2006.12.12——一项发表在12月11日《Archives of Internal Medicine》（《美国内科杂志》）上的随机对照试验称，按摩可有效缓解膝关节炎（osteoarthritis，OA）的疼痛。
位于美国新泽西州Newark郡的新泽西医学及牙科大学（University of Medicine and Dentistry of New Jersey）的Adam I. Perlman, MD, MPH（master of public health，公共卫生学硕士）及其同事写道：“按摩是一项很有吸引力的关节炎治疗方法，但其疗效仍是不确切的。按摩可能具有如下作用：缓解症状、通过增加受累关节的局部血液循环来促进关节炎康复进程、增强关节支持肌肉的肌力、增强关节灵活性、缓解疼痛等等。然而，具我们所知，迄今为止尚无明确的评估按摩对OA疗效的研究。”
在这项wait-list对照研究中，68位影像学诊断为膝关节炎的成年患者被随即分配到按摩组（第1－4周接受每周两次的标准瑞典按摩，第5－8周为每周一次）和对照组（延期处理）。主要终点为Western Ontario and McMaster Universities关节炎指数（WOMAC）疼痛和功能评分以及疼痛评估直观类比标度（visual analog scale，VAS）。
治疗组病情显著改善表现在一下几方面：平均WOMAC总分（-17.44 ± 23.61 mm; P < .001）、疼痛（-18.36 ± 23.28; P < .001），四肢强直（-16.63 ± 28.82 mm; P < .001）、躯体功能（-17.27 ± 24.36 mm; P < .001） 、疼痛评估直观类比标度（-19.38 ± 28.16 mm; P < .001）、活动范围（3.57 ± 13.61度; P = .03），行走50英尺所需时间（-1.77 ± 2.73秒; P < .01）。用多变量模型控制人口因素对结果无明显影响。
作者写道：“这项初步研究显示按摩对膝OA的治疗是有效的，并且疗效可持续到治疗后数周。伴疼痛的膝OA病人对按摩显示出良好的依从性。对于维持原疗法的病人，按摩亦可缓解疼痛并改善功能。”
研究的局限性包括，意向性分析和基线水平的提高，导致低估疗效；丢失随访；wait-list control设计导致在为期8周的时间里研究人员和处理组接触增多；无法比较不同频率、时间和种类的按摩的疗效；均一的研究样本限制了疗效的推广；研究仅持续16周。
作者总结道：“考虑到OA药物和非药物治疗的局限性和可能的不良反应，按摩可作为传统治疗模式基础上有效的附加手段。有必要开展更进一步研究以明确按摩的最佳治疗规程、全部功效、费用效益和对其他疾病的疗效。”
美国疾病控制和预防中心以及疾病预防研究中心资助了这项研究，且与作者无经济关系。
Massage Therapy May Help Reduce Pain of Knee Osteoarthritis
December 12, 2006 — Massage therapy is effective in reducing pain in patients with knee osteoarthritis (OA), according to the results of a randomized controlled trial reported in the December 11 issue of the Archives of Internal Medicine.
"Massage therapy is an attractive treatment option for osteoarthritis (OA), but its efficacy is uncertain," write Adam I. Perlman, MD, MPH, of the University of Medicine and Dentistry of New Jersey in Newark, and colleagues. "Massage therapy may diminish symptoms and improve the course of OA by increasing local circulation to the affected joint, improving the tone of supportive musculature, enhancing joint flexibility, and relieving pain.... However, to our knowledge, to date, no study has specifically evaluated the effectiveness of massage therapy for OA."
In this wait-list controlled trial, 68 adults with radiographically confirmed OA of the knee were randomized either to massage treatment (twice-weekly sessions of standard Swedish massage in weeks 1 - 4 and once-weekly sessions in weeks 5 - 8) or to the control group (delayed intervention). The main endpoints were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and functional scores and the visual analog scale (VAS) of pain assessment.
The massage therapy group had significant improvements in mean WOMAC global scores (-17.44 ± 23.61 mm; P < .001), pain (-18.36 ± 23.28; P < .001), stiffness (-16.63 ± 28.82 mm; P < .001), and physical function domains (-17.27 ± 24.36 mm; P < .001) and in the VAS of pain assessment (-19.38 ± 28.16 mm; P < .001), range of motion in degrees (3.57 ± 13.61; P = .03), and time to walk 50 ft in seconds (-1.77 ± 2.73; P < .01). Controlling for demographic factors using multivariable models did not affect this pattern of findings.
"This pilot study suggests that massage therapy is efficacious in the treatment of OA of the knee, with beneficial effects persisting for weeks following treatment cessation," the authors write. "Massage therapy seems to be well tolerated by people with painful OA of the knee. Massage also seems to decrease pain and improve function in participants who were allowed to maintain their usual treatment."
Study limitations include intent-to-treat analysis and carrying forward baseline values that may have underestimated the magnitude of treatment effect; losses to follow-up; wait-list control design resulting in increased contact with study personnel for the massage group during the 8-week intervention; inability to compare the efficacy of different frequency, duration, or type of massage therapy; homogeneous study sample limiting generalizability; and study duration for only 16 weeks.
"Given the limitations and potential adverse effects of pharmacologic and nonpharmacologic treatments for OA, massage therapy seems to be a viable option as an adjunct to more conventional treatment modalities," the authors conclude. "Further study of massage to determine optimal treatment protocols, absolute efficacy, cost-effectiveness, and generalization to other patient groups is clearly warranted."
The Centers for Disease Control and Prevention and Prevention Research Center supported this study. The authors have disclosed no relevant financial relationships.
http://www.medscape.com/viewarticle/549193
编辑：蓝色幻想
