Agency News and Notes

Evidence report finds modest and short-term benefit of complementary and alternative therapy for back and neck pain

A new evidence report by the Agency for Healthcare Research and Quality concludes that the benefits of complementary and alternative medicine (CAM therapies)—which include acupuncture and spinal manipulation for low back pain, neck pain, and disability—were modest in size and were mostly evident immediately or shortly after treatment. The observed benefit appeared to fade over time. The reviewers, who were co-led by Andrea Furlan, M.D., Ph.D., Alexander Tsertsvadze, M.D. M.Sc., and Fatemeh Yazdi, M.Sc., with the AHRQ-supported University of Ottawa Evidence-based Practice Center, were not able to draw more definitive conclusions. That's because the evidence was of low to moderate quality, heterogeneous, often inconsistent, and sometimes lacking. Some general findings of the report include the following:

• CAM therapies tended to reduce pain and/or disability more than usual medical care (generally anti-inflammatory drugs and exercise), physical therapy, or no treatment;
• Acupuncture was better than placebo (e.g., sham-TENS, sham-laser, or sham-medication), but only for reducing pain intensity immediately after treatment;
• For people with chronic neck pain, acupuncture was no different from sham-acupuncture, pain medication, mobilization or traction, or laser therapy for reducing pain or disability after treatment.
• Spinal manipulation was better than placebo, and equivalent to pain medication for reducing pain intensity.
• Mobilization was better than placebo for reducing acute and subacute neck pain, but not chronic neck pain.
• Massage was better than placebo for reducing intensity of acute or subacute pain, but not chronic pain.

This review was requested and supported by the National Institutes of Health's National Center for Complementary and Alternative Medicine. For more information, the full report, Complementary and Alternative Therapies for Back Pain II, can be accessed at http://www.ahrq.gov/clinic/tp/backcam2tp.htm.

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