Potential for Massage Therapy to Manage Fatigue, Pain and Spasticity in People with Multiple Sclerosis

Background: Fatigue, pain and spasticity are common symptoms affecting daily activity, participation and quality of life (QOL) in people with multiple sclerosis (PwMS). Approximately one third of surveyed PwMS report they use massage therapy (MT) as an adjunct to medical treatment because conventional treatment is not effective in managing their symptoms. However, there is no empirical evidence of the effectiveness of MT for managing symptoms in PwMS. 

Objectives: To assess the effectiveness of MT for decreasing fatigue, pain and spasticity in PwMS and improve their perception of health and QOL.

Methods: This non-randomized, pre-post design pilot study assessed changes in fatigue, pain, spasticity, perception of health and QOL in PwMS over 18 years old who received a standardized routine of MT by a licensed massage therapist (LMT) one time a week for 6 weeks. Symptoms were assessed pre and post each MT session. Deviations from the MT protocol were documented. The Modified Fatigue Index Scale (MFIS), MOS Pain Effects Scale (PES), Modified Ashworth Scale (MAS), Penn Spasm Frequency Scale (PSFS), Mental Health Inventory (MHI), and Health Status Questionnaire (HSQ) were collected before and after completion of the intervention.

Results: Twenty-four of 28 participants enrolled completed the study.There were no adverse events related to the MT, and no reports of increased symptoms after each session. There was a significant decrease in MFIS (p=0.00) and PES scores (p=0.00) from pre- to post-testing. There was no significant change in the MAS in either leg. MHI and HSQ scores significantly increased (p=0.00). The MFIS score was positively correlated with total PES change score (r=0.532, p=0.01), and negatively correlated with total MHI change (r=-0.647, p=0.00), and the change scores for the Physical Functioning (r=-0.544, p=0.01), Role-Physical (r=-0.576, p=0.00), Bodily Pain (r= - 0.57, p=0.00), Role-Emotional (r=-0.543, p=0.01) and Social (r=-0.519, p=0.01) subscales of the HSQ. Total PES change score was negatively correlated with total MHI score (r=-0.584, p=0.00) and Role-Physical subscale of the HSQ (r=-599, p=0.00). There were no other statistically significant relationships between MFIS, PES and MHI or HSQ.

Conclusions: Massage therapy may be beneficial for decreasing fatigue and pain, and improving perception of health and QOL in people with MS. As applied in this study, MT did not improve spasticity. Given the small number of participants and no control group, further study is warranted to determine whether the changes reported are due to MT and to explore other massage routines or dosing that may be effective for PwMS. Even with these limitations, this evidence suggests that MT should be considered an option for management of fatigue and pain in PwMS.