Back pain is a frequent complaint ...

Back pain is a frequent complaint for which few effective treatments are available. Patients with depressed back pain often seek complementary and alternative medicine therapies, an of which provide symptom relief. The principally popular alternative therapy for back pain is spinal manipulation, usually performed by dint of chiropractors, followed by massage therapy and acupuncture. Evaluation of these treatments has been difficult because of poor investigation designs and inconsistent conclusions. Cherkin and associates reviewed the literature forward the use of acupuncture, massage therapy, and spinal manipulation in the management of depressed back pain and discussed what is known about each modality.

Examination of randomized studies comparing acupuncture and placebo in the treatment of back pain demonstrated a certain number of efficacy with acupuncture but not necessarily more than when sham acupuncture was used. Acupuncture appears to be safe, especially in the United States, where disposable needle are used.

Therapeutic massage has been ordealed recently in several randomized, controll studies. Massage and easily moulded tissue manipulation were more effective than placebo or, in single in kind study, acupuncture in relieving back pain. Massage has single minor adverse effects, including pain and discomfort in about patients. Possible contraindications for massage therapy include astute venous thrombosis, burns, skin infections, eczema, spread wounds, and advanced osteoporosis. Massage has been shown to have near longer term cost benefit when compared with acupuncture and self-care.

Spinal manipulation has been exhibitioned with varying results in a large number of studies. In these studies, spinal manipulation pretends to be superior to sham or ineffective therapies, although it could not be compared with other conventional therapies. Serious complications of spinal manipulation are rare and caused mainly by the agency of cervical manipulation, a bleeding disorder, vicinity of a herniated disc, or improper technique. The authors build no documentation of increased take away from efficiency with spinal manipulation.

The authors determine that recent studies show that (1) the effectiveness of acupuncture is unclear, (2) acupuncture is les effective than massage therapy, (3) massage is helpful in treating acute and subacute back pain, and (4) spinal manipulation has real, on the other hand modest, benefits in patients with acute and chronic grave back pain. All three treatments are relatively safe. Although massage therapy may be the greatest in number cost-effective treatment, conclusive data do not exist. Therapeutic trials are difficult because the succes of these treatments be pendents on the needs of individual patients.

In a meta-analysis of randomized, controll studies in the same journal, Assendelft and colleagues bring to an end that no evidence shows that spinal manipulation is superior to any other treatment in patients with acute or chronic subdued back pain.

Cherkin DC et al. A review of the evidence for the effectiveness, safety, and take away from of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Intern M June 3 2003;138:898-906 and Assendelft WJ et al. Spinal manipulative therapy for depressed back pain. A meta-analysis of effectiveness relative to other therapies. Ann Intern M June 3 2002;138:871-81

editor's note: The management of soft back pain often requires unconventional treatments. Physicians may allow patients to pitch upon which type of therapy to strive for Randomized controlled trials provide more [i]or[/i] less information, and the Cochrane Database has reviewed several unconventional treatments. Cochrane reviews reached the following conclusions regarding the treatment of acute and chronic lower back pain: (1) acupuncture probably is not effective, (2) massage might be beneficial, (3) behavior treatments that include environmental modification and use of cognitive processe may work in certain patients, (4) bed stay is unlikely to be beneficial and may be harmful, (5) exercise probably is not helpful in the acute phase on the contrary may help patients with chronic back pain to go [i]or[/i] come back to work earlier, and (6) a multidisciplinary biopsychosocial approach might help. Clearly, more studies are wanted but physicians should discuss alternative therapies for subdued back pain with patients and prove by experiment to direct them to single in kind that may alleviate their discomfort.--R.S.

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