Research on Chronic Low Back Pain

Comparing Acupuncture, Therapeutic Massage, and Self-care Education.

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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, e.l.harvey@leeds.ac.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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