Complementary and Alternative Medicine for Chronic Musculoskeletal Pain

Two other studies compared massage to no treatment and found it significantly improved chronic neck pain immediately after the end of treatment. ^33,35 Kong and colleagues also found similar effects for shoulder pain at immediate and short-term
follow-up but not for neck or shoulder pain when massage was compared with active therapies. ³³ Furlan and colleagues’ meta-analysis found that massage compared with relaxation or physical therapy was significantly better at reducing chronic nonspecific low back pain immediately after treatment. ³⁵

Spinal Manipultaion

Spinal manipulation is high-velocity and low-amplitude localized force directed at specific spinal segments. ³⁴ It is performed by using the hands or a device to apply a controlled force to a joint of the spine and is practiced by osteopathic physicians, naturopathic physicians, chiropractors, physical therapists, and some medical doctors. ¹⁹

In a study to assess its effectiveness, Rubinstein and colleagues found low-quality evidence to very-low-quality evidence to suggest that SMT does not provide a more clinically beneficial effect compared with sham, passive modalities, or other interventions for the relief of chronic low back pain. ³⁸ Comparative interventions included usual medical care, physical therapy, exercise, physiotherapy, and multimodal treatments. Standaert and colleagues also found no difference between motor control exercise and SMT in pain relief. ⁴² They concluded that although the evidence is low, there is an indication that structured exercise and SMT seem to offer equivalent benefits in terms of pain for those with chronic lower back pain with clinical benefits evident within 8 weeks of care. ⁴²

Gross and colleagues found that when cervical manipulation was compared with control for chronic mechanical neck pain, there was moderate-quality evidence for similar effects at short-term and intermediate follow-up. ³⁴ They also reported low-quality evidence in support of thoracic manipulation alone or in combination with electrothermal or individualized physiotherapy and suggested cervical manipulation may provide short-term but not long-term pain relief. ³⁴ Furlan and colleagues reported moderate-quality evidence that spinal manipulation provided significantly better posttreatment neck pain relief compared with placebo. ³⁵ They also found low evidence that it was significantly better than placebo, acupuncture, and pain medication at immediate follow-up. ³⁵

Conclusion

Considerable effort was made to retrieve all studies; however, the authors cannot be certain that the review was exhaustive. They also relied on other analyses of primary studies for the conclusion.

The 3 types of musculoskeletal pain in the review were low back, neck, and knee pain related to osteoarthritis. The authors found that the most common CAM modality studied for chronic musculoskeletal pain was acupuncture. Studies on massage therapy and SMT that were relevant to the review were limited.

Two studies reported strong level of evidence for acupuncture. ^36,40 One study reported that acupuncture was superior to no treatment or to sham acupuncture for relief of chronic knee pain. ⁴⁰ The other study reported that acupuncture was more effective than conventional therapy alone when it was combined with conventional therapy for chronic low back pain, but there was no difference when compared with sham acupuncture for short-term pain relief. ³⁶ The strength of the evidence for acupuncture combined with conventional treatment for low back pain was conflicting. One other review found low evidence for its benefit. Similar to Hopton and MacPherson, this review found that acupuncture treatment seemed to provide effective short-term relief of chronic low back pain. ¹⁴ Evidence would also seem to support acupuncture for the short-term relief of chronic neck pain and knee pain associated with osteoarthritis.