A Systematic Review and Meta-Analysis of Efficacy, Cost-Effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-Back Pain

Abstract

Background. Back pain is a common problem and a major cause of disability and health care utilization. Purpose. To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain. Data Sources. Records without language restriction from various databases up to February 2010. Data Extraction. The efficacy outcomes of interest were pain intensity and disability. Data Synthesis. Reports of 147 randomized trials and 5 nonrandomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically nonsignificant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature. Conclusions. CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment. CAM therapies did not significantly reduce disability compared to sham. None of the CAM treatments was shown systematically as superior to one another. More efforts are needed to improve the conduct and reporting of studies of CAM treatments.

Cupping for Treating Neck Pain in Video Display Terminal (VDT) Users: A Randomized Controlled Pilot Trial

“…Together with modifications of life style and workstations, an appropriate treatment for neck pain is needed to improve work efficiency and public health. Various complementary and alternative (CAM) therapies have been suggested to have immediate or short-term effects on neck pain 32) , but few studies have evaluated the effect in VDT workers. In this sense, it is meaningful and useful in a modern society to evaluate the problems related to VDT work as we did in this study.…”

A 46-year-old man with acute low-back pain

“…There is evidence from systematic reviews to support the use of superficial heat (benefit over placebo, acetaminophen or ibuprofen), 5 spinal manipulation (benefit over sham therapy), 6 massage (benefit over inactive control) 7 and acupuncture (benefit over no treatment) 8 in patients with acute low-back pain. For flexion-aggravated low-back pain, home exercises are indicated and should include repeated passive extension in the lying position progressing to standing (see link to CORE Back Tool and other useful tools in Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10 .1503/cmaj.150660/-/DC1).…”

Evaluation of the Effects of Intravenous and Percutaneous Low Level Laser Therapy in the Management of Shoulder Myofascial Pain Syndrome

“…2,3 Myofascial pain syndrome (MPS) is a major cause of morbidity and drug abuse and is estimated to constitute one third of these doctor visits. 1,3 Improved life span and general health due to technological progress in medical fields lead to increased overall years of work.…”

“…Despite decades of research on MPS, this disorder still lacks a clear treatment frame 4 and MPS management is based on multimodal approach. 5 Actual treatment modalities comprise awareness of associated factors, medication, stretching exercises, acupuncture, injections, manual therapy, ultrasound, laser therapy, electrical stimulation, transcutaneous electrical nerve stimulation and biofeedback, 2,6 but no single combination has provided us with an effective and efficient treatment method since recurrence is still high. 7 Many studies have been performed on the effects of percutaneous low level laser (PLLL) on MPS, and showed some positive results, 5 but many of these studies lack validity.…”