Massage therapy will never replace opioids, and anyone who tells you differently doesn't know much about either. In acute pain, there isn't much that can rival the pain relief provided by opioids, but opioids are not a long-term solution for chronic pain. More than 50 million Americans live with chronic pain.1 These people could be better served by something other than opioids, and that could be good news for massage.
The spotlight2 that has been shone on opioid misuse has more individuals3 and more organizations, like the American Medical Association (AMA)4 and The Joint Commission,5 thinking about massage therapy as a long-term solution to chronic pain. Among the first of the Centers for Disease Control and Prevention (CDC) declarations in their Guidelines for Prescribing Opioids for Chronic Pain (2016) is that "[n]onpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain."6
The massage and bodywork field sees snippets of news like this, and our Facebook-driven, too-busy-to-read-a-whole-article, myth-based lore about massage as a long overlooked panacea supports our illusion that our time has finally come. We put our hands and our anti-drug, anti-big medicine opinions out there and expect them to show us the money.
Yes, the big movers and shakers, stakeholders, and levers (as they are often called) see the benefit of massage therapy, but they really don't know what to think about the people who would provide that therapy. I attend a variety of nonmassage health-care and health-policy conferences in my work, and the leaders at insurance companies tell me they struggle to solve the problem of how to reimburse for massage therapy—mainly because "there is such wide variability in the product." Basically, they're saying, "We can't trust massage therapists to provide a reliable, safe, and effective product."
If I'm an insurance company or a doctor, and one of my policyholders or patients has an issue like low-back pain,7 I really want to provide that person with something that works so I can minimize treatment and cost. Massage therapy sounds like a low-risk, high-impact possibility, but if I'm doing my homework, I know that what actually happens in the treatment room may or may not be evidence-based.
The massage therapist over here is using singing bowls to treat everything from multiple sclerosis to sprained ankles, and the massage therapist over there is using cups and candles, and the one over there just took a weekend course in dry needling and will give that a shot. If the therapist who treats my patient feels anxious about results and the approach in the first session didn't seem effective, they may use singing bowls for the first treatment, dry needling for the second, and maybe Swedish for the third. All of these may "work," but the trajectory of healing is going to be pretty unpredictable. As a result, I can't say in good faith that the person with back pain is going to be treated effectively by "massage therapy."
Acupuncture and physical therapy are just two examples of nonpharmacologic treatments, but they are worlds ahead of massage therapy in terms of education and research rigor, which means—no matter what—the field of massage therapy could be left behind . . .
I do know that there is considerably more rigor in the education (more about this next time) required of acupuncturists and physical therapists, for example, and since either of those interventions will scratch the nonpharmacological itch, I may recommend those instead. Doctors and insurance companies don't care about massage therapy's future. They care about effective, reliable treatment.
Don't get distracted by conspiracy theories about the soulless doctors and insurance companies who only want to get rich and who don't really care about people or their pain. If you've gone there, you're missing the point. Acupuncture and physical therapy are just two examples of nonpharmacologic treatments, but they are worlds ahead of massage therapy in terms of education and research rigor, which means—no matter what—the field of massage therapy could be left behind in this rush to decrease opioid use.
Patients who can afford it will always pay for massage therapy, and that's lucky for them, but there are millions of people who can't pay out of pocket for massage therapy, whose lives would be markedly improved by the kind of access that would be enabled by more widespread insurance coverage. Neither insurance reimbursement nor acceptance as frontline providers are eventualities that are owed to us. We have to earn them.
1. James Dahlhamer et al., "Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults—United States, 2016," Morbidity and Mortality Weekly Report 67, no. 36 (September 2018): 1,001-06, http://dx.doi.org/10.15585/mmwr.mm6736a2.
2. John Weeks, "Five Eras and 125 Milestones in The Rise of Integrative Health and Medicine," Integrative Medicine 16, no. 1 (February 2017): 26-8, www.ncbi.nlm.nih.gov/pmc/articles/PMC5312742.
3. Sara Fleming et al., "CAM Therapies Among Primary Care Patients Using Opioid Therapy for Chronic Pain," BMC Complementary and Alternative Medicine 7, no. 15 (May 2007), https://doi.org/10.1186/1472-6882-7-15.
4. John Weeks, "AMA, Other Leading Medical Organizations Urge Insurance for Non-Pharma/Integrative Pain Care," Huffington Post, December 17, 2016, www.huffpost.com/entry/ama-other-leading-medical_b_13696232.
5. Katherine Rushlau, "Joint Commission Introduces New Pain Management Standards," Integrative Practitioner, January 29, 2019, www.integrativepractitioner.com/joint-commission-introduces-new-pain-management-standards.
6. Centers for Disease Control and Prevention, CDC Guideline for Prescribing Opioids for Chronic Pain, reviewed August 2019, www.cdc.gov/drugoverdose/prescribing/guideline.html.
7. Laura Allen, "Case Study: The Use of Massage Therapy to Relieve Chronic Low-Back Pain," International Journal of Therapeutic Massage and Bodywork 9, no. 3 (September 2016): 27-30, www.ncbi.nlm.nih.gov/pmc/articles/PMC5017818.
Gossiping with or about clients is always unethical. But there are limited scenarios where it is legally OK to violate confidentiality.
When we use the term emotional release, we create an agenda where none should exist.
What does acting and staying within your scope of practice look like, and when is a referral more appropriate?
Clients and therapists alike have the right of refusal. Don't be afraid to use it.
