Pain management is a complex issue that is the subject of much debate and scrutiny. Yet, pain is a significant public health issue affecting the quality of life for millions of people. This article explores the ways in which massage therapy is used in pain management plans and the potential benefits for your clients.
There is no one-size-fits-all approach to pain management. Which treatments will be appropriate depends on the nature and severity of a person’s pain. However, the general consensus is that a multimodal approach that combines several strategies is most effective. Massage therapy is a proven and valuable contribution to this protocol.
Massage and the Biopsychosocial Model
In this article, we will look at three categories of massage effects: local, systemic and psychosocial. These three categories emerge from the prominent biopsychosocial model of pain in rehabilitation science.
This comprehensive model recognizes pain as not simply a physical experience but instead influenced by a combination of biological, psychological and social (BPS) factors. New considerations of how people experience pain acknowledge that an individual’s pain is complex and dynamic and that multiple factors affect pain perception and its impact on daily functioning.
First, let’s review the essential components of pain physiology so you understand how massage might help with pain management. There are specialized sensory receptors throughout the body that are sensitive to thermal, mechanical and chemical stimuli. These receptors are called nociceptors. The signal transmission process from these receptors to the central nervous system (CNS) is called nociception.
Nociceptive signals are processed and interpreted when they arrive in the brain. It is only at the point of interpretation by the brain that pain is registered.
Specialized nerve fibers send signals to the CNS. Some nerve fibers have a protective coating called a myelin sheath, which allows them to transmit impulses faster. Nociceptive signals typically travel along unmyelinated or thinly myelinated fibers, which means they may travel more slowly than other signals like proprioception.
In 1965, scientists Ronald Melzack (1929-2019) and Patrick Wall 1925-2001) proposed the Gate Control Theory of Pain. The gate theory suggests how proprioceptive signals may arrive at the spinal cord before nociceptive signals and thereby limit the amount of nociceptive information being sent to the brain.
This theory helps explain why rubbing a painful body area reduces the pain experienced at that moment. This process explains one way massage helps with some pain complaints, especially acute pain.
In general, massage alleviates physical discomfort and improves overall function. This fact has been proven over decades of massage and soft-tissue therapy. As additional funds are given to quality research, perhaps more exact science on what massage’s physiological effects are will be discovered.
In the meantime, we know that massage addresses muscle tightness and trigger points, reduces edema and fibrous adhesions, increases flexibility and range of motion, and contributes to healing.
Overall, massage improves healing times and improves function. With injury conditions, massage contributes significantly to their therapeutic treatment in a host of ways, which is why most professional sports teams have massage therapists on standby.
People seek massage for pain relief because it has localized effects that often address pain immediately.
Some of the most profound ways massage is helpful in acute and chronic pain conditions fall under the category of systemic effects. Systemic effects are those that involve tissues or processes that occur remote from where pain is felt or are experienced generally. A more far-reaching systemic effect of massage for pain management occurs through a neurological phenomenon called descending modulation.
Descending modulation refers to the brain and spinal cord’s process of regulating the neural activity that produces pain. It is called “descending” modulation because higher brain function alters the signal processing from lower centers in the brain and spinal cord. The nervous system can either increase or decrease its pain sensitivity. It does this through two forms of descending modulation, descending facilitationand descending inhibition.
Descending facilitation is a process by which the central nervous system amplifies or enhances incoming signals from the periphery, such as from the skin or joints. These changes can occur through activating certain pathways and neurotransmitters. An example of descending facilitation in a chronic pain condition is when someone with lower back pain experiences pain even from light touch, such as a feather duster or gentle massage.
The heightened response is because the descending facilitatory pathways have become overactive, amplifying the signals from the lower back and making them feel more intense. A result can be pain that is perceived in other areas of the body, such as the legs or feet, as the brain interprets the amplified signals as coming from multiple sources.
In this example, the nervous system is “turning up the volume” on incoming signals from the lower back, causing the individual to experience pain even from light touch, which would not normally be painful. This overactivity of descending facilitatory pathways is one of the underlying mechanisms of chronic pain conditions.
Descending inhibition is a process by which the central nervous system reduces or dampens the intensity of incoming neural signals. The downplaying of signals occurs through the activation of certain pathways and neurotransmitters as well, such as the release of endorphins, which bind to the same receptors as opioids and reduce pain perception. Touch research shows that other transmitters and chemicals, such as oxytocin, serotonin and dopamine, can also be released.
Encouraging descending inhibition is particularly important for pain management. Massage can also encourage descending inhibition by activating certain pathways in the CNS that reduce pain sensitivity and perception. Through activating these inhibitory pathways, massage can help decrease pain signals, allowing for pain relief and an improved overall sense of well-being.
Massage’s other systemic effects include the overall sense of relaxation and well-being that come from the therapy. Improved relaxation and sleep, along with decreased stress, are key results from effective massage.
There is more interest today in looking at the science behind massage, and we are eager for research that explores these aspects. Massage helps address these issues and reduces pain, which is the goal of pain management.
There is growing interest in understanding how external context and internal state shape the experience of touch. Research indicates that psychological and neurobiological mechanisms play a crucial role in how we integrate tactile information into our touch experiences. We have learned that gentle touch and contextual information mutually influence each other.
Touch can have a significant impact on our emotions and social connections. It is well-known that appropriate and gentle touch can provide relief from negative feelings and evoke feelings of pleasure. One of the primary reasons therapeutic massage is found to be so beneficial has much to do with these contextual and social aspects. The benefits of soft lighting, calm music, the smells of the treatment room, and an assumed safe space all contribute to the therapeutic effects.
Of all health care professionals, it is the massage therapist who most often provides 50 minutes or more of treatment. The directed attention the individual therapist gives the client is inherently validating for chronic pain sufferers. The massage therapist may be the only care professional they have who acknowledges their pain and directs dedicated time to its resolution. This focus and the environment are essential psychosocial factors that contribute to the beneficial effects of the treatments.
Dedicated time with the massage therapist and the soothing environment contribute to the healing properties of massage.
Yet, it is crucial to note that the touch experience can be vastly different if the recipient is uncomfortable with the person providing it or the context has negative connotations with touch. Consequently, the experience of the same touch may be flipped to something unpleasant. Notably, this explains why the experience can be devastating to a client when massage becomes unsafe.
A notable example of how massage therapy addresses all three legs of the biopsychosocial model is in treating post-traumatic stress disorder (PTSD) in military veterans or survivors of sexual assault and abuse. These individuals are often highly sensitized to touch in negative ways and experience a wide range of profound pain.
The soothing and caring environment of massage provides a safe space for these clients to experience the positive aspects of touch. At the same time, therapeutic treatments can be applied to address specific pain complaints. Those therapists trained in these techniques follow particular protocols in their pain management plans that consider all aspects of the biopsychosocial model.
Several years ago, I was at the San Diego Pain Summit, a conference devoted to exploring pain management strategies across multiple health professions. I was talking with a physician over lunch about our work, and he said, “of all these professions represented here, I think massage therapy has the greatest ability to comprehensively impact these patients through all three aspects of the biopsychosocial domains.”
That physician was correct. We have a powerful treatment strategy at our disposal. It is both remarkable and empowering that we can make such dramatic changes in someone’s pain experience simply by what we do with our hands in combination with how we provide the optimal treatment environment.
About the Author
Whitney Lowe, LMT, directs the Academy of Clinical Massage. He teaches continuing education in advanced clinical massage through the academy, and offers an online training program in orthopedic massage. He is a regular contributor to MASSAGE Magazine.