Gout athritis can bring sudden and intense pain at your joints, particularly the big toe, ankles, elbows, wrists, fingers, and knees. While traditional treatments typically involve medication and dietary changes, massage therapy can be used to alleviate severe pain from flare ups.
While the Arthritis Foundation recommends getting a regular massage to reduce pain associated with all forms of arthritis, there’s very little scientific evidence to support or refute massage’s effectiveness for gout arthritis. However, based on the existing evidence for other types of arthritis, massage therapy may alleviate gout arthritic pain in the short term.
What is gout and how does it cause pain?
Gout is primarily caused by a rise of blood urate levels, which is a byproduct of purine metabolism. (Purine is a compound that cells use to make DNA and RNA.) This leads to a supersaturation of urate in your body, increasing the risk of the formation and deposition of urate crystals in and around joints.
Tophus is the accumulation of uric crystals at the toe joints, particularly the big toe, which results in gout. (Illustration by Nick Ng)
According to gout expert Professor Nicola Dalbeth from the University of Auckland and her colleagues, some people with urate crystals in their joints get sudden, sharp pain attacks because of inflammation. This happens when the crystals activate certain immune cells called macrophages, which trigger a process involving other cell parts.
This process turns an inactive protein—interleukin 1β—into an active form that causes inflammation. Along with the crystals, triggers such as long-chain free fatty acids are needed for this reaction. The inflammation worsens as more immune cells release chemicals that cause swelling and pain. Eventually, the body uses anti-inflammatory signals and special structures from immune cells to calm the inflammation.
If left untreated, advanced stages of gout typically show signs after 10 years after the initial flare up, wrote Dalbeth et al. One common sign is a tophus that forms at the first joint of the big toe. (A tophus is a deposit of urate crystals in the body’s soft tissues and joints and resembles a bulge.) Sometimes multiple tophi can form on the joints of fingers, ankles, tarsal, hands, and wrists.
Gout is caused by the buildup of monosodium urate crystals in and around the joints and sometimes in the skin and other soft tissues. These crystals trigger a strong inflammatory response, where the immune system forms clusters of giant cells and histiocytes around them, creating a type of granuloma. (Photo by Dr. Michael P Lee via Flickr, CC BY-SA 4.0)
How does massage alleviate gout pain?
While there’s little scientific evidence on what massage therapy can do for gout arthritis, research from other types of arthritis indicates that massage could reduce the pain temporarily.
A 2017 systematic review of seven randomized-controlled trials that included patients with osteoarthritis or rheumatoid arthritis found that massage therapy “is superior to nonactive therapies in reducing pain and improving certain functional outcomes.” However, the research quality is considered to be low and moderate with high risks of bias.
“It is unclear whether massage therapy is more effective than other forms of treatment,” the researchers wrote.
Despite the inconclusion, several mechanisms play a role in pain reduction, including descending modulation, increase of endorphins in the brain, and skin receptors that detect pressure and type of touch.
For details, read “Does massage reduce arthritis pain?”
Massage precautions for gout.
During an acute gout attack, direct pressure on the affected joint should be avoided as it could further irritate and inflame the area as well as causing pain.
Use gentler approaches, such as a modified Swedish massage with lighter and slow strokes or lymphatic drainage massage.
Massage therapists should consult with the client’s physician and/or physical therapist because treatment. Massage therapy should not be a primary treatment for gout, but it may be used as an adjunct therapy to reduce pain, provide comfort and improve movement and function.
Also, there is no evidence that massage therapy can break down or remove urate crystals from joints.
Other non-drug treatments for gout arthritis
Besides medications, exercise and heat-and-cold therapy may reduce gout pain and improve function, based on existing research.
Exercise
In a 2021 systematic review of 10 studies, exercise may reduce the likelihood of gout flare up. The researchers hypothesized that physical inactivity can cause body fat to accumulate, which may increase chronic inflammation.
“Skeletal muscles produce myokines during exercise which has [an] anti-inflammatory effect for the patients,” they wrote. “Exercises break [the] vicious cycle of chronic inflammation and so reduce the deleterious effect of disease.”
The researchers also pointed out that there is little information about how gout impacts exercise during different stages of the condition.
A 2017 systematic review of 10 studies found that exercise can help those who are overweight or obese in reducing uric acid levels and gout attacks, but these studies’ evidence level was ranked low to moderate.
The researchers reported that there isn’t enough evidence to determine the best amount or speed of weight loss, but losing over 7 kilograms (15.4 pounds) or more than 2 kilograms (4.4 pounds) per week—through surgery or diet—had positive effects on uric acid levels in the medium to long term (based on three studies).
Losing more than 3.5 kilograms (7.7 pounds) also reduced gout attacks in the medium to long term (based on six studies). However, further research may change these findings, they wrote.
Also, the researchers wrote that serious side effects and complications were poorly reported. For example, bariatric surgery temporarily increased uric acid levels and gout attacks immediately after surgery.
“Since the current evidence consists of a few studies (mostly observational) of low methodological quality, there is an urgent need to initiate rigorous prospective studies (preferably randomised controlled trials),” the researchers concluded.
In 2020, a group of researchers from Ohio State University found that exercise could reduce certain genes that cause inflammation from expression in mice. They wrote that low and moderate-intensity exercise produces the anti-inflammatory effect to varying degrees, while high-intensity exercise provides “no significant difference in inflammation compared to non-exercising controls.”
“Consistent with the animal model, gout patients with higher levels of physical activity have more favorable prognostic data,” they wrote. “Collectively, these data suggest the need for further research and may be the foundation to a future paradigm-shift in conventional exercise recommendations provided by rheumatologists to gout patients.”
Heat-cold therapy
Heat-cold therapy may alleviate joint pain in people with gout. A 2021 study of 120 patients with gout compared the intervention group that received heat-cold therapy along with conventional care, such as diet and exercise, with the control group that received the conventional care only.
Patients in the intervention group received alternating heat-cold therapy twice a day for seven days, where their feet, hands, and arms were covered with a plastic bag and were submerged in warm water at 42 degrees Celsius (107 degrees Fahrenheit) for four minutes.
Then their limbs are placed in cold water for about 30 seconds before they are put back in the warm water. This process is repeated for five cycles. After the feet and arms were cleaned with shampoo and dried with a towel, the caregiver applied coconut oil on them for five minutes. The patients were advised to continue this treatment five days a week for one month after discharge.
The researchers reported that the intervention group’s quality of life, sleep quality, and uric acid levels were improved significantly compared to the control group. They added that an increase in parasympathetic activity in the nervous system and a decrease in sympathetic activity would be expected to accompany pain relief with relaxation.
“The cause of the low parasympathetic activity is unknown,” they wrote. “Still, the reduction in sympathetic nerve activity in patients may be due to the effects of soaking in warm water, alternate cold application, and tactile stimulation from massage.”
Nick Ng is the editor of Massage & Fitness Magazine and the managing editor for My Neighborhood News Network.
An alumni from San Diego State University with a bachelor’s in graphic communications, Nick also completed his massage therapy training at International Professional School of Bodywork in San Diego in 2014. In 2021, he earned an associate degree in journalism at Palomar College.
When he gets a chance, he enjoys weightlifting at the gym, salsa dancing, and exploring new areas in the Puget Sound area in Washington state.
