Research: CHERKIN and colleagues,

Listed in Issue 92


CHERKIN and colleagues, Group Health Cooperative and University of Washington, Seattle, Washington 98101, USA, have reviewed (48 references) the efficacy, safety, and cost of acupuncture, massage, and spinal manipulation for back pain.


Conventional treatments for back pain, although widely used, have limited success. Therefore sufferers often turn to complementary therapies. This study was aimed at providing a balanced summary of the best available evidence for the efficacy, safety and cost of the most popular complementary treatments for back pain.


Medline, Embase, and the Cochrane Controlled Trials Register were searched. Randomized controlled trials published since 1995 and studying acupuncture, massage, or spinal manipulation were extracted and reviewed.


Because the quality of the 20 trials of acupuncture included in the review is generally poor, the effectiveness of acupuncture for back pain is at present unclear. 3 studies of massage reported that massage is effective for subacute and chronic back pain. 26 trials of spinal manipulation suggest that spinal manipulation is better than placebo therapy but no better than conventional treatment.


Initial studies find that massage is beneficial for chronic back pain. Spinal manipulation offers small benefits comparable to those found with conventional treatment. All of the treatments investigated seem to be relatively safe. Preliminary evidence suggests that massage but not acupuncture or spinal manipulation may reduce healthcare costs.


Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. A review of the evidence for the effectiveness, safety and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Annals of Internal Medicine 138 (11): 898-906, Jun 2003.

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