Comparative Efficacy of Oil–Assisted Deep–Tissue Nuad Thai with and without Thai Herbal Hot Compress for Relieving Muscle Pain in Patients with Myofascial Pain Syndrome: A Randomized Controlled Trial

Abstract

Introduction and Objective: Chronic pain, particularly in patients with myofascial pain syndrome (MPS), characterized by hyperirritable myofascial trigger points (TrPs) within skeletal muscles, is a significant health problem affecting quality of life with high recurrence rates, especially in the trapezius muscle. This study aimed to compare the efficacy of oil–assisted deep–tissue Nuad Thai combined with Thai herbal hot compress versus oil–assisted deep–tissue Nuad Thai alone in relieving chronic pain.

Methods: A randomized controlled trial (RCT) was conducted in 60 participants aged 25–55 years with trapezius MPS, divided into two groups of 30 using stratified randomization. The experimental group received a 1–hour session of oil–assisted deep–tissue Nuad Thai using the "Chaloei Sak" (folk–style) technique along the "Sen Sib" lines (similar in pressure and strokes to Swedish massage) combined with a 20–30–minute standard Thai herbal hot compress. The control group received only a 1–hour oil–assisted deep–tissue Nuad Thai. Both groups received treatment once weekly for three consecutive weeks. Outcomes were evaluated using the Visual Analog Scale (VAS) for pain assessment, Neck Disability Index (NDI), Pressure Pain Threshold (PPT) at 7 trigger points (TrP1–TrP7) of left and right sides of trapezius muscle, participant–perceived pain improvement and participant satisfaction. Following one drop–out in the experimental group after the first session due to personal illness, per–protocol analysis was performed on 59 participants (29 experimental, 30 control).

Results: Baseline characteristics showed no statistically significant differences between groups (p > 0.05). After 3 weeks, both groups showed significant reductions in VAS pain and NDI scores (p < 0.05). Mean reductions for the experimental and control groups were 4.55 vs. 4.17 points for VAS and 14.17 vs. 11.40 points for NDI, respectively, with no significant differences between groups. PPT values increased significantly across all trigger point locations (p < 0.001) in both groups, most prominently at TrP2 (upper portion). Though the increase of PPT values in experimental group seemed to be slightly higher than that of the control group, there were no significant differences between groups. Regarding perceived pain improvement, most participants in the experimental group (55.20%) reported moderate improvement, whereas 63.34% of participants in the control group reported high improvement, with no statistically significant difference between groups (p = 0.174). Participant satisfaction was 100.00% in the experimental group and 96.70% in the control group (p = 1.000).

Discussion: Both modalities effectively reduced VAS and NDI after 3 weeks. Mechanical pressure from deep–tissue massage facilitated myofascial release, enhanced blood circulation, and inhibited spinal pain signals via gate control theory alongside parasympathetic activation. Despite non–significant intergroup differences (p > 0.05), the experiment group that also received herbal hot compress showed slightly greater pain reduction, this could partly be due to the thermal effects lowering connective tissue viscosity while increasing vasodilation, combined with anti–inflammatory action from phlai (Zingiber montanum rhizome) and turmeric. Significant PPT increases at all trigger points (p < 0.001), especially TrP2, confirmed reduced muscle pain sensitivity.

Conclusion and Recommendations: Both oil–assisted deep–tissue Nuad Thai with herbal hot compress and oil–assisted deep–tissue Nuad Thai alone significantly reduced pain and improved neck function without statistical intergroup differences. Both methods are safe, cost–effective alternative therapies suitable for individuals experiencing chronic pain resulting from repetitive strain and muscular overuse.