December 2019

Tissue Stiffness is Not Related to Pain Experience: An Individually Controlled Study in Patients with Chronic Neck and Back Pain

Authors: Ann-Kathrin Lederer , Christian Maly, Tomas Weinert, Roman Huber


University Medical Center of Freiburg, Institute for Infection Prevention and Hospital Epidemiology, Center for Complementary Medicine, Freiburg, Germany

Journal: Evidence-Based Complementary and Alternative Medicine - Volume 2019, Article ID 1907168, 7 pages (DOI: 10.1155/2019/1907168)

Background: Massage therapies such as cupping are often applied in patients with chronic neck and back pain with the assumption that they can reduce increased tissue stiffness and, therefore, improve pain. The aim of this study was to clarify whether tissue stiffness is related to pain experience in patients with chronic (>3 months) back and neck pain and whether it can be altered by a cupping massage.

Methods: The tissue stiffness of the point of subjectively felt maximum pain intensity of 40 patients with neck (n = 20) or lower back pain (n = 20) was measured by a myometer. Exact contralateral side served as an individual control. Side of higher stiffness was then treated with a cupping massage. 5, 10, 15, and 20 minutes as well as 24 hours after treatment, tissue stiffness was measured again. Patients rated their pain on a standardized pain questionnaire (neck pain disability score (NDI) or Oswestry disability index (ODI), respectively) before and 24 hours after treatment.

Results: Compared to the contralateral control side, the more painful side did not exhibit an increased stiffness of myofascial tissue before treatment (p = 0.827). The tissue stiffness and the side difference between treated and nontreated control sides decreased significantly after cupping (p = 0.002 and p = 0.001, respectively) but returned to baseline after 24 hours. NDI and ODI scores significantly decreased 24 hours after cupping (NDI: p = 0.012, ODI: p = 0.002).

Conclusion: Tissue stiffness might not be related to pain experience in patients with chronic neck and lower back pain.

Our study gives new insights into the relation between the myometrically measurable tissue stiffness and pain. This study found no relation between the most painful site and tissue stiffness as measured with a myometer in 40 participants with chronic neck and back pain. It also found that tissue stiffness as measured with a myometer did not change following cupping massage applied at the most painful site. The results of the study should lead to further, confirmatory research.