Chronic Mechanical Spinal Pain Syndromes

a Associate Pro Medicine, James Australia. b Adjunct Asso Tropical Medicine land, Australia. Sources of supp ment Health Depa Submit requests Box 880, Indooroo (e-mail: lggiles@a 0161-4754/$30. Copyright D 20 doi:10.1016/j.jm Objective: To assess the long-term benefits of medication, needle acupuncture, and spinal manipulation as exclusive and standardized treatment regimens in patients with chronic (N13 weeks) spinal pain syndromes. Study Design: Extended follow-up (N1 year) of a randomized clinical trial was conducted at the multidisciplinary spinal pain unit of Townsville’s General Hospital between February 1999 and October 2001. Patients and Methods: Of the 115 patients originally randomized, 69 had exclusively been treated with the randomly allocated treatment during the 9-week treatment period (results at 9 weeks were reported earlier). These patients were followed up and assessed again 1 year after inception into the study reapplying the same instruments (ie, Oswestry Back Pain Index, Neck Disability Index, Short-Form-36, and Visual Analogue Scales). Questionnaires were obtained from 62 patients reflecting a retention proportion of 90%. The main analysis was restricted to 40 patients who had received exclusively the randomly allocated treatment for the whole observation period since randomization. Results: Comparisons of initial and extended follow-up questionnaires to assess absolute efficacy showed that only the application of spinal manipulation revealed broad-based long-term benefit: 5 of the 7 main outcome measures showed significant improvements compared with only 1 item in each of the acupuncture and the medication groups. Conclusions: In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit. (J Manipulative Physiol Ther 2005;28:3-11) Key Indexing Terms: Acupuncture; Chiropractic; Medicine; Spinal; Pain C hronic spinal pain is commonly triggered by an injury or disease, and mechanical spinal pain presents a diagnostic and treatment challenge because reaching a specific diagnosis is often impossible. fessor, School of Public Health and Tropical Cook University, Townsville, Queensland, ciate Professor, School of Public Health and , James Cook University, Townsville, Queensort: Supported by the Queensland State Governrtment. for reprints to: Lynton G.F. Giles, DC, PhD, PO pilly, Queensland 4068, Australia ustarnet.com.au). 00 05 by National University of Health Sciences. pt.2004.12.004 A pathological cause cannot be identified for most episodes of spinal pain with only approximately 15% of patients being given a definitive diagnosis. The search for effective conservative treatments for acute and chronic nonspecific low-back pain has been largely inconclusive, as is the case with neck and thoracic spine pain. Conflicting claims exist for nearly every form of conservative therapy for low-back disorders, probably because studies have been performed among widely differing types of patients with back pain or because of methodological problems. Thus, there is still sparse conclusive knowledge about the absolute efficacy of any intervention for chronic spinal pain syndromes, althoughGiles et al found a high level of patient satisfaction with a multidisciplinary team approach to spinal pain syndromes. A review of the conflicting literature on the efficacy and effectiveness of medication, acupuncture, and spinal manipulation for chronic uncomplicated spinal pain treatment can be found in Giles andMuller.