Key Point

• The holistic importance of massage therapy needs to be recognized as a key to relieving a client’s pain.

Millions of Americans live with poorly managed pain.¹ Many overlapping and complicated factors inform this reality. Nevertheless, while the burden of chronic pain is monumental and massage therapy is offhandedly considered a discipline that “helps” with pain, we remain on the margins when it comes to our integration in health care.

Pain is complex, even if we’re just looking at some of the main categories of pain—neuropathic, nociceptive, musculoskeletal, myofascial, psychogenic, mechanical. Pain is so common that it’s not given the actual, curious, connected attention it deserves, the attention that might invite us all to consider just how valuable massage therapists could be in addressing it.

Understanding Total Pain

So, what is this thing we call pain? Dame Cicely Saunders, founder of the first hospice and of the hospice philosophy of care, developed a concept of “total pain” in the 1960s.² Total pain, according to Saunders, is “the suffering that encompasses all of a person’s physical, psychological, social, spiritual, and practical struggles.” Saunders developed the concept of total pain after thousands of conversations with people living and dying with cancer in the 1960s.³

Massage therapy education and the massage profession have both done a less than stellar job of supporting us in understanding the complexity of the experience of pain. This is a major oversight when we consider that one of the top reasons people seek the services of a massage therapist is relief from pain.⁴ 

The tricky part is that most of our clients don’t understand the multifactorial experience of pain either. We share this sense that pain is a thing I can point to—“It hurts here” or “It hurts when I do this.” We rarely dip into curiosity about the other factors that might be exacerbating that pain, from marital troubles to the stress of caring for one’s elderly parent to climate change or politics. Addressing total pain effectively demands we move away from reductive perspectives about its causes and possible solutions. 

More Than Touch

When massage therapists have appropriate training and then inhabit a space within the full scope of this gorgeous discipline of massage therapy, the “touching” part that gets all the press gives way to an exchange between two people that can result in enhanced coping, more peace, and less distress.⁵

The effect of a therapeutic encounter with a trained massage therapist working within the broad scope of their complex, psychosocially relevant discipline has seriously unexplored potential to address total pain. Here’s the definition of massage therapy that emerged from a two-day symposium in 2010 with 32 massage therapy experts from the US, Europe, and Canada: “Massage therapy consists of the application of massage and non-hands-on components, including health promotion and education messages, for self-care and health maintenance; therapy, as well as outcomes, can be influenced by: therapeutic relationships and communication; the therapist’s education, skill level, and experience; and the therapeutic setting.”

In the first part of the sentence, “the application of massage” (that’s the rubbing part) is mentioned and then the definition goes on to include all the factors that will ultimately determine if that rubbing has an effect. Therapeutic relationship, communication, education, skill level, experience, and environment all come together to result in the practice of a discipline uniquely able to address this concept of total pain.

In a pair of studies that Healwell published in 2021 and 2023, pain decreased measurably in all arms (387 subjects), but the data show that an increase in peace and a decrease in distress occurred more than for pain alone in significantly more patients.⁶ So, yes, massage therapists were involved in decreasing patients’ experiences of discrete pain, but even when their subjective pain scores did not decrease, it was often the case that a patient’s sense of peace increased and their experience of distress lessened. The subjects in these studies were people in the hospital, but do we really think that our marathon runners and office workers don’t struggle to feel a sense of peace and that the absence of that peace doesn’t impact how they experience their bodies?

When massage therapists bring advanced skills of communication, including inquiry, silence, and clinical curiosity, we engage in a process of unfolding the overlapping dimensions of total pain. The physical touch that is often highlighted as the substance of our work is simply a gateway to this deeper connection that addresses pain in ways our clients will never consider or request. 

Notes

1. US Pain Foundation, “Research Pain to Manage Pain,” accessed July 30, 2024, https://uspainfoundation.org/news/research-pain-to-manage-pain.

2. Chi-Keong Ong and Duncan Forbes, “Embracing Cicely Saunders’s Concept of Total Pain,” British Medical Journal 331, no. 7516 (September 2005): 576, https://pubmed.ncbi.nlm.nih.gov/16150775. 

3. Helle Timm, “Transformation of the Concepts and Practice of Total Pain and Total Care: 30 Years of Danish Hospices,” Frontiers in Sociology 8 (May 2023): 1145131, https://doi.org/10.3389/fsoc.2023.1145131.

4. News in Health, “Massage Therapy: What You Knead to Know,” accessed July 30, 2024, https://newsinhealth.nih.gov/2012/07/massage-therapy.

5. M. K. Brennan et al., “Hospital Based Massage Therapy Specific Competencies,” Journal of Bodywork and Movement Therapies 23, no. 2 (April 2019): 291–4, https://pubmed.ncbi.nlm.nih.gov/31103110; Academic Consortium for Complementary & Alternative Health Care, “Competencies for Optimal Practice in Integrated Environments,” accessed July 30, 2024, https://nexusipe-resource-exchange.s3-us-west-2.amazonaws.com/ACCAHC%20Competencies%20for%20Optimal%20Practice%20in%20Integrated%20Environments%202012_0.pdf; Anne Kelemen et al., “‘I Didn’t Know Massages Could Do That:’ A Qualitative Analysis of the Perception of Hospitalized Patients Receiving Massage Therapy from Specially Trained Massage Therapists,” Complementary Therapies in Medicine 52 (August 2020): 102509, https://pubmed.ncbi.nlm.nih.gov/32951756; Hunter Groninger et al., “Massage Therapy for Hospitalized Patients Receiving Palliative Care: A Randomized Clinical Trial,” Journal of Pain and Symptom Management 65, no. 5 (May 2023): 428–41. https://pubmed.ncbi.nlm.nih.gov/36731805.

6. Anne Kelemen et al., “‘I Didn’t Know Massages Could Do That:’ A Qualitative Analysis of the Perception of Hospitalized Patients Receiving Massage Therapy from Specially Trained Massage Therapists;” Hunter Groninger et al., “Massage Therapy for Hospitalized Patients Receiving Palliative Care: A Randomized Clinical Trial.”