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The biological mechanics of how touch might work to reduce pain were explored in a compelling study published in September in the Journal of Alternative and Complementary Medicine. The lead author, Dr. Mark Hyman Rapaport, chief of psychiatry and behavioral neurosciences at Cedars-Sinai Medical Center in Los Angeles, found that even a single deep-tissue Swedish-massage session resulted in a significant decrease in the hormone arginine vasopressin (AVP). AVP constricts blood vessels and raises blood pressure, both of which can cause agitation and spikes in pain. The study also showed that either massage or light-touch therapy produced reductions in levels of cortisol, a hormone associated with higher levels of pain that is released when people are stressed.
Intrigued that massage could have such immediate biological effects, I asked Rapaport if I could undergo the same procedure as the 53 study participants. After giving two samples of blood to serve as a baseline, I was worked over (not too strenuously) by a massage therapist for 45 minutes. A sound machine issued the gentle music of ocean waves. And then the bad part: six more blood draws over one hour.
I found the whole experience stressful, partly because I was reporting but mostly because a large needle was shoved into the soft crease of my arm the whole time. That's why my results surprised me: my levels of cortisol declined by a stunning 56%. The massage therapist also rubbed away a huge amount of my AVP; it went from 85 picograms per milliliter to 59. Not bad for 45 minutes of massage — although without follow-up tests, it's not clear how long the benefits lasted.
Does this mean we should get a massage every day? Every week? "The jury is still out on dosage," Rapaport told me. But he recommends "occasional" massages.
His study needs to be replicated, but it offers an explanation for why so many people seek massage to reduce neck, back and joint pain. Other studies are finding that other kinds of touch — even just placing both hands on different areas of a patient's body — can reduce pain. A 2008 Annals of Internal Medicine paper reported the results of a trial involving 380 advanced-cancer patients with moderate-to-severe pain. The authors — a team from Florida Atlantic University and the University of Colorado Denver — randomly assigned participants to receive either six 30-minute massages over two weeks or six control sessions in which a therapist placed both hands on 10 different areas of the body for three minutes each.
The study found that touch of either kind was associated with statistically significant improvements in pain reports with very few side effects. The authors point out that one reason pain may decline with touch is that healthy people have an aversion to touching sick people, so those who are ill get fewer hugs and less hand holding. Under this theory, isolation literally hurts, and though it's a bit treacly to say, a hug can heal.
A Little Pain, Some Gain
I've always been puzzled by acupuncture, because it's supposed to help by hurting. When I underwent acupuncture for the first time a couple of weeks ago, my right ear and left foot bled where the needles were inserted. However — perhaps because the acupuncturist suggested the session would ease my chronic insomnia — I slept eight hours that night, longer than I have slept in a single night since the early '90s.
What can needles do to alleviate pain? A remarkable study published in 2009 in the journal Acupuncture in Medicine found that in four trials involving more than 1,000 subjects with osteoarthritis, 46% of those who got 10 acupuncture sessions over six weeks responded with a decline in lower-back pain. Only 27% of those who received standard treatment — anti-inflammatory drugs, exercise and physical therapy — enjoyed pain relief. (A subsequent study found that anti-inflammatories are only about 5% better than sugar pills in relieving osteoarthritis pain.)
Twelve other studies, involving 3,172 patients with knee osteoarthritis, found that acupuncture reduced self-reported pain by 7.4% — a modest figure but still better overall than the alleviation produced by standard-care control therapies involving drugs. Similarly, a 2009 paper by scientists in four countries found that acupuncture managed migraine pain only slightly better than drugs did, but with far fewer side effects. Sufferers who got acupuncture also had fewer migraines than those who got prophylactic pain medications. Finally, the multinational group of scientists found that even nine months after acupuncture treatment ended, patients who had been randomly assigned to the needle therapy were doing better than those treated with routine care.
The mechanism by which acupuncture works remains murky, but according to a 2010 study released by the Cochrane Collaboration, a health-research group, positron-emission-tomography scans have shown that needle pricks "can stimulate regions of the brain associated with natural opiate production." These naturally occurring painkillers come to the rescue when aroused by the needle pricks and then stay active for at least a few hours. Another theory is that acupuncture tamps down both inflammation and the nervous-system pathways that control pain, but how it might accomplish these tasks isn't clear.