As the U.S. struggles with an opioid crisis and its devastating effects on lives, society and the economy, it’s important to look carefully at the role that comprehensive integrative pain management (CIPM) therapies such as massage therapy can play in mitigating aspects of this epidemic. Using massage therapy as a first line approach and as an integrated complement to other pharmacological and nonpharmacological approaches can produce an overall reduction of medical costs and help to avoid dependence on opioids. The American Massage Therapy Association (AMTA) is leading the effort to draw attention to the role of massage therapy in CIPM.
There is significant evidence supporting the inclusion of massage therapy for many important patient health treatments, including those for chronic pain management (such as back pain, headache, carpal tunnel syndrome, osteoarthritis, neck and shoulder pain, fibromyalgia, and hospice care), behavioral health treatment (anxiety and stress, depression, PTSD, and substance use disorder recovery), rehabilitation/physical training (athletic training/injury treatment, ergonomics and job-related injuries, cardiac rehab, joint replacement surgery, and scar management), and acute medical conditions (cancer management, post-operative pain, lymphatic drainage, and maternity and newborn care).
When massage therapy is part of a comprehensive integrative approach to a variety of health conditions, massage therapists become important members of care teams. Using a team approach to care delivery means that physicians can delegate more responsibility to other health professionals, each of whom can then practice “to the top of their license” to support more efficient processes and improve patient health outcomes.
Opioid medications used for pain management have become highly abused drugs, leading to one of the worst public health crises in recent history. While at first opioids may be perceived as an effective and inexpensive pain treatment, the continual rise in the number of patients who come to struggle with opioid addiction increases both the human and financial costs in the long run. The widespread nature of this crisis has compelled leaders in medical, research, public health and political arenas to actively provide guidance and seek out viable and economically feasible non-pharmacologic interventions, which include massage therapy.
Too often, patients are given opioids for their pain issues when there are potentially complementary and alternative types of treatment or strategies that augment medication and reduce potential addiction, such as massage therapy.
According to the Joint Commission and the American College of Physicians, nonpharmacologic approaches or techniques like massage therapy can replace opioids for many types of pain. John Dunham and Associates calculates that number to be as many as 5 million of the 27+ million opioid patients in the United States. This has the potential to reduce the number of people with addiction disorder by nearly 111,137 per year. The projection suggests providing massage therapy as a tool for pain management instead of opioids can save the United States as much as $25.99 billion per year.
In this sense, the benefits of massage therapy (in addition to reducing the patient’s pain) are twofold: reducing the number of people who potentially struggle with opioid addiction and reducing the impact on the American economy by up to $25.99 billion annually. This economic model is at the heart of AMTA’s recently published document, “Massage Therapy in Integrative Care & Pain Management.”
Encouraging medical practitioners to prescribe massage in cases where it would be an effective pain management tool, and encouraging insurance companies to cover it, can clearly help decrease the costs of opioid addiction. As stated in a recent letter from the National Association of Attorneys General to the America’s Health Insurers Plans (AHIP), massage therapy is not the only solution to this problem, but it is an important part of a comprehensive national approach to reducing addiction and its attendant costs.
Massage therapy is recognized by the National Institutes of Health (NIH), and included in nonpharmacological pain guidelines issued by The Joint Commission, as well as the American College of Physicians (ACP) and the Federation of State Medical Boards. And, in its revision for 2019 coverage, the Medicare Managed Care Manual Chapter 4 - Benefits and Beneficiary Protections recommends the following:
“Medically-Approved Non-Opioid Pain Management (PBP B13d, e, or f ): Medically-approved non-opioid pain treatment alternatives, including therapeutic massage furnished by a state licensed massage therapist. “Massage” should not be singled out as a particular aspect of other coverage (e.g., chiropractic care or occupational therapy) and must be ordered by a physician or medical professional in order to be considered primarily health related and not primarily for the comfort or relaxation of the enrollee. The non-opioid pain management item or service must treat or ameliorate the impact of an injury or illness (e.g., pain, stiffness, loss of range of motion).”
A comprehensive approach to pain relief and management, which includes massage therapy, is an important step for health care in the United States.