treatment would be determined on the basis of existing data, but likely would be lengthy. The principal endpoint would be whether surgery was determined to be needed. The length of time to follow the subjects would be determined after consultation with experts in the field. Low Back Pain Studies Studies on low back pain fit into two larger categories of investigation of the effects of massage on musculoskeletal disorders resulting in acute and/or chronic pain. Initial work has begun in this field. Researchers at Group Health Center for Health Studies and Beth Israel Deaconess’ Center for Alternative Medicine Research and Education are conducting high quality comparisons of massage and other treatments for lower back pain (both acute and persistent). Cherkin et. al2 indicate possible directions for additional work. For instance, given the relative success of massage compared to acupuncture and selfeducation shown in the Cherkin study, further investigations could attempt to determine whether there is a “best” massage treatment for persistent low back pain. 2B. SUGGESTED SECONDARY PREVENTION STUDIES The MRAW recommended that attention be given to designing high quality studies examining the potential of massage in the area of secondary prevention. Two examples were given. Study Of The Potential For Massage Therapy To Prevent Falling Among The Elderly Falling is a frequent occurrence among elderly persons, which results in both personal and social costs. With an aging population, such as exists in most industrialized countries, this issue will be of great interest. 2 Cherkin, DC, Eisenberg D, Sherman, KJ, et al (2001). Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Archives of Internal Medicine, 161, 1081-1088. 7 It is often said by massage therapists that massage could be used to improve “groundedness” and balance. This could be tested in an elderly population. Subjects could be recruited through private physicians or medical centers after their first visit to a doctor for a fall. Age-related stratification of sample populations may be necessary. Subjects would be randomized to at least two conditions. One group would receive massage (the frequency and number of treatments to be set by the study team), and the other group would receive no massage treatment. Principle outcome measures could include both objective measures related to falling such as the time between falling episodes and the severity of injuries incurred, as well as measures related to quality of life. Secondary Prevention Of Depression Thousands of Americans experience depression and/or take antidepressant medications. This is a painful and costly condition, often accompanied by the unwanted side effects of antidepressants. Depression is affecting younger and younger populations. It is a worthy subject of investigation and preliminary data from studies done at the Touch Research Institute indicate massage may be an effective treatment. Subjects in such a study would be patients who already have experienced clinical depression and are deemed in remission. They would be randomly assigned to massage or no-massage treatment. The frequency and duration of treatment would be determined after examination of existing data. The principal outcome measure would be remission/relapse rate as indicated by future diagnoses of depression, use of antidepressants, and self-reports. 2C. SUGGESTED REPLICATION STUDIES One effect of the relative lack of funding for massage research, and the lack of acknowledged agenda for the work, is that few studies with promising results have been replicated. This is a serious, but easily remedied problem and the MRAW named replication of the best studies as one of the research priorities for the field of therapeutic massage and bodywork. 3. FUND STUDIES OF PHYSIOLOGICAL (OR OTHER) MECHANISMS BY WHICH MASSAGE THERAPY ACHIEVES ITS EFFECTS Inquiry into the avenues through which massage produces its effects is a pertinent and wideopen area for investigation. A myriad of studies could be conducted under this general heading. Systematic Documentation of The Physiological Effects Of Massage It would be useful to conduct research designed to describe the physiological effects of massage separate from the matter of clinical impact. There are physiological effects that are regarded by many as established, but which have not been investigated since the advent of recent measurement tools. The claim that massage increases circulation of blood and lymph would be an example of this, as would investigation of the extent to which massage elicits sympathetic or parasympathetic response. Also, it would be useful to conduct research on the nature of fascia and its role in the effects of massage. 8 Seeking Explanations Of Established Effects Where certain effects of massage have been repeatedly demonstrated, it would be beneficial to establish how the body produces the effect. For instance, studies investigating the effects of massage on premature infants have consistently shown that those infants receiving massage have significantly greater weight gain than the unmassaged infants (a range of 28- 47%), without any greater caloric intake. The mechanism of this weight gain has