A systematic review and meta-analysis of efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine for neck and low-back pain - PubMed (original) (raw)

doi: 10.1155/2012/953139. Epub 2011 Nov 24.

Fatemeh Yazdi, Alexander Tsertsvadze, Anita Gross, Maurits Van Tulder, Lina Santaguida, Joel Gagnier, Carlo Ammendolia, Trish Dryden, Steve Doucette, Becky Skidmore, Raymond Daniel, Thomas Ostermann, Sophia Tsouros

Affiliations

A systematic review and meta-analysis of efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine for neck and low-back pain

Andrea D Furlan et al. Evid Based Complement Alternat Med. 2012.

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.

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Figures

Figure 1

Figure 1

Flow diagram.

Figure 2

Figure 2

Figure 3

Figure 3

Acupuncture versus no treatment for chronic nonspecific low-back pain (Pain intensity: Visual Analogue Scale).

Figure 4

Figure 4

Acupuncture versus placebo for chronic nonspecific low-back pain (Pain intensity: Visual Analogue Scale).

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Figure 5

Acupuncture versus Manipulation for chronic nonspecific low-back pain (Pain intensity: Visual Analogue Scale).

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Figure 6

Acupuncture versus placebo for chronic-specific and nonspecific neck pain (Pain intensity: Visual Analogue Scale).

Figure 7

Figure 7

Funnel plot of trials comparing VAS score (acupuncture versus placebo).

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