A systematic review on the effectiveness of complementary and alternative medicine for chronic non-specific low-back pain

Abstract

The purpose of this systematic review was to assess the effects of spinal manipulative therapy (SMT), acupuncture and herbal medicine for chronic non-specific LBP. A comprehensive search was conducted by an experienced librarian from the Cochrane Back Review Group (CBRG) in multiple databases up to December 22, 2008. Randomised controlled trials (RCTs) of adults with chronic non-specific LBP, which evaluated at least one clinically relevant, patient-centred outcome measure were included. Two authors working independently from one another assessed the risk of bias using the criteria recommended by the CBRG and extracted the data. The data were pooled when clinically homogeneous and statistically possible or were otherwise qualitatively described. GRADE was used to determine the quality of the evidence. In total, 35 RCTs (8 SMT, 20 acupuncture, 7 herbal medicine), which examined 8,298 patients, fulfilled the inclusion criteria. Approximately half of these (2 SMT, 8 acupuncture, 7 herbal medicine) were thought to have a low risk of bias. In general, the pooled effects for the studied interventions demonstrated short-term relief or improvement only. The lack of studies with a low-risk of bias, especially in regard to SMT precludes any strong conclusions; however, the principal findings, which are based upon low- to very-low-quality evidence, suggest that SMT does not provide a more clinically beneficial effect compared with sham, passive modalities or any other intervention for treatment of chronic low-back pain. There is evidence, however, that acupuncture provides a short-term clinically relevant effect when compared with a waiting list control or when acupuncture is added to another intervention. Although there are some good results for individual herbal medicines in short-term individual trials, the lack of homogeneity across studies did not allow for a pooled estimate of the effect. In general, these results are in agreement with other recent systematic reviews on SMT, but in contrast with others. These results are also in agreement with recent reviews on acupuncture and herbal medicine. Randomized trials with a low risk of bias and adequate sample sizes are direly needed.Electronic supplementary materialThe online version of this article (doi:10.1007/s00586-010-1356-3) contains supplementary material, which is available to authorized users.

Trends over time in the size and quality of randomised controlled trials of interventions for chronic low-back pain

“…The largest number of trials came from the review of physical and rehabilitation interventions (n = 83) [12], followed by complementary and alternative therapies (n = 30) [13], injection and denervation procedures (n = 27) [15], and pharmacological interventions (n = 17) [14]. The earliest year of publication for an included trial was 1980, with an increase in the number of RCTs per year until 2008, which is the last date that literature was searched.…”

“…The earliest year of publication for an included trial was 1980, with an increase in the number of RCTs per year until 2008, which is the last date that literature was searched. The systematic review on complementary and alternative therapies [13] excluded five trials from the meta-analysis because of methodological ''fatal flaws''. As these flaws question the veracity of the results of these trials, the risk of bias scores were not included in the current analysis.…”

“…Four systematic reviews, commissioned by the Dutch Health Care Insurance Council (CVZ), were performed to evaluate current evidence for physical and rehabilitation interventions [12], complementary and alternative therapies [13], pharmacological interventions [14], and injection and denervation procedures [15] in patients with chronic LBP. The current study is based on the trials that were included in this series of systematic reviews.…”

Acupuncture in the Treatment of Chronic Low Back Pain

“…11,15,22,23,24,25,26 One of these only included studies already mentioned in the 2005 Cochrane systematic review, and was subsequently omitted from the present summary. 11 The present article summarizes the six remaining systematic reviews published since 2005; these systematic reviews described nine studies not included in the Cochrane systematic review update (Table 1).…”

“…24 Rubenstein et al published a systematic review of three common CAM therapies for chronic low back pain: acupuncture, herbal medicine, and spinal manipulation. All eighteen studies included in their acupuncture analyses were previously discussed by Yuan et al 26 Based on one study alone, 30 Rubenstein and colleagues hesitantly concluded that acupuncture is more effective than no treatment at short term pain relief.…”