Chronic spinal pain – a randomized clinical trial comparing medication, acupuncture, and spinal manipulation

Giles LGF, Muller R.Spine 2003;28:1490-1503.

A randomized, controlled clinical trial published in Spine reveals that chiropractic manipulation (adjustment) is superior to both drugs and acupuncture in the treatment of chronic spinal pain (people with pain lasting more than 13 weeks). The study, conducted at a multidisciplinary spinal pain outpatient unit in an Australian public hospital, involved 115 patients randomly assigned to receive one of three interventions: medication, needle acupuncture or chiropractic manipulation.

Patients randomized to the acupuncture or spinal manipulation group were given an initial physical examination by the treating clinician to determine which form of acupuncture needle placement and needling would take place, or what type of spinal manipulation would be performed, respectively. Patients randomized to the medication group were given Celebrex, unless the patient had used it previously. The next drug of choice was Vioxx, followed by paracetamol (up to 4g/day). Doses were left to the sports physician’s discretion.

Chiropractic patients were given two treatments per week.

The patients were assessed four times: at the initial visit, and two, five and nine weeks after the initial treatment. While a number of patients didn’t finish the study, due to noncompliance or treatment changes, the statistical significance of the results was maintained for most outcomes. At the end of the study, the group receiving manipulation experienced the most recovered patients (9) compared with three for the acupuncture group and only two for the medication group. This was significant, considering the nature of chronic spine pain.

One of the study’s most remarkable findings was that patients in the manipulation group reported a 47 percent improvement on a general overall health questionnaire, compared to only 15 percent for the acupuncture group and 18 percent for the medication group.

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