This is a fabulous question - in fact so much so, I wrote a dissertation on this subject for my clinical massage and rehab qualification. So can massage help with chronic pain and if so how?
Yes Massage is currently being used in the US to alleviate pressure on pain medication:
Doctors are calling for a multifaceted approach to pain management there, which utilises massage as a "routine complementary part of an individualised multimodal and stepped care plan for pain management" (Buckenmaier, 2016).
There is a considerable portfolio of evidence that massage can help with chronic pain for
So How Can Massage Help with Pain?
The Massage Industry usually explains that we can:
Increase Blood Flow
Reduce Muscle Tension
Reduce Nerve pain
Increase Sense of Well-Being
Reduced Pain
Improved Quality of Life
Increased Range of Motion
Improved Mental Health
But How Accurate Are These Claims & Are They Evidenced Based?
1. Can Massage Increase Blood Flow in Tissues?
The short answer: Maybe but maybe not.
This is actually incredibly hard to measure the effects of massage therapy on blood flow and vascularisation in a trial. (Weerapong et al., 2005)
What this means is some authors failed to measure an increase of
microcirculation from a needling technique that they themselves thought might be ineffective.
Other authors cite each other repeating the claim that massage increases circulation.
Logically we know that when we exercise we have an increase in blood volume from an increase in heart rate that is driven physiologically from an increased oxygen need for our skeletal muscles to move (they need energy and oxygen is delivered from the lungs to the blood).
Whether the passive movement of muscles when they are receiving massage is enough to increase blood flow is unclear during the treatment. Perhaps it is more due to the after effects of having opened a restricted tissue region that allows more blood access to those tissues.
Some authors argue that the pressure from massage increases venous flow return and thereby affecting the arterial blood arriving at the tissue.
In any case the evidenced based jury is actually still out on this most often touted claim from massage therapies/manual therapies. We can only make arguments from a physiological basis and not from the results of a randomised controlled trial.
2. Can Massage Increase range of motion?
Yes it can but the answer is nuanced and has many factors in the soup.
Some authors in the literature argue that there isn't satisfactory evidence for massage to increase muscle length and pliability (Weerapong et al., 2005).
That the muscles we treat don't get physically longer and that muscles and tendons can't change the static structures of joints.
This perspective is very old-fashioned at this point in time and excludes any research from the fascial world.
These arguments only look at the body from the perspective of a bag of bones and not as the bones and fascia (all the connective tissue surrounding them) acting as a complex composite material weaving support through every layer of tissue within a person and working harmoniously.
Research on that composite material (fascia) that wraps and envelops every layer of muscle, tendon, bone, organ, blood vessel, nerve and skin shows that actually fascia can not only contract and harden to protect the body when a force arrives to destabilise it's structure and function, but will mitigate that force of an injury across it's whole network preventing breaks (Turvey and Fonseca, 2014, Klingler et al., 2014).
This is a wonderful feature of fascia's protective mechanism, unfortunately it's fantastic at adapting to damage in so many ways but doesn't do so well when multiple injuries pile up.
The good news is small changes in fascia from treatment can have significant changes globally across the body.
A brilliant example of this feature are results published that showed an increase in neck flexibility after stretching the calf and foot (Zügel et al., 2018).
As we stretch fascia the water content inside the tissue reduces and the tissue pliability and elongation increases. In healthy tissues, at rest water, content increases once more (Schleip et al., 2012; Turvey and Fonseca, 2014).
This process is thought to protect an individual from pain and injury.
In fact two authors (Driscoll., 2018) and (Schleip et al., 2019) suggest that the dynamic adaptability of fascia helps prevent chronic pain risk factors preventing fascial thickening and cracking which were present in chronic lower back pain (Klingler et al., 2014).
Cells in the fascia are thought to be responsible for the monitoring of the active hydration in the tissue.
Myofascial release and passive stretching are suggested to be 2 ways in which an individual can change multiple joints ranges of motion and improve mobility (Bordoni and Myers, 2020).
The current research suggests as we treat we are interacting with these features of fascial hydration that govern tissue pliability in the fascial chain.
3. Can Massage reduce Muscle tension?
For ages, you might have heard other manual therapist say that you can't reduce tension in tissues that muscles in the legs are always in active co-contraction and this helps us remain upright.
So until recently I wouldn't be able to say Yes massage can reduce tension.
But as always it's nuanced and massage does this by a combination of effects, through the release of trigger points and ongoing reduces in strain across fascial networks.
But the topic is quite nuanced and evolving because until recently there wasn't much satisfactory evidence of trigger points.
But what actually is a muscle knot?
For ages in the literature if you looked up a muscle knot or trigger point you'd find the definition of a:
"hyper irritable spot found in a local band of taut skeletal muscle tissue, with a typical pain referral pattern". (Simons et al., 1999)
It suggests there is a place in the muscle tissue that if someone were to press into it, it would feel like a taut nodule and would refer pain in a typical pattern either locally on the spot or in one of the well known patterns for that muscle.
Recent research suggests that there is a very physical explanation for how this happens under the microscope.
The basic structure of a muscle:
Our muscles are made from:
Bundles of muscle fascicles coated in a fascial lining called epimysium
Each fascicle also has a surrounding perimysium on the outside and endomysium on the inside separating bundles of muscle fibers.
Inside each muscle fiber (a sarcolemma) are many many strands of actin and myosin proteins which actively contract in the smallest unit of muscle tissues, a sarcomere.
Recent research has shown that contraction in a singular sarcomere (smallest muscle unit) could produce localised stiffness that radiated exceptionally far from the original source of the individual proteins (de Souza Leite et al., 2017)
These ideas combined with fascial mechanisms suggest that when we treat myofascial trigger points and adhesions in muscle and connective tissues, we are decoupling contractions in these small muscle units and the effect of fascia that interweaves through all these tissues is to release the strain patterns trapped in the tissues across the whole body (Turvey and Fonseca, 2014).
In this way it is suggested that we increase tissue pliability but perhaps not in the most obvious way. We are not hammering a piece of steel into shape. We are gently teasing strain patterns out of a bound fascial system with ideas that nerves are helping us reach a state of relaxation in the system.
So the long and the short of it is these ideas are actually much more nuanced than they first appear.
4. Can Massage reduce Nerve pain?
Yes it does, in a quite massive way - but as always the answer is complicated!
This is a massive question and definitely has to have another blog or 3!
But very quickly....
We have many touch receptors in our skin, muscles and joints (McMahon et al., 2013; Wall, 2002).
They respond to many forms of stimulus:
motion (mechanoreceptors)
pressure A-beta
heat A-delta
chemicals C-fibers
They also respond in different time scales
exceptionally fast - think the feeling of breaking a bone, sharp and immediate.
medium - this builds relatively quickly throbbing when you've shoved your hand in a door.
slow - many days to weeks later as a bruise forms - this is the chemical irritation to cell damage.
But they also respond to different forms of touch:
fast deep strokes - pressure sensing nerves.
warmth - hot stones
light gentle touch - chemical sensors
slow movements into joints - mechanoreceptors in joints.
How we treat can potentially affect all of these sensory fibres and start doing the work of calming the nervous system down from the small fibres in the skin/tissue all the way to junctions of nerves and then the spine and then the brain.
Pain is a highly complex structure and not to be underestimated but with the right informed approach we can make a huge difference to someone's quality of life.
Wright and Sluka (2001), Goats (1994b) and Tsao (2007) report massage “activates segmental inhibitory mechanisms to suppress pain” and “that connective tissue massage may activate descending pain inhibitory systems”
- meaning in a simplified way massage reduces our perception and reporting of pain.
Melzack and Wall, (1965) suggest touch offers pain inhibition by closing neural gates (junctions where pain sensation propagates along the nervous system to the brain), utilising the differing speeds of touch receptors (A-delta versus C-fibres) (Field, 2019).
Many authors instead suggest relaxation, autonomic downregulation, vagal activity and reduced HPA produce the relaxation often experienced in both physiological and psychological results (Field, 2014; Moyer et al., 2004; Tsao, 2007; Weerapong et al., 2005)
It is likely that every layer of our physiology gets involved in the process of receiving therapeutic touch and is one of the reasons why skin to skin contact is calming in new born babies.
5. can massage reduce pain?
The short answer is yes, it can and here is why....
Pain is a complex neurological process that affects every level of our system from the nerves that sense the initial injury to the chains of nerves in the arms and limbs up to the spine and thence to the brain.
When we treat we are not only changing the way we interact with our sensory network in our skin and tissues of the musculoskeletal system and spine, we are also changing the way our brain is interpreting those sensations.
When we get into pain after a long period of time we often get into a flight or flight response where we become weary of new experiences and link them back to something that has happened to us in the past often negatively (sometimes without even realising we are doing it).
We become very protective and guard against new experiences.
One way to start changing that is by introducing new pleasant experiences through touch into a network that's become hard wired to pain.
Offering safety, support, understanding and empathy not just in our words but that's conveyed even in the way we touch and listen to a body/person starts changing that person's internal sensory world for the better.
Helping you make sense of what's happened and form a path out of it with compassion and knowledge further empowers an individual to know that they have power over their experience and can reduce pain and move forward once more.
Pain is sometimes described as being in the brain - it is but it's not just here.
It's in our whole being and needs so many factors working in harmony to change.
6. can massage increase a sense of well-being?
Yes, it totally can and it's linked to the release of feel-good hormones after a massage treatment.
Recent evidence suggests cortisol levels alongside anxiety scores reduced in the massaged participant group (Weerapong et al., 2005).
Oxytocin (a feel good hormone) increased in another study of the massaged group.
Oxytocin is thought to affect our HP axis (our flight or fight drive) and is therefore highly important in lowering stress in our fast paced world (Morhenn et al., 2012).
So every time you get a massage, if you need this evidence to back yourself up, massage is a wonderful form of self-care both physically and mentally.
7. can massage affect immune response?
The short answer is yes!
Morhenn et al. (2012) concluded massage benefitted immune system function, reduced stress, and increased vasodilation and well-being.
Ironson et al. (1996), measured immune markers and saw them increase in HIV communities who undertook massage.
Mpouzika (2012) suggested that touch had “positive effects on pathophysiologic processes aggravated by stress, such as immune, neuroendocrine dysfunction and inflammation”.
Greater resilience to disease and increased immune function is one of my favourite findings from the research and is so so encouraging when I am working with vulnerable immune compromised communities who still seek pain relief, for instance when working with cancer patients.
8. can massage affect lymphatic drainage?
Yes, however the data is actually from quite a while ago.
The effects of massage to improve lymph function have been utilised post-operatively alongside compression therapy successfully for many years since Pflug (1974).
9. can massage improve mental health?
Yes, there are many studies showing decreases in anxiety and depression scores.
(Field et al., 2002; Field et al., 1996; Field et al., 1992; Hall et al., 2020; Hatayama et al., 2008)
Alongside recent evidence of reduced cortisol levels and anxiety scores in groups that received massage as an intervention (Weerapong et al., 2005), massage also improves sense of well-being.
Recent research suggests that pain isn't just in the brain. Pain is often a complex interweaving of sensations brought to us from our neural and fascial nets (throughout our body) interwoven with interpretation from our brain
At every layer of our nervous system we have neural cells that can heighten or lower pain sensations. The greatest of these is the brain.
There are many regions of the brain thought to be responsible for the processing of memory, attention, experience, and beliefs, which culminate into the pain experience.
We bring all of ourselves to our injury and experiences when they happen.
New research even suggests that pain is a part of our homeostatic balance alongside sensations like: temperature, itch, hunger and thirst and which map onto emotional centres in the brain (Craig, 2003).
This suggests that there is more in common between emotions like fear that keep us safe and pain. In fact the cross over here goes even further to areas of the brain in charge of our fight or flight response to trauma.
Truly all these responses are interwoven and complex.
This research showing that pain pathways in the body map to areas of the brain responsible for maintaining physiological health and balance have been argued to be bi-directional, suggesting that our emotions can govern our physical health and our physical health in an equal and opposite manner effects our emotions.
Massage as a form of increasing someone's embodiment and awareness of the present moment in a mindful manner affect and mediate a part of the brain (insula cortex) responsible for pain processing (Gibson, 2019), alongside down regulating our sensory environment from our body to our brain.
I find this area of where the body meets the brain and how they inter be, fascinating and think this is the future of understanding our current chronic pain crisis in medicine.
I will be writing more on this topic in the future.
10. So can massage improve quality of life?
The short answer is yes, but it's very hard to measure.
From all the other factors we can:
Improve range of motion,
Reduce their pain state,
Help them rebuild quality of life and live with greater well-being.
Increase resiliency,
Reduce anxiety and depression,
Improve mood
Increase how grounded and embodied someone is, after trauma.
The latter has to be done very carefully, but it is one of my favourite benefits of massage.
A whistle stop tour of the power of therapeutic touch & massage
Hopefully I've convinced you that massage is incredibly powerful at reducing chronic pain and improving our health in many ways.
However the most often reported claims aren't always fully evidence based partly because of how hard they are to measure.
Whilst they might not all be true, there are some massive unsung heroes in the effects of massage.
One of my favourite unsung heroes is its effect on immune function and how much it can help immune-suppressed populations still get out of pain and live a happier healthier life.
The warmest of wishes to you.
Stay kind to yourself.
Carmen
references:
References: click to expand the list
ADAMS, R., WHITE, B. & BECKETT, C. 2010. The effects of massage therapy on pain management in the acute care setting. Int J Ther Massage Bodywork, 3, 4-11.
ALBRING, A., WENDT, L., BENSON, S., NISSEN, S., YAVUZ, Z., ENGLER, H., WITZKE, O. & SCHEDLOWSKI, M. 2014. Preserving Learned Immunosuppressive Placebo Response: Perspectives for Clinical Application. Clinical Pharmacology & Therapeutics, 96, 247-255.
AMANZIO, M. & BENEDETTI, F. 1999. Neuropharmacological Dissection of Placebo Analgesia: Expectation-Activated Opioid Systems versus Conditioning-Activated Specific Subsystems. The Journal of Neuroscience, 19, 484-494.
ASSOCIATION, B. M. 2017. Chronic Pain: supporting safer prescribing of analgesiccs. BMA council.
BARRAZA, J. A. & ZAK, P. J. 2009. Empathy toward strangers triggers oxytocin release and subsequent generosity. Ann N Y Acad Sci, 1167, 182-9.
BENEDETTI, F. & DOGUE, S. 2015. Different Placebos, Different Mechanisms, Different Outcomes: Lessons for Clinical Trials. PLOS ONE, 10, e0140967.
BENEDETTI, F., DURANDO, J., GIUDETTI, L., PAMPALLONA, A. & VIGHETTI, S. 2015. High-altitude headache: the effects of real vs sham oxygen administration. Pain, 156, 2326-2336.
BIALOSKY, J. E., BISHOP, M. D., GEORGE, S. Z. & ROBINSON, M. E. 2011. Placebo response to manual therapy: something out of nothing? Journal of Manual & Manipulative Therapy, 19, 11-19.
BORDONI, B. & MYERS, T. 2020. A Review of the Theoretical Fascial Models: Biotensegrity, Fascintegrity, and Myofascial Chains. Cureus, 12, e7092.
BUCHBINDER, R., OSBORNE, R. H., EBELING, P. R., WARK, J. D., MITCHELL, P., WRIEDT, C., GRAVES, S., STAPLES, M. P. & MURPHY, B. 2009. A Randomized Trial of Vertebroplasty for Painful Osteoporotic Vertebral Fractures. New England Journal of Medicine, 361, 557-568.
BUCKENMAIER, C., CAMBRON, J., WERNER, R., BUCKENMAIER, P., DEERY, C., SCHWARTZ, J. & WHITRIDGE, P. 2016. Massage therapy for pain—call to action. Pain Medicine: The Official Journal of the American Academy of Pain Medicine, 17, 1211.
CERRITELLI, F., CHIACCHIARETTA, P., GAMBI, F., PERRUCCI, M. G., BARASSI, G., VISCIANO, C., BELLOMO, R. G., SAGGINI, R. & FERRETTI, A. 2020. Effect of manual approaches with osteopathic modality on brain correlates of interoception: an fMRI study. Scientific Reports, 10, 3214.
CHAITOW, L. 2011. Is a postural-structural-biomechanical model, within manual therapies, viable?: A JBMT debate. J Bodyw Mov Ther, 15, 130-52.
CHAUDHRY, H., HUANG, C.-Y., SCHLEIP, R., JI, Z., BUKIET, B. & FINDLEY, T. 2007. Viscoelastic behavior of human fasciae under extension in manual therapy. Journal of Bodywork and Movement Therapies, 11, 159-167.
CHAUDHRY, H., SCHLEIP, R., JI, Z., BUKIET, B., MANEY, M. & FINDLEY, T. 2008. Three-dimensional mathematical model for deformation of human fasciae in manual therapy. J Am Osteopath Assoc, 108, 379-90.
CHVETZOFF, G. L. & TANNOCK, I. F. 2003. Placebo Effects in Oncology. JNCI: Journal of the National Cancer Institute, 95, 19-29.
COLLOCA, L. 2017. Treatment of Pediatric Migraine. N Engl J Med, 376, 1387-8.
CORBIN, L. 2005. Safety and Efficacy of Massage Therapy for Patients with Cancer. Cancer Control, 12, 158-164.
CRAIG, A. D. 2003. Interoception: the sense of the physiological condition of the body. Curr Opin Neurobiol, 13, 500-5.
CRAWFORD, C., BOYD, C., PAAT, C. F., PRICE, A., XENAKIS, L., YANG, E. & ZHANG, W. 2016. The Impact of Massage Therapy on Function in Pain Populations-A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part I, Patients Experiencing Pain in the General Population. Pain Med, 17, 1353-1375.
CUTSHALL, S. M., WENTWORTH, L. J., ENGEN, D., SUNDT, T. M., KELLY, R. F. & BAUER, B. A. 2010. Effect of massage therapy on pain, anxiety, and tension in cardiac surgical patients: A pilot study. Complementary Therapies in Clinical Practice, 16, 92-95.
DE SOUZA LEITE, F., MINOZZO, F. C., ALTMAN, D. & RASSIER, D. E. 2017. Microfluidic perfusion shows intersarcomere dynamics within single skeletal muscle myofibrils. Proceedings of the National Academy of Sciences, 114, 8794-8799.
DI LERNIA, D., SERINO, S. & RIVA, G. 2016. Pain in the body. Altered interoception in chronic pain conditions: A systematic review. Neurosci Biobehav Rev, 71, 328-341.
DOMMERHOLT, J., BRON, C. & FRANSSEN, J. 2006. Myofascial trigger points: an evidence-informed review. Journal of Manual & Manipulative Therapy, 14, 203-221.
DRISCOLL, M. 2018. Fascia - The unsung hero of spine biomechanics. J Bodyw Mov Ther, 22, 90-91.
EIDE, P. K. 2000. Wind-up and the NMDA receptor complex from a clinical perspective. European Journal of Pain, 4, 5-15.
FAIRWEATHER, R. & MARI, M. 2015. Massage Fusion, Jessica Kingsley Publishers.
FARB, N., DAUBENMIER, J., PRICE, C. J., GARD, T., KERR, C., DUNN, B. D., KLEIN, A. C., PAULUS, M. P. & MEHLING, W. E. 2015. Interoception, contemplative practice, and health. Front Psychol, 6, 763.
Field, T., Morrow, C., Valdeon, C., Larson, S., Kuhn, C. and Schanberg, S., 1992. Massage reduces anxiety in child and adolescent psychiatric patients. Journal of the American Academy of Child & Adolescent Psychiatry, 31(1), pp.125-131.
Field, T., Ironson, G., Scafidi, F., Nawrocki, T., Goncalves, A., Burman, I., Pickens, J., Fox, N., Schanberg, S. and Kuhn, C., 1996. Massage therapy reduces anxiety and enhances EEG pattern of alertness and math computations. International journal of neuroscience, 86(3-4), pp.197-205.
FIELD, T. 2014. Massage therapy research review. Complementary Therapies in Clinical Practice, 20, 224-229.
FIELD, T. 2016. Knee osteoarthritis pain in the elderly can be reduced by massage therapy, yoga and tai chi: A review. Complementary Therapies in Clinical Practice, 22, 87-92.
FIELD, T. 2019. Pediatric Massage Therapy Research: A Narrative Review. Children, 6, 78.
Field, T., 2002. Massage therapy. Medical Clinics, 86(1), pp.163-171
FIELD, T., DELAGE, J. & HERNANDEZ-REIF, M. 2003. Movement and massage therapy reduce fibromyalgia pain. Journal of Bodywork and Movement Therapies, 7, 49-52.
FIELD, T., DIEGO, M., DELGADO, J., GARCIA, D. & FUNK, C. G. 2013. Rheumatoid arthritis in upper limbs benefits from moderate pressure massage therapy.
Complementary Therapies in Clinical Practice, 19, 101-103.
FIELD, T., DIEGO, M., HERNANDEZ-REIF, M. & SHEA, J. 2007. Hand arthritis pain is reduced by massage therapy. Journal of Bodywork and Movement Therapies, 11, 21-24.
FIELD, T., PECK, M., HERNANDEZ-REIF, M., KRUGMAN, S., BURMAN, I. & OZMENT-SCHENCK, L. 2000. Postburn Itching, Pain, and Psychological Symptoms Are Reduced With Massage Therapy. The Journal of Burn Care & Rehabilitation, 21, 189-193.
FLOWERS, K. M., PATTON, M. E., HRUSCHAK, V. J., FIELDS, K. G., SCHWARTZ, E., ZEBALLOS, J., KANG, J. D., EDWARDS, R. R., KAPTCHUK, T. J. & SCHREIBER, K. L. 2021. Conditioned open-label placebo for opioid reduction after spine surgery: a randomized controlled trial. Pain, 162, 1828.
GERDLE, B., GHAFOURI, B., ERNBERG, M. & LARSSON, B. 2014. Chronic musculoskeletal pain: review of mechanisms and biochemical biomarkers as assessed by the microdialysis technique. Journal of pain research, 7, 313-326.
GIBSON, J. 2019. Mindfulness, interoception, and the body: A contemporary perspective. Frontiers in Psychology, 10, 2012.
GIORDANO, J. 2005. The neurobiology of nociceptive and anti-nociceptive systems. Pain physician, 8, 277-90.
GOATS, G. C. 1994a. Massage--the scientific basis of an ancient art: Part 1. The techniques. British journal of sports medicine, 28, 149-152.
GOATS, G. C. 1994b. Massage--the scientific basis of an ancient art: Part 2. Physiological and therapeutic effects. Br J Sports Med, 28, 153-6.
Hall, H.G., Cant, R., Munk, N., Carr, B., Tremayne, A., Weller, C., Fogarty, S. and Lauche, R., 2020. The effectiveness of massage for reducing pregnant women's anxiety and depression; systematic review and meta-analysis. Midwifery, 90, p.102818.
Hatayama, T., Kitamura, S., Tamura, C., Nagano, M. and Ohnuki, K., 2008. The facial massage reduced anxiety and negative mood status, and increased sympathetic nervous activity. Biomedical Research, 29(6), pp.317-320.
HECHLER, T., ENDRES, D. & THORWART, A. 2016. Why Harmless Sensations Might Hurt in Individuals with Chronic Pain: About Heightened Prediction and Perception of Pain in the Mind. Front Psychol, 7, 1638.
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.
HEWITT, O. 2021. ‘Through the journey of sense-making’: A qualitative interview study of osteopaths’ opinions about the role of interoception within osteopathy. Masters of Osteopathy Indidvudal Enquiry, University College of Osteopathy.
HOENEMEYER, T. W., KAPTCHUK, T. J., MEHTA, T. S. & FONTAINE, K. R. 2018. Open-Label Placebo Treatment for Cancer-Related Fatigue: A Randomized-Controlled Clinical Trial. Scientific Reports, 8, 2784.
HRÓBJARTSSON, A. & GØTZSCHE, P. C. 2010. Placebo interventions for all clinical conditions. Cochrane Database Syst Rev, 2010, Cd003974.
HUBBARD, D. R. & BERKOFF, G. M. 1993. Myofascial trigger points show spontaneous needle EMG activity. Spine (Phila Pa 1976), 18, 1803-7.
HUGUENIN, L. K. 2004. Myofascial trigger points: the current evidence. Physical therapy in sport, 5, 2-12.
IRONSON, G., FIELD, T., 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. Int J Neurosci, 84, 205-17.
JOHNSON-RAUEN, N., DEGNIM, A., JAKUB, J., CUTSHALL, S., THOMLEY, B., BRODT, J., VANDERLEI, L., CASE, J., BUNGUM, L., CHA, S., BAUER, B. & BOUGHEY, J. 2012. Effect of Massage Therapy for Postsurgical Mastectomy Recipients. Clinical journal of oncology nursing, 16, 121-4.
JONAS, W., SCHOOMAKER, E., BERRY, K. & BUCKENMAIER, C., 3RD 2016. A Time for Massage. Pain Med, 17, 1389-90.
JONAS, W. B., CRAWFORD, C., COLLOCA, L., KAPTCHUK, T. J., MOSELEY, B., MILLER, F. G., KRISTON, L., LINDE, K. & MEISSNER, K. 2015. To what extent are surgery and invasive procedures effective beyond a placebo response? A systematic review with meta-analysis of randomised, sham controlled trials. BMJ Open, 5, e009655.
KAADA, B. & TORSTEINBØ, O. 1989. Increase of plasma beta-endorphins in connective tissue massage. Gen Pharmacol, 20, 487-9.
KANNER, R. 2009. Chapter 1 - Definitions. In: ARGOFF, C. E. & MCCLEANE, G. (eds.) Pain Management Secrets (Third Edition). Philadelphia: Mosby.
KAPTCHUK, T. J. 1998. Powerful placebo: the dark side of the randomised controlled trial. Lancet, 351, 1722-5.
KENNEDY, A. B., CAMBRON, J. A., SHARPE, P. A., TRAVILLIAN, R. S. & SAUNDERS, R. P. 2016. Clarifying Definitions for the Massage Therapy Profession: the Results of the Best Practices Symposium. Int J Ther Massage Bodywork, 9, 15-26.
KLINGLER, W., VELDERS, M., HOPPE, K., PEDRO, M. & SCHLEIP, R. 2014. Clinical relevance of fascial tissue and dysfunctions. Curr Pain Headache Rep, 18, 439.
KRUEGER, F. 2021. The Neurobiology of Trust, Cambridge, Cambridge University Press.
KUMAR, S., BEATON, K. & HUGHES, T. 2013. The effectiveness of massage therapy for the treatment of nonspecific low back pain: a systematic review of systematic reviews. Int J Gen Med, 6, 733-41.
LEE, S.-H., KIM, J.-Y., YEO, S., KIM, S.-H. & LIM, S. 2015. Meta-Analysis of Massage Therapy on Cancer Pain. Integrative Cancer Therapies, 14, 297-304.
LEVINE, J. D., GORDON, N. C. & FIELDS, H. L. 1978. The mechanism of placebo analgesia. Lancet, 2, 654-7.
LIDSTONE, S. C., SCHULZER, M., DINELLE, K., MAK, E., SOSSI, V., RUTH, T. J., DE
LA FUENTE-FERNÁNDEZ, R., PHILLIPS, A. G. & STOESSL, A. J. 2010. Effects of Expectation on Placebo-Induced Dopamine Release in Parkinson Disease. Archives of General Psychiatry, 67, 857-865.
MCMAHON, S. F. M. S. F. S. B., KOLTZENBURG, M. M. D. F., TRACEY, I. & TURK, D. C. 2013. Wall & Melzack's Textbook of Pain: Expert Consult - Online and Print, Elsevier Health Sciences.
MCPARTLAND, J. M. & SIMONS, D. G. 2006. Myofascial trigger points: translating molecular theory into manual therapy. Journal of Manual & Manipulative Therapy, 14, 232-239.
MEAKINS, A. 2015. Soft tissue sore spots of an unknown origin. Br J Sports Med, 49,
348.
MEHLING, W. 2016. Differentiating attention styles and regulatory aspects of self-reported interoceptive sensibility. Philos Trans R Soc Lond B Biol Sci, 371.
MELZACK, R. & WALL, P. D. 1965. Pain mechanisms: a new theory. Science, 150, 971-9.
MELZACK, R. & WALL, P. D. 1996. The Challenge of Pain, Penguin Books.
MORHENN, V., BEAVIN, L. E. & ZAK, P. J. 2012. Massage increases oxytocin and reduces adrenocorticotropin hormone in humans. Altern Ther Health Med, 18, 11-8.
MOSELEY, J. B., O'MALLEY, K., PETERSEN, N. J., MENKE, T. J., BRODY, B. A., KUYKENDALL, D. H., HOLLINGSWORTH, J. C., ASHTON, C. M. & WRAY, N. P. 2002. A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. New England Journal of Medicine, 347, 81-88.
MOYER, C. A., ROUNDS, J. & HANNUM, J. W. 2004. A meta-analysis of massage therapy research. Psychol Bull, 130, 3-18.
NEGAHBAN, H., REZAIE, S. & GOHARPEY, S. 2013. Massage therapy and exercise therapy in patients with multiple sclerosis: a randomized controlled pilot study. Clinical Rehabilitation, 27, 1126-1136.
NICE. 2021. Chronic Pain: How common is it? [Online]. Available: https://cks.nice.org.uk/topics/chronic-pain/background-information/prevalence/ [Accessed].
PAPATHANASSOGLOU, E. D. E. & MPOUZIKA, M. D. A. 2012. Interpersonal Touch:Physiological Effects in Critical Care. Biological Research For Nursing, 14, 431-443.
PFLUG, J. J. 1974. Letter: Intermittent compression: a new principle in treatment of wounds? Lancet, 2, 355-6.
PRICE, D. D. 2015. Unconscious and conscious mediation of analgesia and hyperalgesia. Proc Natl Acad Sci U S A, 112, 7624-5.
QUINN, C., CHANDLER, C. & MORASKA, A. 2002. Massage Therapy and Frequency of Chronic Tension Headaches. American Journal of Public Health, 92, 1657-1661.
QUINTNER, J. L. & COHEN, M. L. 1994. Referred pain of peripheral nerve origin: an alternative to the "myofascial pain" construct. Clin J Pain, 10, 243-51.
RASSIER, D. 2017. New understanding of how muscles work [Online]. McGill University.
Available: https://www.mcgill.ca/newsroom/channels/news/new-understanding-how-muscles-work-269759 [Accessed 11.1.2023 2023].
RICKARDS, L. D. 2006. The effectiveness of non-invasive treatments for active myofascial trigger point pain: a systematic review of the literature. International journal of osteopathic medicine, 9, 120-136.
RIEWALD, S. A. & DELP, S. L. 1997. The action of the rectus femoris muscle following distal tendon transfer: does it generate knee flexion moment? Dev Med Child Neurol, 39, 99-105.
ROLDAN, C. J. & HU, N. 2015. Myofascial pain syndromes in the emergency department: what are we missing? The Journal of emergency medicine, 49, 1004-1010.
SCHLEIP, R. 2003. Fascial plasticity – a new neurobiological explanation: Part 1. Journal of Bodywork and Movement Therapies, 7, 11-19.
SCHLEIP, R., DUERSELEN, L., VLEEMING, A., NAYLOR, I. L., LEHMANN-HORN, F., ZORN, A., JAEGER, H. & KLINGLER, W. 2012. Strain hardening of fascia: static stretching of dense fibrous connective tissues can induce a temporary stiffness increase accompanied by enhanced matrix hydration. J Bodyw Mov Ther, 16, 94-100.
SCHLEIP, R., GABBIANI, G., WILKE, J., NAYLOR, I., HINZ, B., ZORN, A., JÄGER, H., BREUL, R., SCHREINER, S. & KLINGLER, W. 2019. Fascia Is Able to Actively Contract and May Thereby Influence Musculoskeletal Dynamics: A Histochemical and Mechanographic Investigation. Front Physiol, 10, 336.
SCHLEIP, R., NAYLOR, I. L., URSU, D., MELZER, W., ZORN, A., WILKE, H. J., LEHMANN-HORN, F. & KLINGLER, W. 2006. Passive muscle stiffness may be influenced by active contractility of intramuscular connective tissue. Med Hypotheses, 66, 66-71.
SCOTT, D. J., STOHLER, C. S., EGNATUK, C. M., WANG, H., KOEPPE, R. A. & ZUBIETA, J. K. 2008. Placebo and nocebo effects are defined by opposite opioid and dopaminergic responses. Arch Gen Psychiatry, 65, 220-31.
SHAH, J. P. & GILLIAMS, E. A. 2008. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. Journal of bodywork and movement therapies, 12, 371-384.
SHERMAN, K. J., DIXON, M. W., THOMPSON, D. & CHERKIN, D. C. 2006. Development of a taxonomy to describe massage treatments for musculoskeletal pain. BMC Complementary and Alternative Medicine, 6, 24.
SIHVONEN, R., PAAVOLA, M., MALMIVAARA, A., ITÄLÄ, A., JOUKAINEN, A., NURMI, H., KALSKE, J. & JÄRVINEN, T. L. N. 2013. Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear. New England Journal of Medicine, 369, 2515-2524.
SIMONS, D. G. 2002. Understanding effective treatments of myofascial trigger points. Journal of Bodywork and movement therapies, 6, 81-88.
SIMONS, D. G., TRAVELL, J. G. & SIMONS, L. S. 1999. Travell & Simons' myofascial pain and dysfunction: upper half of body, Lippincott williams & wilkins.
SOMANI, S., MERCHANT, S. & LALANI, S. 2013. A literature review about effectiveness of massage therapy for cancer pain. J Pak Med Assoc, 63, 1418-21.
STAUD, R., PRICE, D. D., ROBINSON, M. E., MAUDERLI, A. P. & VIERCK, C. J. 2004. Maintenance of windup of second pain requires less frequent stimulation in fibromyalgia patients compared to normal controls. Pain, 110, 689-696.
STAUD, R., VIERCK, C. J., CANNON, R. L., MAUDERLI, A. P. & PRICE, D. D. 2001. Abnormal sensitization and temporal summation of second pain (wind-up) in patients with fibromyalgia syndrome. Pain, 91, 165-175.
STECCO, C., FEDE, C., MACCHI, V., PORZIONATO, A., PETRELLI, L., BIZ, C., STERN, R. & DE CARO, R. 2018. The fasciacytes: A new cell devoted to fascial gliding regulation. Clin Anat, 31, 667-676.
TRACHSEL, L. A. & CASCELLA, M. 2021. Pain Theory, StatPearls Publishing, Treasure Island (FL).
TSAO, J. C. I. 2007. Effectiveness of Massage Therapy for Chronic, Non-Malignant Pain: A Review. Evidence-Based Complementary and Alternative Medicine, 4, 416030.
TURVEY, M. T. & FONSECA, S. T. 2014. The Medium of Haptic Perception: A Tensegrity Hypothesis. Journal of Motor Behavior, 46, 143-187.
VAN GRIENSVEN, H., STRONG, J. & UNRUH, A. M. 2013. Pain: A Textbook for Health
Professionals, Churchill Livingstone Elsevier.
VASE, L., RILEY, J. L., 3RD & PRICE, D. D. 2002. A comparison of placebo effects in clinical analgesic trials versus studies of placebo analgesia. Pain, 99, 443-452.
WALL, P. 2002. Pain: The Science of Suffering, Columbia University Press.
WEERAPONG, P., HUME, P. A. & KOLT, G. S. 2005. The Mechanisms of Massage and Effects on Performance, Muscle Recovery and Injury Prevention. Sports Medicine, 35, 235-256.
WEIMER, K., COLLOCA, L. & ENCK, P. 2015. Placebo effects in psychiatry: mediators and moderators. The Lancet Psychiatry, 2, 246-257.
WENTWORTH, L. J., BRIESE, L. J., TIMIMI, F. K., SANVICK, C. L., BARTEL, D. C., CUTSHALL, S. M., TILBURY, R. T., LENNON, R. & BAUER, B. A. 2009. Massage Therapy Reduces Tension, Anxiety, and Pain in Patients Awaiting Invasive Cardiovascular Procedures. Progress in Cardiovascular Nursing, 24, 155-161.
WISE, R. A., BARTLETT, S. J., BROWN, E. D., CASTRO, M., COHEN, R., HOLBROOK, J. T., IRVIN, C. G., RAND, C. S., SOCKRIDER, M. M. & SUGAR, E. A. 2009. Randomized trial of the effect of drug presentation on asthma outcomes: the American Lung Association Asthma Clinical Research Centers. J Allergy Clin Immunol, 124, 436-
44, 444e1-8.
WRIGHT, A. & SLUKA, K. A. 2001. Nonpharmacological treatments for musculoskeletal pain. Clin J Pain, 17, 33-46.
ZAK, P., KURZBAN, R. & MATZNER, W. 2006. Oxytocin is associated with human trustworthiness. Hormones and behavior, 48, 522-7.
ZAK, P. J., STANTON, A. A. & AHMADI, S. 2007. Oxytocin Increases Generosity in Humans. PLOS ONE, 2, e1128.
ZÜGEL, M., MAGANARIS, C. N., WILKE, J., JURKAT-ROTT, K., KLINGLER, W., WEARING, S. C., FINDLEY, T., BARBE, M. F., STEINACKER, J. M., VLEEMING, A., BLOCH, W., SCHLEIP, R. & HODGES, P. W. 2018. Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement. British Journal of Sports Medicine, 52, 1497-1497.
Comments