News about problems related to opioid use confronts us every day.
Those problems include opioid overprescribing, addiction, overdose and death.
Although medical experts say opioids can be effective tools when used properly, evidence shows they are being used improperly.
The release of three new reviews on the benefits of massage therapy for pain relief could raise massage therapy’s profile, leaders in the massage field say—for it is pain that drives many Americans to an opioid prescription, and sometimes on to opioid or heroin abuse; addiction; and, too often, overdose.
The Opioid Epidemic
In 2014, more than 28,000 Americans overdosed on some type of opioid, a figure representing more than 60 percent of all drug overdose deaths, according to the Centers for Disease Control & Prevention (CDC)—and the rate of death due to opioid overdose increased by 14 percent from 2013 to 2014, the most recent year for which statistics are available.
Opioids are medications classified as narcotics, and include oxycodone (OxyContin and Percocet); hydrocodone (Vicodin); diphenoxylate (Lomotil); codeine; and morphine, according to the National Institutes of Health’s (NIH) National Institute on Drug Abuse (NIDA). Heroin is synthesized from morphine, and “[r]esearch now suggests that abuse of these [prescription opioid] drugs may open the door to heroin abuse,” a NIDA statement noted.
Millions of dollars in government funding are flowing toward prevention, education and treatment of opioid use. That flow has rarely included funding of complementary therapies such as massage or acupuncture, despite such therapies’ indicated pain-relieving abilities, low cost and safety.
Could that change?
New Massage Reviews
The new massage therapy reviews, published online May 10 and highlighted at the Massage Therapy Foundation’s (MTF) International Massage Therapy Research Conference: Integrating Therapies for Pain, held May 12–15 in Seattle, Washington, are:
- “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”;
- “The Impact of Massage Therapy on Function in Pain Populations—A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part II, Cancer Pain Populations”; and
- “The Impact of Massage Therapy on Function in Pain Populations—A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part III, Surgical Pain Populations.”
All three reviews ran online in the journal Pain Medicine, published by Oxford University Press.
According to Wayne Jonas, M.D., who was one of four members on the MTF conference’s Approaching Pain with Manual Therapy panel, a trained team performed the systematic review process “for trusted evidence” on each of the three new reviews.
Several massage educators co-wrote the article “Massage Therapy for Pain—Call to Action,” published May 8 in Pain Medicine. Among the authors are MTF President Jerrilyn Cambron, D.C., Ph.D., and former MTF President Ruth Werner, B.C.T.M.B.
In the article, the authors outlined the problems with the opioid epidemic in the U.S., and noted, “It is not that opioid medications are inherently bad. On the contrary, as a diverse group of pain management specialists, we would hate to lose this valuable pain management option.
“It is our incomplete understanding of opioids and their appropriate role in pain management, as well as a health care workforce unprepared by their training to manage pain effectively, that often results in the exclusion of all other options, and has led our patients and us into this predicament … massage therapy is the evidence-based new thinking that will, with other integrative, non-pharmacologic approaches, help pain medicine overcome the current opioid-focused old thinking that has devastated so many lives.”
Response to the Opioid Epidemic
Various governmental agencies have, according to a March statement from the White House, responded to the opioid epidemic in the U.S. by:
- Doubling, by the Department of Health & Human Services (HHS), the number of patients a physician can prescribe buprenorphine to, to fight opioid addiction;
- Releasing, by the Substance Abuse and Mental Health Services Administration, $11 million total to up to 11 states to increase medication-assisted treatment;
- Expanding, by the Department of Agriculture, its Rural Health and Safety Education Grant Program to include address of problems related to substance abuse in rural areas;
- Funding, by the HHS, of $94 million for medication-assisted treatment of opioid use disorders at close to 300 community health centers in underserved communities;
- Publishing, by the Centers for Disease Control & Prevention, the CDC Guideline for Prescribing Opioids for Chronic Pain, United States, 2016; and
- Signing, by President Barack Obama, in March, of a memorandum calling for the establishment of a task force to increase access to substance-use and mental health disorder treatment.
Discovery to Delivery
Hypothetically, how would funding for massage become part of the flow of assistance combatting the opioid epidemic?
Jonas said moving from evidence of a therapy to practice of a therapy—from discovery to delivery—is complicated; however, as president and CEO of The Samueli Institute, which facilitates that very process for complementary therapies by engaging in research, Jonas said there is a framework that aids researchers in moving from evidence to practice.
The Samueli Institute conducted the meta-analysis of massage therapy for pain that resulted in the three above-mentioned reviews, having been commissioned by the Massage Therapy Foundation, with support from the American Massage Therapy Association, to do so.
Yet, Jonas added, it takes—beyond research—focus, concerted effort and right timing for a therapy to become incorporated into practice.
As an example, he pointed to acupuncture, which was found by an NIH consensus conference 20 years ago to be safe, effective and not a placebo—but, he asked, “How many of you can walk into your hospital and if someone has gotten surgery they automatically get acupuncture? It’s still not there; people are not moving in the same direction.”
Another Approaching Pain with Manual Therapy panel member, massage therapist, author and educator Diana Thompson, L.M.P., said the massage field needs to take more responsibility for pushing the movement toward integrative care forward.
That movement, she said, is being driven first by patients and secondly by hospitals and clinics whose patient-satisfaction ratings go up when they include massage therapy.
“I think massage is moving into hospitals, slowly,” Thompson said. “I want to see that happen faster.” (See Thompson’s article, “Medical Massage: Your Role on the Integrative Health Care Team,” in the June print edition of MASSAGE Magazine.)
Thompson outlined three ways that incorporation can happen: by massage therapists adequately charting and measuring clients’ progress; communication with biomedical health care professionals (biomedical meaning a focus on biology, rather than social, environmental or psychological influences, in short, Western-style medicine); and inclusion.
“One of the biggest issues, besides access [to patients], is communication,” she said. “How do we really talk to the other members of the health care team?”
The answer to that question, she added, is found in two areas: massage therapists becoming versed in biomedical language; and massage therapists communicating through a shared electronic health record system.
Still, Thompson added, massage therapists aren’t always included in biomedical consultation group meetings, “but because we are touching people in ways that very few people in their lives touch them, we know a lot about those people—and [physicians] really should invite us to those meetings.”
Massage therapist, researcher and educator Cynthia Price, L.M.P., Ph.D., who also sat on the conference’s Approaching Pain with Manual Therapy panel, said massage therapists have a potentially unique role to play in pain treatment: facilitating body awareness.
“There are few other body practitioners with their hands on someone who can take the time and help them explore their experience of pain,” Price said. Mainstream health care practitioners don’t know exactly what massage therapists can do, she added.
Price recalled a woman she knew who had taken opioids for chronic pain for decades. “She was an unhappy person with depressed mood,” Price said. Price worked with the woman during an eight-week study to explore the bodily experience of her pain.
“In the course of eight weeks, she explored her pain and attended to what it really feels like, and she discovered the pain wasn’t her whole life, it was a contained part [of her life],” Price recalled.
“At the end of the study, she realized the pain didn’t have the power, but that she could live with it and get around it, and she saw how she had [previously] separated herself from her body,” she said.
“We need to let people know what we can do,” Price said. “We have something really special, and we need to make [the delivery of massage therapy] happen—and it really is a good time [for that].”
According to the CDC, 78 Americans die every day from an opioid overdose.
There is an opportunity for massage therapy, at this time, to garner the attention needed to move into delivery, and become a means of reducing patients’ pain, according to the pain panel members.
“You have a readiness in the country right now to use nonpharmacological approaches to pain, and you have evidence that some therapies can be effective,” Jonas said. Specifically, he said, in addressing opioid use.
Could incorporating massage therapy into the battle with the U.S. opioid epidemic contain the potential, as the pain panel experts indicated, to save people from suffering, save the medical system money—and save lives?
Information presented in this article is not intended to replace advice from a medical professional.
Karen Menehan is MASSAGE Magazine’s editor in chief. Her recent articles for massagemag.com include “Getting to the Heart of Prejudice in Health Care,” “The Massage Chair Celebrates 30 Years,” and “Massage Envy Launches Plan for Global Domination.”