Massages For Pain Management

/ Thomas Cohn, MD

Massage therapy is a multi-billion dollar business. Many people who have pain love getting a massage. For pain practitioners, it is a common question whether it can be prescribed and whether insurance will pay for it. Massage definitely feels good, but it does have limited benefits. In acute pain, it does not speed recovery and studies do not support its use. In chronic pain, it does help reduce pain perception, but the mechanism of action is not well known.

There are many different types of massage; research has yet to show whether a particular form is better. Some common types of massage include:

  • Deep tissue
  • Swedish
  • Structural
  • Other specific targeted techniques.

Structural, which works on actual muscle activity and is often performed by physical therapists as part of a comprehensive exercise process, may be covered by insurance.

Pain Massage

Massage is clearly a hands-on activity. A therapist often spends 45 minutes with direct contact with the patient. The interaction between patient and practitioner is prolonged and personal. The end result is often significant relaxation, which leads to less muscle discomfort and less pain. Whether massage changes anything physically in the body is unknown. Research has not been able to show any actual structural or hormonal changes in the body associated with massage.

Prescription Massages?

Pain practitioners are often reluctant to prescribe massage. In general, massage is considered a passive modality in treatment of a condition. Massage is something done to the patient while the patient lays still. Physical therapy and exercise requires action and activity on the part of a patient. Most pain conditions are worsened by inactivity. Pain experts try to promote a return to normal levels of activity. Being passive in treatment, which is part of massage, is not ideal in the overall management of pain. Since the goal of pain management is to have people active and moving, laying still and receiving a massage is felt to be a negative pathway.

Massage may feel good, it may reduce pain on a temporary basis, but it does not change the body and does not heal the pain. Activity, exercise, strengthening and conditioning are all essential in the long term management of pain. The goal of pain care is to improve function. Massages for pain certainly have short term benefits, but they should not be viewed as a long term solution.