Shopping Cart
Your Cart is Empty
Quantity:
Subtotal
Taxes
Shipping
Total
There was an error with PayPalClick here to try again
CelebrateThank you for your business!You should be receiving an order confirmation from Paypal shortly.Exit Shopping Cart

Blog

Blog

CAM Therapies in treating non-specific LOW BACK PAIN

Posted on September 27, 2015 at 11:05 AM

 

 

 

Complementary and Alternative Therapies for Back Pain II

 

Evidence Reports/Technology Assessments, No. 194

 

Investigators: Andrea D Furlan, MD, PhD, Fatemeh Yazdi, BScPT, MSc, Alexander Tsertsvadze, MD, MSc, Anita Gross, BScPT, MSc, Maurits Van Tulder, PhD, Lina Santaguida, BScPT, PhD, Dan Cherkin, PhD, Joel Gagnier, ND, PhD, Carlo Ammendolia, DC, PhD, Mohammed T Ansari, MBBS, MMedSc, MPhil, Thomas Ostermann, PhD, Trish Dryden, RMT, MEd, Steve Doucette, MSc, Becky Skidmore, MLS, Raymond Daniel, BA, Sophia Tsouros, BHKin, Laura Weeks, PhD, and James Galipeau, PhD.

 

University of Ottawa Evidence-based Practice Center

 

Rockville (MD): Agency for Healthcare Research and Quality (US); 2010 Oct.

Report No.: 10(11)-E007

 

Copyright and Permissions

 

 

 

Structured Abstract

 

Background:

Back and neck pain are important health problems with serious societal and economic implications. Conventional treatments have been shown to have limited benefit in improving patient outcomes. Complementary and Alternative Medicine (CAM) therapies offer additional options in the management of low back and neck pain. Many trials evaluating CAM therapies have poor quality and inconsistent results.

 

Objectives:

To systematically review the efficacy, effectiveness, cost-effectiveness, and harms of acupuncture, spinal manipulation, mobilization, and massage techniques in management of back, neck, and/or thoracic pain.

 

Data Sources:

MEDLINE, Cochrane Central, Cochrane Database of Systematic Reviews, CINAHL, and EMBASE were searched up to 2010; unpublished literature and reference lists of relevant articles were also searched.

 

Study Selection:

All records were screened by two independent reviewers. Primary reports of comparative efficacy, effectiveness, harms, and/or economic evaluations from randomized controlled trials (RCTs) of the CAM therapies in adults (age ≥ 18 years) with back, neck, or thoracic pain were eligible. Non-randomized controlled trials and observational studies (case‐control, cohort, cross-sectional) comparing harms were also included. Reviews, case reports, editorials, commentaries or letters were excluded.

 

Data Extraction:

Two independent reviewers using a predefined form extracted data on study, participants, treatments, and outcome characteristics.

 

Data Analysis:

Included studies were stratified by the region, cause, and duration of pain. Evidence was summarized qualitatively and RCTs were pooled according to the post-treatment followup at which the outcomes were measured. Subgroup and sensitivity analyses were planned a priori. Publication bias was examined through visual inspection of funnel plot and a regression-based method.

 

Results:

265 RCTs and 5 non-RCTs were included. Acupuncture for chronic nonspecific low back pain was associated with significantly lower pain intensity than placebo but only immediately post-treatment (VAS: -0.59, 95 percent CI: -0.93, -0.25). However, acupuncture was not different from placebo in post-treatment disability, pain medication intake, or global improvement in chronic nonspecific low back pain. Acupuncture did not differ from sham-acupuncture in reducing chronic non-specific neck pain immediately after treatment (VAS: ‐0.24, 95 percent CI: -1.20, 0.73). Acupuncture was superior to no treatment in improving pain intensity (VAS: -1.19, 95 percent CI: 95 percent CI: -2.17, -0.21), disability (PDI), functioning (HFAQ), well-being (SF-36), and range of mobility (extension, flexion), immediately after the treatment. In general, trials that applied sham-acupuncture tended to produce negative results (i.e., statistically non-significant) compared to trials that applied other types of placebo (e.g., TENS, medication, laser). Results regarding comparisons with other active treatments (pain medication, mobilization, laser therapy) were less consistent Acupuncture was more cost-effective compared to usual care or no treatment for patients with chronic back pain.

 

For both low back and neck pain, manipulation was significantly better than placebo or no treatment in reducing pain immediately or short-term after the end of treatment. Manipulation was also better than acupuncture in improving pain and function in chronic nonspecific low back pain. Results from studies comparing manipulation to massage, medication, or physiotherapy were inconsistent, either in favor of manipulation or indicating no significant difference between the two treatments. Findings of studies regarding costs of manipulation relative to other therapies were inconsistent.

 

Mobilization was superior to no treatment but not different from placebo in reducing low back pain or spinal flexibility after the treatment. Mobilization was better than physiotherapy in reducing low back pain (VAS: -0.50, 95 percent CI: -0.70, -0.30) and disability (Oswestry: -4.93, 95 percent CI: -5.91, -3.96). In subjects with acute or subacute neck pain, mobilization compared to placebo significantly reduced neck pain. Mobilization and placebo did not differ in subjects with chronic neck pain.

 

Massage was superior to placebo or no treatment in reducing pain and disability only amongst subjects with acute/sub-acute low back pain. Massage was also significantly better than physical therapy in improving back pain (VAS: -2.11, 95 percent CI: -3.15, -1.07) or disability. For subjects with neck pain, massage was better than no treatment, placebo, or exercise in improving pain or disability, but not neck flexibility. Some evidence indicated higher costs for massage use compared to general practitioner care for low back pain.

 

Reporting of harms in RCTs was poor and inconsistent. Subjects receiving CAM therapies reported soreness or bleeding on the site of application after acupuncture and worsening of pain after manipulation or massage. In two case-control studies cervical manipulation was shown to be significantly associated with vertebral artery dissection or vertebrobasilar vascular accident.

 

Conclusions:

Evidence was of poor to moderate grade and most of it pertained to chronic nonspecific pain, making it difficult to draw more definitive conclusions regarding benefits and harms of CAM therapies in subjects with acute/subacute, mixed, or unknown duration of pain. The benefit of CAM treatments was mostly evident immediately or shortly after the end of the treatment and then faded with time. Very few studies reported long-term outcomes. There was insufficient data to explore subgroup effects. The trial results were inconsistent due probably to methodological and clinical diversity, thereby limiting the extent of quantitative synthesis and complicating interpretation of trial results. Strong efforts are warranted to improve the conduct methodology and reporting quality of primary studies of CAM therapies. Future well powered head to head comparisons of CAM treatments and trials comparing CAM to widely used active treatments that report on all clinically relevant outcomes are needed to draw better conclusions.

 

Categories: None

Post a Comment

Oops!

Oops, you forgot something.

Oops!

The words you entered did not match the given text. Please try again.

1322 Comments

Reply cialis dosage
8:43 AM on November 9, 2021 
Zithromax Without Prescription
Reply ivermectin pills for sale
4:45 PM on November 9, 2021 
Buy Cheap Fluoxetine And Cialis
Reply cleaply
2:29 PM on November 11, 2021 
Lasix
Reply vadsUsefe
11:26 AM on November 12, 2021 
Stromectol
Reply furosemide tablets 40 mg
12:45 PM on November 12, 2021 
Donepezil Online Order
Reply where to buy prednisone for dogs without prescrition
6:43 PM on November 12, 2021 
pamphlet for cialis
Reply Neidelp
1:02 AM on November 13, 2021 
prednisolone in dogs
Reply priligy dapoxetine amazon
6:46 PM on November 13, 2021 
Prevacid Buy One Get One
Reply Guesego
10:19 AM on November 21, 2021 
Cytotec Abortion Buy Online In The Us buy cialis
Reply gabapentin overdose
12:02 PM on December 4, 2021 
find cialis cheap
Reply Neocolf
2:41 AM on December 5, 2021 
hydroxychloroquine for sale online
Reply hydroxychloroquine purchase
12:16 AM on December 6, 2021 
Comprar Viagra Sin Receta En Valencia
Reply cialis without a doctor's prescription
2:14 AM on December 6, 2021 
cialis omeopatico
Reply what are the risks of taking gabapentin?
1:29 AM on December 9, 2021 
When Will Alli Be Back In Stock
Reply dabefly
12:57 AM on December 11, 2021 
cialis from usa pharmacy
Reply TURFPAITA
2:35 AM on December 21, 2021 
viagra for altitude sickness
Reply Bradsskxk
6:25 PM on January 3, 2022 
tadalafil generic https://cialisicp.com/
Reply buy tadalis
4:11 AM on January 6, 2022 
tadalafil brands where to order tadalafil tablets
Reply Bradsnbnv
12:33 PM on January 6, 2022 
Reply adidas yeezy
3:53 AM on January 7, 2022 
I definitely wanted to jot down a quick word to say thanks to you for some of the amazing tips you are giving here. My particularly long internet lookup has at the end been compensated with useful tips to exchange with my partners. I would express that most of us readers actually are quite blessed to dwell in a very good community with very many wonderful individuals with good principles. I feel very much privileged to have discovered your weblog and look forward to some more excellent times reading here. Thanks once again for all the details.
adidas yeezy http://www.yeezysadidas.us