Massage therapy is increasingly available as a supportive therapy to patients in medical centers providing cancer treatment. This article provides an overview of the evidence base relevant to the use of massage with the intended goal of alleviating symptoms and side effects experienced by cancer patients. Collectively, the available data support the view that massage, modified appropriately, offers potential beneficial effects for cancer patients in terms of reducing anxiety and pain and other symptoms. Replication of preliminary studies with larger, more homogeneous patient samples and rigorous study designs will help to clarify which massage modalities have the most potential benefit for which patients before, during, and after specific types of cancer treatment.

Myers CD, Walton T, Small BJ. Integrative Medicine, Health Outcomes and Behavior Program, Moffitt Cancer Center, 12902 Magnolia Drive, MRC-PSY, Tampa, FL 33612, USA. Hematol Oncol Clin North Am. 2008 Aug;22(4):649-60.

OBJECTIVES: To develop and test the feasibility and acceptability of a structured design for a massage therapy clinical trial that included a treatment arm designed to control for the non-specific effects of a massage therapy intervention. DESIGN: Pilot randomized controlled clinical trial. SETTING: University-integrated medicine research clinic. INTERVENTIONS: Participants were randomized to a structured Swedish-style massage therapy intervention, a light-touch bodywork control intervention, or usual medical care. Details of the interventions are provided. MAIN OUTCOME MEASURES: The primary outcome measures were the adherence of the participants to the study protocol and the perception of the intervention experience. RESULTS: Forty-four participants were randomized. Participants often found adherence to the twice-weekly outpatient bodywork interventions to be somewhat difficult; while, overall, 84% of participants completed the study, only 76% of those in an intervention arm successfully completed the trial. Participants randomized to the massage arm expressed uniformly positive attitudes both before and after the intervention. While some participants randomized to the light-touch bodywork arm initially expressed some reservations about their randomization assignment, all participants available for interview were pleased with their experience after the intervention period. CONCLUSIONS: The proposed design was found to be relatively straightforward to implement and acceptable to participants. Early disappointment with not receiving massage therapy expressed by the light-touch intervention participants dissipated quickly. Twice-weekly outpatient intervention appointments were found to be highly burdensome for many patients actively undergoing chemotherapy, thus reducing adherence.

Patterson M, Maurer S, Adler SR, Avins AL. Osher Center for Integrative Medicine, University of California, San Francisco, CA, USA. Complement Ther Med. 2008 Jun;16(3):169-76.

Although massage administered between workouts has been suggested to improve recovery and subsequent performance, its application between bouts of repetitive supramaximal anaerobic efforts within a given workout has received little attention. The purpose of the study compared different forms of very short rest periods administered between resistance exercise sets of individual workouts on subsequent performance. With a within-subjects design methodology, subjects (n = 30) performed three workouts that were identical in terms of the exercises (45 degrees leg press, prone leg curl, seated shoulder press, standing barbell curl), number of sets, and the resistance employed. For each workout, subjects received one of the following treatments between sets: 1 minute of rest as they stood upright, 30 seconds of rest as they stood upright, or 30 seconds of concurrent massage and body part elevation (MBPE), which entailed petrassage of the exercised limbs in a raised and supported position in an attempt to abate fatigue and enhance recovery from the previous set. Subjects were instructed to perform as many repetitions as possible for each set. For each exercise, two dependent variables were calculated: a total work/elapsed time ratio and the cumulative number of repetitions performed. For each exercise, one-way repeated-measures analysis of variance and Tukey's post hoc test revealed the following total work/elapsed time results: 1 minute rest <30 seconds' rest, 30 seconds' MBPE. For each exercise, cumulative repetition results were as follows: 1 minute rest >30 seconds' rest, 30 seconds' MBPE. Results imply that rest period duration exerts more influence on resistance exercise performance than MBPE. Those who seek improved resistance exercise performance should pay particular attention to rest period durations.

Caruso JF, Coday MA. Exercise Science Program, University of Tulsa, Tulsa, Oklahoma, USA. john-caruso@utulsa.edu J Strength Cond Res. 2008 Mar;22(2):575-82.

Research on massage therapy for maternal pain and anxiety in labour is currently limited to four small trials. Each used different massage techniques, at different frequencies and durations, and relaxation techniques were included in three trials. Given the need to investigate massage interventions that complement maternal neurophysiological adaptations to labour and birth pain(s), we designed a pilot randomised controlled trial (RCT) to test the effects of a massage programme practised during physiological changes in pain threshold, from late pregnancy to birth, on women's reported pain, measured by a visual analogue scale (VAS) at 90min following birth. To control for the potential bias of the possible effects of support offered within preparation for the intervention group, the study included 3 arms - intervention (massage programme with relaxation techniques), placebo (music with relaxation techniques) and control (usual care). The placebo offered a non-pharmacological coping strategy, to ensure that use of massage was the only difference between intervention and placebo groups. There was a trend towards slightly lower mean pain scores in the intervention group but these differences were not statistically significant. No differences were found in use of pharmacological analgesia, need for augmentation or mode of delivery. There was a trend towards more positive views of labour preparedness and sense of control in the intervention and placebo groups, compared with the control group. These findings suggest that regular massage with relaxation techniques from late pregnancy to birth is an acceptable coping strategy that merits a large trial with sufficient power to detect differences in reported pain as a primary outcome measure.

Eur J Pain. 2008 Feb 25 Kimber L, McNabb M, Mc Court C, Haines A, Brocklehurst P. Horton Maternity Unit, Oxford Road, Banbury, Oxfordshire 0X16 9AL, UK.

The care of patients with cancer not only involves dealing with its symptoms but also with complicated information and uncertainty; isolation; and fear of disease progression, disease recurrence, and death. Patients whose treatments require them to go without human contact can find a lack of touch to be an especially distressing factor. Massage therapy is often used to address these patients' need for human contact, and findings support the positive value of massage in cancer care. Several reviews of the scientific literature have attributed numerous positive effects to massage, including improvements in the quality of patients' relaxation, sleep, and immune system responses and in the relief of their fatigue, pain, anxiety, and nausea. On the basis of these reviews, some large cancer centers in the United States have started to integrate massage therapy into conventional settings. In this paper, we recognize the importance of touch, review findings regarding massage for cancer patients, describe the massage therapy program in one of these centers, and outline future challenges and implications for the effective integration of massage therapy in large and small cancer centers.

J Altern Complement Med. 2008 Mar;14(2):209-14. Russell NC, Sumler SS, Beinhorn CM, Frenkel MA. Integrative Medicine Program, Unit 145, The University of Texas M.D. Anderson Cancer Center, Houston, TX.

In the present study, we describe the effects of deep tissue massage on systolic, diastolic, and mean arterial blood pressure. Materials and methods: The study involved 263 volunteers (12% males and 88% females), with an average age of 48.5. Overall muscle spasm/muscle strain was described as either moderate or severe for each patient. Baseline blood pressure and heart rate were measured via an automatic blood pressure cuff. Twenty-one (21) different soothing CDs played in the background as the deep tissue massage was performed over the course of the study. The massages were between 45 and 60 minutes in duration. The data were analyzed using analysis of variance with post-hoc Scheffe's F-test. Results: Results of the present study demonstrated an average systolic pressure reduction of 10.4 mm Hg (p < 0.06), a diastolic pressure reduction of 5.3 mm Hg (p < 0.04), a mean arterial pressure reduction of 7.0 mm Hg (p < 0.47), and an average heart rate reduction of 10.8 beats per minute (p < 0.0003), respectively.

J Altern Complement Med. 2008 Mar;14(2):125-8. Kaye AD, Kaye AJ, Swinford J, Baluch A, Bawcom BA, Lambert TJ, Hoover JM. Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA.

Background: People with depressive disorders or subsyndromal symptoms of depression (SSD) often use complementary and alternative therapies, including massage therapy (MT). This systematic review evaluates the evidence, from randomised clinical trials (RCTs), for the effectiveness of multiple sessions of classical European (Swedish) MT for the treatment of depression. Methods: Eligible RCTs were identified via eight electronic databases and manual searches of references. Two reviewers independently selected trials, assessed trial quality and extracted data. Results: Four RCTs met our inclusion criteria. Three of these RCTs compared MT with relaxation therapies, but provided insufficient data and analyses to contribute meaningfully to the evaluation of MT for depression. The fourth included RCT used MT as a control condition to evaluate a depression-specific acupuncture treatment. This trial provided limited evidence that, in the early stages of treatment, MT is less effective than acupuncture for treating depression, a treatment which itself is not accepted for this condition. Conclusions: Despite previous research suggesting that MT may be an effective treatment for depression, there is currently a lack of evidence to support this assertion from RCTs that have selected participants for depression or SSD.

Int J Clin Pract. 2008 Feb;62(2):325-33. Coelho HF, Boddy K, Ernst E. Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK.

There has been a growing emphasis on evaluating and improving the experience of the hospitalized patient. In 2004, the Cardiovascular Surgery team at Mayo Clinic Rochester, though achieving a high level of technical expertise and clinical outcomes, recognized that patients were not rating their overall hospital experience as highly as was expected. After a systematic evaluation of the hospital experience, tension, stress, pain, and anxiety were identified as key challenges for patients. A multidisciplinary team was created to evaluate pain management practices and explore methods for reducing pain, anxiety, and tension. An extensive review of the literature and site visits to other institutions provided the foundation for the program. The term "Healing Enhancement" was coined to identify the goals of this emerging paradigm that focused on all aspects of the patient's experience-mind, body, and spirit. Integrated therapies such as music, massage, guided imagery, and relaxation training were explored to measure their role in patient care.

Complement Ther Clin Pract. 2007 Nov;13(4):217-23. Cutshall SM, Fenske LL, Kelly RF, Phillips BR, Sundt TM, Bauer BA. Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

To determine predictors of complementary and alternative medicine (CAM) use, we used a cohort of 1445 non-institutionalized Mexican Americans aged 65 and older from the first wave (1993-1994) of the Hispanic Established Population for the Epidemiologic Study of the Elderly, followed until 2000-2001. The main outcome was use of any CAM (herbal medicine, chiropractic, acupuncture, massage therapy, relaxation techniques or spiritual healing) in the past 12 months and was assessed at 7 years of follow-up. Potential predictors of CAM use at baseline included sociodemographics, acculturation factors, and medical conditions. The overall rate of CAM use among older Mexican Americans was 31.6%. Independent predictors of higher CAM use were female gender, being on Medicaid, frequent church attendance and higher number of medical conditions. In contrast, subjects who were born in US and spoke either Spanish or English at interview had lower CAM use compared with subjects who were born in Mexico.

Complement Ther Clin Pract. 2007 Nov;13(4):224-31. Loera JA, Reyes-Ortiz C, Kuo YF. Department of Internal Medicine-Geriatrics Division, University of Texas Medical Branch, Galveston, TX 77555-0460, USA.

The purpose of this study was to acquire a theoretical understanding of what it is like to work as a tactile massage therapist (TMT). There is insufficient knowledge in this area-despite increasing demand and implementation of tactile massage; so 26 female TMTs were interviewed (6 interview groups in Stockholm County). Grounded theory was used to analyse the data. The analysis resulted in a theoretical model that explains how TMTs individually underwent a transformation in which they learned about the energy-controlling system (energy takers, energy returners, and energy controllers) and managed to implement this demanding treatment, while maintaining health and inner balance in order to have total presence during treatment sessions. Results showed that total presence was crucial for implementing high-quality treatment, and inability to control energy may pose a risk to inner balance and health among TMTs.

Complement Ther Clin Pract. 2007 Nov;13(4):258-65. Andersson K, Wändell P, Törnkvist L. Center for Family and Community Medicine, Karolinska Institutet, Huddinge, Sweden.

The study aimed to compare the effects of facial massage with that of foot massage on sleep induction and vital signs of healthy adults and to test a methodology that could be used by a lone researcher in such a study. A randomised within-group crossover pilot study of six healthy female volunteers was conducted. The interventions were a 20min foot and a 20min facial massage using peach-kernel base oil Prunus persica. A drop in systolic blood pressure of 8.5mmHg was recorded immediately after facial massage compared to that of 1mmHg recorded after foot massage. Both treatments were equally effective in reducing subjective levels of alertness during the interventions, with face massage marginally better at producing subjective sleepiness. A lone researcher using these methods would be able objectively to measure vital signs before and after interventions, but not during; and would be able subjectively to measure sleep induction in non-sleep-laboratory contexts.

Complement Ther Clin Pract. 2007 Nov;13(4):266-75. Ejindu A. London South Bank University, Faculty of Health and Social Care, LSBU at Havering Campus, Gubbins Lane, Harold Wood, Romford, RM3 0BE, UK.

OBJECTIVE: To find out efficacy and benefits of early starting of stimulation therapy in coma patients. DESIGN: Randomized controlled trial. METHOD: Sixty children admitted to the Department of Pediatrics, having coma due to non-traumatic neurological insult were randomly selected. Both study and control groups had 30 patients each. Children in the study group were given stimulation therapy while those in control group received no stimulation. The level of consciousness was assessed before and two weeks after giving stimulation therapy. RESULTS: Improvement in level of consciousness was better in study group as compared to control after two weeks of stimulation therapy. CONCLUSION: Stimulation therapy was found to be highly effective in coma patients.

Indian Pediatr. 2006 Oct;43(10):856-60. Karma D, Rawat AK.

Department of Pediatrics, Shyam Shah Medical College and Associated Gandhi Memorial Hospital, Rewa, Madhya Pradesh, India.

BACKGROUND: Infant massage is increasingly being used in the community for low-risk babies and their primary care givers. Anecdotal claims suggest benefits for sleep, respiration, elimination and the reduction of colic and wind. Infant massage is also thought to reduce infant stress and promote positive parent-infant interaction. OBJECTIVES: The aim of this review was to assess the effectiveness of infant massage in promoting infant physical and mental health in population samples. SEARCH STRATEGY: Searches were undertaken of CENTRAL 2005 (Issue 3), MEDLINE (1970 to 2005), PsycINFO (1970 to 2005), CINAHL (1982 to 2005), EMBASE (1980 to 2005), and a number of other Western and Chinese databases. SELECTION CRITERIA: Studies in which babies under the age of six months were randomised to an infant massage or a no-treatment control group, and utilising a standardised outcome measuring infant mental or physical development. DATA COLLECTION AND ANALYSIS: Weighted and standardised mean differences and 95% confidence intervals are presented. Where appropriate the results have been combined in a meta-analysis using a random effects model. MAIN RESULTS: Twenty-three studies were included in the review. One was a follow-up study and thirteen were included in a separate analysis due to concerns about the uniformly significant results and the lack of dropout. The results of nine studies providing primary data suggest that infant massage has no effect on growth, but provides some evidence suggestive of improved mother-infant interaction, sleep and relaxation, reduced crying and a beneficial impact on a number of hormones controlling stress. Results showing a significant impact on number of illnesses and clinic visits were limited to a study of Korean orphanage infants. There was no evidence of effects on cognitive and behavioural outcomes, infant attachment or temperament. The data from the 13 studies regarded to be at high risk of bias show uniformly significant benefits on growth, sleep, crying and bilirubin levels. AUTHORS' CONCLUSIONS: The only evidence of a significant impact of massage on growth was obtained from a group of studies regarded to be at high risk of bias. There was, however, some evidence of benefits on mother-infant interaction, sleeping and crying, and on hormones influencing stress levels. In the absence of evidence of harm, these findings may be sufficient to support the use of infant massage in the community, particularly in contexts where infant stimulation is poor. Further research is needed, however, before it will be possible to recommend universal provision.

Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005038.

Underdown A, Barlow J, Chung V, Stewart-Brown S.

Warwick Medical School, Institute of Education, University of Warwick, Coventry, UK. angela@underdown5.freeserve.co.uk

The study purpose was to examine dissociation in body therapy for women receiving psychotherapy for childhood sexual abuse. An initial intervention study provided an opportunity to examine dissociation; the sample of 24 women received eight, 1-h body therapy sessions. The Dissociative Experiences Scale served as the predictor variable, and the outcome measures reflected psychological and physical health, and body connection. Repeated measures analysis of variance was used to examine dissociation reduction across time. Pearson correlations were used to describe associations between the relative change in dissociation and outcomes. The results demonstrated that the greatest change was the reduction of dissociation; there was an incremental effect across time and a strong association between change in dissociation and health outcomes. High dissociation at baseline (moderate levels) predicted positive outcomes. The results demonstrated the importance of moderate dissociation as an indicator of distress, and the central role of dissociation reduction in health and healing.

Complement Ther Clin Pract. 2007 May;13(2):116-28. Epub 2006 Nov 22.

Price C.

University of Washington, Box 357263, Seattle, WA 98105, USA. cynthiap@u.washington.edu

BACKGROUND: Complementary and alternative medicine (CAM) is an increasingly common therapy used to treat chronic pain syndromes. However; there is limited information on the utilization and efficacy of CAM therapy in primary care patients receiving long-term opioid therapy. METHOD: A survey of CAM therapy was conducted with a systematic sample of 908 primary care patients receiving opioids as a primary treatment method for chronic pain. Subjects completed a questionnaire designed to assess utilization, efficacy and costs of CAM therapies in this population. RESULTS: Patients were treated for a variety of pain problems including low back pain (38.4%), headaches (9.9%), and knee pain (6.5%); the average duration of pain was 16 years. The median morphine equivalent opioid dose was 41 mg/day, and the mean dose was 92 mg/day. Forty-four percent of the sample reported CAM therapy use in the past 12 months. Therapies utilized included massage therapy (27.3%, n = 248), chiropractic treatment (17.8%, n = 162), acupuncture (7.6%, n = 69), yoga (6.1%, n = 55), herbs and supplements (6.8%, n = 62), and prolotherapy (5.9%, n = 54). CAM utilization was significantly related to age female gender, pain severity income pain diagnosis of neck and upper back pain, and illicit drug use. Medical insurance covered chiropractic treatment (81.8%) and prolotherapy (87.7%), whereas patients primarily paid for other CAM therapies. Over half the sample reported that one or more of the CAM therapies were helpful. CONCLUSION: This study suggests CAM therapy is widely used by patients receiving opioids for chronic pain. Whether opioids can be reduced by introducing such therapies remains to be studied.

BMC Complement Altern Med. 2007 May 16;7:15.

Fleming S, Rabago DP, Mundt MP, Fleming MF.

Bastyr University, Seattle, Washington 98122, USA. sara.fleming@bastyr.edu

Previous reviews of massage therapy for chronic, non-malignant pain have focused on discrete pain conditions. This article aims to provide a broad overview of the literature on the effectiveness of massage for a variety of chronic, non-malignant pain complaints to identify gaps in the research and to inform future clinical trials. Computerized databases were searched for relevant studies including prior reviews and primary trials of massage therapy for chronic, non-malignant pain. Existing research provides fairly robust support for the analgesic effects of massage for non-specific low back pain, but only moderate support for such effects on shoulder pain and headache pain. There is only modest, preliminary support for massage in the treatment of fibromyalgia, mixed chronic pain conditions, neck pain and carpal tunnel syndrome. Thus, research to date provides varying levels of evidence for the benefits of massage therapy for different chronic pain conditions. Future studies should employ rigorous study designs and include follow-up assessments for additional quantification of the longer-term effects of massage on chronic pain.

Evid Based Complement Alternat Med. 2007 Jun;4(2):165-79. Epub 2007 Feb 5.

Tsao JC.

Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, USA.

Non-pharmacological treatment for patients with chronic widespread pain (CWP) and fibromyalgia (FM) aims to enhance overall health. This chapter reviews studies of exercise, education, movement therapies and sensory stimulation. Based on a systematic review of randomized controlled trials (RCTs), we suggest that aerobic exercise of low to moderate intensity, such as walking and pool exercise, can improve symptoms and distress in patients with CWP and FM, and it may improve physical capacity in sedentary patients. Aerobic exercise of moderate to high intensity has been shown to improve aerobic capacity and tender-point status. Educational programmes have been shown to enhance self-efficacy and health perception. There is no conclusive evidence about the type of educational programme that works best, but a small-group format and interactive discussions appear to be important components. Exercise combined with education appears to produce synergies. Studies of movement therapies (such as qigong) and sensory treatments (such as acupuncture and massage) are few in number. There is today no conclusive evidence about the effects of these treatments in CWP, although positive effects have been reported in a few studies.

Best Pract Res Clin Rheumatol. 2007 Jun;21(3):513-34.

Mannerkorpi K, Henriksson C.

Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, Göteborg University, Guldhedsgatan 10, SE-413 46 Göteborg, Sweden.