Daniel C. Cherkin, PhD; Karen J. Sherman, PhD; Richard A. Deyo, MD, MPH; Paul G. Shekelle, MD, PhD
Grant Support: By grant RO1 HS 09989 from the Agency for Healthcare Research and Quality and the National Center for Complementary and Alternative Medicine, National Institutes of Health, and by grants AT00622 and AT00606 from the National Center for Complementary and Alternative Medicine, National Institutes of Health.
Potential Financial Conflicts of Interest:Employment: K.J. Sherman (former Research Director of the Northwest Institute of Acupuncture and Oriental Medicine); Grants pending: D.C. Cherkin (National Institutes of Health), K.J. Sherman (National Institutes of Health).
Requests for Single Reprints: Daniel C. Cherkin, PhD, Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101.
Current Author Addresses: Drs. Cherkin and Sherman: Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101.
Dr. Deyo: Departments of Medicine and Health Services, University of Washington, 146 North Canal Street, Suite 300, Seattle, WA 98103-8652.
Dr. Shekelle: RAND, 1700 Main Street, PO Box 2138, Santa Monica, CA 90407.
Few treatments for back pain are supported by strong scientific evidence. Conventional treatments, although widely used, have had limited success. Dissatisfied patients have, therefore, turned to complementary and alternative medical therapies and providers for care for back pain.
To provide a rigorous and balanced summary of the best available evidence about the effectiveness, safety, and costs of the most popular complementary and alternative medical therapies used to treat back pain.
MEDLINE, EMBASE, and the Cochrane Controlled Trials Register.
Systematic reviews of randomized, controlled trials (RCTs) that were published since 1995 and that evaluated acupuncture, massage therapy, or spinal manipulation for nonspecific back pain and RCTs published since the reviews were conducted.
Two authors independently extracted data from the reviews (including number of RCTs, type of back pain, quality assessment, and conclusions) and original articles (including type of pain, comparison treatments, sample size, outcomes, follow-up intervals, loss to follow-up, and authors' conclusions).
Because the quality of the 20 RCTs that evaluated acupuncture was generally poor, the effectiveness of acupuncture for treating acute or chronic back pain is unclear. The three RCTs that evaluated massage reported that this therapy is effective for subacute and chronic back pain. A meta-regression analysis of the results of 26 RCTs evaluating spinal manipulation for acute and chronic back pain reported that spinal manipulation was superior to sham therapies and therapies judged to have no evidence of a benefit but was not superior to effective conventional treatments.
Initial studies have found massage to be effective for persistent back pain. Spinal manipulation has small clinical benefits that are equivalent to those of other commonly used therapies. The effectiveness of acupuncture remains unclear. All of these treatments seem to be relatively safe. Preliminary evidence suggests that massage, but not acupuncture or spinal manipulation, may reduce the costs of care after an initial course of therapy.
Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. A Review of the Evidence for the Effectiveness, Safety, and Cost of Acupuncture, Massage Therapy, and Spinal Manipulation for Back Pain. Ann Intern Med. ;138:898–906. doi: 10.7326/0003-4819-138-11-200306030-00011
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Published: Ann Intern Med. 2003;138(11):898-906.
Back Pain, Rheumatology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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