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Randomized Trial Comparing Traditional Chinese Medical
Acupuncture, Therapeutic
Massage,
and Self-care Education
for Chronic Low
Back
Pain
Daniel C. Cherkin, PhD; David
Eisenberg, MD; Karen J. Sherman, PhD;
William Barlow, PhD; Ted J. Kaptchuk,
OMD; Janet Street, RN, MN, PNP;
Richard A. Deyo, MD, MPH
Arch Intern Med. 2001;161:1081-1088.
Background
Because the value of popular
forms
of alternative care
for
chronic
back
pain
remains uncertain, we compared the
effectiveness of acupuncture, therapeutic
massage,
and self-care education
for
persistent
back
pain.
Methods We randomized 262 patients aged 20 to
70 years who had persistent
back
pain
to receive Traditional Chinese Medical
acupuncture (n = 94), therapeutic
massage
(n = 78), or self-care educational materials
(n = 90). Up to 10
massage
or acupuncture visits were permitted over 10
weeks. Symptoms (0-10 scale) and dysfunction
(0-23 scale) were assessed by telephone
interviewers masked to treatment group. Follow-up was
available
for
95% of patients after 4, 10, and 52 weeks, and none
withdrew
for
adverse effects.
Results Treatment groups were compared after
adjustment
for
prerandomization covariates using an intent-to-treat
analysis. At 10 weeks,
massage
was superior to self-care on the symptom
scale (3.41 vs 4.71, respectively; P = .01) and
the disability scale (5.88 vs 8.92,
respectively; P<.001).
Massage
was also superior to acupuncture on the
disability scale (5.89 vs 8.25, respectively;
P = .01). After 1 year,
massage
was not better than self-care but was better
than acupuncture (symptom scale: 3.08 vs
4.74, respectively; P = .002; dysfunction scale:
6.29 vs 8.21, respectively; P = .05).
The
massage
group used the least medications (P<.05)
and had the lowest costs of subsequent care.
Conclusions Therapeutic
massage
was effective
for
persistent low
back
pain,
apparently providing long-lasting benefits. Traditional
Chinese Medical acupuncture was relatively
ineffective.
Massage
might be an effective alternative to conventional
medical care
for
persistent
back
pain.
From the Center
for
Health Studies, Group Health Cooperative, Seattle, Wash
(Drs Cherkin and Barlow and Ms Street); Beth Israel–Deaconess
Center
for
Alternative Medicine Research and Education, Department
of Medicine, Harvard Medical School, Boston, Mass (Drs
Eisenberg and Kaptchuk); Northwest Institute of
Acupuncture and Oriental Medicine, Seattle (Dr Sherman);
and the Departments of Medicine and Health Services,
University of Washington, Seattle (Dr Deyo).
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