THERAPIES & TRADITIONS · GUIDE
Guideline Views on Massage: What Medical Societies Say for Back Pain and Other Conditions
What the American College of Physicians, NICE and cancer-care societies say about massage for back pain, chronic pain and cancer symptoms, with dates and evidence strength.
Content last updated . This page has not been medically reviewed.
Back to Massage & BodyworkA clinical guideline is a recommendation written by a panel after reviewing studies. It is more cautious than a headline and tied to a date. This page reports what specific guidelines said, as we read them on 2026-10-22. Guidelines change, so check the date in the table. Information only; it is not advice about your own care, and massage should not be used to delay seeing a health care provider about a medical problem [1].
Low back pain
American College of Physicians (ACP, United States, 2017). The guideline noted that most people with acute or subacute low back pain improve over time regardless of treatment [2]. For that group it advised choosing non-drug treatment such as superficial heat (moderate-quality evidence), massage, acupuncture or spinal manipulation (low-quality evidence), and gave this a strong recommendation [2]. For chronic low back pain, the first options it named began with exercise [2]. The U.S. National Center for Complementary and Integrative Health (NCCIH) reports that the ACP guideline included massage as an option for acute or subacute low-back pain but not among the options for chronic low-back pain [1]. The review behind the guideline did say evidence continued to support massage, along with other therapies, for chronic low back pain, rated low to moderate, with small to moderate and generally short-term pain benefits [3].
NICE (England, NG59). NICE says to consider manual therapy, including soft tissue techniques such as massage, for low back pain with or without sciatica, but only as part of a treatment package that includes exercise [4]. The recommendation is marked "2016, amended 2026" and the guidance was last updated on 29 July 2026 [4].
Cochrane review (2015). Not a guideline, but often quoted: the authors had very little confidence that massage is an effective treatment for low back pain [5].
Chronic pain in general
NICE (NG193, 2021). For chronic primary pain in people 16 and over, NICE recommends a supervised group exercise programme and says to consider acceptance and commitment therapy or cognitive behavioural therapy [6]. The recommendations page we read does not name massage. Absence from a list is not a ruling that massage is harmful or useless; it means the panel did not make a recommendation about it.
AHRQ-funded review (2020). Not a guideline. For chronic low back pain, massage was linked to short-term improvement in pain (moderate strength of evidence) [7]. For chronic neck pain, massage improved function and pain in the short term, with low strength of evidence [7]. Effect sizes were generally small [7].
Cancer and supportive care
| Guideline | What it said about massage | Notes |
|---|---|---|
| Society for Integrative Oncology and ASCO, pain (2022) | Massage may be recommended for patients experiencing pain during palliative or hospice care [8] | Based on an intermediate level of evidence and moderate strength of recommendation [8] |
| Same guideline | Acupuncture, reflexology or acupressure may be recommended for general cancer pain or musculoskeletal pain [8] | Massage is not on this particular list |
| SIO/ASCO, breast cancer (2018) | Massage is among approaches recommended for depression and mood disorders [9] | The anxiety and stress recommendation named music therapy, meditation, stress management and yoga [9] |
NCCIH adds that lung cancer guidelines suggest massage could be added as supportive care when anxiety or pain is not adequately controlled by usual care, and that the evidence for massage easing pain and anxiety in cancer is not strong [1]. Anyone in cancer treatment should talk to their oncology team first; see Massage and Cancer.
Headache, fibromyalgia and other conditions
We did not find a clinical guideline for these that we could read. NCCIH reports that only a small number of massage headache studies have been completed [1], that hand massage had no effect on migraine frequency in one study [1], and that massage may help some fibromyalgia symptoms if continued for long enough [1]. A 2026 Veterans Affairs evidence map of 14 systematic reviews on non-painful conditions found high-certainty evidence that massage may improve functional constipation, with remaining reviews low or very low certainty or not rated [10]. For osteoarthritis, we read only an abstract of the 2019 American College of Rheumatology guideline that did not mention massage, so we do not state its position. Proper evidence not found here: a readable guideline recommendation for massage in osteoarthritis, headache or fibromyalgia (we searched PubMed for the American College of Rheumatology osteoarthritis and VA/DoD low back pain guidelines and read the two NICE pages above, 2026-10-22).
What guidelines do not tell you
They do not say who is safe to massage; for that see Massage Safety and Contraindications. They do not cover comfort or relaxation, which many people value in its own right. And they depend on the same trials, with the same blinding limits, described in How Massage Is Studied.
Frequently asked questions
Do medical guidelines recommend massage for back pain?
Some do, in limited ways. The ACP 2017 guideline listed massage among options for acute or subacute low back pain, with low-quality evidence [2]. NICE says to consider soft tissue techniques such as massage only as part of a package that includes exercise [4].
Is massage recommended for chronic low back pain?
NCCIH notes the ACP guideline did not include it among chronic options [1], while NICE would consider it alongside exercise [4]. Guidelines differ because panels weigh the same low-certainty trials differently.
What do cancer guidelines say?
The 2022 SIO/ASCO pain guideline says massage may be recommended for pain during palliative or hospice care [8]. The 2018 breast cancer guideline lists massage among approaches recommended for depression and mood disorders [9].
Why does NICE chronic pain guidance not mention massage?
We cannot say why. The recommendations page we read lists exercise and psychological therapies and does not name massage [6].
Can I use a guideline to decide whether to have a massage?
Use it as background only. Talk to your own clinician about your situation, and read Massage Evidence by Goal for the studies behind these recommendations.
References
- NCCIH, Massage Therapy: What You Need To Know (page last updated May 2019). Read 2026-10-22.
- Qaseem et al., Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians (Ann Intern Med, 2017). Abstract read 2026-10-22.
- Chou et al., Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline (Ann Intern Med, 2017). Abstract read 2026-10-22.
- NICE, Low back pain and sciatica in over 16s: assessment and management (NG59), recommendations (published 30 November 2016, last updated 29 July 2026). Read 2026-10-22.
- Furlan et al., Massage for low-back pain (Cochrane Database Syst Rev, 2015). Abstract read 2026-10-22.
- NICE, Chronic pain (primary and secondary) in over 16s (NG193), recommendations (published 7 April 2021). Read 2026-10-22.
- Skelly et al., Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update (AHRQ, 2020). Abstract read 2026-10-22.
- Mao et al., Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline (J Clin Oncol, 2022). Abstract read 2026-10-22.
- Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline (J Clin Oncol, 2018). Abstract read 2026-10-22.
- Mak et al., Evidence Map of Massage Therapy and Acupressure for Non-Painful Health Conditions (VA Evidence Synthesis Program, July 2026). Abstract read 2026-10-22.