices such as hand
splits. The overall management of JRA consists of
a multidisciplinary approach to comprehensive
care, incorporating pharmacotherapy, physical and
occupational therapy, orthopedic surgery, and
psychosocial services. Despite the comprehensive
approach to patient care, pain remains an
undertreated clinical problem (Lovell & Walco,
1989).
Because of the limited effects of anti-inflammatory
drugs and the reluctance to use narcotics for pain
reduction, investigators have been exploring other
methods including meditation, progressive muscle
relaxation and guided imagery (Walco, Vami &
Ilowite, 1992). In the Walco et al. (1992) study, 5
to 16 year old children reported lower pain levels
on visual analogue scales after eight sessions. In
another study, modest pain reduction was achieved
after training in progressive muscle relaxation,
electromyogram (EMG) feedback, and thermal
biofeedback (Lavigne, Ross, Berry, Hayford &
Pachman, 1992).

Touch Research Institutes University of Miami School of Medicine

In our study on massage therapy with JRA children

and adolescents the masssages were expected to
lower levels of anxiety, depression and pain as well
as stress hormone (cortisol) levels. Teaching the
parents to massage their children was also expected
to give the parents a positive role in their childs
treatment and thereby reduce their own anxiety
levels.
Method
Following the parents informed consent and
the childrens assent, the sample was comprised of 20
children (14 females) (R = 5- 15 years; M = 9.8) who
had been diagnosed with JRA on average 4 years
previously and who were recruited from two
rheumatologists. Entry criteria were 1) diagnosis of
Juvenile Rheumatoid Arthritis by the pediatric
rheumatologist, 2) age range between 4 and 16 years,
and 3) no other serious or chronic illness. Ten
percent of the parents and 25% of the children had
previously received various kinds of massage
therapy. On average the rheumatologists scored
these children 7.4 on the Juvenile Arthritis Functional
Assessment. This assessment was a modified form of
the Activities of Daily Living Index developed by
Walco et al., 1992. This scale ranged from 0 to 46,
with 0 being full functional activity and 46 being
completely inactive. The physicians average score
of 7.4 suggested that the sample had mild functional
limitations (dressing, bathing, eating and gross motor
activities).
The children were randomly assigned to
massage therapy or relaxation therapy groups. The
parents in each group were given live demonstrations
and videotapes illustrating the therapy techniques.
Typically, parents can learn this procedure after 30
minutes of demonstration and practice, and then they
use the tape and daily practice to improve their skill.
Having the parents massage their children as opposed
to massage therapists empowers the parents for being
part of their childrens treatment process, reduces the
parents anxiety and stress hormone levels and
enables a more frequent and more cost effective
treatment for the children.
Procedures
Massage Therapy. These children received a
daily 15 minute massage with moderate pressure by
one of their parents for 30 days. This 15-minute
massage was comprised of two standardized phases
given in a progressive sequence typically followed by
massage therapists.
Relaxation Therapy.
These children
experienced a 15-minute relaxation session with their
parents every night for one month. On the first day

of the study therapists trained and provided the

parents with written instruction on the relaxation
sessions. These sessions were performed with the
subjects laying on their back and being instructed to
tighten and flex different muscles of the body in a
head to feet progression as was done in a study on
children with psychiatric problems (Platania-Solazzo
et al., 1992).
Results
Pre/Post Session Assessment. Data analyses
on the pre/post session immediate effects revealed the
following immediate effects favoring the massage
group including: 1) lower parent anxiety by selfreport on the State Anxiety Inventory; 2) lower child
anxiety based on behavioral observation; and 3)
lower stress hormone levels (salivary cortisol) in the
children receiving the massage.
First Day/Last Day Assessments. Analyses
of the child assessments of self on the first day/last
day revealed the following changes favoring the
massage group: 1) fewer words for pain; 2) less pain
at present; 3) less pain over the past week; and 4)
fewer severe pain points. Analyses of the first
day/last day parent report measures revealed the
following changes by the last day favoring the
massaged children: 1) less pain at present; 2) less
pain over the past week; 3) fewer severe pain points;
4) less pain severity at 9 PM in the evening; and 5)
less pain limiting of vigorous activity. Analyses of
the first day/last day physicians assessment revealed
the following changes favoring the massaged
children: 1) less pain; and 2) less morning stiffness.
Fibromyalgia
Abstract
In a study on fibromyalgia (pain all over the
body for no known etiology) (Sunshine et al., 1996),
participants were randomly assigned to one of three
conditions: 1) massage therapy; 2) transcutaneous
electrical stimulation (TENS), a steel roller the size
of a pen that transmits a small barely discernible
current as it is rolled across the body; or 3)
transcutaneous electrical stimulation without current
(SHAM TENS), for 30 minute treatment sessions two
times per week for 5 weeks (Sunshine et al., 1996).
The massage therapy subjects reported lower anxiety
and depression, and their cortisol levels were lower
immediately after the therapy sessions on the first
and last days of the study. The massage therapy
group improved on a dolorimeter measure of pain.
Thus, massage therapy was the most effective
therapy with fibromyalgia patients.
Touchpoints Vol. 9 No.2 Page 2

Touch Research Institutes University of Miami School of Medicine

Background
Fibromyalgia was once considered a
depressive disorder. However, this view has been
replaced by the new theory that both central and
peripheral pain mechanisms are activated in these
patients.
For example, disturbances in muscle
microcirculation have been reported (Bartels &
Danneskiold-Samse, 1986; Bengtsson, Henriksson &
Larsson, 1986; Henriksson, Bengtsson & Larsson,
1982; Simms, 1994), as well as alterations in
restorative sleep and neuroendocrine function,
resulting in low levels of serotonin, growth hormone,
and somatomedin-C (Bennett, 1993). In addition,
substance P levels in the cerebrospinal fluid are
significantly elevated in this patient population
(Russell, Orr, Vapraio, Alboukrek, Michalek,
MacKillip, Lopez & Littman, 1993; Vaeroy, Helle,
Forre, Kass & Terenius, 1988).
Fibromyalgia patients tend to have multiple
symptoms including generalized pain, myalgia,
arthralgia, nonrestorative sleep, irritable bowel,
temporomandibular dysfunction, anxiety, depression,
headache,
and
neuropsychiatric
complaints.
Unfortunately, many traditional therapies, both
pharmacological and nonpharmacological, have
yielded little or no benefit. Although many nonmedicinal treatments have been proposed, few
controlled studies of this type have been published
(McCain, 1989; Yunus & Masi, 1985).
FMS patients may benefit from massage
therapy because it enhances immunological and
neuroendocrine function, for example decreasing
cortisol and norepinephrine levels, and increasing
serotonin levels and natural killer cell activity. The
low serotonin levels in fibromyalgia patients have
been related to their nonrestorative sleep, mood
alteration, and increased pain sensitivity. In at least
one study, massage therapy increased serotonin levels
(Ironson et al., 1996), and in another, sleep patterns
improved (Field et al., 1992). Although these data
are suggestive, they are based on studies with other
disease groups.
The purpose of the present study was to
determine the effects of massage therapy on pain,
depression and anxiety associated with fibromyalgia.
Massage therapy was compared to microcurrent
transcutaneous electrical stimulation (TENS) as
another possible therapy. This was performed in a
double blind fashion using sham TENS as a control.
Method
Thirty female adult fibromyalgia syndrome
patients were recruited from local rheumatology
practices. These patients were not receiving any

other treatment at the time of the study. They

averaged 50 years (R=18-80), were middle income
levels on average, and were distributed 32%
Caucasian, 44% Hispanic, and 24% Black. The
subjects were randomly assigned to one of three
groups, massage therapy, TENS, and SHAM TENS.
The three groups of women did not differ on the
demographic variables of ethnicity, income or age.
The physician and researchers responsible for the pre
and post assessments were blind to the group
assignment of the subjects. Assessments were made
only during the first and last sessions (session 1 and
session 10).
Procedure
Before the study period the subjects were
assessed by a rheumatologist to determine the
fibromyalgia diagnosis according to the criteria
established by the American College of
Rheumatology.
Point pressure threshold was
measured with the use of a dolorimeter by exerting a
force of 1 kg./sec. over the 18 tender points outlined
in the ACR classification criteria. All pre and post
tests were performed by the same rheumatologist on
the first and last days of therapy. Patients were
required to maintain their pharmacological regimen
during the course of the study.
Massage Therapy. The massage therapy
sessions consisted of Swedish massage (with
pressure) stroking of the head, neck, shoulders, back,
arms, hands, legs and feet for thirty minutes.
To be continued.

Tiffany Field
Touchpoints Vol. 9 No.2 Page 3

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