Introduction 1 1 2 3 Table 6 Methods 4 5 Tables 1–6 Results Empirical Findings Massage Therapy for Low Back Pain 3 Table 1 et al 6 et al 7 Table 1 8 Table 1 Table 1 Table 1 9 10 11 11 6 7 9 6 7 12 13 14 8 Beneficial Effects for Subacute and Chronic Non-specific Low Back Pain 11 Although the Cochrane review represents a synthesis of the most rigorous trials to date examining massage for LBP, it should be noted that the review based their conclusions on a relatively small number of studies. For example, their conclusions regarding the superiority of massage to relaxation and acupuncture were based on only a single study each, and therefore await further confirmation in future trials. On the other hand, the studies included in the review demonstrated therapeutic effects for massage that exceeded or equaled those obtained from various active treatment conditions. This level of evidence is more encouraging than that obtained from trials showing that massage is superior to no treatment or waitlist control. Pain Management for Headaches from Massage Therapy 15 16 17 Table 2 18 n n Table 2 19 19 20 Moderate Evidence for Cranioscaral Massage in Managing Tension-Type Headache Pain 21 22 23 Shoulder Pain — Moderate Support for the Use of Massage Therapy 24 Table 3 25 26 Table 3 27 n n Table 3 25 et al 24 Comparison with Acupuncture for Neck Pain 28 n n n Table 3 Effectiveness of Massage Therapy for Neck Pain Remains Unclear 29 30 31 Preliminary Support for Pain Relief in Carpal Tunnel Syndrome 32 Table 3 The findings of this single study provide preliminary support for the application of massage to CTS. However, the sample size was very small, and it is unclear whether the physicians assessing the patients were aware of group assignment. Moreover, it is unclear to what extent patients practiced self-massage at home and whether the amount of massage administered was related to treatment response. Further work with larger samples and more rigorous study methodology are needed to determine the effectiveness of massage therapy for CTS. Equivocal Support for Analgesic Effects in Fibromyalgia 33 Table 4 34 Table 4 35 Table 4 36 Table 4 Summary — Massage Therapy for Fibromyalgia 33 34 36 35 Application to Mixed Chronic Pain Conditions 37 Table 5 38 39 Table 5 Moderate Support for Short-term Benefits of Massage Therapy for Mixed Chronic Pain Conditions These reports provide modest support for the immediate benefits of massage for a variety of chronic pain complaints. However, it appears that these treatment gains were not maintained following the end of active treatment. A potential difficulty with such studies including heterogeneous pain complaints is ensuring that treatment and control conditions are equivalent on key clinical and demographic characteristics. On the other hand, evidence of therapeutic effects across a variety of pain conditions supports the generalizability of the findings to a potentially broader group of patients. Future studies incorporating samples with mixed chronic pain conditions may also examine which types of pain conditions may benefit most from massage therapy in order to promote a more targeted approach to treatment. Meta-Analysis — Massage Therapy Effects on Pain 30 et al 30 30 et al 30 9 11 40 24 29 et al 30 35 38 39 Discussion  3 25 et al 30 15 16 17 18 20 18 33 34 36 35 37 38 39 31 Putative Mechanisms of Massage Therapy for Chronic Pain 41 42 43 44 45 46 43 47 48 49 50 Clinical Implications: The Application of Massage Therapy for Chronic Pain 3 Future Directions: Critical Issues for Studies on Massage Therapy for Chronic Pain 21 23 et al 30 after 11 et al 30 51 Limitations of the Current Review and Concluding Statements The main limitation of the current study is its reliance on existing reviews and meta-analyses. Thus, many of the conclusions drawn in this article are based on the findings of other authors. Relatedly, the soundness of the methodological approach of these existing reviews may have been limited (e.g. due to improper exclusion of specific studies) as well as highly variable across reviews. Nevertheless, the reliance on extant reviews was considered necessary in order to synthesize a vast and diverse literature examining a broad array of chronic pain conditions. Another limitation of the present study is that only those pain conditions that were the subject of at least one controlled trial of massage therapy were included. Thus, not all chronic pain problems were examined in this review. It is possible that positive effects for massage therapy on other chronic pain conditions may have been reported in uncontrolled trials and/or case studies. et al 30