Given the aggressive treatments that some people pursue for chronic low back pain, it is important for journalists to report research that points to a benefit from non-surgical therapies as well.
This isn’t the first study of massage for low back pain. Prior studies haven’t shown much benefit for low back pain that is less than 1 month in duration, but prior studies have shown benefit for those with pain for more than 3 months (chronic). As such these results aren’t breaking new ground. What it does show is that two forms of massage give similar results and that the benefits of massage in terms of pain diminish over time. Massage did show peristent improvement in function at 26 weeks. At 52 weeks function was better in the relaxation massage group but not the structural massage group when compared to usual care (though the direct comparison of the two massage groups didn’t significantly differ).
In summary, this study adds to the evidence that massage provides short-term benefit for patients with chronic low back pain that diminishes over time in terms of pain, but maintains its benefit in terms of function. This is good news, but it isn’t a cure.
Chronic low back pain is a common problem for which there is rarely a cure and for which many treatments appear to provide similar modest benefit but wtih very different risks and costs. Journalists join patients in the search for a cure, and the “dramatic” results reported appear to start us down that inaccurate slope. The story doesn’t say that the short-term benefits don’t all persist. But it does save itself by highlighting that the long-term benefit seen in the patient described may be as much attributable to treatment (exercise) she received after completing massage, as to the massage itself.
Massage, too, has a cost, and could have been ballparked at the very least. What do 10 sessions of massage therapy cost?
The study reported that the massage treatments “would have cost about $540 in the community.” The study goes on to state, “There is no evidence that these treatments reducted costs of back pain-lreated health care services during the 1-year posttreatment period.” This information could have been easily conveyed.
The story painted only half the picture: “After 10 weeks, the results were dramatic.” If these differences at 10 weeks had persisted, then dramatic would be appropriate. Rather it implies that these patients were cured, which is not the case. And 1 in 3 patients didn’t improve. That doesn’t feel dramatic. In addition, the story also messes up on the longer term outcomes. While function remained better in the massage groups at 6 and 12 months, pain didn’t. So the statement, “He says massage relieved the pain for six months or more” is a mischaracterization. In fact, pain differences seen at 10 weeks were not maintained at 26 and 52 weeks.
Harms weren’t mentioned but it would have been easy to cite what the study reported: that adverse events, mainly increased pain, was uncommon (4-7%) in those treated with massage. Even saying that massage is generally a safe treatment would have been fine.
Not all studies are bulletproof and when authors cite a possible limitation of their own work, we think journalists should at least give that a brief mention. It would have been worth noting a limitation that the authors themselves addressed – “Participants who received usual medical care were aware that they were not getting massage treatments and that other participants were; that might have led them to report worse symptoms than if they were unaware of what treatments other people were getting.”
We wish the story had been more specific that those studied had low back pain of no identified cause lasting at least 3 months. But there wasn’t any overt disease mongering.
No truly independent source was interviewed – only two researchers involved in the study.
We like how the story ended, explaining more about the patient profiled in the story:
“she remains free of back pain, but not without some effort on her part. Other studies have shown that building strong and flexible muscles can help prevent back pain. O’Brien-Murphy never exercised before. But now she does weight training, muscle stretches and aerobic exercise — activities all shown to help prevent recurrence of lower back pain.”
However, these facts put her story in a different light. The wonderful results of massage for this patient may have a lot to do with other treatments she received after the massage was over. So massage may not have cured her. It provided a means to engaging in physical activity which she hadn’t been able to do. That’s dramatic – not the massage, but that she has been able to maintain her improvement through hard work!
Massage is widely available. The story states, “relaxation massage is more widely available”.
The story explained one novel feature of the research: “Prior studies of massage for back pain had tested only structural forms of massage, not relaxation massage. But relaxation massage is more widely available, and it’s often less costly.”
It does not appear that the story relied solely or largely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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