Pain Inhibitory Response to Massage for Individuals with Neck Pain

Daphne Bricker

Authors:  Daphne Bricker, Joel Bialosky, Abigail Wilson

Faculty Mentor:  Joel Bialosky

College:  College of Public Health and Health Professions


Massage is effective in treating some individuals with neck pain; however, the mechanisms through which massage relieves pain are unknown, prohibiting a mechanistic based treatment stratification approach. Pain inducing massage (PIM) is known to be more effective than pain free massage (PFM) in decreasing pain sensitivity, suggesting a mechanism similar to conditioned pain modulation (CPM). This study aims to determine if PIM results in similar changes in pain sensitivity as a CPM paradigm using a coldpressor task in participants with neck pain. Twenty-one participants (81% female, median age 23 years (IQR=21.00-26.00) were randomly assigned to four, one-minute exposures to a coldpressor task, PIM, or PFM. Pressure pain thresholds (PPT) were assessed on the contralateral foot before and immediately after each exposure period. The coldpressor task and PIM resulted in significantly greater pain than PFM. A significant lessening of PPT was observed only within the PFM group (suggesting increased pain sensitivity). Pain associated with PPT was similar across each time point within each group suggesting a similar pain experience despite the differing levels of pressure resulting in the pain ratings. In conclusion, both PIM and a coldpressor task elicited a protective effect on pain sensitivity suggesting similar underlying mechanisms.

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18 Responses
  1. Sean Forbes

    Nice poster! Do you expect differences in responses to treatments with different types of neck pain – more acute versus chronic, for example? Thanks

    1. Daphne Bricker

      Hi Sean! This study only looked at participants experiencing neck pain for at least 3 months (i.e. chronic pain), so I’m not sure if any differences would be seen. If I had to guess I would say the responses would probably be pretty similar, considering both groups would be experiencing neck pain at the time of the study. Thank you for your question!

  2. Rachel Bomser

    Excellent job Daphne! Do you think the results of your study would hold true for other types of pain relief massage (such as lower back)?

    1. Daphne Bricker

      Thank you Rachel! I would say that the results would hold true for lower back pain as both areas are connected to spinal pain inhibitory pathways. This would be a great way to expand the literature! Thank you for your comment!

  3. Beau Goergen

    Great work, Daphne. Do you think the study results would be similar if your test patients were older? For example, a median age of 55+?

    1. Daphne Bricker

      Hi Beau! With the study’s location on the University of Florida campus, it was difficult to recruit participants in the 55+ age bracket, hence the participants’ median age of 23 years. With that being said, it is difficult to predict the results of an older participant group. However, I think an older age group would more accurately predict the results of patients seeking physical therapy treatment for neck pain, as these patients tend to be older adults.

    1. Daphne Bricker

      Hello there! Given our small sample size, we were unable to study the difference in response between genders. However, it would be interesting to replicate the study with more participants to study this question! Thank you for your comment!

  4. Maddie Rodriguez

    Daphne, this is fantastic! Your study was wonderfully informative, yet is inspiring for possible future extensions of your study! Awesome job!

  5. Adam

    Great insight on reactions to pain, Daphne. Do you expect the results from your research will lead to improvements in treating patients within a facility, as well as self-treatments in the home?

    1. Daphne Bricker

      Thank you for your question. I think, so far, the results highlight improvements that can be made in the clinical setting by using stratified care (using patient characteristics to determine the best treatment options). Therefore, this study does not provide insight into self-care. However, that would be an excellent next step to further improve physical therapy outcomes for patients with neck pain.

  6. Nedi Ferekides

    Great poster! Inducing pain seems counter-intuitive to healing. Did this research help to shed any light on how pain would help an individual in the long-term?

    1. Daphne Bricker

      Hi Nedi! Yes! We found that pain inducing massage elicits a protective effect. That is, it maintains your pain sensitivity at a level higher than elicited from a pain free massage. Therefore, pain inducing massage may be able to be used in place of a conditioned pain modulation paradigm in a physical therapy clinic!

  7. Taylor Gauss

    Hi Daphne!! This research is extremely fascinating and can be put to good use in occupational and physical therapy settings.