The immediate effect of traditional Malay massage on substance P, inflammatory mediators, pain scale and functional outcome among patients with low back pain: study protocol of a randomised controlled trial

Nurhanisah Sejari, Kamaria Kamaruddin, Kalavathy Ramasamy, Siong Meng Lim, Chin Fen Neoh, Long Chiau Ming, Nurhanisah Sejari, Kamaria Kamaruddin, Kalavathy Ramasamy, Siong Meng Lim, Chin Fen Neoh, Long Chiau Ming

Abstract

Background: The treatment of low back pain is very challenging due to the recurrent nature of the problem. It is believed that traditional Malay massage helps to relieve such back pain but there is a lack of scientific evidence to support both the practice of traditional Malay massage and the mechanism by which it exerts its effect. The aim of this study is to investigate the immediate effect of traditional Malay massage on the pain scale, substance P, inflammatory mediators, and functional outcomes among low back pain patients.

Methods: A non-blinded, randomised controlled trial will be conducted. A total of sixty-six patients who fulfil the inclusion criteria will be recruited. The participants will be randomly allocated into intervention (traditional Malay massage) and control (relaxation position) groups. Blood and saliva samples will be collected before and immediately after intervention. All collected samples will be analysed. The primary outcomes are the changes in the level of substance P in both saliva and blood samples between both groups. The secondary outcomes include the levels of inflammatory mediators [i.e. TNF-α, IL-1β, IL-8, monocyte chemotactic protein-1, IL-6 and IL-10, and the soluble form of the intercellular adhesion molecule], the pain intensity as measured by a visual analogous scale and functional outcomes using the Roland-Morris Disability Questionnaire.

Discussion: Massage is a type of physical therapy that has been proven to be potentially capable of reducing unpleasant pain sensations by a complex sensory response and chemical mediators such as substance P and various inflammatory mediators. Previous studies conducted using Thai, Swedish, or other forms of massage therapies, have showed inconsistent findings on substance P levels pre and post the interventions. Each massage genre varies in terms of massage and joint mobilization points, as well as the lumbar spinous process. Traditional Malay massage, known locally as "Urut Melayu", involves soft-tissue manipulation of the whole body applied using the hands and fingers. This massage technique combines both deep muscular tissue massage and spiritual rituals. This trial is expected to give rise to new knowledge underlying the mechanisms for pain and inflammation relief that are activated by traditional Malay massage.

Trial registration: Australian New Zealand Clinical Trials ACTRN12615000537550 .

Figures

Fig. 1
Fig. 1
Study protocol

References

    1. Henry LJ, Esfehani AJ, Ramli A, Ishak I, Justine M, Mohan V. Patterns of work-related musculoskeletal disorders among workers in palm plantation occupation. Asia-Pac J Public He. 2015;27(2):1785–92. doi: 10.1177/1010539513475657.
    1. Hong JH, Reed C, Novick D, Happich M. Costs associated with treatment of chronic low back pain an analysis of the UK general practice research database. Spine (Phila Pa 1976) 2013;38(1):75–82. doi: 10.1097/BRS.0b013e318276450f.
    1. Gould HJ, III, Kaye AD. The Anatomy of Pain. In: Kaye AD, Urman RD, Vadivelu N, editors. Essentials of Regional Anesthesia. New York: Springer; 2012. pp. 83–119.
    1. Leal EC, Carvalho E, Tellechea A, Kafanas A, Tecilazich F, Kearney C, et al. Substance P promotes wound healing in diabetes by modulating inflammation and macrophage phenotype. Am J Pathol. 2015;185(6):1638–48. doi: 10.1016/j.ajpath.2015.02.011.
    1. Lisowska B, Lisowski A, Siewruk K. Substance P and chronic pain in patients with chronic inflammation of connective tissue. PLoS One. 2015;10(10):e0139206. doi: 10.1371/journal.pone.0139206.
    1. Cohen SP, Mao J. Neuropathic pain: mechanisms and their clinical implications. BMJ. 2014;348:f7656. doi: 10.1136/bmj.f7656.
    1. Waters-Banker C, Dupont-Versteegden EE, Kitzman PH, Butterfield TA. Investigating the mechanisms of massage efficacy: the role of mechanical immunomodulation. J Athl Train. 2014;49(2):266–73. doi: 10.4085/1062-6050-49.2.25.
    1. Amadesi S, Reni C, Katare R, Meloni M, Oikawa A, Beltrami AP, et al. Role for substance P–based nociceptive signaling in progenitor cell activation and angiogenesis during ischemia in mice and in human subjects clinical perspective. Circulation. 2012;125(14):1774–86. doi: 10.1161/CIRCULATIONAHA.111.089763.
    1. Beider S, Moyer CA. Randomized controlled trials of pediatric massage: a review. Evid Based Complement Alternat Med. 2007;4(1):23–34. doi: 10.1093/ecam/nel068.
    1. Fernandez-Lao C, Cantarero-Villanueva I, Diaz-Rodriguez L, Fernandez-de-las-Penas C, Sanchez-Salado C, Arroyo-Morales M. The influence of patient attitude toward massage on pressure pain sensitivity and immune system after application of myofascial release in breast cancer survivors: a randomized, controlled crossover study. J Manipulative Physiol Ther. 2012;35(2):94–100. doi: 10.1016/j.jmpt.2011.09.011.
    1. Klingler W, Jurkat-Rott K, Lehmann-Horn F, Schleip R. The role of fibrosis in Duchenne muscular dystrophy. Acta Myol. 2012;31(3):184–95.
    1. Mackawan S, Eungpinichpong W, Pantumethakul R, Chatchawan U, Hunsawong T, Arayawichanon P. Effects of traditional Thai massage versus joint mobilization on substance P and pain perception in patients with non-specific low back pain. J Bodyw Mov Ther. 2007;11(1):9–16. doi: 10.1016/j.jbmt.2005.11.001.
    1. Brune K, Patrignani P. New insights into the use of currently available non-steroidal anti-inflammatory drugs. J Pain Res. 2015;8:105–18. doi: 10.2147/JPR.S75160.
    1. Field T, Diego M, Cullen C, Hernandez-Reif M, Sunshine W, Douglas S. Fibromyalgia pain and substance P decrease and sleep improves after massage therapy. J Clin Rheumatol. 2002;8(2):72–6. doi: 10.1097/00124743-200204000-00002.
    1. Gore M, Tai KS, Sadosky A, Leslie D, Stacey BR. Use and costs of prescription medications and alternative treatments in patients with osteoarthritis and chronic low back pain in community‐based settings. Pain Pract. 2012;12:550. doi: 10.1111/j.1533-2500.2012.00532.x.
    1. Othman CN, Farooqui M, Lamina RAC, Din N. Malay traditional massage therapy (MTMT) seeking behaviours among Malays for their chronic diseases-case study. Procedia Soc Behav Sci. 2012;50:591–601. doi: 10.1016/j.sbspro.2012.08.062.
    1. Sejari N, Kamaruddin K, Long CM. The effectiveness of traditional Malay massage: a narrative review. Arch Pharm Pract. 2014;5(4):144. doi: 10.4103/2045-080X.142048.
    1. Shamsuddin S, Rani AAA, Mohamad MS, Halim NHA, Zin MHM, Chyi WW, et al. Traditional and Complementary Medicine Division, Ministry of Health Malaysia. 2011. Traditional and Complementary Medicine Programme in Malaysia.
    1. Traditional & Complementary Medicine Division . Annual report. Malaysia: Ministry of Health; 2011.
    1. Peake JM, Della Gatta P, Suzuki K, Nieman DC. Cytokine expression and secretion by skeletal muscle cells: regulatory mechanisms and exercise effects. Exerc Immunol Rev. 2015;21:8–25.
    1. Roland M, Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976) 1983;8(2):141–4. doi: 10.1097/00007632-198303000-00004.
    1. Crossley KM, Bennell KL, Cowan SM, Green S. Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid? Arch Phys Med Rehabil. 2004;85(5):815–22. doi: 10.1016/S0003-9993(03)00613-0.
    1. Verhoef MJ, Vanderheyden LC, Dryden T, Mallory D, Ware MA. Evaluating complementary and alternative medicine interventions: in search of appropriate patient-centered outcome measures. BMC Complement Altern Med. 2006;6:6–38. doi: 10.1186/1472-6882-6-38.
    1. Dupont WD, Plummer WD., Jr Power and sample size calculations for studies involving linear regression. Control Clin Trials. 1998;19(6):589–601. doi: 10.1016/S0197-2456(98)00037-3.
    1. Wellington J. Noninvasive and alternative management of chronic low back pain (efficacy and outcomes) Neuromodulation. 2014;17(Suppl 2):24–30. doi: 10.1111/ner.12078.
    1. Buttagat V, Eungpinichpong W, Kaber D, Chatchawan U, Arayawichanon P. Acute effects of traditional Thai massage on electroencephalogram in patients with scapulocostal syndrome. Complement Ther Med. 2012;20(4):167–74. doi: 10.1016/j.ctim.2012.02.002.
    1. Anuar HM, Fadzil F, Ahmad N, Abd Ghani N. Urut Melayu for poststroke patients: a qualitative study. J Altern Complement Med. 2012;18(1):61–4. doi: 10.1089/acm.2010.0797.
    1. Fadzil F, Anuar HM, Ismail S, Abd Ghani N, Ahmad N. Urut Melayu, the traditional Malay massage, as a complementary rehabilitative care in postpartum stroke. J Altern Complement Med. 2012;18(4):415–9. doi: 10.1089/acm.2010.0802.
    1. Molina-Ortega F, Lomas-Vega R, Hita-Contreras F, Plaza Manzano G, Achalandabaso A, Ramos-Morcillo AJ, et al. Immediate effects of spinal manipulation on nitric oxide, substance P and pain perception. Man Ther. 2014;19(5):411–7. doi: 10.1016/j.math.2014.02.007.

Source: PubMed

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