Benefits of Touch and Massage Research
New Research Analysis Indicates Massage Therapy Shows Promise for Pain & Anxiety in Cancer Patients
Based on the evidence, massage therapy shows promise for reducing pain intensity/severity, fatigue, and anxiety in cancer populations compared to the active comparators evaluated in a new systematic review. This is the conclusion of a collaborative meta-analysis of research on massage therapy for pain conducted by Samueli Institute and commissioned by the Massage Therapy Foundation, with support from the American Massage Therapy Association. This review and analysis is published in the August issue of the journal Pain Medicine.
Based on the evidence, massage therapy shows promise for reducing pain intensity/severity, fatigue, and anxiety in cancer populations compared to the active comparators evaluated in a new systematic review. This is the conclusion of a collaborative meta-analysis of research on massage therapy for pain conducted by Samueli Institute and commissioned by the Massage Therapy Foundation, with support from the American Massage Therapy Association. This review and analysis is published in the August issue of the journal Pain Medicine.
Massage Therapy Beneficial for Cancer Patients
The study concludes that patients should consider massage therapy as a therapeutic option to help manage their cancer pain. Pain is the most common and debilitating symptom among cancer patients. While the exact prevalence of pain varies depending on the type and stage of cancer, research shows that pain generally affects over 50% of those undergoing cancer therapy and up to 90% with advanced cancer experience pain1.
According to a 2007 meta-analysis, which pooled data from 52 studies, the prevalence of pain was found to be approximately 59% among patients undergoing active cancer treatment and over 50% across all cancer types, with the highest pooled prevalence of 70% among head/neck cancer patients2. These figures convey that cancer pain is perhaps not adequately addressed by the current health care system and underscore the significant challenges faced by treating oncologists and other medical professionals in the field of cancer pain management.
Pain & Anxiety in Cancer Patients
Cancer pain can range from mild to severe and from acute to chronic. Pain management can be challenging; not only can cancer pain be spontaneous, as in the case with the emergence of breakthrough pain3 (i.e., sudden, transient exacerbation of pain intensity in patients with stable and controlled chronic pain) despite continued administration of analgesics4, but it can also affect patients physically, emotionally, socially, and spiritually. Patients often experience significant anxiety and depression5,6, as well as insomnia, fatigue, weakness, and other complications that can exacerbate each other, impair normal daily activities, and negatively impact quality of life7–9.
Specific factors surrounding the massage protocol, as well as selection of appropriate controls and standard outcomes, need to be well-understood before definitive clinical conclusions and recommendations regarding the usage and implementation of massage can be made for cancer pain at a policy level. However, this review’s promising results appear to warrant investment of time and resources into future research aimed at addressing these aforementioned gaps in order to ultimately consider massage therapy a standard treatment for cancer populations experiencing pain.
About the Study
Pain is multi-dimensional and may be better addressed through an integrative approach. Massage therapy is commonly used among people seeking pain management and research has generally supported its use. But, until now there has been no published, rigorous review of the available research and evidence for its efficacy for pain populations, especially for cancer populations.
This systematic review and meta-analysis is the first to rigorously assess the quality of massage therapy research and evidence for its efficacy in treating pain, function-related and health-related quality of life in cancer populations. It is the second of a three-part series of articles which assessed research on massage therapy for various aspects of pain.
References
1. Lesage P, Portenoy RK. Trends in cancer pain management. Cancer Control 1999;6(2):136–45.Medline
2. van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, et al. Prevalence of pain in patients with cancer: A systematic review of the past 40 years. Ann Oncol 2007;18(9):1437–49.Abstract/FREE Full Text
3. Margarit C, Julia J, Lopez R, et al. Breakthrough cancer pain—Still a challenge. J Pain Res 2012;5:559–66.Medline
4. Smith H. A comprehensive review of rapid-onset opioids for breakthrough pain. CNS Drugs 2012;26(6):509–35.CrossRefMedlineWeb of Science
5. O'Mahony S, Goulet J, Kornblith A, et al. Desire for hastened death, cancer pain and depression: Report of a longitudinal observational study. J Pain Symptom Manage 2005;29(5):446–57.CrossRefMedlineWeb of Science
6. Archie P, Bruera E, Cohen L. Music-based interventions in palliative cancer care: A review of quantitative studies and neurobiological literature. Support Care Cancer 2013;21(9):2609–24.CrossRefMedline
7. Coleman EA, Goodwin JA, Coon SK, et al. Fatigue, sleep, pain, mood, and performance status in patients with multiple myeloma. Cancer Nurs 2011;34(3):219–27.CrossRefMedline
8. Dalal S, Hui D, Nguyen L, et al. Achievement of personalized pain goal in cancer patients referred to a supportive care clinic at a comprehensive cancer center. Cancer 2012;118(15):3869–77.CrossRefMedline
9. Reyes-Gibby CC, Wang J, Spitz M, et al. Genetic variations in interleukin-8 and interleukin-10 are associated with pain, depressed mood, and fatigue in lung cancer patients. J Pain Symptom Manage 2013;46(2):161–72.CrossRefMedlineWeb of Science
Tiffany Field and The Touch Research Institute
The Touch Research Institute was formally established in 1992 by Director Tiffany Field, Ph.D. at the University of Miami School of Medicine via a start-up grant from Johnson & Johnson.
The TRI was the first center in the world devoted solely to the study of touch and its application in science and medicine. The TRI distinguished team of researchers, representing Duke, Harvard, Maryland, and other universities, strive to better define touch as it promotes health and contributes to the treatment of disease. Research efforts that began in 1982 and continue today have shown that touch therapy has numerous beneficial effects on health and well-being.
ANOREXIA
Hart, S., Field, T., Hernandez-Reif, M., Nearing, G., Shaw, S., Schanberg, S. & Kuhn, C. (2001). Anorexia nervosa symptoms are reduced by massage therapy. Eating Disorders, 9, 289-299.
Nineteen women diagnosed with anorexia nervosa were given standard treatment alone or standard treatment plus massage therapy twice per week for five weeks. The massage group reported lower stress and anxiety levels and had lower cortisol levels following massage. Over the five-week treatment period they also reported decreased body dissatisfaction on the Eating Disorder Inventory and showed increased dopamine and norepinephrine levels.
ANXIETY
Field, T., Ironson, G., Scafidi, F., Nawrocki, T.,Goncalves, A., Burman, I. , Pickens, J., Fox, N., Schanberg, S., & Kuhn, C. (1996). Massage therapy reduces anxiety and enhances EEG pattern of alertness and math computations. International Journal of Neuroscience, 86, 197-205.
Adults were given a chair massage, and control group adults were asked to relax in a chair for 15 minutes, two times a week for five weeks. Frontal delta power increased for both groups, suggesting relaxation. The massage group showed decreased alpha and beta power, and increased speed and accuracy on math computations. At the end of the five-week period depression scores were lower for both groups but job stress scores were only, for the massage group.
BACK PAIN
Hernandez-Reif, M., Field, T., Krasnegor, J., & Theakston, H. (2001). Lower back pain is reduced and range of motion increased after massage therapy. International Journal of Neuroscience, 106, 131-145.
Massage therapy was compared to relaxation for chronic low back pain. By the end of the study, the massage therapy group, as compared to the relaxation group, reported less pain, depression and anxiety and improved sleep. They also showed improved trunk and pain flexion performance, and their serotonin and dopamine levels were higher.
Field, T., Hernandez-Reif, M., Diego, M., & Fraser, M. (2007). Lower back pain and sleep disturbance are reduced following massage therapy. Journal of Bodywork and Movement Therapy, 11, 141-145.
Massage therapy versus relaxation therapy with chronic low back pain patients was evaluated for reducing pain, depression, anxiety and sleep disturbances, for improving trunk range of motion (ROM) and for reducing job absenteeism and increasing job productivity. Thirty adults with low back pain with a duration of at least 6 months pain participated in the study. On the first and last day of the 5-week study participants completed questionnaires and were assessed for ROM. By the end of the study, the massage therapy group, as compared to the relaxation group, reported less pain, depression, anxiety and sleep disturbance. They also showed improved trunk and pain flexion performance.
BLOOD PRESSURE
Hernandez-Reif, M., Field, T., Krasnegor, J. & Theakston, H.(2000). High blood pressure and associated symptoms were reduced by massage therapy. Journal of Bodywork and Movement Therapies, 4, 31-38.
High blood pressure is associated with elevated anxiety, stress and stress hormones, hostility, depression and catecholamines. Massage therapy and progressive muscle relaxation were evaluated as treatments for reducing blood pressure and these associated symptoms. Adults who had been diagnosed as hypertensive received ten 30 min massage sessions over five weeks or they were given progressive muscle relaxation instructions (control group). Sitting diastolic blood pressure decreased after the first and last massage therapy sessions and reclining diastolic blood pressure decreased from the first to the last day of the study. Although both groups reported less anxiety, only the massage therapy group reported less depression and hostility and showed decreased cortisol.
BURNS
Field, T., Peck, M., Krugman, S., Tuchel, T., Schanberg, S., Kuhn, C. & Burman, I. (1998). Burn injuries benefit from massage therapy. Journal of Burn Care and Rehabilitation, 19, 241-244.
Twenty-eight adult patients with burns were randomly assigned before debridement to either a massage therapy group or a standard treatment control group. State anxiety and cortisol levels decreased, and behavior ratings of state, activity, vocalizations and anxiety improved after the massage therapy sessions on the first and last days of treatment.
Field, T., Peck, M., Hernandez-Reif, M., Krugman, S., Burman, I. & Ozment-Schenck, L. (2000). Post burn itching, pain, and psychological symptoms are reduced with massage therapy. Journal of Burn Care and Rehabilitation, 21, 189-193.
Twenty patients with burn injuries were randomly assigned to a massage therapy or a standard treatment control group during the remodeling phase of wound healing. The massage therapy group received a 30-minute massage with cocoa butter to a closed, moderate-sized scar tissue area twice a week for 5 weeks. The massage therapy group reported reduced itching, pain, and anxiety and improved mood immediately after the first and last therapy sessions, and their ratings on these measures improved from the first day to the last day of the study.
Diego, M. & Field, T. (2009). Moderate Pressure Massage Elicits a Parasympathetic Nervous System Response. International Journal of Neuroscience, 119, 630-639.
Twenty healthy adults were randomly assigned to a moderate pressure or light pressure massage therapy group, and EKGs were recorded during a 3-minute baseline, during the 15-minute therapy group, and EKGs were recorded during a 3-minute baseline, during the 15-minute massage period and during a 3-minute post massage period. EKG data were then used to derive the high frequency (LH), low frequency (LF) components of heart variabilty and the low to high frequency ratio as noninvasive markers of autonomic nervous system activity. The participants who received the moderate pressure massage exhibited a parasympathetic nervous system response characterized by an increase in HF, suggesting increased vagal efferent activity and a decrease in the LF/HF ratio, suggesting a shift from sympathetic to parasympathetic activity that peaked during the first half of the massage period. On the other hand, those who received the light pressure massage exhibited a sympathetic nervous system response characterized by decreased HF and increased LF/HF.
Field, T., Diego, M., & Hernandez-Reif, M. (2010). Moderate pressure is essential for massage therapy effects. International Journal of Neuroscience, 120, 381-385.
Moderate pressure appears to be necessary for massage therapy effects. Studies comparing moderate and light pressure massage are reviewed and they suggest that growth and development are enhanced in infants and stress is reduced in adults, but only by moderate pressure massage. The stimulation of pressure receptors leads to increased vagal activity which, in turn, seems to mediate the diverse benefits noted for massage therapy.
DANCE
Leivadi, S., Hernandez-Reif, M., Field, T., Rourke, M., DÕArienzo, S., Lewis, D., del Pino, N., Schanberg, S. & Kuhn, C. (1999). Massage therapy and relaxation effects on University dance students. Journal of Dance Medicine and Science, 3, 108-112.
Thirty female university dancers were randomly assigned to a massage therapy or relaxation therapy group. The therapies consisted of 30-minute sessions twice a week for five weeks. Both groups reported less depressed mood and lower anxiety levels. However, cortisol decreased only for the massage therapy group. Both groups reported less neck, shoulder, and back pain after the treatment sessions and reduced back pain across the study.
DEPRESSION
Field, T., Grizzle, N., Scafidi, F., & Schanberg, S. (1996). Massage and relaxation therapies' effects on depressed adolescent mothers. Adolescence, 31, 903-911.
Thirty-two depressed adolescent mothers received ten 30-minute sessions of massage therapy or relaxation therapy over a five-week period. Subjects were randomly assigned to each group. Although both groups reported lower anxiety following their first and final sessions, although only the massage therapy group showed behavioral and stress hormone changes, including a decrease in anxious behavior, heartrate and cortisol levels.
Ironson, G., Field, T.M., Scafidi, F., Hashimoto, M., Kumar, M., Kumar, A., Price, A., Goncalves, A., Burman, I. , Tetenman, C., Patarca, R. & Fletcher, M.A. (1996). Massage therapy is associated with enhancement of the immune system's cytotoxic capacity. International Journal of Neuroscience, 84, 205-217.
Twenty nine gay men with HIV received massage for 1 month. Major immune findings for the effects of the month of massage included an increase in Natural Killer Cell number. Major neuroendocrine findings included a decrease in cortisol. Anxiety also decreased and relaxation increased which were correlated with increased in NK cell numbers.
Sunshine, W., Field, T.M., Quintino, O., Fierro, K., Kuhn, C., Burman, I. & Schanberg, S. (1996). Fibromyalgia benefits from massage therapy and transcutaneous electrical stimulation. Journal of Clinical Rheumatology, 2, 18-22.
Adult fibromyalgia syndrome subjects were randomly assigned to a massage therapy, a transcutaneous electrical stimulation (TENS), or a transcutaneous electrical stimulation no-current group for 30-minute treatment sessions two times per week for 5 weeks. The massage therapy subjects reported lower anxiety and depression, and their cortisol levels were lower immediately after the therapy sessions on the first and last days of the study. The TENS group showed similar changes, but only after therapy on the last day of the study.
Field, T., Hernandez-Reif, M., Taylor , S., Quintino, O., & Burman, I. (1997). Labor pain is reduced by massage therapy. Journal of Psychosomatic Obstetrics and Gynecology, 18, 286-291.
Twenty-eight women were recruited from prenatal classes and randomly assigned to receive massage in addition to coaching in breathing from their partners during labor , or to receive coaching in breathing alone. The massaged mothers reported a decrease in depressed mood, anxiety and pain, and showed less agitated activity and anxiety and more positive affect following the first massage during labor. In addition the massaged mothers had shorter labors, a shorter hospital stay and less postpartum depression.
Field, T., Quintino, O., Henteleff, T., Wells-Keife, L. & Delvecchio-Feinberg, G. (1997). Job stress reduction therapies. Alternative Therapies, 3, 54-56.
The immediate effects of brief massage therapy, music relaxation with visual imagery, muscle relaxation, and social support group sessions were assessed in 100 hospital employees at a major public hospital. The effects of the therapies were assessed using a within-subjects pre-post test design and by comparisons across groups. The groups reported decreased anxiety, depression, fatigue, and confusion, as well as increased vigor following the session.
Field, T.M., Sunshine, W., Hernandez-Reif, M., Quintino, O., Schanberg, S., Kuhn, C., & Burman, I. (1997). Massage therapy effects on depression and somatic symptoms in chronic fatigue syndrome. Journal of Chronic Fatigue Syndrome, 3, 43-51.
Twenty subjects with chronic fatigue immunodeficiency syndrome were randomly assigned either to a massage therapy or an attention control group. Although depression and anxiety scores were initially as high as clinically depressed patients, analyses of the before versus after therapy session measures on the first and last day of treatment revealed that immediately following massage therapy depression scores, pain, and cortisol levels decreased more in the massage versus control group.
ELDERLY
Field, T., Hernandez-Reif, M., Quintino, O., Schanberg, S. & Kuhn, C. (1998). Elder retired volunteers benefit from giving massage therapy to infants. Journal of Applied Gerontology, 17, 229-239.
Elderly retired volunteers give massage to infants and were compared with those receiving massage themselves. After the first and last day sessions of giving massages, the elderly retired volunteers had less anxiety and depression and lower stress hormones. Over the 3-week period, depression and stress neurotransmitters decreased and lifestyle and health improved.
HEADACHES
Hernandez-Reif, M., Dieter J., Field, T., Swerdlow, B., & Diego, M. (1998). Migraine headaches are reduced by massage therapy. International Journal of Neuroscience, 96, 1-11.
Twenty-six adults with migraine headaches were randomly assigned to a wait-list control group or to a massage therapy group, who received two 30-minute massages per week for five consecutive weeks. The massage therapy subjects reported fewer distress symptoms, less pain, more headache free days, fewer sleep disturbances, and they showed an increase in serotonin levels.
MUITIPLE SCLEROSIS
Hernandez-Reif, M., Field, T., Field, T., & Theakston, H. (1998). Multiple sclerosis patients benefit from massage therapy. Journal of Bodywork and Movement Therapies, 2, 168-174.
Twenty-four adults with multiple sclerosis were randomly assigned to a standard medical treatment control group or a massage therapy group that received 45-minute massages twice a week for 5 weeks. The massage group had lower anxiety and less depressed mood immediately following the massage sessions and, by the end of the study, they had improved self-esteem, better body image and image of disease progression and enhanced social functional status.
PREGNANCY
Field, T., Hernandez-Reif, M., Hart, S., Theakston, H., Schanberg, S., Kuhn, C. & Burman, I. (1999). Pregnant women benefit from massage therapy. Journal of Psychosomatic Obstetrics & Gynecology, 20, 31-38.
Twenty-six pregnant women were assigned to a massage therapy or a relaxation therapy group for 5 weeks. Both groups reported feeling less anxious after the first session and less leg pain after the first and last session. Only the massage therapy group, however, reported reduced anxiety, improved mood, better sleep and less back pain by the last day of the study.
Latifses, V., Bendell Estroff, D., Field, T., & Bush, J. (2005). Father massaging and relaxing their pregnant wives lowered anxiety and facilitated marital adjustment. Journal of Bodywork and Movement Therapies, 9, 277-82.
Fathers learned to massage their pregnant wives conducted progressive muscle relaxation. Massage therapy lowered the fathers’ anxiety and improved marital adjustment.
Field, T., Deed, O., Diego, M., Gualer, A., Sullivan, S., Wilson, D. & Nearing, G. (2009). Benefits of combining massage therapy with group interpersonal psychotherapy in prenatally depressed women. Journal of Bodywork and Movement Therpies, 13, 297-303.
One hundred and twelve pregnant women who were diagnosed depressed were randomly assigned to a group who received group Interpersonal Psychotherapy or to a group who received both group Interpersonal Psychotherapy and massage therapy. The data suggested that the group who received psychotherapy plus massage attended more sessions on average, and a greater percentage of that group completed the 6-week program. The group who received both therapies also showed a greater decrease in depression, depressed affect and somatic-vegetative symptom scores on the Center for Epidemiological Studies-Depression Scal , a greater decrease in anxiety scale scores and a greater decrease in cortisol levels. The group therapy process appeared to be effective for both groups as suggested by the increased expression of both positive and negative affect and relatedness during the group therapy sessions.
Field, T., Diego, M., Hernandez-Reif, M., Deeds, O. & Figueiredo, B. (2009). Pregnancy massage reduces prematurity, low birthweight and postpartum depression. Infant Behavior & Development, 32, 454-460.
One hundred and twelve pregnant women who were diagnosed depressed were randomly assigned to a group who received group Interpersonal Psychotherapy or to a group who received both group Interpersonal Psychotherapy and massage therapy. The data suggested that the group who received psychotherapy plus massage attended more sessions on average, and a greater percentage of that group completed the 6-week program. The group who received both therapies also showed a greater decrease in depression, depressed affect and somatic-vegetative symptom scores on the Center for Epidemiological Studies-Depression Scale, a greater decrease in anxiety scale scores and a greater decrease in cortisol levels. The group therapy process appeared to be effective for both groups as suggested by the increased expression of both positive and negative affect and relatedness during the group therapy sessions.
Field, T. (2010). Pregnancy and labor massage therapy. Expert Review of Obstetrics and Gynecology, 5, 177-181.
Women who received massage therapy reported decreased depression, anxiety, and leg and back pain. Cortisol levels decreased and, in turn, excessive fetal activity decreased, and the rate of prematurity was lower in the massage group. In a study of labor pain, women who received massage therapy experienced significantly less pain, and their labors were on average 3 h shorter with less need for medication. An underlying mechanism we have been exploring is that these effects are mediated by increased vagal activity.
PREMENSTRUAL SYNDROME
Hernandez-Reif, M, Martinez , A., Field, T., Quintino, O., Hart, S., & Burman, I. (2000). Premenstrual syndrome symptoms are relieved by massage therapy. Journal of Psychosomatic Obstetrics & Gynecology, 21, 9-15.
Twenty-four women with premenstrual dysphoric disorder were randomly assigned to a massage therapy or a relaxation therapy group. The massage group showed decreased anxiety, depressed mood and pain immediately after the first and last massage sessions. The longer term effects of massage therapy included a reduction in pain and water retention and overall menstrual distress.
Field, T. (In Press) Pregnancy and Labor Alternative Therapy Research. Alternative Therapies in Health and Medicine.
Medline and papers were reviewed for the most popular complementary and alternative therapies used during pregnancy and labor, including massage therapy, acupuncture, relaxation, yoga, and exercise. The pregnancy research suggests that alternative therapies have been effective for reducing pregnancy-related back and leg pain and nausea and for reducing depression and cortisol levels and the associated prematurity rate. The labor research generally shows that alternative therapies reduce pain and thereby the need for medication.
SEXUAL ABUSE
Field, T., Hernandez-Reif, M., Hart, S., Quintino, O., Drose, L., Field, T., Kuhn, C., & Schanberg, S (1997). Effects of sexual abuse are lessened by massage therapy. Journal of Bodywork and Movement Therapies, 1, 65-69.
Women who had experienced sexual abuse were given a 30-minute massage twice a week for 1 month. Immediately after the massage the women reported being less depressed and less anxious and their salivary cortisol levels decreased following the session. Over the 1-month treatment period the massage therapy group experienced a decrease in depression and in life event stress. Although the relaxation therapy control group also reported a decrease in anxiety and depression, their stress hormones did not change, and they reported an increasingly negative attitude toward touch.
The TRI was the first center in the world devoted solely to the study of touch and its application in science and medicine. The TRI distinguished team of researchers, representing Duke, Harvard, Maryland, and other universities, strive to better define touch as it promotes health and contributes to the treatment of disease. Research efforts that began in 1982 and continue today have shown that touch therapy has numerous beneficial effects on health and well-being.
ANOREXIA
Hart, S., Field, T., Hernandez-Reif, M., Nearing, G., Shaw, S., Schanberg, S. & Kuhn, C. (2001). Anorexia nervosa symptoms are reduced by massage therapy. Eating Disorders, 9, 289-299.
Nineteen women diagnosed with anorexia nervosa were given standard treatment alone or standard treatment plus massage therapy twice per week for five weeks. The massage group reported lower stress and anxiety levels and had lower cortisol levels following massage. Over the five-week treatment period they also reported decreased body dissatisfaction on the Eating Disorder Inventory and showed increased dopamine and norepinephrine levels.
ANXIETY
Field, T., Ironson, G., Scafidi, F., Nawrocki, T.,Goncalves, A., Burman, I. , Pickens, J., Fox, N., Schanberg, S., & Kuhn, C. (1996). Massage therapy reduces anxiety and enhances EEG pattern of alertness and math computations. International Journal of Neuroscience, 86, 197-205.
Adults were given a chair massage, and control group adults were asked to relax in a chair for 15 minutes, two times a week for five weeks. Frontal delta power increased for both groups, suggesting relaxation. The massage group showed decreased alpha and beta power, and increased speed and accuracy on math computations. At the end of the five-week period depression scores were lower for both groups but job stress scores were only, for the massage group.
BACK PAIN
Hernandez-Reif, M., Field, T., Krasnegor, J., & Theakston, H. (2001). Lower back pain is reduced and range of motion increased after massage therapy. International Journal of Neuroscience, 106, 131-145.
Massage therapy was compared to relaxation for chronic low back pain. By the end of the study, the massage therapy group, as compared to the relaxation group, reported less pain, depression and anxiety and improved sleep. They also showed improved trunk and pain flexion performance, and their serotonin and dopamine levels were higher.
Field, T., Hernandez-Reif, M., Diego, M., & Fraser, M. (2007). Lower back pain and sleep disturbance are reduced following massage therapy. Journal of Bodywork and Movement Therapy, 11, 141-145.
Massage therapy versus relaxation therapy with chronic low back pain patients was evaluated for reducing pain, depression, anxiety and sleep disturbances, for improving trunk range of motion (ROM) and for reducing job absenteeism and increasing job productivity. Thirty adults with low back pain with a duration of at least 6 months pain participated in the study. On the first and last day of the 5-week study participants completed questionnaires and were assessed for ROM. By the end of the study, the massage therapy group, as compared to the relaxation group, reported less pain, depression, anxiety and sleep disturbance. They also showed improved trunk and pain flexion performance.
BLOOD PRESSURE
Hernandez-Reif, M., Field, T., Krasnegor, J. & Theakston, H.(2000). High blood pressure and associated symptoms were reduced by massage therapy. Journal of Bodywork and Movement Therapies, 4, 31-38.
High blood pressure is associated with elevated anxiety, stress and stress hormones, hostility, depression and catecholamines. Massage therapy and progressive muscle relaxation were evaluated as treatments for reducing blood pressure and these associated symptoms. Adults who had been diagnosed as hypertensive received ten 30 min massage sessions over five weeks or they were given progressive muscle relaxation instructions (control group). Sitting diastolic blood pressure decreased after the first and last massage therapy sessions and reclining diastolic blood pressure decreased from the first to the last day of the study. Although both groups reported less anxiety, only the massage therapy group reported less depression and hostility and showed decreased cortisol.
BURNS
Field, T., Peck, M., Krugman, S., Tuchel, T., Schanberg, S., Kuhn, C. & Burman, I. (1998). Burn injuries benefit from massage therapy. Journal of Burn Care and Rehabilitation, 19, 241-244.
Twenty-eight adult patients with burns were randomly assigned before debridement to either a massage therapy group or a standard treatment control group. State anxiety and cortisol levels decreased, and behavior ratings of state, activity, vocalizations and anxiety improved after the massage therapy sessions on the first and last days of treatment.
Field, T., Peck, M., Hernandez-Reif, M., Krugman, S., Burman, I. & Ozment-Schenck, L. (2000). Post burn itching, pain, and psychological symptoms are reduced with massage therapy. Journal of Burn Care and Rehabilitation, 21, 189-193.
Twenty patients with burn injuries were randomly assigned to a massage therapy or a standard treatment control group during the remodeling phase of wound healing. The massage therapy group received a 30-minute massage with cocoa butter to a closed, moderate-sized scar tissue area twice a week for 5 weeks. The massage therapy group reported reduced itching, pain, and anxiety and improved mood immediately after the first and last therapy sessions, and their ratings on these measures improved from the first day to the last day of the study.
Diego, M. & Field, T. (2009). Moderate Pressure Massage Elicits a Parasympathetic Nervous System Response. International Journal of Neuroscience, 119, 630-639.
Twenty healthy adults were randomly assigned to a moderate pressure or light pressure massage therapy group, and EKGs were recorded during a 3-minute baseline, during the 15-minute therapy group, and EKGs were recorded during a 3-minute baseline, during the 15-minute massage period and during a 3-minute post massage period. EKG data were then used to derive the high frequency (LH), low frequency (LF) components of heart variabilty and the low to high frequency ratio as noninvasive markers of autonomic nervous system activity. The participants who received the moderate pressure massage exhibited a parasympathetic nervous system response characterized by an increase in HF, suggesting increased vagal efferent activity and a decrease in the LF/HF ratio, suggesting a shift from sympathetic to parasympathetic activity that peaked during the first half of the massage period. On the other hand, those who received the light pressure massage exhibited a sympathetic nervous system response characterized by decreased HF and increased LF/HF.
Field, T., Diego, M., & Hernandez-Reif, M. (2010). Moderate pressure is essential for massage therapy effects. International Journal of Neuroscience, 120, 381-385.
Moderate pressure appears to be necessary for massage therapy effects. Studies comparing moderate and light pressure massage are reviewed and they suggest that growth and development are enhanced in infants and stress is reduced in adults, but only by moderate pressure massage. The stimulation of pressure receptors leads to increased vagal activity which, in turn, seems to mediate the diverse benefits noted for massage therapy.
DANCE
Leivadi, S., Hernandez-Reif, M., Field, T., Rourke, M., DÕArienzo, S., Lewis, D., del Pino, N., Schanberg, S. & Kuhn, C. (1999). Massage therapy and relaxation effects on University dance students. Journal of Dance Medicine and Science, 3, 108-112.
Thirty female university dancers were randomly assigned to a massage therapy or relaxation therapy group. The therapies consisted of 30-minute sessions twice a week for five weeks. Both groups reported less depressed mood and lower anxiety levels. However, cortisol decreased only for the massage therapy group. Both groups reported less neck, shoulder, and back pain after the treatment sessions and reduced back pain across the study.
DEPRESSION
Field, T., Grizzle, N., Scafidi, F., & Schanberg, S. (1996). Massage and relaxation therapies' effects on depressed adolescent mothers. Adolescence, 31, 903-911.
Thirty-two depressed adolescent mothers received ten 30-minute sessions of massage therapy or relaxation therapy over a five-week period. Subjects were randomly assigned to each group. Although both groups reported lower anxiety following their first and final sessions, although only the massage therapy group showed behavioral and stress hormone changes, including a decrease in anxious behavior, heartrate and cortisol levels.
Ironson, G., Field, T.M., Scafidi, F., Hashimoto, M., Kumar, M., Kumar, A., Price, A., Goncalves, A., Burman, I. , Tetenman, C., Patarca, R. & Fletcher, M.A. (1996). Massage therapy is associated with enhancement of the immune system's cytotoxic capacity. International Journal of Neuroscience, 84, 205-217.
Twenty nine gay men with HIV received massage for 1 month. Major immune findings for the effects of the month of massage included an increase in Natural Killer Cell number. Major neuroendocrine findings included a decrease in cortisol. Anxiety also decreased and relaxation increased which were correlated with increased in NK cell numbers.
Sunshine, W., Field, T.M., Quintino, O., Fierro, K., Kuhn, C., Burman, I. & Schanberg, S. (1996). Fibromyalgia benefits from massage therapy and transcutaneous electrical stimulation. Journal of Clinical Rheumatology, 2, 18-22.
Adult fibromyalgia syndrome subjects were randomly assigned to a massage therapy, a transcutaneous electrical stimulation (TENS), or a transcutaneous electrical stimulation no-current group for 30-minute treatment sessions two times per week for 5 weeks. The massage therapy subjects reported lower anxiety and depression, and their cortisol levels were lower immediately after the therapy sessions on the first and last days of the study. The TENS group showed similar changes, but only after therapy on the last day of the study.
Field, T., Hernandez-Reif, M., Taylor , S., Quintino, O., & Burman, I. (1997). Labor pain is reduced by massage therapy. Journal of Psychosomatic Obstetrics and Gynecology, 18, 286-291.
Twenty-eight women were recruited from prenatal classes and randomly assigned to receive massage in addition to coaching in breathing from their partners during labor , or to receive coaching in breathing alone. The massaged mothers reported a decrease in depressed mood, anxiety and pain, and showed less agitated activity and anxiety and more positive affect following the first massage during labor. In addition the massaged mothers had shorter labors, a shorter hospital stay and less postpartum depression.
Field, T., Quintino, O., Henteleff, T., Wells-Keife, L. & Delvecchio-Feinberg, G. (1997). Job stress reduction therapies. Alternative Therapies, 3, 54-56.
The immediate effects of brief massage therapy, music relaxation with visual imagery, muscle relaxation, and social support group sessions were assessed in 100 hospital employees at a major public hospital. The effects of the therapies were assessed using a within-subjects pre-post test design and by comparisons across groups. The groups reported decreased anxiety, depression, fatigue, and confusion, as well as increased vigor following the session.
Field, T.M., Sunshine, W., Hernandez-Reif, M., Quintino, O., Schanberg, S., Kuhn, C., & Burman, I. (1997). Massage therapy effects on depression and somatic symptoms in chronic fatigue syndrome. Journal of Chronic Fatigue Syndrome, 3, 43-51.
Twenty subjects with chronic fatigue immunodeficiency syndrome were randomly assigned either to a massage therapy or an attention control group. Although depression and anxiety scores were initially as high as clinically depressed patients, analyses of the before versus after therapy session measures on the first and last day of treatment revealed that immediately following massage therapy depression scores, pain, and cortisol levels decreased more in the massage versus control group.
ELDERLY
Field, T., Hernandez-Reif, M., Quintino, O., Schanberg, S. & Kuhn, C. (1998). Elder retired volunteers benefit from giving massage therapy to infants. Journal of Applied Gerontology, 17, 229-239.
Elderly retired volunteers give massage to infants and were compared with those receiving massage themselves. After the first and last day sessions of giving massages, the elderly retired volunteers had less anxiety and depression and lower stress hormones. Over the 3-week period, depression and stress neurotransmitters decreased and lifestyle and health improved.
HEADACHES
Hernandez-Reif, M., Dieter J., Field, T., Swerdlow, B., & Diego, M. (1998). Migraine headaches are reduced by massage therapy. International Journal of Neuroscience, 96, 1-11.
Twenty-six adults with migraine headaches were randomly assigned to a wait-list control group or to a massage therapy group, who received two 30-minute massages per week for five consecutive weeks. The massage therapy subjects reported fewer distress symptoms, less pain, more headache free days, fewer sleep disturbances, and they showed an increase in serotonin levels.
MUITIPLE SCLEROSIS
Hernandez-Reif, M., Field, T., Field, T., & Theakston, H. (1998). Multiple sclerosis patients benefit from massage therapy. Journal of Bodywork and Movement Therapies, 2, 168-174.
Twenty-four adults with multiple sclerosis were randomly assigned to a standard medical treatment control group or a massage therapy group that received 45-minute massages twice a week for 5 weeks. The massage group had lower anxiety and less depressed mood immediately following the massage sessions and, by the end of the study, they had improved self-esteem, better body image and image of disease progression and enhanced social functional status.
PREGNANCY
Field, T., Hernandez-Reif, M., Hart, S., Theakston, H., Schanberg, S., Kuhn, C. & Burman, I. (1999). Pregnant women benefit from massage therapy. Journal of Psychosomatic Obstetrics & Gynecology, 20, 31-38.
Twenty-six pregnant women were assigned to a massage therapy or a relaxation therapy group for 5 weeks. Both groups reported feeling less anxious after the first session and less leg pain after the first and last session. Only the massage therapy group, however, reported reduced anxiety, improved mood, better sleep and less back pain by the last day of the study.
Latifses, V., Bendell Estroff, D., Field, T., & Bush, J. (2005). Father massaging and relaxing their pregnant wives lowered anxiety and facilitated marital adjustment. Journal of Bodywork and Movement Therapies, 9, 277-82.
Fathers learned to massage their pregnant wives conducted progressive muscle relaxation. Massage therapy lowered the fathers’ anxiety and improved marital adjustment.
Field, T., Deed, O., Diego, M., Gualer, A., Sullivan, S., Wilson, D. & Nearing, G. (2009). Benefits of combining massage therapy with group interpersonal psychotherapy in prenatally depressed women. Journal of Bodywork and Movement Therpies, 13, 297-303.
One hundred and twelve pregnant women who were diagnosed depressed were randomly assigned to a group who received group Interpersonal Psychotherapy or to a group who received both group Interpersonal Psychotherapy and massage therapy. The data suggested that the group who received psychotherapy plus massage attended more sessions on average, and a greater percentage of that group completed the 6-week program. The group who received both therapies also showed a greater decrease in depression, depressed affect and somatic-vegetative symptom scores on the Center for Epidemiological Studies-Depression Scal , a greater decrease in anxiety scale scores and a greater decrease in cortisol levels. The group therapy process appeared to be effective for both groups as suggested by the increased expression of both positive and negative affect and relatedness during the group therapy sessions.
Field, T., Diego, M., Hernandez-Reif, M., Deeds, O. & Figueiredo, B. (2009). Pregnancy massage reduces prematurity, low birthweight and postpartum depression. Infant Behavior & Development, 32, 454-460.
One hundred and twelve pregnant women who were diagnosed depressed were randomly assigned to a group who received group Interpersonal Psychotherapy or to a group who received both group Interpersonal Psychotherapy and massage therapy. The data suggested that the group who received psychotherapy plus massage attended more sessions on average, and a greater percentage of that group completed the 6-week program. The group who received both therapies also showed a greater decrease in depression, depressed affect and somatic-vegetative symptom scores on the Center for Epidemiological Studies-Depression Scale, a greater decrease in anxiety scale scores and a greater decrease in cortisol levels. The group therapy process appeared to be effective for both groups as suggested by the increased expression of both positive and negative affect and relatedness during the group therapy sessions.
Field, T. (2010). Pregnancy and labor massage therapy. Expert Review of Obstetrics and Gynecology, 5, 177-181.
Women who received massage therapy reported decreased depression, anxiety, and leg and back pain. Cortisol levels decreased and, in turn, excessive fetal activity decreased, and the rate of prematurity was lower in the massage group. In a study of labor pain, women who received massage therapy experienced significantly less pain, and their labors were on average 3 h shorter with less need for medication. An underlying mechanism we have been exploring is that these effects are mediated by increased vagal activity.
PREMENSTRUAL SYNDROME
Hernandez-Reif, M, Martinez , A., Field, T., Quintino, O., Hart, S., & Burman, I. (2000). Premenstrual syndrome symptoms are relieved by massage therapy. Journal of Psychosomatic Obstetrics & Gynecology, 21, 9-15.
Twenty-four women with premenstrual dysphoric disorder were randomly assigned to a massage therapy or a relaxation therapy group. The massage group showed decreased anxiety, depressed mood and pain immediately after the first and last massage sessions. The longer term effects of massage therapy included a reduction in pain and water retention and overall menstrual distress.
Field, T. (In Press) Pregnancy and Labor Alternative Therapy Research. Alternative Therapies in Health and Medicine.
Medline and papers were reviewed for the most popular complementary and alternative therapies used during pregnancy and labor, including massage therapy, acupuncture, relaxation, yoga, and exercise. The pregnancy research suggests that alternative therapies have been effective for reducing pregnancy-related back and leg pain and nausea and for reducing depression and cortisol levels and the associated prematurity rate. The labor research generally shows that alternative therapies reduce pain and thereby the need for medication.
SEXUAL ABUSE
Field, T., Hernandez-Reif, M., Hart, S., Quintino, O., Drose, L., Field, T., Kuhn, C., & Schanberg, S (1997). Effects of sexual abuse are lessened by massage therapy. Journal of Bodywork and Movement Therapies, 1, 65-69.
Women who had experienced sexual abuse were given a 30-minute massage twice a week for 1 month. Immediately after the massage the women reported being less depressed and less anxious and their salivary cortisol levels decreased following the session. Over the 1-month treatment period the massage therapy group experienced a decrease in depression and in life event stress. Although the relaxation therapy control group also reported a decrease in anxiety and depression, their stress hormones did not change, and they reported an increasingly negative attitude toward touch.