Randomized Trial Comparing Traditional Chinese Medical Acupuncture, Therapeutic Massage, and Self-care Education for Chronic Low Back Pain

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Abstract
BACK PROBLEMS are among the most prevalent conditions afflicting Americans and one of the most common reasons for using complementary and alternative medical (CAM) therapies. In 1997, one third of US adults with low back pain visited a CAM provider for this problem, most commonly chiropractors, massage therapists, and acupuncturists.1,2 Ernst3 identified only 4 randomized trials evaluating therapeutic massage, and these reached conflicting conclusions; all were judged to be of poor quality and included massage only as a "control" therapy. Studies4-6 of acupuncture for back pain have also been inconclusive because of poor methodological quality and treatment protocols that do not reflect common practice. Because of the lack of rigorous efficacy studies, national evidence-based guidelines for acute low back pain have not recommended the use of either acupuncture or massage.7 We compared the effectiveness and cost of acupuncture, therapeutic massage, and educational materials emphasizing self-management techniques for chronic low back pain.