title: Massage Impact on Pain in Opioid-dependent Patients in Substance Use Treatment.
abstract: BACKGROUND
  Chronic pain is a common cause of health care utilization and high levels of pain are pronounced in individuals engaged in methadone maintenance treatment. Although massage has been demonstrated to alleviate chronic pain symptoms, its use as an adjunctive therapy to modify pain during opioid-replacement treatment is absent from the literature.
  
  
  OBJECTIVE
  To consider the efficacy of Swedish massage in reducing pain in opioid-dependent patients with chronic pain receiving methadone treatment.
  
  
  METHODS
  Trial was conducted at a nonprofit methadone treatment center serving low-income patients.
  
  
  METHODS
  A randomized clinical trial with randomized to either 1) massage plus treatment-as-usual (TAU) (n = 27) or 2) TAU (n = 24). Durability of treatment effect was evaluated at Week 12.
  
  
  METHODS
  Eight weekly 50-minute Swedish massage sessions plus TAU or TAU alone.
  
  
  METHODS
  Pain, anxiety, depression, physical functioning, decreased substance use, and improvement in treatment engagement.
  
  
  RESULTS
  Randomized participants were comparable at Baseline for demographic, pain, physical, and emotional variables. Massage group reported improved pain scores; worst pain had a clinically significant 2-point improvement while the other pain scores did not. Overall improvements were not observed in treatment engagement or levels of anxiety, depression, or physical functioning. A subgroup of the participants, who felt they could be pain-free, consistently reported improvements in pain from Baseline to Week 8, and this was most pronounced and clinically significant in the massage group.
  
  
  CONCLUSIONS
  These preliminary findings do not support an overall clinically significant positive effect of Swedish massage on reduction in pain ratings or improvement in anxiety, depression, or treatment engagement in a substance-using, opioid-dependent population with chronic pain. Future nonpharmacologic pain research in marginalized substance-using populations may wish to consider some of the challenges and limitations faced in this project.
authors.affiliation: Research Division, CODA, Inc., Portland, OR, USA.
authors.forename: Katharina L
authors.initials: KL
authors.lastname: Wiest
authors.affiliation: Research Division, CODA, Inc., Portland, OR, USA.
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Asphaug
authors.affiliation: Research Division, CODA, Inc., Portland, OR, USA.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Carr
authors.affiliation: 4423 NE Tillamook St., Portland, OR, USA.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Gowen
authors.affiliation: Research Division, CODA, Inc., Portland, OR, USA.
authors.forename: Timothy T
authors.initials: TT
authors.lastname: Hartnett
keywords: massage; methadone; opioid dependence; pain; self-efficacy; substance use