A State by State Massage Therapist Licensure Guide

Massage Therapy as an Alternative to Opioids

Why is it that even public health departments are talking massage? In part, it's because research points to massage therapy as an effective therapy for chronic pain. Pain is serious business, and sometimes it's very risky business.

People who become opiate statistics aren't necessarily the stereotypical drug user. Sometimes they're people with serious pain issues who are given legitimate prescriptions. Some never use the medication for a high. The issue is one of continued pain – the medication isn't working well enough! It may work but only at a high dose and only for a limited duration. Physicians themselves may prescribe more than is prudent. In many cases, people take matters into their own hands. When the prescribed dosage is only marginally effective, they self-medicate. They break some rules in their desperation to make the pain go away. Their stories have been chronicled through NPR and other organizations (http://www.npr.org/sections/health-shots/2015/09/22/436905063/to-curb-pain-without-opioids-oregon-looks-to-alternative-treatments).

The Montana Kaimin has profiled a young woman who was only 15 when she developed a condition that resulted in severe pain (http://www.montanakaimin.com/news/finding-relief-chronic-pain-patients-forced-into-trial-and-error/article_151f8606-1fe1-11e7-a1a4-3b32aa4d14fb.html). She was given a choice between medical marijuana and opioids. She chose the opioids that she considered safer and less stigmatizing. Only after she had been on high doses long-term and the combination of drugs and lingering pain had made it impossible to stay in college – and only after severe depression had set in -- did she cross the line into blatant abuse and illegal activity.

Most people who are prescribed opiates for medical conditions do not abuse them. It’s not the majority. Yet it’s not uncommon. The consequence can be high. The most serious: death.

Even those who are not at risk of becoming a statistic have reason to be wary and seek alternatives -- if they can. Opiates aren't healthy, and they aren't what they want in their bodies. They don't want to be physically dependent on drugs even if they aren't addicted. The risk, unfortunately, goes up with time.

Leaders in Change

Massage therapists can point to a growing body of research about the efficacy of massage in pain management. The Mayo Clinic, for example, has found evidence for the efficacy of massage in the treatment of knee osteoarthritis. Researchers at the University of Kentucky have found efficacy for treating lower back pain, particularly in adults over 50.

There can be obstacles to putting research into action. Alternative treatments such as massage are less likely to be covered under healthcare plans. Fortunately, this is beginning to change. Indeed, some patients are eligible through Medicaid. The particulars vary from state to state. The National Academy for State Health Policy (NASHP) reported in 2016 that qualifying Neighborhood Health Plan of Rhode Island (NHPRI) patients could receive massage therapy based on diagnoses of neck pain, back pain, or fibromyalgia (https://nashp.org/wp-content/uploads/2016/09/Pain-Brief.pdf).

The West Virginia attorney general has been active in rallying other states to urge insurance carriers to change policy to promote non-opioid pain treatments, massage among them (http://woay.tv/2017/09/18/attorney-general-morrisey-leads-37-states-territories-to-fight-opioid-incentives/).

The traditional medical establishment is beginning to alter its stance. The American College of Physicians issued new guidelines in February of 2017 calling for treatment of acute and sub-acute lower back pain with treatments such as massage, acupuncture, and superficial warming. (Superficial warming, notably, is often given coverage in massage school.)

Use of Massage with Infants Who Are Born Opioid-Dependent

Practitioners and researchers are exploring different ways that massage could help in the opiate crisis, including use of massage to soothe infants born with neonatal abstinence syndrome (NAS). It has long been believed that newborns who scored high for NAS symptomology needed to be in neonatal intensive care units receiving minute doses of substances such as morphine in order to wean them off drugs. Not so, say Kentucky practitioners -- at least not in the majority of cases. One thing these opiate-exposed babies benefit from is a mother by their side who is offering comfort. They also benefit from therapies like massage, aromatherapy, and Jin Shin Jyutsu, an Asian bodywork therapy. VICE News has spotlighted what’s happening in Kentucky. At Kentucky Children’s Hospital, one can find a massage therapist demonstrating how to calm an infant in the neonatal ward (https://news.vice.com/en_us/article/4345dg/pregnant-women-opioid-addiction-treatment). Two photos show infant massage; one shows a very smiley baby.

Next Steps

Like other pain treatment, massage works for some but not for others. Generally, it is more realistic to look for a reduction in symptoms as opposed to complete alleviation. Further research is indicated to determine what types of massage are most affective for what types of pain and under what circumstances. At least one study has suggested better outcomes for comprehensive massage therapy as opposed to just soft tissue manipulation (https://academic.oup.com/painmedicine/article/17/7/1353/2223191). Another area for exploration is the role patient expectation plays in determining outcomes.

A massage is not simply a massage. Some massage therapists employ many techniques, tailored toward their clients’ specific needs. Patients with a range of conditions, including fibromyalgia, report significant benefits (https://www.fmcpaware.org/massage-for-fibromyalgia-a-therapist-s-point-of-view.html).

With so much to gain, massage therapists may want to be more active in promoting massage as a part of healthcare. Diana Thompson, L.M.P., stresses that it's important for massage therapists to learn biomedical language in order to better communicate with other healthcare providers (https://www.massagemag.com/can-massage-help-combat-opioid-epidemic-36842/). She also advocates for inclusion of massage therapists on biomedical consultation groups and for communication with other health practitioners using shared electric health records.

The Massage Therapy Foundation has provided a database about massage and pain as well as other research tools (http://massagetherapyfoundation.org/massage-research/research-tools/).