Chronic spinal pain syndromes: A clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation

Objective: To compare needle acupuncture, medication (tenoxicam with raniti dine), and spinal manipulation for managing chronic (>13 weeks duration) sp inal pain syndromes. Design: Prospective, randomized, independently assessed preintervention and postintervention clinical pilot trial. Setting: Specialized spinal pain syndrome outpatient unit at Townsville Gen eral Hospital, Queensland, Australia. Subjects: Seventy-seven patients (without contraindication to manipulation or medication) were recruited. Interventions: One of three separate, clearly defined intervention protocol s: needle acupuncture, nonsteroidal anti-inflammatory medication, or chirop ractic spinal manipulation. Main Outcome Measures: Main outcome measures were changes (4 weeks vs initi al visit) in the scores of the (1) Oswestry Back Pain Disability Index, (2) Neck Disability Index, and (3) three visual analogue scales of local pain intensity. Results: Randomization was successful. After a median intervention period o f 30 days, spinal manipulation was the only intervention that achieved stat istically significant improvements (all expressed as percentages of the ori ginal scores) with (1) a reduction of 30.7% on the Oswestry scale, (2) an i mprovement of 25% on the neck disability index, and (3) reductions on the v isual analogue scale of 50% for low back pain, 46% for upper back pain, and 33% for neck pain (all P <.001). Neither of the other interventions showed any significant improvement on any of the outcome measures. Conclusions: The consistency of the results provides, in spite of several d iscussed shortcomings of this pilot study, evidence that in patients with c hronic spinal pain syndromes spinal manipulation, if not contraindicated, r esults in greater improvement than acupuncture and medicine.