Cross-sectional studies have shown that arthritis is the most frequent reason for the elderly to use complementary and alternative medicine (CAM), probably due to ineffective pain relief, or adverse effects attributed to conventional medication, or the patients' own health beliefs . So far, increasing interest has focused on massage therapy as complementary and alternative treatment for OA. Nonetheless, since massage characteristics such as massage technique, duration, frequency, and number of sessions are supposed to closely relate to pain relief efficacy, the massage procedure used in this study was therefore performed by the same massage practitioner and confined to a one-hour session of Suandok massage, three times weekly for three consecutive weeks, in order to standardize massage therapy given to each patient in the TM group. A three times weekly dosing protocol was likely to be adequate according to the evidence from a previous randomized dose-finding trial showing that a one-hour once weekly massage protocol is the lowest optimal dose.