Is massage better than anti-inflammatory drugs (NSAIDS)

The trial where massage and NSAIDS were directly compared.

What the trial did

In this trial (1)⁠ 60 people with long standing upper back pain were given 5 days of either:

• 400mg of the NSAID Iboprufen three times daily, or
• daily self application of self massage using a tool called a Wilai Stick. We cover this in the section of self massage options below.

The researchers measured pain, plus functional things such as muscle tightness and head/neck movement.

What the trial found

Those receiving the massages had a good reduction in pain, and improvement in the the functional things such as head/neck movement. On the other hand those receiving the Iboprufen only had a slight improvement in pain and no improvement in the functional things

Summary of clinical trial results and safety for massage

According to these reviews (2–4) of the clinical trial results of massage therapy for back pain massage there have been several clinical trials, and they have shown massage to give a moderate improvement. Massage therapy has also been shown to be incredibly safe.

Summary of the clinical trial results and safety for NSAIDS

Clinical trial results

According to the following reviews (5–7)⁠ of the clinical trials of the use of NSAIDS for back pain the results range from very small and not clinically significant, to small to moderate short term relief.

Safety of NSAIDS

As well as there being practically no evidence of being effective NSAIDS have a horrendous record of causing serious medical side effects and death. In spite of this they are the most commonly used drug in the world are often seen as the first option for general practitioners to prescribe. Let’s look at look at what NSAIDS do.

• NSAIDS are responsible for 100,000 hospitisations a year. The medical cost of treating NSAID side effects is $4 billion per year. 16,500 people die each year from these side effects. (8)⁠
• According to the USA FDA, 2-4% of those taking NSAIDS for a year will develop a symptomatic ulcer which may be life threatening. (9)⁠
• 1-2% of NSAIDS users will become hospitalised, and the annual death rate is 0.08-0.22% (9)⁠
• 50% of those taking NSAIDS will develop mucosal lesions which cause bleeding, ulcers and perforations. Patients can eventually die from these complications. (10)⁠
• the newer “safer” NSAIDS are killing people too (11)⁠

Why ulcers caused by NSAIDS are so dangerous

Several of the reviews of NSAIDS recommend that to improves safety doctors be diligent in assessing patients receiving NSAIDS (12,13)⁠ There’s one big problem though. If you have a bleeding ulcer in your skin it’s very obvious: you can see the blood. If a gastro intestinal ulcer bleeds though the blood stays inside you and is digested. You don’t see that you are bleeding to death. Despite the encouragement for doctors to be vigilant the facts speak for themselves.

Your self massage options

Professional massage therapists provide excellent care, but ongoing regular massages can be expensive. Self massage removes most of this ongoing cost, but as discussed in our article on the use of foam rollers a lot of self massage is riskier and a lot less effective than professional massage. Lets look at your safe effective self massage options. There are many forms of self massage, but these fit into two basic categories: massage that mimics the manual therapy of a profession therapist and those that use vibration.

Massage that mimics professional manual massage

• Balls and rollers
• Thai self massage
• Chairs and cushions

Appendix: how clinical trials can mislead

References

1. Wamontree P, Kanchanakhan N, Eungpinichpong W, Jeensawek A. Effects of traditional Thai self-massage using a Wilai massage stickTM versus ibuprofen in patients with upper back pain associated with myofascial trigger points: a randomized controlled trial. J Phys Ther Sci. 2015;27(11):3493–7.
2. Kumar S, Beaton K, Hughes T. The effectiveness of massage therapy for the treatment of nonspecific low back pain: A systematic review of systematic reviews. Int J Gen Med. 2013;6:733–41.
3. Cherkin D et. al. A Review of the Evidence for the Effectiveness , Safety , and Cost of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Intern Med. 2003;38:898–906.
4. Furlan AD, Brosseau L, Imamura M, Irvin E. Massage for low-back pain: A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine (Phila Pa 1976). 2002;27(17):1896–910.
5. Enthoven WTM, Roelofs PDDM, Deyo RA, van Tulder MW, Koes BW. Non-steroidal anti-inflammatory drugs for chronic low back pain. Vol. 2016, Cochrane Database of Systematic Reviews. 2016.
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10. Patrignani P et. al. Managing the adverse effects of nonsteroidal anti-infalmmatory drugs. Expert Rev Clin Pharmacol. 2011;4(5):605–21.
11. Sostres C, Gargallo CJ, Lanas A. Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage. Arthritis Res Ther. 2013;15(SUPPL 3):1–8.
12. Cryer B. NSAID-associated deaths: The rise and fall of NSAID-associated GI mortality. Am J Gastroenterol. 2005;100(8):1694–5.
13. Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: A review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Vol. 147, Annals of Internal Medicine. 2007. 492–504 p.
14. Blower AL, Brooks A, Fenn GC, Hill A, Pearce MY, Morant S, et al. Emergency admissions for upper gastrointestinal disease and their relation to NSAID use. Aliment Pharmacol Ther. 1997;11(2):283–91.
15. Reported road casualties in Great Britain: provisional estimates year ending 2020. UK Dep Transp Stat release