0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Academia and the Profession |

COMPLEMENTARY AND ALTERNATIVE MEDICINE SERIES

Series Editors: David M. Eisenberg, MD, and Ted J. Kaptchuk, OMD

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.

A Review of the Evidence for the Effectiveness, Safety, and Cost of Acupuncture, Massage Therapy, and Spinal Manipulation for Back Pain

Daniel C. Cherkin, PhD; Karen J. Sherman, PhD; Richard A. Deyo, MD, MPH; and Paul G. Shekelle, MD, PhD
[+] Article and Author Information

From Group Health Cooperative and University of Washington, Seattle, Washington; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California; and RAND, Santa Monica, California.


Ann Intern Med. 2003;138(11):898-906. doi:10.7326/0003-4819-138-11-200306030-00011
Text Size: A A A

Background: 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.

Purpose: 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.

Data Sources: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register.

Study Selection: 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.

Data Extraction: 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).

Data Synthesis: 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.

Conclusions: 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.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)