title: Five-week outcomes from a dosing trial of therapeutic massage for chronic neck pain.
abstract: OBJECTIVE
  This trial was designed to evaluate the optimal dose of massage for individuals with chronic neck pain.
  
  
  METHODS
  We recruited 228 individuals with chronic nonspecific neck pain from an integrated health care system and the general population, and randomized them to 5 groups receiving various doses of massage (a 4-week course consisting of 30-minute visits 2 or 3 times weekly or 60-minute visits 1, 2, or 3 times weekly) or to a single control group (a 4-week period on a wait list). We assessed neck-related dysfunction with the Neck Disability Index (range, 0-50 points) and pain intensity with a numerical rating scale (range, 0-10 points) at baseline and 5 weeks. We used log-linear regression to assess the likelihood of clinically meaningful improvement in neck-related dysfunction (≥5 points on Neck Disability Index) or pain intensity (≥30% improvement) by treatment group.
  
  
  RESULTS
  After adjustment for baseline age, outcome measures, and imbalanced covariates, 30-minute treatments were not significantly better than the wait list control condition in terms of achieving a clinically meaningful improvement in neck dysfunction or pain, regardless of the frequency of treatments. In contrast, 60-minute treatments 2 and 3 times weekly significantly increased the likelihood of such improvement compared with the control condition in terms of both neck dysfunction (relative risk = 3.41 and 4.98, P = .04 and .005, respectively) and pain intensity (relative risk = 2.30 and 2.73; P = .007 and .001, respectively).
  
  
  CONCLUSIONS
  After 4 weeks of treatment, we found multiple 60-minute massages per week more effective than fewer or shorter sessions for individuals with chronic neck pain. Clinicians recommending massage and researchers studying this therapy should ensure that patients receive a likely effective dose of treatment.
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Sherman
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Cook
authors.forename: Robert D
authors.initials: RD
authors.lastname: Wellman
authors.forename: Rene J
authors.initials: RJ
authors.lastname: Hawkes
authors.forename: Janet R
authors.initials: JR
authors.lastname: Kahn
authors.forename: Richard A
authors.initials: RA
authors.lastname: Deyo
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Cherkin
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000628:therapy*; D002985:Clinical Protocols; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008405:Massage; D008875:Middle Aged; D019547:Neck Pain / Q000628:therapy*; D010147:Pain Measurement; D016896:Treatment Outcome
keywords: chronic neck pain; clinical trial; complementary and alternative medicine; disability; holistic medicine; massage; pain management