Comparative Effectiveness of Exercise, Acupuncture, and Spinal Manipulation for Low Back Pain

@article{Standaert2011ComparativeEO,
  title={Comparative Effectiveness of Exercise, Acupuncture, and Spinal Manipulation for Low Back Pain},
  author={Christopher J Standaert and Janna L Friedly and Mark Erwin and Michael J. Lee and Glenn R. Rechtine and Nora B. Henrikson and Daniel C Norvell},
  journal={Spine},
  year={2011},
  volume={36},
  pages={S120–S130}
}
Study Design. Systematic review. Objective. We sought to answer the following clinical questions: (1) Is structured exercise more effective in the treatment of chronic low back pain (LBP) than spinal manipulative therapy (SMT)? (2) Is structured exercise more effective in the treatment of chronic LBP than acupuncture? (3) Is SMT more effective in the treatment of chronic LBP than acupuncture? (4) Do certain subgroups respond more favorably to specific treatments? (5) Are any of these treatments… 
Acupuncture for the Relief of Chronic Pain: A Synthesis of Systematic Reviews
TLDR
It is suggested that an enriched enrolment with randomised withdrawal design may overcome some of these methodological shortcomings of RCTs and improve the quality of evidence so that healthcare providers and commissioners can make informed choices on the interventions which can legitimately be provided to patients living with chronic pain.
Effects of spinal manipulation versus therapeutic exercise on adults with chronic low back pain: a literature review.
  • Alban Merepeza
  • Medicine, Psychology
    The Journal of the Canadian Chiropractic Association
  • 2014
TLDR
There is no conclusive evidence that clearly favours spinal manipulation or exercise as more effective in treatment of CLBP, with both interventions offering equal effects in the long term.
How Effective is Physical Therapy for Common Low Back Pain Diagnoses?: A Multivariate Analysis of 4597 Patients
TLDR
It is observed that a substantial percentage of the population did not meet MCID for pain and function following treatment of low back pain with physical therapy, and common risk factors for treatment failure included smoking and presence of night symptoms.
Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain
TLDR
It is suggested that spinal manipulative therapy may be as effective as other recommended therapies for the management of non-specific and chronic primary spine pain, including standard medical care or physical therapy.
Effectiveness of Strengthening Exercises for the Elderly with Low Back Pain to Improve Symptoms and Functions: A Systematic Review
TLDR
This study is a systematic review of experimental study which evaluated the evidence regarding exercises for older people with LBP by using EBSCO Academic Search Premier, EBSco EconLit, Science Direct, PUBMED, and PEDro from 2006 to 2016 to determine the effect of strengthening exercises for old people with low back pain.
Impact of selected magnetic fields on the therapeutic effect in patients with lumbar discopathy: A prospective, randomized, single-blinded, and placebo-controlled clinical trial.
TLDR
It was determined that the application of magnetic therapy significantly reduces pain symptoms and leads to an improvement of functional ability in patients with LBP.
The addition of manipulation to an extension-oriented intervention for a patient with chronic LBP
TLDR
The management and outcomes of a patient with chronic LBP who met two categories of the revised treatment based classification (TBC) approach and reported a clinically meaningful improvement after seven visits of manipulation and extension-oriented interventions are described.
The Outcomes of Manipulation or Mobilization Therapy Compared with Physical Therapy or Exercise for Neck Pain: A Systematic Review
TLDR
It is suggested that there are minimal short- and long-term treatment differences in pain, disability, patient-rated treatment improvement, treatment satisfaction, health status, or functional improvement when comparing manipulation or mobilization therapy to physical therapy or exercise in patients with neck pain.
Quality of systematic reviews on specific spinal stabilization exercise for chronic low back pain.
TLDR
This review of SRs identified several high-quality reviews that indicated some benefit of specific stabilization exercise programs for patients with nonspecific chronic LBP.
...
...

References

SHOWING 1-10 OF 53 REFERENCES
The use of electro-acupuncture in conjunction with exercise for the treatment of chronic low-back pain.
TLDR
This study indicates that the combination of electro-acupuncture and back exercise might be an effective option in the treatment of pain and disability associated with chronic LBP.
A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain.
TLDR
Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits, which raises questions about acupuncture's purported mechanisms of action.
Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation
TLDR
Evidence is provided that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication, and the data do not strongly support the use of only manipulation, only acupuncture, or only nonsteroidal antiinflammatory drugs for the treatment of chronic spinalPain.
Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain.
TLDR
Acupuncture plus routine care was associated with marked clinical improvements in these patients and was relatively cost-effective, and nonrandomized patients had more severe symptoms at baseline and showed improvements in back function similar to those seen in randomized patients.
Acupuncture in patients with chronic low back pain: a randomized controlled trial.
TLDR
Acupuncture was more effective in improving pain than no acupuncture treatment in patients with chronic low back pain, whereas there were no significant differences between acupuncture and minimal acupuncture.
Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain
TLDR
Weak evidence was found of an effect of acupuncture on persistent non-specific low back pain at 12 months, but stronger evidence of a small benefit at 24 months, and Referral to a qualified traditional acupuncturist for a short course of treatment seems safe and acceptable to patients with low backPain.
Exercise therapy for treatment of non-specific low back pain.
TLDR
Exercise therapy appears to be slightly effective at decreasing pain and improving function in adults with chronic low-back pain, particularly in healthcare populations.
A Review of the Evidence for the Effectiveness, Safety, and Cost of Acupuncture, Massage Therapy, and Spinal Manipulation for Back Pain
TLDR
This work attempts to provide clinicians, patients, and health plans with a clear and balanced understanding of the current evidence about the effectiveness, safety, and cost of the CAM therapies most often used by Americans to treat low back pain: acupuncture, massage therapy, and spinal manipulation.
German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups.
TLDR
Low back pain improved after acupuncture treatment for at least 6 months and effectiveness of acupuncture, either verum or sham, was almost twice that of conventional therapy.
Addition of Choice of Complementary Therapies to Usual Care for Acute Low Back Pain: A Randomized Controlled Trial
TLDR
A model of care that offered access to a choice of complementary and alternative medicine therapies for acute LBP did not result in clinically significant improvements in symptom relief or functional restoration, and this model was associated with greater patient satisfaction but increased total costs.
...
...