Recently, the Centers for Disease Control and Prevention (CDC) published the “CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016.”1 This publication is a result of the significant increase in opioid use over the past decade. According to the publication, approximately 20 percent of pain patients have been prescribed an opioid at some point; and from 2007 to 2012, opioid prescriptions increased a whopping 7.3 percent per capita. This five-year increase demonstrates the opioid prescription epidemic we have across our nation, which has led primary-care providers to worry about patient addiction and question whether there are alternative treatments for their chronic-pain patients.
Pain management through other options was not a focus of this guideline on opioid use. However, there was a suggestion that long-term opioid therapy must be considered within the context of all pain-management strategies. Nonpharmacologic therapy and nonopioid pharmacologic therapy were described as the preferred treatment for chronic pain. And even when opioids are prescribed, physicians are encouraged to prescribe them in combination with nonpharmacologic therapy.
In response to the CDC guidelines for opioid use, the National Institutes of Health National Center for Complementary and Integrative Health published a recent systematic review assessing complementary health-care approaches to pain management.2 The researchers searched Medline for randomized clinical trials that were completed in the United States or at least included participants from the United States in order to best determine the expected outcomes for US primary-care providers. Conditions of interest included: back pain, fibromyalgia, neck pain, osteoarthritis of the knee, and severe headache/migraine. The complementary nonpharmacologic treatments assessed included acupuncture, manipulation, massage therapy, relaxation approaches, tai chi, yoga, and certain dietary supplements.
The findings of this study were complex in that there were many different factors to consider in each of the trials, such as the research methods, diagnostic conditions, and treatment logistics. However, in general, the data demonstrated that certain complementary therapies were considered beneficial in treatment of the following painful conditions: acupuncture and yoga for back pain; acupuncture and tai chi for osteoarthritis of the knee; massage therapy for neck pain; and relaxation techniques for severe headaches and migraines. Weaker evidence was present for massage therapy, osteopathic manipulation, and spinal manipulation for back pain, and relaxation approaches and tai chi for fibromyalgia.
A similar review article published in Pain Medicine specifically focused on massage therapy for pain conditions.3 This article was more inclusive in that it combined articles from around the world and included any condition that involved pain in which functional outcomes were also measured. Several databases were searched for clinical trials and the quality of all included clinical trials was assessed.
The results of this review demonstrated that massage therapy should be recommended as an option for pain management, particularly when compared to no other treatment. Massage therapy also demonstrated a significant benefit for anxiety and health-related quality of life, when compared with other active treatments.
In both of these review articles, massage therapy was found to be beneficial for pain conditions. However, these findings come with the cautionary tale that pain conditions can present in many different ways, and each case should be treated individually. Patient comorbidities, clinical characteristics, and demographics may have an influence on the benefit of massage therapy for pain reduction. The style, location on the body, depth, and duration of massage therapy provided to your clients may also affect their results. When in doubt, work with each client’s health-care team to determine the best treatment plan for them.
Overall, massage therapy should be considered as a possible treatment option for patients with painful conditions, either as a standalone form of care or as part of a treatment plan that may or may not include opioid prescriptions. Each client is different and involvement of the health-care team is needed to determine the best course of action for each patient.

Notes
1. Centers for Disease Control and Prevention, “CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016,” accessed September 2016, www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm.
2. R. Nahin et al., “Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States,” Mayo Clinic Proceedings 91, no. 9 (September 2016): 1,292–1,306.
3. C. Crawford et al., “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,” Pain Medicine (May 2016): 1–23. doi: 10.1093/pm/pnw099.

Jerrilyn Cambron, DC, PhD, MPH, LMT, is an educator at the National University of Health Sciences and president of the Massage Therapy Foundation. Contact her at jcambron@nuhs.edu.