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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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