Given the widespread use of various massage therapies for pain, we conducted an evidence mapping process to determine the distribution of evidence available for various pain indications as well as different forms of massage therapy, identify gaps in evidence, and inform future research priorities. This mapping project provides a visual overview of the distribution of evidence for massage therapy for indications of pain, as well as an accompanying narrative that will help stakeholders interpret the state of evidence to inform policy and clinical decision-making.
We searched PubMed, Embase, and Cochrane for systematic reviews reporting pain outcomes for massage therapy. Abstracted data included: number of studies included in the review that report massage as the intervention and pain as an outcome; total number of studies included in the review; descriptions of the massage style, provider, co-interventions, duration, and comparators; pain type; main findings relevant to massage for pain; and whether the systematic review focused solely on massage as the intervention or included a variety of interventions, of which massage was one. Quality of each systematic review was assessed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria. We used a bubble plot to visually depict the number of included articles, pain indication, effect of massage for pain, and strength of findings for each included systematic review.
We identified 31 systematic reviews, of which 21 were considered high-quality. Systematic reviews varied in the amount of detail they collected in describing the massage therapy. Some common massage types included Swedish massage, myofascial therapies, Shiatsu, Chinese traditional massage, Thai massage, slow stroke massage, and more general descriptions of massage. The most common type of pain included in systematic reviews was neck pain (n=6). Findings from high-quality systematic reviews describe potential benefits of massage for pain indications including labor, shoulder, neck, back, cancer, fibromyalgia, and temporomandibular disorder. However, no findings were rated as moderate- or high-strength.
More research is needed to establish confidence in the effect of massage for pain. Primary studies often do not provide adequate details of the massage therapy provided, especially in the descriptions of provider type. Few primary studies of large samples with rigorous methods have been conducted, as noted by many of the systematic review authors included in this evidence map.
