Massage therapy plays a significant part in many pain management approaches. Massage is commonly used to treat a wide variety of health conditions and can provide some really positive results for chronic pain patients. Massage therapy is defined as, “patterned and purposeful manipulation of soft-tissue for therapeutic purposes to prevent or reduce pain, spasm, tension or stress and to promote health and wellness,” as this 2019 study explains.
History of massage therapy
As far back as the second century massage has been used to treat ailments. The earliest records of massage being used were in China and Egypt. A Chinese text called “The Yellow Emperor’s Classic Book of Internal Medicine” is the first known published text about massage. It was published in England in 1949, and is often still referred back to for those learning about massage and during massage therapist training. Even in the drawings in Ancient Egyptian Tombs, massage is depicted as part of their medical approach.
In the 1800’s a Swedish doctor called Per Henril Ling developed an approach to massage then called the ‘Swedish Movement System.’ This formed the basis of what we now know as Swedish massage! The positive effects massage could have on both body and mind began to be researched and valued all around the world. Many types of massage have developed since then, with new benefits discovered.
Benefits of massage on chronic pain
Chronic pain can cause stress levels to rise. Prolonged stress keeps your body stuck in a state of ‘fight or flight’. This means that all your body’s resources are sent to the parts of the body which would be needed for action. Unfortunately this results in other areas of your body not getting the resources they need, and your body becoming overworked. Your muscles become tighter, which can contribute to pain levels and lack of mobility over time. Fatigue can be increased during prolonged stress because your body is literally worn out. It can become harder to sleep, mental health issues can be exacerbated and your digestive system can be affected. These are only a few of the results of prolonged stress, but needless to say stress worsens the symptoms of chronic pain.
The stress and pain cycle can be a tough one to break. However, massage is one approach which can help. In this detailed study they found that during massage, levels of cortisol (the stress hormone) were reduced by up to 31%! This indicates that massage is highly effective at reducing stress levels, and in turn reducing chronic pain.
The study also found that during massage, levels of serotonin were increased by 28% and levels of dopamine were increased by 31%. Serotonin is a chemical within our bodies which, among other vital jobs, helps us to maintain our mood. It promotes happiness and a feeling of emotional wellbeing. Dopamine plays a vital part in how we feel pleasure and experience joy. It also helps us to feel motivated and stay focused on the task at hand.
When these two chemicals are increased within our bodies, we’re more likely to have a stable mood and to be in a positive mindset. Our thoughts influence our pain levels, so more positive thoughts can help us to reduce stress and negative thinking about our pain, in turn reducing pain. A more stable mindset can help us tackle comorbid mental illness, again leading to reduced chronic pain symptoms. With a more positive mindset, we are more likely to cope in an adaptive (helpful) way with our chronic pain. We’re likely to be more hopeful about the future and more motivated to keep up with treatments.
Many chronic pain patients struggle with tense muscles. This can be caused by increased levels of stress, comorbid health conditions, deconditioning through reduced functioning and more. Muscle tension can be very painful, and reduce the patient’s range of motion, contributing to reduced activity levels. Massage can help to release the tension in the muscles, in turn relieving pain and increasing relaxation.
During massage, blood flow is increased which helps your body to function optimally and keeps your immune system healthy. Massage can help with lymphatic drainage, which simply means that your body is getting rid of any toxins and is better equipped to fight disease and ill health. Removal of these toxins can also help your body to fight the fatigue that often comes with pain. Increased blood flow and lymphatic drainage can also help to reduce inflammation. Like pain, when inflammation becomes chronic it can have many negative effects, including worsening chronic pain symptoms. By tackling inflammation, symptoms can be reduced.
This study on the effect of massage therapy on fibromyalgia patients found that those who had a regular massage were able to sleep far more deeply and for longer. Insomnia is a prevalent problem when it comes to those of us with chronic pain. It can be hard to sleep when you’re in pain and are unable to get comfortable. Lack of sleep has many negative impacts including reduced energy, unstable mood, reduced cognitive ability and reduced immune response. Basically a lack of sleep can lead to an increase in chronic pain symptoms. So by improving a patient’s ability to sleep, the body and mind can get the rest they need to function properly during the waking hours.
The study also found that ‘substance P’ was decreased in those who were receiving massages. ‘Substance P’ is a neurotransmitter which passes on important messages throughout our nervous system. It responds to outside stress, and is “involved in sensory and, most notably, nociceptive pathways”. Nociceptive pathways are pain pathways. This means that ‘substance P’ can influence pain levels. It’s also found in areas where there is inflammation. Therefore ‘substance P’ being reduced in those who were receiving massages would indicate that massage can reduce pain and inflammation.
Considering the gate control theory, many scientists believe massage is able to close the pain gate, basically blocking pain messages from arriving in the brain. The gate control theory sounds complicated, but basically means that sensory information has to pass through a number of ‘gates’ within our nervous system before they get to the brain. These ‘gates’ either block pain signals or allow them to pass through to be processed and actioned by the brain. In this theory, massage is stimulating larger nerve fibres near the skin’s surface, causing another sensation to take priority, disrupting or blocking the pain signals (closing the ‘gate’).
This study on treating chronic pain with massage found that it was just as effective as other treatments, and even had longer lasting results in reducing chronic pain symptoms than some other treatments. Meanwhile this study from the Clinical Journal of Rheumatology compared the results of massage therapy with that of Transcutaneous Electrical Nerve Stimulation (TENS). They discovered that massage therapy brought the most effective, long-lasting results for the patients in the trial.
When massage therapy is combined with other treatments to treat the psychological aspects of chronic pain, it can be highly successful. In particular when massage is combined with exercise and pain neuroscience education it can bring about excellent results.
Types of massage and what to expect
Massage therapy is thought of as a complementary or alternative therapy, which means that it is not backed by as much science as some other therapies. It also means it may not be recommended as often by medical professionals. However this doesn’t mean massage can’t be helpful.
Massage can focus on one area of the body or more, depending on the purpose of the massage. Often massage will involve the entire body. Massage tends to be done by hand by a massage therapist, although it has become more common to use mechanical devices in recent years as mentioned here.
Some people may only see a massage therapist now and then, while others may need to attend massage therapy regularly in order to maintain the results. Massage therapy can be accessed privately or through a referral from your doctor. Physical therapy often involves a massage element. You may also come across massage therapy within a pain clinic or pain management programme.
When you attend a massage therapist, you’ll first talk about your medical history and what your goals are from the sessions. Like any other therapist, your massage therapist will develop a treatment plan and talk you through it. Ensure you ask any questions you have and raise any concerns. It’s important you feel as relaxed as possible during the massage so addressing worries beforehand can be beneficial.
Once you’re ready to get started, you will likely be asked to remove your clothes (don’t worry you’ll be covered by a sheet). You will usually lie down in a calming, relaxing room on a comfortable massage table. A massage can last anywhere between 30 minutes to 90 minutes. If you are worried at any time during the massage or you feel as though something is more painful than it should be, voice your concerns so that the therapist can adjust their technique or reassure you.
There are a huge variety of types of massage. Some of the more common ones you are likely to come across include:
- Swedish massage
Swedish massage is often used by massage therapists and is what most of us know as ‘traditional’ massage. It typically involves kneading and rolling the muscles to relieve tension. Often long firm strokes are used and occasionally light tapping will be utilized. The level of pressure will vary depending on the patient’s needs and tolerance level. This type of massage may be a little uncomfortable but is designed to be gentle, and shouldn’t cause pain.
- Hot stone massage
This type of massage is very similar to Swedish massage, but involves the use of heated stones as well as the therapist’s touch. The heated stones are thought to increase relaxation and help to relieve pain. In particular, hot stone massage is understood to improve the quality of sleep in patients.
- Deep tissue massage
Deep tissue massage involves a lot more pressure with the therapist really getting deep into the muscles. This helps to relax really tense muscles. This type of massage is a lot more firm and so can be painful, but shouldn’t be so painful that you are crying out. Ensure you communicate with your massage therapist if at any time you are worried or feel that it’s becoming too much. After a deep tissue massage you are likely to feel sore for a few days. This isn’t anything to worry about and your massage therapist should talk you through what to expect.
- Trigger point massage
Many points in our body have an effect on other areas of our body. For example, if our neck is tense it can result in headaches. During trigger point massage the therapist will put pressure on specific trigger points to release tension and in turn provide pain relief. Deep, firm pressure is applied to the trigger points until they release, so as with deep tissue massage this can be a little painful and uncomfortable.
- Myofascial release
The fascia is a thin layer of what is known as connective tissue which covers all the muscles in your body. The fascia should be flexible. Your massage therapist will be able to feel if it is not. If there is tension in the fascia, the therapist will focus on those areas to try and release the pressure. This study on myofascial release and the effects it had on fibromyalgia patients found that, “anxiety levels, quality of sleep, pain, and quality of life were improved in the experimental group over the placebo group. “
During a shiatsu massage the therapist will use pulsing, firm pressure across your body to encourage relaxation. The therapist will often put pressure on acupressure points, which are thought to increase relaxation. A study on the Shiatsu method of massage in regards to treating chronic pain found improvements in pain patients including: “improvement of pain intensity, pressure pain threshold, sleep quality, and symptoms”.
- Thai massage
Thai massage combines gentle pressure on pressure points and tense areas, with yoga poses. The therapist will stretch and move your body into specific poses thought to relieve stress and muscle tension. This review on the effectiveness of Thai and Swedish massage concluded, “Thai and Swedish massages are reported to relieve chronic low back pain by enhancing physical functions; providing pain relief, improving disability and range of motion, improving psychological functions; reducing anxiety and improving mood.”
- Foam rolling
Foam rolling is a form of self-massage that you can do at home. All you need is a foam roller (relatively inexpensive) and guidance on how to ‘roll out’ areas of stress and tension. Our app (update Aug 2023: Pathways is now a web app! Start our program here) for chronic pain (download links below) includes guided instructionals on foam rolling to help ease pain.
Massage doesn’t have to be done in a clinical setting, so it’s important that you choose someone who is qualified and properly registered. When it’s combined with other therapies, massage can have some significant results on improving quality of life for pain patients. It’s about finding out what works for you.
- Nuray Elibol, Uğur Cavlak, (2019), “Massage therapy in chronic musculoskeletal pain management: a scoping review of the literature”. Medicina Sportiva: vol. XV, no 1, 3067-3073
- Jennie C. I. Tsao, (2006), “Effectiveness of Massage Therapy for Chronic, Non-Malignant Pain: A Review”. Evidence-Based Complementary and Alternative Medicine: Volume 4
- Field, Tiffany; Diego, Miguel; Cullen, Christy; Hernandez-Reif, et al, (2002), “Fibromyalgia Pain and Substance P Decrease and Sleep Improves After Massage Therapy”. JCR: Journal of Clinical Rheumatology: April 2002 – Volume 8 – Issue 2 – p 72-76
- Rose Adams, MHA, BSW, LMT, Barb White, MS, LMT, Cynthia Beckett, PhD, RNC-OB, LCCE, (2010), “The Effects of Massage Therapy on Pain Management in the Acute Care Setting”. Int J Ther Massage Bodywork. 2010; 3(1): 4–11.
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- Susan L.K.Yuan MSc, Ana A.Berssaneti PhD, Amelia P.Marques PhD, (2013), “Effects of Shiatsu in the Management of Fibromyalgia Symptoms: A Controlled Pilot Study”. Journal of Manipulative and Physiological Therapeutics: Volume 36, Issue 7, September 2013, Pages 436-443
- Sritoomma Netchanok, Moyle Wendy, Cooke Marie, O’Dwyer Siobhan, (2012), “The effectiveness of Swedish massage and traditional Thai massage in treating chronic low back pain: A review of the literature”. Complementary Therapies in Clinical Practice: Volume 18, Issue 4, November 2012, Pages 227-234
- Field T, Hernandez-Reif M, Diego M, Schanberg S, Kuhn C, (2005), “Cortisol decreases and serotonin and dopamine increase following massage therapy.” Int J Neurosci. 2005 Oct;115(10):1397-413.
- Pain Doctor, (2020), “5 Best Types Of Massage That Can Help With Your Pain”.
- Science Direct, (2020), “Substance P”.
All Allied Health Schools, (2020), “History of Massage Therapy & How It Evolved”.
Please note: This article is made available for educational purposes only, not to provide personal medical advice.