In the United States, back pain has become a prevalent health problem for a large percentage of the population. Billions of dollars are spent every year for treatment; employers and employees are also losing money because of loss of productivity. For back pain relief, those who suffer this common condition usually try the usual pain medications but many of them are not satisfied with the results. Some may even fears about possible adverse effects. Fortunately, a growing number of patients with back pain are now trying complementary and alternative medical therapies. A recent study published in the Annals of Internal Medicine look at the effectiveness, safety and cost of spinal manipulation, massage and acupunture.

Over the years, there were randomized controlled trials (RCTs) that were conducted to evaluate acupuncture, massage therapy, or spinal manipulation for nonspecific back pain. A randomized controlled trial is usually conducted to test the efficacy of various types of treatment for a group of patients. Reviews were also done to evaluate a number of these trials. To have an overview of the results from these reviews, a group of researchers compiled and analyzed data from these reviews as well as directly from the actual articles that described the trials. The reviews provide information on number of trials covered, type of back pain, quality assessment, and conclusions or results. The original articles provide information on the type of pain, comparison treatments, sample size, outcomes, follow-up intervals, loss to follow-up, and the conclusions of the authors.

Overall, there was evidence for the safety of acupuncture, massage and spinal manipulation. However, it was not clear from the 20 randomized controlled trials with acupuncture that it was effective in relieving back pain. Based on the three trials with massage, it was found to work for subacute and persistent back pain and has the potential to reduce health care costs after initial course of therapy. Spinal manipulation, however, is more effective than placebo therapies and has some advantages comparable to the benefits of traditional therapies for acute and chronic back pain according to findings from 26 trials.

Spinal manipulation has become the most sought after complementary and alternative medical therapy for back pain in the United States. It is offered mostly in chiropractic clinics and covered by most insurance plans. As it becomes increasingly available for pain treatment, more studies will also be available in support of its effectiveness and safety.


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