Does acupuncture or massage work in people with persistent back pain?

BACKGROUND: Back problems are among the most prevalent conditions afflicting Americans, and complementary and alternative medical therapies are frequently sought for treatment. This randomized trial compares acupuncture, massage, and self-care education in the treatment of persistent back pain.

POPULATION STUDIED: Individuals aged 20 to 70 years who visited a primary care physician for low back pain were identified, and those who were interested were contacted. The typical study subject was aged 45 years, white, well educated, and employed. Exclusion criteria included sciatica, pregnancy, involvement with litigation or compensation claims for back pain, severe or progressive neurologic deficits, lumbar surgery within the past 3 years, serious comorbid conditions, and bothersomeness of back pain rated as less than 4 on a scale from 0 to 10.

STUDY DESIGN AND VALIDITY: A total of 262 study participants were randomly allocated to receive traditional Chinese medical acupuncture, massage therapy that focused on the manipulation of soft tissue, or self care. The authors did not state whether the investigators knew to which group the patients would be assigned before enrolling them in the study. Study acupuncturists, massage therapists, and consultants established treatment protocols that were considered clinically reasonable.The acupuncturists and massage therapists were allowed to schedule up to 10 visits over 10 weeks. The patients allocated to self care received high-quality and relatively inexpensive unpublished educational materials designed for people with chronic back pain. Interviewers who were masked to treatment group performed follow-up by telephone. Randomization was successful and follow-up personnel were blinded. There were no significant differences among the groups at baseline. The study was designed to have 80% power to detect a 2.5-point difference on the Roland Disability Scale and a 1.5-point difference on the symptom bothersomeness scale for the comparison of acupuncture and massage. Many of the acupuncturists felt some level of restraint in treatment options because of study protocols.

OUTCOMES MEASURED: The primary outcomes of interest were symptoms and dysfunction. Patients measured how bothersome symptoms of back pain, leg pain, numbness, and tingling had been during the preceding week on a scale of 0 to 10. Dysfunction was measured on a modified Roland Disability Scale. Secondary outcomes included disability, utilization, cost, satisfaction with overall care for the back problem, use of medications, the 12-item Medical Outcomes Study short form (SF-12) physical and mental health summary scales, and numbers of days of aerobic exercise and back exercise performed. results At 10 weeks, the massage group had less severe symptoms than the self-care group (P=.01) and less dysfunction than the self-care group (P <.001) and the acupuncture group (P=.01). At 1 year, massage was superior to acupuncture in its effect on symptoms (P=.002) and function (P=.051). At 10 weeks, the massage group and the acupuncture group did not differ from each other in medication use, but did use significantly less medication than the self-care group (P <.05.) Use of medications at 1-year was lower in the massage group than in the other groups (P <.05.) There was no difference in the SF-12 mental health score at 10 weeks, though the SF-12 physical health scores showed massage to be superior to self care (P=.004). At 1 year there were no differences in the SF-12 physical or mental health scores. At the end of the treatment period there was no difference among the groups in number of days exercised.