The efficacy of a preparatory phase of a touch-based approach in treating chronic low back pain: a randomized controlled trial

Abstract

Federico Zangrando,1 Giulia Piccinini,2 Clara Tagliolini,1 Gabriella Marsilli,2 Marco Iosa,3 Maria Chiara Vulpiani,2 Teresa Paolucci1 1Complex Unit of Physical Medicine and Rehabilitation, Policlinico Umberto I Hospital, “Sapienza” University of Rome, Rome, Italy; 2Unit of Physical Medicine and Rehabilitation, Sant’Andrea Hospital, “Sapienza” University of Rome, Rome, Italy; 3Clinical Laboratory of Experimental Neurorehabilitation, Santa Lucia Foundation, Rome, Italy Background: Massage therapy is an important element of rehabilitation in the treatment of chronic low back pain (CLBP). The objective of this study was to determine the relative efficacy of massage therapy between traditional massage and a new massage approach for CLBP. We also examined whether any reduction in pain was linked to interoceptive awareness and parasympathetic activation.Methods: A single-blind, randomized, controlled trial of 51 patients who were allocated into a traditional massage therapy group (TMG; N=24, mean age: 50.54±9.13 years) or experimental massage therapy group (SMG; N=27, mean age: 50.77±6.80 years). The primary outcome was the reduction in pain per the visual analog scale (VAS); the secondary outcome measures were multidimensional pain intensity on the McGill Pain Questionnaire, pain-related disability per the Waddel Disability Index, interoceptive awareness per the Multidimensional Assessment of Interoceptive Awareness Questionnaire, quality of life per the Short Form - 12 Health Survey, and heart rate variability, expressed as the coherence ratio (CR) by photoplethysmography. The following outcome measures were assessed at baseline, at the end of the treatment program, and at the 3-month follow-up. The mean and standard deviation were calculated for continuous data. Mann–Whitney U test was used to perform between-group comparisons, Friedman’s analysis was used for data on the 3 assessment times in each group, and Spearman’s R coefficient was used to analyze correlations.Results: Both approaches had a positive result on pain, an effect that was more acute in the SMG versus TMG for all pain scales, with better maintenance at the 3-month follow-up (VAS p=0.005 and p=0.098; Waddell Index p=0.034 and 0.044; McGill total p=0.000 and 0.003). In the SMG, CR scores were significant at baseline and at the end of the treatment program (p=0.000 and 0.002).Conclusion: The new massage approach with a preparatory phase that is pleasant to the touch was more effective than the traditional approach for CLBP. Keywords: perception, rehabilitation, quality of life, pain memory, massage

Keywords

• perception
• chronic low back
• quality of life
• pain memory