The news this week was grim, yet perhaps not surprising: Drug overdose is now the leading cause of death in Americans under the age of 50, according to data compiled by the New York Times. The newspaper culled through reports from county coroners, medical examiners and state health departments to reach this conclusion, which it reported June 5.
The release of three reviews on the benefits of massage therapy for pain relief could raise massage therapy’s profile—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.
All three reviews ran online in the journal Pain Medicine, published by Oxford University Press—and although the studies were first published a little more than a year ago, they are still being shared and referred to by media outlets, business websites and educational institutions.
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.
In 2016, the number of Americans who died due to drug overdoses had risen to 59,000, according to the Times. “The death count is the latest consequence of an escalating public health crisis: opioid addiction, now made more deadly by an influx of illicitly manufactured fentanyl and similar drugs,” the newspaper noted.
News about problems related to opioid use confronts us every day. Those problems include overprescribing opioids, addiction, overdose and death.
Although medical experts say opioids can be effective tools when used properly, evidence shows they are often being used improperly.
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.
Overdose deaths from heroin alone have quadrupled since 2010, according to the CDC. Then there is the growing popularity of drugs such as fentanyl and its analog, carfentanil, “an elephant tranquilizer 5,000 times stronger than heroin,” the Times noted.
Over the past few years, government funding has flowed 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?
The massage therapy reviews, published online May 10, 2016 and highlighted at the Massage Therapy Foundation‘s (MTF) International Research Conference: Integrating Therapies for Pain, held May 12–15 in Seattle, Washington, last year 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.”
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, 2016, 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 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,” they continued.
“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.”
Discovery to Delivery
Hypothetically, how would funding for massage become part of 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 Sameuli 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 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.”
Thompson outlined three ways that incorporation can happen: by massage therapists adequately charting and measuring clients’ progress; communication with biomedical healthcare 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 healthcare team?”
The answer to that question, she added, is found in two areas: massage therapists’ becoming as familiar with biomedical language as biomedical healthcare providers do of massage therapists’ 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 healthcare 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 women 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].”
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 Jonas.
“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,”—specifically, he said, in addressing opioid use.
According to the CDC, 78 Americans died every day from an opioid overdose in most of 2016. By December 2016, the last date for which this figure is available, that number had risen to 91 per day.
Could a hands-on approach to the U.S. opioid epidemic have the potential 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.
About the Author
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 “70 Percent of Hospital Patients Will Pay for Massage.”