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

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. 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). 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 was1.Favoured over an education-booklet (MD -4.80, −9.17 to −0.43), traction (MD -19.10, −31.07 to −7.13), and higher over lower dose (MD -17.40, −25.40 to −9.40).2.Likely comparable to acupuncture (MD 2.09, −1.13 to 5.30), exercise (MD -2.50, −6.41 to 1.41), and ultrasound (MD -12.80, −26.43 to 0.83).3.Not favoured (less effective) when compared to kinesiotaping (MD 9.59, 0.68 to 18.51), manipulation-mobilisation (MD 7.93, 0.01 to 15.85), and mobilisation-plus-exercise (not reported). Massage may not increase risks of minor adverse events: RR 0.37 (95% CI 0.22 to 0.61). 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.