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.