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Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation

Giles, Lynton G. F., DC, PhD*†; Muller, Reinhold, PhD

doi: 10.1097/01.BRS.0000077932.80560.02
Randomized Trial

Study Design. A randomized 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%vs 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 improvement than acupuncture or medication. However, the data do not strongly support the use of only manipulation, only acupuncture, or only nonsteroidal antiinflammatory drugs for the treatment of chronic spinal pain. The results from this exploratory study need confirmation from future larger studies.

From the *National Unit for Multidisciplinary Studies of Spinal Pain, The University of Queensland, The Townsville Hospital, Townsville, Queensland,

and the †School of Public Health and Tropical Medicine, James Cook University, Townsville, Queensland, Australia.

Supported by the Queensland State Government Health Department and partly supported by The Townsville Hospital.

Acknowledgment date: June 3, 2002.

First revision date: October 8, 2002.

Acceptance date: December 10, 2002.

Address correspondence and reprint requests to Lynton G. F. Giles, DC, PhD, P.O. Box 2131, Townsville, Queensland, Australia 4810; E-mail: lgiles@austarnet.com.au

The legal regulatory status of the device(s)/drug(s) that is/are the subject of this manuscript is not applicable in my country. The device(s)/drug(s) is/are FDA-approved or approved by a corresponding national agency for this indication. Yes, State funds were received to support this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2003 Lippincott Williams & Wilkins, Inc.