A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation.

Giles and Muller: Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation. Spine July 15, 2003; 28(14):1490-1503

Objective: To compare medication, needle acupuncture, and spinal manipulation for managing chronic spinal pain.

Design: RCT, 115 patients, public hospitals multidisciplinary spinal pain unit. Evaluated at 2, 5, and 9 weeks. Manipulation performed by DCs with 18 adjustments or less. Drugs used; Celebrex, Vioxx, paracetamol. Average duration of spine pain was 8.3 years for the manipulation group.

Results: The highest proportion of early (asymptomatic status) recovery was
found for manipulation (27.3%), followed by acupuncture (9.4%) and medication (5%).

Conclusions: The consistency of the results provides evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication.

Points of interest:

1. It is impossible to reach specific diagnosis for the pathologic cause for 85% of those with an episode of spinal pain.
2. Patients with low back pain do exhibit abnormal spinal motion.
3. There is insufficient evidence for the use of NSAIDs to manage chronic low back pain.
4. The new COX-2 nonsteroidal anti-inflammatory (NSAIDs) drugs have problems and significant contraindications.
5. Gastrointestinal toxicity induced by NSAIDs is one of the most common serious adverse drug events in the industrialized world.
6. In this study, in the medication group, more patients experienced adverse events (6.1%) than recovered from their spinal complaints (5%).
7. Even though the chiropractic treatment group was the most chronic (8.3 years), 27.3% recovered with 18 spinal adjustments over a period of 9 weeks, or less. This means that better than every fourth patient became asymptomatic with 9 weeks or less of chiropractic manipulation, even though they had been chronic for more than 8 years.
8. The chiropractic group showed significantly greater improvement in subjective complaints, functional abilities, objective range of spinal motion, and in general health status than acupuncture and medication.
9. In this study, patient involvement in litigation did not influence the outcome measures.
10. In the treatment of chronic spinal pain, chiropractic manipulation is superior to acupuncture and medication.