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Complementary and alternative therapies for back pain II.

Andrea D Furlan, Fatemeh Yazdi, Alexander Tsertsvadze

    Evidence Report/Technology Assessment
    |November 7, 2012
    PubMed
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    Complementary and Alternative Medicine (CAM) therapies like acupuncture, spinal manipulation, and massage show short-term benefits for back and neck pain but lack long-term evidence. More high-quality research is needed to confirm their effectiveness and safety.

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    Area of Science:

    • Pain Management Research
    • Evidence-Based Medicine
    • Complementary and Alternative Medicine (CAM)

    Background:

    • Back and neck pain are significant health issues with substantial societal and economic impact.
    • Conventional treatments often yield limited benefits for patients.
    • Complementary and Alternative Medicine (CAM) therapies present additional management options, though trial quality and results are frequently inconsistent.

    Purpose of the Study:

    • To systematically review the efficacy, effectiveness, cost-effectiveness, and harms of acupuncture, spinal manipulation, mobilization, and massage.
    • To evaluate these CAM therapies for managing back, neck, and/or thoracic pain.

    Main Methods:

    • Comprehensive literature search of multiple databases (MEDLINE, Cochrane, EMBASE, CINAHL) up to 2010, including unpublished literature.
    • Inclusion of randomized controlled trials (RCTs) and non-randomized controlled trials/observational studies for harms.
    • Data extraction by two independent reviewers on study, participant, treatment, and outcome characteristics.

    Main Results:

    • Acupuncture showed short-term pain reduction for chronic low back pain compared to placebo but not for disability or medication use.
    • Spinal manipulation was superior to placebo or no treatment for immediate/short-term pain relief in back and neck pain.
    • Massage demonstrated superiority over placebo/no treatment for acute/sub-acute low back pain and over physical therapy for back pain.
    • Reporting of harms was poor; adverse events included pain worsening and, in rare cases, vertebral artery dissection associated with cervical manipulation.

    Conclusions:

    • Evidence quality for CAM therapies is poor to moderate, primarily for chronic pain, limiting definitive conclusions for acute/sub-acute conditions.
    • Observed benefits of CAM treatments are mostly immediate or short-term, fading over time, with limited long-term outcome data.
    • Inconsistent trial results due to methodological and clinical diversity necessitate improved study conduct, reporting quality, and well-powered head-to-head comparisons.