CAM for Back and Neck Pain: Review of the Research
Chiropractic, acupuncture and massage research reviewed in detailed University of Ottawa report
By Editorial Staff
A massive research review and analysis conducted by the University of Ottawa Evidence-Based Practice Center, as commissioned by the U.S. Agency for Healthcare Research and Quality, and "summarized" in nearly 700 pages, provides insight into the clinical efficacy and cost-effectiveness of chiropractic, acupuncture and massage therapy. The report relies on data from 265 randomized, controlled trials and five non-RCTs involving CAM use by adults with back, neck and/or thoracic pain.
For the sake of brevity, we present excerpts from the results section of the report's structured abstract only; access the report in its entirety atwww.ahrq.gov/down loads/pub/evidence/pdf/backpaincam/backcam2.pdf.
Chiropractic: "For both low back and neck pain, manipulation was significantly better than placebo or no treatment in reducing pain immediately or short-term after the end of treatment. Manipulation was also better than acupuncture in improving pain and function in chronic nonspecific low back pain. Results from studies comparing manipulation to massage, medication, or physiotherapy were inconsistent, in favor of manipulation or indicating no significant difference."
"Mobilization was superior to no treatment but not different from placebo in reducing low back pain or spinal flexibility after the treatment. Mobilization was better than physiotherapy in reducing low back pain ... and disability (Oswestry). ... In subjects with acute or subacute neck pain, mobilization compared to placebo significantly reduced neck pain. Mobilization and placebo did not differ in subjects with chronic neck pain."
Massage: "Massage was superior to placebo or no treatment in reducing pain and disability only amongst subjects with acute/sub-acute low back pain. Massage was also significantly better than physical therapy in improving back pain ... or disability. For subjects with neck pain, massage was better than no treatment, placebo, or exercise in improving pain or disability, but not neck flexibility. "
Acupuncture: "Acupuncture for chronic nonspecific low back pain was associated with significantly lower pain intensity than placebo, but only immediately post-treatment ... However, acupuncture was not different from placebo in post-treatment disability, pain medication intake, or global improvement in chronic nonspecific low back pain. Acupuncture did not differ from sham-acupuncture in reducing chronic non-specific neck pain immediately after treatment. ... Acupuncture was superior to no treatment in improving pain intensity ... disability (PDI), functioning (HFAQ), well-being (SF-36), and range of mobility (extension, flexion), immediately after the treatment. In general, trials that applied sham-acupuncture tended to produce negative results (i.e., statistically non-significant) compared to trials that applied other types of placebo (e.g., TENS, medication, laser)."
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