Massage Therapy Journal Summer 2025

Summer 2025 • 21

Chronic Pain: Beyond the Physical The Centers for Disease Control and Prevention estimates that 20.9% of U.S. adults (51.6 million people) live with chronic pain, and 6.9% (17.1 million people) experience what’s called high-impact chronic pain (i.e., chronic pain that results in substantial restriction to daily activities). 15 Chronic pain is defined as “persistent discomfort lasting beyond 3 to 6 months.” 16 This includes headaches, migraines, back pain, neuropathy, rheumatoid arthritis, chronic fatigue syndrome, fibromyalgia and many other common conditions. The idea that massage therapy can relieve pain is well-known, but if you’re anything like us, you didn’t learn much in massage school about how pain actually happens— its causes, its patterns and its relationship to non-physical factors. The nuanced and multifactorial experience called pain 17 tends to be understood in our profession as an amorphous experience of unpleasantness that provides us with our most primary mandate: Stop the pain. Unfortunately, not all pain is created equal. For instance, a simple online search about the cause of headaches will take you down an infinite rabbit hole that could lead you to believe that you should just stay in bed if you want to avoid a headache. Similarly, the cause of fibromyalgia is unknown, and treatments are not only varied, but an approach that works for one person may have the opposite effect on another. 18,19 Back pain has been the subject of massage therapy research for decades, but it, too, has many causes and the successful massage therapy dosage and therapeutic approach are specifically related to the cause of the pain. All of this boils down to an imperative for critical thinking and a more than tangential understanding of pain science. A healthy dose of advanced communication skills wouldn’t hurt either. 20 Pain can be neuropathic, nociceptive, musculoskeletal, inflammatory, psychogenic,

mechanical, or even an overlapping and cyclical combination of these. While these terms may make an incredible song for Mary Poppins II , they can befuddle a practitioner who is unaware of their complexity. Understanding pain, its characteristics and causes is key to successful and supportive care. It’s also important to understand that pain is a symptom, not a diagnosis. This truth should invite curiosity. “Of what issue or issues is this person’s pain a symptom?” “What can I learn about that issue that will help me better understand how to use the skills and techniques of the discipline of massage therapy to support this person?” As with most serious health conditions, chronic pain often results in symptoms that are challenging to mental health, including anxiety, depression 21 and sleep disruption, 22 which lead to other issues like difficulty with activities of daily living and substance use disorder. 23 People who live with chronic pain experience a shrinking of their world and ability to function in it that is similar to the experience of people with other health conditions explored in this article. When research about massage and pain is conducted, it’s rare that patient experience is captured with qualitative interviews or other tools designed to elicit the nuanced changes that may result from massage therapy. Even so, research suggests that massage therapists have the potential to reduce pain perception, 24,25 improve overall mood 26 and mental well being 27,28,29 in people with chronic pain. Improved sleep quality, 30,31 positive, nurturing touch, and reduced feelings of isolation 2,3 are also important benefits. Certainly, the hands-on part of massage therapy is important in our work with people impacted by the illnesses explored in this article, and we hope you’ll continue to challenge and expand your own concept of the value you can bring to the lives of these people and their caregivers. When researchers do invite patients to share their experiences of massage, they

amtamassage.org/mtj