Objective
To assess the long-term benefits of medication, needle acupuncture, and spinal manipulation
as exclusive and standardized treatment regimens in patients with chronic (>13 weeks)
spinal pain syndromes.
Study Design
Extended follow-up (>1 year) of a randomized clinical trial was conducted at the multidisciplinary
spinal pain unit of Townsville's General Hospital between February 1999 and October
2001.
Patients and Methods
Of the 115 patients originally randomized, 69 had exclusively been treated with the
randomly allocated treatment during the 9-week treatment period (results at 9 weeks
were reported earlier). These patients were followed up and assessed again 1 year
after inception into the study reapplying the same instruments (ie, Oswestry Back
Pain Index, Neck Disability Index, Short-Form-36, and Visual Analogue Scales). Questionnaires
were obtained from 62 patients reflecting a retention proportion of 90%. The main
analysis was restricted to 40 patients who had received exclusively the randomly allocated
treatment for the whole observation period since randomization.
Results
Comparisons of initial and extended follow-up questionnaires to assess absolute efficacy
showed that only the application of spinal manipulation revealed broad-based long-term
benefit: 5 of the 7 main outcome measures showed significant improvements compared
with only 1 item in each of the acupuncture and the medication groups.
Conclusions
In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated,
may be the only treatment modality of the assessed regimens that provides broad and
significant long-term benefit.
Key Indexing Terms
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References
- Pain: an overview.Lancet. 1999; 353: 1607-1609
- Diagnostic evaluation of LBP: reaching a specific diagnosis is often impossible.Arch Intern Med. 2002; 162: 1444-1447
- Influence of previous pain experience on the episode incidence of low back pain: results from the South Manchester Back Pain Study.Pain. 1996; 66: 181-185
- Idiopathic low back pain: magnitude of the problem.in: White AA Gordon SL American Academy of Orthopaedic Surgeons symposium on idiopathic low back pain. Mosby, Toronto1982: 5-8
- Conservative treatment of acute and chronic nonspecific low back pain: a systematic review of randomized controlled trials of the most common interventions.Spine. 1997; 22: 2128-2156
- Chronic low back pain in primary care: a prospective study on the management and course.Fam Pract. 1998; 15: 126-132
- Non-operative treatment of low back disorders. Differentiating useful from useless therapy.in: Frymoyer JW The adult spine: principles and practice. Raven Press, New York1991: 1567-1580
- Patient satisfaction, characteristics, radiology, and complications associated with attending a specialized government funded multidisciplinary spinal pain unit.J Manipulative Physiol Ther. 2003; 26: 293-299
- Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture and spinal manipulation.Spine. 2003; 28: 1490-1503
- Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment.BMJ. 1990; 300: 1431-1437
- Management of chronic pain.Lancet. 1999; 353: 1865-1869
- Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a non-steroidal anti-inflammatory drug and spinal manipulation.J Manipulative Physiol Ther. 1999; 22: 376-381
- Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up.BMJ. 1995; 311: 349-351
- A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study.Spine. 2002; 27: 2193-2204
- Seeking care for low back pain in the general population. A two-year follow-up study: results from the MUSIC-Norrtalje study.Spine. 2002; 27: 2159-2165
- Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain.Spine. 2002; 27: 2383-2389
- Myofascial pain syndromes: a short review. The Web-Journal of Acupuncture.
- Chiropractic management of low back pain of mechanical origin.in: Giles LGF Singer KP Clinical anatomy and management of low back pain. Butterworth Heinemann, Oxford1997: 344-357
- Measurement of pain.Lancet. 1974; 2: 1127-1131
- The Oswestry low back pain disability questionnaire.Physiotherapy. 1980; 66: 271-273
- The neck disability index: a study of reliability and validity.J Manipulative Physiol Ther. 1991; 14: 409-415
- Rand 36-item health survey 1.0.Rand Corporation, Santa Monica, CA1992
- SF-36 physical and mental health summary scores: a user's manual.The Health Institute, New England Medical Centre, Boston, MA1994
- Better reporting of randomised controlled trials: the CONSORT statement.BMJ. 1996; 313: 570-571
- Blinding in randomised trials: hiding who got what.Lancet. 2002; 359: 696-700
- Scientific approach to the assessment and management of activity-related spinal disorders. A monograph for physicians. Report of the Quebec Task Force on spinal disorders.Spine. 1987; 12: s1-s59
- Spine update. Methods for evaluating treatment outcomes and ways to overcome potential obstacles.Spine. 1994; 19: 1751
- The low back.in: Cruess JRW Adult orthopaedics. Churchill-Livingstone, New York, NY1984: 843-937
- Relative cost-effectiveness of extensive and light multidisciplinary treatment programs versus treatment as usual for patients with chronic low back pain on long-term sick leave.Spine. 2002; 9: 901-910
- Suffering: the contributions of persistent pain.Lancet. 1999; 353: 2233-2237
- Chronic pain of spinal origin. The costs of intervention.Spine. 2002; 27: 2614-2619
- Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain.Clin J Pain. 2002; 18: 355-365
Article info
Footnotes
Sources of support: Supported by the Queensland State Government Health Department.
Sources of support: Supported by the Queensland State Government Health Department.
Identification
Copyright
© 2005 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
