Massage for neck pain contrasted against standard (non-surgical) treatment: A systematic review update

OBJECTIVES: The aim of this systematic review update was to determine the average effect of massage for adults with neck pain (NP) contrasted against another standard treatment. METHODS: Randomised controlled trials comparing massage to standard treatments were included; placebo/no treatment comparisons were excluded. Databases were searched (CENTRAL, MEDLINE, EMBASE, CINAHL, ICL, trial registries) from inception to Oct-1-2023. We used the standard Cochrane methodological procedures: rated Risk of Bias 1.0, abstracted mean differences (MD), meta-analysed data, and rated the level of certainty (GRADE). RESULTS: We included 42 studies (2656 participants; 67% high RoB) contrasted against 10 unique treatments. Trials studied ages 18-70, 70% female, and mean pain severity 52 Visual Analogue Scale (VAS). Very-low to moderate-certainty evidence for pain (MD VAS 0-100, 95% CI) at ≤12 weeks follow-up follows. The pre-stated minimal important difference margin was 10 VAS points. Massage was Massage may not increase risks of minor adverse events: RR 0.37 (95% CI 0.22 to 0.61). CONCLUSION: For subacute-chronic NP, pain reduction varied by comparison. The evidence was limited by imprecision and high RoB. Focused planning for adequately dosed longer-term trials is needed.