Massage Therapy as an Alternative to Opioids

Prescription opioids carry serious risk of addiction, abuse, and overdose, in addition to a number of side effects, even when taken as directed. According to the Centers for Disease Control, deaths from prescription opioids—drugs like oxycodone, hydrocodone, and methadone—have more than quadrupled since 1999.  

For that reason, a number of health organizations and governmental agencies are seriously looking at alternative ways to manage pain.

The American Massage Therapy Association (AMTA) continues to be actively engaged with several organizations, as well as federal and state governmental agencies regarding massage therapy for pain and specifically as an alternative to opioids.

In the News: Massage as an Alternative to Opioids

  • July 2019 - Florida passed a new law that requires the Department of Health to develop and publish an online educational pamphlet on the use of non-opioid alternatives for pain, including massage therapy. The publication to include information about the advantages of each non-opioid approach, with references on its efficacy. This legislature will make a difference in how the residents of Florida view their options for pain care and management, with a clear endorsement of massage therapy. Learn more about the new Florida law »
  • February 2019 – The U.S. Senate Health, Education, Labor & Pension Committee (H.E.L.P) held a hearing on the opioids crisis in the country, which was focused on approaches to pain other than opioids. AMTA’s representative attended the session where testimony was given on the importance of nonpharmacological approaches to pain (including massage therapy) and the need for more insurance carriers to cover these approaches. Those referring to the value of massage therapy and the challenges of lack of insurance coverage included Halena Gazelka, M.D., Assistant Professor of Anesthesiology and Perioperative Medicine, Director, Mayo Clinic Inpatient Pain Service. She stated, “…we want to offer services like massage therapy, but have issues with reimbursement.”
  • January 2019 – The Centers for Medicare and Medicaid Services (CMS) wrote to all Medicare Advantage programs encouraging them to cover massage therapy in 2020, going beyond their 2019 recommendation to consider massage coverage. Their letter now says the following about “Non-Opioid Pain Management Supplemental Benefits” “CMS encourages MA (Medicare Advantage) organizations to consider Part C benefit designs for supplemental benefits that address medically-approved non-opioid pain management and complementary and integrative treatments. For example, “peer support services” delivered by qualified individuals may be effective in facilitating recovery and assist in navigating health care resources. For purposes of completing the PBP, peer support services and/or psychosocial services/cognitive behavioral therapy can be included in counseling services (PBP 14c). In addition, non-Medicare covered chiropractic services (PBP 7b), acupuncture (PBP 13a), and therapeutic massage (PBP B14c) furnished by a state licensed massage therapist, may also be incorporated into plan designs. “Massage” should not be singled out as a particular aspect of other coverage (e.g., chiropractic care or occupational therapy) and must be ordered by a physician or medical professional in order to be considered primarily health related and not primarily for the comfort or relaxation of the enrollee. The non-opioid pain management item or service must treat or ameliorate the impact of an injury or illness (e.g., pain, stiffness, loss of range of motion).”
  • January 2019 – The U.S. Department of Health and Human Services (HHS), through an Inter-Agency Task Force, published a draft report on pain management best practices. This draft calls for individualized, patient-centered pain management, and it includes recommendations related to massage therapy.
  • September 2018  CMS has announced that many Medicare Advantage plans will cover massage therapy for pain management, provided by a state licensed massage therapist, beginning in 2019. “As a result of the new flexibilities on supplemental benefits available for the first time in 2019, about 270 plans are providing nearly 1.5 million enrollees with access to the following new types of benefits: expanded health-related supplemental benefits, such as adult day care services, in-home services, caregiver support services, home-based palliative care and therapeutic massage.”
  • August 2018 – AMTA began an outreach effort with approximately 700 Medicare Advantage insurance companies encouraging them to follow the Center for Medicare Services recommendations by covering medically-approved massage therapy provided by state licensed massage therapists. While coverage of massage therapy is not automatic, AMTA is asking Medicare Advantage plans to consider it for 2019 and 2020. 
  • August 2018 – AMTA published Massage Therapy in Integrative Care & Pain Management, a detailed overview of research on the efficacy of massage therapy and results of an economic modeling indicating that using massage therapy instead of opioids for specific types of pain, could save the U.S. between $23 and $25 billion each year. 
  • Fall 2017 – AMTA met with a representative and provided feedback to the FDA regarding the important role massage therapy can play. The FDA released guidelines calling on health care providers to be informed on the range of therapeutic options for managing pain, including non-pharmacologic approaches and therapies. While the FDA was not specific about these approaches, the National Institutes of Health (NIH) has for several years now, included massage therapy among its list of complementary therapies.
  • Fall 2017 – The U.S. Food & Drug Administration (FDA) sought public comment on the "FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain".  Learn more »
  • Fall 2017 – Consumer Reports  discussed massage therapy as an approach to low back pain.
  • September 2017 – 37 US Attorney Generals called for Inclusion of Massage in Insurance Coverage. See the coverage in ABC News, and read the letter.
  • NBC medical correspondent Dr. John Torres reported on the Today Show that the CDC recommends massage therapy, NSAIDS and acupuncture as an alternative to opioids. Watch the Today Show Segment »

Clinical Recommendations - Massage Therapy for Pain

  • January 2019 – The Joint Commission published its updated standards for non-pharmacologic strategies for pain, which include the use of massage therapy.
    https://www.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFaqId=1813&ProgramId=46
    https://www.jointcommission.org/new_joint_commission_advisory_on_non-pharmacologic_and_non-opioid_solutions_for_pain_management/
    https://www.jointcommission.org/new_revised_pain_assessmentmanagement_standards_for_behavioral_health_care_home_care_nursing_care_to_be_introduced/
  • September 2018 - The final draft of the "U.S. Food and Drug Administration's (FDA's) Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain" includes a recommendation of complementary therapies as defined by NIH/NCCIH. The Opioid Analgesic REMS (Risk Evaluation and Mitigation Strategy) program requires that health care providers receive training on pain management, and should be knowledgeable about the range of non-pharmacologic treatment options available. 
  • April 2018 - The Center for Medicare Services published new guidelines for Medicare Advantage programs coverage in 2019. "Medically-Approved Non-Opioid Pain Management (PBP B13d, e, or f): Medically-approved non-opioid pain treatment alternatives, including therapeutic massage furnished by a state licensed massage therapist. Massage should not be singled out as a particular aspect of other coverage (e.g., chiropractic care or occupational therapy) and must be ordered by a physician or medical professional in order to be considered primarily health related and not primarily for the comfort or relaxation of the enrollee. The non-opioid pain management item or service must treat or ameliorate the impact of an injury or illness (e.g., pain, stiffness, loss of range of motion)." Medicare Managed Care Manual Chapter 4 - Benefits and Beneficiary Protections
  • The American College of Physicians issued guidelines recommending massage therapy for low-back pain in 2017.
  • The Federation of State Medical Boards issued recommendations in April 2017 on approaches to pain, including massage therapy among non-pharmacologic therapies.
  • Since November 2014, The Joint Commission hospital standards for non-pharmacologic strategies for pain included the use of massage therapy. [Joint Commission Perspectives, Volume 34, Number 11, November 2014, pp. 11-11(1). Clarification to Standard PC.01.02.07]

Integrative Collaborations

AMTA continues to work with a variety of national integrative care groups to promote inclusion of massage therapy into approaches to pain other than opioids.

  • January 2019 – AMTA begins active discussions with the Academic Consortium for Integrative Medicine and Health on collaborative approaches to massage therapy research and national health care policy. The consortium is a nonprofit organization of more than 70 highly-esteemed academic medical centers and affiliate institutions whose mission is to advance the principles and practices of integrative healthcare within academic institutions. The group invited AMTA to make a presentation to its members in March.
  • The Spring 2018 issue of The Pain Practitioner included an article by AMTA Past President Dolly Wallace on massage therapy as an alternative to opioids for pain. 
  • The Spring 2017 issue of The Pain Practitioner included an article by AMTA President Dolly Wallace on the benefits of massage therapy for people with arthritis.

Helping Government Address Opioid Use

  • February 2019, the U.S. Department of Health and Human Services (HHS), through an Inter-Agency Task Force, published a draft report on pain management best practices. This draft calls for individualized, patient-centered pain management, and it includes recommendations related to massage therapy. AMTA provided comments to improve the pain management plan and continues to be actively engaged with HHS and the Task Force to work toward massage therapy’s full inclusion as part of the recommendations. This has included direct meetings with the chair of the Task Force and other stakeholder groups. Read the full report https://www.hhs.gov/ash/advisory-committees/pain/reports/2018-12-draft-report-on-updates-gaps-inconsistencies-recommendations/index.html
  • August 2018, AMTA began distributing its new resource, Massage Therapy in Integrative Care & Pain Management, to federal and state governmental agencies, as well as, insurers and health care organizations. This document reinforces strong research on the efficacy of massage therapy and features results of an economic modeling indicating that using massage therapy instead of opioids for specific types of pain could save the U.S. between $23 and $25 billion each year. 
  • On March 14, 2018, AMTA representatives met with senior staff at the National Center for Complementary and Integrative Health, part of the National Institutes of Health (NIH). The meeting focused on the necessity of increasing the amount of massage therapy research, as massage therapy has become more accepted as an important approach to managing pain.
  • Late 2017 and early 2018, AMTA provided detailed information on the efficacy of massage therapy for pain to the U.S. House of Representatives Ways & Means Committee and its Energy & Commerce Committee, as they prepared for hearings related to the opioid crisis.
  • AMTA worked directly with the West Virginia Attorney General on a program to reduce use of opioids for pain. The state has been positive about the incorporation of massage therapy in a list of approaches to pain that can help stop the rampant use of opioids there – the highest in the country. The state public education program includes a recommendation of massage therapy as a first-line approach vs. opioids. As a result, AMTA has been actively discussing a similar approach with legislators in an increasing number of states.
  • AMTA also connected the state officials in West Virginia with researchers in Kentucky working on this same subject. We have an ongoing relationship with researchers at the University of Kentucky for educational roundtables in West Virginia and Kentucky. They recently published some of their results, showing the value and efficacy of massage as a substitute for opioids.
  • December 2017, AMTA submitted recommendations to the Agency for Healthcare Research and Quality (an agency of the U.S. Department of Health & Human Services) for inclusion of research on massage therapy for chronic pain, to be included in their analysis and recommendations for non-pharmacologic approaches.
  • October 2017, AMTA was an exhibitor at the Appalachian Opioid Conference and met with state officials from multiple states about how to integrate massage therapy into non-pharmacologic approaches to pain as a way to counter the national opioid epidemic.

Research & Resources Supporting Massage for Pain Management

Massage vs. Opioids fact sheet »

Learn more about AMTA's Massage Therapy in Integrative Care & Pain Management Resource 

The Massage Therapy Foundation and Samueli Institute research meta-analysis funded by AMTA will help continue conversations on this important topic.


Additional Resources

Current Research on the Health Benefits of Massage Therapy

Communicating + Collaborating with Health Care Professionals

Low Back Pain & Massage Therapy | 2.5 CE Credits

"I am very glad to be aligned with a professional organization that gives so much to its members."

Satu F., AMTA member since 2003

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