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Chronic spinal pain. A randomized clinical trial comparing medication, acupuncture, and spinal manipulation [with consumer summary]
Giles LG, Muller R
Spine 2003 Jul 14;28(14):1490-1503
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

STUDY DESIGN: A randomised controlled clinical trial was conducted. OBJECTIVE: To compare medication, needle acupuncture, and spinal manipulation for managing chronic (> 13 weeks duration) spinal pain because the value of medicinal and popular forms of alternative care for chronic spinal pain syndromes is uncertain. SUMMARY OF BACKGROUND DATA: Between February 1999 and October 2001, 115 patients without contraindication for the three treatment regimens were enrolled at the public hospital's multidisciplinary spinal pain unit. METHODS: One of three separate intervention protocols was used: medication, needle acupuncture, or chiropractic spinal manipulation. Patients were assessed before treatment by a sports medical physician for exclusion criteria and by a research assistant using the Oswestry Back Pain Disability Index (Oswestry), the Neck Disability Index (NDI), the Short-Form-36 Health Survey questionnaire (SF-36), visual analog scales (VAS) of pain intensity and ranges of movement. These instruments were administered again at 2, 5, and 9 weeks after the beginning of treatment. RESULTS: Randomization proved to be successful. The highest proportion of early (asymptomatic status) recovery was found for manipulation (27.3%), followed by acupuncture (9.4%) and medication (5%). Manipulation achieved the best overall results, with improvements of 50% (p = 0.01) on the Oswestry scale, 38% (p = 0.08) on the NDI, 47% (p < 0.001) on the SF-36, and 50% (p < 0.01) on the VAS for back pain, 38% (p < 0.001) for lumbar standing flexion, 20% (p < 0.001) for lumbar sitting flexion, 25% (p = 0.1) for cervical sitting flexion, and 18% (p = 0.02) for cervical sitting extension. However, on the VAS for neck pain, acupuncture showed a better result than manipulation (50% versus 42%). CONCLUSIONS: The consistency of the results provides, despite some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term.
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