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Research on Chronic Low Back Pain
Comparing Acupuncture, Therapeutic Massage, and
Self-care Education.
Two-hundred and sixty two patients, aged 20 – 70, who had persistent back
pain were randomized to receive Traditional Chinese Medical acupuncture,
therapeutic massage, or self-care educational materials. Up to 10 massage
therapy or acupuncture visits were permitted over 10 weeks. Follow-up was
available for 95% of patients after four, 10 and 52 weeks and was assessed by
telephone interviewers masked to treatment group.
Symptoms and dysfunction were primary outcomes observed. Secondary outcomes
include disability, utilization, and cost. Other secondary outcomes measured use
of medication and satisfaction with overall care for the back problem.
After 10 weeks, 74% of patients rated massage as very helpful compared with
46% for acupuncture. Of those using self-care materials only 17% and 26%
considered the book and videotapes, respectively, very helpful. Outcomes
observed for massage and acupuncture at 10 weeks remained relatively unchanged
at one year.
Massage was superior to acupuncture in its effect on symptoms and function.
However, substantial improvements in the self-care group during this period were
noted. The results of this study suggest that massage is an effective short-term
treatment for chronic low back pain with benefits that persist for at least one
year.
Self-care educational materials had little early effect but by year one were
almost as effective as massage. The study was unable to identify any subgroups
that were especially likely to benefit from one or both of these therapies. The
persistent effects and substantially lower utilization of care for the massage
group suggest that the initial costs might be offset by reductions in subsequent
care.
Daniel C. Cherkin, PhD; David Eisenberg, MD, Karen J.
Sherman, PhD, William Barlow, PhD, Ted K. Kaptchuk, OMD, Janet Street, RN, MN,
PNP, Richard A. Deyo, MD, MPH; Arch Intern Med / Vol 161, April 2001
Lower Back Pain is Reduced and Range of Motion Increased after Massage
Therapy
Twenty-four adults with lower back pain were randomly assigned to a massage
therapy or a progressive muscle relaxation group. Massage and relaxation
sessions were 30 minutes long, twice a week for five weeks. On the first and
last day of the five-week study participants completed questionnaires, provided
a urine sample and were assessed for range of motion. Stress, anxiety, pain and
sleep levels were also assessed.
Treatment effects were evaluated for reducing pain, depression, anxiety and
stress hormone and sleeplessness and for improving trunk range of motion
associated with chronic low back pain.
By the end of the study, the massage therapy group, as compared to the
relaxation group, reported experiencing less pain, depression, anxiety and
improved sleep. They also showed improved trunk and pain flexion performance,
and their serotonin and dopamine levels were higher. The study showed that
massage therapy is effective in reducing pain, stress hormones and symptoms
associated with chronic low back pain.
Maria Hernandez-Reif, Tiffany Field, Josh Krasnegor and
Hillary Theakston: Intern. J. Neuroscience, 2001, Vol 106
Research on Acupressure massage and exercises for chronic lower back pain
This study aimed to quantify the effectiveness of therapeutic ‘acupressure’
massage versus Swedish massage and individual medical exercises versus group
exercise in lower back pain sufferers.
One hundred and nine patients participated in a complex in-patient
rehabilitation program. They were randomized to four groups in a 2x2 factorial
design. Functional ability/disability and pain intensity were the main outcomes
measured and pre- and post-changes were evaluated, as was lumbar motility.
Because of some differences between groups at baseline, group-standardized
outcomes were used for analysis.
Acupuncture massage showed beneficial effects for both disability and pain
compared with Swedish massage. Given the fact that even the treatments,
considered to be the best available, achieved at best moderate effects. The
observed effects, sized with acupuncture massage are promising and warrant
further investigation in further studies. In contrast to common view, individual
exercises were not found to be superior to group exercises in the present study.
A. Franke, S. Gebauer, K. Franke, T. Brockow; Forsch
Komplementarmed Klass Naturheikd 2000
Complementary Treatment for Back Pain
Background: 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.
Methods: Randomized controlled trials
published since 1995 and studying acupuncture, massage, or spinal manipulation
were extracted and reviewed.
Results: 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.
Conclusions: 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.
HARVEY and colleagues, Department of Health Sciences, Alcuin College,
University of York, York, UK, ,
introduce a treatment package of spinal manipulation for back pain agreed on by
the UK
chiropractic, osteopathy and physiotherapy professional associations.
Abstract: In this review (29 references), a
spinal manipulation package agreed by the UK professional associations
representing chiropractors, osteopaths and physiotherapists is described. It was
devised for use in a large national trial of exercise and spinal manipulation
for back pain designed to answer important questions about the benefits of
spinal manipulation for back pain. In the design of this trial it was
acknowledged that the spinal manipulation treatments provided by practitioners
from the three professions shared more similarities than differences, and it
became possible to devise a homogeneous package representative of, and
acceptable to, all three. The resulting package is pragmatic in that it
represents what happens to most people undergoing manipulation, and it excludes
discipline-specific variations and other ancillary treatments.
Harvey E, Burton AK,
Moffett JK, Breen A. Spinal manipulation for low-back pain: a treatment package
agreed to by the UK chiropractic, osteopathy and physiotherapy professional
associations. Manual Therapy 8 (1): 46-51, Feb 2003.
CHERKIN and colleagues, Group Health Cooperative and University of
Washington, Seattle, Washington 98101
Effectiveness of massage therapy for subacute low-back pain
This study compared the effectiveness of comprehensive massage therapy, two
separate components of massage therapy and a placebo for the treatment of
sub-acute low back pain. There were 107 subjects randomly assigned to one of
four groups: comprehensive massage therapy (soft-tissue manipulation, remedial
exercise and posture education), soft-tissue manipulation only, remedial
exercise with posture education only or a placebo of sham laser treatment.
Two primary outcome measures were functionality and pain relief. Two
secondary outcome measures were anxiety and lumbar range of motion.
At the end of the treatment the soft-tissue manipulation group had
significantly better scores than the sham laser group on the PPI.
At follow-up the soft-tissue manipulation group was not distinguishable from
the exercise group; both group means were statistically better than the mean for
the sham laser group on the RDQ. At the end of treatment and at follow-up the
comprehensive massage therapy group had significantly better scores than the
sham laser group on state anxiety, whereas no other group did. The mean scores
on the pain indexes for all the groups were lower at the end of treatment than
at baseline.
All subjects’ reported levels of pain in the comprehensive massage therapy
group decreased in intensity from baseline to post treatment, which did not
occur in any other group. At the onemonth follow-up, 63% of the subjects in the
comprehensive massage therapy group reported no pain, as compared with 27% in
the soft-tissue manipulation group, 14% in the exercise group and 0% in the sham
laser group.
Michele Preyde; Canadian Medical Association Journal, June
27, 2000
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