Evidence Report/Technology Assessment 

Number 194 

Complementary and Alternative Therapies for Back 

Pain II 

Prepared for: 

Agency for Healthcare Research and Quality 

U.S. Department of Health and Human Services 

540 Gaither Road 

Rockville, MD 20850 

www.ahrq.gov 

Contract No. 290-2007-10059-I (EPCIII)
 

Prepared by: 

University of Ottawa Evidence-based Practice Center, 

Ottawa, Ontario, Canada 

EPC Director 

David Moher, Ph.D. 

Investigators 

Andrea D. Furlan, M.D., Ph.D. Mohammed T. Ansari, MBBS, MMedSc, 

Fatemeh Yazdi, BSc.PT, MSc. MPhil. 

Alexander Tsertsvadze, M.D., MSc. Thomas Ostermann, Ph.D. 

Anita Gross, BSc.PT, MSc. Trish Dryden, RMT, M.Ed. 

Maurits Van Tulder, Ph.D. Steve Doucette, MSc. 

Lina Santaguida, BSc.PT, Ph.D. Becky Skidmore, MLS 

Dan Cherkin, Ph.D. Raymond Daniel, B.A. 

Joel Gagnier, ND, Ph.D. Sophia Tsouros, B.H.Kin. 

Carlo Ammendolia, DC, Ph.D. Laura Weeks, Ph.D. 

James Galipeau, Ph.D. 

AHRQ Publication No. 10(11)-E007 

October 2010 
This report is based on research conducted by the University of Ottawa Evidence-based 

Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality 

(AHRQ), Rockville, MD (Contract No. 290-2007-10059-I (EPCIII)). The findings and 

conclusions in this document are those of the author(s), who are responsible for its content, 

and do not necessarily represent the views of AHRQ. No statement in this report should be 

construed as an official position of AHRQ or of the U.S. Department of Health and Human 

Services. 

The information in this report is intended to help clinicians, employers, policymakers, and 

others make informed decisions about the provision of health care services. This report is 

intended as a reference and not as a substitute for clinical judgment. 

This report may be used, in whole or in part, as the basis for the development of clinical 

practice guidelines and other quality enhancement tools, or as a basis for reimbursement and 

coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of 

such derivative products may not be stated or implied. 
This document is in the public domain and may be used and reprinted without permission except 

those copyrighted materials noted for which further reproduction is prohibited without the 

specific permission of copyright holders. 

Suggested Citation: 

Furlan A, Yazdi F, Tsertsvadze A, Gross A, Van Tulder, M, Santaguida L, Cherkin D, Gagnier J, 

Ammendolia C, Ansari M, Ostermann T, Dryden T, Doucette S, Skidmore B, Daniel R, Tsouros 

S, Weeks L, Galipeau J. Complementary and Alternative Therapies for Back Pain II. Evidence 

Report/Technology Assessment No. 194. (Prepared by the University of Ottawa Evidence-based 

Practice Center under Contract No. 290-2007-10059-I (EPCIII). AHRQ Publication No. 10(11)­

E007. Rockville, MD: Agency for Healthcare Research and Quality. October 2010. 

No investigators have any affiliations or financial involvement (e.g., employment, 

consultancies, honoraria, stock options, expert testimony, grants or patents received or 

pending, or royalties) that conflict with material presented in this report. 

ii 
Preface 

The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-Based 

Practice Centers (EPCs), sponsors the development of evidence reports and technology 

assessments to assist public- and private-sector organizations in their efforts to improve the 

quality of health care in the United States. The National Center for Complementary and 

Alternative Medicine (NCCAM) requested and funded this report. The reports and assessments 

provide organizations with comprehensive, science-based information on common, costly 

medical conditions and new health care technologies. The EPCs systematically review the 

relevant scientific literature on topics assigned to them by AHRQ and conduct additional 

analyses when appropriate prior to developing their reports and assessments. 

To bring the broadest range of experts into the development of evidence reports and health 

technology assessments, AHRQ encourages the EPCs to form partnerships and enter into 

collaborations with other medical and research organizations. The EPCs work with these partner 

organizations to ensure that the evidence reports and technology assessments they produce will 

become building blocks for health care quality improvement projects throughout the Nation. The 

reports undergo peer review prior to their release. 

AHRQ expects that the EPC evidence reports and technology assessments will inform 

individual health plans, providers, and purchasers as well as the health care system as a whole by 

providing important information to help improve health care quality. 

We welcome comments on this evidence report. They may be sent by mail to the Task Order 

Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, 

Rockville, MD 20850, or by e-mail to epc@ahrq.gov. 

Carolyn M. Clancy, M.D. Josephine P. Briggs, M.D. 

Director Director 

Agency for Healthcare Research and Quality National Center for Complementary and 

Alternative Medicine 

National Institute of Health 

Jean Slutsky, P.A., M.S.P.H. 

Director, Center for Outcomes and Evidence Stephanie Chang M.D., M.P.H. 

Agency for Healthcare Research and Quality Director, EPC Program 

Agency for Healthcare Research and Quality 

Margaret Coopey. R.N., M.G.A., M.P.S. 

EPC Program Task Order Officer 

Agency for Healthcare Research and Quality 

iii 

Acknowledgments 

The University of Ottawa Evidence-based Practice Center thanks Katja Boehm, Manchun 

Fang, and Keiko Asakawa, for their assistance with data extraction of the foreign language 

studies. We would also like to thank Sepideh Ghorbani and Nisha Hazra for their assistance with 

data extraction, and the building of summary and evidence tables. Administrative support of this 

project was possible with help from Chantelle Garritty, Jodi Peters, and Bev MacLaren. We 

thank them for their continuing assistance. 

v 
vi 
Structured Abstract 

Background: Back and neck pain are important health problems with serious societal and 

economic implications. Conventional treatments have been shown to have limited benefit in 

improving patient outcomes. Complementary and Alternative Medicine (CAM) therapies offer 

additional options in the management of low back and neck pain. Many trials evaluating CAM 

therapies have poor quality and inconsistent results. 

Objectives: To systematically review the efficacy, effectiveness, cost-effectiveness, and harms 

of acupuncture, spinal manipulation, mobilization, and massage techniques in management of 

back, neck, and/or thoracic pain. 

Data Sources: MEDLINE, Cochrane Central, Cochrane Database of Systematic Reviews, 

CINAHL, and EMBASE were searched up to 2010; unpublished literature and reference lists of 

relevant articles were also searched. 

Study Selection: All records were screened by two independent reviewers. Primary reports of 

comparative efficacy, effectiveness, harms, and/or economic evaluations from randomized 

controlled trials (RCTs) of the CAM therapies in adults (age  18 years) with back, neck, or 

thoracic pain were eligible. Non-randomized controlled trials and observational studies (casecontrol, cohort, cross-sectional) comparing harms were also included. Reviews, case reports, 

editorials, commentaries or letters were excluded. 

Data Extraction: Two independent reviewers using a predefined form extracted data on study, 

participants, treatments, and outcome characteristics. 

Data Analysis: Included studies were stratified by the region, cause, and duration of pain. 

Evidence was summarized qualitatively and RCTs were pooled according to the post-treatment 

followup at which the outcomes were measured. Subgroup and sensitivity analyses were planned 

a priori. Publication bias was examined through visual inspection of funnel plot and a regressionbased method. 

Results: 265 RCTs and 5 non-RCTs were included. Acupuncture for chronic nonspecific low 

back pain was associated with significantly lower pain intensity than placebo but only 

immediately post-treatment (VAS: -0.59, 95 percent CI: -0.93, -0.25). However, acupuncture 

was not different from placebo in post-treatment disability, pain medication intake, or global 

improvement in chronic nonspecific low back pain. Acupuncture did not differ from shamacupuncture in reducing chronic non-specific neck pain immediately after treatment (VAS: ­

0.24, 95 percent CI: -1.20, 0.73). Acupuncture was superior to no treatment in improving pain 

intensity (VAS: -1.19, 95 percent CI: 95 percent CI: -2.17, -0.21), disability (PDI), functioning 

(HFAQ), well-being (SF-36), and range of mobility (extension, flexion), immediately after the 

treatment. In general, trials that applied sham-acupuncture tended to produce negative results 

(i.e., statistically non-significant) compared to trials that applied other types of placebo (e.g., 

TENS, medication, laser). Results regarding comparisons with other active treatments (pain 

vii 
medication, mobilization, laser therapy) were less consistent Acupuncture was more costeffective compared to usual care or no treatment for patients with chronic back pain. 

For both low back and neck pain, manipulation was significantly better than placebo or no 

treatment in reducing pain immediately or short-term after the end of treatment. Manipulation 

was also better than acupuncture in improving pain and function in chronic nonspecific low back 

pain. Results from studies comparing manipulation to massage, medication, or physiotherapy 

were inconsistent, either in favor of manipulation or indicating no significant difference between 

the two treatments. Findings of studies regarding costs of manipulation relative to other 

therapies were inconsistent. 

Mobilization was superior to no treatment but not different from placebo in reducing low back 

pain or spinal flexibility after the treatment. Mobilization was better than physiotherapy in 

reducing low back pain (VAS: -0.50, 95 percent CI: -0.70, -0.30) and disability (Oswestry: -4.93, 

95 percent CI: -5.91, -3.96). In subjects with acute or subacute neck pain, mobilization compared 

to placebo significantly reduced neck pain. Mobilization and placebo did not differ in subjects 

with chronic neck pain. 

Massage was superior to placebo or no treatment in reducing pain and disability only amongst 

subjects with acute/sub-acute low back pain. Massage was also significantly better than physical 

therapy in improving back pain (VAS: -2.11, 95 percent CI: -3.15, -1.07) or disability. For 

subjects with neck pain, massage was better than no treatment, placebo, or exercise in improving 

pain or disability, but not neck flexibility. Some evidence indicated higher costs for massage use 

compared to general practitioner care for low back pain. 

Reporting of harms in RCTs was poor and inconsistent. Subjects receiving CAM therapies 

reported soreness or bleeding on the site of application after acupuncture and worsening of pain 

after manipulation or massage. In two case-control studies cervical manipulation was shown to 

be significantly associated with vertebral artery dissection or vertebrobasilar vascular accident. 

Conclusions: Evidence was of poor to moderate grade and most of it pertained to chronic nonspecific pain, making it difficult to draw more definitive conclusions regarding benefits and 

harms of CAM therapies in subjects with acute/subacute, mixed, or unknown duration of pain. 

The benefit of CAM treatments was mostly evident immediately or shortly after the end of the 

treatment and then faded with time. Very few studies reported long-term outcomes. There was 

insufficient data to explore subgroup effects. The trial results were inconsistent due probably to 

methodological and clinical diversity, thereby limiting the extent of quantitative synthesis and 

complicating interpretation of trial results. Strong efforts are warranted to improve the conduct 

methodology and reporting quality of primary studies of CAM therapies. Future well powered 

head to head comparisons of CAM treatments and trials comparing CAM to widely used active 

treatments that report on all clinically relevant outcomes are needed to draw better conclusions. 

viii 
Contents 

Executive Summary .................................................................................................................... 1 

Evidence Report...................................................................................................................... 13 

Chapter 1. Introduction ............................................................................................................. 15 

Background............................................................................................................................. 15 

Most Commonly Used CAM Therapies for Back Pain .......................................................... 15 

 Back Pain and Treatment Approaches .................................................................................... 16 

Chapter 2. Methods................................................................................................................... 19 

Key Questions......................................................................................................................... 19 

Data Sources and Literature Search Strategies ....................................................................... 21 

Study Selection ....................................................................................................................... 21 

Data Abstraction ..................................................................................................................... 22 

 Assessment of Study Quality and Reporting .......................................................................... 23 

Rating the Strength of Evidence ............................................................................................. 23 

 Evidence Synthesis and Analysis ............................................................................................ 25 

Qualitative Analysis.................................................................................................................. 25 

Quantitative Analysis................................................................................................................ 25 

Subgroup and Sensitivity Analyses .......................................................................................... 26
 

Chapter 3. Results ..................................................................................................................... 27 

Literature Search Results ........................................................................................................ 27 

General Characteristics of the Included Studies ..................................................................... 29 

Assessment of Risk of Bias ....................................................................................................... 30 

Population Characteristics of RCTs.......................................................................................... 34 

Interventions and Control Treatments ...................................................................................... 34 

KQ1. What is the Efficacy, Effectiveness and Cost-effectiveness of the Most Prevalent Types 

of Practitioner-based Manual CAM Therapies Compared to Other CAM Therapies, 

Conventional Therapies, Placebo, no Treatment, or Wait List in Improving Outcomes in 

Patients With Nonspecific and Certain Specific Types of Back and Neck Pain? .................... 36 

Efficacy & Effectiveness .......................................................................................................... 36 

1 - Acupuncture for Treatment of Low Back Pain ................................................................. 36 

2 - Acupuncture for Treatment of Neck Pain .......................................................................... 64 

3 - Spinal Manipulation for Treatment of Low Back Pain ..................................................... 80 

4 - Manipulation + Mobilization for treatment of Low Back Pain ......................................... 95 

5 - Flexion Distraction on Treatment of Low Back Pain ........................................................ 99 

6 - Manipulation.................................................................................................................... 102 

7 - Manipulation + Mobilization for Treatment of Neck Pain .............................................. 115 

8 - Manipulation for Treatment of Thoracic Pain ................................................................. 117 

9 - Mobilization for Treatment of Low Back Pain ............................................................... 120 

10 - Mobilization for Treatment of Neck Pain ........................................................................ 133 

11 - Massage for Treatment of Low Back Pain ...................................................................... 142 

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12 – Massage for Treatment of Neck Pain.............................................................................. 155 

Cost Effectiveness................................................................................................................... 164 

Low Back Pain........................................................................................................................ 164 

Neck Pain................................................................................................................................ 169 

KQ1a-b. For any of the CAM Therapies Found to be Effective for Back Pain, what Patient, 

Treatment Provider and Trial Specific Factors Influence Success of Treatments? .................... 172 

Subgroup Analysis.................................................................................................................. 172 

Sensitivity Analyses ................................................................................................................ 174 

KQ1c. Does the Use of any of the Three Most Prevalent Types of CAM for Back Pain in 

Adults Result in a Decreased or Increased Utilization of Conventional Management? ............. 176 

Low Back Pain........................................................................................................................ 176 

Neck Pain................................................................................................................................ 184 

Publication Bias ...................................................................................................................... 192 

Harms of CAM in RCTs ......................................................................................................... 189 

1 - Acupuncture for Treatment of Low Back Pain ............................................................... 189 

2 - Acupuncture for Treatment of Neck Pain ........................................................................ 190 

3 - Manipulation for Treatment of Low Back Pain............................................................... 190 

4 - Manipulation + Mobilization for Treatment of Low Back Pain ...................................... 191 

5 - Flexion Distraction for Treatment of Low Back Pain ..................................................... 191 

6 - Manipulation for Treatment of Neck Pain ....................................................................... 191 

7 - Manipulation + Mobilization for Treatment of Neck Pain .............................................. 192 

8 - Mobilization for Treatment of Low Back Pain ............................................................... 192 

9 - Mobilization for Treatment of Neck Pain ........................................................................ 192 

10 - Mobilization for Treatment of Thoracic Pain .................................................................. 192 

11 - Massage for Treatment of Low Back Pain ...................................................................... 192 

12 - Massage for Treatment of Neck Pain .............................................................................. 192 

 Harms Reported in Nonrandomized Controlled Studies ...................................................... 193 

Acupuncture for Treatment of Low Back Pain....................................................................... 193 

Manipulation and Mobilization for Treatment of Low Back Pain ......................................... 193 

Spinal Manipulation for Treatment of Neck Pain ................................................................... 193 

Chapter 4. Discussion ................................................................................................................. 195 

Overview.............................................................................................................................. 195 

Acupuncture......................................................................................................................... 195 

Major Findings - Low Back Pain............................................................................................ 195
 

Major Findings - Neck pain .................................................................................................... 196 

General Issues and Harms....................................................................................................... 196 

Consistency with Other Systematic Reviews ......................................................................... 196 

Clinical Relevance .................................................................................................................. 197 

Manipulation/Mobilization ..................................................................................................... 198 

Major findings – Low back pain – Manipulation ................................................................... 198 

Major findings – Low back pain – Mobilization .................................................................... 198 

Major findings – Neck pain – Manipulation........................................................................... 198 

Major findings – Neck pain – Mobilization............................................................................ 198 

General Issues and Harms....................................................................................................... 199 

x 
Consistency with Other Systematic Reviews ......................................................................... 201 

Clinical Relevance .................................................................................................................. 201 

Massage................................................................................................................................. 202 

Major findings – Low back pain............................................................................................. 202 

Major findings – Neck pain .................................................................................................... 202 

General Issues and Harms....................................................................................................... 203 

Consistency with Other Systematic Reviews ......................................................................... 203 

Clinical Relevance .................................................................................................................. 204 

Cost-Effectiveness of CAM Therapies ..................................................................................... 204

 Strengths and Limitations of Review ........................................................................................ 204 

Strengths ................................................................................................................................. 204 

Limitations .............................................................................................................................. 205 

Future Research ...................................................................................................................... 206 

References and Included Studies .............................................................................................. 209 

Figures 

Figure 1. Analytical framework .................................................................................................... 20 

Figure 2. PRISMA chart for study retrieval and selection............................................................ 28 

Figure 3. Risk of bias score (%).................................................................................................... 39 

Figure 4. Pain intensity (VAS score) – Immediate post-treatment............................................... 50 

Figure 5. Pain intensity (VAS score) – Short-term post-treatment............................................... 51 

Figure 6. Pain intensity (VAS score) – Intermediate-term post-treatment ................................... 51 

Figure 7. Pain intensity (VAS score) – Long-term post-treatment ............................................... 52 

Figure 8. Disability (RMDQ score) – Immediate post-treatment ................................................. 53 

Figure 9. Proportion of subjects on sick leave - Immediate post-treatment ................................. 53 

Figure 10. Proportion of subjects with global improvement – Short-term post-treatment ........... 53 

Figure 11. Proportion of subjects with global improvement – Intermediate-term
 

post-treatment ............................................................................................................................... 54 

Figure 12. Functional disability (HFAQ score) – Immediate post-treatment ............................... 54 

Figure 13. Functional disability (HFAQ score) – Intermediate post-treatment............................ 54 

Figure 14. Pain intensity (VAS score) – Short-term post-treatment............................................. 55 

Figure 15. Pain intensity (VAS score) – Immediate post-treatment............................................. 56 

Figure 16. Pain intensity (VAS score) – Immediate post-treatment............................................. 56 

Figure 17. Disability (Oswestry score) – Immediate post-treatment............................................ 57 

Figure 18. Pain intensity (VAS score) – Immediate post-treatment............................................. 57 

Figure 19. Pain intensity (VAS score) – Short-term post-treatment............................................. 58 

Figure 20. Pain intensity (VAS score) – Immediate post-treatment............................................. 59 

Figure 21. Pain intensity (VAS score) – Short-term post-treatment............................................. 59 

Figure 22. Pain intensity (VAS score) – Intermediate-term post-treatment ................................. 60 

Figure 23. Disability (RMDQ score) – Short-term post-treatment............................................... 60 

Figure 24. Risk of bias scores (%)................................................................................................ 66 

Figure 25. Pain intensity (VAS Score) – Immediate post-treatment ............................................ 74 

Figure 26. Pain intensity (VAS Score) – Immediate post-treatment ............................................ 76 

Figure 27. Risk of bias scores (%)................................................................................................ 82 

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Figure 28. Risk of bias scores (%)................................................................................................ 96 

Figure 29. Risk of bias scores (%).............................................................................................. 100 

Figure 30. Risk of bias scores (%).............................................................................................. 104 

Figure 31. Risk of bias scores (%).............................................................................................. 121 

Figure 32. Pain intensity (VAS score) – Immediate post-treatment........................................... 128 

Figure 33. Disability (Oswestry score) – Immediate post-treatment.......................................... 128 

Figure 34. Finger to floor distance (in cm) – Immediate post-treatment .................................... 128 

Figure 35. Pain intensity (VAS score) – Immediate post-treatment........................................... 130 

Figure 36. Global perceived scale – Immediate post-treatment ................................................. 130 

Figure 37. Range of mobility (lumbar extension) – Immediate post-treatment ......................... 130 

Figure 38. Range of mobility (lumbar flexion) – Immediate post-treatment ............................. 131 

Figure 39. Finger to floor distance (in cm) – Immediate post-treatment .................................... 131 

Figure 40. Range of mobility (right lateral flexion; in degrees) – Immediate post-treatment.... 131 

Figure 41. Range of mobility (left lateral flexion; in degrees) – Immediate post-treatment ...... 131 

Figure 42. Risk of bias scores (%).............................................................................................. 134 

Figure 43. Risk of bias scores (%).............................................................................................. 144 

Figure 44. Pain intensity (VAS score) – Immediate post-treatment........................................... 152 

Figure 45. Range of mobility (trunk flexion: touch toe without pain) – Immediate 

post-treatment ............................................................................................................................. 152 

Figure 46. Pain intensity (VAS score) – Immediate post-treatment........................................... 153 

Figure 47. Risk of bias scores (%).............................................................................................. 157 

Figure 48. Pain intensity (VAS Score) – Immediate post-treatment (lower risk-of-bias trials) . 174 

Figure 49. Pain intensity (VAS score) – Immediate post-treatment (higher risk-of-bias trials) . 175 

Figure 50. Funnel plot of trials comparing VAS score (acupuncture versus placebo) ............... 189 

Tables 

Table 1. Study quality and risk-of-bias ......................................................................................... 24 

Table 9. Key results – Acupuncture treatment in patient with neck pain & cervicogenic 

Table 12. Spinal manipulation + mobilization for treatment of low back pain- Control 

Table 14. Key results – Manipulation therapy for treatment of neck pain & cervicogenic 

Table 2. Grading of evidence........................................................................................................ 25 

Table 3. Primary records with companion reports ........................................................................ 29 

Table 4. Risk of bias assessment of RCTs.................................................................................... 31 

Table 5. Selected risk of bias tool assessment items in RCTs by CAM treatment type ............... 33 

Table 6. Acupuncture for treatment of low back pain- Control interventions .............................. 37 

Table 7. Key results – Acupuncture treatment in patients with low back pain ............................ 40 

Table 8. Acupuncture for treatment of neck pain- Control interventions ..................................... 64 

headaches ...................................................................................................................................... 67 

Table 10. Spinal Manipulation for Treatment of low back pain- Control Interventions .............. 80 

Table 11. Key results –Spinal manipulation therapy for low back pain ....................................... 83 

interventions.................................................................................................................................. 95 

Table 13. Spinal manipulation for treatment of neck pain- Control interventions ..................... 102 

headaches .................................................................................................................................... 105 

Table 15. Key Results – Manipulation therapy for thoracic pain ............................................... 118 

xii 
Table 16. Mobilization for treatment of low back pain- Control interventions .......................... 120 

Table 24. Summary of RCTs reporting data on economic evaluation of CAM versus other 

Table 25. Summary of RCTs reporting data on economic evaluation of CAM versus other 

Table 28. Utility of conventional medicine for low back pain: Use of conventional 

Table 17. Key results – Mobilization therapy for low back pain................................................ 122 

Table 18. Spinal mobilization for treatment of neck pain- Control interventions ...................... 133 

Table 19. Key results – Mobilization therapy for neck pain ....................................................... 135 

Table 20. Massage for treatment of low back pain- Control interventions ................................ 142 

Table 21. Key results – Massage therapy for low back pain ...................................................... 145 

Table 22. Massage for treatment of neck pain- Control interventions ....................................... 155 

Table 23. Key results – Massage therapy for neck pain ............................................................. 158 

treatments- Low back pain .......................................................................................................... 167 

treatments- Neck pain ................................................................................................................. 171 

Table 26. Subgroup analyses ...................................................................................................... 173 

Table 27. Utility of conventional medicine for low back pain: Use of medication .................... 177 

treatments .................................................................................................................................... 180 

Table 29. Utility of conventional medicine for low back pain: Work absenteeism ................... 182 

Table 30. Utility of conventional medicine for neck pain: Use of medication ........................... 185 

Table 31. Utility of conventional medicine for neck pain: Work absenteeism .......................... 187 

Appendixes 

Appendix A: Exact Search Strings 

Appendix B: Sample Data Abstraction Forms 

Appendix C: Evidence Tables 

Appendix D: List of Excluded Studies 

Appendix E: Peer Reviewers & Technical Expert Panel 

Appendix F: Quality Assessment Forms 

Appendix G: Quality Assessment Data 

Appendix H: Unobtained Articles 

Appendix I: Summary Tables 

Appendixes and Evidence Tables for this report are provided electronically at: 

http://www.ahrq.gov/downloads/pub/evidence/pdf/backpaincam/backcam2.pdf. 

xiii 
Executive Summary 

Background 

Back and neck pain are important health problems with serious societal and economic 

consequences. The prevalence of back and/or neck pain in US in 2007 was estimated to be 31 

percent. The costs associated with low productivity, lost-time at work, permanent disability, and 

healthcare are enormous. Conventional medical treatments have been shown to have limited 

effectiveness in the management of back and neck pain. Complementary and Alternative Medicine 

(CAM) therapies offer additional options for management of back and neck pain. The number of 

people in Western societies using CAM therapies is increasing. The most prevalent CAM therapies 

are spinal manipulation, acupuncture, and massage. The number of randomized controlled trials 

(RCTs) evaluating CAM therapies for back and neck pain has increased over the past two decades. 

The results of these trials are inconsistent. 

The University of Ottawa Evidence-based Practice Center (UO-EPC) reviewed and synthesized 

evidence to better understand effectiveness and safety of the most prevalent CAM therapies in the 

management of back, neck, and thoracic pain in adults. The current review commissioned by the 

Agency for Healthcare Research and Quality (AHRQ) and National Center for Complementary and 

Alternative Medicine (NCCAM) aimed to address the following research Key Questions (KQ): 

KQ1. What is the efficacy, effectiveness and cost-effectiveness of the most prevalent types of 

practitioner-based manual CAM therapies (e.g., spinal manipulation, spinal mobilization, massage; 

acupuncture) compared to other CAM therapies, conventional therapies, placebo, no treatment, or 

wait list in improving outcomes (e.g., QoL, Pain, Function, progression of acute to chronic/ or 

disabling BP) in patients with nonspecific and certain specific (e.g. disc herniation, spinal stenosis, 

facet joint syndrome, whiplash) types of back and neck pain. 

a. For any of the CAM therapies found to be effective for BP, what factors influence success 

of treatments? 

i. Patient-specific factors 

ii. Socio-demographics (e.g., age, gender, race, education, income) 

iii. Comorbidities 

b. Severity, specific causes (as identified in Q1), and duration of BP 

i. Treatment-specific factors (e.g., dose, frequency, duration) 

ii. Treatment provider-specific factors (e.g., training, specialization, experience) 

c. Does the use of any of the 3 most prevalent types of CAM for BP in adults result in a 

decreased or increased utilization of conventional management (diagnostic tests, number of visits & 

dose of medications, procedures)? 

KQ2. What are the contraindications and safety profile of the three most prevalent CAM 

therapies for BP in adults compared to that for other CAM therapies, conventional therapies, placebo 

or no treatment? Does the safety profile of these therapies change across subgroups of patients with 

comorbidities? 

1 
Methods 

Data Sources and Search Strategy 

A comprehensive search was conducted in the following databases: MEDLINE, the Cochrane 

Library, EMBASE, and Allied and Complementary Medicine (AMED) were all searched from 

inception until February 2010. CINAHL, Mantis, and the ACP Journal Club were also searched from 

inception until September 2008. Additional literature was searched through bibliographies of 

relevant items. The Web sites of relevant organizations/agencies, trial registries, and conference 

proceedings were searched for the grey literature. 

Study Selection Criteria and Process 

Randomized controlled trials (RCTs) reporting efficacy/effectiveness and/or economic data of 

the CAM therapies (acupuncture, manipulation, mobilization, massage) versus any inactive or active 

treatments in adults with back, neck, or thoracic pain were eligible. Nonrandomized controlled trials 

and observational studies (e.g., cohort, case-control, cross-sectional) reporting harms were also 

included. 

Reports published in English, German, Dutch, Chinese, Japanese, Italian, French, Portuguese, 

and Spanish were eligible for inclusion. Systematic and narrative reviews, case reports, editorials, 

commentaries or letters to the editor were excluded. 

Titles and abstracts of all identified bibliographies were screened for eligibility by two 

independent reviewers who later reviewed full-text reports of potentially eligible records. 

Discrepancies were resolved by consensus. 

Data Extraction 

Two independent reviewers extracted data using an a priori developed abstraction form. The 

abstracted data were crosschecked and conflicts were resolved by consensus. 

Primary efficacy/effectiveness outcomes included pain intensity (e.g., Visual Analog Scale-VAS, 

McGill Pain Questionnaire-MPQ) function (Hannover Functional Ability Questionnaire-HFAQ), 

and disability (e.g., Roland Morris Disability Questionnaire-RMDQ, Northwick Park Neck Pain 

Questionnaire-NPQ, Pain Disability Index-PDI, and Oswestry Disability Index). Secondary 

outcomes included spinal range of motion (ROM), straight leg raise (SLR), finger-to-floor distance 

(FFD), and muscle strength. Harms (e.g., any adverse event, withdrawals due to adverse events, 

specific adverse events) were extracted as proportions of patients with an event. 

For cost-effectiveness analysis, data was extracted on: a) costs in the health care sector, b) costs 

of production loss, c) costs in other sectors, d) patient and family costs, and e) total costs. 

 Assessment of Study Quality and Reporting 

The risk of bias for RCTs was assessed using the criteria list recommended in the Updated 

Method Guidelines for Systematic Reviews in the Cochrane Collaboration Back Review Group. 

Depending on the number of ‘Yes’ ratings (score range: 0-4) across four domains (treatment 

2 
allocation concealment, balance in baseline characteristics, blinding, and number/reasons for 

dropouts), the quality of individual studies was classified into three groups: good (score: 4), fair 

(score: 2-3), and poor (score: 0-1). The overall bias was explored using risk-of-bias graphs. The 

quality of observational studies was assessed using the modified Downs and Black tool. 

Methodological quality of economic studies was determined using the 19-item CHEC list. 

Quantitative Synthesis 

The results were grouped according to a type of experimental intervention (e.g., acupuncture, 

manipulation, mobilization, massage), pain location in spinal region (low back, neck, thorax), 

duration of pain (acute/sub-acute, chronic, mixed, unknown), and cause of pain (specific versus 

nonspecific). Study, treatment, population, and outcome characteristics were summarized in text 

and/or summary tables. 

We pooled RCTs with similar populations (demographics, duration, and cause of pain), same 

types of experimental and controls treatments, which reported outcomes measured with the same 

instruments (and scale) at similar post-treatment followup periods. The meta-analyses of pain were 

based on a 1-10 visual analogue scale. The random-effects models of DerSimonian and Laird were 

used to generate pooled estimates of relative risks (RRs) and weighted end point mean difference 

(WMDs) with 95 percent confidence intervals (CIs). Statistical heterogeneity was evaluated using 

the Chi-square test and the I2

 statistic (low: 25.0 percent; moderate: 50.0 percent; high: 75.0 

percent). Subgroup (e.g., patients’ age, gender) and sensitivity (e.g., trial quality) analyses were 

planned to investigate the sources of unexplained heterogeneity. 

If data allowed, the statistically significant pooled estimates of post-treatment pain intensity were 

planned to be examined in order to determine the degree of clinical importance for the observed 

differences between the treatment groups. The degree of clinical importance was defined as small 

(WMD < 10 percent of the VAS scale), medium (10 percent  WMD < 20 percent of the VAS 

scale), and large (WMD 20 percent of the VAS scale). 

Publication bias was examined through visual inspection of funnel plot asymmetry with respect 

to contours of statistical significance and the Egger’s regression-based method. 

Rating the Strength of Evidence 

We assessed the overall strength of evidence using the approach of grading system outlined in 

the Methods guide prepared for the AHRQ Evidence-based Practice Center (EPC) program. The 

grading method consists of four major domains: risk of bias (high, medium, low), consistency, 

directness, and precision. Body of evidence for a given outcome was classified into four groups: 

high, moderate, low, or insufficient (no evidence). The initial grade was reduced by one level (e.g., 

from high to moderate; from moderate to low) for each of the domains not met and by two levels in 

case of high risk of bias (e.g., from high to low grade; from moderate to low grade). 

3 
Results
 

KQ1. Efficacy/effectiveness and Cost-effectiveness of CAM Therapies 

Compared to no Treatment, Placebo, and Other Active CAM/nonCAM 

Therapies in Management of Back, Neck, and/or Thoracic Pain. 

In total, 265 RCTs (including 10 reporting economic data), and five controlled observational 

studies which provided harms data were included. Most studies included subjects with chronic 

nonspecific pain. Immediate and short-term post-treatment follow-ups were most frequently 

reported. Only the main findings for pain, disability, and mobility are reported in this summary. 

Efficacy/Effectiveness 

Acupuncture – Low Back Pain. In subjects with chronic nonspecific LBP, acupuncture 

compared to placebo led to statistically significantly lower pain intensity (Grade – moderate) but 

only for the immediate-post-treatment followup (10 trials; pooled VAS: -0.59, 95 percent CI: ­

0.93, -0.25). Acupuncture did not significantly differ from placebo in improving pain intensity 

scores, well-being, disability, use of medication, proportion of subjects on sick leave, and 

proportion of subjects with global improvement at short-, intermediate-, and long-term posttreatment. Trials using TENS-sham, laser-sham, or medication-sham compared to those using 

sham-acupuncture tended to produce results in favor of acupuncture in relation to pain intensity 

and disability. 

Subjects in acupuncture group had statistically significantly better post-treatment pain 

intensity (three trials; pooled short-term VAS: -1.19, 95 percent CI: -2.17, -0.21; Grade - 

moderate), pain disability index (one trial; immediate-term PDI; Grade - moderate), function 

(two trials; immediate-term HFAQ; Grade - moderate), well-being (two trials; immediate-term 

SF-36; Grade - moderate), or ROM (one trial; immediate-/intermediate-term extension, flexion 

Grade - low) compared to ‘no treatment’ group. 

Subjects in the acupuncture group compared with those in usual care had significantly better 

post-treatment pain intensity (two trials; short-/intermediate-term VAS; Grade - moderate), 

disability (two trials; short-/intermediate-term RMDQ; Grade - moderate), quality of life (one 

trial; intermediate-term SF-12; Grade - moderate), or function (one trial; intermediate-term 

HFAQ; Grade - moderate). 

In two meta-analyses, acupuncture did not significantly differ from pain medication in 

reducing immediate post-treatment pain (four trials; immediate-term pooled VAS: 0.11, 95 

percent CI: -1.42, 1.65; Grade – low) or disability (two trials; pooled Oswestry: -2.40, 95 percent 

CI: -12.20, 7.40; Grade – low). In contrast, another meta-analyses indicated significantly worse 

post-treatment pain (two trials; immediate VAS: 3.70, 95 percent CI: 1.50, 5.80; Grade – low) 

for acupuncture versus manipulation. 

Subjects receiving acupuncture had significantly better immediate post-treatment pain and 

disability than subjects receiving physiotherapy (two trials; trial one - light, electricity and heat 

therapy; trial two - hot packs, ultrasound, short-wave diathermy, TENS, muscle strengthening; 

Grade – low). There was no difference between acupuncture and massage in healthcare 

4 
utilization (one trial; intermediate-term number of provider visits, percentage of subjects using 

medication; Grade - low). 

In subjects with acute nonspecific LBP there was no statistically significantly difference 

between acupuncture and usual care groups (one trial; immediate-short-intermediate-term 

RMDQ; Grade-low). 

Acupuncture – Neck Pain. Two meta-analyses indicated no significant difference between 

acupuncture and sham-acupuncture in subjects with chronic specific (two trials; Grade – 

moderate; VAS: 0.27, 95 percent CI: -0.60, 1.13) or nonspecific pain (three trials; Grade – low; 

VAS: -0.24, 95 percent CI: -1.20, 0.73) for immediate post-treatment pain intensity. Trials using 

TENS-sham, laser-sham, or medication-sham compared to those using sham-acupuncture tended 

to produce results in favor of acupuncture in relation to pain intensity and disability. 

There were inconsistent results for immediate- or short-term post-treatment pain intensity 

between acupuncture and pain medication groups of subjects. Intermediate-term followup 

indicated no significant difference between acupuncture and pain medication groups. 

Acupuncture did not differ from standard mobilization and traction techniques or laser therapy in 

short-term post-treatment pain intensity or disability. Immediate/short-term post-treatment pain 

and disability were better in manipulation than acupuncture groups (two trials, Grade - low). 

Manipulation – Low Back Pain. In subjects with acute/sub-acute nonspecific LBP, 

manipulation was significantly more effective than placebo (five trials; Grade – moderate) or no 

treatment (one trial; Grade – low) in reducing pain intensity (VAS score) immediately or shortterm after the end of treatment. There was no significant difference between manipulation and 

placebo in post-treatment pain medication intake, disability, or back flexibility (three trials; 

Grade -low). Manipulation did not differ from medication in reducing pain intensity (two trials; 

Grade - low). 

In subjects with chronic nonspecific LBP, manipulation was significantly more effective than 

placebo in reducing pain intensity (VAS score) immediately or short-term after the end of 

treatment (three trials; Grade – low). Manipulation was significantly better (in immediate posttreatment pain; two trials; Grade – low) or no different (in intermediate-term post-treatment pain; 

one trial; Grade – low) from medication in improving pain intensity. 

In older subjects with mixed duration LBP, spinal manipulation was significantly better than 

medical care in improving immediate and short-term post-treatment disability (Oswestry) and 

perception of global improvement but not pain intensity or physical function (one trial; Grade – 

low). 

Results from studies comparing manipulation to massage or physiotherapy in improving 

post-treatment pain intensity (two trials; Grade – low) or mobility (three trials; grade – low) were 

inconsistent, either in favor of manipulation or indicating no significant difference between the 

two treatments. 

In two large trials (UK BEAM and Childs 2004), subjects receiving combination of 

manipulation and exercise or best care by general practitioner improved in pain and disability 

compared to subjects with no spinal manipulation treatment (Grade – Moderate). 

Manipulation – Neck Pain. Subjects receiving manipulation had significantly better posttreatment pain (two trials; Grade - moderate) disability (one trial; Grade - low), or mobility 

(extension, flexion, rotation) (one trial; Grade - low) compared to those taking placebo. 

Manipulation did not significantly differ from medication in reducing pain intensity (three trials; 

Grade - moderate) and disability (two trials - Grade – moderate). 

5 
Mobilization – Low Back Pain. There were no significant differences in pain intensity 

(VAS) and ROM (flexion, extension, floor to floor) between subjects who received mobilization 

and placebo immediately or short-term after treatment (two trials; specific acute/sub-acute and 

nonspecific mixed duration pain; grade – low). Subjects with specific acute/sub-acute pain 

receiving mobilization had significantly reduced intake of analgesic medication and duration of 

sick leave compared to those receiving placebo (one trial; Grade - low). 

Subjects with acute/sub-acute and chronic pain (specific or nonspecific) receiving 

mobilization experienced significantly improved pain intensity (VAS, MPQ) and lumbar ROM 

(side bending) compared to subjects not receiving any treatment, immediately and short-term 

after treatment (two trials; Grade – low). Results regarding disability (RMDQ, Oswestry) were 

inconsistent, showing either a significant difference in favor of mobilization (one trial; Grade – 

low) or no difference between mobilization and no treatment (one trial; Grade - low). In subjects 

with mixed duration of pain, there were no significant differences in pain intensity (VAS) and 

ROM (flexion, extension) immediately or short-term after treatment (one trial; Grade – low). 

In two meta-analyses, subjects with chronic nonspecific pain receiving mobilization 

(traditional bone setting) compared to physiotherapy (massage, stretching, trunk exercise) had 

significantly lower pain intensity (two trials, Grade – low; VAS score: -0.50, 95 percent CI: ­

0.70, -0.30) and disability degree (two trials, Grade – moderate; Oswestry score: -4.93, 95 

percent CI: -5.91, -3.96) immediately after treatment. There was no significant difference 

between the groups in the mean finger to floor distance immediately after treatment (two trials, 

Grade – moderate; -0.89, 95 percent CI: -1.89, 0.12). Similarly, mobilization and physiotherapy 

groups did not significantly differ in ROM (Schober’s test, extension, straight leg raising) 

immediately or intermediate-term after treatment (one trial; Grade - low). In subjects with 

nonspecific pain of mixed duration, mobilization was significantly superior to physiotherapy 

(massage, mobilization, thermal, and electrotherapies according to the Finnish routine) in 

reducing disability (Oswestry), but only at intermediate term post-treatment (one trial, Grade – 

low). There was no significant difference between the groups in the number of sick leave days 

for the trial period. 

The immediate- or intermediate-term post-treatment pain intensity (VAS score; one trial; 

Grade - low), disability (Oswestry; one trial; Grade - low), and ROM (Schober’s test, extension, 

straight leg raising; two trials; Grade - low) did not significantly differ between mobilization and 

exercise given to subjects with nonspecific chronic or mixed duration of pain. 

Mobilization – Neck Pain. Mobilization was significantly better than placebo in subjects 

with acute/sub-acute nonspecific pain (one trial; Grade – Low), but did not differ from placebo in 

subjects with chronic nonspecific pain (one trial; Grade – low). 

Subjects with chronic or mixed nonspecific pain receiving mobilization had significantly 

lower pain intensity compared to no treatment (two trials; Grade - Low). There was no 

significant difference between the mobilization and no treatment groups in the mean intake of 

analgesic medication pills and the number of sick leave days immediately or short-term after 

treatment (one trial; Grade - low). 

Mobilization was significantly better than massage or physiotherapy (massage, stretching and 

exercise) in improving pain (VAS score), disability (NDI), global assessment, analgesic 

medication intake, and the number of sick leave days in chronic nonspecific pain at intermediateterm post-treatment followup (one trial; Grade – Low). Subjects with mixed duration nonspecific 

6 
pain in the mobilization and continued general practitioner care groups had similar posttreatment pain intensity and disability (VAS and NDI; one trial; Grade – low). 

Massage – Low Back Pain. Subjects with nonspecific acute/sub-acute pain receiving 

massage had significantly better pain intensity (VAS, MPQ) and disability (Oswestry) compared 

to no treatment (one trial; Grade – low) or placebo (two trials; Grade –moderate) immediately or 

short-term after the end of treatment. In subjects with nonspecific chronic pain, massage did not 

significantly differ from no treatment or placebo in improving immediate or intermediate-term 

post-treatment pain intensity (VAS, MPQ; two trials; Grade – low), disability (Oswestry, 

RMDQ; two trials; Grade – low), general health perception (one trial; Grade – low), or health 

status (SF-36; one trial; Grade – low). 

In two meta-analyses, massage was significantly better in reducing pain compared to 

relaxation (two trials; Grade – low; VAS score: -1.27, 95 percent CI: -2.46, -0.08) or physical 

therapy (two trials; Grade – moderate; VAS score: -2.11, 95 percent CI: -3.15, -1.07) 

immediately after treatment in subjects with chronic nonspecific pain. In another meta-analysis, 

massage was not significantly better than relaxation in improving immediate post-treatment 

ROM (two trials; Grade – low; trunk flexion: 2.21, 95 percent CI: -1.10, 5.52). In subjects with 

chronic nonspecific pain, massage was significantly more effective than physical therapy in 

reducing pain (SF-PQ, VAS), disability (RMDQ, modified Oswestry), and the number of days 

off work immediately or intermediate-term after the treatment (two trials; Grade - low). In 

subjects with chronic nonspecific pain, there was no significant difference between receiving 

massage and general practitioner care in improving pain (VAS score), disability (RMDQ), or 

well-being (SF-36) intermediate-term after the end of treatment (one trial; Grade – low). 

Massage – Neck Pain. Subjects with acute/sub-acute, chronic, or unknown duration of 

nonspecific pain receiving massage had significantly improved pain (2-point decrease on NRS11, VAS, Pressure Pain Threshold scores) compared to placebo (three trials; Grade – Low), 

immediately after treatment. In subjects with chronic specific pain, massage did not significantly 

differ from placebo in improving range of mobility (one trial; Grade – low) or well-being (SF-36, 

role physical, pain index; one trial; Grade - low). 

Massage, compared to no treatment, significantly improved pain intensity (NPQ, VAS 

scores) but not ROM (flexion, extension) in subjects with chronic or unknown duration of 

nonspecific pain, immediately after the end of treatment (two trials; Grade – low). 

In subjects with chronic nonspecific pain (one trial; Grade – Low), massage compared to 

exercise significantly improved disability (NPQ) but not ROM (flexion, extension). 

7 
Cost-effectiveness 

This review included results from 10 studies of full economic evaluations of acupuncture (low 

back pain: two studies, neck pain: one study), spinal manipulation (low back pain: four studies, neck 

pain: two studies), and massage (one study) for low back and neck pain. 

Acupuncture - Low back pain. Two economic evaluations showed that acupuncture was costeffective compared to usual care and compared to no treatment in patients with chronic low back 

pain. However, in both studies health gains were small and one study used no treatment control 

group and had only 3 months followup. 

Acupuncture - Neck pain. One study showed that in subjects with chronic neck pain 

acupuncture use was associated with significantly higher total costs compared to usual care ($1,565 

versus $1,496). 

Manipulation - Low back pain. There were no differences in costs between manual therapy, 

general practitioner care and intensive therapy for acute low back pain. Costs were higher for 

manipulation compared with medical care without producing better clinical outcomes for patients 

with mixed duration of LBP (acute, subacute and chronic). This was associated with significantly 

more visits to chiropractic care than medical care. Spinal manipulation in addition to general 

practitioner care was relatively cost-effective compared to general practitioner care alone for patients 

with sub-acute and chronic low back pain. In chronic LBP patients, there were no differences in 

costs between physician consultation, spinal manipulation plus stabilizing exercises, and physician 

consultation alone. Results are difficult to compare due to differences in health care systems, 

perspectives, interventions, populations, and methods used. 

Manipulation - Neck pain. One study in subjects with neck pain found that pulsed short-wave 

diathermy was less cost-effective compared with manual therapy or exercise/advise. In another 

study, manual therapy was less costly and more effective than physiotherapy (functional, active and 

postural or relaxation exercises, and stretching) or general practitioner care. 

Massage - Low back pain. One study reported an economic evaluation of therapeutic massage, 

exercise, Alexander technique, and usual general practitioner care in patients with chronic low back 

pain showing that massage was more costly and less effective than usual care by the general 

practitioner. 

8 
KQ1 a-c. Patient- and Trial-specific Factors Influencing Treatment 

Success 

The amount of evidence regarding factors potentially influencing treatment effect (e.g., age, 

gender race, education, income, cause of pain, type of treatment provider, dose of treatment) was 

relatively limited. 

There was no discernable pattern indicating that the effect of acupuncture was different in 

subjects with specific and nonspecific pain (neck and low back pain). 

In one trial (Grade – Low), the subject’s age, gender, symptom duration, or the therapist’s years 

of experience did not have a significant effect on the mean change for Oswestry score between 

spinal manipulation in addition to exercise and exercise alone. In another trial (Grade - Moderate) 

the beneficial effect of massage compared to physical therapy (physical modalities, exercise and 

traction) was similar across age ( 50, and > 50 years) and gender groups. 

Massage was significantly better in reducing pain intensity compared to physical therapy in 

subjects with severe pain at baseline. The reduction in pain intensity did not differ between the 

massage and physical therapy groups amongst subjects with lower baseline pain scores. The baseline 

severity did not modify the effect of massage (versus physical therapy) measured at intermediateterm after the end of treatment (i.e., massage was significantly better than physical therapy in 

reducing pain across the baseline pain severity groups). 

This review identified evidence on utilization of conventional healthcare (e.g., routine visits to 

physician, use of analgesics, hospital stay) and work absenteeism. 

The use of conventional healthcare was not different in acupuncture versus self care, usual care, 

or massage for subject with chronic LBP (two trials). Similarly, the use of conventional care did not 

differ between spinal manipulation and hospital outpatient management, or physician consultation 

for LBP (two trials). In contrast, the use of conventional care was significantly reduced for subjects 

receiving spinal manipulation in addition to exercise compared to exercise alone (one trial). 

The use of analgesics was significantly reduced for acupuncture versus placebo, waiting list, 

TENS, or usual care in LBP (four trials); and between acupuncture and placebo in subjects with neck 

pain (one trial). In contrast, the use of analgesics did not significantly differ between acupuncture 

and self care in LBP (one trail); between acupuncture and placebo, self care, or other treatments for 

NP (five trials). Similarly, the use of analgesics did not differ between spinal manipulation and 

placebo, or conventional care in subjects with low back pain(five trials, Grade – Low); between 

spinal manipulation or mobilization and prescription medication, no treatment neck collar, or 

physiotherapy for subjects with neck pain (five trials). 

The extent of work absenteeism was significantly greater in exercise alone versus acupuncture in 

LBP (one trial); between mobilization and no treatment or physiotherapy in neck pain (two trials). 

Sick leaves due to pain, did not differ between acupuncture and placebo or usual care in LBP (two 

trails); and between mobilization and neck collar or ‘act as usual’ in neck pain (one trial). 

The sensitivity analysis, performed on acupuncture trials, found no evidence that treatment effect 

was strongly influenced by study quality. The pooled estimates of mean difference in pain intensity 

(VAS score) for ‘lower risk-of-bias’ and ‘higher risk-of-bias’ trials were -0.43 (95 percent CI: -0.76, 

-0.09) and -0.75 (95 percent CI: -1.39, -0.11), respectively. 

9 
KQ2. Harms of CAM Therapies 

The reporting of harms was poor across studies of CAM interventions. Only very few trials 

reported any information on adverse events. The reported information was not detailed, lacked 

consistency, and was not comparable. No definitions were presented. Therefore, the rates of adverse 

events between the different interventions could not be meaningfully compared. 

Acupuncture. The reported events in RCTs were mostly of moderate transient nature amongst 

these most commonly reported events were soreness/pain at the site of needling, bruising light 

headedness, minor bleeding, dizziness, or headache. The proportion of subjects with any adverse 

event did not reportedly differ in acupuncture versus TENS or usual care groups. In one 

nonrandomized trial, discomfort or soreness in the acupuncture, chiropractic therapy, and massage 

groups were 5.0 percent, 8.0 percent, and 7.0 percent, respectively. 

Manipulation/Mobilization. The reported events in RCTs were mostly moderate in severity and 

of transient nature (e.g., increased pain). In one RCT, after 2 weeks of treatment, patients with neck 

pain receiving manipulation were not at significantly increased risk for having an adverse event 

compared to patients receiving mobilization (OR = 1.44, 95 percent CI: 0.83, 2.49). In another RCT, 

the proportion of patients with neck pain having adverse events was similar in manipulation versus 

Diazepam groups (9.5 percent versus 11.1 percent). In two case control studies, subjects  45 years 

of age with vertebro-basilar artery (VBA) stroke were more likely to visit a chiropractic or primary 

care physician than subjects without VBA stroke. This association was not observed in older subject 

visiting a chiropractic clinic. In one case control study, the excess risk of vascular accident was 

observed for both, subjects undergoing chiropractic care and subjects undergoing primary care 

treatments. In another case-control study, subjects with cervical artery dissection were more likely to 

have had spinal manipulation within 30 days (OR = 6.62, 95 percent CI: 1.4, 30.0). In one cohort 

study, rate of complications did not differ between subjects with low back pain receiving 

manipulation plus mobilization versus no treatment. 

Massage. In few RCTs, subjects receiving massage experienced worsening of back/neck pain or 

soreness of mild and transient nature. One study reported allergic reactions (rashes and pimples) in 

five subjects due to massage oil. 

In one RCT, the proportion of patients with neck pain having adverse events in massage group 

was lower (7.0 percent) compared to acupuncture (33.0 percent) or placebo-laser (21.0 percent). 

Conclusions and Future Research 

This review identified a large amount of evidence on comparative effectiveness of single 

mode CAM interventions for management of back and neck pain in subjects with a wide 

spectrum of causes (specific and nonspecific) and duration (acute to chronic) of pain. The 

reviewed evidence was of low to moderate grade and inconsistent probably due to substantial 

methodological and/or clinical diversity, thereby rendering some between-treatment comparisons 

inconclusive. The differences in the therapy provider’s experience, training, and approaches 

(e.g., deep or superficial massage, choice of trigger points, needling techniques) may have 

additionally contributed to disparate results. Evidence for acute, sub-acute, and mixed specific 

pain was sparse compared to that for chronic nonspecific pain. Poorly reported harms data 

limited our ability to meaningfully compare rates of adverse events between the treatments. 

10 
Generally, CAM treatments were more effective in reducing pain and disability compared to no 

treatment, physical therapy, or standard care immediately or at short-term followup. Results of trials 

comparing CAM treatment to sham were less consistent either showing significant differences in 

favor of CAM or no significant differences between the treatments. 

For chronic nonspecific back pain, acupuncture was better than placebo but only for improving 

pain intensity at immediately post-treatment. The long-term post-treatment disability and utilization 

of conventional healthcare did not differ between subjects with low back pain receiving acupuncture 

and usual care. Trials that applied sham-acupuncture tended to produce negative results (i.e., 

statistically nonsignificant) compared to trials that applied other types of placebo (e.g., TENS, 

medication, laser) between acupuncture and placebo groups. Acupuncture significantly decreased 

pain medication use compared with no treatment or placebo, but not so compared with self-care, 

Botulinum toxin, or Lidocaine injection. There was no statistically significant difference between 

acupuncture and control treatments for the number of visits to other healthcare providers. 

Manipulation did not differ from pain medication in improving pain intensity. Manipulation was 

significantly more effective than acupuncture in reducing immediate post-treatment pain intensity. 

Results for pain intensity or disability were inconsistent regarding manipulation compared to 

massage or physiotherapy for treatment of LBP. Subjects receiving manipulation did not differ in 

healthcare utilization from subjects receiving exercise, physician consultation, medical care, or 

placebo. 

In chronic or mixed duration of low back pain, mobilization was similar to placebo in reducing 

pain or to physiotherapy (which may include a combination of manual treatment and physical 

modality but not physical modalities alone) in improving immediately after or short term posttreatment. 

For subjects with chronic neck pain, acupuncture was not different from sham-acupuncture, pain 

medication, mobilization/traction, or laser therapy in reducing pain or disability after the treatment. 

Subjects with neck pain benefited more with manipulation than placebo in terms of pain, disability, 

and neck flexibility.

 Mobilization was more effective than placebo in improving acute/subacute neck pain but not 

chronic neck pain. In subjects with neck pain (chronic, mixed duration), mobilization was better than 

no treatment in reducing pain intensity, but not in reducing the intake of pain medication pills or the 

number of sick leave days immediately or short-term after the treatment. Mobilization was better 

than physiotherapy or massage in reducing pain intensity and disability in subjects with chronic 

nonspecific neck pain. Massage was not different from placebo in improving well-being or ROM in 

subjects with chronic neck pain. 

In summary, the degree of clinical importance for the differences in pooled pain intensity 

observed between the treatment groups for low back pain was small (acupuncture versus placebo; 

mobilization versus physical therapy), medium (acupuncture versus no treatment; massage versus 

relaxation), or large (acupuncture versus manipulation, in favor of manipulation; massage versus 

physical therapy). 

Due to the small number of economic evaluations, inconsistent standards of comparison, and 

substantial heterogeneity (diversity of healthcare payment systems across countries) it was not 

possible to reach clear conclusions about the cost-effectiveness of any of the CAM treatments. 

Spinal manipulation for back pain was not cost-effective relative to medical care. Acupuncture was 

cost-effective relative to usual care or no treatment in subjects with back pain. Evidence for massage 

was insufficient. 

11 
In several studies subjects receiving CAM therapies reported soreness or bleeding on the site of 

application (acupuncture groups) and worsening of pain/back pain (manipulation/massage groups). 

More data from long term and large head to head trials with sufficient duration of CAM 

treatments and trials comparing CAM treatment to other widely used active treatments (e.g. 

comprehensive physiotherapy) reporting clinically relevant and validated outcomes (e.g. pain 

intensity, disability, direct and indirect costs, utility of conventional care, and adverse events) are 

needed for definitive conclusions. 

Future studies should control for or examine the influence of treatment dose/duration, care 

provider-(e.g. certification, years of experience) and population-specific variables on treatment 

effect estimate. 

12 
Evidence Report 
15

Chapter 1. Introduction

Background

Back and neck pain are important health problems with serious societal and economic 

consequences. One study published in 2007 showed that the 3 month prevalence of back and/or 

neck pain in U.S. was 31 percent (low back pain: 34 million, neck pain: nine million, both back 

and neck pain: 19 million).1 Most of the acute back pain episodes resolve spontaneously within a 

few days or weeks with frequent recurrences. The burden related to back pain results from the 

minority of the acute cases that become chronic leading to low productivity, lost-time at work, 

permanent disability, and healthcare costs which are enormous. A recently published systematic 

review of 27 studies showed that the largest proportion of direct medical costs for low back pain 

was spent on physical therapy (17 percent) and inpatient services (17 percent), followed by 

pharmacy (13 percent) and primary care (13 percent). Among studies providing estimates of total 

costs, indirect costs resulting from lost work productivity accounted for the majority of overall 

costs associated with low back pain.

Complementary and Alternative Medicine (CAM) offers additional options for the 

management of back and neck pain problems. The number of people in Western society who 

seek the care with CAM therapies is increasing. The most prevalent CAM therapies for back and 

neck pain are spinal manipulation, acupuncture, and massage.2These interventions have the 

following aspects in common: a hands-on therapy, multiple visits, utilize primarily passive with 

some active modality elements, prolonged interaction with the healthcare practitioner and a 

naturalistic approach that avoids drugs or surgical interventions.

Most Commonly Used CAM Therapies for Back Pain

Acupuncture is one of the oldest forms of therapy and has its roots in ancient Chinese 

philosophy. According to the classic acupuncture theory all disorders are reflected at specific 

points, either on the skin surface or just below it. An appropriate choice of the 361 classic 

acupuncture points is believed to restore the balance in the body. Modern acupuncturists use not 

only traditional meridian acupuncture points, but also nonmeridian or extra-meridian 

acupuncture points. Many acupuncturists (particularly those with conventional medical training) 

practice without reference to traditional Chinese concepts. The exact mechanisms underlying the 

action of acupuncture remain unclear. It has been suggested that acupuncture might act by 

principles of the gate control theory of pain. Another theory relates to diffuse noxious inhibitory 

control (DNIC), which implies that noxious stimulation of heterotopic body areas modulates the 

pain sensation originating in areas where a patient feels pain. There is also some evidence that 

acupuncture may stimulate the production of endorphins, serotonin, and acetylcholine within the 

central nervous system, enhancing analgesia.3 Acupuncture is a heterogeneous set of diverse 

practices and therefore some types of acupuncture maybe more effective than others.

Spinal manipulation therapy is defined as the application of high-velocity, low-amplitude 

manual thrusts to the spinal joints. The practice of spinal manipulation is frequently performed 

by chiropractors,

4

and also by osteopaths, and physical therapists. The mechanism of effect of 

spinal manipulation is unclear; it is hypothesized that spinal manipulation displaces and deforms 

the tissues, altering orientation or position of anatomic structures, unbuckling some structures, 
16

releasing entrapped structures or disrupting adhesions. Other hypotheses focus on the 

neurological response of cell or matrix systems to the input forces of spinal manipulation. 

Evidence suggests that spinal manipulation impacts primary afferent neurons from paraspinal 

tissues, the motor control system, and pain processing.5

Spinal mobilization is another commonly used manual therapy that uses low grade/velocity , 

small or large amplitude passive movement and neuromuscular techniques within a patient’s 

range of motion. The mechanism of action of spinal mobilization is also not entirely clear. It has 

been proposed that these spinal techniques improve signs and symptoms by directly facilitating 

the restricted mobility of the facet joints and simultaneously influencing the mobility of the 

intervertebral joint.6Spinal mobilization is frequently performed by chiropractors,

4

and also by 

osteopaths, and physical therapists.

Massage is a way of easing pain, while at the same time aiding relaxation and promoting a 

feeling of well-being and a sense of receiving good care by manipulation of local or remote soft 

tissue. The mechanisms by which massage exerts these multiple therapeutic effects are not yet

known. It was hypothesized7that massaging affected muscles and fascia induces local

biochemical changes that modulate local blood flow and oxygenation in muscle. These local 

effects may influence neural activity at the spinal cord segmental level and could modulate the 

activities of subcortical nuclei that influence mood and pain perception. Soft tissue massage may 

increase the pain threshold through the release of endorphins. Mechanistic studies are needed to 

delineate underlying biologic and psychological effects of massage and their relationship to 

outcomes.3It is important to note that manual therapies (massage and manipulation / 

mobilization) are practiced in different ways by different practitioners (e.g. chiropractic 

manipulation may be quite distinct from that practiced by a physical therapist). 

Additionally, nonspecific effects of therapy (i.e. attention/touch/empathy) need to be also 

considered. For example, it is difficult to separate out specific effects from nonspecific effects of 

CAM treatment due to the inability to blind subjects to the treatment. 

Back Pain and Treatment Approaches

The classification of back pain is not consistent within the clinical community. Generally, 

back pain treatments are aimed at specific anatomical regions (cervical, thoracic, and lumbar); 

there is variation in how the various CAM techniques actually affect the intended region 

currently being treated or other parts of the back. In addition to the body region, clinicians tend 

to define and develop treatment approaches for back pain based on the perceived underlying 

mechanical or pathological diagnosis; patients are generally categorized into specific back or 

nonspecific back pain groups. Specific back pain can include such patient diagnoses as 

radiculopathopathy, degenerative disc disease, disc herniation, spinal stenosis, or myofascial pain 

syndrome to name a few. Nonspecific back pain represents the largest clinical groups in which 

patients are categorized and generally reflects that no particular functional or structural factor is 

ascribed as the primary source of the current episode. Within both these categories of back pain, 

there is inconsistency in the manner in which patients are assigned to one or the other category. 

This problem is further compounded when considering that back pain is recurrent in nature; 

therefore, many patients with acute back pain may in fact have chronic back pain but are 

currently being treated for an acute exacerbation. All these factors are potentially key sources of 

heterogeneity across studies.
17

Given the inconsistency of grouping persons with symptomatic back pain, it is not surprising 

that there is significant variation in the treatment approaches used. Variation is further increased 

by the differing health professionals as well as differing philosophies of treatment within a 

specific health discipline. Finally, clinicians frequently employ mixed modalities when treating 

patients with back pain that can be within a specific CAM therapy (for example manipulation 

and mobilization) or across different types of CAM therapies (for example combining 

mobilization with acupuncture and exercise). Our primary focus in this systematic review is on 

evaluating the efficacy of the most prevalent CAM therapies, massage, manual therapy, and 

acupuncture; and as such, we limited combined treatments to those which would allow 

evaluation of each of these primary CAM therapies.
Chapter 2. Methods 

Key Questions 

The current systematic review is supported by (NCCAM) and (AHRQ) in order to better 

understand the status of research that has been done in treatment of back pain (cervical, thoracic, 

lumbar regions) with some of the most prevalent CAM interventions as identified by a recent 

review (CAM I) 

1. What is the efficacy, effectiveness and cost-effectiveness of the most prevalent types of 

practitioner-based manual CAM therapies (e.g., spinal manipulation, spinal mobilization, 

massage; acupuncture) compared to other CAM therapies, conventional therapies, placebo, no 

treatment, or wait list in improving outcomes (e.g., QoL, Pain, Function, progression of acute to 

chronic/ or disabling BP) in patients with nonspecific and certain specific (e.g. disc herniation, 

spinal stenosis, facet joint syndrome, whiplash) types of back and neck pain. 

a. For any of the CAM therapies found to be effective for BP, what factors influence 

success of treatments? 

i. Patient-specific factors: 

ii. Socio-demographics (e.g., age, gender, race, education, income) 

iii. Comorbidities 

b. Severity, specific causes (as identified in Q1), and duration of BP 

i. Treatment-specific factors (e.g., dose, frequency, duration) 

ii. Treatment provider-specific factors (e.g., training, specialization, experience) 

c. Does the use of any of the three most prevalent types of CAM for BP in adults result 

in a decreased or increased utilization of conventional management (diagnostic tests, number of 

visits & dose of medications, procedures)? 

2. What are the contraindications and safety profile of the three most prevalent CAM 

therapies for BP in adults compared to that for other CAM therapies, conventional therapies, 

placebo or no treatment? Does the safety profile of these therapies change across subgroups of 

patients with co morbidities? 

For a schematic view of the key questions that incorporates the relevant clinical context, 

please refer to Figure 1. 

19 
Analytical Framework 

Figure 1. Analytical framework 

A

ck, 

Neck & 

Thoracic) 

Duration of 

pain: 

acute/subacute 

chronic 

mixed/unknown 

Classified as: 

1 - Non-specific 

2 – Specific 

cause (disc 

herniation; 

degenerative 

disc disease, 

myofascial pain 

syndrome, etc.) 

$ 

$ 

$ 

$ 

A

Muscle strength 

Physiological 

measures 

Adult Patients 

with Back Pain 

(Low ba

dult Patients 

with Back Pain

(Low back, 

Neck & 

Thoracic)

Duration of 

pain:

acute/subacute

chronic

mixed/unknown 

Classified as:

1 - Non-specific

2 – Specific

cause (disc 

herniation;

degenerative 

disc disease,

myofascial pain 

syndrome, etc.) 

Population 

Assessments: baseline; after treatment; short term (< 3 months); intermediate (< 6 months); long term (> 6 months) 

Choice of treatment Outcomes 

Pain 

Loss of function 

Quality of life 

Work absenteeism 

Conventional care 

use 

Range of motion 

Cost effectiveness: 

Cost with respect to 

clinical outcomes: 

Any adverse events 

Conventional 

care (general 

practitioner 

care, 

medication; 

physiotherapy, 

etc) 

No treatment/ 

rest/ 

moderation of 

activities 

CAM 

treatments 

(acupuncture, 

spinal 

manipulation or 

mobilization; soft 

tissue massage) 

KQ1: Direct (clinical) outcomes KQ1: Indirect outcomes 

dult Patients 

with Back Pain

(Low back, 

Neck & 

Thoracic)

Duration of 

pain:

acute/subacute

chronic

mixed/unknown 

Classified as:

1 - Non-specific

2 – Specific

cause (disc 

herniation;

degenerative 

disc disease,

myofascial pain 

syndrome, etc.) 

Diagnosis 

Direct costs Indirect costs 

$ 

KQ2: harms 

$

$

$

$

20 
Data Sources and Literature Search Strategies 

Electronic search strategies were developed and tested through an iterative process by an 

experienced medical information specialist in consultation with the UO-EPC team. We searched 

the following electronic databases: MEDLINE (Ovid MEDLINE(R) In-Process & Other 

NonIndexed Citations); MEDLINE (Ovid MEDLINE(R): 1950 to 2010 February Week 1); the 

Cochrane Library 2010 Issue 1 including CENTRAL, Cochrane Database of Systematic 

Reviews, DARE, HTA, and NHSEED; EMBASE (1980 to 2010 Week 4); CINAHL (1982 to 

September Week 3 2008); AMED (Allied and Complementary Medicine: 1985 to January 2010); 

Mantis (1880 to October 2008); EBM Reviews - ACP Journal Club (1991 to August 2008). 

Specialized CAM databases were also searched, including the Index to Chiropractic Literature 

(ILC) October 2008; Acubriefs 2008 October; Complementary and Alternative Medicine (NZ) 

2008; and the LILACS Database October 2008. Some of these databases provided extensive 

coverage of foreign language materials (e.g., Asian, South American studies). Bibliographic 

records of potentially relevant nonEnglish publications were retrieved in MEDLINE, EMBASE, 

Central, Acubriefs, AMED, LILACS, and Mantis. There was no unique database for foreign 

language records. We utilized strategies combining controlled vocabulary and keywords such as 

Acupuncture, Electroacupuncture, Needling, Acupressure, Moxibustion, and Manipulative 

Medicine. The searches were not restricted to any language or date. Additional potentially 

eligible references were sought through hand-searching the bibliographies of relevant items. 

(Appendix A) 

We identified unpublished literature through searching the Web sites of relevant specialty 

societies and organizations, health technology assessment agencies, economic research 

institutions, guideline collections, trial registries, and conferences. 

Study Selection 

To assess relative benefits and harms as well as cost-effectiveness of CAM treatments’ (i.e., 

acupuncture, manipulation, mobilization, massage, and flexion-distraction technique) use in 

adults (age  18 years) with back, neck, headache, or thoracic pain (acute, sub-acute, chronic, 

mixed duration), we selected primary reports of comparative efficacy/harms and economic 

evaluation from randomized controlled trials (RCTs). Trials including participants with pain due 

to specific or nonspecific causes were eligible for inclusion in the review. Additionally, 

nonrandomized controlled trials and observational studies (e.g., cohort, case-control, crosssectional studies) reporting comparative data on long-term (> 6 months) harms were eligible for 

inclusion. 

Control (comparator) treatments included no treatment, placebo (sham), or any other active 

treatment (e.g., CAM therapy, medication, physiotherapy, ultrasound, exercise, heat/cold 

therapy, electrotherapy, spinal mechanical traction, spinal injection, aquatic therapy). Trials 

using combination of CAM with other ‘active therapy’ versus the same ‘active therapy’ were 

included only if the effect of CAM alone was ascertained, based on the assumption of no 

interaction between the CAM and the ‘active therapy’. Trials using a combination of 

manipulation and mobilization in an experimental arm were also included in the review. 

The review of non-English publications was limited to German, Dutch, Chinese, Japanese, 

Italian, French, Portuguese, and Spanish. We included relevant unpublished literature in the 

21 
review. Systematic and narrative reviews, case reports, editorials, commentaries or letters to the 

editor were excluded. 

The results of the literature search were uploaded to the software program TrialStat SRS 

version 4.0 along with screening questions developed by the review team and supplemental 

instructions. A calibration exercise was undertaken to pilot and refine the screening process. 

Initially, two independent reviewers screened titles and abstracts of all identified bibliographic 

records (screening level I). Then the same reviewers retrieved and reviewed full-text reports of 

all potentially eligible records (screening level II). Discrepancies at both screening levels were 

discussed and resolved by consensus. 

The literature selection process, including reasons for exclusions, is presented in the 

PRISMA study flow diagram (Chapter 3, Figure 2). 

Data Abstraction 

Two reviewers independently abstracted relevant information from each included study using 

an a priori developed abstraction form. The abstracted data were crosschecked and conflicts were 

resolved by consensus. The abstracted data included study characteristics (study author, design, 

sample size, country), type of experimental treatment (e.g., acupuncture, spinal manipulation), 

type of control treatment (e.g., pain medication, neck exercise, traction, sham-acupuncture, 

advice, education, no treatment/waiting list), treatment-related factors (e.g., spine region of 

administration, frequency, number of sessions, dose, specific acupoints, depth/duration of needle 

insertion, electrical stimulation of needles, mechanically assisted manipulation, manual 

acupuncture), baseline population characteristics (e.g., age, gender, race, pain location/extension, 

duration of pain, cause of pain, pain severity, comorbidities), and treatment provider-specific 

factors (e.g., years of education/experience, specialization, training). 

The abstracted data for each continuous outcome included: mean (or median), standard 

deviation (and/or standard error), and 95 percent confidence interval (95 percent CI). For 

dichotomous outcomes, proportions and corresponding 95 percent CIs were abstracted. 

Primary efficacy/effectiveness outcomes that were abstracted were: pain intensity (e.g., 

Visual Analog Scale-VAS, Numerical Rating Scale-NRS, McGill Pain Questionnaire-MPQ, Von 

Korff Chronic Pain Grade Scale), function (Hannover Functional Ability Questionnaire-HFAQ) 

and disability (e.g., Roland Morris Disability Questionnaire-RMDQ: 0-24, Northwick Park Neck 

Pain Questionnaire-NPQ: 0-36, modified NPQ: 8 items 0-32, Oswestry Disability Index: 0-50, 

Activities of Daily Living-ADL, Neck Disability Index-NDI: 0-50, and Pain Disability IndexPDI) well being/quality of life (e.g., EQ-5D, SF-36 physical functioning or pain domains), global 

perceived effect (GPE), work related outcomes (e.g., work absenteeism, sick leave), and 

conventional health care utilization (e.g., number of visits to health care services, intake of pain 

medications). 

Secondary efficacy/effectiveness outcomes considered for abstraction included 

spinal range of motion (ROM; flexibility, extension, rotation), straight leg raise (SLR), finger 

floor distance (FFD), and muscle strength. 

The timing of post-treatment followup for each outcome was ascertained and then 

categorized into four groups: immediate, short- (< 3 months), intermediate-(3 months to 12 

months), and long-term (> 12 months) post-treatment followup. 

22 
For cost-effectiveness analysis, the following data was extracted: a) costs in the health care 

sector, b) costs of production loss, c) costs in other sectors, d) patient and family costs, and e) 

total costs. 

Any data on harms was also abstracted (i.e., proportion of patients with at least one event). 

We considered the following harms outcomes: any adverse events, serious adverse events, 

withdrawals due to adverse events, and specific adverse events (e.g., increase in pain, bruising, 

local bleeding, infection, punctured organs, swelling, allergies, 

cauda-equina syndrome). 

Assessment of Study Quality and Reporting 

The risk of bias for RCTs was assessed using the criteria list recommended in the Updated 

Method Guidelines for Systematic Reviews in the Cochrane Collaboration Back Review Group.8 

The tool is shown in Appendix F. 

For each study, a criterion was rated as "yes", "no" or "don't know". The quality of individual 

studies were classified into three groups (i.e., good, fair, and poor), depending on the number of 

‘Yes’ ratings across the following four domains (questions 2, 3, 4, and 9 of risk of bias tool): a) 

treatment allocation concealment (selection domain), b) balance of baseline characteristics 

between the groups (selection domain), c) patients’ blinding status to the intervention they 

received (blinding domain), and d) number/reasons for dropouts/withdrawals (attrition domain). 

For example, studies with scores of 0-1, 2-3, and 4 (i.e., number of ‘yes’ ratings on four 

domains) were classified as having poor, fair, and good quality, respectively. 

To explore overall bias, we constructed risk-of-bias graphs that are presented in the Results 

sections.8 

Studies of other designs were assessed using the modified tool suggested by Downs and 

Black.9

 The items of this tool cover the following constructs: selection of study population, 

comparability of study groups (important confounders controlled for through either matching 

and/or adjusting in the analysis), and ascertainment of outcomes (independent blind assessment, 

sufficient length of followup). 

Additionally, methodological quality of the included economic studies was determined using 

the CHEC list. This list consists of 19 items for the assessment of the quality of economic 

evaluations conducted alongside randomized clinical trials that were selected in a Delphi process 

by 23 experts in the field of health economics (see Appendix F).10 

Rating the Strength of Evidence 

We assessed the overall strength of evidence using the approach of grading system suggested 

by the Evidence-based Practice Center (EPC) program of the U.S. Agency for Healthcare 

Research and Quality (AHRQ).11 This system is largely based on the Grading of 

Recommendations Assessment, Development, and Evaluation (GRADE) working group 

approach.12 The evidence grading method consists of four major domains: 1) risk of bias 

(aggregate measure of the overall quality or degree of bias of study/studies for a given outcome 

or comparison), 2) consistency (the degree to which results of studies for a given outcome or 

comparison are uniform in terms of effect direction and statistical significance), 3) directness 

(whether or not the interventions were compared in head-to-head trials; ultimate health outcomes 

23 
versus surrogate outcomes), and 4) precision (the degree of variability/uncertainty around the 

pooled effect estimate). 

The overall quality of evidence (risk-of-bias) for a given outcome was derived from the 

quality scores of individual study or studies (poor, fair, or good) and was categorized in three 

groups (high, medium, or low). If evidence consisted of only one study (or multiple studies of 

the same quality rating), then the study quality corresponded to risk-of-bias for this evidence in 

the following manner: study quality (poor) = risk-of-bias (high), study quality (fair) = risk-ofbias (medium), and study quality (good) = risk-of-bias (low). In case of evidence consisting of 

multiple studies with different quality ratings (studies of poor, fair, and good quality mixed 

together), the mean quality score (i.e., mean number of ‘Yes’) was calculated. Evidence with 

mean quality score < 2 was labeled as having high risk of bias, 2  mean quality score < 4 was 

labeled as having medium risk of bias, and the mean quality score of 4 was labeled as low risk of 

bias. The relationship between the risk of bias for evidence and mean quality score based on 

individual study (or studies) is presented in Table 1. 

Table 1. Study quality and risk-of-bias 

Quality score* Study Quality Risk of Bias 

0  N < 2 Poor High 

2  N < 4 Fair Medium 

N = 4 Good Low 

* Number of ‘Yes’ on 4 domains; in case of a single study, N is a whole number (0, 1, 2, 3, 4); in case of multiple 

studies, N is a mean number which may be whole number or fraction 

Depending on ratings for four domains (risk of bias, consistency, directness, and precision), 

the grade of evidence was high, moderate, low, or insufficient (Table 2). The initial high grade 

was reduced by one level (from high to moderate; from moderate to low grade) for each of the 

domains not met: risk of bias (medium), consistency (inconsistent, single trial-not applicable), 

precision (imprecise), and directness (indirect). The grade was reduced by two levels from high 

to low in case of high risk of bias. Although we ascertained and presented ratings for ‘precision’ 

in the tables for specific outcomes, we did not downgrade the strength of evidence based on this 

domain simply due to the absence of a pooled estimate and 95 percent confidence intervals. The 

absence of evidence was graded as ‘insufficient’. Results were considered consistent when 

statistically significant or nonsignificant effects in the same direction were observed across trials. 

The pooled estimate with relatively narrow range of effect sizes (95 percent confidence intervals) 

with clear direction leading to clinically uniform conclusion was considered as ‘precise 

evidence’. Clinical outcomes such as pain, disability or function, quality of life, proportion of 

subjects who improved, time to (or duration of) analgesic effect, and use of analgesics were 

considered as ‘direct evidence’. Other measures such as range of motion (ROM), pressure pain 

threshold (PPT), utilization of conventional healthcare system (e.g., general practitioner visits, 

imaging studies), sick leave (e.g., length, proportion of subjects), and proportion of subjects 

cured were considered as ‘indirect evidence’. The grading results for strength of evidence are 

presented throughout the Results section (Chapter 3, Tables 5, 7, 9, 12, 13, 15, 17, 19, and 21). 

For reasons of brevity, these tables do not include trials comparing benefits/harms of CAM 

treatments combined with other therapies (except for manipulation plus mobilization in 

experimental arm), or trials comparing different modalities of the CAM treatments (manipulation 

daily versus manipulation weekly; deep acupuncture versus superficial acupuncture). 

The graded evidence is presented in the results section. (Chapter 3) 

24 
Table 2.Grading of evidence 

Grade Domain 

High All 4 domains are met (e.g., low risk of bias, precise, direct, consistent) 

Moderate 1 of the domains is not met (e.g., medium risk of bias, precise, direct, consistent) 

Low 2-4 of the domains are not met (e.g., high risk of bias, precise, indirect, 

inconsistent) 

Insufficient No evidence/absence of evidence 

Evidence Synthesis and Analysis 

The results (both quantitative and qualitative parts) of this review were grouped according to 

a type of experimental intervention (e.g., acupuncture, manipulation, mobilization, massage), 

pain location in spinal region (low back, neck, head, thorax), duration of pain (acute/sub-acute, 

chronic, mixed, unknown), and cause of pain (specific versus nonspecific). 

The results of all analyses for any given outcome (e.g., pain, global measure, function, 

disability, harms, medication use) were presented within subgroups defined by location, 

duration, and cause of pain, and were presented separately with respect to control intervention 

(e.g., no treatment, placebo, other CAM treatment, medication, other treatment) and timing of 

outcome ascertainment during post-treatment followup (immediate, short-, intermediate-, and 

long-term). 

Qualitative Analysis 

For each study, information on sample size, demographics (e.g., age, gender, race), settings 

(e.g., population-based, primary care, hospital), treatments (type, dose, frequency, and 

experience of the caregiver), outcomes (e.g., pain, disability, function, medication use), and 

source of funding (e.g., industry, government) were summarized in text and/or summary tables. 

The results of one or more trials that compared two or more treatments with respect to change in 

any given outcome were summarized in text as well as in numerous tables. (Refer to Chapter 3). 

Quantitative Analysis 

 The decision to pool individual study results was based on clinical judgment with regards to 

comparability of study populations, treatments, and outcome measures. We considered studies 

suitable for pooling if they used the same design (RCT), enrolled similar populations (e.g., 

chronic specific neck pain), evaluated the same types of treatments (e.g., acupuncture versus 

placebo; manipulation versus no treatment), and reported the same outcomes measured with 

identical scale and ascertained in similar post-treatment followup periods (e.g., pain intensity on 

VAS immediately after the treatment). The meta-analyses of pain were based on 1-10 visual 

analogue scale. We used DerSimonian and Laird random-effects models to generate pooled 

estimates of relative risks (RRs) and weighted between-group end point mean differences 

(WMDs) with 95 percent CIs.13 Statistical heterogeneity was evaluated using a chi-square test 

and the I2 statistic (low: 25.0 percent; moderate: 50.0 percent; high: 75.0 percent).8 

When studies did not report summary statistics (e.g., mean score, standard deviation, 

standard error) adequately, we calculated the needed parameters if data for individual patients 

were reported. If a study reported only a standard error of the mean response, we converted it to 

a standard deviation. Trials were not incorporated into meta-analyses if the needed data (e.g., 

25 
mean and standard deviation) could not be derived. Trials with obvious between-group baseline 

imbalances in the outcome were not pooled unless the mean change from baseline and 

corresponding SDs for the compared study groups were reported. 

If data allowed, the statistically significant pooled estimates of post-treatment pain intensity 

and disability were planned to be examined in order to determine the degree of clinical 

importance for the observed differences between the treatment groups. The assessment of the 

degree of clinical importance was based on the criteria from the updated methods guideline for 

systematic reviews suggested by the Cochrane Back Review Group which were defined as small 

(WMD < 10 percent of the VAS or a disability scale), medium (10 percent  WMD < 20 percent 

of the VAS or a disability scale), and large (WMD  20 percent of the VAS or a disability 

scale).14 

We examined the extent of publication bias through visual inspection of funnel plot 

asymmetry with respect to contours of statistical significance (Moreno et al. 2009)15 and the 

Egger’s regression-based method.16 

Subgroup and Sensitivity Analyses

 We planned to conduct subgroup and sensitivity analyses to explore statistical heterogeneity, 

if the collected data allowed. The a priori defined population subgroups were based on patientspecific factors (age, gender, race, education, comorbidity). Trial-specific factors were study 

quality (risk-of-bias) and type of treatment provider. To explore the impact of study quality on 

the pooled effect estimate between two treatments, trials were categorized into two groups: 

‘higher risk-of-bias’ and ‘lower risk-of-bias.’ If for a trial, seven or more items of the risk-of-bias 

tool were rated as ‘Yes’ this trial was categorized into ‘lower risk-of-bias’ group, otherwise into 

‘higher risk-of-bias’ group. Afterwards, the pooled treatment effect estimates across the two 

strata of trials with ‘lower risk-of-bias’ and ‘higher risk-of-bias’ were compared in terms of their 

effect size, direction, statistical significance, and 95 percent CI. 

We performed all analyses using R software, version 2.4.0 (www.r-project.org). 

26 
Chapter 3. Results 

Literature Search Results 

The original (Oct. 2008) and updated (Feb. 2010) search of MEDLINE, and all other sources 

(including expert nominated records) for primary studies yielded 10,505 citations. After 

removing 3,783 duplicate records, titles and abstracts of 6,756 records were screened. Of these, 

1,339 were potentially relevant records. We were able to retrieve full text articles for 1,167 

records. The remaining 172 records were not further screened since full texts for them could not 

be obtained. 

 In total, 811 records did not meet eligibility criteria applied during the full text screening, 

and therefore were excluded (Appendix D); thus a total of 356 records were included in this 

report. Of these 356 records, only 33 were quantitatively analyzed. Figure 2 outlines the study 

flow process for this review. 

27 
Figure 2. PRISMA chart for study retrieval and selection 

28 
General Characteristics of the Included Studies 

Of the 356 included records, 86 were identified as multiple publications of the primary 

studies. In this review, multiple publication is defined as a single study results published more 

than once, or part of data from an original report was republished separately. In general, a 

publication that provided the most comprehensive report of the original trial was used as the 

primary study. If multiple publications included the same data, the report published earlier was 

regarded as the main study. 

The publication date of primary studies ranged from 1976 to 2009. The included records 

were published in English (273), Chinese (72), German (10), Japanese (nine), Spanish (one), and 

Italian (one) language. 

In total, 270 unique studies were included in this report. Table 3 outlines the included 

original and secondary publications. Of the 270 primary studies, 265 were RCTs and five were 

cohort or case-control studies. 

The CAM interventions in the 265 RCTs (351 publications) were acupuncture (155 trials), 

spinal manipulation (66 trials), spinal mobilization (29 trials), spinal manipulation + mobilization 

(11 trials), and massage (33). There were few studies in which both regions of pain, or more than 

one CAM interventions were studied. Ten trials of economic evaluation of CAM treatments were 

also included. 

Table 3. Primary records with companion reports 

Primary Record Secondary record(s) 

Aigner 1999 17 Aigner 1998 18; Aigner 1998 19 

Alaksiev 1996 20 Alaksiev 1994 21 

Brinkhaus 2006 22 Brinkhaus 2003 23 

Witt 2006 24 Witt 2005 25; Witt 2006 26 

Carlsson 2001 27 Carlsson 1993 28 

Cherkin 2001 29 Kalaukalani 2001 30 

Childs 2004 31 Childs 2003 32; Childs 2006 33; Fritz 2005 34; Whitman 2004 35; 

Childs 2004 36 

Endres 2007 37 Haake 2007 38 

Ferreira 2007 39 Ferreira 2009 40 

Franke 2000 41 Franke 2000 42 

Fryer 2005 43 Hodgson 2006 44 

Ga 2007 45 Ga 2007 46 

Gallacchi 1983 47 Gallacchi 1981 48 

Garvey 1989 49 Garvey 1990 50 

Giles 2003 51 Muller 2005 52 

Grant 1999 53 Grant 1998 54 

Hadler 1987 55 

Hancock 2007 56 

Hoiriss 2004 57 

Hadler 1990 58 

Hancock 2008 59; Badgett 2008 60 

Hoiriis 2002 61 

Hoving 2006 62 Kothals-de-Bos 2003 63; Kothals-de-Bos 2005 64 

Hurwitz 2002 65 

Hurwitz 2006 66 

Hurwitz 2006 67; Hurwitz 2004 68; Hurwitz 2005 69 

Hertzman-Miller 2002 70; Hurwitz 2005 71; Kominski 2005 72; 

Goldstein 2002 73; Hurwitz 2002 74; Hurwitz 2002 75; Hurwitz 

2002 76 

Irnich 2001 77 Irnich 2000 78; Konig 2003 79 

Irnich 2002 80 Irnich 2002 82 

29 
Primary Record Secondary record(s) 

Jull 2005 81

Koes 1992 84 

Koes 1993 85 

Kothals-de-Bos 2003 63

Lehmann 1983 88 

Lewis 2007 89 

Little 2008 90 

Meade 1991 95

Molsberger 2002 99

Pope 1994 101

Rupert 1985 104

Seidel 2002 106

Sims-Williams 1979 108

Thomas 2005 110

Triano 1995 119

Tsukayama 2002 121

UK BEAM Trial Team 2004 123

Venancio 2008 126

White 2004 128 

Willich 2006 130 

Witt 2006 131

Yuan 2006 134

Yuan 2009 136 

Zhang 2008 138

 Jull 2002 83 

Koes 1993 85; Koes 1992 86 

Koes 1992 86; Koes 1992 87 

 Hoving 2006 62 

Lehmann 1986 91 

Dziedzic 2005 92 

Little 2008 93; Hollinghurst 2008 94 

 Meade 1995 96; Meade 1990 97; Meade 1990 98 

 Molsberger 1998 100 

 Hsieh 1992 102; Pope 1993 103 

 Rupert 1985 105 

 Seidel 2003 107 

 Jayson 1981 109 

 Thomas 2006 111; Ratcliffe 2006 112; Thomas 2009 113; Thomas 

2003 114; Thorpe 2002 115; Thorpe 2002 116; MacPherson 2004 

117; MacPherson 2002 118 

 Triano 1994 120 

 Tsukayama 2000 122 

 Farrin 2005 124; UK BEAM Trial Team 2004 125 

 Venancio 2009 127 

White 2002 129 

Witt 2006 131 

 Becker-Witt 2004 132; Walsh 2005 133; Willich 2006 130 

 Yuan 2004 135 

Yuan 2006 137 

 Zhang 2007 139 

Assessment of Risk of Bias 

RCTs reporting efficacy and harms. The risk of bias was assessed for 242 studies. The 

remaining RCTs were reported in abstract form and were not suitable for this assessment. 

Overall, the metrological quality of the RCTs were poor (median score = 5/13; Inter-quartile 

range: 3, 7). Only 94 (39 percent) of the studies scored six or higher from the total of 13 items of 

risk of bias tool. We found that 99 (41 percent) studies described an adequate method of 

randomization. The remaining studies either did not report the method used for randomization 

(7.0 percent) or the method used was not clearly described (52.0 percent). Concealment of 

treatment allocation was judged as adequate in 21.1 percent of RCTs and inadequate in 10.3 

percent. More information on rating of risk of bias is provided in Table 4 and Appendix G. 

30 
Table 4. Risk of bias assessment of RCTs 

Quality components N studies (%) 

Adequate method of randomization 99 (40.9%) 

Adequate method of allocation concealment 51 (21.1%) 

Similarity at baseline regarding the most important prognostic 

indicators 

158 (65.3%) 

Appropriate patient blinding to the intervention 43 (17.8%) 

Appropriate care provider blinding to the intervention 7 (2.9%) 

Appropriate outcome assessor blinding to the intervention 85 (35.1%) 

Similar or no cointerventions between groups 103 (42.6%) 

Acceptable compliance in all groups 82 (33.9%) 

Described and acceptable drop-out rates 132 (54.5%) 

Similarity of timing of the outcome assessment in all groups 214 (88.4%) 

Inclusion of an intention-to-treat analysis 84 (34.7%) 

Absence of selective outcome reporting 127 (52.5%) 

Absence of other potential bias 12 (5.0%) 

Total Risk of Bias scores (max 13); median (IQR) 5 (3, 7) 

RCTs reporting economic evaluation. Three studies collected costs appropriate to their 

chosen perspective. Two studies did not state the perspective adopted for the economic 

evaluation. Most studies measured costs using diaries, questionnaires, or practice or insurance 

records, and valued costs appropriately using published sources. Where appropriate, most studies 

conducted an incremental cost-effectiveness analysis. The length of followup for all of the 

studies was at least 1 year. In one study whose length of followup was more than 1 year, 

discounting was undertaken. Appendix G – Tables 5.1 & 5.2 shows the results of the assessment 

of the quality of the economic evaluations. 

Controlled observational studies (cohort, case-control). Assessment of quality of 

reporting in observational studies was done by using the modified Downs and Black tool. In 

general, the objective, and the main outcome of the studies were well described and the studies 

were of large sample size providing sufficient power to detect clinically important effects. Detail 

information could be found in Appendix G, table 6.1. 

Risk of bias of RCTs by CAM intervention. In this review the results are presented for 

CAM interventions for treatment of low back pain, thoracic pain, and neck pain. For each of 

these pain regions, the CAM interventions are organized by the following order: 

x Acupuncture 

x Spinal manipulation 

x Flexion distraction technique (only for LBP) 

x Spinal mobilization 

x Spinal manipulation + mobilization 

x Massage 

Summary of the results of risk of bias assessment for these CAM interventions within each 

pain region (LBP, NP) is presented in the respective sections of the results (Figures 3, 24, 27, 28, 

29, 30, 31, 42, 43, and 47). Here we attempted to compare the risk of bias in the included studies 

across the five CAM interventions. The summary of findings regarding the most relevant items 

of risk of bias are outlined in Table 5. In summary, the items related to randomization, 

concealment of treatment allocation, differences in baseline prognostic indicators, blinding of 

outcome assessor, imbalance in use of cointervention, reporting of intention to treat analysis, and 

31 
selected outcome reporting bias was the focus of this comparison. As judged by median and inter 

quartile ranges of total score (13 items), trials in manual therapies of LBP had slightly lower risk 

of bias (median 7, 8, and 6 for spinal mobilization, manipulation + mobilization, and massage, 

respectively) with the exception of manipulation therapy (median score = 2, IQR 1, 3) compared 

with acupuncture (median score = 4, IQR 1, 3). In the trials on treatment of neck pain, there was 

no difference in the total scores (median scores = 4, 3, 3, and 5 for acupuncture, manipulation, 

mobilization, and massage, respectively). 

32 
Table 5. Selected risk of bias tool assessment items in RCTs by CAM treatment type 

Selected Items of Risk of 

Bias tool 

Acupuncture Spinal manipulation Spinal mobilization Manipulation+ 

mobilization 

Massage 

LBP NP LBP NP LBP NP LBP LBP NP 

Appropriate method of 

randomization 

44 (43.1) 14 (26.4) 6 (18.2) 15 (51.7) 6 (37.5) 4 (44.4) 6 (66.7) 10 (50.0) 6 (37.5) 

Inappropriate method of 

randomization 

10 (9.8) 4 (7.5) 4 (12.1) 2 (6.9) 1 (6.3) 1 (11.1) 0 1 (5.0) 0 

Appropriate concealment of 

treatment allocation 

20 (19.6) 8 (15.1) 3 (9.1) 10 (34.5) 3 (18.8) 5 (55.6) 4 (44.4) 4 (20.0) 3 (18.8) 

Inappropriate concealment 

of treatment allocation 

11 (10.8) 2 (3.8) 7 (21.2) 4 (13.8) 2 (12.5) 1 (11.1) 1 (11.1) 3 (15.0) 0 

Dissimilarity of baseline 

prognostic indicators 

8 (7.8) 6 (11.3) 3 (9.1) 4 (13.8) 1 (6.3) 0 1 (11.0) 1 (5.0) 5 (31.3) 

Appropriate outcome 

assessor blinding 

29 (28.4) 14 (26.4) 15 (45.5) 10 (34.5) 10 (62.5) 5 (55.6) 5 (55.6) 4 (40.0) 7 (43.8) 

Inappropriate outcome 

assessor blinding 

10 (9.8) 0 2 (6.1) 2 (6.9) 0 5 (55.6) 0 2 (10.0) 1 (6.3) 

Imbalance in use of 

cointerventions between 

groups 

5 (4.9) 1 (1.9) 1 (3.0) 3 (10.3) 2 (12.5) 0 0 0 0 

Described and acceptable 

drop out rates * 

47 (46.1) 27 (50.9) 12 (36.4) 19 (65.5) 10 (62.5) 5 (55.6) 7 (77.8) 14 (70.0) 10 (62.5) 

Unacceptable drop out rates 45 (44.1) 14 (26.4) 6 (18.2) 3 (10.3) 2 (12.5) 1 (11.1) 1 (11.1) 2 (10.0) 1 (6.3) 

Similarity of timing in 

assessment of outcomes 

between groups 

92 (90.2) 41 (77.4) 27 (81.8) 24 (82.8) 15 (93.8) 9 (100.0) 8 (88.9) 19 (95.0) 14 (87.5) 

Reporting of intention-totreat analysis 30 (29.4) 13 (24.5) 10 (30.3) 12 (41.4) 5 (31.3) 2 (22.2) 4 (44.4) 10 (50.0) 7 (43.8) 

Absence of selected 

outcome reporting 

39 (38.2) 26 (49.1) 17 (51.5) 20 (69.0) 10 (62.5) 6 (66.7) 5 (55.6) 13 (65.0) 11 (68.8) 

Selected outcome reporting 

bias 

17 (16.7) 8 (15.1) 10 (30.3) 5 (17.2) 2 (12.5) 3 (33.3) 4 (44.4) 4 (20.0) 4 (25.0) 

Total Score of Risk of Bias 

(max 13) Median (IQR) 

4 (1, 3) 4 (3, 6) 2 (3, 6) 3 (4, 7) 7 (4, 7) 3 (5, 7) 8 (3, 6) 6 (5, 8) 5 (3, 6) 

*

 Item number # 9 of the Cochrane risk of bias tool: the number of participants who were included in the study but did not complete the observation period or were not included in 

the analysis must be described and reasons given. If the percentage of withdrawals and drop-outs does not exceed 20% for short-term follow-up and 30% for long-term follow-up 

and does not lead to substantial bias a “yes” is scored. (N.B. these percentages are arbitrary, not supported by literature). 

33 
Population Characteristics of RCTs 

The majority of trials included adult men and women aged 18 – 65 years. Three trials 

included only male and three trials included only female participants. Nine trials included older 

adults aged 55 and older. 

Acupuncture. In total, 15,187 participants were included in the LBP and NP trials. The 

largest trial was conducted in Germany and included a total of 3,093 participants with chronic 

nonspecific low back pain. This trial reported efficacy and cost effectiveness and is discussed in 

detail in respective sections of the review. In 97 trials, subjects had nonspecific pain and in the 

remaining 91 trials subjects had specific pain. 

Ninety-two trials enrolled subjects with identified or specific cause of pain such as disc 

perturbation, whiplash, cervicogenic headache, or underlying neurological causes. Details of 

these conditions can be found in Tables 1.1 – 1.8 (low back pain) and 2.1- 2.8 (neck pain) in 

Appendix C, and throughout the results section. 

Manual treatments (spinal manipulation, mobilization and combined treatment). In 

total, 22,638 subjects were included in 100 trials. The majority of these trials (90 trials) included 

subjects with nonspecific pain. Details of these conditions can be found in Tables 1.9 – 1.34 (low 

back pain) and 2.9- 2.18 (neck pain) in Appendix C, and throughout the results section. 

Massage. In total, 4,050 subjects were included in 35 trials for treatment of LBP or NP. In 24 

of the trials, subjects had nonspecific pain and in the remaining 11 trials subjects had specific 

pain (whiplash, myofascial pain, and other causes). Details of these conditions can be found in 

Tables 1.35 – 1.40 (low back pain) and 2.19- 2.26 (neck pain) in Appendix C, and throughout the 

results section. 

Interventions and Control Treatments 

Acupuncture. In 155 acupuncture trials, a large variety of methods of acupuncture 

treatments were used to compare the effect of acupuncture versus control treatments. The 

control treatments in these trials included active (i.e. physical modalities and exercise) or 

inactive treatments (i.e. placebo, no treatment). Details of treatment techniques and controls used 

can be found in Tables 1.1 – 1.8 (low back pain) and 2.1- 2.8 (neck pain) in Appendix C. The 

treatment providers for acupuncture trials were trained or licensed acupuncturists (27 trials), 

general practitioners or physicians with especial training in acupuncture (41 trials), neuropathy 

physicians (nine trials), general practitioners (five trials), and trained physiotherapists (four 

trials). In the majority of foreign language publications, particularly in Chinese trials, the 

treatment provider was referred as “therapist” (17 trials). The information about treatment 

provider was not reported for 85 trials. Specific details about treatment providers, years of 

experience (when reported), treatment duration, and outcomes assessed in each trial are 

presented in Appendix I. 

Manual treatment (spinal manipulation, mobilization and combined treatment). In total, 

101 primary trials used techniques of manipulation, mobilization or combination of both for 

treatment of low back, thoracic and neck pain. The details of treatment techniques and control 

interventions (active and inactive) used in these trials can be found in Tables 1.9 – 1.34 (low 

back pain) and 2.9- 2.18 (neck pain) in Appendix C. In 32 trials, spinal manipulation or 

mobilization was provided by experienced and licensed chiropractors. In the remaining studies 

manipulation or mobilization was provided by physical therapists (17 trials), general 

34 
practitioners (five trials), licensed or qualified manual therapy practitioners (six trials), physical 

therapists with manual therapy training (three trials), clinicians or experienced clinicians (four 

trials), neurologists or rheumatologists with chiropractic training (three trials), folk healers (one 

trial), and osteopaths (one trial). The information regarding treatment provider was not reported 

for the remaining 29 trials. Specific details about treatment providers, years of experience (when 

reported), treatment duration, and outcome assessed in each trial, are presented in Appendix I. 

Massage. In total, 35 studies used massage for treatment of LBP, or NP. Details of treatment 

techniques and control interventions (active and inactive) used in these trials can be found in 

Tables 1.35 – 1.40 (low back pain) and 2.19- 2.26 (neck pain) in Appendix C. In eight trials, 

treatment providers were licensed or experienced massage therapists. In the remaining trials, 

treatment of massage was provided by physical therapists (five trials), reflexologists, acupressure 

therapists, folk healers (four trials), general practitioners (four trials), manual therapists (two 

trials), experienced bone setters (one trial), and chiropractic students (one trial). For the 

remaining 10 trials, the information on treatment providers was not reported. Specific details 

about treatment providers, years of experience (when reported), treatment duration, and outcome 

assessed for each trial are presented in Appendix I. 

35 
KQ1. What is the Efficacy, Effectiveness and Costeffectiveness of the Most Prevalent Types of Practitionerbased Manual CAM Therapies Compared to Other CAM 

Therapies, Conventional Therapies, Placebo, no Treatment, 

or Wait List in Improving Outcomes in Patients With 

Nonspecific and Certain Specific Types of Back and Neck 

Pain? 

Efficacy & Effectiveness 

1 - Acupuncture for Treatment of Low Back Pain 

We included 105 trials in this section. Results of 15 trials were reported in multiple 

publications (Table 3). 

Population/trial characteristics. The studies were conducted in Australia (four)52,140-142, 

Austria (one)143, Canada (two)144,145, China (54)134,138,146-174 175-197, Germany (six)22,24,37,99,198,199 , , 

Hong Kong (one)200, Iran (one)201, Ireland (four)136,146,202,203, Italy (two)204,205, Japan (15)121,206­

215,215-218, Korea (one)219, Norway (one),220 Pakistan (one)221, Sweden (two)27,222, UK 

(three)53,110,223, and United States (eight)29,49,88,224-228. 

The proportions of men and women were similar in 46 studies (40 percent - 60 percent). In 

14 studies there were a greater proportion of men (> 60 percent) and in 15 studies women were 

the majority (> 60 percent). One study recruited only women,219 and another one only men.144 In 

six studies the proportion of men and women between the arms was not similar.140,197,209,209,218,228 

The majority of trials (94 percent) recruited general adult age population (18 – 60 years old). 

Seven studies recruited only elderly subjects (60 years or older).53,207,208,216,217,226,227 

Information on racial composition or ethnicity was reported for six studies.29,110,198,224,226,228 

The Asian trials (72 studies) did not report the racial composition and was assumed to be 100 

percent Asian. 

In total 15,162 participants with LBP were randomized to acupuncture or control groups. The 

sample size in these trials varied from nine217 to 284124 participants. 

In the majority of trials (90 percent), acupuncture (various methods of needling techniques 

including electro-acupuncture) was used alone (95 studies), whereas in the remaining trials, it 

was used in combination with ‘other treatments’ (11 studies).99,144,158,161,172,185,193,198,200,216,226 The 

comparison arm in these trials was the same ‘other treatment.’ Table 6 presents the control 

interventions in the included studies. 

36 
Table 6. Acupuncture for treatment of low back pain- Control interventions 

Type of control 

group 

Cause of 

Pain 

N 

studies 

Detail of Control intervention 

1- Nonactive Control treatments 

Placebo/sham Nonspecific 20 Non penetrating needling 202,206,207 

Superficial needling 37, with injection of anesthetics and no 

stimulation142 

Superficial needling at nonacupuncture points 22,99,203 without 

stimulation or ‘de qi’198 

Guided tube: with tapping on the tube 206,210,212,213, without 

tapping156, with toothpick inside the tube228 

Needling at nonacu points145,218 

Sham TENS27,88,223 

Sham EMG225 

Not described197 

Specific 3 Superficial needling with injection of lidocaine at nonacu 

points141 

Sham TENS201 

Gentle tapping162 

No-treatment or 

waiting list 

Nonspecific 4 No acupuncture24 

Waiting list22,222 

Delayed acupuncture 227 

2- Active Controls 

Exercise/ 

physical activity 

Nonspecific 1 Standard exercise program200 

Specific 0 NA 

Physical 

modalities 

Non 

Specific 

5 TENS: Home treatment applied at acu-points121,209, details not 

reported 53, applied over centre of pain,88 TENS with 

acupuncture216 

Specific 1 TENS on selected tender points alone176 , 

Physiotherapy Nonspecific 2 Posture training aimed to remove muscle imbalanceaccording to Bruegger-concept198 

Physical modalities such as light, electricity or heat163 

Specific 1 Physical modalities such as hot packs, ultrasound, shortwave diathermy, and TENS in addition to muscle 

strengthening201 

Traction Nonspecific 0 NA 

Specific 1 Traction,158,193,229 and rotatory manipulation159 

Education/Self 

care 

Non 

Specific 

1 Self care education booklet and videotapes29,228 

Specific 0 NA 

Manual treatment Non 

Specific 

6 Massage (acupressure) and ethyl chloride spray49, Swedish 

massage29 

Manipulation and/or mobilization224 

Manipulation52,140 

Massage and mobilization161 

Mobilization or manipulation (and oral medication)164 

Specific 0 NA 

Standard care or 

GP 

Non 

Specific 

5 Physiotherapy/exercise, medication, and advise37,99,110,224,226 

Specific 1 Standard care (specific methods not reported)144 

Medication Non 

Specific 

7 Oral analgesics, 52,140,214,220,221 Chinese herbal medication, 175 

topical analgesics 216 

37 
Specific 6 Oral analgesics, 134,138,146,186 intramuscular injection of 

analgesics154,195 

Other method of 

acupuncture 

Non 

Specific 

17 Various method of needling on acu-points,27,49,218,219,225,230 

alternative acu-points, 153,168,174,204,211,215,217 addition or use of 

warming needle/Moxibustion,215 non local points, 

superficial/deep needling,143 various dosing regiment,136,204,227 

auricular, or alternative auricular technique143 dry needling 

(vs. two techniques of trigger point injection with 

lidocaine)49, personalized (vs. standard),231 

Specific 30 Needling on muscle tendons, 147, various method of needling 

on acu-points,150,162,166,170,194 alternative acupoints148,149,151,157,160,165,169,171,182,183,190,195,219 addition or use of 

warming needle/Moxibustion,152,177,181 non local 

points,154,179,184,187 superficial/deep needling,178,205,208 flyprobing189 

Active treatment 

when compared 

with combination 

of same active 

treatment with 

acupuncture 

Non 

Specific 

6 Standard care (continued usual care: NSAIDs, muscle 

relaxant, paracetamol and back exercises), 226 orthopedic 

therapy, 99exercise,200 physiotherapy (not described),198 

TENS,216 

Specific 9 Standard care (physiotherapy, remedial exercises, and 

occupational therapy)144 

Traction, 158,159,192,193 

Massage, 161,172,185,232 

Acupuncture in 

combination with 

another 

treatment 

Non 

Specific 

1 TENS216 

Specific 5 Traction, 159,188 massage, 232 injection and massage,191 

cupping, 192 

Acu=acupuncture; EMG=electromyography; GP=general practitioner care; NA= not applicable; TENS=transcutaneous electrical nerve 

stimulation 

Treatments were scheduled for one, two or three courses, each course ranging from 5 to 15 

days in duration. The frequency of treatments in most studies was once a day consecutively for 

the duration of the study course. The number of acupuncture treatments across the studies was 

fewer than 10,160,168,170,181 10 - 20,138,149,153,162-164,166,167,171,174-177,194,197 and 21 - 45.134,150,184,190 The 

number of treatments in Chinese studies varied. Three of these studies did not report this 

information.156,180,195 

The frequency of treatment in the remaining studies that reported this data were the 

following: One treatment, 49,206,210,212,213,218,225 One to two sessions per week (up to 18 treatments 

in total),22,24,37,52,88,121,121,136,140-142,144,145,155,160,199,202,205,208,209,211,211,214,214,217,222,224,228,233 three 

sessions per week (up to 15 treatments in total),151,197,200,201,207,207,219 four sessions per week (12 

treatments in total),99 and five sessions per week (up to 21 treatments in total).150,163,198,226 

Risk of bias. The risk-of-bias graph for the trials included in this sub-section is presented in 

Figure 3. All trials were randomized. The adequate method of randomization and treatment 

allocation concealment was reported for about 44.0 percent and 20.0 percent of the trials, 

respectively. In 68.0 percent of the trials, the subjects’ baseline characteristics distribution across 

the treatment arms was similar (i.e., balanced). In one trial,53 the baseline distribution of VAS 

score was higher in the acupuncture versus TENS group (140 versus 101). For at least half of the 

trials, it was unclear whether or not the subjects and assessors were blinded to the type of 

treatment. About 47.0 percent of the trials reported acceptable drop-out rate. In one trial,140 the 

38 
drop out rate in acupuncture group was very high (52.0 percent). Results based on intention-totreat analysis were explicitly reported for about 30.0 percent of the trials. 

The data for selected items of the risk of bias tool across the CAM interventions 

(acupuncture; spinal manipulation; spinal mobilization; combination of manipulation and 

mobilization; and massage therapy) is displayed in table 7.1 of Appendix G. 

Figure 3. Risk of bias score (%) 

0% 20% 40% 60% 80% 100% 

Q13 

Q12 

Q11 

Q10 

Q9 

Q8 

Q7 

Q6 

Q5 

Q4 

Q3 

Q2 

Q1 

Yes No Unclear 

1. Was the method of randomization adequate? 

2. Was the treatment allocation concealed? 

3. Were the groups similar at baseline regarding the most important prognostic indicators? 

4. Was the patient blinded to the intervention? 

5. Was the care provider blinded to the intervention? 

6. Was the outcome assessor blinded to the intervention? 

7. Were cointerventions avoided or similar? 

8. Was the compliance acceptable in all groups? 

9. Was the drop-out rate described and acceptable? 

10. Was the timing of the outcome assessment in all groups similar? 

11. Did the analysis include an intention-to-treat analysis? 

12. Are reports of the study free of suggestion of selective outcome reporting? 

13. Is this study free of any other bias? 

Efficacy results. A summary of the key results is presented in Table 7. For further detail of 

the trials please see the evidence tables. (Appendix C, table 1.1 – table 1.8) 

39 
Table 7- Key results – Acupuncture treatment in patients with low back pain 

Acupuncture 

therapy 

Duration of 

pain 

Cause 

of 

pain 

Outcome 

Risk 

-ofbias 

Precision of 

the pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

Acu vs. No Tx Acute/subacu 

te 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS VAS: C M Precise (3) £ 

24,222,227 

Yes Direct > SS Moderate 

PDI: B 

22 

L - NA Direct > SS Moderate 

HFAQ: B

22,24 

M - Yes Direct > SS Moderate 

SF-36: B 

22,24 

M - Yes Direct > SS Moderate 

ROM (ext, flx): B, D 222 M - NA Indirect > SS Low 

Mixed/ 

Unknown 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Acu vs. PL Acute/subacu 

te 

S - - - - - - Insufficient 

NS VAS: C 202,212 M - Yes Direct = S-NS Moderate 

RMDQ: C 202 M - NA Direct = S-NS Low 

Use of medication: 

B 202 

M - NA Direct > SS Low 

Chronic S - - - - - - Insufficient 

NS VAS: B M Precise (10) 22,37,99,141,156,1 

97,198,203,206,228 

Yes Direct > SS Moderate 

VAS: C M Precise (3) 27,37,99 Yes Direct = S-NS Moderate 

VAS: D M Precise (3) 22,27,228 Yes Direct = S-NS Moderate 

VAS: E M Precise (4) 22,27,198,228 Yes Direct = S-NS Moderate 

40 
Acupuncture 

therapy 

Duration of 

pain 

Cause 

of 

pain 

Outcome 

Risk 

-ofbias 

Precision of 

the pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

SF-36: B 

22,203 

M - No Direct => Low 

SF-36: D 

22 

L - NA Direct = S-NS Moderate 

MPQ: B

141,203 

M - Yes Direct = S-NS Moderate 

Use of medication: 

B 

141 

M - NA Indirect = S-NS Low 

RMDQ: B M Imprecise 

(2)

197,228 

Yes Direct = S-NS Moderate 

% pts on sick leave: 

B 

M Imprecise 

(2) 27,99 

Yes Indirect = S-NS Low 

% pts with global 

improvement: C 

M Imprecise 

(2) 27,99 

No Direct = S-NS Low 

% pts with global 

improvement: D 

M Imprecise 37,203 

Yes Direct = S-NS Moderate 

HFAQ: B L Precise (2) 22,37 No Direct < SS Moderate 

HFAQ: D L Precise (2) 22,37 No Direct < SS Moderate 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown 

S - - - - - - Insufficient 

NS 

VAS: B 

210,218 

M - Yes Direct > SS Moderate 

% pts who 

improved: B145 

H - NA Direct = S-NS Low 

E-Acu vs. PL Acute/subacu 

te 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S VAS: B 

201 

H - NA Direct > SS Low 

NS Trunk ext: C 

88 

H - NA Indirect > SS Low 

41
 
Acupuncture 

therapy 

Duration of 

pain 

Cause 

of 

pain 

Outcome 

Risk 

-ofbias 

Precision of 

the pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

Trunk ext: C 

88 

H - NA Indirect > SS Low 

Mixed/ 

Unknown 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Acu vs. Med Acute/subacu 

te 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS VAS: B H Precise (4) 51,140,216,221 No Direct = S-NS Low 

Oswestry: B H Imprecise 

(2) 51,140 

No Direct = S-NS Low 

Mixed S % pts cured: B 134,146 

H - Yes Indirect => Low 

Time (in min) to 

analgesic effect: 

B154,195 

M - Yes Direct > SS Moderate 

Duration (in hr) of 

analgesic effect: 

B154,195 

M - Yes Direct > SS Moderate 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS % pts who 

improved: B 49 

M - NA Direct = S-NS Low 

E-Acu vs. 

Med 

Acute/subacu 

te 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS VAS: B221 H - NA Direct > SS Low 

Mixed S % pts who 

improved: B

138,139 

M - Yes Direct > SS Moderate 

Raising straight leg: 

B 138 

M - NA Indirect > SS Low 

NS - - - - - - Insufficient 

Unknown S % pts who 

improved: B 186 

H - NA Direct > SS Low 

42
 
Acupuncture 

therapy 

Duration of 

pain 

Cause 

of 

pain 

Outcome 

Risk 

-ofbias 

Precision of 

the pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

NS - - - - - - Insufficient 

Acu vs. PT Acute/subacu 

te 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS Oswestry: B 163 

M - NA Direct > SS Low 

% pts cured: B 163 M - NA Indirect = S-NS Low 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

E-Acu vs. PT Acute/subacu 

te 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S VAS: B 

201 

H - NA Direct > SS Low 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Acu vs. ST Acute/subacu 

te 

S - - - - - - Insufficient 

NS RMDQ: B, C, D 224 M - NA Direct = S-NS Low 

Chronic 

S - - - - - - Insufficient 

NS 

RMDQ: C, D

226,228 

M - Yes Direct > SS Moderate 

VAS: C, D

226,228 

M - Yes Direct > SS Moderate 

HFAQ: D

37 

L - NA Direct > SS Moderate 

SF-12: D 

37 

L - NA Direct > SS Moderate 

SF-36-bodily pain: 

E 

110 

M - NA Direct > SS Low 

43
 
Acupuncture 

therapy 

Duration of 

pain 

Cause 

of 

pain 

Outcome 

Risk 

-ofbias 

Precision of 

the pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

Oswestry: E

110 

M - NA Direct = S-NS Low 

MPQ: E

110 

M - NA Direct = S-NS Low 

Utilization of 

conventional care 

110,112 

M - NA Indirect = S-NS Low 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Acu vs. Man Acute/subacu 

te 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS VAS: B H Precise (2) 51,140 

No Direct < SS Low 

Mixed/ 

Unknown 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Acu vs. Ma Acute/subacu 

te 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS RMDQ: B, D 29 M - NA Direct < SS Low 

VAS: B, D 29 M - NA Direct < SS Low 

% pts using 

medication: D 29 

M - NA Direct = S-NS Low 

Conventional care 

(number of provider 

visits): D29 

M - NA Indirect = S-NS Low 

Conventional care 

(number of imaging 

studies): D29 

M - NA Indirect = S-NS Low 

Mixed/ 

Unknown 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Acu vs. TENS Acute/subacu S - - - - - - Insufficient 

44
 
Acupuncture 

therapy 

Duration of 

pain 

Cause 

of 

pain 

Outcome 

Risk 

-ofbias 

Precision of 

the pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

te NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS VAS: B M Imprecise 

(2) 53,216 

No Direct = S-NS Low 

VAS: C M Precise (2) 53,216 No Direct = S-NS Low 

Mixed/ 

Unknown 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

E-acu vs. 

TENS 

Acute/subacu 

te 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS VAS: B 

121,209 

M - No Direct => Low 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Acu vs. E-acu Acute/subacu 

te 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS VAS: B, C 143 M - NA Direct < SS Low 

N of analgesic 

tablets: B, C 143 

M - NA Direct < SS Low 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S % pts cured: B 186 

M - NA Indirect < SS Low 

NS - - - - - - Insufficient 

S=specific; NS=nonspecific; SS=statistically significant; S-NS=statistically nonsignificant; Man=manipulation; Acu=acupuncture; Ma=massage; Mob=mobilization; PL=placebo; 

Tx=treatment. Med=medication(s); Int=intervention; PT=physiotherapy; ST=standard therapy; E-acu=electro-acupuncture; MR=muscle relaxation; TENS= transcutaneous electrical 

nerve stimulation; Ex=exercise; TrP=trigger point; VAS=visual analog scale; RMDQ=Roland Morris Disability scale; NHP=Nottingham Health Profile; PPT= pressure pain threshold; 

HFAQ=Hanover functional ability questionnaire; MPQ=McGill pain questionnaire; ext=extension; flx=flexion; rot=rotation; PDI=pain disability index; min=minute(s); hr(s)=hour(s); 

L=low; M=medium; H=high; pt(s)=patient(s); SF=short-form; NPQ=neck pain questionnaire; GWBS=global well-being scale; SLR=straight leg raising; GPE= Global perceived effect; 

NSAIDS=nonsteroidal antiinflammatory drugs; FTF=finger-to-floor; SF-PQ=short form pain questionnaire; PRI=pain rating index; PPI=present pain intensity; NA=not applicable 

45
 
Ȍ Grade (High, moderate, low, and insufficient) 

£ Number of pooled trials 

B = immediate post-treatment 

C = short-term post-treatment 

D = intermediate-term post-treatment 

E = long-term post-treatment 

H = high 

L = low 

M = medium 

- No evidence 

= Similar beneficial effect 

> Favors treatment A over treatment B 

< Favors treatment B over treatment A 

><, =>, <= Inconsistent beneficial effect 

46
 
Population with acute/subacute pain. There were nine trials of patients with acute or 

subacute LBP included in this sub-section.152,160,167-169,202,212,220,224 Of these, five trials studied 

patients with nonspecific LBP167,202,212,220,224 and four trials – patients with LBP due to disc 

protrusion or lumbar sprain.152,160,168,169 

Subjects with specific pain. 

Acupuncture versus placebo. No relevant studies were identified. 

Acupuncture versus no treatment. No relevant studies were identified. 

Acupuncture (type 1) versus acupuncture (type 2). In three trials, different modalities of 

electro-acupuncture (local single-point versus conventional)160 and acupuncture (needling XiCleft points versus conventional needling;169 warming needle moxibustion versus conventional 

needling152) were compared in treating subjects with LBP due to disc protrusion. In all three 

trials, experimental treatment modalities (local single-point electro-stimulation, needling XiCleft points, and needle warming moxibustion) were shown to be more effective than 

conventional acupuncture (or electro-acupuncture) in improving immediate post-treatment pain 

(VAS score, therapeutic effect – the absence of pain) or disability (Oswestry Disability Index 

score).152,160,169 In one trial,168 in subjects with pain due to lumbar sprain, needling at Yanglao 

(S16) was associated with a numerically higher response rate (percent subjects free of lumbar 

pain with tenderness relieved by 80.0 percent, lumbar flexion 110°, extension 30°, free and 

unlimited squatting) compared to needling at paravertebral or Ashi acu-points (94.4 percent 

versus 69.7 percent, p < 0.01). In the same trial, earlier administration of treatment tended to 

produce better response rates irrespective of the type of acupuncture. No pain intensity or 

disability outcomes were reported. 

Acupuncture versus other treatments. No relevant studies were identified. 

Acupuncture versus medication. In one trial,220 there was no difference immediately, shortterm, or intermediate-term after the end of treatment between acupuncture and Naproxen 500 

mg, taken twice daily for 10 days, in measures of pain (VAS). 

Acupuncture + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Acupuncture versus placebo. The effects of acupuncture and placebo (nonpenetrating 

needling, or guided tube) were compared in two trials.202,212 Although in the first trial,202 

immediately or 3 months after the treatment subjects in the acupuncture group had numerically 

improved degree of disability (RMDQ score) and pain (mean VAS score: 1-100) compared to 

subjects who received placebo (sham acupuncture), these differences were not statistically 

significant due to a low power of this trial (RMDQ score difference at 3 months: 2.6, 95 percent 

CI: -0.7, 5.9 and VAS score difference at 3 months: 10.6, 95 percent CI: -4.1, 25.3). In the same 

trial, at the end of treatment, subjects randomized to acupuncture were taking significantly fewer 

pain medication tablets for LBP compared to those in the placebo-treated group (1.0 ± 0.3 versus 

4.2 ± 0.6, p < 0.05). 

In the other trial,212 acupuncture, compared to placebo, was associated with a 

nonsignificantly lower pain intensity VAS score (49.9 ± 22.2 versus 51.8 ± 26.1, p > 0.05). 

Acupuncture versus no treatment. No relevant studies were identified. 

Acupuncture versus another type/method of the same CAM. No relevant studies were 

identified. 

47 
Acupuncture versus other treatments. In one trial,224 the addition of patients’ choice for 

acupuncture to usual care did not improve the degree of disability (RMDQ score) compared to 

usual care alone immediately, shortly, or intermediate-term post-treatment. 

Acupuncture versus medication. No relevant studies were identified. 

Acupuncture (type 1) versus acupuncture (type 2). The combination of acupuncture, pricking 

collateral, cupping, and moxibustion was shown to be associated with greater improvement in 

complete curative effect (i.e., complete relief of the severe pain and positive symptoms, recovery 

of motility and other functions, and ability to engage in normal work and life) compared to 

acupuncture alone or combined with cupping.167 

Population with chronic pain. A total of 42 trials were included in this section, the majority 

of which studied subjects with nonspecific LBP (36 studies).22,24,27,29,37,52,53,88,99,136,140­

143,155,156,163,174,197,198,200,203,204,206,207,211,213,214,216,217,222,223,225-228 The remaining six trials included 

subjects with LBP due to specific causes (e.g., myofascial pain syndrome, spondylitis, disc 

protrusion, sciatica, injuries/fractures).144,162,201,205,208,221 

Subjects with specific pain. 

Acupuncture versus placebo. One trial compared the effects of electro-acupuncture and 

placebo (sham TENS) on the reduction of pain intensity in subjects with sciatica.201 The use of 

electro-acupuncture was significantly more effective in reducing pain or sciatica at short term 

followup compared to placebo. 

Acupuncture versus no treatment. No relevant studies were identified. 

Acupuncture versus another type/method of the same CAM. No relevant studies were 

identified. 

Acupuncture versus other treatments. One trial compared the effects of electro-acupuncture 

to that of physiotherapy (hot packs, ultrasound, short wave diathermy, TENS, muscle stretching) 

in subjects with sciatica.201 The use of electro-acupuncture was found to be clinically and 

significantly more beneficial in reducing short-term post-treatment pain compared to 

physiotherapy 201 

Acupuncture versus medication. In one trial,221 the use of electro-acupuncture in patients with 

herniated lumbar disc was shown to be significantly beneficial in reducing pain intensity 

immediately after the treatment compared to 50 mg diclofenic (mean VAS, 1-100: 25.7 ± 2.3 

versus 33.3 ± 2.5, p < 0.05). 

Acupuncture (type 1) versus acupuncture (type 2). In two trials, different needling techniques 

were compared in subjects with spondylitis, and lumbar strain (soft tissue injury),162 or 

myofascial pain syndrome.205 In the first study,162 for the subgroup of patients with lumbar strain 

(soft-tissue injury) dermal needling was better than only acupuncture. For the subgroup of 

patients with hyperplastic spondylitis, body acupuncture was better than dermal needling.162 In 

the other study,205 in-depth needling205 had significantly better analgesic effect at 3 months 

followup compared to superficial needling in patients with myofascial pain syndrome. This 

beneficial effect was not apparent at the end of 8 treatment sessions. 

In one additional trial,208 standard, deep, and superficial needling modalities applied to the 

trigger points were compared (insertion depth: 20 mm, 23 mm, 3 mm, respectively) with respect 

to immediate post-treatment reductions in pain intensity (VAS: 1-100) and disability (RMDQ 

scores) in elderly subjects with spondylosis, osteoporosis, or trauma. Although there was a 

numerical preponderance in favor of deep needling for pain intensity, the observed betweengroup differences were not statistically significant (VAS: 56.8 ± 25.1 versus 44.4 ± 19.1 versus 

48
 
50.1 ± 32.5, p > 0.05). The mean RMDQ disability score was similar across the groups (4.2 ± 4.3 

versus 4.2 ± 1.2 versus 4.3 ± 2.2).208 

In one trial of higher risk of bias (20 patients), 211 distal point needling for low-back pain of 

any duration was no different from local lumbar area needling for measures of pain, function and 

range of motion. 

Subjects with nonspecific pain. 

Acupuncture versus placebo. The effects of acupuncture and placebo were compared in 16 

trials.22,27,37,88,99,141,142,156,197,198,203,206,207,213,223,228 The results of these trials were conflicting. In 

nine trials,27,88,99,156,206,207,213,223,228 acupuncture was significantly better than placebo in reducing 

pain intensity (VAS scores, percent subjects with improved pain or with relief  50 

percent)27,88,99,206,207,223 or disability levels (RMDQ scores)207,228 immediately or shortly after the 

end of treatment. For example, in one trial,156 Fu’s subcutaneous needling was compared to 

placebo (sham-acupuncture) with respect to post-treatment reduction in motion-related pain 

(MRP score) and pain under pressure (PUP)., Fu’s subcutaneous needling compared to placebo 

produced significantly greater immediate post-treatment reductions on both MRP (2.66 ± 2.42 

versus 0.54 ± 1.14) and PUP (2.38 ± 2.39 versus 0.36 ± 0.99). The placebo treatments used in 

these trials were toothpick inside the tube,228 sham TENS,27,88,223 nonpenetrating needling,206,207 

superficial needling at nonacupuncture points,99 and guided tube. 156,213 

In contrast, results from six other trials indicated that acupuncture was not significantly better 

than placebo in reducing back pain (VAS scores: 0-100, modified MPQ, Von Korff Chronic Pain 

Grade Scale: 0-10), disability (PDI, HFAQ), or improving quality of life (SF-12 physical score) 

immediately or shortly (3 months) after the end of treatment.37,141,142,197,198,203 For example, in 

one of these trials 141 although immediate mean post-treatment VAS score was numerically lower 

in the acupuncture versus placebo group, the between-group difference was not statistically 

significant (30.2 ± 3.0 versus 40.0 ± 3.8, p > 0.6). The degree of pain measured by MPQ also 

yielded nonsignificant between-group difference. In general, the use of analgesic medication and 

degree of disability (scale not specified) decreased, but did not differ between the two groups. 

The placebo used in these trials were superficial needling with injection of Lidocaine at 

nonacupuncture points,141 superficial needling at nonacupuncture points,198,203 superficial 

needling 37, and injection of anesthetics and no stimulation.142 The placebo was not described for 

one trial.197 

Moreover, in one trial,22 immediately after the end of treatment, acupuncture produced 

significantly greater improvements in pain (VAS scores: 34.5 versus 43.7, p = 0.03) and quality 

of life (SF-36 physical health domain: 40.5 versus 36.2, p < 0.004) compared to placebo, the 

differences in pain (VAS score: 38.4 versus 42.1, p = 0.39) and quality of life (SF-36 physical 

health domain: 39.3 versus 37.6, p = 0.27) were no more significant at four and 10 months posttreatment followup.22 The effects of acupuncture and placebo TENS were compared in two 

trials,27,203 in one of which acupuncture was shown to be similar to placebo-TENS in terms of 

pain relief (MPQ, VAS scores) or quality of life (SF-36),203 while the other trial27 showed that in 

short term post-treatment reduction in pain (VAS scores) was significantly greater in the 

acupuncture versus placebo-TENS group. There was no significant difference in pain intensity 

between the two groups at 4 months after the end of treatment (p = 0.12). 

The meta-analyses indicated statistically significant pooled mean differences between the 

effects of acupuncture and placebo in reducing pain intensity (VAS scores) immediately (-0.59, 

95 percent CI: -0.93, -0.25).22,37,99,141,156,197,198,203,206,228 (Figure 4). However, the short-term (­

1.11, 95 percent CI: -2.33, 0.11),27,37,99 intermediate (-0.18, 95 percent CI: -0.85, 0.49),22,27,228 

49
 
Figure 4. Pain intensity (VAS score) – Immediate post-treatment 

Difference in means and 95% CI 

Acupuncture Placebo 

Study Name N Mean (SD) N Mean (SD) Favors Favors 

Acupuncture Placebo 

Mendelson et al, 1983 36 3 (1 .8) -0.98 (-1.95, -0.01) 41 4 (2 .4)

Leibing et al, 2002 35 2.1 (2.22. )1 (2.2 -1.1 (-2.1, -0.1) 40 3.2 (2.23. )2 (2.2

Molsberger et al, 2002 -1 (-1.73, -0.27) 58 2.6 (2.12. )6 (2.1 58 3.6 (1.93. )6 (1.9

Kerr et al, 2003 -1.04 (-2.57, 0.49) 26 5.1 (2.25. )1 (2.2 20 6.2 (3.16. )2 (3.1

Brinkhaus et al, 2006 -0.92 (-1.75, -0.09) 140 3.5 (2 .9)5 (2 70 4.4 (3 )

-0.8 (-1.54, -0.06) Inoue et al, 2006 15 4.7 (0.74. )7 (0.7 16 5.5 (1.35. )5 (1.3

-1.23 (-2.48, 0.02) Fu et al, 2006 32 2.6 (2.62. )6 (2.6 28 3.8 (2.33. )8 (2.3

-0.25 (-1.13, 0.63) Kwon et al, 2007 24 3.3 (1.63. )3 (1.6 23 3.6 (1.53. )6 (1.5

-0.24 (-0.51, 0.03) Haake et al, 2007 370 4.9 (1 .9)9 (1 375 5.1 (1 .9)1 (1 

0.3 (-0.24, 0.84) Cherkin et al, 2009 158 3.3 (2 .5)3 (2 162 3 (2 .4)

Pooled 894 833 -0.59 (-0.93, -0.25)

-10.00 -5.00 0.00 5.00 10.00 

Heterogeneity: Chi2 = 18.9, df = 9 (P = 0.03); I2 = 52.3% 

and long-term (-0.21, 95 percent CI: -0.64, 0.22)22,27,198,228 post-treatment mean VAS differences 

between acupuncture and placebo groups were not statistically significant (Figures 5-7). Note 

that the degree of heterogeneity for immediate and short-term post-treatment pooled estimates 

for the mean VAS score (Figures 4-5) is substantial (I2

 range: 52.3 percent-85.0 percent), and 

therefore, these results warrant cautious interpretation. 

50
 
Figure 5. Pain intensity (VAS score) – Short-term post-treatment 

Difference in means and 95% CI 

Acupuncture Placebo 

Study Name N Mean (SD) N Mean (SD) Favors Favors 

Acupuncture Placebo 

Carlsson et al, 2001 34 5.2 (2.4) 16 6.4 (2.5)

Molsberger et al, 2002 47 2.3 (2) 41 4.3 (2.3)

Haake et al, 2007 373 4.54 (1.9) 376 4.85 (2)

Pooled 434 433 

-1.2 (-2.64, -0.01) -1.2 (-2.64, -0.01)

-2 (-2.9, -0.1)

-0.31 (-0.59, 0.49)

-1.11 (-2.33, 0.11)

-10.00 -5.00 0.00 5.00 10.00 

Heterogeneity: Chi2 = 13.4, df = 2 (P < 0.05); I2 = 85.0% 

Figure 6. Pain intensity (VAS score) – Intermediate-term post-treatment 

Difference in means and 95% CI 

Acupuncture Placebo 

Study Name N Mean (SD) N Mean (SD) Favors Favors 

Acupuncture Placebo 

Carlsson et al, 2001 23 4.8 (2.2) 9 6.2 (3.0) 

Brinkhaus et al, 2006 140 3.8 (3.0) 70 4.2 (3.0) 

Cherkin et al, 2009 158 3.7 (2.6) 162 3.5 (2.7) 

Pooled 321 241 

-1.4 (-3.28, 0.48) -1.4 (-3.28, 0.48)

-0.36 (-1.22, 0.5)

0.2 (-0.38, 0.78)

-0.18 (-0.85, 0.49)

-10.00 -5.00 0.00 5.00 10.00 

Heterogeneity: Chi2 = 3.1, df = 2 (P =0.20); I2 = 37.2% 

51
 
Figure 7. Pain intensity (VAS score) – Long-term post-treatment 

Difference in means and 95% CI 

Acupuncture Placebo 

Study Name N Mean (SD) N Mean (SD) Favors Favors 

Acupuncture Placebo 

Carlsson et al, 2001 21 4.2 (2.2) 6 5.4 (3.5)

Leibing et al, 2002 33 3.1 (1.8) 31 3.5 (2.2)

Brinkhaus et al, 2006 137 3.9 (2.9) 68 4.5 (3)

Cherkin et al, 2009 158 3.5 (2.7) 162 3.4 (2.7)

Pooled 349 267 

-1.2 (-3.48, 1.08)

-0.4 (-1.38, 0.58)

-0.57 (-1.43, 0.29)

0.1 (-0.49, 0.69) 0.1 (-0.49, 0.69)

-0.21 (-0.64, 0.22)

-10.00 -5.00 0.00 5.00 10.00 

Heterogeneity: Chi2 = 2.6, df = 3 (P =0.45); I2 = 0.0% 

Based on our meta-analyses, there were no significant differences between acupuncture and 

placebo in improving disability (pooled mean RMDQ difference score; 0.81, 95 percent CI: ­

0.27, 1.9)197,228 and reducing proportion of subjects on sick leave (pooled RR = 0.59, 95 percent 

CI: 0.23, 1.52),27,99 immediately after the treatment (Figures 8-9). Similarly, the proportion of 

patients with global improvement did not significantly differ in acupuncture and placebo groups 

in short- (pooled RR = 1.89, 95 percent CI: 0.93, 3.83)27,99 or intermediate-term (pooled RR = 

1.10, 95 percent CI: 0.96, 1.26)37,203 post-treatment period (Figures 10-11). Moreover, two metaanalyses showed statistically significantly improved degree of functional disability on HFAQ 

score in favor of acupuncture over placebo at post-treatment immediate (4.00, 95 percent CI: 

1.30, 6.80)22,37 or intermediate-term of followup (4.00, 95 percent CI: 1.10, 6.80) 22,37 (Figures 

12-13). 

52
 
Figure 9. Proportion of subjects on sick leave - Immediate post-treatment 

Relative risk and 95% CI Relative risk and 95% CI lative risk and 95% CI

Favors Favors 

Acupuncture Acupuncture cupuncture Placebo Acupunture Placebo Acupunture Placebo cupunture Placebo

Study Name Study Name tudy Name n / N n / N

Carlsson et al, 2001 Carlsson et al, 2001 arlsson et al, 2001 6 / 13 7 / 13 0.86 (0.40, 1.86) 0.86 (0.40, 1.86) 6 (0.40, 1.86)

Molsberger et al, 2002 Molsberger et al, 2002 olsberger et al, 2002 3 / 21 5 / 11 0.31 (0.09, 1.08) 0.31 (0.09, 1.08) 1 (0.09, 1.08)

Pooled9 / 34 12 / 24 0.59 (0.23, 1.52) 0.59 (0.23, 1.52) 9 (0.23, 1.52)

0.1 0.2 0.5 1 2 5 10 0.1 0.2 0.5 1 2 5 10 0.2 0.5 1 2 5 10

Heterogeneity: Chi2 = 1.8, df = 1 (P = 0.17); I2 = 45.3% 

Figure 8. Disability (RMDQ score) – Immediate post-treatment 

Difference in means and 95% CI

Acupuncture Placebo Acupuncture Placebo Favors Favors

Acupuncture Acupuncture Placebo

Study Name N Mean ( SD) N Mean ( SD) N Mean (SD) N Mean (SD)

-10.00 -5.00 0.00 5.00 10.00 -10.00 -5.00 0.00 5.00 10.00

Heterogeneity: Chi2 = 0.18, df = 1 (P < 0.66); I2 = 0.0% 

Kwon et al, 2007 Kwon et al, 2007 245.16 (4.9) 234.92 (4.8) 0.24 (-2.5, 3.0)

Cherkin et al, 2009 Cherkin et al, 2009 1586.3 (5.7) 1625.4 (4.9) 0.90 (-0.26, 2.1)

Pooled182 185 0.81 (-0.27, 1.9)

Heterogeneity: Chi2 = 4.5, df = 1 (P = 0.03); I2 = 77.9% 

Figure 10. Proportion of subjects with global improvement – Short-term post-treatment 

53
 
Figure 12. Functional disability (HFAQ score) – Immediate post-treatment 

Difference in means and 95% CI Difference in means and 95% CI

Acupuncture Placebo Acupuncture Placebo FavorsFavors cupuncture Placebo Acupuncture Acupuncture upuncture Placebo

Study Name Study Name tudy Name N Mean ( SD) N Mean ( SD) Mean ( SD) N Mean (SD) N Mean (SD)

Haake et al, 2007 Haake et al, 2007 ke et al, 2007 387 65.4 (22.9) 38761.3 (22.7) 4.1 (0.89, 7.3) 4.1 (0.89, 7.3)0.89, 7.3)

Brinkhaus et al, 2006 Brinkhaus et al, 2006 haus et al, 2006 146 66.8 (18.3) 7362.9 (20.3) 3.9 (-1.4, 9.2) 3.9 (-1.3.9 (-1.4, 9.2)

Pooled533 460 4.0 (1.3, 6.8) 4.0 (1.3, 6.8)1.3, 6.8)

-25.00 -12.50 0.00 12.50 25.00 -25.00 -12.50 0.00 12.50 25.00 25.00 -12.50 0.00 12.50 25.00

Heterogeneity: Chi2 = 0.004, df = 1 (P = 0.94); I2 = 0.0% 

Figure 13. Functional disability (HFAQ score) – Intermediate post-treatment 

Difference in means and 95% CI

Acupuncture Placebo Acupuncture Placebo FavorsFavors

Acupuncture Acupuncture Placebo

Study Name N Mean (SD) N Mean (SD) N Mean (SD) N Mean (SD)

Haake et al, 2007 Haake et al, 2007 38766.8 (23.1) 38762.2 (23.0) 4.6 (1.4, 7.8))

1.9 (-4.0, 7.8)

Pooled533 460

Brinkhaus et al, 2006 Brinkhaus et al, 2006 14666.0 (20.1) 7364.1 (22.9)

4.0 (1.1, 6.8)

-25.00 -12.50 0.00 12.50 25.00 -25.00 -12.50 0.00 12.50 25.00

Heterogeneity: Chi2 = 0.6, df = 1 (P = 0.43); I2 = 0.0% 

Figure 11. Proportion of subjects with global improvement – Intermediate-term post-treatment 

2 2 Heterogeneity: Chi = 1.4, df = 1 (P = 0.24); I = 25.9% 

Acupuncture versus no treatment. There were four trials in which acupuncture was compared 

to no treatment in relation to low back pain intensity, back function, and overall quality of 

life.22,24,222,227 The results from these trials were consistent in showing a significant immediate, 

short, and intermediate-term post-treatment benefit of acupuncture compared to no treatment. 

For example, in three trials,22,24,227 subjects who received acupuncture experienced greater 

54
 
Figure 14. Pain intensity (VAS score) – Short-term post-treatment 

Difference in means and 95% CI Difference in means and 95% CI

Acupuncture No Treatment Acupuncture No Treatment FavorsFavors

Acupuncture Acupuncture No Treatment

Study Name N Mean ( SD) N Mean ( SD) N Mean (SD) N Mean (SD)

Coan et al, 1980 25 2.8 (2.0) 25 4.7 (2.0)

Thomas et al, 1994 30 4.0 (5.0) 10 6.1 (1.8)

Witt et al, 1994 1350 1.7 (1.2) 1244 2.4 (1.3)

Pooled 1405 1279

-1.85 (-2.96, -0.74) 

-2.10 (-5.29, 1.09) 

-1.19 (-2.17, -0.21) 

-0.68 (-0.78, -0.58) 

-1.85 (-2.96, -0.74)

-2.10 (-5.29, 1.09)

-1.19 (-2.17, -0.21)

-0.68 (-0.78, -0.58)

-10.00 -5.00 0.00 5.00 10.00 -10.00 -5.00 0.00 5.00 10.00

Heterogeneity: Chi2 = 4.99, df = 2 (P = 0.08); I2 = 59.9% 

improvements in pain (VAS score: 0-10),22,24,227 pain disability index (PDI score),22 back 

function (Hannover Functional Ability Questionnaire, HFAQ),22,24 or quality of life (SF-36, 

physical health and pain subscale domains)22,24 compared with those in ‘no treatment‘ groups 

immediately or intermediate-term after the end of treatment. In the remaining one trial,222 there 

was statistically significantly better scores for pain (VAS scores) and mobility in the acupuncture 

(or electro-acupuncture) versus ‘no treatments’ group immediately or short-term after the 

treatment.222 

The pooled estimate for short-term post-treatment pain intensity was statistically significant 

in favor of acupuncture (Figure 14; weighted mean difference on VAS score: -1.19, 95 percent 

CI: -2.17, -0.21).24,222,227 

Acupuncture versus other CAM treatment. Subjects who received manipulation,51,52,140 

massage,29 or electro-acupuncture143 had significantly lower post-treatment pain intensity (VAS, 

MPQ scores) or disability (RDI, Oswestry, NDI scores) compared to subjects who received 

manual acupuncture. However, results from intermediate-term followup (3 months posttreatment) of one of these trials51,52 indicated numerically similar pain intensity in the 

manipulation group (median VAS score: 3.7) compared with acupuncture group (median VAS 

score: 3.9). The use of pain medication was significantly decreased in electro-acupuncture group 

compared to manual acupuncture group (six tablets versus 150 tablets, p < 0.001).143 In another 

trial,29 the use of pain medication did not differ in the acupuncture versus massage group (51.0 

percent versus 47.0 percent, p > 0.05). 

The meta-analysis comparing the effects of acupuncture and manipulation on immediate 

post-treatment pain intensity (Figure 15) indicated significant reductions in favor of 

manipulation over acupuncture (pooled mean difference in VAS score: 3.70, 95 percent CI: 1.5, 

5.8).51,140 Although both trials51,140 reported immediate-term post-treatment disability data 

(Oswestry scores), they were not pooled due to obvious between-group baseline imbalance in 

this outcome scores. 

55
 
Figure 15. Pain intensity (VAS score) – Immediate post-treatment 

Difference in means and 95% CI Difference in means and 95% CI

Study Name N Mean (SD)

Acupuncture

N Mean (SD)

Manipulation Favors 

Acupuncture

Favors

Manipulation

Giles et al, 1999 16 5.1 (7.8) 32 2.5 (7.0)

Giles et al, 2003 33 7.0 (5.2) 35 3.0 (5.2)

Pooled 49 67

-10.00 -5.00 0.00 5.00 10.00

2.6 (-1.75, 6.9) 

4.0 (1.5, 6.5) 

3.7 (1.5, 5.8) 

2.6 (-1.75, 6.9)

4.0 (1.5, 6.5)

3.7 (1.5, 5.8)

2.6 (-1.75, 6.9) 

Heterogeneity: Chi2 = 0.3, df = 1 (P = 0.58); I2 = 0.0% 

Figure 16. Pain intensity (VAS score) – Immediate post-treatment 

Difference in means and 95% CI

Acupuncture Acupuncture Medication FavorsFavors

Study Name N Mean ( SD) N Mean ( SD) N Mean (SD) N Mean (SD) Acupuncture Acupuncture Medication

Giles et al, 1999 Giles et al, 1999 16 5.1 (7.8) 16 5.1 (7.8) 20 3.8 (4.8) 20 3.8 (4.8) 1.3 (-2.8, 5.4)

Giles et al, 2003 Giles et al, 2003 33 7.0 (5.2) 33 7.0 (5.2) 35 5 (3.7) 35 5 (3.7) 2.0 (-0.13, 4.1)

Wang et al, 2004 Wang et al, 2004 23 2.6 (2.3) 23 2.6 (2.3) 17 3.3 (2.5) 17 3.3 (2.5) -0.76 (-2.3, 0.74)

Itoh et al, 2009 Itoh et al, 2009 7 4.8 (1.9) 7 4.8 (1.9) 7 5.8 (2.2) 7 5.8 (2.2) -1.1 (-3.2, 1.0)

Pooled79 79 0.11 (-1.42, 1.65)

-10.00 -5.00 0.00 5.00 10.00 -10.00 -5.00 0.00 5.00 10.00

Heterogeneity: Chi2 = 5.7, df = 3 (P = 0.12); I2 = 47.6% 

Acupuncture versus usual care. The effect of acupuncture compared to usual care (e.g., pain 

medication, antiinflammatory pills, general practitioner visits, exercise, and lifestyle 

modifications) was studied in three trials.37,226,228 In these trials subjects who received 

acupuncture improved in pain intensity, degree of disability, or quality of life compared to 

subjects in usual care groups.37,226,228 

Acupuncture versus medication. The effect of acupuncture was compared to that of 

medication in four trials.51,140,214,216 In three studies51,52,140,216 acupuncture did not have a 

significantly different effect from that of medication in reducing immediate, or short term posttreatment pain intensity or disability (RMDQ, Oswestry score). In one of these trials51,52 

acupuncture group achieved numerically better median Oswestry disability score than 

medication (13 versus 24) in intermediate term post treatment followup. This trial failed to report 

test results for between-group comparisons. In two meta-analyses (Figures 16-17) the immediate 

post-treatment effects of acupuncture and medication were not significantly different with 

respect to reductions in pain intensity (pooled mean difference in VAS score: 0.11, 95 percent 

CI: -1.42, 1.65)51,140,216,221 and disability (pooled mean difference in Oswestry score: -2.40, 95 

percent CI: -12.20, 7.40).51,140 

56
 
Figure 17. Disability (Oswestry score) – Immediate post-treatment 

Difference in means e in means and 95% CI

Study Name N Mean ( ( SD)

Acupuncture

N Mean (SD)

Medication Favors 

Acupuncture

Favors 

Medication

Giles et al, 1999

Giles et al, 2003

Pooled

16

33

49

24.5 (26.6)

26.0 (20.7)

20

35

55

20.0 (21.5)

32.0 (23.7)

4.5 (-11.2, 20.2) 

-6.0 (-16.6, 4.6) 

-2.4 (-12.2, 7.4) 

4.5 (-11.2, 20.2)

-6.0 (-16.6, 4.6)

-2.4 (-12.2, 7.4) 

-25.00 -12.50 0.00 12.50 25.00

Heterogeneity: Chi2 = 1.2, df = 1 (P = 0.27); I2 = 15.3% 

Figure 18. Pain intensity (VAS score) – Immediate post-treatment 

Difference in means and 95% CI Difference in means and 95% CI

FavorsFavors 

Acupuncture Acupuncture TENS

Study Name N Mean ( SD) N Mean ( SD) N Mean (SD) N Mean (SD)

Acupuncture Acupuncture TENS

Grant et al, 1999 30 7.1 (6.6) 27 4.7 (4.4)

Itoh et al, 2009 7 4.8 (1.9) 6 6.1 (2.4)

Pooled 37 33

2.40 (-0.54, 5.34) 

-1.34 -3.66, 0.98) 

0.42 (-3.24, 4.07) 

2.40 (-0.54, 5.34)

-1.34 -3.66, 0.98)

0.42 (-3.24, 4.07)

-10.00 -5.00 0.00 5.00 10.00 -10.00 -5.00 0.00 5.00 10.00

Heterogeneity: Chi2 = 3.8, df = 1 (P = 0.05); I2 = 74.0% 

Acupuncture versus other treatment. In three trials,53,163,216 the use of manual acupuncture 

was shown to be significantly superior to physiotherapy (consisted of light, electricity, and/ or 

heat therapy) in improving the degree of disability (Oswestry score)163 and similar to TENS in 

decreasing pain intensity (VAS scores).53,216 In one of these trials, the reduction in the use of pain 

medication was greater for the acupuncture versus TENS group (50.0 percent versus 33.0 

percent, p < 0.05).53 

The meta-analyses results from two trials in elderly (Figures 18-19) showed nonsignificant 

differences between acupuncture and TENS in reducing immediate (pooled mean difference in 

VAS score: 0.42, 95 percent CI: -3.24, 4.07)53,216 or short-term (pooled mean difference in VAS 

score: -0.15, 95 percent CI: -0.62, 0.33)53,216 post-treatment pain intensity. 

57
 
Figure 19. Pain intensity (VAS score) – Short-term post-treatment 

Difference in means and 95% CI Difference in means and 95% CI

Study Name N Mean ( ( SD)

Acupuncture

N Mean (SD)

TENS Favors 

Acupuncture

Favors

TENS

Grant et al, 1999

Itoh et al, 2009

Pooled

30

7

37

6.0 (6.5)

4.3 (2.6)

27

6

33

6.3 (6.0)

5.8 (2.3)

0.05 (-0.57, 0.47) 

-0.60 (-1.71, 0.52) 

-0.15 (-0.62, 0.33) 

0.05 (-0.57, 0.47)

-0.60 (-1.71, 0.52)

-0.15 (-0.62, 0.33)

-10.00 -5.00 0.00 5.00 10.00 -10.00 -5.00 0.00 5.00 10.00

Heterogeneity: Chi2 = 0.8, df = 1 (P = 0.38); I2 = 0.0% 

In one trial,29 the post-treatment RMDQ scores did not differ between acupuncture and ‘selfcare’ groups immediately (7.9 versus 8.8, p = 0.75) and also 1 year after the treatment (8.0 versus 

6.4, p = 0.10). Another trial,216 demonstrated statistically significantly greater immediate posttreatment improvements for subjects treated with combination of acupuncture and TENS 

compared to those treated with acupuncture alone with respect to pain intensity (VAS: 36.6 ± 8.0 

versus 37.4 ± 26.0, p < 0.008) and disability (RMDQ: 3.8 ± 0.8 versus 5.4 ± 3.4). 

In two trials, subjects in electro-acupuncture groups had significantly lower post-treatment 

pain intensity scores (VAS, Numerical Rating Scale of Pain-NPRS)88,155 or increased trunk 

strength extension88 compared with subjects who received TENS88 or exercise sessions.155 

Acupuncture + other treatment versus other treatment. There were five trials,99,198,200,216,226 in 

which both acupuncture and control (i.e., no treatment) groups were given either orthopaedic 

treatment,99 usual care (e.g., NSAIDs, muscle relaxants, Paracetamol, and back exercises),226 

TENS,216 exercise,200or physiotherapy (method use was aimed to remove a muscle imbalance 

using the Bruegger-concept and special training of proper posture and motion)198 The addition of 

acupuncture to the above-mentioned therapies resulted in significant improvements in pain 

intensity (VAS mean scores) and disability (Pain Disability Index, Modified Roland Disability 

Score) compared to the control treatments (i.e., orthopaedic, usual care, or physiotherapy alone), 

immediately 99,198,226 or short-term99 after the end of treatment. In one of the trials,226 the patterns 

of pain medication use did not differ significantly between the acupuncture and control groups (p 

= 0.07). 

In one trial,200 subjects receiving a combination of electro-acupuncture and exercise had 

significantly improved pain intensity (NRS scores), disability (Aberdeen Low Back Pain scale), 

and spinal angular ROM (flexion and extension) compared with subjects receiving exercise alone 

at 3 months post-treatment. The use of analgesics was similar across the two groups (p = 

0.385).200 

In three meta-analyses (Figures 20-22) statistically significant differences in favor of 

combination of acupuncture with other treatment over other treatment were shown in the 

reduction of pain intensity immediately (pooled mean difference in VAS score: -1.65, 95 percent 

CI: -2.32, -0.98),99,198,200 short-term (pooled mean difference in VAS score: -2.23, 95 percent CI: 

-3.68, -0.79), 99,200 and intermediate-term (pooled mean difference in VAS score: -1.55, 95 

percent CI: -2.29, -0.81)198,200 after the end of treatment. In one meta-analysis based on two 

studies in elderly (Figure 23), there was no statistical significant difference in short-term posttreatment disability between the two intervention groups (pooled mean difference in RMDQ 

score: -3.15, 95 percent CI: -7.16, 0.87).216,226 

58
 
Figure 20. Pain intensity (VAS score) – Immediate post-treatment 

Study Name N Mean ( SD) 

Acupuncture & Other 

N Mean (SD) 

Other 

Favors 

Acupuncture 

& Other 

Yeung et al, 2003

Molsberger et al, 2002

Leibing et al, 2001

26

58

35

3.8 (2.1)

2.6 (2.1)

2.1 (2.2)

26

58

39

5.1 (2.2)

3.9 (2.1)

4.4 (1.7)

Pooled 119 123 

Difference in means and 95% CI 

Favors 

Other
 

-2.3 (-3.19, -1.41)

-1.3 (-2.06, -0.54)

-1.31 (-2.47, -0.15)

-1.65 (-2.32, -0.98)

-10.00 -5.00 0.00 5.00 10.00 

Heterogeneity: Chi2 = 3.2, df = 2 (P = 0.20); I2 = 37.0% 

Figure 21. Pain intensity (VAS score) – Short-term post-treatment 

Difference in means and 95% CI 

Favors 

Study Name N Mean ( SD) 

Acupuncture & Other 

N Mean (SD) 

Other Acupuncture 

& Other 

Favors 

Other 

Molsberger et al, 20et al, 2002 47 2.3 (2) 36 5.2 (1.9) -2.9 (-3.75, -2.05)

Yeung et al, 2003et al, 2003 26 3.8 (2.1) 26 5.2 (2.5) -1.42 (-2.67, -0.17)

Pooled 73 62 -2.23 (-3.68, -0.79)

-10.00 -5.00 0.00 5.00 10.00 

Heterogeneity: Chi2 = 3.7, df = 1 (P = 0.05); I2 = 72.8% 

59
 
Figure 22. Pain intensity (VAS score) – Intermediate-term post-treatment 

Difference in means and 95% CI 

Acupuncture & Other Other 

Study Name N Mean ( SD) N Mean (SD) 

Leibing et al, 2001 Leibing et al, 2001 33 3.1 (1. 8)1 31 4.5 (2 )

Yeung et al, 2003 Yeung et al, 2003 26 3.5 (2.23. )5 (2.2 26 5.3 (2. 3)3 

Pooled 59 57
 

-10.00 -5.00 0.00 5.00 10.00 

Favors 

Acupuncture 

& Other 

Favors 

Other 

-1.55 (-2.29, -0.81) 

-1.81 (-3.03, -0.59) 

-1.40 (-2.33, -0.47) 

-1.55 (-2.29, -0.81)

-1.81 (-3.03, -0.59)

-1.40 (-2.33, -0.47)

Heterogeneity: Chi2 = 0.3, df = 1 (P = 0.6); I2 = 0.0% 

Figure 23. Disability (RMDQ score) – Short-term post-treatment 

Difference in means and 95% CI 

Favors 

Acupuncture + Other Other Favors Acupuncture Other + Other Study Name N Mean ( SD) N Mean (SD) 

Meng et al, 2003 Meng et al, 2003 24 6.3 (4.46. )3 (4.4 23 11 .4 (4.8) 1.4 (4.8)

Itoh et al, 2009 Itoh et al, 2009 6 6.5 (1. 6)5 (1. 6 7.5 (3 .6)

Pooled 30 29 

-10.00 -5.00 0.00 5.00 10.00 

-3.15 (-7.16, 0.87) 

-1.0 (-4.15, 2.15) 

-5.1 (-7.73, -2.47) 

-3.15 (-7.16, 0.87)

-1.0 (-4.15, 2.15)

-5.1 (-7.73, -2.47)

Heterogeneity: Chi2 = 3.8, df = 1 (P = 0.05); I2 = 73.9% 

Acupuncture (type 1) versus acupuncture (type 2). In one trial,225 two modalities of needle 

insertion levels (muscle and overlying skin) were compared to electrical twitch-obtaining 

intramuscular stimulation (ETOIMS). Two weeks post-treatment, subjects in ETOIMS group had 

significantly lower mean VAS score (3.7 ± 1.9) compared with those in subjects in the two other 

groups of muscle and skin stimulation (4.2 ± 1.9 and 4.3 ± 2.3, respectively). 

In two trials,136,204 different weekly frequencies of acupuncture were compared (high - five 

times versus low – twice). In one of these trials,136 post-treatment pain intensity (VAS scores) 

and degree of disability (RMDQ scores) were similar in groups of subjects randomized to high 

frequency (1 year VAS score: 1.41, 95 percent CI: 0.58, 2.24; 1 year RMDQ score: 13.10, 95 

percent CI: 10.10, 16.11) versus low frequency (1 year VAS score: 1.35, 95 percent CI: 0.52, 

2.18; 1 year RMDQ score: 12.33, 95 percent CI: 10.35, 14.31) at all points of post-treatment 

followup (5 weeks, 3 months, and 1 year). 

The immediate and delayed acupuncture treatments were compared in three trials showing 

subjects to have similar post-treatment pain intensity (VAS score)22,24,227 or quality of life (SF36: physical and mental components).24 

In one trial,217 two groups of subjects receiving trigger point acupuncture versus tender point 

acupuncture were compared with respect to pain intensity (VAS) and disability (RMDQ) 

60
 
immediately after the treatment, showing significant improvements for both endpoints in the 

trigger point group compared to the tender point group. 

In another trial,155 subjects in the electro-acupuncture and electrical heat acupuncture groups 

had similar pain intensity (NPRS: 2.43 ± 1.87 versus 2.27 ± 2.15, p > 0.05) and disability degree 

(RMDQ: 5.93 ± 3.79 versus 8.00 ± 5.66, p > 0.05). 

In one trial,174 patients with chronic LBP responded better to electroacupuncture at local 

points than to acupuncture at local point in addition to weizhong point (curative effect rate: 96.1 

percent versus 88.7 percent, P < 0.05) at similar needle retention duration (30 minutes). 

Population with mixed duration of pain. A total of 44 trials with subjects having LBP of 

mixed duration were included in this section.110,121,134,138,146-151,153,154,157,158,161,164-166,170-173,175,177­

185,187-195,209 The majority of these trials (39 studies) enrolled subjects with LBP due to specific 

causes (e.g., sciatica, disc protrusion, myofascial pain syndrome, lumbar transverse process 

syndrome, and spondylosis).134,138,146-151,154,157-159,161,164-166,170-173,177-185,187-195,232 Only five trials 

studied subjects with nonspecific LBP.110,121,153,175,209 

Subjects with specific pain. 

Acupuncture versus placebo. No relevant studies were identified. 

Acupuncture versus other treatment. In one trial, the use of electro-acupuncture was more 

effective in reducing pain and increasing range of motion (straight leg raising) than manual 

therapy (manipulation or mobilization) or oral medication,164 In two other trials, the 

combinations of warming needle and moxibustion produced significantly better results than 

acupuncture alone.146,181 

Acupuncture (type 1) versus acupuncture (type 2). There were 23 trials conducted 

predominantly in Chinese subjects with lumbar intervertebral disc protrusion,148­

151,154,157,165,166,170,171,177-179,181-184,187,189,190,194,195 and myofascial pain,147which compared routine 

acupuncture (or electro-acupuncture) alone or in combination with other treatments (e.g., 

cupping, moxibustion, massage, traction, laser knife, hypodermic catgut embedding therapy, 

polarized light) to acupuncture of different modalities (e.g., abdomen-/body-acupuncture, round 

sharp/filiform needle, point-through-point, superficial needling, deep puncture), or needle-knife. 

Outcomes used in these studies were curative effect (definition varied across trials), VAS for 

pain intensity,154,157,165,166,195 and well being.170,171,177,178,182,184,187,189,190,194,195 

In four trials,149,165,178,183 deep or point-through-point needling produced significantly greater 

therapeutic effect (i.e., being free of pain symptoms) compared with conventional acupuncture. 

The use of round sharp needle,194 contralateral needle,171 or along channel needle148 produced 

better therapeutic effect than conventional acupuncture. In two trials,179,187 abdominal 

acupuncture showed a significantly better effect compared with body acupuncture. Electroacupuncture was worse than hypodermic catgut as shown in one study.182 

Acupuncture versus other treatments. No relevant studies were identified. 

Acupuncture versus medication. Elongated needling acupuncture,134 warming needle 

acupuncture,146 and electro-acupuncture138 were reported to result in better curative effects than 

that of medication for patients with disc herniation. The medication used in these trials included 

oral Fenbid, Mobic, and Nimeisulide. For example the clinical cure rate for one study was 56.67 

percent in acupuncture versus 26.67 percent in oral medication group.146 Similarly acupuncture 

at Gentong ankle points,154 or huaisanzhen point,195 was better than intramuscular injection of 

Aspirin-DL-lysine + saline,154 or Bilinfen (0.9g) + physiological saline (2 ml)195 shown by higher 

curative effects. In one trial,138 the application of electro-acupuncture, compared to 7.5 mg/d 

mobic, significantly improved LBP pain, walking ability, raising straight leg, or muscle strength. 

61
 
Acupuncture + other treatments versus the same other treatments. In two trials, scalp 

acupuncture in addition to traction193 or massage185 was shown to be more effective than traction 

or massage alone immediately after treatment. For example, in one study, 193 the rates of 

clinically cured subjects in the combination and single treatment groups were 21.4 percent 

(acupuncture + traction) and 13.5 percent (traction alone), respectively. 

The combination of acupuncture and traction,158 or manual therapy161,172,185 had a 

significantly better analgesic effect compared to traction or manual therapy alone in patients with 

disc herniation.158,161,172,185 In one of these studies, mean post-treatment VAS scores were 

statistically significantly different: 1.91 ± 0.93 (acupuncture + traction) versus 3.58 ± 1.52 

(traction alone).158

 Similarly, abdominal acupuncture in addition to body acupuncture and traction was also 

found to be more effective than body acupuncture or traction alone in patients with disc 

herniation (effective rate: 96.88 percent versus 89.29 percent, P < 0.05).180 

In several other trials, acupuncture (or electro-acupuncture) in combination with another 

therapy (e.g., moxibustion, laser knife, massage) was shown to be more beneficial than 

acupuncture, laser knife, traction, or massage alone.150,158,172,177,193 

Subjects with nonspecific pain. 

Acupuncture versus placebo .No relevant studies were identified. 

Acupuncture versus no treatment. No relevant studies were identified. 

Acupuncture versus usual care. In one trial,110,112 a long-term post-treatment SF-36 bodily 

pain score was significantly improved in acupuncture group versus usual care group (mean 

between-group difference: 8.0, 95 percent CI: 2.8, 13.2). There were statistically nonsignificant 

differences in favor of acupuncture for disability (Oswestry score: -3.4, 95 percent CI: -7.8, 1.0) 

and pain intensity (MPQ: -0.2, 95 percent CI: -0.6, 0.1). There were no significant differences 

between the acupuncture and usual care groups in the long-term post-treatment mean hospital 

stay (days), general practitioner visits (3.78 ± 3.36 versus 4.26 ± 4.74), and outpatient visits (0.50 

± 1.62 versus 0.41 ± 1.95).112 

Acupuncture (type 1) versus acupuncture (type 2). In one trial,153 O3 acupoint injection had a 

significantly greater therapeutic effect compared to electro-acupuncture. 

Acupuncture versus other treatments. In two trials, the effect of electro-acupuncture was 

compared to that of TENS121,209 for LBP treatment. In the first trial,209 electro-acupuncture and 

TENS did not significantly differ in pain relief. However, in the other trial,121 electroacupuncture was associated with a significantly lower pain intensity (VAS scores) compared to 

TENS (mean between-group VAS score difference: 21, 95 percent CI: 4.12, 37,95). 

Acupuncture versus medication. No relevant studies were identified. 

Acupuncture + other treatments versus the same other treatments. No relevant studies were 

identified. 

Population with unknown duration of pain. Nine trials were included in this subsection.49,145,176,186,199,210,215,218,219 Six trials were restricted to subjects with nonspecific 

LBP49,145,199,210,215,218 and three trials enrolled patients with low back pain due to specific causes 

(sciatica, lumbar vertebrae hyperplasia, intervertebral disk herniation).176,186,219 

Subjects with specific pain. 

Acupuncture versus placebo. No relevant studies were identified. 

Acupuncture versus no treatment. No relevant studies were identified. 

Acupuncture versus another type/method of the same CAM. No relevant studies were 

identified. 

62
 
Acupuncture versus other treatments. In one trial,186 the rate of cure (i.e., pain was absent) 

was significantly greater in electro-acupuncture (52.0 percent) versus medication group (42.0 

percent). In another trial,176 the rate of cure (i.e., absence of pain) was significantly better in the 

electro-acupuncture versus TENS (80.0 percent versus 44.9 percent, p < 0.005). 

Acupuncture versus medication. No relevant studies were identified. 

Acupuncture (type 1) versus acupuncture (type 2). One trial,219 showed that subjects who 

received acupuncture at Kuesu point had immediate greater decrease in pain intensity score 

(PRS) than those who received acupuncture at nonKuesu point (PRS score: 5.30 versus 2.40, p = 

0.003) and improvement in ROM extension (73.0 percent versus 40.0 percent). In one trial,186 the 

rate of cure (i.e., pain was absent) was significantly greater in electro-acupuncture (52.0 percent) 

versus acupuncture (40.0 percent). 

Subjects with nonspecific pain. 

Acupuncture versus placebo. In one trial, there were no significant differences in the 

proportions of subjects with improved pain (not specified) between the acupuncture versus 

placebo (sham-acupuncture).145 Either real needling210 or total body acupuncture 218 was superior 

to sham needling in reducing LBP pain intensity immediately post treatment. For example, in 

one study,210 the mean pain intensity (VAS score) was 37.3 in acupuncture group and 64.1 in the 

placebo group. 

Acupuncture versus no treatment. No relevant studies were identified. 

Acupuncture (type 1) versus acupuncture (type 2). In two trials199,215 different methods of 

acupuncture were compared. In one trial,199 insertion of needles within the affected segment near 

typical acu-points showed to have better analgesic effect than insertion of the needles within the 

affected segment but far away from the acu-points (mean VAS score: 41.0 versus 83.0) In the 

other trial,215 needle retention for about 10 minutes was more effective than the removal 

immediately after the insertion. 

Acupuncture versus other treatments. In one trial, there was no significant difference in the 

proportion of subjects with improved pain between subjects in dry needling acupuncture (61 

percent improved) and subjects in acupressure + vapocoolant spray group (66 percent).49 

Acupuncture versus medication. No relevant studies were identified. 

Acupuncture + other treatments versus the same other treatments. In one trial,49 there was no 

significant difference in the proportion of subjects with improved pain between the dry needling 

acupuncture + Lidocaine injection (40 percent) and Lidocaine injection alone (45 percent) groups 

immediately after the end of treatment. In this trial, although the rate of pain improvement was 

numerically in favor of acupuncture (dry needling, or trigger point injection) compared to 

Lidocaine, the observed differences did not reach the statistical significance (61.0 percent versus 

40.0 percent-45.0 percent, p > 0.05). 

63
 
2 - Acupuncture for Treatment of Neck Pain 

This section included 52 trials. Results of 10 trials were reported in multiple publications 

(Table 3). 

Population/trial characteristics. The trials were conducted in Australia (three)51,140,234, 

Austria (two)17,235, Brazil (one)126, South Korea (one)46, China (20)229,236-254, Germany 

(four)77,80,106,131, Italy (one)255, Japan (two)256,257, Korea (one)45, New Zealand (one)258, Spain 

(one)259, Sweden (two)260,261, Switzerland (one)47, Taiwan (one)262, Turkey (one)263, United 

Kingdom (four)128,264-266, and United States (six).267-272 

Most trials included adults whose age ranged from 18 to 60 years. One study recruited 

elderly adults only (60 years of age or older).45 

The proportion of women was greater in 23 studies45,77,80,106,126,128,131,140,235,240,241,245,255­

257,259,264-269,272, similar to that of men in 13 studies,51,229,234,236-239,242,244,247,249,251,252 smaller to that 

of men in two studies,258,270 and not reported in 10 studies.17,47,248,250,253,254,260-262,271 One study 

included only women.263 

Racial composition of the study population was not reported in the majority of trials. 

In total 8,515 participants with neck pain were randomized to acupuncture or control groups. 

Sample size for these trials ranged from 13258 to 3,451 participants.131 

Acupuncture alone (various methods of needling techniques) was used in 47 studies.45­

47,51,77,79,80,106,126,128,140,229,234-246,248-263,265,266,268,269,271,272 Acupuncture was used in combination 

with other intervention in the experimental arm in seven studies.17,46,131,247,264,267,270 The control 

treatment for these trials was the same treatment included in the acupuncture arm (i.e. 

experimental treatment). Table 8 presents the control interventions in the included studies. 

Table 8. Acupuncture for treatment of neck pain- Control interventions 

Type of control 

group 

Cause of 

Pain 

N 

studies 

Detail of Control intervention 

Placebo/sham Non 

Specific 

8 Non penetrating needling at 47,256,257 sham TENS at 128, TENS 

(not at acu or not specified),258,259,266 needling at nonacu 

points47 

Specific 8 Laser pen,17,77,80,106,263 needling at nonacu-points,234,248 

superficial needling at 260,261 

No-treatment/ 

waiting list 

Non 

Specific 

0 NA 

Specific 1 No treatment264 

2- Active Controls 

Exercise/physical 

activity 

Non 

Specific 

0 NA 

Specific 0 NA 

Cervical Collar 

(specific pain: 

whiplash injury) 

Non 

Specific 

1 Collar and analgesics17 

Specific 0 NA 

Usual care Non 

Specific 

2 Medication, massage, recommended exercise,267 

conventional treatment as needed,131 

Specific 1 Cervical collar, medication (Chlormezanon, Paracetamol) 

with or without laser17 

Physiotherapy Nonspecific 1 standard localized mobilization techniques, most commonly 

Maitland (rotation, postero-anterior oscillatory movement 

and longitudinal traction)265 

Specific 0 NA 

64
 
Traction Nonspecific 0 NA 

Specific 2 Traction alone229; traction and massage,252 

Physical 

modalities 

Nonspecific 3 TENS bilaterally (no details provided),272 

Low level laser therapy (7, and -30 mW) on 106 laser 

acupuncture at classical 47 

Specific 1 Laser at trigger points of upper trapezius muscle,263 

Manual therapy Nonspecific 1 Traction and massage252 

Specific 4 Spinal manipulation51,140,244, massage, 245 

Medication Nonspecific 2 Rofecoxib/Vioxx followed by Paracetamol/Acetaminophen,51 

Tenoxican and Ranitidine, 140 

Specific 4 Lidocaine alone or in combination with Decadron,45,126 

NSAIDs,268, Diazepam260 

Other methods of 

acupuncture 

Nonspecific 3 Superficial vs. trigger point, 256, needling along vs. across 

muscle fibers,240, with/out electrical stimulation,46,235 

Specific 24 Alternative techniques on acu-point needling (Shu)236 Acu 

with thrusting, or twirling manipulation,80,237 auricular 

needling at alternative oto-points,238 long vs. short duration 

needle retention,239 trigger point injection with Lidocaine, 262 

, alternative ,46,241,242,253,254,268,269,271 addition of auricular 

acu,255, acu with/out electrical stimulation,243,261,271 

Moxibustion in addition to electro-acupuncture,245,251, 

alternative needling method,249,250,252-254 

Other active 

treatment (also in 

acupuncture 

group) 

Nonspecific 3 Conventional care by GP,131,270 medication, massage, 

recommended exercise 267 

Specific 6 Stretching exercise,264 usual care,270 spinal manipulation,244 

cervical collar, medication and medication17 manual 

therapy247 massage246 

Acupuncture in 

combination with 

another treatment 

(vs. acupuncture 

alone) 

Nonspecific 0 NA 

Specific 3 Spinal manipulation,244 cervical collar and medication,17 

spinal manipulation + massage, 247 

Acu=acupuncture; EMG=electromyography; GP=general practitioner care; NA= not applicable; NSAIDs= nonsteroid antiinflammatory 

drugs; TENS=transcutaneous electrical nerve stimulation 

The number of treatments in Chinese studies varied from one to three courses, each course 

ranging 5-15 days in duration. The frequency of treatments in the majority of studies was once a 

day consecutively for the duration of the study course. The number of treatments ranged from < 

10 sessions,234,237,247 10-20 sessions,241-243 up to 21-45 sessions.229,236,239,245,246,250,253 Two of the 

Chinese studies did not report the frequency or number of treatments.254,273 

The frequency of treatment in the remaining studies reporting this information was a single 

treatment,80,238,240,248,260-262 one to two sessions per week (up to 12 treatments in 

total),79,131,235,244,255-257,263,265,267 two sessions per week (up to 18 treatments in 

total),47,51,77,106,128,140,249,258,259,266,268,272 three sessions per week (up to nine treatments in 

total),45,46,271 and four sessions per week (> 24 treatments in total).270 

Risk of bias. The risk-of-bias graph for the trials included in this sub-section is presented in 

Figure 24. All trials were randomized. The adequate method of randomization and treatment 

allocation concealment was reported for about 26.0 percent and 15.0 percent of the trials, 

respectively. In 62.0 percent of the trials, the subjects’ baseline characteristics distribution across 

the treatment arms was similar (i.e., balanced). For at least 15.0 percent of the trials, it was 

65
 
unclear whether or not the subjects and assessors were blinded to the type of treatment. That 

subjects were blinded was reported for only 62.0 percent of the trials. Half of the trials reported 

acceptable drop-out rates (i.e., < 20.0 percent).9

 Results based on intention-to-treat analysis were 

explicitly reported for 25.0 percent of the trials. The data for selected items of the risk of bias 

tool across the CAM interventions (acupuncture; spinal manipulation; spinal mobilization; 

combination of manipulation and mobilization; and massage therapy) is displayed in table 7.2 of 

Appendix G. 

Figure 24. Risk of bias scores (%) 

0% 20% 40% 60% 80% 100% 

Q13 

Q12 

Q11 

Q10 

Q9 

Q8 

Q7 

Q6 

Q5 

Q4 

Q3 

Q2 

Q1 

Yes No Unclear 

Efficacy results. A summary of the key results is presented in Table 9. For further detail of 

the trials please see the evidence tables.(Appendix C, table 2.1 – table 2.8) 

66
 
Table 9 – Key results – Acupuncture treatment in patient with neck pain & cervicogenic headaches 

Acupuncture 

therapy 

Duration of 

pain 

Cause 

of pain Outcome 

Risk 

-ofbias 

Precision 

of the 

pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

Acu vs. No Tx Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic/Mixe 

d 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S SF-MPQ: B 

264 

M - NA Direct = S-NS Low 

PPT: B 

264 

M - NA Indirect = S-NS Low 

SF-MPQ: C

264 

M - NA Direct > SS Low 

PPT: C 

264 

M - NA Indirect = S-NS Low 

NS - - - - - - Insufficient 

Acu vs. PL Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S VAS: B M Precise (2)£ 

80,234 

Yes Direct = S-NS Moderate 

NS VAS: B M Precise (3) 256,257,266 

No Direct = S-NS Low 

Mixed S VAS: B 263 H - NA Direct = S-NS Low 

NHP: B, D 

263 

H - NA Direct = S-NS Low 

Use of 

analgesics 

(mean N of pills 

per day): B, D 263 

H - NA Direct = S-NS Low 

ROM (flx, rot): B, 

D 263 

H - NA Indirect = S-NS Low 

NS - - - - - - Insufficient 

Unknown S % pts without 

symptoms: B 248 

H - NA Direct > SS Low 

NS - - - - - - Insufficient 

Acu vs. Med Acute/sub- S - - - - - - Insufficient 

67
 
Acupuncture 

therapy 

Duration of 

pain 

Cause 

of pain Outcome 

Risk 

-ofbias 

Precision 

of the 

pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

acute NS - - - - - - Insufficient 

Chronic S VAS: B 45,126,268 H - No Direct => Low 

NS VAS: B 51,260 H - Yes Direct = S-NS Low 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown 

S VAS: C 

249,262 

H - Yes Direct > SS Low 

NS - - - - - - Insufficient 

Acu vs. Mob Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS VAS: B, D

265 

M 

-

NA Direct = S-NS Low 

NPQ: B, D 

265 

M - NA Direct = S-NS Low 

GHQ: B, D

265 

M - NA Direct = S-NS Low 

Mixed/ 

Unknown 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Acu vs. ST Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS NPQ: B 

267 

M - NA Direct = S-NS Low 

% pts using 

medication: B 

267 

M - NA Direct > SS Low 

Mixed/ 

Unknown 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Acu vs. Man Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S VAS-C 244 H - NA Direct = S-NS Low 

NS VAS: C 51,140 H - Yes Direct >< (NR) Low 

68
 
Acupuncture 

therapy 

Duration of 

pain 

Cause 

of pain Outcome 

Risk 

-ofbias 

Precision 

of the 

pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

VAS: D 51,52 H - NA Direct = (NR) Low 

Oswestry: C, D 

51,140 

H - Yes Direct < (NR) Low 

NDI: C, D 

51,140 

H - Yes Direct < (NR) Low 

SF-36: C, D 51 H - NA Direct < (NR) Low 

Mixed/ 

Unknown 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Acu vs. Ma Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S ROM (flx, ext, 

rotation): C 77 

H - NA Indirect = S-NS Low 

VAS: C 77 H - NA Direct > SS Low 

NS - - - - - - Insufficient 

Mixed/ 

Unknown 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Acu vs. Laser 

Tx 

Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS VAS: C 

47,106 

L - - Direct = S-NS Moderate 

ROM: C 

47,106 

L - - Indirect = S-NS Low 

Mixed S VAS: B 

263 

H - NA Direct < SS Low 

ROM: B 

263 

H - NA Indirect < SS Low 

NHP: B 

263 

H - NA Direct < SS Low 

Use of 

analgesics 

(mean N of pills 

per day): B 263 

H - NA Direct < SS Low 

69
 
Acupuncture 

therapy 

Duration of 

pain 

Cause 

of pain Outcome 

Risk 

-ofbias 

Precision 

of the 

pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

VAS: D 

263 

H - NA Direct = S-NS Low 

ROM: D 

263 

H - NA Indirect = S-NS Low 

NHP: D 

263 

H - NA Direct = S-NS Low 

Use of 

analgesics 

(mean N of pills 

per day): D 263 

H - NA Direct = S-NS Low 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Acu vs. E-acu Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S VAS: B 261 H - NA Direct = S-NS Low 

NS - - - - - - Insufficient 

Mixed S % pts who 

improved: B 243 

H - NA Direct < SS Low 

Time to effect 

(days): B 243 

H - NA Direct < SS Low 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Headache 

Acu vs. TrP 

Injection 

Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S VAS: B 126 H - NA Direct = S-NS Low 

N of analgesics 

ingested weekly: 

C 126 

H - NA Direct 

= S-NS 

Low 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

70
 
Acupuncture 

therapy 

Duration of 

pain 

Cause 

of pain Outcome 

Risk 

-ofbias 

Precision 

of the 

pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

NS - - - - - - Insufficient 

Acu vs. PT Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

S=specific; NS=nonspecific; SS=statistically significant; S-NS=statistically nonsignificant; Man=manipulation; Acu=acupuncture; Ma=massage; Mob=mobilization; PL=placebo; 

Tx=treatment. Med=medication(s); Int=intervention; PT=physiotherapy; ST=standard therapy; E-acu=electro-acupuncture; MR=muscle relaxation; TENS= transcutaneous electrical 

nerve stimulation; Ex=exercise; TrP=trigger point; VAS=visual analog scale; RMDQ=Roland Morris Disability scale; NHP=Nottingham Health Profile; PPT= pressure pain threshold; 

HFAQ=Hanover functional ability questionnaire; MPQ=McGill pain questionnaire; ext=extension; flx=flexion; rot=rotation; PDI=pain disability index; min=minute(s); hr(s)=hour(s); 

L=low; M=medium; H=high; pt(s)=patient(s); SF=short-form; NPQ=neck pain questionnaire; GWBS=global well-being scale; SLR=straight leg raising; GPE= Global perceived effect; 

GHQ=general health questionnaire; NSAIDS=nonsteroidal antiinflammatory drugs; FTF=finger-to-floor; SF-PQ=short form pain questionnaire; PRI=pain rating index; PPI=present pain 

intensity; NA=not applicable 

71
 
Ȍ Grade (High, moderate, low, and insufficient) £ Number of pooled trials 

B = immediate post-treatment 

C = short-term post-treatment 

D = intermediate-term post-treatment 

- No evidence 

= Similar beneficial effect 

> Favors treatment A over treatment B 

E = long-term post-treatment < Favors treatment B over treatment A 

H = high 

L = low 

><, =>, <= Inconsistent beneficial effect 

M = medium 

72
 
Population with acute/subacute pain. This sub-section included only one trial conducted in 

subjects with specific neck pain (whiplash injuries). 

Subjects with specific pain. 

Acupuncture versus placebo. One trial17 evaluated the effects of acupuncture, laser 

acupuncture, and no treatment randomly given to patients with acute whiplash injuries. In all 

three groups, patients additionally received the combination of cervical collar and medication 

(450 mg Paracetamol and 100 mg Chlormezanon in a dose of three tablets a day). Patients who 

received acupuncture experienced numerically greater improvements in cervical ROM, shortened 

duration of acute pain and sick leave as compared to those in the other two treatment groups. 

Acupuncture versus no treatment. No relevant studies were identified. 

Acupuncture versus another type/method of the same CAM. No relevant studies were 

identified. 

Acupuncture versus other treatments. No relevant studies were identified. 

Acupuncture versus medication. No relevant studies were identified. 

Acupuncture + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Acupuncture versus placebo. No relevant studies were identified. 

Acupuncture versus no treatment. No relevant studies were identified. 

Acupuncture versus another type/method of the same CAM. No relevant studies were 

identified. 

Acupuncture versus other treatments. No relevant studies were identified. 

Acupuncture versus medication. No relevant studies were identified. 

Acupuncture + other treatments versus the same other treatments. No relevant studies were 

identified. 

Population with chronic pain. A total of 31 trials evaluated the efficacy and/or harms of 

acupuncture in patients with chronic neck pain.45-47,51,77,80,106,126,128,131,140,234,235,241,244,251,254-261,265­

268,270-272 Of these, 13 trials included patients with specific neck pain (e.g., myofascial pain 

syndrome, spinal canal stenosis, cervical disc disease)45,46,77,80,126,234,241,244,251,254,255,268,271 and the 

remaining 18 trials included patients with nonspecific neck pain.47,51,106,128,131,140,235,256-261,265­

267,270,272 

Subjects with specific pain. 

Acupuncture versus placebo. In three trials, acupuncture77,234 or dry needling80 were similar 

to sham acupuncture234 or laser acupuncture77,80) for immediate/short-term post-treatment pain 

intensity (VAS, PPT),77,80,234 disability (NDI),234 and cervical ROM77,80,234 in patients with disc 

space narrowing/joint arthritis234 or myofascial pain syndrome.77,80 For example, in one of these 

trials,80 post-treatment mean VAS values in dry needling and sham laser acupuncture groups 

were 29.2 (± 21.9) and 28.0 (± 19.4), respectively. The corresponding mean ROM values were 

48.1 (± 7.0) versus 47.4 (± 7.1).80 In the same trial,80 distant acupuncture led to significantly 

lower pain intensity on VAS compared to sham (19.1 ± 16.1 versus 28.0 ± 19.4). No formal 

statistical test results for between-group comparisons were reported (e.g., p-value, 95 percent 

confidence interval).80 

Results of one meta-analysis indicated no significant difference between acupuncture and 

placebo in the reduction of pain intensity, immediately after the end of treatment (pooled mean 

difference in VAS score: 0.27, 95 percent CI: -0.60, 1.13)80,234 (Figure 25). 

73 
Figure 25. Pain intensity (VAS Score) – Immediate post-treatment 

Difference in means and 95% CI

FavorsFavors 

Acupuncture Acupuncture Placebo Acupuncture Placebo Acupuncture Placebo

Study Name N Mean ( SD) N Mean ( SD) N Mean (SD) N Mean (SD)

0.78 (-1.04, 2. 60)

Irnich et al, 2002 Irnich et al, 2002 332.92 (2.2) 342.8 (1.9)

Zhu et al, 2002 Zhu et al, 2002 142.89 (2.8) 152.11 (2.2)

0.12 (-0.86, 1.10)

Pooled47 49 0.27 (-0.60, 1.13)

-10.00 -5.00 0.00 5.00 10.00 -10.00 -5.00 0.00 5.00 10.00

Heterogeneity: Chi2 = 0.4, df = 1 (P = 0.81); I2 = 0.0% 

Acupuncture versus no treatment. No relevant studies were identified. 

Acupuncture (type 1) versus acupuncture (type 2). In seven trials,46,80,241,251,254,268,271 different 

modes of acupuncture were evaluated. These included electro-acupuncture local points,271 

electro-acupuncture remote points,271 intramuscular stimulation (IMS)-acupuncture,46 turtle 

probing needling,241 local dry needling,80 acu-point sticking therapy,254 and relevant versus 

irrelevant points.268 

In one trial,271 the use of electro–acupuncture (a local percutaneous electrical nerve 

stimulation) at local points was superior to acupuncture alone or electro–acupuncture at remote 

points in patients with cervical disc disease. The immediate post-treatment percent change on 

VAS for acupuncture versus local electro-acupuncture was 9.0 percent versus 38.0 percent; and 

the percent decrease in need for analgesics across these groups was 6.0 percent versus 37.0 

percent. In another trial,80 distant acupuncture led to a significantly lower pain intensity on VAS 

(19.1 ± 16.1) compared with dry needling (29.2 ± 21.9) in patients with myofascial pain 

syndrome. There was a slight benefit of using Japanese acupuncture over irrelevant acupuncture 

(i.e., targeting nonspecific points) in immediate-/short-term post-treatment levels of pain 

intensity (SF-MPQ) in patients with myofascial pain syndrome (p < 0.05).268 In one trial,254 

acupoint sticking therapy produced a greater effect rate ( percentage of patients with no 

symptoms, able to work, without relapse) compared to standard acupuncture (93.5 percent versus 

72.4 percent, p < 0.05). In one trial, standard acupuncture did not differ from turtle-probing 

needling in producing immediate post-treatment analgesic effect (VAS pain post treatment mean 

34.0 versus 36.0).241 Similarly, addition of IMS to dry needling in patient with myofascial pain 

syndrome did not have a significant effect on relieving pain when compared to dry needling 

alone (mean VAS post treatment: 4.54 ± 1.82 versus 4.69 ± 2.05).46 In one trail, there was either 

numerically or statistically significant greater benefit for the combination of acupuncture + 

Moxibustion, compared to acupuncture alone in improving immediate/short-term post-treatment 

pain intensity (NRS, VAS, FACES, PPT).251 

Acupuncture versus other treatments. In two trials acupuncture was compared either to 

massage77or spinal manipulation.244 In the first trial,77 which enrolled 177 patients with whiplash 

injuries and myofascial pain syndrome, acupuncture was shown to produce statistically 

significantly greater reduction in pain intensity (VAS score scale: 0-100) compared to massage 

in a short-term post-treatment period (mean change in VAS score from baseline: 24.22 versus 

7.89, p = 0.005). The difference in efficacy with respect to pain intensity between acupuncture 

and massage was more pronounced in patients with myofascial pain syndrome or those with 

longer duration of disease (> 5 years). Although short-term post-treatment cervical ROM 

74
 
(flexion, extension, and rotation) in the acupuncture group was significantly greater than that in 

the massage group (mean degrees: 19.8 ± 38.0 versus 5.1 ± 22.2, p = 0.031), this difference 

between the two groups decreased at a later followup (mean ± SD: 8.9 ± 30.1 versus 5.5 ± 37.2, 

p = 0.81). No significant between-group difference was noted for PPT at any followup point.77 

The combination of warm acupuncture and spinal manipulation had a better analgesic effect than 

acupuncture or spinal manipulation alone, in patients with neck pain due to spinal stenosis (mean 

VAS at short-term followup: 2.36 ± 2.8 versus 4.46 ± 3.11 versus 4.43 ± 2.51).244 

Acupuncture versus medication. Three trials 45,126,268 compared acupuncture to medications or 

medical injections. In two trials,45,126 subjects with myofascial pain syndrome and headache 126 

or chronic neck pain with headache 45 treated with acupuncture did not differ from those treated 

with injection of Lidocaine,45,126 Lidocaine plus corticoid,126 or Botulinum toxin126 for short-term 

post-treatment improvements in pain (Symptom Severity Index, VAS, Wong-Baker FACES pain 

scale)45,126 or cervical ROM (flexion, extension, tilting, and rotation).45 For example, in one of 

these trials,45 2 week post-treatment mean VAS values (scale: 0-10) for acupuncture and 

Lidocaine groups were 3.82 ± 2.47 and 3.46 ± 2.47, respectively (p > 0.05). The ROM flexion 

and extension values in the acupuncture group were 68.89 ± 11.19 and 67.72 ± 14.06, 

respectively. The corresponding ROM values in the Lidocaine injection group were 68.33 ± 

14.78 and 65.00 ± 13.87. Although the number of ingested ibuprofen pills over 3 months 

numerically increased in all three intervention groups (needle, Lidocaine, Lidocaine plus 

corticoid, Botulinum toxin),126 there was no significant between-group difference at any time 

during the study periods (12 weeks: 32.93 ± 61.17 versus 35.28 ± 45.20 versus 17.85 ± 25.80 

versus 15.53 ± 21.93, respectively). In one trial,268 relevant acupuncture was found to be 

modestly more effective than NSAIDs in reducing pain intensity (VAS, SF-MPQ) for myofascial 

pain syndrome. 

Acupuncture + other treatments versus the same other treatments. Two trials,244,255 compared 

the efficacy and/or harms of acupuncture alone to combination of acupuncture with other 

treatments. These treatments included acupuncture + traction manipulation, 244 and acupuncture 

+ auriculotherapy.255 

There was either numerically or statistically significant greater benefit for the combination of 

acupuncture with traction manipulation, compared to acupuncture alone in improving 

immediate/short-term post-treatment pain intensity (NRS, VAS, FACES, PPT).244 In one trial,255 

amongst patients with myofascial pain syndrome, there was no statistically significant difference 

between short-/intermediate-term post-treatment effects of acupuncture alone versus acupuncture 

plus auricular acupuncture therapy on pain intensity (MPQ mean ± SD: 15.6 ± 11.4 versus 12.9 ± 

13.9, p > 0.05; VAS pain mean ± SD: 18.9 ± 15.6 versus 21.0 ± 19.9, p > 0.05). 

Subjects with nonspecific pain. 

Acupuncture versus placebo. Standard acupuncture and placebo were compared in 10 

trials,47,106,128,256-261,266 of which six found no significant difference between the two treatments in 

reducing post-treatment (immediate, short, or intermediate) pain (VAS, PPT, 

MPQ),47,256,257,260,261,266 or increasing cervical ROM.266 In most these trials placebo was 

represented by sham-acupuncture,47,256,257,260,261 and in one trial placebo was transcutaneous 

nerve stimulation (TENS).266 

In contrast, in five trials,106,128,258-260 acupuncture was significantly better than placebo in 

improving pain intensity (VAS, NPQ, five-point scale)106,128,258-260 disability (NDI),128 the 

proportion of patients not taking analgesic medication,259 cervical mobility (active, passive; 

ROM),106,259 or quality of life (SF-36 physical component).128,259 The placebo treatments used in 

75
 
these trials were sham TENS at acupuncture points128, TENS (not at acu-points or not 

specified),258,259 or placebo-Diazepam.260 

The meta-analysis showed no significant difference between acupuncture and placebo (shamacupuncture) in reduction of immediate post-treatment pain intensity (pooled mean difference in 

VAS score: -0.24, 95 percent CI: -1.20, 0.73)256,257,266 (Figure 26). Trials comparing acupuncture 

to other types of placebos (e.g., TENS, drug)128,258-260 could not be pooled due to heterogeneity 

across outcomes, followup periods, or missing data. 

Figure 26. Pain intensity (VAS Score) – Immediate post-treatment 

Difference in means and 95% CI

Acupuncture Placebo Acupuncture Placebo FavorsFavors

Acupuncture Acupuncture Placebo

Study Name N Mean (SD) N Mean (SD) N Mean (SD) N Mean (SD)

Petrie et al, 1986 13 3.66 (2.3) 12 3.29 (1.9)

Nabeta et al, 2002 17 4.33 (2.0) 17 4.68 (2.5)

Itoh et al, 2007 8 4.59 (1.8) 7 5.46 (2.0)

Pooled 38 36

-0.35 (-1.88, 1.18) 

-0.87 (-2.77, 1.03) 

-0.24 (-1.20, 0.73) 

0.37 (-1.27, 2.01) 

-0.35 (-1.88, 1.18)

-0.87 (-2.77, 1.03)

-0.24 (-1.20, 0.73)

0.37 (-1.27, 2.01)

-10.00 -5.00 0.00 5.00 10.00 -10.00 -5.00 0.00 5.00 10.00

Heterogeneity: Chi2 =0.97, df = 2 (P = 0.61); I2 = 0.0% 

Acupuncture versus no treatment. No relevant studies were identified. 

Acupuncture (type 1) versus acupuncture (type 2). In five trials, different modes of 

acupuncture were compared.47,235,240,256,261 The following techniques were compared as follows: 

standard acupuncture versus trigger point acupuncture,256 standard acupuncture versus electroacupuncture,235,261 classical acupuncture versus laser acupuncture,47 needle insertion across the 

muscle fibers versus needle insertion along the muscle fibers.240

 Authors of one trial256 found standard acupuncture to be clinically less beneficial than trigger 

point acupuncture but similar to nontrigger acupuncture in decreasing pain intensity (VAS: 51.6 

± 22.0 versus 11.0 ± 9.3 versus 57.6 ± 18.0, respectively) and disability (NDI: 10.9 ± 6.6 versus 

3.1 ± 3.2 versus 12.0 ± 4.5, respectively) immediately after treatment. In another trial,235 the 

addition of electro-acupuncture produced significantly greater improvements in VAS scores 

compared to standard acupuncture alone immediately and short-term after the treatment (p < 

0.05). In one trial, 47 laser acupuncture at classical acupuncture points and conventional needle 

acupuncture at classical acupuncture points did not differ in pain relief. There was no significant 

difference between standard acupuncture and nontraditional acupuncture (i.e., inconsistent with 

Chinese practice) as reported in this trial.47 In one trial,240 there were no significant differences 

between insertion of needles along the muscle fibers towards trigger points and insertion of 

needles across muscle fibers, in reducing motion related pain (mean VAS score), pain under 

pressure, or ROM. The standard acupuncture did not differ from electro-acupuncture in 

producing immediate post-treatment analgesic effect (VAS pain post-treatment mean ±SD: 1.8 ± 

1.0 versus 1.4 ± 1.5, p > 0.05).in patients with cervical osteoarthritis.261 

Acupuncture versus other treatments. Results from three trials indicated that there was no 

significant difference between standard acupuncture as compared to standard localized 

mobilization techniques,265 or laser therapy (three separate doses),47,106 in reducing 

immediate/short-term post-treatment pain intensity (VAS, PPT),106,265 disability (NPQ),265 

cervical ROM (extension, flexion),106,265 or improving general health (General Health 

76
 
Questionnaire 28).265 In one of two trials,51,140 acupuncture was better than manipulation in 

reducing pain intensity (VAS score: percentage decrease) short-term after the end of 9 weeks 

treatment (50.0 percent versus 42.0 percent).51 In the same trial,51,52 intermediate-term followup 

results (3 months post-treatment) indicated numerically similar pain intensity in the acupuncture 

group compared with manipulation group (VAS median scores: 2.5 versus 2.8). This trial failed 

to report test results for between-group comparisons. In the other trial,140 immediate posttreatment reduction in pain intensity (VAS: 33.0 percent) and neck disability (NDI score: 25.0 

percent) was significantly greater in manipulation versus acupuncture group. 

Acupuncture versus medication. Acupuncture and medication (e.g., NSAIDs, analgesics) 

were compared in three trials.51,140,260 

In the first trial,260 with a limited statistical power, there was no statistically significant difference 

in pain VAS scores immediately post-treatment between the acupuncture and Diazepam (orally, 

five mg) groups of subjects with osteoarthritis. The second trial140 did not report between group 

differences in pain and disability scores. Calculation of median effect size suggested no 

difference in pain and disability at immediate post-treatment followup. The proportion of 

patients crossing over to another intervention was statistically significantly different (p = 0.002) 

across the three interventions: manipulation (22.2 percent), acupuncture (60.0 percent), and 

NSAIDs (62.0 percent).140 In the third trial,51 acupuncture group appeared to have a significantly 

improved neck pain (mean VAS scores) compared to medication group immediately post 

intervention. For example, mean VAS ± SD scores in the acupuncture and medication groups 

were 4.0 ± 4.4 and. 6.0 ± 4.4, respectively.51 Intermediate-term followup results (3 months posttreatment) from one of these trials 51,52 showed numerically better pain intensity for acupuncture 

compared to medication (VAS median scores: 2.5 versus 4.7). This trial failed to report test 

results for between-group comparisons. 

Acupuncture + other treatments versus the same other treatments. This sub-section included 

three trials.131,267,270 In two trials,131,267 acupuncture was added to either general practitioner care 

267 or conventional care,131 and in one trial,270 acupuncture and waiting list control groups were 

compared. 

In the first trial,131 treatment with acupuncture added to routine – conventional care was 

shown to produce a significantly reduced pain intensity (VAS scores), disability (Neck Pain and 

Disability scale; NPAD), and physical functioning scores (SF-36) compared to treatment with 

routine care alone immediately after the end of treatment. The between-group differences for SF36 (physical functioning: 1.3, 95 percent CI: 0.1, 2.5) and NPAD (2.9, 95 percent CI: 0.8, 4.9) 

were statistically significant at 3 months post-treatment. In the other trial,267 acupuncture was 

added to general practice care and showed no difference in pain and disability (NPQ) compared 

to general practice care alone immediately post-treatment. The proportion of patients reporting 

the use of medication in the acupuncture group decreased from baseline to 3 months (from 40.0 

percent to 11.1 percent) as opposed to the general practitioner group in which it did not change 

over the same period of time (from 43.0 percent to 42.0 percent). In the third trial,270 there was 

no significant difference in the mean pain scores (3.6 versus 5.4) or mean number of pills taken 

per week (7.5 versus 8.7) between the combined acupuncture and other treatment alone at 12 

weeks post-randomization. 

Population with mixed duration of pain. A total of 14 trials evaluating the efficacy and/or 

harms of acupuncture in patients with neck pain of mixed duration were included in this 

section.229,236-238,240,242,243,245-247,252,253,263,269 All except for one trial240 enrolled patients with 

specific neck pain (e.g., spondylosis, spondylopathy, myofascial pain syndrome, whiplash 

77
 
injuries). Please, see the results of two trials246,247 in the Massage section, Mixed Duration Neck 

Pain sub-sections. 

Subjects with specific pain. 

Acupuncture versus placebo. In one trial,263 60 patients with myofascial pain syndrome had 

similar post-treatment pain intensity (VAS, PPT), cervical ROM, functional status (Nottingham 

Health Profile - pain scale), and the use of analgesics in the acupuncture versus placebo (laser 

pen) group and the observed differences were statistically nonsignificant at all followup time 

points. 

Acupuncture versus no treatment. No relevant studies were identified. 

Acupuncture (type 1) versus acupuncture (type 2). In six trials, acupuncture was compared to 

electro-acupuncture,243 deep needling,236 lifting-thrusting needling,237 penetrative needling,238 

needle-knife,242 or centro-square needling.252 One additional trial compared most tender points 

and nonselective points.269 

Two trials demonstrated that in patients with spondylopathy or spondylosis, the use of 

electro-acupuncture had significantly better therapeutic effect (percentage of the relative mean 

score change between baseline and post-treatment followup) compared to routine acupuncture.243 

Different modalities of acupuncture were compared in six Chinese trials.236-238,242,252,269 The 

results indicated numerically or statistically significantly better therapeutic effects (defined 

differently across the trials as dichotomous outcome) of deep needling,236 lifting-thrusting 

needling,237 penetrative needling,238 needle-knife,242 or centro-square needling252 compared with 

routine acupuncture (at Jiaji, Cuchi points). In one trial,269 there was a greater proportion of 

patients with myofascial pain syndrome having pain relief (‘yes’ or ‘no’ answer) amongst those 

needled at most tender points as opposed to those needled at nonselective points. 

Acupuncture versus other treatments. In three trials, acupuncture was compared to laser,263 

traction-massage,252 or traction.229 In the first trial,263 patients immediately after being treated 

with laser therapy, had significantly improved pain intensity (VAS: 2.05 ± 1.43 versus 3.71 ± 

2.33, p < 0.05; PPT: 3.99 ± 1.22 versus 2.51 ± 1.57, p < 0.001), cervical ROM (flexion: 64.16 ± 

9.25 versus 59.67 ± 10.52, p < 0.001; extension: 81.95 ± 10.84 versus 72.86 ± 12.18, p < 0.001), 

and functional status (Nottingham Health Profile - pain scale: 13.51 ± 14.07 versus 33.86 ± 

28.37, p < 0.001) compared to those treated with acupuncture. However, 5 months posttreatment, the observed between-group differences in the above mentioned outcomes got 

numerically diminished and were no longer statistically significant (p > 0.05). Although the use 

of analgesics immediately after the treatment was significantly lower in the laser therapy versus 

acupuncture group (0.85 ± 1.53 versus 3.62 ± 4.41, p < 0.05), 5 months later the use of 

analgesics between the two groups differed no more (1.41 ± 3.43 versus 2.53 ± 2.74, p > 0.05).263 

In the second trial,252 acupuncture was shown to have a greater effect on well being (no 

numerical data reported) compared to traction-massage in patients with spondylosis. In one 

trial,229 it was demonstrated that in patients with spondylopathy or spondylosis, the use of 

electro-acupuncture had significantly better therapeutic effect (percentage of the relative mean 

score change between baseline and post-treatment followup) compared to traction. 

Acupuncture versus medication. No relevant studies were identified. 

Acupuncture + other treatments versus other treatments. In one small Chinese trial,245 the 

combination of electro-acupuncture and acupuncture did not differ from electro-acupuncture 

alone in producing curative therapeutic effect (percentage of patients with no symptoms who 

were able to work without relapse). 

78
 
Subjects with nonspecific pain. 

Acupuncture versus placebo. No relevant studies were identified. 

Acupuncture versus no treatment. No relevant studies were identified. 

Acupuncture (type 1) versus acupuncture (type 2). In one trial of 47 patients,240 two 

modalities of Fu’s subcutaneous needling were compared, needling along the local muscle fibers 

pointed to the myofascial trigger points, and needling across the local muscle fibers pointed to 

the myofascial trigger points. 

Although post-treatment pain intensity (VAS; motion-related, pain under pressure) and 

cervical ROM improved significantly in both groups, there were statistically nonsignificant 

differences with respect to pain intensity (motion-related: 3.59 versus 2.76, p = 0.95; pain under 

pressure: 3.82 versus 3.28, p = 0.38) and cervical ROM (flexion, extension, and rotation: 1.36 

versus 1.12, p = 0.38) between the two groups of patients. 

Acupuncture versus other treatments. No relevant studies were identified. 

Acupuncture versus medication. No relevant studies were identified. 

Acupuncture + other treatments versus the same other treatments. No relevant studies were 

identified. 

Population with unknown duration of pain. A total of six trials were included in this subsection.239,248-250,262,264 

Subjects with specific pain. 

Acupuncture versus placebo. In one trial,248 acupuncture was shown to be associated with a 

significantly greater effective rate (percentage of patients with no symptoms or relapse: 75.5 

percent versus 52.8 percent, p < 0.05) compared to placebo (needling at non acupuncture points) 

right after the treatment. 

Acupuncture versus no treatment. In one trial,264 acupuncture was shown to be significantly 

more effective than no treatment in improving pain intensity (short form MPQ) and PPT shortly 

after the end of treatment. 

Acupuncture (type 1) versus acupuncture (type 2). In three Chinese trials,239,249,250 different 

modalities of acupuncture were compared. These included needle pricking,249 long-time needle 

retention,239 or point-through-point needling.250 In all three trials the short-term post-treatment 

results indicated numerically or statistically significantly better therapeutic effects (defined 

differently across the trials as dichotomous outcome) of needle pricking,249 long-time needle 

retention,239 or point-through-point needling250 compared to routine acupuncture. 

Acupuncture versus other treatments. In three trials,249,262,264 acupuncture was shown to be 

significantly more effective than injection of Lidocaine,249,262 or exercise264 in improving pain 

intensity (VAS, SF-MPQ, PPT) and/or disability (neck pain disability VAS) shortly after the end 

of treatment. 

Acupuncture versus medication. No relevant studies were identified. 

Acupuncture + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Acupuncture versus placebo. No relevant studies were identified. 

Acupuncture versus no treatment. No relevant studies were identified. 

Acupuncture versus another type/method of the same CAM. No relevant studies were 

identified. 

Acupuncture versus other treatments. No relevant studies were identified. 

Acupuncture versus medication. No relevant studies were identified. 

79
 
Acupuncture + other treatments versus the same other treatments. No relevant studies were 

identified. 

3 – Spinal Manipulation for Treatment of Low Back Pain 

We included 28 studies using manipulation alone and six studies using manipulation plus 

other treatments.31,57,123,274-276 Note that one trial277 reported results for subjects with acute and 

chronic pain separately, therefore this trial appears in two sub-sections of acute and chronic pain. 

Results of nine trials were reported in multiple publications (Table 3). 

Population/trial characteristics. The studies were conducted in Australia (three),51,140,274 

Bulgaria (one),20 Canada (four),278-281 China (two),275,282 Denmark (three),276,283,284 Egypt 

(one),104 Italy (one),277 South Africa (one),285 UK (five),123,230,286-288 and United States 

(13).31,55,57,101,119,289-296 

The proportion of men and women was similar in 19 studies (40 percent to <60 

percent).20,31,51,55,57,119,123,140,275-279,285,288,289,291,295,296 In five studies, there was a greater proportion 

of men (> 60 percent)101,280,281,284,290 and in five studies women were the majority (> 60 

percent).274,282,283,286,293 For the remaining studies, this information was not 

reported.104,230,287,292,294 

The included studies consisted of adults aged 18 years or older. The racial composition or 

ethnicity was reported for only four studies.123,275,289,290 In three trials, the majority of subjects 

were Caucasians.123,289,290 This information was not reported for the remaining trials. 

In total 15,969 participants with LBP were randomized to manipulation (alone or combined 

with other treatment) or control groups. One large RCT accounted for 11,128 patients during its 

11 years of recruitment between 1986 and 2007.275 Table 10 presents the control interventions in 

the included studies. 

Table 10. Spinal Manipulation for Treatment of low back pain- Control Interventions 

Type of control 

group 

Cause of 

Pain 

N 

studies 

Detail of Control intervention 

1 – Inactive treatments 

Placebo/sham Non 

Specific 

9 Sham adjustment + placebo medication,57 sham adjustment 

and muscle relaxation,57 sham adjustment,119,293 light 

physical contact at lumbar spine,291 sham mobilization,20 

similar palpation and positioning as manipulation group + 

nontherapeutic massage to site unrelated to pain,104no 

physical contact281 simulated short wave,284 placebo gel,277 

Specific 0 NA 

No-treatment/ 

waiting list/ bed 

rest 

Non 

Specific 

4 No treatment,288,288,291 bed rest,277 

Specific 0 NA 

2- Active treatments 

Exercise/physical 

activity 

Non 

Specific 

1 low-stress aerobic and lumbar spine strengthening,123 

Specific 0 NA 

Usual care Non 

Specific 

3 Base on UK National Acute Back Pain Guidelines,123 

analgesic medication prescription, local analgesicanesthetic injections(also bed rest and or physiotherapy 

including ultrasound and diathermy and ergonomic 

advice),283 physician consultation, medication,296 

Specific 0 NA 

80
 
Corset Non 

Specific 

1 Lumbo-sacral corset,101 

Specific 

Education Non 

Specific 

4 Back school program,280,290 education booklet,278 

educational material, and presentation by therapist,119 

Specific 

Physiotherapy Nonspecific 2 McKenzie approach,278 massage, electrotherapy, infrared,277 

Specific 0 NA 

Physical 

modalities 

Nonspecific 3 TENS,101 ultrasound,286 Infrared lamp over the most painful 

area of the low back,230 

Specific 0 NA 

Other Manual 

therapy 

Nonspecific 7 Myofascial therapy,290 massage,101,292,295 post isometric 

relaxation,20 spinal mobilization55,296 

Specific 0 NA 

Medication Nonspecific 5 Paracetamol/Acetaminophen,51 Tenoxican and Ranitidine,

140 medication and bed rest,104 Naprosyn,287 Diclophenac,277 

Specific 0 NA 

Other methods of 

manipulation 

Nonspecific 3 Not described,282 full spine adjustment, or combination of 

full spin and cervical adjustment,294 application of activator 

adjusting instrument,285 

Specific 0 NA 

Other active 

treatment (also in 

manipulation 

group) 

Nonspecific 4 Exercise,31,123,274,276 

Specific 1 Lumbar traction and physical modalities,275 

Spinal 

manipulation in 

combination with 

another 

treatment (vs. 

acupuncture 

alone) 

Nonspecific 2 Physical modalities (heat/ ice, ultrasound, electrotherapy, 

massage and/or trigger point therapy) in 3, 6, 9, or 12 

treatment sessions,289 myofascial therapy,290 

Specific 0 NA 

GP=general practitioner care; NA= not applicable; TENS=transcutaneous electrical nerve stimulation; UK=United Kingdom 

The treatment in studies was administered with the following frequency: single treatment, 

279,281,291,295,297 less than once a week for total duration of 12 weeks,95 once a week for a total 

duration of 1 to 3 weeks,288,290one-two sessions per week for a duration to 12 weeks,39,123,286,298 

twice a week for duration of to 12 weeks,51,274,282,285,289 three or four times per week for a 

duration of 2-3 weeks,20,57,101,104,230,284 and four to seven times per week for a duration of 2-6 

weeks.119,140,275,277 In one trial, the frequency of treatment administration varied.295 The 

information regarding the frequency or duration of treatment was not reported for two trials.31,294 

Risk of bias. The risk-of-bias graph for the trials included in this sub-section is presented in 

Figure 27. All trials were randomized. One trial, was reported in an abstract format and was not 

included in the assessment of risk of bias.287 The adequate method of randomization and 

treatment allocation concealment was reported for 18.0 percent and 11.0 percent of the trials, 

respectively. Up to 61.0 percent of the trials reported that distribution of the subjects’ baseline 

characteristics across the treatment arms was similar. The subjects were reported to be blinded in 

only 11.0 percent of the trials. About 36.0 percent of the trials reported acceptable drop-out rate. 

Results based on intention-to-treat analysis were explicitly reported for 25.0 percent of the trials. 

The data for selected items of the risk of bias tool across the CAM interventions (acupuncture; 

81
 
spinal manipulation; spinal mobilization; combination of manipulation and mobilization; and 

massage therapy) is displayed in table 7.1 of Appendix G. 

Figure 27. Risk of bias scores (%) 

0% 20% 40% 60% 80% 100% 

Q13 

Q11 

Q9 

Q7 

Q5 

Q3 

Q1 

Yes No Unclear 

Efficacy results. A summary of the key results is presented in Table 11. For further detail of 

the trials please see the evidence tables. (Appendix C, table 1.9 – table 1.16) 

82
 
Table 11 – Key results –Spinal manipulation therapy for low back pain 

CAM therapy Duration of 

pain 

Cause 

of pain Outcome 

Risk 

-ofbias 

Precision of 

the pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

Man vs. No 

Tx 

Acute/subacute S - - - - - - Insufficient 

NS VAS: B 291 M - NA Direct > SS Low 

Chronic S - - - - - - Insufficient 

NS ROM: B 281 H - NA Indirect = S-NS Low 

Mixed S - - - - - - Insufficient 

NS VAS: B, C 288 H - NA Direct > NR Low 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Man vs. PL Acute/subacute S - - - - - - Insufficient 

NS VAS: B, C

20,57,277,284,291 

M - Yes Direct > SS Moderate 

Oswestry: B, C 57 M - NA Direct = S-NS Low 

ROM (schober’s 

test): B, C 20,57,284 

M - No Indirect => Low 

Number of 

analgesics 

ingested weekly: 

B 57 

M - NA Indirect = S-NS Low 

Chronic S - - - - - - Insufficient 

NS VAS: B, C

119,277,293 

M - No Direct => Low 

Oswestry: C 119 M - NA Direct = S-NS Low 

Mixed S - - - - - - Insufficient 

NS VAS: B 104 H - NA Direct > NR Low 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Man** vs. PL Acute/subacute S - - - - - - Insufficient 

NS VAS: B 56 M - NA Direct = S-NS Low 

RMDQ: B 56 M - NA Direct = S-NS Low 

SF-36 56 M - NA Direct = S-NS Low 

Chronic/Mixe 

d 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

83
 
CAM therapy Duration of 

pain 

Cause 

of pain Outcome 

Risk 

-ofbias 

Precision of 

the pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

NS ROM (flx, ext, 

SLR): B, C, D 108 

H - NA Indirect = S-NS Low 

Man vs. Med 

Acute/subacute 

S - - - - - - Insufficient 

NS 

VAS: B, C 287 NA#

 - NA Direct = S-NS Low 

RMDQ: B, C 287 NA# - NA Direct = S-NS Low 

VAS: D 277 H - NA Direct = S-NS Low 

Chronic 

S - - - - - - Insufficient 

NS 

VAS: B 51,140 H - Yes Direct > SS Low 

VAS: C, D 277 H - NA Direct = S-NS Low 

Oswestry: B 51,140 H - Yes Direct > SS Low 

Mixed 

S - - - - - - Insufficient 

NS % pain-free pts: 

B, C 283 

H - NA Indirect = S-NS Low 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Man vs. PT Acute/subacute S - - - - - - Insufficient 

NS VAS: C 277 H - NA Direct > SS Low 

Chronic S - - - - - - Insufficient 

NS VAS: C 277 H - NA Direct < SS Low 

Mixed S - - - - - - Insufficient 

NS VAS: B, C

278 

H - NA Direct = S-NS Low 

RMDQ: B, C 278 H - NA Direct = S-NS Low 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Man** vs. PT Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS VAS: B, C 84 M - NA Direct > SS Low 

84
 
CAM therapy Duration of 

pain 

Cause 

of pain Outcome 

Risk 

-ofbias 

Precision of 

the pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

Physical 

functioning (10­

point scale): 

B, C 84 

M - NA Direct > SS Low 

GPE: B, C 84 M - NA Direct = S-NS Low 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Man vs. ST 

Acute/subacute 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed 

S 

NS 

VAS: B, C 296 L - NA Direct = S-NS Low 

RMDQ: B, C 296 L - NA Direct > SS Low 

SF-36: B, C 296 L - NA Direct = S-NS Low 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Man** vs. ST 

Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed 

S - - - - - - Insufficient 

NS 

VAS: C, D, E 66 M - NA Direct = S-NS Low 

RMDQ: C, D, E 66 

M - NA Direct = S-NS Low 

% pts using 

NSAIDs or 

muscle 

relaxants: D 66 

M -

NA Indirect > SS Low 

Unknown S - - - NA - - Insufficient 

NS Oswestry: E 95 M - NA Direct > SS Low 

SLR (right): E 95 M - NA Indirect > SS Low 

SLR (left): E 95 M - NA Indirect = S-NS Low 

% pts taking 

analgesics: E 95 

M - NA Indirect = S-NS Low 

85
 
CAM therapy Duration of 

pain 

Cause 

of pain Outcome 

Risk 

-ofbias 

Precision of 

the pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

% pain-free pts: 

E 95 

M - NA Indirect = S-NS Low 

ROM (flx): E 95 M - NA Indirect = S-NS Low 

Man vs. Ma Acute/subacute S - - - - - - Insufficient 

NS VAS: B 101 H - NA Direct = S-NS Low 

ROM (etx, flx): B

101 

H - NA Indirect = S-NS Low 

SLR: B 101 H - NA Indirect = S-NS Low 

Chronic S - - - - - - Insufficient 

NS N days of pain 

relief: B, C 292 

M - NA Indirect > SS Low 

Mixed S - - - - - - Insufficient 

NS ROM (walking, 

bending, 

twisting): B 295 

H - NA Indirect .= S-NS Low 

ROM (sitting, 

reaching, 

dressing): B 295 

H - NA Indirect > SS Low 

SLR: B 295 H - NA Indirect = S-NS Low 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Man vs. 

TENS 

Acute/subacute S - - - - - - Insufficient 

NS VAS: B 101 H - NA Direct = S-NS Low 

ROM (etx, flx): B

101 

H - NA Indirect = S-NS Low 

SLR: B 101 H - NA Indirect = S-NS Low 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed/ 

Unknown 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Man** vs. Ex Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS VAS: B, C, D 299 M - NA Direct > SS Low 

Oswestry: B, C, 

D 299 

M - NA Direct > SS Low 

86
 
CAM therapy Duration of 

pain 

Cause 

of pain Outcome 

Risk 

-ofbias 

Precision of 

the pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

% pts on sick 

leave: B, D 299 

M - NA Indirect > SS Low 

Patient-Specific 

Functional Scale: 

C 39 

M - NA Direct > SS Low 

Global perceived 

Effect: C 39 

M - NA Direct > SS Low 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

S=specific; NS=nonspecific; SS=statistically significant; S-NS=statistically nonsignificant; Man=manipulation; Acu=acupuncture; Ma=massage; Mob=mobilization; PL=placebo; 

Tx=treatment. Med=medication(s); Int=intervention; PT=physiotherapy; ST=standard therapy; E-acu=electro-acupuncture; MR=muscle relaxation; TENS= transcutaneous electrical 

nerve stimulation; Ex=exercise; TrP=trigger point; VAS=visual analog scale; RMDQ=Roland Morris Disability scale; NHP=Nottingham Health Profile; PPT= pressure pain threshold; 

HFAQ=Hanover functional ability questionnaire; MPQ=McGill pain questionnaire; ext=extension; flx=flexion; rot=rotation; PDI=pain disability index; min=minute(s); hr(s)=hour(s); 

L=low; M=medium; H=high; pt(s)=patient(s); SF=short-form; NPQ=neck pain questionnaire; GWBS=global well-being scale; SLR=straight leg raising; GPE= Global perceived effect; 

NSAIDS=nonsteroidal antiinflammatory drugs; FTF=finger-to-floor; SF-PQ=short form pain questionnaire; PRI=pain rating index; PPI=present pain intensity; NA=not applicable 

87
 
Ȍ Grade (High, moderate, low, and 

insufficient) 

** Manipulation in combination with 

mobilization

 £ Number of pooled trials 

# Abstract 

B = immediate post-treatment 

C = short-term post-treatment 

D = intermediate-term post-treatment 

E = long-term post-treatment 

H = high 

L = low 

M = medium 

- No evidence 

= Similar beneficial effect 

> Favors treatment A over treatment 

B 

< Favors treatment B over treatment 

A 

><, =>, <= Inconsistent beneficial 

effect 

88 
Population with acute/subacute pain. This sub-section included 11 

trials.20,55,57,101,123,274,277,284,287,290,291 All trials enrolled subjects with nonspecific LBP. Results 

from two trials, comparing manipulation to massage,101 or manipulation to mobilization55 are 

presented in the Acute or Sub-Acute LBP sub-sections of Massage and Mobilization sections. 

Subjects with specific pain. 

Manipulation versus placebo. No relevant studies were identified. 

Manipulation versus no treatment. No relevant studies were identified. 

Manipulation versus another type/method of the Same CAM. No relevant studies were 

identified. 

Manipulation versus other treatments. No relevant studies were identified. 

Manipulation versus medication. No relevant studies were identified. 

Manipulation + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Manipulation versus placebo. In five trials,20,57,277,284,291 manipulation was compared to 

placebo at immediate or short-term post-treatment followup, indicating significantly greater 

improvements for manipulation versus placebo groups in reducing immediate or short-term posttreatment pain intensity (VAS). In contrast, there were no between-group differences in disability 

(Oswestry),57 flexibility/mobility,20,57 or pain medication use.57 For example, in one trial,277 

manipulation was significantly superior to placebo in relieving pain in subjects with or without 

neurological signs at short term followup (four-point VAS; p< 0.01). Intermediate-term posttreatment data of the same trial showed no significant difference in relieving pain between the 

groups of manipulation and placebo. In another trial,284 subjects randomized to manipulation had 

significantly better immediate-term post-treatment pain intensity (percentage of pain-free 

subjects: 92.0 percent versus 25.0 percent, p < 0.01) and mobility (improvement on Schober’s 

test: 100.0 percent versus 50.0 percent, p < 0.01) compared to those randomized to placebo (i.e., 

simulated short-wave therapy). 

Manipulation versus no treatment. The use of manipulation, compared to ‘no treatment’ was 

associated with a significantly lower immediate post-treatment pain intensity on five-point VAS 

(p = 0.03). 291 

Manipulation versus another type/method of the same CAM. No relevant studies were 

identified. 

Manipulation versus other treatments. In one trial,20, post-treatment differences in pain 

intensity (VAS), disability (Oswestry), depression score (modified Zung scale), integrated 

electromyographic activity (EMG(, and maximal voluntary contraction were not significant 

between the manipulation and the muscle relaxation groups. 

In another study,277 at short term post-treatment followup, manipulation was more efficacious 

in relieving pain four-point VAS) and improving function (using a four-point disability 

questionnaire) compared to bed rest or physiotherapy (massage, analgesic currents and 

diathermy) in subjects with acute pain. However, this advantage was not sustained at 6 months 

followup in both groups of subjects with or without radiating pain. In this trial, a subgroup of 

subjects with acute pain and a chronic history of pain were randomized to manipulation versus 

physiotherapy, low back school, or bed rest. Manipulation therapy at short term (3 weeks, 2 

months) followup was significantly better in reducing pain intensity than back school or placebo. 

For the same period, physiotherapy was shown to be more effective in relieving pain and 

improving function than manipulation. At intermediate (6 months) post-treatment followup, 

89 
manipulation was better than placebo but did not differ from physiotherapy or back 

school.(numerical data not reported; only graphs were presented).277

 In two trials,101,290 manipulation did not differ from myofascial therapy (alone or combined 

with manipulation),290 TENS,101 or corset101 in improving pain intensity (VAS),101,290 disability 

(RMDQ),290 or range of mobility (straight leg raising, pelvic flexion/extension, Schober’s 

test),101 immediately after the end of treatment. 

In one trial,123 manipulation combined with best care had a modest improvement compared to 

best care alone or combined with exercise in disability and pain. 

Manipulation versus medication. In one trial,287 there were no significant post-treatment 

differences between the manipulation and medication (e.g., antiinflammatory agents) groups 

with respect to reduction in pain intensity or disability. 

In another study,277 at short term post-treatment followup, manipulation was more efficacious 

in relieving pain (4-point VAS) and improving function (using 4-point disability questionnaire) 

compared to drug therapy in subjects with acute pain. This advantage was not sustained at 6 

months followup. In this trial, a subgroup of subjects with acute pain in a chronic history of pain 

were also randomized to manipulation versus drug therapy. For 3 weeks and 2 months posttreatment periods, drug therapy was shown to be more effective in relieving pain and improving 

function than manipulation. At intermediate (6 months) post-treatment followup, manipulation 

did not differ from drug therapy (numerical data not reported; only graphs were presented).277 

Manipulation + other treatments versus the same other treatments. In one trial,274 short-term 

post-treatment pain intensity (VAS: 0.0 ± 0.0 versus 13.57 ± 9.40, p < 0.0005), ROM (flexion: 

45.60 ± 6.95 versus 31.14 ± 7.48, p < 0.0005), and disability (RMDQ: 0.33 ± 0.82 versus 3.64 ± 

2.80, p < 0.001) were significantly better in the manipulation + exercise group compared to the 

exercise alone group. 

Population with chronic pain. This sub-section included 12 trials. 51,119,140,276,277,279­

281,286,289,292,293 All trials studied subjects with nonspecific LBP. See additional results of one trial 

51 in the Acupuncture, Chronic LBP section. See result for another trial,279 in the Mobilization, 

Chronic LBP section. 

Subjects with specific pain. 

Manipulation versus placebo. No relevant studies were identified. 

Manipulation versus no treatment. No relevant studies were identified. 

Manipulation versus another type/method of the same CAM. No relevant studies were 

identified. 

Manipulation versus other treatments. No relevant studies were identified. 

Manipulation versus medication. No relevant studies were identified. 

Manipulation + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Manipulation versus placebo. The effects of manipulation and placebo were compared in 

three trials.119,277,293 In these trials, manipulation was associated with significantly greater 

improvements in pain (VAS) compared to placebo. 

In the first trial,119 immediately after the treatment, subjects in the manipulation group had a 

significantly improved disability level (i.e., decreased Oswestry scores) compared to those in 

placebo group (9.5 ± 6.3 versus 15.5 ± 10.8, p = 0.012). Although the observed difference 2 

weeks after the treatment was numerically in favor of manipulation, compared to placebo, this 

90
 
difference did not reach the traditional level of statistical significance (10.6 ± 11.7 versus 14.0 ± 

11.7, p = 0.41).119 

In the second trial,293 the improvement in post-treatment pain intensity (VAS) was 

numerically greater in the manipulation versus placebo group immediately (1.3 versus 0.7, pvalue for between-group comparison not reported) or short-term post-treatment (2.3 versus 0.6, 

p-value for between-group comparison not reported). 

In the third trial,277 manipulation was significantly better in reducing short- and intermediateterm post-treatment pain intensity (4- point VAS) compared to placebo in patients with chronic 

LBP with or without radiating pain. This trial failed to report numeric data. 

Manipulation versus no treatment. In one trial,281 subjects randomized to manipulation and 

‘no treatment’ were compared with respect to flexion-relaxation degree. In this trial, the posttreatment flexion-relaxation degree did not differ between subjects in the manipulation and ‘no 

treatment’ groups. 

Manipulation (type 1) versus manipulation (type 2). In one trial,289 the short-term posttreatment effect on pain (NRS-11) and functional disability (the Modified Von Korff Scales - 

MVK) was significantly increased for subjects who received a greater number of manipulation 

treatments whether alone or combined with physical therapy.289 

Manipulation versus other treatments. In two trials, manipulation was shown to produce 

significantly greater immediate post-treatment improvements in pain (VAS, NRS), disability 

(RMDQ, Oswestry), and ROM (lumbar flexion and extension) compared to massage,292 or 

ultrasound.286 

In one trial,277 at 3 weeks post-treatment, physiotherapy (massage, and physical modalities) 

was more effective compared to manipulation or back school in patients without radiating pain. 

In this subgroup, patients originally randomized to manipulation showed significantly more 

improvement compared to back school (or placebo) at 3 weeks and 2 months but not at 6 months 

followup. The same trial, but in a subgroup of patients with radiating back pain, showed more 

improvement in pain and function with manipulation than back school at 3 weeks but not at 2 

months or 6 months of followup. Physiotherapy and low back school were more effective than 

manipulation in both 2 months and 6 months followup. This trial failed to report numeric data.277 

In another trial,280 subjective analgesic effect of back school program was significantly better 

compared to manipulation in patients with sacroiliac joint pain immediately after the treatment. 

Manipulation versus medication. In one trial,277 at 3 weeks, short term- and intermediateterm post-treatment, spinal manipulation was not significantly different from drug therapy in 

reducing pain (4-point VAS; no numeric data were given). In contrast, in two other trials,51,140 

subjects in manipulation groups experienced significantly greater immediate post-treatment 

reductions in pain intensity (VAS score: 38.0 percent -50.0 percent) and disability (Oswestry 

score: 30.7 percent -50.0 percent) compared with subjects in the medication groups. 

Manipulation + other treatments versus the same other treatments. In one trial,276 at shortand intermediate-term after the treatment, manipulation combined with exercise did not 

significantly differ from exercise alone in improving pain (VAS). 

Manipulation versus manipulation + other treatments. In one trial,289 the short-term posttreatment effect on pain (NRS-11) and functional disability (the Modified Von Korff Scales - 

MVK) did not differ between manipulation alone or combined with physical therapy.289 

91
 
Population with mixed duration of pain. This sub-section included 10 trials. 

31,104,230,275,278,283,288,294-296 Of the nine trials, two studied subjects with specific LBP (e.g., disc 

protrusion, sciatica).230,275 

Subjects with specific pain. 

Manipulation versus placebo. No relevant studies were identified. 

Manipulation versus no treatment. No relevant studies were identified. 

Manipulation versus another type/method of the same CAM. No relevant studies were 

identified. 

Manipulation versus other treatments. The immediate and short-term post-treatment effects 

of manipulation and infra-red therapy were compared in subjects with sciatica.230 Similar 

recovery rates (percentage of pain-free subjects) were found between the two groups amongst 

subjects with normal straight leg raise (58.0 percent versus 68.0 percent, p > 0.05). In contrast, 

amongst subjects with restricted straight leg raise, the between-group difference in recovery rate 

was significant, favoring subjects in the manipulation group over infra-red therapy group (77.2 

percent versus 56.6 percent, p < 0.05). 

In one trial, 11,128 subjects with disc protrusion who received a combination of 

manipulation and physiotherapy (traction, microwave and other modalities) had significantly 

greater healing (73.4 percent versus 47.3 percent, p < 0.01) and effective rates (98.6 percent 

versus 96.4 percent, p < 0.01) compared to subjects who received physiotherapy alone.275 

Manipulation versus medication. No relevant studies were identified. 

Manipulation + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Manipulation versus placebo. In one trial,104 the immediate post-treatment back pain 

improvement (percent change on VAS) was numerically greater in the manipulation group 

compared to placebo group (statistical test results were not provided). The beneficial effect of 

manipulation relative to placebo was more evident in subjects under 40 years (compared to 

subjects 40 years or older) or subjects with sub-acute LBP (versus subjects with acute LBP).104 

Manipulation versus no treatment. In one trial,288 subjects randomized to receive 

manipulation, experienced significant reduction (from baseline) in immediate/short-term posttreatment pain intensity (VAS: 12.20 versus 10.40, p < 0.05). In contrast, subjects randomized to 

no treatment group, did not experience significant reduction in pain intensity (p = 0.10). 

Manipulation (type 1) versus manipulation (type 2). In one trial,294 subjects with sub-acute 

and chronic LBP who received upper cervical adjustment as well as upper cervical + full spine 

adjustment experienced significant improvement in pain intensity (VAS score) compared to 

baseline. The group of subjects who received full spine adjustment only, did not improve in pain 

intensity (VAS) but did improve in disability (Oswestry score). Numerical data for these groups 

were not reported. 

Manipulation versus other treatments. In one trial,278 short-term post-treatment effects of 

manipulation and ‘educational booklet’ were compared and no significant differences in pain 

(11-point pain scale measuring symptom bothersomeness: 2.0 ± 2.2 versus 3.2 ± 3.2, p = 0.06) or 

disability (RMDQ: 3.1 ± 4.1 versus 4.1 ± 4.9, p = 0.28) were found between the two groups. In 

the same trial, no significant differences were found in short-term post-treatment effects on pain 

(percentage of pain-free subjects, 11-point pain scale) or disability (RMDQ) between 

manipulation and physiotherapy (McKenzie technique based on diagnoses of derangement, 

dysfunction or postural syndromes). In another trial,296 high or low velocity spinal manipulation 

92
 
(SM) was compared to minimal conservative medical care (aiming to improve pain with 

optimization of activities of daily living with patient specific choice of medication) in older 

adults. Spinal manipulation was significantly more effective compared to medical care alone in 

improving immediate, short-, or intermediate-term post-treatment disability (adjusted RMDQ 

score: 0-24) and perception of global improvement (score: 1-10), but not pain (VAS score: 0­

100) or physical function (SF-36 score: 0-100). The adjusted RMDQ mean change from baseline 

values in the high and low velocity manipulation and medical care groups were 2.7 (95 percent 

CI: 2.0, 3.3), 2.9 (95 percent CI: 2.2, 3.6), and 1.6 (95 percent CI: 0.5, 2.8), respectively. 

Manipulation versus other CAM treatments. In one trial,295 subjects in the manipulation 

groups did not significantly differ from subjects in the massage group, with respect to straight leg 

raising.295 In this trial, the data immediately after the end of treatment indicated significantly 

better spinal flexibility (e.g., walking, bending, twisting, sitting down in a chair, reaching, 

dressing) in the manipulation group compared to the massage group.295 

In one trial,296 high velocity spinal manipulation was similar to low velocity manipulation in 

reducing immediate, short term- and intermediate-term post treatment pain intensity (VAS score: 

0-100) or disability (Oswestry score: 0-24) in adults  55 years or older. Both treatment methods 

were effective in the reduction of LBP symptoms. 

Manipulation versus medication. The results of one underpowered trial283 indicated 

statistically nonsignificantly greater proportion of pain-free subjects in the manipulation versus 

medication group (50.0 percent versus 11.0 percent, p = 0.15), and therefore were rendered as 

inconclusive. In another trial,104 the immediate post-treatment back pain improvement (percent 

change on VAS) was numerically greater in the manipulation group compared to the medication 

group (statistical test results were not provided). The beneficial effect of manipulation relative to 

medication was more evident in subjects under 40 years (compared to subjects 40 years or older) 

or subjects with sub-acute/chronic LBP (versus subjects with acute LBP).104 

Manipulation + other treatments versus the same other treatments. In one trial,31 131 

subjects were randomized to either a combination of manipulation and exercise or exercise alone 

for 4 weeks. The subjects then were grouped into positive and negative subgroups according to 

whether or not they met a pre-specified set of 5 criteria (duration of current episode < 16 days, 

no symptoms distal to the knee, FABQ work subscale score < 19,  1 hypomobile lumbar spine 

segment,  1 hip with > 35 degrees of internal rotation range motion). Immediately after the end 

of treatment, the rate of success (> 50.0 percent improvement on Oswestry disability scale) in the 

manipulation group was significantly greater compared to the exercise alone group (62.9 percent 

versus 36.1 percent, p = 0.002). At intermediate-term post-treatment followup, the mean 

Oswestry disability score was significantly lower in subjects receiving manipulation plus 

exercise compared to those receiving exercise alone (mean between-group difference: 10.1, 95 

percent CI: 4.3, 15.9, p = 0.001). Moreover, medication use and healthcare utilization was 

significantly lower in the manipulation group compared to the exercise group. The subgroup 

analysis indicated that the greatest treatment effect of manipulation relative to exercise was 

observed for subjects classified as positive on the prediction rule (i.e., meeting at least 4 of the 5 

criteria). In the same trial,31,35 the subject’s age, gender, symptom duration, or the therapist’s 

years of experience did not have a significant effect on the mean change on Oswestry score. 

This study also reported an increased risk of worsening disability for patients who did not 

receive spinal manipulation (11 percent versus 3 percent in exercise group and spinal 

manipulation + exercise group respectively; RR = 8.0, 95 percent CI: 1.1, 63.5) measured by 

Oswestry disability scores obtained at 6 months of followup. In addition, failure rates were 

93
 
higher in subgroup of patients with hypomobility (74.4 percent versus 26 percent in exercise 

versus manipulation + exercise groups respectively). However, patients with hypermobility were 

more likely to benefit from stabilizing exercise than spinal manipulation + exercise (failure rates 

of 22.0 percent versus 83.3 percent in exercise and spinal manipulation + exercise groups 

respectively). 

Population with unknown duration of pain. This sub-section included two trials,282,285 one 

of which was restricted to subjects with specific LBP (degenerative spondylolisthesis)282 and the 

other to subjects with nonspecific LBP (i.e., sacroiliac joint syndrome).285 

Subjects with specific pain. 

Manipulation versus placebo. No relevant studies were identified. 

Manipulation versus no treatment. No relevant studies were identified. 

Manipulation (type 1) versus manipulation (type 2). In one trial,282 fine adjusting 

manipulation was associated with a significantly greater therapeutic effect (percentage of pain 

free subjects) compared to that for the reduction manipulation in subjects with degenerative 

spondylolisthesis (60.0 percent versus 36.7 percent, p < 0.05). 

Manipulation versus other treatments. No relevant studies were identified. 

Manipulation versus medication. No relevant studies were identified. 

Manipulation + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Manipulation versus placebo. No relevant studies were identified. 

Manipulation versus no treatment. No relevant studies were identified. 

Manipulation (type 1) versus manipulation (type 2). In one trial,285 although routine 

manipulation and manually assisted manipulation using Activator Adjusting Instrument (AAI) 

produced statistically significant reductions in pain (NRS) and disability (Oswestry) for subjects 

with sacroiliac joint syndrome, the between-group differences for these outcomes were not 

significant. 

Manipulation versus other treatments. No relevant studies were identified. 

Manipulation versus medication. No relevant studies were identified. 

Manipulation + other treatments versus the same other treatments. No relevant studies were 

identified. 

94
 
4 – Manipulation + Mobilization for treatment of Low Back Pain 

There were 10 trials identified for this section. Results of six studies were reported in 

multiple publications (Table 3). 

Population/trial characteristics. These trials were conducted in Australia (two),39,56 Ireland 

(one),300 the Netherlands (one),84 Norway (one),299 UK (four),95,108,301,302 and US (one).66 

The proportion of men and women were similar in eight trials.56,66,84,95,108,299,300,302 In one 

trial,39 the majority of subjects were females. 

The number of study participants in these trials ranged from 49299 to 74195 with a total of 

2,838 subjects in all trials combined. Table 12 presents the control interventions in the included 

studies. 

Table 12. Spinal manipulation + mobilization for treatment of low back pain- Control interventions 

Type of control 

group 

Cause of 

Pain 

N 

studies 

Detail of Control intervention 

1 – Inactive treatments 

Placebo/sham Non 

Specific 

1 sham manipulation + mobilization and placebo Diclofenac 

(double placebo),56 low intensity microwave108 

Specific 0 NA 

2 – Active treatments 

Exercise/physical 

activity 

Non 

Specific 

2 motor control exercise (retraining specific trunk muscles 

using ultrasound feedback),39 general and individualized 

exercise programs (strengthening, stretching, mobilizing, 

coordination, and stabilizing exercise for the abdominal, 

back, pelvic, and lower limb muscles according to clinical 

findings)299 

Specific 0 NA 

Usual care Non 

Specific 

2 Medical care alone,66 in combination with physical 

modalities66 

Conventional outpatient care95 

Specific 0 NA 

Education Non 

Specific 

 Educational booklet302 

Specific 0 NA 

Physiotherapy Nonspecific 1 Manual therapy and physical modalities (exercise, massage, 

heat, electrotherapy, ultrasound, short-wave diathermy)84 

Specific 0 NA 

NA= not applicable; 

The duration of treatments varied from four to 12 weeks and the frequency of treatments 

were at least twice a week. 

Risk of bias. The risk-of-bias graph for the trials included in this sub-section is presented in 

Figure 28. All trials were randomized. The adequate method of randomization and treatment 

allocation concealment was reported for 67.0 percent and 44.0 percent of the trials, respectively. 

Up to 89.0 percent of the trials reported that distribution of the subjects’ baseline characteristics 

across the treatment arms was similar. The subjects were reported to be blinded in only 22.0 

percent of the trials. About 78.0 percent of the trials reported acceptable drop-out rate. Results 

based on intention-to-treat analysis were explicitly reported for 44.0 percent of the trials. 

95
 
Figure 28. Risk of bias scores (%) 

0% 20% 40% 60% 80% 100% 

Q13 

Q12 

Q11 

Q10 

Q9 

Q8 

Q7 

Q6 

Q5 

Q4 

Q3 

Q2 

Q1 

Yes No Unclear 

Efficacy results. A summary of the key results is presented in Table 11. For more details 

please see evidence tables. (Appendix C, table 1.21 – table 1.27) 

Population with acute/subacute pain. There were two trials56,300 included in this subsection. Both trials were restricted to subjects with LBP due to nonspecific causes. 

Subjects with specific pain. 

Manipulation + mobilization versus placebo. No relevant studies were identified. 

Manipulation + mobilization versus no treatment. No relevant studies were identified. 

 Manipulation + mobilization versus another type/method of the same CAM. No relevant 

studies were identified.

 Manipulation + mobilization versus other treatments. No relevant studies were identified.

 Manipulation + mobilization versus medication. No relevant studies were identified.

 Manipulation + mobilization + other treatments versus the same other treatments. No 

relevant studies were identified. 

Subjects with nonspecific pain.

 Manipulation + mobilization versus placebo. In one trial,56 manipulation + mobilization was 

compared to double placebo (sham manipulation and placebo medication) and the results 

indicated nonsignificant differences in time to achieve recovery, post-treatment pain intensity 

(VAS), disability (RMDQ), and global perceived effects between the two groups. 

Manipulation + mobilization versus no treatment. No relevant studies were identified. 

 Manipulation + mobilization versus another type/method of the same CAM. No relevant 

studies were identified.

 Manipulation + mobilization versus other treatments. In one trial,300 post-treatment pain 

intensity (VAS, MPQ), quality of life (SF-36), disability (RMDQ), and range of mobility (e.g., 

flexion, functional activity) did not differ between the combination of manipulation and 

mobilization and inferential therapy at short- intermediate-, or long-term followup periods. 

In another trial,301 patients in manipulation + mobilization group had significantly lower number 

of treatments to reach a symptom free status than those in microwave diathermy group. There 

was also a statistically significant difference between the intervention and control group in 

lumbar extension favoring manipulation + mobilization immediately post 3 weeks of treatment 

96
 
(p < 0.05) but not for any other objective measures. In both trials, manipulation + mobilization 

treatments were delivered by experienced physiotherapists. 

 Manipulation + mobilization + other treatments versus the same other treatments. No 

relevant studies were identified. 

Population with chronic pain. There were two trials39,299 included in this sub-section. Both 

trials were restricted to subjects with LBP due to nonspecific causes. 

Subjects with specific pain.

 Manipulation + mobilization versus placebo. No relevant studies were identified. 

Manipulation + mobilization versus no treatment. No relevant studies were identified. 

 Manipulation + mobilization versus another type/method of the same CAM. No relevant 

studies were identified.

 Manipulation + mobilization versus other treatments. No relevant studies were identified.

 Manipulation + mobilization versus medication. No relevant studies were identified.

 Manipulation + mobilization + other treatments versus the same other treatments. No 

relevant studies were identified. 

Subjects with nonspecific pain.

 Manipulation + mobilization versus placebo. No relevant studies were identified. 

Manipulation + mobilization versus no treatment. No relevant studies were identified. 

 Manipulation + mobilization versus another type/method of the same CAM. No relevant 

studies were identified.

 Manipulation + mobilization versus other treatments. In one trail,299 the manual therapy 

group showed significantly greater improvements than the exercise therapy group on pain 

intensity, functional disability, general health and return to work throughout the 2 months 

intervention in group of sick-listed patients. Immediately after the 2 month treatment period, 67 

percent in the manual therapy and 27 percent in the exercise therapy group had returned to work 

(p < 0.01), a relative difference that was maintained throughout followup. 

In another trial,39 motor control exercise (retraining specific trunk muscles using ultrasound 

feedback) and manipulation + mobilization produced slightly better short-term function (mean 

difference on Patient-Specific Functional scale: 2.30, 95 percent CI: 0.4, 4.2) and perceptions of 

effect (mean Global Perceived Effect difference: 1.20, 95 percent CI: 0.4, 2.0) than general 

exercise group, but not better intermediate or long-term effects,. There was no significant 

difference between the manipulation and motor control exercise in function (mean difference: 

0.4, 95 percent CI: -1.5, 2.4) or global perceived effect (mean difference: 0.5, 95 percent CI: ­

0.2, 1.1). 

Manipulation + mobilization versus medication. No relevant studies were identified.

 Manipulation + mobilization + other treatments versus the same other treatments. No 

relevant studies were identified. 

Population with mixed duration of pain. This sub-section included three trials restricted to 

subjects with nonspecific LBP.66,84,302 

Subjects with specific pain.

 Manipulation + mobilization versus placebo. No relevant studies were identified. 

Manipulation + mobilization versus no treatment. No relevant studies were identified. 

 Manipulation + mobilization versus another type/method of the same CAM. No relevant 

studies were identified.

 Manipulation + mobilization versus other treatments. No relevant studies were identified.

 Manipulation + mobilization versus medication. No relevant studies were identified. 

97
 
 Manipulation + mobilization + other treatments versus the same other treatments. No 

relevant studies were identified. 

Subjects with nonspecific pain.

 Manipulation + mobilization versus placebo. No relevant studies were identified. 

Manipulation + mobilization versus no treatment. No relevant studies were identified. 

 Manipulation + mobilization versus another type/method of the same CAM. No relevant 

studies were identified.

 Manipulation + mobilization versus other treatments. In one trial,66 the combination of 

manipulation and mobilization (with or without physical modalities) was not significantly 

different from medical care alone or medical care combined with physical modalities (in 

reducing pain (VAS) and disability (RMDQ) at short, intermediate, and long-term time points 

post-treatment. Throughout the followup, the use of prescription drugs (e.g., NSAIDs, muscle 

relaxants, analgesics) was significantly greater in the medical care group versus manipulation 

group (at 6 months: 32.0 percent versus 24.0 percent). The mean number of doctor visits during 

6 months of followup was greater among subjects in the manipulation versus medical care group 

(5.4 versus 2.9). Chiropractors administered the manual treatment in this trial. 

Similarly, another trial,302 did not find any significant differences in disability (i.e., Disability 

Index) between subjects receiving osteopathic manipulation versus ‘educational booklet.’ 

In one trial,84 the combination of manipulation and mobilization produced significantly 

greater improvements in intermediate- and long-term post-treatment pain intensity(10-point 

scale: minimal severity = 1, maximal severity = 10) and physical functioning (10-point scale) 

compared to physiotherapy (exercise, massage, heat, electrotherapy, ultrasound, short-wave 

diathermy). The global perceived effect (six-point scale) did not differ between subjects who 

received manipulation plus mobilization and physiotherapy (intermediate-term post-treatment: 

3.5 ± 1.9 versus 3.5 ± 1.8, p > 0.05).84 The subgroup analysis of the same trial85 revealed that the 

beneficial effect of manipulation compared to physiotherapy was maximized in subjects with 

chronic pain (longer than one year) and in subjects younger than 40 years old. The manual 

therapy was delivered by physiotherapist who had an additional three years of training in 

manipulation. 

Manipulation + mobilization versus medication. No relevant studies were identified.

 Manipulation + mobilization + other treatments versus the same other treatments. No 

relevant studies were identified. 

Population with unknown duration of pain. This sub-section included two trials with 

subjects having nonspecific LBP.95,108 

Subjects with specific pain.

 Manipulation + mobilization versus placebo. No relevant studies were identified. 

Manipulation + mobilization versus no treatment. No relevant studies were identified. 

 Manipulation + mobilization versus another type/method of the same CAM. No relevant 

studies were identified.

 Manipulation + mobilization versus other treatments. No relevant studies were identified.

 Manipulation + mobilization versus medication. No relevant studies were identified.

 Manipulation + mobilization + other treatments versus the same other treatments. No 

relevant studies were identified. 

98
Subjects with nonspecific pain.

 Manipulation + mobilization versus placebo. In one trial,108 the combination of 

manipulation and mobilization did not significantly improve immediate-, short-, or intermediateterm post-treatment lumbar mobility (flexion, extension, straight leg raising) compared to 

placebo (microwave at a very low setting). For example, mean values for extension in the 

combination and placebo groups immediately after the end of treatment were 42.96 ± 9.09 and 

44.43 ± 11.38, respectively (p > 0.1). The corresponding values for flexion were 2.40 ± 10.30 

and 22.75 ± 9.62, respectively (p > 0.1). Treatments were delivered by trained physiotherapists. 

Manipulation + mobilization versus no treatment. No relevant studies were identified. 

 Manipulation + mobilization versus another type/method of the same CAM. No relevant 

studies were identified.

 Manipulation + mobilization versus other treatments. In one trial,95 subjects receiving 

manipulation plus mobilization (delivered by trained chiropractor) had significantly improved 

long-term post-treatment pain (percentage of pain-free subjects), disability (Oswestry) and 

straight leg raising compared to those receiving conventional care. The use of analgesics did not 

differ between the two groups. The combination group had a significantly fewer subjects who 

were absent from work (percentage of subjects taking time off work) compared to the 

conventional care group. The subjects with severe disability at entry (Oswestry > 40.0 percent) 

responded more favorably than subjects with less severe disability at entry (Oswestry  40.0 

percent). 

Manipulation + mobilization versus medication. No relevant studies were identified.

 Manipulation + mobilization + other treatments versus the same other treatments. No 

relevant studies were identified. 

5 – Flexion Distraction for Treatment of Low Back Pain 

There were four trials identified and included in this sub-section. All four trials recruited 

participants with nonspecific pain. 

Population/trial characteristics. All four trails were conducted in US. One of these trials 

was of particularly small sample size (only 13 subjects).303 

Two of these trials reported information on ethnicity,304,305 and two trials reported the 

proportion of men and women in the trial.303,305 

In total, there were 576 subjects randomize to flexion distraction technique therapy or control 

groups. The number of study participants ranged from 13 in one trial,303 to 235 in the largest 

trial.305 Control interventions were: 

x Placebo (two studies)303,304 

x Other treatments (two studies) including physical modalities,297, and exercise305 

The duration of treatments varied from 1 to 4 weeks. The frequency of treatments varied 

from twice a week to four times a week. 

Risk of bias. The risk-of-bias graph for the trials included in this sub-section is presented in 

Figure 29. All trials were randomized. The adequate method of randomization and treatment 

allocation concealment was reported for 25.0 percent and 50.0 percent of the trials, respectively. 

Up to 50.0 percent of the trials reported that distribution of the subjects’ baseline characteristics 

across the treatment arms was similar. The subjects were reported to be blinded in 50.0 percent 

of the trials. All of the trials reported acceptable drop-out rate. Results based on intention-to-treat 

analysis were explicitly reported for 25.0 percent of the trials. 

99
 
Figure 29. Risk of bias scores (%) 

0% 20% 40% 60% 80% 100% 

Q13 

Q12 

Q11 

Q10 

Q9 

Q8 

Q7 

Q6 

Q5 

Q4 

Q3 

Q2 

Q1 

Yes No Unclear 

Population with acute/subacute pain. No relevant studies were identified or included. 

Population with chronic pain. Only one trial was included in this section.305 

Subjects with specific pain. 

Flexion distraction versus placebo. No relevant studies were identified. 

Flexion distraction versus no treatment. No relevant studies were identified. 

Flexion distraction versus another type/method of the same CAM. No relevant studies were 

identified. 

Flexion distraction versus other treatments. No relevant studies were identified. 

Flexion distraction versus medication. No relevant studies were identified. 

Flexion distraction + other treatments versus the same other treatments. No relevant studies 

were identified. 

Subjects with nonspecific pain. 

Flexion distraction versus placebo. No relevant studies were identified. 

Flexion distraction versus no treatment. No relevant studies were identified. 

Flexion distraction versus another type/method of the same CAM. No relevant studies were 

identified. 

Flexion distraction versus other treatments. In one trial,305 the effects of flexion-distraction 

therapy and physical therapy (exercise program) on short-term post-treatment pain intensity 

(VAS) and disability (RMDQ) did not significantly differ. After 1 year of care, subjects who 

received flexion-distraction therapy had a significantly lower mean pain score (VAS) than 

subjects who received physical therapy (20.6 ± 1.9 versus 21.6 ± 2.0, p = 0.02). 

Flexion distraction versus medication. No relevant studies were identified. 

Flexion distraction + other treatments versus the same other treatments. No relevant studies 

were identified. 

Population with mixed duration of pain. Two trials were included in this sub-section.303,304 

Both trials studied subjects with nonspecific pain 

Subjects with specific pain. 

Flexion distraction versus placebo. No relevant studies were identified. 

Flexion distraction versus no treatment. No relevant studies were identified. 

100
 
Flexion distraction versus another type/method of the same CAM. No relevant studies were 

identified. 

Flexion distraction versus other treatments. No relevant studies were identified. 

Flexion distraction versus medication. No relevant studies were identified. 

Flexion distraction + other treatments versus the same other treatments. No relevant studies 

were identified. 

Subjects with nonspecific pain. 

Flexion distraction versus placebo. In two trials,303,304 comparing the flexion-distraction 

technique to placebo (hand-held instrument producing effect similar to manual adjustments), no 

significant differences in disability (RMDQ, Pain Disability Index - PDI) were found between 

the two groups. The treatment effect was not modified by age, gender, duration of symptoms, or 

prior treatment with chiropractic therapy.304 

Flexion distraction versus no treatment. No relevant studies were identified. 

Flexion distraction versus another type/method of the same CAM. No relevant studies were 

identified. 

Flexion distraction versus other treatments. No relevant studies were identified. 

Flexion distraction versus medication. No relevant studies were identified. 

Flexion distraction + other treatments versus the same other treatments. No relevant studies 

were identified. 

Population with unknown duration of pain. Only one trial was included in this section.297 

This trial was restricted to subjects with nonspecific pain. 

Subjects with specific pain. 

Flexion distraction versus placebo. No relevant studies were identified. 

Flexion distraction versus no treatment. No relevant studies were identified. 

Flexion distraction versus another type/method of the same CAM. No relevant studies were 

identified. 

Flexion distraction versus other treatments. No relevant studies were identified. 

Flexion distraction versus medication. No relevant studies were identified. 

Flexion distraction + other treatments versus the same other treatments. No relevant studies 

were identified. 

Subjects with nonspecific pain. 

Flexion distraction versus placebo. No relevant studies were identified. 

Flexion distraction versus no treatment. No relevant studies were identified. 

Flexion Distraction versus another type/method of the same CAM. No relevant studies were 

identified. 

Flexion distraction versus other treatments. No relevant studies were identified. 

Flexion distraction versus medication. No relevant studies were identified. 

Flexion distraction + other treatments versus the same other treatments. In one trial,297 

flexion-distraction combined with hot pack was significantly superior to hot pack alone in 

reducing pain intensity (VAS) and increasing lumbar ROM in subjects with LBP due to 

osteoarthritis. 

101
 
6 – Manipulation for Treatment of Neck Pain 

This section included 28 trials. Two trials were reported in six publications (Table 3). 

The results from seven studies that compared techniques of manipulation and mobilization 

are presented in this section.65,306-310 Results from two trials51,140comparing the effectiveness of 

manipulation and acupuncture are reported in the Acupuncture for Treatment of Neck Pain 

section. 

Population/trial characteristics. The trials were conducted in Australia (three),51,140,311 

Canada (five),309,312-315 China (one), 316 Denmark (one),317 Germany (one),308 South Africa 

(three),307,318,319 Nigeria (one),320 Spain (three),310,321,322 and United States (eight).65,306,323-328 The 

information on the country was not reported for two studies.329,330 

There was a greater proportion of women ( 60 percent) versus men in eight 

studies,65,310,313,314,323,324,326,328 and greater proportion of men ( 60 percent) versus women in two 

studies.312,320 The proportions of men and women were similar in six studies.51,306,308,317,321,322 

The gender distribution was not reported for six studies.309,311,315,325,329,330 

Patients in the included trials were adults aged 18 or older. The information regarding 

ethnicity was reported for only five trials.65,320,323,327,328 

In total 1,820 patients were included in these trials. The experimental intervention included 

spinal manipulation alone or in combination with other treatment (two studies).321,322 In one 

study,328 two different dosing regiments of spinal manipulation (two randomized arms) were 

used combined with other treatments. 

Control interventions for 29 trials with spinal manipulation or spinal manipulation + other 

treatments are displayed in Table 13. 

Table 13. Spinal manipulation for treatment of neck pain- Control interventions 

Type of control 

group 

Cause of 

Pain 

N 

studies 

Detail of Control intervention 

1- Inactive treatments 

Placebo/sham Non 

Specific 

7 Rotational mobilization,312 light hand placement without 

tension or pressure,308,326 light hand placement with slight 

rotation but no tension or thrust,310 sham ultrasound,330 

sham manipulation delivered with a deactivated Pettibon,311 

no description provided,325

 Specific 0 NA 

No-treatment/ 

waiting list 

Non 

Specific 

1 Positioning as spinal manipulation group without any 

intervention,324 

Specific 0 NA 

2 – Active treatments 

Physiotherapy Nonspecific 0 NA 

Specific 1 Active exercises, electrotherapy, ultrasound in soft tissues 

(whiplash) of the neck region, manual therapy, muscle stretching and 

multimodal therapy321 

Physical Nonspecific 1 TENS,316 

modalities Specific 0 NA 

Manual therapy Nonspecific 5 Mobilization,65,306,308,309 massage,317 

Specific 0 NA 

Medication Nonspecific 4 Diazepam,329 Amitriptyline,331 Paracetamol/Acetaminophen,51 

Tenoxican and Ranitidine, 140 

Specific 0 NA 

Other methods of Nonspecific 6 Manipulation on contra-lateral side,307,314 manipulation to 

102
 
spinal 

manipulation 

dysfunctional sections of cervical spine only,313 cervical and 

upper thoracic manipulation,318 manipulation according to 

sham endplay findings generated by a computer 

algorithm,327 mechanically assisted manipulation315 

Specific 1 Top vs. top and bottom segment adjustments,319 

Active treatment 

(also in 

manipulation 

group) 

Nonspecific 2 Physical modalities (electro-thermal therapy),322 sham 

ultrasound,330 

Specific 0 NA 

Spinal 

manipulation in 

combination with 

another 

treatment (vs. 

manipulation 

alone) 

Nonspecific 1 Cervical post isometric relaxation,323

 Specific 0 NA 

NA= not applicable; TENS = transcutaneous electrical nerve stimulation 

The majority of studies reported a single treatment session for the length of the 

trial.65,306,309,310,312-315,324-327,329 One study reported four treatment visits for duration of 2 

weeks.323 The remaining studies implemented one or two treatments for a duration of 3 to 11 

weeks,319,322 twice a week for total duration of 4 to 10 weeks,51,140,307,318,330,332 and three to five 

times a week for a total duration of 3 to 12 weeks.320,321 

Risk of bias. The risk-of-bias graph for the trials included in this sub-section is presented in 

Figure 30. All trials were randomized. The adequate method of randomization and treatment 

allocation concealment was reported for 52.0 percent and 34.0 percent of the trials, respectively. 

About 62.0 percent of the trials reported that distribution of the subjects’ baseline 

characteristics across the treatment arms was similar. In 72.0 percent of the trials, study 

participants were not blinded to the treatment. About 66.0 percent of the trials reported 

acceptable drop-out rate. Results based on intention-to-treat analysis were explicitly reported for 

41.0 percent of the trials. The data for selected items of the risk of bias tool across the CAM 

interventions (acupuncture; spinal manipulation; spinal mobilization; combination of 

manipulation and mobilization; and massage therapy) is displayed in table 7.2 of Appendix G. 

103
 
Figure 30. Risk of bias scores (%) 

0% 20% 40% 60% 80% 100% 

Q13 

Q12 

Q11 

Q10 

Q9 

Q8 

Q7 

Q6 

Q5 

Q4 

Q3 

Q2 

Q1 

Yes No Unclear 

Efficacy results. A summary of the key results is presented in Table 14. For further detail of 

the trials please see the evidence tables. (Appendix C, table 2.9 – table 2.16) 

104
 
Table 14 – Key results – Manipulation therapy for treatment of neck pain & cervicogenic headaches 

CAM 

therapy 

Duration of 

pain 

Cause 

of pain Outcome 

Riskofbias 

Precision 

of the 

pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

Man vs. No 

Tx 

Acute/subacute 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown 

S - - - - - - Insufficient 

NS VAS: B 324 M - NA Direct = S-NS Low 

ROM: B 324 M - NA Indirect = S-NS Low 

Man vs. PL 

Acute/subacute 

S - - - - - - Insufficient 

NS VAS: B 

308,314 

H - Yes Direct > SS Low 

Chronic 

S - - - - - - Insufficient 

NS 

VAS: B, C 326,330 M - Yes Direct > SS Moderate 

PPT: B, C

326,330 

M - Yes Direct > SS Moderate 

NDI: B, C326 M - NA Direct > SS Low 

Mixed 

S - - - - - - Insufficient 

NS 

PPT: B 312 H - NA Direct > SS Low 

VAS: B 310 M - NA Direct > SS Low 

ROM: B 310 M - NA Indirect > SS Low 

Unknown S - - - - - - Insufficient 

NS VAS: B 325 H - NA Direct > SS Low 

Man** vs. PL Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS ROM: B (ext, 

flx) 84 

M - NA Indirect = S-NS Low 

Physical 

functioning 

(10-point 

M - NA Direct > SS Low 

105
 
CAM 

therapy 

Duration of 

pain 

Cause 

of pain Outcome 

Riskofbias 

Precision 

of the 

pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

scale): B 84 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Man** vs. PT Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS VAS: B 85 M - NA Direct > SS Low 

Mixed S - - - - - - Insufficient 

NS ROM: B (ext, 

flx) 84 

M - NA Indirect = S-NS Low 

Physical 

functioning 

(10-point 

scale): B 84 

M - NA Direct > SS Low 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Man** vs. ST Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS ROM: B (ext, 

flx) 84 

M - NA Indirect = S-NS Low 

Physical 

functioning 

(10-point 

scale): B 84 

M - NA Direct > SS Low 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Man** vs. Ex 

Acute/subacute 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic 

S - - - - - - Insufficient 

NS 

Headache 

frequency 

(mean number 

per week): B, C 

M - NA Direct = S-NS Low 

106
 
CAM 

therapy 

Duration of 

pain 

Cause 

of pain Outcome 

Riskofbias 

Precision 

of the 

pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

83 

VAS: B, C 83 M - NA Direct = S-NS Low 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Man vs. PT Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Man vs. Med Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS VAS: C 51,140,329 H - No Direct = > Low 

NDI: C 51,140 H - Yes Direct > SS Low 

% pain-free 

pts: C 51 

H - NA Indirect > SS Low 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Man vs. Mob Acute/subacute S - - - - - - Insufficient 

NS VAS: B 308 M - NA Direct = S-NS Low 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS VAS: B 309,310 M - Yes Indirect > SS Low 

ROM (ext): B 

310 

M - NA Indirect > SS Low 

107
 
CAM 

therapy 

Duration of 

pain 

Cause 

of pain Outcome 

Riskofbias 

Precision 

of the 

pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

VAS: D 65 M - NA Direct = S-NS Low 

NDI: D 65 M - NA Direct = S-NS Low 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Man vs. Ex Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Headache 

Man vs. 

NoTx 

Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Man vs. PL Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS ROM (ext, flx, 

rotation): B 311 

L - NA Indirect > SS Low 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS VAS: B, D 333 M - NA Direct = S-NS Low 

Pain duration 

(# of hours 

daily): B, D 333 

M - NA Direct = S-NS Low 

108
 
CAM 

therapy 

Duration of 

pain 

Cause 

of pain Outcome 

Riskofbias 

Precision 

of the 

pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

Use of 

analgesics (# 

of tablets 

daily): B, D 333 

M - NA Indirect = S-NS Low 

Man vs. 

Cold Packs 

Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S VAS: B 334 M - NA Direct > SS Low 

VAS: C 334 M - NA Direct = S-NS Low 

ROM (ext, flx): 

B, C 334 

M - NA Indirect = S-NS Low 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - Insufficient 

NS - - - - - Insufficient 

Man vs. Mob Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Man vs. Ex Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

109
 
CAM 

therapy 

Duration of 

pain 

Cause 

of pain Outcome 

Riskofbias 

Precision 

of the 

pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

S=specific; NS=nonspecific; SS=statistically significant; S-NS=statistically nonsignificant; Man=manipulation; Acu=acupuncture; Ma=massage; Mob=mobilization; 

PL=placebo; Tx=treatment. Med=medication(s); Int=intervention; PT=physiotherapy; ST=standard therapy; E-acu=electro-acupuncture; MR=muscle relaxation; TENS= 

transcutaneous electrical nerve stimulation; Ex=exercise; TrP=trigger point; VAS=visual analog scale; RMDQ=Roland Morris Disability scale; NHP=Nottingham Health 

Profile; PPT= pressure pain threshold; HFAQ=Hanover functional ability questionnaire; MPQ=McGill pain questionnaire; ext=extension; flx=flexion; rot=rotation; PDI=pain 

disability index; min=minute(s); hr(s)=hour(s); L=low; M=medium; H=high; pt(s)=patient(s); SF=short-form; NPQ=neck pain questionnaire; GWBS=global well-being scale; 

SLR=straight leg raising; GPE= Global perceived effect; NSAIDS=nonsteroidal antiinflammatory drugs; FTF=finger-to-floor; SF-PQ=short form pain questionnaire; PRI=pain 

rating index; PPI=present pain intensity; NA=not applicable 

Ȍ Grade (High, moderate, low, and insufficient) E = long-term post-treatment = Similar beneficial effect 

> Favors treatment A over treatment B 

< Favors treatment B over treatment A 

><, =>, <= Inconsistent beneficial effect 

H = high 

L = low 

M = medium 

- No evidence 

** Manipulation in combination with mobilization 

B = immediate post-treatment 

C = short-term post-treatment 

D = intermediate-term post-treatment 

110
 
Population with acute/subacute pain. In total, there were four trials eligible for this section, 

all of which enrolled patients with nonspecific pain.308,314,315,322 

Subjects with specific pain. 

Manipulation versus placebo. No relevant studies were identified. 

Manipulation versus no treatment. No relevant studies were identified. 

Manipulation versus another type/method of the same CAM. No relevant studies were 

identified. 

Manipulation versus other treatments. No relevant studies were identified. 

Manipulation versus medication. No relevant studies were identified. 

Manipulation + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Manipulation versus placebo. In one trial,314 immediate post single treatment mean VAS 

scores indicated statistically significantly lower degree of pain in patients receiving ipsilateral 

manipulation compared to placebo ultrasound (23.6 r 18.6 versus 46.5 r 21.8, p = 0.001). There 

was no difference between the applications of contralateral manipulation and placebo in lowering 

pain intensity (p = 0.93).314 Manipulation was administered by chiropractors. 

In another trial,308 manipulation delivered by trained chiropractors resulted in significantly 

lower pain intensity (VAS) compared with placebo (light hand placement on the side of neck 

without application of any side-different pressure or tension) immediately after the treatment (p 

= 0.01). 

Manipulation versus no treatment. No relevant studies were identified. 

Manipulation versus mobilization. In one trial,308 the post-treatment mean VAS scores were 

not statistically significantly different between the patients randomized to manipulation and 

those randomized to mobilization (p = 0.16; no other numerical data were reported). 

Manipulation (type 1) versus manipulation (type 2). In one trial,314 the application of 

ipsilateral manipulation led to a lower intensity of pain on VAS compared to contralateral 

manipulation (41.4 r 28.4, p = 0.0005). 

Immediate post-treatment results of another trial indicated that spinal manipulation did not 

differ from manipulation with mechanically-assisted device (VAS: 21.8 r 21.4 versus 20.4 r

18.4, respectively, p = 0.77). 315 Both treatments were performed by experienced 

chiropractors.315 

Manipulation versus other treatments. No relevant studies were identified. 

Manipulation versus medication. No relevant studies were identified. 

Manipulation + other treatments versus the same other treatments. In one trial,322 patients 

randomized to receive a combination of thoracic spine manipulation and electro-thermal therapy 

compared to those randomized to electro-thermal therapy alone, experienced greater short-term 

post-treatment mean improvements in pain – VAS score (between-group mean score difference: 

26.5, 95 percent CI: 22.9, 30.2) and disability – the Northwick Neck Pain Questionnaire (NPQ) 

(between-group mean score difference: 8.8, 95 percent CI: 7.5, 10.1). The treatments were 

performed by an experienced manual therapist. 

Population with chronic pain. A total of eight trials were included in this 

section.51,140,311,316,317,326,328,329 All trials enrolled patients with nonspecific chronic neck pain. In 

four of these trials, the treatment of cervicogenic headaches was the primary goal.311,316,317,328 

111
 
Subjects with specific pain. 

Manipulation versus placebo. No relevant studies were identified. 

Manipulation versus no treatment. No relevant studies were identified. 

Manipulation versus another type/method of the same CAM. No relevant studies were 

identified. 

Manipulation versus other treatments. No relevant studies were identified. 

Manipulation versus medication. No relevant studies were identified. 

Manipulation + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Manipulation versus placebo. In two studies, it was demonstrated that patients randomized to 

manipulation experienced significantly greater immediate post-treatment reduction in pain 

(measured on VAS, PPT) 326,330 and disability (measured on NDI)326 compared to patients 

randomized to placebo (hand maneuver without high velocity thrust in patients naïve to spinal 

manipulation,326 and sham ultrasound330). Treatments consisted of a single thoracic manipulation 

by physical therapists in one trial,326 and five cervical osteopathic interventions over a 10 week 

period in the other trial.330 In one trial,311 the use of cervical manipulation performed by a trained 

chiropractor was associated with significant increase in cervical ROM (extension, flexion, 

rotation) compared to sham manipulation for cervicogenic headache.311 

Manipulation versus no treatment. No relevant studies were identified. 

Manipulation versus mobilization. No relevant studies were identified. 

Manipulation (type 1) versus manipulation (type 2). One dose-response study,328 showed 

significantly better response in headache-related pain intensity (VAS score) and disability 

(Modified Von Korff scale) with a higher dose of manipulation (three to four chiropractor visits 

per week for 3 weeks) compared to one chiropractor visit (per week for 3 weeks) in short-term 

followup. 

Manipulation versus another type/method of the same CAM. No relevant studies were 

identified. 

Manipulation versus other treatments. In one trial,316 there was a significant improvement in 

pain intensity in the manipulation group versus TENS group (2.81 ± 1.15 versus 5.26 ± 1.83).316 

Both groups improved in pain intensity and ROM compared to baseline but there was no 

difference in post treatment scores between the groups in ROM measures (1.17 ± 0.86 versus 

1.43 ± 1.04). 

Another trial,317 compared the effect of 3 weeks treatment with manipulation by registered 

chiropractors to that of low level laser and massage in patient with cervicogenic headaches. In 

this trial, the use of analgesics decreased by 36 percent in the manipulation group but was not 

changed in massage group. This difference was statistically significant (P = 0.04). This study 

also reported significantly greater improvement in number of headache hours per day in the 

manipulation group versus soft tissue massage group (decrease of 69 percent versus 37 percent, p 

= 0.03).317 

Manipulation versus medication. In one trial,329 although both manipulation (performed by a 

trained rheumatologist) and medication groups demonstrated improvement on mean VAS at 3 

weeks (5.0 ± 3.2 versus 1.8 ± 3.1, P = 0.20), there was no significant difference between 

manipulation and medication (Diazepam) in short-term post-treatment reduction of pain (VAS). 

In contrast, findings from two other trials,51,140 indicated a significant superiority of manipulation 

performed by experienced chiropractors over medication (e.g., NSAIDs, Celebrex, Vioxx, 

112
 
Paracetamol) in reducing immediate/short-term post-treatment pain intensity and disability 

(Oswestry scale, NDI).51,140 In one of these trials,51 the proportion of pain-free patients after the 

treatment was significantly higher in the manipulation group compared to the medication group 

(27.3 percent versus 5.0 percent, p = 0.05). 

Manipulation + other treatments versus the same other treatments. No relevant studies were 

identified. 

Population with mixed duration of pain. This section included eight 

trials.65,306,309,310,312,321,323,327 All except for one trial included subjects with nonspecific pain.321 

Subjects with specific pain. 

Manipulation versus placebo. No relevant studies were identified. 

Manipulation versus no treatment. No relevant studies were identified. 

Manipulation versus another type/method of the same CAM. No relevant studies were 

identified. 

Manipulation versus other treatments. No relevant studies were identified. 

Manipulation versus medication. No relevant studies were identified. 

Manipulation + other treatments versus the same other treatments. In one trial,321 patients 

with whiplash injuries receiving manipulation of thoracic spine (performed twice in combination 

with physiotherapy on the 5th and 10th sessions) had significantly greater mean reduction in pain 

score (VAS) at immediate/short-term post-treatment followup compared to patients treated with 

physiotherapy alone which consisted of active exercise, electrotherapy, ultrasound, and manual 

therapy (2.27 r 0.87 versus 1.66 r 0.91, p = 0.002). 

Subjects with nonspecific pain. 

Manipulation versus placebo. In one trial,312 patients randomized to a single cervical 

manipulation experienced significantly greater immediate post-treatment percent increase (40.0 

percent-55.0 percent) in pressure pain threshold (PPT) around fixation level of 4 tender points 

compared to placebo (0-0.8 percent, p < 0.0001). In another trial,310 spinal manipulation was 

more effective than sham treatment in patients with mechanical neck pain in improving pain 

(VAS) and cervical ROM. 

Manipulation versus no treatment. No relevant studies were identified. 

Manipulation versus mobilization. Results regarding the comparison of manipulation and 

mobilization in terms of improvement in pain and disability were reported for 3 trials and were 

inconsistent.65,309,310 For example, in one trial in 100 patients with unilateral mechanical pain, 

manipulation was found to be more effective (nonsignificant) than mobilization in immediate 

post-treatment improvement in pain intensity (NRS-101, VAS).309 In a larger trial (336 

patients),65 the intermediate-term post-treatment differences between the groups of manipulation 

and mobilization were clinically negligible and statistically nonsignificant with respect to pain 

intensity (NRS-11: -0.02, 95 percent CI: -0.69, 0.65) and disability (NDI: 0.46, 95 percent CI: ­

0.89, 1.82). 

In one trial, comparing two different modalities of the combined treatment of manipulation 

and mobilization (thrust versus nonthrust), thrust manipulation/ mobilization group achieved 

greater short-term post-treatment improvements in disability (between-group mean NDI score 

difference: 10.03, 95 percent CI: 5.3, 14.7) and pain intensity (between-group mean Numeric 

Pain Rating Scale score difference: 2.03, 95 percent CI: 1.4, 2.7) compared to nonthrust 

manipulation/mobilization group of patients.306 

Manipulation (type 1) versus manipulation (type 2). The effectiveness of manipulation based 

on endplay assessment and manipulation determined by sham was compared in one trial.327 The 

113
 
between-group differences in immediate/short-term post-treatment pain (NRS, McGill Pain 

Questionnaire or MPQ, VAS, PPT) and disability (NDI) were statistically nonsignificant. 

Manipulation versus other treatments. No relevant studies were identified. 

Manipulation versus medication. No relevant studies were identified. 

Manipulation + other treatments versus the same other treatments. No relevant studies were 

identified. 

Manipulation versus manipulation + other treatment. In one small trial323 of 6 subjects 

randomized to receive either manipulation alone or in combination with postisometric relaxation, 

no meaningful results were obtained regarding the between-group differences in immediate posttreatment disability (NDI score) or pain intensity (VAS score) due to small sample size. The 

manipulation alone group had a numerical favor over the combination group. 

Population with unknown duration of pain. This section included six trials comprising of 

patients with neck pain of unknown duration.307,313,318-320,324,325 One of these trials enrolled 

patients with specific pain (facet syndrome, whiplash injury)319,320 and the remaining five trials – 

patients with nonspecific neck pain.307,313,318,324,325 

Subjects with specific pain. 

Manipulation versus placebo. No relevant studies were identified. 

Manipulation versus no treatment. No relevant studies were identified. 

Manipulation (type 1) versus manipulation (type 2). In one trial of 30 patients with facet 

syndrome,319 two approaches of manipulation (i.e., top segment adjustment in the direction of the 

restriction versus top and bottom segment adjustments in the direction of the restriction and the 

opposite direction, respectively) were compared in terms of short-term post-treatment reduction 

in pain intensity (NRS-101, MPQ-short form) and disability (NDI). Both groups had 

significantly improved pain and disability measures. The only between-group difference was 

observed for cervical forward flexion ROM in favor of the top and bottom segment adjustment 

technique. 

Manipulation versus other treatments. No relevant studies were identified. 

Manipulation versus medication. No relevant studies were identified. 

Manipulation + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Manipulation versus placebo. In one trial,325 manipulation was compared to placebo with 

respect to immediate-term post-treatment reduction in pain intensity (VAS). In this trial, patients 

who received manipulation had a significantly greater mean reduction in VAS scores (15.5, 95 

percent CI: 11.8, 19.2) than those who received placebo (4.2, 95 percent CI: 1.9, 6.6). 

Manipulation versus no treatment. In one trial,324 manipulation groups had a modest 

improvement in cervical ROM or pain (VAS) compared to no treatment group. There was no 

significant difference between the manipulation and no treatment groups in immediate-term posttreatment pain intensity during left and right cervical rotation.324 

Manipulation (type 1) versus manipulation (type 2). In three trials,307,313,318 two different 

modalities of manipulation were compared. In the first trial,318 there was no significant 

difference in post-treatment pain (MPQ-short form, NRS-101), disability (NDI), or ROM 

between the two approaches of manipulation (cervical versus cervical/thoracic). In the second 

trial313 there was a modest advantage in improving muscle strength (in pounds) for manipulation 

applied in the upper and lower spine compared to that applied only in the lower spine (19.6 ± 6.5 

versus 15.5 ± 6.4, p = 0.05). The third study reported similar beneficial effect of cervical rotatory 

114
 
manipulation compared to supine lateral break manipulation in immediate and short-term posttreatment followup for pain intensity and disability (NRS, MPQ-short-form, and NDI), and 

cervical ROM.307 

Manipulation versus other treatments. No relevant studies were identified. 

Manipulation versus medication. No relevant studies were identified. 

Manipulation + other treatments versus the same other treatments. No relevant studies were 

identified. 

7 – Manipulation + Mobilization for Treatment of Neck Pain 

Two studies were included in this section, both of which were reported in multiple 

publications (Table 3). 

Population/trial characteristics. These studies were conducted in the Netherlands85and 

Australia.81 The proportion of females was greater (70 percent of all patients) for the Australian 

study.81 The treatment duration was 6 weeks in both trials. 

Manual therapy in these trials were compared with exercise, physiotherapy, and no treatment. 

Risk of bias. Both trials had fair risk of bias (i.e., scored two out of four on treatment 

allocation concealment, balance of baseline characteristics between the groups, patients’ blinding 

status, and reasons/number of dropouts/withdrawals). 

Efficacy. A summary of the key results is presented in Table 14. For further detail of the 

trials please see the evidence tables. (Appendix C, table 2.9 – table 2.16) 

Population with acute/ subacute pain. No relevant studies were identified (see one study85 

in the Population with Chronic Pain sub-section). 

Population with chronic pain. 

Subjects with specific pain. No relevant studies were identified. 

Subjects with nonspecific pain. 

Manual therapy versus placebo. No relevant studies were identified. 

Manual therapy versus no treatment. No relevant studies were identified. 

Manual therapy versus medication. No relevant studies were identified 

Manual therapy versus other treatments. In the first trial,85the use of manual therapy (spinal 

manipulation + mobilization) led to a significantly greater improvement in the main complaint 

(pain, and/or physical functioning measured by a 10-point scale) when compared to 

physiotherapy (exercise, massage, heat, electrotherapy, ultrasound, shortwave diathermy) in 

patients with chronic or sub-acute nonspecific neck pain. The mean difference in physical 

functioning at 12 weeks followup between physiotherapy and manual therapy while adjusting for 

baseline differences was 1.9. The unadjusted mean improvements from baseline in physical 

functioning at 12 weeks for the manual therapy and physiotherapy groups were 4.8 and 3.4, 

respectively. The mean changes in cervical ROM (forward flexion, lateral flexion, extension) 

between the groups ranged from zero to five degrees which were neither clinically meaningful 

nor statistically significant. The long-term results (12 months post-treatment)85,87 were reported 

for the combined sample of subjects with low back and neck pain and therefore are not presented 

in this review. 

In the second trial,81,83 spinal manipulation plus mobilization with or without exercise (low 

load endurance exercises aimed to train muscle control of the cervico-scapular region) and 

exercise alone did not differ in the degree of reducing headache frequency (average number of 

headache days per week), intensity (VAS score: 0-10) and neck pain (percentage of patients who 

115
 
improved  50 percent on a 10 point pain rating scale calculated from MPQ). However, all three 

active treatments were significantly better in reducing pain intensity and the frequency of 

headache than the control (i.e., no treatment) group (p < 0.001). In all active treatment groups, 

the median daily medication intake (Anatomical Therapeutic Chemical code) at 12 months posttreatment were significantly decreased (93 percent - 100 percent) compared to baseline. In 

contrast, the daily median medication intake in the no active treatment group increased by 33.0 

percent compared to baseline (p < 0.015). 

Population with mixed duration of pain. No relevant studies were identified. 

Population with unknown duration of pain. No relevant studies were identified. 

116
 
8– Manipulation for Treatment of Thoracic Pain 

Only one trial335 was identified and included in this section. In this trial, 30 subjects with 

nonspecific thoracic pain of unknown duration were randomized to receive either manipulation 

or placebo (nonfunctional ultrasound) for 3 weeks. The outcomes of interest, assessed 

immediately or short-term (1 month) after the end of treatment were ROM of the thoracic spine 

(flexion, extension, rotation) and pain threshold. The study authors also assessed subjective 

measures of pain intensity (VAS, MPQ) and disability (Oswestry). 

Population/trial characteristics. This trial was conducted in the United Kingdom. The 

participants were men (47 percent) and women 16 – 55 years old. Half of study participants were 

16 – 24 years old. Thoracic pain was located in mid section of thorax (T5 – T9) in 77 percent, 

and upper (T1 – T4) and lower sections (T10 – T12) of the thoracic spine in the remaining 23.0 

percent. The intervention consisted of thoracic spine manipulation (n = 15) and the control 

consisted of nonfunctional ultrasound application which the study considered as placebo 

treatment (n = 15). The patients received treatment until they were free of symptoms or up to a 

maximum of 6 treatments during a minimum period of 2 weeks to a maximum period of 3 weeks 

with two to three treatments per week. A followup consultation for reassessment took place 1 

month after the final treatment. 

Risk of bias. This trial was rated as high risk of bias. Neither randomization nor treatment 

allocation concealment could be ascertained. The care provider and outcome assessors were not 

blinded to the intervention. The dropout rates were not reported either. 

Efficacy. Please see Table 15 for the key efficacy results. Immediately after the end of 

treatment, there were statistically significant differences for right and left lateral flexion 

measures, between the manipulation and placebo groups, in favor of manipulation (p < 0.025). 

After 1 month of followup, the between-group differences for all the ROM measures were not 

statistically significant at Į = 0.025 (p > 0.025). The immediate post-treatment mean pain score 

(VAS) was significantly lower in the manipulation versus placebo group (21.9 ± 11.4 versus 35.6 

± 14.2, p = 0.014). Meanwhile, pain and disability scores of MPQ and Oswestry scales were not 

significantly different between the two groups of subjects. At 1 month of followup, only pain 

measured on MPQ was significantly lower in the manipulation versus placebo group (0.08 ± 0.18 

versus 0.13 ± 0.11, p = 0.03). 

117
 
Table 15 – Key Results – Manipulation therapy for thoracic pain 

CAM therapy Duration of 

pain 

Cause 

of 

pain 

Outcome 

Riskofbias 

Precision 

of the 

pooled 

estimate 

Consistency Directness Finding GRADE Ȍ

Man vs. PL Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS VAS: B 335 H - NA Direct > SS Low 

MPQ: B 335 H - NA Direct = S-NS Low 

MPQ: C 335 H - NA Direct > SS Low 

Oswestry: B 335 H - NA Direct = S-NS Low 

ROM (right/left 

lateral flx): B 335 

H - NA Indirect > SS Low 

ROM (flx, ext, 

rotation): C 335 

H - NA Indirect = S-NS Low 

S=specific; NS=nonspecific; SS=statistically significant; S-NS=statistically nonsignificant; Man=manipulation; Acu=acupuncture; Ma=massage; Mob=mobilization; PL=placebo; 

Tx=treatment. Med=medication(s); Int=intervention; PT=physiotherapy; ST=standard therapy; E-acu=electro-acupuncture; MR=muscle relaxation; TENS= transcutaneous 

electrical nerve stimulation; Ex=exercise; TrP=trigger point; VAS=visual analog scale; RMDQ=Roland Morris Disability scale; NHP=Nottingham Health Profile; PPT= pressure 

pain threshold; HFAQ=Hanover functional ability questionnaire; MPQ=McGill pain questionnaire; ext=extension; flx=flexion; rot=rotation; PDI=pain disability index; 

min=minute(s); hr(s)=hour(s); L=low; M=medium; H=high; pt(s)=patient(s); SF=short-form; NPQ=neck pain questionnaire; GWBS=global well-being scale; SLR=straight leg 

raising; GPE= Global perceived effect; NSAIDS=nonsteroidal antiinflammatory drugs; FTF=finger-to-floor; SF-PQ=short form pain questionnaire; PRI=pain rating index; 

PPI=present pain intensity; NA=not applicable 

118
 
Ȍ Grade (High, moderate, low, and insufficient) B = immediate post-treatment 

C = short-term post-treatment 

D = intermediate-term post-treatment 

E = long-term post-treatment 

H = high 

L = low 

M = medium 

- No evidence 

= Similar beneficial effect 

> Favors treatment A over treatment B 

< Favors treatment B over treatment A 

><, =>, <= Inconsistent beneficial effect 

119
 
9– Mobilization for Treatment of Low Back Pain 

 This section included 18 trials. One trial was reported in two publications (Table 3) 

Population/trial characteristics. The studies were conducted in Australia (three),336-338 

Canada (one),279, Bulgaria (one),339 China (one),340 Finland (four),341-344 Spain (one),345, Sweden 

(one),346 Thailand (one),347 United Kingdom, (one)348 and United States (four).55,349-351 

The proportion of men and women was similar in nine studies, 55,336,338-341,343,344,348 and 

differed (> 60.0 percent men or women) in six trials.279,337,345,347,350,351 Two studies included 

either only women346 or only men.349 Information on gender was not reported for one study.342 

The trials recruited adults with the mean age ranging from about 20.0 years349 to 47.0 

years.336 Table 16 presents the control interventions in the included studies. 

Table 16. Mobilization for treatment of low back pain- Control interventions 

Type of control Cause of N Detail of Control intervention 

group Pain studies 

1 – Inactive treatments 

Placebo/sham Non 

Specific 

2 Comfortable positioning of patients without physical 

contact ,348 sham mobilization339 

Specific 1 Manual transverse frictions on the gluteus medius 

muscles346 

No treatment Non 

Specific 

3 Control without any manual or physical treatments337,345,349 

Specific 0 NA 

2 – Active treatments 

Exercise/physical 

activity 

Non 

Specific 

3 Rhythmical bending of lumbar spine and stretching,342 

press up maneuver in prone position,350 home exercise 

with specific instruction by physiotherapist344 

Specific 1 Low-tech exercise consist of McKenzie technique and 

spinal stabilization exercises,351 high-tech exercise 

consist of cardiovascular, isotonic and isokinetic 

exercise351 

Physiotherapy Nonspecific 4 massage, therapeutic stretching, trunk stabilization 

exercise, exercise therapy,341 manual, thermal, and 

electrotherapies according to the Finnish routine, 

massage, specific mobilizations, and manual traction, 

stretching342 massage, therapeutic stretching and exercise 

therapy,343 manual therapy without thrusts, thermal, 

electrotherapy344 

Specific 0 NA 

Traction Nonspecific 1 Traction with sham mobilization,339 

Specific 0 NA 

Physical modalities Nonspecific 1 Sinous-modulated current therapy and sham 

mobilization,339 

Specific 1 Hot-pack, ultrasound, TENS,351 

Manual therapy Nonspecific 3 Spinal manipulation,55,279 massage347 

Specific 1 Massage340 

Other technique of 

spinal mobilization 

Nonspecific 1 Postero-anterior mobilization at the most symptomatic 

lumbar spine (vs. same technique at randomly selected 

lumbar level)338

 Specific 0 NA 

NA= not applicable 

120 
The number of treatments used in 10 studies ranged from one 279,336-338,345,347,349,350 to five 

sessions.341,343 In three studies, up to 10 342,344 or 12 sessions,339 and in one study351 – 24 

treatments sessions were provided. This information was not clearly reported for four 

studies.55,340,346,348 

Risk of bias. The risk-of-bias graph for the trials included in this sub-section is presented in 

Figure 31. All trials were randomized. The adequate method of randomization and treatment 

allocation concealment was reported for 38 percent and 19 percent of the trials, respectively. 

Only about half of the trials reported that distribution of the subjects’ baseline characteristics 

across the treatment arms was similar. In 69.0 percent of the trials, study participants were not 

blinded to the treatment. Up to 63.0 percent of the trials reported acceptable dropout rate. Results 

based on intention-to-treat analysis were explicitly reported for 31.0 percent of the trials. The 

data for selected items of the risk of bias tool across the CAM interventions (acupuncture; spinal 

manipulation; spinal mobilization; combination of manipulation and mobilization; and massage 

therapy) is displayed in table 7.1 of Appendix G. 

Figure 31. Risk of bias scores (%) 

0% 20% 40% 60% 80% 100% 

Q13 

Q12 

Q11 

Q10 

Q9 

Q8 

Q7 

Q6 

Q5 

Q4 

Q3 

Q2 

Q1 

Yes No Unclear 

Efficacy results. A summary of the key results is presented in Table 17. For further detail of the 

trials please see the evidence tables. (Appendix C, table 1.17 – table 1.20) 

121
 
Table 17. – Key results – Mobilization therapy for low back pain 

CAM therapy Duration of 

pain 

Cause 

of pain Outcome 

Risk 

-ofbias 

Precision of 

the pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

Mob vs. No 

Tx 

Acute/subacute S - - - - - - Insufficient 

NS VAS: B, C 349 H - NA > SS Low 

MPQ: B, C 349 H - NA Direct > SS Low 

Chronic S Oswestry: B, C 351 H - NA Direct = S-NS Low 

NS VAS: B 345 M - NA Direct > SS Low 

ROM (right and 

left side bending): 

B 345 

M - NA Indirect > SS Low 

RMDQ: B 345 M - NA Direct > SS Low 

Mixed S - - - - - - Insufficient 

NS VAS: B, C 337 H - NA Direct = S-NS Low 

ROM (flx, ext, 

FTF): B, C 337 

H - NA Indirect = S-NS Low 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mob vs. PL Acute/subacute S VAS: B 346 H - NA Direct = S-NS Low 

ROM (flx, ext): B

346 

H - NA Indirect = S-NS Low 

% pts using 

analgesics: B 346 

H - NA Indirect > SS Low 

Median duration 

of sick leave: B 346 

H - NA Indirect > SS Low 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS VAS: B, C 348 M - NA Direct = S-NS Low 

ROM (ext, FTF): 

B, C 348 

M - NA Indirect = S-NS Low 

ROM (full and 

total flx): B 348 

M - NA Indirect > SS Low 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mob vs. PT Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

122 
CAM therapy Duration of 

pain 

Cause 

of pain Outcome 

Risk 

-ofbias 

Precision of 

the pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

Chronic S Oswestry: B, C 351 H - NA Direct = S-NS Low 

NS VAS: B M Precise (2) £ 

341,343 

No Direct > SS Low 

Oswestry: B M Precise (2) 341,343 Yes Direct > SS Moderate 

FTF: B M Precise (2) 341,343 

Yes Direct = S-NS Moderate 

VAS: B, D 344 H - NA Direct = S-NS Low 

ROM (modified 

Schober test): B, 

D 344 

H - NA Indirect = S-NS Low 

SLR (degrees): B, 

D 344 

H - NA Indirect = S-NS Low 

ROM (ext; in 

degrees): B, D 344 

H 

-

NA Indirect = S-NS Low 

Mixed S - - - - - - Insufficient 

NS Oswestry: B 342 M - NA Direct = S-NS Low 

Oswestry: D 342 M - NA Direct > SS Low 

# of sick leave 

days: B, C, D 342 

M - NA Indirect = S-NS Low 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mob vs. Man Acute/subacute S - - - - - - Insufficient 

NS RMDQ: B 55 M - NA Direct < SS Low 

Chronic S - - - - - - Insufficient 

NS PPT: B 279 M - NA Direct = S-NS Low 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mob vs. Ma Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

123
 
CAM therapy Duration of 

pain 

Cause 

of pain Outcome 

Risk 

-ofbias 

Precision of 

the pooled 

estimate 

Consisten 

cy 

Directness Finding GRADE Ȍ

NS VAS: B 347 H - NA Direct < SS Low 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S VAS: B 340 H - NA Direct = S-NS Low 

NS - - - - - - Insufficient 

Mob vs. Ex Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS ROM (modified 

Schober test): B, 

D 344 

H - NA Indirect = S-NS Low 

SLR (degrees): B, 

D 344 

H - NA Indirect = S-NS Low 

ROM (ext; in 

degrees): B, D 344 

H 

-

NA Indirect = S-NS Low 

Mixed S - - - - - - Insufficient 

NS VAS: B 350 H - NA Direct = S-NS Low 

ROM (ext): B 350 H - NA Indirect = S-NS Low 

Oswestry: B 342 M - NA Direct = S-NS Low 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

S=specific; NS=nonspecific; SS=statistically significant; S-NS=statistically nonsignificant; Man=manipulation; Acu=acupuncture; Ma=massage; Mob=mobilization; PL=placebo; 

Tx=treatment. Med=medication(s); Int=intervention; PT=physiotherapy; ST=standard therapy; E-acu=electro-acupuncture; MR=muscle relaxation; TENS= transcutaneous electrical 

nerve stimulation; Ex=exercise; TrP=trigger point; VAS=visual analog scale; RMDQ=Roland Morris Disability scale; NHP=Nottingham Health Profile; PPT= pressure pain threshold; 

HFAQ=Hanover functional ability questionnaire; MPQ=McGill pain questionnaire; ext=extension; flx=flexion; rot=rotation; PDI=pain disability index; min=minute(s); hr(s)=hour(s); 

L=low; M=medium; H=high; pt(s)=patient(s); SF=short-form; NPQ=neck pain questionnaire; GWBS=global well-being scale; SLR=straight leg raising; GPE= Global perceived effect; 

NSAIDS=nonsteroidal antiinflammatory drugs; FTF=finger-to-floor; SF-PQ=short form pain questionnaire; PRI=pain rating index; PPI=present pain intensity; NA=not applicable 

124
 
Ȍ Grade (High, moderate, low, and insufficient) 

£ Number of pooled trials 

B = immediate post-treatment 

C = short-term post-treatment 

- No evidence 

= Similar beneficial effect 

D = intermediate-term post-treatment > Favors treatment A over treatment B 

E = long-term post-treatment < Favors treatment B over treatment A 

H = high ><, =>, <= Inconsistent beneficial effect 

L = low 

M = medium 

125 
Population with acute/subacute pain. There were four trials, of which, three trials studied 

subjects with nonspecific pain55,339,349 and one – subjects with cause-specific pain (i.e., pelvic 

joint dysfunction.346 

Subjects with specific pain. 

Mobilization versus placebo. In one trial,346 consisting of mostly women (96.0 percent) 

affected by sacroiliac joint dysfunction, there was no statistically significant difference in posttreatment pain intensity and lumbar mobility between subjects in the mobilization and placebo 

(massage therapy consisting of manual transverse frictions of the gluteus medius muscle) 

groups. The median number of analgesic pills taken was significantly higher in the placebo 

group (median: 3.5, range: 0-54) compared to mobilization group (median: 0, range: 0-132). The 

median duration of sick leave (in days) was also significantly greater in the placebo (median: 14, 

range: 0-26) versus mobilization group (median: 7, range: 0-35). 

Mobilization versus no treatment. No relevant studies were identified. 

Mobilization versus another type/method of the same CAM. No relevant studies were 

identified. 

Mobilization versus other treatments. No relevant studies were identified. 

Mobilization versus medication. No relevant studies were identified. 

Mobilization + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Mobilization versus placebo. No relevant studies were identified. 

Mobilization versus no treatment. In one trial,349 mobilization was compared to no treatment 

in post-treatment pain and disability. Immediately or short-term after the end of treatment, 

mobilization group had significantly lower pain scores (VAS, MPQ; p = 0.001) compared to ‘no 

treatment’ group. 

Mobilization versus another type/method of the same CAM. No relevant studies were 

identified. 

Mobilization versus other treatments. 

In one trial,339 immediate or intermediate-term post-treatment pain intensity was significantly 

lower in the mobilization group compared to electro-stimulation, traction, or medication group. 

Mobilization versus medication. No relevant studies were identified. 

Mobilization + other treatments versus the same other treatments. No relevant studies were 

identified. 

Mobilization versus manipulation. In one trial,55 2 weeks after the randomization, the 

manipulation group of subjects had a significantly better disability score (RMDQ) compared to 

the mobilization group. 

Population with chronic pain. Seven trials were included in this sub-section,.279,341,343­

345,347,351 Of these, six trials studied subjects with nonspecific LBP and one trial included postlaminectomy patients.351 

Subjects with specific pain. 

Mobilization versus placebo. No relevant studies were identified. 

Mobilization versus no treatment. Immediate and short-term post-treatment degree of 

disability (Oswestry score) did not differ between the mobilization and no treatment groups. 351 

Mobilization versus another type/method of the same CAM. No relevant studies were 

identified. 

126 
Mobilization versus other treatments. Immediate and short-term post-treatment degree of 

disability (Oswestry score) did not differ between the subjects who received mobilization and 

physiotherapy (physical modalities including exercise).351 

Mobilization versus medication. No relevant studies were identified. 

Mobilization + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Mobilization versus placebo. No relevant studies were identified. 

Mobilization versus no treatment. Kaltenborn’s wedge assisted posteroanterior mobilization 

was shown to be significantly superior to ‘no treatment’ in improving pain (VAS: p < 0.001), 

back bending mobility (right side: p < 0.004, left side: p < 0.02), and disability (RMDQ: p < 

0.003).345 

Mobilization versus another type/method of the same CAM. No relevant studies were 

identified. 

Mobilization versus other treatments. In two trials, mobilization (traditional bone setting 

technique) was compared with physiotherapy (massage, therapeutic stretching, trunk 

stabilization exercise, and exercise therapy) in terms of pain intensity (VAS), disability 

(Oswestry), back mobility (lateral bending), quality of life (HRQoL-15D questionnaire), and 

global assessment (scores from -1 to +10).341,343 In one of these trials,343 scores for 1 month 

post-treatment global assessment and quality of life were better in the mobilization compared to 

physiotherapy group. 

Based on the results from two meta-analyses (Figures 32-33), subjects with chronic 

nonspecific LBP in the mobilization groups had significantly reduced immediate post-treatment 

pain intensity (pooled mean difference in VAS score: -0.50, 95 percent CI: -0.72, -0.28)341,343 or 

disability (pooled mean difference in Oswestry score: -4.93, 95 percent CI: -5.91, -3.96) 341,343 

compared to those in the physiotherapy groups. According to a meta-analysis of the same trials 

(Figure 34),341,343 the mean difference in finger to floor distance (in cm) between the 

mobilization and placebo groups was not statistically significant (pooled mean difference: -0.89, 

95 percent CI: -1.89, 0.12) 

In one trial,344 there was no difference between subjects in the mobilization versus 

physiotherapy or exercise (light back movements) groups with respect to immediate and 

intermediate-term post-treatment pain intensity (VAS), ROM (modified Schober’s test; extension 

in degrees), and straight leg raising. In this study mobilization was performed by folk-healers 

practitioners who had no formal medical education. 

127
 
Figure 32. Pain intensity (VAS score) – Immediate post-treatment 

Difference in means and 95% CI Difference in means and 95% CI

Mobilization Physiotherapy Mobilization Physiotherapy FavorsFavors

Mobilization Mobilization Physiotherapy

Study Name N Mean (SD) N Mean (SD) N Mean (SD) N Mean (SD)

Ritvanen et al, 2007 Ritvanen et al, 2007 332.3 (0.5) 282.8 (0.4) -0.50 (-0.73, -0.27)

Zaproudina et al, 2009 Zaproudina et al, 2009 572.18 (2.5) 602.68 (2.0) -0.50 (-1.31, 0.31)

Poole d 90 88 -0.50 (-0.72, -0.28)

-2 -1 0 1 2 -2 -1 0 1 2

Heterogeneity: Chi2 = 0.0, df = 1 (P = 1.00); I2 = 0.0% 

Figure 33. Disability (Oswestry score) – Immediate post-treatment 

Difference in means and 95% CI Difference in means and 95% CI

Mobilization Physiotherapy Mobilization Physiotherapy FavorsFavors

Mobilization Mobilization Physiotherapy

Study Name N Mean ( SD) N Mean ( SD) N Mean (SD) N Mean (SD)

Ritvanen et al, 2007 Ritvanen et al, 2007 3312.0 (2.0) 2817.0 (2.0) -5.00 (-6.01, -3.99)

Zaproudina et al, 2009 Zaproudina et al, 2009 5712.3 (11) 6016.3 (9.9) -4.00 (-7.79, -0.21)

Poole d 90 88 -4.93 (-5.91, -3.96)

-10 -5 0 5 10 -10 -5 0 5 10

Heterogeneity: Chi2 = 0.24, df = 1 (P = 0.61); I2 = 0.0% 

Figure 34. Finger to floor distance (in cm) – Immediate post-treatment 

Difference in means and 95% CI

Mobilization Physiotherapy Mobilization Physiotherapy FavorsFavors

Mobilization Mobilization Physiotherapy

Study Name N Mean (SD) N Mean (SD) N Mean (SD) N Mean (SD)

Ritvanen et al, 2007 Ritvanen et al, 2007 335.4 (2.2) 286.3 (1.9) -0.90 (-1.94, 0.14) -0.90 (-1.94, 0.14)

Zaproudina et al, 2009 Zaproudina et al, 2009 573.1 (11.6) 603.8 (10.9) -0.70 (-4.41, 3.01) -0.70 (-4.41, 3.01)

Pooled 90 88 -0.89 (-1.89, 0.12) -0.89 (-1.89, 0.12)

-10 -5 0 5 10 -10 -5 0 5 10

Heterogeneity: Chi2 = 0.01, df = 1 (P = 0.91); I2 = 0.0% 

Mobilization versus medication. No relevant studies were identified. 

Mobilization + other treatments versus the same other treatments. No relevant studies were 

identified. 

Mobilization versus manipulation. In one trial,279 short-term post-treatment effects of 

mobilization and manipulation on pain were compared. The post-treatment pain pressure 

threshold was similar in the manipulation and mobilization groups. 

Mobilization versus massage In one trial,347 short-term post-treatment effects of mobilization 

and massage on pain were compared. The post-treatment pain intensity (VAS) was slightly but 

significantly greater in the mobilization group compared to the massage group (3.36 ± 0.25 

versus 2.48 ± 0.25, p = 0.017). 

Population with mixed duration of pain. Six trials were included in this sub-section.336­

338,342,348,350 All of these trials enrolled subjects with nonspecific LBP in whom the effect of 

128
 
mobilization was compared to that of ‘no treatment’,337 placebo,348 exercise,342,350 or 

physiotherapy.342 In two trials,336,338 two delivery modes of mobilization were compared 

(therapist-selected levels versus randomly selected levels). 

Subjects with specific pain. 

Mobilization versus placebo. No relevant studies were identified. 

Mobilization versus no treatment. No relevant studies were identified. 

Mobilization versus another type/method of the same CAM. No relevant studies were 

identified. 

Mobilization versus other treatments. No relevant studies were identified. 

Mobilization versus medication. No relevant studies were identified. 

Mobilization + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Mobilization versus placebo. In one trial,348 mobilization did not significantly differ from 

placebo (consisted of patients lying in a comfortable position with no manual intervention 

applied) in reducing immediate or short-term post-treatment pain intensity (VAS) or spinal ROM 

(flexion, extension, finger-to-floor). There was a small but a statistically significant difference in 

favor of mobilization (versus placebo) for improving spinal ROM (true flexion: 49.2o ± 16.4 

versus 45.3 o ± 14.1, p = 0.005; total flexion: 76.7 o ± 22.4 versus 69.7 o ± 21.5, p = 0.005) 

immediately after the treatment. The intervention was provided by experience physiotherapist 

trained for mobilization for movement techniques. 

Mobilization versus no treatment. In one trial, 337mobilization did not significantly differ 

from ‘no treatment’ in reducing immediate or short-term post-treatment pain intensity (VAS) or 

spinal ROM (flexion, extension, finger-to-floor). 

Mobilization (type1) versus mobilization (type2). In one of the two trials,336,338comparing 

therapist-selected levels to randomly selected levels of mobilization, current pain intensity was 

significantly reduced in the therapist-selected group (1.34, 95 percent CI: 1.02, 1.66) compared 

to the random group (0.88, 95 percent CI: 0.52, 1.24).338 The reduction in pain (NRS-11) was 

greater for subjects whose most painful movement was flexion (as opposed to extension, lateral 

flexion). The post-treatment spinal ROM (fingertip-to-floor, flexion, extension, lateral flexion, 

worst movement) or global perceived effect did not differ between the groups.338 In contrast, 

results from the other trial,336 indicated no significant difference between the two types of 

mobilization in terms of immediate pain reduction (NRS-11: 1.3 ± 1.4 versus 1.2 ± 1.7, p > 

0.05). Significant interaction effects were found for the most painful movement direction for the 

left (p = 0.006) and right lateral flexion (p = 0.02). 

A series of meta-analyses based on the above-mentioned trials (Figures 35-41)336,338 did not 

show any significant differences between the two modalities of mobilization for mean 

improvement in pain intensity (pooled mean reduction in VAS score: 0.29, 95 percent CI: -0.06, 

0.64), global perceived scale (0.20, 95 percent CI: -0.23, 0.62), extension (pooled mean change 

in degrees: 0.01, 95 percent CI: -0.83, 0.85), flexion (pooled mean change in degrees: 0.90, 95 

percent CI: 0.16, 1.96), and finger to floor distance (pooled mean change in degrees: 0.88, 95 

percent CI: -0.12, 1.88). Similarly, the pooled estimates for differences between mean changes of 

the two groups for right lateral flexion (0.14, 95 percent CI: -0.51, 0.79) and left lateral flexion 

(mean degrees: 0.31, 95 percent CI: -0.35, 0.96) were not statistically significant. 

129
 
Figure 35. Pain intensity (VAS score) – Immediate post-treatment 

Difference in mean change from baseline and 95% CI Difference in mean change from baseline and 95% CI

Therapist Ran Therapist domRan

Favors Favors Favors Favors

Study Name N Mean (SD) N Mean (SD) N Mean (SD) N Mean (SD) RandomTherapist

Chiradejnant et al, 2003 70 1.3 (1.4) Chiradejnant et al, 2003 70 1.3 (1.4) 70 1.2 (1.7) 70 1.2 (1.7) 0.10 (-0.42, 0.62)

Chiradejnant et al, 2002 60 1.34 (1.3) 0.46 (-0.02, 0.94) Chiradejnant et al, 2002 60 1.34 (1.3) 60 0.88 (1.4) 60 0.88 (1.4)

Pooled130130 0.29 (-0.06, 0.64)

-5 -2.5 0 2.5 5 -5 -2.5 0 2.5 5

Heterogeneity: Chi2 = 0.9, df = 1 (P = 0.31); I2 = 0.0% 

Figure 36. Global perceived scale – Immediate post-treatment 

Difference in mean change Difference in mean change from baseline and 95% CI from baseline and 95% CI

Therapist Random Therapist Random

Favors Favors Favors Favors

Study Name N Mean (SD) N Mean (SD) N Mean (SD) N Mean (SD) RandomTherapist

Chiradejnant et al, 2003 Chiradejnant et al, 2003 70 1.4 (1.8) 70 1.4 (1.8) 70 1.2 (1.9) 70 1.2 (1.9) 0.20 (-0.41, 0.81)

Chiradejnant et al, 2002 Chiradejnant et al, 2002 60 1.28 (1.4) 60 1.28 (1.4) 60 1.09 (1.9) 60 1.09 (1.9) 0.19 (-0.41, 0.79)

Pooled130130 0.20 (-0.23, 0.62)

-5 -2.5 0 2.5 5 -5 -2.5 0 2.5 5

Heterogeneity: Chi2 = 0.0, df = 1 (P = 0.98); I2 = 0.0% 

Figure 37. Range of mobility (lumbar extension) – Immediate post-treatment 

Difference in mean change from baseline and 95% CI

Therapist Random Therapist Random

Favor s Favo rs Study Name N Mean (SD) N Mean (SD) N Mean ( SD) N Mean ( SD) Random TherapistTherapist

Chiradejnant et al, 2003 Chiradejnant et al, 2003 70 2.2 (2.9) 70 2.2 (2.9) 70 2.6 (2.8) 70 2.6 (2.8) -0.40 (-1.34, 0.54) -0.40 (-1.34, 0.54)

Chiradejnant et al, 2002 Chiradejnant et al, 2002 60 2.48 (2.8) 60 2.48 (2.8) 60 2.02 (2.9) 60 2.02 (2.9) 0.46 (0.55, 1.47)

Pooled130130 0.01 (-0.83, 0.85)

-5 -2.5 0 2.5 -2.5 0 2.5 5

Heterogeneity: Chi2 = 1.5, df = 1 (P = 0.22); I2 = 32.6% 

130
 
Figure 39. Finger to floor distance (in cm) – Immediate post-treatment 

Difference in mean change from baseline and 95% CI Difference in mean change from baseline and 95% CI

Therapist Therapist Random

FavorsFavors Study Name N Mean (SD) N Mean (SD) N Mean ( SD) N Mean ( SD) RandomTherapist

Chiradejnant et al, 2003 Chiradejnant et al, 2003 70 2 (2.6) 70 2 (2.6) 70 0.5 (5.6) 70 0.5 (5.6) 1.50 (0.05, 2.95) 1.50 (0.05, 2.95)

Chiradejnant et al, 2002 Chiradejnant et al, 2002 60 1.5 (3.8) 60 1.5 (3.8) 60 1.04 (2.5) 60 1.04 (2.5) 0.46 (-0.68, 1.60)

Pooled130130 0.88 (-0.12, 1.88)

-5 -2.5 0 2.5 5 -5 -2.5 0 2.5 5

Heterogeneity: Chi2 = 1.2, df = 1 (P = 0.26); I2 = 18.2% 

Figure 40. Range of mobility (right lateral flexion; in degrees) – Immediate post-treatment 

Difference in mean change from baseline and 95% CI

Therapist Random Therapist Random

Favors Favors

Study Name N Mean (SD) N Mean (SD) N Mean (SD) N Mean (SD) Random TherapistTherapist

Chiradejnant et al, 2003 Chiradejnant et al, 2003 70 2.0 (2.5) 70 1.9 (2.7) 70 2.0 (2.5) 70 1.9 (2.7) 0.10 (-0.76, 0.96)

Chiradejnant et al, 2002 Chiradejnant et al, 2002 60 2.57 (2.9) 60 2.57 (2.9) 60 2.37 (2.6) 60 2.37 (2.6) 0.20 (-0.79, 1.19)

Pooled130130 0.14 (-0.51, 0.79)

-5 -2.5 0 2.5 5

Heterogeneity: Chi2 = 0.02, df = 1 (P = 0.88); I2 = 0.0% 

Figure 41. Range of mobility (left lateral flexion; in degrees) – Immediate post-treatment 

Difference in mean change from baseline and 95% CI Difference in mean change from baseline and 95% CI

Therapist Ran Therapist domRan

Favors Favors N Mean (SD) N Mean (SD) N Mean ( SD) N Mean ( SD) Study Name Random TherapistTherapist

Chiradejnant et al, 2003 Chiradejnant et al, 2003 70 2.2 (2.6) 70 2.2 (2.6) 70 2.2 (2.6) 70 2.2 (2.6) 0.00 (-0.86, 0.86)

Chiradejnant et al, 2002 Chiradejnant et al, 2002 60 2.75 (2.9) 60 2.75 (2.9) 60 2.08 (2.4) 60 2.08 (2.4) 0.67 (-0.27, 1.61)

Pooled130130 0.31 (-0.35, 0.96)

-5 -2.5 0 2.5 5

Heterogeneity: Chi2 = 1.0, df = 1 (P = 0.30); I2 = 5.6% 

Figure 38. Range of mobility (lumbar flexion) – Immediate post-treatment 

-5 -2.5 0 2.5 5

1.60 (-0.16, 3.36) 

0.50 (-0.83, 1.83) 

0.90 (0.16, 1.96) 

-5 -2.5 0 2.5 5

1.60 (-0.16, 3.36)

0.50 (-0.83, 1.83)

0.90 (0.16, 1.96)

Difference in mean change from baseline and 95% CI Difference in mean change from baseline and 95% CI

TherapistTherapist Random

Favor s Favo rs Study Name N Mean (SD) N Mean (SD) N Mean (SD) N Mean (SD) Rando m TherapistTherapist

Chiradejnant et al, 2003 Chiradejnant et al, 2003 70 3.5 (3.8) 70 3.5 (3.8) 70 1.9 (6.5) 70 1.9 (6.5)

Chiradejnant et al, 2002 Chiradejnant et al, 2002 60 1.8 (4.0) 60 1.8 (4.0) 60 1.3 (3.4) 60 1.3 (3.4)

Pooled130130

Heterogeneity: Chi2 = 0.9, df = 1 (P = 0.32); I2 = 0.0% 

131
 
Mobilization versus other treatments. Results from two trials comparing mobilization to a press 

up exercise indicated either no significant difference between the two in reducing pain (VAS) 

and lumbar ROM (total lumbar extension) immediately after the end of a single treatment350 or a 

slight numerical difference in favor of mobilization (bone-setting) (versus exercise) in reducing 

disability (Oswestry) at intermediate-term after the end of 6 weeks treatment (manual, thermal, 

and electrotherapies according to the Finnish routine) within-group reductions: 5.9 percent, p = 

0.009 versus 6.2 percent, p = 0.02, respectively).342 In the second trial,342 there was no difference 

between bone-setting and physiotherapy in terms of reduction of the Oswestry disability score 

(within-group reductions: 4.7 versus 4.0). In this trial, reduction in number of sick leaves was not 

statistically or clinically significant between the three groups during one year post intervention. 

The average number of visits to health centers for back pain decreased in all groups, with 

significant changes only in physiotherapy (mean change from year before therapy = 0.5 

compared with 0.1 in bone setting, and -0.1 in exercise group, p < 0.1).342 

Mobilization versus medication. No relevant studies were identified. 

Mobilization + other treatments versus the same other treatments. No relevant studies were 

identified. 

Population with unknown duration of pain. One trial was included in this section. This 

trail included subjects with lumbar intervertebral disc protrusion-induced back-leg pain.340 

Subjects with specific pain. 

Mobilization versus placebo. No relevant studies were identified. 

Mobilization versus no treatment. No relevant studies were identified. 

Mobilization versus massage. In one trial of subjects with LBP due to disc protrusion, there 

was no statistically significant difference in post-treatment pain intensity on VAS (5.59 ± 0.80 

versus 4.71 ± 0.52, p > 0.05) between the groups of mobilization (oblique-pulling method) and 

massage (kneading method of tender points).340 

Mobilization versus other treatments. No relevant studies were identified. 

Mobilization versus medication. No relevant studies were identified. 

Mobilization + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Mobilization versus placebo. No relevant studies were identified. 

Mobilization versus no treatment. No relevant studies were identified. 

Mobilization versus another type/method of the same CAM. No relevant studies were 

identified. 

Mobilization versus other treatments. No relevant studies were identified. 

Mobilization versus medication. No relevant studies were identified. 

Mobilization + other treatments versus the same other treatments. No relevant studies were 

identified. 

132
 
10 - Mobilization for Treatment of Neck Pain 

This section included 11 trials. Note that two trials were reported in multiple publications 

(Table 3). Results from four trials comparing mobilization to manipulation,65,308-310 are presented 

in the Spinal Manipulation section. Results from one trial are presented in Acupuncture 

section.265 Results of cost effectiveness for one trial62-64 are reported in the respective section. 

Population/trial characteristics. The trials were conducted in Finland (two)352,353, Belgium 

(one)354, Canada (two)309,355, Spain (one) 310, Germany (one)308, Sweden (one)356, Thailand 

(one)357, United States (one) 65, and the Netherlands (one).62 

In total, 1,504 patients were included in these trials. All studies recruited adults aged 18 years 

or older. In four studies, the majority were women.65,310,352,354 The proportion of men and women 

was similar in four studies,308,353,355,357 and differed in one study,358 and were not reported for two 

studies.309,356 Table 18 presents the control interventions in the included studies. 

Table 18. Spinal mobilization for treatment of neck pain- Control interventions 

Type of control 

group 

Cause of 

Pain 

N 

studies 

Detail of Control intervention 

1 – Inactive treatments 

Placebo/sham Non 

Specific 

3 Manual contact without any movement of cervical spine or 

tension in the region,308,355,356 

Specific 0 NA 

No-treatment/ 

waiting list 

Non 

Specific 

1 No physical contact355 

Specific 0 NA 

2 – Active treatments 

Education Non 

Specific 

0 NA 

Specific 

(whiplash) 

1 Information and advise on staying active,359 

Physiotherapy Nonspecific 1 Massage, therapeutic stretching, and exercise therapy,353 

Specific 0 NA 

Cervical collar Nonspecific 0 NA 

Specific 

(whiplash) 

1 Semi-rigid neck collar,359 

Physical 

modalities 

Nonspecific 0 NA 

Specific 1 Ultrasound,354 

Manual therapy Nonspecific 4 Manipulation,65,308-310 massage,353 

Specific 0 NA 

Other methods of 

mobilization 

Nonspecific 1 Randomly selected (vs. therapist selected) mobilization357 

Specific 1 Antero-posterior unilateral pressure,320 cervical oscillatory 

rotation,320 transverse oscillatory pressure320 

NA= not applicable 

In five trials, single session of treatment was applied.309,310,354,355,357 The duration of treatment 

in the remaining six trials was up to 8 weeks.62,65,308,352,353,356 

Risk of bias. The risk-of-bias graph for the trials included in this sub-section is presented in 

Figure 42. All trials were randomized. The adequate method of randomization and treatment 

allocation concealment was reported for 44.0 percent and 56.0 percent of the trials, respectively. 

About 67.0 percent of the trials reported that distribution of the subjects’ baseline characteristics 

across the treatment arms was similar. In 78.0 percent of the trials, study participants were not 

133
 
blinded to the treatment. Up to 56.0 percent of the trials reported acceptable drop-out rate. 

Results based on intention-to-treat analysis were explicitly reported for 22.0 percent of the trials. 

The data for selected items of the risk of bias tool across the CAM interventions (acupuncture; 

spinal manipulation; spinal mobilization; combination of manipulation and mobilization; and 

massage therapy) is displayed in table 7.2 of Appendix G. 

Figure 42. Risk of bias scores (%) 

0% 20% 40% 60% 80% 100% 

Q13 

Q12 

Q11 

Q10 

Q9 

Q8 

Q7 

Q6 

Q5 

Q4 

Q3 

Q2 

Q1 

Yes No Unclear 

Efficacy results. A summary of the key results is presented in Table 19. For more detail of 

trials please see evidence tables. (Appendix C, table 2.18 – table 2.19) 

134
 
Table 19 – Key results – Mobilization therapy for neck pain 

CAM therapy Duration of 

pain 

Cause 

of 

pain 

Outcome 

Riskofbias 

Precision 

of the 

pooled 

estimate 

Consistency Directness Finding GRADE Ȍ

Mob vs. No 

Tx 

Acute/subacute 

S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic 

S - - - - - - Insufficient 

NS VAS: B 355 M - NA Direct > SS Low 

PPT: B 355 M - NA Direct > SS Low 

Mixed 

S - - - - - - Insufficient 

NS 

VAS: B 352 H - NA Direct > SS Low 

Pain 

medications 

taken (# of pills 

annually): B, C 352 

H - NA Indirect = S-NS Low 

# of sick leave 

days: B, C, D 352 H - NA Indirect = S-NS Low 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mob vs. PL Acute/subacute S - - - - - - Insufficient 

NS VAS: B 308 M - NA Direct > SS Low 

Chronic S - - - NA - - Insufficient 

NS VAS: B 355 M - NA Direct = S-NS Low 

PPT: B 355 M - NA Direct > SS Low 

Mixed S - - - - - - -

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mob vs. Ma Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS VAS: D 353 M - NA Direct > SS Low 

NDI: D 353 M - NA Direct > SS Low 

# of sick leave 

days: D 353 

M - NA Indirect > SS Low 

135
 
CAM therapy Duration of 

pain 

Cause 

of 

pain 

Outcome 

Riskofbias 

Precision 

of the 

pooled 

estimate 

Consistency Directness Finding GRADE Ȍ

Global 

assessment 

(score: -1, +10): 

D 353 

M - NA Indirect 

> SS 

Low 

ROM (rotation, 

frons-knee 

distance): D 353 

M - NA Indirect 

= S-NS 

Low 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mob vs. PT Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS VAS: D 353 M - NA Direct > SS Low 

NDI: D 353 M - NA Direct > SS Low 

# of sick leave 

days: D 353 

M - NA Indirect > SS Low 

% pts using 

analgesics: D 353 

M - NA Indirect > SS Low 

Mixed S - - - - - - Insufficient 

NS VAS: D62 H - NA Direct > SS Low 

NDI: D62 H - NA Direct = S-NS Low 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mob vs. ST 

Acute/subacute S - - - - - - -

NS - - - - - - -

Chronic S - - - - - - -

NS - - - - - - -

Mixed 

S - - - - - - -

NS VAS: D62 H - NA Direct = S-NS Low 

NDI: D62 H - NA Direct = S-NS Low 

Unknown S - - - - - - -

NS - - - - - - -

S=specific; NS=nonspecific; SS=statistically significant; S-NS=statistically nonsignificant; Man=manipulation; Acu=acupuncture; Ma=massage; Mob=mobilization; PL=placebo; 

136
 
CAM therapy Duration of 

pain 

Cause 

of 

pain 

Outcome 

Riskofbias 

Precision 

of the 

pooled 

estimate 

Consistency Directness Finding GRADE Ȍ

Tx=treatment. Med=medication(s); Int=intervention; PT=physiotherapy; ST=standard therapy; E-acu=electro-acupuncture; MR=muscle relaxation; TENS= transcutaneous 

electrical nerve stimulation; Ex=exercise; TrP=trigger point; VAS=visual analog scale; RMDQ=Roland Morris Disability scale; NHP=Nottingham Health Profile; PPT= pressure 

pain threshold; HFAQ=Hanover functional ability questionnaire; MPQ=McGill pain questionnaire; ext=extension; flx=flexion; rot=rotation; PDI=pain disability index; 

min=minute(s); hr(s)=hour(s); L=low; M=medium; H=high; pt(s)=patient(s); SF=short-form; NPQ=neck pain questionnaire; GWBS=global well-being scale; SLR=straight leg 

raising; GPE= Global perceived effect; NSAIDS=nonsteroidal antiinflammatory drugs; FTF=finger-to-floor; SF-PQ=short form pain questionnaire; PRI=pain rating index; 

PPI=present pain intensity; NA=not applicable 

137
 
Ȍ Grade (High, moderate, low, and insufficient) B = immediate post-treatment - No evidence 

C = short-term post-treatment = Similar beneficial effect 

D = intermediate-term post-treatment > Favors treatment A over treatment B 

E = long-term post-treatment < Favors treatment B over treatment A 

H = high ><, =>, <= Inconsistent beneficial effect 

L = low 

M = medium 

138
 
Population with acute/subacute duration of pain. One trial,308 was included in this section. 

This trial enrolled patients with nonspecific pain. Additional results from this trial are also 

reported in the Spinal Manipulation, Acute Neck Pain sub-section. 

Subjects with specific pain. 

Mobilization versus placebo. No relevant studies were identified. 

Mobilization versus no treatment. No relevant studies were identified. 

Mobilization versus another type/method of the same CAM. No relevant studies were 

identified. 

Mobilization versus other treatments. No relevant studies were identified. 

Mobilization versus medication. No relevant studies were identified. 

Mobilization + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Mobilization versus placebo. In one trial,308 patients in mobilization group had significantly 

(p < 0.01) lower intensity of pain compared to placebo (hand placement without any pressure or 

tension). 

Mobilization versus no treatment. No relevant studies were identified. 

Mobilization versus another type/method of the same CAM. No relevant studies were 

identified. 

Mobilization versus other treatments. No relevant studies were identified. 

Mobilization versus medication. No relevant studies were identified. 

Mobilization + other treatments versus the same other treatments. No relevant studies were 

identified. 

Population with chronic duration of pain. There were two trials included in this subsection, one studied subjects with nonspecific chronic neck pain,355 and the other - subjects with 

specific chronic neck pain.358 

Subjects with specific pain. 

Mobilization versus placebo. No relevant studies were identified. 

Mobilization versus no treatment. No relevant studies were identified. 

Mobilization versus another type/method of the same CAM. No relevant studies were 

identified. 

Mobilization versus other treatments. No relevant studies were identified. 

Mobilization versus medication. No relevant studies were identified. 

Mobilization + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Mobilization versus placebo. In one trial,355 post-treatment mean VAS scores were not 

significantly different between mobilization and placebo (hand placement without movement of 

vertebral segment) groups (p = 0.09). However, the mobilization group had a significantly 

greater PPT mean score compared to the placebo group. 

Mobilization versus no treatment. In one trial, 355 post-treatment mean PPT and VAS scores 

in the mobilization group were significantly greater compared to no treatment group (p < 0.001 

and p = 0.04, respectively). 

Mobilization versus another type/method of the same CAM. No relevant studies were 

identified 

139 
Mobilization versus other treatments (including CAM). In one trial,353 subjects who received 

bone setting experienced significantly greater improvements in pain intensity (PPT, VAS) and 

disability level (NDI) compared to patients who received physiotherapy (massage, therapeutic 

stretching, and exercise therapy) or traditional massage. Moreover, patients in the bone-setting 

group during 1 year of followup had a lower number of sick leave days (0.61 per person) 

compared to those in the physiotherapy (2.6 per person) or the traditional massage group (3.9 per 

person). Similarly, the bone-setting group had a greater percent decrease in the use of analgesics 

compared to physiotherapy and traditional massage groups (65.7 percent, 50.0 percent, and 56.2 

percent, respectively). 

Mobilization versus medication. No relevant studies were identified. 

Mobilization + other treatments versus the same other treatments. No relevant studies were 

identified. 

Population with mixed duration of pain. There were eight trials included in this 

section.62,65,309,310,352,354,356,357 Only one trial included patients with pain due to specific cause - 

neurogenic disorder.354 In these trials clinical benefits/harms of mobilization were compared to 

those of no treatment,352 manipulation,65,309,310 mobilization,357 placebo,354, continued GP care,62 

physiotherapy,62 or analgesic medication.356 

Results from three trials where mobilization is compared to manipulation,65,309,310 are also 

presented in the Spinal Manipulation, Mixed Duration Neck Pain sub-sections. 

Subjects with specific pain. 

Mobilization versus placebo. No relevant studies were identified. 

Mobilization versus no treatment. No relevant studies were identified. 

Mobilization versus another type/method of the same CAM. No relevant studies were 

identified. 

Mobilization versus other treatments. In a small trial of 20 patients diagnosed with 

neurogenic cervicobrachial pain,354 the efficacy of mobilization performed by physical therapist 

was compared to pulsed ultrasound applied over the painful area. The application of mobilization 

technique was associated with statistically significant immediate post-treatment improvement 

compared to baseline in pain intensity on VAS (from 7.3 r 1.8 to 5.8 r 2.1, p = 0.005) and 

cervical ROM (from 137.3 r 15.4 to 156.7 r 10.7, p = 0.0005). In contrast, in control group, the 

corresponding within-group changes in VAS (from 7.7 r 1.9 to 7.4 r 1.8, p = 0.16) and ROM 

(from 130.2 r 14.7 to 130.7 r 16.0, p = 0.78) were not significant. Statistical test results for the 

inter-group comparisons (mobilization versus placebo) were not provided.354 

Mobilization versus medication. No relevant studies were identified. 

Mobilization + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Mobilization versus placebo. No relevant studies were identified. 

Mobilization versus no treatment. In one study,352 the use of bone-setting resulted in a 

significantly greater proportion of improved subjects (> 50 percent improvement in VAS) 

compared to control group (neither offered nor denied treatment) after 5 weeks (p = 0.04) and 6 

months ( p = 0.002) of treatment. This difference was not statistically significant after one year 

(p = 0.2). In this trial slight self-rated improvement compared with baseline was reported after 5 

weeks by 20/21 subjects in the massage group versus 3/17 subjects in the control group (p < 

0.001). These rates were 15/20 versus 6/18 (p = 0.01) after 5 weeks, and 16/20 versus 5/18 (p = 

0.002) after one year. There were no statistically significant differences between bone-setting 

140
 
and the no treatment group in the annual number of pain medications taken (63 r 146 versus 188 

r 332, p = 0.1) and the number of sick leave days (4.5 r 20.0 versus 16.9 r 53, p = not 

reported).352 

Mobilization (type 1) versus mobilization (type 2). One trial,357 comparing an immediate 

post-treatment effect of randomly chosen mobilization versus preferred mobilization, showed 

similar degree of global perceived effect (an ordinal 7-point scale; ranging from 1 = completely 

recovered to worse than ever = 7) and pain intensity (VAS) between the two groups. The same 

trial indicated the preferred mobilization group being superior to randomly chosen mobilization 

group with respect to cervical flexion ROM (p = 0.024). 

Mobilization versus other treatments. In one trial,62 spinal mobilization led to statistically 

significant improvement in pain intensity (VAS) compared to GP care which consisted of 

counseling and advice on staying active, role of psychosocial factors, self-care such as heat 

application, home exercises, and ergonomic advice (mean difference 0.9, 95 percent CI: 0.1, 1.5) 

but not to physiotherapy including specific exercises (mean difference 0.3, 95 percent CI: -0.6, 

1.2) in short term followup. At the same followup, there was no significant difference for 

disability (NDI) between the treatment groups. At 52 weeks, spinal manipulation faired 

statistically significantly better than physiotherapy (mean difference 1.0, 95 percent CI: 0.1, 1.9) 

in improving pain intensity (VAS), but not compared to GP care (mean difference 0.5, 95 percent 

CI: -0.4, 1.3). 

Mobilization versus medication. No relevant studies were identified. 

Mobilization + other treatments versus the same other treatments. In one trial,356 short-term 

post-treatment analgesic effect of mobilization and medication (Premaspin 0.5 g daily) was 

significantly greater compared to the same medication alone (pain free subjects: 48 percent 

versus 12 percent, p < 0.05). 

Population with unknown duration of pain. 

Subjects with specific pain. 

Mobilization versus placebo. No relevant studies were identified. 

Mobilization versus no treatment. No relevant studies were identified. 

Mobilization (type 1) versus mobilization (type 2). In one trial,320 there was a significantly (p 

< 0.001) higher proportion of pain-free subjects in the anterior-posterior unilateral pressure (63.0 

percent) and posterior-anterior unilateral pressure (46.0 percent) groups compared to subjects in 

the cervical oscillatory rotation (17.0 percent) and transverse oscillatory pressure groups (25.0 

percent). This trial included patients with cervical spondylolysis. 

Mobilization versus other treatments. No relevant studies were identified. 

Mobilization versus medication. No relevant studies were identified. 

Mobilization + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Mobilization versus placebo. No relevant studies were identified. 

Mobilization versus no treatment. No relevant studies were identified. 

Mobilization versus another type/method of the same CAM. No relevant studies were 

identified. 

Mobilization versus other treatments. No relevant studies were identified. 

Mobilization versus medication. No relevant studies were identified. 

Mobilization + other treatments versus the same other treatments. No relevant studies were 

identified. 

141
 
11 - Massage for Treatment of Low Back Pain

A total of 20 trials were included in this section. Four trials were reported in multiple 

publications (Table 3). 

Population/trial characteristics. The trials were conducted in Belgium (one),360 Canada 

(one),361 China (two),340,362 Germany (one),41 Hungary (one),363 Taiwan (two),364,365 Hong Kong 

(one),366 Thailand (two),347,367 United Kingdom (three),90,368,369 and United States 

(six).29,101,295,370-372 

The proportions of women and men were similar for 13 studies (40.0 percent-60.0 percent). 

29,41,295,340,360-363,365,369-372 In five studies, there were more women than men,90,347,364,366,367 and in 

one – more men.101 The proportions of men and women could not be ascertained for one trial.368 

The study participants were adults aged 18 or older. Information regarding ethnicity was 

reported for only three trials.29,370,372 For one Chinese study, the participants’ ethnicity was 

assumed to be Asian.362 The majority of subjects (> 65.0 percent) in two studies were 

Caucasians.29,372 The remaining studies did not report any data on ethnicity. 

In total 2,953 subjects with low back pain (of specific and nonspecific cause) were included 

in these trials and 884 of them were randomized to massage treatment. Table 20 presents the 

control interventions in the included studies. 

Table 20. Massage for treatment of low back pain- Control interventions 

Type of control Cause of N Detail of Control intervention 

group Pain studies 

1 – Inactive treatments 

Placebo/sham Non 

Specific 

3 Foot massage (avoiding points representative of the 

vertebrae of the spine and surrounding musculature),368 , 

minimal but continuous suction delivered by device,360 

sham laser361 

Specific 0 NA 

No-treatment/ 

waiting list 

Non 

Specific 

2 Routinely examined without therapy,360,363,366 

Specific 0 NA 

2 – Active treatments 

Exercise/physical 

activity 

Non 

Specific 

3 Specific (1st group), and nonspecific (2nd

 group) exercise in 

addition to sham massage,371 Alexander lesson techniques 

(multiple groups with various doses)90 training for home 

program,373 

Specific 0 NA 

Usual care Non 

Specific 

3 prescription by physician, and behavioral counseling with 

practice nurse,90 continued care by general practitioner369 

self care,29 

Specific 0 NA 

Physiotherapy Nonspecific 3 pelvic manual traction, spinal manipulation, thermotherapy, 

infrared light therapy, electrical stimulation, and 

exercise,364,365 massage + exercise + postural education361 

Specific 0 NA 

Relaxation Nonspecific 3 Progressive muscle relaxation techniques369,370,372 

Specific 0 NA 

Other Nonspecific 2 Lumbar corset,101 balenotherapy (mineral hydrotherapy) in 

two groups: with and without traction,363 traction,362 

Specific 0 NA 

Physical 

modalities 

Nonspecific 2 TENS,101,374 

Specific 0 NA 

142
 
Type of control Cause of N Detail of Control intervention 

group Pain studies 

Manual therapy Nonspecific 4 Manipulation,101,292,295, mobilization,347 

Specific 1 Oblique pulling (mobilization technique),340 

Other methods of 

massage 

Nonspecific 1 Swedish massage (light stroking or effleurage, and 

petrissage), 367 

Specific 0 NA 

Massage in 

combination with 

another 

treatment (versus 

massage alone) 

Nonspecific 0 NA 

Specific 3 Individual gymnastic exercise,41 exercise362 electro 

therapy339 

NA= not applicable; TENS=transcutaneous electrical nerve stimulation 

Generally, trials included multi-session treatments which ranged from under 14 

treatments,29,41,90,101,295,340,361,363-365,367-370,372-374 to 20 sessions339,362 in the course for the trial 

ranging from three to 10 weeks in total. Two studies were designed as single intervention 

trials.347,360 

Risk of bias. The risk-of-bias graph for the trials included in this sub-section is presented in 

Figure 43. All trials were randomized. The adequate method of randomization and treatment 

allocation concealment was reported for 50.0 percent and 20.0 percent of the trials, respectively. 

About 90.0 percent of the trials reported that distribution of the subjects’ baseline characteristics 

across the treatment arms was similar. In half of the trials, study participants were not blinded to 

the treatment. Up to 70.0 percent of the trials reported acceptable drop-out rate. Results based on 

intention-to-treat analysis were explicitly reported for 50.0 percent of the trials. The data for 

selected items of the risk of bias tool across the CAM interventions (acupuncture; spinal 

manipulation; spinal mobilization; combination of manipulation and mobilization; and massage 

therapy) is displayed in table 7.1 of Appendix G. 

143
 
Figure 43. Risk of bias scores (%) 

0% 20% 40% 60% 80% 100% 

Q13 

Q12 

Q11 

Q10 

Q9 

Q8 

Q7 

Q6 

Q5 

Q4 

Q3 

Q2 

Q1 

Yes No Unclear 

Efficacy results. A summary of the key results is presented in Table 21. For more detail of 

trials please see evidence tables. (Appendix C, table 1.35 – table 1.41) 

144
 
Table 21– Key results – Massage therapy for low back pain 

CAM therapy Duration of 

pain 

Cause 

of 

pain 

Outcome 

Risk 

-ofbias 

Precision 

of the 

pooled 

estimate 

Consistency Directnes 

s Finding GRADE Ȍ

Massage vs. 

No Tx 

Acute/subacute S - - - - - - Insufficient 

NS VAS: C 360 M - NA Direct > SS Low 

Oswestry: C 360 M - NA Direct > SS Low 

Chronic S - - - - - - Insufficient 

NS VAS: B, D 369 M - NA Direct = S-NS Low 

Oswestry: B, D 

369 

M - NA Direct = S-NS Low 

GHP: B, D 369 M - NA Direct = S-NS Low 

SF-36: B, D 369 M - NA Direct = S-NS Low 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Massage vs. 

PL 

Acute/subacute S - - - - - - Insufficient 

NS VAS: B, C 360,361 M - Yes Direct > SS Moderate 

Oswestry: C 360 

, 

M - NA Direct > SS Low 

RMDQ: B, C 

361 

M - NA Direct > SS Low 

MPQ: B, C

360,361 

M - Yes Direct > SS Moderate 

Chronic S - - - - - - Insufficient 

NS VAS: D 368 H - NA Direct = NR Low 

MPQ: D 368 H - NA Direct = NR Low 

RMDQ: D 368 H - NA Direct = NR Low 

SF-36: D 368 H - NA Direct = NR Low 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Massage vs. 

PT 

Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

145 
CAM therapy Duration of 

pain 

Cause 

of 

pain 

Outcome 

Risk 

-ofbias 

Precision 

of the 

pooled 

estimate 

Consistency Directnes 

s Finding GRADE Ȍ

Chronic S - - - - - - Insufficient 

NS VAS: D 364 M - NA Direct > SS Low 

SF-PQ: B, D 365 M - NA Direct > SS Low 

RMDQ: B, D 

364 

M - NA Direct > SS Low 

Modified 

Oswestry: B, D 

364 

M - NA Direct > SS Low 

# of days off 

from work: B, D 

364 

M - NA Indirect > SS Low 

VAS: B M Precise 

(2) 364,365 

Yes Direct > SS Moderate 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Massage vs. 

ST 

Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS RMDQ: D 90 M - NA Direct = S-NS Low 

VAS: D 90 M - NA Direct = S-NS Low 

SF-36: D 90 M - NA Direct = S-NS Low 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Massage vs. 

Ex 

Acute/subacute S - - - - - - Insufficient 

NS VAS: B, C 361 M - NA Direct > SS Low 

RMDQ: B, C 361 M - NA Direct > SS Low 

ROM (modified 

Schober test): B, 

C 361 

M - NA Indirect = S-NS Low 

Chronic S - - - - - - Insufficient 

146
 
CAM therapy Duration of 

pain 

Cause 

of 

pain 

Outcome 

Risk 

-ofbias 

Precision 

of the 

pooled 

estimate 

Consistency Directnes 

s Finding GRADE Ȍ

NS VAS: B 41,90 M - Yes Direct = S-NS Moderate 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Massage vs. 

TENS 

Acute/subacute S - - - - - - Insufficient 

NS VAS: B 101 H - NA Direct = S-NS Low 

ROM (Schober’s 

test: ext, flx): B 101 

H - NA Indirect = S-NS Low 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

- - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Massage vs. 

Relax 

Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic 

S - - - - - - Insufficient 

NS 

VAS: B H Imprecise 

(2) 370,372 

Yes Direct > SS Low 

ROM (flx): B H Imprecise 

(2) 370,372 

Yes Indirect = S-NS Low 

VAS: B, D 369 M - NA Direct = S-NS Low 

Oswestry: B, D 369 M - NA Direct = S-NS Low 

SF-36: B, D 369 M - NA Direct = S-NS Low 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

S=specific; NS=nonspecific; SS=statistically significant; S-NS=statistically nonsignificant; Man=manipulation; Acu=acupuncture; Ma=massage; Mob=mobilization; PL=placebo; 

147
 
CAM therapy Duration of 

pain 

Cause 

of 

pain 

Outcome 

Risk 

-ofbias 

Precision 

of the 

pooled 

estimate 

Consistency Directnes 

s Finding GRADE Ȍ

Tx=treatment. Med=medication(s); Int=intervention; PT=physiotherapy; ST=standard therapy; E-acu=electro-acupuncture; MR=muscle relaxation; TENS= transcutaneous 

electrical nerve stimulation; Ex=exercise; TrP=trigger point; VAS=visual analog scale; RMDQ=Roland Morris Disability scale; NHP=Nottingham Health Profile; PPT= pressure 

pain threshold; HFAQ=Hanover functional ability questionnaire; MPQ=McGill pain questionnaire; ext=extension; flx=flexion; rot=rotation; PDI=pain disability index; 

min=minute(s); hr(s)=hour(s); L=low; M=medium; H=high; pt(s)=patient(s); SF=short-form; NPQ=neck pain questionnaire; GWBS=global well-being scale; SLR=straight leg 

raising; GPE= Global perceived effect; NSAIDS=nonsteroidal antiinflammatory drugs; FTF=finger-to-floor; SF-PQ=short form pain questionnaire; PRI=pain rating index; 

PPI=present pain intensity 

148
 
B = immediate post-treatment - No evidence Ȍ Grade (High, moderate, low, and insufficient) C = short-term post-treatment = Similar beneficial effect £ Number of pooled trials D = intermediate-term post-treatment > Favors treatment A over treatment B 

E = long-term post-treatment < Favors treatment B over treatment A 

H = high ><, =>, <= Inconsistent beneficial effect 

L = low 

M = medium 

149 
Population with acute/subacute pain. There were five trials eligible for the inclusion in this 

sub-section, all of which studied subjects with sub-acute LBP of nonspecific cause.101,360,361,363,366 

Subjects with specific pain. 

Massage versus placebo. No relevant studies were identified. 

Massage versus no treatment. No relevant studies were identified. 

Massage versus another type/method of the same CAM. No relevant studies were identified. 

Massage versus other treatments. No relevant studies were identified. 

Massage versus medication. No relevant studies were identified. 

Massage + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Massage versus placebo. In two trials,360,361 the use of massage produced significantly lower 

immediate or short-term post-treatment pain intensity (VAS, MPQ) and disability scores 

(Oswestry, RMDQ) compared to placebo (minimal but continuous suction delivered by 

device,360 and sham laser361). For example, in one of these trials,361 the short-term post-treatment 

mean RMDQ scores in the massage and placebo groups were 2.86 ± 3.1 and 6.5 ± 4.2, 

respectively (p < 0.001). The corresponding values for pain intensity on the Pain Rating Index 

(PRI) were 4.5 ± 5.7 and 7.7 ± 6.0, respectively (p = 0.006). The massage and placebo groups 

did not differ in post-treatment lumbar ROM.361 One of these trials employed a single treatment 

design.360 

Massage versus no treatment. In one trial,360 the effect of a single massage treatment 

(roptrotherapy - deep cross-friction massage with a copper myofascial T-bar) was compared to 

that of ‘no treatment,’ showing significantly decreased pain intensity (VAS: 37.0 ± 19.0 versus 

52.0 ± 21.0, p < 0.001) and disability scores (Oswestry: 16.0 ± 5.0 versus 31.0 versus 12.0, p < 

0.001) amongst the massage-treated subjects compared to those in ‘no treatment’ group at shortterm post-treatment followup (1 week post-treatment). 

Massage versus another type/method of the same CAM. No relevant studies were identified. 

Massage versus other treatments. Massage was compared to other treatments in four 

trials.101,361,363,366 In the first trial,361 comprehensive treatment of massage plus exercise and 

postural education was shown to produce significantly greater short-term post-treatment 

improvements in pain intensity (PRI, VAS) and disability (RMDQ), compared to massage (softtissue manipulation), or remedial exercise alone. In the same trial, immediate or short-term posttreatment lumbar ROM did not differ across the massage, soft-tissue manipulation, and remedial 

exercise groups. Similarly, in the second trial,101 the magnitude of improvement immediately 

post-treatment in pain intensity (VAS), extension and flexion (using Schober method), or 

maximum voluntary extension effort (MVEE) was not significantly different in the massage 

versus spinal manipulation, TENS, or corset group. In the third trial,363 one year after the end of 

treatment, subjects who received underwater massage, underwater traction, or balneotherapy did 

differ in the use of analgesic pills (# taken daily: 2.3 ± 1.7 versus 2.1 ± 1.2 versus 1.9 ± 1.8, 

respectively) or pain intensity (VAS: 54.7 ± 33.7 versus 45.8 ± 26.2 versus 49.5 ± 25.7, 

respectively). In the fourth trial,366 acupressure on eight fixed acupoints with aromatic lavender 

essential oil (performed by a nurse trained in Chinese medicinal nursing) significantly improved 

short-term post-treatment pain intensity (VAS: 0.61 versus 0.99, p = 0.0001), walking time (in 

seconds: 0.91 versus 1.03, p = 0.05), and lateral fingertip-to-floor distance (in centimeters: 0.96 

versus 1.01, p = 0.01) compared with usual care. There was no significant difference between the 

two groups for post-treatment pain duration (in hours: 0.76 versus 1.05, p = 0.08). 

150 
Massage versus medication. No relevant studies were identified. 

Massage + other treatments versus the same other treatments. No relevant studies were 

identified. 

Population with chronic pain. There were 11 trials that were included in this 

section.29,41,90,347,364,365,368-372 Additional results (acupuncture versus massage) from one trial29 are 

reported in the Acupuncture, Chronic LBP sub-section. Results of one trial347 are presented in the 

Mobilization (Chronic LBP) sub-section. All trials included subjects with pain due to nonspecific 

causes. 

Subjects with specific pain. 

Massage versus placebo. No relevant studies were identified. 

Massage versus no treatment. No relevant studies were identified. 

Massage versus another type/method of the same CAM. No relevant studies were identified. 

Massage versus other treatments. No relevant studies were identified. 

Massage versus medication. No relevant studies were identified. 

Massage + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Massage versus placebo. In one trial,368 subjects randomized to massage (reflexology) had 

numerically similar degree of improvement in intermediate-term post-treatment pain intensity 

(VAS: 2.2 versus 3.3, MPQ: 6.0 versus 7.5), disability (MRDQ: 4 versus 3.5), and health status 

(SF-36: physical functioning and bodily pain) compared to subjects in the placebo group. 

Placebo intervention in this trial included light pressure foot massage which was avoided on the 

points used for intervention group. Note that this was a pilot study and it was not adequately 

powered to detect a pre-specified difference. 

Massage versus no treatment. The immediate and intermediate-term post-treatment effects of 

massage (reflexology) and ‘no treatment’ with respect to pain (VAS), disability (Oswestry), 

global health perception, and physical/social functioning (SF-36) were compared in one trial.369 

Although subjects in both groups improved in all outcomes, there was no significant betweengroup difference after the end of treatment. 

Massage versus another type/method of the same CAM. No relevant studies were identified. 

Massage versus other treatments. In three trials, massage370,372 or reflexology369 was 

compared to relaxation therapy in terms of post-treatment reduction in pain intensity (VAS, 

MPQ), disability (Oswestry), global health perception, physical/social functioning (SF-36), stress 

(mood , anxiety), and/or lumbar ROM (trunk flexion). In two of the three trials,370,372 massage 

was shown to produce significantly lower pain intensity, improved depression/anxiety score, 

ROM, and sleep compared to relaxation therapy, immediately after the end of treatment. In 

contrast, the third trial369 did not demonstrate any significant immediate (or intermediate-term) 

post-treatment differences in pain (immediate post-treatment VAS: 50.0 ± 25.7 versus 47.2 ± 

26.3), disability (immediate post-treatment Oswestry: 29.8 ± 19.6 versus 33.4 ± 22.3) or physical 

functioning (SF-36: 53.9 ± 27.8 versus 57.1 ± 30.2 ) between the massage versus relaxation 

therapy groups. In one trial,90 at 1 year post intervention, the groups receiving exercise followed 

by Alexander technique lessons (six or 24 lessons plus exercise prescription from a doctor, and 

counseling from a nurse) significantly improved in disability compared to subjects receiving six 

sessions of massage (mean difference from baseline in RMDQ: -3.40, 95 percent CI: -4.76, ­

2.03, versus -1.40, 95 percent CI: -2.77, -0.03 versus -0.58, 95 percent CI: -1.94, 0.77 for 24 and 

six lessons of Alexander technique, and massage, respectively). 

151
 
The meta-analyses based on pooled results of two trials370,372 were performed to quantify and 

compare the effects of massage and relaxation with respect to improving pain intensity (VAS 

score) and trunk flexion (touch toe without pain in cm) in subjects with chronic nonspecific LBP 

(Figures 44-45). The result of one meta-analysis indicated a significantly lower pain intensity in 

the massage compared to relaxation group (pooled mean difference on VAS score: -1.27, 95 

percent CI: -2.46, -0.08). Although the difference with respect to trunk flexion was numerically 

in favor of massage over relaxation, this difference did not reach the traditional level of statistical 

significance (pooled mean difference: 2.21, 95 percent CI: -1.10, 5.52). 

Figure 44. Pain intensity (VAS score) – Immediate post-treatment 

Difference in means and 95% CI

Massage Massage Relaxation FavorsFavors

Massage Massage Relaxation Study Name N Mean ( SD) N Mean ( SD) N Mean (SD) N Mean (SD)

Field et al, 2007 15 1.4 (1.6) 15 2.7 (2.4)

Hernandez-Reif et al, 2001 12 1.7 (2.3) 12 2.9 (2.8)

Pooled 27 27

-5.0 -2.5 0 2.5 5.0 

-1.30 (-2.76 (0.16) 

-1.20 (-3.25, 0.85) 

-1.27 (-2.46, -0.08) 

-5.0 -2.5 0 2.5 5.0

-1.30 (-2.76 (0.16)

-1.20 (-3.25, 0.85)

-1.27 (-2.46, -0.08)

Heterogeneity: Chi2 = 0.0, df = 1 (P = 0.93); I2 = 0.0% 

Figure 45. Range of mobility (trunk flexion: touch toe without pain) – Immediate post-treatment 

Difference in means and 95% CI 

Massage Relaxation Favors Favors 

Relaxation Massage Study Name N Mean ( SD) N Mean (SD) 

Field et al, 2007 15 61.9 (8.0) 15 

Hernandez-Reif et al, 2001 12 61.4 (7.4) 12 

Pooled 27 27 

60.7 (4.7) 

58.2 (3.6) 

1.20 (-3.50, 5.90) 

3.20 (-1.46, 7.86) 

2.21 (-1.10, 5.52) 

-10 -5 0 5 10 

Heterogeneity: Chi2 = 0.3, df = 1 (P = 0.55); I2 = 0.0% 

The immediate and intermediate-term post-treatment effects of massage (acupressure) and 

physical therapy (PT) were compared in two trials.364,365 Both trials demonstrated superiority of 

massage over PT in significantly better scores for pain intensity (VAS, Chinese version of ShortForm Pain Questionnaire – SF-PQ), disability (RMDQ, modified Oswestry questionnaire) or 

lower number of days off from work (1.5 ± 5.4 versus 3.5 ± 9.3, p < 0.05). In one of these 

trials,365 the intermediate-term post-treatment mean pain intensity score in the massage group 

was significantly lower compared to that in the PT group (SF-PQ: 1.08 ± 1.43 versus 3.15 ± 

3.62, p = 0.0004). The magnitude of benefit of massage relative to PT did not differ across age 

and gender groups.365 

The meta-analysis of two trials364,365 restricted to subjects with chronic nonspecific low back 

pain showed a statistically significant difference in favor of massage over physical therapy in 

152
 
Figure 46. Pain intensity (VAS score) – Immediate post-treatment 

Difference in means and 95% CI

Massage Physical Therapy Favors

Massage

Favors

Physical Therapy

Study Name N Mean ( ( SD) N Mean (SD)

Hsieh et al, 2004 69 2.3 (2.6) 77 5.1 (5.1)

Hsieh et al, 2006 64 3.1 (2.2) 65 4.8 (2.3)

Pooled 133 132

-2.80 (-4.14, -1.46) 

-1.70 (-2.48, -0.92) 

-2.11 (-3.15, -1.07) 

-2.80 (-4.14, -1.46)

-1.70 (-2.48, -0.92)

-2.11 (-3.15, -1.07)

-10 -5 0 5 10 -10 -5 0 5 10

Heterogeneity: Chi2 = 1.9, df = 1 (P = 0.16); I2 = 48.6% 

reducing pain intensity immediately post-treatment (pooled mean difference on VAS score: ­

2.11, 95 percent CI: -3.15, -1.07) (Figure 46). 

One trial demonstrated significantly lower pain intensity (VAS) and disability (HFAQ) 

scores for subjects after receiving acupuncture massage compared to Swedish massage followed 

by individual exercise.41 In another trial,29 immediate post-treatment symptom bothersomeness 

scale (p = 0.02) and disability (RMDQ; p < 0.001) scores were better in the massage versus selfcare group. After a 1 year followup, these differences were not significant (p = 0.42 and p = 0.97, 

respectively). In one study,371 subjects who received the combination of massage and specific 

exercise had a numerically lower immediate post-treatment pain intensity (VAS score) compared 

to those who received specific or nonspecific exercise alone. In the specific exercise group the 

post-treatment disability was significantly increased versus pre-treatment disability. 

Massage versus medication. No relevant studies were identified. 

Massage + other treatments versus the same other treatments. No relevant studies were 

identified. 

Massage versus standard therapy. In one trial,90 the effectiveness of massage was compared 

to that of normal care in improving pain intensity, disability (RMDQ), and quality of life (SF36). In this trial, there were significant reductions for all intervention groups in RMDQ disability 

score and days in pain at 3 months followup. However, no differences were observed in the 

disability scores between the massage and standard care groups. 

Population with mixed duration of pain. This sub-section included three trials.295,362,367 

One trial362 included subjects with LBP due to specific cause (i.e., disc herniation), and one 

trial367 subjects with nonspecific LBP. Results from one trial295 are reported in the Manipulation, 

Mixed LBP sub-section. 

Subjects with specific pain. 

Massage versus placebo. No relevant studies were identified. 

Massage versus no treatment. No relevant studies were identified. 

Massage versus another type/method of the same CAM. No relevant studies were identified. 

Massage versus other treatments. In one trial,362 the combination of massage and exercise 

was as effective as massage alone or more effective than traction in improvement of lumbar 

function among subjects with LBP due to disc herniation. 

153
 
Massage versus medication. No relevant studies were identified. 

Massage + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Massage versus placebo. No relevant studies were identified. 

Massage versus no treatment. No relevant studies were identified. 

Massage (type 1) versus massage (type 2). In one trial,367 subjects who received traditional 

massage (Thai-massage) did not differ from Swedish massage in pain intensity (VAS), disability 

(Owestry), and back flexion/extension immediately, short-term or log-term period after the end 

of treatment. 

Massage versus other treatments. No relevant studies were identified. 

Massage versus medication. No relevant studies were identified. 

Massage + other treatments versus the same other treatments. No relevant studies were 

identified. 

Population with unknown duration of pain. 

This sub-section included one trial, with subjects having specific LBP.340 Results of this trial 

are presented in the Mobilization alone (Unknown Duration LBP) sub-section. 

Subjects with specific pain. 

Massage versus placebo. No relevant studies were identified. 

Massage versus no treatment. No relevant studies were identified. 

Massage versus another type/method of the same CAM. No relevant studies were identified. 

Massage versus other treatments. No relevant studies were identified. 

Massage versus medication. No relevant studies were identified. 

Massage + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Massage versus placebo. No relevant studies were identified. 

Massage versus no treatment. No relevant studies were identified. 

Massage versus another type/method of the same CAM. No relevant studies were identified. 

Massage versus other treatments. No relevant studies were identified. 

Massage versus medication. No relevant studies were identified. 

Massage + other treatments versus the same other treatments. No relevant studies were 

identified. 

154
 
12 – Massage for Treatment of Neck Pain 

This section included 14 trials. Two trials were reported in multiple publications(Table 3). 

Results of two trials are also presented in the Acupuncture, Chronic Duration Neck Pain77 and 

Mobilization, Chronic Duration Neck Pain353 sections. 

Population/trial characteristics. The trials were conducted in Australia (one),43 China, 

(three)246,247,375 Germany, (one)77 Spain (two),376,377 Taiwan (one),378 Turkey (one),379 United 

Kingdom (two),380,381 and the United States (three).382-384 

All studies included adults of 18 years or older. The proportion of women and men were 

similar in two studies.375,376 In eight studies, the proportion of women (> 60 percent) was greater 

than that of men,43,77,377-379,382-384 and in one study, the proportion of men was greater than that of 

women (> 60 percent).246 In two studies, the proportions of men and women were similar.247,381 

The proportion of men/women could not be ascertained for one study.380 

In one study, the majority of patients were Caucasians.383 In trials conducted in China, the 

study participants’ ethnicity was assumed to be Asian,246,247,375 No ethnicity information was 

reported for the remaining studies. 

In total, 1,104 patients were included in these trials and 676 of them were randomized to 

massage only43,77,246,247,352,376-384 or to massage + other intervention.247,375,378,384 Table 22 presents 

the control interventions in the included studies. 

Table 22. Massage for treatment of neck pain- Control interventions 

Type of control Cause of N Detail of Control intervention 

group Pain studies 

1 – Inactive treatments 

Placebo/sham Non 

Specific 

2 Sham ultrasound,380,381

 Specific 2 Sham laser,77 sham myofascial release43 

No-treatment/ 

waiting list 

Non 

Specific 

1 Similar patient positioning as the massage 

group with not intervention,377 

Specific 2 Upright seated position with no 

intervention,382,384 

2 – Active treatments 

Usual care Non 

Specific 

0 NA 

Specific 1 Self care: home exercise program followed 

by moist heat and stretching,382 

Education Non 

Specific 

1 Self-care book,383 

Specific 0 NA 

Physiotherapy Nonspecific 1 Massage, therapeutic stretching, and 

exercise therapy,353 

Specific 0 NA 

Physical 

modalities 

Nonspecific 0 NA 

Specific 1 Hot pack (in multiple groups in combination 

with massage and other physical 

modalities),378 

Other treatments Nonspecific 1 Control: neither given nor denied 

treatment,352 

Specific 2 Traction,375 vapo-coolant spray and 

stretching technique,379 

Manual therapy Nonspecific 1 Bone setting,353 

155
 
Type of control Cause of N Detail of Control intervention 

group Pain studies 

Specific 0 NA 

Other methods of 

massage 

Nonspecific 4 Five session of massage (vs. ),353 trigger 

point pressure release,380 myofascial band 

therapy,381 progressive pressure of tender 

points,377 

Specific 1 Ischemic compression to average pain 

threshold in three different duration: 30, 60, 

and 90 seconds (vs. ischemic compression 

to pain threshold at 30, 60 and 90 

seconds),378 

Massage in 

combination with 

another treatment 

(vs. acupuncture 

alone) 

Nonspecific 0 NA 

Specific 4 Needle scalpel therapy,246 acupuncture and 

manipulation,247 head traction and extension 

exercise,384physical modalities,378 

NA= not applicable 

Number of massage treatment sessions varied and included a single treatment,43,378-381,384 five 

treatments over 3 weeks,77 up to 10 treatments,247,375,383 18 treatments,382 and 21 treatments246 

across all trials. 

Risk of bias. The risk-of-bias graph for the trials included in this sub-section is presented in 

Figure 47. All trials were randomized. The adequate method of randomization and treatment 

allocation concealment was reported for 38.0 percent and 19.0 percent of the trials, respectively. 

Only a half of the trials reported that distribution of the subjects’ baseline characteristics across 

the treatment arms was similar. In 56.0 percent of the trials, study participants were not blinded 

to the treatment. About 63.0 percent of the trials reported acceptable drop-out rate. Results based 

on intention-to-treat analysis were explicitly reported for 44.0 percent of the trials. The data for 

selected items of the risk of bias tool across the CAM interventions (acupuncture; spinal 

manipulation; spinal mobilization; combination of manipulation and mobilization; and massage 

therapy) is displayed in table 7.2 of Appendix G. 

156
 
Figure 47. Risk of bias scores (%) 

0% 20% 40% 60% 80% 100% 

Q13 

Q12 

Q11 

Q10 

Q9 

Q8 

Q7 

Q6 

Q5 

Q4 

Q3 

Q2 

Q1 

Yes No Unclear 

Efficacy results. A summary of the key results is presented in table 23. For further detail of 

the trials please see the evidence tables. (Appendix C, table 2.19 – table 2.26) 

157
 
Table 23 – Key results – Massage therapy for neck pain 

CAM therapy Duration of 

pain 

Cause 

of 

pain 

Outcome 

Riskofbias 

Precision 

of the 

pooled 

estimate 

Consistency Directness Finding GRADE Ȍ

Massage vs. 

No Tx 

Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS NPQ: B 382 M - NA Direct > SS Low 

ROM (ext, flx): B 382 

M - NA Indirect = S-NS Low 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S PPT: B 384 H - NA Direct = S-NS Low 

NS VAS: B 377 M - NA Direct > SS Low 

Massage vs. 

PL 

Acute/subacute S - - - - - - Insufficient 

NS  2-point 

decrease on 

NRS-11: B 381 

M - NA Direct > SS Low 

Chronic S VAS: B, C 77 H - NA Direct > SS Low 

ROM (ext, flx): B, 

C, D 77 

H - NA Indirect = NR Low 

SF-36 (role 

physical, pain 

index): D 77 

H - NA Direct = NR Low 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS PPT: B 43 H - NA Direct > SS Low 

Massage vs. 

Ex 

Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS NPQ: B 382 M - NA Direct > SS Low 

ROM (ext, flx): B 382 M - NA Indirect = S-NS Low 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

158 
CAM therapy Duration of 

pain 

Cause 

of 

pain 

Outcome 

Riskofbias 

Precision 

of the 

pooled 

estimate 

Consistency Directness Finding GRADE Ȍ

NS - - - - - - Insufficient 

Massage vs. 

PT 

Acute/subacute S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Chronic S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Mixed S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Unknown S - - - - - - Insufficient 

NS - - - - - - Insufficient 

Tx=treatment. Med=medication(s); Int=intervention; PT=physiotherapy; ST=standard therapy; E-acu=electro-acupuncture; MR=muscle relaxation; TENS= transcutaneous 

electrical nerve stimulation; Ex=exercise; TrP=trigger point; VAS=visual analog scale; RMDQ=Roland Morris Disability scale; NHP=Nottingham Health Profile; PPT= pressure 

pain threshold; HFAQ=Hanover functional ability questionnaire; MPQ=McGill pain questionnaire; ext=extension; flx=flexion; rot=rotation; PDI=pain disability index; 

min=minute(s); hr(s)=hour(s); L=low; M=medium; H=high; pt(s)=patient(s); SF=short-form; NPQ=neck pain questionnaire; GWBS=global well-being scale; SLR=straight leg 

raising; GPE= Global perceived effect; NSAIDS=nonsteroidal antiinflammatory drugs; FTF=finger-to-floor; SF-PQ=short form pain questionnaire; PRI=pain rating index; 

PPI=present pain intensity; NA=not applicable 

159
 
B = immediate post-treatment - No evidence 

Ȍ Grade (High, moderate, low, and insufficient) C = short-term post-treatment = Similar beneficial effect 

D = intermediate-term post-treatment > Favors treatment A over treatment B 

E = long-term post-treatment < Favors treatment B over treatment A 

H = high ><, =>, <= Inconsistent beneficial effect 

L = low 

M = medium 

160 
Population with acute/subacute pain. There was one trial evaluating the effectiveness of 

massage given to patients with subacute neck pain.381 

Subjects with specific pain. 

Massage versus placebo. No relevant studies were identified. 

Massage versus no treatment. No relevant studies were identified. 

Massage versus another type/method of the same CAM. No relevant studies were identified. 

Massage versus other treatments. No relevant studies were identified. 

Massage versus medication. No relevant studies were identified. 

Massage + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Massage versus other treatments or placebo. This trial included patients with nonspecific 

neck pain who were randomized to receive trigger point therapy, myofascial band therapy, or 

placebo (ultrasound).381 Although the trial authors measured pain intensity (NRS-11, PPT) and 

cervical ROM, the results were reported on a dichotomous scale (i.e., odds ratios, number needed 

to treat) instead of continuous scale (i.e., mean scores). The patients treated with trigger point 

therapy were seven times more likely to improve in terms of pain reduction (decrease of at least 

two points on NRS-11) compared to patients treated with myofascial band therapy or placebo 

(odds ratio: 7.4, 95 percent CI: 1.22, 45.02).381 

Massage versus no treatment. No relevant studies were identified. 

Massage versus another type/method of the same CAM. No relevant studies were identified. 

Massage versus other treatments. No relevant studies were identified. 

Massage versus medication. No relevant studies were identified. 

Massage + other treatments versus the same other treatments. No relevant studies were 

identified. 

Population with chronic pain. A total of four trials restricted to patients with specific 

(whiplash injuries, myofascial pain syndrome)77,379,382 and nonspecific neck pain,383 were 

included in this sub-section. 

Subjects with specific pain. 

Massage versus placebo. In one trial,77 patients with whiplash and myofascial pain syndrome 

who received massage had lower pain intensity compared to those in sham laser group (VAS: 

7.89 versus 17.28, p < 0.05). 

Massage versus no treatment. In one trial,382 immediate post-treatment mean NPQ score was 

significantly lower in the massage group (13.24 ± 11.88) compared with that in no treatment 

group (35.64 ± 12.54). The patients who received massage had a slight but only numerically 

greater cervical ROM extension (49.38 ± 13.71) and flexion (50.0 ± 3.74) compared to those 

who had not received any treatment (extension: 46.80 ± 13.60, flexion: 44.1 ± 12.28). 

Massage versus another type/method of the same CAM. No relevant studies were identified. 

Massage versus other treatments. There was one trial evaluating the clinical benefits of 

massage compared with vapocoolant spray in the treatment of patients with chronic myofascial 

pain syndrome.379 The application of massage did not differ from vapocoolant spray in reducing 

immediate post-treatment pain on VAS (2.60 ± 1.73 versus 2.88 ± 1.50) or increasing cervical 

ROM (flexion, extension). The only significant difference was observed for rotation to left in 

favor of spray versus massage (78.65 versus 72.45, p < 0.05).379 

In another trial,382 immediate post-treatment mean NPQ score was significantly lower in the 

massage group (13.24 ± 11.88) compared to that in the exercise group (20.23 ± 12.06). In this 

161 
trial, patients who received massage had a slight but only numerically greater cervical ROM 

extension (49.38 ± 13.71) and flexion (50.0 ± 3.74) compared to those who received exercise 

(extension: 48.38 ± 11.8, flexion: 48.62 ± 14.04). 

Massage versus medication. No relevant studies were identified. 

Massage + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Massage versus placebo. No relevant studies were identified. 

Massage versus no treatment. No relevant studies were identified. 

Massage versus another type/method of the same CAM. No relevant studies were identified. 

Massage versus other treatments. In one trial,383 there was no difference in immediate and 

intermediate-term post-treatment degree of disability between patients who received 10 weeks of 

massage and self-care instruction (16 weeks post-treatment difference in NDI mean score: -1.9, 

95 percent CI: -4.4, 0.63, p = 0.14). At 16 weeks post-treatment, the use of medication, which 

was similar in the groups at baseline, increased by 14.0 percent in the self-care group but did not 

change in the massage group.383 

Massage versus medication. No relevant studies were identified. 

Massage + other treatments versus the same other treatments. No relevant studies were 

identified. 

Population with mixed duration of pain. A total of six trials restricted to patients with 

specific (whiplash injury, spondylosis, spondylopathy, myofascial pain syndrome)246,247,375,376 

and nonspecific380 neck pain of mixed duration (acute, sub-acute, chronic) were included in this 

section. 

Subjects with specific pain. 

Massage versus placebo. No relevant studies were identified. 

Massage versus no treatment. No relevant studies were identified. 

Massage versus another type/method of the same CAM. No relevant studies were identified. 

Massage versus other treatments. No relevant studies were identified. 

Massage versus medication. No relevant studies were identified. 

Massage + other treatments versus the same other treatments. No relevant studies were 

identified. 

Massage alone versus massage (combined or alone). In one trial,376 40 patients with 

myofascial pain syndrome experienced equal immediate post-treatment clinical benefit in terms 

of pain intensity reduction after being randomized to receive either ischemic compression (PPT: 

2.2 r 0.6 and VAS: 3.8 r 0.9) or transverse friction massage (PPT: 2.35 r 0.4 and VAS: 4.2 r

0.4; for both outcomes between-group p > 0.40). 

In two trials246,247 of patients with spondylosis or spondylopathy, massage combined with 

either acupoint injection247 or needle scalpel246 produced statistically significantly greater rates of 

cure (post-treatment absence of symptoms and physical signs) compared with massage alone. 

Massage + other treatment versus other treatment. In one Chinese study,375 the combination 

of massage and traction was compared to traction alone in subjects with spondylopathy. The 

immediate post-treatment improvement score (measured using Cervical Spondylopathy 

Therapeutic Effect Rating Scale) but not effective rate (subjects with improved clinical and body 

symptoms but partially affected daily activities) was significantly higher in the massage 

combination versus traction alone group (0.50 ± 0.16 versus 0.36 ± 0.14, p < 0.01). 

162
 
Subjects with nonspecific pain. 

Massage versus placebo. No relevant studies were identified. 

Massage versus no treatment. No relevant studies were identified. 

Massage (type 1) versus massage (type2). In one trial, 380 the effectiveness of ischemic 

compression and trigger point pressure release was compared. In this trial, patients had similar 

post-treatment pain intensity (VAS, PPT) across the randomized groups. For example, the effect 

on mean VAS scores was similar (p > 0.10) for patients treated with ischemic compression (22.9 

r 12.7) versus sham ultrasound (22.6 r 8.2). Likewise, no between-group differences (p > 0.10) 

were found in relation to the mean pain pressure threshold (PPT) scores (4.45 r 1.69 versus 3.77 

r 1.76 versus 3.37 r 1.62).380 

Massage versus other treatments. No relevant studies were identified. 

Massage versus medication. No relevant studies were identified. 

Massage + other treatments versus the same other treatments. No relevant studies were 

identified. 

Population with unknown duration of pain. A total of four studies were included which 

enrolled patients with specific (myofascial trigger point syndrome),43,378,384 or nonspecific

377 cause.

Subjects with specific pain. 

Massage versus placebo. In one trial,43 the application of manual pressure to trigger points 

(to patient’s pain tolerance level) sustained for 60 seconds resulted in a statistically greater 

improvement compared to sham myofascial release (p < 0.001). 

Massage versus no treatment. No relevant studies were identified. 

Massage (type 1) versus massage (type2). In one trial,384 single treatment with either 

occipital release (O/R), active head retraction with extension exercises , or no treatment did not 

differ in reducing sensitivity (PPT in kg/cm2) of cervical and scapular trigger points (2.5 r 1.1 

versus 2.8 r 1.3 versus 2.6 r 1.5, p = NR). 

In another trial,378 immediate effects of ischemic pressure applied at two intensities (low 

pressure = at pain threshold, high pressure = at averaged pain threshold and tolerance) were 

measured. The use of ischemic compression therapy with low pressure (90 seconds) and high 

pressure (60 – 90 seconds) was associated with a significant reduction of pain (VAS), elevation 

of pain tolerance, and improvement of ROM compared to that of ischemic compressions with 

low or high pressure at shorter durations (p < 0.05). 

Massage versus other treatments. No relevant studies were identified. 

Massage versus medication. No relevant studies were identified. 

Massage + other treatments versus the same other treatments. No relevant studies were 

identified. 

Subjects with nonspecific pain. 

Massage versus placebo. No relevant studies were identified. 

Massage versus no treatment. In one trial,377 both classical and modified strain/counterstrain 

techniques produced significantly better immediate post-treatment pain intensity scores (VAS) 

compared to no treatment in subjects with nonspecific neck pain (p < 0.001). The ‘no treatment’ 

group in this study did not experience any change from baseline in the pain intensity measure (p 

> 0.30). 

Massage (type 1) versus massage (type2). In one trial, 377 local pain elicited by application of 

4.5 kg/cm2

 of pressure on the tender points improved after a single treatment with either classical 

or modified strain/counterstrain technique in subjects with nonspecific neck pain. However, the 

163
 
difference in immediate post-treatment VAS scores between the two classical and modified 

strain/counterstrain groups was not statistically significant (p = 0.8). 

Massage versus other treatments. No relevant studies were identified. 

Massage versus medication. No relevant studies were identified. 

Massage + other treatments versus the same other treatments. No relevant studies were 

identified. 

Cost Effectiveness 

In total 10 trials were included for cost-effectiveness of CAM treatment for 

LBP24,72,94,112,125,385,386, and neck pain.63,89,130 The trials recruited patients with nonspecific pain 

(Table 24 and 25). 

Low Back Pain 

We identified 10 studies.24,29,72,94,112,125,224,278,385,386 Of these 10 studies, seven were reports of 

full economic evaluations of the cost-effectiveness of spinal manipulation72,125,385,386, 

acupuncture,24,112 and massage 94 for low back pain. The three remaining studies had not 

performed a full economic evaluation by combining differences in costs and effects of the two 

(or more) compared alternatives and therefore were excluded from the review.29,224,278 

Population/trial characteristics. The studies were conducted in Finland,385 Germany,24 

Sweden,386 United Kingdom,94,112,125 and United States.72 The mean age ranged from 37 to 54 

years and the proportion of men and women were balanced in all trials. In total, 5,984 

participants with nonspecific LBP were included in these seven trials. The duration of pain was 

acute in one trial,386, chronic in three trials,24,94,385 and mixed in three trials.72,112,125 

Acupuncture. Ratcliffe et al,112 compared individualized acupuncture treatment for 3 months 

from acupuncturists trained in traditional Chinese medicine with usual care. The study 

population consisted of patients with subacute and chronic low back pain. The total costs of 

health care utilization during 2 year followup were higher in the acupuncture group ($859) 

compared with the usual care group ($645). The difference in health gain was .012 QALY at 1 

year and 0.027 QALY at 2 year followup. The incremental cost-utility ratio was $7931 per 

QALY gained. From the health services perspective, the acceptability curve showed that 

acupuncture had a more than 90 percent chance of being cost-effective at a $37,400 (GBP 

20,000) per QALY threshold. The study showed that, from societal perspective (including costs 

of health care utilization, patient costs and costs of productivity losses) acupuncture was more 

dominant (i.e. less costly and more effective) compared with GP care. 

Witt et al,24 conducted an economic evaluation alongside a large randomized trial (N=3093) 

comparing acupuncture with no treatment (delayed acupuncture) in patients with chronic low 

back pain. The difference in QALYs at 3 months between the acupuncture and control group was 

0.03. The costs of acupuncture were higher than the costs of the control group; mean difference 

at 3 months was $423 (95 percent CI: 224, 622) in total costs, and $461 (95 percent CI: 342, 579) 

in back pain specific costs. The incremental cost-utility ratios were $15,895 (Euro 10,526) per 

QALY gained for overall costs and $17,321 (Euro 11,470) per QALY gained for back pain 

specific costs. At a threshold of $22,662 (Euro 15,000) per QALY acupuncture had a more than 

90 percent chance of being cost-effective. 

164
 
Spinal manipulation. Four full economic evaluations on spinal manipulation were 

identified.72,125,385,386 In a large randomized control study 72 that recruited patients from a large 

medical group practices (HMO), the authors compared four treatments: chiropractic care (spinal 

manipulation), chiropractic care plus physical modalities (heat, cold, ultrasound, and electrical 

muscle stimulation provided by chiropractor), medical care, and medical care plus physical 

therapy. (Table 22) The study population consisted of 681 acute, subacute or chronic low back 

pain patients. The authors conducted a cost-minimization analysis, given that that previously 

published findings showed no clinically meaningful difference in effects between these four 

treatments. The results showed that the adjusted mean outpatient costs of low back pain in 18 

months were $765 for medical care plus physical therapy, $565 for chiropractic plus physical 

modalities, $550 for chiropractic, and $463 for medical care. The authors concluded that costs 

were higher for chiropractic care compared with medical care without producing better clinical 

outcomes. Physical therapy in addition to medical care does not seem to be a cost-effective 

strategy for low back pain. However, the authors did not include in their analyses pharmaceutical 

costs and costs of production loss. 

Niemisto,385 compared a combined intervention of physician consultation, spinal 

manipulation and stabilizing exercises to physician consultation alone in 204 patients with 

chronic low back pain. The economic evaluation was conducted from a societal perspective. 

Costs of health care consumption and costs of productivity loss were included. There were no 

statistically significant differences in costs between the two groups. The incremental cost of the 

combination treatment compared with the physician consultation only for one point improvement 

on pain intensity (100 mm VAS) was $23. 

Seferlis et al,386 conducted a cost-minimization analysis of manual therapy, general 

practitioner care, and intensive training, since a previously conducted randomized trial had not 

identified any statistically significant differences in clinical effects between the three 

interventions. The study population consisted of patients with acute low back pain. Direct and 

indirect costs were included. The results showed that direct costs per patient were $1,054 for 

manual therapy, $404 for GP care, and $1,123 for intensive therapy. Indirect costs per patient 

were $6,163 for manual therapy, $7,072 for GP care, and $5,556 for intensive therapy. Finally, 

the total costs per patient were $7,217 for manual therapy, $7,476 for GP care, and $6,680 for 

intensive therapy. This study did not report any quality of life or additional cost of drug 

outcomes. There were no statistically significant differences in costs between the groups. 

The UK BEAM trial,125 compared the cost-effectiveness of adding spinal manipulation, 

exercise classes, or manipulation followed by exercise (combined treatment) to “best care” in 

general practice for patients with subacute and chronic low back pain. Results showed that 

adding spinal manipulation to GP care was effective in improving QALY compared to GP care 

alone, and would cost $ 8880 per QALY gained from the health sector’s perspective. In contrast, 

adding both spinal manipulation and exercise to GP care did not statistically significant improve 

QALY compared to GP care alone, but would only cost $7030 per QALY gained. The authors 

concluded that spinal manipulation in addition to GP care appeared relatively cost-effective 

compared to GP care alone from the health sector’s perspective.125 

Massage. Hollinghurst et al,94 reported an economic evaluation of therapeutic massage, 

exercise, Alexander technique and usual GP care in patients with chronic and recurrent low back 

pain. The authors used a 4 X 2 factorial design in which participants were randomized to one of 

eight groups. Total NHS costs over 1 year (costs of interventions, GP visits, other primary and 

secondary care, and medication) were $460 (± 364) for the massage group (n=64), $97 (± 179) 

165
 
for GP care without exercise (n=60), $388 (± 260) for 6 sessions of Alexander technique without 

exercise (n=53), $1,087 (± 467) for 24 sessions of 

Alexander technique without exercise (n=61), $427 (± 190) for 6 sessions of Alexander 

technique with exercise (n=57), $1,177 (± 585) for 24 sessions of Alexander technique with 

exercise (n=56), $476 (± 647) for massage with exercise (n=56), and $275 (± 932) for GP care 

with exercise (n=51). Exercise had the highest probability of being the most cost-effective first 

choice of therapy. The acceptability curves showed that if exercise is the first choice, at a 

threshold of GBP $18,000 per QALY, the chance that a second intervention is cost-effective is 

80 percent. 

166
 
Table 24. Summary of RCTs reporting data on economic evaluation of CAM versus other treatments- Low back pain 

Hollinghurst, S 

ATEAM study 

(2008)90,94 

UK 

Author, Year 

Country of Study 

N= 579 

LBP, N-S; Chronic 

N (sample size) 

Region, Cause, 

Duration of Pain 

x Intervention: 

massage, and six or 24 

lessons in the 

Alexander technique. 

x Control: Normal care 

(control) 

50% of each group 

randomized to exercise 

(by GP) + behavioral 

counseling (by a nurse) 

Intervention/s 

Costs to NHS & cost to 

participants 

(incremental cost 

effectiveness ratios & 

cost effectiveness 

acceptability curves) 

1 year 

Outcomes 

Duration of Outcome 

Assessment 

The acceptability curves showed 

that if exercise is the first choice, at 

a threshold of GBP $18,000 per 

QALY the chance that a second 

intervention is cost-effective is 80% 

Exercise had the highest probability 

of being the most cost-effective first 

choice of therapy. 

Conclusion (by study authors) 

U.S. 

Kominski, GF 

(2005)66,70-76,387 

Niemisto, L 

subacute 

N = 681 

LBP, N-S; Acute/ 

x

x

physical therapy (MD + 

PT), 

x chiropractic care 

(CC) 

x CC + physical 

modalities (Pm) 

medical care only 

(MD) 

medical care with 

productivity loss) 

Cost-effectiveness 

analysis was not 

performed 

18 months 

Total outpatient costs 

(excluding 

pharmaceuticals, and 

105.8% grater than MD 

Higher costs for CC without 

producing better clinical outcomes 

Adjusting for covariates, cost for 

CC 51.9% grater than MD; CC + Pm 

3.2% grater than CC; and MD + PT 

Finland 

(2003)385 

Seferlis, T 

N = 204 

LBP, N-S, Chronic 

x

x

educational booklet 

SM + MD 

Physician 

consultation + 

General Practitioner 

1 year 

Total healthcare cost 

Productivity loss (full day 

or half day salary) 

Total (direct & indirect) 

improvement on pain intensity (100 

mm VAS) = $23. 

No SS differences in cost between 

two groups 

The incremental cost of SM + MD 

compared with the physician 

consultation for one point 

There were no differences between 

Sweden 

(2000)386,388 

Ratcliffe (2006)110­

N-S; Acute 

N = 180 

LBP w/out sciatica 

requiring sick leave; 

x

x

N= 241 x

x Intensive training 

program 

care (GP) 

Manual therapy (MT) 

Acupuncture (Acu) 

alternative, i.e. a costminimization analysis 

1 year 

cost per patient 

Method used: least-cost 

Total NHS cost 

Indirect costs, defined as sick-leave 

for LBP represent about 90% of the 

total cost 

the three tx groups in total cost, 

with GP being the least costly. 

Total costs to the U.K. health 

167 
Author, Year 

Country of Study 

N (sample size) 

Region, Cause, 

Duration of Pain 

Intervention/s 

Outcomes 

Duration of Outcome 

Assessment 

Conclusion (by study authors) 

118,389 

U.K. 

LBP; N-S; Mixed 

duration 

x Usual care (UC) Incremental cost pr QALY 

2 years 

N = 2841 

LBP; N-S; Chronic 

x Acupuncture (Acu) + 

routine care 

x No tx (delayed acu) + 

routine care 

UK BEAM trial 

team (UK beam 

study123,125,390 

U.K. 

Witt, CM (2006)24­

26 

Germany 

N = 1287 

LBP; N-S; Mixed 

duration 

x Spinal manipulation 

(SM) + best care by 

general practitioner 

care (GP) 

x SM + exercise 

x GP + exercise 

x GP alone 

Healthcare costs 

Quality adjusted life 

QALY 

Cost per QALY 

1 year 

The incremental cost 

effectiveness ratio 

6 months 

service were higher on average for 

the Acu ($859) than for the UC 

($645) 

Acu tx has > 90% chance of being 

cost effective at a $37,400 cost per 

QALY threshold. 

All three active txs increased pts’ 

average QALYs compared with GP 

alone. 

SM + GP care appears relatively 

cost-effective compared to GP care 

alone from the health sector’s 

perspective. 

The incremental cost-effectiveness 

ratio was $15,895 per QALY 

At a threshold of $22,662 per QALY 

acu had a more than 90% chance of 

being cost-effective. 

RCT= randomized control trial; LBP = low back pain; AT= Alexander technique; NS = non specific; Acu = acupuncture; TENS = transcutaneous electrical stimulation; tx = 

treatment; GP= general practitioner (care); PT= physical therapy; QALY= quality adjusted life years; MD=medical care; w/out=with or without; Pm=physical modalities; 

HRQoL=health related quality of life; NHS = National Healthcare Services; SS = statistically significant; U.K.= United Kingdom 

168
 
Neck Pain 

Three full economic evaluations were identified that evaluated the cost-effectiveness of 

spinal manipulation,63,89 and acupuncture130 for neck pain. 

These trials were reported in multiple publications 62,63; 89,92; and 130,131 (Table 23) 

Population/trial characteristics. The trials were conducted in Germany,130, the 

Netherlands,63 and the United Kingdom.89 In total, 3,984 participants with mixed nonspecific 

neck pain were included. The mean age of participants ranged from 45 to 53 years and the 

proportions of men and women were not significantly different in any of these trials. 

Acupuncture. Willich et al,130 performed cost-effectiveness and cost-utility analyses 

alongside a randomized controlled trial comparing additional acupuncture compared with usual 

care alone in patients with chronic neck pain. Subjects in the usual care group received 

acupuncture treatment after the 3 months study period. Adults with chronic neck pain (> 6 

months) were included. A total of 3,451 subjects were randomized to either acupuncture 

(n=1,753) or usual care (n=1,698). The mean (SD) QALYs over 3 months followup were 0.649 

(0.096) in the acupuncture group and 0.625 (0.103) in the usual care group, with a mean 

difference of 0.024 (p=0.004). Acupuncture treatment was associated with significantly higher 

total costs over 3 months of followup compared to usual care ($1,157 versus $810); the mean 

difference in total costs was $347 (95 percent CI: 220, 477). This difference in cost was mainly 

due to costs of acupuncture ($452). The incremental costs-effectiveness ratio was $15.710 per 

QALY; the net benefit of acupuncture was $1147. 

Spinal manipulation. Lewis et al,89 conducted cost-effectiveness and cost-utility analyses 

alongside a randomized controlled trial (Diedzic et al) comparing advice and exercise plus 

manual therapy (n=114) and advice and exercise plus pulsed shortwave diathermy (n=121) with 

advice and exercise alone (n=115) for patients with nonspecific neck pain. Experienced 

physiotherapists provided all interventions. The results showed that the mean improvement in 

neck pain (VAS) at 6 months was 10.2 in the manual therapy group, 10.3 in the pulsed shortwave 

diathermy group and 11.5 in the advice and exercise group. The mean quality adjusted life years 

(QALY) scores for the treatment three groups were 0.342, 0.360, and 0.362, respectively. The 

mean health care costs were $190, $197 and $169 and the mean total costs were $486, $543 and 

$598, respectively. From the health care perspective, the cost-effectiveness acceptability curves 

showed that the probability of each intervention being cost-effective at the $48,000 per QALY 

threshold was 0.37 for manual therapy, 0.31 for pulsed shortwave diathermy and 0.32 for advice 

and exercise alone. From the societal perspective, these probabilities were 0.44, 0.26 and 0.30, 

respectively. Although the authors concluded that the interventions of choice are likely to be 

manual therapy or advice and exercise alone, and that pulsed shortwave diathermy is unlikely to 

be a cost-effective intervention, the probabilities that any of these interventions is cost-effective 

are very low. 

Korthals-de Bos et al,63 conducted an economic evaluation alongside a randomized 

controlled trial (Hoving et al)62 to evaluate the cost effectiveness of manual therapy (n=60), 

physiotherapy (individualized exercise therapy, active and postural or relaxation exercises, 

stretching, and functional exercises; n=59), and care by a general practitioner (n=64) for subjects 

with nonspecific neck pain. Study participants were treated by the general practitioners, 

physiotherapists, or manual therapists. Manual therapy provided faster improvement compared 

with physiotherapy and general practitioner care up to 26 weeks, but there were no statistically 

significant differences at 52 weeks of followup. The total costs of manual therapy ($402) were 

169 
around one third of the costs of physiotherapy ($1,166) and general practitioner care ($1,240). 

These differences were statistically significant for manual therapy versus physiotherapy and 

manual therapy versus general practitioner care, but not for general practitioner care versus 

physiotherapy. 

170
 
Table 25. Summary of RCTs reporting data on economic evaluation of CAM versus other treatments- Neck pain 

Willich, SN 

(2006)130,131 

Germany 

Author, Year 

Country of Study 

Lewis, M 

N = 3451 

NP, N-S; Chronic 

N (sample size) 

Region, Cause, 

Duration of Pain 

N = 350 

x Acupuncture (Acu) + 

routine care 

x routine care 

Intervention/s 

advice and exercise 

Direct and indirect cost 

(not including private 

medical expenses) 

The incremental costeffectiveness ratio of acu 

tx 

3 months 

Outcomes 

Duration of Outcome 

Assessment 

Health care & societal 

The incremental costs-effectiveness 

ratio was $15.710 per QALY; the net 

benefit of acup was $1147. 

Conclusion (by study authors) 

Probability of each intervention 

U.K. 

(2005)89,92 NP, N-S; Mixed 

x

+ pulsed shortwave 

diathermy (PSWD) 

x advice and exercise 

alone 

(A&E)+ manual tx (MT) 

x advice and exercise 

6 months 

costs 

QALY utility scores 

 Health care perspective-: MT = 

0.37, PSWD = 0.31, and A&E = 0.32 

 Societal perspective- MT = 0.44, 

PSWD = 0.26, and A&E = 0.30 

PWSD was the last cost effective of 

three tx strategies 

being cost-effective at the $48,000 

per QALY threshold

the Netherlands 

Kothals de Bos 

(2005)63,64 

N = 183 

NP; N-S; Mixed 

x

National Healthcare Services; SS = statistically significant; UK= United Kingdom 

x General practitioner 

care (GP) 

Spinal mobilization 

(SM) 

x Physiotherapy (PT) 

RCT= randomized control trial; NP= neck pain; NS = non specific; Acu = acupuncture; TENS = transcutaneous electrical stimulation; tx = treatment; GP= general practitioner; 

PT= physical therapy; QALY= quality adjusted life years; MD=medical care; w/out=with or without; Pm=physical modalities; HRQoL=health related quality of life; NHS = 

utility ratios were 

evaluated 

1 year 

Direct and indirect costs 

Cost effectiveness, and 

cost 

MT was less costly and more 

effective than PT, or GP 

The total costs of MT were around 

one third of the costs of PT, or GP 

171 
KQ1a-b. For any of the CAM Therapies Found to be Effective 

for Back Pain, what Patient, Treatment Provider and Trial 

Specific Factors Influence Success of Treatments? 

Subgroup Analysis 

The amount of evidence regarding factors potentially influencing treatment effect (e.g., age, 

gender race, education, income, cause of pain, type of treatment provider, dose of treatment) was 

relatively limited. Effects of treatment related factors such as duration, frequency (number of 

sessions) are explored qualitatively if reported in the efficacy and effectiveness sections for dose 

response studies (see Chapter 3). 

Qualitative analysis. We identified only seven trials that included age-specific populations 

(i.e., elderly),45,53,207,208,216,217,226,227 Six trials that included women only219,263 or men 

only.144,284,349 (see Table 26). Of these, nine trials were conducted to assess the effects of 

acupuncture in subjects with low back pain.53,144,207,208,216,217,219,226,227 The results of trials across 

these subgroups were not comparable due to different control treatments and/or duration/cause of 

pain in subjects included in these trials. 

In one trial reporting subgroup effects of manipulation in subjects with mixed duration of low 

back pain. 34,81 The subject’s age, gender, symptom duration, or the therapist’s years of 

experience did not have a significant effect on the mean change for Oswestry score between two 

groups receiving spinal manipulation in addition to exercise and exercise alone. Within the spinal 

manipulation group, subjects positive on the rule (4/5 of the above criterion) had a significantly 

greater improvement on Oswestry score compared to subjects negative on the rule (immediately 

and short-term post-treatment: 10.3, 95 percent CI: 2.2, 18.4, p < 0.014).81 In the same study, 

patients with LBP of mixed duration who were judged to have lumbar hypomobility experienced 

greater benefit from spinal manipulation than subjects without hypomobility (mean difference, 

23.7 percent, 95 percent CI: 5.1, 42.4). Subjects with lumbar hypermobility receiving a program 

of stabilizing exercise had a greater benefit than subjects without hypermobility (mean 

difference, 36.4 percent, 95 percent CI: 10.3, 69.3). 34

 In one trial reporting subgroup analysis of subjects with chronic nonspecific low back 

pain,365 the beneficial effect of massage compared to physical therapy (physical modalities, 

exercise and traction) was similar across age ( 50 years: p = 0.0023 and > 50 years: p = 0.0221) 

and gender groups (male: p = 0.0356, female: p = 0.001). However, the short term post-treatment 

effect of massage differed across baseline pain severity groups (VAS  8: p = 0.179, and VAS > 

8: p = 0.0001). Specifically, massage was significantly better in reducing pain intensity 

compared to physical therapy but only in subjects with severe pain at baseline (immediately posttreatment mean VAS: 2.84 ± 3.13 versus 8.19 ± 5.60, p = 0.0001). The intermediate-term (6 

months post-treatment followup) effect of massage compared to physical therapy was 

significantly more beneficial and was not different across the severity groups (VAS  8: p = 

0.0319, and VAS > 8: p = 0.0016). 

Quantitative analysis. We were not able to conduct the analysis quantitatively due to 

insufficient data. The largest meta-analysis of this review included only 10 trials (acupuncture 

versus placebo for chronic nonspecific low back pain; (see Figure 4) and the remaining smaller 

meta-analyses included a range of two to four trials. The pooled trials did not include solely 

subjects from the subgroups of interest. 

172 
Table 26. Subgroup analyses 

Body region 

Intervention 

Elderly Only women Only men 

No. of studies Outcomes (efficacy) No. of 

studies 

Outcomes 

(efficacy) 

No. of studies Outcomes 

(efficacy) 

LBP 

Acupuncture 

753,207,208,216,217,226,227 Pain (VAS)

53,207,208,216,217,226,227 

Disability 

(RMQ)207,208,216,217,226 

QOL53,226 

1219 Pain (VAS) 

QOL 

1144 Pain + ability to 

return to work 

NP 

Acupuncture 

145 Pain (VAS) 1263 Pain (VAS) 

Function (NHP) 

Cervicogenic 

headache 

Acupuncture 

None NA None NA None NA 

LBP 

Manipulation 

None NA None NA 1284 NA 

Cervicogenic 

headache 

Manipulation 

None NA None NA None NA 

LBP 

Mobilization 

None NA None NA 1349 Pain (VAS) 

NP 

Mobilization 

None NA None NA None NA 

LBP 

Massage 

None NA None NA None NA 

NP 

Massage 

None NA None NA None NA 

All 8 14 2 NA 3 0 

Abbreviations: NA=not applicable; LBP= low back pain; NP= neck pain; VAS=visual analogue scale; PPT=Pressure Pain Threshold; NHP=Nottingham Health Profile; 

173 
Figure 48. Pain intensity (VAS Score) – Immediate post-treatment (lower risk-of-bias trials) 

Difference in means and 95% CI 

Acupuncture Placebo 

Study Name N Mean (SD) N Mean (SD) Favors Favors 

Acupuncture Placebo 

Brinkhaus et al, 2006 140 3.5 (2.9) 70 4.4 (3)

Inoue et al, 2006 15 4.7 (0.7) 16 5.5 (1.3)

Kwon et al, 2007 24 3.3 (1.6) 28 3.6 (1.5)

Haake et al, 2007 370 4.9 (1.9) 375 5.1 (1.9)

Pooled 549 489 

-0.92 (-1.75, -0.09)

-0.8 (-1.54, -0.06)

-0.25 (-1.13, 0.63)

-0.24 (-0.51, 0.03)

-0.43 (-0.76, -0.09)

-10.00 -5.00 0.00 5.00 10.00 

Heterogeneity: Chi2 = 3.92, df = 3 (P = 0.27); I2 = 23.5% 

Sensitivity Analyses 

The conduct of sensitivity analysis was possible for only one meta-analysis (Figure 4) with 

pooled mean difference -0.59, 95 percent CI: -0.93, -0.25). We explored the impact of study 

quality (risk-of-bias) on the pooled effect estimate of mean pain score difference between 

acupuncture and placebo. Initially, the 10 trials were categorized into two groups: ‘higher riskof-bias’ and ‘lower risk-of-bias.’ If for a trial, seven or more items of the risk-of-bias tool were 

rated as ‘Yes’ this trial was categorized into ‘lower risk-of-bias’ group, otherwise into ‘higher 

risk-of-bias’ group. Thus, there were four ‘lower risk-of-bias’ trials22,37,197,206 and six ‘higher 

risk-of-bias’ trials.99,141,156,198,203,228 The pooled effect estimates for the two categories of trials 

were -0.43 (95 percent CI: -0.76, -0.09) and -0.75 (95 percent CI: -1.39, -0.11), respectively 

(Figures 48-49). This analysis suggests that the quality (risk of bias) of trial did not appreciably 

modify the effect of acupuncture compared to placebo in subjects with chronic nonspecific low 

back pain. 

174 
Figure 49. Pain intensity (VAS score) – Immediate post-treatment (higher risk-of-bias trials) 

Difference in means and 95% CI 

Acupuncture Placebo 

Study Name N Mean (SD) N Mean (SD) Favors Favors 

Acupuncture Placebo 

Mendelson et al, 1983 36 3 (1.8 ) -0.98 (-1.95, -0.01) 41 4 (2 .4)

Leibing et al, 2002 35 2.1 (2.22.1 (2. )2 -1.1 (-2.1, -0.1) 40 3.2 ( 2.2)2 (

Molsberger et al, 2002 -1 (-1.73, -0.27) 58 2.6 (2.12.6 (2. )1 58 3.6 ( 1.9)6 (

Kerr et al, 2003 -1.04 (-2.57, 0.49) 26 5.1 (2.25.1 (2. )2 20 6.2 ( 3.1)2 (

Fu et al, 2006 -1.23 (-2.48, 0.02) 32 2.6 (2.62.6 (2. )6 28 3.8 ( 2.3)8 (

Cherkin et al, 2009 0.3 (-0.24, 0.84) 0.3 (-0.24, 0.84) 158 3.3 (2.53.3 (2. )5 162 3 (2 .4)

Pooled 345 349 -0.75 (-1.39, -0.11)

-10.00 -5.00 0.00 5.00 10.00 

Heterogeneity: Chi2 = 14.5, df = 5 (P = 0.01); I2 = 65.4% 

175 
KQ1c. Does the Use of any of the Three Most Prevalent 

Types of CAM for Back Pain in Adults Result in a Decreased 

or Increased Utilization of Conventional Management? 

Low Back Pain 

The comparative data on days off work, medication use, and health care utilization reported 

for 16 trials of low back pain are presented in Tables 27­

29.22,24,29,31,53,66,95,111,112,143,202,342,346,369,385,391 

Acupuncture. In the first trial,202 there was no statistically significant difference between 

subjects in acupuncture and placebo groups in the post-treatment number of days off work. The 

mean (or median) number of pain medication pills per unit of time (day of week) was 

significantly lower in subjects who received acupuncture compared to those who received 

placebo (mean number of pills per day: 1.0 ± 0.3 versus 4.2 ± 0.6)202 or TENS (median number 

of pills per week: 15 versus 28).53 Subjects receiving acupuncture had significantly lower 

number of days using analgesics compared to subjects receiving no treatment or placebo.22 

The time to return to full time work and number of pills consumed was significantly 

shorter/lower for subjects receiving electro-acupuncture compared to subjects receiving manual 

acupuncture (no numerical data were given). 

Subjects receiving acupuncture did not significantly differ from subjects receiving self-care 

in the number of medication fills (4.4 ± 8.9 versus4.0 ± 8.6), provider visits, or imaging tests per 

year.29 Similar results were obtained in another study that compared acupuncture to usual care 

for chronic nonspecific patients in a 2 year study. One trial,111 reported numerically lower 

proportions of any medication users amongst subjects in the acupuncture versus usual care 

groups (40.0 percent versus 59.0 percent). 

Manipulation. Most studies reporting the data on days off work, medication use, and health 

care utilization indicated nonsignificant differences between the groups of spinal manipulation 

and exercise (days off work),31 physician consultation (days off work, healthcare utilization),385 

medical care (pain medication use: proportion of users or number of pills),66 or placebo (pain 

medication use: proportion of users or number of pills).39 

Mobilization. In one trial in subjects with low back pain and sciatica due to sacroiliac joint 

dysfunction, the median number of analgesic pills taken was significantly higher in the placebo 

group (median: 3.5, range: 0-54) compared to mobilization group (median: 0, range: 0-132).346 

The median duration of sick leave (in days) was also significantly greater in the placebo 

(median: 14, range: 0-26) versus mobilization group (median: 7, range: 0-35).346 

In another trial including patients with chronic nonspecific low back pain, the number of patients 

on sick leave decreased in three groups of patients randomized to bone setting, physiotherapy 

and exercise. There were no significant differences in proportion of patients on sick leave in the 

year before the intervention compared to the year after the intervention between the three groups. 

In this study, the average number of visits to health centers for back pain was reduced in all three 

groups, but was only significant in physiotherapy group.342 (Table 26) 

Massage. There were no statistically significant differences in pain medication use (e.g., 

proportion of patients using medications) and number of provider visits between subjects who 

received massage versus relaxation or self-care at end of treatment.29,369 

176
 
Table 27. Utility of conventional medicine for low back pain: Use of medication 

Author, Year 

(ID) 

Intervention (sample 

size) 

Control 

(sample size) 

Region, Cause, 

duration of Pain 

Healthcare 

Utilization- end 

point 

Results 

CAM 

Results 

Control 

CAM vs. 

Control 

Acupuncture 

Brinkhaus Acupuncture (147) Placebo (minimal LBP, N-S Days with 2.0 (4.8) 4.9 (8.3); Acupuncture 

200622 acupuncture); analgesics in 6.2 (1.6) vs. minimal 

waiting list (154) last 4 week- acupuncture 

immediately -2.9 (95%CI: -

post 5.0, -0.8) 

intervention (8 

weeks) Acupuncture 

vs. waiting 

list 

-4.3 (95%CI:-

6.5, -2.0) 

Cherkin 200129 Acupuncture (94) Self care (90) LBP, NS, Number of pain 4.4 (8.9) 4.0 (8.6) NS 

Chronic medication fills1 year 

Kennedy, Acupuncture (24) Placebo (24) LBP, NS, Acute Mean (SD) 1.0 (0.3) 4.2 (0.6) S 

2008202 tablets/day at 

end of tx 

Thomas Acupuncture (160) Usual care (81) LBP, N-S, Pts using any 40% 59% S (-19, 95% 

2006111 Mixed medication in CI:-35.0, -3.0) 

past 4 weeks- 2 

years 

Grant 199953 Acupuncture (32) TENS (28) LBP, N-S, Median (IQ B) 15 (5­ B) 28 (7­ S 

Chronic range) tablets 37) 42) 

(elderly consumed in C) 14 (0­ C) 24 (2­

last week­ 38) 42) 

immediate post 

tx (B); 3 months 

(C) 

Sator- Acupuncture Acupuncture LBP, N-S, Consumption of 6 150 S 

Katzenschlager (electrical/auricular) (manual/auricular) Chronic rescue 

2004143 (31) (30) medication 

(Tramadol), 

number of 

tablets used177 
Author, Year 

(ID) 

Intervention (sample 

size) 

Control 

(sample size) 

Region, Cause, 

duration of Pain 

Healthcare 

Utilization- end 

point 

Results 

CAM 

Results 

Control 

CAM vs. 

Control 

Spinal manipulation 

Childs 200431

Hurwitz 200666

Meade 199195

Santilli 2006391

Santilli 2006391

Niemistö 

 Spinal manipulation 

+ exercise (70) 

 Spinal manipulation 

(169) 

 Spinal manipulation 

(treated by 

chiropractor) (384) 

 Spinal manipulation 

(53) 

 Spinal manipulation 

(53) 

Spinal manipulation 

Exercise alone 

(61) 

Medical care (170) 

Hospital 

outpatient 

management 

(357) 

Placebo 

manipulation 

(simulated Spinal 

manipulation) (49) 

Placebo 

manipulation 

(simulated Spinal 

manipulation) (49) 

Physician 

LBP, NS, Mixed 

LBP, N-S, 

Mixed 

LBP, N-S, 

Unknown/ 

Mixed 

LBP and 

Sciatica, 

Specific, Acute/ 

subacute 

LBP and 

Sciatica, 

Specific, Acute 

LBP, N-S, 

% of pts taking 

any medication 

in past week – 6 

mo fu 

% of pts using 

prescription 

pain medication6 months (D), 1 

year (E1), 18 

months (E2) 

Pts using 

analgesics and 

antiinflammatory 

drugs- 6 months 

(D); 1 year (E1); 

2 years (E2) 

Number of days 

on 

antiinflammatory 

drugs (NSAIDs) 

Number of drug 

prescriptionsPts using 

9.6%

D) 24% 

E1) 20% 

E2) 19% 

D) 33% 

E1) 30% 

E2) 30% 

1.8 (2.9) 

2.6 (4.0) 

23% 

 25% 

D) 32% 

E1) 29% 

E2) 27% 

D) 35% 

E1) 29% 

E2) 36% 

3.7 (7.1) 

4.6 (8.9) 

26% 

S 

NS (also pts 

in Spinal 

manipulation 

were more 

likely to use 

over the 

counter pain 

medication at 

D than pts in 

medical care, 

but not at E1-

2, 56% vs. 

49%, 

respectively) 

-1.8 (95% CI: 

-9.3, 5.7) 

0.7 (95% CI: -

7.6, 9.0) 

-6.0 (95% CI: 

-19.1, 7.1) 

NS 

NS 

NS 

178
 
Author, Year 

(ID) 

Intervention (sample 

size) 

Control 

(sample size) 

Region, Cause, 

duration of Pain 

Healthcare 

Utilization- end 

point 

Results 

CAM 

Results 

Control 

CAM vs. 

Control 

2003385 (102) consultation (102) chronic analgesics for 

LBP- 1 year 

Nordgren, WU 

1992346 

Spinal mobilization 

(18) 

Placebo 

(massage) (21) 

LBP, and 

Sciatica, 

Specific 

Acute/subacute 

Number of 

analgesic pills 

(median, range) 

0 (0-132) 3.5 (0.5) S (p< 0.05) 

Massage 

Cherkin 200129 Massage (94) Self care (90) LBP, NS, 

Chronic 

Number of pain 

medication fills1 year 

2.5 (3.6) 4.0 (8.6) S 

Poole 2007369 Massage (77) Relaxation; (82) LBP, NS, 

Chronic 

Pts using 

prescribed 

medication for 

LBP- 6 months 

43.1% 52.6%; 

55.8% 

NR 

Poole 2007369 Massage (77) Relaxation; (82) LBP, N-S, 

Chronic 

Pts using over 

the counter 

medication for 

LBP- 6 months 

18.5% 15.8%; 

18.6% 

NS 

Data are given as mean(SD) when not indicated 

End point= denotes the last follow up in which the data was reported 

NS= not significant; N-S=nonspecific; pt/s= patient/s; tx=treatment/intervention; LBP= low back pain; TENS= transcutaneous electrical stimulation; B=immediately post 

treatment; C= short term follow up (up to 3 months post treatment); D=intermediate follow up (up to 6 months post treatment); E=long term follow up (over 6 months post 

treatment) 

179
 
Table 28. Utility of conventional medicine for low back pain: Use of conventional treatments 

Author, Year 

(ID) Intervention Control 

Region, 

Cause, 

duration of 

Pain 

Healthcare 

Utilization- end point 

Results 

CAM 

Results 

Control CAM vs. Control 

Acupuncture 

Cherkin 200129 Acupuncture Self care (90) LBP, N-S, Number of provider 1.9 (3.7) 1.5 (4.0) NS 

(94) Chronic visits- 1 year 

Massage (78) 1.0 (2.1) 

Cherkin 200129 Acupuncture Self care (90) LBP, N-S, Number of imaging 0.2 (0.4) 0.1 (0.4) NS 

(94) Chronic studies- 1 year 

Massage (78) 0.1 (0.4) 

Thomas Acupuncture Usual care (59) LBP, N-S, Mean number of a- 3.78 a- 4.25 NS 

2008112 (123) Chronic healthcare visits: (3.36) (4.74) 

a-GP 

b-outpatient b- 0.50 b- 0.41 

c- NHS (National (1.62) (1.95) 

Health Services) 

d- private c- 8.79 c- 9.59 

(5.30) (5.60) 

- 2 years 

d- 0.98 d- 0.90 

(4.68 (3.65) 

Spinal manipulation

Childs 200431 Spinal Exercise alone (61)
 LBP, N-S, % of pts seeking tx 11.5% 42.5%
 S 

manipulation
 Mixed for LBP- 6 mo fu 

+ exercise 

(70) 

Meade 199195 Spinal Hospital outpatient LBP, N-S, Pts seeking any 36% 41% -4.9 (95% CI: -18.5, 8.7) 

manipulation management (357) further tx- between
 

(treated by
 1 and 2 years 

chiropractor)
 

(384) 

Niemistö385 Spinal Physician LBP, N-S, Number of visits to 2.1 (2.6) 2.4 (3.3) NS 

manipulation consultation (102) chronic physicians- 1 year 

(102) 

180 
Author, Year 

(ID) Intervention Control 

Region, 

Cause, 

duration of 

Pain 

Healthcare 

Utilization- end point 

Results 

CAM 

Results 

Control CAM vs. Control 

Niemistö385 Spinal 

manipulation 

(102) 

Physician 

consultation (102) 

LBP, N-S, 

chronic 

Number of visits to 

physiotherapy or 

other therapists- 1 

year 

7.6 (7.7) 6.0 (7.3) NS 

Spinal mobilization 

Massage 

Hemmila, HM Spinal Physiotherapy (34) LBP, N-S Mean change from 0.1 0.5 S (only in Physiotherapy 

2002342 mobilization Chronic baseline in number group compared to 

(bone of visits to health baseline) 

setting)(44) centers for back 

pain 

Hemmila, HM Spinal Exercise (35) LBP, N-S Mean change from 0.1 0.1 NS 

2002342 mobilization Chronic baseline in number 

(bone of visits to health 

setting)(44)
 centers for back 

pain 

Cherkin 200129 Massage (94) Self care (90) LBP, N-S, Number of imaging 0.1 (0.4) 0.1 (0.4) NS 

Chronic studies- 1 year 

Cherkin 200129 Massage (94) Self care (90) LBP, N-S, Number of provider 1.0 (2.1) 1.5 (4.0) NS 

Chronic visits- 1 year 

Poole 2007369 Massage (77) Relaxation; (82) LBP, N-S, Pts using usual 47.0% 36.8%; No statistical results 

Chronic care (including reported. 

Usual care (131) medication)- 6 30.2% The data for pts using 

months treatments other than 

medication could not be 

teased out appropriately 

Data are given as mean(SD) when not indicated 

End point= denotes the last follow up in which the data was reported 

NS= not significant; N-S=nonspecific; pt/s= patient/s; tx=treatment/intervention; LBP= low back pain; TENS= transcutaneous electrical stimulation; B=immediately post treatment; C= short 

term follow up (up to 3 months post treatment); D=intermediate follow up (up to 6 months post treatment); E=long term follow up (over 6 months post treatment) 

181
 
Table 29. Utility of conventional medicine for low back pain: Work absenteeism 

Author, Year 

(ID) 

Intervention (number 

of subjects) 

Control (number of 

subjects) 

Region, Cause, 

duration of Pain 

Healthcare 

Utilization- end 

point 

Results 

CAM 

Results 

Control CAM vs. Control 

Acupuncture 

Kennedy, 

2008202 Acupuncture (24) Placebo (24) LBP, NS, Acute Days off workat end of tx 

13.9 (5.3) 10.9 (4.1) NS 

SatorKatzenschlager 

2004143 

Acupuncture 

(electrical/auricular) 

(31) 

Acupuncture 

(manual/auricular) 

(30) 

LBP, NS, 

Chronic 

Time to return to 

full time work 

No 

numerical 

data 

reported 

No 

numerical 

data 

reported 

Pts in electrical 

auricular 

acupuncture 

returned to work 

earlier than pts in 

manual 

acupuncture 

Spinal manipulation 

Childs 200431 Spinal manipulation 

+ exercise (70) 

Exercise alone 

(61) 

LBP, NS, Mixed % of pts with 

missed any time 

work in past 6 

wks- 6 mo fu 

41.2% 38.3% NS 

Niemistö 385 Spinal manipulation 

(102) 

Physician 

consultation (102) 

LBP, N-S, 

chronic 

Days absence of 

work- 1 year 

13.9 (26.6) 18.5 (38.8) NS 

Nordgren, WU 

1992346 

Spinal mobilization 

(18) 

Placebo 

(massage) (21) 

LBP, and 

Sciatica, 

Specific 

Acute/subacute 

Median duration 

of sick leaves 

during the 

follow-up period 

7, (0-35) 14 (0-26) S (p < 0.05) 

Hemmila, HM 

2002342 

Spinal mobilization 

(bone setting)(44) 

Physiotherapy 

(34) 

LBP, N-S 

Chronic 

Mean change in 

sick leave days 

for back paincomparison 

between year 

before and year 

after the 

intervention 

0.8 2.1 NS 

Hemmila, HM 

2002342 Spinal mobilization 

(bone setting)(44) 

Exercise (35) LBP, N-S 

Chronic 

Mean change in 

sick leave days 

for back paincomparison 

between year 

0.8 -1.0 NS 

182 
Author, Year 

(ID) 

Intervention (number 

of subjects) 

Control (number of 

subjects) 

Region, Cause, 

duration of Pain 

Healthcare 

Utilization- end 

point 

Results 

CAM 

Results 

Control CAM vs. Control 

before and year 

after the 

intervention 

Hemmila, HM 

2002342 

Spinal mobilization 

(bone setting)(44) 

Physiotherapy 

(34) 

LBP, N-S 

Chronic 

% of patients on 

sick leave for 

back pain in the 

year after 

therapy 

16% 9% NS 

Hemmila, HM 

2002342 Spinal mobilization 

(bone setting)(44) 

Exercise (35) LBP, N-S 

Chronic 

% of patients on 

sick leave for 

back pain in the 

year after 

therapy 

16% 17% NS 

Data are given as mean(SD) when not indicated 

End point= denotes the last follow up in which the data was reported 

NS= not significant; N-S=non-specific; pt/s= patient/s; tx=treatment/intervention; LBP= low back pain; TENS= transcutaneous electrical stimulation; B=immediately post treatment; C= short 

term follow up (up to 3 months post treatment); D=intermediate follow up (up to 6 months post treatment); E=long term follow up (over 6 months post treatment) 

183
 
Neck Pain 

The comparative data on days off work, medication use, and health care utilization reported 

for 12 trials of neck pain are presented in Tables 30-31. 126,127,235,259,263,266,267,271,320,352,353,383 

Acupuncture. The number of analgesics consumed by subjects receiving acupuncture did 

not significantly differ from that consumed by subjects receiving Botulinum toxin127 or 

Lidocaine injection.126 The proportion of patients not taking rescue medication was significantly 

greater in the acupuncture versus placebo group (RR = 4.0, 95 percent CI: 2.3, 7.0).259 In another 

trial,271 the mean percent decrease in analgesic use was significantly greater in the local 

acupuncture versus remote acupuncture group (37.0 percent versus 9.0 percent). 

Manipulation. No relevant trials were identified. 

Mobilization. In two studies, analgesic medication use (i.e., percent decrease in annual use, 

mean annual number of doses) and the mean number of sick leave days were numerically better 

(no statistical test results reported) in the mobilization group versus no treatment352 or 

physiotherapy (massage, stretching, and exercise).35 

Massage. In the massage groups of two trials,353,383 the use of pain medication was 

significantly lower compared to the self-care book (mean increase: 0 percent versus 14.0 percent 

respectively)383 but not significantly different compared to physiotherapy group (mean decrease: 

56.2 percent versus 50.0 percent, respectively).353 

184 
Table 30. Utility of conventional medicine for neck pain: Use of medication 

Author, Year 

(ID) Intervention Control 

Cause, 

duration of 

Pain 

Medication intake- end 

point Results CAM Results Control CAM vs. Control 

Acupuncture 

Ilbuldu 

2004263 

Petrie 

1986266 

Vas 2006259

Vas 2006259

Salter 

2006267 

Venancio 

2008126 

Venancio 

2009127 

Acupuncture 

(dry needling) 

(20) 

Acupuncture 

(13) 

 Acupuncture 

(61) 

 Acupuncture 

(61) 

Acupuncture 

+ GP care (10) 

Acupuncture 

(15) 

Acupuncture 

(15) 

1- Laser tx (20) 

2- Placebo laser 

(20) 

Placebo TENS 

(12) 

Placebo TENS 

(62) 

Placebo TENS 

(62) 

GP care (14) 

Lidocaine 

injection; 

Lidocaine + 

corticoid (30) 

Botulinum toxin 

[not sure, 

possibly same as 

REFID 19: (30)] - 

SG 

NP; 

Myofascial 

Pain; Mixed 

NP- N-S, 

Chronic 

NP; N-S; 

chronic 

NP; N-S; 

chronic 

NP- N-S, 

Chronic 

Headache, 

N-S; Chronic 

Headache, 

N-S; Chronic 

Mean analgesic use- 4 

weeks (B); 6 months 

(D) 

Mean daily pill count4 weeks (B); 3 months 

(C) 

Pts (%) taking some 

rescue medicationone week post tx (C), 

Pts (%) using other 

medications 

(tetrazepam)- one 

week post tx (C) 

Number of pts using 

medication- 3 months 

Number of analgesics 

(ibuprofen tablets) 

ingested- 3 months 

Number of analgesics 

(ibuprofen tablets) 

ingested- 3 months 

B) 3.6 (4.4) 

D) 2.5 (2.7) 

B) 2.7 (2.5) 

C) 2.4 (2.6) 

29.5%

8 (29.6%) 

11.1%

32.9 (61.7) 

32.9 (61.7) 

B) 

1- 0.8 (1.3); 

2- 2.1 (3.4) 

D) 

1- 1.1 (3.4); 

2- 2.5 (3.5) 

B) 1.2 (1.1) 

C) 0.8 (0.5) 

 98.3%

19 (67.9%) 

 41.7%

32.3 (45.2); 

17.8 (25.8) 

15.5 (21.9) 

B) S 

D) NS 

NS 

4.0 (95% CI: 2.3, 

7.0) 

NR 

NS 

NS 

NS 

185 
Author, Year 

(ID) Intervention Control 

Cause, 

duration of 

Pain 

Medication intake- end 

point Results CAM Results Control CAM vs. Control 

White 

2000271 Acupuncture 

(ES) at local 

points (68) 

Acupuncture (ES) 

at remote points 

(68) 

NPSpecific; 

Chronic 

Mean (SD) % 

decrease in average 

oral analgesic 

medication- 3 months 

37% (18%) 9% (13%) S 

White 

2000271 

(Cross 

over) 

Acupuncture 

(ES) at local 

points (68) 

Acupuncture (no 

ES) at local points 

(68) 

NPSpecific; 

Chronic 

Mean (SD) % 

decrease in average 

oral analgesic 

medication- 3 months 

37% (18%) 6% (15%) S 

Spinal mobilization 

Hemmila 

2005352 

Mobilization 

(22) 

No tx 

(intervention was 

neither offered 

nor denied) (20) 

NP- N-S; 

Mixed/Unkn 

own 

The mean annual 

number of doses- 1 

year 

63 (146) 188 (332) NS 

Zaproudina 

2007353 

Mobilization 

(35) 

Physiotherapy 

(34) 

NP- N-S, 

Chronic 

Decrease in use of 

painkillers (%)- 1 year 

67.0% 50.0% NR 

Massage 

Zaproudina 

2007353 

Massage (35) Physiotherapy 

(34) 

Cen, 2009383 Massage (32) Self care book 

(32) 

Data are given as mean(SD) when not indicated 

End point= denotes the last follow up in which the data was reported 

NP- N-S, 

Chronic
 

NP- N-S, 

Chronic
 

Decrease in use of 56.2% 50.0% NS 

painkillers (%)- 1 year 

Increase in use of 0% (no 14% S 

medication-6 months change) 

NS= not significant; N-S=nonspecific; pt/s= patient/s; tx=treatment/intervention; LBP= low back pain; TENS= transcutaneous electrical stimulation; B=immediately post treatment; C= 

short term follow up (up to 3 months post treatment); D=intermediate follow up (up to 6 months post treatment); E=long term follow up (over 6 months post treatment) 

186
 
Table 31. Utility of conventional medicine for neck pain: Work absenteeism 

Author, Year 

(ID) Intervention Control 

Cause, 

duration of 

Pain 

Work outcome- end 

point 

Results 

CAM Results Control CAM vs. Control 

Spinal mobilization 

Hemmila Mobilization No treatment NP- N-S; Mean sick leave 4.5 (20.0) 16.9 (53.0) NR 

2005352 (22) (intervention was Mixed/Unkn days prescribed 

neither offered own due to NP- 1 year 

nor denied) (20) 

Hemmila Mobilization No treatment NP- N-S; Number of pts 3 (13.6%) 5 (25.0%) NR 

2005352 (22) (intervention was Mixed/Unkn prescribed sick 

neither offered own leave- 1 year 

nor denied) (20) 

Zaproudina Mobilization Physiotherapy NP- N-S, Number of sick 0.61 2.6 S 

2007353 (35) (34) Chronic leave days per 

person- 1 year 

Kongste Mobilization Neck collar; (156) NP; Specific Pts with affected 22% (95% 28% NS 

2007359 (149) (whiplash); work ability, % CI: 15, 30) (95%CI: 20, 

Act as usual (153) Acute (95%CI)- 1 year 36) 

25% 

95%CI: 17, 33) 

Zaproudina Massage (35) Physiotherapy NP- N-S, Number of sick 3.9 2.6 NR 

2007353
 (34) Chronic leave days 

Massage 

Data are given as mean(SD) when not indicated End point= denotes the last follow up in which the data was reported 

NS= not significant; N-S=nonspecific; pt/s= patient/s; tx=treatment/intervention; acu=acupuncture; SM=spinal manipulation; LBP= low back pain; TENS= transcutaneous electrical 

stimulation; B=immediately post treatment; C= short term follow up (up to 3 months post treatment); D=intermediate follow up (up to 6 months post treatment); E=long term follow up 

(over 6 months post treatment) 

187
 
Figure 50. Funnel plot of trials comparing VAS score (acupuncture versus placebo) 

Significance level <1%

Standard Er Standard E rorr

0.0

0.2

0.4

0.6

0.8

Individual study estimates

Fixed effect meta-analysis Fixed effect meta-analysis

Significance level 1-5%

Significance level 5-10%

Signficance level >10% Signficance level >10%

-5 -4 -3 -2 -1 0 1 2 3 4 -5 -4 -3 -2 -1 0 1 2 3 4

Difference in means

5 

Publication Bias 

Visual inspection of the funnel plot (Figure 50) for the acupuncture trials comparing 

immediate mean post-treatment VAS scores between acupuncture and placebo treatment groups 

suggested some degree of asymmetry. Specifically, there was a relative lack of trials with 

negative results (i.e., fewer trials in areas of statistical nonsignificance), indicating a potential for 

publication bias. The Egger’s regression-based analysis16 yielded a statistically significant result 

(p = 0.03). 

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KQ2 - What are the Contraindications and Safety Profile of 

the Three Most Prevalent CAM Therapies for Back Pain in 

Adults Compared to That for Other CAM Therapies, 

Conventional Therapies, Placebo or no Treatment? Does the 

Safety Profile of These Therapies Change Across Subgroups 

of Patients With Comorbidities? 

Harms of CAM in RCTs 

1 - Acupuncture for Treatment of Low Back Pain 

Any information on harms was reported for 25 

trials.22,24,29,37,49,53,110,121,136,138,139,143,156,162,197,198,198,200,207,209,216,220,224,226,228 Most reported events 

that were of moderate and transient nature. Specific adverse events reported by subjects who 

received acupuncture were soreness/pain at the site of 

needling,22,24,29,49,110,121,136,156,162,198,198,207,224,226,228 bruising,226 light headedness,226 minor 

bleeding,22,24,121,136,138,139,156 dizziness,53,136 influenza,53 problem with circulation,198 or 

headache.136 In one trial,143 reportedly no needle-induced adverse events had occurred. 

In two trials, the proportion of subjects with any adverse events did not differ between 

acupuncture and placebo groups.22,37 For example, in one of these trials,22 10.7 percent (15/140) 

and 17.1 percent (12/70) of subjects reported any adverse events for the acupuncture and the 

placebo group, respectively (p = 0.20). One trial228 reported 3.8 percent (6/147) of the subjects in 

the acupuncture having an adverse event versus none in the placebo group (p = 0.04). In another 

trial,207 one patient in acupuncture group (n=13) reported deterioration of symptoms and 

withdrew from the trial. There were seven patients in the acupuncture (n=32) and four patients in 

the placebo (minimal needling) group (n=28), respectively who reported bleeding.156 

The proportion of subjects with at least one adverse event was similar in acupuncture and 

usual care (or conventional treatment) groups.37,49,220,226 Subjects in usual care groups had 

epigastric pain,139,220,226 nausea,139 poor appetite,139 or headache.136,139,226 In one of these trials,220 

the medication group reported higher proportion of gastroenteric adverse events compared with 

the acupuncture group (15/29 versus 0/28, p < 0.01). 

In three trials,53,121,216 the incidence of adverse events in acupuncture (or electro-acupuncture) 

and TENS was numerically similar. In one of these trials,53 there were 16.6 percent (5/30) and 

14.8 percent (4/27) of the subjects who had an adverse event. In the other trial,216 one patient 

dropped out due to deterioration of symptoms after receiving the combination of acupuncture 

and TENS. 

In one trial,29 11 percent (10/94) of patients in the acupuncture group and 13 percent (10/78) 

in the massage group reported “significant discomfort or pain” during or shortly after treatment. 

In another trial,200 comparing acupuncture plus exercise to exercise alone, one patient in the 

combination group (n=26), developed stroke. Three patients in one trial did not tolerate pain 

during tapping in the dermal needling group (n=88) and were excluded without receiving the 

treatment.162 One patient experienced itching with electrode (acupuncture with electric 

stimulation group; n=31) and one patient had dullness after treatment with TENS (n=33).209 

189
 
 In one trial,136 the proportions of subjects with an adverse event in the high-frequency 

acupuncture (five times per week) and the low-frequency acupuncture (two times per week) 

groups were 73.3 percent (11/15) and 46.6 percent (7/15), respectively (p-value not reported). 

In four trials, reportedly no serious adverse events occurred in acupuncture versus massage,29 

usual care110 ‘no treatment,’24,29 or placebo (sham-acupuncture) group.197 For one trial,37 after 6 

months of followup, 40 and 12 serious adverse events were reported for the acupuncture (n=387) 

and the usual care group (n=388), respectively. Similarly, another trial,22 reported 9.3 percent 

(13/140) and 5.7 percent of (4/70) of the subjects had serious adverse events in the acupuncture 

and placebo groups, respectively. 

2 - Acupuncture for Treatment of Neck Pain 

Only 13 trials reported any information on adverse events.45,46,51,77,80,128,131,235,256,257,259,262,272 

The reporting of adverse events in these trials was generally poor (i.e., inconsistent, not enough 

detail, not well defined, no numerical or statistical data). 

For example, in two trials45,262 comparing acupuncture to Lidocaine injection, no severe 

adverse events were observed262 and one patient treated with acupuncture (n=18) withdrew from 

the trial due to cholecystectomy.45 The proportions of patients with soreness in the acupuncture 

and Lidocaine injection groups were 50.0 percent (9/18) and 38.1 percent (8/18), respectively (p 

= 0.74).45 In the same trial, none of the subjects who received acupuncture developed dizziness 

or haemorrhage, whereas there were two subjects each with either dizziness or haemorrhage in 

the Lidocaine injection group (0 percent versus 4.8 percent). 

In seven trials, the proportions of patients who withdrew or those reporting adverse events 

were similar in acupuncture (range: 6.0 percent-33.0 percent) versus placebo (TNS) groups 

(range: 0 percent-21.0 percent).77,80,128,256,257,259,272 The patients who received acupuncture 

reported the following events: needle reaction, mild headache, euphoria, enhanced vision, 

dizziness, mild hypotonia, sweating, swelling of the hand, bruising, and ulcer of the 

ear,77,80,128,259 whereas patients in the placebo groups reported cephalea,259 aggravation of 

symptoms,128,256,259 tiredness, nausea, tingling in the thumb, or uncomfortable cold feeling from 

the electrodes.128 No serious adverse events were reportedly noted.77,80 

In one trial,51 no adverse events were reported for patients receiving acupuncture (n=34) or 

manipulation (n=35); In total, about 6.1 percent (4/40) patients who were treated with 

medications (e.g., 200-400 mg/d Celebrex, 12.5-25.0 mg/d Vioxx) had indigestion, abdominal 

pain, or skin rash. In another trial,131 8.3 percent (n=1005) of the patients treated with 

acupuncture (both randomized and nonrandomized: n=12148) developed adverse events (minor 

local bleeding or hematoma, needing pain, or vegetative symptoms). 

No post-needling soreness, hypotension, or hematoma was observed in two other trials 

comparing acupuncture alone to the combination of acupuncture either with electrostimulation235 or paraspinal needling.46 

3 - Manipulation for Treatment of Low Back Pain 

Any information on harms was reported for only four trials.276,288,290,296 The reported adverse 

events were mostly moderate in severity and of transient nature. Most commonly reported 

specific event in subjects randomized to manipulation was increased pain or soreness.276,290,296 In 

the first trial,276 there were four and three subjects with worsening of LBP in the manipulation 

190
(n=35) and exercise (n=37) groups, respectively. In the second trial,290 there were six and four 

subjects with an adverse event in the manipulation (n=47) and myofascial therapy (n=50) groups, 

respectively. One subject in the myofascial therapy group developed constant tinnitus.290 In one 

trial,288 no adverse events were registered except for one subject (group identity not reported) 

who had constipation after consuming 24 Codeine Phosphate capsules in the first 4 days. 

Another trial296 reported the absence of serious adverse events in subjects with subacute or 

chronic LBP randomized to manipulation (n=191) or standard care (Paracetamol, 

Acetaminophen, NSAIDs, or muscle relaxants; n=49). The number of adverse events in two 

manipulation groups (high-velocity low-amplitude and low-velocity variable-amplitude; n=191) 

was 16 (15 events of low back soreness/pain) compared to four adverse events (rash due to 

Celebrex, headache, leg cramps/pain across chest, slurred speech) in the standard treatment 

group (n=49). 

4 - Manipulation + Mobilization for Treatment of Low Back Pain 

Only three trials reported any harms related data.39,56,66 

In one trial,39 reportedly no adverse events had occurred. In another trial,66 no treatmentrelated adverse events requiring institutional review board notification had occurred. One trial 

reported the absence of serious adverse events in subjects receiving manipulation (n=59).56 In the 

same trial, 22 subjects (11 subjects in the medication - NSAIDs, analgesics group and 11 

subjects in placebo group) reported dizziness, gastrointestinal disturbances, and heart 

palpitations.56 One patient in the medication group (n=60) had a suspected hypersensitivity and 

withdrew from the trial. 

5 - Flexion Distraction for Treatment of Low Back Pain 

Only one trial305 reported any information on harms. In this study, reportedly no adverse 

event had occurred during the study period. 

6 - Manipulation for Treatment of Neck Pain 

Only six trials reported any information on adverse events.51,65,306,320,323,329 The reporting of 

adverse events in the majority of these trials was generally poor (i.e., inconsistent, not enough 

detail, not well defined, no numerical or statistical data). Results for one trial are presented in the 

Acupuncture section, Harms sub-section.51,52 

In one trial of 280 patients comparing manipulation to mobilization,65,69 after 2 weeks of 

treatment, patients randomized to manipulation (n=171) were at statistically nonsignificantly 

increased risk for having any adverse event (adjusted OR = 1.44, 95 percent CI: 0.85, 2.43) 

compared to patients randomized to mobilization (n=165). Most frequently reported events were 

neck soreness/stiffness (27.7 percent versus 22.3 percent), radiating pain (6.4 percent versus 5.8 

percent), tiredness (12.1 percent versus7.9 percent), headache (15.6 percent versus 15.8 percent), 

and dizziness (4.3 percent versus 2.2 percent). Another trial,329 reported proportions of patients 

with at least one adverse event in the manipulation plus Diazepam group and the Diazepam 

group alone were 9.5 percent (2/21) and 11.1 percent (2/18; superficial phlebitis), respectively. 

There were reportedly no serious adverse events in one trial306 in patients randomized to the 

combination of manipulation and mobilization with (n=30) or without thrust (n=30). There were 

191
 
nine and ten patients reporting mild-to-moderate severity adverse events in the nonthrust and 

thrust groups, respectively (p = 0.67). 

In one trial,323 two subjects, one in the manipulation (n=3) and the other in the manipulation 

combination group (n=3) experienced transient but severe neck pain/stiffness. 

7 - Manipulation + Mobilization for Treatment of Neck Pain 

In one trial,81,83 although there were no important adverse events, 6.7 percent (not specified 

the number of subjects or a treatment group - manipulation plus exercise: n=49, manipulation 

alone: n=51) of the subjects reported provoked headaches as a result of the intervention. 

8 - Mobilization for Treatment of Low Back Pain 

None of the reviewed trials provided any information on the absence or presence of harms 

reported by subjects. 

9 - Mobilization for Treatment of Neck Pain 

Any information on adverse events was reported for two studies.320,357 In the first study, none 

of the patients reported any adverse events.357 In the other trial,320 posterior-anterior unilateral 

pressure (PAUP), anterior-posterior unilateral pressure (APUP), transverse oscillatory pressure 

(TOP), and cervical oscillatory rotation (COR) techniques did not worsen the patients’ condition. 

The relapse rates in the TOP and COR treatment groups after 3 months were 8.0 percent (2/24) 

and 12.0 percent (3/24), respectively. 

10 - Mobilization for Treatment of Thoracic Pain 

None of the reviewed trials provided any information on the absence or presence of harms 

reported by subjects. 

11 - Massage for Treatment of Low Back Pain 

Any information on harms was reported only for four trials.90,366-368 For two trials,366,368 it 

was explicitly stated that no adverse events had occurred during the treatment period. In one 

trial,90 one subject reported worsening of back pain in the massage group (n=75) as opposed to 

no adverse events reported for the group of exercise (n=72) or Alexander technique lessons 

(n=73). In another trial,367 five to 10 subjects from each group (Thai-massage: n=90 versus 

Swedish massage: n=90) reported soreness of transient nature which disappeared in 5-10 

minutes. There were five additional subjects in the Swedish massage group (n=90) who reported 

allergic reaction (rashes and pimples) to the massage oil.367 

12 - Massage for Treatment of Neck Pain 

Only two studies reported any information on adverse events.77,383 In one trial,77 the 

proportion of patients with adverse events in massage group was numerically lower 7.0 percent 

192
 
(4/57) compared to acupuncture 33.0 percent (17/51) or placebo-laser 21.0 percent (12/57). No 

serious adverse events were observed in this trial. In the other trial,383 nine patients randomized 

to massage (n=32) had mild adverse events (discomfort or pain: n = 5, increased soreness posttreatment: n = 3, and nausea: n = 1). 

Harms Reported in Nonrandomized Controlled Studies 

This review identified five nonrandomized studies and one experimental controlled trial,224 

The nonrandomized studies included two cohorts,392,393 and three case-control studies6,394,395 that 

reported on the incidence of harms in subjects receiving CAM therapies. 

Acupuncture for Treatment of Low Back Pain 

Although one study,224 was a trial that compared subjects with acute nonspecific LBP 

randomly assigned to usual care or choice of CAM care (acupuncture, massage, and chiropractic 

therapy), the occurrence of harms was reported only for the three groups of subjects who chose 

to receive acupuncture, chiropractic therapy, or massage within the choice of CAM care group (n 

= 300). The post-treatment rates of minor (clinically in-significant) discomfort or soreness in the 

acupuncture, chiropractic therapy, and massage groups were 5.0 percent (3/58), 8.0 percent 

(6/76), and 7.0 percent (10/152), respectively. No further details of harms were described. 

Manipulation and Mobilization for Treatment of Low Back Pain 

In a retrospective cohort study,392 the rates complications were compared between two 

groups of subjects with nonspecific LBP of unknown duration who had received either 

mobilization plus manipulation (n=75) or no therapy (n=75). Findings showed no differences in 

rates of complications between the two groups. No further description of adverse events was 

provided in this study. The authors also reported that subjects who received chiropractic therapy 

had a longer mean length of hospital stay (4.52, 95 percent CI: 3.78, 5.36) and lower cost of 

treatment compared to subjects who did not receive such therapy (3.40, 95 percent CI: 2.87, 

4.03), the between-group difference being statistically significant (p < 0.01). 

In a small prospective cohort study of 68 chronic LBP patients,393 treatment with medicationassisted manipulation or spinal manipulation alone for at least 4 – 6 weeks resulted in no 

complications. In this study spinal manipulation had been delivered by two chiropractors. In 

addition to the intervention treatment, participants received advice for exercise. 

Spinal Manipulation for Treatment of Neck Pain 

In a nested case-control study,394 patients under the age of 60 years with cervical arterial 

dissection and ischemic stroke or TIA were followed-up (1995-2000) matched to controls (by 

sex and within age strata). This study showed that SMT was independently associated with a 

greater risk of vertebral arterial dissection, even after controlling for neck pain. In this study, 

patients with arterial dissection (n = 51) compared to controls (n = 100) were more likely to have 

had SMT within 30 days (14.0 percent versus 3.0 percent, p = 0.032). In multivariate analysis, 

193
 
SMT within 30 days was associated with a significantly greater risk of vertebral artery dissection 

(OR = 6.6, 95 percent CI: 1.4 to 30.0). 

 In another case-control study conducted in Canada and involving 582 cases each matched 

with four age and sex controls, cases were five times more likely than controls to have visited a 

chiropractor in the week before a vertebro-basilar accident (OR= 5.03, 95 percent CI: 1.3, 43.8). 

These patients were also five times more likely to have had  three visits to a chiropractic care in 

the month before the vertebro-basilar accident (OR= 4.98, 95 percent CI: 1.3, 18.6). These 

associations were observed only for patients aged 45 years or younger.6 

In a recently published case control study,395 818 cases with and 3164 matched controls 

without vertebro-basilar artery (VBA) stroke were compared with respect to having received 

chiropractic treatment. 

A chiropractic visit in the month before the index date was associated with an increased risk 

of VBA stroke in those under 45 years of age (OR=3.13, 95 percent CI: 1.48, 6.63). Similarly, 

increased risk was found for patients visiting a primary care physician in the month before the 

index date for patients under 45 years of age (OR= 3.57, 95 percent CI: 2.17, 5.86) and patients 

over 45 years of age (OR= 2.67, 95 percent CI: 2.25, 3.17). 

194
 
Chapter 4. Discussion 

Overview 

This evidence report summarized, critically appraised, and compared the evidence on clinical 

benefits, costs, and harms associated with use of complementary and alternative medicine 

(CAM) and other therapies for the treatment of adults with low back, neck, and thoracic pain. In 

this report, results from 364 randomized controlled trials (RCTs) and six nonrandomized (one 

experimental and five observational) studies are summarized and reviewed. In general, the 

overall strength of the evidence was graded as low to moderate and the majority of it pertained to 

chronic nonspecific low back pain. Reporting quality across the trials, especially for harms was 

poor and inconsistent. The study results were often inconsistent probably due to substantial 

methodological (e.g., length of followup, blinding, design) and/or clinical (e.g., populations, 

treatments, and outcomes) diversity which limited the extent of comparability, interpretability, 

and pooling of the data. The therapy provider’s experience, training, and approaches (e.g., deep 

or superficial massage, choice of trigger points, needling techniques) which differed across the 

trials may have additionally contributed to disparate results. Only a few studies measured 

outcomes at long-term post-treatment followup. 

Acupuncture 

Major Findings - Low Back Pain 

x	 For chronic nonspecific back pain, there was moderate grade evidence that acupuncture 

was better than sham acupuncture in reducing pain intensity, but only immediately after 

the end of treatment. The degree of clinical importance for the pooled differences in pain 

intensity observed between acupuncture and placebo was judged as small. Acupuncture 

did not differ from placebo in improving post-treatment well-being, disability, use of 

medication, sick leave, and global improvement (grade: low to moderate). 

x	 Acupuncture was significantly better than no treatment or usual care in reducing 

immediate- or short-term low back pain intensity, disability, and function (grade: 

moderate). The ROM and well-being were significantly better after acupuncture versus 

no treatment (grade: moderate). The clinical importance for the pooled differences in pain 

intensity observed between acupuncture and no treatment was judged as of medium 

degree. 

x	 The long-term post-treatment disability and utilization of conventional healthcare did not 

differ between subjects with low back pain receiving acupuncture and usual care (grade: 

low). 

x	 Acupuncture did not differ from pain medication but was better than physical therapy in 

reducing immediate-term post-treatment low back pain or disability (grade: low). 

x	 Manipulation was significantly more effective than acupuncture in reducing immediate 

post-treatment low back pain intensity (grade: low). The pooled differences observed in 

pain intensity between acupuncture and manipulation was of significant clinical 

importance. 

195 
Major Findings - Neck Pain 

x There was insufficient evidence regarding benefits of acupuncture compared to no 

treatment in subjects with neck pain. 

x For subjects with chronic neck pain, acupuncture was not different from shamacupuncture, pain medication, mobilization/traction, or laser therapy in reducing pain or 

disability after the treatment (grade: low). 

x Manipulation was significantly better than acupuncture in reducing immediate or shortterm post-treatment pain intensity or disability (grade: low). 

General Issues and Harms 

The results suggest that acupuncture might be an option for the treatment of acute, subacute, 

and chronic LBP (specific or nonspecific cause). For chronic nonspecific back pain there is 

evidence that real acupuncture is no better than sham acupuncture, but better than no treatment or 

usual care. The benefit of acupuncture was mostly evident immediately or shortly after the end of 

the treatment and then faded with time. The evidence base for acute, subacute, and mixed 

duration specific LBP was very sparse and less conclusive. 

Trials that applied sham-acupuncture tended to produce negative results (i.e., statistically 

nonsignificant) compared to trials that applied other types of placebo (e.g., TENS, medication, 

laser) between acupuncture and placebo groups. These findings agree with others indicating, that 

indeed, different types of controls used in acupuncture trials may result in different effects. 

3,396 The reasons for inconsistent results observed in acupuncture placebo-controlled trials are not 

readily explained. One explanation is the beneficial effect of sham-acupuncture which rests on 

the diffuse noxious inhibitory control (DNIC), where neurons in the dorsal horn of the spinal 

cord are strongly inhibited by the application of a nociceptive stimulus to any part of the body 

distinct from their excitatory receptive fields.397 Another explanation could be the nonspecific 

effects of attention and beliefs in a potentially beneficial treatment. The next explanation is that 

the risk of bias of individual trials may have an influence on the treatment effect. The sensitivity 

analysis results of this review did not suggest that the pooled effect of acupuncture (compared to 

placebo) with respect to back pain intensity was strongly influenced by the risk of bias of the 

trials. 

Since only few trials reported any information on harms, it is difficult to adequately compare 

the event rates across the treatment arms. 

Consistency With Other Systematic Reviews 

The evidence base of acupuncture for low-back pain has grown in the last decade. The first 

Cochrane review on this topic was published in 1999 and included only eleven RCTs.398 The 

next update was published in 2005 and included 35 RCTs.3 The present report includes 105 

RCTs of acupuncture for low back pain and has a wider scope than the previous Cochrane 

review since additionally, it includes studies in subjects with specific causes of low back pain. 

A recently published systematic review of acupuncture for low-back pain (23 trials) showed 

similar results to the present report.399 The authors concluded that there was strong evidence that 

196
 
acupuncture is no different from sham acupuncture, basing their conclusion on three trials with 

low risk of bias that showed no difference 22,37,141 and one trial with high risk of bias that showed 

acupuncture being superior over sham acupuncture.207 We based our conclusion on 12 placebocontrolled trials in low back pain. There is still a lot of uncertainty regarding the physiological 

effects of the needles.22,27,37,37,99,141,156,197,198,203,206,228 One explanation for the beneficial effects 

of sham acupuncture is the diffuse noxious inhibitory controls (DNIC) where neurons in the 

dorsal horn of the spinal cord are strongly inhibited when a nociceptive stimulus is applied to any 

part of the body, distinct from their excitatory receptive fields. 400 Another explanation could be 

the nonspecific effects of attention and beliefs in a potentially beneficial treatment. 

We identified three systematic reviews for neck pain.401-403 In the most recently published 

review completed by the Neck Pain Task Force,402 only ten studies judged to have adequate 

internal validity were included and assessed. The authors concluded that acupuncture was likely 

helpful for neck pain not associated with whiplash associated disorders.402 Another review by Fu 

and colleagues401 included only RCTs with neck pain for at least 1 month, using traditional or 

electro-acupuncture. They excluded trials in subjects with multiple pain sites, with neck pain not 

being the main symptom, where only different forms of acupuncture were being compared or if 

neck pain was not the primary outcome. Based on 14 trials, they found that acupuncture was 

more effective than placebo or sham acupuncture in the treatment of neck pain for short-term 

pain reduction. In the third review,403 ten trials of subjects with chronic neck pain were included. 

They concluded that there was moderate evidence that acupuncture was more effective for pain 

relief than some types of sham controls, measured immediately post-treatment; there was limited 

evidence that acupuncture was more effective than massage at short-term followup; for chronic 

neck disorders with radicular symptoms, there was moderate evidence that acupuncture was 

more effective than a wait-list control at short-term followup. Although the present review 

includes a much wider range of trials, it does find similar results to these reviews. 

Clinical Relevance 

Furlan et al., showed that improvement in acute LBP with acupuncture was on average 52.0 

percent of the VAS (minimum 25.0 percent and maximum 80.0 percent) while improvement for 

chronic LBP was on average 32.0 percent of the VAS (min -17 percent and max - 62 percent). 

For people with chronic LBP receiving no treatment, the average improvement was 6.0 percent, 

and for sham acupuncture it was 23.0 percent (minimum -19.0 percent and maximum 44.0 

percent).3 Thus, acupuncture may be beneficial to those suffering from both acute and chronic 

low back pain. However, how beneficial acupuncture is when compared to standard medical 

care is not known. 

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Manipulation/Mobilization 

Major Findings – Low Back Pain – Manipulation 

x In subjects with nonspecific low back pain, manipulation was significantly better than 

placebo (grade: moderate) or no treatment (grade: low) in reducing pain intensity, but not 

disability, pain medication intake or ROM immediately or short-term after the treatment. 

x Manipulation did not differ from pain medication in improving pain intensity (grade: low). 

Results for pain intensity or disability were inconsistent regarding manipulation 

compared to massage or physiotherapy (grade: low) 

Major Findings – Low Back Pain – Mobilization 

x In subjects with acute/subacute or chronic low back pain, mobilization was significantly 

better than no treatment in improving pain intensity and lumbar flexibility immediately 

and short-term after the treatment (grade: low). 

x Mobilization was similar to placebo in reducing specific acute/subacute or nonspecific 

mixed duration pain or ROM immediately and short term post-treatment (grade: low). 

x Mobilization was similar to physiotherapy (a combination of manual treatment and 

physical modality but not physical modalities alone) in improving ROM for nonspecific 

chronic or mixed duration pain immediately and short term post-treatment (grade: low). 

x	 Mobilization was better than physiotherapy (a combination of manual treatment and 

physical modality but not physical modalities alone) in reducing immediate-term 

post-treatment pain intensity (grade: low). The differences observed in pooled pain 

intensity between mobilization and physiotherapy was not of significant clinical 

importance. 

Major Findings – Neck Pain – Manipulation 

x Subjects with neck pain benefited more with manipulation than placebo in terms of pain 

(grade: moderate), disability (grade; low), and neck flexibility (grade; low). 

Major Findings – Neck Pain – Mobilization 

x In subjects with neck pain (chronic, mixed duration), mobilization was better than no 

treatment in reducing pain intensity (grade: low), but not in reducing the intake of pain 

medication pills or the number of sick leave days immediately or short-term after the 

treatment (grade: low). 

x Mobilization was more effective than placebo in improving acute/subacute neck pain but 

not in improving chronic neck pain (grade: low). Mobilization was better than 

physiotherapy or massage in reducing pain intensity and disability in subjects with 

chronic nonspecific neck pain at intermediate-term after the treatment (grade: low). 

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General Issues and Harms 

In general, manipulation was shown to be more effective than placebo or no treatment in 

reducing pain intensity in subjects with back or neck pain. The benefits of manipulation appeared 

to be mostly limited to a period immediately or in the short-term (2 weeks to 6 months) 

following the treatment. Results regarding the comparison of manipulation to other treatments 

(e.g., pain medication, massage, or physiotherapy) in pain reduction were less consistent. The 

reviewed evidence indicated that mobilization for back or neck pain as associated with greater 

reductions in pain intensity compared with no treatment. However, the evidence regarding the 

comparison of mobilization to placebo was less consistent across subjects with low back and 

neck pain. Mobilization was better than placebo in reducing pain intensity amongst subjects with 

acute or subacute neck pain, but not amongst those with chronic neck pain. Some evidence 

indicated that subjects with low back or neck pain benefited from mobilization more than from 

physiotherapy in improving pain intensity. 

There are various methods and techniques of spinal manipulation and mobilization as well 

skill levels of manual practitioners. In this review, there were several trials of manipulation and 

mobilization comparing various methods or techniques. However, due to conflicting results, 

clinical heterogeneity, and low methodological quality (high risk of bias) across the trials, we 

were unable to determine which method or technique of manipulation or mobilization is more 

effective and whether the skill level of the practitioners influenced the outcome. 

 The lack of long term benefits for spinal manipulation/mobilization is not surprising given 

the recurrent nature of non specific LBP.279,309 It is uncertain whether manipulation/mobilization 

received during recurrent episodes (as in clinical practice) rather than during a single episode or 

period would result in long-term benefit including reduced frequency of recurrences. 

Low back pain is one of the most common and expensive disorders in developed countries. 

There is a high variation in the care provided for low back pain, and the optimal approach 

remains still unknown.278,404 Spinal manipulation and mobilization are common treatments for 

low back pain, particularly among chiropractors and low back pain is the most common 

complaint seen by chiropractors.405 One third of all patients who seek care for low back pain, see 

chiropractors,406 and over 90 percent of chiropractors use spinal manipulation when treating 

patients.407 Physiotherapists and osteopaths also use manipulation and mobilization for the 

treatment of low back pain, but the evidence on the frequency of their use is limited. For 

physiotherapists, the use of high velocity low amplitude manipulation in patients with acute low 

back pain varies from 4.0 percent408 to 2.0 percent409 and the use of mobilization is up to 40.0 

percent. Previous research has shown that 25.0 percent-40.0 percent of patients with low back 

pain referred to physiotherapy were positively identified as likely to benefit from spinal 

manipulation based on a clinical prediction rules.306 

There is a great diversity in the outcome measures used for pain (18 methods or instruments), 

function/disability (nine methods), global perceived effect (four methods), patient satisfaction 

(three methods) and quality of life (five methods) .410 The Cochrane Collaboration Back Group 

has published guidelines recommending key outcome measurement categories and related 

minimal clinically important difference or minimal detectable change.14 The psychometric 

properties and usefulness of key condition-specific disability measures are important to 

adequately interpret findings. For example, the Neck Disability Index has been recently reviewed 

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for establishing clinically meaningful change.411 Although this is one of the most commonly used 

instruments for neck pain, the minimal clinically important difference (MCID) was shown to be 

vary across different studies and disorder types ranging from 5/50 to 19/50. There is some 

evidence that individualized questionnaires like the Patient Specific Disability added to 

standardized self-report disability measures may enhance our ability to capture change in clinical 

trials. Future trials may wish to incorporate such instruments as well as specify the rationale for 

the MCID. 

Only few trials evaluating mobilization and/or manipulation provided any information on the 

absence or presence of harms. The adverse events were not collected in a systematic manner and 

were poorly reported. Transient increase in low back pain was among the most common adverse 

events. Moreover, the findings of three case-control studies6,394,395 suggested that younger adults 

( 45 years) receiving spinal manipulation were at a higher risk of having vertebral artery 

dissection or vertebrobasilar vascular accident. However, according to a more recent study,395 

this risk was similar to that related to the visiting a primary care physician for treatment of neck 

pain. Higher level of evidence from RCTs will help to draw more definitive conclusions 

regarding the risk of vascular events following manual therapies for neck pain. 

Previous studies suggested that manual therapy including spinal manipulation or mobilization 

for low back pain is rarely associated with serious adverse events.412,413 

A number of investigators have made attempts to estimate the risk for serious adverse events 

in patients with neck pain receiving manipulation therapy, ranging from one in several million,414 

to one in 100,000415 but these estimations were limited by numerous methodological flaws and 

challenges. The evidence for serious or catastrophic events is found only in case reports and 

retrospective case series or surveys from neurologists.416-418 The inherent bias of retrospective 

reports is the over-reporting of serious adverse events compared to minor and moderate events. 

While the calculation of risk for the occurrence of catastrophic events such as stroke or death 

from cervical manipulation is supported by temporal and biologic plausibility arguments, it is 

plagued by numerous biases such as measurement or selection bias. The risk for catastrophic 

events in RCTs could not be estimated. Long term cohort trials and the establishment of 

mandatory national reporting registries by manipulation therapy practitioners, physicians and 

neurologists can address this safety issue in CAM treatments. Currently, a paucity of reports of 

adverse events related to mobilization techniques exists and this needs to be corrected. 

The lack of accurate incidence rates for adverse events may be attributed to numerous 

methodological challenges. The most common problems were: a) the lack of consensus on 

standardized definitions of adverse events, b) inadequate followup (the followup duration should 

be long enough to detect adverse events, be able to examine the persistence of benefits, and to 

assess the sustainability of the intervention), c) short-term followup can exaggerate benefits by 

overlooking any adverse events which may emerge more slowly. The problem is also impeded 

when typical symptoms evaluated for benefit are also considered as adverse events. For example, 

pain relief is a desired outcome of benefit, but if pain increases (short term) as a results of a 

manual therapy intervention, it is not always clear if this is an adverse event (unintended) or the 

lack of efficacy of the treatment. Adverse events may depend on accumulated dose or time. A 

framework for defining adverse events specific to manual therapy has been proposed419 but it 

falls short of providing standardized definitions with regards to severity and thresholds for 

adversity of common symptoms . 

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Consistency With Other Systematic Reviews 

The findings in this review are not divergent from previous reviews. For example, Assendelft 

et al.,420 conducted a systematic review and meta-analysis of 39 RCTs evaluating manipulation 

and/or mobilization for patients with acute/subacute or chronic low back pain. This review 

combined manipulation and mobilization trials and excluded studies that did not assess clinically 

relevant outcomes such as pain, global improvement or functional status. The authors concluded 

that spinal manipulation (or mobilization) was more effective (both statistically and clinically 

important differences were found) than sham therapy or ineffective treatments and equally 

effective when compared to other effective treatments such as general practitioner care, 

physiotherapy, exercise or back school. These results were consistent regardless of symptom 

duration or the presence of back-related leg pain.420 The benefits were found in the short-term for 

acute low back pain and in the short and long-term for chronic low back pain. The results did not 

differ when only trials of spinal manipulation alone were included in the analysis. 

Bronfort et al.,421 conducted a systematic review on the efficacy of manipulation or 

mobilization for low back pain and found moderate evidence that manipulation provided more 

short-term pain relief than mobilization and detuned diathermy, and limited evidence on faster 

recovery than the commonly used physical therapy treatment. For chronic low back pain, this 

review found moderate evidence that manipulation had an effect similar to nonsteroidal 

antiinflammatory drugs. Manipulation/mobilization was effective in the short term when 

compared with placebo and general practitioner care, and in the long term compared to physical 

therapy. There was moderate evidence that manipulation was better than physical therapy and 

home back exercise in both the short- and long-term. In patients with a mix of acute and chronic 

low back pain, this review found that manipulation/mobilization provided either similar or better 

pain outcomes in the short and long term compared with placebo, McKenzie therapy, medical 

care, management by physical therapists, soft tissue treatment or back school. 

The findings of this review regarding neck pain are consistent with those of other reviews.422­

426 While some differences can be explained by the inclusion criteria and grading of trials 

between this and other two reviews,422,423 the major results in general are similar. Two additional 

systematic reviews 427,428 assessed multimodal interventions that included mobilization and 

manipulation combined with other interventions. The trials included in these reviews were 

outside the scope of this review. 

Clinical Relevance 

It is uncertain what is the optimal frequency and duration of manipulation/mobilization 

therapy for nonspecific low back pain. In clinical practice, frequency and duration of treatment 

are usually tailored to the individual needs of the patient. In this review, adult patients classified 

as having nonspecific low back pain were assumed to be homogeneous in terms of the disease. 

However, some evidence suggests that there are subgroups of nonspecific LBP patients who are 

likely to respond differently to various types of intervention.429,430 A clinical prediction rule with 

five variables (symptom duration, fear–avoidance beliefs, lumbar hypomobility, hip internal 

rotation range of motion, and no symptoms distal to the knee), has been recently developed and 

validated application of which can increase the probability of success with manipulation from 45 

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percent to 95 percent for subjects with nonspecific low back pain.31,431 In clinical practice, only 

some patients with nonspecific low back pain may receive manipulation depending on the 

clinical presentation. 

In our review the intervention was restricted to manipulation alone, mobilization alone, or 

combination of manipulation and mobilization. This was done to adequately evaluate these 

specific interventions. However, this may not reflect the realities of clinical practice, where 

multi-modal approaches are the norm. Combining various forms of manipulation, mobilization, 

education and exercise that is individualized to the patient is supported from a theoretical and 

clinical reasoning perspective. Trials that included multi-modal treatment were excluded from 

this review, and therefore our findings may not be readily applicable to multimodal treatments 

used in practice including manipulation or mobilization. 

This review attempted to answer the question of efficacy: “Can manipulation or mobilization 

positively affect neck pain?” The included studies may not reflect typical practice in the 

community of manual therapy. For example, single session or low dose trials with immediate 

post-treatment followup tend to give positive findings and exaggerate the treatment benefit. 

There were some trials in this review that were pragmatic and were designed to answer how well 

manipulation works in practice.51,140,307,318,320,321,330,332 These trials tended to have larger samples, 

a longer duration or higher dose of treatment, enroll more heterogeneous populations, and allow 

the manual therapy interventions to vary as they would in clinical practice. These effectiveness 

trials are designed to give a broader clinical applicability. Their findings were more conservative 

and varied relative to the less pragmatic trials. 

Massage 

Major Findings – Low Back Pain 

x Massage was superior to placebo or no treatment (grade: low) in reducing pain (grade: 

moderate) and disability (grade: low) immediately post-treatment only in subjects with 

acute/subacute but not in subjects with chronic low back pain (grade: low). 

x	 Massage was significantly better than relaxation (clinical importance of difference: 

medium degree) or physical therapy (clinical importance of difference: large degree) 

in reducing chronic nonspecific low back pain intensity but not ROM, immediately 

after the treatment (grade: low to moderate). 

Major Findings – Neck Pain 

x Massage was better than no treatment in reducing immediate-term post-treatment pain 

intensity in subjects with chronic or unknown duration of nonspecific pain (grade: low). 

x Massage was better than placebo in reducing neck pain intensity immediately after the 

treatment in subjects with acute/subacute or unknown duration of nonspecific pain 

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(grade: low). Massage was not different from placebo in improving well-being or ROM 

in subjects with chronic pain (grade: low). 

General Issues and Harms 

When the outcomes of pain and function are examined, it seems that massage had a more 

consistent impact in pain intensity than on function or ROM for which many trials had 

conflicting findings. This might be due to psychological factors that contribute to disability 

which are not addressed by massage therapy. 

Typically, massage therapy is delivered differently in many different parts of the world. The 

variations in practice settings, study populations, severity of the disorder, duration and number of 

massage sessions, types of placebo (e.g., TENS, massage) and adjuvant modalities might all 

contribute to different results. In the reviewed trials, practice settings as well as inclusion and 

exclusion criteria for study populations were often poorly specified. One bias inherent in all trials 

was that blinding of the patient, care provider, and often outcome assessor was often not 

achieved and may have led to exaggerated treatment effect estimates. Blinding of the therapist is 

not possible, therefore, effort is needed to blind the outcome assessor. In most of the reviewed 

studies, the primary outcome was a “self-reported” outcome such as pain, global perceived 

effect, disability/function or quality of life, in other words a “subjective” outcome type. Bias may 

be introduced when blinding of patients and care giver is inadequate. Furthermore, massage trials 

often used primary outcomes such as single-item pain scales. For such trials, the patient 

automatically becomes the “outcome assessor” and therefore cannot be blinded. For other multiitem self report tools, such as the Neck Disability Index, the patient may be naïve, may have 

lower recall of their original rating and may not always be considered to be the “outcome 

assessor”. Outcomes utilizing performance based findings are needed to balance the inherent bias 

in reporting self-reported outcome measures. 

Information on harms reported in the massage trials was very limited. No serious adverse 

events were reported. In a few trials, subjects receiving massage experienced transient back/neck 

soreness. 

Consistency With Other Systematic Reviews 

A Cochrane Review of massage for nonspecific low-back pain, updated in 2008, included 13 

RCTs.432 All 13 studies were also included in this review. The present review included four more 

trials. Two of these trials were published after the Cochrane review,93,368 and two trials in 

subjects with disc herniation were excluded from the Cochrane review because of the population 

eligibility criterion.159,362 The Cochrane review concluded that “massage was superior for pain 

and function compared with placebo or no treatment on both short and long-term followups. 

Massage was similar to exercise, and it was superior to joint mobilization, relaxation therapy, 

physical therapy, acupuncture, and self-care education. 

In two reviews of neck pain,433,434 limited implications for clinical practice were noted. No 

recommendations could be made due to unclear evidence and the difficulty in comparing very 

different massage forms. Four different massage therapy approaches, all in trials of very low 

quality (high risk of bias) and of moderate clinical applicability showed evidence of no benefit in 

pain relief when compared to different forms of control treatment. The trials within these two 

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reviews included ischemic compression, the use of a J-cane tool, Western massage, and occipital 

release for typically subacute or chronic neck pain. 

Clinical Relevance 

The application of the massage techniques can be very different in research trials relative to 

how it is applied in clinical practice. A standardized taxonomy is needed for massage and 

although one has been suggested,435 there is no movement to adopt it within the research 

community. 

Cost-Effectiveness of CAM Therapies 

There was consistent evidence for the cost-effectiveness of acupuncture for back and neck 

pain relative to usual care or no treatment, but this was based on only three studies. Because the 

benefits of spinal manipulation were modest or absent in the six trials of spinal manipulation that 

included economic analyses, there is no compelling evidence for the cost-effectiveness of this 

treatment for back or neck pain. The only trial that included massage as a treatment found 

massage more costly and less effective than usual physician care. In summary, because of the 

small number of economic evaluations, the inconsistent standards of comparison, and the 

substantial heterogeneity among these studies (different countries with different health care 

payment systems), it is not possible to reach clear conclusions about the cost-effectiveness of any 

of these CAM treatments for back or neck pain or to make global application of the findings. 

These initial studies suggest that spinal manipulation may not be cost-effective and acupuncture 

is promising. There have not yet been any economic evaluations of a defined massage treatment 

protocol for back or neck pain. 

Strengths and Limitations of Review

Strengths 

This review identified a large amount of evidence on efficacy and safety of CAM treatments 

used in the management of back and neck pain. The reviewers used systematic, comprehensive, 

and independent strategies to minimize the risk of bias in searching, identifying, retrieving, 

screening, abstracting, and appraising the primary studies. The search strategy, which was not 

restricted by the language or year of publication, was applied to multiple electronic sources. 

Furthermore, the references of included studies were hand-searched for potentially eligible 

reports. Further strength of this review is that results of individual trials regarding primary 

outcomes were stratified and subgrouped by spine region (e.g., low back, neck), duration of pain 

(acute, subacute, chronic, mixed, and unknown), and cause of pain (specific or nonspecific). The 

reviewers were able to pool results of individual trials in series of meta-analyses for all reviewed 

major treatments (acupuncture, manipulation, mobilization, and massage) within subgroups of 

populations defined by spine region (low back, neck), duration of pain (acute, subacute, chronic, 

mixed, and unknown), and length of post-treatment followup for each outcome (immediate, 

short-term, intermediate-term, and long-term). The reviewers assessed and reported the degree 

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of clinical importance of the observed statistically significant pooled differences in pain intensity 

between the treatment groups. 

This review assessed the extent of publication bias using a visual inspection of the funnel 

plot and the Egger’s regression-based technique.16 Although the visual inspection method is not 

very reliable, it conveys some general idea as to how symmetrical the dispersion of individual 

trial effect estimates is around more precise effect.8

 Note that methodological and clinical 

heterogeneity across trials may also contribute to funnel plot asymmetry.15 The funnel plot of 

acupuncture placebo-controlled trials showed some degree of asymmetry which may have arisen 

due to publication bias. Publication bias, if present, may have led to overestimation of the 

treatment effect of acupuncture compared to placebo in reducing pain intensity. We aimed to 

minimize publication bias by supplementing the comprehensive search strategy with inclusion of 

grey literature and reports published in non-English journals. 

The collected data allowed us to perform a sensitivity analysis which explored the influence 

of study quality (i.e., risk-of-bias) on the pooled treatment effect (reduction of pain intensity) in 

trials comparing acupuncture to placebo. 

Limitations 

This review is limited by the information provided in the included primary studies. Most of 

these studies were of high risk of bias. Many trials had small sample size (e.g. pilot, feasibility 

studies) or used a single treatment session and may have had limited power to detect clinically 

meaningful differences in the primary outcomes between the study treatment groups. A high 

proportion of acupuncture trials published in Chinese did not explicitly define the primary binary 

outcome ‘curative effect,’ the definition of which may have varied across these trials. Study 

reports did not always provide sufficient quantitative information (e.g., standard deviations, 

standard errors, mean endpoints) necessary for pooling the results of individual trials. Authors of 

many trials failed to report statistical test results for between-group differences in outcome 

measures after the end of treatment. The occurrence of harms was not reported in the majority of 

trials, making it difficult to draw definitive conclusions regarding absolute or relative safety of 

the reviewed treatments. 

The risk-of-bias graphs indicated that the adequacy of methods for randomization was not 

clear for at least 40 percent of all trials. It was not clear whether or not the treatment allocation 

was concealed for more than half of all trials. Study participants’ blinding status was reported 

more frequently compared to assessors’ blinding status. The baseline distribution of subjects’ 

characteristics and study participants’ blinding status were better reported than methods of 

randomization or treatment of allocation. The overall proportion of double blind trials amongst 

the trials reporting this information was very low (about 10.0 percent). It should be noted that in 

most situations where physical treatments are applied, effective blinding is very difficult or 

impossible to achieve. The absence of data for the above-mentioned domains (i.e., randomization 

methods, treatment allocation concealment, blinding status) limits the extent of valid 

interpretation of the review results. 

There was substantial clinical (e.g., populations, treatments, and outcomes) and 

methodological (e.g., length of followup, blinding, design) heterogeneity present across included 

trials which may have led to the disparate results. For example, there were many different 

treatment modalities used within acupuncture (e.g., dry needling, conventional needling, 

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warming needle, electro-acupuncture, trigger-point acupuncture, laser-acupuncture), spinal 

manipulation therapy (e.g., manual manipulation, instrument-assisted manipulation), flexiondistraction technique, osteopathy, mobilization, traditional bone-setting techniques, and massage 

(e.g., acupressure, reflexology) or their combinations with other therapies (e.g., pain 

medications, physiotherapy, traction, exercise, standard therapy, advice/education) making it 

very difficult to meaningfully compare and summarize the efficacy and safety parameters of the 

review. Moreover, the therapy provider’s experience, training, and approaches (e.g., deep or 

superficial massage, choice of trigger points, needling techniques) which differed across the 

trials may have additionally impacted the trial results. The observed variability in the 

experimental interventions was compounded by a wide variety of control (comparison) 

treatments used across the trials (e.g., physiotherapy, exercise, advice/book, standard therapy, 

other CAM therapy, placebo, no treatment). For example, some trials used different types of 

placebo (detuned short-wave diathermy, superficial needling, TENS placebo, sham 

manipulation, sham acupuncture, sham massage) whose effects may have been different, thereby 

contributing additional heterogeneity. The above-mentioned clinical diversity limited the extent 

of statistical pooling of trial results. Some of the pooled analyses revealed unexplained statistical 

heterogeneity. Therefore, the results of such meta-analyses should be viewed with caution. 

 Quantitative subgroup analyses exploring the effects of age, gender, race, type of treatment 

provider, or dose of treatment could not be performed due to lack or insufficient data. For 

example, the largest meta-analysis in this review included only 10 trials and the remaining 

smaller meta-analyses included a range of two to four trials. None of the pooled trials included 

solely subjects from these subgroups of interest. Similarly, the results from several trials that 

were conducted in subjects of specific age- or gender-based subgroups (e.g., elderly, young 

adults, men, and women) were not comparable due to different control treatments used, duration 

of pain, and/or cause of pain in subjects included in these trials. 

One more limitation of this review may be the use of a nonweighted system for averaging 

risk of bias (i.e. high, medium, low) for multiple studies for grading overall strength of evidence. 

This review focused on manipulation or mobilization to estimate the efficacy. Results from 

these studies may not be readily applicable to various combinations of interventions used in 

today’s practice. However, the assessment of a single intervention is the first step in teasing out 

which therapeutic item is more effective in reducing pain and improving function. 

Future Research 

Stronger efforts are needed to improve the quality of conduct and reporting of primary 

studies evaluating CAM therapies. The primary study authors should consider CONSORT 

statement as a reporting guide in order to improve the quality of reporting.436 For example, 

authors of future trials should direct more attention to minimizing bias (e.g., randomization 

sequence generation, treatment allocation concealment, blinding, incomplete outcome data, and 

selective outcome reporting) in conducting, analyzing, and reporting results of primary trials. 

Some factors that may influence results of clinical trials assessing patient-reported outcomes 

for manipulative treatments were discussed by Licciardone et al.,437 who listed the following 

sources of bias: a) attrition or selection bias (e.g., differential dropout or withdrawal rates, selfselection bias), b) investigator bias (e.g., allocation concealment), and c) nonspecific treatment 

206
 
effects due to investigator-subject relationship, regression to the mean, and subjects’ expectation 

of outcomes/treatment credibility due to awareness of the treatment they are assigned to receive. 

Moreover, trial authors need to characterize and report frequency (e.g., number of sessions 

per unit of time) and duration of treatments used, in order to help establish which of these 

characteristics make these therapies most optimal in terms of benefits and harms. 

Trial investigators need to consider the use of validated instruments for measuring outcomes. 

Currently, there is a great diversity in outcome measures used for pain, function/disability, global 

perceived effect, patient satisfaction and quality of life. The Cochrane Collaboration Back Group 

has published guidelines recommending key outcome measurement categories and related 

minimal clinically important difference or minimal detectable change.14 For efficiency purposes, 

a single trial should ideally measure maximum number of relevant outcomes (pain, function, 

return to work, and health care utilization). To minimize the risk of bias inherent to some 

subjective outcome measures (e.g., pain, disability, quality of life, GPE, patient satisfaction), 

investigators should additionally measure and report objective outcomes (e.g., performancebased outcomes, impairment measures, range of motion, muscle strength). 

Since in most studies of low back and neck pain, the primary outcome is self-reported pain, 

global perceived effect, disability/function or quality of life, the lack of blinding or inadequate 

blinding of study subjects or outcome assessors may bias the trial results. Therefore, it is 

important that more efforts be directed towards better blinding methodologies applied in future 

trials. 

For a given trial, it is important to consider an appropriate placebo treatment. For example, in 

this review, trials that applied sham-acupuncture or sham-manipulation tended to have negative 

results compared to trials that applied other types of placebo (e.g., no treatment, laser-placebo, 

TENS-placebo). Future head-to-head trials comparing CAM treatments should ideally have a 

large sample size, since in case of small trials, it is difficult to explain whether the negative 

results are due to true equivalence between the interventions or due to small samples. 

Factorial design including randomization first to CAM therapy or no treatment, and then 

randomizing to other treatment modalities would be most informative to delineate the 

additive/subtractive and individual effects of CAM therapies relative to any given treatment. 

Future trials should help to better inform the influence of treatment-, care-provider (e.g. 

experience, skills), and population-specific factors on treatment effect estimates. It is desirable 

that treatment providers (chiropractors, acupuncturists, massage therapists) employed in future 

trials be highly experienced. More research should be conducted elucidating clinical benefits of 

different forms of CAM therapies relative to each other, since at present there is no clear 

advantage of any particular type. It is also important to collect and report information on 

patients’ previous experience, beliefs, and their expectations of CAM therapies to assess the 

impact of these factors on the success of care. More data from well-conducted trials are needed 

for definitive conclusions regarding the relationships between the use of CAM and conventional 

therapies in subjects with neck and back pain. 

Finally, the exploration and explanation of key causal or biological mechanisms underlying 

the effects of CAM therapies and their variation across subgroups of patients are also warranted. 

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Kohlbeck FJ, Haldeman S, Hurwitz EL, et al. 

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52. 

Smith WS, Johnston SC, Skalabrin EJ, et al. 

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MacDermid JC, Walton DM, Avery S, et al. 

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401. 

Le BD, Willer JC, De BT. Morphine blocks 

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van Tulder MW, Cherkin DC, Berman B, et al. 

Acupuncture for low back pain. Cochrane 

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Yuan J, Purepong N, Kerr DP, et al. 

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systematic review. [Review] [89 refs]. Spine 

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Le BD, Villanueva L, Bouhassira D, et al. 

Diffuse noxious inhibitory controls (DNIC) in 

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Stevinson C, Honan W, Cooke B, et al. 

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Medicine 2001;94(3):107-10. 

Gouveia LO, Castanho P, Ferreira JJ, et al. 

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Haldeman S, Carey P, Townsend M, et al. 

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dissection after cervical manipulation: the effect 

of referral bias. Spine J 2002 Sep;2(5):334-42. 

Rivett DA, Sharples KJ, Milburn PD. Effect of 

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75. 

Complement Med 2009 Feb 13. 416. Di Fabio RP. Manipulation of the cervical spine: 

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Hurwitz EL, Aker PD, Adams AH, et al. 

Manipulation and mobilization of the cervical 

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59. 

Carnes D, Mullinger B, Underwood M. Defining 

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427. 

428. 

429. 

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therapy and exercise for neck pain: A systematic 

review. [In Press] Man Ther 2009. 

D'Sylva J, Miller J, Gross A, et al. Manual 

therapy with or without physical medicine 

modalities for neck pain: A systematic review. 

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classification-based physical therapy with therapy 

based on clinical practice guidelines for patients 

with acute low back pain: a randomized clinical 

trial. Spine 2003 Jul 1;28(13):1363-71. 

Brennan GP, Fritz JM, Hunter SJ, et al. 

420. 

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423. 

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425. 

Assendelft W, Morton S, Yu E, et al. Spinal 

manipulative therapy for low back pain. A metaanalysis of effectiveness relative to other 

therapies. Ann Intern Med 2003;138(11):871-81. 

Bronfort G, Evans RL, Maiers M, et al. Spinal 

manipulation, epidural injections, and self-care 

for sciatica: a pilot study for a randomized 

clinical trial. J Manipulative Physiol Ther 2004 

Oct;27(8):503-8. 

Guzman J, Haldeman S, Carroll LJ, et al. 

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Joint Decade 2000-2010 Task Force on Neck 

Pain and Its Associated Disorders: from concepts 

and findings to recommendations. Spine (Phila 

Pa 1976 ) 2008 Feb 15;33(4 Suppl):S199-S213 

Gross A, Miller J, D'Sylva J, et al. Manipulation 

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Database Syst Rev 2010;(1): 

Vernon H, Humphreys K, Hagino C. Chronic 

mechanical neck pain in adults treated by manual 

therapy: a systematic review of change scores in 

randomized clinical trials. J Manipulative 

Physiol Ther 2007 Mar;30(3):215-27. 

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431. 

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434. 

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436. 

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2006;31(6):623-31. 

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Prediction Rule for Classifying Patients with Low 

Back Pain Who Demonstrate Short-Term 

Improvement With Spinal Manipulation . Spine 

2002;27(DEC):2835-43. 

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Syst Rev 2008;(4):CD001929, 2008. 

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systematic review. Spine (Phila Pa 1976 ) 2007 

Feb 1;32(3):353-62. 

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Complement Altern Med 2006;6:24. 

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statement: revised recommendations for 

improving the quality of reports of parallel-group 

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18;285(15):1987-91. 

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226
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix A 

Ovid MEDLINE(R) 1950 to February Week 1 2010 

1 exp Neck/ or exp spine/ or exp back/ or Neck Muscles/ or Zygapophyseal Joint/ 

2 pain/ or pain, intractable/ or pain, referred/ 

3 (pain* or ache*).tw. 

4 3 or 2 

5 4 and 1 

6 exp back pain/ 

7 exp back injuries/ 

8 (backpain* or backache*).tw. 

9 exp spinal injuries/ 

10 exp spinal diseases/ 

11 ((disc* or disk*) adj3 (degener* or displace* or prolapse* or hernia* or bulge or 

protrusion* or extrusion* or sequestration* or disorder* or disease* or rupture* or 

slipped)).tw. 

12 ((stenosis or stenoses) adj3 (lumbar or spine or spines or spinal)).tw. 

13 (Spondylolys* or spondylolisthes* or Spondylisthes*).tw. 

14 (Discitis or diskitis or Spondylodis*).tw. 

15 (osteoporo* adj3 compression fracture*).tw. 

16 vertebrogenic pain syndrome*.tw. 

17 Sciatica/ 

18 (Sciatica or ischialgia).tw. 

19 (Sciatic adj3 (Neuralgia or Bilateral)).tw. 

20 Neck Pain/ 

21 (cervicalgia or Cervicodynia).tw. 

22 ((anterior or posterior) adj3 (cervical pain or cervical ache*)).tw. 

23 ((cervicogenic or cervico-genic) adj3 headache*).tw. 

24 exp neck injuries/ 

25 (neckache* or neckpain*).tw. 

26 (whiplash* or whip lash* or radiculomyelopath* or radiculo-myelopath*).tw. 

27 (neck disorder* adj3 radicul*).tw. 

28 (failed back or back surgery syndrome* or FBSS).tw. 

29 ((Zygapophyseal or Facet or facets) adj3 (syndrome* or degenerat*)).tw. 

30 ((back or neck or spine or spinal or lumbar* or thoracic) adj3 (ache* or aching or 

pain* or strain*)).tw. 

31 (lumbago or dorsalgia).tw. 

32 (myofascial adj3 (pain* or ache*)).tw. 

33 or/5-32 

34 Acupuncture/ 

35 Acupuncture Therapy/ 

36 Electroacupuncture/ 

A - 1 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

37 (Acupuncture or acu-puncture or electroacupuncture or electro-acupuncture or 

electric acupuncture or electric acu-puncture or needling or acupressure or acupressure or mox?bustion).tw. 

38 exp Manipulation, Spinal/ 

39 Manipulation, Chiropractic/ 

40 Chiropractic/ 

41 ((back or neck or spine or spinal or lumbar or cervical or chiropractic* or 

musculoskeletal* or musculo-skeletal*) adj3 (adjust* or manipulat* or mobiliz* or 

mobilis*)).tw. 

42 (Manual adj therap*).tw. 

43 (Manipulati* adj (therap* or medicine)).tw. 

44 exp Massage/ 

45 (massag* or reflexolog* or rolfing or zone therap*).tw. 

46 (Chih Ya or Shiatsu or Shiatzu or Zhi Ya).tw. 

47 (Flexion adj2 distraction*).tw. 

48 (myofascial adj3 (release or therap*)).tw. 

49 Muscle energy technique*.tw. 

50 Trigger point*.tw. 

51 Proprioceptive Neuromuscular Facilitation*.tw. 

52 Cyriax Friction.tw. 

53 (Lomilomi or lomi-lomi or trager).tw. 

54 Aston patterning.tw. 

55 (Strain adj counterstrain).tw. 

56 Alexander technique*.tw. 

57 (Craniosacral Therap* or Cranio-sacral Therap*).tw. 

58 (amma or ammo or Effleurage or Petrissage or hacking or Tapotment).tw. 

59 Complementary Therapies/ 

60 ((complement* or alternat* or osteopathic*) adj (therap* or medicine)).tw. 

61 (Tui Na or Tuina).tw. 

62 or/34-61 

63 33 and 62 

The following filters were applied and overlap removed: 

Randomized/Controlled Clinical Trials 

64 exp Randomized Controlled Trials as topic/
 

65 Randomized Controlled Trial.pt. 

66 Controlled Clinical Trial.pt.
 

67 (random* or sham or placebo*).tw. 

68 Placebos/ 

69 Random Allocation/
 

70 Single Blind Method/
 

71 Double Blind Method/
 

72 ((singl* or doubl* or tripl* or trebl*) adj (blind* or dumm* or mask*)).tw. 

73 (RCT or RCTs).tw.
 

A - 2 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

74 (control* adj2 (study or studies or trial*)).tw. 

75 or/64-74
 

76 63 and 75
 

77 animal/ 

78 human/ 

79 77 not (77 and 78) 

80 76 not 79
 

Systematic Review 

81 Meta-Analysis/ 

82 exp Meta-Analysis as Topic/ 

83 Meta analysis.pt. 

84 (meta analy* or metaanaly* or met analy* or metanaly*).tw. 

85 Review Literature as Topic/ 

86 (collaborative research or collaborative review* or collaborative overview*).tw. 

87 (integrative research or integrative review* or integrative overview*).tw. 

88 (quantitative adj3 (research or review* or overview*)).tw. 

89 (research integration or research overview*).tw. 

90 (systematic* adj3 (review* or overview*)).tw. 

91 (methodologic* adj3 (review* or overview*)).tw. 

92 exp Technology Assessment, Biomedical/ 

93 (hta or htas or technology assessment*).tw. 

94 ((hand adj2 search*) or (manual* adj search*)).tw. 

95 ((electronic adj database*) or (bibliographic* adj database*)).tw. 

96 ((data adj2 abstract*) or (data adj2 extract*)).tw. 

97 (Data adj3 (pool or pooled or pooling)).tw. (5850) 

98 (Analys* adj3 (pool or pooled or pooling)).tw. 

99 Mantel Haenszel.tw. 

100 (Cochrane or PubMed or MEDLINE or EMBASE or PsycINFO or PsycLIT or 

PsychINFO or PsychLIT or CINAHL or Science Citation Index).ab. 

101 or/81-100 

102 63 and 101 

103 102 not 79 

104 103 not 80 

Safety 

81 (ae or to or po or co).fs. 

82 (safe or safety or unsafe).tw. 

83 (side effect* or side event*).tw. 

84 ((adverse or undesirable or harm* or injurious or serious or toxic) adj3 (effect* or 

reaction* or event* or incident* or outcome*)).tw. 

85 (abnormalit* or toxicit* or complication* or consequence* or noxious or 

tolerabilit*).tw. 

86 or/81-85 

A - 3 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

87 63 and 86 

88 87 not 79 

89 88 not 80 

Economics 

90 economics/ 

91 exp "costs and cost analysis"/
 

92 Value of Life/
 

93 economics medical/ 

94 (econom* or cost or costs or costly or costing or price or prices or pricing).ti,ab.
 

95 (expenditure* not energy).ti,ab.
 

96 (value adj2 money).ti,ab. 

97 budget.ti,ab.
 

98 or/90-97
 

99 63 and 98
 

100 99 not 79
 

101 100 not (80 or 89) 

EMBASE 1980 to 2010 Week 4 

1 exp Neck/ or exp spine/ or exp back/ or Neck Muscle/ or Back Muscle/ or 

Zygapophyseal Joint/ 

2 Pain/ or Intractable Pain/ or Referred Pain/ 

3 (pain* or ache*).tw. 

4 2 or 3 

5 1 and 4 

6 exp Backache/ 

7 (backache or backpain).tw. 

8 exp Spine Injury/ 

9 exp Spine Disease/ 

10 ((disc* or disk*) adj3 (degener* or displace* or prolapse* or hernia* or bulge or 

protrusion* or extrusion* or sequestration* or disorder* or disease* or rupture* or 

slipped)).tw. 

11 ((stenosis or stenoses) adj3 (lumbar or spine or spines or spinal)).tw. 

12 (Spondylolys* or spondylolisthes* or Spondylisthes*).tw. 

13 (Discitis or diskitis or Spondylodis*).tw. 

14 (osteoporo* adj3 compression fracture*).tw. 

15 vertebrogenic pain syndrome*.tw. 

16 Ischialgia/ 

17 (Ischialgia or sciatica).tw. 

18 (Sciatic adj3 (Neuralgia or Bilateral)).tw. 

19 Neck Pain/ 

20 (cervicalgia or Cervicodynia).tw. 

21 ((anterior or posterior) adj3 (cervical pain or cervical ache*)).tw. 

A - 4 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22 ((cervicogenic or cervico-genic) adj3 headache*).tw. 

23 exp neck injuries/ 

24 (neckache* or neckpain*).tw. 

25 (whiplash* or whip lash* or radiculomyelopath* or radiculo-myelopath*).tw. 

26 (failed back or back surgery syndrome* or FBSS).tw. 

27 (myofascial adj3 (pain* or ache*)).tw. 

28 ((Zygapophyseal or Facet or facets) adj3 (syndrome* or degenerat*)).tw. 

29 ((back or neck or spine or spinal or lumbar* or thoracic) adj3 (ache* or aching or 

pain* or strain*)).tw. 

30 (lumbago or dorsalgia).tw. 

31 (neck disorder* adj3 radicul*).tw. 

32 or/5-31 

33 exp Acupuncture/ 

34 Electroacupuncture/ 

35 (Acupuncture or acu-puncture or electroacupuncture or electro-acupuncture or 

electric* acupuncture or electric* acu-puncture or needling or acupressure or acupressure or mox?bustion).tw. 

36 exp Manipulative Medicine/ 

37 chiropractic/ 

38 ((back or neck or spine or spinal or lumbar or cervical or chiropractic* or 

musculoskeletal* or musculo-skeletal*) adj3 (adjust* or manipulat* or mobiliz* or 

mobilis*)).tw. 

39 (Manual adj therap*).tw. 

40 (Manipulati* adj (therap* or medicine)).tw. 

41 Massage/ 

42 (massag* or reflexolog* or rolfing or zone therap*).tw. 

43 (Chih Ya or Shiatsu or Shiatzu or Zhi Ya).tw. 

44 (Flexion adj2 distraction*).tw. 

45 (myofascial adj3 (release or therap*)).tw. 

46 Muscle energy technique*.tw. 

47 Trigger point*.tw. 

48 Proprioceptive Neuromuscular Facilitation*.tw. 

49 Cyriax Friction.tw. 

50 (Lomilomi or lomi-lomi or trager).tw. 

51 Aston patterning.tw. 

52 (Strain adj counterstrain).tw. 

53 Alexander technique*.tw. 

54 (Craniosacral Therap* or Cranio-sacral Therap*).tw. 

55 (amma or ammo or Effleurage or Petrissage or hacking or Tapotment).tw. 

56 Alternative Medicine/ 

57 ((complement* or alternat* or osteopathic*) adj (therap* or medicine)).tw. 

58 (Tui Na or Tuina).tw. 

59 or/33-58 

60 32 and 59 

A - 5 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The following filters were applied and overlap removed: 

Randomized/Controlled Clinical Trials 

61 Randomized Controlled Trial/ 

62 exp Controlled Clinical Trial/ 

63 (random* or sham or placebo*).tw. 

64 Placebo/ 

65 Randomization/ 

66 Single Blind Procedure/
 

67 Double Blind Procedure/
 

68 ((singl* or doubl* or tripl* or trebl*) adj (blind* or dumm* or mask*)).tw. 

69 (RCT or RCTs).tw.
 

70 (control* adj2 (study or studies or trial*)).tw. 

71 or/61-70
 

72 60 and 71
 

73 human.sh. 

74 nonhuman.sh. 

75 animal.sh. 

76 animal experiment.sh. 

77 or/74-76
 

78 77 not (73 and 77) 

79 72 not 78
 

Systematic Review 

80 Meta Analysis/ (34242) 

81 "systematic review"/ (24457) 

82 (meta analy* or metaanaly* or met analy* or metanaly*).tw. (22067) 

83 (collaborative research or collaborative review* or collaborative overview*).tw. 

(834) 

84 (integrative research or integrative review* or integrative overview*).tw. (128) 

85 (quantitative adj3 (research or review* or overview*)).tw. (1551) 

86 (research integration or research overview*).tw. (59) 

87 (systematic* adj3 (review* or overview*)).tw. (17008) 

88 (methodologic* adj3 (review* or overview*)).tw. (1013) 

89 biomedical technology assessment/ (5472) 

90 (hta or htas or technology assessment*).tw. (1902) 

91 ((hand adj2 search*) or (manual* adj search*)).tw. (2396) 

92 ((electronic adj database*) or (bibliographic* adj database*)).tw. (2660) 

93 ((data adj2 abstract*) or (data adj2 extract*)).tw. (11462) 

94 (Data adj3 (pool or pooled or pooling)).tw. (4432) 

95 (Analys* adj3 (pool or pooled or pooling)).tw. (3135) 

96 Mantel Haenszel.tw. (1463) 

97 (Cochrane or PubMed or MEDLINE or EMBASE or PsycINFO or PsycLIT or 

PsychINFO or PsychLIT or CINAHL or Science Citation Index).ab. (28709) 

A - 6 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

98 or/80-97 (100019) 

99 60 and 98 (421) 

100 99 not 78 (421) 

101 100 not 79 (178) 

Safety 

80 (ae or co or si or to).fs. 

81 (safe or safety or unsafe).tw. 

82 (side effect* or side event*).tw. 

83 ((adverse or undesirable or harm* or injurious or serious or toxic) adj3 (effect* or 

reaction* or event* or incident* or outcome*)).tw. 

84 (abnormalit* or toxicit* or complication* or consequence* or noxious or 

tolerabilit*).tw. 

85 or/80-84 

86 60 and 85 

87 86 not 78 

88 87 not 79 

Economics 

89 health-economics/ 

90 exp economic-evaluation/ 

91 exp health-care-cost/
 

92 (econom* or cost or costs or costly or costing or price or prices or pricing).ti,ab.
 

93 (expenditure* not energy).ti,ab.
 

94 (value adj2 money).ti,ab. 

95 budget*.ti,ab.
 

96 socioeconomics/ 

97 or/89-96
 

98 60 and 97
 

99 98 not 78
 

100 99 not (79 or 88) 

AMED <1985 to January 2010> 

1 exp Neck/ or exp spine/ or exp back/ or Neck Muscles/
 

2 pain/ or pain intractable/ 

3 (pain* or ache*).tw.
 

4 2 or 3
 

5 1 and 4
 

6 exp backache/
 

7 back injuries/
 

8 (backache* or backpain*).tw.
 

9 spinal injuries/
 

A - 7 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10 exp spinal disease/ 

11 ((disc* or disk*) adj3 (degener* or displace* or prolapse* or hernia* or bulge or 

protrusion* or extrusion* or sequestration* or disorder* or disease* or rupture* or 

slipped)).tw. 

12 ((stenosis or stenoses) adj3 (lumbar or spine or spines or spinal)).tw. 

13 (Spondylolys* or spondylolisthes* or Spondylisthes*).tw. 

14 (Discitis or diskitis or Spondylodis*).tw. 

15 (osteoporo* adj3 compression fracture*).tw. 

16 vertebrogenic pain syndrome*.tw. 

17 sciatica/ 

18 (Sciatica or Ischialgia).tw. 

19 (Sciatic adj3 (Neuralgia or Bilateral)).tw. 

20 neck pain/ 

21 (cervicalgia or Cervicodynia).tw. 

22 ((anterior or posterior) adj3 (cervical pain or cervical ache*)).tw. 

23 ((cervicogenic or cervico-genic) adj3 headache*).tw. 

24 exp neck injuries/ 

25 (neckache* or neckpain*).tw. 

26 (neck disorder* adj3 radicul*).tw. 

27 (whiplash* or whip lash* or radiculomyelopath* or radiculo-myelopath*).tw. 

28 (failed back or back surgery syndrome*).tw. 

29 FBSS.tw. 

30 ((Zygapophyseal or Facet or facets) adj3 (syndrome* or degenerat*)).tw. 

31 ((back or neck or spine or spinal or lumbar* or thoracic) adj3 (ache* or aching or 

pain* or strain*)).tw. 

32 (lumbago or dorsalgia).tw. 

33 (myofascial adj3 (pain* or ache*)).tw. 

34 or/5-33 

35 exp acupuncture/ 

36 exp acupuncture therapy/ 

37 (Acupuncture or acu-puncture or electroacupuncture or electro-acupuncture or 

electric acupuncture or electric acu-puncture or needling or acupressure or acupressure or mox?bustion).tw. 

38 spinal manipulation/ 

39 exp manipulation chiropractic/ 

40 chiropractic/ 

41 ((back or neck or spine or spinal or lumbar or cervical or chiropractic* or 

musculoskeletal* or musculo-skeletal*) adj3 (adjust* or manipulat* or mobiliz* or 

mobilis*)).tw. 

42 (Manual adj therap*).tw. 

43 (Manipulati* adj (therap* or medicine)).tw. 

44 massage/ 

45 (massag* or reflexolog* or rolfing or zone therap*).tw. 

46 (Chih Ya or Shiatsu or Shiatzu or Zhi Ya).tw. 

47 (Flexion adj2 distraction*).tw. 

48 (myofascial adj3 (release or therap*)).tw. 

A - 8 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

49 Muscle energy technique*.tw.
 

50 Trigger point*.tw.
 

51 Proprioceptive Neuromuscular Facilitation*.tw. 

52 Cyriax Friction.tw.
 

53 (Lomilomi or lomi-lomi or trager or Tui Na or Tuina).tw. 

54 Aston patterning.tw.
 

55 (Strain adj counterstrain).tw.
 

56 Alexander technique*.tw.
 

57 (Craniosacral Therap* or Cranio-sacral Therap*).tw. 

58 (amma or ammo or Effleurage or Petrissage or hacking or Tapotment).tw. 

59 complementary therapies/ 

60 ((complement* or alternat* or osteopathic*) adj (therap* or medicine)).tw. 

61 or/35-60
 

62 34 and 61
 

The following filters were applied and overlap removed: 

Randomized/Controlled Clinical Trials 

63 randomized controlled trials/ 

64 randomized controlled trial.pt. 

65 controlled clinical trial.pt. 

66 (random* or sham or placebo*).tw. 

67 Placebos/ 

68 double blind method/ or random allocation/ 

69 ((singl* or doubl* or tripl* or trebl*) adj (blind* or dumm* or mask*)).tw. 

70 (RCT or RCTs).tw.
 

71 (control* adj2 (study or studies or trial*)).tw. 

72 randomised controlled trial.pt. 

73 or/63-72
 

74 62 and 73
 

Systematic Review 

75 meta analysis/ 

76 meta analysis.pt. 

77 (meta analy* or metaanaly* or met analy* or metanaly*).tw. 

78 (collaborative research or collaborative review* or collaborative overview*).tw.
 

79 (integrative research or integrative review* or integrative overview*).tw.
 

80 (quantitative adj3 (research or review* or overview*)).tw. 

81 (research integration or research overview*).tw.
 

82 (systematic* adj3 (review* or overview*)).tw. 

83 (methodologic* adj3 (review* or overview*)).tw. 

84 (hta or htas or technology assessment*).tw. 

85 ((hand adj2 search*) or (manual* adj search*)).tw. 

86 ((electronic adj database*) or (bibliographic* adj database*)).tw. 

A - 9 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

87 ((data adj2 abstract*) or (data adj2 extract*)).tw. 

88 (Data adj3 (pool or pooled or pooling)).tw. 

89 (Analys* adj3 (pool or pooled or pooling)).tw. 

90 Mantel Haenszel.tw. 

91 (Cochrane or PubMed or MEDLINE or EMBASE or PsycINFO or PsycLIT or 

PsychINFO or PsychLIT or CINAHL or Science Citation Index).ab. 

92 or/75-91 (2843) 

93 62 and 92 (150) 

94 93 not 74 

Safety 

75 (safe or safety or unsafe).tw. 

76 (side effect* or side event*).tw. 

77 ((adverse or undesirable or harm* or injurious or serious or toxic) adj3 (effect* or 

reaction* or event* or incident* or outcome*)).tw. 

78 (abnormalit* or toxicit* or complication* or consequence* or noxious or 

tolerabilit*).tw. 

79 adverse effects/ 

80 or/75-79 

81 62 and 80 

82 81 not 74 

Economics 

84 Economics/ 

85 exp "costs and cost analysis"/ or patient satisfaction/ or "quality of life"/ 

86 (econom* or cost or costs or costly or costing or price or prices or pricing or 

budget*).ti,ab. 

87 (expenditure* not energy).ti,ab. 

88 (value adj2 money).ti,ab. 

89 (QOL or QOLY or QOLYs or HRQOL or QALY or QALYs).ti,ab. 

90 or/84-89 

91 62 and 90 

92 91 not (74 or 82) 

ACP Journal Club <1991 to August 2008> 

1 (backpain* or backache*).tw. 

2 ((disc* or disk*) adj3 (degener* or displace* or prolapse* or hernia* or bulge or 

protrusion* or extrusion* or sequestration* or disorder* or disease* or rupture* or 

slipped)).tw. 

3 ((stenosis or stenoses) adj3 (lumbar or spine or spines or spinal)).tw. 

4 (Spondylolys* or spondylolisthes* or Spondylisthes*).tw. 

5 (Discitis or diskitis or Spondylodis*).tw. 

A - 10 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6 (osteoporo* adj3 compression fracture*).tw. 

7 vertebrogenic pain syndrome*.tw. 

8 (Sciatica or ischialgia).tw. 

9 (Sciatic adj3 (Neuralgia or Bilateral)).tw. 

10 (cervicalgia or Cervicodynia).tw. 

11 ((anterior or posterior) adj3 (cervical pain or cervical ache*)).tw. 

12 ((cervicogenic or cervico-genic) adj3 headache*).tw. 

13 (neckache* or neckpain*).tw. 

14 (whiplash* or whip lash* or radiculomyelopath* or radiculo-myelopath*).tw. 

15 (failed back or back surgery syndrome* or FBSS).tw. 

16 ((Zygapophyseal or Facet or facets) adj3 (syndrome* or degenerat*)).tw. 

17 ((back or neck or spine or spinal or lumbar* or thoracic) adj3 (ache* or aching or 

pain* or strain*)).tw. 

18 (lumbago or dorsalgia).tw. 

19 (myofascial adj3 (pain* or ache*)).tw. 

20 (neck disorder* adj3 radicul*).tw. 

21 or/1-20 

22 (Acupuncture or acu-puncture or electroacupuncture or electro-acupuncture or 

electric acupuncture or electric acu-puncture or needling or acupressure or acupressure or mox?bustion).tw. 

23 ((back or neck or spine or spinal or lumbar or cervical or chiropractic* or 

musculoskeletal* or musculo-skeletal*) adj3 (adjust* or manipulat* or mobiliz* or 

mobilis*)).tw. 

24 (Manual adj therap*).tw. 

25 (Manipulati* adj (therap* or medicine)).tw. 

26 (massag* or reflexolog* or rolfing or zone therap*).tw. 

27 (Chih Ya or Shiatsu or Shiatzu or Zhi Ya).tw. 

28 (Flexion adj2 distraction*).tw. 

29 (myofascial adj3 (release or therap*)).tw. 

30 Muscle energy technique*.tw. 

31 Trigger point*.tw. 

32 Proprioceptive Neuromuscular Facilitation*.tw. 

33 Cyriax Friction.tw. 

34 (Lomilomi or lomi-lomi or trager or Tui Na or Tuina).tw. 

35 Aston patterning.tw. 

36 (Strain adj counterstrain).tw. 

37 Alexander technique*.tw. 

38 (Craniosacral Therap* or Cranio-sacral Therap*).tw. 

39 (amma or ammo or Effleurage or Petrissage or hacking or Tapotment).tw. 

40 ((complement* or alternat* or osteopathic*) adj (therap* or medicine)).tw. 

41 or/22-40 

42 21 and 41 

A - 11 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CINAHL <1982 to September Week 3 2008>
 

1 Neck/ 

2 Back/ 

3 exp Spine/ 

4 Neck Muscles/ 

5 or/1-4 

6 pain/ 

7 Referred Pain/ 

8 (pain* or ache*).tw. 

9 or/6-8 

10 5 and 9 

11 exp Back Pain/ 

12 exp Back Injuries/ 

13 (backache* or backpain*).tw. 

14 exp Spinal Injuries/ 

15 exp Spinal Diseases/ 

16 ((disc* or disk*) adj3 (degener* or displace* or prolapse* or hernia* or bulge or 

protrusion* or extrusion* or sequestration* or disorder* or disease* or rupture* or 

slipped)).tw. 

17 ((stenosis or stenoses) adj3 (lumbar or spine or spines or spinal)).tw. 

18 (Spondylolys* or spondylolisthes* or Spondylisthes*).tw. 

19 (Discitis or diskitis or Spondylodis*).tw. 

20 (osteoporo* adj3 compression fracture*).tw. 

21 vertebrogenic pain syndrome*.tw. 

22 Sciatica/ 

23 (Sciatica or Ischialgia).tw. 

24 (Sciatic adj3 (Neuralgia or Bilateral)).tw. 

25 Neck Pain/ 

26 (cervicalgia or Cervicodynia).tw. 

27 ((anterior or posterior) adj3 (cervical pain* or cervical ache*)).tw. 

28 ((cervicogenic or cervico-genic) adj3 headache*).tw. 

29 exp Neck Injuries/ 

30 (neckache* or neckpain*).tw. 

31 (whiplash* or whip lash*).tw. 

32 (failed back or back surgery syndrome* or FBSS).tw. 

33 (neck disorder* adj3 radicul*).tw. 

34 ((Zygapophyseal or Facet or facets) adj3 (syndrome* or degenerat*)).tw. 

35 ((back or neck or spine or spinal or lumbar* or thoracic) adj3 (ache* or aching or 

pain* or strain*)).tw. 

36 (lumbago or dorsalgia).tw. 

37 (myofascial adj3 (pain* or ache*)).tw. 

38 or/10-37 

39 exp Acupuncture/ 

A - 12 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

40 (Acupuncture or acu-puncture or electroacupuncture or electro-acupuncture or 

electric* acupuncture or electric* acu-puncture or acupressure or acu-pressure or 

mox?bustion).tw. 

41 exp chiropractic/ or manipulation, chiropractic/ 

42 ((back or neck or spine or spinal or lumbar or cervical or chiropractic* or 

musculoskeletal* or musculo-skeletal*) adj3 (adjust* or manipulat* or mobiliz* or 

mobilis*)).tw. 

43 (Manual adj therap*).tw. 

44 (Manipulati* adj (therap* or medicine)).tw. 

45 exp Massage/ 

46 (massag* or reflexolog* or rolfing or zone therap*).tw. 

47 (Chih Ya or Shiatsu or Shiatzu or Zhi Ya or Tui Na).tw. 

48 (Flexion adj2 distraction*).tw. 

49 (myofascial adj3 (release or therap*)).tw. 

50 Muscle energy technique*.tw. 

51 Trigger point*.tw. 

52 Proprioceptive Neuromuscular Facilitation*.tw. 

53 Cyriax Friction.tw. 

54 (Lomilomi or lomi-lomi or trager or Tui Na or Tuina).tw. 

55 Aston patterning.tw. 

56 (Strain adj counterstrain).tw. 

57 Alexander technique*.tw. 

58 (Craniosacral Therap* or Cranio-sacral Therap*).tw. 

59 (amma or ammo or Effleurage or Petrissage or hacking or Tapotment).tw. 

60 Alternative Therapies/ 

61 ((complement* or alternat* or osteopathic*) adj (therap* or medicine)).tw. 

62 or/39-61 

63 38 and 62 

The following filters were applied and overlap removed: 

Randomized/Controlled Clinical Trials 

64 exp Clinical Trials/
 

65 clinical trial.pt. 

66 (random* or sham or placebo*).tw. 

67 Placebos/ 

68 Random Assignment/ 

69 ((singl* or doubl* or tripl* or trebl*) adj (blind* or dumm* or mask*)).tw. 

70 (RCT or RCTs).tw.
 

71 (control* adj2 (study or studies or trial*)).tw. 

72 or/64-71
 

73 63 and 72 

A - 13 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Systematic Review 

74 systematic review.pt. 

75 Meta Analysis/
 

76 (meta analy* or metaanaly* or met analy* or metanaly*).tw. 

77 (collaborative research or collaborative review* or collaborative overview*).tw.
 

78 (integrative research or integrative review* or integrative overview*).tw.
 

79 (quantitative adj3 (research or review* or overview*)).tw.
 

80 (integrative research or research integration or research overview*).tw. 

81 (systematic* adj3 (review* or overview*)).tw. 

82 (methodologic* adj3 (review* or overview*)).tw. 

83 (hta or htas or technology assessment*).tw. 

84 ((hand adj2 search*) or (manual* adj2 search*)).tw. 

85 ((electronic adj database*) or (bibliographic* adj database*)).tw. 

86 ((data adj2 abstract*) or (data adj2 extract*)).tw.
 

87 (data adj3 (pool or pooled or pooling)).tw.
 

88 (analys* adj3 (pool or pooled or pooling)).tw.
 

89 Mantel Haenszel.tw.
 

90 (Cochrane or PubMed or MEDLINE or EMBASE or PsycINFO or PsycLIT or 

PsychINFO or PsychLIT or CINAHL or Science Citation Index).ab. 

91 or/74-90 

92 63 and 91 

93 92 not 73 

Safety 

74 (safe or safety or unsafe).tw.
 

75 (side effect* or side event*).tw.
 

76 ((adverse or undesirable or harm* or injurious or serious or toxic) adj3 (effect* or 

reaction* or event* or incident* or outcome*)).tw. 

77 (abnormalit* or toxicit* or complication* or consequence* or noxious or 

tolerabilit*).tw. 

78 (ae or po or co).fs. 

79 or/74-78 

80 63 and 79 

81 80 not 73 

Economics 

84 exp economics/ (258163) 

85 exp financial management/ (17991) 

86 exp financial support/ (168377) 

87 exp "financing organized"/ (51967) 

88 exp "business"/ (26100) 

89 or/85-88 (249186) 

90 84 not 89 (24912) 

A - 14 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

91 health resource allocation/ (3423) 

92 health resource utilization/ (4982) 

93 exp "Quality of Life"/ (23733) 

94 Patient Satisfaction/ (14059) 

95 (econom* or cost or costs or costly or costing or price or prices or pricing or 

budget*).ti,ab. (53804) 

96 (expenditure* not energy).ti,ab. (2243) 

97 (value adj2 money).ti,ab. (187) 

98 (QOL or QOLY or QOLYs or HRQOL or QALY or QALYs).ti,ab. (3012) 

99 or/90-98 (107583) 

100 63 and 99 (255) 

101 100 not (73 or 81) 

MANTIS <1880 to October 2008> 

1 neck.de. 

2 (spine or Cervical Vertebrae or Coccyx or Intervertebral Disk or Lumbar Vertebrae 

or Sacrum or Spinal Canal or Thoracic Vertebrae).de. 

3 (Back or Lumbosacral Region or Sacrococcygeal Region).de. 

4 neck muscles.de. 

5 Zygapophyseal Joint.de. 

6 or/1-5 

7 pain.de. 

8 pain, intractable.de. 

9 pain, referred.de. 

10 (pain* or ache* or aching).tw. 

11 or/7-10 

12 6 and 11 

13 (back pain or low back pain).de. 

14 back injuries.de. 

15 (backpain* or backache*).tw. 

16 (spinal injuries or spinal fractures).de. 

17 (spinal diseases or Intervertebral Disk Displacement or Spinal Stenosis or 

Spondylolisthesis or Spondylolysis).de. 

18 ((disc* or disk*) adj3 (degener* or displace* or prolapse* or hernia* or bulge or 

protrusion* or extrusion* or sequestration* or disorder* or disease* or rupture* or 

slipped)).tw. 

19 ((stenosis or stenoses) adj3 (lumbar or spine or spines or spinal)).tw. 

20 (Spondylolys* or spondylolisthes* or Spondylisthes*).tw. 

21 (Discitis or diskitis or Spondylodis*).tw. 

22 (osteoporo* adj3 compression fracture*).tw. 

23 vertebrogenic pain syndrome*.tw. 

24 Sciatica.de. 

25 (Sciatica or ischialgia).tw. 

26 (Sciatic adj3 (Neuralgia or Bilateral)).tw. 

A - 15 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

27 neck pain.de. 

28 (cervicalgia or Cervicodynia).tw. 

29 ((anterior or posterior) adj3 (cervical pain or cervical ache*)).tw. 

30 ((cervicogenic or cervico-genic) adj3 headache*).tw. 

31 (neck injuries or Whiplash Injuries).de. 

32 (neckache* or neckpain*).tw. 

33 (whiplash* or whip lash* or radiculomyelopath* or radiculo-myelopath*).tw. 

34 (neck disorder* adj3 radicul*).tw. 

35 failed back surgery.de. 

36 (failed back or back surgery syndrome* or FBSS).tw. 

37 facet syndrome.de. 

38 ((Zygapophyseal or Facet or facets) adj3 (syndrome* or degenerat*)).tw. 

39 ((back or neck or spine or spinal or lumbar* or thoracic) adj3 (ache* or aching or 

pain* or strain*)).tw. 

40 (lumbago or dorsalgia).tw. 

41 (myofascial pain syndromes or myofascial).de. 

42 (myofascial adj3 (pain* or ache*)).tw. 

43 or/12-42 

44 Acupuncture.de. 

45 Acupuncture Therapy.de. 

46 electroacupuncture.de. 

47 (Acupuncture or acu-puncture or electroacupuncture or electro-acupuncture or 

electric acupuncture or electric acu-puncture or needling or acupressure or acupressure or mox?bustion).tw. 

48 Manipulation, Spinal.de. 

49 Manipulation, Chiropractic.de. 

50 Chiropractic.de. 

51 ((back or neck or spine or spinal or lumbar or cervical or chiropractic* or 

musculoskeletal* or musculo-skeletal*) adj3 (adjust* or manipulat* or mobiliz* or 

mobilis*)).tw. 

52 (Manual adj therap*).tw. 

53 (Manipulati* adj (therap* or medicine)).tw. 

54 (Massage or Acupressure).de. 

55 (massag* or reflexolog* or rolfing or zone therap*).tw. 

56 (Chih Ya or Shiatsu or Shiatzu or Zhi Ya).tw. 

57 (Flexion adj2 distraction*).tw. 

58 (myofascial adj3 (release or therap*)).tw. 

59 Muscle energy technique*.tw. 

60 Trigger point*.tw. 

61 Proprioceptive Neuromuscular Facilitation*.tw. 

62 Cyriax Friction.tw. 

63 (Lomilomi or lomi-lomi or trager).tw. 

64 Aston patterning.tw. 

65 (Strain adj counterstrain).tw. 

66 Alexander technique*.tw. 

67 (Craniosacral Therap* or Cranio-sacral Therap*).tw. 

A - 16 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

68 (amma or ammo or Effleurage or Petrissage or hacking or Tapotment).tw. 

69 Complementary Therapies.de. 

70 ((complement* or alternat* or osteopathic*) adj (therap* or medicine)).tw. 

71 (Tui Na or Tuina).tw.
 

72 or/44-71
 

73 43 and 72
 

The following filters were applied and overlap removed: 

Randomized/Controlled Clinical Trials 

74 (Randomized Controlled Trial or Randomized Controlled Trials).de. 

75 (Controlled Clinical Trial or Controlled Clinical Trials).de. 

76 (random* or sham or placebo*).tw. 

77 Placebos.de. 

78 Random Allocation.de.
 

79 Single Blind Method.de.
 

80 Double Blind Method.de.
 

81 ((singl* or doubl* or tripl* or trebl*) adj (blind* or dumm* or mask*)).tw. 

82 (RCT or RCTs).tw.
 

83 (control* adj2 (study or studies or trial*)).tw. 

84 or/74-83
 

85 animal.de. 

86 human.de. 

87 85 not (85 and 86) 

88 73 and 84
 

89 88 not 87 

Systematic Review 

90 Meta-Analysis.de.
 

91 (meta analy* or metaanaly* or met analy* or metanaly*).tw. 

92 (collaborative research or collaborative review* or collaborative overview*).tw.
 

93 (integrative research or integrative review* or integrative overview*).tw.
 

94 (quantitative adj3 (research or review* or overview*)).tw.
 

95 (research integration or research overview*).tw.
 

96 (systematic* adj3 (review* or overview*)).tw. 

97 (methodologic* adj3 (review* or overview*)).tw. 

98 Technology Assessment, Biomedical.de. 

99 (hta or htas or technology assessment*).tw. 

100 ((hand adj2 search*) or (manual* adj search*)).tw. 

101 ((electronic adj database*) or (bibliographic* adj database*)).tw.
 

102 ((data adj2 abstract*) or (data adj2 extract*)).tw.
 

103 (Data adj3 (pool or pooled or pooling)).tw.
 

104 (Analys* adj3 (pool or pooled or pooling)).tw.
 

105 Mantel Haenszel.tw.
 

A - 17 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

106 (Cochrane or PubMed or MEDLINE or EMBASE or PsycINFO or PsycLIT or 

PsychINFO or PsychLIT or CINAHL or Science Citation Index).ab. 

107 or/90-106 

108 73 and 107 

109 108 not 87 

110 109 not 89 

Safety 

90 (safe or safety or unsafe).tw. 

91 (side effect* or side event*).tw. 

92 ((adverse or undesirable or harm* or injurious or serious or toxic) adj3 (effect* or 

reaction* or event* or incident* or outcome*)).tw. 

93 (abnormalit* or toxicit* or complication* or consequence* or noxious or 

tolerabilit*).tw. 

94 adverse effects.de. 

95 complications.de. 

96 toxicity.de. 

97 or/90-96 

98 73 and 97 

99 98 not 87 

100 99 not 89 

Economics 

101 economics.de. 

102 "costs and cost analysis".de.
 

103 "value of life".de. 

104 economics, medical.de. 

105 (econom* or cost or costs or costly or costing or price or prices or pricing).ti,ab.
 

106 (expenditure* not energy).ti,ab. 

107 (value adj2 money).ti,ab. 

108 budget.ti,ab. 

109 cost benefit analysis.de. 

110 or/101-109
 

111 73 and 110 

112 111 not 87
 

113 112 not (89 or 100)
 

Cochrane Library 2010 Issue 1 

Systematic Review and RCT/CCT 

1 MeSH descriptor Neck explode all trees 

2 MeSH descriptor Spine explode all trees 

A - 18 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3 MeSH descriptor Back explode all trees 

4 MeSH descriptor Neck Muscles explode all trees 

5 MeSH descriptor Zygapophyseal Joint explode all trees 

6 MeSH descriptor Pain explode all trees 

7 MeSH descriptor Pain, Intractable explode all trees 

8 MeSH descriptor Pain, Referred explode all trees 

9 (pain* or ache*):ti,ab,kw 

10 (1 OR 2 OR 3 OR 4 OR 5) 

11 (6 OR 7 OR 8 OR 9) 

12 (10 AND 11) 

13 MeSH descriptor Back Pain explode all trees 

14 MeSH descriptor Back Injuries explode all trees 

15 (backpain* or backache*):ti,ab,kw 

16 MeSH descriptor Spinal Injuries explode all trees 

17 MeSH descriptor Spinal Diseases explode all trees 

18 (disc* or disk*) NEAR/3 (degener* or displace* or prolapse* or hernia* or bulge or 

protrusion* or extrusion* or sequestration* or disorder* or disease* or rupture* or 

slipped):ti,ab,kw 

19 (stenosis or stenoses) NEAR/3 (lumbar or spine or spines or spinal):ti,ab,kw 

20 (Spondylolys* or spondylolisthes* or Spondylisthes*):ti,ab,kw or (Discitis or 

diskitis or Spondylodis*):ti,ab,kw 

21 (osteoporo* NEAR/3 compression fracture*):ti,ab,kw 

22 (vertebrogenic pain syndrome*):ti,ab,kw 

23 MeSH descriptor Sciatica explode all trees 

24 (Sciatica or ischialgia):ti,ab,kw or (Sciatic NEAR/3 (Neuralgia or 

Bilateral)):ti,ab,kw 

25 MeSH descriptor Neck Pain explode all trees 

26 (cervicalgia or Cervicodynia):ti,ab,kw or (anterior or posterior) NEAR/3 (cervical 

pain or cervical ache*):ti,ab,kw or (cervicogenic or cervico-genic) NEAR/3 

headache*:ti,ab,kw 

27 MeSH descriptor Neck Injuries explode all trees 

28 (neckache* or neckpain*):ti,ab,kw or (whiplash* or whip lash* or 

radiculomyelopath* or radiculo-myelopath*):ti,ab,kw or (failed back or back 

surgery syndrome* OR FBSS):ti,ab,kw or (lumbago or dorsalgia):ti,ab,kw 

29 (neck disorder*) NEAR/3 radicul*:ti,ab,kw or (Zygapophyseal or Facet or facets) 

NEAR/3 (syndrome* or degenerat*):ti,ab,kw or (back or neck or spine or spinal or 

lumbar* or thoracic) NEAR/3 (ache* or aching or pain* or strain*):ti,ab,kw or 

(myofascial adj3 (pain* or ache*)):ti,ab,kw 

30 (12 OR 13 OR 14 OR 15 OR 16 OR 17 OR 18 OR 19 OR 20 OR 21 OR 22 OR 23 

OR 24 OR 25 OR 26 OR 27 OR 28 OR 29) 

31 MeSH descriptor Acupuncture explode all trees 

32 MeSH descriptor Acupuncture Therapy explode all trees 

33 MeSH descriptor Electroacupuncture explode all trees 

34 (acupuncture or electric acupuncture or electric acu-puncture or needling or 

acupressure or acu-pressure or mox?bustion):ti,ab,kw 

35 MeSH descriptor Manipulation, Spinal explode all trees 

A - 19 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

36 MeSH descriptor Manipulation, Chiropractic explode all trees 

37 MeSH descriptor Chiropractic explode all trees 

38 (back or neck or spine or spinal or lumbar or cervical or chiropractic* or 

musculoskeletal* or musculo-skeletal*) NEAR/3 (adjust* or manipulat* or 

mobiliz* or mobilis*):ti,ab,kw or (Manual NEXT therap*):ti,ab,kw or (Manipulati* 

NEXT (therap* or medicine)):ti,ab,kw 

39 MeSH descriptor Massage explode all trees 

40 (massag* or reflexolog* or rolfing or zone therap*):ti,ab,kw or (Chih Ya or Shiatsu 

or Shiatzu or Zhi Ya):ti,ab,kw or (Flexion NEAR/2 distraction*):ti,ab,kw or 

(myofascial NEAR/3 (release or therap*)):ti,ab,kw or (Muscle energy 

technique*):ti,ab,kw 

41 (Trigger point*):ti,ab,kw or (Proprioceptive Neuromuscular Facilitation*):ti,ab,kw 

or (Cyriax Friction):ti,ab,kw or (Lomilomi or lomi-lomi or trager or Tui Na or 

Tuina):ti,ab,kw or (Aston patterning):ti,ab,kw 

42 (Strain NEAR/1 counterstrain):ti,ab,kw or (Alexander technique*):ti,ab,kw or 

(Craniosacral Therap* or Cranio-sacral Therap*):ti,ab,kw or (amma or ammo or 

Effleurage or Petrissage or hacking or Tapotment):ti,ab,kw or (complement* or 

alternat* or osteopathic*) NEXT (therap* or medicine):ti,ab,kw 

43 MeSH descriptor Complementary Therapies, this term only 

44 (31 OR 32 OR 33 OR 34 OR 35 OR 36 OR 37 OR 38 OR 39 OR 40 OR 41 OR 42 

OR 43) 

45 (30 AND 44) 

Safety 

46 Any MeSH descriptor with qualifier: AE 

47 Any MeSH descriptor with qualifier: TO 

48 Any MeSH descriptor with qualifier: PO 

49 Any MeSH descriptor with qualifier: CO 

50 (safe or safety or unsafe):ti,ab,kw or (side effect* or side event*):ti,ab,kw or 

(adverse or undesirable or harm* or injurious or serious or toxic) NEAR/3 (effect* 

or reaction* or event* or incident* or outcome*):ti,ab,kw or (abnormalit* or 

toxicit* or complication* or consequence* or noxious or tolerabilit*):ti,ab,kw 

51 (46 OR 47 OR 48 OR 49 OR 50) 

52 (45 AND 51) 

Economics 

53 MeSH descriptor Economics, this term only 

54 MeSH descriptor Economics, Medical, this term only 

55 MeSH descriptor Costs and Cost Analysis explode all trees 

56 MeSH descriptor Value of Life explode all trees 

57 MeSH descriptor Quality-Adjusted Life Years explode all trees 

58 MeSH descriptor Patient Satisfaction explode all trees 

59 Any MeSH descriptor with qualifier: EC 

A - 20 
 

 

 

 

60 (econom* or cost or costs or costly or costing or price or prices or pricing or 

budget*):ti,ab,kw or (expenditure* not energy):ti,ab,kw or (value NEAR/2 

money):ti,ab,kw or (QOL or QOLY or QOLYs or HRQOL or QALY or 

QALYs):ti,ab,kw 

61 (53 OR 54 OR 55 OR 56 OR 57 OR 58 OR 59 OR 60) 

62 (45 AND 61) 

63 (62 AND NOT 52) 

Index to Chiropractic Literature 

2008 Oct 10 

S1 Subject:: "BACK PAIN" OR "BACK INJURIES" OR "NECK INJURIES" OR 

"NECK PAIN" OR "SPINAL DISEASES" OR "SPINAL INJURIES" OR 

"SCIATICA" OR All Fields:backpain* or backache* OR "back pain" OR "back 

ache" OR "back pains" OR "back aches" OR neck pain* OR neck ache* OR 

"neck pain" OR neck ache" OR "neck pains" OR "neck aches" OR All 

Fields:Spondylolys* or Spondylolisthes* or Spondylisthes* or Discitis or Diskitis 

or Spondylod* OR Sciatica OR Ischialgia* OR Cervicalgia OR Cervicodynia 

S2 All Fields:whiplash* or "whip lash" OR "whip lashes" or radiculomyelopath* or 

"radiculo-myelopathy" OR "radiculo-myelopathies" OR All Fields:"failed back" 

or "back surgery syndrome" or "back surgery syndromes" or FBSS OR All 

Fields:lumbago or dorsalgia or "myofascial pain" OR "myofascial ache" 

S3 All Fields: "cervical pain" OR "cervical ache" OR "vertebrogenic pain syndrome" 

OR "vertebrogenic pain syndromes" OR All Fields:"degenerated disk" OR 

"degenerative disk" OR "degenerated disks" OR "degenerative disks" OR All 

Fields:"degenerated disc" OR "degenerative disc OR "degenerated discs" OR 

"degenerative discs" 

S4 All Fields:"prolapsed disk" OR "prolapsed disks" OR "prolapsed disc" OR 

"prolapsed discs" OR "disk prolapse" OR "disc prolapse" "herniated disk" OR 

"herniated disks" OR "herniated disc" OR "herniated discs" OR All 

Fields:"displaced disk" OR "displaced disks" OR "displaced disc" OR "displaced 

discs" OR "osteoporotic compression fracture" OR "osteoporotic compression 

fractures" OR All Fields::"lumbar stenosis" OR "lumbar stenoses" OR "spinal 

stenosis" OR "spinal stenoses" OR "cervicogenic headache" OR "cervicogenic 

headaches" OR "cervico-genic headache" OR "cervico-genic headaches" 

S5 All Fields:radiculomyelopathy OR radiculomyelopathies OR "radiculomyelopathy" OR "radiculo-myelopathies" OR All Fields:"Zygapophyseal joint 

syndrome" OR "Zygapophyseal joint syndromes" OR "Z-joint syndrome" OR "Zjoint syndromes" OR "facet joint syndrome" OR "facet joint syndromes" OR All 

Fields:"thoracic pain" OR "thoracic ache" OR "spinal pain" OR "spinal ache" OR 

"lumbar pain" OR "lumbar ache" 

A - 21 
S6 S1 OR S2 OR S3 OR S4 OR S5 

S7 Subject:"ACUPUNCTURE" OR "ACUPRESSURE" OR "ACUPUNCTURE 

THERAPY" OR "ELECTROACUPUNCTURE" OR "MANIPULATION, 

LUMBAR" OR "MANIPULATION, CERVICAL" OR "MANIPULATION, 

CHIROPRACTIC" OR "MANIPULATION, SPINAL" OR "MANIPULATION, 

THORACIC" OR Subject:"MASSAGE" OR "CHIROPRACTIC" OR All Fields: 

acupuncture or "acu-puncture" or electroacupuncture or "electro-acupuncture" or 

"electric acupuncture" or "electric acu-puncture" or needling or acupressure or 

"acu-pressure" or moxibustion or moxabustion 

S8 All Fields:"manual therapy" OR "manual therapies" OR massage* or reflexology* 

or rolfing or "zone therapy" or "zone therapies" OR All Fields:"Chih Ya" or 

Shiatsu or Shiatzu or "Zhi Ya" or "Flexion distraction" OR "Trigger point" OR 

"Trigger points" OR "Proprioceptive Neuromuscular Facilitation" OR 

"Proprioceptive Neuromuscular Facilitations" OR All Fields:"myofascial release" 

or "myofascial therapy" OR "myofascial therapies" OR "Muscle energy 

technique" OR "Muscle energy techniques" OR "Cyriax Friction" 

S9 All Fields:: Lomilomi or "lomi-lomi" or trager or "Aston patterning" or "Strain 

counter strain" or "Alexander technique" or "Alexander techniques" or "Toy Na" 

or Tuna OR All Fields:Craniosacral Therapy" or "Craniosacral Therapies" or 

"Cranio-sacral Therapy"or "Cranio-sacral Therapies" or amma or ammo or 

Effleurage or Petrissage or hacking or Tapotment OR All Fields:manipulat* or 

mobiliz* or mobilis* 

S10 All Fields:"complementary therapy" OR "complementary therapies" OR 

"complementary medicine" OR All Fields:"alternative therapy" OR "alternative 

therapies" OR "alternative medicine" OR All Fields:"osteopathic therapy" OR 

"osteopathic therapies" OR "osteopathic medicine" 

S11 S7 OR S8 OR S9 OR S10 

S12 S6 AND S11 

Randomized/Controlled Clinical Trials 

S13 , Publication Type:Randomized Controlled Trial 

S14 Subject:"RANDOMIZED CONTROLLED TRIALS AS TOPIC" OR 

"CONTROLLED CLINICAL TRIALS" OR "PLACEBOS" OR All 

Fields:random* or sham or placebo* or RCT or RCTs or CCT or CCTs OR All 

Fields:"controlled clinical trial" or "controlled clinical trials" or "controlled study" 

or "controlled studies" or "control study" or "controlled studies" 

A - 22 
S15 S12 AND S14 

S16 S13 OR S15 

Safety 

S17 All Fields:safe or safety or unsafe or "side effect" or "side effects" or "side event" 

or "side events" OR All Fields:abnormalit* or toxicit* or complication* or 

consequence* or noxious or tolerabilit* OR All Fields:adverse or undesirable or 

harm* or injurious or serious or toxic 

S18 S12 AND S17 

Economics 

S19 Subject:"ECONOMICS" OR "ECONOMICS, MEDICAL" OR "COSTS AND 

COST ANALYSIS" OR All Fields:econom* or cost or costs or costly or costing 

or price or prices or pricing or budget* or expenditure or value or money 

S20 S12 AND S19 

LILACS 

2008 Oct 13 

( ( ( ( ( "BACK PAIN" or "NECK PAIN" ) or "SPINAL DISEASES" ) or "BACK 

INJURIES" ) or "SPINAL INJURIES" ) or "NECK INJURIES" ) or "SCIATICA" 

[Descritor de assunto] and acupuncture or electroacupuncture or acupressure or massage 

or manipulation or chiropractic or osteopathic [Palavras] 

Acubriefs 

2008 Oct 10 

KW: Back pain + SPECIALTY: RCT/randomized controlled trials 

KW: neck pain + SPECIALTY: RCT/randomized controlled trials 

KW: thoracic pain + SPECIALTY: RCT/randomized controlled trials 

KW: spinal diseases + SPECIALTY: RCT/randomized controlled trials 

KW: lumbago + SPECIALTY: RCT/randomized controlled trials 

KW: facet joint + SPECIALTY: RCT/randomized controlled trials 

Excluded PubMed refs, ACP Jnl Club, Cochrane, ClinicalTrials.gov, animal studies 

A - 23 
Appendix B 

Data extraction and related forms 

General Data 

Data element Comments, coding 

Ref id 

First author, year 

Companion ref id 

Inclusion Criteria 

Exclusion Criteria 

country/ region in which study was 

conducted 

N assessed for eligibility 

Intervention 

Intervention description (if applicable) 

dose, frequency of treatment, 

duration of treatment 

Type of treatment provider (describe in brief) 

mean n of treatments / study 

period 

SD [SEM] treatments 

N of patient in each group 

Mean age 

SD age 

[SEM age] 

Males % 

Ethnicity % 

Work status

 (i.e. unemployed= n/N, %)- if this outcome is 

reported for end of treatment, please fill in the 

corresponding worksheet 

Education status (i.e. post secondary education= n/N, %) 

Other social status data (provide detail) 

Previous surgery related to pain (n) 

Co-interventions (describe per group) 

B-1
 
Data element Comments, coding 

Co-morbidities (describe and provide number for each group) 

Location of pain low back (LBP) 

neck (NP) 

thorax (TP) 

Pain Grading (categories of intensity) 

Duration of pain 

acute (0 - 4 weeks) 

subacute (4 - 12 

weeks) 

chronic (=/> 12 

weeks) 

unknown (mix) 

mean duration of pain 

SD duration of pain (convert SEM to SD) 

Past episodes of pain if acute 

Specify cause of pain 

NS = Non Specific 

1= disc/joint disease 

2 = spinal stenosis 

3 = facet joint syndrome 

4 = spondylosysis 

5= osteoporotic fracture 

6 = myofascial pain 

7 = degenerative disease 

8 = whiplash 

9 = mechanical 

10 = work related 

11 = cervico-genic 

12 = radiculopathy 

13 = mixed specific (flag this) 

NR = Not reported 

n (%) with radiating pain 

List all relevant 

outcomes/instruments evaluated in 

this study (at which time point) 

Patients lost at each follow up 

A = Baseline 

B = Immediate followup 

C = Short term followup 

D = Intermediate term followup 

E = Long term followup 

Overall conclusions on efficacy 

from an abstract if no/little results 

reported 

Additional Comments or important 

notes about this study 

Abbreviations: tx = treatment; SD = Standard Deviation, AE = Adverse Events, % = Percent SEM = 

Standard Error of the Mean 

B-2 
Pain Data 

Data element Comments, coding for data extraction 

Ref id 

First author, year 

Intervention groups (number each group 1-10) 

comparison groups (group 1 vs. group 2) 

Instrument/s (describe full detail of the 

instrument used, use as many rows as 

needed to include all reported) 

 VAS (0-100) for pain 

PDI 

n of words 

Other (specify each instrument in the 

respective cell of the worksheet to which 

you are extracting) 

Baseline 

N evaluated / group 

Baseline mean 

Baseline SD 

Intermediate follow-up 

N evaluated 

Post treatment mean 

Post treatment SD 

Mean change from baseline 

Change from baseline SD 

95% CI- Low 

95% CI- High 

 P value 

Between group difference in post 

treatment mean 

(in column E clearly state which group is 

being subtracted from which group. Also 

be mindful of the sign of the difference 

[+ or -]) 

Between group difference SD 

95% CI- Low 

95% CI- High 

 P value 

B-3
 
Between group difference in mean 

changes from baseline 

Between group difference SD 

95% CI- Low 

95% CI- High 

 P value 

n of patients with > 50% or 100% pain 

reduction 

(please specify) 

% of patients with >50% or 100% pain 

reduction 

Risk Ratio 

Risk difference 

95% CI- Low 

95% CI- High 

 P value 

Short term follow-up 

N evaluated / group 

Post tx mean 

Post tx SD 

Mean change from baseline 

Change from baseline SD 

95% CI- Low 

95% CI- High 

 P value 

between group difference in mean 

changes from baseline 

between group difference SD 

95% CI- Low 

95% CI- High 

 P value 

n of patients with > 50% or 100% pain 

reduction 

% of patients with >50% or 100% pain 

reduction 

B-4
 
Risk ratio 

Risk difference 

95% CI- Low 

95% CI- High 

 P value 

Intermediate follow-up 

N evaluated / group 

Post tx mean 

Post tx SD 

Mean change from baseline 

Change from baseline SD 

95% CI- Low 

95% CI- High 

 P value 

between group difference in mean 

changes from baseline 

between group difference SD 

95% CI- Low 

95% CI- High 

 P value 

n of patients with > 50% or 100% pain 

reduction (please specify) 

% of patients with >50% or 100% pain 

reduction 

Risk ratio 

Risk difference 

95% CI- Low 

95% CI- High 

 P value 

Long Term follow-up 

N evaluated / group 

Post tx mean 

B-5
 
Post tx SD 

Mean change from baseline 

Change from baseline SD 

95% CI- Low 

95% CI- High 

 P value 

between group difference in mean 

changes from baseline 

between group difference SD 

95% CI- Low 

95% CI- High 

 P value 

n of patients with > 50% or 100% pain 

reduction (please specify) 

% of patients with >50% or 100% pain 

reduction 

Risk ratio 

Risk difference 

95% CI- Low 

95% CI- High 

 P value 

Abbreviations: tx= treatment; SD = Standard Deviation, AE = Adverse Events, % = Percent SEM = 

Standard Error of the Mean 

Function / Disability Data 

Data element Comments, coding for data extraction 

Ref id 

First author, year 

Intervention groups (number each group 1-10) 

comparison groups (group 1 vs. group 2) 

Instrument/s (describe full detail of the 

instrument used, use as many rows as 

needed to include all reported) 

 VAS (0-100) for pain 

PDI 

n of words 

Other (specify each instrument in the 

respective cell of the worksheet to which 

B-6
 
you are extracting) 

Baseline 

N evaluated / group 

Baseline mean 

Baseline SD 

Intermediate follow-up 

N evaluated 

Post treatment mean 

Post treatment SD 

Mean change from baseline 

Change from baseline SD 

95% CI- Low 

95% CI- High 

 P value 

Between group difference in post 

treatment mean 

(in column E clearly state which group is 

being subtracted from which group. Also 

be mindful of the sign of the difference 

[+ or -]) 

Between group difference SD 

95% CI- Low 

95% CI- High 

 P value 

Between group difference in mean 

changes from baseline 

Between group difference SD 

95% CI- Low 

95% CI- High 

 P value 

n of patients with > 50% or 100% pain 

reduction 

(please specify) 

% of patients with >50% or 100% pain 

reduction 

Risk Ratio 

Risk difference 

B-7
 
95% CI- Low 

95% CI- High 

 P value 

Short term follow-up 

N evaluated / group 

Post tx mean 

Post tx SD 

Mean change from baseline 

Change from baseline SD 

95% CI- Low 

95% CI- High 

 P value 

between group difference in mean 

changes from baseline 

between group difference SD 

95% CI- Low 

95% CI- High 

 P value 

n of patients with > 50% or 100% pain 

reduction 

% of patients with >50% or 100% pain 

reduction 

Risk ratio 

Risk difference 

95% CI- Low 

95% CI- High 

 P value 

Intermediate follow-up 

N evaluated / group 

Post tx mean 

Post tx SD 

Mean change from baseline 

B-8
 
Change from baseline SD 

95% CI- Low 

95% CI- High 

 P value 

between group difference in mean 

changes from baseline 

between group difference SD 

95% CI- Low 

95% CI- High 

 P value 

n of patients with > 50% or 100% pain 

reduction (please specify) 

% of patients with >50% or 100% pain 

reduction 

Risk ratio 

Risk difference 

95% CI- Low 

95% CI- High 

 P value 

Long Term follow-up 

N evaluated / group 

Post tx mean 

Post tx SD 

Mean change from baseline 

Change from baseline SD 

95% CI- Low 

95% CI- High 

 P value 

between group difference in mean 

changes from baseline 

between group difference SD 

95% CI- Low 

95% CI- High 

B-9
 
 P value 

n of patients with > 50% or 100% pain 

reduction (please specify) 

% of patients with >50% or 100% pain 

reduction 

Risk ratio 

Risk difference 

95% CI- Low 

95% CI- High 

 P value 

Abbreviations: tx= treatment; SD = Standard Deviation, AE = Adverse Events, % = Percent SEM = 

Standard Error of the Mean 

Quality of Life Data 

Data element Comments, coding for data extraction 

Ref id 

First author, year 

Intervention groups (number each group 1-10) 

comparison groups (group 1 vs. group 2) 

Instrument/s (describe full detail of the 

instrument used, use as many rows as 

needed to include all reported) 

 VAS (0-100) for pain 

PDI 

n of words 

Other (specify each instrument in the 

respective cell of the worksheet to which 

you are extracting) 

Baseline 

N evaluated / group 

Baseline mean 

Baseline SD 

Intermediate follow-up 

N evaluated 

Post treatment mean 

Post treatment SD 

Mean change from baseline 

B-10
Change from baseline SD 

95% CI- Low 

95% CI- High 

 P value 

Between group difference in post 

treatment mean 

(in column E clearly state which group is 

being subtracted from which group. Also 

be mindful of the sign of the difference 

[+ or -]) 

Between group difference SD 

95% CI- Low 

95% CI- High 

 P value 

Between group difference in mean 

changes from baseline 

Between group difference SD 

95% CI- Low 

95% CI- High 

 P value 

n of patients with > 50% or 100% pain 

reduction 

(please specify) 

% of patients with >50% or 100% pain 

reduction 

Risk Ratio 

Risk difference 

95% CI- Low 

95% CI- High 

 P value 

Short term follow-up 

N evaluated / group 

Post tx mean 

Post tx SD 

Mean change from baseline 

Change from baseline SD 

95% CI- Low 

B-11
 
95% CI- High 

 P value 

between group difference in mean 

changes from baseline 

between group difference SD 

95% CI- Low 

95% CI- High 

 P value 

n of patients with > 50% or 100% pain 

reduction 

% of patients with >50% or 100% pain 

reduction 

Risk ratio 

Risk difference 

95% CI- Low 

95% CI- High 

 P value 

Intermediate follow-up 

N evaluated / group 

Post tx mean 

Post tx SD 

Mean change from baseline 

Change from baseline SD 

95% CI- Low 

95% CI- High 

 P value 

between group difference in mean 

changes from baseline 

between group difference SD 

95% CI- Low 

95% CI- High 

 P value 

n of patients with > 50% or 100% pain 

reduction (please specify) 

B-12
 
% of patients with >50% or 100% pain 

reduction 

Risk ratio 

Risk difference 

95% CI- Low 

95% CI- High 

 P value 

Long Term follow-up 

N evaluated / group 

Post tx mean 

Post tx SD 

Mean change from baseline 

Change from baseline SD 

95% CI- Low 

95% CI- High 

 P value 

between group difference in mean 

changes from baseline 

between group difference SD 

95% CI- Low 

95% CI- High 

 P value 

n of patients with > 50% or 100% pain 

reduction (please specify) 

% of patients with >50% or 100% pain 

reduction 

Risk ratio 

Risk difference 

95% CI- Low 

95% CI- High 

 P value 

Abbreviations: tx= treatment; SD = Standard Deviation, AE = Adverse Events, % = Percent SEM = 

Standard Error of the Mean 

B-13 
Work Data 

Data element Comments, coding for data extraction 

Ref id 

First author, year 

Intervention groups (number each group 1-10) 

comparison groups (group 1 vs. group 2) 

Instrument/s (describe full detail of the 

instrument used, use as many rows as 

needed to include all reported) 

 VAS (0-100) for pain 

PDI 

n of words 

Other (specify each instrument in the 

respective cell of the worksheet to which 

you are extracting) 

Baseline 

N evaluated / group 

N at full time work 

N at part time sick leave 

N at full time sick leave 

continuous measures of work (specify: unemployed; homemaker; 

retired- all not due to pain) 

Other – mean 

Other- SD (SEM) 

Other data (describe with numeric details) 

Intermediate follow-up 

N of patient at full time work 

Risk ratio 

Odds ratio 

Risk difference 

95% CI- Low 

95% CI- High 

 P value 

N of patient at part time sick leave 

Risk ratio 

B-14
 
Odds ratio 

Risk difference 

95% CI- Low 

95% CI- High 

P value 

N of patient at full time sick leave 

Risk ratio 

Odds ratio 

Risk difference (please specify) 

95% CI- Low 

95% CI- High 

P value 

Other- continues measure, specify 

Other post tx- mean 

Other- post tx SD [SEM] 

95% CI- Low 

95% CI- High 

P value 

Other dichotomous measure, provide 

numeric data, n 

Risk ratio [odds ratio] 

95% CI- Low 

95% CI- High 

Short term followup 

N of patient at full time work 

Risk ratio 

Odds ratio 

Risk difference 

95% CI- Low 

95% CI- High 

P value 

B-15
 
N of patient at part time sick leave 

Risk ratio 

Odds ratio 

Risk difference 

95% CI- Low 

95% CI- High 

P value 

N of patient at full time sick leave 

Risk ratio 

Odds ratio 

Risk difference (please specify) 

95% CI- Low 

95% CI- High 

P value 

Other- continues measure, specify 

Other post tx- mean 

Other- post tx SD [SEM] 

95% CI- Low 

95% CI- High 

P value 

Other dichotomous measure, provide 

numeric data, n 

Risk ratio [odds ratio] 

95% CI- Low 

95% CI- High 

Intermediate followup 

N of patient at full time work 

Risk ratio 

Odds ratio 

Risk difference 

95% CI- Low 

B-16
 
95% CI- High 

P value 

N of patient at part time sick leave 

Risk ratio 

Odds ratio 

Risk difference 

95% CI- Low 

95% CI- High 

P value 

N of patient at full time sick leave 

Risk ratio 

Odds ratio 

Risk difference (please specify) 

95% CI- Low 

95% CI- High 

P value 

Other- continues measure, specify 

Other post tx- mean 

Other- post tx SD [SEM] 

95% CI- Low 

95% CI- High 

P value 

Other dichotomous measure, provide 

numeric data, n 

Risk ratio [odds ratio] 

95% CI- Low 

95% CI- High 

Long Term followup 

N of patient at full time work 

Risk ratio 

Odds ratio 

B-17
 
Risk difference 

95% CI- Low 

95% CI- High 

P value 

N of patient at part time sick leave 

Risk ratio 

Odds ratio 

Risk difference 

95% CI- Low 

95% CI- High 

P value 

N of patient at full time sick leave 

Risk ratio 

Odds ratio 

Risk difference (please specify) 

95% CI- Low 

95% CI- High 

P value 

Other- continues measure, specify 

Other post tx- mean 

Other- post tx SD [SEM] 

95% CI- Low 

95% CI- High 

P value 

Other dichotomous measure, provide 

numeric data, n 

Risk ratio [odds ratio] 

95% CI- Low 

95% CI- High 

Abbreviations: tx= treatment; SD = Standard Deviation, AE = Adverse Events, % = Percent SEM = 

Standard Error of the Mean 

B-18 
Utility - HealthCare Data 

Data element Comments, coding for data extraction 

Ref id 

First author, year 

Intervention groups (number each group 1-10) 

Comparison groups (group 1 vs. group 2) 

Instrument/s (describe full detail of the 

instrument used, use as many rows as 

needed to include all reported) 

 VAS (0-100) for pain 

PDI 

n of words 

Other (specify each instrument in the 

respective cell of the worksheet to which 

you are extracting) 

Baseline Conventional care Continuous outcomes 

N evaluated 

Describe outcome (units of measure) 

Baseline mean 

Baseline SD 

Between group difference in post 

treatment mean 

SEM (convert SD to SEM) 

95% CI- Low 

95% CI- High 

P value 

Between group difference in mean 

changes from baseline 

SEM (convert SD to SEM) 

95% CI- Low 

95% CI- High 

P value 

Baseline Conventional Care Dichotomous data 

Describe conventional care used and units (diagnostic procedure, treatment 

sessions per patient per duration, etc.) 

Reported n for column AE 

B-19
 
Reported % for Column AE 

Risk ratio 

Odds ratio 

Risk difference 

95% CI- Low 

95% CI- High 

P value 

Post Treatment Conventional care Continuous outcomes 

N evaluated 

Describe outcome (units of measure) 

Baseline mean 

Baseline SD 

Between group difference in post 

treatment mean 

SEM (convert SD to SEM) 

95% CI- Low 

95% CI- High 

P value 

Between group difference in mean 

changes from baseline 

SEM (convert SD to SEM) 

95% CI- Low 

95% CI- High 

P value 

Post Treatment Conventional Care Dichotomous data 

Describe conventional care used and units (diagnostic procedure, treatment 

sessions per patient per duration, etc.) 

Reported n for column AE 

Reported % for Column AE 

Risk ratio 

Odds ratio 

Risk difference 

B-20
 
95% CI- Low 

95% CI- High 

P value 

Abbreviations: tx= treatment; SD = Standard Deviation, AE = Adverse Events, % = Percent SEM = 

Standard Error of the Mean 

Cost Data 

Data element Comments, coding for data extraction 

Ref id 

First author, year 

Intervention groups (number each group 1-10) 

Comparison groups (group 1 vs. group 2) 

Instrument/s (describe full detail of the 

instrument used, use as many rows as 

needed to include all reported) 

 VAS (0-100) for pain 

PDI 

n of words 

Other (specify each instrument in the 

respective cell of the worksheet to which 

you are extracting) 

Unit of cost (for example US dollars) 

Cost 1 

 (cost in health care sector, cost of 

production loss, costs in other sectors, 

patient and family costs, total costs) 

N evaluated 

Cost 1 (describe all, including method of 

calculation) 

Cost 1, mean 

Cost 1, SD (convert SEM to SD) 

Between group difference in cost per 

treatment 

in column E clearly state which group is 

being subtracted from which group. Also 

be mindful of the sign of the difference 

[+ or -]) 

SEM (convert SD to SEM) 

95% CI- Low 

95% CI- High 

Cost 2 

 (cost in health care sector, cost of 

production loss, costs in other sectors, 

patient and family costs, total costs) 

B-21
 
N evaluated 

Cost 2 (describe all, including method of 

calculation) 

Cost 2, mean 

Cost 2, SD (convert SEM to SD) 

Between group difference in cost per 

treatment 

in column E clearly state which group is 

being subtracted from which group. Also 

be mindful of the sign of the difference 

[+ or -]) 

SEM (convert SD to SEM) 

95% CI- Low 

95% CI- High 

Cost 3 

 (cost in health care sector, cost of 

production loss, costs in other sectors, 

patient and family costs, total costs) 

N evaluated 

Cost 3 (describe all, including method of 

calculation) 

Cost 3, mean 

Cost 3, SD (convert SEM to SD) 

Between group difference in cost per 

treatment 

in column E clearly state which group is 

being subtracted from which group. Also 

be mindful of the sign of the difference 

[+ or -]) 

SEM (convert SD to SEM) 

95% CI- Low 

95% CI- High 

Cost 4 

 (cost in health care sector, cost of 

production loss, costs in other sectors, 

patient and family costs, total costs) 

N evaluated 

Cost 4 (describe all, including method of 

calculation) 

Cost 4, mean 

Cost 4, SD (convert SEM to SD) 

Between group difference in cost per 

treatment 

(in column E clearly state which group is 

being subtracted from which group. Also 

be mindful of the sign of the difference 

[+ or -]) 

SEM (convert SD to SEM) 

B-22
 
95% CI- Low 

95% CI- High 

Abbreviations: tx= treatment; SD = Standard Deviation, AE = Adverse Events, % = Percent SEM = 

Standard Error of the Mean 

Harms Data 

Data element Comments, coding for data extraction 

Ref id 

First author, year 

Intervention groups (number each group 1-10) 

Describe Adverse event 

N evaluated 

N with any Adverse event At least one AE 

Rate (%) 

Rate ratio 

Odds 

Odds ratio 

95% CI- Low 

95% CI- High 

P value 

Withdrawal due to AE 

Rate (%) 

Rate ratio 

Odds 

Odds ratio 

95% CI- Low 

95% CI- High 

Describe Serious Adverse Events 

N of patients with serious AE 

Rate (%) 

B-23
 
Rate ratio 

Odds 

Odds ratio 

95% CI- Low 

95% CI- High 

Specific AE 

N of patients with specific AE 

Risk/rate 

Rate ratio 

P value 

Specific AE 

Abbreviations: tx= treatment; SD = Standard Deviation, AE = Adverse Events, % = Percent SEM = 

Standard Error of the Mean 

B-24
 
Table 1.1 Low Back Pain - Acupuncture – Acute/Sub-acute - Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Huang, SR 

(2006)1 

Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

Disc herniation 

Groups 

IG (n = 53)– local 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: 8 wks 42.8 vs. CG = single-point E-acu: At Pain: NA QoL/ well being: 

Country: Final assessments: 46.2 yrs Yaotu; 0.6ms, 15Hz, 

China immediately post tx Duration of 50min/time, 2times/wk Disability: ODQ (A, 

% of male: IG = Pain: x 4- total of 9 tx B) Results: 

N screened: 98 52.8%; CG = Acute  2wk, IG Drop outs: 0 Immediate post tx: 

Quality N randomized: 98 46.7% = 7.2 ds; CG = Results: 

score: 4/13 N completed tx: 98 6.9 ds CG (n = 45) – Routing Baseline: Short term: NR 

N attended last fu: NR Racial E-acu: acupuncture at Pain: NA 

composition: Severity of pain Dachangyu, Disability: NR Intermediate: NR 

Initial of Inclusion: L4/5 Disc NR (Grading): Guangyuanyu, Bamiu, 

reviewer: herniation or with other Work status: NR NR Jiaji, Xubian, Huantiao, Immediate post tx: Long term: NR 

SG disc herniation; Age < 65 Fengshi, Yinmen, Mean chg from A: 

yrs; Duration of pain  Other socio- Co- Weizhong, IG = 18.7; CG = Harms: NR 

2w; Non-use of demographics: interventions: Yanglinquan, 35.65 

glucocorticoid and non- NR NR Chenshan, Kunlun; Pain: NA Summary 

steroidal anti- same as IG Disability: NR local single-point 

inflammatory drugs in the Co morbidities: Drop outs: 0 electro-acu group 

study period NR Short term: NR is more effective 

Exclusion: than routine 

pregnant/breast-feeding Prior episode of Intermediate: NR electro-acu group 

women; After operation; pain if acute: NR 

Up L3/4 Disc herniation Long term: NR 

or L5/S1 Disc herniation; Prior CAM 

syndrome; Other chronic intervention: NR 

pain diseases; 

Hypertension; Heart Prior surgery 

disease; Mental Pt related to current 

complaint: NR 

C-1
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Lai, Y 

(2004)2 Trial Design 

RCT 

Mean age 

(SD/range): NR 

Cause of Pain: 

disc/joint 

Groups 

IG (n = 41)– 

Outcomes: 

Pain: Pain VAS, B, 

Outcomes: 

QoL/ well being: 

disease Acupuncture Xi-cleft pain difference from Well being, 

Country: Tx duration: 20 ds % of male: NR and normal points: baseline Chinese Standard, 

China Final assessments: 38mmX25-40mm B 

immediately post tx Racial needle for Xi-cleft Disability: NA Results: 

composition: Duration of point, retention Immediate post tx: 

Quality N screened: Don’t know Asian Pain: 30min+point injection Results: IG = 97.6%, CG = 

score: 3/13 N randomized: 76 IG - 12 hr- 39 ds of Angelicate, 2 Baseline: 85.7% improved 

N completed tx: 76 Work status: NR for whole study, ml/point,; 1tx/d, 10 Pain: NR 

N attended last fu: NR It mentioned in tx/course x 2 Disability: NA Short term: NR 

Initial of the report as Drop outs: 0 

reviewer: Eligibility criteria: Other socio­ acute.; CG – 13 Immediate post tx: Intermediate: NR 

SG inclusion: 1. Diagnostic demographics: hr -39 ds for CG (n = 35) – Pain: IG = 5.63 

using Chinese New NR whole study, Acupuncture normal (1.12); CG = 4.51 Long term: NR 

Medicine Clinical Trial acute as well points: 38 mm x 40-75 (0.92) 

Reference 1993 ref[2] Co morbidities: mm needle for normal Disability: NA Harms: NR 

NR Severity of pain point acu, retention 30 

exclusion: Pt with server (Grading): NR min + point injection of Short term: NR Summary: acu 

protrusion, which press Prior episode of Angelicate, 2 ml/point,; can relieve the 

the nerve pain if acute: NR same as IG Intermediate: NR pain in Pts with 

Co- Drop outs: 0 lumbar 

Prior CAM interventions: Long term: NR intervertebral disc 

intervention: NR NR protrusion. The 

effect of needling 

Xi-Cleft points as a 

Prior surgery main tx in 

related to current cooperation with 

complaint: NR point injection is 

better than that of 

routine acu therapy 

in cooperation with 

point injection 

C-2
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Wen-Jun, L Trial Design Mean age Cause of Pain: Groups Outcome Outcome 

(2000)3 RCT (SD/range): 14­

65 yrs 

Sprain IG1 (n = 112)– AcuTx: Lumbar acupoint 

instruments: 

Pain: NR 

instruments: 

QoL/ well being: 

Country: Tx duration: NR chosen at L2-4, Response rate 

China Final assessments: 

immediately post tx 

% of male: 

84.5% Duration of 

Pain: 

needles inserted 

perpendicular, 

manipulation: pushing 

Disability: NA 

Results: 

Immediate post tx: 

IG1: 69.7% vs. IG2 

Quality Racial Acute, NR and withdrawal, Baseline: NA 94.4% p < 0.01 

score: 2/13 N screened: NR 

N randomized: 238 

N completed tx: NR 

composition: NR 

Work status: NR 

Severity of pain 

(Grading): NR 

retatined for 15-20 

min, after acu, 

moxibusion applied; 5 

Pain: NR 

Disability: NR Short term: NR 

Initial of N attended last fu: NR tx total Immediate post tx: Intermediate: NR 

reviewer: Other socio- Co- Drop outs: NR NA 

SG 

Eligibility criteria: 

- inclusion: Pts with acute 

lumbar sprain 

- exclusion: NR 

demographics: 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

interventions: 

NR IG2 (n = 126) – AcuControl: needle is 

rapidly inserted into 

S16 point to 0.5-1.0 

cun depth and twisted 

for 30-60 sec to obtain 

response; retain for 

10-20 min; after relief 

of pain, the Ashi point 

is treated by inserting 

the needle to 1.5-2.5 

cun depth; 

moxibustion given at 

the same site for 10-15 

min; 5 tx total 

Drop outs: NR 

Pain: NR 

Disability: NR 

Short term: NR 

Intermediate: NR 

Long term: NR 

Long term: NR 

Harms: NR 

Summary of 

results (if 

provided): NA 

C-3
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Xing-wei 

(2007)4 

Trial Design-RCT Mean age 

(SD/range): Cause of Pain: 

Groups 

IG (n = 39) – routine 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: 15 ds IG = 47 Vs. CG 1-disc/joint acu. +warming needle Pain: NR QoL/ well being: 

Country: Final assessments: = 44 yrs disease moxibustion: unilateral 

China immediately post tx and bilateral stinulated Disability: NR Other:cure rate, 

% of male: at BL 23, GV 4, GV effective rate 

N screened: NR IG = 51.3%, CG 3,BL 40 etc. with Results: 

Quality N randomized: 78 = 56.4% needles until "deqi" Baseline: NA 

score: 3/13 N completed tx:78 Duration of sensation reached ret. Pain: NR Results: 

N attended last fu: NR Racial Pain: 30 min; 1sess/d x 15 Disability: NR Immediate post tx: 

composition: acute; subacute sess. Cure rate: 29 vs. 

Initial of Inclusion: NR ( up to 12 wks), Drop outs: A= 0 Immediate post tx: 16% 

reviewer: Diagnosed as lumbar Work status: IG = 9.7 ds; CG NA effective: 8 vs. 

SG herniation according to NR = 10.6 ds CG (n = 39) – Routin Pain: NR 12% 

"People's Republic of Other socio- Acu.: same routine Disability: NR ineffective: 2 vs. 

China in the demographics: Severity of pain acupunture as in 11% 

pharmaceutical industry NR (Grading): intervention grp was Short term: NR total efficacy: 

standards - traditional Co morbidities: NR applied; same as IG 94.9% vs. 71.8% 

Chinese medicine NR Drop outs: A=0 Intermediate: NR Short term: NR 

diagnostic efficacy Prior episode of Costandards". Diagnosis pain if acute: interventions: Long term: NR Intermediate: NR 

verified with CT or MRI; NR NR 

Age < 70 Prior CAM Long term: NR 

intervention: 

Exclusion: NR Harms: NR 

other vertebral disc or 

joint disease; chronic Pts Prior surgery 

with multiple related to current 

reoccurrence at remission complaint: NR 

stage; heat resistancetype 

C-4
 
Table 1.2 Low Back Pain - Acupuncture – Acute/Sub-acute - Non –Specific Pain 

Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Araki, S 

(2001)5 

Trial Design 

RCT 

Mean age 

(SD/range): IG = 

Cause of Pain: 

N-S 

Groups 

IG (n = 20)– Acu: 

Outcome 

instruments: 

Outcome 

instruments: 

44.25 (15) vs. CG needle(s) inserted into Pain: VAS (mm)of QoL/ well being: 

Country: Tx duration: single tx = 43.3 (13.8) yrs SI3 bilaterally with deqi pain and LBP score 

Japan Final assessments: sensation at supine (JOA) Other: NA 

immediately post tx % of male: 70% Duration of position and then pts 

total Pain: Acute, NR were made to perform Disability: JOA Results: 

Quality N screened: 40 back EX, needles left in Score Baseline: 

score: 10/13 N randomized: 40 Racial Severity of pain situ during EX, insertion 

N completed tx: 40 composition: (Grading): NR depth was 2.5 cm, acu Results: Immediate post tx: 

N attended last fu: 33 Asian needles(50 mm length, Baseline: 

Initial of 0.20 mm diameter); Pain: IG = 66.6 Short term: NR 

reviewer: SG Inclusion: Pts with Work status: NR Co­ single tx (4.7), CG = 71.5 

acute low-back pain interventions:NR Drop outs: 7 total in both (4.84) Intermediate: NR 

(who have gait Other socio­ grps Disability: IG = 4.45 

disturbance; demographics: (0.57), CG = 5.35 Long term: NR 

information from NR CG (n = 20) – Sham: (0.6) 

author.) needling performed to Harms: NR 

Co morbidities: SI3 bilaterally point at Immediate post tx: 

Exclusion: no NR supine position, Pain: IG = 49.55 

information (more than mimicked needle (5.06), CG = 55.65 

3 ds duration of LBP, Prior episode of insertion: tapped head (6.13) 

sciatica; information pain if acute: NR of guide tube then pts Disability: IG = 6.6 

from author.) made to perform back (0.72), CG = 6.5 

Prior CAM EX, needling gesturing (0.69) 

intervention: NR performed during back 

EX; single tx Short term: NR 

Prior surgery 

related to current Intermediate: NR 

complaint: NR 

Long term: NR 

C-5
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Cao, W 

(2001)6 

Trial Design 

RCTMean age (SD/range): 18-72 

Cause of Pain: 

24.5% acute 

Groups 

IG1 (n = 100)– Acu with 

Outcomes: 

Pain: NA 

Outcomes: 

QoL/ well being: 

yrs sprain in the filiform needle: 1 - point 

Country: Tx duration: 6hrs – 9 waist;21.5%; through point method Disability: NA Curative Effect at 5: 

China ds % of male: 33.8% hyperosteogenc with twisting IG1(n =7), IG2 (n = 

Final assessments: y and manipulation;; 5-10tx, Results: 8), IG3 (n = 15), 

immediately post tx Racial osteoporosis of 1tx/2ds Baseline: NA CG (n = 32) 

composition: NR LV, 14.8% acute Drop outs: NR Pain: improved; CE at 

Quality N screened: 400 prolapse of the Immediate post tx: 10: IG1 (n = 10), 

score: 0/13 N randomized: 400 Work status: NR LVD, 10.3% IG2 (n = 100) – As IG1 + NA IG2 (n = 11), IG3 (n 

N completed tx: NR musculus cupping: acu as IG1, Pain: = 38), CG (n = 33) 

N attended last fu: NR Other socio­ piriformis, and cupping used after Disability: NA improved 

Initial of demographics: other causes needling on the sore 

reviewer: SG Inclusion: pts with NR points Retained for 5-15 Short term: NR Results: 

acute lumbago (severe Duration of minutes; same as IG1 Baseline:NA 

and very severe pain) Co morbidities: Pain: Drop outs: NR Intermediate: NR 

who sought medical NR Acute, NR Immediate post tx: 

advice from Dep. of IG3 (n = 100) – Same Long term: NR NA 

Acu and Moxi and the Prior episode of Severity of as IG2 + pricking 

surgical Dep. Of pain if acute: NR pain (Grading): collateral same as IG1 Short term: NR 

orthopedics - 338 were grade I vs. Drop outs: NR 

outPts and 62 inPts, Prior CAM grade II - IG1= 7 Intermediate: NR 

106 pts were seen for intervention: NR vs. 28; IG2 = 67 CG (n = 100) – As IG3 + 

the first time vs.33; IG3 = 73 moxibusion: As IG3 + Long term: NR 

Prior surgery vs. 27; CG = 69 moxibustion on affected 

Exclusion: NR related to current vs. 31 part using 5 moxa cones Harms: NR 

complaint: NR until local skin turned 

from purple; same as 

IG1 

Drop outs: NR 

C-6
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Eisenberg, 

DM (2007)7 

Trial Design-RCT Mean age 

(SD/range): IG1 – 

Cause of Pain: 

N- S 

Groups 

IG (n = 58)– Acu: NR; 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: 5 wks IG3 = 43.2 (12.7) 10 sessions over 5 wks Pain: NA QoL/ well being: 

Country: Final assessments: vs. CG = 42.7 Drop outs: 4 Disability: NA NR 

US immediately post tx (12.7) yrs 

Duration of IG2 (n = 76) – Chiro: NR Results: Short term: NR 

N screened: NR % of male: IG1 – Pain: same as IG1 Baseline: NA 

Quality N randomized: 434 IG3 = 45 vs. CG = Acute, NR Drop outs: 4 Pain: Intermediate: NR 

score: 8/13 N completed tx: 418 50 Disability: 

N attended last fu: NR Severity of pain IG3 (n = 152) - Long term: NR 

Racial (Grading): Massage: NR; same as Immediate post tx: 

Initial of Inclusion: Pts with composition: NR IG1 NA Harms: Harms (B): 

reviewer: SG acute LBP for 21 d or 63.9% White Drop outs: 4 Pain: NA Minor 

less aged > 18 yrs Co- Disability: NA discomfort/sorenes 

Exclusion: Pain not in Work status: IG1­ interventions: CG (n = 148) – Usual s; IG1 = 5%, IG2 = 

LB; pain lasting > 21 d; IG3= 86.5%; CG Same as care: NSAIDs, muscle Short term: NR 8%, IG3 = 7%, CG 

back of neck surgery =82.4%, NS interventions relaxants, limited bed = NR 

in past 5 yrs; history of rest, education, activity Intermediate: NR 

vertebral fracture or Other socio­ alterations; 5 wks 

dislocation; demographics: Drop outs: 2 Long term: NR 

unexplained fever or 65.45% Married 

weight loss; or with partner 

(fibromyalgia, drug Efficacy data 

abuse, arthritis), Co morbidities: reported for the 

history of cancer other NR combination of 

than non-melanoma Prior episode of CAM txs and is not 

skin cancer, pain if acute: NR used in this report. 

osteoporosis, clotting Prior CAM 

disorders, use of intervention: NR 

anticoagulant drugs, Prior surgery 

systemic related to current 

corticosteroids, complaint: NR 

pregnancy 

C-7
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Kenndy, Trial Design Mean age Cause of Pain: Groups Outcomes: Outcomes: 

(2008)8 RCTTx duration: 

(SD/range): 

% of male: 54.2 

N-S 

Duration of 

IG (n = 24) – 

Acupuncture: unilateral 

or bilateral points with 8­

Pain: VAS (average 

and worst, 0 - 100) 

Disability: RMDQ 

QoL/ well being: 

NR 

Country: Final assessments: 3 vs. 417% Pain: Acute 13 needles stimulated Other: work 

Irelnad mos after last 

intervention 

N screened: 55 

Racial 

composition: 

Severity of pain 

(Grading): NR 

manually every 5 min 

until 30 sec of "de qi" 

sensation reached; 

needle retention time = 

Results: 

Immediate post tx: 

Pain, average: 27.3 

vs. 36.3 

absenteeism; Med 

used, exit 

questionnarie 

Quality N randomized: 48 Work status: 30 min. RMDQ: 6.0 vs. 12.8 Results: 

score:8/13 N completed tx: 45 

N attended last fu: 40 

Inclusion: 18-70 yrs 

adults with N-S LBP, 

with/out referred pain, 

up to 12 wks duration. 

Exclusion: red flags 

(defined by CSAG*), 

contra-indications to 

acu; previous acu tx; 

conflilcting or ongoing 

tx 

employed= 54.2% 

vs. 45.8% 

sick leave= 29.2% 

vs. 20.8% 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

Cointerventions: 1- 

strd advice to 

remain active (to 

all pts: back 

book, evidencebased booklet) 

2- uncontrolled 

Med 

(prescribed or 

over the counter 

-mg and n/d) 

3- analgesic use 

in n=44 (92%) 

grp 1+ grp2 at 

baseline 

The Park Sham Device 

(AcuPrime, UK) with 

verum acu single use 

needles with guide tube, 

size 0.25 mm x 40 mm; 

at least 3, max 12 tx in a 

4-6 wk 

Drop outs: 3 

CG (n = 24) – Placebo: 

same device as 

intervention grp; nonpenetrating sham 

needles (size 0.3 mm x 

40 mm, AcuPrime Dong 

Bang) in same acu 

points and clinical 

protocol; schedule as IG 

Drop outs: 8 

Short term (3 mos 

post tx): 

Pain, average: 26.5 

vs. 40.7 

RMDQ: 50. vs. 7.0 

Intermediate: 

Long term: NR 

Immediate post tx: 

tablet use: 1.0 (0.3) 

vs. 4.2 (0.6) 

Days off work: 13.9 

vs. 10.9 ds 

Short term: NR 

Intermediate: NR 

Long term: NA 

Harms: NR 

C-8
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Kittang, G 

(2001)9 

Trial Design 

RCTMean age (SD/range): NR 

Cause of Pain: 

N-S 

Groups 

IG (n = 30) – 

Outcomes: 

Pain: VAS 

Outcomes: 

QoL/ well being: 

Acupuncture: needling NR 

Country: Tx duration: 10 ds/2 % of male: NR in "lumbago 1 and 3" 

Norway wks with medical lumbago Results: Other: use of 

Final assessments: 6 Racial and in "upper lip" with Baseline: analgesic drugs: IG 

mos composition: NR Duration of more lateral pain. Later Pain: NR used significantly 

Quality Work status: 2 of 

Pain: Acute, NR txs were 5 needles 

across at level L2, at Immediate post tx: 

less drughs during 

the 1st wk after start 

score: 7/13 N screened: NR 3 on sick leave at Severity of pain Ashi points (local pain Pain: IG = 13 (0), of tx than those 

N randomized: 60 time of inclusion (Grading): NR point) and in both CG = 12.9 (0) receiving naproxen: 

N completed tx: 57 ankles. Analgesia was 2/28 vs. 11/29, P < 

Initial of N attended last fu: 57 Other socio­ allowed and sick leave Short term: IG = 6.4 0.01 

reviewer: SG demographics: Co­ provided when (0), CG = 8.7 (0) 

Inclusion: 18-67 yrs NR interventions:Ad necessary; 4 tx, within 2 

with acute LBP (lasting vice and EX wks Intermediate: IG = 

less than 10 ds) Co morbidities: Drop outs: 3 (not clear 9.6 (0), CG = 14.4 Harms: 

NR which grp or at what (0) gastroenteric side 

Exclusion: Neurologic time point) effects (0/28 vs. 

outcomes, rheumatic Prior episode of Long term: NR 15/29, p < 0.01) 

illness, malign pain if acute: NR CG (n = 30) – 

disease, systemic use Medication: Naproxen 

of anti-inflammatory Prior CAM 500 mg twice daily for 

drugs or steroids intervention: NR 10 ds 

before inclusion and Drop outs: NR 

use of medicine that Prior surgery 

may interact with anti- related to current 

inflammatory drugs complaint: NR 

C-9
 
Table 1.3 Low Back Pain- Acupuncture – Chronic Specific Pain 

Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Ceccherelli, Trial Design-RCT Mean age Groups Outcome Outcome 

F 

(2001)10 Tx duration: 6 wks 

(SD/range): IG = 

41.65 (11.37) vs. 

LBP 

Cause of Pain: 

IG (n = 21)– Deep-Acu: 

Sedatelec 300um, 10, 

instruments: 

Pain: McGill Pain 

instruments: 

QoL/ well being: 

Final assessments: 3 CG = 41.63 (8.87) N-S 29 and 49mm lengths. Questionnaire: No. NA 

Country: mo yrs (lumbosacral Points were extra 19, of words; total 

Italy myofacial pain) VG6, bilaterally: GB34, scores (B, C) Results: 

N screened: NR % of male: full UB54, UB62 + 4 TP or Baseline: 

N randomized: 42 sample: 71% most painful points in Results: 

Quality N completed tx: 42 lumbar area. Needles Baseline: Immediate post tx: 

score: 9/13 N attended last fu: 42 Racial Duration of stimulated for 1 min Pain: IG = 13.81 

composition: NR Pain: after insertion and for (3.95), CG = 13.7 Short term: NR 

Inclusion: Lumbar chronic 20s/5, 10, 15min, Freq (3.49); IG = 35.4 

Initial of myofascial pain, Work status: NR (lumbosacral was 2 Hz; (14.53), CG = Intermediate: NR 

reviewer: SG continuous pain > 3 myofacial pain), 20min/session, 8 34.75 (11.43) 

mo or recurrent acute Other socio- NR sessions total in 6 wks Long term: NR 

pain >1 mo, not been demographics: Drop outs: none Immediate post tx: 

resolved with drug NR Severity of pain Pain: IG = 7.81 Harms: NR 

therapy (Grading): NR CG (n = 21) – (4.88), CG = 10.4 

Co morbidities: Superficial Acu: same (6.76); IG = 14.54 

NR Co­ as described for (10.88), CG = 

Exclusion: Paraplegia interventions:NR acupunture, but the 22.25 (16.08) 

or quadriplegia, Prior episode of depth of insertion was 

radiographic evidence pain if acute: NR only 2mm in the skin; Short term: IG = 

of osteoporosis or same as IG 3.63 (6.13), CG = 

neurological signs; Prior CAM Drop outs: none 8.5 (7.12); IG = 7.5 

systemaic organic intervention: NR (12.94), CG = 18 

diseases, psychiatric (17.16) 

inllnes Prior surgery 

related to current Intermediate: NR 

complaint: NR Long term: NR 

C-10
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Gunn, CC Trial Design-RCT Mean age Groups Outcome Outcome 

(1980)11 

Tx duration: 5-10 wks 

(SD/range): Total: 

40.6 (range 20­

LBP 

Cause of Pain: 

IG (n = 28)– Acu+ 

standard care: dry 

instruments: 

Pain: NA 

instruments: 

QoL/ well being: 

Country: Final assessments: 62) yrs Fracture needling of muscle Pain + work status 

Canada immediately post tx 

N screened: 146 

% of male: 100% 

total 

motor points using 

traditional acu methods; 

Needles: 3, 4, and 5 cm 

Disability: NA 

Results: 

questionnarie

 n (%) with full 

recovery;partial 

Quality N randomized: 55 Duration of L; diameter of 30 gauge; Baseline: recovery; slight 

score: 4/13 N completed tx: NR 

N attended last fu: NR 

Racial 

composition: NR 

Pain: 

Chronic, 

disability period: 

inserted perpendicularly 

to the skin of muscle 

zone of innervations; 

Pain: NA 

Disability: NA 

recovery; no 

recovery 

Other: 

Initial of Inclusion: male Work status: NR 28.6 (12-168) mechanical stimulation Immediate post tx: 

reviewer: SG workers disabled from 

injury for at least 12 

wks ;with 8 wks run in 

period of standard 

Clinical regimen before 

admission into the trial; 

disability periods(12 to 

168 wks) wks 

Exclusion: 

psychosomatic 

backache; pts with 

spontaneous recovery 

Other sociodemographics: 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: pts 

with prior surgery 

were included 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

wks 

Severity of pain 

(Grading): NR 

Cointerventions: 

Standard Tx 

by pecking and twirling 

movements- e 

stimulation with low 

voltagle of 9 V for a few 

sec to each pint or a 

phasic current applied 

for 15 min until visible 

muscle fibrillation until 

Teh Ch'i phenomenon 

(soreness, heaviness or 

pressure, numbness, 

fullness or distention); 

once or twice/wk for 10 

tx 

Drop outs: NR 

CG (n = 27) – STD Tx: 

NR; NR 

Drop outs: NR 

Pain: NA 

Disability: NA 

Short term: NR 

Intermediate: NR 

Long term: NR 

Results: 

Baseline: 

Immediate post tx: 

IG = 4 (13.8), CG= 

0; IG = 14 (48.3), 

CG = 4 (14.8); IG = 

10 (34.5), CG = 11 

(40.7); IG = 1 (3.4); 

CG = 11 (40.7) 

Short term: 

Intermediate: NR 

Long term: NR 

Harms: NR 

C-11
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hollisaz, 

MT(2008) 12 

Trial Design-RCT Mean age 

(SD/range): NR 

Cause of Pain: Groups 

IG (n = 41)– 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: NR Duration of Acupncture: 10-15 Pain: VAS Pain Complication 

Country: Iran Final assessments: % of male: 45.4 Pain: chronic needles inserted in reduction % reduction 

immediately post tx painful points to depth of (intensitiy of last 

(last fu is immediately Racial Severity of pain 1-5cm. Each session session/ that of Results: 

Quality post tx) composition: NR (Grading): NR lasted 20 min and a beginning) Immediate post tx: 

score: 2/13 Pts were current with 2-10 mA Disability: NR Complication 

N screened: NR Work status: NR classified into 4 intensity and 4 HZ reduction: 89.3% 

N randomized: 119 pain intensity frequency; 15 sessions Results: vs. 51.8% vs. 

N completed tx: Other socio­ groups (VAS 0 – in total 31.9% 

assume 119 demographics: 100) mild = 0­ Drop outs: NR Immediate post tx: 

N attended last fu: NR 25; moderate % of pain reduction: Short term: NR 

assume 119 25-50; 62.1% vs. 52.5% Intermediate: NR 

Co morbidities: severe=50-75, IG2 (n = 38) – vs. 17.5% Long term: NR 

Inclusion: Pts with Buttock pain: dn very severe = Physiottherapy: hot Short term: NR 

LBP of sciatica origin 80.5% vs. 79% 75-100 packs, ultrasound, short- Intermediate: NR Harms: NR 

(> 6 mo) aged  20 yrs vs. 70%; wave diathermy, TENS, Long term: NR 

Paravertebral Co­ muscle strengthening; Summary: Pain 

Exclusion: Indication muscle spasm: 61 interventions: 30 minutes per session; reduction in sever 

for surgery, vs. 71% vs. NR 15 sessions in total grp was 50.5 vs. 

reluctance/compliance 45.5%; Scoliosis: Drop outs: NR 51.6 vs. 37.1 vs. 

for attendance < 5 Tx 22 vs. 42% vs. 29% in very severe, 

sessions, > 50 yrs old, 12; Claudication: CG (n = 40) – Placebo sever, moderate, 

contraindications of 14 vs. 23.7% vs. needles set on the and mild group 

acu Tx (systemic 12.6% intended points by respectively; % of 

disease, prosthesis, adhesives and after resolved 

cutaneous infections) Prior CAM turning the machine on compications did 

intervention: NR the current intensity was not differ 

zero; every other d over significantly in 4 

Prior surgery 1 mo: pain groups 

related to current Drop outs: NR 

complaint: NR 

C-12
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Itoh, K 

(2004)13 

Trial Design 

RCT 

Mean age: G1 = 

70.1 – 73.8 yrs LB 

Groups 

IG1 (n =12 )– 

Outcome 

instruments: 

Outcome 

instruments: 

Cause of Pain: Superficial-Acu: needles Pain: VAS (B) QoL/ well being: 

Country: Tx duration: 6 wks % of male: 28.6% NR 0.2mm x 50 mm NR 

Japan Final assessments: inserted in the skin over Disability:RMDQ)im 

immediately post tx Racial the TP to 3 mm depth, mediate post tx Results: 

composition: NR when pt felt dull pain, Baseline: NA 

Quality N screened: NR Duration of manipulation stppd but Results: 

score: 7/13 N randomized: 35 Work status: NR Pain: Chronic, retained for 10 min; 3 Immediate post tx: Immediate post tx: 

N completed tx: 27 IG1 = 5.2 (2.6), wks x 2tx periods, 2 wks Pain: (n = 9): IG1 = NA 

N attended last fu: NR Other socio­ IG2 = 7.4 (4.35), between tx periods 48.2 (30.5), IG2 = Short term: NR 

Initial of demographics:NR CG = 5.4 (3.7) Drop outs: A = 3 33.1 (19.2), CG = 

reviewer: SG Inclusion: Lumbar yrs 53.7 (21.9) Intermediate: NR 

LBP of at least 6 mo, Co morbidities: IG2 (n = 10) – Deep­ (P>0.05) 

normal neurologic Spondylosis (n=8) Severity of pain acu: Same as IG1 but Disability: (n= 9): Long term: NR 

function of Osteoporosis IG1, (Grading): 20 mm in depth, IG1 = 4.3 (2.2), IG2 

lumbosacral nerves, CG (n=2), IG2 (n NR stransverse oscillatory = 4.2 (1.2), CG = Harms: NR 

no pain radiation, = 3) rotped when twitch was 4.2 (4.3) (P>0.05) 

persisting pain Compression Co­ elicited and retained for 

intensity VAS => 5 fracture IG1, CG interventions:Po 10 min; same as IG1 Short term: NR 

(0=no pain, 10=worst (n=1), IG2 (n = 2) ultice:IG1 (n=7), Drop outs: A = 1 Intermediate: NR 

pain imaginable) IG2(n = 6), CG Long term: NR 

despite after taking Prior episode of (n =5) CG (n = 13) – Standardtherapy with pain if acute: NR Analgesic IG1, acu: in lumbar and lower 

lornoxicam and IG2(n=3), CG (n extremity (depth of 

tramadol Prior CAM = 2) 20mm) and the "sparrow 

intervention: NR Vit. D IG1 (n=1), pecking" technique 

Exclusion: Major Prior surgery IG2 (n = 3), CG needle was retained for 

trauma or systemic related to current (n = 2) 10 more min; same as 

disease, other ongoing complaint: NR IG1 

txs Drop outs: A = 3 

C-13
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Nan, L Trial Design Mean age Cause of Pain: Groups Outcome Outcome 

(2005)14 RCT (SD/range): IG = 

45.8 (11.2) vs. 

Group 1a & 2a – 

Lumbar strain; 

IG 1a (n = 88), 1b(n = 

92– 1a – Dermal 

instruments: 

Pain: Pts with 

instruments: 

QoL/ well being: 

Country: Tx duration: not clear CG = 46.2 (10.9) 1b & 2b – needling: gentle tapping grade II pain(easily 

China Final assessments: 

immediately post tx 

yrs 

% of male: NR 

hyperplastic 

spondylitis 

method in local pain/or 

along the meridian till 

the local skin turned red; 

neglected) 

Results: 

Other: 

Pts with no pain(B) 

Quality N screened: 366 heavy tapping for Baseline: Results: 

score: 3/13 N randomized: 360 

N completed tx: 360 

N attended last fu: NR 

Racial 

composition: 

Asian 

Duration of 

Pain: 

obvious pain till slightly 

bleeding; 5 tx/course, 2 

courses, 10 tx sessions 

Pain: NA 

Immediate post tx: 

Baseline: 

Immediate post tx: 

Initial of Chronic, IG = total; 1b – Dermal Pain: IG 1a = 29, IG 1a = 37, 1b = 

reviewer: SG Inclusion: pts age 18 

- 65 yrs with lumbar 

strain hyperplastic 

spondylitis in reference 

with relevant stand. 

implementation in 

Traumatology in 

Chinese Medicine 

Exclusion: not in 

conformity of the dx/ or 

associated with other 

syndromes or 

complications; poor 

compliance; other 

severe primary 

diseases 

Work status: NR 

Other sociodemographics: 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

3.14 (0.98), CG 

= 3.11 (0.90) yrs 

Severity of pain 

(Grading): NR 

Cointerventions:NR 

needling: same as 

above; 5 tx course, x 2 

courses, 10 sessions 

total 

Drop outs: 3 

CG 2a (n = 91), 2b (n = 

89) – 2a - Body Acu: 

accord. differentiation of 

syndromes in Chinese 

medicine; Needles: 0.34 

gauge, and 30 - 70 mm 

L, 15 - 60 mm deep 

perpendicular or oblique 

needling till soreness 

and distension 

appeared- points: (BL 

25), (BL 23); 2b – Same 

as above; 7 tx, once/ 

2ds/ course, 14 txs 

Drop outs: 3 

1b (34); CG 2a = 

32, 2b = 29 

Short term: NR 

Intermediate: NR 

Long term: NR 

24; CG 2a = 27, 2b 

= 22 

Short term: NR 

Intermediate: NR 

Long term: NR 

Harms: NR 

C-14
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Wang, BX 

(2004)15 

Trial Design 

RCT 

Mean age 

(SD/range): 

Cause of Pain: 

Mechanical 

Groups 

IG (n = 23)– E-Acu: 

Outcome 

instruments: 

Outcome 

instruments: 

Mean: 46 yrs conditions but Needles inserted in Pain: Pain intensity QoL/ well being: 

Country: Tx duration: 5-7 ds Range: 20-59 not cancer acupoints huantiao and (tenderness) at NA 

Pakistan Final assessments: % NS: 100% of weizhong and twirled buttock (B) 

immediately post tx % of male: 75% all pts until pts felt soreness, Results: 

% S: heaviness, and Disability: NA Baseline: 

Quality Racial distention; G6805-II type 

score: 2/13 N screened: NR composition: Duration of electric stimulator was Results: Immediate post tx: 

N randomized: 40 Pakistani Pain: used for 25 min.; 1tx/d Baseline: 

N completed tx: 37 Chronic, NR for 7d Pain: IG = 49.5 Short term: NR 

Initial of N attended last fu: NR Work status: NR Drop outs: 3 (NR) (1.4), CG = 50.3 

reviewer: SG Severity of pain (1.2) Intermediate: NR 

Other socio­ (Grading): NR CG (n = 17) – Disability: NA 

Eligibility criteria: demographics: Medication: Diclofenic - Long term: NR 

NR Co­ 25 mg/tablet; Given post Immediate post tx: 

- inclusion: Pts with interventions:NR cibum at 50 mg tid for 5 Pain: IG = 25.7 Harms: NR 

intervertebral disc Co morbidities: ds (2.3), CG = 33.3 

protrusion aged => 18 NR Drop outs: NR (2.5) (P<0.05) Summary of 

yrs suffering from Disability: results (if 

radiating pain to the Prior episode of provided): 

lower limb for > 2 yrs pain if acute: NR Short term: NR Greater decrease 

in pain intensity in 

Prior CAM Intermediate: NR the buttock for pts 

- exclusion: NR intervention: NR treated with E-Acu 

Long term: NR compared to those 

Prior surgery treated with the 

related to current Med 

complaint: NR 

C-15
 
Table 1.4 Low Back Pain - Acupuncture - Chronic - Non-Specific Pain 

Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Brinkhaus 

(2006)16,17 

Trial Design 

RCT 

Mean age 

(SD/range): IG1 = 

Cause of Pain: 

N-S 

Groups 

IG (n = 145)– Acu: 4 

Outcome 

Instrumets: 

Outcome 

instruments: 

59.1 (8.8), IG2 = local points: bladder 20­ Pain: VAS-ITT QoL/ well being: 

Country: Tx duration: 8 wks 58.2 (9.4), CG = 34; bladder 50-54; analysis SF-36 (physical 

Germany Final assessments: 58.9 (9.5) yrs gallbladder 30; health) 

Duration of governing vessel 3, 4, 5, Disability: FFbH-R Other: 

N screened: 301 % of male: IG1 = Pain: and 6; extraordinary score; PDI score 

Quality N randomized: 297 36.6%, IG2 = Chronic, IG1 = points Huatojiaji and Results: Results: 

score: 8/13 N completed tx: 397 24.7%, CG = 14.7 (11), IG2 = Shiqizhuixia. needled at Baseline: Baseline: IG1 = 

N attended last fu: NR 31.6% 13.6 (10.5), CG least 2 distant points Pain: IG1 = 63.2 32.8 (8.2), IG2 = 

= 15.8 (11.8) yrs from (bilaterally): small (13.2), IG2 = 66.6 31.8 (8.3), CG = 

Initial of Inclusion: clinical Racial intestine 3; bladder 40, (15.7), CG = 66.1 31.6 (8.2) 

reviewer: SG diagnosis of CLBP, composition: NR Severity of pain 60, and 62; kidney 3, (13.6) 

aged 40 - 75 yrs, pain (Grading): NR and 7; gallbladder 31, Disability: IG1 = Immediate post tx: 

intensity of at least 40, Work status: NR 34, and 41; liver 3; and 57.1 (18.6), IG2 = IG1 = 40.5 (9.7), 

on a 100 mm VAS on Co­ governing vessel 14 and 57.2 (17.3), CG = IG2 = 36.2 (10.3), 

last 7 ds, only use of Other socio­ interventions:an 20- in addition other 56.7 (20); IG1 = CG = 33.9 (9.5) 

steroid anti­ demographics:NR algestic med. acu;12 sessions, 30 28.9 (11.1), IG2 = IG1 vs. CG 

inflammatory drugs for use in last 6 min/session over 8 wks 31.5 (11.1), CG = =p<0.001, IG1 vs. 

pain in last 4 wks Co morbidities:NR mos(n,%): IG1 = Drop outs: C = 7, D = 31 (13.3) IG2 = p=0.16 

59 (40.4), IG2 = 1,E = 2 Short term: NR 

Exclusion: protrusion Prior episode of 27 (37), CG = Immediate post tx: 

or prolapse of 1 or pain if acute: NR 26 (32.9) IG2 (n = 71) –Sham- Pain: IG1 = 34.5 Intermediate: NR 

more intervertebral Acu: NR; NR (28.5), IG2 = 29.8 

discs with concurrent Prior CAM Drop outs: C = 5, E = 2 (23.6), CG = 25.1 Long term: NR 

neurological intervention: NR (6.9) 

symptoms, radicular CG (n = 79) – Waiting Disability: IG1 = Harms: NR 

pain, prior vertebral Prior surgery list: no tx; NR 66.8 (18.3), IG2 = 

column surgery; other related to current Drop outs: C= 5 62.9 (20.3), CG = 

S causes of pain complaint: NR 57.7 (19.9); IG1 = 

18.8 (13.1), IG2 = 

21.5 (13.2), CG = 

27.1 (14.1) 

C-16
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Carlsson, Trial Design Mean age Cause of Pain: Groups Outcome Outcome 

CPO 

(2001)18 

RCT (SD/range): total 

= 49.5 (15.4) yrs 

N-S IG1 (n = 18)– Manual 

acu: local points, BL24, 

instruments: instruments: 

QoL/ well being: 

Tx duration: 8 wks BL25, BL26, Ex Jiaji and Pain: VAS (A, B)in NA 

Country: Final assessments: 6 % of male: 34% distal points, LI11, LI4, the morning; in the Other: 

Sweden mos total Duration of BL40, BL57 and BL60; evening 

Pain: total= 9.5 “de qi” feeling sought at Results: 

N screened: NR Racial (7.0)yrs needle-tip depth of 2-3 Results: Baseline: 

Quality N randomized: 50 composition: NR cm, needles (0.3 and Baseline: Immediate post tx: 

score: 6/13 N completed tx: N-S Severity of 0.32 mm and length 30 Pain: IG1 + IG2 = 

N attended last fu: NR Work status: total: pain (Grading): and 70 mm) stimulated 57 (21), CG = 47 Short term: NR 

retired 17 (34%), NR 3 times during 20 min tx (23) 

Initial of Inclusion: lumbar or full time 12 (24%), sessions to restore de qi Intermediate: NR 

reviewer: SG lumbosacral LBP for at unemployed 1 Co- feeling; once/wk for 8 wk Immediate post tx: 

least 6 mos; no (2%) interventions:c Drop outs: 13 Pain: NR Long term: NR 

radiation of pain below orsets, nerve 

the knee level; normal Other socio­ blocks, IG2 (n = 16) – EA: 4 Short term: % Harms: NR 

neurologic demographics: analgestics, needles, 1 pair/side in change from 

examination findings of NR TENS, and LB, freq 2Hz every 2.5s, baseline in the Summary: 

lumbosacral nerve 

function Co morbidities: 

internse PT 

includingtraction 

interrupted by a 15 Hz 

train for 2.5s using 

morning: 1st = 88%, 

2nd = 76% 

NR , warmth, and Chinese acu ES; 2-3 % change from 

Exclusion: major EX sessions/as IG1 baseline in the 

trauma or systemic 

disease; pregnancy; 

Prior episode of 

pain if acute: NR 

Drop outs: -- evening 1st = 87%, 

2nd = 74% 

hx of acu tx CG (n = 16) – TENS: 

Prior CAM mock TENS given by Intermediate: NR 

intervention: NR impressive, stationary, 

disconnected GRASS, Long term: NR 

Prior surgery electrodes placed on 

related to current most painful area in LB; 

complaint: total 2 same as IG1 

(4%) Drop outs: 10 

C-17
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Cecherelli, F 

(2003)19 

Trial Design 

RCT 

Mean age 

(SD/range):IG = 

Cause of Pain: 

NR 

Groups 

IG (n = 16)– Acu: the 

Outcome 

instruments: 

Outcome 

instruments: 

57.17 (±13.06), needles were inserted in Pain: QoL/ well being: 

Country: Tx duration: 5-10 wks CG = 49.36 the muscles and in the NA NA 

Italy, Padova Final assessments: (±11.98) yrs intraspinal ligaments. Results: 

immediately post tx Duration of The following points Baseline: Results: 

% of male: IG= Pain: Chronic > were stimulated Pain: NA Baseline: 

Quality N screened: 31 31%, CG = 27% 3 mos manually for 20 seconds Immediate post tx: 

score: 7/13 N randomized: 31 per tx: Immediate post tx: 

N completed tx: 31 Racial Severity of Ex 29 (Shiqizhuixia) Pain: Short term: NR 

N attended last fu: NR composition: pain (Grading): 3 GV (yaoyangguan) Intermediate: NR 

Initial of Europian-Italian NR 30 BL (Baihuanshu)) Short term: NR Long term: NR 

reviewer: SG Inclusion: Pts with 31 BL (Shanglio) Harms: NR 

chronic "lombalgia" Work status: NR Co- 60 BL (Kunlun) Intermediate: NR 

meaning LBP (pain > 3 interventions:N 62 BL (Shenmai); 1 Summary: IG = 11 

mos) Other socio- R session/wk for 5 wks Long term: NR pts obtained a good 

Exclusion: radicular demographics: Drop outs: None result (68.8%), 1 an 

signs associated with NR unsatisfactory 

scoliosis as CG (n = 15) – Acu: result, and 4 a poor 

demonstrated on X-ray Co morbidities: same as IG; 10 tx of result (25%). The 

or degenerative disc NR acu, 1 tx/wk for 10 wks remaining pain was 

disease with significant Drop outs: None 65.5% of the 

reduction of interdiscal Prior episode of original pain. 

spaces, radicular pain if acute: NR CG= 13 pts (86.7) 

symptoms with dural had a good result) 

sac signs, Pts showing Prior CAM and 2 a poor result 

signs of neuro­ intervention: NR (13.3%). The 

muscular disease remaining pain was 

Prior surgery 43.9% of the 

related to current original pain 

complaint: NR 

C-18
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Cherkin, DC See LBP massage See LBP See LBP See LBP massage See LBP massage See LBP massage 

(2001)20 section massage section massage section section section 

section 

Cherkin, DC Trial Design – RCT Mean age Cause of Pain: Groups Outcome Outcome 

(2009)21 (SD/range): 46 – 49 N-S, 21.5% IG1 (n = 157)– Ind-Acu: instruments: instruments: 

Tx duration: 7 wks yrs with radiating 32-gauge needles were Disability: RMDQ QoL/ well being: 

Country: 

US 

Final assessments: 3 

mos 

N screened: 2605 

% of male: IG1 = 

32, IG2 = 54, IG3 = 

40, CG = 36% 

pain used (0.25 mm) at least 

1.5" in length; needling 

depth varied from 1 to 3 

cm, 10.8 (5-20) needles 

retained for 18 (15-20) min, 

short- and 

intermediate-term 

post-tx 

Results: 

Immediate post 

tx:NR 

Quality N randomized: 638 Racial composition: Duration of twice for 3 wks, then Results: 

score: 6/13 N completed tx: 638 White/Hispanic Pain: once/wk for 4 wks Baseline: Short term: NR 

N attended last fu: 606 Chronic, NR Drop outs: C=10,D = 16 Disability: IG1 =

Work status: 10.8 (5.2), IG2 = Intermediate: NR 

Initial of 

reviewer: SG 

Inclusion: Pts aged 

18-70 yrs receiving 

care for CLBP (3-12 

mo) within the past yr 

employed IG1 = 22, 

IG2 = 20, IG3 = 22, 

CG = 19 

Other sociodemographics: 

Severity of 

pain (Grading): 

NR 

CoIG2 (n = 158) – St-Acu: 

same as IG1 with 8 

commonly used acu points 

Du 3, Bladder 23-bilateral, 

LB ashi point, Bladder 40­

bilateral, Kidney 3-bilateral, 

10.8 (5.6), IG3 = 

9.8 (5.2), CG = 11 

(5.2) 

Immediate post tx: 

Long term: NR 

Harms: 11 pts had 

moderate shortExclusion: Specific Married: 58.3% interventions: needled for 20 min; same Disability: NR term and 1 pt had 

causes of BP (cancer, Electro­ as IG1 severe AE; IG1 = 6, 

fractures, spinal Co morbidities: NR stimulation, Drop outs:C=6, D=11 Short term: IG1 = IG2 = 6, P = 0.04 

stenosis, infection), Prior episode of moxibustion, 6.4 (5.3), IG2 = 6.3 

back problem pain if acute: NR herbs were also IG3 (n = 162) – Sham: (5.7), IG3 = 5.4 

complication (back 

surgery, sciatica), 

contraindication to acu 

Prior CAM 

intervention: NR 

prescribed toothpick in a needle guide 

tube, twirling for 10 min; 

same as IG1 

Drop outs: C=3, D=10 

(4.9), CG = 8.9 (6) 

Intermediate: NR 

Prior surgery 

related to current CG (n = 161) – Usual care: Long term: NR 

complaint: None self-care book; NA 

Drop outs: C=13, D=18 

C-19
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Chu, J 

(2004)22 

Trial Design 

RCTMean age (SD/range): 53.4 

Cause of Pain: 

Herniated 

Groups 

IG1 (n =12 ) – EOutcomes: 

Pain: Pain intensity 

Outcomes: 

QoL/ well being: 

(13.9) yrs nucleus MS(ETOIMS): (VAS): B (right NA 

Country: Tx duration: 3 wks pulposus (n=4) Monopolar 37 mm-long after, 1 wk post-Tx, 

US Final assessments: 2 % of male: 50% Lumbar EMG needle electrode and 2 wks post-Tx) Results: 

wks spondylosis inserted into paraspinal 

Racial (n=4) muscle sites (T10 - S1), Disability: NA Immediate post tx: 

N screened: NR composition: NR Spondylolisthesi kept for 2 secs 

Quality N randomized: 36 s (n=2) stationary then Results: Short term: NR 

score: 7/13 N completed tx: NR Work status: NR withdrawn, electric Baseline: 

N attended last fu: NR current (frqcy: 2 HZ and Pain: IG1 = 4.3 Intermediate: NR 

Other socio- intensity: 2 mA) was (2.3), IG2 = 4.6 

Initial of Inclusion: Pts with demographics: Duration of supplied at individual (2.1), CG = 4.2 Long term: NR 

reviewer: SG CLBP (duration  3 NR Pain: points; 20 min/session (1.9) 

mo) Chronic, 28.2 Drop outs: NR Harms: NR 

Co morbidities: (19.1) yrs Immediate post tx: 

Exclusion: Radiation NR IG2 (n = 12) – MS: Pain: IG1 = 2.3 

of pain below the Severity of same as IG1 minus (1.1), IG2 = 3.9 

buttock, drug/alcohol Prior episode of pain (Grading): electric current; same as (1.8), CG = 3.5 

abuse, sciatica, spinal pain if acute: NR NR IG1 (2.3) (P < 0.01) 

surgery, spinal nerve Drop outs: NR 

root or spinal cord Prior CAM Co- CG (n = 12)–SS: Skin Disability: NA 

injury, previou use of intervention: NR interventions:N stimulation, insertion of 

Acu, skin infections, R EMG needle electrode Short term: NR 

open wounds, limited to skin (no 

bleeding disorders, Prior surgery penetration, no Intermediate: NR 

immune deficiencly, related to current electricity) 

valvular heart disease, complaint: NR Drop outs: NR Long term: NR 

pace makers, 

pregnancy 

C-20
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Coan, R 

(1980)23 

Trial Design 

RCT 

Mean age 

(SD/range): IG = 

Cause of Pain: 

NR 

Groups 

IG (n = 23)– Acu 

Outcome 

instruments: 

Outcome 

instruments: 

47.2, CG = 47 yrs (immediate): performed Pain: VAS 10cm QoL/ well being: 

Country: Tx duration: NR according to the for pain (0-10) (A, NR 

USA Final assessments: 3­ % of male: IG = classical Oriental C, D) 

6 mos 43.5%, CG = 50% Duration of meridian theory of Results: 

Pain: promoting healing by Results: Baseline: NA 

Quality N screened: NR Racial Chronic, IG = stiumlating the energy Baseline: 

score: 3/13 N randomized: 39 composition: NR 8.2, CG = flow in the body. In Pain: IG = 5.5, Immediate post tx: 

N completed tx: NR 12.6(assuming some pts, E-Acu was CG(A1) = 4.8, CG NR 

N attended last fu: NR Work status: NR yrs)-SG used; NR (A2)= 4.7 

Initial of Drop outs: NR Short term: NR 

reviewer: SG Inclusion: LBP for 6 Other socio- Severity of Immediate post tx: 

mos or more, no demographics: pain (Grading): CG (n = 16) – Acu Pain: NR Intermediate: NR 

previous acu tx, no NR NR (delayed): same as IG; 

history of diabetes, NR Short term: IG = 2.7 Long term: NR 

infection or cancer, not Co morbidities: Co- Drop outs: NR (2.8), CG (A1) = 2.8 

more than 2 back NR interventions:N (2), CG (A2) = 2.8 Harms: NR 

surgeries R (1.9) 

Prior episode of 

Exclusion: NR pain if acute: NR Intermediate: IG = 

3.8 (1.7), CG (A1) = 

Prior CAM 3.4 (1.4), CG (A2) = 

intervention: NR 4.6 (-0.1) 

Prior surgery Long term: NR 

related to current 

complaint: NR 

C-21
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Fu ZH 

200624 

Trial Design 

RCT 

Mean age 

(SD/range): 

Cause of Pain: 

N=-S 

Groups 

IG (n = 32)– Fu’s 

Outcome 

instruments: 

Outcomes: 

QoL/ well being: 

IG = 53.3 (12.4) subcutaneous needling: Pain: MRP -VAS NR 

Country: Tx duration: NR vs. CG = 58.8 needle penetrates (B); PUP - VAS (B) 

China Final assessments: (10.8) yrs subcutaneously into Results: 

immediately post tx Duration of layer in insertion points Disability: 

% of male: IG = Pain: chosen based on Immediate post tx: 

Quality 0.437%, CG = Chronic, IG = experience and ancient Results: NA 

score: 3/13 N screened: NR 0.5% 5.43 (7.45); CG Chinese medical book; Baseline: 

N randomized: 60 = 5.56 (6.54) insertion points were Pain: IG = 5.22 Short term: NR 

N completed tx: 60 Racial chosen at the same side (2.47), CG = 4.32 

Initial of N attended last fu: NR composition: NR Severity of pain with suffered back; if (2.13); IG = 5.28 Intermediate: NR 

reviewer: SG (Grading): both sides afflicted, one (2.22), CG = 4.07 

Work status: NR NR more severe side was (2.19) Long term: NR 

Inclusion: Adults (20­ treated; NR Disability: 

60 yrs) with CLBP Other socio- Co- Drop outs: NR Harms: NR 

between the 12th rib demographics: interventions:NR Immediate post tx: 

and gluteal fold NR CG (n = 28) – minimal Pain: IG = 2.56 

needling: NR; NR (2.59), CG = 3.79 

Exclusion: systemic Co morbidities: Drop outs: NR (2.33); IG = 2.91 

disorders, disc/spine NR (2.48), CG = 3.71 

surgery, psychiatric (2.09) 

diseases, taking Prior episode of Disability: NR 

analgesics, hormones pain if acute: NR 

Short term: NR 

Prior CAM 

intervention: NR Intermediate: NR 

Prior surgery Long term: NR 

related to current 

complaint: None 

C-22
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Giles, LG 

(2003)25,26 

Trial Design 

RCT 

Mean age 

(SD/range): IG1 = 

Cause of Pain: 

N- S 

Groups 

IG (n = 36)– Acu(LB, 

Outcome 

instruments: 

Outcome 

instruments: 

23.8 (4.8), IG2 = neck, thorax): needling Pain: VAS (1 - QoL/ well being: 

Country: Tx duration: 9 wks 25 (8.1), CG = the TP & distal 100)- ITT NR 

Australia Final assessments: 1 29.5 (2.07) yrs analgesia producing Disability: Oswestry 

yr Duration of sypatholytic acu points Results: 

% of male: IG1 = Pain: below the elbow or Results: 

Quality 55.9, IG2 = 51.4, chronic (> 13 knee, intervals for 20 Baseline: Immediate post 

score: 6/13 N screened: 533 CG = 57.5 wks) min- insertion depth 20­ Pain: IG1 = 6 (2.2), tx:NR 

N randomized: 115 50 mm, kin the IG2 = 6 (2.9), CG = 

N completed tx: 69 Racial Severity of pain maximum pain area and 5 (3.7) Short term: NR 

Initial of N attended last fu: 62 composition: NR (Grading): NR up to 5 mm in the distal Disability: IG1 = 30 

reviewer: SG points; same as IG2 (17.03), IG2 = 22 Intermediate: NR 

Inclusion: pts at least Work status: NR Co- Drop outs: B = 14, E = (22.96), CG = 32 

17 yrs old with interventions: 6/20 (19.3) Long term: NR 

uncomplicated Other socio- NR 

mechanical spinal pain demographics: IG2 (n = 36) – Spinal Immediate post tx: Harms: N=22, 13 

for minimum of 13 wks skilled trade: manipulation: high Pain: IG1 = 4 (3.7), in IG1, 4in IG2, 5 in 

28.8% velocity, low amp thrust IG2 = 3 (5.2), CG = CG, n=1 committed 

Exclusion: pts with to a joint; 20 5 (3.7) suicide after end of 

nerve root Co morbidities: min/session, 2 tx/wk up Disability: IG1 = 26 tx; most frequent 

involvement, spinal Prior episode of to 9 wks (20.74), IG2 = 14 AEs were 

anomalies (other than pain if acute: NR Drop outs: B = 11, E= (24.4), CG = 32 hematoma and 

sacralization or 4/23 (23.7) bleeding 

lumbarization), Prior CAM 

pathology other than intervention: NR CG (n = 43) – Short term: NR 

mild to moderate Medication that has not 

osteroarthrosis, Prior surgery been tried: Intermediate: IG1 = 

spondylolisthesis of L5 related to current Drop outs: B = 21, E= 13 (22.9), IG2 = 16 

or S1 exceeding complaint: NR 12/19 (17.8), CG = 24 

Grade 1 (25.2) 

C-23
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Grant, DJ 

(1999)27 

Trial Design 

RCT 

Mean age 

(SD/range): IG = LBP 

Groups 

IG (n = 32)– Acu: (32 

Outcome 

instruments: 

Outcome 

instruments: 

75 range (60-83), Cause of Pain: gauge, 1.5 inch length Pain: VAS- QoL/ well being: 

Country: Tx duration: 4 wks CG = 72 (60-90) N-S with guide tube). Points reported as Median NA 

U.K Final assessments: 3 yrs were as in routine (IQR), converted to Results: 

mos clinical practice, using mean (SD) Baseline: NA 

% of male: 6.25%, only points on the back. 

Quality N screened: 81 vs. 14.28% Duration of 6 needles used on Disability: NHP- Immediate post tx: 

score: 6/13 N randomized: 60 Pain: average at each tx with reported as median NA 

N completed tx: 60 Racial Chronic, NR minimum of 2 and a max (IQR) converted to Short term: NR 

N attended last fu: 60 composition: NR of 8.; 2 tx of 20min/wk mean (SD) 

Initial of Severity of for 4 wks Intermediate: NR 

reviewer: SG Inclusion: Pts at least Work status: NR pain (Grading): Drop outs: 2 Results: 

60 yrs old with NR Baseline: Long term: NR 

complain of back pain Other socio- CG (n = 28) – TENS: Pain: IG = 140(P 

of at least 6 mos demographics: Co- standard make and =66), CG = 101 (P Harms: (n = 2): 

duration NR interventions:P model of machine (TPN = 43.7) influenza and 

ts were allowed 200, Physio-Med- Disability: IG = 76.7 immobility following 

Exclusion: Tx with Co morbidities: to continue the Servics) using 50 Hz (35.3)(P = 33.2), dental tx which 

anticoagulants, tx with NR analgesic use stimulation iwht the CG = 50.1 (40) (P = required 

systemic intensity adjusted to suit 34.4) hospitalization; (n = 

corticosteroids, Prior episode of the Pts. Units were used Immediate post tx: 1): acute 

dementia, previous tx pain if acute: NR by Pts or the caregiver Pain: NR depression 

with acu or TENS, at home; 30 Disability: NR 

cardiac pacemaker, Prior CAM min/session, max of 6 

other severe intervention: NR hrs/d, fu of 20 Short term: NR 

concomitant disease, min/session, twice/d 

inability of Pt or Prior surgery Drop outs: 1 Intermediate: NR 

caregiver to apply related to current 

TENS machine. complaint: NR Long term: NR 

C-24
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Haake, M 

(2007)28 

Trial Design 

RCT 

Mean age 

(SD/range): IG1 = 

Cause of Pain: 

N-S 

Groups 

IG1 (n = 387)– Acu 

Outcome 

instruments: 

49.6 (14.6), IG2 = (verum): Acu included Pain: Pain: CPGS 

Country: Tx duration: up to 7 51.3 (14.5), CG = fixed points and (D) Outcomes: 

Germany wks 49.2 (14.8) yrs individual points QoL/ well being: 

Final assessments: Duration of according to Chinese Disability: HFAQ SF-12 (physical 

immediately post tx % of male: IG1 = Pain: medicine; 14-20 needles (D) score) 

Quality 42.6%, IG2 = Chronic, 8 yrs inserted to a depth of 5­ Other: 

score: 10/13 N screened: 1802 42.5%, CG = (same for all 40 mm depending on Results: 

N randomized: 1162 36.2% grps) location. Induction of de Baseline: Results: 

N completed tx: 1117 Qi in the body was Pain: IG1 = 67.7 Baseline: 

Initial of N attended last fu: NR Racial Severity of pain elicited by ME; 2 (13.9), IG2 = 67.8 IG1 = 31.8 (6.8), 

reviewer: SG composition: NR (Grading): NR sessions/ wk, 5 more (14.6), CG = 67.8 IG2 = 31.6 (6.8), 

Inclusion: > 18 yrs old session if pts (13.2) 31.5 (6.9) 

adults with CLBP for  Work status: NR Co­ experienced 10-50% Disability: IG1 = Immediate post tx: 

24 wks interventions:No reduction in pain 46.3 (14.7), IG2 = NA 

Other socio­ ne Drop outs: C = 10 46.7 (14.5), CG = 

Exclusion: Received demographics: 46.3 (15.3) Short term: NR 

acu for LBP at any NR IG2 (n = 388) – 

time in the past, Co morbidities: Standard therapy: 10 Immediate post tx: Intermediate: IG1(n 

history of spinal NR sessions of PT, EX, Pain: = 373) = 41.6 

fracture, disc or spinal NSAIDs, pain Med up to Disability: (10.5), IG2 (n = 

surgery, Prior episode of max daily dose; same 364) = 35.8 (9.5), 

infections/tumor of the pain if acute: NR as IG1 Short term: NR CG (n = 372) = 

spine, bone/joint Drop outs: C = 24 39.5 (10.1) 

disorder, scoliosis, Prior CAM Intermediate: NR 

chronic pain, drug intervention: NR CG (n = 387) – Sham Long term: NR 

abuse, pregnancy or acu: sham needles were Long term: NR 

epilepsy Prior surgery only superficially (1-3 Harms: NR 

related to current mm) inserted without 

complaint: None stimulation; up to 7 wks 

Drop outs: C = 11 

C-25
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hirota, S 

(2005)29 

Trial Design 

RCTMean age (SD/range): NR, 

Cause of Pain: 

Not S 

Groups 

IG (n = 4) – Trigger 

Outcomes: 

Pain: VAS 

Outcomes: 

QoL/ well being: 

aged 65+ point needling Disabilty: RDQ NR 

Country: Tx duration: 5 wks % NS: all pts 

Japan Final assessments: % of male: NR 1tx/wk for 5 wks Disability: RDQ Other: NA 

immediately post tx Drop outs: NR 

Racial Duration of Results: Results: 

N screened: 12 composition: Pain: chronic, CG (n = 5) – Tender Baseline: Baseline: NA 

Quality N randomized: 9 Assuming all point needling Pain: 72.3 (3.1) vs. 

score: 5/13 N completed tx: NR Asians Severity of pain 71.6 (3.9) Immediate post tx: 

N attended last fu: NR (Grading): NR 1 tx/wk for 5 wks Disability: 3.1 (1.4) NA 

Work status: NR Drop outs: NR vs. 5.8 (4.0) 

Initial of Inclusion: pts with Co- Short term: NR 

reviewer: SG chronic (> 6 mos) LBP Other socio­ interventions:NR Immediate post tx: 

demographics: Pain: 61.5(29.3) Intermediate: NR 

Exclusion: NR NR vs. 71.5 (24.3) 

Disability:7.5 (1.9) Long term: NR 

Co morbidities: vs. 9.0 (4.1) 

NR Harms: NR 

Short term: NR 

Prior episode of Summary: After tx 

pain if acute: NR Intermediate: NR period, VAS and 

RDQ values 

Prior CAM Long term: NR improved sign. In 

intervention: NR IG, no sign. 

improvements in 

Prior surgery CG 

related to current 

complaint: NR 

C-26
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hollisaz , MT 

(2008)12 

Trial Design 

RCT 

Mean age 

(SD/range): NR 

Cause of Pain: 

NR 

Groups 

IG (n = 41)– E-Acu: 10­

Outcome 

instruments: 

Outcome 

instruments: 

15 needles inserted in Pain: Pain QoL/ well being: 

Country: Tx duration: 1 mo % of male: 45.4% painful points to depth of reduction (%) NA 

Iran Final assessments: 1-5cm.20min/session, Other: complication 

immediately post tx Racial Duration of current with 2-10 mA Disability: NA reduction 

composition: NR Pain: intensity and 4 HZ 

Quality N screened: NR Work status:NR Chronic, NR frequency; NR Results: NA Results: 

score: 2/13 N randomized: 119 Severity of pain Drop outs: NR Baseline: Immediate post tx: 

N completed tx: NR Other socio­ (Grading): Pain: 89.3% vs. 51.8% 

N attended last fu: NR demographics: NR IG2 (n = 38) – Disability: vs. 31.9% 

Initial of NR Physiotherapy: 

reviewer: SG Eligibility criteria: Co morbidities: Co­ 30min/session, hot Immediate post tx: Short term: NR 

- inclusion: Pts with Buttock pain: interventions: packs, ultrasound, short- Pain reduction, 

LBP of sciatical origin 80.5% NR wave diathermy, TENS, mean % (SD): 62.1 Intermediate: NR 

(> 6 mo) aged => 20 Paravertebral muscle strengthening; (18.6) vs. 52.5 

yrs muscle spasm: NR (17.5) vs. 17.5 Long term: NR 

- exclusion: Indication 61.0% Drop outs: NR (12.7), p < 0.05 

for surgery, Scoliosis: 22.0% Disability: Harms: NR 

reluctance/compliance Claudication: CG (n = 40) – Placebo: 

for attendance < 5 Tx 14.6% instead of needles, pts Short term: NR Summary of 

sessions, > 50 yrs old, set on intended points results (if 

contraindications of Prior episode of by adhesives, after Intermediate: NR provided): E-Acu 

acu Tx (systemic pain if acute: NR turning machine on the more effective in 

disease, prosthesis, current intensity was Long term: NR resolving 

cutaneous infections) Prior CAM zero; sessions every symptoms 

intervention: NR other d for 1 mo compared to PT or 

Prior surgery Drop outs: NR placebo 

related to current 

complaint: NR 

C-27
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Inoue, M 

(2006)30 

Trial Design 

RCT 

Mean age 

(SD/range): IG = 

Cause of Pain: 

lumbar vertebral 

Groups 

IG (n = 15)– Acu: 

Outcome 

instruments: 

Outcome 

instruments: 

68 (6), CG = 70 arthritis (dx by needle (L: 40 mm; D: Pain: Pain (VAS- QoL/ well being: 

Country: Tx duration: single tx (8) yrs MRI or 0.18 mm- by Seirin Co. 0= no pain; 100= NA 

Japan Final assessments: radiological Shizauoka, Japan) worse pain) at time Other: 

immediately post tx % of male: IG = findings) inserted to a depth of B while adopting 

73.3%, CG = 20 mm at the most the most painful Results: 

Quality N screened: NR 62.5% painful point and position Baseline: 

score: 9/13 N randomized: 31 stimulated the needle 

N completed tx: 31 Racial Duration of with sparrow pecking Disability: range of Immediate post tx: 

N attended last fu: NR composition: NR Pain: method for 20 seconds; lumbar spinal flxInitial of (assume 100% Subacute; 1 tx not abstracted Short term: NR 

reviewer: SG Inclusion: pts Asians) chronic, IG = 83 Drop outs: 0 

consulted for LBP, (39), CG = 84 Results: Intermediate: NR 

newly referred and Work status: NR (46) mos CG (n = 16) – Sham Baseline: 

those re-attending, Acu: therapist taped the Pain: IG = 61 (11), Long term: NR 

with only LBP in a Other socio- Severity of end of guide tube on the CG = 61 (9) 

limited area, which demographics: pain (Grading): skin at the most painful Disability: NR Harms: NR 

was exacerbated in NR NR point, without a needle 

particular posture and acted as if they Immediate post tx: 

Co morbidities: Co- were insuring a needle; Pain: IG = 47 (7), 

Exclusion: pts with NR interventions:N 1 tx CG = 55 (13) 

leg symptoms, those R Drop outs: 0 Disability: NR 

unable to locate area Prior episode of 

of pain, pain was not pain if acute: NR Short term: NR 

worsened by changes 

in posture; pts with Prior CAM Intermediate: NR 

symptoms or findings intervention: NR 

on imaging indicating Prior surgery Long term: NR 

need for Med related to current 

/surgery/underlying complaint: NR 

disease 

C-28
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Inoue, M 

(2000)31 

Trial Design - RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

Non S 

Groups 

IG (n = 15) – Acu: two 

Outcomes: 

Pain: VAS of pain 

Outcomes: 

QoL/ well being: 

Tx duration: single tx 59.6 (21.1) vs. needling points chosen at the most 

Fu duration: NR CG = 60.1 (20.7) Duration of bilaterally from lumbar restricted action (10 Other: NR 

Country: yrs Pain: chronic, area(4 points): BL52 cm) 

Japan N screened: NR NR and EX-B7, needles Results: 

N randomized: 27 % of male: NR inserted and sparrow- Results: Baseline: 

N completed tx: 27 Severity of pain picking technique Baseline: 

N attended last fu: NR Racial (Grading): NR performed for 20 sec, Pain: IG = 6 (1.7), Immediate post tx: 

Quality composition: pts treated one time CG = 5.4 (1.8) 

score: 10/13 Inclusion: Pts with Asian immediately before Short term: NR 

chronic lumbago who Co­ regular acu tx; single tx Immediate post tx: 

attended the university Work status: NR interventions: Drop outs: 0 Pain: IG = 3.9 (2.6), Intermediate: NR 

Initial of acu clinic as outpt, NR CG = 3.6 (2.1) 

reviewer: SG consent to attend trial Other socio- CG (n = 12) – Sham Long term: NR 

demographics: acu: two needling points Short term: NR 

Exclusion: NR chosen bilaterally from Harms: NR 

neurological findings, lumbar area (4 in total) Intermediate: NR 

pain or numbness in Co morbidities: same points as IG, 

lower extremity; NR mimicked needle Long term: NR 

malignancy, infection insertions: tapped head 

or inflammatory Prior episode of of needle guide tube, 

disease; fracture; pain if acute: NR gesture needling 

lumbago due to performed for 20 sec, 

urological problem, Prior CAM pts treated one time 

gynecological problem, intervention: NR immediately before 

digestive problem or regular acu tx; single tx 

cardio-vascular Prior surgery Drop outs: 0 

problem; dementia; related to current 

pregnancy complaint: NR 

C-29
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Itoh, K Trial Design-RCT Mean age Cause of Pain: Groups Outcomes: Outcome 

(2009)32 (SD/range): total: N-S IG1 (n = 8)– Acu: (BL23), Pain: VAS 10 cm instruments: 

Tx duration: 5 wks range 61-81 yrs (BL25), (BL32), (BL40), (lower better) QoL/ well being: 

Country: 

Japan 

Final assessments: 10 

wks 

N screened: NR 

% of male: 37.5% 

total Duration of 

Pain: 

(BL60), (GB30) and 

(GB34). Stainless steel 

needles (0.2 mm x 40 mm, 

Seirin Co Ltd) inserted into 

the muscle to a depth of 10 

Disability: (RDQ)- 

24 items 

Results-Baseline: 

NA 

Results: 

Baseline: 

Quality N randomized: 32 Racial chronic (> 6 mm using 'sparrow Pain Immediate post tx: 

score: 6/13 N completed tx: 25 composition: NR mos) pecking' technique for 15 Immediate post tx: 

N attended last fu: 26 Severity of minutes on the affected IG1 = 37.4 (25.9), Short term: NR 

Work status: NR pain (Grading): LBP; 1 tx/wk for 5 wks IG2 = 53.2 (25.1), 

Initial of Inclusion: outpts older NR Drop outs: 1 IG3 = 36.8 (53.1 Intermediate: NR 

reviewer: SG than 60 yrs+; with 

lumbar or lumbosacral 

LBP for at least 6 mos; 

no radiation of LBP; 

Other sociodemographics: 

NR 

Cointerventions:n 

o intake of other 

IG2 (n = 8)– TENS: 15 min 

on most tender point and 

near side of point; as IG1 

Drop outs: 2 

(27.9) 

RMD, mean: IG1 = 

5.4, IG2 = 6.2, IG3 

= 3.8, CG = 7.3 

Long term: NR 

Harms: 

normal neurological Co morbidities: tx including Short term: deterioration of 

findings of lumbosacral NR analgesics, anti­ IG3 (n = 8)– Acu + TENS: IG1 = 43.3 (25.7), symptoms: IG3 = 1 

nerve inflammatory 15 minutes of TENSE + 15 IG2 = 58 (23.7), dropout, 12.5% 

Prior episode of agents or min of acu as described for IG3 = 49.2 (10.3), 

Exclusion: if receiving pain if acute: NR poultice grp 1 and 2; as IG1 58.1 (28.9) 

acu > 6 mos; major containing Drop outs: 3 

trauma or systemic 

disease; receiving 

conflicting or ongoing 

Prior CAM 

intervention: NR 

methylsalicylic 

acid during the 

study 

CG (n = 8) – transverse 

oscillatory rotical poutice: 

transverse oscillatory 

RMD-mean: IG1 = 

6.7, IG2 = 7.5, IG3 

= 6.5, CG = 7.7 

co-interventions Prior surgery rotical poutice only when 

related to current necessary; NR Intermediate: NR 

complaint: NR Drop outs: 1 

Long term: NR 

C-30
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Itoh, K 

(2006)33 

Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

Spondylosis/ 

Groups 

IG (n = 13)– Trigger 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: 3-12 wks 73.5 (10) vs. CG Osteoporosis/ point Acu: needles (0.2 Pain: Pain: VAS 10 QoL/ well being: 

Country: Final assessments: = 78.8 (4.7) yrs compression mm x 50 mm, Seirin, cm scale, A, B NR 

Japan immediately post tx /fracture Japan) were inserted Results: 

% of male: NR into the skin over the TP Disability: RMQ 

N screened: 26 to a depth of 10-* 40 (RMQ) Immediate post tx: 

Quality N randomized: 26 Racial mm, appropriate to the NR 

score: 8/13 N completed tx: 23 composition: NR Duration of target muscle. Attempt Results: 

N attended last fu: NR Pain: chronic, IG to elicit a local muscle Baseline: Short term: NR 

Work status: NR = 4.2 (3.5); CG twitch response using Pain: IG = 65 Intermediate: NR 

Initial of Inclusion: pts aged at = 5.4 (6.2) yrs the 'sparrow pecking' (13.1); CG = 69 Long term: NR 

reviewer: SG least 65 yrs with tx of Other socio­ technique- needle (12.5) 

LBP- lumbar or demographics: Severity of pain retained for 10 min post Disability: NR Harms: 

lumbosacral pain for at NR (Grading): NR appropriate response; 3 deterioration of 

least 6 mo; leg pain if tx/wk, 3-12 wks trial, Immediate post tx: symptoms ( n = 1) 

minor severity in Co morbidities: Co­ total 36 tx Pain: IG = 27.3 withdrawal due to 

comparison to back NR interventions: Drop outs: B = 1 (13.5); CG (n = AE 

pain; normal baseline meds: 11)= 69.6 (10.9) 

neurological exam Prior episode of anti- CG (n = 13) – Sham: Disability: NR Summary: RMQ: 

findings of lumbosacral pain if acute: NR inflammatory similar needles as IG IG scored 

nerve function poulitice Med used but the tips had Short term: NR significantly lower 

Prior CAM CG=3/13 been cut off to prevent scores (P < 0.01) 

Exclusion: major intervention: NR the needle penetrating Intermediate: NR than CG - harms of 

trauma or systemic the skin. The cut ends tx are NR (1 

disease; other Prior surgery were smoothed with Long term: NR WDAE, which was 

conflicting or on-going related to current sandpaper manually; after the 1st periodtxs; pts with medical complaint: NR same as IG data is not 

conditions were Drop outs: B = 2 extracted) 

included if there had 

been no change in 

drugs or dosage 

C-31
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Kerr, P 

(2003)34 

Trial Design-RCT Mean age 

(SD/range): IG1 = 

Cause of Pain: 

N-S (IG1-some 

Groups 

IG1 (n = 26)– Acu: 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: 6 wks 42. 6 (11.5 ), IG2 with leg pain, Bl23, Bl25, GB 30, Bl40, Pain: PRI; VAS QoL/ well being: 

Country: Final assessments: 6 = 42.8 (12), CG = detail NR) Ki3 and Governor (mm) SF- 36 (short form 

Northern mo 36.1 (14.9) yrs Vessel 4. 11 Disability: NA 36) 

Ireland needles/session, (Seirin Results: Other: 

N screened: 60 % of male: IG1 = acu needles N8, 0.30 x Baseline: 

N randomized: 60 50%, IG2 = 35%, Duration of 50mm, c-type needle). Pain: IG1 = 29 Results: 

Quality N completed tx: 32 CG = 57% Pain: The needles were (11.1), IG2 = 28.5 Baseline: 

score: 4/13 N attended last fu: 34 Chronic, IG1 = inserted until the (13); IG1 = 79.7 IG1 = 52.3 (18.7), 

Racial 86.1 (84.9), IG2 sensation of 'ch'i" was (20.3), IG2 = 76 IG2 = 47.3 (23.7) 

Inclusion: LBP composition: NR = 72.8 (77.4), produced in prone (17.6) 

Initial of symptoms > 6 mos CG = 51.6 position. Disability: NA Immediate post tx: 

reviewer: SG (rule out natural Work status: NR (44.2) mos Pts also given leaflet IG1 = 63.9 (20.3), 

recovery processes), regarding LBP that Immediate post tx: IG2 = 57.5 (23.2) 

with or without leg Other socio- Severity of pain included standardized Pain: IG1 = 20.3 

pain, and with no demographics: (Grading): NR advice and EXs; (9), IG2 = 23.7 (13); Short term: NR 

neurologic deficits NR 30min/tx, 1tx/wk for 6 IG1 = 51.3 (22.4), 

Co­ wks IG2 = 61.7 (30.6) Intermediate: NR 

Exclusion: Co morbidities:NR interventions: Drop outs: 14 Disability: NA 

contraindications to Pts already on Long term: NR 

acu therapy, <18 yrs, Prior episode of pain Med but IG2 (n = 20)– Placebo- Short term: NR 

pregnancy, underlying pain if acute: NR details are NR TENS: A nonfunctioning Harms: NR 

systemic disorders and TENS machine was Intermediate: N of 

diagnoses of Prior CAM attached to 4 electrodes pts with >50% pain 

rheumatoid arthritis, intervention: NR placed over the lumbar reduction on scale: 

osteoarthritis of the spine; same as IG1 IG1 = 91%, IG2 = 

spine or cancer. Prior surgery Drop outs: 14 75% 

related to current 

complaint: NR CG (n = 14) – Non- Long term: NR 

attendees: NR; NR 

Drop outs: NR 

C-32
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Kwon, Y.D 

(2007)35 

Trial Design- RCT Mean age 

(SD/range): NR 

Cause of Pain: 

Non S 

Groups 

IG (n = 25) – Acu: ME 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: 4 wks (no sign. diff. by reinforcing and Pain: VAS scores QoL/ well being: 

Country: Final assessments: between grps in Duration of reducing by lifting and PGA, Pt global 

China immediately post tx age) Pain: unit NR – thrusting needle in 20 Disability: RDQ assessment 

mean: IG = min and pts felt de-qi 

N screened: 57 % of male: IG = 7.38 (6.66), CG sensation(needles 0.25 Results: Results: 

Quality N randomized: 50 46%, CG = 21% = 9.96 (7.14) mm x 40 mm) inserted Baseline: Baseline: IG = 

score: 7/13 N completed tx: 47 into acupoints at depth Pain: IG = 52.24 20.76 (8.97), CG = 

N attended last fu: 50 Racial Severity of pain of 25-30 mm, acupoints: (19.76), CG = 21.08 (10.02) 

composition: NR (Grading): mild: BL 23, BL 52, BL 29, 51.28 (21.24) 

Initial of Inclusion: lumbar or IG = 6 (25%), CV2, and GB 30; 3 tx/wk Disability: IG = 6.32 Immediate post tx: 

reviewer: SG lumbosacral pain for Work status: NR CG = 5 (21.7%); for 4 wks, total of 12 (3.86), CG = 6.76 IG = 16.6 (7.2), CG 

duration of at least 3 moderate: IG = sessions (4.75) = 18 (6.7) 

mos; older than 20 yrs Other socio­ 14 (58%), CG = Drop outs: A = 2 Short term: NR 

of age, LBP as main demographics: 14 (60.9%); Immediate post tx: 

complaint; normal NR severe: IG = 4 CG (n = 25) – Sham Pain: IG = 33 Intermediate: NR 

neurological (16.7%), CG = 4 acu: ME was not used (15.75), CG = 

examination; Co morbidities: (17.4%) during the 20 mintues 35.52 (15.22) Long term: NR 

NR period and subjects did Disability: IG = 5.16 

Exclusion: potential Co­ not feel De-qi. Same (4.86), CG = 4.92 Harms: NR 

lumbar disease; other Prior episode of interventions:NR needles inserted into (4.83) 

diseases such as pain if acute: NR non acupoints, at depth 

bleeding, dementia, of 10 - 20 mm away Short term: NR 

epilepsy, neurogenic Prior CAM from the acupoints of 

disorder or systemic intervention: NR intervention grp; same Intermediate: NR 

disease), planned as IG 

lumbar surgery, prior Prior surgery Drop outs: A = 1 Long term: NR 

use of acu within past related to current 

6 mo, current use of complaint: NR 

systematic 

corticosteroids 

C-33
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Lehmann, 

TR (1983)36 

Trial Design 

RCT 

Mean age 

(SD/range): Rprtd 

Cause of Pain: 

N-S 

Groups 

IG (n = 17)– Acu: 

Outcome 

instruments: 

Outcome 

instruments: 

for total grp: 39 stimulus was a biphasic Pain: NA QoL/ well being: 

Country: Tx duration: 3 wks yrs (range 20-59) wave at a frequ of 2-4 NA 

Iowa- Final assessments: 3­ Hz and increased to the Disability: NA 

University 6 mos % of male: total: Duration of pts level of tolerance. Results: 

hospital 67% Pain: Visible muscle Results: NA Baseline: NA 

N screened: NR Chronic, total: contractions usually Baseline: 

N randomized: 54 Racial 48% > 18 mo; occurred. Stimulation Pain: Immediate post tx: 

Quality N completed tx: 32 composition: NR 35% between 6­ loci were along the inner Disability: 

score: 1/13 N attended last fu: NR 18 mo; 17% and outer bladder m; 2 Short term: NR 

Work status: total: between 3-6 mo tx/wk for 3 wks Immediate post tx: 

Inclusion: Pts with 94% receiving Severity of Drop outs: A = 0, B = 5 Pain: Intermediate: NR 

Initial of chronic disabling LBP compensation pain (Grading): D = 0 Disability: 

reviewer: SG who demonstrate at NR Long term: NR 

least minimal levels of Other socio- Co- IG2 (n = 18) –TENSE: Short term: NR 

motivation and in demographics: interventions:c stimulated the pts at a Harms: NR 

whom the level of total: 93% married omprehensive pulse width of 250/sec, Intermediate: NR 

disability would multidisciplinary freq of 60 Hz, and sub 

warrant the expense of Co morbidities: educational threshold intensity- point Long term: NR 

inPt tx NR program and of stimulation were over 

twice daily EX the center of pain. pts 

Exclusion: candidates Prior episode of training with leg pain, stimulation 

for lumbar surgery; pain if acute: NR sessions. 2 pts was also performed over 

LBP < 3 mos; were depressed related nerves.; 1tx/daily 

pregnancy; Prior CAM and received tx for 3 wks 

osteomyelitis of spine, intervention: NR by a psychiatrist Drop outs: B = 4, D = 0 

discitis, tumor, 

ankylosing spondylitis, CG (n = 18) – Sham 

vertebral fractures and Prior surgery TENSE: same as IG2; 

structural scoliosis related to current same as IG2 

complaint: NR Drop outs: B = 3, D = 2 

C-34
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Leibing, E 

(2002)37 

Trial Design 

RCT 

Mean age (SD): 

IG1 = 47.9 (11.1), 

Cause of Pain: 

N-S 

Groups 

IG1 (n = 40)– Body and 

Outcome 

instruments: 

Outcome 

instruments: 

IG2 = 49 (9.4), ear Acu+ Physio: 20 Pain: 10cm VAS; QoL/ well being: 

Country: Tx duration: 24 ds CG = 47.5 (8.9) fixed body acupoints) Pain Disability NA 

Germany Final assessments: 1 yrs and 6 on the ear Index 

yr + Duration of (alternately on one ear); Results: 

% of male: NR Pain: Chronic, 20 sessions total, 5 Results: Baseline: 

Quality N screened: 208 IG1 = 8.7 (7.7), tx/wk for first 2 wks and Baseline: Immediate post tx: 

score: 2/13 N randomized: 131 Racial IG2 = 9.5 (8.3), once/wk for next 10 wks Pain: IG1 = 4.8 

N completed tx: 114 composition: NR CG = 10.6 (8.7) Drop outs: A-B = 5, E= 2 (1.8), IG2 = 5.3 Short term: NR 

N attended last fu: 131 yrs (1.8), CG = 5.4 

Initial of Work status: IG2 (n = 45) – Physio: (1.9) P = 0.0009; Intermediate: NR 

reviewer: SG Inclusion: Non- Employed, n Severity of According to Bruggar­ IG1 = 25.2 (13.4), 

radiating pain for more (%):107 (81.4%) pain (Grading): concept, aim was to IG2 = 25.5 (10.4), Long term: NR 

than 6 mo. Age 18-65 NR remove a muscle CG = 24.9 (13.7) P 

yrs Other socio­ imbalance through = 0.0001 Harms: painfulness 

demographics: Co- special training of proper of acu (2), problem 

Exclusion: Abnormal Married: 74.8% interventions:a posture and motion; Immediate post tx: with circulation (1), 

neurological status, nalgesic Med total of 26 sessions, 30 Pain: NR IG1 = 7.5% 

concomitant severe Co morbidities: use, n (%): IG1 min/tx over 12 wks 

disease, psychiatric NR = 24 (60), IG2 = Drop outs: A-B = 5, D= 9 Short term: P value: 

illness, current 20 (44.4), CG = IG1 = 1.8, IG2 = 

psychotherapy, Prior episode of 22 (47.8) CG (n = 46) – Sham­ 2.2, CG = 2; IG1 = 

pathological pain if acute: NR Acu + Physio: Needles 12.5, IG2 = 11.3, 

lumbosacral anterior- Prior CAM were inserted CG = 10 

posterior and lateral X- intervention: NR superficially, 10-20 mm 

rays (except for minor Prior surgery distant to the verum- Intermediate: NR 

degenerative related to current acupoints, outside the 

changes), rheumatic complaint: IG1 = meridians, and were not Long term: NR 

inflammatic disease 4 (10), IG2 = 2 stimulated (no "de qi"); 

(4.4), CG = 4 as other groups 

(10.9) Drop outs: A-B= 7, D = 9 

C-35
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Li, N 

(2005)38 

Trial Design 

RCT 

Mean age 

(SD/range): IG = 

Cause of Pain: 

N-S 

Groups 

IG (n = 31)– 

Outcome 

instruments: 

Outcome 

instruments: 

57 (16) vs. CG = Acupuncture: acu at Pain: Ovarall QoL/ well being: 

Country: Tx duration: 4 wks 56 (19) yrs Shenyu, Dachangyu, efficiency(B); NR 

China Final assessments: Ashi, Weizhong, Relapse rate(D) 

immediately post tx % of male: Chengshan, Kunlun, Results: 

IG = 38.7%; CG = Duration of Fuliu; 35min/d x 5/wk x Disability: Oswestry 

Quality 48.3% Pain: 4 LBP disability Immediate post tx: 

score: 4/13 N screened: 60 Chronic (>1yr), Drop outs: 0 index(A,B) NR 

N randomized: 60 Racial IG = 7.4 (5.3) 

N completed tx:60 composition: yrs; CG = 8.1 CG (n = 29) – Results: Short term: NR 

Initial of N attended last fu: NR NR (5.7) yrs Physiotherapy: light, Baseline: 

reviewer: SG Work status: NR electricity, heat; same Pain: NR; NR Intermediate: NR 

Severity of pain as IG Disability: IG = 

Inclusion: LBP and Other socio­ (Grading): Drop outs: 0 38.58 (5); CG = Long term: NR 

duration of pain >1 yr; demographics: NR 40.24 (5.8) 

age:18- 70 yrs; NR Harms: NR 

Oswestry LBP Co- Immediate post tx: 

disability index > 30; Co morbidities: interventions:NR Pain: NR; NR Summary of 

Pts adhere to be NR Disability: IG = results (if 

follow-up 11.55 (3.24); CG = provided) 

Prior episode of 18.83 (5.24) Acupuncture is 

Exclusion: Infection, pain if acute: NR better than 

tumor, osteoporosis, Short term: NR hysiotherapy 

rheumatoid arthritis, Prior CAM 

fracture, radiating pain intervention: NR Intermediate: NR 

Long term: NR 

Prior surgery 

related to current 

complaint: NR 

C-36
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

MacDonald, Trial Design Mean age Cause of Pain: Groups Outcome Outcome 

AJR (1983)39 RCT (SD/range): NR Mixed-Specific, IG (n = 8)– Acu: TPs instruments: instruments: 

NR found by palpation 30­ Pain: numerical QoL/ well being: 

Country: Tx duration: NR % of male: IG = guage(0.32mm scale: 1 - 3 NR 

England/UK Final assessments: 25% vs. CG = diameter) needles improvements Other: Combined 

immediately post tx 33% inserted to depth of recored as minimal (1 average reduction 

Quality 

score: 2/13 

N screened: NR 

N randomized: 17 

N completed tx: NR 

Racial 

composition: NR 

Duration of 

Pain: Chronic, 

NR 

4mm for 5 min for 1st tx 

to provide noxious 

stimulus, doubled if 

failed, E-acu performed 

– 24%), moderate 

(25-49%), good (50­

74%) and excellent 

(75-99%) 

(%) 

Immediate post tx: 

71.7 vs. 21.35 

Short term: NR 

Initial of 

N attended last fu: NR Work status: NR Severity of pain 

(Grading): VAS 

if failed; 1tx/wk, 

increased as required 

Results: 

Immediate post tx: Intermediate: NR 

reviewer: SG Other socio­ rating 0-10 Drop outs: NR proportion with pain Inclusion: Patients demographics: (measurement relief: 77.35 vs. Long term: NR 

with CLBP which had NR of pain; pain CG (n = 9) – Placebo: 30.14 

failed to derive relief relief) TPs found by palpation pain score Harms: NR 

from conventional Co morbidities: and standard reduction (%): methods; referred NR Co­ electroenceplalographic 57.15 vs. 22.74 

back pain for at least interventions:As electrodes (1cm in activity pain score

one yr. Prior episode of ked to continue diameter) were attached reduction (%): pain if acute: NR existing drug over tender regions. The 52.04 vs. 5.83 

regimens and electrodes were 

Exclusion: NR Prior CAM other forms of attached by wires to the Physical sign intervention: NR support as apparatus. Tx time was reduction (%): required doubled if no beneficial 96.78 vs. 29.17, p < Prior surgery results produced; same 0.01 

related to current as IG 

complaint: NR Drop outs: NR Short term: NR 

Intermediate: NR 

Long term: NR 

C-37
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Mendelson, Trial Design Mean age Cause of Pain: Groups Outcome Outcome 

G 

(1983)40 

RCT (SD/range): IG = 

54.5 (11.8), CG = 

NR IG (n = 36)– Acu: pt 

prone, needles inserted: 

instruments: 

Pain: 1)VAS 

instruments: 

QoL/ well being: 

Tx duration: 4 wks 53.6 (11.9) for LBP, points 23,25,36 100mm for pain (0­ NA 

Country: Final assessments: & 40 on urinary bladder 100) (A, B); McGill Other: 

Australia immediately post tx % of male: IG = Duration of meridian; if sciatica Pain Questionnaire 

52.8%, CG = Pain: present, points 30, (PRI, PPI) (A, B) Results: 

N screened: NR 43.9% Chronic, IG = 34,39 & 60 on Baseline: NA 

Quality N randomized: 77 12.3 (10.9), CG gallbladder meridian. Results: 

score: 6/13 N completed tx: 72 Racial = 12.1 (10.8) yrs Needles stimulated Baseline: Immediate post tx: 

N attended last fu: NR composition: NR mentally until “the ‘chi” Pain: VAS: IG = 

Severity of sensation of heaviness 50.5 (20.4), CG = Short term: NR 

Initial of Inclusion: CLBP, no Work status: NR pain (Grading): and numbness elicited, 53.7 (25) 

reviewer: SG litigation or NR then left for 30 min, avg Intermediate: NR 

compensation claims Other socio­ of 8needles/tx; 30 Immediate post tx: 

pending, no overt demographics: Co- min/tx, 2tx/wk for 4 wks Pain: VAS: IG = Long term: NR 

psychiatric illness, NR interventions: Drop outs: A=? B=5 30.2 (18), CG = 40 

ability to read and NR (total for both groups) (24.3) (P<0.001) Harms: NR 

write in English Co morbidities: McGill(PRI)-mean: 

NR CG (n = 41) – Placebo: IG = 38%, CG = 

Exclusion: NR intradermal injection of 42%; McGill (PPI)­

Prior episode of 2% lidocaine given at mean: IG = 27%, 

pain if acute: 13 non-acu, non-tender CG = 30% 

for both groups sites in lumbar area, acu 

needles superficially Short term: NR 

Prior CAM inserted into infiltrated 

intervention: NR areas for 30 min, similar Intermediate: NR 

n of needles used; same 

Prior surgery as IG Long term: NR 

related to current Drop outs: see IG 

complaint: NR 

C-38
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Mendelson, 

G (1978)41 

Trial Design 

RCT 

Mean age 

(SD/range): 53.5 

Cause of Pain: 

NR 

Groups 

IG (n = 36)– Acu: 

Outcome 

instruments: 

Outcome 

instruments: 

yrs(of both Inserting a N of needles Pain: VAS 100mm QoL/ well being: 

Country: Tx duration: 4 wks groups) intramuscularly in the LB for pain (0-100) (A, NA 

Australia Final assessments: region and stimulating B) Results: 

immediately post tx % of male: 48% Duration of them manually; 30 Immediate post tx: 

total Pain: min/tx, 2 tx/wk for 4 wks Results: NR 

Quality N screened: NR Chronic, 11.7 Drop outs: NR Baseline: 

score: 1/13 N randomized: 77 Racial yrs(for both Pain: IG = 50.8 Short term: NR 

N completed tx: NR composition: NR groups) CG (n = 41) – Placebo: (20.4), CG = 52.3 

N attended last fu: NR Acu needles were (24.3) Intermediate: NR 

Initial of Work status: NR Severity of inserted 

reviewer: SG Inclusion: CLBP, no pain (Grading): subcutaneously, a small Immediate post tx: Long term: NR 

Litigation or Other socio- NR amount of local Pain: IG = 35 

compensation claims demographics: anesthetic was injected (22.2), CG = 38.5 Harms: NR 

pending, no overt NR Co- through them and the (26.9) 

psychiatric illness, interventions:N needles were not Summary: No raw 

fluent in English, Co morbidities: R stimulated; same as IG Short term: NR data reported for 

referred by their NR Drop outs: NR the following 

attending doctor Intermediate: NR outcomes: 

Prior episode of 1) McGill Pain 

Exclusion: NR pain if acute: NR Long term: NR Questionnaire 

2) Analgesic Intake 

Prior CAM 3) Spinal Mobility 

intervention: NR 4) Subjective rating 

of pain and 

Prior surgery disability 

related to current 

complaint: NR 

C-39
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Meng, CF 

(2003)42 

Trial Design 

RCT 

Mean age 

(SD/range): IG = 

Cause of Pain: 

N-S 

Groups 

IG (n = 31)– Acu: 

Outcome 

instruments: 

Outcome 

instruments: 

72 (5) vs. CG = aseptic technique and Pain: VAS- word QoL/ well being: 

Country: Tx duration: 2 wks 70 (6) yrs % S: buttock disposable, sterile anchors (ITT) 

NY-US Final assessments: pain: IG = needles .. Deqi Results: 

immediately post tx % of male: IG = 48.4%, CG = sensation; ES 4-6 Hz; Disability: mRDQ-( Immediate post tx: 

42%, CG = 37.5% 25% 10-14 needles; 20 ITT) NR 

Quality N screened: 250 minutes; acu protocol; 

score: 7/13 N randomized: 55 Racial Duration of biwkly 5 sessions, 10 Results: Short term: NR 

N completed tx: 55 composition: Pain: chronic, IG sessions total Baseline: 

N attended last fu: 55 84.7% Caucasian 12 (16), CG = Drop outs: NR Pain: IG = 1.6 (1); Intermediate: NR 

Initial of 12 (14) yrs CG = 1.7 (1) 

reviewer: SG Inclusion: chronic N-S Work status: NR CG (n = 24) – Usual Disability: IG = 9.8 Long term: NR 

LBP > 12 wks; age 60 Severity of pain care: NSAIDs, (3.6); CG = 11.8 

yrs or more; Other socio­ (Grading): NR analgesics, EXs; NR (5.3) Harms: NR 

radiography within demographics: Drop outs: NR 

past yr NR Co- Immediate post tx: Summary of 

interventions: Pain: IG = 1.6 (NR); results (if 

Co morbidities: Nsaids: Non- CG = 1.1 (NR) provided): acu is 

Exclusion: S LBP; NR narcotic Disability: IG = effective, safe 

lumbar surgery; prior analgesic 13.1; CG = 12.4 adjunctive tx for 

use of acu; use of Prior episode of agents: aspirin: CLBP in elderlycorticosteroids, muscle pain if acute: NR Muscle Short term: VAS: IG small sample size 

relaxants, narcotics, Relaxants = 1.4 (NR), CG = study. 

anticoagulants, Prior CAM 2.4 (NR); RDQ: IG 

epidural steroid intervention: NR = 6.3 (4.4), CG = 

injections within past 3 11.4 (4.8) 

mo Prior surgery 

related to current Intermediate: NR 

complaint: NR Long term: NR 

C-40
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Molsberger, 

AF (2002)43 

Trial Design 

RCT 

Mean age 

(SD/range): IG1 = 

Cause of Pain: 

N-S 

Groups 

IG1 (n = 65)– Verum 

Outcome 

instruments: 

Outcome 

instruments: 

49 (8), IG2 = 50 acu+conventional Pain: VAS: mean QoL/ well being: 

Country: Tx duration: NR (6), CG = 49 (7) orthopedic therapy. pain intensity (ITT) NA 

Germany Final assessments: 3 yrs Always a numb, warm Disability: NA 

mos Duration of feeling around the acu Results: 

% of male: IG1 = Pain: point (Deqi) was Results: Immediate post tx: 

Quality N screened: NR 44.6 – 53.3% Chronic, IG1 = achieved; 30min/tx, Baseline: NR 

score: 3/13 N randomized: 186 11.5 (9.2), IG2 = 3tx/wk Pain: IG1 = 68 (17), 

N completed tx: 174 Racial 9.9 (7.7), CG = Drop outs: B = 7, C = 11 IG2 = 64 (11), CG = Short term: NR 

N attended last fu: 186 composition: NR 8.1 (5.7) 67 (14) Intermediate: NR 

Initial of IG2 (n = 61)– Sham Disability: NA Long term: NR 

reviewer: SG Inclusion: pain for at Work status: NR Severity of pain Acu+ conventional 

least 6 wks; average (Grading): NR orthopedic tx: 10 Immediate post tx: Harms: NR 

pain score of at least Other socio­ needles applied at depth Pain: IG1 = 26 (21), 

50mm on a 100mm demographics:# Co­ < 1 cm at lumbarnon­ IG2 = 36 (19), CG = Summary of 

VAS during the last of d in hospital: interventions: acu points, and 5 39 (21); N of pts results (if 

wk, age 20 - 60 yrs, IG1 = 31.4 (5.4), % of pts with needles on either side of with >50% pain provided): night 

the ability to IG2 = 32.4 (6.2), diclofenac the back; same as IG1 reduction: IG1 = pain (n of no ro 

communicate in CG = 31.7 (5.8) intake: IG1 = Drop outs: B = 3, C = 17 65%, IG2 = 34%, mild/no of 

German 18%, IG2 = CG = 43% moderate to 

Exclusion: sciatica or Co morbidities:NR 20%, CG = 15% CG (n = 60) – nil + Disability: NA severe):IG1 = 

other neurological conventional orthopedic 31/28, IG2 = 28/32, 

disorders; history of Prior episode of therapy: daily PT, Short term: IG1 = CG = 23/36 

disc or spine surgery; pain if acute: NR physical EXs, back 23 (20), IG2 = 43 

systematic bone and school, mud packs, (23), CG = 52 (19) 

joint disorder Prior CAM infrared heat therapy. N of pts with >50% 

intervention: NR 50mg diclofenac on pain reduction:IG1 

demand up to 3 /d; NR = 77%, IG2 = 29%, 

Prior surgery Drop outs: B = 2, C = 22 CG = 14% 

related to current Intermediate: NR 

complaint: NR Long term: NR 

C-41
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Sakai, T 

(1998)44 

Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

N-S 

Groups 

IG (n = 14)– 

Outcomes: 

Pain: Subjective 

Outcomes: 

QoL/ well being: 

Tx duration: 2 wks 50.8 (18.1) vs. Acupuncture: There is symptoms in JOA 

Country: Final assessments: CG = 53.8 (8.5) no information about score( 3 pt); Pain Other: NA 

Japan Post-tx yrs stimulation technique relief score 

Duration of and insertion depth. Results: 

N screened: NR % of male: IG = Pain: Chronic, Needling points in Disability: ADL in 

Quality N randomized: 26 28.6%, CG = 25% IG = 92.5, CG = lumbar part were JO score (14 pt) Immediate post tx: 

score: 0/13 N completed tx: 26 25.5 chosen from BL23, 25, NR 

N attended last fu: 26 Racial 32, 52 and 2 extra Results: 

composition: Severity of pain channel points, and that Baseline: Short term: NR 

Initial of Inclusion: N-S LBP Asian (Grading): NR in L/E were chosen from Pain: IG = 1.3 

reviewer: SG BL37, 40, 57, ST36, (0.5), CG = 1.4 Intermediate: NR 

Exclusion: Work status: NR GB34 by palpation. (0.5); IG = 10 (0) 

osteoarthritis of Co- Acupuncture tx was Disability: IG = 7.6 Long term: NR 

lumbar-spine, Other socio­ interventions:NR performed 3 times; 2 tx/ (2.3), CG = 10.3 (1) 

osteoporosis, other S demographics: wk, 2 wks, 4 tx total Harms: NR 

causes of pain; NR Drop outs: NR Immediate post tx: 

diabetes or Pain: IG = 2.4 (0.5), Summary: 

malignancy; increase Co morbidities: CG (n = 12) – CG = 2.5 (0.5); IG = Duration of LBP in 

of CRP or ESR; Med NR Medication (NSAID): 2.3 (1.5) acu group may be 

of corticosteroid, Medication which Disability: IG = 12.1 longer than that in 

immunosuppressant Prior episode of includes NSAID or (2), CG = 13.3 (0.8) Med group. ADL 

agent, NSAID or pain if acute: NR kampo medicine; NR score in JOA score 

muscle relaxant; Drop outs: NR Short term: NR in acu group was 

problem of general Prior CAM lower than that in 

condition; dementia; intervention: NR Intermediate: NR Med group, 

pregnancy; elderly pt. disability in acu 

Prior surgery Long term: NR group may be more 

related to current severe than that in 

complaint: NR Med group 

C-42
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Sator- Trial DesignRCT- Mean age Cause of Pain: Groups Outcomes: Outcomes: 

Katzenschla (SD/range): IG = 36 pts had LBP IG (n = 31)– Auricular Pain: Pain intensity QoL/ well being: 

ger, SM 

(2004)45 

Tx duration: 6 wks 

Final assessments: 

54.1 (12.3) vs. 

CG = 53.1 (12.1) 

of muscular 

origin, 25 pts 

E-Acu: frequency of 

stimulation was 1 Hz, 

(VAS) = numerical 

data NR 

QOL, well being = 

numerical data NR 

immediately post tx yrs had additional high phase was from 1 

Country: severe skeletal to 10 ms. After 3 hrs of Disability: NA Return to work: 

Austria N screened: 87 % of male: 0.3% changes on stimulation, 3 hrs break, 

N randomized: 61 radiograph/reso max current: 4 mA and Results: Immediate post tx: 

N completed tx: 55 Racial nance imaging Titan needles (27­ Baseline: NR 

N attended last fu: NR composition: NR of spine, gauge, 3 mm length) Pain: NR 

Quality including inserted in lumbar spine, Immediate post tx: Short term: NR 

score: 9/13 Inclusion: Lumbar Work status: NR spondylarthrosis 40; shen men, 55; and Pain: NR 

LBP of at least 6 mo, and localized cushion 29; Disability: NA Intermediate: NR 

normal neurologic Other socio- disc protrusion 48hrs/session, 1 

Initial of function of demographics: session/wk for 6 wks Short term: NR Long term: NR 

reviewer: SG lumbosacral nerves, NR Drop outs: 2 Return to work 10 

no pain radiation, Co morbidities: Intermediate: NR (77%) vs. 3 (25%) 

persisting pain NR Duration of CG (n = 30)– Auricular 

intensity VAS => 5 Prior episode of Pain: Acu: same as IG Long term: NR Harms: NR 

despite after taking pain if acute: NR Chronic, 4.6 (1) Drop outs: 4 Summary: 

therapy with yrs Decrease in pain 

lornoxicam and Prior CAM intensity 

tramadol intervention: NR Severity of significantly greater 

pain (Grading): in E-Acu vs. Acu. 

Exclusion: Allergy Prior surgery VAS  5 Increase in 

against lornoxicam or related to current Co- psychological welltramadol, history of complaint: NR interventions:N being, physical 

drug abuse, R activity, and quality 

pregnancy, of sleep greater in 

concomitant use of E-Acu vs. Acu. 

TENS or pacemaker, 

history of Acu 

C-43
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Takeda, H Trial Design Mean age Cause of Pain: Groups Outcome Outcome 

(2001)46 RCT (SD/range): IG = 

26.4 (6.4) vs. CG 

N-S IG (n = 10)– Distal point 

needling: acupoints in 

instruments: 

Pain: VAS; PPT 

instruments: 

QoL/ well being: 

Country: Tx duration: 3 wks = 35.8 (9.3) yrs lumbar area: BL23 and threshold at lumbar; 

Japan Final assessments: 

immediately post tx % of male: ratio: 

IG – 8/2, CG – 

Duration of 

Pain: Chronic, 

EX-B7, mimicked needle 

insertion:tapped head of 

needle guide tube, 

PPT threshold at 

foot Results: 

Immediate post tx: 

Quality N screened: NR 9/1, majority male IG = 40.4 (75.9); gesture of needle Disability: ADL NR 

score: 5/13 N randomized: 20 

N completed tx: 18 

N attended last fu: NR 

Racial 

composition: 

CG = 810 (76.5) 

mos 

performed. Acu points in 

BL37, 40 and 58 

needles by real acu 

score 

Results: 

Short term: NR 

Initial of Asian Severity of pain needle (40 mm in length Baseline: Intermediate: NR 

reviewer: SG Inclusion: Students of 

acu college who are 

suffering from lumbago 

Exclusion: no 

information [students 

who have sciatica(info 

from author)] 

Work status: NR 

Other sociodemographics: 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

(Grading): NR 

Cointerventions:NR 

and o.2 mm in diameter) 

insertion depth of 1-2 

cm, sparrow pecking 

techn. Done 5 times 

then removed; 2tx/wk for 

3 wks 

Drop outs: 1 

CG (n = 10) – Lumbar 

area needling: same 

point in lumbar area 

needled by real acu 

needle, same needles 

as IG used, sparrow 

pecking tech. 5 times, 

same acupoint for lower 

extremity mimicked 

needle insertion: tapped 

head of needle guide 

tube, gesture needling 

performed; same as IG 

Drop outs: 1 

Pain: IG = 35.9 

(16.2), CG = 27.4 

(21.9); IG = 5.2 

(3.3), CG = 6.6 (2); 

IG = 2.4 (1.6), CG = 

3 (1.1) 

Disability: IG = 13.9 

(2), CG = 14.2 (2.5) 

Immediate post tx: 

Pain: IG = 28 

(24.3), CG = 17 

(20.9); IG = 5.3 

(3.3), CG = 6.5 

(2.1); IG = 2.7 (2), 

CG = 2.7 (1.5) 

Disability: IG = 14.4 

(1.6), CG = 15 (1.4) 

Long term: NR 

Harms: NR 

C-44
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Thomas, A 

(1994)47 

Trial Design 

RCT 

Mean age 

(SD/range): NR 

Cause of Pain: 

Osteroarthiris of 

Groups 

IG (n = 33)– Acu: ME of 

Outcomes: 

Pain: activities with 

Outcome 

instruments: 

lumar, or needles, low freq. e­ < 50% pain- no QoL/ well being: 

Country: Tx duration: 6 wks % of male: NR sacrolilac joint stimul. At 2Hz and high numerical data- p 

Sweden Final assessments: 6 with sciatica, freq. at 80 Hz values reported Other: ROM 

mos Racial intervertebral 

composition: NR disc 3 tx, each 30 min of MS, Short term: NR Results: 

Quality N screened: NR degeneration, LFES or HFES, then Immediate post tx: 

score: 4/13 N randomized: 43 Work status: NR lubar strain with continued tx with Intermediate: NR no numeric data 

N completed tx: 40 sciatica, preferred mode for 6 provided 

N attended last fu: Other socio­ osteoporosis wks Long term: NR 

Initial of NR demographics: with dorsolumar Drop outs: A = 3 Note: data is Short term: NR 

reviewer: SG NR strain; chronic presented in bar 

Inclusion: pts with disc prolapse; CG (n = 10) – Waiting graphs and not Intermediate: NR 

chorinc LBP treated at Co morbidities: chronic lumbar list: NR; NR extracted in this 

two clinics; sudden or NR strain Drop outs: 0 report. Long term: NR 

insidious onset of LBP 

with or without trauma; Prior episode of Harms: NR 

duration > /= 6 mo; pain if acute: NR Duration of 

remissions and Pain: Summary: Results 

occasional pain free Prior CAM chronic (at least suggest that 2Hz 

intervals; recurrences intervention: NR 6 mos) ES is the mode of 

with pain of variable choice when using 

intensity; Prior surgery Severity of acu in the tx of 

Exclusion: major related to current pain (Grading): chronic nociceptive 

depressive illness or complaint: NR NR LBP 

neurosis, past back 

surgery; other Cosignifican systemic or interventions:N 

neurological disorders R 

C-45
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Tsui MLK 

(2004)48 

Trial Design 

RCT 

Mean age: 40.0 

yrs 

Cause of Pain: 

NR 

Groups 

IG1 (n = 14)– E-acu: 

Outcomes: 

Pain: Pain intensity 

Outcome 

instruments: 

dual channel machine (VAS) QoL/ well being: 

Country: Tx duration: 4 wks % of male: IG1 = with freq. of 1 Hz-999 Disability: RMDQ NA 

China Final assessments: 3 24%, IG2 = 29%, Hz, 4 local points over Results: 

mos CG = 40% Duration of bilateral side of LB and Immediate post tx: Results: NA 

Pain: 2 over the buttock/ leg, Pain: IG1 = 3.07 Baseline: NA 

Quality N screened: NR Racial Chronic, NR needles inserted to (1.9), IG2 = 2.86 Immediate post tx: 

score: 6/13 N randomized: 42 composition: All achieve “de qi”, needles (1.75), CG = 5.5 NA 

N completed tx: 42 Asian Severity of in acu points BL-26 and (1.83) 

N attended last fu: 42 pain (Grading): GB-30 were attached to Disability: IG1 = Short term: NR 

Initial of Work status: NR NR the machine; 2 tx/wk for 8.57 (4.01), IG2 = 

reviewer: SG Inclusion: Pts aged 4 wks, 8 sessions total 7.93 (5.14), CG = Intermediate: NR 

20-55 yrs with LBP Other socio- Co- each 20 min 9.36 (3.56) 

radiating down to the demographics: interventions:in Drop outs: 3 total NR Short term: VAS- Long term: NR 

thigh or calf for => 3 NR structed to IG1 = 2.43 (1.87), 

mo mechanical cause perform same IG2 (n = 14) – E-heat IG2 = 2.27 (2.15), Harms: NR 

but not from cancer or Co morbidities: set of back EX acu: machine used to CG = 5.21 (1.88) 

TB, with positive SLR NR as in the produce heat + needles, P = 0.001 

findings Exercise group; 4 channels delivered 38- RMDQ – IG1 = 

Prior episode of analgesics 48°C, same acupoints 7.64 (3.75), IG2 = 

Exclusion: Repeated pain if acute: as IG1; same as IG1 8.36 (4.65), CG = 

history of LBP, Mechanical 8.79 (3.4) 

hip/back previous conditions but not CG (n = 14) – Exercise: 

surgery, spinal cancer back Mob and Intermediate: 

stenosis with abdominal stabilization; RMDQ – IG1 = 

claudication, spine Prior CAM 6 BM x 20, 1 AS x 10, 3 5.93 (3.79), IG2 = 8 

fracture, systemic intervention: NR times/d (5.66), CG = 8.57 

arthritis, (3.48) 

spondylolisthesis Prior surgery 

grade 3-4,osteoporosis related to current 

complaint: NR 

C-46
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Witt, CM 

(2006)49 

Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

N-S 

Groups 

IG (n = 1451) –Acu: 

Outcomes: 

Pain: BP score 

Outcomes: 

QoL/ well being: 

Tx duration: 3 mos 53.1 (13.5) vs. disposable needles- at SF-36- health 

Country: Final assessments: 1 CG = 526 (13.2) acu points decided by Disability: Back related QoL A, B, C 

Germany yr yrs the treating physician; 3 function; HFAQ 

Duration of mo tx phase, max 15 tx, Results: 

N screened: 11630 % of male: IG = Pain: 74% received 5-10 Results: Baseline: 

N randomized: 2840 42.3%; CG = Chronic, IG = sessions, 21 Baseline: IG = 34.3 (9), CG = 

Quality N completed tx: 2840 43.1% 7.2 (8) yrs; CG = received>10 sessions, Pain: mean-change 34.6 (9.6) 

score: 7/13 N attended last fu: 7.2 (7.8) yrs 5% received< 5 from A: IG = 37%; (P<0.001) 

2518 Racial sessions CG = 9.8% Immediate post tx: 

composition: NR Severity of Drop outs: C = 88, D= 

Initial of Inclusion: clinical pain (Grading): 130 Immediate post tx: Short term: NR 

reviewer: SG diagnosis of CLBP Work status: NR NR Pain: ---

lasting more than 6 CG (n = 1390) –Control: Disability: Mean Intermediate: NR 

mo; aged  18, Other socio- Co- NR; 3 mo tx phase change from A: IG 

provision of written demographics: interventions:u Drop outs: C = 130, D = = 33.3%, CG = Long term: NR 

informed consent NR sual care 193 11.3%; IG = 12.1, 

CG = 2.7 Harms: NR 

Exclusion: protusion Co morbidities: 

or prolapse of one or NR Short term: Pain: IG 

more intervertebral = 33.5%, CG = 

discs with concurrent Prior episode of 30.8% 

neurologic symptoms; pain if acute: NR 

other S causes of pain Intermediate: NR 

Prior CAM 

intervention: NR Long term: NR 

Prior surgery 

related to current 

complaint: NR 

C-47
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Yeung, KN 

(2003)50 

Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

N-S(CG = 12% 

Groups 

IG (n = 26) – Acu + EX: 

Outcomes: 

Pain: NRS: avg 

Outcomes: 

QoL/ well being: 

Tx duration: 4 wks 50.4 (16.3) vs. with prolapsed E-Acu points: BL23, pain; worst pain NA 

Country: Fu duration (last CG = 55.6 (10.4) disc) BL40, and SP6. Needles 

Hong Kong assessment: 3 mos yrs % NS:14 applied to ipsilateral Disability: 

(53.8%) pain side needles, #30 Aberdeen LBP Results: 

N screened: NR % of male: IG = (0.3 mm) 40 mm long scale 

N randomized: 52 15.4%; CG = needles inserted and Immediate post tx: 

Quality N completed tx: 52 19.2% Duration of manipulated until Teh Results-Baseline: 

score: 7/13 N attended last fu: 49 Pain: Chi obtained. Pain: IG = 6.38 Short term: NR 

Racial Chronic, NR Stimulation on needle (1.77), CG = 5.88 

Inclusion: pts with composition: NR sat a freq of 2Hz for 30 (1.84); IG = 6.65 Intermediate: NR 

Initial of chronic N-S LBP (> 6 Severity of min-n the intensity of (1.77), CG = 6.5 

reviewer: SG mo) with or without Work status: NR pain (Grading): stimulation set at (1.56) Long term: NR 

radiation- aged 18-75 NR tolerable to the Pts and Disability: IG = 

yrs Other socio- Co- often with evoked visible 35.32 (11.72), CG Harms: 1 Pt- stroke 

demographics: interventions: muscle contraction; = 32.49 (13.79) before 3 mos fu 

Exclusion: structural NR analgesic use: 3times/wk for 4 wks Immediate post tx: 

deformity (ankylosing IG =3.8%, CG Drop outs: C = 2 Pain: IG = 3.81 

spondylitis, scoliosis); Co morbidities: =0% (2.1), CG = 5.12 

lower limb fracture; NR other tx (tui na, CG (n = 26) – Exercise: (2.18); IG = 3.92 

tumors; spinal massage, Standard group EX (2.43), CG = 5.35 

infection; caudaequina Prior episode of chiropractor, program, back (2.04) 

syndrome; pregnancy; pain if acute: NR bone setter or strengthening and Disability: IG = 

spinal cord corset):IG = 5 stretching EXs; 1 hr 20.02 (10.41), CG 

compression; pts Prior CAM (19.2%), CG = 6 session/wk for 4 wks = 30.82 (13.03) 

unable to keep intervention: NR (23.1%) Drop outs: C = 1 

appointments; Short term: 

receiving acu tx within Prior surgery Aberdeen: IG = 

the past 6 mo; related to current 19.86 (10.12), CG 

receiving physio tx complaint: NR = 25.82 (13.11) 

within the past 3 mo Intermediate: NR 

Long term: NR 

C-48
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Yu, W 

(1997)51 

Trial Design 

RCTMean age (SD/range): NR 

Cause of Pain: 

N-S with leg 

Groups 

IG (n = 103) – Acu local 

Outcomes: 

Pain: NA 

Outcomes: 

QoL/ well being: 

pain point: eletro-acu, local well being, B 

Country: Tx duration: 10-20 ds % of male: NR pain point, retention 30 Disability: NA 

China Final assessments: min; 1 tx/d, 20 tx/course, Results: 

immediately post tx Racial 1-2 courses Results: NA 

composition: Duration of Drop outs: B=0 Baseline: Immediate post tx: 

Asian Pain: Pain: N (%) improved – 

Quality N screened: Don’t >6 mos CG (n = 97) – Acu local Immediate post tx: IG = 99 (96.1%), 

score: /13 know Work status: NR point and weizhong NA CG = 86 (88.7%) 

N randomized: 200 Severity of point: eletro-acu, local Pain: P<0.01 

N completed tx: 200 Other socio- pain (Grading): pain point + weizhong, Disability: 

Initial of N attended last fu: NR demographics: NR retention 30 min; same Short term: NR 

reviewer: SG NR as IG Short term: NR 

Inclusion: pain in Co- Drop outs: B=0 Intermediate: NR 

waist and leg Co morbidities: interventions:N Intermediate: NR 

NR R Long term: NR 

Exclusion: NR Long term: NR 

Prior episode of Harms: NR 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

C-49
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Yuan, J Trial Design Mean age Cause of Pain: Groups Outcome Outcome 

(2009)52 RCT (SD/range): 43.53 

(9.67) vs. 43.87 

Non S IG (n = 15)– Acutraditional Chinese instruments: 

Pain: VAS (0 – 10) 

instruments: 

QoL/ well being: 

Country: Tx duration: 5 and 2 (10.45) yrs % NS: all Pts methode, needles 0.25 Disability Data in graph 

UK wks 

Final assessments: 1 

yr % of male: 60% in Duration of 

mm x 0.25 mm x 50 

mm. manually 

stimulated to produce 

Results: NA 

Baseline: 

Pain mean (95% 

Other: NA 

Results- mean 

Quality both groups Pain: 14.2 vs. ‘de qui’ sensation, CI) average pain: (95% CI) : 

score: 9/13 N screened: NR 

N randomized: 30 

N completed tx: 30 

Racial 

composition: NR 

11 yrs 

Severity of 

retained for 20-30 min; 

2x / wk for 5 wks 

Drop outs: 1 at 2, 5 and 

4.30 (3.06, 5.53) 

vs. 3.98 (2.87, 

5.10) 

Baseline: “QOL: 

2.20 (1.72, 2.68) 

vs. 2.86 (2.07, 

Initial of N attended last fu: 21 pain (Grading): 12 wks; 4 at 1 yr fu Disability (RMDQ): 3.65) 

reviewer: SG 

Inclusion: Subjects 

with chronic NS LBP 

Exclusion: Infection, 

tumor, osteoporosis, 

fracture, structural 

deformity, 

inflammatory disorder, 

radicular syndrome or 

cauda equina 

syndrome 

Work status: 

employed (%): 7 

vs. 13 

Other sociodemographics: 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

NR 

Cointerventions: 

pts taking Med 

(%): 33 vs. 20 

IG2 (n = 15) – Acutraditional Chinese acu 

method as IG1, 5x/wk 

for 2 wks 

Drop outs: 5 at 1 yr fu 

6.40 (4.37, 8.43) 

vs. 7.80 (5.41, 

10.19) 

Immediate post tx: 

Pain: NR 

Short term: NR 

Intermediate: NR 

Long term: NR 

Note: only baseline 

values are 

reported. Outcome 

results for 

immediate, short 

term and long term 

fu are presented in 

graphs and not 

Immediate post tx: 

Short term: NR 

Intermediate: NR 

Long term: NR 

Harms: minor 

bleeding 4 vs. 7; 

pain: 2 vs. 0 

Tiredness or other 

discomfort: 1 vs. 4 

Summary: There 

were no significant 

differences between 

the groups in terms of 

any of the outcomes, 

related to current 

complaint: NR 

extracted in this 

report 

(Pain, Disabiltiy, well 

being) at each followup time point. 

C-50
 
Table 1.5 Low Back Pain - Acupuncture - Mixed duration- Specific Pain 

Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Chen, MZ 

(2005)53 

Trial Design 

RCTMean age (SD/range): IG1 = 

Cause of Pain: 

Spinal stenosis 

Groups 

IG1 (n = 30) –Acu 

Outcomes: 

Pain: Pain 

Outcomes: 

QoL/ well being: 

34.24 (5.78); IG2 warming needle + oral threshold(A,B) NR 

Country: Tx duration: 10 ds = 33.36 (7.58); nimeisulide; acupoint 

China Final assessments: IG3 = 35.78 Duration of injection of Disability: NR 

immediately post tx (9.65) yrs Pain: anisodamine; 15-30 Results: 

Unknown or min.d for 10 ds Results: Baseline: NA 

% of male: 70% mixed duration: Drop outs: A = 0, B= 0 Baseline: NR 

Quality N screened: 90 IG1 = 5.25 yrs Pain threshold: IG1 Immediate post tx: 

score: 4/13 N randomized: 90 Racial (3.95); IG2 = IG2 (n = 30) – Oral Med: = 0.98 (0.27); IG2 = 

N completed tx:90 composition: NR 5.78yrs (4.87); oral nimeisulide tablet; 1.04 (0.27); IG3 = Short term: NR 

N attended last fu: NR IG3 = 4.71 yrs 0.1 bid for 10 ds 0.86 (0.22) 

Initial of Work status: NR (3.96) Drop outs: NR Intermediate: NR 

reviewer: SG Immediate post tx: 

Inclusion: L4,L5 Other socio­ IG3 (n = 30) – acupoint Pain threshold: IG1 Long term: NR 

spinal stenosis; pain demographics: Severity of injection: of = 2.62 (0.59); IG2 = 

threshold 0.4-1.8 mA NR pain (Grading): anisodamine <10 mg/d x 1.54 (0.39); IG3 = Harms: NR 

NR 10 ds 1.58 (0.22) 

Exclusion: disc Co morbidities: Drop outs: NR Disability: NR Summary of 

herniation, bone TB, NR Co- results (if 

tumor; pain threshold interventions:N Short term: NR provided): 

< 0.4 mA Prior episode of R warming needle is 

pain if acute: NR Intermediate: NR better than oral 

medicine and 

Prior CAM Long term: NR acupoint injection 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

C-51
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Chen, X 

(2007)54 

Trial Design 

RCTMean age (SD/range): NR 

Cause of Pain: 

Disc/joint 

Groups 

IG (n = 44)– Deep Acu 

Outcomes: 

Pain: NA 

Outcomes: 

QoL/ well being: 

disease of lumbar kiaji points: well being, B, 

Country: Tx duration: not clear % of male: IG = acupoint: Jiaji, deeply Disability: NA based on Chinese 

China Final assessments: 52.3%; CG = acu 3 inches Medical Diagnostic 

immediately post tx 56.8% retention 20min; 10 Results: and therapeutic 

Duration of tx/course, 3 d rest Baseline: NA Effective Standard 

N screened: not Racial Pain: between courses x 2 Pain: 

Quality mentioned composition: IG - 5d to 5yr: courses Immediate post tx: Results: 

score: 3/13 N randomized: 88 Asian acute, subacute, Drop outs: B =0 NA 

N completed tx: 88 chronic; CG - 7d Pain: Immediate post tx: 

N attended last fu: NR Work status: NR to 4 yr: acute, CG (n = 44) – Disability: IG = 95.5%, CG = 

Initial of subacute, Conventional Acu of jiaji 77.3% improved 

reviewer: SG Eligibility criteria: Other socio- chronic point: retention 20 min, Short term: NR 

- inclusion: diagnosed demographics: Severity of normal depth; 11 Short term: NR 

using Chinese Medical NR pain (Grading): tx/course, 3 ds between Intermediate: NR 

Diagnostic and NR courses x 3 courses Intermediate: NR 

therapeutic Effective Co morbidities: Drop outs: B =0 Long term: NR 

Standard NR Co- Long term: NR 

CT exmination showed interventions:N 

lumbar intervertebral Prior episode of R Harms: NR 

Disc Protrusion pain if acute: NR 

- exclusion: spinal Summary (if 

stenosis, myofacial , Prior CAM provided): Deep 

Mawei nerve pain, intervention: NR acu of lumbar jiaji 

tumor...etc. points has a good 

curative effect on 

Prior surgery lumbar 

related to current intervertebral disc 

complaint: NR protrusion. 

C-52
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Cu, J 

(2004)55 

Trial Design 

RCTMean age (SD/range): 

Cause of Pain: 

Disc/joint 

Groups 

IG (n = 25) – Scalp acu 

Outcomes: 

Pain: NA 

Outcomes: 

QoL/ well being: 

IG = 41.4 vs. CG disease + massage: 0.35 Chinese Medical 

Country: Tx duration: 20 ds = 43.6 yrs mmX75 mm needle, Disability: NA Diagnostic and 

China Final assessments: severe pain, retention therapeutic 

immediately post tx % of male: IG = 24hrs massage: elbow Results: Standard 

56% vs. CG = Duration of point massage ,2 palms Baseline: NA Results: 

60% Pain: massage lumbar Pain: NA Immediate post tx: 

Quality N screened: not acute, subacute, muscle, 2 twists press Immediate post tx: IG = 96%, CG = 

score: 4/13 mentioned Racial chronic, NR muscles on 2 sides of NA 88% improved 

N randomized: 50 composition: Severity of pain spine, thumb massage Pain: NA (P<0.01) 

N completed tx: 50 Asian (Grading): buttock muscle, traction, Disability: NA 

Initial of N attended last fu: NR etc; 1 tx/d, 10tx/course, Short term: NR 

reviewer: SG Work status: Co­ 3 ds between courses x Short term: NR 

NR interventions: 2 courses Intermediate: NR 

Eligibility criteria: Other socio- NR Drop outs: B=0 Intermediate: NR 

- Inclusion: Chinese demographics: Long term: NR 

Medical Diagnostic CG (n = 25)– Massage: Long term: NR 

and Therapeutic Co morbidities: same as IG; same as Harms: NR 

Standard. NR IG 

Drop outs: B=0 Summary: IG has 

- exclusion: Pts with Prior episode of an obvious 

severe nerve function pain if acute: NR therapeutic effect 

defeat, caudal nerve on prolapse of 

was pressed, and who Prior CAM lumbar 

is suitable for surgery intervention: NR intervertebral disc 

and they exert the 

therapeutic effect 

Prior surgery possibly through 

related to current regulative action on 

complaint: NR immune functions 

C-53
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Ding, X 

(2002)56 

Trial Design 

RCTMean age (SD/range): NR 

Cause of Pain: 

Disc/joint 

Groups 

IG (n = 34)– injection + 

Outcomes: 

Pain: NR 

Outcomes: 

QoL/ well being: 

disease acu on healthy side: well being (cure 

Country: Tx duration: 28 ds % of male: IG = 0.3mmX 75mm needle, Disability: NR effect) 

China Final assessments: 32.4%; CG = injection on healthy side 

immediately post tx 35.3% and acu on affected Results: 

Duration of side, 100mg Vitamin B1 Baseline: NA Results: 

N screened: Don’t Racial Pain, range: +0.2 mg Vitamin B12 Pain: Immediate post tx: 

Quality know composition: NR IG - 7ds-2 yrs: injection in Jiaji.; 1 tx/d Immediate post tx: IG = 82.4%, CG = 

score: 3/13 N randomized: 68 Asian acute, subacute, for 5 ds, 2 ds rest, 20 tx NA 14.7% 

N completed tx:68 Work status: NR chronic; CG ­ total Pain: -

N attended last fu: NR 7ds-1.5yrs: Drop outs: 0 Disability: NA Short term: NR 

Initial of Other socio- acute, subacute, Intermediate: NR 

reviewer: SG Eligibility criteria: demographics: chronic CG (n = 34) – injection Short term: NR 

- inclusion: 1. NR Severity of +acu on affected side: Long term: NR 

Diagnosed as pain (Grading): both injection and acu Intermediate: NR Harms: NR 

intervertebral disc Co morbidities: NR on affected side, 100mg 

protrusion NR Co- Vitamin B1 +0.2 mg Long term: NR Summary (if 

2. Only one side is in interventions: Vitamin B12 injection in provided): 

pain Prior episode of NR Jiaji; 2 tx/d for 5 ds , 2 contralateral acu 

3. Who has obvious 1 pain if acute: NR ds rest, 20 tx total. has a better effect 

or 2 sympotoms: Drop outs: 0 for protrusion of 

can not go to sleep, Prior CAM intervertebral disc 

turn aside, walk, intervention: NR accompanied by 

caugh,sneeze, bowel tenderness on Jiaji 

movement, bend waist points on the 

because of the pain Prior surgery healthy side than 

4. Pain in waist 1 Jiaji related to current routine acu on the 

and waist 5 jiaji is in complaint: NR affected side 

the healthy side. and 

pain rate is ++ above 

- exclusion: NR 

C-54
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Ding, Y 

(1998)57 

Trial Design 

RCTMean age (SD/range): IG = 

Cause of Pain: 

Lumbar muscle 

Groups 

IG (n = 35) – fly-probingOutcomes: 

Pain: NA 

Outcomes: 

QoL/ well being: 

45 vs. CG = 42 strain acupoint manipulation: well being 

Country: Tx duration: not clear yrs major acupoint: Disability: NA Results : 

China Final assessments: yaoyangguan, ashi 

immediately post tx % of male: IG = supplement acupoint: Results: Immediate post tx: 

80% vs. CG = Duration of weizhong Baseline: NA IG = 94.3%, CG = 

63.2% Pain: 0.38 mmx75 mm Pain: NA 73.7% improved 

Quality N screened: not IG = <1 yr to >6 needle, Immediate post tx: (P<0.01) 

score: 3/13 mentioned Racial yr, CG = NR when getting qi, use NA 

N randomized: 54 composition: flying-probing acupoint Pain: NA Short term: NR 

N completed tx: 54 Asian Severity of pain manipulation Disability: NA 

Initial of N attended last fu: NR (Grading): retention 40-50 min; Intermediate: NR 

reviewer: SG Work status: NR 1tx/d, 10tx/course Short term: NR 

NR Drop outs: B=0 Long term: NR 

Eligibility criteria: Other socio- Co- Intermediate: NR 

- inclusion: LBP demographics: interventions: CG (n = 19)– Routine Harms: NR 

repeatedly occur, NR acu: acupoints as Long term: NR 

lumbar sacrum pain Co morbidities: above, Summary: flybecome worse with NR when getting qi, probing-acupoint 

fatigue retention 20 min; same manipulation as a 

X-ray and examination Prior episode of as IG main acu tx has a 

exclude the other pain if acute: NR Drop outs: B=0 stronger effect in 

disease the LBP promoting the flow 

caused by Qi and Prior CAM of qi and produced 

blood stagnant. intervention: NR a better effect in 

stransverse 

- exclusion: NR oscillatory rotping 

Prior surgery pain. 

related to current 

complaint: NR 

C-55
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Guo, W 

(2005)58 

Trial Design 

RCTMean age (SD/range): IG = 

43(11.33) vs. CG 

Cause of Pain 

Disc herniation 

Groups 

IG (n = 100) – E-acu + 

acupoint injection: 1st 

Outcomes: 

Pain: VRS(A,B) 

Outcomes: 

QoL/ well being: 

NR 

Country: 

China 

Tx duration: NR 

Final assessments: 

= 44 (10.12) yrs stage :E-acu + acupoint 

inject at Jiaji; 2nd stage: 

Disability: 

Results: Other: Angle for 

immediately post tx % of male: IG = Duration of E-acu; inject using 3ml Baseline: SLR test 

54%; CG = 51.5% Pain: Triamcinolone Immediate post tx: 

Unknown or Acetonide 40mg + 20g/L Pain: IG = 1.32 Results : 

Quality N screened: 197 Racial mixed duration, Lidocaine Hydrochloride (0.31); CG = 3.11 Immediate post tx: 

score: 4/13 N randomized: 197 composition: NR IG = 2.5 (2.44) 2ml + Vitamin B12 (0.23) ( P<0.01) IG = 70 (215); CG 

N completed tx: 197 yrs; CG = 2.41 ( 500ug+ NS 4ml) /5d x 2 Disability: NR = 50 ( 20) 

N attended last fu: NR Work status: NR 2.33) yrs Drop outs: A = 0;B = 0 

Initial of Short term: NR Short term:NA 

reviewer: SG Inclusion: Disc Other socio- Severity of pain CG (n = 97) – SM or 

herniation; age:20-70 demographics: (Grading): NR Mob + oral Med: NR; Intermediate: NR Intermediate:NA 

yrs; Diagnosed by CT NR Ibuprofen Sustained 

or MRI; Clinical Release Tablets 0.3g Long term: NR Long term: NR 

Positive Signs Co morbidities: Co­ po.bid; Phenprobamate 

NR interventions: tablets Harms: NR 

Traction therapy 0.4,po.tid;Tab.Vitamin 

Exclusion: pregnant Prior episode of B1 20mg, tid) x 2m Summary: Electroand breast-feeding pain if acute: NR Drop outs: A = 0;B = 0 acupucture plus 

women; Serious acupoint inject Med 

cardiovascular and Prior CAM group is better than 

cerebrovascular intervention: NR SM or spinal Mob 

diseases; Serious liver plus oral Med 

and kidney disease; Prior surgery group 

Serious infecton; related to current 

Lumbar TB or tumor; complaint: NR 

Gastrointestinal 

disease 

C-56
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Huang, GF 

(2006)59 

Trial Design 

RCT 

Mean age 

(SD/range): NR 

Cause of Pain: 

Disc herniation 

Groups 

IG (n = 36) – Special eOutcomes: 

Pain: VAS 

Outcome 

instruments: 

acu: acu at QoL/ well being: 

Country: Tx duration: 20 ds % of male: IG = Jiaji,Huangtiao, NA 

China Final assessments: 58.8%, CG = NR Yanglinqiang and Results- Other: overall 

immediately post tx Duration of Wenzhong points; 10­ Immediate post tx: efficacy 

Racial Pain: 20mA, Pain: 5.09 (0.61) 

Quality composition: 2d-10yr; NR 30min/d*10d/course x 2 vs. 6.58 (0.6) Results: 

score: 6/13 N screened: 68 NR Drop outs: 0 

N randomized: 68 Severity of pain Short term: NR Immediate post tx: 

N completed tx:68 Work status: NR (Grading): CG (n = 32) – Routine Intermediate: NR Time of analgesic 

Initial of N attended last fu: NR NR e-acu: acu at Shenyu, Long term: NR effects and lasting 

reviewer: SG Other socio­ Dachangyu,Xubian, effect was better in 

demographics: Co­ Huantiao,Chengfu,Yinm IG vs. CG, P < 0.01 

Eligibility criteria: NR interventions: en, Weizhong and Short term: NR 

- inclusion: Disc NR Yanglinqian; same as IG 

herniation Co morbidities: Drop outs: 0 Intermediate: NR 

- exclusion: pregnant NR 

and breast-feeding Long term: NR 

women; Serious Prior episode of 

disease; mental Pts; pain if acute: nR Harms: NR 

Cauda equina 

compression; have Prior CAM Summary of 

other indications for intervention: NR results: 

surgery electroaupuncture 

at Jiaji is better 

Prior surgery than routine acu 

related to current (time of analgesic 

complaint: NR effect, and overall 

efficacy) 

C-57
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Huang, GF 

(2006)60 

Trial Design 

RCT 

Mean age 

(SD/range): 41.5 

Cause of Pain: 

Disc herniation 

Groups 

IG (n = 45) – Acu + 

Outcome 

instruments: 

Outcome 

instruments: 

(13.7) yrs Spinal manipulation; Pain: VAS; Overall QoL/ well being: 

Tx duration: 24 ds Duration of acupunture at Ashi, efficiency Excellent rate 

Country: Final assessments: % of male: 51.1% Pain: Mixed Huantiao, Weizhong and 

China Post-tx Chenshan; 30 min/ tx, 6 Disability: NR Results: 

Racial Severity of pain tx/ course, 4 courses Immediate post tx: 

composition: (Grading): Drop outs: A = 0, C = 0 Results: excellent rate: 

Quality N screened: 90 NR NR Immediate post tx: 86.6% vs. 57.78%, 

score: 6/13 N randomized: 90 Work status: NR Pain, mean (SD): p < 0.01 

N completed tx: 90 Co- CG (n = 45) – Spinal 1.91 (0.93) vs. 3.58 

N attended last fu: 90 Other socio­ interventions: manipulation: (1.52), p < 0.01] Short term: NR 

Initial of demographics: NR mechanical traction; 30 Disability: NR 

reviewer: SG NR min/ tx, 6 tx/ course, 4 Intermediate: NR 

Inclusion: Disc courses Short term: NR 

herniation; aged 18-65 Co morbidities: Drop outs: A = 0, C = 0 Long term: NR 

yrs; Diagnosed by CT NR Intermediate: NR 

or MRI Harms: NR 

Prior episode of Long term: NR 

Exclusion: pain if acute: NR Summary of 

Spondylolysis with results (if 

spondylolisthesis;Serio Prior CAM provided): 

u disease;Severe intervention: NR Combinative group 

osteoporosis;Lumbar is better 

tumor and TB Prior surgery 

related to current 

complaint: NR 

C-58
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hua-Sheng Trial Design-RCT Mean age Cause of Pain: Groups Outcome Outcome 

Tang 

(2008)61 Tx duration: 40 ds 

(SD/range): IG = 

40 vs. CG = 40 

1-disc/joint 

disease 

IG1 (n = 85) – 

Acupuncture along 

instruments: 

Pain: no numeric 

instruments: 

QoL/ well being: 

Final assessments: 6 yrs channel: induce "de qi" data NR 

Country: mo sensation using 

China % of male: IG = electrical impluse device Disability: no Other: cured and 

N screened: NR 57.6% vs. CG = connected with needles, numeric data markedly effective 

N randomized: 165 56.2% Duration of stimulated at frq of 6­ rate; and 

Quality N completed tx: 133 Pain: acute; 8Hz, 30 min/sess,1 Results: recurrence of pain 

score: 3/13 N attended last fu: NR Racial subacute (up to sess/d x 40 ds 

composition: NR 12 wks); Drop outs: D = 10 Immediate post tx: Results: 

Inclusion: 20-69 yrs; Chronic (> 12 Pain: NR Immediate post tx: 

Initial of CLBP and/or traumatic Work status: NR wks); IG = 13 CG (n = 80) – routine Disability: NR cured and markedly 

reviewer: SG LB injury; LBP mo. acu: Selected 6-8 effective rate: 

complicated with Other socio- CG = 12 mo. acupoints among BL23, Short term: NR 88.2% vs. 72.5%; 

radiant pain towards demographics: 24, 25, 26, 40, 54, 60 Recurrence of pain, 

lower extremities NR Severity of pain and GB 30, 34; same as Intermediate: NR rate of 24% vs. 

and/or sciatica; (Grading): NR IG 41.4% 

disappearance of Co morbidities: Drop outs: D = 22 Long term: NR 

normal spinal curve NR Short term: NR 

and/or Scoliosis Coassociated with Prior episode of interventions: Intermediate: NR 

tenderness; Straight pain if acute: NR NR 

leg raise positive; CT Long term: NR 

and/or MRI indicate Prior CAM 

intervention: NR Harms: NR 

Exclusion: lumber 

herination complicated Prior surgery 

with spondylolisthesis related to current 

and/or myelocele; complaint: NR 

pregnant and postnatal 

woman 

C-59
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Jia, Chao 

(2004)62 

Trial Design 

RCT 

Mean age 

(SD/range): 

Cause of Pain: 

disc/joint 

Groups 

IG (n = 45)– deeplyOutcome 

instruments: 

Outcomes: 

QoL/ well being: 

NR disease acupuncturing jiaji Pain: VAS(diff. Chinese Medical 

Country: Tx duration: 20 ds % of male: acupoint + acupoint­ between baseline Diagnostic and 

China Final assessments: NR injection: 65mm, size 28 and immediate effectiveness 

immediately post tx Racial needle for acu +injection tx)cm; standard 

composition: of dangui; + 2ml dangui Disability: NR 

Quality N screened: 82 Asian Duration of injection 30 min/tx, Results: 

score: 5/13 N randomized: 82 Pain: 1tx/d, 10 tx/course x 2 + Results: Immediate post tx: 

N completed tx: 82 Work status: NR only mentioned 2ml dangui injection 1 Pain, mean improved: 96% vs. 

N attended last fu: NR people has pain tx/d, 10 tx/course, total changes from 83% 

Initial of Other socio­ < 6 mos and as of 2 course baseline: IG = 5.18 

reviewer: SG Eligibility criteria: demographics: well >6mos Drop outs: 0 (0.32) cm, CG = Short term: NR 

Inclusion: diagnosed NR 3.84 (0.27)cm; Intermediate: NR 

as Cervical Severity of pain CG (n = 37) – Disability: NR Long term: NR 

Spondylosis using Co morbidities: (Grading): acupuncturing back-shu 

ref[1] 1993-chinese, NR Mcgill: PRI, PRI acupoint +acupoint – Immediate post tx: Harms: NR 

only those who were injection: same as IG ; NR Summary: The 

compliance with the tx, Prior episode of Co­ same as clinical effect of 

only those who pain if acute: NR interventions: IG Short term: NR deep-acpuncturing 

reponsed to the NR Drop outs: 0 jiaji acupoint 

surveys. Prior CAM Intermediate: NR +acupoint-injection 

Cause of pain: 1­ intervention: NR is better than that 

Lumbar disc hemiation Long term: NR of acupuncturing 

back-shu acupoint 

Exclusion: tumor, Prior surgery combined with 

fracture, with heart, related to current point-injection 

lung and kidney complaint: NR 

disease etc. 

C-60
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Li, D 

(2006)64 

Trial Design 

RCTMean age (SD/range): NR 

Cause of Pain: 

Lumbar disc 

Groups 

IG1 (n = 80) – Traction 

Outcomes: 

Pain: NRS, 

Outcomes: 

QoL/ well being: 

herniation rotator manipulation of improvement of NR 

Country: Tx duration: 2-4 wks % of male: NR sumbar spine tx: tx clinical signs as 

China Final assessments: 6 performed to the well as curative Results: 

mos Racial segment of the effect (scores in Immediate post tx: 

composition: Duration of intervertebral disc summary) 

Asian Pain: Mixed, NR herniation; once/wk, 2 Short term: NR 

Quality N screened: NR wks Results: 

score: 6/13 N randomized: 240 Work status: NR Severity of pain Drop outs: 0 Immediate post tx: Intermediate: NR 

N completed tx: 240 (Grading): NR Pain: see summary 

N attended last fu: 240 Other socio­ IG2 (n = 80) – Acu Long term: NA 

Initial of demographics: silver needle heat Short term: NR 

reviewer: SG Inclusion: pts with NR Co­ conductive tx: Harms: NR 

lumbar disc herniation interventions:NR conducted to pts waist Intermediate: NR 

Co morbidities: and buttocks; Same as Summary: the 

Exclusion: NR NR IG1 Long term: NA NRS scores 

Drop outs: 0 decreased in three 

Prior episode of gps after 3 mo tx, 

pain if acute: NR CG (n = 80) – Traction + especially CG 

needle heat: (combination), t = 

Prior CAM Combination of IG1 and 8.52, p < 0.01; 

intervention: NR IG2; each tx method most of the painful 

was done in 2 wks, 4 symptoms were 

Prior surgery wks total controlled after 6 

related to current Drop outs: 0 mo in CG (t = 7.08, 

complaint: NR p < 0.01) 

C-61
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Li, Q Trial Design Mean age Cause of Pain: Groups Outcomes: Outcomes: 

(1997)65 RCT- (SD/range): 

NR 

Disc/joint 

disease 

IG (n = 78) – 

Acu+cupping: major 

Pain: NA QoL/ well being: 

well being 

Country: Tx duration: varied acupoints: shenshu, Disability: NA 

China with pts. 

Final assessments: 

immediately post tx 

% of male: IG, CG 

= 51.3% 

Racial 

Duration of 

Pain: 

yaoshu, weizhong, 

renzhong, chize, 

supplement acupoint: for 

Pts with cold dampness 

Results: 

Baseline: NA 

Pain: NA 

Results: 

Immediate post tx: 

IG = 100%, CG = 

97.4% improved 

Quality composition: Acute, , add yangguan, Immediate post tx: 

score: 2/13 N screened: not 

mentioned 

N randomized: 156 

Asian 

Work status: 

subacute, 

chronic, NR 

shangliao, xialiao; 

for pts with blood 

staganant, add geshu, 

NA 

Pain: NA 

Disability: NA 

Short term: NR 

Intermediate: NR 

Initial of N completed tx: 156 NR Severity of pain and ganshu 

reviewer: SG N attended last fu: NR 

Eligibility criteria: 

- inclusion: NR 

- exclusion: NR 

Other sociodemographics: 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

(Grading): 

NR 

Cointerventions: 

NR 

for pts with kidney 

debility, add mingmen, 

taixi 

retention 20 

min+cupping: cupping 

on the shenshu, yaoshu 

and most painful point. 

retention 15 min; Acu: 

1tx/d, 10 tx/course until 

cured; cupping:1tx/2ds 

Drop outs: B=0 

CG (n = 78)– Acu: same 

as IG; 2tx/d, 10tx/course 

until cured 

Drop outs: B=0 

Short term: NR 

Intermediate: NR 

Long term: NR 

Long term: NR 

Harms: NR 

Summary: 

Acupuncture + 

cupping are 

significantly better 

than acu alone. 

C-62
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Liang, SY 

(2008)66 

Trial Design 

RCT 

Mean age 

(SD/range): NR 

Cause of Pain: 

myofacitis 

Groups 

IG (n = 56) – Tendon 

Outcome 

instruments: 

Outcome 

instruments: 

(abstract) muscle picking: picking Pain: NA QoL/ well being: 

Country: Tx duration: possibly 2 % of male: NR pain tendon-muscle NR 

China wks tubereles on the back; 2 Disability: NA Therapeutic effects 

Final assessments: Racial Duration of tx courses(possibly 5 or (pain, work, and 

immediately post tx composition: NR Pain: cannot tell 7 ds each), 14 sessions Results: NA function): IG = 

Quality total Baseline: NR 89.3% vs. CG = 

score: NA N screened: 112 Work status: NR Severity of pain Drop outs: NR Pain:NR 78.6%, P < 0.05 

N randomized: 112 (Grading): NR Disabilty: 

N completed tx: NR Other socio- CG (n = 56) – E-acu: at Results: 

Initial of N attended last fu: NR demographics: Co­ acupoints: BL 11; BL 13, Immediate post tx: Baseline: NR 

reviewer: SG NR interventions:NR BL 15, SI 11, and EX- Pain: NA 

Inclusion: pts with B2; same as IG Disability: NA Immediate post tx: 

myofacitis LBP Co morbidities: Drop outs: NR 

NR Short term: NR Short term: NR 

Exclusion: NR 

Prior episode of Intermediate: NR Intermediate: NR 

pain if acute: NR 

Long term: NR Long term: NR 

Prior CAM 

intervention: NR Harms: NR 

Prior surgery 

related to current 

complaint: NR 

C-63
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Luo, S 

(2007)67 

Trial Design 

RCT 

Mean age 

(SD/range): NR 

Cause of Pain: 

NR, 100% with 

Groups 

IG (n = 56) – Scalp Acu 

Outcome 

instruments: 

Outcome 

instruments: 

range 23-72 yrs radiating pain + traction: STD scalp- Pain: NA QoL/ well being: 

Country: Tx duration: NR point lines inserted by 

China Final assessments: % of male: NR sterilized needles- Disability: NA Other: 

immediately post tx pushed to the sub layer n (%) Clinically 

Racial Duration of of galea aponeurotica. Results: cured; marked 

Quality N screened: NR composition: NR Pain: mixed, NR Needles manipulated Baseline: effective’ improved; 

score: /13 N randomized: 108 1 d-17 yrs when sucking sensation Pain: NA no change 

N completed tx: NR Work status: NR felt under the needle by Disability: NA 

N attended last fu: NR Severity of pain Zhu’s reducing method; Results: 

Initial of Other socio­ (Grading): NR 5-8 min of needle Immediate post tx: Baseline: NR 

reviewer: SG Inclusion: varying demographics: retention, followed by qi Pain: NA 

degrees of LBP NR Co­ method, needles Disability: NA Immediate post tx: 

radiating to the lower interventions:NR retained for 30 min + IG = 12 (21.4), CG 

limb. With straightened Co morbidities: traction Short term: NR = 7 (13.5); IG = 22 

leg raising test, the NR Drop outs: NR (39.3),CG = 18 

raising </= 30 degrees Intermediate: NR (34.6); IG = 18 

in 37 cases, 31 - 65 in Prior episode of CG (n = 52) – Traction: (32.1), CG = 16 

68 cases, sand 3 pain if acute: NR horizontal traction in Long term: NR (30.8); IG = 4 (7.1), 

cases with positive supine position for mild CG = 11 (21.2) 

response in the Prior CAM pts and in prone position Short term: NR 

intensive test. All pts intervention: NR of severe cases; 30 

diagnosed with CT and min/session Intermediate: NR 

or MRI exam. Prior surgery Drop outs: NR 

related to current Long term: NR 

Exclusion: NR complaint: NR 

Harms: NR 

C-64
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Mu, JP 

(2007)63 

Trial Design 

RCT 

Mean age 

(SD/range): IG1 = 

Cause of Pain: 

1-disc/joint 

Groups 

IG1 (n = 40)– E-acuOutcome 

instruments: 

Outcome 

instruments: 

39 (8.7) yrs; IG2 = disease Jiaji points: Needle 75­ Pain: SF-MPQ QoL/ well being: 

Country: Tx duration: 3 wks 37 (4.8) yrs; CG = 90mm deep at EX-B2, 

China Final assessments: 42 ( 6.5) yrs connect needles with Disability: NR 

immediately post tx G805 electric impluse Results: 

% of male: NR device, stimulate at freq. Results: Immediate post tx: 

Quality N screened: NR Duration of of 10-20Hz for 30min.; 1 Baseline: Cure rate: 25% vs. 

score: 5/13 N randomized: 120 Racial Pain: sess/d x 21 sessions Pain: 41.9 (2.0) vs. 35.1 vs. 47.4% 

N completed tx: 120 composition:NR Unknown: IG1 = Drop outs: 0 42.4 (1.2) vs. 41.3 effective: 47.5% vs. 

N attended last fu: NR 1.9 (1.7) yrs; (1.8) 46 vs. 44.7% 

Initial of Work status: NR IG2 = 2.1 (1.5) IG2 (n = 40) – Laser Disability: NR ineffective: 27.5% 

reviewer: SG Eligibility criteria: yrs; CG = 2.2 needle knife grp: cut vs. 18.9 vs. 7.9% 

- inclusion: lumbar Other socio­ (1.9) yrs inter/supra spinal Immediate post tx: total efficacy: 

herniation; age demographics: ligments and muscles. Pain: 9.4 (1.8) vs. 72.5% vs. 81.1 vs. 

between 20-65; acute NR Severity of pain SJ-L laser needle-kinfe 8.5 (2.2) vs. 4.7 92.1% 

LBP less than 2 wks (Grading): were remained for (1.3) reoccurrence (6 

after lumber herniation Co morbidities: NR 30min; 1 session/wk for Disability: NR mos post tx): 63% 

diagnosed; not NR 3 wks vs. 74.2 vs. 55.2% 

undergoing Co- Short term: 

homonotherapy or Prior episode of interventions: CG (n = 40) – Jiaji EA + Short term: NR 

taking steriod pain if acute: NR laser needle knife: Intermediate: NR 

hormones; signed NR Combine txs 1 and 2 Intermediate: NR 

consent form Drop outs: Long term: NR 

- exclusion: pregnant Prior CAM Long term: NHA 

and postnatal woman; intervention: 

cardio-cerebrovascular NR Harms: NR 

disease; dropped off or 

cannot be followed up; Prior surgery 

lumbar tuberculosis related to current 

and lumbar spinal cord complaint: NR 

tumor; 

C-65
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Peng, Y Trial Design-RCT- Mean age Cause of Pain: Groups Outcomes: Outcomes: 

(2006)68 

Country: 

China 

Tx duration: 20 ds 

Final assessments: 

immediately post tx 

N screened: unknown 

N randomized: 116 

N completed tx: 116 

(SD/range): IG = 

48 (10.61) vs. CG 

= 46 (11.3) yrs 

% of male: IG = 

55.2%, CG = 

51.7% 

Disc/joint 

disease 

Duration of 

Pain: 

IG (n = 58) – round sharp 

needle+massage: major 

acupoints: tuxue (pain point 

beside lumbar vertebra 

spinous process), 

supplement acupoints: with 

pain in zutaiyangjing, add 

zhibian, yinmen, chengshan, 

weizhong, kunlun; with pain in 

Pain: NA 

Disability: NA 

Results: 

Baseline: NA 

Pain: NA 

QoL/ well being: 

well being, B, 

Chinese Medical 

Diagnostic and 

Therapeutic 

Standard 

Quality N attended last fu: NR NR zushaoyangjing, add huantiao, Immediate post tx: Results: 

score: 3/13 

Initial of 

reviewer: SG 

Inclusion: diagnosed 

using Chinese Medical 

Diagnostic and 

Therapeutic Standard 

30-60 yrs 

CT-MRI examined and 

diagnosed and signed 

Racial 

composition: 

Asian 

Work status: 

NR 

Other socioSeverity of pain 

(Grading): 

NR 

Cointerventions: 

fengshi, xuanzhong, zusanli, 

yanglingquan, qiulinquan, 

qiuxu, kunlun; with pain in 

both, press taiyangjing, 

zushaoyangjing; with qi 

stagnant, add yaoyangguan, 

xuehai; with colddampness, 

add sanyinjiao, minmen, liver 

or kidney deficit, add ganshu 

NA 

Pain: NA 

Disability: NA 

Short term: NR 

Intermediate: NR 

Immediate post tx: 

IG = 98.3%, CG = 

82.8% improved 

(P<0.01) 

Short term: NR 

consent form 

Exclusion: pts with 

heart, brain blood vessel, 

liver, kidney or 

hemopoietic system 

disease, mental health, 

severe infection, 

pregnant women, lumbar 

vertebra tubercle, 

marrow tumor, and 

spondylolysis, prolapse 

in the middle with marrow 

demographics: 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

NR 

and shenshu. 

0.15mm x87 mm round sharp 

needle for major points 

0.30 mmx40 mm filiform 

needle 

retention 30 min 

massage: rolling manipulation 

on waist and buttock for 10 

min, massage on muscle 

beside lumbar vertebra, then 

knock the same spots lightly. 

Then let the Pt sleep on 

his/her side, massage Pt's 

shoulder, then relax for 5 min.; 

Long term: NR Intermediate: NR 

Long term: NR 

Harms: NR 

Summary: round 

sharp needle 

combined with 

massage has a 

disfunction, relapse after 

surgery those pts who 

dropped out and 

stransverse oscillatory 

rotped the tx were not 

included. 

Prior surgery 

related to current 

complaint: NR 

1tx/d, 10tx/course, rest 2 ds, 2 

courses 

Drop outs: unknown 

CG (n = 58)– filiform needle + 

massage: acupoints are all the 

same as those in the tx group, 

just use filiform needle; same 

as IG 

Drop outs: unknown 

better therapeutic 

effect on prolapse 

of lumbar 

intervertebral disk. 

C-66 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Qian-mei Trial Design Mean age Cause of Pain: Groups Outcome Outcome 

(2007) 

69 

RCT (SD/range): 

NR 

Disc/joint 

disease 

IG (n = 66)– Needling 

acupoints at same 

instruments: 

Pain: NA 

instruments: 

QoL/ well being: 

Tx duration: 7 wks nervous segment: insert 

Country: Final assessments: % of male: IG = needles 60mm deep, Disability: NA Other: cure rate; 

China imm. post-tx 51.5% Vs. CG = stimulate manually until efficacy rate 

56% soreness and numbness Results: 

Quality N screened: NR Duration of reached, PM such as Baseline: Results: 

score: 4/13 N randomized: 116 Racial Pain: light nd heat applied on Pain: NA Immediate post tx: 

N completed tx: 116 composition: NR acute; subacute low back; 3 sess/wk x Disability: NA Cure rate: 37% vs. 

N attended last fu: 116 ( up to 12 wks); 21 sess. 13% 

Initial of Work status: NR Chronic (> 12 Drop outs: A= 0 Immediate post tx: significantly 

reviewer: SG Eligibility criteria: wks), NR Pain: NA effective: 23% vs. 

- inclusion: diagonosed Other socio- CG (n = 50) – Needles Disability: NA 20% 

as lumbar herniation demographics: Severity of pain were inserted at ineffective: 1% vs. 

according to NR (Grading): routinely selected Short term: NR 7% 

"traditional Chinese NR acupoints on low back total efficacy: 

medicine diagnostic Co morbidities: and buttock; same as IG Intermediate: NR 90.9% vs. 66% 

efficacy standards" NR Co- Drop outs: A= 0 

interventions: Long term: NR Short term: NR 

- exclusion: age >70; Prior episode of NR 

undergoing other pain if acute: Intermediate: NR 

therapies and taking NR 

steriod hormones; Long term: NR 

Cauda equina Prior CAM 

syndrome; pregnant intervention: Harms: NR 

and postnatal woman; NR 

cardio-cerebrovascular 

disease Prior surgery 

related to current 

complaint: NR 

C-67
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Qu, Y Trial Design Mean age Cause of Pain: Groups Outcome Outcome 

(2006)70 RCT (SD/range): IG ­ syndrome of L3 IG (n = 60)– Acu with instruments: instruments: 

Country: 

China 

Tx duration: 1 wk 

Final assessments: 

immediately post tx 

range 25 – 61, 

CG - 23 - 65 yrs 

% of male: IG = 

58%, CG = 55% 

transverse 

process 

% NS: 

% S: 

warming needles: 

subcutaneous injection 

with 0.5% lidocaine 

done on punctured 

points with pimple 

Pain: NA 

Disability: NA 

Results: 

QoL/ well being: 

Therapeutic effects: 

Cured; Improved; 

No effect; Total n 

(%) 

Quality 

score: 2/13 

N screened: 120 

N randomized: 120 

N completed tx: NR 

Racial 

composition: NR 

Duration of 

Pain:mixed, IG -

(31 chronic, 29 

formed about 5 mm in 

diameter, during the 

moxibustion, if the skin 

Baseline: NA 

Pain: 

Disability: 

Results: 

Initial of 

N attended last fu: NR Work status: NR actue -

subacute), CG -

burning on the acu spot 

was hardly tolerated the Immediate post tx: 

Immediate post tx: 

IG = 49 (81.7), CG 

reviewer: SG Inclusion: outPts with 

dx on syndrome of L3 

transverse process (in 

Criteria on Diagnosis 

Other sociodemographics: 

NR 

(33 chronic, 27 

acute -

subacute) 

aseptic physiological 

saline was sparyed 

Drop outs: NR 

NA 

Pain: 

Disability: 

= 35 (58.3); IG = 10 

(16.7), CG = 22 

(36.7); IG = 1 (1.6), 

CG = 3 (5); IG = 59 

and Theraputic Effects 

on Syndromes of 

Chinese Medicine) 

Co morbidities: 

NR 

Severity of pain 

(Grading): 

NR 

CG (n = ) – E-acu: 

bilateral application with 

filiform needle (0.30 mm 

Short term: NR 

Intermediate: NR 

(98.4), CG = 57 

(95) 

Short term: NR 

randomized based on 

visiting sequence 

(results separated for 

Prior episode of 

pain if acute: NR Cointerventions:NR 

x 50 mm); even needling 

technique, electric acu 

apparatus was applied 

Long term: NR Intermediate: NR 

acute to subacute and 

chronic pts) 

Prior CAM 

intervention: NR 

with continuous wave, 

50 hz , 2 - 4 V. needles 

were retained for 30 

Long term: NR 

Harms: NR 

Exclusion: NR min; , 1tx/d, 7 tx total 

Prior surgery Drop outs: NR 

related to current 

complaint: NR 

C-68
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Rui-ping She

 (2008)71 

Trial Design 

RCT 

Mean age 

(SD/range): NR 

Cause of Pain: 

1 - disc/joint 

Groups 

IG (n = 140)– Acu at 

Outcomes: 

Pain: NR 

Outcome 

instruments: 

Tx duration: 20 ds disease Qiangji 4 points deeply QoL/ well being: 

Country: Final assessments: % of male: IG = insert needles until Disability: NR 

China immediately post tx 55%; CG = 56.8% vertebrae reached Other: cure rate 

connected to impulse Results-Baseline: 

N screened: NR Racial Duration of device and stimulated at Pain: NR Results: 

Quality 

score: 3/13 

N randomized: 179 

N completed tx:179 

composition: 

NR 

Pain: acute; 

subacute ( up to 

tolerated freq.; 40 

min/sess, 1 sess/d x 20 

Disability: NR Cure rate: 

End of 1st course: 

N attended last fu: NR 12 wks); ds, 5 ds break after 10 Immediate post tx: 42.1% vs. 28.1% 

Initial of Inclusion: show 7/10 

Work status: 

NR 

Chronic (> 12 

wks); NR 

sessions 

Drop outs: NR 

Pain: NR 

Disability: NR End of 2nd course: 

reviewer: SG following symptoms 82.9% vs. 16.8% 

LBP; sciatica; lower Other socio- Severity of pain CG (n = 139) – Routine Short term: NR 

limb numbness; limp demographics: (Grading): acu: needles were Intermediate: 

intermittently; NR NR inserted 25-40mm deep, Intermediate: NR Long term: NR 

protective posture; manipulate needles 

Deformity of spinal Co morbidities: Current tx/ co­ connected with electrical Long term: NR Harms: NR 

cord; straight leg raise NR intervention impulse device and 

test (+); Bragard's test common in all stimulated at tolerated Summary: 

(+); dysuria or lower Prior episode of groups: frq.; same as IG 

limb myophagism; CT: pain if acute: 1. lay on solid Drop outs: NR 

dura mater and nerve NR bed for 16hrs 

root disturbed; MRI: 2. waist and 

intervertebral space Prior CAM back support 

narrow intervention: 

Exclusion: NR 

spondylolisthesis; 

myofacial pain Prior surgery 

syndrome; spinal canal related to current 

stenosis or spinal complaint: NR 

fracture; 

C-69
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Wang, Y 

(2004)72 

Trial Design 

RCTMean age (SD/range): 

Cause of Pain: 

N-S 

Groups 

IG (n = 66) – WaiguanOutcomes: 

Pain: NA 

Outcomes: 

QoL/ well being: 

NR through-Neiguan and Well being, B 

Country: Tx duration: NR % of male: Duration of Lumbus 2-4 , transverse Disability: NA 

China Final assessments: IG = 68.2% vs. Pain: process acu methods: Results: 

immediately post tx CG = 60% NR 40-50 mm needle on Results: 

waiguan-through- Baseline: NA Immediate post tx: 

Racial Severity of Neiguan Pain: NA IG = 95.5%, CG 

Quality N screened: not composition: pain (Grading): 75 mm needle on Immediate post tx: =71.1% improved 

score: 2/13 mentioned NR (most likely NR lumbus 2-4 NA (P<0.05) 

N randomized: 111 Asian) retention 30 min; 1tx/d, Pain: NA 

N completed tx: 111 Co- 10 tx/course Disability: NA Short term: NR 

Initial of N attended last fu: NR Work status: interventions:N Drop outs: B=0 

reviewer: SG NR R Short term: NR Intermediate: NR 

Other socio- CG (n = 45)– routine 

Eligibility criteria: demographics: acu: acupoints: Intermediate: NR Long term: NR 

- inclusion: diagnosed shenshu, zhishi, zhibian, 

third lumbar vertebra Co morbidities: weizhong Long term: NR Harms: NR 

transverse process NR eletronic acu Summary ( if 

syndrome retention 30 min; same provided) : IG = 

Prior episode of as IG cure rate and total 

- exclusion: NR pain if acute: NR Drop outs: B=0 effective rate were 

66.7% and 95.5%, 

Prior CAM CG = 46.7% and 

intervention: NR 71.1% respectively, 

showing that the 

curative effect was 

Prior surgery better in the IG 

related to current than in the CG 

complaint: NR 

C-70
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Wang, YQ 

(2005)73 

Trial Design 

RCT 

Mean age: 45.7 

yrs 

Cause of Pain: 

Disc herniation 

Groups 

IG (n = 30)– Acu + 

Outcome 

instruments: 

Outcome 

instruments: 

massage+ spinal Mob: Pain: QoL/ well being: 

Country: Tx duration: 20 ds % of male: IG = Duration of Ventral acu; 32# needle, VAS(A,B);Overall Overall efficacy 

China Final assessments: 76.7% vs. CG = Pain: 50min/d x 2 courses efficiency (B) Other: NA 

NR 71.4% Unknown or each 10 ds 

mixed duration, Drop outs: 0 Disability: NA Results: 

Quality Racial NR Immediate post tx: 

score: 6/13 N screened: 58 composition: CG (n = 28) – massage Results: overall efficacy: 

N randomized: 58 NR Severity of pain + spinal Mob: NR; Immediate post tx: 64% vs. 85%, p < 

N completed tx: 58 Work status: NR (Grading): 20 min/d x 2 courses, 10 Pain: IG = 0.83 0.05 

Initial of N attended last fu: NR NR ds each (0.23), CG = 2.85 

reviewer: SG Other socio- Drop outs: 0 (0.49); Short term: NR 

demographics: Co- Disability: NR 

Eligibility criteria: NR interventions: Intermediate: NR 

- inclusion: disc NR Short term: NR 

herniation Co morbidities: Long term: NR 

- exclusion: Obvious NR Intermediate: NR 

symptoms in Pts with Harms: NR 

spinal cord Prior episode of Long term: NR 

compression pain if acute: NR Summary of 

results (if 

Prior CAM provided): 

intervention: NR massage plus 

spinal Mob plus 

Prior surgery acu group is better 

related to current than massage plus 

complaint: NR spinal Mob group 

C-71
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Wu, Y 

(2004)74 

Trial Design 

RCTMean age (SD/range): 

Cause of Pain: 

Disc/joint 

Groups 

IG (n = 62) –Abdominal 

Outcomes: 

Pain: NA 

Outcomes: 

QoL/ well being: 

NR disease acu: acupoint: well being, 

Country: Tx duration: 30 ds % of male: IG = 40-60 mm needle; 1 Disability: NA 

China Final assessments: 62.9% vs. CG = tx/d, 10tx/course, 3 ds Results: 

immediately post tx 57.7% Duration of between courses x 3 Results: Immediate post tx: 

Pain: courses Baseline: NA IG = 98.4%, CG = 

Racial Acute, Drop outs: B=0 Pain: NA 86.5% improved 

Quality N screened: not composition: subacute, Immediate post tx: (P<0.025) 

score: 3/13 mentioned Asian chronic CG (n = 52)– Body acu:, NA 

N randomized: 114 retention for 30-50 min; Pain: NA Short term: NR 

N completed tx: 114 Work status: Severity of same as IG Disability: NA 

Initial of N attended last fu: NR NR pain (Grading): Drop outs: B=0 Intermediate: NR 

reviewer: SG Other socio- NR Short term: NR 

demographics: Long term: NR 

Eligibility criteria: Current Intermediate: NR 

- inclusion: diagnosed Co morbidities: tx/ co- Harms: NR 

using Chinese Medical NR intervention Long term: NR 

Diagnostic and common in all Summary: 

Therapeutic Standard Prior episode of groups: abdominal acu has 

pain if acute: NR NR a good therapeutic 

- exclusion: NR effect on prolapse 

Prior CAM of lumbar 

intervention: NR intervertebral disc 

with a short 

therapeutic course 

Prior surgery 

related to current 

complaint: NR 

C-72
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Xia, F Trial Design Mean age Cause of Pain: Groups Outcomes: Outcomes: 

(1997)75 RCT- (SD/range): 

NR 

Disc/joint 

disease 

IG (n = 41) – 

Acu+injection+massage: 

Pain: NA QoL/ well being: 

well being, B 

Country: 

China 

Tx duration: 1 mo 

Final assessments: 

immediately post tx 

% of male: NR 

Racial 

composition: Duration of 

acupoint: jiaji, add 

huantiao, fengshi, 

yanglingquan, juegu, 

ashixue for lumbar or leg 

pain on zushao yangdan 

Disability: NA 

Results: 

Baseline: NA 

Results: 

Immediate post tx: 

Asian Pain: jing; add zhibian, yinmen, Pain: NA IG = 98%, CG = 

Quality N screened: not Acute, subacute weizhong, chengshan, Immediate post tx: 90% improved 

score: 2/13 mentioned 

N randomized: 81 

N completed tx: 81 

Work status: 

NR 

Other socioand chronic 

Severity of 

kunlun, aishixue for pain on 

taiyang pangguangjing. 

Retention 15 min, every 5 

NA 

Pain: NA 

Disability: NA 

(P<0.05) 

Short term: NR 

Initial of 

reviewer: SG 

N attended last fu: NR 

Eligibility criteria: 

demographics: 

Co morbidities: 

NR 

pain (Grading): 

NR 

Comin run needle once 

injection: B1, B12 4 ml 

injection into 3-4 acupoints 

massage waist and leg 

(affected sides), shake 

Short term: NR 

Intermediate: NR 

Intermediate: NR 

Long term: NR 

- inclusion: Xray or CT 

diagnosed 

- exclusion: NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

interventions: 

NR 

ankles; 1tx/2ds, 10 

tx/course, 5 ds rest 

Drop outs: B=0 

CG (n = 40)– Acu: 

acupoint: jiaji, add 

huantiao, fengshi, 

yanglingquan, juegu, 

ashixue for lumbar or leg 

pain on zushao yangdan 

jing; add zhibian, yinmen, 

weizhong, chengshan, 

kunlun, aishixue for pain on 

taiyang pangguangjing. 

Retention 15 min, every 5 

min run needle once; same 

as IG 

Drop outs: B=0 

Long term: NR Harms: NR 

C-73
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Xingsheng, 

C (1998)76 

Trial Design 

RCT 

Mean age : 45.6 

yrs 

Cause of Pain: 

sciatic neuritis; 

Groups 

IG (n = 108)– 

Outcome 

instruments: 

Outcome 

instruments: 

lumbar Acu(PTP+DP): Point- Pain: NR QoL/ well being: 

Country: Tx duration: 10-30 ds % of male: 59.1% hyperosteogeny; To-Point Penetration 

China Final assessments: prolapsed method + Deep Disability: NR Other: 

immediately post tx Racial intervertebral Puncture; manual Cured: all signs 

composition: disc; soft tissue twirling was used to Results: and symptoms 

Quality Asian injury; sacroilitis; obtain local sensations Baseline: NA disappeared 

score: 2/13 N screened: NR coxarthritis; of soreness and Pain: completely and 

N randomized: 198 Work status: NR sciatic nerve distenstion; the needle Disability: affected limb 

N completed tx: NR injury by retained for 30 min; 1-2 moved freely 

Initial of N attended last fu: NR Other socio­ injection: tx/d, 10 Immediate post tx: 

reviewer: SG demographics: rheumatoid sessions/course, 1-3 NA Results: 

Inclusion: Pts with NR spondylitis; courses Pain: Short term: NR 

sciatica aged  18 yrs lumbarization of Drop outs: NR Disability: 

Co morbidities: sacrum; Intermediate: IG = 

Exclusion: Pts with NR CG (n = 90) – Short term: NR 74 (68.5%), CG = 

fractures or visceral Duration of Acu(routine): Routine 31 (34.4%) 

referred pain from Prior episode of Pain: Mixed, 3.5 filiform needling Intermediate: NR 

infection, neoplasm, or pain if acute: NR mos (2d-12 yrs) techniques; points Long term: NR 

aortic aneurysm Severity of pain chosen according to Long term: NR 

Prior CAM (Grading): NR individual Harms: NR 

intervention: NR manifestations; manual 

Co­ twirling as IG 

Prior surgery interventions:NR Drop outs: NR 

related to current 

complaint: NR 

C-74
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Yao, Z 

(2007)77 

Trial Design 

RCT 

Mean age 

(SD/range): NR 

Cause of Pain: 

Disc/joint 

Groups 

IG (n = 62)– Acu + 

Outcome 

instruments: 

Outcome 

instruments: 

disease moxibusion: Acupoint: Pain: NA QoL/ well being: 

Country: Tx duration: 21 ds % of male: NR Huatuo Jiaji xue, 30 min Disability: NA well being, B: pain 

China Final assessments: retention, and symptoms 

immediately post tx Racial TDP moxibusion , Results: disappear, waist 

composition: Duration of select 4, 5, 6 point in the Baseline: NA function is back to 

Quality N screened: Don’t Asian Pain: lower limb of the Pain: normal, can return 

score: 3/13 know less than 2 affected side, 40 mm Disability: to work 

N randomized: 116 Work status: NR mons to greater needles, 40 min Other: 

N completed tx: 116 than 6 mons, retention; 1 tx/d, 6 Immediate post tx: 

Initial of N attended last fu: NR Other socio- NR tx/course, 1 d between NA Results: 

reviewer: SG demographics: courses x 3 courses Pain: Immediate post tx: 

Eligibility criteria: NR Severity of pain Drop outs: B=0 Disability: IG = 91.9%, CG = 

- inclusion: diagnosed (Grading): NR 90.7% improved 

using Chinese Medical Co morbidities: CG (n = 54) – E-acu- Short term: NR (P>0.05) 

Diagnostic and NR Co­ acupoints: shenshu, 

therapeutic Effective interventions:NR dachangshu, Intermediate: NR Short term: NR 

Standard, Prior episode of guanyuanshu, huantiao, 

pain if acute: NR fengshi, weizhong, Long term: NR Intermediate: NR 

- exclusion: fracture, fenglong, zhusanli, jugu, 

tumor kunlun, taichong. Long term: NR 

Prior CAM 30 min retention; same 

intervention: NR as IG Harms: N 

Drop outs: B=0 

Prior surgery 

related to current 

complaint: NR 

C-75
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Ye, D 

(2002)78 

Trial Design 

RCT 

Mean age 

(SD/range): NR 

Cause of Pain: 

Disc/joint 

Groups 

IG1 (n = 20)– eletric 

Outcome 

instruments: 

Outcome 

instruments: 

disease acu+traction+Tuina(mas Pain: NA QoL/ well being: 

Country: Tx duration: 2 mos % of male: NR sage: acute- pelvis well being, B, 

China Final assessments: traction for 20 min then Disability: NA Chinese Medical 

immediately post tx Racial electric acu, Retention Diagnostic and 

composition: Duration of 15 min( 5Hz­ Results: therapeutic 

Quality Asian Pain: 10Hz)+20min (0.5Hz­ Baseline: NA Standard 

score: 2/13 N screened: not Work status: NR acute, subacute 1Hz); 1 tx/d, 10 Pain: 

mentioned and chronic, NR tx/course x 3, subacute Disability: Results: 

N randomized: 60 Other socio­ and chronic period- Immediate post tx: 

Initial of N completed tx: NR demographics: Severity of pain electric acu and traction Immediate post tx: improved IG = 

reviewer: SG N attended last fu: NR NR (Grading): (same as IG1),+ Tuina NA 95%, IG2 = 90%, 

NR 20 min, 1 tx/2 ds, 10 CG = 90% 

Co morbidities: tx/course, 3 courses Pain: 

Eligibility criteria: NR Co- Drop outs: don’t know Disability: Short term: NR 

- inclusion: 1­ interventions:NR 

diagnosed using Prior episode of IG2 ( n = 20) – electric Short term: NR Intermediate: NR 

Chinese Medical pain if acute: NR acu+traction: tx of 

Diagnostic and electric acu and traction Intermediate: NR Long term: NR 

therapeutic Standard Prior CAM as IG1; same as IG1 

intervention: NR Drop outs: don’t know Long term: NR Harms: NR 

- exclusion: NR 

CG (n = 20) – electric Summary: electric 

Prior surgery acu+Tuina(massage: tx acu + traction 

related to current of eletric acu and Tuina mainly applied for 

complaint: NR as IG1; same as IG1 the early stage and 

Drop outs: Don’t know Tuina combined by 

electric acu + 

traction for the 

middle-later stage 

C-76
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Ye, L 

(2004)79 

Trial Design 

RCTMean age (SD/range): IG = 

Cause of Pain: 

Prolapse of 

Groups 

IG (n = 49) – 

Outcomes: 

Pain: score (put 

Outcomes: 

QoL/ well being: 

38.3(possibly lumbar hypodermic catgut under pain tab, Well-being, B, 

Country: Tx duration: 3 wks total) intervertebral embedding therapy on however it is a Other: 

China Final assessments: disc prolapsed of lumbar score for symptoms 

immed. Post-tx % of male: intervertebral disc, somatoscopy and Results: 

51%(assuming acupoints: jiaji, huantiao, activity of daily life), 

total) weizhong, xuanzhong, A, B Immediate post tx: 

Quality N screened: NR Duration of ashi. % improved: IG = 

score: /13 N randomized: 98 Racial Pain: mixed, 3-5cm beside acupoints, Results: 44, P = 

N completed tx: 98 composition: 369.4, NR embeded 3-4cm Baseline: 0.897959184; CG = 

N attended last fu: 98 Asian hypodermic catgut; 1 Pain: IG = 9.49 42, P= 

Initial of Severity of pain tx/course, embedded for (1.29), CG = 9.47 0.857142857 

reviewer: SG Inclusion: MRI and Work status: NR (Grading): NR a wk then for next (1.32) 

CT examination, using course, 3 courses total Short term: NR 

Chinese Medical Other socio- Co- Drop outs: B = 0 Immediate post tx: 

Diagnostic and demographics: interventions:NR Pain: IG = 18.31 Intermediate: NR 

Therapeutic Standard NR CG (n = 49) – E-Acu: (1.83), CG = 15.54 

for lumbar NR; NR (1.92) Long term: NR 

intervertebral disc Co morbidities: Drop outs: NR 

NR Short term: NR Harms: NR 

Exclusion: NR 

Prior episode of Intermediate: NR Summary: The 

pain if acute: NR hypodermic satgut 

Long term: NR embedding therapy 

Prior CAM can increase 

intervention: NR therapeutic effect 

on prolapse of 

Prior surgery lumbar 

related to current intervertebral disc 

complaint: NR 

C-77
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Ye, Z 

(2004)80 

Trial Design 

RCT 

Mean age 

(SD/range): 

Cause of Pain: 

Disc/joint 

Groups 

IG (n = 30)– NeedleOutcome 

instruments: 

Outcome 

instruments: 

IG = 45 vs. CG = disease knife +Take Chinese Pain: NR QoL/ well being: 

Country: Tx duration: 20 – 60 ds 44 yrs medicine + therapy by Cure rate 

China Final assessments: hand: 50-100kg traction, Disability: NR 

immediately post tx % of male: after 15 min, local 

IG = 76.7%, CG = Duration of anesthesia, use needle- Results: Results: 

Quality N screened: Don’t 76.9% Pain: knife; Baseline: NA Immediate post tx: 

score: 2/13 know IG - 1 wk to 12 therapy by hand Pain: improved; overall: 

N randomized: 56 Racial mo : acute to +Chinese Medicine; 6 tx Disability: IG = 100%, CG = 

N completed tx: 56 composition: chronic; CG - 5 total, 5 ds between 2 tx 88.5 %, P<0.05 

Initial of N attended last fu: NR Asian ds to 11 mo: Drop outs: 0 Immediate post tx: 

reviewer: SG acute to chronic NA Short term: NR 

Eligibility criteria: Work status: NR CG (n = 26) – Eletroacu Pain: Intermediate: NR 

inclusion: Diagnostic Severity of pain +Take Chinese Disability: Long term: NR 

as lumbar Other socio­ (Grading): medicine+ herapy by 

intervertebral disc demographics: NR hand; 1 tx/d, 10 Short term: NR Harms: NR 

protruston using CT NR tx/course, 3-5 d no tx 

examination and Co­ between course, total of Intermediate: NR Summary: 

based on Shanghai Co morbidities: interventions: 6 course Needle-knife 

Chinese Medical NR NR Drop outs: 0 Long term: NR composite tx is 

Diagnostic and superior to electroTreatment Standard Prior episode of acu composite tx. 

pain if acute: NR 

exclusion: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

C-78
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zeng, Y 

(2007)81 

Trial Design-RCT Mean age 

(SD/range): NR 

Cause of Pain: 

Disc/joint 

Groups 

IG (n = 67)–Abdomen 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: NR disease acu: acupoint: shuifen, Pain: NA QoL/ well being: 

Country: Final assessments: % of male: qihai, guanyuan, well being, B, 

China immediately post tx IG = 44.8% vs. renzhong+yintang for Disability: NA based on Chinese 

CG = 48.5% acute lumbar Medical Diagnostic 

N screened: NR Duration of intervertebral disc Results: and therapeutic 

Quality N randomized: 133 Racial Pain: protrusion, Qixue (two Baseline: NA Effective Standard 

score: 2/13 N completed tx: 133 composition: acute, subacute, sides) +siman (two Pain: NA 

N attended last fu: NR Asian chronic, NR sides) +wailin (two Disability: NA Results: 

Inclusion: diagnosed sides) for waist pain, Immediate post tx: 

Initial of using Chinese Medical Work status: NR Severity of pain qipang (healthy Immediate post tx: IG = 95.5%, CG = 

reviewer: SG Diagnostic and (Grading): side)+wailin (healthy NA 86.4% improved 

therapeutic Effective Other socio- NR side) for sciatic nerve Pain: NA 

Standard; 20-65 yrs; demographics: Co­ pain+ lower rheumatism Disability: Short term: NR 

CT or MRI exam NR interventions: point (affected side) 

showed lumbar NR retention 30min; 1 tx/d, Short term: NR Intermediate: NR 

intervertebral Disc Co morbidities: 10 tx/course 

Protrusion; Signed NR Drop outs: B =0 Intermediate: NR Long term: NR 

consent form 

Exclusion: disease Prior episode of CG (n = 66) –Body acu: Long term: NR Harms: NR 

with heart, brain pain if acute: acupoint: dachangshu, 

vessel, liver, kidney guanyuanshu, baliao, Summary: 

and blood producing Prior CAM jiaji, chibian, huantiao, abdomen acu has a 

problem, mental intervention: NR chengshan, yinmen, good effect on 

health; infection, weizhong, lumbar 

pregnant women, yanglingquan, fengshi, intervertebral disc 

women in breast Prior surgery kunlun. Points on protrusion with a 

feeding, lumbar spinal related to current affected side short course of tx 

tubercal, spinal cord complaint: NR retention 30 min; same 

tumor, dysfunction with as IG 

spinal cord, relapse Drop outs: B =0 

after surgery 

C-79
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zhang, B 

(2002)82 

Trial Design-RCT Mean age: IG1 = 

46, IG2 = 43, CG 

Cause of Pain: 

disc/joint 

Groups 

IG (n = 96)– Acu+ 

Outcome 

instruments: 

Outcomes: 

QoL/ well being: 

Tx duration: not clear = 47 yrs disease massage: on S acup Pain: NR Cure rate 

Country: Final assessments: points; Disability: NR 

China immediately post tx % of male: IG1 = 1 tx/d, 10tx/course, 3-5 Results: 

69.8%, IG2 = d between tx Results: NR Immediate post tx: 

N screened: Don’t 60.7%, CG = Duration of Drop outs: B = 0 N (%) improved – 

Quality know 66.3% Pain: Immediate post tx: IG1 = 96 (100%), 

score: 2/13 N randomized: 278 3 ds- 10 yrs: IG2 (n = 84) – Acu: Pain: IG2 = 73 (86.9%), 

N completed tx: NR Racial acute, sub- same as IG1; 2 tx/d, 10 CG = 90 (91.8%) 

N attended last fu: NR composition: acute, chronic tx/course, 3-5 ds Short term: NR Short term: NR 

Initial of Asian between tx 

reviewer: SG Inclusion: Diagnosed Severity of Drop outs: B = 0 Intermediate: NR Intermediate: NR 

using X-ray and CT Work status: NR pain (Grading): 

examination and NR CG (n = 98) – Massage: Long term: NR Long term: NR 

Clinical Disease Other socio­ lay on tummy, rolling, 

Diagnostic and demographics: Co- rubbing massage on Harms: NR 

therapeutic Effective- NR interventions:N waist and lower limb, Summary: IG1 is 

Chinese ref 1987 R manipulation on superior to IG2 or 

Co morbidities: huatuojiaji and beishu CG tx and at 

Exclusion: Tumor, NR for 10 min, traction for 1 present is one of 

facture, inflammation min, and repeat 3-5 the better methods 

in lumbar spine, Prior episode of times, stretch and shake for treating lumbar 

internal organ failure, pain if acute: NR waist and left and right intervertebral disc 

tubercle in lumbar turn for 2-3 times, Roll, protrusion 

spine Prior CAM rub and push from waist 

intervention: NR to two lower limbs for 5 

mins followed by 1 hour 

Prior surgery rest 

related to current 3 tx/d, 10 tx/course, 3-5 

complaint: NR ds between tx 

Drop outs: B = 0 

C-80
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zhang, B 

(2007)83 

Trial Design 

RCT 

Mean age 

(SD/range): 

Cause of Pain: 

NR 

Groups 

IG (n = 98) – E-Acu: 

Outcome 

instruments: 

Outcome 

instruments: 

IG = 47.6 (5.23) filiform 0.38 mm Pain: Shanghai QoL/ well being: 

Country: Tx duration: 20 ds vs. CG = 46.9 diameter needles Diagnose and 

China Final assessments: (6.12) yrs of 40-70 mm length Treatment Routine Other: 

immediately post tx % of male: IG = Duration of inserted 1.5-2 cun, of TCM Syndromes N of pts with >50% 

50%, CG = 50% Pain: followed by 2 min issued by Shanghai pain reduction: IG = 

Quality N screened: NR Acute-chronic: reinforcing and reducing Municipal Health 82%, CG = 73% 

score: 6/13 N randomized: 194 Racial IG – 1 mo­ manipulations by Bureau; Results: 

N completed tx:188 composition: NR 10yrs; CG – rotating until electric Scoring of pain: not Baseline: 

N attended last fu: NR 3wks-20yrs shock sensation; obvious=0, Immediate post tx: 

Initial of Work status: NR afterwards, the needles occasional/mild=1, 

reviewer: SG Eligibility criteria: Severity of pain were connected to occasional severe Short term: NR 

- inclusion: Pts aged Other socio­ (Grading): G6805-II electric or frequent mild=2, Intermediate: NR 

25-60 yrs with LDH not demographics: NR stimulator for 20 min frequent severe=3 Long term: NR 

taking any therapies NR with continuous wave 40 

- exclusion: LDH cases Co- HZ frequency and 2mA Disability: Harms: NR 

with complications of Co morbidities: interventions:NR intensity; 1tx/d, 

lumbar NR 10d/course for 20 d, 5 d Results: Summary of 

spondylolisthesis; between 2 courses Baseline: results (if 

complications of Prior episode of Drop outs: 2 Pain: NR provided): 

general collagenous pain if acute: NR Disability: NA E-Acu was more 

immune diseases or CG (n = 96) – Mobic: effective than 

other infections; those Prior CAM NR; 7.5 mg/d orally for Immediate post tx: Western drug in 

taking glucocorticoids intervention: NR 20 d (2 Tx courses each Pain: NR improving LBP, 

or with severe 10 d and 5 d apart) Disability: NA pain in lower limbs, 

complications Drop outs: 4 walking, sensory 

Prior surgery Short term: NR function, SLR and 

related to current muscle power 

complaint: NR Intermediate: NR 

Long term: NR 

C-81
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zhang, BM Trial Design Mean age Cause of Pain: Groups Outcomes: Outcome 

(2008)84 RCT (SD/range): Disc Herniation IG (n = 100)– E-acu Pain: NR instruments: 

IG = 47.62 (5.23) with current intensity of QoL/ well being: 

Country: Tx duration: 20 ds Vs. CG = 46.96 2 mA at frequency of ; Disability: NR overall efficacy 

China Final assessments: 

immediately post tx 

(6.12) yrs 

% of male: IG = 

Duration of 

Pain: IG -

4HZ; 

20min/once a d for 10 

ds with 5 ds interval 

Results: 

Baseline: 

Results: 

Immediate post tx: 

overall efficacy (%): Quality 53.1%; CG = 51% Acute (< 4 wks) Drop outs: A = 1, B = 1 Pain: NR 86.53% vs. 75%, p < 

score: 4/13 N screened: 200 ; CG - Chronic Disability: IG (n = 0.01 

N randomized: 200 Racial (>/= 12 wks) CG (n = 100) – Oral 96), CG (n = 91); Short term: NR 

N completed tx:196 composition: NR Med: 30# 1.5 and 3 inch IG (n = 85), CG (n Intermediate: NR 

Initial of N attended last fu: NR Severity of pain needle; MOBAC tablets = 80); IG (n = 80, Long term: NR 

reviewer: SG 

Inclusion: Disc 

herniation; 25-60yrs; 

Work status: NR 

Other sociodemographics: 

(Grading): 

NR 

Co7.5 mg/d x 10 d/course x 

2 

Drop outs: A = 1, B =1 

CG (n = 84); IG (n= 

82), CG (n = 88); 

IG (n = 72), CG (n= 

74) 

Harms: poor 

appetite, nausea, 

abdomen pain, 

swelling, headache NR interventions:No and dizziness in CG 

description; IG = Immediate post tx: but not in IG – Local 

Eexclusion: Disc Co morbidities: 3.06, CG = Pain: NR hematoma 3.06% in 

herniation with NR 56.25 Disability: NR IG 

spondylolysis; Pts oral 

glucocorticoid Prior episode of 

pain if acute: NR 

Prior CAM 

Short term: NR 

Intermediate: NR 

Summary of results: 

e-acu is better than 

oral medicine in 

improving lumbago, 

pain or numbness of intervention: NR Long term: NR lower limb, walking 

ability , raising 

Prior surgery straight leg and 

related to current muscle stretngh 

complaint: NR 

C-82
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zhang, Trial Design Mean age Cause of Pain: Groups Outcomes: Outcome 

Honglai 

(2003)85 

RCT (SD/range): NR Spondylosis IG (n = 60)– Electroacu: tianzhu, jinbailao 

Pain: McGill PRI 

total; difference 

instruments: 

QoL/ well being: 

Tx duration: 45 ds % of male: IG = and dashu (two sides) between baseline Cure, improved, 

Final assessments: 53.3%, CG = 55% for major acu points and fu on VAS effective, no effect 

immediately post tx Duration of dazhui, fengchi, n (%) 

Country: Racial Pain: Chronic, fengmen, jianjin and Results: Results: 

China composition: IG = 81.9 mo, waiguan for wind Baseline: Immediate post tx: 

N screened: unknown Asian IG2 = 92.2 mo, dampness quchi, pishu, Pain: IG = 8.57 IG = 56 (93.3%), 

N randomized: 120 CG = 91.1 mo fenglong, geshu for (2.33), CG = 8.61 CG = 47 (78.3%) 

Quality N completed tx: 120 Work status: NR tanyuzhu type ganshu, (2.42); NR 

score: 6/13 N attended last fu: NR Severity of pain pishu, and zusanli for qi Short term: NR 

Other socio­ (Grading): stagnant type ganshu, Immediate post tx: 

demographics: McGill, VAS pishu, zusanli for qi and Pain: IG = 6.73 Intermediate: NR 

Initial of Inclusion: diagnosed NR blood stagnant type (2.12), CG = 7.55 

reviewer: SG as Cervical yanglao, ganshu, (2.28); IG = 4.87 Long term: NR 

Spondylosis using ref Co morbidities: Co­ shenshu and taixi for (1.67), CG = 3.56 

[1] 1993-chinese, NR interventions:NR liver and kidney debility. (1.26) Harms: NR 

Special attention (only 1.5 Chinese inch, size 

those who were Prior episode of 30 needle, freq. 120­ Short term: NR Summary: IG in 

compliant with the tx, pain if acute: NR 250/min, retention therapeutic effect 

only those who 30min; 1 tx/d, 15 Intermediate: NR and improvement 

responded to the Prior CAM tx/course, 3 courses, 2 d of pain for cervical 

surveys) intervention: NR rest between courses Long term: NR spondylosis is 

Drop outs: A = NR, B= 0 better than the CG. 

Prior surgery This study found 

Exclusion: acute related to current CG (n = 60) – Traction: that both tx have 

external injury cause, complaint: NR 30 min, average traction better effect with 

not compliant = 7.5kg; Same as IG younger pts 

Drop outs: A = NR, B= 0 compared with 

older pts 

C-83
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zhang, Trial Design Mean age Cause of Pain: Groups Outcome Outcomes: 

Zhong-yi RCT (SD/range): NR Disc/joint IG (n = 30)– Acu+ instruments: QoL/ well being: 

(2002)86 

Tx duration: 10 wks % of male: NR 

disease massage: acupoints: 

qihaishu, dachangshu, 

Pain: NR 

Disability: NR 

well being, B, 

based on Chinese 

Country: Final assessments: guanyuanshu, Medical Diagnostic 

China immediately post tx 

N screened: Don’t 

Racial 

composition: 

Asian 

Duration of 

Pain: 

xiaochangshu, 

huatuojiaji 

supplement acupoints: 

Results: 

Baseline: NA 

Pain: NA 

and therapeutic 

Effective Standard 

1994 

Quality know IG and CG -5d zhibian, huantiao, Disability: NA 

score: 1/13 N randomized: 61 

N completed tx: 61 

N attended last fu: NR 

Work status: NR 

Other socioto 18 yrs: acute, 

subacute and 

chronic, NR 

xiajuliao, chengfu, 

weizhong, 

yanglingquan, 

Immediate post tx: 

NA 

Results: 

Immediate post tx: 

Improved: IG = 

Initial of demographics: chengshan and kunlun Pain: NA 96.7%, CG = 

reviewer: SG Eligibility criteria: 

- inclusion: diagnosed 

as Lumbar 

Intervertebral Disc 

Protrusion using X-ray, 

CT or MRI 

- exclusion: NR 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

Severity of pain 

(Grading): 

NR 

Cointerventions: 

NR 

50mm diameter, 75-100 

mm needle 

retention 20min 

and cupping on affected 

sides for 20 min; 2 

tx/wk, 10 tx/course x 2 

Drop outs: NR 

CG (n = 31) – Massage: 

massage on the affected 

side, pressure the pain 

point, huantiao, 

chenfuxue. Then 

massage weizhong, 

chenshang, kunlun, 

taixi, xiexi; same as IG 

Drop outs: B = 0 

Disability: NA 

Short term: NR 

Intermediate: NR 

Long term: NR 

90.3% 

Short term: NR 

Intermediate: NR 

Long term: NR 

Harms: NR 

Summary: 

The curative effect 

is better in the IG 

than in the CG. 

C-84
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zhong, B 

(2006)87 

Trial Design 

RCT 

Mean age 

(SD/range): 

Cause of Pain: 

Lumber 

Groups 

IG (n = NR)– Abdominal 

Outcome 

instruments: 

Outcome 

instruments: 

NR vertebra Acu + traction + body Pain: NA QoL/ well being: 

Country: Tx duration: NR % of male: tranverse acu: abodominal acu: Disability: NA NR 

China Final assessments: NR major point: shuifen, Total efficacy rate: 

immediately post tx qihai, add guanyuan. Results: NA Results: 

Racial Wailin, siman for waist Baseline: 

Quality composition: Duration of pain, add qipang, Pain: Immediate post tx: 

score: 2/13 N screened: NR Asian Pain: wailing( affected side), Disability: IG = 96.88%; CG = 

N randomized: NR acute, subacute, lower ; NR 89.29%, 

N completed tx: NR Work status: NR chronic, N Drop outs: Immediate post tx: 

Initial of N attended last fu: NR NA Short term: NR 

reviewer: SG Other socio- Severity of pain CG (n = NR) – Lumbar Pain: 

demographics: (Grading): traction + body acu: NR; Disability: Intermediate: NR 

Eligibility criteria: NR NR NR 

- inclusion: Had Drop outs: NR Short term: NR Long term: NR 

injuries, caught cold; Co morbidities: CoWaist pain NR interventions: Intermediate: NR Harms: NR 

accompanied with NR 

sciatic nerve pain; Prior episode of Long term: NR Summary: 

Lumbar bend, pain if acute: Abdominal acu + 

limitation on traction and body 

movement, pain Prior CAM Acu as acomposite 

around Jitu with intervention: NR tx has an exact 

radiating pain, skin effect on lumbar 

nerve control too intervertebral disc 

sensitive or obtuse, Prior surgery protrusion 

related to current 

- exclusion: <15 or >65 complaint: NR 

yrs 

C-85
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zhou, Q Trial Design Mean age Cause of Pain: Groups Outcomes: Outcomes: 

(1998)88 RCT- (SD/range): Disc/joint IG (n = 30) –Acu on Jiaji: Pain: NA QoL/ well being: 

IG and CG = 48 disease lumbar intervertebral disc well being, B 

Country: 

China 

Tx duration: 30 ds 

Final assessments: 

immediately post tx 

yrs 

% of male: NR 

Duration of 

protrusion to left or right, 

chose acupoints : huatuo 

jiaji (affected side), 

supplement acupoints: 

chibian, huantiao, yinmen, 

Disability: NA 

Results: 

Baseline: NA 

Results: 

Immediate post tx: 

Racial Pain: weizhong, chengshan, Pain: NA IG = 90%, CG = 

Quality N screened: not composition: 4 d to 4 yrs, NR kunlun or fengshi, Immediate post tx: 75% improved 

score: 3/13 mentioned Asian yanglinquan, juegu, qiuxu. NA (P<0.05) 

N randomized: 58 Severity of pain Lumbar intervertebral disc Pain: NA 

N completed tx: 58 Work status: (Grading): protrusion to middle chose Disability: NA Short term: NR 

Initial of 

reviewer: SG 

N attended last fu: NR 

Eligibility criteria: 

NR 

Other sociodemographics: 

NR 

Cointerventions: 

acupoints: huatuo jaji (two 

sides), supplement 

acupoints as above. 

retention 20 min, + 

moxibusion on lumbar 

Short term: NR 

Intermediate: NR 

Intermediate: NR 

Long term: NR 

- inclusion: CT Co morbidities: acupoints; 1 tx/d, 

diagnosed as lumbar NR NR 10tx/course x 3 courses Long term: NR Harms: NR 

interverbral disc Drop outs: B=0 

protrusion Prior episode of 

pain if acute: NR CG (n = 28)– acu on 

- exclusion: NR 

Prior CAM 

intervention: NR 

pangguangjingxue: 

acupoints : pangguang 

(affected side, or two 

sides), e.g qihaishu, 

dachangshu, 

guanyuanshu, 

Prior surgery xiaochangshu. 

related to current supplement acupoint as 

complaint: NR above; same as IG 

Drop outs: B=0 

C-86
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zhou, Q 

(1998)89 

Trial Design 

RCTMean age: 45 yrs Cause of Pain: Disc/joint 

Groups 

IG (n = 96) – 

Outcomes: 

Pain: pain, VAS, 1 

Outcomes: 

QoL/ well being: 

% of male: 51 disease Huaisanzhen: hour later, 12 hours Well being, 

Country: Tx duration: NR acupoints: huaisanzhen, later, 24 hours Chinese Medical 

China Final assessments: Racial 0.35 mmx 75 mm later, 48 hours later Diagnostic and 

immediately post tx composition: needle, Therapeutic 

Asian Duration of retention 30 min ; NR Disability: NA Standard 

N screened: not Pain: Drop outs: B=0 

Quality mentioned Work status: NR, IG = 1.9 Results: Results: 

score: 4/13 N randomized: 192 NR (1.7) yrs; CG1 = CG1 (n = 48) – Drug: Baseline: Immediate post tx: 

N completed tx: 192 Other socio­ 2 (1.6)NS; CG2 injection of Bilinfen Pain: IG = 10, CG1 IG = 83.3%, CG1 = 

N attended last fu: NR demographics: = 1.9 (1.6)NS 0.9g+physiological = 10, CG2 = 10 6.3%, CG2 = 8.3% 

Initial of saline 2 ml; NR improved 

reviewer: SG Eligibility criteria: Co morbidities: Severity of pain Drop outs: B =0 Immediate post tx: 

- inclusion: diagnosed NR (Grading): Pain: IG = 3.7 (1.5), Short term: NR 

using Chinese Medical NR CG2 (n = 48)– Acu: CG1 = 5.5 (2), CG2 Intermediate: NR 

Diagnostic and Prior episode of acupoint: shenshu, = 5.2 (1.2) Long term: NR 

Therapeutic Standard pain if acute: NR Co­ qihaishu, jiaji, ciliao, 

and 1988 Clinical Trial interventions: zhibian, huantiao, Disability: NA Harms: NR 

Diagnostic Standard Prior CAM NR ashixue, weizhong, 

20-65 yr; Signed intervention: NR yanglinquan, xuanzhong Short term: NR Summary: timing 

consent form retention 30 min; NR analgesic effect 

Prior surgery Drop outs: B=0 Intermediate: NR was shorter, the 

- exclusion: pregnant, related to current effect lasting time 

breast feeding women, complaint: NR Long term: NR was longer, and the 

Pts with heart or brain analgsic effect and 

blood vessel, liver, the comprehensive 

kidney primary disease therapeutic effect 

diagnosed as prolapse were better in the 

of lumbar IG vs. CG1, &2 

intervertebral dic but (P<0.01) 

no nerve root pain 

C-87
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zhou, YL 

(2006)90 

Trial Design 

RCTMean age (SD/range): IG1 = 

Cause of Pain: 

Disc herniation; 

Groups 

IG1 (n = 162) –AcuOutcomes: 

Pain: VAS only at 

Outcomes: 

QoL/ well being: 

45.72 (11.2); IG2 Degenerative ankle-three-needle: baseline; time of 

Tx duration: 10 ds = 44.44 (10.36); disc disease points Gentong NO.1, 2 inducing analgesia Other: straight-leg 

Country: Final assessments: CG = 46.08 and 3 were selected; raising test 

China immediately post tx (10.76) yrs needle:size 75mm, Disability: NR Results: 

30min Immediate post tx: 

% of male: IG1 = Duration of Drop outs: 0 Results: IG1 = 61.7 (13.4); 

N screened: 380 51.9%; IG2 = Pain: vs. 52.1 ( 18.9); vs. 

Quality N randomized: 310 46.1% CG = Unknown or IG2 (n = 76) – Routine Immediate post tx: 53.6 (15.2) 

score: 5/13 N completed tx: 310 44.4% mixed duration, Acu: acu at Shenshu, Pain: VAS- NR 

N attended last fu: NR IG1 2.62 (2.55) Qihaishu,Jiaji and Qilao; Short term: NR 

Racial yrs; IG2 = 2.58 needle:size 75mm, time of inducing Intermediate: NR 

Initial of composition: NR (2.7) yrs; CG = 30min alagesia, minutes: Long term: NR 

reviewer: SG Eligibility criteria: 2.60 (2.57) yrs Drop outs: 0 6 vs. 27 vs. 18 

- inclusion: Disc Work status: NR minutes Harms: NR 

herniation; VAS  3; CG(n = 72) – Med inject: Effect lasting for 

Sign a consent form; Other socio- Severity of pain routine buttock 24.5 vs. 8.9 vs. 6.4 Summary: 

20-65 yrs demographics: (Grading): intramuscular injection hours Analgesic effect 

NR NR of aspirm-DL-lysine plus within 48 hrs, 

- exclusion: NR saline; aspirm-DL-lysine Disability: NR Straight leg raising 

Co morbidities: Co­ 0.9g plus saline 2ml test: ankle-threeNR interventions:NR Drop outs: 0 Short term: NR needle group is 

Intermediate: NR better than the 

Prior episode of Long term: NR other two groups 

pain if acute: NR but there are not 

Prior CAM different between 

intervention: NR routine acu group 

Prior surgery and medicine 

related to current injection group. 

complaint: NR 

C-88
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zhou, Z 

(2004)91 

Trial Design 

RCTMean age (SD/range): 

Cause of Pain: 

Disc/joint 

Groups 

IG (n = 42) – Abdominal 

Outcomes: 

Pain: NA 

Outcomes: 

QoL/ well being: 

NR disease acu + Danshen well being, B, 

Country: Tx duration: 24 ds % of male: IG = injection+ light Disability: NA Chinese Medical 

China Final assessments: 66.7% vs. CG = illuminate: (for short Diagnostic and 

immediately post tx 60% acute, use shallow acu; Results: therapeutic 

Duration of long acute, use deep Baseline: NA Standard 

N screened: not Racial Pain: acu); 30 min retention Pain: NA 

Quality mentioned composition: acute, subacute, 250 ml Danshen Immediate post tx: Results: 

score: 4/13 N randomized: 160 Asian chronic injection; 1 tx/d, NA Immediate post tx: 

N completed tx: 160 6tx/course x 4 courses, Pain: NA IG = 97.6%, CG = 

N attended last fu: NR Work status: Severity of 1 d rest between Disability: NA 47.5% improved 

Initial of NR pain (Grading): courses, injection: 1 tx/d (P<0.01) 

reviewer: SG Eligibility criteria: Other socio- NR for 20 ds Short term: NR 

- inclusion: 1-LBP or demographics: Drop outs: B =0 Short term: NR 

sciatic nerve pain, pain Co- Intermediate: NR 

may become worse Co morbidities: interventions: CG (n = 40)– Lumbar Intermediate: NR 

when coughing, NR TDP illuminate shallow acu +Danshen Long term: NR 

sneezing or bow abdomen injection+ TDP Long term: NR 

movement Prior episode of (around illuminate: use shallow 

2-pain on lumbar pain if acute: NR shenque ) + 250 lumbar acu, acupoint in Harms: NR 

vertebra or sciatic ml Danshen lumbar and leg . TDP 

nerve, test of rasing Prior CAM injection illuminate lumbar area Summary: there 

straight leg intervention: NR (L4-5 as centre), 30 min was a very sign. 

3-CT or MRI retention difference in the 

exmination diagnostic 250 Danshen injection effective rate 

lumbar intervertebral Prior surgery Drop outs: B =0 between the IG and 

disc protrusion related to current the CG 

- exclusion: spinal complaint: NR 

stenosis, 

tumor 

C-89
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zhu, Q 

(2003)92 

Trial Design 

RCTMean age (SD/range): 

Cause of Pain: 

Disc/joint 

Groups 

IG (n = 31) – acu + 

Outcomes: 

Pain: Pain, VAS, 

Outcomes: 

QoL/ well being: 

IG = 34.01 (0.18) disease moxibusion + autonomic A, B well being, B 

Country: Tx duration: 30 ds vs. CG = 32.96 traction of knee-chest: 

China Final assessments: (0.22) yrs acupoint: jiajixue, add Disability: NA 

Immed. Post-tx chibian, huantiao, Results: 

% of male: IG = Duration of fengshi, weizhong, Results: 

80.6% vs. CG = Pain: yanglinquan, Baseline: NA Immediate post tx: 

Quality N screened: not 79.3% Acute, xuanzhong, Pain: IG = 4.42 IG = 93.5%, CG = 

score: 4/13 mentioned subacute, taichongxue. (1.03); CG = 4.415 75.9% improved 

N randomized: 60 Racial chronic, IG = 4.8 Acupuncture retention (0.1) (P<0.05) 

N completed tx: 60 composition: mos; CG = 5.21 15 min +moxibusion 

Initial of N attended last fu: NR Asian mos autonomic traction for Immediate post tx: Short term: NR 

reviewer: SG 15 min; 1 tx/d, 1 d NA 

Work status: Severity of pain rest/wk, 30 tx total Pain: IG = 1.57 Intermediate: NR 

Eligibility criteria: NR (Grading): Drop outs: B=0 (0.012); CG = 2.89 

- inclusion: diagnosed Other socio- NR (0.026) Long term: NR 

using Chinese Medical demographics: CG (n = 29)– Acu + Disability: NA 

Diagnostic and Co­ moxibusion : same as Harms: NR 

Therapeutic Standard Co morbidities: interventions: IG; same as IG Short term: NR 

NR NR Drop outs: B=0 

- exclusion: spinal Intermediate: NR 

stenosis, lumbar Prior episode of 

buttlock myofacial pain pain if acute: NR Long term: NR 

syndrom, caudal nerve 

tumor, epidural tumor, Prior CAM 

pradiculitis, deformity intervention: NR 

of sacrum vertebra Prior surgery 

related to current 

complaint: NR 

C-90
 
Table 1.6 Low Back Pain - Acupuncture - Mixed - Non-Specific Pain 

Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

He (1997)93 Trial Design Mean age Cause of Pain: Groups Outcome Outcome 

Country: 

RCT (SD/range): NR, 

range 22-79 yrs 

N-S IG (n = 50)– Manual 

Acu + moxi + Chinese 

instruments: 

Pain: NA 

instruments: 

QoL/ well being: 

China Tx duration: 20 ds 

Final assessments: 

immediately post tx 

% of male: IG = 

42%, CG = 46% 

Duration of 

Pain: 

Acute to 

herbal medicine: De qi 

sensation was obtained. 

Moxibustion was used 

Disability: NA Results: 

Immediate post tx: 

Quality 

score: 4/13 N screened: 100 Racial 

chronic, 5ds-6 

mos 

2-3 times on the handle 

of the needles and 

Results: 

Baseline: NA 

% Cured- tx effect: 

IG = 82%, CG = 

N randomized: 100 composition: needles were retained Pain: 64%; %marked 

Initial of 

N completed tx: NR 

N attended last fu: NR 

Chinese Severity of 

pain (Grading): 

for 30 mins. Herbal 

formula was given daily; 

Disability: effective: IG = 10%, 

CG = 12%; % 

reviewer: SG Work status: NR NR total of 20 tx- once/d up Immediate post tx: improved: IG = 6%, 

Inclusion: LBP, fixed 

in location, limited 

ROM, worse in cold 

Other sociodemographics: 

Cointerventions:N 

to 10 tx, two 5 d tx 

sessions 

Drop outs: NR 

NA 

Pain: 

Disability: 

CG = 8%; No 

change: IG = 2%, 

CG = 16% 

and raining weather. NR R 

CG (n = 50) – Chinese Short term: NR Short term: NR 

Exclusion: Kidney Co morbidities: herbal Med: no Intermediate: NR 

diseases or bone 

diseases confirmed by 

NR description; same as IG 

Drop outs: NR 

Intermediate: NR Long term: NR 

urine test and x-ray 

test. 

Prior episode of 

pain if acute: NR 

Long term: NR Harms: NR 

Summary: 

IG is better that CG 

Prior CAM alone for treating 

intervention: NR LBP with cold and 

dampness based 

Prior surgery on TCM diagnosis 

related to current 

complaint: NR 

C-91
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Sakai, T Trial Design Mean age Cause of Pain: Groups Outcomes: Outcomes: 

(2001)94 RCT- (SD/range): IG = Lumbago (22), IG (n = 32) – E-Acu: Pain: Pain relief QoL/ well being: 

37.3 (12.5) vs CG lumbar Needling points chosen scale (VAS-10 cm) NA 

Country: 

Japan 

Tx duration: 2 wks 

Final assessments: 

immediately post tx 

= 36.2 (12) yrs 

% of male: IG = 

spondylosis 

(15), discopathy 

(9), acute LBP 

by palpation of 

quadratus lumborum 

and/or erector spinae, 2 

before run in 

period; response 

rate of pain releif 

Results: 

Immediate post tx: 

N screened: 71 64.5%; CG = (3), points were used scale, n %; after Short term: NR 

N randomized: 68 45.5% spondylolysis bilateraly, in total 4 run in period Intermediate: NR 

Quality N completed tx: 63 (3), points for each tx., 2 Disability: JOA 

score: 8/13 N attended last fu: NR Racial spondylolisthesi disposable needles score after 1 wk run Long term: NR 

composition: s (1), sacroiliitis used: 0.20 mm and 0.24 in 

Initial of 

reviewer: SG 

Inclusion (1) LBP 

without sciatica, (2) at 

least 2-wk history of LBP, 

and (3) over twenty yrs 

old. 

Exclusion: neurological 

Asian 

Work status: NR 

Other socio­

(1) and unclassified (10). mm diam., 50 mm and 

60 mm in length, 

needles inserted into 

muscles; 2 tx/wk for 2 

wks, total 4 tx sessions 

Results: 

Immediate post tx: 

Pain: IG = 5.3 (3), 

CG = 5.9 (3.4); NR 

% pts with no pain: 

Harms: NR 

Summary: There 

was no difference 

between groups in 

findings, pain/numbness demographics: Duration of Drop outs: 1 IG = 13, CG = 10; n any parameter. 

in lower extremity; NR Pain: mixed, IG of pts with >50% 

malignancy, infection/ = 52.8 (6.11); CG (n = 36) – TENS: pain reduction: IG 

inflammatory disease; Co morbidities: CG = 93.9 stimulating points 41.9, CG = 30.3 

fracture; lumbago due to NR chosen by palpation of Disability: IG = 14.3 urological , gynecological 

, digestive or cardiovascular problem; pts 

who cannot stransverse 

oscillatory rot other 

Prior episode of 

pain if acute: NR 

Prior CAM 

Severity of pain 

(Grading): NR 

Coquadratus lumborum 

and/or erector spinae, 2 

points were used 

bilateraly, in total 4 

(2.2), CG = 14.4 

(2.7) 

Short term: NR 

conflicting/ongoing tx; intervention: NR interventions:NR points for each tx; at 

problem of general freq. 1Hz for 15 min Intermediate: NR 

condition; dementia; adjusted to make 

pregnancy Prior surgery contraction w/o pain; Long term: NR 

related to current same as IG; Drop outs:4 

complaint: NR 

C-92
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Thomas, KJ 

(2007)95 

Trial Design 

RCTMean age (SD/range): IG = 

Cause of Pain: 

N-S 

Groups 

IG (n = 159) – Acu: 177 

Outcomes: 

Pain: SF-36 Bodily 

Outcomes: 

QoL/ well being: 

42 (10.8) vs. CG acupoints bilaterally and Pain score; PPI of SF-36 

Country: UK Tx duration: 24 mos = 44 (10.4) yrs Duration of unilaterally, needles 25­ McGill 

Final assessments: Pain: 40 mm long and 0.20­ questionnaire 

immediately post tx % of male: IG = Chronic, IG = 0.30mm in diameter; Results: 

37.7% , CG = 17.1 (13.5);CG max 10tx/pt Disability: Oswestry Immediate post tx: 

Quality N screened: 298 42.5% = 16.7 (14.6) Drop outs: C = 13, D= Low Back Pain NR 

score: 9/13 N randomized: 239 12, E = 36 Disability – 

N completed tx: 239 Racial Severity of pain reported as % Short term: IG = 

N attended last fu: NR composition: (Grading): CG (n = 80) – Usual Tx: 20.4, CG = 23.3 

Initial of IG (n = 100)- (both grps): Mix of PT, Med, and Results: 

reviewer: SG Eligibility criteria: white; CG (n = Bothersome BP back EXs; NR Intermediate: NR 

- inclusion: Patients 97.5) - white in past wk Drop outs: D =21, E = Immediate post tx: 

aged 18-65 yrs with N- Work status: (extreme): 56% 21 Pain: IG = 60.9 Long term: NR 

S LBP of 4-52 wk Full-time: IG = Co­ (23), CG = 55.4 

duration 51.6; CG = 56.3 interventions: (25.4); IG = 2.43, Harms: collected 

Moxa (17.7%), CG = 2.77 for acu grp only: 

- exclusion: Possible Co morbidities: massage ODI adjusted one pts visited 

spinal pathology, NR (42.2%), mean: 20.4 vs. 23.3 accident and 

carcinoma, motor acupressure Short term: NR emergency with 

weakness, disc Prior episode of (12.8%), Intermediate: NR symptoms of painc 

prolapse, past spinal pain if acute: NR cupping (4.5%), Long term, (12 attack following tx; 

surgery, bleeding Chinese herbs montsh) no SAE during the 

disorders, or current Prior CAM (4.5%), diet Pain (PPI, adjusted trial 

Acu Tx intervention: NR (11.3%), yoga mean): 2.44 vs. 

EX (3.3%), 2.51 

Prior surgery relaxation ODI, adjusted 

related to current (3.0%) mean: 20.1 vs. 20.6 

complaint: NR 

C-93
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Tsukayama, Trial Design Mean age Cause of Pain: Groups Outcome Outcome 

H (2002)96 RCT (SD/range): IG = 

47 (10) vs. CG = 

N-S IG (n = 9)– E-Acu:, 

insertion depth 20mm. 

instruments: 

Pain: VAS 

instruments: 

QoL/ well being: 

Country: Tx duration: 2 wks 43 (13) yrs e-stimulation was (100mm)- average NR 

Japan Final assessments: 

imm. Post-tx % of male: IG = 

11%, CG = 20% 

Duration of 

Pain: Chronic, 

applied to the inserted 

needles freq of 1 Hz/15 

min- then adjusted to 

during the 

intervention period 

Results: 

Baseline: 

Quality N screened: 21 IG = 7.9 (5.4), max tolerable level, Disability: JOA Immediate post tx: 

score: 7/13 N randomized: 19 

N completed tx: 19 

N attended last fu: 19 

Racial 

composition: 

Assuming 100% 

CG = 8.5 (9.05) 

yrs 

muscle contraction was 

observed. press tack 

needles were inserted 

Results: 

Baseline: 

Short term: NR 

Intermediate: NR 

Long term: NR 

Initial of Asian Severity of pain after EA at 4/8 chosen Pain: NR 

reviewer: SG Inclusion: LBP 

without sciatica, at 

least 2 wks history of 

pain and > 20 yrs of 

age 

Exclusion: 

radiculopathy of 

neuropathy, fracture, 

tumour, infection or 

internal disease, other 

general health 

problemsadn 

conflicting or ongoing 

txs. 

Work status: NR 

Other sociodemographics: 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

(Grading): NR 

Cointerventions:NR 

points in each session 

and left in situ for 

several ds; 2tx/wk for 2 

wks 

Drop outs: A = 1, B = 0 

CG (n = 10) – TENS:. 

EA was applied in the 

same manner as IG. 

After each session a 

poulitice containing 

methy salicylic acid, 

menthol and 

antihistamine was 

prescribed to be applied 

at home in between 

treatmetns to the low 

back region; same as IG 

Drop outs: A = 0 

B=0 

Disability: IG = 16.3 

(2.3), CG = 15.6 

(3.7) 

Immediate post tx: 

Pain: IG = 56 (10), 

CG = 78 (10) 

Disability: IG = 18.6 

(0.6), CG = 15.8 

(1.2) 

Short term: NR 

Intermediate: NR 

Long term: NR 

Harms: One case 

of each: IG- (n = 5) 

transient 

aggravation, 

discomfort due to 

ress tack needles, 

pain on needle 

insertion, small 

subcutaneous 

bleeding; CG – (n = 

3) transient 

aggravation , 

transient fatigue, 

itching with 

electrode 

C-94
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zhang, Y 

(2007)97 

Trial Design 

RCTMean age (SD/range): IG1 = 

Cause of Pain: 

N-S 

Groups 

IG1 (n = 40) – E-acu: 

Outcomes: 

Pain: NR 

Outcomes: 

QoL/ well being: 

37.73(5.62); IG2 G6805 E-acu Therapy 

Country: Tx duration: 10 ds = 39.57 (7.35); Instrument; 4-6Hz, Disability: NA Other: NA 

China Final assessments: IG3 = 40.53 15min/d for 10 ds 

immediately post tx (8.27) yrs Drop outs: B= 0 Results: 

Duration of Baseline: NA Results: 

% of male: IG1 = Pain: IG2 (n = 40) – Acupoint Pain: NR Baseline: NA 

Quality N screened: 120 55; IG2 = 47.5; Unknown or injection of Danggui:NR; Immediate post tx: 

score: 4/13 N randomized: 120 IG3 = 60 mixed duration: 0.5-1ml/d for 10 ds Pain: NR Immediate post tx: 

N completed tx:120 IG1 = 2.32 yrs Drop outs: NR Disability: NA 

N attended last fu: NR Racial (0.54); IG2 = Short term: NR 

Initial of composition: NR 2.78yrs (0.53); IG3 (n = 40) – acupoint Short term: NR 

reviewer: SG IG3 = 2.92 yrs injection of O3: German Intermediate: NR 

Eligibility criteria: Work status: NR (0.26) instrument; 30ug/ml x 3­ Intermediate: NR 

- inclusion: Low back 5 ml/d for 10 ds Long term: NR 

pain Other socio- Drop outs: NR Long term: NR 

- exclusion: demographics: Severity of Harms: NR 

Osteoporotic; tumor; NR pain (Grading): 

Spondylolysis with NR Summary of 

spondylolisthesis;Supp Co morbidities: results (if 

urative inflammation NR Co- provided): 

interventions:N acupoint injection 

Prior episode of R of O3 is the best 

pain if acute: NR than other txs 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

C-95
 
Table 1.7 Low Back Pain - Acupuncture - Unknown - Specific Pain 

Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Lee, J 

(2007)98 

Trial Design 

RCT 

Mean age 

(SD/range): NR 

Cause of Pain: 

100% with 

Groups 

IG (n = 16)– KuesuOutcome 

instruments: 

Outcome 

instruments: 

radiating pain point acu: Acu on B25, Pain: Pain rating QoL/ well being: 

Country: Tx duration: 3 wks % of male: NR B26, & B60 with Kuesu scale (0 -100) NR 

Korea Final assessments: point (3-cun from the Results- mean: 

immediately post tx Racial Duration of sacrum center, Disability: NA Immediate post tx 

composition: NR Pain: Unknown, paralleled to the 4th Estimation Index of 

Quality N screened: 33 NR sacrum foramen) Results: Backache (0 – 

score: /13 N randomized: 31 Work status: NR Raising, thrusting, Immediate post tx: 100): 0.45 vs. 0.26 

N completed tx: 23 Severity of pain twirling or rot techniques Pain: 5.30 vs. 2.40 Difference between 

N attended last fu: NR Other socio­ (Grading): were used to gain "de- before and after tx 

Initial of demographics: NR Qi". Needles inserted 4­ Disability: NR (after- before): 38.8 

reviewer: SG Eligibility criteria: NR 5cun 90° relative to skin vs. 19.0 

- inclusion: Female Pts Co­ surface; 4-5 tx/wk for Short term: NR 

20-50 yrs old with LBP Co morbidities: interventions:NR 3wks, needle inserted Pain elimination 

and accompanied NR for 11 min. Intermediate: NR ratio (%): 73.3% vs. 

sciatic neuralgia Drop outs: A = 2 40.0% on ROM 

Prior episode of B = 6 Long term: NR test; 53.3% vs. 

- exclusion: other S pain if acute: NR 20.0% on motor 

causes such as CG (n = 15) – Non test, and 66.7% vs. 

fracture, tumor or Prior CAM Kuesu-point acu: Acu on 30.0% on walking 

infection of lumbar, intervention: NR same points as IG on heel test. 

cauda equina without Kuesu point. On 

syndrome, B25, B26; Short term: NR 

spondylolisthesis, Prior surgery same as IG Intermediate: NR 

spondylosis grade II- related to current Drop outs: NR Long term: NR 

IV, osteoporosis, complaint: NR 

scoliosis, health Harms: NR 

examination, CLBP 

due to heavy labour. 

C-96
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Li, Y 

(2006)99 

Trial Design-RCT Mean age 

(SD/range):NR 

Region of pain: 

LBP 

Groups 

IG (n = 40)– 

Outcomes 

(describe 

Outcomes 

(describe 

Tx duration: 1 month years Cause of Pain: Acupuncture, by instrument used): instrument used): 

Country: Fu duration (last Specific: therapist at Shenshu Curative rate No other relevant 

China assessment): % of male: NR prolapsed disc (BL23), Dachangshu (markedly cured) outcomes reported 

immediately post tx (BL 25), Baliao (BL 31, Pain (VAS) 

Racial Duration of 32, 33, 34), Zhibian (BL 

Quality N screened: NR composition: Pain, mean 54) combined with 

score: /13 N randomized: 77 assumed all Asian (SD/range): polarized light – ResultsN completed tx: 77 NR treatment duration: 1 

N attended last fu: 77 Work status: NR month Immediate post tx: 

Initial of (attrition NR) Severity of pain Pain-mean: 

reviewer: FY Other socio­ (Grading): NR Baseline: 6.05 

Inclusion: adult demographics: No CG (n = 37) – (1.18) vs. 5.95 

without any major data reported Western medication: (1.22) 

complications and Current Dikelake (75 mg) once Post tx: 2.28 (0.95) 

diagnosis of prolapsed Co morbidities: treatment/ co­ daily—total treatment vs. 3.49 (1.45)—p < 

lumbar inter vertebral NR intervention duration = 1 month 0.05 

disc common in all 

Prior episode of groups: NR % of pts with 

Exclusion: NR pain if acute: NR markedly cured 

status: 95% vs. 

Prior CAM 75% 

intervention: NR Short term: NA 

Prior surgery Intermediate: NA 

related to current 

complaint: NR Long term: NA 

C-97
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Wang, Z 

(2009) 100 

Trial Design 

RCT 

Mean age 

(SD/range): IG = 

Cause of Pain: 

Sciatica 100% 

Groups 

IG (n = 70)– E-Acu: acu 

Outcome 

instruments: 

Outcome 

instruments: 

68 (3.5) vs. CG = with radiating points such as BL 24, Pain: NA QoL/ well being: 

Country: Tx duration: 2 course 67 (3.7) yrs pain BL 25, BL 26; 2 courses cure rate (QoL) at 

China NR (possible 5-7 ds in each Disability: NA the end of each 

Final assessments: % of male: IG = course) course 

immediately post tx 58.8%, CG = 59% Duration of Drop outs: NR Results: 

Quality Pain: NR Baseline: Results: 

score: /13 Racial CG (n = 69) – TENS: Pain: NA Immediate post tx: 

N screened: NR composition: Severity of pain skin electrode sticking at Disability: NA % improved: IG = 

N randomized: 139 Asian (Grading): NR the PPT point of the 80%, CG = 44.9% 

Initial of N completed tx: NR nerve trunk connected Immediate post tx: Short term: NR 

reviewer: SG N attended last fu: NR Work status: NR with pulse current AN 

Co- Drop outs: NR Pain: Intermediate: NR 

Other socio­ interventions: Disability: 

Inclusion: pts with demographics: NR Long term: NR 

senile radical xciatica NR Short term: NR 

Harms: NR 

Exclusion: NR Co morbidities: Intermediate: NR 

NR Summary of 

Long term: NR results (if 

Prior episode of provided): end of 

pain if acute: NR 1st course the 

cured rate was 

Prior CAM 41.1% vs. 29% 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

C-98
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Wu, Y 

(2004)101 

Trial Design 

RCTMean age (SD/range): 

Cause of Pain: 

Disc/joint 

Groups 

IG1 (n = 100) – E-acu: 

Outcomes: 

Pain: NA 

Outcomes: 

QoL/ well being: 

NR disease at Shiqizhui, well being, B, using 

Country: Tx duration: 20 ds % of male: NR yaoyangguan, huantiao, Disability: NA both Chinese and 

China Final assessments: Duration of yanglingquan (affected Western diagnostic 

immediately post tx. Racial Pain: side) + geshuxue + Results: and therapeutic 

composition: NR hegu + yinlingquan (two standard for 

Asian sides) for pts with cold Baseline: NA Lumbar 

Quality N screened: Not Severity of dampness and hot Pain: NA intervertebral disc 

score: 4/13 mentioned Work status: pain (Grading): dampness; + sanyinjiao protrusion 

N randomized: 300 NR NR for liver and kidney Immediate post tx: 

N completed tx: NR deficit. retention 20 min; NA Results: 

Initial of N attended last fu: NR Other socio- Co- 1 tx/d, 10 tx/course, 5 ds Pain: NA Immediate post tx: 

reviewer: SG demographics: interventions: 

NR 

between courses x 2 

courses, after 1st course 

Disability: NA IG1 = 88%, IG2 = 

72% , CG = 76% 

Eligibility criteria: Co morbidities: add lumbar traction Short term: NR improved 

- inclusion: diagnosed NR (5min, 1tx/d, 10tx) 

as lumbar Drop outs: unknown Intermediate: NR Short term: NR 

intervertebral disc Prior episode of 

protrusion, 25-60 yrs, pain if acute: NR IG2 (n = 100) – Acu: Long term: NR Intermediate: NR 

stransverse oscillatory same as IG1; same as 

rot using other tx or Prior CAM IG1 Long term: NR 

medicine, signed intervention: NR Drop outs: unknown 

consent form Harms: NR 

- exclusion: pts with CG (n = 100)– Medicine: 

spondylolysis, Prior surgery fenbid 75 mg/time; 1 

infection, all body related to current tx/d,10tx/ course, 5 ds 

collagen immune complaint: NR between courses x 2 

disease using courses 

glucocorticoid, pts Drop outs: unknown 

whose symptoms 

became worse during 

the study. 

C-99
 
Table 1.8 Low Back Pain - Acupuncture - Unknown - Non-Specific Pain 

Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Edelist, G Trial Design Mean age Cause of Pain: Groups Outcome Outcome 

(1976)102 RCT (SD/range): NR Disc disease IG (n = 15)– Acu: 

needles inserted 

instruments: 

Pain: Patients with 

instruments: 

QoL/ well being: 

Country: Tx duration: 2 ds % of male: NR bilaterally(Ta-ch'ang-yu: no pain measured NR 

Canada Final assessments: 

immediatedy post tx Racial 

composition: NR 

Duration of 

Pain: 

3.6 cm lateral to the 

midline at a level 

between the 4th and 5th 

by VAS 

Disability: NR 

Results: 

Baseline: NA 

Quality N screened: NR NR lumbarvertebrae- and Immediate post tx: 

score: 2/13 N randomized: 30 

N completed tx: NR 

N attended last fu: 

Work status: NR 

Other socioSeverity of 

pain (Grading): 

the distal margin of the 

gastrocnemius muscle); 

needles were manip. 

Results: 

Immediate post tx: 

n (%) of pts with no 

Short term: NR 

Initial of NR demographics: NR until Te Chi was elicited- pain: IG = 7 Intermediate: NR 

reviewer: SG 

Inclusion: Pts with 

disc disease- not 

responding to 

conventional therapy 

including bed rest, 

analgesics, heat, and 

PT 

Exclusion: NR 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

Cointerventions: 

NR 

needles then attached to 

ES G68.5 and set to 

stimulate at a freq of 3­

10 Hz with an intensity 

tolerable to pts. Needles 

were stimulated for 30 

sec then removed; 3 tx 

over 2 ds 

Drop outs: NR 

CG (n = 15) – Sham 

acu: needles as IG 

inserted at level of L4-5 

bilaterally, 15cm lateral 

to midline, needle in 

each leg 10cm below 

politeal fossa, 6cm 

lateral to midline, 

stimulated as IG; same 

as IG 

Drop outs: NR 

(46.7%), CG = 6 

(40%) 

Short term: NR 

Intermediate: NR 

Long term: NR 

Long term: NR 

Harms: NR 

C-100
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Garvey, TA 

 (1989)103 

Trial Design 

RCT 

Mean age 

(SD/range): total 

Cause of Pain: 

Mechanical 

Groups 

IG1 (n = 13)– TP 

Outcome 

instruments: 

Outcome 

instruments: 

38 yrs strain lidocaine injection; Pain: Pain QoL/ well being: 

Country: Tx duration: 1 tx, NR one time tx improvement- NR 

U.S Final assessments: 3 % of male: 65.1% Duration of Drop outs: 3 improved at C 

mo total Pain: NR (ITT); Pain 

IG2 (n = 14) – TP: 0.75 improvement- Results: 

Quality N screened: NR Racial Severity of ml of 1% lidocaine and improved at C 

score: 7/13 N randomized: 63 composition: NR pain (Grading): 0.75 ml of Aristospan (completers only) Immediate post tx: 

N completed tx: 63 NR (20 mg/ml), using a 21­ NA 

N attended last fu: 63 Work status: NR gauge needle after and Results: 

Initial of Co- isopropyl alcohol wipe; Immediate post tx: Short term: NR 

reviewer: SG Inclusion: pts treated Other socio­ interventions:h one time tx NR 

for strain LBP (defined demographics: ot shower twice Drop outs: 3 Short term: Intermediate: NR 

as non-radiating pain NR a d and Pain: 

with normal neurologic restricted IG3 (n = 20) – Dry IG1 = 31%, IG2 = Long term: NR 

examination, absence Co morbidities: physical activity- needling injection: single 26%, IG3 = 55%, 

of tension signs and NR causioned dry needle stick (i.e. CG = 50%; IG1 = Harms: NR 

normal lumbosacral against starting acu) with a 21 gauge 40%, IG2 = 45%, 

roentgenograms) with Prior episode of any EX needle after and IG3 = 61%, CG = 

nonsteriodal anti- pain if acute: NR program, same isopropyl alcohol wipe; 66% 

inflammatory agents, in all groups one time tx 

hot showers 2xd, and Prior CAM Drop outs: 2 Intermediate: NR 

avoidance of activity intervention: NR 

that might aggrevate CG (n = 16) – Long term: NR 

the pain for 4 wks Prior surgery Ethylchloride spray, 

(initial run in period) related to current followed by 20 seconds 

complaint: NR of acupressure using the 

Exclusion: NR plastic needle guard; 

one time tx 

Drop outs: 4 

C-101
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Inoue, M 

(2001)104 

Trial Design 

RCT 

Mean age 

(SD/range): IG = 

Cause of Pain: 

Lumbago 

Groups 

IG (n = 10)– Acu: one 

Outcome 

instruments: 

Outcome 

instruments: 

55.1 (18.8) vs. needling point chosen Pain: VAS of(100 QoL/ well being: 

Country: Tx duration: single tx CG = 56.3 (18.2) Duration of from lumbar area: most mm) pain at the 

Japan Final assessments: yrs Pain: NR painful locus detected. most restricted Results: 

immediately post tx Needles inserted and action Immediate post tx: 

% of male: NR Severity of pain sparrow-picking NA 

Quality N screened: 21 (Grading): NR technique performed for Results: Short term: NR 

score: 10/13 N randomized: 16 Racial 20 sec. pts treated once Baseline: 

N completed tx: 16 composition: Co­ time immediately before Pain: IG = 72.2 Intermediate: NR 

N attended last fu: NR Asian interventions: regular acu tx; single tx (19), CG = 68.2 

Initial of NR Drop outs: 0 (12.8) Long term: NR 

reviewer: SG Inclusion: Pts with Work status: NR 

lumbago who attended CG (n = 6) – Sham Acu: Immediate post tx: Harms: NR 

the university acu Other socio- One needling point was Pain: IG = 37.3 

clinic as outPt and demographics: chosen from lumber (24.4), CG = 64.1 Summary of 

gave consent to attend NR area: most painful locus (13.5) results (if 

to the trial. was detected, as same provided): There 

Exclusion: other S Co morbidities: as RA group, mimicked Short term: NR was difference 

causes, systemic NR needle insertion: tapped between the IG and 

problems; pts who head of needle guide Intermediate: NR CG 

can’t stransverse Prior episode of tube, and then gesture 

oscillatory rot pain if acute: NR of needling was Long term: NR 

conflicting /ongoing tx; performed for 20 sec. 

problem of general Prior CAM Pts were treated one 

condition; (8) intervention: NR time immediately before 

dementia; pregnancy regular acu tx; single tx 

Prior surgery Drop outs: 0 

related to current 

complaint: NR 

C-102
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Kawase, Y 

(2006)105 

Trial Design 

RCT 

Mean age 

(SD/range): IG1 = 

Cause of Pain: 

N-S 

Groups 

IG1 (n = 12)– Body Acu 

Outcome 

instruments: 

Outcome 

instruments: 

47.2 (17.6), IG2 = pole tx + low freq. acu: Pain: Therapeutic QoL/ well being: 

Country: Tx duration: NR 57.8 (13), IG3 = CV12, LR14, ST25, effectiveness (VAS) NA 

Final assessments: 54.5 (16.3), CG = CV6, BL10, GP20, Disability: Activities 

immediately post tx 51.7 (18.1) yrs Duration of BL11, GB21, BL13, BL of daily living Results: 

Pain: NR, IG1 = 14, BL 20, BL23, BL25, (numeric data not Immediate post tx: 

Quality N screened: NR % of male: IG1 = 51 (65), IG2 = point therapy: BL40, shown) NA 

score: 10/13 N randomized: 64 42%, IG2 = 77%, 48 (49.8), IG3 = Low freq. acu: BL23(-) Short term: NR 

N completed tx: 64 IG3 = 60%, CG = 47.4 (74.1), CG to BL40(+), 5Hz, 2V, 5 Results: 

N attended last fu: NR 47% = 49.3 (69.9)- min, depth 5-7 mm; 1 tx Immediate post tx: Intermediate: NR 

Initial of (not sure if Drop outs: 0 Pain: 51.0 (65.0) 

reviewer: SG Inclusion: NR Racial values vs. 48.0 (49.8) vs. Long term: NR 

composition: NR measured in d, IG2 (n = 13) – Body acu 47.4 (74.1) vs. 49.3 

Exclusion: Those who wks, mo, or yrs)­ pole tx: sham (69.9) Harms: NR 

do not have good Work status: NR SG acu:BL20, BL23, BL25; 

overall physical status NR Disability: NR Summary: 

Those who were found Other socio- Severity of pain Drop outs: 0 Significant 

inappropriate for acu demographics: (Grading): NR Short term: NR improvement 

therapy (based on NR IG3 (n = 20) – Low freq. (p<0.05) in pain (in 

hand examination Co­ acu: 30mm No18. or Np Intermediate: NR terms of VAS 

(e.g., those with Co morbidities: interventions: 20 disposal stainless scores) and ADL 

pathological reflex, NR Point therapy steel needle; NR Long term: NR (in terms of JOA 

pain while resting, pain (BL40) Drop outs: 0 scores) was found 

when needling) Prior episode of for all groups 

pain if acute: NR CG (n = 19) – Sham except for CG 

Acu: NR – possibly 

Prior CAM same as IG2-SG; NR 

intervention: NR Drop outs: 0 

Prior surgery 

related to current 

complaint: NR 

C-103
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Kurosu, Y Trial Design Mean age Cause of Pain: Groups Outcome Outcome 

(1979 RCT (SD/range): Non-S IG 1a (n = 10) Acu: instruments: instruments: 

&1980)106 

Tx duration: NR 

majority range 40 

- 50 yrs Duration of 

needles retained for 10 

min in 6-8 points in LB 

Pain: Pain recovery 

score by 

QoL/ well being: 

NR 

Country: Final assessments: 3 Pain: NR region: BL23, 24 25, 26, questionnaire: 2nd 

Japan mos 

N screened: 20 

% of male: IG 1 & 

2a = 50%, IG 1 & 

2b = 55% 

Severity of pain 

(Grading): NR 

27, 31, 52, and 3 extra 

points,needles (50 mm x 

0.25 mm) inserted at 

visit before 2nd tx; 

4th visit before 4th tx 

Results: 

Immediate post tx: 

NR 

Quality N randomized: 20 depth of 2-4 cm Results: 

score: 3/13 N completed tx: 20 

N attended last fu: 20 

Racial 

composition: 

Asian 

Cointerventions:NR 

depended on const. of 

pts; 1b (n = 10) – same 

as 1a + needle retention 

Immediate post tx: 

NR 

Short term: NR 

Intermediate: NR 

Initial of Inclusion: Pts with in abdominal points Short term: IG 1a = 

reviewer: SG LBP or the LB and 

sacral region. 

Exclusion: NR 

Work status: NR 

Other sociodemographics:NR 

Co morbidities:NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

CVF4, 12 and bilateral 

ST25, depth of insertion 

1-1.5 cm for 10 min.; NR 

Drop outs: 0 

CG 2a (n = 10) Garlic 

moxibusion(acu?): same 

points as IG, detail NR, 

put garlic on surface of 

body and burn moxa on 

that; 2b (n = 10) –simple 

needle insertion: needle 

inserted and removed at 

same points as IG 

+needle retention as IG 

1b ; NR 

Drop outs: 0 

0.58 (0.64), 1b = 

1.18 (0.747), CG 

2a = 0.42 (0.66), 2b 

= 0.22 (0.253) ; IG 

1a = 0.865 (0.799), 

1b = 0.625 (0.648), 

CG 2b = 0.22 

(0.253) 

Intermediate: NR 

Long term: NR 

Long term: NR 

Harms: NR 

Summary: In tx of 

LBP, eedle 

retention technique 

was much superior 

to simple needle 

insertion technique. 

C-104
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Mencke 

(1988)107 

Trial Design 

RCT 

Mean age 

(SD/range): Both 

Cause of Pain: 

N-S + disc 

Groups 

IG (n = 40)– Typical 

Outcomes: 

Pain: VAS Pain 

Outcome 

instruments: 

grps together: herniation AP: Needles were scale QoL/ well being: 

Country: Tx duration: 3 wks 49.4, Range 29­ placed within the NR 

Germany Final assessments: 8 79 Duration of affected segment near Results: 

wks Pain: unknown AP and TPs; 6 tx Immediate post tx: Results: 

% of male: 49.3% sessions over 3 wks, 6­ Pain: 41.0 vs. 83.0 Immediate post tx: 

Quality N screened: 75 Severity of 12 needles/session, AP Disability: 0.0043, NR 

score: 9/13 N randomized: 75 Racial pain (Grading): needles 0.2-3cm depth vs. 0.0461 

N completed tx: 75 composition: NR VAS (0-10) but Drop outs: none (abduction), IG = Short term: NR 

N attended last fu: NR 0.0044, CG = 

Initial of NR Work status: NR CG (n = 35) – Atypical 0.001(anteversion), Intermediate: NR 

reviewer: SG Co- AP: Needles were IG = 0.0177, CG = 

Other socio­ interventions: placed within the 0.0757(retroversion Long term: NR 

Inclusion: Pts have demographics: none affected segment but far ), IG = 0.0567, CG 

Exclude: previously been NR away from AP and TPs; = 0.4609 (outer Harms: NR 

Shoulder treated unsuccessfully Session 1: 5 mins, rot), IG = 0.0001, 

and Back (GP, orthopedic, Co morbidities: session 2: 10 mins, CG = 0.2324 (inner Summary: highly 

physiotherapist), no No session 3: 15 mins, rot),IG = 8.0, CG = signif. differences 

involvement in other session 4 +>: 20 mins -0.3 (anteversion of in improvement 

therapies Prior episode of Drop outs: none head) between typically & 

pain if acute: NR Short term: NR atypically treated 

Exclusion: NR Pts 

(anyone not meeting Prior CAM Intermediate: NR 

inclusion criteria) intervention: NR Long term: NR 

Prior surgery 

related to current 

complaint: NR 

C-105
 
Table 1.9 Low Back Pain - Manipulation – Acute/Sub-acute - Specific Pain – No Studies 

Table 1.10 Low Back Pain – Manipulation – Acute/Sub-acute - Non-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Alaksiev, A 

(1996)108 

Trial Design-RCT Mean age 

(SD/range): NR 

Cause of Pain: 

N-S 

IG1 (n = 22) – High 

velocity, low 

Outcomes: Outcomes: 

QoL/ well being: NR 

Tx duration: 20 ds amplitude technique: Disability: NA 

Country: Final assessments: % of male: Duration of NR; 2-4 sessions, 20 Results: 

Bulgaria immediately post tx balanced Pain: Acute, ds Results: 

Sub-acute, NR Drop outs: NR Baseline: Immediate post tx: 

N screened: 64 Racial Disability: NR NA 

Quality N randomized: 65 composition: NR Severity of pain IG2 (n = 21) – Postscore: 3/13 N completed tx: NR (Grading): NR isometric relaxation; Immediate post tx: Short term: NR 

N attended last fu: NR Work status: NR 12 sessions Disability: 

Drop outs: NR Intermediate: NR 

Initial of Inclusion: NR Other socio- Co- Short term: NR 

reviewer: SG demographics: interventions:NR CG (n = 21): shame Long term: NR 

Exclusion: NR NR manipulation; 2-4 tx Intermediate: NR 

Harms: NR 

Co morbidities: Long term: NR 

NR 

No numeric data 

Prior episode of given 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: None 

C-106
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hadler NM Trial Design-RCT Cause of Pain: IG (n = 28) – Outcomes: Outcomes: 

(1987)109 

Tx duration: NR 

Mean age 

(SD/range):NR(tr 

NS Mobilization: Pt was 

positioned first on the 

Pain: NR 

Disability: RMDQ 

QoL/ well being: NR 

Country: Final assessments: ial intended for a Duration of right and then on the Results: 

US immediately post tx 

N screened: 57 

younger adults) 

% of male: 48% 

Pain: Acute  2 

wks: n = 13 

left side; the operator 

grasped both knees 

with one arm while 

Results: 

Immediate post tx: 

Disability: IG = 9.1 

Immediate post tx: 

NA 

Quality N randomized: 54 total Severity of pain pressing down on the (5.3), CG = 3.9 Short term: NR 

score: 7/13 N completed tx: NR 

N attended last fu: NR Racial 

composition: NR 

(Grading): NR on the pts’ lower 

spine with the 

opposite hand; then 

(4.3) 

Short term: NR 

Intermediate: NR 

Initial of Inclusion: Pts aged 18­ Co­ the subjects legs Long term: NR 

reviewer: SG 40 yrs with acute LBP (

1 mo), no other episode 

of back pain in previous 6 

mo, not work-related 

pain, no previous surgery 

Exclusion: NR 

Work status: NR 

Other sociodemographics: 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: None 

interventions:NR were gently flexed on 

the hips twice; NR 

Drop outs: NR 

CG (n = 26) – 

Manipulation: Pt was 

positioned on right, 

then on the left side; 

then pt positioned in 

a spinal rot position, 

shoulders and the 

face up to the ceiling 

and pelvis rotated 

down toward the 

table; a long lever 

HV thrust was 

applied to the lower 

spine while 

stabilizing the thorax; 

NR 

Drop outs: NR 

Intermediate: NR 

Long term: NR 

Harms: NR 

Summary: 

Manipulation was 

more effective than 

Mob at reducing 

disability score in the 

first wk of tx (time 

and tx interaction 

significant p < 0.04) 

for those with 

duration of pain for 

2-4 wks (longer pain 

duration at entry) 

C-107
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hoiriis K 

(2004)110 Trial Design-RCT Mean age 

(SD/range): IG1 

Cause of Pain: 

N-S 

Groups 

IG1 (n = 50)– Chiro 

Outcomes: 

Pain: VAS (10 cm) 

Outcome 

instruments: 

Tx duration: 2 wks = 42.2 (9.7), IG2 adjustments and Disability: Oswestry QoL/ well being: NR 

Country: Final assessments: 3 = 40.5 (10.1), Duration of medical placebo: 

Mariette, GA mos CG = 43.1 (9.8) Pain: Sub-acute, upper cervical and Results- Results: 

yrs IG1 = 3.7 (1.3), lumbar, sacral, or Immediate post tx: Immediate post tx: 

N screened: 535 IG2 = 3.6 (1.5), pelvic adjustments Pain: IG1 = 2.44 NA 

Quality N randomized: 156 % of male: CG = 3.8 (1.4) performed manually (2.22), IG2 = 2.73 

score: 8/13 N completed tx: 110 56.7% total wks with HVLA thrust; 7 (2.15), CG = 3.18 Short term: NR 

N attended last fu: 110 visits of chiro, 2 wks (2.4) 

Racial Severity of pain Drop outs: NR Disability: IG1 = Intermediate: NR 

Initial of Inclusion: 21 - 59 yrs old composition: NR (Grading): NR 17.02 (13.75), IG2 

reviewer: SG with uncomplicated LBP IG2 (n = 53)– = 16.99 (12.18), Long term: NR 

of 2 - 6 wks duration Work status: NR muscle relaxants and CG = 19.35 (13.7) 

Co­ sham adjustments: Harms: NR 

Other socio­ interventions:NR designed to mimic Short term: 

Exclusion: Previous demographics: chiro adjustments; 2 VAS: IG1 = 1.71 

spinal surgery, spinal NR capsules, 3 times (1.88), IG2 = 2.24 

fractures, spinal stenosis, Co morbidities: daily from A, B, C, D (2.23), CG = 2.21 

and known or suspected NR bottles, 2 wks (2.02) 

disk herniation; previous Prior episode of Drop outs: NR ODQ: IG1 = 11.94 

LBP within 18 mos; pain if acute: IG1 (11.93), IG2 = 

neuropathy; spondylitis; = 0.36 (0.6), IG2 CG (n = 53) – 16.04 (16.12), CG 

vascular disease; = 0.46 (0.64), medical placebo and = 16.32 (12.95) 

malignant disease; CG = 0.58 (0.67) sham adjustments: 

cervical complaint; same as IG1 and Intermediate: NR 

pregnancy; and personal Prior CAM IG2; 

injury litigation. intervention: NR Drop outs: NR Long term: NR 

Prior surgery 

related to current 

complaint: NR 

C-108
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hsieh, C 

(2002)111 Trial Design-RCT Mean age: 48 

yrs 

Cause of Pain: 

N-S 

Groups 

CG (n = 48)– Back 

Outcomes: 

Pain: VAS 

Outcome 

instruments: 

Tx duration: 3 wks school program: Disability: Roland QoL/ well being: NR 

Country: Final assessments: 6 % of male: Duration of videos; instructions Morris activity sclae 

California, mos 65.4% Pain: Sub-acute, and supervised 

US CG = 10.7 (6.6), home programs Results- Immediate post tx: 

N screened: 206 Racial IG1 = 11.8 (6.8), 1 x/wk for 3 wks Immediate post tx: NA 

N randomized: 200 composition: IG2 = 11.8 (7.2), Drop outs: mB = 6 Pain: CG = 2.13 Short term: NR 

Quality N completed tx: 184 White: 71.7% IG3 = 11.5 (7.2) (1.28), IG1 = 2.78 Intermediate: NR 

score: 4/13 N attended last fu: 178 wks IG1 (n = 51) – (1.82), IG2 = 2.58 Long term: NR 

Work status: NR Myofascial therapy: (1.93), IG3 = 2.04 

Inclusion: 18 yrs or Severity of pain sprays and stretches (1.35) Harms: 23 pts 

Initial of older, LBP duration of Other socio­ (Grading): NR after isometric Disability: CG = reported adverse 

reviewer: SG more than 3 wks-6 mo for demographics: contraction at 50- 4.26 (3.52), IG1 = effects from txcurrent episode or a pain- NR Current tx/ co­ 70% MVC; 3 x/wk for 5.8 (5.12), IG2 = mostly transient 

free period of at least 2 intervention: 3 wks 4.42 (4.92), IG3 = exacerbations of 

mo in preceding 8 mo for Co morbidities: 10% reported Drop outs: 2 3.73 (3.76) symptoms, n = 2 

recurrent NR use of otc pain claimed that IG2 

Exclusion: pregnancy; Meds. 6 pts IG2 (n = 49) – SM Short term: NR aggravated 

serious medical Prior episode of reported 8 visits manipulation: HVLA symptoms, n = 1 

problems, definable pain if acute: NR to health care maneuver in the Intermediate: Pain: constant tinnitus in 

neurologic abnormalities practitioners. lumbar / sacroiliac CG = 2.29 (1.98), IG1 

in the lower extremities; Prior CAM Among these Drop outs: B = 3,D = IG1 = 2.99 (2.28), 

spine disorders with bony intervention: NR visits, 2 were 5 IG2 = 2.4 (2.41), 

lesions, with radiographs related to LBP. IG3 = 2.24 (2.01) 

were taken as clinically Prior surgery IG3 (n = 52) – SM + RMAS: CG = 3.48 

indicated; sign. mental related to current myofascial therapy (3.86), IG1 = 5.06 

disorders; obesity; leg complaint: NR Duation as other (4.78), IG2 = 3.29 

pain with positive nerve grps (4.73), IG3 = 3.56 

root tension; history of Drop outs: B = 4 (3.46) 

lumbar surgery 

Long term: NR 

C-109
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Morton, J Trial Design-RCT Mean age (SD): Cause of Pain: Groups Outcome Outcome 

(1999)112 

Tx duration: 4 wks 

IG = 42.9 (9.1) 

vs. CG = 46.4 

Non-S IG (n = 15)– 

Manipulation + 

instruments: 

Pain: VAS (0 – 100) 

instruments: 

QoL/ well being: NR 

Country: Final assessments: 3 (9.0) yrs Exercise: HV thrust 

US mos 

N screened: NR 

% of male: IG = 

27%, CG = 43% 

Duration of 

Pain: Acute, NR 

to joint to briefly force 

beyond its restricted 

ROM or sudden HV 

Disability: RolandMorris Disability 

Results: NA 

Immediate post tx: 

Quality N randomized: 29 Severity of pain short-amp motion Results-Baseline: 

score: 4/13 N completed tx: 29 

N attended last fu: 29 

Racial 

composition: NR 

(Grading): NR 

Codelivered at 

pathological limit of 

accessory ROM to 

Pain: IG = 49.73 

(23.62), CG = 

46.57 (25.1) 

Short term: NR 

Intermediate: NR 

Initial of Inclusion: 18-70 yrs with Work status: NR interventions:NR gap the joint, Disability: IG = 10.6 

reviewer: SG acute mechanical LBP of 

approx. 4 wks or less. 

Pain located between 

T12 and the gluteal fold 

(might radiate to one 

lower limb) 

Exclusion: 

Contraindications for 

manipulations neoplastic 

disease, bone disease, 

inflammatory arthritis, 

advanced diabetes 

mellitus, vascular 

abnormalities, visceral 

arterial disease, 

congenital generalized 

hypermobility, severe 

nerve root pain, 

claimants. 

Other sociodemographics: 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

manipulation L1­

L5/L5-S1 traction 

gap, EXs designed to 

re-educate multifidus 

musculature in its 

stabilizing role; 8 tx, 

4 wks 

Drop outs: NR 

CG (n = 14) – 

Exercise: Same as 

IG, training in handsknee position, 

gradually to standing 

position with lumbar 

spine in neutral and 

enhanced by use of 

pelvic stabilizer; 

same as IG 

Drop outs: NR 

(5.23), CG = 10.07 

(6.4) 

Immediate post tx: 

Pain: IG = 2.4 (3), 

CG = 25.43 (17.34) 

Disability: IG = 1.93 

(2.52), CG = 6 

(5.22) 

Short term: AVASIG = 0 (0), CG = 

13.57 (9.4) 

RMD: IG = 0.33 

(0.82), CG = 3.64 

(2.8) 

Intermediate: NR 

Long term: NR 

Long term: NR 

Harms: NR 

Summary: Pts who 

receive manipulation 

with EXs for acute 

LBP of mechanical 

origin will improve 

more and faster than 

pts who receive an 

EX program alone. 

C-110
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Pope, M 

(1994)113 Trial Design-RCT Mean age 

(SD/range): 32 

Cause of Pain: 

NS 

Groups 

IG (n = 60)– 

Outcomes: 

Pain: 10 cm VAS 

Outcome 

instruments: 

Tx duration: 3 wks yrs Manipulation: Disability: QoL/ well being: NR 

Country: Final assessments: 3 wks Duration of dynamic short level, Other: ROMUS % of male: 62% Pain: Mix HVLA thrust on Results- modified Schober’s 

N screened: NR lumbar spine/ Immediate post tx test: Flexion; 

Quality N randomized: 150 Racial Severity of pain sacroiliac joint; 3 (after 4 wks): ExtensionImmediate 

score: 5/13 N completed tx: 148 composition: NR (Grading): NR x/wk for 3 wks Pain change from post tx: 

N attended last fu: 148 Drop outs: B = 17 baseline: IG = -24.1 -mean change: IG = 

Work status: NR (27), CG = -17.2 0.38 (1.25), CG = ­

Initial of Inclusion: ages 18-55 Co- CG (n = 30) – Soft­ (25.1), IG2 = -9.6 0.08 (1.2), IG2 = ­

reviewer: SG yrs; general good health; Other socio­ interventions:NR tissue massage: (30), IG3 = -15.9 0.02 (0.82), IG3 = 

LBP between 3 wks-6 demographics: Effleurage conducted (27) 0.33 (0.93); 

mo; free from LBP for NR with Pt in prone VAS at 4 wks, IG = -0.29 (0.59), 

minimum 3 wks position; 15 min/tx, 3 mean: IG = 8.61; CG = -0.32 (0.63), 

Co morbidities: x/wk for 3 wks CG = 7.23; IG2 = IG2 = 0.63 (0.89), 

Exclusion: pregnancy; NR Drop outs: B = 10 6.86; IG3 = 5.28 IG3 = -0.27 (0.72) 

sciatica; neurologic 

deficits, loss of sensation, Prior episode of IG2 (n = 30) -TMS: Short term: NR 

strength and reflex; no pain if acute: NR max 91 mA, 4 Intermediate: NR Short term: NR 

prior vertebral fracture, electrodes on back in Long term: NR Intermediate: NR 

tumor, infection or Prior CAM area, for 8 hrs/d; 1 Long term: NR 

spondyloarthropathy; no intervention: NR hr at a time; 1x/wk 

prior back surgery; for 3 wks Harms: NR 

Davenport weight index Drop outs: B = 10 

greater than 33; no prior Prior surgery 

MT for this episode of related to current IG3 (n = 30) – Lumbo 

LBP complaint: NR sacral corset r max. 

10 min at a time, 3 

x/d; 1x/wk for 3 wks 

Drop outs: B = 6 

C-111
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Postacchini Trial Design-RCT Mean age Cause of Pain: IG (n = 56) – Outcomes: Outcomes: 

(1988)114 (SD/range): IG = N-S Rotational Pain: % pts QoL/ well being: NR Tx duration: One session 30.1 (8.4) vs. CG manipulation: reporting pain 

Country: Final assessments: 3 mos = 32.1 (9.8) yrs Duration of Rotational (severity level) Other: Straight leg 

USA 

Quality 

N screened: 1880 

N randomized: 95 

N completed tx: 69 

% of male: 59% 

total 

Pain: 

Acute/Subacute, IG = 30 

manipulation of the 

lumbosacral spine; 1 

tx 

Disability: 

Results-Baseline: 

raising (°) 

Immediate post tx: 

score: 3/13 N attended last fu: NR (27.7) ds, CG = Drop outs: NR Pain: NR Improvement: 3.3 vs. 

Racial 19.6 (20.4) ds Disability: NR – 0.5 

Inclusion: LBP; presence of composition: NR CG (n = 39) – Soft- Short term: 

Initial of palpatory cues indicating Severity of pain tissue massage; 1 tx Immediate post tx: Improvement 7.8 vs. 

reviewer: SG that manipulation might be Work status: NR (Grading): NR Drop outs: NR Pain: Pts reporting 8.8 

successful; absence of 

psychosocial problems that 

might affect tx outcome, 

absence of contraindications 

for vertebral manipulation; 

Other sociodemographics: 

NR 

Cointerventions:NR 

improvement in 

amount of pain 

84% in IG vs. 68% 

in CG 

Intermediate: NR 

Long term: NR 

absence of previous 

experience with Co morbidities: Disability:NR Harms: NR 

manipulative therapy. NR Short term: no pain

Exclusion: Pregnancy, data could be used. Summary: at 

previous experience with Prior episode of discharge there was manipulation, disability 

income, pending litigation, 

previous back surgery, 

obesity, drug or alcohol 

abuse, and pain not 

pain if acute: NR 

Prior CAM 

intervention: NR 

Intermediate: NR 

Long term: NR 

no significant 

difference between 

groups- tx was 

effective for 88% vs. 

treatable by manipulation of 86% of pts 

the lumbosacral area. 

Prior surgery 

related to current 

complaint: None 

C-112
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Postacchini 

(1988)115 Trial Design-RCT Mean age 

(SD/range): NR 

Cause of Pain: 

N-S 

IG1 (n = 87) – 

Manipulation: 

Outcomes: 

Mean improvement, 

Outcomes: 

QoL/ well being: NR 

Country: 

Tx duration: 

Final assessments: 6 % of male: Duration of 

standard technique; 

7 tx for 1st wk, then 2 

Results: 

Immediate post tx: Results:NA 

Italy mos 50.5% total Pain: Mixed, NR tx for up to 6 wks Not presented at 

this table. Immediate post tx: 

N screened: 459 Racial Severity of pain IG2 (n = 81) – Drug Short term: NA 

Quality N randomized: 398 composition: NR (Grading): NR therapy: Diclophenac Acute: 9.7 vs. 10.7 

score: 6/13 N completed tx: 375 “full dose”; 10-20 ds vs. 8.4 vs. 7.5 vs. Short term: NR 

N attended last fu: NR Work status: NR 7.3 Intermediate: NR 

Co­ IG3 (n = 78) – Chronic: 2.6 vs. 2.2 Long term: NR 

Initial of Other socio­ interventions:NR Physiotherapy: vs. 4.2 vs. 4.6 Harms: NR 

reviewer: SG Inclusion: Pts presenting demographics: massage, vs.1.2 

at two LB clinics, 17-58 NR electrotherapy, Acute with chronic Summary: in pts 

yrs infrared, etc.; 7 tx/wk history: 6.8 vs. 8.7 with acute 

Co morbidities: for up to 3 wks vs. 9.9 vs. 10.4 vs. improvement initially 

NR 5.4 observed in SM grp 

Exclusion: BP related to CG1 (n = 29) – Bed Acute with radiating (not at 6 mos fu, with 

neo-plastic or infectious Prior episode of rest: NR; 15-24 hrs pain: 9.2 vs. 8.7 vs. no diff between tx 

diseases of the spine, pain if acute: NR for up to 8 ds 6.0 vs. 5.7 vs. 5.1 grps); in pts with 

pregnancy, nursing Chronic with chronic pain best 

women, pts with serious Prior CAM CG2 (n = 50) – Back radiating pain: 6.2 result was achieved 

general diseases, intervention: NR school: NR; 4 vs. 7.5 vs. 6.4 vs. with PT at short term 

psychiatric disturbances, sessions in 1 wk 2.8 vs. 2.1 and BSP at 6 mos 

medico-legal litigation fu. 

Prior surgery CG3 (n = 73) – Intermediate: (data 

related to current Placebo gel: NR; 2 reported but not 

complaint: None tx/ds for up to 2 wks presented in this 

Drop outs: Total lost table) 

to follow-up = 23 

Long term: NR 

C-113
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Rasmussen, 

G (1979)116 Trial Design-RCT Mean age 

(SD/range): 34.9 

Cause of Pain: 

NR 

Groups 

IG (n = 12) – Short 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: 2 wks (7.3) yrs (total) wave: NR; 3 Pain: Restoration (n QoL/ well being: NR 

Country: Final assessments: Duration of times/wk for 2 wks of pts with >50% 

Denmark immediately post tx, and % of male: 100% Pain: Acute, NR Drop outs: B = 2 pain reduction) Other: Schober’s 

1 yr (total) test 

Racial Severity of pain Disability: Immediate post tx: 

Quality N screened: NR composition: NR (Grading): NR CG (n = 12) – pts with 

score: 2/13 N randomized: 24 Manipulation: Results: improvement: 12 vs. 

N completed tx: 24 Work status: NR Rotational Immediate post tx: 6 

N attended last fu: NR Co­ manipulation in the Pain: IG = 3, CG = pts with no 

Initial of Other socio­ interventions:NR pain free direction; 11 improvement: 0 vs. 6 

reviewer: SG Inclusion: Male outPts, demographics: as IG Disability: NR 

20-50 yrs of age with NR 

LBP, without signs of root Short term: NR Short term: NR 

pressure; duration less Co morbidities: 

than 3 wks; no tx except NR Intermediate: NR Intermediate: NR 

analgesics prior to the 

trial Prior episode of Long term: NR Long term: all 

pain if acute: NR restored pts were 

free of sympomes 

Exclusion: Prior CAM for at least one yr 

contraindications to intervention: NR 

manipulation Harms: NR 

Prior surgery 

related to current 

complaint: NR 

C-114
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Sanders GE 

(1990)117 Trial Design-RCT Mean age 

(SD/range): NR 

Cause of Pain: 

NS 

Groups 

IG (n = 6)– SM: A 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: one tx single HVLA Pain: VAS QoL/ well being: NR 

Country: Final assessments: % of male: 50% Duration of adjustive SM at the 

US immediately post tx Pain: Acute, NR L4/L5-S1 spinal Results: Other: plasma 

Racial region; one tx Baseline: endorphin levels 

Quality N screened: NR composition: NR Severity of pain Drop outs: NR Pain: IG = 2.67 

score: 7/13 N randomized: 18 (Grading): NR (0.52), CG = 2.33 Results: 

N completed tx: NR Work status: NR CG (n = 6) – Sham: (0.52), CG2 = 2.17 Baseline: NA 

N attended last fu: NR light physical contact (0.41) 

Initial of Other socio- Co­ at the L4/L5-S1 Immediate post tx: 

reviewer: SG demographics: interventions:NR spinal region; one tx Immediate post tx: NA 

Inclusion: Pts with acute NR Drop outs: NR Pain: data 

LBP (< 2 wks) naïve to presented in Short term: NA 

chiropractic manipulation Co morbidities: CG2 (n = 6) – No tx; graphs- not used in 

and had not taken any NR NA; NA this report. Intermediate: NR 

pain Med for 48 hrs prior Drop outs: NR 

to the study enrollment Prior episode of Short term: NR Long term: NR 

pain if acute: NR 

Exclusion: NR Intermediate: NR Harms: NR 

Prior CAM 

intervention: NR Long term: NR Summary: there 

was a significant 

reduction of pain in 

Prior surgery manipulation grp but 

related to current not in the other grps 

complaint: NR 

C-115
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Shah, M 

(1989)118 Trial Design 

RCT 

Mean age 

(SD/range): NR 

Cause of Pain: 

N-S 

Groups 

IG (n = 10)– 

Outcomes: 

Pain: pain rating 

Outcome 

instruments: 

Manipulation: NR; 7 scale at d 0 – 7- no QoL/ well being: NR 

Country: Tx duration: NR % of male: NR ds (assumed) numeric data is General 

United Final assessments: Duration of Drop outs: NR reported imporvement 

Kingdom immediately post tx Racial Pain: Acute, NR 

composition: NR CG (n = 6) – Disability: disability 

Severity of pain Naprosyn (oral Med): questionnaire at d Results: 

Quality N screened: NR Work status: NR (Grading): NR NR; 7 ds (assumed) 0, wk 1, and wk 4 – Immediate post tx: at 

score: Not N randomized: 16 Drop outs: NR no numeric data d 7, 50% vs. 83% 

applicable N completed tx: NR Other socio­ reported improved (data for 

(abstract N attended last fu: NR demographics: Co­ wek 4 was 

only) NR interventions:NR Results: incomplete) 

Inclusion: pts with acute 

back pain Co morbidities: Immediate post tx: Short term: NR 

Initial of NR Pain: NA 

reviewer: SG Exclusion: NR Disability: NA Intermediate: NR 

Prior episode of 

pain if acute: NR Short term: NR Long term: NR 

Prior CAM Intermediate: NR Harms: NR 

intervention: NR 

Long term: NR 

Prior surgery 

related to current 

complaint: NR 

C-116
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

UK BEAM Trial Design-RCT Mean age Cause of Pain: IG1 (n= 338) – GP: Outcome Outcomes: 

trial; (SD/range): 43.1 N-S Based on UK instruments: QoL/ well being: 

Russell I 

(2004)119 

Tx duration: 4-8 wks 

Final assessments: 9 

(11.3) yrs (total) 

Duration of 

National Acute BP 

Guidelines, 

Pain & Disability: 

reported as Results: 

mos % of male: Pain: Acute Drop outs: n = 349 adjusted means- Immediate post tx: 

43.2% total (total) values not shown NA 

Country: N screened: 3535 Severity of pain 

United N randomized: 1334 Racial (Grading): NR CG1(n= 310) – Results: Short term: NR 

Kingdom N completed tx: NR composition: Exercise; 8 sessions CG1 (1.4, 95% CI: Intermediate: NR 

N attended last fu: NR 95.8% White for 4-8 wks 0.6, 2.1) and IG2 Long term: NR 

Quality Co­ (1.6, 95% CI: 0.8, 

score: 5/13 Inclusion: Pts aged 18­ Work status: NR interventions:NR IG2 (n = 180) – 2.3) improved Harms: No SAE 

65 yrs with LBP (RMDQ  Private manipulation: disability compared occurred. Other AE 

4) who had experienced Other socio­ techniques used by to GP immediately was NR. 

Initial of the pain daily for past mo demographics: chiropractitioner after the tx; IG2 

reviewer: SG Exclusion: Serious NR improved disability 

spinal disorder IG3 (n = 173) – at wk 9 post-tx (1.0, 

(malignancy, OP, AS, Co morbidities: manipulation - NHS-: 95% CI: 0.2, 1.8) 

cauda equina, infection, NR as IG2 in NHS vs. IG1; for CG2, 

or compression), Prior episode of premises this improvement 

previous spinal surgery, pain if acute: immediately after 

severe mental disorder, CG2 (n = 172) – the tx was 1.9 (95% 

CVD, hypertension Prior CAM Private-M + Exercise: CI: 1.2, 2.6) and 1.3 

(systolic blood pressure > intervention: NR as above (95% CI: 0.5, 2.1) 

180 mm Hg and diastolic at 9 mo after the tx; 

> 105 mm Hg), anti- Prior surgery CG3 (n = 161) NHS- no difference 

coagulant Tx, steroids, related to current M + Exercise: as IG2 between IG2 vs. 

RMDQ  3, English complaint: None and CG IG3 

literacy 

Table 1.11 Low Back Pain – Manipulation – Chronic - Specific Pain---no trials 

C-117
 
Table 1.12 Low Back Pain – Manipulation - Chronic - Non-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Biedermann 

F (1980)120 

Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

NR 

Groups 

IG (n = NR)– 

Outcomes: 

Pain: Duration or 

Outcomes: 

QoL/ well being: NR 

Tx duration: NR 31.4 (9.19) vs. Rotational relief (mean in ds) Spinal flexibility: 

Country: Fu duration: 3 mos CG = 29.7 (5.58) manipulation: pt’s (numeric data NR) 

Korea yrs thoracic and lumbar 

N screened: 1649 spine extended and Results: Results: 

N randomized: NR % of male: NR Duration of rotated in intent to Immediate post tx: Immediate post tx: 

N completed tx: NR Pain: NR stretch paravertebral Pain: NR NA 

Quality N attended last fu: 59 Racial structured in 

score: 3/13 composition: NR Severity of pain lumbosacral area Short term: IG = Short term: NR 

Inclusion: Sudden onset (Grading): NR Drop outs: NR 8.01 (2.02), CG = 

usually associated with Work status: NR 2.94 (0.52) Intermediate: NR 

Initial of trauma, recent onset CG (n = NR) – Softreviewer: SG usually of 2 or 3 wks, Other socio- Co­ tissue massage: Pt Intermediate: NR Long term: NR 

abnormally low SLR tests demographics: interventions:NR and manipulator 

NR assumed same Long term: NR Harms: NR 

Exclusion: Pregnancy, relative positions, but 

disorders of the spinal Co morbidities: rotal movement of Note: patitent who 

cord or cauda equina, NR the vertebrae was responded to SM 

advanced occlusive minimized while the tend to be older at 

vertebral artery disease, Prior episode of lumbosacral start of LBP compre 

spinal disease including pain if acute: NR paravertebral areas to those who were 

congenital defects, were massaged. not. 

marked spinal instability, Prior CAM Drop outs: NR 

herniated nucleus intervention: NR 

pulposus, osteoporosis, 

ankylosing spondylitis 

Prior surgery 

related to current 

complaint: NR 

C-118
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Cote P 

(1994)121 Trial Design-RCT Mean age 

(SD/range): 31 

Cause of Pain: 

Mechanical 

Groups 

IG (n = 16) – 

Outcomes 

(instrument used): 

Outcomes: 

QoL/ well being: NR 

Tx duration: one session (7.15) yrs total Mobilization: side- Pain: PPT: L5 

Country: Final assessments: post- Duration of lying position, rot tender point; SI 

Canada tx % of male: IG = Pain: Chronic, force was created at ligament tender Results: 

37.5%, CG = 74 (83.3) mo the lumbo-sacral point; gluteus Immediate post tx: 

N screened: NR 71.4% (total) junction or sacroiliac tender point 

Quality N randomized: 30 joints; joint taken to Short term: NR 

score: 4/13 N completed tx: 30 Racial Severity of pain its limit of passive Results: Intermediate: NR 

N attended last fu: 30 composition: NR (Grading): NR motion and HVLA Long term: NR 

thrust applied Immediate post tx: 

Initial of Inclusion: Pts with Work status: NR through the joint PPT Harms: NR 

reviewer: SG mechanic CLBP > 2 mo Co­ producing an audible IG = 5.6 (2.1), CG = 

Other socio­ interventions:NR sound; one session 5.0 (2.9) Summary: The two 

Exclusion: seronegative demographics: Drop outs: 0 groups did not differ 

spondyloarthropathy or NR SI in mean PPT scores 

rheumatoid arthritis, CG (n = 14) – IG = 5.6 (2.1), CG = for the three 

lumbar radiculopathy, hip Co morbidities: Manipulation: a long 5.5 (3.1) myofascial points 

pathology, NR lever HV thrust (L5 tender point, SI 

abdominal/pelvic organ applied to the lower Gluteus pain ligament tender 

pathology, pregnancy, Prior episode of spine while IG = 5.6 (2.2), CG = point, and gluteus 

current use of muscle pain if acute: NR stabilizing the thorax 5.2 (2.7) tender point); 

relaxants or anti- in side lying and ANOVA indicated no 

inflammatory drugs Prior CAM prone position ; one Short term: NR SS time*tx term 

intervention: NR session interaction (P > 

Drop outs: 0 Intermediate: NR 0.267) 

Prior surgery Long term: NR 

related to current 

complaint: NR 

C-119
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Giles, LG 

(2003)25,26 

Trial Design-RCT Mean age 

(SD/range): IG1 

Cause of Pain: 

N-S 

Groups 

IG (n = 36)– Acu: TP 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: 9 wks = 23.8 (4.8), IG2 & distal analgesia Pain: VAS (1 - QoL/ well being: NR 

Country: Final assessments: 1 yr = 25 (8.1), CG = Duration of producing 100)- ITT 

Australia 29.5 (2.07) Pain: sypatholytic acu Disability: Oswestry 

N screened: 533 chronic (> 13 points- insertion Back Results: 

N randomized: 115 % of male: IG1 = wks) depth 20-50 mm, 2 

Quality N completed tx: 69 55.9%, IG2 = tx/wk up to 9 wks Results: Immediate post tx: 

score: 6/13 N attended last fu: 62 51.4%, CG = Severity of pain Drop outs: B = 14, E NA 

57.5% (Grading): NR = 6/20 Immediate post tx: Short term: NR 

Inclusion: pts at least 17 Pain: IG1 = 4 (3.7), 

Initial of yrs old with Racial Co­ IG2 (n = 36) – Spinal IG2 = 3 (5.2), CG = Intermediate: NR 

reviewer: SG uncomplicated composition: NR interventions: manipulation: HVLA 5 (3.7) 

mechanical spinal pain NR thrust; 20 Disability: IG1 = 26 Long term: NR 

for minimum of 13 wks, Work status: NR min/session, 2 tx/wk (20.74), IG2 = 14 

for long term fu (> 1 yr), Other socio­ up to 9 wks (24.4), CG = 32 Harms: N=22, 13 in 

those who received demographics: Drop outs: B = 11, (23.7) IG1, 4in IG2, 5 in 

randomly allocated tx 25.7% Pensioner E= 4/23 CG, n=1 committed 

during 9 wk tx period /Unemployed Short term: NR suicide after end of 

Exclusion: pts with CG (n = 43) – new tx; most frequent 

nerve root involvement, Co morbidities: Med: Intermediate: AEs were hematoma 

spinal anomalies (other NR Celecoxib/Celebrex and bleeding 

than sacralization or (200 - 400 mg/d), Long term: 

lumbarization), pathology Prior episode of Rofecoxib/Vioxx Disability IG1 = 13 

other than mild to pain if acute: NR (12.5 - 25 mg/d), (22.9), IG2 = 16 

moderate osteroarthrosis, paracetamol/acetami (17.8), CG = 24 

spondylolisthesis of L5 or Prior CAM nophen (500 mg (25.2) 

S1 exceeding Grade 1, intervention: NR tablets 2-6/d up to 4 

previous spinal surgery, g/d) 

Prior surgery Drop outs: B = 21, E 

related to current = 12/19 

complaint: NR 

C-120
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Giles, LGF 

(1999)122 Trial Design-RCT Mean age 

(SD/range): IG1 

Cause of Pain: 

N-S 

Groups Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: 3-4 wks = 46.5 (9.6), IG2 IG1 (n = 18)– Acu: Pain: Pain (VAS) at QoL/ well being: NR 

Country: Final assessments: = 42.5 (9.6), CG Duration of treating clinician time A, B (change 

Australia immediately post tx = 35 (14.1) yrs Pain: decided which form from baseline) Immediate post tx: 

Chronic(13 of acu takenN screened: 875 % of male: IG1 = wks), IG1 = 7.5 HWATO Chinese Disability: Owstery Short term: NR 

Quality N randomized: 69 35%, IG2 = 53%, (10.4), IG2 = 6 disposible acu guide Disiablity Index at Intermediate: NR 

score: 1/13 N completed tx: not CG = 19% (5.9), CG = 5 tube needles 50mm A, B(change from Long term: NR 

clear (9.6) yrs long with a gauge of baseline) Harms: NR 

N attended last fu: NR Racial 0.25 mm for 20; 6 tx 

Initial of composition: NR Severity of over 3-4 wks Results: Summary: SM more 

reviewer: SG Inclusion: pts suffering pain (Grading): Drop outs: 26 Immediate post tx: effective than acu or 

from spinal pain for at Work status: NR NR Pain, mean Med; overall 33 pts 

least 13 wks; age of at IG2 (n = 32) – change: -1.0 vs. ­ (43%) had to change 

least 18 yrs Other socio- Co- Manipulation: Spinal 5.0 vs. -1.0 to another 

demographics: interventions: manipulation was intervention after 

Exclusion: Nerve root NR NR performed to be safe Disability, mean study period 

involvements; spinal and appropriate by change: -7.0 vs. ­ because of inefficacy 

anomalities; pathology Co morbidities: the chiropractor for 16.5 vs. -0.4 or side effects.% of 

other than mild to NR the spinal level of necessary crossing 

moderate osteoarthrosis; involvement only. A Short term: NR over differed 

previous spinal surgery Prior episode of HVLA SM was significantly (p = 

and leg length inequality pain if acute: NA performed; as IG1 Intermediate: NR 0.002) with respect 

of >9mm with postural Drop outs: 13 to 3 interventions, 

scoliosis Prior CAM Long term: NR manipulation 22.2%, 

intervention: NR CG (n = 19) – acu 60%, Med 62% 

Medication: 

Prior surgery tenoxican (20mg/d) 

related to current and ranitidine (50mg 

complaint: NR x 2/ d); 15-20min/ tx 

over 3-4 wks 

Drop outs: 10 

C-121
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Haas, M 

(2004)123 

Trial Design-RCT- 4x2 

factorial design – dose 

Mean age 

(range): IG1 = 44 

Cause of Pain: 

Non-S 

Groups 

IG1/2 (n= 18): Spinal 

Outcomes: 

Pain: Von Korff 

Outcomes: 

QoL/ well being: NR 

response of SM - 54 yrs, manipulation alone Pain Scale (0-100) 

Country: Duration of (SM) + PM (PM) Disability: Von Korff 

US Tx duration: 3 wks % of male: IG1 = Pain: Chronic 1 visits/ wk- 3 wks Results- Disability Scale (0-100) 

Final assessments: 56%; IG2 = 50%, Dropouts: Immediate post tx: Immediate post tx: 

Quality immediately post tx IG3 = 33%, IG4 Severity of pain Pain: IG1/2: 27 (29)/ 31 

score: 7/13 = 44% (Grading): IG3/4 (n= 18) IG1/2: 37 (29)/ 40 (32) 

N screened: 201 NR SM; or SM + PM (31) IG3/4: 25 (21)/ 21 

N randomized: 72 Racial 2 visits/wk- 3 wks IG3/4: 2 31 (21)/ 37 (20) 

Initial of N completed tx: 72 composition: Co- Dropouts: (22) IG5/6: 5/6:13 (11)/ 

reviewer: SG N attended last fu: 67 majority (> 75%) interventions:NR IG5/6: 21 (12)/ 25 21 (22) 

White non­ (22) IG7/8: 10 (14)/10 

Inclusion: Current Hispanic IG5/6: (n= 18) IG7/8: 22 (24)/ 19 (11) 

episode of CLBP (> 3 Work status: NR SM; or SM + PM (16) 

mos) Must be 18 yrs and 3 visits/wk- 3 wks Short term: 

older and have English Prior episode of Dropouts: IG1/2: 30 (21)/ 26 

literacy pain if acute: NR Short term: (21) 

Pain: IG3/4: 37 (31)/ 22 

Exclusion: prior chiro Prior CAM IG7/8: (n= 18) IG1/2: 46 (27)/ 38 (24) 

care in 3 mo before intervention: NR SM; or SM + PM (23) IG5/6: 8 (17)/ 21 (14) 

baseline; 4 visits/wk- 3 wks IG3/4: 46 (26)/ 37 IG7/8: 39 (30)/ 13 

contraindications to SM; Prior surgery Dropouts: (20) (14) 

involvement in litigation related to current IG5/6: 18 (20)/ 29 Intermediate: NR 

for a health problem/non­ complaint: NR (18) Long term: NR 

compliance IG7/8: 50 (25)/ 19 

(14) Harms: No AE was 

reported by pts 

C-122
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Herzog 

(1991)124 Trial Design-RCT Mean age 

(SD/range): 33.5 

Cause of Pain: 

N-S 

IG (n = 16) – Spinal 

manipulation: 

Outcomes: 

Pain: VAS (0-10) 

Outcomes: 

QoL/ well being: NR 

Tx duration: 4 wks yrs Manipulation Disability: Oswestry 

Country: Final assessments: 4 wks Duration of (sacroiliac); 10 Results: 

Canada % of male: Pain: Mixed, NR sessions over 4 wks, Results: 

N screened: 120 67.5% or until complete Baseline: Immediate post tx: 

Quality N randomized: 29 Severity of pain recovery Pain: NR NA 

score: 5/13 N completed tx: 29 Racial (Grading): NR Drop outs: B = 8 Disability: NR 

N attended last fu: NR composition: NR Short term: NR 

CG (n = 13) – Back Immediate post tx: 

Initial of Inclusion: Chronic Work status: NR Co­ school: stretching Pain: NR Intermediate: NR 

reviewer: SG sacroiliac joint problem, interventions:NR and postural EXs; Disability: NR 

18-50 yrs, ambulatory Other socio- Same as IG Long term: NR 

demographics: Drop outs: NR Short term: NR 

Exclusion: Extreme NR Harms: NR 

obesity Intermediate: NR 

Co morbidities: Summary: No raw 

NR Long term: NR data reported. CG 

was a better tx 

Prior episode of modality than the IG 

pain if acute: NR according to the 

clinical measures of 

Prior CAM rehabilitation. 

intervention: NR Precisely opposite 

results were found 

for the 

Prior surgery biomechanical 

related to current measures. 

complaint: None 

C-123
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Lalanne, K 

(2009)125 

Trial Design-RCT Mean age (SD): 

IG = 36.1 (12.3) 

Cause of Pain: 

NS 

Groups 

IG (n = 13)– Lumbar 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: one session vs. CG = 43.5 spine manipulation: Pain: VAS (1-100) QoL/ well being: NR 

Country: Fu duration: imm. Post-tx (10.5) yrs Duration of spinous pull method - Mean angles of 

Quebec Pain: Chronic, applied to middle Results: flextion relaxation 

N screened: 27 % of male: IG = <1 yr >10 yrs lumbar segments; 1 Baseline: phenomenon/EMG 

N randomized: 27 61.5%, CG = manipulation Pain: IG = 26.9 activity (data not 

Quality N completed tx: 27 42.8% Severity of pain Drop outs: 0 (21.8), CG = 23.3 shown) 

score: 1/13 N attended last fu: 27 (Grading): Pts (21.8) 

Racial with severe pain CG (n = 14) – Immediate post tx: 

Inclusion: 18-60 yrs; composition: NR (VAS > 7) were Control: (no Immediate post tx: NA 

Initial of constant or recurrent LBP excluded manipulation-side Pain: IG = 24.9 

reviewer: SG for more than 6 mo Work status: NR lying posture) same (22.3), CG = 30.1 Short term: NR 

Co­ position as IG lying (26.9) 

Exclusion: Other socio­ interventions:EX on left side for 10 sec Intermediate: NR 

spondylolisthesis; axial demographics: + education and Drop outs: 0 Short term: NR 

skeletal inflammation or NR counseling Long term: NR 

osteoarthritis; sessions about Intermediate: NR 

collagenosis; Co morbidities: pain and stress Harms: NR 

osteoporosis; spinal NR management- + Long term: NR 

surgery; neuromuscular EMG 

disease; lower limb Prior episode of biofeedback to 

musculoskeletal injuries; pain if acute: NR relax the back 

malignant tumor; during trunk flx 

hypertension; infection; Prior CAM task 

or any other non­ intervention: NR 

mechanical condition; 

radiculopathy; 

progressive neurological Prior surgery 

deficit; myelopathy; related to current 

herniated lumbar disc; complaint: NR 

and severe pain >7 on 

VAS. 

C-124
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Mohseni- Trial Design-RCT Mean age Cause of Pain: Groups Outcome Outcome 

Bandpei, M 

(2006)126 Tx duration: not clear, 3-6 

(SD/range): IG = 

34.8 (10.6) vs. 

N-S IG (n = 60)– SM + 

Exercise, HV thrust 

instruments: 

Pain: VAS (0-100) 

instruments: 

QoL/ well being: NR 

wks? CG = 37.2 (10.2) Duration of applied on lumbar 

Country: Final assessments: yrs Pain: spine and sacro-iliac Disability: Oswestry Results: 

UK immediately post tx % of male: IG = 

39%, CG = 43% 

Chronic, IG = 

35.9 (48.3); CG 

joint after end of 

range; 1st session 40 

Disability Index (%) 

Data shown are 

mean within group 

differences from 

Quality N screened: 233 = 50.8 (62.9) min, rest 20 min mean within group baseline: 

score: 2/13 N randomized: 120 Racial Severity of pain Drop outs: A = 5, B = differences from 

N completed tx: 107 composition: NR (Grading): 8 baseline: Immediate post tx: 

N attended last fu: NR NR lumbar flx (mm): 

Initial of Work status: NR CG (n = 60) – Results: 16.0 vs. 6 

reviewer: SG Inclusion: Patients with Co- Ultrasound + Immediate post tx: Lumbar extenstion 

CLBP, 18-55 yrs with Other socio­ interventions:1 Exercise: Frequency Pain: 41.6 vs. 25.1, (mm): 9.0 vs. 5.0 

pain in LB between L1 demographics: pt dropped out of 1MHz used; 6 p = 0.012 

and L5 and the sacroiliac Smokers: 50%; during tx due to sessions, 1-2 Short term: NR 

joints; had LBP > 3 mo, Meds: 50%; co-intervention times/wk Disability: 

signs and symptoms 17.9 vs. 10.1 Intermediate: NR 

interpreted to be referred Co morbidities: 

from the lumbar spine NR Short term: NR Long term: NR 

and not other organs, 

good self-reported Prior episode of Intermediate: Harms: one Pt 

general health pain if acute: NR Pain: 37.9 vs. 22.8 droped out due to 

Exclusion: History of Disability: 16.7 vs. TP, no indication of 

prior tx including Prior CAM 11.5 group allocation 

manipulation, chiro, intervention: NR 

osteopathy, ultrasound; Long term: NR 

receiving disability benefit Prior surgery 

as a result of LBP; related to current 

underlying disease complaint: None 

C-125
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Postacchini 

(1988)115 Trial Design-RCT Mean age 

(SD/range): NR 

Cause of Pain: 

N-S 

IG1 (n = 87) – 

Manipulation: 

Outcomes: 

Data reported in 

Outcomes: 

QoL/ well being: NR 

Country: 

Tx duration: Varied, see 

intervention detail % of male: 

standard technique; 

7 tx for 1st wk, then 2 

graphs for 

subgroups (data Results: 

Italy Final assessments: 1 yr 50.5% total tx for up to 6 wks not shown) 

Duration of Immediate post tx: 

N screened: 459 Racial Pain: Mixed, NR IG2 (n = 81) – Drug Results: NA 

Quality N randomized: 398 composition: NR therapy: Diclophenac Immediate post tx: 

score: 6/13 N completed tx: 375 Severity of pain “full dose”; 10-20 ds Disability: IG = 9.1 Short term: NR 

N attended last fu: NR Work status: NR (Grading): NR (5.3), CG = 3.9 

IG3 (n = 78) – (4.3) Intermediate: NR 

Initial of Other socio- Physiotherapy: 

reviewer: SG Inclusion: Pts presenting demographics: Co­ massage, Short term: NR Long term: NR 

at two LB clinics, 17-58 NR interventions:NR electrotherapy, 

yrs infrared, etc.; 7 tx/wk Intermediate: NR Harms: NR 

Co morbidities: for up to 3 wks 

NR Long term: NR Summary: no 

Exclusion: BP related to CG1 (n = 29) – Bed significant 

neo-plastic or infectious Prior episode of rest: NR; 15-24 hrs differences in 

diseases of the spine, pain if acute: NR for up to 8 ds outcomes of pain 

pregnancy, nursing and disability at long 

women, pts with serious Prior CAM CG2 (n = 50) – Back term fu between 

general diseases, intervention: NR school: NR; 4 groups. 

psychiatric disturbances, sessions in 1 wk 

medico-legal litigation 

Prior surgery CG3 (n = 73) – 

related to current Placebo gel: NR; 2 

complaint: None tx/ds for up to 2 wks 

Drop outs: Total lost 

to follow-up = 23 

C-126
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Rasmussen 

J (2008)127 Trial Design 

RCT 

Mean age 

(SD/range): IG = 

Cause of Pain: 

NR, % with 

Groups 

IG (n = 35)– 

Outcomes: 

Pain: VAS (0-10) 

Outcome 

instruments: 

38 vs. CG = 42 radiating pain: Extension EX + QoL/ well being: NR 

Tx duration: NR yrs IG = 54, CG = manipulation: 2 Degree of reduced 

Country: Final assessments: 2 78 simple ext EXs; high Results: mobility of most 

Denmark wks, 4 wks, and 1 yr % of male: IG = velocity, low Baseline: affected segments 

51%, CG = 43% amplitude thrust at Pain: IG = 5 (0.76), 

N screened: 97 the level of reduced CG = 5 (0.76) Results: 

N randomized: 72 Racial movement, called Immediate post tx: 

Quality N completed tx: 72 composition: NR Duration of dysfunction; 3-5 Immediate post tx: Strong: 1 (3%) vs. 6 

score: 6/13 N attended last fu: NR Pain: Chronic, times/EX, repeated Pain: --- (17%) 

Work status: 7% [median 4-6 times, at least Medium: 10 (29%) 

Inclusion: 18-60 yrs; Unemployed (quartiles) IG = once/hr Short term: at 4 vs. 6 (17%) 

Initial of LBP more than 3 mo 17 (6-47) mo; Drop outs: Total for wks Light: 24 (69%) vs. 

reviewer: SG Other socio- CG = 8 (4-41) both groups: D=16 VAS: IG = 3 (0.76), 23 (66%) 

Exclusion: ongoing demographics: mo CG = 3 (0.76) 

insurance claim; 58% Married; CG (n = 37) – Short term: NR 

unsettled social pension 35% Smokers Severity of pain Extension EX: 2 Intermediate: NR 

claim; LBP caused by (Grading): NR simple ext EXs; Intermediate: NR 

major accident; pain ext Co morbidities: same as IG Long term: at 1 yr 

below knee; excessive VAS: IG = 2 (0.51), Long term: NR 

distribution of pain Prior episode of Co- CG = 2 (0.51) 

according to a pain pain if acute: NR interventions:NR Harms: 4 pts in IG 

drawing; neurological repoted worsening of 

diseases including known Prior CAM pain after 4 wks vs. 

disc herniation; intervention: NR 3 in CG 

significant medical Similar in 3 mos and 

diseases including 1 yr. No pts was 

cancer; inflammation Prior surgery hospitalized during 

related to current fu perioe due to LBP 

complaint: NR or disc herniation 

C-127
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Triano JJ 

(1995)128 Trial Design-RCT Mean age 

(SD/range): 41.6 

Cause of Pain: 

Mechanical 

IG1 (n = NR) – SM 

(HVLA): applied to 

Outcomes: 

Pain: VAS 

Outcome 

instruments: 

Tx duration: 4 wks (14.7) yrs (total) lumbar and pelvic Disability: Oswestry QoL/ well being: NR 

Country: Final assessments: 3 Duration of site(s) pts in laterally 

US mos % of male: 54% Pain: Chronic, posture on table, free Resultstotal NR leg flexed at knee Results: 

N screened: 1267 and pelvis to cause Immediate post tx: Immediate post tx: 

Quality N randomized: 209 Racial Severity of pain relative flx of lumbar Pain: IG1 = 13.9 NA 

score: 6/13 N completed tx: NR composition: NR (Grading): NR spine; daily 2 wks (15.3), IG2 = 19.8 

N attended last fu: NR Drop outs: C = 7 (18.3), CG = 19.6 Short term: NR 

Work status: NR Co­ (17.6) 

Initial of interventions:NR IG2 (n = NR) – HVLF Disability: IG1 = 9.5 Intermediate: NR 

reviewer: SG Inclusion: Pts aged  18 Other socio­ mimic: one side only (6.3), IG2 = 15.5 

yrs with mechanic CLBP demographics: to avoid (10.8), CG = 12.3 Long term: NR 

(pain > 12 mo between NR accumulation effect; (8.4) 

L1 and L5 including pt placed on a table Harms: NR 

sacroiliac joints) Co morbidities: center with legs bent Immediately post tx 

experiencing palpatory NR bilaterally; as IG1 with withdrawals: 

tenderness Drop outs: C = 14 VAS: IG = 13.3 

Prior episode of (15.9), IG2 = 21.7 

Exclusion: Neuropathy, pain if acute: NR CG (n = NR) – BEP: (24.4), CG = 15.1 

systemic disease no physical contact (19.4) 

affecting musculoskeletal Prior CAM or EXs,included Oswestry: IG1 = 

system, severe intervention: NR attractive color 10.6 (11.7), IG2 = 

osteoporosis, fracture, graphics coupled 14 (11.7), CG = 

spinal pathology, with common 11.4 (10.3) 

receiving other tx for Prior surgery anatomic and 

back pain related to current biomechanical 

complaint: NR information on spine 

function and hygiene; 

as IG1 

Drop outs: C = 18 

C-128
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Waagen, G 

(1986)129 Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

Non-specified 

Groups 

IG (n = 11)– 

Outcomes: 

Pain: 10 cm VAS 

Outcome 

instruments: 

Tx duration: 2 wks 25.2 vs. CG = Adjustment: spinal decrease after tx QoL/ well being: 

Country: Fu duration: 2 wks 24.3 yrs Duration of adjustive therapy and at 2 wks post tx Global index change 

Iowa, US Pain: Chronic, only, full-spine from baseline: IG = 

N screened: NR % of male: IG = IG = 2.5 yrs, CG adjustments Disability: NR 1.71, CG = -2.08 

N randomized: 29 54.5%, CG = = 2.8 yrs administered to each 

Quality N completed tx: 29 38.9% pt to Sally correct all Results- Other: Leg raising 

score: 5/13 N attended last fu: 17 Severity of pain chiropractic lesions Immediate post tx: test: 

Racial (Grading): pre- found by clinician; 2­ Pain-mean change: D-mean change: IG 

Inclusion: chief composition: NR trial pain level: 3 tx/wk for 2 wks IG = 1.3, CG = 0.7 = 6 (8.65), CG = ­

Initial of complaint of LBP; no IG = 3.7, CG = Drop outs: B = 2 13.5 (10.3) 

reviewer: SG experience with chiro Work status: NR 4.6 Short term: PainCG (n = 18) – Sham mean change: IG = IG = 6 (6.2), CG = ­

Exclusion: pregnancy, Other socio- Co­ adjustment: using 2.3, CG = 0.6 15 (5.8); 

malingering, workmen's demographics: interventions:NR minimal force for 

compensation for back NR generalized Short term: NR 

problem, not ambulatory, manipulation; 

obesity, radiographic Co morbidities: simulated by Harms: NR 

evidence of osseous NR applying gentle 

fractures, osteoporosis or pressure over both 

spondylolisthesis, BP Prior episode of posterior superior 

result of visceral disorder, pain if acute: NR iliac spines such that 

positive indication of disk lumbar section fell; tx 

herniation, severe Prior CAM concludes with paraconcurrent infectious or intervention: NR spinal soft tissue 

other systemic disease massage; same as 

process, neurologic IG 

deficits indicated by leg Prior surgery Drop outs: B = 8 

pain or numbness or related to current 

weakness complaint: NR 

C-129
 
Table 1.13 Low Back Pain – Manipulation – Mixed - Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Mathews W 

(1988)130 

Trial Design-RCT Mean age 

(SD/range): NR 

Cause of Pain: 

Specifically 

Groups 

IG (n = 158) – 

Outcomes: 

Pain: VAS (n 

Outcome 

instruments: 

Tx duration: 2-3 wks defined Rotational “recovered”) QoL/ well being: 

Country: Final assessments: post­ % of male: NR syndromes of Manipulation: 2 trials, Disability: Oswestry NR 

United tx LBP alone pain on forward flx but Disability Index 

Kingdom Racial (lumbago) and ext was pain free, (data shown in 

N screened: 895 composition: NR LBP with pain in direct vertical pressure graphs. Numeric Results: 

N randomized: 282 the leg (sciatica) was applied first. Leg values could not be Immediate post tx: 

Quality N completed tx: NR Work status: NR of more painful side extracted and are NA 

score: 2/13 N attended last fu: NR was lifted and used to not shown in this 

Other socio­ rotate the pelvis over, table) Short term: NR 

demographics: and away from that 

Initial of Inclusion: 18-60 yrs of NR Duration of side, body weight was Results: Intermediate: NR 

reviewer: SG age; presenting episode Pain: Acute, NR utilized to apply overof pain of less than 3 mo Co morbidities: pressure using the Immediate post tx: Long term: NR 

NR Severity of pain length of the leg as a Pain: IG = 116, CG 

Exclusion: NR (Grading): NR lever, short or long, = 73; P = 0.05 Harms: NR 

Prior episode of applying the force 

pain if acute: NR through the pt's Short term: NR Summary: back 

Co­ buttock; unclear school therapy was 

Prior CAM interventions:NR Drop outs: NR Intermediate: NR a better tx modality 

intervention: NR than the SM 

Long term: NR according to the 

CG (n = 134) – clinical measures 

Prior surgery Control: 2 trials, of rehabilitation. 

related to Infrared lamp over the 

current most painful area of 

complaint: NR the LB; 15 min/tx, 3 

tx/wk for 2-3 wks 

Drop outs: NR 

C-130
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zhang, W 

(2008)131 

Trial Design-RCT Mean age 

(SD/range): NR 

Cause of Pain: 

Disc/joint 

Groups 

IG (n = 5760)– 

Outcomes: 

Pain: VAS 

Outcome 

instruments: 

Tx duration: 30 ds disease Manipulative reduction QoL/ well being: 

Country: Final assessments: post­ % of male: NR + lumbar traction + Results: well being, 

China tx various Baseline: instrument NR (% 

Racial physiotherapies: 25-30 Pain: IG = 7.82 improved) 

N screened: NR composition: kg traction, 20-30 (2.25), CG = 8.1 

Quality N randomized: 11128 Asian Duration of min/tx, microwave trt­ (1.81) Results: 

score: 4/13 N completed tx: 11088 Pain: Acute, 12-15 w, 20 min/tx, Immediate post tx: 

N attended last fu: 11088 Work status: NR Sub-acute, middle frequency trt, Immediate post tx: IG = 98.6%, CG = 

chronic; IG = 2 Chinese medicine Pain-mean change: 96.4% 

Initial of Inclusion: diagnosed Other socio­ ds-30 yrs, CG = fumigate ; 1 tx/d, 10 IG = 2.13 (1.46), 

reviewer: SG using Chinese Medical demographics: 1 d-26 yrs tx/course, 3 courses CG = 4.65 (2.14) Short term: NR 

Diagnostic and NR Drop outs: B = 23 

therapeutic Effective Severity of pain Short term: NR Intermediate: NR 

Standard, diagnosed Co morbidities: (Grading): NR CG (n = 5368) – 

using CT or MRT, sign on NR lumbar traction Intermediate: NR Long term: NR 

consent form Co­ +various 

Prior episode of interventions:NR physiotherapies: 25­ Long term: NR Harms: NR 

Exclusion: pregnant, pain if acute: NR 30kg traction, 20-30 

breast feeding, Lumbar min/tx, microwave trt: 

intervertebral disc Prior CAM 12-15 w, 20 min/tx 

hemiation plus Mawei intervention: NR middle frequency trt 

nerve synthesize, lumbar Chinese medicine 

tumor or tubercal, fumigate; same as IG 

headache or heart pain Prior surgery Drop outs: B = 17 

etc. high blood pressure, related to 

heart disease, the other current 

serious disease related to complaint: NR 

organ or system, and 

people with mental health 

issues 

C-131
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zhang, W 

(2008)131 

Trial Design-RCT Mean age 

(SD/range): NR 

Cause of Pain: 

Disc/joint 

Groups 

IG (n = 5760)– 

Outcomes: 

Pain: VAS 

Outcome 

instruments: 

Tx duration: 30 ds disease Manipulative reduction QoL/ well being: 

Country: Final assessments: post­ % of male: NR + lumbar traction + Results: well being, 

China tx various Baseline: instrument NR (% 

Racial Duration of physiotherapies: 25-30 Pain: IG = 7.82 improved) 

N screened: NR composition: Pain: Acute, kg traction, 20-30 (2.25), CG = 8.1 

Quality N randomized: 11128 Asian Sub-acute, min/tx, microwave trt­ (1.81) Results: 

score: 4/13 N completed tx: 11088 chronic; IG = 2 12-15 w, 20 min/tx, 

N attended last fu: 11088 Work status: NR ds-30 yrs, CG = middle frequency trt, Immediate post tx: Immediate post tx: 

1 d-26 yrs Chinese medicine Pain-mean change: IG = 98.6%, CG = 

Initial of Inclusion: diagnosed Other socio­ fumigate ; 1 tx/d, 10 IG = 2.13 (1.46), 96.4% 

reviewer: SG using Chinese Medical demographics: Severity of pain tx/course, 3 courses CG = 4.65 (2.14) 

Diagnostic and NR (Grading): NR Drop outs: B = 23 Short term: NR 

therapeutic Effective Short term: NR 

Standard, diagnosed Co morbidities: Co- CG (n = 5368) – Intermediate: NR 

using CT or MRT, sign on NR interventions:NR lumbar traction Intermediate: NR 

consent form +various Long term: NR 

Prior episode of physiotherapies: 25­ Long term: NR 

Exclusion: pregnant, pain if acute: NR 30kg traction, 20-30 Harms: NR 

breast feeding, Lumbar min/tx, microwave trt: 

intervertebral disc Prior CAM 12-15 w, 20 min/tx 

hemiation plus Mawei intervention: NR middle frequency trt 

nerve synthesize, lumbar Chinese medicine 

tumor or tubercal, fumigate; same as IG 

headache or heart pain Prior surgery Drop outs: B = 17 

etc. high blood pressure, related to 

heart disease, the other current 

serious disease related to complaint: NR 

organ or system, and 

people with mental health 

issues 

C-132
 
Table 1.14 Low Back Pain - Manipulation - Mixed - Non-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Childs JD 

(2004)132 

Trial Design-RCT Mean age: 34 

yrs 

Cause of Pain: 

Symptoms distal 

Groups 

IG (n = 70) – SM + 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: 4 wks to the knee: IG Exercise: During 1st Pain: QoL/ well being: NR 

Country: Final assessments: 6 % of male: IG = = 25.7%, CG = two PT sessions, pts Disability: ODQ 

mos 57%, CG = 59% 21.3% received high­ % pts with Med use 

US velocity thrust SM Results: in the last wk- Short 

N screened: 543 Racial Duration of and range-of-motion Baseline: term (6 mos fu): 

Quality N randomized: 131 composition: NR Pain: Acute and EX only; the first, Disability: IG = 41.4 36.5% vs. 60.0% 

score: 8/13 N completed tx: 131 Sub-acute, IG = PTst performed (10.1); CG = 40.9 

N attended last fu: NR Work status: NR 22 ds; CG = 30 manipulation by (10.8) Missed time at work 

ds using the technique in last 6 wks due to 

Initial of Inclusion: LBP pts aged Other socio­ reported by Flynn et Immediate post tx: BP: 9.6% vs. 25% 

reviewer: SG 18-60 yrs with ODQ demographics: Severity of pain al.; 4 wks Disability: NR 

score  30% Smokers: IG = (Grading): NR Drop outs: D = 18 Seeking tx for BP: 

17.1%, CG = Short term: 1 vs. 2 11.5% vs. 42.5% 

Exclusion: serious 29.5% CG (n = 61) – 10.1-P = 0.001 

spinal condition (tumor, Co- Exercise: low-stress Intermediate: NR 

compression fracture, or Co morbidities: interventions:NR aerobic and lumbar Intermediate: NR Long term: NR 

infection), nerve root NR spine strengthening Harms: drop out not 

compression, positive program which Long term: NR due to AE 

straight leg increase < Prior episode of targeted the trunk 

45 degrees of diminished pain if acute: NR musculature Data for short term Summary: ODQ 

reflexes, sensation, or identified as fu collected for scores of SM was 

lower extremity strength, Prior CAM important stabilizer of IG, n = 52 greater if performed 

pregnant, previous intervention: NR the spine in the CG, n - = 40 by practitioners with 

surgery to the lumbar literature; 4 wks < 3 yrs of experience 

spine or buttock Prior surgery Drop outs: D = 21 compared to that for 

related to current those with 3 yrs of 

complaint: NR experience 

C-133
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Cherkin D 

(2008)133 Trial Design 

RCT 

Mean age: 40 

yrs 

Cause of Pain: 

N-S 

Groups 

IG1 (n = 133)– 

Outcomes: 

Pain: symptom 

Outcomes: 

QoL/ well being: 

Physical therapy: bothersomeness NR 

Country: Tx duration: 1 mo % of male: Duration of relies on pt­ (VAS) 

Ottawa, Final assessments: 3 52.6% total Pain: Unknown, generated forces and Disability: RDQ Results: 

Canada mos 6 wks emphasizes self- Immediate post tx: 

Racial care; up to 9 visits Results: 

N screened: 3800 composition: NR Severity of pain over 1 mo Short term: 

Quality N randomized: 321 (Grading): NR Drop outs: A = 4,B = Immediate post tx: 

score: 5/13 N completed tx: 307 Work status: 0 Pain: 2.3 (2.61), vs. Intermediate: NR 

N attended last fu: 298 88% Employed Co­ 1.9 (1.94), CG = 

interventions:NR IG2 (n = 122)– Chiro 3.1 (2.96) Long term: NR 

Initial of Inclusion: 20-64 yrs old Other socio­ manipulation: a Disability: IG1 = 4.1 

reviewer: SG who saw their primary demographics: short-lever, high­ (4.64), IG2 = 3.7 Harms: No 

care physician for LBP 15.6% Smokers velocity thrust (4.43), CG = 4.9 important AE effects 

and who still had pain directed Sally at a (4.35) of tx wre reported in 

seven ds later Co morbidities: "manipulable lesion"; any of the groups 

NR same as IG1 Short term: 

Exclusion: NR Prior episode of Drop outs: A = 3,B=0 Pain: IG1 = 2.7 

pain if acute: (2.76), IG2 = 2 

56% with .2 CG (n = 66) – (2.22), CG = 3.2 

episodes Educational booklet: (3.2) 

discussed causes of 

Prior CAM back pain, prognosis, RDQ: IG1 = 4.1 

intervention: NR appropriate use if (4.97), IG2 = 3.1 

imaging studies and (4.16), CG = 4.3 

Prior surgery specialists, and (4.86) 

related to current activities for 

complaint: NR promoting recovery Intermediate: NR 

and preventing 

recurrences; initial Long term: NR 

consultation only 

Drop outs: A = 1,B=5 

C-134
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hoehler F 

(1981)134 

Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

N-S 

Groups 

IG (n = 56)– 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: NR 30.1 (8.4) vs. CG Manipulation: rotal Pain: Improvement QoL/ well being: NR 

Country: Final assessments: 3 wks = 32.1 (9.8) yrs Duration of manipulations of the in pain (see Results 

US post discharge Pain: 50% lumbosacral spine; # summary) Immediate post tx: 

% of male: 59% Acute, 23% of tx varied Pts reporting tx as 

N screened: 1880 total Chronic Drop outs: NR Disability: NA effective: 88% vs. 

Quality N randomized: 95 86% 

score: 3/13 N completed tx: NR Racial Severity of pain CG (n = 39) – Soft- Results: Improvement in SLR 

N attended last fu: NR composition: NR (Grading): NR tissue massage: soft­ (to pain): 

tissue massage of Immediate post tx: 7.8 (7.4) vs. 8.6 (8.4) 

Initial of Work status: NR the lumbosacral Pain: ---

reviewer: SG Inclusion: presence of Co­ areas, with the rotal Disability: NA Short term (3 wks 

palpatory cues indicating Other socio­ interventions:NR thrust omitted; same post discharge): 

that manipulation might demographics: as IG Short term: NR 

be successful NR Drop outs: NR Pts reporting 

Intermediate: NR improvement in 

Co morbidities: amount of pain from 

Exclusion: Manipulation NR Long term: NR baseline – IG = 88%, 

contraindicated or CG = 68% 

alternative tx strongly Prior episode of 

indicated; pregnancy; pain if acute: NR Intermediate: NR 

previous experience with 

manipulation; disability Prior CAM Long term: NR 

income; pending intervention: NR 

litigation; previous back Harms: NR 

surgery; obesity; drug or 

alcohol abuse; pain not Prior surgery 

treatable by manipulation related to current 

of lumbosacral area. complaint: NR 

C-135
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Bronfort, G 

(1989)135 

Trial Design- RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

N-S 

Groups 

IG (n = 10)– 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: 1 mo 36 (4) vs. CG = Chiropractic: S Pain: % of pts QoL/ well being: NR 

Final assessments: 39 (3.9) yrs Duration of manipulative improved 

Country: immediately post tx Pain: NR procedures carried Patient’s 

Denmark % of male: IG = out with LAHV aimed Disability: NR assessment of pain 

N screened: 21 20%, CG = 78% Severity of pain at selected according to genderN randomized: 19 (Grading): NR dysfunctional Results: % with no pain at 6 

Quality N completed tx: 19 Racial articulations involving Ptient’s mos: male 40% vs. 

score: 2/13 N attended last fu: NR composition: NR all sections of spine assessment of female 20% 

Co­ and pelvis as improvement- % 

Inclusion: Native to Work status: NR interventions:NR detected by motion with no pain: Intermediate fu: 

Initial of chiropractic and between palpation, Use of analgesics 

reviewer: SG 18-70 yrs of age. Other socio­ instructions given on Immediate post tx: during 6 mos (%): 

Primarily suffering from demographics: how to minimize risk 20% vs. 22% 10% vs. 33% 

LBP of various durations NR of future LBP 

with or without radiating episodes; 1 mo Short term: 20% vs. Unable to work at 6 

pain to one or both lower Co morbidities: Drop outs: A = 2 11% monhts: 10% vs. 

extremities NR 11% 

Exclusion: LBP due to CG (n = 9) – Medical: Intermediate: 50% 

destructive, metabolic Prior episode of Mostly analgesic vs. 11% Harms: worse pain 

and inflammatory pain if acute: IG Med prescription, compared to baeline 

disease, organic referred = 60, CG = 22 local analgesic- Long term: NR after tx 10% vs. 

pain syndromes, vascular (with more than anaesthestic 11%; short term & 

and circulatory diseases 3 episodes, N-S injections, bedrest intermediate fu 0 in 

of the lower extremities, if acute) and or PTincluding both groups; 

psychological ultrasound, tx for LBP. 

disturbances, nerve root Prior CAM diathermy & 

or spinal cord intervention: NR ergonomic advice; 

compression syndromes 1 mo 

warranting surgical Prior surgery Drop outs: NR 

intervention, essentially related to current 

weakened health. complaint: NR 

C-136
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Rupert R 

(1985)136 Trial Design-RCT Mean age 

(SD/range): NR 

Cause of Pain: 

N-S 

IG (n = 49) – 

Chiropractic 

Outcomes: 

Pain: VAS - % LBP 

Outcomes: 

QoL/ well being: NR 

Tx duration: unspecified adjustment: Specific improvement (data 

Final assessments: % of male: NR Duration of short-lever shown in graphsCountry: immediately post tx Pain: Mixed, NR manipulation using not extracted) Results: 

Egypt Racial spinous processes or Immediate post tx: 

N screened: 145 composition: NR Severity of pain mamillary bodies as Results: NA 

N randomized: 145 (Grading): NR lever arms; 3 tx/wk, Immediate post tx: 

Quality N completed tx: NR Work status: NR duration of trial Pain: IG = 47%, Short term: NR 

score: 2/13 N attended last fu: NR unspecified CG1 = 19%, CG2 = 

Other socio- Co- Drop outs: NR -40% Intermediate: NR 

Inclusion: 18-68 coming demographics: interventions:NR 

Initial of to three hospitals for low- NR CG1 (n = 46) – Sham Short term: NR Long term: NR 

reviewer: SG back pain and/or manipulation: 

restriction in lumbar Co morbidities: touching and Intermediate: NR Harms: NR 

ROM. NR palpitating the pt on 

the adjusting table in Long term: NR Summary: Trial only 

Exclusion: Pts familiar Prior episode of the same tx setting reports preliminary 

with manipulation; spinal pain if acute: NR as IG. CG1 received data, does not 

cord involvement, a non-therapeutic specify the duration 

osseous pathology, Prior CAM massage to a site of the trial and # of 

tumors, bleeding intervention: NR unrelated to the area txs- pts uncder 40 

disorders, acute of pain; 3tx/wk yrs of age noted 

inflammatory joint Drop outs: NR more immediate pain 

diseases, acute or Prior surgery relief than those over 

progressive neurological related to current CG2 (n = 50) – 40. 

defecit, chronic systemic complaint: None Drugs and bed rest; 

disease, pain referred 3 tx/wk 

from visceral pathology, Drop outs: NR 

and advanced pregnancy 

C-137
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hoiriis, K 

(1999)137 

Trial Design-RCT Mean age 

(SD/range): NR 

Cause of Pain: 

N-S 

Groups 

IG1 (n = )– Cervical 

Outcomes:-report 

of significant 

Outcome 

instruments: 

Tx duration: up to 6 mos Adjustments: NR; pts improvement from QoL/ well being: NR 

Country: Final assessments: % of male: NR Duration of adjusted up to 6 mo initial values 

NR imm.post tx Pain: Sub-acute, Drop outs: NR 

Racial NR Pain: VAS-Only Results: 

N screened: 800 composition: NR IG2 (n = ) – Full results for all Immediate post tx: 

Quality N randomized: 26 Severity of pain Spine adjustments: groups together are NA 

score: 0/13 N completed tx: NR Work status: NR (Grading): NR NR; same as IG1 given 

N attended last fu: NR Drop outs: NR (Baseline=4.04, Short term: NR 

Other socio­ follow-up=1.57) 

Initial of Inclusion: LBP of demographics: Co- CG (n = ) – Intermediate: NR 

reviewer: SG greater than 2 mo NR interventions:NR Combination of both Disability: Oswestry 

techniques; same as Disability Q-Only Long term: NR 

Co morbidities: IG1 results for all 

Exclusion: presence of NR Drop outs: NR groups together are Harms: NR 

serious disease, cervical given 

complaint, or postsurgical Prior episode of 

low back syndrome pain if acute: NR Results: 

Prior CAM Immediate post tx: 

intervention: NR Pain: ----

Disability: ---

Prior surgery Short term: NR 

related to current 

complaint: NR Intermediate: NR 

Long term: NR 

C-138
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Herzog 

(1991)124 Trial Design-RCT Mean age 

(SD/range): 33.5 

Cause of Pain: 

N-S 

Groups Outcomes: 

Pain: VAS (0-10) 

Outcomes: 

QoL/ well being: NR 

Tx duration: 4 wks yrs IG (n = 16) – Spinal Disability: Oswestry 

Country: Final assessments: Duration of manipulation: Results: 

Canada immediately post tx % of male: Pain: Mixed, NR Manipulation Results: Immediate post tx: 

67.5% (sacroiliac); 10 Baseline: NA 

Quality N screened: 120 Severity of pain sessions over 4 wks, Pain: NR 

score: 6/13 N randomized: 29 Racial (Grading): NR or until complete Disability: NR Short term: NR 

N completed tx: 29 composition: NR recovery 

N attended last fu: NR Drop outs: B = 8 Immediate post tx: Intermediate: NR 

Initial of Work status: NR Co- Pain: NR 

reviewer: SG Inclusion: Chronic interventions:NR CG (n = 13) – Back Disability: NR Long term: NR 

sacroiliac joint problem, Other socio­ school: stretching 

18-50 yrs, ambulatory demographics: and postural EXs; Short term: NR Harms: NR 

NR Same as IG 

Exclusion: Extreme Drop outs: NR Intermediate: NR Summary: No raw 

obesity Co morbidities: data reported. CG 

NR Long term: NR was a better tx 

modality than the IG 

Prior episode of according to the 

pain if acute: NR clinical measures of 

rehabilitation. 

Prior CAM Precisely opposite 

intervention: NR results were found 

for the 

biomechanical 

Prior surgery measures. 

related to current 

complaint: None 

C-139
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hondras, M 

(2009) 138 

Country: 

USA 

Quality 

score: 11/13 

Initial of 

reviewer: ST 

Trial Design: RCT 

Tx duration: max 12 visits 

Final assessments: 18 wks 

post tx 

N screened: 1849 

N randomized: 240 

N completed tx: 225 

N attended last fu: NR 

Inclusion: Age at least 55 

yrs, presented with 

nonspecific LBP of at least 4 

weeks duration and met the 

diagnostic classification of 1, 

2, or 3 according to the 

Quebec Task Force on 

Spinal Disorders. 

Exclusion: LBP with: 

radiculopathy/neurological 

signs; comorbidities or 

general poor health that 

could complicate the 

prognosis; major clinical 

depression; bone/joint 

pathology that 

contraindicated SM; 

current/pending litigation; 

pacemaker; receiving 

disability for any condition; 

received SM within the past 

month; unwilling to postpone 

the use of MT for LBP 

except for those provided in 

the study; unable to 

comprehend English. 

Age: Mean (yrs) 

IG1 = 63.8 (7.6) 

IG2 = 62.3 (6.1) 

CG = 63.0 (6.0) 

% male: 

IG1 = 55.2%; 

IG2 = 55.8%; 

CG = 59.2% 

Racial 

composition: 

White: 

IG1 = 95.8%, 

IG2 = 95.8%, 

CG = 98%; 

Hispanic: 

IG1 = 2.1%; , 

IG2 = 2.1%; , 

CG = 6.1% 

Work status: 

Full-time: 

IG1 = 34.4%, 

IG2 = 40%, 

CG = 34.7%; 

Comorbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior surgery 

related to current 

complaint: NR 

Cause of Pain: 

NR 

Duration of 

Pain: 

Mean (SD): 

IG1= 11.9 y 

(13.4), 

IG#2 = 15.1 y 

(16.7), 

CG = 9.6 y 

(11.1) 

Severity of pain 

- Avg low back 

pain during past 

week 0-100mm: 

IG#1 = 42.1 

(23.6), IG#2 = 

42.5 (25.2), CG 

= 42.4 (24.5) 

Conterventions: 

NR 

Groups 

IG1 (n = 96) – Highvelocity low 

amplitude SM; max 

12 visits, not to 

exceed 3x/wk for 1st 

2 wks, 2x/wk for wks 

3 & 4, 1x/wk for wks 

5 & 6. 30 min home 

exercise instruction. 

Drop outs: 2 

IG2 (n = 95) – Lowvelocity variable 

amplitude SM; max 

12 visits, not to 

exceed 3x/wk for 1st 

2 wks, 2x/wk for wks 

3 & 4, 1x/wk for wks 

5 & 6. 30 min home 

exercise instruction. 

Drop outs: 4 

CG (n = 49)- Minimal 

conservative medical 

care; 3x over 6 wks 

Additional visits as 

necessary. 30 min 

home exercise 

instruction. 

Drop outs: 9 

Outcome 

instruments: 

Pain: VAS (0-100mm) 

No Pain - Worst Pain 

Disability: RMD (0­

24); FABQ physical 

subscale (0-24); SF36 physical function 

subscale (0-100) 

Results: Baseline: 

Pain: 

QTF 1 – IG1 = 66.7%, 

IG2 = 60%, 

CG = 61.2%; 

Disability: 

RMD – IG1 = 6.5 

(4.1), 

IG2 = 6.6 (4.6), 

CG = 5.7 (4.0); 

Immediate post tx ­

Mean chg from 

baseline (range): 

Pain: No significant 

results 

Disability: RMD - IG1 

= 2.7 (2.0, 3.3), IG2 = 

2.9 (2.2, 3.6), CG = 

1.6 (0.5, 2.8); 

Short term: NR 

Intermediate: NR 

Outcome 

instruments: 

QoL/ well being: NA 

Results: 

Immediate post tx: 

Short term: NR 

Intermediate: NR 

Long term: NR 

Harms: No serious 

adverse events. 

Summary 

Biomechanically 

distinct forms of SM 

did not lead to 

different outcomes in 

older LBP patients 

and both SM 

procedures were 

associated with 

small yet clinically 

important changes in 

functional status by 

the end of treatment 

for this relatively 

health older 

population. 

C-140
 
Table 1.15 Low Back Pain - Manipulation - Unknown - Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Dai, DC 

(2006)139 

Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

Spondylolysis 

Groups 

IG (n = 50)– Spinal 

Outcomes: 

Pain: Local STD of 

Outcome 

instruments: 

Tx duration: 5 wks 58.86 (7.24) vs. with spondylo­ fine adjusting integrated score of QoL/ well being: NR 

Country: Final assessments: post- CG = 57.37 listhesis manipulation: NR; 20 symptoms and 

China tx (7.43) yrs min/ tx, 2 tx/ wk for 5 function 

wks Excellent rate of tx: 

N screened: 99 % of male: IG = Duration of Drop outs: 0 Disability: x-ray Immediate post tx: 

Quality N randomized: 99 22%, CG = Pain: Cannot tell changes of lumbar 60% vs. 36.7% 

score: 3/13 N completed tx: 99 24.5% CG (n = 49) – spine 

N attended last fu: 99 Severity of pain Flexing hip and knee Short term: NR 

Racial (Grading): manipulation: NR; Results-Baseline: 

Initial of composition: NR same as IG Pain: IG=7.62 Intermediate: NR 

reviewer: SG Inclusion: Lumbar Drop outs: 0 (2.22), CG =7.92 

stability of degenerative Work status: NR Co­ (2.06) Long term: NR 

spondylolishesis interventions:So Disability: ---

Other socio­ ft-tissue Harms: NR 

demographics: manipulation Immediate post tx: 

Exclusion: History of NR Pain: IG = 3.38 Summary: lumbar 

lumbar surgery, Severe (1.14), CG = 3.97 lordosis, 

lumbar trauma, Bone TB Co morbidities: (1.76) lumbosacral angle in 

and tumor, Pts with Disability: ---- IG appeared 

central nervous Prior episode of significant changes 

symptoms,Serious pain if acute: NR Short term: NR after spine fine 

cardiovascular and adjusting compared 

cerebrovascular Prior CAM Intermediate: NR to baseline. 

disease,Psychiatric pts intervention: NR 

Long term: NR 

Prior surgery 

related to current 

complaint: NR 

C-141
 
Table 1.16 Low Back Pain – Manipulation - Unknown - Non-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Shearar K 

(2004)140 

Trial Design 

RCT 

Mean age 

(SD/range): NR 

Cause of Pain: 

Sacroiliac joint 

Groups 

IG (n = 30)– HVLA 

Outcome 

instruments: 

Outcome 

instruments: 

Abstract syndrome chiropractic Pain: NRS-101­ QoL/ well being: NR 

Tx duration: 2 wks % of male: adjustments: mean values only 

Country: Final assessments: approx. 50% National-Diversified 

South Africa imm.post tx Duration of Technique; 4 tx over Disability: Revised Results: 

Racial Pain: Unknown, 2 wks ODQ Immediate post tx: 

composition: NR NR Drop outs: NR NA 

Quality N screened: 60 Results: 

score: 1/13 N randomized: 60 Work status: NR Severity of pain CG (n = 30) – Baseline: Short term: NR 

N completed tx: 60 (Grading): NR Mechanical force, Pain: IG = 49.1, CG 

N attended last fu: 60 Other socio­ manually assisted = 48.9 Intermediate: NR 

Initial of demographics: chiropractic Disability: IG = 

reviewer: SG NR Co­ adjustments: using 37.4, CG = 36.6 Long term: NR 

Inclusion: 18 - 59 ; interventions:NR an Activator 

diagnosed with sacroiliac Co morbidities: Adjusting Instrument; Immediate post tx: Harms: NR 

joint syndrome NR same as IG Pain: IG = 23.4, CG 

Drop outs: NR = 22.5 

Exclusion: NR Prior episode of Disability: IG = 

pain if acute: NR 18.5, CG = 15.1 

Prior CAM Short term: 

intervention: NR 

Intermediate: 

Prior surgery Long term: 

related to current 

complaint: NR 

C-142
 
Table 1.17 Low Back Pain – Mobilization – Acute/Sub-acute-non Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hadler NM 

(1987)109 

Trial Design-RCT Mean age 

(SD/range): NR 

Cause of Pain: 

Non-S 

IG (n = 28) – 

Mobilization: Pt was 

Outcomes: Outcomes: 

QoL/ well being: NR 

Tx duration: NR positioned first on the Disability: RMDQ 

Country: Final assessments: % of male: 48% Duration of right and then on the 

US immediately post tx total Pain: Acute  2 left side; the operator Results: Results: 

wks: n = 13 grasped both knees Baseline: Immediate post tx: 

N screened: 57 Racial with one arm while Disability: NR NA 

Quality N randomized: 54 composition: NR Severity of pain pressing down on the 

score: 7/13 N completed tx: NR (Grading): NR on the pts’ lower Immediate post tx: Short term: NR 

N attended last fu: NR Work status: NR spine with the Disability: IG = 9.1 Intermediate: NR 

opposite hand; then (5.3), CG = 3.9 Long term: NR 

Initial of Inclusion: Pts aged 18­ Other socio- Co­ the subjects legs (4.3) 

reviewer: SG 40 yrs with acute LBP ( demographics: interventions:NR were gently flexed on Harms: NR 

1 mo), no other episode NR the hips twice; NR Short term: NR 

of back pain in previous 6 Drop outs: NR Summary: SM was 

mo, not work-related Co morbidities: Intermediate: NR more effective than 

pain, no previous surgery NR CG (n = 26) – Mob at reducing 

Manipulation: HV Long term: NR disability score in the 

Exclusion: NR Prior episode of thrust was applied to first wk of tx (time 

pain if acute: NR the lower spine while and tx interaction 

stabilizing the thorax; significant p < 0.04) 

Prior CAM NR for those with 

intervention: NR Drop outs: NR duration of pain of 2­

4 wks 

Prior surgery 

related to current 

complaint: None 

C-143
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hanrahan, S 

(2005)141 

Trial Design-RCT Mean age 

(SD/range): 20.3 

Cause of Pain: 

N-S 

Groups 

IG (n = 9)– 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: NR yrs Experimental: Pain: MPQ: no QoL/ well being: 

Country: Final assessments: standard tx of numeric data 

U.S. immediately post tx % of male: 100 Duration of cryotherapy and provided Muscle force: data 

Pain: Acute stretching, grade 1 not shown 

N screened: 19 Racial and 2 joint Mobs Disability: NA 

Quality N randomized: 19 composition: NR Severity of pain administered at the 

score: 2/13 N completed tx: 19 (Grading): NR lumbar spine; 30 sec Results: Results: 

N attended last fu: NR Work status: NR each, 6 repetitions Immediate post tx: Immediate post tx: 

Drop outs: A=0, B=0 Pain: NA 

Initial of Inclusion: All male Other socio- Co- Disability: NA Short term: NR 

reviewer: SG collegiate athletes with demographics: interventions:NR CG (n = 10) – 

acute LBP for less than Height: 185.4 cm Control: standard tx Short term: NR Intermediate: NR 

48 hrs. Mechanical LBP, avg; Weight: 92 protocol of 

not radicular. Prior tx of kg avg cryotherapy and Intermediate: NR Long term: NR 

lumbar spine not stretching, placed in 

excluded Co morbidities: prone position of Long term: NR Harms: NR 

NR comfort during joint 

Exclusion: Any Mobs; NR Summary: Overall 

conditions (e.g. Prior episode of Drop outs: NR pain decreased for 

Neurologic deficit or pain if acute: NR all over time. MPQ 

suspected disk (P = 0.001). Pain 

herniation) for which joint Prior CAM decreased for the 

Mob techniques were intervention: NR sensory pain 

contraindicated. Any subscale (P = 0.000) 

radicular, disk, or fracture Prior surgery and difference was 

involvement related to current noted between 

complaint: NR groups and tests (P 

= 0.048). 

C-144
 
Table 1.18 Low Back Pain – Mobilization – Acute/Sub-acute Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Wreje U 

(1992)142 

Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

Pelvic joint 

Groups 

IG (n = 18) – SM: 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: 3 wks 31.9 vs. CG = dysfunction MET and segmental Pain: VAS [no QoL/ well being: NR 

Country: Final assessments: 31.4 yrs Mob by Kubis, based numerical data] 

Sweden immediately post tx Duration of on pts clinical Results: 

% of male: 0 Pain: Acute, NR picture, techniques Disability: NA Immediate post tx: 

N screened: 46 were combined with NA 

Quality N randomized: 39 Racial Severity of pain stretching of the Results: 

score: 4/13 N completed tx: 32 composition: NR (Grading): NR paracoccygeal Short term: NR 

N attended last fu: NR ligaments per rectum Immediate post tx: 

Work status: NR by putting little Pain: --- Intermediate: NR 

Initial of Inclusion: LBP due to Co­ pressure on coccyx Disability: NA 

reviewer: SG pelvic joint dysfunction Other socio­ interventions:No in dorsal direction; 3 Long term: NR 

(positive test results on demographics: ne wks Short term: NR 

the following: asymmetry NR Drop outs: n =7(total) Harms: NR 

of the pelvis, movement, Intermediate: NR 

and provoked pain) Co morbidities: CG (n = 21) – Sham- Summary: The use 

NR SM: manual Long term: NR of analgesics was 

Exclusion: Pregnancy, transverse frictions higher in the CG 

pain duration > 3 mo, Prior episode of on the gluteus compared to IG (p < 

malignancy, neurological pain if acute: NR medius muscles for 0.05) over 3 wks; 

disease, lumbar spine three minutes; as IG there was no 

pathology Prior CAM Drop outs: between group 

intervention: NR difference in pain 

Prior surgery 

related to current 

complaint: None 

C-145
 
Table 1.19 Low Back Pain – Mobilization – Chronic-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms

 Timm 

(1994)143 

Trial Design-RCT- Mean age:41 – 

45 yrs 

Cause of Pain: 

Post 

Groups 

IG (n = 50) – Joint 

Outcomes: 

Disability: 

Outcomes: 

QoL/ well being: NR 

Tx duration: 8 wks laminectomy manipulation: Large Oswestry; 

Country: Final assessments: Post­ % of male: 72.8 amplitude, low Results- Other: modified 

US tx Duration of velocity Maitland; 3 Schober (ROM) (cm) 

Racial Pain: Chronic, tx/wk for 8 wks Immediate post tx: 

Quality N screened: NR composition: NR NR Drop outs: None Disability: IG = 5.57 Results- mean 

score: 4/13 N randomized: 250 (2.38), CG1 = 2.55 (SD): 

N completed tx: 250 Work status: Severity of pain CG1 (n = 50) – (1.03), CG2 = 5.69 Immediate post tx: 

N attended last fu: 250 100% employed (Grading): Physiotherapy: hot (3.1), CG3 = 4.84 IG = 6.46 (2.17), 

Initial of in automotive NR packs, ultrasound, (2.67), CG4 = 2.19 CG1 = 6.31 (1.52), 

reviewer: SG Inclusion: lumbar- industry TENS; Same as IG (1.54); CG2 = 8.81 (2.36), 

related pain and Co- Drop outs: None CG3 = 9.07 (2.61), 

associated Other socio­ interventions:NR Short term: NR CG4 = 6.24 (1.47) 

symptomatology for at demographics: CG2 (n = 50) – Low- Intermediate: NR 

least 6 mo prior to the NR tech McKenzie EXs: Long term: NR Short term: NR 

period of study following Co morbidities: NR; As IG Intermediate: NR 

a single-level lumbar NR Drop outs: None Long term: NR 

laminectomy of the L5 Prior episode of 

segment performed at pain if acute: NR CG3 (n = 50) – High- Harms: NR 

least 1 yr before the start tech Cybex EXs: NR; 

of the experiment; Prior CAM Same as IG Note: atuthors 

intermittent or constant intervention: NR Drop outs: None concluded that the 

pain in one of the lower low tech EX 

extremities but not below Prior surgery CG4 (n = 50) – No produced longer 

the level of the knee related to current Tx pain relief and was 

complaint: 50 Drop outs: None also most costExclusion: NR effective. 

C-146
 
Table 1.20 Low Back Pain – Mobilization – Chronic-Non-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Ritvanen T 

(2007)144 

Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

N-S 

Groups 

IG (n = 33) – TBS: 

Outcomes: 

Pain: VAS 

Outcomes: 

QoL/ well being: NR 

Tx duration: 2 mos 40.7 (4.75) vs. based on manual 

Country: Final assessments: 3 CG = 41.5 (5.95) Duration of whole body tx; tx Disability: ODQ Finger to floor 

Finland mos yrs Pain: Chronic, starts from toes and distance (cm); lateral 

IG = 7 yrs (7); feet up to the hands Results: bending (right and 

N screened: 150 % of male: IG = CG = 11 yrs (8) and head mobilizing Baseline: left)- cm. 

Quality N randomized: 61 54.5%; CG = tissues and Pain: IG = 40 (4), 

score: 5/13 N completed tx: 61 57.1% Severity of pain malocclusions; 5 tx CG = 41 (4) Results: 

N attended last fu: 54 (Grading): NR with 2 wk intervals Disability: IG = 18 Immediate post tx: 

Racial over 2 mo (2), CG = 21 (2) finger to floor 

Initial of Inclusion: Pts with composition: NR Co- Drop outs: C = 2 distance: 5.4 (2.2) 

reviewer: SG CLBP aged 20-60 yrs Work status: NR interventions:Pai Immediate post tx: vs. 6.3 (1.9) 

who had restricted nkillers CG (n = 28) – PT: Pain: NR Right lateral 

functioning Other socio- Included massage, Disability: NR bending: 17.1 (0.6) 

demographics: therapeutic vs. 17.1 (0.7) 

Exclusion: severe NR stretching, trunk Short term: Left lateral bending: 

neurologic, metabolic, or stabilization EX, EX VAS: IG = 23 (5), 17.4 (0.7) vs. 16.5 

CVD , back surgery, Co morbidities: therapy; same as IG CG = 28 (4) (0.8) 

mental disease, major NR Drop outs: C = 5 ODQ: IG = 12 (2), 

structural abnormality, CG = 17 (2) Short term: NR 

pregnancy Prior episode of 

pain if acute: NR Intermediate: NR Intermediate: NR 

Prior CAM Long term: NR Long term: NR 

intervention: NR 

Harms: NR 

Prior surgery 

related to current 

complaint: None 

C-147
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Cote P 

(1994)121 Trial Design-RCT Mean age 

(SD/range): 31 

Cause of Pain: 

Mechanical 

Groups 

IG (n = 16) – 

Outcomes 

(instrument used): 

Outcome 

instruments: 

Tx duration: one session (7.15) yrs total Mobilization: side- Pain: PPT: L5 QoL/ well being: NR 

Country: Final assessments: post- Duration of lying position, a tender point; 

Canada tx % of male: IG = Pain: Chronic, counter-rot force was Sacroiliac (SI) Results: 

37.5%, CG = 74 (83.3) mo created at the lumbo­ ligament tender Baseline: NA 

N screened: NR 71.4% (total) sacral junction or point; gluteus 

Quality N randomized: 30 sacroiliac joints; joint tender point Immediate post tx: 

score: 4/13 N completed tx: 30 Racial Severity of pain taken to its limit of (gluteal) 

N attended last fu: 30 composition: NR (Grading): NR passive motion and Short term: NR 

HVLA thrust applied Results: Intermediate: NR 

Initial of Inclusion: Pts with Work status: NR through the joint Immediate post tx: Long term: NR 

reviewer: SG mechanic CLBP > 2 mo Co­ producing an audible Pain: 

Other socio­ interventions:NR sound; one session L5: IG = 5.6(2.1), Harms: NR 

Exclusion: seronegative demographics: Drop outs: 0 CG = 5.1 (3.0); 

spondyloarthropathy or NR SI: IG = 5.6 (2.1), Summary of results 

rheumatoid arthritis, CG (n = 14) – CG = 5.5 (3.1) (if provided): The 

lumbar radiculopathy, hip Co morbidities: Manipulation: a long Gluteal : IG = 5.6 two groups did not 

pathology, NR lever HV thrust (2.2), CG = 5.2 differ in mean PPT 

abdominal/pelvic organ applied to the lower (2.7) scores for the three 

pathology, pregnancy, Prior episode of spine while myofascial points 

current use of muscle pain if acute: NR stabilizing the thorax Short term: NR (L5 tender point, SI 

relaxants or anti- in side lying and ligament tender 

inflammatory drugs Prior CAM supine position Intermediate: NR point, and gluteus 

intervention: NR Drop outs: 0 tender point); 

Long term: NR ANOVA indicated no 

SS time*tx term 

Prior surgery interaction (P > 

related to current 0.267) 

complaint: NR 

C-148
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Mackawan S 

(2007)145 Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

N-S 

Groups 

IG (n = 35)– 

Outcomes: 

Pain: VAS (10 cm); 

Outcome 

instruments: 

Tx duration: one session 38.97 (7.85) vs. Traditional Thai QoL/ well being: NR 

Country: Final assessments: post- CG = 38.57 Duration of massage(TTM): Results: 

Thailand tx (7.66) yrs Pain: Chronic, Deep massage with Baseline: Results: NA 

NR prolonged pressure Pain: IG = 4.22 Baseline: 

N screened: NR % of male: IG = (5-10s/point) on the (1.98), CG = 4.35 

Quality N randomized: 67 34%, CG = 44% Severity of pain muscles along with (1.71) Immediate post tx: 

score: 5/13 N completed tx: 67 (Grading): NR passive stretching. 

N attended last fu: 67 Racial Gentle stretching of Immediate post tx: Short term: NR 

composition: NR the joints and Pain: IG = 2.45 

Initial of Inclusion: 20-60 yrs; Co­ muscles relieves (1.75), CG = 3.39 Intermediate: NR 

reviewer: SG persistent CLBP (> 12 Work status: interventions:NR tension, enhances (1.66) 

wks); no evidence of Government flexibility, and Long term: NR 

underlying diseases or service = 49%; induces a deep state Short term: NR 

anatomical abnormalities Private officer = of tranquility; one 10 Harms: NR 

Exclusion: menstruation; 32.5%; Student= min session Intermediate: NR 

pregnancy; body temp 6%; Business Drop outs: NR 

38.5°C on d of exam.; a owner = 11.5% Long term: NR 

history of acute trauma, CG (n = 32) – Joint 

back surgery, spinal Other socio- Mob: passive 

fracture, joint subluxation demographics: movement of a spinal 

or instability, NR segment with and 

inflammatory joint Co morbidities: occasionally beyond 

disease muscle disease, NR its active ROM.; as 

malignancy or infection; Prior episode of IG 

evidence of neurologic pain if acute: NR Drop outs: NR 

deficits, multiple 

sclerosis, hemi/para Prior CAM 

paresis or myelopathy, intervention: NR 

skin diseases, or Prior surgery 

infectious diseases related to current 

complaint: NR 

C-149
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Lopez de, C 

(2007)146 Trial Design-RCT- Mean age 

(SD/range): NR 

Cause of Pain: 

N-S 

Groups 

IG (n = 100) – 

Outcomes: 

Pain: VAS 

Outcomes: 

QoL/ well being: NR 

Tx duration: NR Mobilization: NR 

Country: Final assessments: % of male: NR Drop outs: NR Disability: Roland Other: ROM 

Spain immediately post tx Duration of Morris 

Racial Pain: NR CG (n =NR)– No tx: Immediate post tx: 

N screened: NR composition: NR NR Results: Flexion IG 6.28 vs. 

N randomized: 100 Severity of pain Drop outs: NR Baseline: CG 5.20 

Quality N completed tx: NR Work status: NR (Grading): NR Pain: IG 48.7 vs. Extension IG 1.80 

score: 8/13 N attended last fu: NR CG 49.23 vs. CG 1.40 

Other socioInclusion: N-S CLBP, demographics: Co- Immediate post tx: Short term: NR 

Initial of aged 18-65 yrs; NR interventions:NR Pain: IG 33.40 vs. 

reviewer: SG Exclusion: ongoing CG 49.77 Intermediate: NR 

insurance claim; Co morbidities: Disability: IG 7.89 

unsettled social pension NR vs. CG 10.64 Long term: NR 

claim; LBP caused by 

major accident; pain ext Prior episode of Short term: NR Harms: NR 

below knee; excessive pain if acute: NR 

distribution of pain Intermediate: NR Summary: IG shoes 

according to a pain Prior CAM a significant 

drawing; neurological intervention: NR Long term: NR improtment in pain, 

diseases including known lateral beniding, 

disc herniation; mobility and 

significant medical Prior surgery disability degree. 

diseases including related to current 

cancer; inflammation; complaint: NR 

language problems; 

suspected noncompliance or planned 

other tx in the first 4 wks 

C-150
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hemmila Trial Design-RCT- Mean age Cause of Pain: Groups Outcomes: Outcomes: 

(1997)147 

Tx duration: 6 wks 

(SD/range): IG = 

42 (12); CG1 = 

N-S IG (n = 34) – Bonesetting: NR; 1-2 tx/wk Pain: 100 mm VAS 

( 

QoL/ well being: NR 

Other: physical 

Country: Final assessments: 6 wks 42 (8.9); CG2 = Duration of for 6 wks Disability: NR measures, mean 

Finland and 6 mos 41 (9.9) yrs Pain: Mixed, IG 

= 7 (8.9) yrs; 

Drop outs: 1 (unclear 

from which grp or at Resultschange from baseline (mm): at 6 

Quality N screened: 147 % of male: IG = CG1 = 8.5 what point) Immediate post tx: wks 

score: 6/13 N randomized: 114 

N completed tx: 113 

N attended last fu: 113 

55.9, CG1 = 

55.5, CG2 = 60 

(10.5) yrs; CG2 

= 6.8 (7.2) yrs CG1 (n = 45) – 

Physiotherapy, 

Pain: no significant 

differences 

between IG and CG 

Modified Schober; 

0.1 vs. 0.8 vs. 2.4 

Side Bending: 11.0 

Initial of Racial Severity of pain mainly manual (no Disability: NR vs. 5.4 vs. -2.1 

reviewer: SG Inclusion: Back pain 

between the shoulders 

and the buttocks 

Exclusion: retirement, 

pregnancy, malignancy, 

rheumatic diseases, 

severe osteoarthritis, 

cauda equina syndrome, 

back operation, or 

vertebral fracture in the 

past 6 mos or any 

condition that would 

prevent or contraindicate 

any of the therapies. 

composition: 

Work status: NR 

Other sociodemographics: 

28.3% Smokers 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

(Grading): 

NR 

Cointerventions:NR 

thrusts), thermal, 

electrotherapy: NR; 

Same as IG 

Drop outs: See IG 

CG2 (n = 35) – 

Home EXs with 

individual instruction 

by PT: NR; Same as 

IG 

Drop outs: See IG 

Short term: 

NR 

Intermediate: 

Pain: no numerical 

mean values 

reported. Sign 

difference between 

IG and CG in 

favore of IG in VAS 

Long term: NR 

Lumbar Extension: 

3.7 vs. 3.6 vs. 3.1 

Straight leg 

raising: 2.4 vs. 1.6 

vs. 1.8 

Short term: NR 

Intermediate (6 

mos): 

Modified Schober: 

4.0 vs. 2.3 vs. -1.0 

Side Bending: 9.3 

vs. 3.6 vs. -2.7 

Lumbar Extension: 

5.4 vs. 6.8 vs. 4.3 

Straight leg 

raising: 2.4 vs. 1.6 

vs. 1.8 

Long term: NR 

Harms: NR 

C-151
 
Table 1.21 Low Back Pain – Manipulation + Mobilization – Acute/Sub-acute- -Specific Pain - No Trials 

Table 1.22 Low Back Pain – Manipulation + Mobilization – Acute/Sub-acute-Non-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hancock MJ Trial Design-RCT Mean age (yrs) Cause of Pain: Groups Outcomes: Outcome 

(2007)148 (SD/range): IG1 N-S IG1 (n = 60)– Pain: NRS (0 – 10); instruments: 

Tx duration: 4 wks = 39.5 (15.8), Diclofenac: NSAID; also d to recovery QoL/ well being: 

Country: Final assessments: 3 mos IG2 = 41.1 (15.4) Duration of 50 mg twice/d, 4 wks (primary outcome global precieved 

Australia N screened: 320 

N randomized: 240 

N completed tx: 240 

% of male: IG1 = 

58%, IG2 = 54% 

Pain: Acute, NR 

Severity of pain 

Drop outs: n = 3 

IG2 (n = 60) – SM: 

of study) 

Disability: RMDQ 

effects: 

Results: 

N attended last fu: 235 (Grading): NR The algorithm-based Immediate post tx at 

Quality Racial approach, Mob or HV Results- 4 wks 

score: 9/13 Inclusion: Pts with acute composition: NR Co­ thrust aiming to 0.2 (95% CI: -0.1 –

LBP (< 6 wks) in the area interventions:par produce motion at Immediate post tx: 0.6) vs. 0.0 (-0.3 – 

Initial of 

reviewer: SG 

between the 12th rib and the 

buttock crease causing 

moderate pain and 

disability 

Work status: NR 

Other sociodemographics: 

acetamol 1 g 4 

times/d + advise 

the joints of the 

lumbar spine thoracic 

spine, sacroiliac joint, 

pelvis and hip; 2-3 

Pain: - 2.0 (-0.7 – 

0.3) vs. -0.1 (-0.6 – 

0.4) 

Disability: -1.0 (-2.0 

0.3) 

Short term: 0.3 (-0.1 

– 0.6) vs. 0.1 (-0.3 – 

Exclusion: present episode NR times/wk, 4 wks – 0.1) vs. -0.7 (-1.8 0.4) 

of pain not preceded by Drop outs: n = 2 – 0.4) 

pain-free period of  1 mo in Co morbidities: Intermediate: NR 

which care was not NR IG3 (n = 60) – Short term: V 

provided, serious spinal Diclofenac + SM + Pain: - 0.2 (-0.7 – Long term: NR pathology, nerve root Prior episode of SMo; 4 wks 0.3) vs. 0.0 (-0.5 – compromise, NSAIDs use or 

SM, spinal surgery in the 

preceding 6 mo, 

contraindication to NSAIDs 

and SM 

pain if acute: NR 

Prior CAM 

intervention: NR 

Drop outs: n = 0 

CG (n = 60) – 

Placebo manipulative 

0.4) 

RMDQ : -0.5 (-1.7 – 

0.7) v.s -0.1 (-1.3 – 

1.1) 

Harms: NR 

therapy + placebo 

Prior surgery diclofenac: NR Intermediate: NR 

related to current Drop outs: n = 0 

complaint: NR Long term: NR 

C-152
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hurley DA 

(2004)149 

Country: 

Ireland 

Quality 

score: 6/13 

Initial of 

reviewer: SG 

Trial Design-RCT 

Tx duration: 8 wks 

Final assessments: 

discharge, 6 mos and 12 

mos 

N screened: 569 

N randomized: 240 

N completed tx: 240 

N attended last fu: 158 

Inclusion: Pts aged 18­

65 yrs with acute LBP 

(duration: 4-12 wks) with 

or without pain irradiation 

to the buttock or legs 

Exclusion: Previous 

spinal surgery, motor 

vehicle accidet, systemic 

disease, concurrent 

medical or 

musculoskeletal 

conditions, 

contraindication to 

manual therapy, 

psychiatric illness, lack of 

fluence in English RMDQ 

< 4 points, pregnancy 

Mean age 

(SD/range): IG = 

39.6 (11.6), IG2 

= 40.2 (12.1), 

CG = 40.5 (11.3) 

yrs 

% of male: IG = 

54%, IG2 = 

50%,CG = 52% 

Racial 

composition: NR 

Work status: 

Employed: IG = 

19%, IG2 = 23%, 

CG = 20% 

Other sociodemographics: 

Non-smokers: IG 

= 49%, IG2 = 

42%, CG = 39% 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Cause of Pain: 

Work-related 

Duration of 

Pain: Acute, IG 

= 7.5 (3.1) wks, 

IG2 = 7.6 (3) 

wks, CG = 8.3 

(2.8) wks 

Severity of pain 

(Grading): NR 

Cointerventions:NR 

Prior surgery 

related to 

current 

complaint: NR 

Groups 

IG (n = 80)– MT: 

Mobilization/manipul 

ation techniques that 

passively move an 

intervertebral joint 

within or beyond its 

existing ROM 

described my 

Maitland; 8 wks 

Drop outs: D = 26 

CG1 (n = 80) – IFT: 

Omega Inter 4150 

portable IFT unit 

(freq: 3.85 kHz, beat 

freq: 140 Hz, 130 

microsec), spinal 

nerve root electrode 

placement method 

via two Reply 658 

carbon silicone selfadhesive electrodes 

50 x100 mm; as IG 

Drop outs: D = 23 

CG2 (n = 80) – MT + 

IFT: Both protocols 

explained above 

provided with MT first 

and then IFT second; 

as IG 

Drop outs: D = 27 

Outcomes: 

Pain: VAS, mean 

change from 

baseline 

Disability: RMDQmean chage from 

baseline 

ResultsImmediate post tx: 

Pain: -19.8 vs. ­

21.4 vs. -24.7 

Disability: -4.5 vs. ­

3.6 vs. -4.7 

Short term: NR 

Intermediate: 

Pain: -17.0 vs. ­

24.6 vs. -20.0 

Disability: -4.7 vs. ­

3.9 vs. -4.6 

Long term: 

Pain: -18.2 vs. ­

26.5 vs. -25.7 

Disabiltiy: -4.7 vs. ­

4.9 vs. -6.5 

QoL: EQ-5D 

Weighted Health 

Index, mean change 

from baseline 

Other: short term SF36 physical 

functiuoning, mean 

change from baseline 

Immediate post tx: 

EQ-5D: 0.16 vs. 0.16 

vs. 0.15 

SF-36: 15.2 vs. 10.6 

vs. 14.3 

Short term: NR 

Intermediate: 

EQ-5D: 0.17 vs. 0.16 

vs. 0.16 

SF-36: 12.6 vs. 10.1 

vs. 14.4 

Long term: NR 

EQ-5D: 0.15 vs. 0.20 

vs. 0.25 

SF-36: 9.4 vs. 11.7 

vs. 21.4 

Harms: No AEs 

were reported. One 

Pts died due to 

causes unrelated to 

LBP or PT 

C-153
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Farrell, JP Trial Design: RCT Mean age: Cause of Pain: Groups Outcome Outcome 

(1982) 150 IG = 43.4; CG = NR IG (n = 24)– passive instruments: instruments: 

Tx duration: 3x/wk for up to 41.83 mobilisation and Pain: Mean subjective QoL/ well being: 

Country: 

Australia 

Quality 

3 weeks. 

Final assessments: 3 weeks 

from date of initial treatment 

N screened: 56 

N randomized: 48 

% of male: 

IG = 67%; CG1 = 

58% 

Duration of 

Pain: Acute 

Severity of pain 

manipulation – 

techniques descrbeid 

by Stoddart and 

Maitland. 

pain rating (0-10) 

Disability: NR 

Results: 

Results: 

Immediate post tx: 

score: 4/13 N completed tx: 48 (Grading): Drop outs: NR Baseline: Short term: NR 

N attended last fu: NR Racial Numerical 

Initial of composition: Rating Scale: (0 CG (n = 24) – Pain: (estimated Intermediate: NR 

reviewer: ST Inclusion: Either sex aged NR – 10) Received 15 minutes based on graph) 

20-65 with pain on lumbar 

movements or straight leg 

raising, pain centrally or 

pravertebrally between T12 

and gluteal folds, symptoms 

of 3 wks durations, 

Work status: NR 

Other sociodemographics: 

IG = 4.95 

(estimated 

based on graph) 

CG1 = 5.25 

of microwave 

diathermy in a 

combfortable sidereclining position ; 10 

repittioan of isometric 

IG = 4.95 

CG = 5.25 

Disability: NR 

Immediate post tx: 

Long term: NR 

Harms: NR 

Summary 

experienced a pain-free NR (estimated abdominal excrcies Pain: (estimated Pts with acute LBP 

period of 6 mnths prior. based on graph) which the subject based on graph) treated by passive 

Exclusion:Had other Co morbidities: also carried out IG = 3.80 mobilisation and 

treatment for the current NR Co­ independently CG = 4.40 manipulation had a episode of LBP, pregnant, Prior CAM interventions: another 3-4 times a shorter mean 

signs of caudaequinal 

pressure, alterered 

sensation, reflexes or 

weakess in lower 

extremities, previous 

intervention: NR 

Prior surgery 

related to current 

NR day; ergonomic 

instructions which 

include advice on 

activities such as 

Disability: NR 

Short term: 

(estimated based on 

graph) (after 3rd tx) 

duration of 

symptoms compared 

with those who were 

treated by 

surgery in the lumbar complaint: NR lifting, sitting, IG = 2.95 microwave 

region, history of fracture in standoing, carrying CG = 2.75 diathermy, isometric 

the lower thoracic lumbar objects and rest (3 wks after initial tx) abdominal exercises 

region, evidence of systemic postures. IG = 0.30 and ergonomic disease or carcinoma. Drop outs: NR CG = 0.30 instructions. 

Intermediate: NR 

Long term: NR 

C-154
 
Table 1.23 Low Back Pain – Manipulation + Mobilization – Chronic-Non-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Aure 

(2003)151 

Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

N-S 

Groups 

IG (n = 27) – Spinal 

Outcomes: 

Pain: VAS 100 mm 

Outcome 

instruments: 

Tx duration: 8 wks 38.9 (12.85) vs. manipulation, S Mob, QoL/ well being: 

Country: Fu duration: 6 mos CG = 41.1 and stretching Disability: Oswestry General health (data 

(10.76) yrs Duration of techniques described Disability Index not shown) 

Norway N screened: 60 Pain: Chronic, by Evjenth, (ODI) 

N randomized: 49 % of male: IG = IG = 16 (17.23), Hamberg, and Other pts sick listed 

Quality N completed tx: 49 52%, CG = 54% CG = 10 (10.77) Kaltenborn were Results- At entery: 100% on 

score: 8/13 N attended last fu: 49 yrs allowed; 16 tx, 45 Immediate post tx: partial or full time 

Racial min/ each, 2 tx/wk for Pain: IG=22 (18.56) sick leave 

Inclusion: Men and composition: NR Severity of pain 8 wks, max. 6 home CG = 37 (25.12) 

Initial of women age 20-60 yrs (Grading): NR EXs during tx period Disability: IG = 18 Immediate post tx: 

reviewer: SG sick-listed between 8 wks Work status: all Drop outs: B=2 (13.26), CG = 30 9 (33%) vs. 16 

and 6 mos due to LBP pts sick-listed for (10.77) (73%) 

with or without leg pain. 8 wks-6 mo Co- CG (n = 22) – 

Exclusion: interventions:NR Exercise therapy: 45 Short term: Short term (4 wks) 

Unemployment or early Other socio­ min of training, EX VAS: IG=22(19.88), 8 (30%) vs. 12 

retirement because of demographics: programs designed CG = 39 (22.53) (57%) 

LBP; prolapsed with NR based on pt exam- ODI: IG=18(11.93) 

neurologic signs and Co morbidities: ination, group CG = 30 (14.36) Intermediate (6 

symptoms requiring NR training and mos): 3 (1150 vs. 13 

surgery; pregnancy; massage not Intermediate: (62%) 

spondylolisthesis; Prior episode of allowed; same as IG VAS: IG=21 (14.58) 

spondylolysis;degenerati pain if acute: NR Drop outs: B=1 CG = 35 (35.89) Long term (12 mos): 

ve olisthesis; fractures; ODI: IG = 17 5 (19%) vs. 13 

suspicion ofmalignancy; Prior CAM (13.25), CG = 26 (59%) 

osteoporosis; previous intervention: NR (14.36) 

back surgery; known Harms: NR 

rheumatic, neurologic, or Long term: NR 

mental disease Prior surgery 

related to current 

complaint: NR 

C-155
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Ferreira ML 

(2007)152 

Trial Design-RCT Mean age 

(SD/range): IG1 

Cause of Pain: 

N-S 

Groups 

IG1 (n = 80) – SM: 

Outcomes: 

Pain: VAS 

Outcome 

instruments: 

Tx duration: 8 wks = 54 (14.4), IG2 Joint Mob or QoL: Global 

Country: Final assessments: 6 = 51.9 (15.3), Duration of manipulation Disability: RMDQ precieved effect 

Australia mos CG = 54.8 (15.3) Pain: Chronic, techniques applied to Resultsyrs IG1 = 60 mo, spine or pelvis, Immediate post tx: Results: 

N screened: NR IG2 = 36 mo, doses and Pain: 4.1 (2.6) vs. , Immediate post tx: 

Quality N randomized: 240 % of male: 31% CG = 60 mo techniques 4 (2.5 ) vs. 4.8 (2.4) 2.3 (2.2) vs. 2.8 (1.8) 

score: 7/13 N completed tx: 240 total sample prescribed based on Disability: 7.9 (6) vs. 1.0 (2.8) 

N attended last fu: 211 Severity of pain pts’ exam results; 12 vs. 7.9 (5.7) vs. 9.7 

Racial (Grading): NR sessions, 8 wks (6.3) Short term: NR 

Initial of Inclusion: Pts with N-S composition: NR Drop outs: D = 7 

reviewer: SG CLBP ( 3 mo) aged 18­ Co- Short term: NR Intermediate: 

80 yrs; pts with OA, disc Work status: NR interventions:No IG2 (n = 80)– MC­ 1.7 (2.6) vs. 1.9 (2.4) 

protrusion, or herniation ne EX: improving Intermediate: vs. 1.4 (2.4) 

without neurological Other socio­ function of trunk VAS: 4.3 (2.6), vs. 

compromise were also demographics: muscles (transversus 4.3 (2.6) vs. 4.8 Long term: 1.2 (2.9) 

included NR abdominis, (2.6) vs. 1.8 (2.5) vs. 1.0 

multifidus, the RMDQ: 7.7 (6.2) (2.8) 

Exclusion: Serious low Co morbidities: diaphragm, and vs.8.4 (6.4) vs. 10.1 

back pathology, NR pelvic floor muscles; (7) Harms: No AEs 

contraindications to EX or cognitive-behavioural were reported. 

SM therapy, neurological Prior episode of therapy encouraging Long term: 

signs, spinal pathology, pain if acute: NR skill acquisition; VAS: 4.9 (2.7) vs. Summary: There 

or back surgery same as IG1 4.9 (2.9),vs. 5.2 were no apparent 

Prior CAM Drop outs: D = 15 (2.8) differences between 

intervention: NR RMDQ: 9.2 (6.6) groups in 

CG (n = 80) – GEN­ vs. 8.8 (6.5) vs. 9.6 either primary or 

EX: 'Back to Fitness' (6.9) secondary variables 

Prior surgery program; 12 1 hr at 6 or 12 mos. 

related to current sessions, 8 wks 

complaint: None Drop outs: D = 7 

C-156
 
Table 1.24 Low Back Pain – Manipulation + Mobilization – Mixed- Specific Pain-No trials 

Table 1.25 Low Back Pain – Manipulation + Mobilization – Mixed-Non-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Chiradejnant 

A, 

(2003)153,154 

Country: 

Australia 

Quality 

score: 5/13 

Initial of 

reviewer: FY 

Trial Design-RCT 

Tx duration: 1 session 

Fu duration (last 

assessment): 

immediately post tx 

N screened: 

N randomized: 140 

N completed tx: 140 

N attended last fu: 140 

Inclusion: Pts with LBP 

and resting pain > 2 on a 

0-10 scale; candidate for 

mobilization by PT 

Exclusion: red flag 

conditions such as 

malignancy or 

inflammatory or infectious 

diseases affecting the 

spine 

Mean age 

(SD/range): 47.4 

(16.4) vs. 45.4 

(16.5) 

% of male: NR 

Racial 

composition: NR 

Other sociodemographics: 

work loss (days) 

4.7 (8.9) vs. 3.9 

(7.7) 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NA 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

Region of pain: 

LBP- NS 

Some with leg 

numbness 

(15.7% vs. 

22.9%) 

Duration of 

Pain, mean 

Mixed, 184.1 

(539.9) vs. 89.3 

(279.7) days 

Severity of pain 

(Grading): NR 

Current 

treatment/ cointervention 

common in all 

groups: NR 

Groups 

IG1 (n = 70) – PT 

selected correct 

mobilization 

technique 

By qualified PTs 

Single session 

Drop outs: 0 

IG2 (n = 70) – 

randomly selected 

mobilization 

technique 

Drop outs: 0 

Outcomes: 

Pain: VAS 

Disability: NR 

Well being: global 

perceived effect (11 

point scale) 

Results: 

Immediate post tx: 

Change from 

baseline: 

Pain: 

Current pain 

intensity 1.3 (1.4) 

vs. 1.2 (1.7) 

On most painful 

movement 1.7 (1.7) 

vs. 1.4 (1.50 

% reduction of pain 

intensity 29.7 (32.7) 

vs. 23.9 (37.9) 

Global perceived 

effect: 1.4 (1.8) vs. 

1.2 (1.9) 

Outcomes: 

Range of 

movements (ROM) 

Change from 

baseline: 

Finger to floor (cm): 

2.0 (2.6) vs. 0.5 (5.6) 

Flexion: -3.5 (3.8) 

vs. -1.9 (6.5) 

Extension (degrees) 

-2.2 (2.9) vs. -2.6 

(2.8) 

Right lateral flexion: 

-2.0 (2.5) vs. -1.9 

(2.7) 

On most painful 

movement: -3.2 (3.2) 

vs. -2.1 (6.3) 

Harms: NR 

C-157
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Goodsell, M 

(2003)155 

Trial Design-RCT- cross 

over 

Mean age 

(SD/range): NR 

Region of pain: 

LBP- NS 

Groups 

IG (n = 12) – Lumbar 

Outcomes: 

Pain: VAS 

Outcomes: 

Range of 

Some with leg postero-anterior movements (ROM) 

Country: Tx duration: 1 session % of male: numbness mobilization applied Results: Change from 

Australia Fu duration (last 58 vs. 36% (15.7% vs. to the most Immediate post tx: baseline: 

assessment): Racial 22.9%) symptomatic spinal Change from Finger to floor (cm): 

immediately post tx composition: NR level baseline: 1.9 vs. 1.8 

Quality Duration of 3 x 1 minute reps- Pain: Flexion (degrees) 

score: 3/13 N screened: NR Other socio- Pain, mean magnitude adjusted In flexion -6.1 vs. ­ 0.9 vs. 1.4 

N randomized: 26 demographics: Mixed, 184.1 at PTs discretion 2.0 Extension 0.9 vs. 1.4 

N completed tx: 26 NR (539.9) vs. 89.3 Drop outs: 0 In extension (mm) ­

Initial of N attended last fu: 26 (279.7) days 7.4 vs. -3.0 

reviewer: FY Co morbidities: CG (n = 14) – Worse pain (mm) ­ Harms: NR 

Inclusion: Pts with LBP NR Severity of pain Control prone lying 13.4 vs. -3.5 

in last 48 hours, back (Grading): NR for 3 minutes Overall (%) -24.5 

pain elicited or increased Prior episode of Drop outs: 0 vs. -11.1 

by active lumbar flexion pain if acute: NA Current 

or extension movements, treatment/ copain elicited on Prior CAM intervention 

application of force to the intervention: NR common in all 

spinous process of 1 or groups: NR 

more lumbar vertebrae Prior surgery 

related to current 

Exclusion: known complaint: NR 

contraindication to 

manual therapy such as 

malignancy, inflammatory 

or infectious disease 

affecting the spine, or 

pregnancy 

C-158
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Himmilä, HM 

(2002)156 

Trial Design-RCT Mean age 

(SD/range): all 

LBP- NS. IG (n = NR )– spinal 

mobilization applied 

Outcomes 

(describe 

Outcomes 

(describe 

Tx duration: 1 session pts: 38.3 (11.7) centrally or instrument used): instrument used): 

Country: Fu duration (last range 18-61 Duration of unilaterally; between Pain by VAS Spinal ROM 

UK assessment): same day- Pain, mean 1 and 3 levels, using Disability by RMDQ Immediate post tx: 

Quality immediately post tx % of male: 58% (SD/range): 2-3 set of 4-6 reps. post placebo total 

score: /13 All pts 26.8 (MWM technique) Results: flexion: 69.7 (21.5); 

N screened: NR Racial (47.9) range 0.1 By senior PTs with Baseline: total extension 21.2 

N randomized: 26 composition: NR – 240 months mean 9 years post VAS at worst 7.0 (11.1) 

Initial of N completed tx: 26 graduate experience (2.0) ; During Post MWM total 

reviewer: FY N attended last fu: 26 Work status: NR Severity of pain and accredited MVM flexion 5.2 (1.9) flexion 76.7 (22.4); 

(Grading): NR course- one session Disability:11.4 (4.7) total extension 24 

Inclusion: ambulatory Other socio­ only (11.0) 

pts with back pain longer demographics: Drop outs: 0 Immediate post tx: 

than 7 weeks NR Current Pain: post placebo: Short term: NA 

treatment/ co­ CG1 (n = NR)– 4.3 (2.2) 

Exclusion: Patients with Co morbidities: intervention Placebo mobilization Post MWM 4.2 Intermediate: NA 

back pain less than 7 NR common in all with only postural (2.5) 

weeks- groups: no placement of Long term: NA 

Prior episode of therapies were subjects similar to 

pain if acute: NR allowed for 1 the intervention Harms: NR 

month prior to group (instruction 

Prior CAM the study was to relax) 

intervention: NR One session only 

Drop outs: 0 

Prior surgery 

related to current 

complaint: NR 

C-159
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hurwitz EL Trial Design-RCT Mean age range: Cause of Pain: Groups Outcome Outcome 

(2006)157 49 – 53 yrs Traumatic back IG1 (n = 169)– SM instruments: instruments: 

Tx duration: 6 wks injury-avg 27.1 or Mob + advise & Pain: VAS QoL/ well being: NR 

Country: Fu duration: 18 monhts % of male: 48.1 Radiating pain: EX 

US (avg for all grps) leg pain below Drop outs: 12 Disability: RMDQ Results: 

N screened: 2355 knee-avg 34.2 monhts = 16 Immediate post tx: 

N randomized: 681 Racial Results- Short term: NR 

Quality N completed tx: 681 composition: IG2 (n = 172) – SM Immediate post tx: Intermediate: NR 

score: 6/13 N attended last fu: 610 majority (> 60%) or Mob + PM ( Most severe pain: Long term: NA 

White Duration of heat/cold, IG1 = 1.83, IG2 = 

Inclusion: age 18 or Pain: ultrasound, EMS) 1.95 Harms: NR 

Initial of older Health maintenance Work status: NR Acute, 26.1 Drop outs: 12 Average pain: IG1 

reviewer: SG organization Sub-acute, 15.7 monhts = 16 = 1.04, IG2 = 1.35 Summary: mean 

membership, sought care Other socio- Chronic, 11.6 Disability-mean: changes in pain 

in one of the study sites demographics: CG1 (n = 170) – IG1 = 3.18, IG2 = intensity and disability 

between 1995-1998 with 

LBP, had no Tx received 

for the past mo, 

Exclusion: Pain due to 

Married: majority 

with high school 

or college 

education & 

married; > 50% 

Severity of pain 

(Grading): NR 

Comedical care: advise 

+ analgesics, 

muscle relaxants, 

anti-inflammatory 

Drop outs: 12 

3.16 

Short term: NR 

Intermediate: NR 

IG 1&2 were similar at 

each fu (adjusted 

mean differences at 6 

mos for most severe 

pain, 0.27, 95% CI: ­

0.32– 0.86; average fracture, tumor, infection, employed - < 2% interventions:NR monhts = 17 pain, 0.22, -0.25– 0.69; 

spondyloarthropathy, or on leave Long term: and disability, 0.75, ­

other non-mechanical CG2 (n = 170) – Pain-mean: IG1 = 0.29 –1.79). PT yielded 

cause, blood disorder or Co morbidities: medical care + PM 2.51, IG2 = 2.51; somewhat better 6-mo 

received anticoagulants NR Drop outs: 12 IG1 = 1.73, IG2 = disability outcomes 

or corticosteroids, no 

ability to speak English 

monhts = 22 1.82 

Disability-mean: 

IG1 = 4.41, IG2 = 

than did medical care 

alone (1.26, 0.20– 

2.32). 

3.68 

C-160
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Koes, B Trial Design-RCT Mean age Cause of Pain: IG1 (n = 36)– SM + Outcome Outcome 

(1992)158 

Tx duration: 6 and 12 

(SD/range): 

42.75 yrs total 

N-S Mob of the spine 

according to Dutch 

instruments: 

Pain: NR 

instruments: 

QoL/ well being: NR 

Country: wks Society for manual 

Netherlands Final assessments: 12 

wks 

% of male: IG1 = 

46% IG2 = 52%, 

CG1 = 62%, 

Duration of 

Pain: Sub-acute, 

Chronic; 26-92 

therapy 

; max. 3 mo 

Drop outs: B = 3,D = 

Disability: NR 

Results: 

Other: 

Immediate post tx at 

Quality N screened: NR CG2 = 48% wks 10 3 mos: 

score: 5/13 N randomized: 136 

N completed tx: NR 

N attended last fu: NR 

Racial 

composition: NR 

Severity of pain 

(Grading): NR 

IG2 (n = 31)– 

Physiotherapy: EX, 

massage, heat, 

Immediate post tx: 

Pain: 

Disability: ----

Improvement in 

physical functioning: 

4.0 (2.3) vs. 3.2 (2.0) 

Initial of electrotherapy, vs. 3.4 (2.3) vs. 3.4 

reviewer: SG Inclusion: pain or selfreported limited ROM in 

the back or neck for at 

least 6 wks 

Exclusion: suspicion of 

underlying pathology 

(e.g., malignity, 

osteoporosis, herniated 

disc), tx with PT or 

manual therapy for back 

or neck complaints during 

past 2 yrs, pregnancy, 

language problem or 

inability to reproduce 

complaints by active or 

passive movements 

during physical 

examination. 

Work status: NR 

Other sociodemographics: 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

Cointerventions:NR 

ultrasound, shortwave diathermy 

Drop outs: B = 5,D = 

17 

CG1 (n = 39)– 

General practitioner: 

continued tx with GP, 

prescription, advice 

on posture, EX, 

sports and bed rest; 

as IG1 

Drop outs: B = 7 

CG2 (n = 30) – 

Placebo: physical 

exam detuned 

diathermy (10 min) 

and ultrasound (10 

min); 2 tx/wk for 6 

wks; 

Drop outs: B = 8 

Short term: 

Intermediate: 

Long term: 

(2.2) 

Spinal flx at 

T1(degrees)- change 

in ROM: -2.0 (15) vs. 

6 (13) vs. 0 (10) vs. 

0 (18) 

Short term: NR 

Intermediate: NR 

Long term: NR 

Harms: NR 

C-161
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Macdonald, 

R (1989)159 

Trial Design-RCT Mean age 

(SD/range): NR 

Cause of Pain: 

N-S 

Groups 

IG (n = 49) – 

Outcomes: 

Pain: PDI (0­

Outcomes: 

QoL/ well being: NR 

Tx duration: until cured Osteopathic 10);Pain analog 

Country: Final assessments: % of male: IG = Duration of manipulation therapy (PA) (0-75) 

London immediately post tx 43%, CG = 39% Pain: Acute (OMT): advice on Results: 

posture, EX,. Disability: Activity Immediate post tx: 

N screened: 100 Racial Severity of pain Osteopathic tx given: Loss (ALA) 

Quality N randomized: 95 composition: NR (Grading): Pain direct pressure and Short term: NR 

score: 5/13 N completed tx: 90 Analog (0-75)(A) stretching to involved Results: 

N attended last fu: NR Other socio­ musculature, LVHA Baseline: Intermediate: NR 

demographics: Co­ oscillatory Pain: 

Initial of Inclusion: Pts 16-70 yrs NR interventions:NR movements to PDI: IG = 6.4 (3), Long term: NR 

reviewer: SG with pain partly or wholly; hypomobile joints, CG = 6.1 (2.5) 

the inferior angles of the Co morbidities: Work status: HVT to hypomobile Harms: n = 20, 

scapulas to the buttock NR Men having vertebral motion PA: IG = 18.9 (10), Excess Lumbar 

folds physically active segments; 2 tx/wk CG = 20.3 (9.2) Lordosis; n = 21, 

Exclusion: inflammatory Prior episode of work (36%) until pts deemed Pins and needles 

joint disease, skeletal pain if acute: 1­ Women having themselves Disability: IG = 34.9 

metastases or infection, 12 mos prior IG - physically active recovered or further (23.1), CG = 22.8 

spondylolisthesis, (26), CG – (21); work (16%) tx believed unlikely to (14.9) 

neurologic deficit in 1-6 yrs prior IG - produce benefit 

structures innervated by (28), CG – (23) Drop outs: B = 5 Immediate post tx: 

lumbar or sacral roots Pain: NR 

that could not be Prior CAM CG (n = 46) – Disability: NR 

ascribed to a previous intervention: NR Control: Advice on 

resolved episode or other posture, EX, Short term: NR 

pathology, osteomalacia/ Prior surgery pts seen in clinic as 

osteoporosis, visceral related to current necessary Intermediate: NR 

pathology that could refer complaint: NR Drop outs: NR 

LBP, pregnancy, sought Long term: NR 

physical tx outside the 

practice for their present 

episode, transient pts 

C-162
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Powers, C Trial Design-RCT Mean age LBP- NS. IG (n = 15 )– spinal Outcomes Outcomes 

(2008)160 (SD/range): 30.2 mobilization (describe (describe 

Country: 

US 

Tx duration: 1 session 

Fu duration (last 

assessment): same dayimmediately post tx 

(7.9) vs. 32.3 

(9.6) 

% of male: 35% 

Duration of 

Pain, mean 

(SD/range): 

(Maitland method) 

one session only 

Drop outs: 0 

instrument used): 

Pain by VAS 

Disability: NR 

instrument used): 

Lumbar extension 

(degrees): 

Baseline: 20.2 (5.2) 

Quality N screened: NR CG1 (n = 15)– press Results: vs. 22.2 (3.9) 

score: 3/13 N randomized: 30 Racial Severity of pain up exercise as far as Baseline: 4.1 (1.7) 

N completed tx: 30 composition: NR (Grading): NR possible without vs. 4.0 (2.1) Immediately post-tx: 

N attended last fu: 30 reproducing lumbar 23.8 (6.5) v.s 24.9 

Initial of Work status: NR pain with standing Immediate post tx: (6.0) 

reviewer: FY Inclusion: adults 18 to 45 

years of age with diagnosis 

of nonspecific LBP < 3 

months with localized LBP 

at or above the waist level, 

decreased lumbar extension 

Other sociodemographics: 

NR 

Current 

treatment/ cointervention 

common in all 

groups: NR 

extension (according 

to the McKenzie and 

May technique) 

One session only 

Drop outs: 0 

2.4 (1.8) vs. 

2.8(1.5) 

Average change 

from baseline 1.7 

(2.1) vs. 1.2 (1.4) 

Average change 

form baseline: 3.6 

(5.0) vs. 2.7 (5.1) 

Short term: NA 

assessed by qualitatively Co morbidities: 

while standing NR Intermediate: NA 

Exclusion: Patients older Prior episode of Long term: NA than 45 years to control for pain if acute: NR confounding of 

osteoarthritis; spinal 

malignancy, cardiovascular 

disease, evidence of cord 

Prior CAM 

intervention: NR 

Harms: NR 

compression, aortic 

aneurysm, hiatal hernia, 

uncontrolled hypertension, Prior surgery 

abdominal hernia, prior LBP related to current 

surgery complaint: pts 

with prior surgery 

were excluded 

C-163
 
Table 1.26 Low Back Pain – Manipulation + Mobilization – Unknown -Specific Pain -No trials 

Table 1.27 Low Back Pain – Manipulation + Mobilization – Unknown -Non-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Meade TW Trial Design-RCT Mean age Cause of Pain: Groups Outcome Outcomes: 

(1991)161 (SD/range): IG = Mechanical IG1 (n = 384)– Chiro: instruments: QoL/ well being: NR 

Country: 

UK 

Tx duration: 3-12 mo 

Final assessments: 1 yr 

N screened: 781 

N randomized: 741 

38.9 (11.2) vs. CG 

= 38.3 (10.8) yrs 

% of male: IG = 

49%, CG = 53% 

Duration of 

Pain: NR 

Severity of pain 

Tx at the discretion 

of chiropractors who 

used chiro 

manipulation on most 

pts; max. 10 

Pain: 

Oswestry Disability 

Questionnaire; 

ODQ(pain intensity) 

Mean changes in SLR 

(degrees) in 6 wks: 

Right leg: 5.0 vs. 7.1 

Left leg: 0.62 vs. 0.85 

Using drugs, %: 35% Quality N completed tx: 741 Racial (Grading): NR sessions for 3-12 Results: vs. 33% 

score: 5/13 N attended last fu: 541 composition: mo, tx completed in 

Co­ 30 wks Immediate post tx: Harms: NR (pts with 

Inclusion: LBP Work status: Self­ interventions:NR Drop outs: E = 137 NR further requally severe 

Initial of 

reviewer: SG 

mechanical origin, no 

contraindication to SM, 

employed: IG = 

11%, CG = 13% IG2 (n = 357) – HM: Short term: 

pain at 1 yr: 25% vs. 

24%) 

no Tx within the past mo 

Exclusion: Nerve root 

Other sociodemographics: NR 

Maitland 

Mob/manipulation; tx 

completed in 12 wks 

Disability-mean 

change: IG1 = 1.03, 

IG2 = 0.67 

Summary: at 2 yrs 

post-R, for those with 

ODQ > 40%, > 

damage, major structural Co morbidities: NR Drop outs: E = 150 improvement in ODQ 

abnormalities visible on Intermediate: scores between IG1 

radiography, osteopenia, Prior episode of Disability-mean vs. IG2 (betweenor infection pain if acute: NR change: NR; IG1 = group difference: 13.3, 

0.94, IG2 = 0.73 95% CI: 0.24, 26.01) 

Prior CAM compared to those with 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

Long term (1 yr) 

Pts with no pain: 

59% vs. 64% 

ODQ  40% at 

baseline (betweengroup difference: 3.19, 

95% CI: -1.52, 7.90) Disability-mean 

change: NR; IG1 = 

0.98, IG2 = 0.63 

C-164
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Sims- Trial Design-RCT Mean age Cause of Pain: Groups Outcome Outcome 

Williams H 

(1979)162 Tx duration: 4 wks 

(SD/range): IG = 

43 (11.8) vs. CG 

N-S, n (%) 

radiating pain: 

IG (n = 48) – SMM: 

based on a method 

instruments: 

Pts with no pain 

instruments: 

QoL/ well being: NR 

Country: 

Final assessments: 3 

mos & 1 yr (postal 

= 42.3 (12.7) yrs IG = 15 (31.2%), 

CG = 4 (8.7%) 

described by 

Maitland; daily for 1st 

(completely better) 

Disability: Flexion; Extension 

UK questionnaire) % of male: IG = wk, then 3 times/wk subjective 

64.5%, CG = Duration of for 3 wks, 4 wks total assessment of Immediate post tx: 

N screened: NR 52.1% Pain: NR Drop outs: D = 14 physical activity Disability: IG = 24 

Quality N randomized: 94 (both arms) (10.3), CG = 22.75 

score: 4/13 N completed tx: 94 Racial Severity of pain Results- (9.62); IG = 42.96 

N attended last fu: 80 composition: NR (Grading): NR CG (n = 46) – Immediate: (9.09); CG = 44.43 

Placebo: microwave Pts with no pain: (11.38) 

Initial of Work status: NR Co­ at the lowest setting 4/48 vs. 1/48 

reviewer: SG Inclusion: pts with N-S interventions:NR directed to the Much better in pain: Short term: IG = 

LBP Other socio­ lumbar spine for 15 13 vs. 14 26.83 (9.41), CG = 

demographics: min with the pt Combined 17 vs. 22.46 (9.43); IG = 

Exclusion: NR prone; same as IG 15 43.13 (9.93), CG = 

contraindications to tx Drop outs: see above Back to normal 44 (11.85) 

Co morbidities: activity (no. of pts): 

NR 19 vs. 20 Intermediate: NR 

Intermediate: NR 

Prior episode of Long term: NR 

pain if acute: NR Long term: NR 

Harms: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

C-165
 
Table 1.28 Low Back Pain – Flexion Distraction Technique – Acute/Subacute- No studies 

Table 1.29 Low Back Pain – Flexion Distraction Technique – Chronic- Specific- No studie 

Table 1.30 Low Back Pain – Flexion Distraction Technique – Chronic -Non-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Cambron JA Trial Design-RCT Mean age : 42 Cause of Pain: Groups Outcome Outcomes: 

(2006)163 yrs N-S IG (n = 123) – Chiro instruments: QoL/ well being: NR 

Tx duration: 4 wks % of male: IG = (flx + distraction): Pain: VAS 

Country: 

US 

Fu duration:1 yr 

N screened: 2176 

N randomized: 235 

66%; CG = 59% 

Racial 

composition: 

Duration of 

Pain: Chronic, 

NR 

(FD) was done on a 

table with a pt lying 

in prone position the 

clinician placed one 

Disability: RMDQ 

ResultsImmediate post tx: 

Pain: 14.6 (1.7) vs. 

19.7 (2) 

Other: NA 

Immediate post tx: 

NA 

Quality N completed tx: 235 Majority White Severity of pain hand over the lumbar Disability: 3.6 (0.4) Short term: NR 

score: 3/13 N attended last fu: 174 (82%) (Grading): NR region at the spinal vs. 3.8 (0.4) 

level of interest and Intermediate: NR 

Inclusion: aged > 18 yrs Work status: NR Co­ used the other hand Short term: 

Initial of 

reviewer: SG 

with CLBP > 3 mo from 

L1 to S1 joint inclusive, 

willing to undergo 

narcotic/NSAIDs muscle 

Other sociodemographics: 

Married:59.5% 

interventions:NR to flex or rotate the 

lower extremity 

section of the table; 

2-4 times/wk, 4 wks 

Pain: 19.3 (2.1), vs. 

22.1 (2.2) 

RMDQ: 2.7 (0.4) vs. 

2.9 (0.4) 

Long term: NA 

Harms: No AE 

occoured within 

relaxant's use Drop outs: E = 27 Intermediate: either tx grps 

Co morbidities: Pain: 19.2 (2) vs.3.8 

Exclusion: CNS CG (n = 112) – (2.4); RMDQ: 2.6 Summary: Pts in IG 

disease, contraindication Prior episode of Exercise: Strength, (0.4) vs. 3.4 (0.5) experienced greater 

to MT, severe pain if acute: NR flexibility, and CV improvements in 

osteoporosis, lumbar EXs; same as IG Long term: pain compared to 

fracture, systemic 

disease affecting 

muscoskeletal system, 

psychiatric disease, 

Prior CAM 

intervention: NR 

Prior surgery 

Drop outs: E = 34 Pain: 20.6 (1.9) vs. 

21.6 (2) 

RMDQ: 2.9 (0.4) vs. 

3.2 (0.4) 

CG; no differences 

were seen in 

disability between 

the two groups 

alcohol/drug abuse, related to current 

morbidly obese, complaint: NR 

pregnant, currently 

receiving Tx for LBP 

C-166
 
Table 1.31 Low Back Pain – Flexion Distraction Technique – Mixed - Specific- No studies 

Table 1.32 Low Back Pain – Flexion Distraction Technique – Mixed - Non-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hawk, C Trial Design-RCT Mean age: 52 yrs Cause of Pain: Groups Outcomes: Outcomes: 

(2005)164 N-S IG (n = 54) – Pain: PDI; RMDQ QoL/ well being: NR Tx duration: 3 wks % of male: IG = Manipulation: 

Country: Fu duration: imm.post-tx 50%; CG = 44% pressure applied to Results: Number of pts with 

Midwestern 

US N screened: 230 

N randomized: 111 

N completed tx: 106 

Racial 

composition: 52% 

White 

Duration of 

Pain: sub-acute 

lumbar/lumbosacral 

region with PA force 

of 80-160 N, Trigger 

Baseline: 

Pain: IG = 26.8 

(12.1), CG = 26.1 

overall complete 

improvedment: 

N attended last fu: 106 or chronic, point therapy: 40-75 (12) Results: 

Work status: ds of (median) IG = 4 N for 4-7 sec, RMDQ: IG = 7.4 Immediate post tx: 

Quality Inclusion: 18 yrs and over, missed work in yrs, CG = 7 yrs releasing for 3-5 sec (3.9), CG = 7.8 0 vs. 1 

score: 8/13 with sub-acute (onset 4-12 past mo: 0 with a max. of 3 reps; (4.6) 

Initial of 

reviewer: SG 

wks prior to contact) or 

CLBP (onset more than 12 

wks prior) 

Exclusion: Pregnancy, 

radiation of pain distal to the 

Other sociodemographics: 

13% Smokers 

Co morbidities: NR 

Severity of pain 

(Grading): NR 

Co8 tx over 3 wks 

Total Drop outs: A = 

119, B = 15 

CG (n = 57) – 

Immediate post tx: 

Pain-mean change: 

IG = 9.1, CG = 7.9 

RMDQ: IG = 2.2, 

Short term: NR 

Intermediate: NR 

Long term: NR 

knee with evidence of interventions:NR Control tx: CG = 1.5 

neurologic involvement, Prior episode of Instrument set to its Harms: N = 1 in IG, 

contraindications to pain if acute: NR “zero point” Short term: NR BP became worse 

manipulation, no indications delivering weight of during visit ; n=1 of musculoskeletal Prior CAM instrument, applied 2 Intermediate: NR WDAE in IG vs. 0 in 

dysfunction, litigation for a 

health-related claim, 

chiropractic care within the 

last mo, or unwillingness to 

postpone other types of 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

inches lateral to 

spine and not more 

than 12 N, effleurage 

applied to pt’s low to 

Long term: NR 

CG 

manual therapy during the middle back for 5-10 

study sec at 10-20 N; same 

as IG 

C-167
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hawk, C 

(1999)165 Trial Design-RCT 

Crossover Design 

Mean age 

(SD/range): 33.5 

Cause of Pain: 

N-S 

Groups 

IG (n = 8) – Active tx 

Outcome 

instruments: 

Outcome 

instruments: 

yrs (all grps) first, symptomatic Pain: VAS (10 cm) QoL/ well being: 

Country: Tx duration: 2 wks Duration of pts: Chiropractic Global well being: 

US Final assessments: 2 wks % of male: Pain: Unknown Adjustment (active) - results reported for 

66.6% all grps Flexion-distraction Results: individual pts- not 

N screened: 18 Severity of pain technique.; 4 visits, 2 shown 

Quality N randomized: 13 Racial (Grading): NR wks Immediate post tx: 

score: /13 N completed tx: 13 composition: NR Drop outs: 0 Pain-mean change: 

N attended last fu: 13 decrease in pain in Short term: NR 

Work status: Co- CG (n = 5) – Placebo IG vs. increase in 

Initial of Inclusion: 18 yrs of age chiropractic interventions:NR tx first, symptomatic CG: -0.7 vs. +0.5 Intermediate: NR 

reviewer: SG or older; self-report of college students pts: Sham 

LBP within the last 6 mo or faculty or staff adjustments were Short term: NR Long term: NR 

members. performed with a 

Exclusion: Unsuited to hand-held instrument Intermediate: NR Harms: one pts 

chiropractic tx: the Other socio­ used in certain showed a negative 

clinician took a case demographics: chiropractic Long term: NR response to both tx 

history on all pts and NR techniques; as IG with decrease in the 

completed a screening Drop outs: 0 GWBS of 1.10 cm 

orthopedic and Co morbidities: for the active tx and 

neurological examination NR 0.20 cm for the 

to rule out placebo; another 

contraindications to Prior episode of 

chiropractic tx; litigation; pain if acute: NR Summary: 

pregnancy improvements were 

Prior CAM greater after IG than 

intervention: NR CG 

Prior surgery 

related to current 

complaint: NR 

C-168
 
Table 1.33 Low Back Pain – Flexion Distraction Technique – Unknown - Specific- No studies 

Table 1.34 Low Back Pain – Flexion Distraction Technique – Unknown -Non-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Beyerman Trial Design-RCT Mean age Cause of Pain: Groups Outcome Outcome 

KL (2006)166 

Tx duration: 5 wks 

(SD/range): NR osteoarthritis IG (n = 124) – FD + 

moist hot pack: 

instruments: 

Disability: ODQ 

instruments: 

QoL/ well being: NR 

Country: Final assessments: 5 wks % of male: NR Duration of impulsion, FD in (pain intensity); 

US 

N screened: NR 

N randomized: 217 

Racial 

composition: NR 

Pain: NR 

Severity of pain 

prone position 

secured to table with 

strap around ankles; 

ODQ (ADL) 

Results: 

Other: NA 

Results: 

Quality N completed tx: 217 (Grading): NR traction in lumbar Baseline: NA 

score: 4/13 N attended last fu: 217 

Inclusion: English 

Work status: NR 

Other socioCointerventions:NR 

spine; flx added by 

using distractive 

repetitions of the 

Immediate post tx: 

Disability: IG = 0.69 

(1.15), CG = 1.31 

Immediate post tx: 

NA 

Initial of speaking pts with demographics: table manually (1.45); 

reviewer: SG arthritis, OA, 

degenerative joint/disc 

disease, facet 

arthropathy, capable of 

traveling to the 

appointments 

Exclusion: Present use 

of chiro therapy, PT, or 

anti-inflammatory Meds 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

controlled; hot packs 

applied for 15 min, 2­

3 visits/wk, 5 wks 

Drop outs: n = 35 

(total sample) 

CG (n = 93) – Moist 

heat: hydro collator 

pack stored at 150­

170 degrees; using 6 

layers of towel 

covering, 3 between 

the skin and hot pack 

and 3 on the 

transverse oscillatory 

rot of the hot pack; 

as IG 

ODQ: IG = 8.56 

(7.1), CG = 12.82 

(7.66) 

Short term: NR 

Intermediate: NR 

Long term: NR 

Short term: NR 

Intermediate: NR 

Long term: NR 

Harms: no AEs was 

repoted by pts 

C-169
 
Table 1.35 Low Back Pain - Massage – Acute/Sub-acute - Specific Pain – No studies 

Table 1.36 Low Back Pain - Massage – Acute/Sub-acute - Non-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Farasyn A Trial Design-RCT Mean age Cause of Pain: Groups Outcome Outcome 

(2006)167 (SD/range): IG = N-S IG (n = 20)– instruments: instruments: 

Tx duration: One session 41 (11), CG1 = 43 Roptrotherapy: deep Pain: VAS (100 mm) QoL/ well being: NR 

Country: 

Belgium 

Final assessments: Post-tx 

N screened: 170 

N randomized: 60 

N completed tx: 60 

(12), CG2 = 40 

(12) yrs 

% of male: IG = 

35, CG1 = 45, 

Duration of 

Pain: Sub-acute, 

NR 

cross-friction 

massage with the aid 

of a myofascial T-bar 

made of bronze, 

Disability: ODI – 

Dutch language 

version 

Results: 

Immediate post tx: 

NA 

Quality N attended last fu: 60 CG2 = 44 Severity of pain applied within the Results: 

score: 7/13 (Grading): NR tolerable threshold of Baseline: Short term: NR 

Inclusion: 21-75 yrs; N-S Racial one 30 min session Pain: IG = 56 (26), 

subacute LBP with or composition: NR Drop outs: 0 CG1 = 57 (20), CG2 Intermediate: NR 

Initial of 

reviewer: SG 

without referred pain to the 

leg 

Exclusion: Acute (3 wks) 

and chronic (> 12 wks) LBP 

and/or neuropathy (sciatica 

Work status: NR 

Other sociodemographics: NR 

Cointerventions:NR CG1 (n = 20) – 

Endermology - a 

LPG device was 

adjusted to a minimal 

= 49 (22) 

Disability: IG = 34 

(11), CG1 = 36 (11), 

CG2 = 29 (11) 

Immediate post tx: 

Long term: NR 

Harms: NR 

or severe root Co morbidities: NR but continuous Pain: IG = 37 (19), 

compression); Fibromyalgia; suction power s; CG1 = 59 (21), CG2 

use of any Med, and/or Prior episode of same as IG = 52 (21) 

psychological tx; pregnancy pain if acute: NR Drop outs: 0 Disability: IG = 16 (5), 

and the existence of any CG1 = 38 (11), CG2 

significant pathology (no 

reported abnormal spinal xray findings e.g. spinal 

fracture, tumor, infection, 

structural deformity, 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

CG2 (n = 20) – no 

tx(delayed tx); same 

as IG 

Drop outs: 0 

= 31 (12) 

Short term: NR 

Intermediate: NR 

inflammatory disorders) complaint: None 

Long term: NR 

C-170
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Aleksiev 

(1995)168 

Trial Design-RCT- cross 

over 

Mean age 

(SD/range): NR 

Region of pain: 

LBP- NS 

Groups 

IG1 (n = 29) – post 

Outcomes: 

Pain: VAS 

Outcomes: 

Range of 

isometric relaxation movements (ROM) 

Country: Tx duration: 12 sessions % of male: Duration of of the LBP muscles Results: No numerical values 

Bulgaria in 20 days Racial Pain, mean and illiopsoas Pain: reported 

Fu duration (last composition: NR Mixed, mean 12 sessions in 20 Data presented in 

assessment): 1 year range 16.7 to days graph—not used Harms: NR 

Quality Other socio­ 18.1 days Drop outs: NR Summary of 

score: 2/13 N screened: NR demographics: findings: statistically 

N randomized: 26 NR Severity of pain IG2 (n = 21) – significant 

N completed tx: 26 (Grading): NR Average frequency improvement of 

Initial of N attended last fu: 26 Co morbidities: sinuous modulated pain in mobilization 

reviewer: FY NR Current current tx + sham group only 

Inclusion: Pts with LBP treatment/ co­ mobilization immediately post tx 

> 1 month more lumbar Prior episode of intervention 12 sessions in 20 All other tx and 

vertebrae pain if acute: NA common in all days follow up outcomes 

groups: NR Drop outs: NR were nonExclusion: compressive Prior CAM significant compare 

neuropathy, traumatic intervention: NR to baseline. 

fractures, IG3 (n=26): Perl’s Improvements 

spondylolisthesis, Prior surgery traction therapy + better in IGs vs. CG 

osteoporosis, related to current sham mobilization (p< 0.05) at short 

inflammation, or tumors complaint: NR 12 sessions in 20 term fu 

days 

Drop outs: NR All pts were pain 

free at 1 year fu 

CG (n=19) sham 

mobilization + 

NSAIDs 

12 sessions in 20 

days 

Drop outs: NR 

C-171
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Konrad K 

(1992)169 Trial Design-RCT Mean age 

(SD/range): IG1 

Cause of Pain: 

N-S 

Groups 

IG1 (n = 35)– 

Outcomes: 

Pain: VAS 

Outcome 

instruments: 

Tx duration: 4 wks = 42 (8.8), IG2 = Balneotherapy: pts Disability: NR QoL/ well being: NR 

Country: Final assessments: 6 39 (9.1), IG3 = Duration of immersed in heated 

Hungary mos 44 (7.6), CG = Pain: Sub-acute, water with minerals; Results: Results: 

41 (8.6) yrs IG1 = 2.5 (1.1), 4 wks Baseline: Immediate post tx: 

N screened: NR IG2 = 2.7 (1.4), Drop outs: 3 Pain: IG1 = 63.4 NA 

Quality N randomized: 158 % of male: 44.7 IG3 = 2.7 (1.8); (24.1), IG2 = 56.7 

score: 6/13 N completed tx: 158 CG = 2.4 (1.7) IG2 (n = 44)– (28.2), IG3 = 68.4 Short term: NR 

N attended last fu: 158 Racial mo Underwater traction (31.9), CG = 61.5 

composition: NR bath traction was (32.8) Intermediate: NR 

Initial of Inclusion: NS LBP with Severity of pain applied; traction belt Disability: ----

reviewer: SG or without radiation to the Work status: NR (Grading): NR was applied to the Long term: NR 

thigh, 1 mo  duration  3 pelvis with 3 kg Immediate post tx: 

mo, a pain free yr before Other socio­ weight on both sides; Pain: IG1 = 31.7 Harms: NR 

the present episode demographics: Co- As IG1 (16.2), IG2 = 24.6 

NR interventions:NR Drop outs: 0 (11.9), IG3 = 33.5 

Exclusion: pregnancy, (19.1), CG = 53.7 

back surgery, Co morbidities: IG3 (n = 26)– (23.8) 

spondylolisthesis, NR Underwater Disability: ----

infections, tumors, massage: movement 

fractions, ankylosing Prior episode of while a stream of hot Short term: NR 

spondylitis, senile pain if acute: NR water played on the 

osteoporosis, scoliosis affected part; As IG1 Intermediate: 

Prior CAM Drop outs: 9 VAS: IG1 = 49.5 

intervention: NR (25.7), IG2 = 45.8 

CG (n = 53) – No tx (26.2), IG3 = 54.7 

Drop outs: NR (33.7), CG = 54.9 

Prior surgery (24.8) 

related to current 

complaint: NR Long term: NR 

C-172
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Pope, M 

(1994)113 Trial Design-RCT Mean age 

(SD/range): 32 

Cause of Pain: 

NR 

Groups 

IG (n = 60)– SM 

Outcomes: 

Pain: 10 cm VAS 

Outcome 

instruments: 

Tx duration: 3 wks yrs through ROM, end a ROM-modified QoL/ well being: NR 

Country: Final assessments: 3 wks dynamic short level, Schober’s test: 

% of male: 62% HVLA thrust on the Flexion; Extension Results: 

California, N screened: NR Duration of lumbar spine and/or Immediate post tx: 

US N randomized: 150 Racial Pain: Mix sacroiliac joint; 3 Results-Baseline: 

N completed tx: 148 composition: NR x/wk for 3 wks Pain: NR Short term: NR 

Quality N attended last fu: 148 Severity of pain Drop outs: B = 17 Disability: NR 

score: 5/13 Work status: NR (Grading): NR Intermediate: NR 

Inclusion: ages 18-55 CG (n = 30) – Soft- Immediate post tx: 

yrs; general good health; Other socio­ tissue massage: Pain: IG = -24.1 Long term: NR 

Initial of LBP between 3 wks-6 demographics: Co- Effleurage in prone ­ (27), CG = -17.2 

reviewer: SG mo; free from LBP for NR interventions:NR on-rhythmic motion,; (25.1), IG2 = -9.6 Harms: NR 

minimum 3 wks 15 min/tx, 3 x/wk for (30), IG3 = -15.9 

Co morbidities: 3 wks (27) Summary of results 

Exclusion: pregnancy; NR Drop outs: B = 10 Disability-mean (if provided): No 

sciatica; neurologic change: IG = 0.38 significant 

deficits, loss of sensation, Prior episode of IG2 (n = 30) – (1.25), CG = -0.08 differences were 

strength and reflex; no pain if acute: NR TENS:, max 91 mA, ; (1.2), IG2 = -0.02 observed for any of 

prior vertebral fracture, 8 hrs/d, on for min. 1 (0.82), IG3 = 0.33 the outcomes 

tumor, infection or Prior CAM hr at a time; 1x/wk (0.93); IG = -0.29 between txs. 

spondyloarthropathy; no intervention: NR for 3 wks (0.59), CG = -0.32 

prior back surgery; Drop outs: B = 10 (0.63), IG2 = 0.63 

Davenport weight index > (0.89), IG3 = -0.27 

33 Prior surgery IG3 (n = 30) – Lumbo (0.72) 

related to current sacral corset during 

complaint: NR waking hrs except Short term: NR 

while bathing; 3 x/d; 

1x/wk for 3 wks Intermediate: NR 

Drop outs: B = 6 

Long term: NR 

C-173
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Preyde M6 

(2000)170 Trial Design-RCT Mean age 

(range):42 – 48 

Cause of Pain: 

Mild strain: 

Groups 

IG1 (n = 25)– 

Outcomes: 

Pain: McGill: PPI; 

Outcome 

instruments: 

Tx duration: 1 mo yrs 24.2%; Sports Comprehensive PRI scores QoL/ well being: NR 

Country: Final assessments: 3 injury: 14.5%; massage+ general Disability: RDQ (0­

Guelph, ON mos % of male: 48.25 Bending/lifting strengthening or 24) Modified schober 

injury: 34%; mobility EXs; 30-35 Results: test (cm) 

N screened: 165 Race: NR Fall/accident: min/ tx, 6 tx over 1 Immediate post tx: Immediate post tx: 

Quality N randomized: 98 7.25%; Stress mo Pain: IG1 = 0.44 IG1 = 6.36 (1.2), IG2 

score: /13 N completed tx: 98 Work status: related: 6.2% Drop outs: A = 1, B = (0.6), IG2 = 1.04 = 5.87 (1.5), CG1 = 

N attended last fu: 91 25.5% % NS: 14% 0, C = 1 (0.7), CG1 = 1.64 5.86 (1.3), CG2 = 

Unemployed/ (0.8), CG2 = 1.65 5.98 (1.2) 

Initial of Inclusion: 18-81 yrs; retired IG2 (n = 25) – Soft­ (0.8) 

reviewer: SG existence of subacute Duration of tissue manipulation: Disability: IG1 = Short term: NR 

(between 1 wk and 8 mo Other socio- Pain: Sub-acute, same as IG1; 6 tx 2.36 (2.8), IG2 = IG1 = 6.47 (1.2), IG2 

LBP; stable health demographics: IG1 = 12 (9.1); over 1 mo 3.44 (2.8), CG1 = = 5.93 (1.4), CG1 = 

68.5% IG2 = 14.8 (8.2); Drop outs: A = 0, B = 6.82 (5.6), CG2 = 5.39 (1.4), CG2 = 

Exclusion: Significant Partnered/ CG1 = 13.2 2, C = 3 6.85 (3.5); 5.5 (1.5) 

pathology, such as bone married (11.1); CG2 = Intermediate: NR 

fracture, nerve damage, 13.3 (8.8) CG1 (n = 22) – Short term: 

or severe psychiatric Co morbidities: Remedial EXs: as Pain: IG1 = 0.42 Long term: NR 

condition including NR Severity of pain IG1; as IG2 (0.6), IG2 = 1.18 

clinical depression as (Grading): NR Drop outs: A = 1, B = (1.5), CG1 = 1.33 Harms: NR 

determined by a Prior episode of 1, C = 1 (0.8), CG2 = 1.75 

physician; pregrnancy. pain if acute: NR (0.6) 

LBP > 8 mo subacute Co­ CG2 (n = 26) – Sham Disability: IG1 = 

cut-off (15 pts), they were Prior CAM interventions:NR laser tx (low level); 1.54 (2), IG2 = 2.86 

not currently intervention: NR 20 min/ tx, 6 tx over (3.1), CG1 = 5.71 

experiencing LBP (13 1 mo (4.8), CG2 = 6.5 

pts), or a diagnosis of Prior surgery Drop outs: A = 0, B = (4.2) 

complex health problems related to current 1, C = 2 Intermediate: NR 

such as multiple sclerosis complaint: None 

(9 pts) Long term: NR 

C-174
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Yip, YB 

(2004)171 Trial Design-RCT Mean age 

(SD/range): 43.8 

Cause of Pain: 

N-S 

Groups 

IG (n = 32)– 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: NR (3.0) vs. 48.1 Massage: acupoint Pain: VAS QoL/ well being: NR 

Country: Final assessments: 3 wks (4.0) yrs Duration of relaxation 

China Pain: flollowod by Disability: NR Other: lateral 

N screened: NR % of male: 15% acupuressure with fingertip to ground 

N randomized: 61 Severity of pain lavender oil Results: (cm) 

Quality N completed tx: 51 Racial (Grading): NR 8 sessions/ 3 wks 

score: 5/13 N attended last fu: 51 composition: NR Drop outs: NR Immediate post tx: Immediate post tx: 

Pain: ---- NR 

Work status: Co- CG (n = 29) – usual Disability: ----

Initial of Inclusion: pts aged 18 or occuPts reported interventions:NR care only; as IG Short term- 1 wk 

reviewer: SG older with N-S subacute Drop outs: NR Short term- 4 wks: post tx: 0.96 (0.01) 

LBP for most ds in past 4 Other socio- Pain: 0.61 (0.06) vs. 1.01 (0.01) cm 

wks; no acu, PT or SM in demographics: vs. 0.99 (0.06) 

past wk Education levels reduction in pain Intermediate: NR 

reported (VAS) one wk post 

Exclusion: S cause of tx: IG 39% more Long term: NR 

LBP; systemic disease, Co morbidities: reduction thant CG 

contraindication to NR Harms: no AEs 

massage, pregnant, Intermediate: NR were reported. 

allergic to natural Prior episode of 

lavender oil, wound at pain if acute: NR Long term: NR Summary: 

any of the acupoint of the 

back or lower limb Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: None 

C-175
 
Table 1.37 Low Back Pain - Massage - Chronic- Specific Pain – No Studies 

Table 1.38 Low Back Pain - Massage - Chronic - Non-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Cherkin, DC Trial Design-RCT Mean age (range): Cause of Pain: Groups Outcome Outcome 

(2001)20 

Tx duration: 10 wks 

44 – 45 yrs N-S, 

Radiation below 

IG1 (n = 94)– Acu: 

chinese medical acu-, 

instruments: 

Pain: Symptom 

instruments: 

QoL/ well being: 

Country: 

U.S 

Final assessments: 

immediately post tx 

N screened: 693 

% of male (range): 

31 – 48% 

Racial 

composition: 

knee: IG1 = 

24%, IG2 = 

30%, CG = 31% 

e-stimulation + manual 

manipulation of the 

needles, indirect 

moxibustion, IR heat, 

cupping,+ EX; up to 10 

bothersomeness 

during past wk (0-10 

scale) 

Disability: Roland 

SF-12, Mental Health 

summary scales 

Other: %pts using Med 

at 10 wks fu: from 69% 

to 51% in acu vs. from 

Quality N randomized: 262 White: 82 – 89% Duration of visits over 10 wks Disability(0-23 scale); 73% to 47% in 

score: 6/13 N completed tx: 249 

N attended last fu: NR Work status: 

employed or selfPain: 

Chronic, % with 

pain > 1 yr: IG1 

Drop outs: B = 5, E= 2 

IG2 (n = 78) Soft tissue 

National Health 

interview survey 

massage group, and 

little change in self 

care group 

Initial of 

reviewer: SG 

Inclusion: Ages 20-70 

yrs who visited a primary 

care physician for LBP 

who had persistent LBP 

for 6 wks. 

employed: IG1 and 

CG = 82%, IG2 = 

90% 

Other sociodemographics: 

= 57%, IG2 = 

64%, CG = 62% 

Severity of 

pain (Grading): 

manipulation - Swedish 

massage, movement 

reeducation, deeptissue, neuromuscular , 

and trigger and 

pressure point;; same 

Results: 

Immediate post tx (10 

wks): 

Pain: 4.0 vs. 3.6 vs. 

4.6 

Disability: 7.9 vs. 6.3 

Short term: NR 

Intermediate: NR 

Long term: NR 

Harms: No SAEs, or 

Exclusion: Sciatica; acu 

or massage for BP within 

past yr, back care from a 

specialist /CAM provider, 

severe clotting disorders 

or anticoagulant therapy, 

cardiac pacemakers, 

underlying systemic or 

visceral disease, 

family income > 

35K/y: IG1 = 55%, 

IG2 = 59%, CG = 

71% 

Co morbidities: NR 

Prior surgery 

related to current 

complaint: IG1 = 

5%, IG2 = 5%, CG 

NR 

Cointerventions: 

narcotic 

analgesics: IG1 

and CG = 9%, 

IG2 = 12% 

as IG1 

Drop outs: B = 1, E= 2 

CG (n = 90) – Self care: 

high-quality educational 

material (book + video 

tapes); NA 

Drop outs: B = 7, E= 7 

vs. 8.8 

Short term : NA 

Intermediate: NR 

Long term (1 yr): 

Pain, mean: 5.4 vs. 

3.2 vs. 3.8 

Disability: 8.0 vs. 6.8 

WDAE 

Summary: 

At 1 yr no significant 

difference in % of pts 

with recurrence of BP 

in last 6 mo (80%), 

seeking back care 

(40%) or visiting an 

acu tx (15%) 

pregnancy = 8% vs. 6.4 

C-176
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Field T 

(2007)172 Trial Design-RCT Mean age 

(SD/range): 41 

Cause of Pain: 

N-S 

Groups 

IG (n = 15)– 

Outcomes: 

Pain: VAS (10 cm) 

Outcome 

instruments: 

Tx duration: Two yrs Massage therapy: QoL/ well being: NR 

Country: sessions Duration of kneeding, rubbing, Disability: Trunk flx 

Miami, US Final assessments: % of male: 53% Pain: Chronic, stroking along entire (cm); pain flx (cm) – 

immediately post tx NR back and legs; two higher scores Results: 

Racial 30 min sessions/ wk optimal Immediate post tx: 

Quality N screened: 30 composition: Severity of pain Drop outs: NR NA 

score: 2/13 N randomized: 30 67% Caucasian (Grading): NR Results: 

N completed tx: 30 CG (n = 15) – Baseline: Short term: NR 

N attended last fu: NR Work status: NR Relaxation therapy: Pain: IG = 5.1 (2.9), 

Initial of Co- PTS were shown CG = 4.4 (2.1) Intermediate: NR 

reviewer: SG Inclusion: Adults with Other socio­ interventions:NR how to use Disability: IG = 58.9 

LBP of a duration of at demographics: progressive MR EXs (7.5), CG = 59.1 Long term: NR 

least 6 mo; cleared by Group avg including tensing and (7.9); IG = 61.6 

their primary physician to =middle class; relaxing large muscle (8.1), CG = 61.1 Harms: NR 

participate in the study M=2.5 on groups starting with (7.6) 

Hollingshead the feet and 

Exclusion: BP due to Index progressing to the Immediate post tx: 

fractured vertebrae, calves, thighs, Pain: IG = 1.4 (1.6), 

herniated or gegenerated Co morbidities: hands, arms, back CG = 2.7 (2.4) 

disks, pts who had NR and face; two 30 min Disability: IG = 61.9 

undergone surgery for sessions at home/ (8), CG = 60.7 

their back pain (i.e. Prior episode of wk (4.7); IG = 63.5 

laminectomies or fusions) pain if acute: NR Drop outs: NR (8.1), CG = 63.6 (4) 

and pts with sciatic nerve 

involvement or legal Prior CAM Short term: NR 

action pending, such as intervention: NR 

workmen's compensation Intermediate: NR 

Prior surgery 

related to current Long term: NR 

complaint: NR 

C-177
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Franke 

(2000)173 Trial Design- RCT Mean age 

(SD/range): IG1 

Cause of Pain: 

Degenerative 

Groups 

IG1 (n = 46)– 

Outcome 

instruments: 

QoL/ well being: 

NR 

Tx duration: NR = 45.2 (8), IG2 = Disease Acupuncture Pain: VAS, flx & ext 

Country: Final assessments: 43.5 (9), IG3 = massage of entire Disability: Results- mean: NR 

Germany immediately post tx 45.6 (7.5), CG = meridians+ group Functional 

44.4 (8) yrs Duration of EX (GE): 12-16 Questionnaire Immediate post tx: 

N screened: 190 Pain: sessions each 30min Hanover (FFbH) 

Quality N randomized: 190 % of male: All > 1 yr Drop outs: 1 Short term: NR 

score: 8/13 N completed tx: 179 Grps : 61% Results: 

N attended last fu: 179 Severity of IG2 (n = 49)– Baseline: Intermediate: NR 

Racial pain (Grading): Swedish Massage Pain: IG1 = 5.4 

Initial of Inclusion: 25-55 yrs old, composition: NR VAS: IG1 = 5.4 (SM) + GE (2.6), IG2 = 4.2 Long term: NR 

reviewer: SG chronic BP> 1 yr, (2.6), IG2 = 4.2 30 min/ session, 8-10 (2.4), IG3 = 4 (2.2), 

German speaking Work status: NA (2.4), IG3 = 4 sessions In gym and CG = 4.4 (2.2) Harms: NR 

(2.2), CG = 4.4 4-6 session in pool Disability: 86 (18) 

Exclusion: neurological Other socio­ (2.2), Flexion Drop outs: 3 for all pts Summary: results 

deficits, neurosis, demographics: lumbar spine with APM are 

psychosis, Med for >3 ds, NR IG1 = 46.4 IG3 (n = 46)– Immediate post tx: promising, warrant 

therapy interruption for (15.6), IG2 = Acupuncture Pain: Mean: IG1 = ­ further investigation, 

>5 ds, people applying Co morbidities: 49.4 (12.4), IG3 massage + individual 1.83, IG2 = -1.00, no superiority 

for early retirement due NR = 52.8, CG = medical EX (IE) IG3 = -1.46, CG = ­ individual vs. grp 

to disability, people 49.1 (13.1), 30 min/ session, 4 0.62 EXs 

unable to work > 4 wks Prior episode of Extension sessions Disability, change 

before rehab or >3 mos pain if acute: NR lumbar spine Drop outs: 5 from baseline APM 

in previous yr IG1 = 12.9 (6.4), vs. SM: 7.0% (95% 

Prior CAM IG2 = 13.6 (6.6), CG (n = 49) – SM + CI: 2.5, 11.6) 

intervention: NR IG3 = 14.8 (7), IE 

CG = 12.2 (6.6) 15 min/ session for 8 Short term: NR 

Prior surgery sessions 

related to current Co- Drop outs: 2 Intermediate: NR 

complaint: NR interventions:N 

R Long term: NR 

C-178
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Geisser, M 

(2005)174 

Trial Design-RCT Mean age 

(range): 37 - 46 

Cause of Pain: 

N-S 

Groups 

IG1 (n = 26) – 

Outcomes: 

Pain: VAS (0-10); 

Outcomes: 

QoL/ well being: NR 

Tx duration: 5 wks yrs Manual therapy, S MPQ (0-78) 

Country: Final assessments: post Duration of EX:; 5 wkly EXs for Results: 

Michigan, tx % of male: 34 Pain: Chronic, 20 min, stretching Disability: Quebec 

US (avg of all grps) 76.9 mo twice daily (10 reps, Back Pain Disability Immediate post tx: 

N screened: 100 hold for 30 sec each) Scale (QBPDS) (0­

N randomized: 100 Racial Severity of pain Drop outs: NR 100) Short term: NR 

Quality N completed tx: NR composition: 85 (Grading): NR 

score: 3/13 N attended last fu: NR Caucasian, 8 IG2 (n = 25) –Sham Results- Intermediate: NR 

African-Am, 5 Co­ therapy, S EX: Same 

Inclusion: 18-65 yrs with Asian-Amer., 2 interventions:NR as IG but MET not Immediate post tx: Long term: NR 

Initial of single or primary Hispanic performed; same as Pain-mean change: 

reviewer: SG complaint of CLBP and IG1 VAS: IG1 = -2.05, Harms: NR 

judged to have Work status: NR Drop outs: NR IG2 = -0.38, IG3 = ­

musculoskeletal pain 0.52, IG4 = -0.91 Summary: Pts in 

based on evaluation by Other socio­ IG3 (n = 24) –manual IG1 displayed 

the physician or physical demographics: therapy, nonS EXs: MPQ: IG1 = -9.39, significant 

therapist NR pts free to choose IG2 = -4, IG3 = ­ improvements in 

how to perform 2.47, IG4 = -1.28 pain. No significant 

Exclusion: Down's Co morbidities: aerobic EX; same as changes in disability 

syndrome, osteoporosis NR IG1 QBPDS-mean were observed with 

of the spine, agenesis of Drop outs: NR change: IG1 = -5, the exception that 

the odontoid process, Prior episode of IG2 = -0.97, IG3 = ­ the IG2 displayed a 

primary joint disease pain if acute: NR IG4 (n = 25) – Sham 6.67, IG4 = -8.58 significant increase 

(active rheumatoid therapy, N-S EX: in disability 

arthritis), metabolic bone Prior CAM same as IG3; same Short term: NR 

disease, malignant bone intervention: NR as IG1 

disease, fracture, Drop outs: NR Intermediate: NR 

hypermobility of the Prior surgery 

lumbar/sacral spine, related to current Long term: NR 

cardiovascular or other complaint: NR 

medical disorders 

C-179
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hernandez- Trial Design-RCT Mean age Cause of Pain: Groups Outcomes: Outcome 

Reif M 

(2001)175 Tx duration: 5 wks 

(SD/range): IG = 

43.8 (13.7) vs. 

N-S IG (n = 12) – 

Massage therapy: 

Pain: SF-MPQ; 

VAS (0-10) 

instruments: 

QoL/ well being: NR 

Final assessments: CG = 36.7 (16.1) Duration of stroking, kneeding, 

Country: immediately post tx yrs Pain: Chronic, rubbing applied to Disability: Other: ROM: Trunk 

US NR the entire back at a flx; pain flx (cm) 

N screened: NR % of male: IG = level tolerant to the Results: 

N randomized: 24 41.6%, CG = Severity of pain pt and to legs; two 30 Baseline: Results: 

Quality N completed tx: 24 50% (Grading): NR min sessions/wk over Pain: Baseline: IG = 56 

score: 2/13 N attended last fu: post tx 5 wks MPQ: IG = 16.5 (7.4), CG = 57.5 

Racial Drop outs: NR (8.2), CG = 16.7 (7.9); IG = 57.7 (8), 

Inclusion: adults with composition: Co­ (7.5) CG = 61.1 (7.6) 

Initial of LBP with a duration of at 66.7% interventions:NR CG (n = 12) – VAS: IG = 5.62 

reviewer: SG least 6 mos Caucasian Relaxation: (2.2), CG = 4.5 Immediate post tx: 

instructed on (1.9) IG = 61.4 (7.4), CG 

Exclusion: BP due to Work status: NR progressive MR Disability: NR = 58.2 (3.6); IG = 

fractured vertebrae exercices tensing 61.3 (9.1), CG = 

herniated or degenerated Other socio­ and relaxing large Immediate post tx: 60.6 (3.9) 

disks, pts who had demographics: muscle groups Pain: 

undergone surgery for 37.4% Middle starting with the feet MPQ: IG = 4.1 (4.9) Short term: NR 

their back pain, and pts class and progressing to CG = 6.4 (6.4) 

with sciatic nerve the calves, thighs, VAS: IG = 1.7 (2.3), Intermediate: NR 

involvement or legal Co morbidities: hands, arms, back CG = 2.9 (2.8) 

action pending, such as NR and face; 30 min/ Disability: NR Long term: NR 

workmen's session at home, 

compensation. Prior episode of twice/wk for 5 wks Short term: NR Harms: NR 

pain if acute: NR Drop outs: NR 

Intermediate: NR Note: massage 

Prior CAM group had less pain, 

intervention: NR Long term: NR depression, anxiety 

Prior surgery and had improved 

related to current sleep 

complaint: None 

C-180
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hsieh LLC 

(2006)176 Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

N-S 

Groups 

IG (n = 64)– 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: 1 mo 50.2 (13.8) vs. Acupressure: NR; 6 Pain: Core outcome QoL/ well being: NR 

Country: Final assessments: 6 CG = 52.6 (17.2) sessions in 1 mo measure-LBP;VASTaiwan mos yrs Duration of Drop outs: D = 9 ITT 

Pain: Chronic, Disability: RMDQ; 

% of male: IG = median (range) CG (n = 65) – PT: Modified Oswestry Other: pts with 

Quality N screened: 188 33%, CG = 26% IG = 3.3 (0.2­ pelvic manual significant degree of 

score: 9/13 N randomized: 129 33.3) yrs, CG = traction, SM, Results- disability (no.) 

N completed tx: 129 Racial 1.6 (0.2-34.3) thermotherapy, Baseline: 28 vs. 20 

N attended last fu: 129 composition: NR yrs infrared light therapy, Immediate post tx: Post tx: 8 vs. 19 

Initial of ES, and EX; same as Pain: IG = 2.11 Intermediate: 1 vs. 8 

reviewer: SG Inclusion: Pts aged > 18 Work status: NR Severity of pain IG (0.86), CG = 2.57 

yrs with CLBP (> 4 mo) (Grading): NR Drop outs: D = 11 (0.83); IG = 30.6 Long term: NR 

Other socio­ (21.75), CG = 48 

Exclusion: cancer, demographics: (23.4) Harms: NR 

systemic diseases, Married: 83.5% Copsychiatric disorders, interventions:NR Disability: IG = 5.4 

pregnancy, acute severe Co morbidities: (5), CG = 9.2 (5.8) 

pain in need of surgery or NR IG = 17 (7.6), CG = 

immediate tx, 20.6 (8.8) 

contraindication to Prior episode of 

acupressure pain if acute: NR Intermediate: Pain: 

IG = 1.59 (0.73), 

Prior CAM CG = 2.17 (0.89); 

intervention: NR IG = 16.1 (17.4), 

CG = 41.4 (24.6) 

Prior surgery Disability: IG = 2.2 

related to current (3.2), CG = 6.7 

complaint: None (5.5); IG = 12.2 

(4.9), CG = 17.9 

(8.1) 

C-181
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hsieh, L 

(2007)177 Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

N-S 

Groups 

IG (n = 69) – 

Outcomes: 

Pain: Pain visual 

Outcome 

instruments: 

Tx duration: 4 wks 47.6 (13.6) vs. Acupressure: no scale (0-5)- SF-PQ QoL/ well being: NR 

Country: Final assessments: 6 CG = 47.6 (14.9) Duration of description given; 6 

Taiwan mos yrs Pain: Chronic (1 session over 4 wk Results: Other: NA 

mo – over 10 period, 15 min/ tx Baseline: 

N screened: 220 % of male: IG = yrs) Drop outs: A = 4, B = Pain: IG = 1.95 Results: 

Quality N randomized: 146 43.4%, CG = 0, D = 13 (2.96), CG = 2.23 Baseline: NA 

score: 9/13 N completed tx: 146 51.9% Severity of pain (3.33); NR 

N attended last fu: 121 (Grading): NR CG (n = 77) – Immediate post tx: 

Racial Physical therapy: Immediate post tx: NA 

Initial of composition: NR followed the routine Pain: NR; IG = 2.28 

reviewer: SG Inclusion: 16 - 84 yrs Co­ practice of the (2.62), CG = 5.05 Short term: NR 

with CLBP Work status: interventions:NR hospital. Included (5.11) 

27.5% pelvic manual Intermediate: NR 

Exclusion: LBP caused Householder traction, Short term: NR 

by severe systematic thermotherapy, Long term: NR 

diseases (SLE or Other socio­ infrared light therapy, Intermediate: NR; 

rheumatoid disease); demographics: ES, and EX therapy, IG = 1.08 (1.43), Harms: No AEs 

contraindications to NR as decided by one CG = 3.15 (3.62) were reported in the 

acupressure and physical senior physical acupressure group 

therapy; cancer, Co morbidities: therapist; same as IG Long term: NR 

pyschiatric disease with NR Drop outs: A = 5, B = 

the presence of overt 0, D = 12 

clinical symptoms before Prior episode of 

participation; severe pain pain if acute: NR 

(pain score >90%), 

surgical operation Prior CAM 

prescribed by a physician intervention: NR 

as tx for LBP 

Prior surgery 

related to current 

complaint: None 

C-182
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Little, P 

(2008)178 Trial Design-RCT Mean age (SD): 

IG1 = 46 (10), 

Cause of Pain: 

N-S 

Groups 

IG 1a (n = 75) 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: 4/6 wks, 5 IG2 = 45 (11), Massage Pain: Median ds QoL/ well being: NR 

Country: mos IG3 = 45 (11), Duration of 1b – massage + EX, with no pain (IQR) 

UK Final assessments: 1 yr IG4 = 46 (10) yrs Pain: Chronic (> (n = 72); 6 sessions, Disability: Roland 

3 mo) or 1 session/ wk for 6 disability score Results: 

N screened: 1027 % of male: 30.5 recurrent (last wks, EX at 6 wks 

Quality N randomized: 579 episode > 3 wks Drop outs: C = 29, E Results: Immediate post tx: 

score: 8/13 N completed tx: NR Racial in duration) = 27 Baseline: NA 

N attended last fu: 464 composition: NR Pain: IG1 = 28 (14­

Severity of pain IG (n = 144) 2a – 6 28), IG2 = 28 (8­ Short term: NR 

Initial of Inclusion: significant Work status: (Grading):  4 Alexander technique 28), IG3 = 28 (13­

reviewer: SG recurrent or CLBP, 74.5% Employed on Roland lessons;; 6 lessons, 28), IG4 = 24.5 (14­ Intermediate: NR 

presenting to primsry disability scale 4 wks 28) 

care with LBP > 3 mo (to Other socio- Drop outs: C = 21, E Disability: NR Long term: NR 

exclude 1st episode), demographics: = 29 

currently scoreing  4 on 59.2% Married Co- Immediate post tx: Harms: worse pain 

Roland disability scale, interventions:NR IG (n = 144) 3a – 24 Pain: NR by one pts no group 

current pain for  3 wks ( Co morbidities: Alexander lessons; in Disability: designation reported 

Exclusion: previous NR 5 mo 

experience of Alexander Drop outs: C = 29, Short term: 

techniques (AT); pts Prior episode of E= 27 changecompared to 

under 18 or over 65; pain if acute: NR control from 

serious spinal disease; IG (n = 144) 4a – baseline 

current nerve root pain Prior CAM Usual care + EX; RDS: -1.90 vs. ­

(below knee in intervention: NR started EX tx at 6 1.71 vs. -2.91 

dermatomal distribution), wks Intermediate: NR 

previous spinal surgery, Prior surgery Drop outs: C = 36, E Long term: \ 

pending litigation; history related to current = 33 Number of ds with 

of psychosis or major complaint: NR LBP was lower 

alcohol misuse after lessons and 

QoL improved also. 

C-183
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Mackawan S 

(2007)145 Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

N-S 

Groups 

IG (n = 35)– 

Outcomes: 

Pain: VAS (10 cm); 

Outcome 

instruments: 

Tx duration: one session 38.97 (7.85) vs. Traditional Thai substance p levels QoL/ well being: NR 

Country: Final assessments: post- CG = 38.57 massage(TTM): in saliva 

Thailand tx (7.66) yrs Deep massage with Results: NA 

Duration of prolonged pressure Results: 

N screened: NR % of male: IG = Pain: Chronic, (5-10s/point) on the Baseline: Immediate post tx: 

Quality N randomized: 67 34%, CG = 44% NR muscles along with Pain: IG = 4.22 

score: 5/13 N completed tx: 67 passive stretching. (1.98), CG = 4.35 Short term: NR 

N attended last fu: 67 Racial Severity of pain Gentle stretching of (1.71); IG = 73.86 

composition: NR (Grading): NR the joints and (62.31), CG = Intermediate: NR 

Initial of Inclusion: 20-60 yrs; muscles relieves 80.61 (85.26) 

reviewer: SG persistent CLBP (> 12 Work status: tension, enhances Long term: NR 

wks); no evidence of Government Co­ flexibility, and Immediate post tx: 

underlying diseases or service= 49% interventions:NR induces a deep state Pain: IG = 2.45 Harms: NR 

anatomical abnormalities Private officer= of tranquility; one 10 (1.75), CG = 3.39 

Exclusion: menstruation; 32.5%; Student= min session (1.66); IG = 50.43 

pregnancy; body temp 6%; Business Drop outs: NR (64.39), CG = 

38.5°C on d of exam.; a owner = 11.5% 56.27 (72.77) 

history of acute trauma, CG (n = 32) – Joint 

back surgery, spinal Other socio- Mob: Spinal Mob is a Short term: NR 

fracture, joint subluxation demographics: passive movement of 

or instability, NR a spinal segment Intermediate: NR 

inflammatory joint Co morbidities: with and occasionally 

disease muscle disease, NR beyond its active Long term: NR 

malignancy or infection; Prior episode of ROM.; as IG 

evidence of neurologic pain if acute: NR Drop outs: NR 

deficits, multiple 

sclerosis, hemi/para Prior CAM 

paresis or myelopathy, intervention: NR 

skin diseases, or Prior surgery 

infectious diseases related to current 

complaint: NR 

C-184
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Poole, H 

(2007)179 Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

N-S 

Groups 

IG (n = 77)– 

Outcomes: 

Pain: SF-36- pain 

Outcomes: 

QoL/ well being: 

Tx duration: 6-8 wks 47.2 (10.5), CG1 Reflexology: Morrell component (0-100); Back depression 

Country: Final assessments: 6 = 45.6 (12), CG2 Duration of technique. No VAS (0-100) inventory- 21 items, 

UK mos = 47.25 (10.2) Pain: Chronic, standardised 4 pt scale (0-3) 

yrs IG = 120.6 protocol was Disability: ODQ 

N screened: 650 (114.5) mo; provided, Immediate post tx: 

Quality N randomized: 234 % of male: IG = CG1 = 128.4 reflexologists were Results: IG = 11 (10.2), CG1 

score: 5/13 N completed tx: 191 37.6, CG1 = (104.5) mo; advised to treat pts Immediate post tx: = 12.9 (11.7), CG2 = 

N attended last fu: 156 35.4, CG2 = 49.3 CG2 = 114.7 CLBP as per their Pain VAS: 39.8 14.4 (10.5) 

(106.7) mo standard practice; 6 (29.2) vs. 41.3 

Initial of Racial tx of 1 hr/wk over 6-8 (28.5) vs. 42.7 Short term: NR 

reviewer: SG Inclusion: 18 - 65 yrs composition: NR Severity of pain wks (28.4) 

with benign CLBP (Grading): NR Drop outs: A = 9, B = Intermediate: IG = 

Work status: 13, D = 8 Disability: 29 (20.2), 11.6 (10.9), CG1 = 

Exclusion: pregnancy, 50% Employed CG1 = 31.3 (21.1), 12.6 (10.9), CG2 = 

significantly co-existing Co­ CG1 (n = 82) – CG2 = 32.9 (17.6); 12.8 (9.2) 

major medical illness, Other socio­ interventions:NR Relaxation: 

diagnosis with a demographics: Progressive MR; 6 tx Short term: NR 

significant co-existing NR of 1 hr/wk over 6 wks Pts not using any tx 

psychiatric disorder and in groups of 1 - 4 Intermediate: Pain: at the end of trial: 31 

under the care of a Co morbidities: Drop outs: A = 13, B 39.8 (29.2) vs. 41.3 vs. 21 vs. 13 

psychiatric services; in NR = 12, D = 3 (28.5) vs. 42.7 Harms: NR 

litigation; previous use of (28.4) 

reflexology and Prior episode of CG2 (n = 75) – Non- Disability: No Note: adding 

contraindication to pain if acute: NR intervention: change reflexology to GP 

reflexology including: Continue regular was not more 

recent surgery and Prior CAM visits to GP Long term: NR effective than usual 

circulatory disorders of intervention: NR Drop outs: A = 21, B GP alone 

the lower limb = 11, D = increase of 

Prior surgery 2 pts 

related to current 

complaint: None 

C-185
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Quinn, F 

(2008)180 Trial Design-RCT Mean age:43 

yrs 

Cause of Pain: 

N-S 

Groups 

IG (n = 7) – 

Outcomes: 

Pain: VAS (10 cm); 

Outcome 

instruments: 

Tx duration: 6 wks Reflexology: McGill Pain (0-77); QoL/ well being: NR 

Country: Final assessments: 3 % of male: IG = Reflexology on key SF-36 (bodily Pain 

UK mos 14.3%, CG = points of the feet that measure)- ITT Other: Physical 

50% Duration of are representative of functioning SF-36­

N screened: 15 Pain: NR the vertabrae of the Disability: RMDQ (0-100) 

Quality N randomized: 15 Racial spine and the 

score: 9/13 N completed tx: 15 composition: NR Severity of pain surrounding Results: Immediate post tx: 

N attended last fu: 15 (Grading): NR musculature (inner Immediate post tx: NA IG = 48.6 (2.2), 

Work status: All edge of both feet); 40 Pain: CG = 43.4 (7.4) 

Initial of employees of min/ wk for 6 wks IG = 3.1, CG = 3.9; 

reviewer: SG Inclusion: Staff University of Co- Drop outs: 1 pt IG = 46.1 (5.2), CG Short term: NR 

employed at the U of Ulster interventions:NR received only 4 tx = 41.8 (9.6) IG = 48.6 (2.2), CG 

Ulster with N-S LBP, any = 44.4 (3) 

phisiotherapy, Med or Other socio- CG (n = 8) – Sham Disability: IG = 6 

other tx for LBP has been demographics: (foot massage): (1.8), CG = 5 (2.6); Intermediate: NR 

stabilized for at least 3 NR simple foot massage 

mos, no involvement in using same Short term: Long term: NR 

other research projects Co morbidities: sequences as in the Pain: IG = 2.2 (1.2), 

within past 3 mos, NR reflexology tx group CG = 3.2 (1.5) Harms: no AEs 

reflexology naïve (with no but less pressure, IG = 11 (8.1), CG = reported in any of 

detailed knowledge of S Prior episode of points representative 6.5 (1.6); the grps throughout 

reflexology points), not pain if acute: NR of the vertabrae of IG = 51.1 (6.7), CG the tx period 

pregnant. the spine and = 46.1 (0.7) 

Prior CAM surrounding 

Exclusion: NR intervention: NR musculatire were Disability: IG = 4 

avoided; same as IG (2.2), CG = 3.5 

Prior surgery Drop outs: None (2.2) 

related to current Intermediate: NR 

complaint: None 

Long term: NR 

C-186
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zaproudina, 

N (2009)181 

Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

N-S 

Groups 

IG (n = 63)– 

Outcomes: 

Pain: VAS (0-100) 

Outcome 

instruments: 

Tx duration: not clear 41.7 (5.8) vs. CG Physical and EX QoL/ well being: NR 

Country: Final assessments: 12 = 40.7 (5.3) yrs Duration of therapy: massage, Disability: Oswestry 

Kuopio, mos Pain: Chronic, therapeutic Disbility Index Other: NA 

Finland % of male: IG = NR stretching and EX (ODI) (0-100) 

N screened: 221 51%, CG = 47% therapy; individual 

N randomized: 122 Severity of pain EX programs for Results: Results: 

Quality N completed tx: NR Racial (Grading): NR home training and Baseline: Baseline: 

score: 5/13 N attended last fu: NR composition: NR ergonomic Pain: IG = 40.8 

instructions; (20.9), CG = 40.9 Immediate post tx: 

Inclusion: CLBP with or Work status: NR Co­ timetable and kind of (22.9) 

Initial of without referred leg pain; interventions:NR tx freely chosen by Disability: IG = 21.5 Short term: NR 

reviewer: SG minimal VAS of 30 and/or Other socio­ physiotherapist; 5 (8.3), CG = 19.9 

Oswestery Disability demographics: sessions (9.7) Intermediate: NR 

Index of at least 16% NR Drop outs: A=3,B=1 

Immediate post tx: Long term: NR 

Exclusion: Pregnancy; Co morbidities: CG (n = 59) – Pain: ----

rheumatic or other NR Traditional bone Disability: ---- Harms: worsening 

disease; severe structural setting; NR; 3-5 of pain (WDAE), 2 

deformity; back Prior episode of sessions, 90 Short term: vs. 1 

operation; acute disk pain if acute: NR min/session, 1 or 2 VAS: IG = 26.8 

herniation; severe wk intervals (20.3), CG = 21.8 

sciatica; receiving any Prior CAM Drop outs: A=5,B=3 (24.5) 

therapy during previous intervention: NR ODI: IG = 16.3 (9.9) 

mo CG = 12.2 (11) 

Prior surgery Intermediate: no 

related to current numeric data 

complaint: NR reported 

Long term: no 

numeric data 

C-187
 
Table 1.39 Low Back Pain - Massage - Mixed - Specific Pain – 

Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zhang, J 

(2004)182 

Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

Disc/joint 

Groups 

CG (n = 55)– Traction: 

Outcomes: 

Pain: Score based 

Outcome 

instruments: 

Tx duration: 3-6 wks? 40.9 (10.5), CG1 disease: lumbar traction table, 0.5 on Shanghai QoL/ well being: 

Country: Final assessments: = 41.2 (10.8), disc herniation weight-weight, 20 Chinese Mediccal 

China post tx CG2 = 42.1 (10.5) min/tx; 1 tx/d, 20 tx diagnosis and Other: marked effect 

yrs total treament Standard of tx 

N screened: 165 Drop outs: A = NR, B = Procedure 

Quality N randomized: 165 % of male: 57% Duration of 0 Results : 

score: 6/13 N completed tx: 165 Pain: Acute, Results: 

N attended last fu: NR Racial Sub-acute and IG (n = 55) – Massage: Baseline: Immediate post tx: 

composition: Most chronic, IG = 6.8 NR; 20 min/ tx; 3 Pain: CG= 12.78 The markedly 

Initial of likely Asian (2.3), CG1 = 6.9 tx/wk, 20 tx total (1.68), IG1 = 12.75 effective rate in IG1 

reviewer: SG Inclusion: diagnosed (2.3), CG2 = 6.8 Drop outs: A = NR, B = (1.65), IG2 = 12.79 was no diff. than IG2 

as Shanghai Chinese Work status: NR (2.4) mo 0 (1.67) but the rate for IG 

Medical Diagnostic was better than CG 

and therapeutic Other socio- Severity of pain IG2 (n = 55) – Immediate post tx: (t = 2.4, p < 0.05) 

Effective Standard, demographics: (Grading): NR Massage + EX: Pain: CG= 17.87 

score between 0-23 NR Massage: 20 min/tx, 3 (7.51), IG1 = 25.71 Short term: NR 

based on Lumbar tx/wk 20 tx total. (4.95), IG2 = 25.83 

Function Assessment Co morbidities: Co- Exercise: 20-30 min/tx, (5.02) Intermediate: NR 

(ref[5]), 20-60 yr, no NR interventions:NR 3 tx/wk 

other tx before, Drop outs: A = NR, B = Short term: NR Long term: NR 

volunteer participation Prior episode of 0 

pain if acute: NR Intermediate: NR Harms: NR 

Exclusion: pregnant, 

brest feeding, with Prior CAM Long term: NR 

fracture, tumor, low intervention: NR 

bone density, skin 

damage, tubercal Prior surgery 

related to current 

complaint: NR 

C-188
 
Table 1.40 Low Back Pain - Massage - Mixed - Non-Specific Pain 

Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Chatchawan Trial Design-RCT Mean age Cause of Pain: Groups Outcomes: Outcome 

U 

(2005)183 Tx duration: 3-4 wks 

(SD/range): IG = 

37.3 (8.8) vs. CG 

Myofacial pain 

syndrome 

IG (n = 90)– 

Traditional Thai 

Pain: VAS (10 cm) 

N based on ITT 

instruments: 

QoL/ well being: NR 

Final assessments: 3 = 35.5 (8.8) yrs massage (TTM); 6 

Country: wks and 1 mo post tx sessions over a 3-4 Disability: ODQ Other: Back 

Thailand % of male: 36% wks, generally 2 performance (data 

N screened: 214 Duration of sessions/wk for 3 wks Results-Baseline: not shown) 

N randomized: 180 Racial Pain: Sub- Drop outs: A = 1, B = Pain: IG = 5.5 (1.5), 

Quality N completed tx: 177 composition: NR acute/chronic, 0, C = 4 CG = 5.2 (1.7) Results: 

score: 6/13 N attended last fu: 172 IG = 36.6 (38.8) Disability: IG = 20.7 Baseline: NA 

Work status: 95% mo; CG = 34.8 CG (n = 90) – Swedish (8.9), CG = 20.7 

Inclusion: 21-50 yrs; Light workers (35.6) mo Massage (SM): (8.3) Immediate post tx: 

Initial of persistent LBP; >/= performed using body- NA 

reviewer: SG one TP was present in Other socio- Severity of pain oil for lubrication for Immediate post tx: 

the upper and/or lower demographics: (Grading): NR the skin; Same as IG Pain: IG = 2.2 (1.9), Short term: NR 

torso region (TP = NR Drop outs: A = 1, B = CG = 2 (1.7) 

presence of focal 1, C = 1 Disability: IG = 13.8 Intermediate: NR 

tenderness at a Co morbidities: Co­ (8.8), CG = 15.4 

palpable nodule in a NR interventions:NR (9.1) Long term: NR 

taut band + pain 

recognition) Prior episode of Short term: Harms: one Pt in IG 

pain if acute: IG = VAS: IG = 2.4 (1.9), droped out due to 

Exclusion: 6.7 (8.1) wks; CG CG = 2.5 (2) car accident 

menstruation; = 5.2 (5) wks ODQ: IG = 13.4 

pregnancy; fever; a hx (10.1), CG = 13.9 

of acute trauma, back Prior CAM (8.9) 

surgery, spinal intervention: NR 

fracture, other Intermediate: NR 

significant disorders of Prior surgery 

musckuloskeletal or related to current Long term: NR 

nerveous system complaint: None 

C-189
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Hoehler F 

(1981)134 

Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

N-S 

Groups 

IG (n = 58)– 

Outcome 

instruments: 

Outcome 

instruments: 

Tx duration: NR 30.1 (8.4) vs. CG Manipulation: rotal Pain: improvement QoL/ well being: NR 

Country: US Final assessments: = 32.1 (9.8) yrs manipulations of the in amout of pain 

immediately post tx; Duration of lumbosacral spine; # Improvement in 

and long term (as % of male: 59% Pain: 50% of tx varied Disability: NR SLR, degrees: 

Quality stated in the study) total Acute, 23% Drop outs: NR 

score: 3/13 Chronic Results: Results: 

N screened: 1880 Racial CG (n = 39) – Soft- Immediate post tx: 

N randomized: 95 composition: NR Severity of pain tissue massage: soft- Immediate post tx: To pelvic rot 1.6 

Initial of N completed tx: NR (Grading): NR tissue massage of the % of Pts with (6.3) vs. 1.0 (6.3) 

reviewer: SG N attended last fu: NR Work status: NR lumbosacral areas, improved pain: To pain: 3.3 (6.2) vs. 

with the rotal thrust 84% vs. 68% – 0.5 (5.9) 

Inclusion: presence of Other socio- Co­ omitted; same as IG 

palpatory cues demographics: interventions:NR Drop outs: NR Disability: NR Short term: NR 

indicating that SM NR 

might be successful Short term: NR Intermediate: NR 

Co morbidities: 

Exclusion: Spinal NR Intermediate: NR Long term: SLR to 

manipulation pelvic rot 8.0 (9.3) 

contraindicated or Prior episode of Long term: vs. 4.1 (8.6); to pain: 

alternative tx strongly pain if acute: NR Pts reporting tx as 7.8 (7.4) vs. 8.6 (8.4) 

indicated; pregnancy; effective: 88% vs. Improvement in 

previous experience Prior CAM 86%) forward flextion (cm): 

with manipulation; intervention: NR 11.4 (15.9) vs. 10.7 

disability income; (14.2) 

pending litigation; Prior surgery 

previous back surgery; related to current Harms: NR 

obesity; drug or complaint: NR 

alcohol abuse 

C-190
 
Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Zhang, J 

(2004)182 Trial Design-RCT Mean age 

(SD/range): IG = 

Cause of Pain: 

Disc/joint 

Groups 

IG (n = 55)– Traction: 

Outcomes: 

Pain: Score based 

Outcome 

instruments: 

Tx duration: 3-6 wks? 40.9 (10.5), CG1 disease: lumbar traction table, 0.5 on Shanghai QoL/ well being: 

Country: Final assessments: = 41.2 (10.8), disc herniation weight-weight, 20 Chinese Mediccal 

China immediately post tx CG2 = 42.1 (10.5) min/tx; 1 tx/d, 20 tx diagnosis and Results: 

yrs total treament Standard Immediate post tx: 

N screened: 165 Drop outs: A = NR, B = Procedure NA 

Quality N randomized: 165 % of male: 57% Duration of 0 

score: 6/13 N completed tx: 165 Pain: Acute, Results: Short term: NR 

N attended last fu: NR Racial Sub-acute and CG1 (n = 55) – Baseline: 

composition: Most chronic, IG = 6.8 Massage: NR; 20 min/ Pain: IG = 12.78 Intermediate: NR 

Initial of likely Asian (2.3), CG1 = 6.9 tx; 3 tx/wk, 20 tx total (1.68), CG1 = 

reviewer: SG Inclusion: diagnosed (2.3), CG2 = 6.8 Drop outs: A = NR, B = 12.75 (1.65), CG2 Long term: NR 

as Shanghai Chinese Work status: NR (2.4) mo 0 = 12.79 (1.67) 

Medical Diagnostic Harms: NR 

and therapeutic Other socio- Severity of pain CG2 (n = 55) – Immediate post tx: 

Effective Standard, demographics: (Grading): NR Massage + EX: Pain: IG = 17.87 

score between 0-23 NR Massage: 20 min/tx, 3 (7.51), CG1 = 

based on Lumbar tx/wk 20 tx total. 25.71 (4.95), CG2 

Function Assessment Co morbidities: Co- Exercise: 20-30 min/tx, = 25.83 (5.02) 

(ref[5]), 20-60 yr, no NR interventions:NR 3 tx/wk 

other tx before, Drop outs: A = NR, B = Short term: NR 

volunteer participation Prior episode of 0 

pain if acute: NR Intermediate: NR 

Exclusion: pregnant, 

brest feeding, with Prior CAM Long term: NR 

fracture, tumor, low intervention: NR 

bone density, skin 

damage, tubercal 

Prior surgery 

related to current 

complaint: NR 

C-191
 
Table 1.41 Low Back Pain - Massage - Unknown - Specific Pain 

Author ID 

Country 

Study 

Characteristics 

Population 

Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Li, ZY Trial Design Mean age Cause of Pain: Groups Outcomes: Outcomes: 

(2006)184 RCT- (SD/range): IG = Disc herniation IG (n = 30) – Living Pain: score QoL/ well being: 46.17(2.99) vs. CG acupoint tx: massage at evaluation of pain; NR 

Tx duration: NR = 44.67 (3.23) yrs acupoint; NR VAS 

Country: 

China 

Final assessments: 

post-tx % of male: IG = 

53.8%; CG = 53.3% Duration of 

Pain: Cannot tell 

Drop outs: A=0;B=0 

CG (n = 30) – ObliqueResults: Baseline: 

Results: 

N screened: 60 Racial composition: pulling: SM, oblique- Pain: 

N randomized: 60 NR Severity of pain pulling on the pt’s IG = 40.6 (2.93), Immediate post tx: 

Quality N completed tx: 60 (Grading): NR lumbar vertebra; NR CG = 42.83 (3.63) NA 

score: 10/13 N attended last fu: 60 Work status: NR Drop outs: A=0;B=0 

IG = 8.99 (0.26), Short term: NR 

Initial of 

Inclusion: Typical 

symptoms; Clinical 

Other sociodemographics: NR Cointerventions:NR 

CG = 8.94 (0.27) 

Intermediate: NR 

reviewer: SG positive signs; 

Diagnosed by CT or 

Co morbidities: NR Immediate post tx: 

Pain: IG = 64.77 Long term: NR 

MRI; aged 20-55 yrs Prior episode of (4.14), CG = 60.7 

pain if acute: NR (5.78) Harms: NR 

Exclusion: Severe 

lumbar trauma; History Prior CAM IG = 4.71 (0.52), 

of lumbar surgery; intervention: NR CG = 5.59 (0.8) 

Lumbar spine bone 

destruction; Central 

nervous symptoms; 

Serious visceral 

Prior surgery 

related to current 

complaint: NR 

Short term: NR 

Intermediate: NR 

Long term: NR 

disease 

Outcomes: ODQ=Oswestry disability questionnaire; RMQ=Roland Morris Questionnaire; NPQ=Northwick Neck Pain Questionnaire; MPQ=McGill Pain 

Questionnaire; ODI=Oswestry Disability Index; NDI=Neck Disability Index; NHP=Nottingham Health Profile; HFAC=Hanover Functional Ability Questionnaire 

PDI=pain disability index; GWBS=global well-being scale; SLR=straight leg raising; GPE=global perceived effect; FTF=finger-to-floor; PPI=present pain intensity; 

PRI=pain rating index; PUP=pain under pressure; MRP=motion related pain; NPAD=Neck Pain and Disability Scale; QoL=Quality of Life; MVEE=maximum 

voluntary extension effort; PQ=pain questionnaire; MPQ=Short Form McGill Pain Questionnaire; RMAS=Roland Morris Activity Scale; QBPDS=Quebec Back Pain 

Disability Scale; mRDQ=modified Roland Morris Questionnarie NRS=numeric pain rating scale; PPT= pressure pain VAS=visual analogue scale;; SF= short form 

threshold; Special terms:HVLA=high velocity low amplitude; ETOIMS=electrical twitch-obtaining intramuscular stimulation; IMS=intramuscular stimulation; FDT= 

C-192
 
flexion distraction technique; TrP=trigger point; GP=general practitioner; CAM=complementary and alternative medicine; NSAIDs=non-steroidal anti-inflammatory 

drugs; NP=neck pain; N-S=non-specific; S=specific; Med=medication; PT= physiotherapy; ST=standard therapy; E-acu=electro acupuncture; MR= muscle 

relaxation; EX=exercise CLBP=chronic low back pain; A=baseline evaluation; B=immediately post treatment; C= short term follow up (up to 3 months post 

treatment); D=intermediate follow up (up to 6 months post treatment); E=long term follow up (over 6 months post treatment); acu=acupuncture; SM=spinal 

manipulation; LBP= low back pain; NP=neck pain; TP=thoracic pain TENS/TNS= transcutaneous electrical nerve stimulation; ROM=range of motion; 

MPS=myofascial pain syndrome; Mob=mobilization; ext=extension; flx=flexion; rot=rotation; MS=MS; PM=physical modalities; mA=milli Amp; Statistical: 

NS=statistically non-significant; SD=standard deviation; SE=standard error; WMD=weighted mean difference ; p=p-value; 95% CI= 95% Confidence Interval; SS= 

statistically significant; General terms: NA=not available/applicable; NR=not reported; Pt(s)=patient(s); d=day(s); mo(s)=month(s); yr(s)=year(s); wk(s)=week(s); 

N=number NS= not significant; pt/s= patient/s; tx=treatment/intervention Fu=follow up; ITT=intention to treat; IG=intervention group; CG=control group; 

RCT=randomized controlled trial; AE(s)=adverse event(s); SAE= serious adverse events; WDAE= withdrawal due to adverse events 

C-193
 
CAM Back Pain II- Evidence Table – Neck Pain 

Table 2.1 Neck Pain - Acupuncture - Acute - Specific Pain 

Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Aigner, N 

(1999)185 

Trial Design 

RCT 

Mean age 

(SD/range):NR 

Region of pain: 

Cervical spine 

Groups 

IG (n = 28) – cervical 

Outcomes (describe 

instrument used): 

Outcomes 

(describe 

Cause of Pain: collar, Chlormezanon, Pain: data presented instrument 

Tx duration: NR % of male: NR NR Paracetamol + Verum in bar graphs – not used): QoL/ well 

Fu duration (last Acupuncture: AP points shown here. being: NR 

Country: assessment): NR Racial T.B.5 (Wai Kuan), S.I.6 

Austria composition: NR (Yang Ku) needled on Disability: NA 

Duration of both sides, propagated 

N screened: 84 Work status: NR Pain, mean sensation along the Results: 

Quality N randomized: 84 (SD/range): channel, paresthesia Baseline: Results- mean: 

score: 6/13 N completed tx: NR Other socio- Acute, NR along the meridians; NR Pain: NA Baseline: NA 

N attended last fu: NR demographics: Drop outs: NR Disability: NA 

NR Severity of pain Immediate post 

Initial of (Grading): NR IG (n = 23) – cervical Immediate post tx: tx: 

reviewer: Inclusion: whiplash for Co morbidities: collar, Chlormezanon, Pain: NA 

SG no longer than 4 ds. 18 NR Paracetamol + laser acu: Disability: NA Short term: NR 

– 65 yrs old Current tx/ co­ low level laser therapy; 

Prior episode of intervention NR Short term: NR Intermediate: NR 

pain if acute: NR common in all Drop outs: NR 

Exclusion: fresh groups: NR Intermediate: NR Long term: NA 

traumatic bone Prior CAM CG (n = 33) – 

fractures near cervical intervention: Chlormezanon, Long term: NR Harms: NR 

spine, massive NR Paracetamol and cervical 

neurological collar: NR; NR Summary: sig 

symptoms, pts with Prior surgery Drop outs: NR improvement in 

small degree of injury related to IG in reduction in 

current duration of pain 

complaint: NR and sick leave 

C-194
 
Table 2.2 Neck Pain - Acupuncture - Acute - Non –Specific Pain - No Studies 

Table 2.3 Neck Pain - Acupuncture - Chronic - Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Birch S Trial Design: RCT Mean age Region of pain: IG1 (n = 15) – Acu- Outcomes: Outcomes 

(1998)190 (SD/range): IG1 = relevant: 1) gauge 2 (0.18) Pain: SF-MPQ (no (describe 

Country: 

US 

Tx duration: 12 wks 

Fu duration (last 

assessment): 6 mos 

N screened: 59 

40.9, IG2 = 38, CG 

= 38.6 yrs 

% of male: IG1 = 

14.3%, IG2 = 23%, 

CG = 14.3% 

Cause of Pain: 

S, NR 

Duration of 

Pain, mean 

mm) shallow needling in 

points 9SI3, BL62, GB41, 

TW5 to 2-3 mm in depth, 

needles connected to IP 

cords and left in place for 

10 min. 2) needling done in 

numerical data 

given); Pain 

intensity rating (1­

10) 

instrument used): 

QoL/ well being: 

NR 

N randomized: 46 (SD/range): neck, shoulder, upper back Results: Results- mean : 

N completed tx: 46 Racial Chronic, IG = in left/right, then heat Baseline: Baseline: NA 

Quality N attended last fu: 36 composition: NR 81.9 mo, IG2 = applied for 10 min; 14 tx, Pain: IG1 = 4.8, 

score: 2/13 92.2 mo, CG = 12 wks IG2 = 4.7, CG = Immediate post tx: 

Inclusion: Chronic Work status: NR 91.1 mo Drop outs: D = 4 4.9 NA 

Initial of 

reviewer: 

SG 

myofascial NP (> 6 mo), 

identifiable painful area 

with hightened sensitivity 

to moderate touch; 

Other sociodemographics: 

33.6% married 

Severity of pain 

(Grading): NR 

IG2 (n = 16) – Acuirrelevant: shallow needling 

with gauge 2 (0.18 mm) 

bilaterally to 2-3 mm depth 

Immediate post tx: 

Pain: IG1 = 1.58 

(1.9), IG2 = 3.37 

Short term: NR 

Intermediate: NR 

unsuccessful response to Co morbidities: NR in hands and feet at LI5, (2.14), CG = 4.76 

PT (traction, heat, US, Current tx/ co­ GB42, TW8, ST41, (2.05) Long term: NR 

massage) Prior episode of intervention needles connected by 

pain if acute: common in all cords as like IG1, left for Short term: NR Harms: NR 

Exclusion: disc accident related groups: 10 min, points BL16, SI9, 

herniation, cervical 

osteoarthritis, infection, 

malignancy, collapsed 

vertebra, collageninjury: 33.6% 

Prior CAM 

intervention: NR 

500 mg/d 

NSAIDs 

LI15 needled bilaterally by 

6 needles to 2-3 mm 

depth; Same as IG1 

Drop outs: D = 3 

Intermediate: NR 

Long term: NR 

vascular disease, brachial Prior surgery CG (n = 15) Medication: 

plexopathy, related to current NSAIDs; 12 wks 

schizophrenia, delusional, complaint: NR Drop outs: D = 3 

psychotic, or bipolar 

disorder 

C-195
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Ceccherelli Trial Design Mean age Region of pain: Groups Outcomes: Outcomes 

F RCT (SD/range): IG = NP IG (n = 31)– somatic Pain: MPQ; VAS (describe 

(2006)194 

Country: 

Italy 

Tx duration: 8 wks 

Fu duration (last 

assessment): 6 mos 

45.5 (10.28) vs. 

CG = 39.8 (9.01) 

yrs 

% of male: 26% 

Cause of Pain: 

S, NR 

Acupuncture; at 3 SI 

(Houxi), 5 TE (Waiguan), 4 

LI (Hegu), 10 BL (Tianzhu), 

20 GB (Fengchi) 

embedded bilaterally; 

points 14 GV (Dazhui) and 

Results: 

Baseline: 

Pain: IG = 40.7 

(17.78), CG = 38.9 

(15.31); IG = 57.9 

instrument used): 

QoL/ well being: 

NR 

total sample 15 GV (Yamen) embedded (18.87), CG = 61 Results- mean : 

N screened: NR Duration of only in the median line. ; (20.73) Baseline: NA 

Quality N randomized: 62 Racial Pain, mean 20 min sessions, 8 

score: 6/13 N completed tx: 62 composition: NR (SD/range): sessions, once/wk Immediate post tx: Immediate post tx: 

Initial of 

reviewer: 

SG 

N attended last fu: 62 

Inclusion: Myofascial 

cervical pain 

Work status: NR 

Other sociodemographics: 

Chronic, NR 

Severity of pain 

(Grading): NR 

Drop outs: 8 (NR), based 

on total sample 

CG (n = 31) – Acu + 

Auricular acu-Tx: Acu as 

IG; after Acu, auricular 

Pain: IG = 13.32 

(9.62), CG = 13.43 

(10.96); 

IG = 15.64 (12.69), 

CG = 19.5 (19.31) 

NA 

Short term: NR 

Intermediate: NR 

Exclusion: fibromyalgia, 

severe systemic illness 

(asthma, emphisema, 

chronic bronchitis, severe 

myocardial failure, 

hypertensive tx with 

reserpine/clonidine, 

osteoporosis, 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

Current tx/ cointervention 

common in all 

groups: 1 g 

paracetamol 

permitted in 

acute pain 

episodes 

needles were inserted (4 

points in each ear) as 

follows: Shen menn pont, 

Lung point; Cervical 

column area, and 

Cephalea point; needles 

with diameter of 300 micro 

m and length of 18 mm 

were used and stimulated 

two at a time witha rotary 

Short term: IG = 

14.2 (10.99), CG = 

11.4 (12.16); 

IG = 15.3 (15.69), 

CG = 18.5 (17.96) 

Intermediate: 

IG = 15.64 (11.43), 

Long term: NR 

Harms: NR 

tranquilizers, drug/alcohol 

use, peripheral or central 

neurological illness (MS, 

epilepsy, brain injury, 

diabetes), adipose 

panniculus 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

movement dx/sx for 20s 

only at the moment of 

embedding; same as IG 

CG = 12.9 (13.87); 

IG = 18.96 (15.6), 

CG = 21 (19.88) 

Long term: NR 

C-196
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Ga, H Trial Design: RCT Mean age Region of pain: Groups Outcomes: Outcomes 

(2007)186 (SD/range): IG = NP IG (n = 18)– Acu: Used Pain: VAS; FACES; (describe 

Country: 

Korea 

Tx duration: not clear 

Fu duration (last 

assessment): 3 mos 

N screened: NR 

N randomized: 39 

79.2 (6.8) vs. CG 

= 75.9 (8.7) yrs 

% of male: IG = 

5.5%, CG =9.5% 

Cause of Pain: 

NR 

modified Simons et al 

technique on pts in 

prone position at TPs 

needled repeatedly 

without pause until all 

PTS 

Results: 

Baseline: 

Pain: IG = 6.98 

(1.32), CG = 6.43 

instrument used): 

QoL/ well being: 

NR 

Other: Passive 

Quality N completed tx: 39 TPs were inactivated, (2.08); IG = 3.5 ROM 

score: 5/13 N attended last fu: 39 Racial Duration of needle diameter 0.3 mm (0.71), CG = 3.43 

composition: Pain, mean and length 60 mm, (0.87); IG = 2.44 Immediate post tx:

Inclusion: Pts aged > 60 yrs Asian (SD/range): needling depth was 30­ (0.7), CG = 2.19 Flexion: 68.9 

Initial of 

reviewer: 

SG 

complaining of chronic 

shoulder/NP or headache for 

more than 6 mo 

Exclusion: Pts who had had 

MTP injections or Acu within 

Work status: NR 

Other sociodemographics: 

Chronic, NR 

Severity of pain 

(Grading): NR 

35, all MTPs treated 

bilaterally; 3 txs at wks 

0, 1, 2 

Drop outs: 1 

(0.6) 

Immediate post tx: 

Pain: IG = 4.69 

(2.05), CG = 3.9 

(2.12); IG = 2.83 

(11.2) vs. 68.3 

(14.8) 

Extension: 67.7 

(14.1) vs. 65.0 

(13.9) 

6 mo preceding the study; NR CG (n = 21) – Lidocaine: (0.99), CG = 2.62 

neck/shoulder surgery within Current tx/ co- MTP injections, same (0.92); IG = 1.94 Short term: NR 

1 yr; taking strong opioids Co morbidities: intervention method as IG using 5 ml (0.87), CG = 1.76 

(morphine); fibromyalgia; NR common in all syringes and 25 guage, (0.77) Intermediate: NR 

cervical radiculopathy, groups: NR 1.5 in long needles myelopathy; severe CVD or 

respiratory diseases; allergy 

to drugs/ injections, drug 

abuse; cognitive deficiency 

Prior episode of 

pain if acute: NR 

Prior CAM 

prefilled with 0.5% 

lidocaine, each MTP 

injected with 0.2 ml of 

lidocaine; same as IG 

Short term: IG = 

3.82 (2.47), CG = 

3.46 (2.47); IG = 

2.11 (1.13), CG = 

2.25 (1.16); IG = 

Long term: NR 

Harms: NR 

intervention: NR Drop outs: 0 1.33 (0.69), CG = 

1.71 (0.72) 

Prior surgery 

related to current Intermediate: NR 

complaint: NR Long term: NR 

C-197
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Irnich D Trial Design Mean age Region of pain: Groups Outcomes: Outcomes 

(2002)188 RCT (SD/range): 51.9 NP IG1 (n = 34)– NL-Acu: Pain: VAS motion- (describe 

[crossover] 

Country: 

Germany 

Tx duration: single 

session (30 min.) 

Fu duration (last 

assessment): immediate 

yrs (total sample) 

% of male: 

26.4% (total 

sample) 

Cause of Pain: 

Myofascial pain 

syndrome 

affected channels were 

indicated by pain 

localization and direction of 

limited mobility; classical 

distant Acu points at the 

extremities were used; in 

related( only 

crossover data 

reported) 

Results: 

instrument used): 

QoL/ well being: 

NR 

post-tx addition, one-two ear Baseline: Results- mean : 

Racial Duration of points were chosen; single Pain: IG1 = 35 Baseline: NA 

Quality composition: NR Pain, mean session, 30 min (22.64), IG2 = 

score: 8/13 N screened: 36 (SD/range): Drop outs: A = 1 33.4 (19.41), CG Immediate post tx: 

Initial of 

reviewer: 

SG 

N randomized: 102 

N completed tx: 101 

N attended last fu: 101 

Work status: NR 

Other sociodemographics: 

NR 

Chronic, 36.7 

mo (total 

sample) 

Severity of pain 

IG2 (n = 34)– L-Acu 

(DN)[dry needling]: strong 

ME on tender spots called 

'ah shi' points, needles 

inserted in local points and 

= 30.4 (18.62) 

Immediate post tx: 

Pain: IG1 = 19.1 

(16.11), IG2 = 

NA 

Short term: NR 

Intermediate: NR 

Inclusion: Pts with 

chronic NP (> 2 mo) and 

myofascial or irritation 

syndrome 

Exclusion: radicular 

cervical syndrome, 

segmental instability, 

Co morbidities: 

NR 

Prior episode of 

pain if acute: 

Myofascial 

syndrome 

(Grading): NR 

Current tx/ cointervention 

common in all 

groups: None 

manipulated until local 

twitch obtained; Same as 

IG1 

Drop outs: A = 1 

CG (n = 34) – Sham-Laser 

acu: Using a handy laser 

pen emitting red light only, 

did not touch the 

skin(distance: 0.5-1 cm); 

29.2 (21.9), CG = 

28 (19.36) 

Short term: NR 

Intermediate: NR 

Long term: NR 

Long term: NR 

Harms: No SAEs 

were observed 

fractur or surgery of the Prior CAM Same as IG1 

cervical spine, intervention: NR Drop outs: 0 

contraindications to acu 

Tx, drug Tx, physical Tx Prior surgery 

or manual Tx any time in related to current 

the last 4 wks complaint: NR 

C-198
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Li, DJ 

(2006)191 Trial Design 

RCT 

Mean age 

(SD/range): 49 

Region of pain: 

NP 

Groups 

IG1 (n = NR)– Spinal 

Outcomes 

(describe 

Outcomes 

(describe 

yrs total Cause of Pain: manipulation: NR; 1 instrument instrument used): 

Tx duration: 2 - 4 wks Spinal stenosis tx/wk, 3 - 4 wks used): QoL/ well being: 

Fu duration (last % of male: IG1 = Drop outs: A = 0, B = 0, Pain: VAS NR 

Country: assessment): 6 mos 52%, IG2 = 56%, C = 0 

China CG = 58% Results: Results- mean : 

N screened: 150 IG2 (n = NR)– Warm Baseline: Baseline: NA 

N randomized: 150 Racial Duration of acu: Acupuncture at Pain: IG1 = 8.81 

Quality N completed tx: 150 composition: NR Pain, mean Ashi points and then (1.82), IG2 = 8.84 Immediate post tx: 

score: 5/13 N attended last fu: 150 (SD/range): warm needle; 15 min/2 (1.81), CG = 8.62 NA 

Work status: NR Chronic (3 mo-2 wks (1.39) 

yrs), NR Drop outs: A = 0, B = 0, Short term: NR 

Initial of Inclusion: Spinal Other socio- C = 0 Immediate post tx: Intermediate: NR 

reviewer: stenosis of neck; age < demographics: Severity of pain Pain: --- Long term: NR 

SG 69 yrs; Disease course < NR (Grading): NR CG (n = NR) – 

2 yrs; Diagnosed by CT Combination: Spinal Short term: IG1 = Harms: NR 

or MRI; Related signs is Co morbidities: manipulation + Warm 4.43 (2.51), IG2 = 

positive NR Current tx/ co­ acu: NR; warm acu was 4.46 (3.11), CG = Summary: SM is 

intervention performed twice after 2.36 (2.8) effecitve for 

Prior episode of common in all every one times of SM relieving muscle 

Exclusion: spinal trauma pain if acute: NR groups: NR Drop outs: A = 0, B = 0, Intermediate: IG1 spasm & relaxing 

in 4 mo; Systemic C = 0 = 3.48 (2.5), IG2 = nerve root 

infection and fever; Prior CAM 2.04 (3.71), CG = adhesion; warm 

Cervical tumor intervention: NR 1.12 (2.78) acu more effective 

in eliminating the 

Prior surgery Long term: NR aseptic 

related to current inflammation of the 

complaint: NR soft tissue & 

improving the 

blood suppy and 

relaxing the 

muscles 

C-199
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Lundenberg, Trial Design Mean age Region of pain: Groups Outcomes Outcomes 

T (1991)193 RCT (SD/range): NR NP and/or TP CG (n = 14) – Sham-acu: (describe (describe 

Tx duration: one 40 min 

session 

% of male: NR 

Cause of Pain: 

Degenerative 

disease (osteoSuperficial needling; 40 

min session 

Drop outs: 0 

instrument 

used): 

Pain: VAS 

instrument used): 

QoL/ well being: 

NR 

Country: 

Sweden 

Fu duration (last 

assessment): NR 

Racial 

composition: NR 

arthritis) IG1 (n = 14)– Acu + ME: 

acu for 40 min on points Li 

sensory (10 cm); 

VAS affective (10 

3 (bilateral), Du 14, Du 16, cm) [no data] Results- mean : 

Work status: NR and Gb 20 (bilateral); Baseline: NA 

Quality N screened: 58 manual rots of the needles 

score: 1/13 N randomized: 58 Other socio- Duration of after insertion for 10 sec/5 Results: Immediate post tx: 

N completed tx: 58 

N attended last fu: NR 

demographics: 

NR 

Pain, mean 

(SD/range): 

min.; As CG1 

Drop outs: 0 Immediate post tx: 

NA 

Initial of 

reviewer: 

SG Inclusion: 44 - 76 yrs; 

Co morbidities: 

NR 

Chronic, NR 

Severity of pain 

IG2 (n = 15)– 2Hz elecroacu: bipolar square wave 

pulses of 0.2 ms duration 

Sensory pain: 2.8 

(1.3) vs. 1.8 (1.0) 

vs. 2.2 (1.7) vs. 

Short term: NR 

Intermediate: NR 

osteoarthritis of the (Grading): NR current adjusted to 2.4 (1.9) 

cervical and/or thoracic Prior episode of localized muscle Long term: NR 

spine (C1-T1) and with no pain if acute: NR contractions; As CG Affective pain 

previous experience of Current tx/ co- Drop outs: 0 score: 2.2 (1.2) Harms: NR 

acu; pain for 6 mo or Prior CAM intervention vs. 1.8 (1.0) vs. 

more 

Exclusion: sensory or 

intervention: NR 

Prior surgery 

related to current 

common in all 

groups: NR 

IG3 (n = 15) – 80 Hz 

electro-acu: intensity was 

adjusted as that 

paraesthesias were 

evoked in the stimulated 

1.4 (1.5) vs. 1.5 

(1.1) 

Short term: NR 

motor deficit complaint: NR area; as CG1 

Drop outs: 0 Intermediate: NR 

Long term: NR 

C-200
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Lv, YX 

(2006)187 Trial Design 

RCT 

Mean age 

(SD/range): IG1 

Region of pain: 

NP 

Groups 

IG1 (n = 36) – TurtheOutcomes 

(describe 

Outcomes 

(describe 

= 40.33 (8.16) Cause of Pain: probing needling: choice instrument instrument used): 

Tx duration: 12 ds vs. IG2 = 42.46 Cervico-genic acupoint at Tian zhu, used): QoL/ well being: 

Country: Fu duration (last (6.72) yrs headache Feng chi, needle size 40 Pain: VAS NR 

China assessment): immediate mm; 30 min/d x 6 d x 2 

post-tx % of male: IG = courses Results: 

36.1%, CG = Drop outs: A = 0, B = 0 Baseline: Results- mean : 

Quality 41.2% Pain: NR Baseline: NA 

score: 3/13 N screened: 80 Duration of IG2 (n = 34) – Routine 

N randomized: 70 Racial Pain, mean acu: choice acupoint at Immediate post tx: Immediate post tx: 

N completed tx: 70 composition: NR (SD/range): Tian zhu, Feng chi,shuai Pain: p < 0.05 

Initial of N attended last fu: 70 Chronic ( 12 gu,Tou wei, Jia ji, Hou xi Short term: NR 

reviewer: Work status: NR wks), NR and Ashi, needle size 40 Short term: NR 

SG mm; Same as IG1 Intermediate: NR 

Inclusion: Cervico-genic Other socio- Severity of pain Drop outs: A = 0, B = 0 Intermediate: NR 

headache demographics: (Grading): NR Long term: NR 

NR Long term: NR 

Exclusion: NR Harms: NR 

Co morbidities: Current tx/ coNR intervention Summary: Turthecommon in all probing has fast 

Prior episode of groups: TDP onset of action and 

pain if acute: NR better than routine 

acu 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

C-201
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Thomas, M 

(1991)195 Trial Design 

RCT 

Mean age 

(SD/range): 42­

Region of pain: 

Cervical 

Groups 

IG1 (n = 11) – Acu: 

Outcomes: 

Pain: VAS 

Outcomes 

(describe 

77 yrs ostearthritis Points were Li3, Du14, affective score (0­ instrument used): 

Tx duration: not clear (spine & neck) Du16, Du20 and GB20 10); VAS sensory QoL/ well being: 

Fu duration (last % of male: NR Cause of Pain: (bilateral). Needles were score (0-10) NR 

Country: assessment): immediate S, Osteoarthritis 2.5 cm long, Insertions 

Sweden post-tx Racial made to depths 0.6-1.3 Results: Results- mean : 

composition: cm. Stimulation brought Baseline: Baseline: NA 

(assume all about by manual rots of Pain: IG1 = 3.5 

Quality N screened: NR white) needles which evoked (1.2), CG1 = 3.1 Immediate post tx: 

score: 5/13 N randomized: 44 Duration of tingling, deqi sensation; (1.1), IG2 = 3.0 NA 

N completed tx: NR Work status: NR Pain, mean 40 min tx, repeated 10 (0.8), CG2 = 2.7 

N attended last fu: NR (SD/range): sec/5 min by further (1); IG1 = 2.5 Short term: NR 

Initial of Other socio- Chronic, NR rots, 3-5 d between trials (0.8), CG1 = 2 

reviewer: demographics: Drop outs: NR for all (0.9), IG2 = 1.9 Intermediate: NR 

SG Inclusion: Pts with NR Severity of pain (0.7), CG2 = 1.9 

chronic cervical (Grading): NR CG1 (n = 11) – Sham­ (0.8) Long term: NR 

osteoarthritis, with pain Co morbidities: Acu: Needles inserted 

for 6 mo or more. Pain NR superficially and left Immediate post tx: Harms: NR 

more severe when joints Current tx/ co­ without eliciting further Pain: IG1 = 2.3 

are in movement than at Prior episode of intervention sensation; 3-5 d (1.5), CG1 = 2.4 Summary: Acu 

rest pain if acute: NR common in all between trials (1.2), IG2 = 2.2 was significantly 

groups: NR (1), CG2 = 2.2 more effective than 

Exclusion: NR Prior CAM IG2 (n = 11) – Pts were (1.3); IG1 = 1.8 placebo-diazepam, 

intervention: NR administered 5mgm (1.2), CG1 = 1.6 but NSly more 

diazepam orally; As (1.1), IG2 = 1.6 effective than 

Prior surgery CG1 (0.7), CG2 = 1.7 diazepam or shamrelated to current (1) acu 

complaint: NR CG2 (n = 11) – ShamDiazepam: pts given 5 Short term: NR 

mgm placebo-diazepam Intermediate: NR 

orally; as CG1 Long term: NR 

C-202
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

White, PF Trial Design-RCT- cross Mean age Region of pain: Groups Outcomes: Outcomes: 

(2000)192 over (SD/range): 52 NP IG1 (n = 68) – acu with Pain: VAS (10 QoL/ well being: NR 

Country: 

US 

Tx duration: 3 wks 

Fu duration (last 

assessment): immediate 

post-tx (data shown for 1st 

phase before cross over) 

(23) yrs total 

% of male: NR 

Racial 

Cause of Pain: 

Disc disease 

ES at local points: 10 

probed connected to 5 

bipolar leads, stimulated 

for 30 min at alternating 

freq. of 15/30 Hz, 

cm)[cross-over 

design] 

Disability: SF-36 

Quality of sleep (data 

not shown) 

Physical activity 

Use of analgesics 

Results- mean : 

composition: NR Duration of intensity adjusted to Results: Immediate post tx: 

N screened: NR Pain, mean produce gentle tapping Baseline: Increased in physical 

Quality N randomized: 68 Work status: NR (SD/range): sensation without Pain: 7.8 (2.5) activity, mean% 

score: 5/13 N completed tx: 68 Chronic, 43 (19) muscle contraction, Disability: NR (SD): 41% (21) vs. 

Initial of 

reviewer: 

SG 

N attended last fu: 68 

Inclusion: pts with history of 

NP and cervical disk disease 

with a stable level of pain for 

a period of at least 3 mo 

Other sociodemographics: 

NR 

Co morbidities: 

mo 

Severity of pain 

(Grading): NR 

max. amp of 37 mA, 

pulse width of 0.7 ms; 

30 min, 3 tx/wk for 3 wks 

Drop outs: 0 

Immediate post tx: 

Pain: NR 

Disability-mean 

11% (17) vs. 16% 

(15) 

Decrease in average 

oral analgesic Med, 

mean% (SD): 37% 

(18) vs. 9% (13) 6% 

before enrollment NR IG2 (n = 68) – acu with change: IG1 = 7.9 (15) 

Exclusion: pain with a Current tx/ co- ES at remote points (LB) (3.6), IG2 = 3.7 

radicular components, a Prior episode of intervention : Ten 32-guage acu-like (1.9), CG = 3.4 Harms: only needle 

recent history of drug or pain if acute: NA common in all needles to depth 2 – 4 (1.7) site AEs were 

alcohol abuse (< 1 yr), groups: NR cm into soft-tissue and Decrease in pain mentioned 

chronic use of opiod 

analgesics, past experience 

with electro-analgesic 

therapies, recent change in 

analgesic Med (< last 3 mo), 

Prior CAM 

intervention: NR 

Prior surgery 

/or paraspinous muscle 

in LB region; As IG1 

Drop outs: 0 

(mean, SD%): 

38% (17) vs. 9% 

(16) vs. 13% (18) 

Summary: IG1 

produces greater 

short term 

improvement in pain 

or an inability to reliably related to current CG (n = 68) – acu Short term: NR control, physical 

complete the assessment complaint: NR needles only at neck: activity, and quality 

tools use to measure short Same as IG2 but in Intermediate: NA of sleep in pts with 

term outcomes. cervical region chronic NP 

according to Long term: NR 

dermatomal distribution 

of NP; As IG1 

Drop outs: 0 

C-203
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Yang, T 

(2009)197 Trial Design 

RCT 

Mean age 

(SD/range): NR 

Region of pain: 

NP 

Groups 

IG (n = 33)– Acupoint 

Outcomes 

(describe 

Outcomes 

(describe 

Cause of Pain: sticking: Tianding (LI instrument instrument used): 

Tx duration: NR % of male: 50% Cervical 17), Futu (LI 18), Dazhui used): QoL/ well being: 

Fu duration (last total intervertebral (GV 14), Tianzong (SI Pain: NA NR 

Country: assessment): 3 mos disc 11), etc.; NR 

China Racial Drop outs: NR Disability: NA Other: Effective 

composition: rate 

N screened: NR Asian CG (n = 33) – Acu: NR; Results: 

Quality N randomized: 66 NR Baseline: NA Immediate post tx: 

score: /13 N completed tx: NR Work status: NR Duration of Drop outs: NR Pain: NA IG = 93.5%, CG = 

N attended last fu: NR Pain, mean Disability: NA 72.4% 

Other socio­ (SD/range): 

Initial of demographics: Chronic, NR Immediate post tx: Short term: IG = 

reviewer: Inclusion: Pts with NR Pain: NA 90.3%, CG = 

SG chronic pain of cervical Severity of pain Disability: NA 65.5% 

intervertebral disc Co morbidities: (Grading): NR 

NR Short term: NR Intermediate: NR 

Exclusion: NR Prior episode of Current tx/ co- Intermediate: NR Long term: NR 

pain if acute: NR intervention 

common in all Long term: NR Harms: NR 

Prior CAM groups: NR 

intervention: NR Summary: IG has 

a satisfactory 

Prior surgery therapeutic effect 

related to current on chronic pain of 

complaint: NR cervical 

intervertebral disc 

C-204
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Zhao, Z 

(2004)196 Trial Design 

RCT 

Mean age 

(SD/range): IG = 

Region of pain: 

NP 

Groups 

IG (n = 53) – 

Outcomes 

(describe 

Outcomes 

(describe 

47.34 (5.1), CG Cause of Pain: Shencongding instrument instrument used): 

Tx duration: 20 – 40 ds = 46.15 (3.5) yrs S moxibustion + acu: acu used): QoL/ well being: 

Fu duration (last points: sishengchong, Pain: NA Well being, n (%) 

Country: assessment): immediate % of male: IG = baihui 

China post-tx 50.9%, CG = 0.35mm diameter, Disability: NA Other: 

47.2% Duration of 50mm long needle, 

Pain, mean puncture down to 20mm Results: Results- mean : 

Quality N screened: Don’t know Racial (SD/range): under skin, twist Baseline: Baseline: 

score: 3/13 N randomized: 106 composition: Chronic, IG = needles for 2-3 min, Pain: NA 

N completed tx: 106 Asian 18.47 (2.5), CG then moxibustion for 7 Disability: NA Immediate post tx: 

N attended last fu: 106 = 16.51 (1.3) time, retention 60 min; 1 IG = 51 (96.2%), 

Initial of Work status: NR tx/d, 10 tx/course, 2 Immediate post tx: CG = 44 (83%) 

reviewer: Severity of pain courses Pain: NA 

SG Inclusion: Diagnostic Other socio­ (Grading): NR Drop outs: B = 0 Disability: NA Short term: NR 

using Chinese Standard; demographics: 

X-ray show unstable of NR CG (n = 53) – Short term: NR Intermediate: NR 

neck spinal and discs Current tx/ co- Acupuncture: other than 

Co morbidities: intervention moxibusion, the other Intermediate: NR Long term: NR 

NR common in all procedures were the 

Exclusion: age < 18 or groups: NR same IG; 2 tx/2 d, 10 Long term: NR Harms: NR 

age > 60 yrs Prior episode of tx/course, 2 courses 

pain if acute: NR Drop outs: B = 0 Summary: 

Shencongdin 

Prior CAM moxibusition has a 

intervention: NR definite therapeutic 

effect with a better 

Prior surgery clinical a pplication 

related to current prospection for 

complaint: NR cervical headache 

C-205
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Zhu XM Trial Design- RCT cross Mean age Region of pain: Groups Outcomes: Outcomes 

(2002)189 over (SD/range): IG = NP IG (n = 14)– Acu: Pain: adapted (describe 

[crossover] 

Country: 

Australia 

Tx duration: 3 wks 

Fu duration: immediate posttx 

N screened: NR 

N randomized: 29 

50 (10.6) vs. CG = 

48.9 (10.1) yrs 

% of male: IG = 

64%, CG = 40% 

Cause of Pain: 

N-S 

Chinese acu dry 

needling both on two 

local and 2 distal points; 

9 sessions, 3 wks 

Drop outs: NR 

MPQ; VAS; daily 

pain duration in 8 

hrs (in hrs) 

Disability: NDI 

instrument used): 

QoL/ well being: 

NR 

Results- mean : 

N completed tx: 29 Racial Duration of Baseline: NA 

N attended last fu: 29 composition: NR Pain, mean CG (n = 15) – Sham­ Results-Baseline: 

Quality (SD/range): Acu: sham acu points Pain: IG = 1.65 Immediate post tx: 

score: 7/13 Inclusion: Pts with CNP, Work status: Chronic, IG = located 2-3 cm lateral to (0.6), CG = 1.67 NA 

Initial of 

reviewer: 

SG 

31-71 yrs had neck 

complaints  6 mo, 

degenerative joint disease, 

osteoarthritis, cervical 

spondylitis, soft tissue 

injuries, cervical sprain or 

Unemployed: 

30.95% 

Other sociodemographics: NR 

79.8 (60) mo; 

CG = 59.7 

(104.9) mo 

Severity of pain 

the real acu points; 

short needles used; 

weak electro-stimulation 

once/min was applied 

for two distal points; 

(0.5); IG = 51.8 

(24.9), CG = 40.3 

(16.5); IG = 6 

(3.8), CG = 8.3 

(5.9) 

Short term: NR 

Intermediate: NR 

whiplash injury, pain felt in Co morbidities: NR (Grading): NR Same as IG Disability: IG = Long term: NR 

the neck and radiating to the Drop outs: NR 10.2 (4.7), CG = 

occiput or shoulders limiting Prior episode of Current tx/ co­ 8.2 (3.6) Harms: NR 

neck movement pain if acute: Neck intervention 

Exclusion: any neck 

condition < 6 mo, any viral 

(hepatitis or HIV), cancer, 

decreased or absent deep 

tendon reflexes, depression, 

injury, n = 17 

Prior CAM 

intervention: NR 

Prior surgery 

common in all 

groups: NR 

Immediate post tx: 

Pain: IG = 0.69 

(0.3), CG = 1.05 

(0.7); IG = 28.9 

(15.5), CG = 21.1 

fibromyalgia syndrome, related to current (10.3); IG = 2.8 

pregnancy, previous cervical complaint: NR (3), CG = 5.6 (4.7) 

spine surgery, acu tx, Disability: IG = 6 

hypertension, thyroid (5.5), CG = 5.7 problem, or diabetes (6.2) 

Short term: NR 

Intermediate: NR 

Long term: NR 

C-206
 
Table 2.4 Neck Pain - Acupuncture - Chronic - Non-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Abernathy, 

AP (2008)198 

Trial Design 

RCT 

Mean age 

(SD/range): 46 

Region of pain: 

NP 

Groups 

IG (n = 113)– 

Outcomes 

(describe 

Outcomes 

(describe 

Abstract 47 yrs total Cause of Pain: Acupuncture: points instrument instrument used): 

Tx duration: 3 wks N-S were chosen based on used): QoL/ well being: 

Fu duration (last % of male: pain characteristics, and Pain: VAS (100 SF-36 

Country: assessment): NR(majority punctures were always mm) improvement from 

US immediately post and 6 female) bilateral; 5 tx sessions baseline: 6.3 vs. 

mos after intervention over 3 wks Results: 0.7, p = 0.002 

Racial Duration of Drop outs: NR Baseline: 

Quality composition: NR Pain, mean Pain: IG = 68.7, Short term: NR 

score: 0/13 N screened: 123 (SD/range): CG (n = 110) – TENS: CG = 42.3 

N randomized: 123 Work status: NR Chronic (t least NR; NR Intermediate: NR 

N completed tx: NR 3 mo) Drop outs: NR Immediate post tx: 

Initial of N attended last fu: NR Other socio- Motion related Long term: NR 

reviewer: demographics: Severity of pain NP, decrease 

SG NR (Grading): VAS from baseline: Harms: AEs were 

Inclusion: pts  18 yrs at least 30 at 42.1 vs. 14.0, p < mild and affected 

old with uncomplicated Co morbidities: baseline 0.001 both groups in the 

NP for at least 3 mo, with NR similar degree 

motion-induced pain of at Current tx/ co- Short term: NR 

least 30 on 100 mm VAS Prior episode of intervention Summary: acu 

pain if acute: NR common in all Intermediate: no produced 3 times 

groups: rescue numeric data the beneficial 

Exclusion: NR Prior CAM Med for all pts if reported. The effects of placebo. 

intervention: NR needed: outcome of pain This study was 

diclofenac and was reported to single blinded. 

Prior surgery tetrazepam be sustained from 

related to current post tx 

complaint: NR 

Long term: NR 

C-207
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Coan RM 

(1982)206 Trial Design 

RCT 

Mean age 

(SD/range): IG = 

Region of pain: 

NP 

Groups 

IG (n = 15)– Acu + 

Outcomes 

(describe 

Outcomes 

(describe 

51.6 vs. CG = 47 Cause of Pain: Usual care: Performed instrument instrument used): 

Tx duration: 8 wks yrs N-S; with according to the used): QoL/ well being: 

Fu duration (last radicular arm classical oriental Pain: VAS; Mean NR 

Country: assessment): 3 mos % of male: IG = and hand pain meridian theory ; acu N of hrs with 

US 13.3%, CG = point selection varied pain/d Mean pain 

40% from pt to pt; 3-4 tx/wk, pills/wk: 

N screened: NR Duration of 8 wks Results: Immediate post tx: 

Quality N randomized: 30 Racial Pain, mean Drop outs: NR Baseline: NR 

score: 4/13 N completed tx: 30 composition: NR (SD/range): Pain: IG = 6, CG 

N attended last fu: 30 Chronic, at least CG (n = 15) – Usual = 5.3; IG = 11.7, Short term: (3 

Work status: NR 6 mos care: NR; NR CG = 11.3 monhts fu) 

Initial of Drop outs: NR 7.5 vs. 8.7- change 

reviewer: Inclusion: Neck pain Other socio- Severity of pain Immediate post tx: from baseline 

SG and/or radicular arm and demographics: (Grading): NR Pain: --- Intermediate: NR 

hand pain  6 mo NR 

Short term: IG = Long term: NR 

Exclusion: No history of Co morbidities: Current tx/ co­ 3.6 (2.21), CG = 

diabetes, previous acu NR intervention 5.4 (2.23); IG = Harms: N of pts 

Tx, infection, or cancer common in all 3.8, CG = 11.3 with worse pain 

Prior episode of groups: than baseline: 0 

pain if acute: NR IG: Chiro: n = 1 Intermediate: NR vs. 4 

Prior CAM CG: Chiro: n = 1 Long term: NA 

intervention: NR Traction: n = 3 

Heat: n = 1 

Prior surgery Diathermy: n =1 

related to current 

complaint: NR 

C-208
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

David J Trial Design Mean age Region of pain: Groups Outcomes Outcomes 

(1998)207 RCT (SD/range): IG = NP IG (n = 35)– Acu: sterile (describe (describe 

Country: 

Tx duration: 6 wks 

Fu duration (last 

assessment): 6 mos 

48 (NR), CG = 

44 (NR) yrs 

% of male: 

Cause of Pain: 

N-S 

disposable 0.25 x 2.5 

acumedic needles; TPs 

were needled; regional 

(GB21) and distal (L14) 

instrument 

used): 

Pain: VAS; NPQ 

(no numerical 

instrument used): 

QoL/ well being: 

GHQ (no numerical 

data given) 

US 28.6% total needling was also used; data given) Results- mean : 

N screened: NR Duration of the needles were left in Baseline:--­

N randomized: 70 Racial Pain, mean situ for 15 min and 

Quality N completed tx: 70 composition: NR (SD/range): manually manipulated Results: Immediate post tx: --- 

score: 4/13 N attended last fu: 65 Chronic ( 6 once at 7 min; 1 tx/wk, 6 Baseline: Short term: NR 

Work status: NR wks) tx, 6 wks Pain: ---

Inclusion: Pts aged 18­ Drop outs: A = 2, B = 3, Intermediate: NR 

Initial of 

reviewer: 

75 yrs with chronic NP (> 

6 wks); types of NP were 

Other sociodemographics: Severity of pain 

(Grading): NR 

D = 1 Immediate post tx: 

Pain: --- Long term: NR 

SG postural, whiplash injury, NR CG (n = 35) – PT: Harms: NR 

occupational NP, cervical standard localized Mob Short term: NR 

spondylosis Co morbidities: Current tx/ co­ techniques, most Summary: No 

NR intervention commonly Maitland rot, Intermediate: NR differences were 

Exclusion: previous acu common in all postero-anterior found in pain, 

Tx or PT, neurological Prior episode of groups: NR oscillatory movement Long term: NA disability, or well 

signs, primary 

piybromyalgia, 

inflammatory NP, 

rheumateoid arthritis, 

pain if acute: 

Mechanical 

Prior CAM 

and longitudinal traction; 

Same as IG 

Drop outs: A = 7, B = 2, 

D = 4 

being in pts between 

Acu vs. PT groups at 

B and D; however, 

both Acu and PT 

were effective in 

osteopathy, ankylosing intervention: NR within-group changes 

spondylitis 

Prior surgery 

related to current 

complaint: NR 

C-209
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Gallacchi G Trial Design Mean age Region of pain: Groups Outcomes Outcomes 

(1983)204,205 

Country: 

Switzerland 

RCT 

Tx duration: 3-4 wks 

Fu duration (last 

assessment): immediate 

post-tx 

(SD/range): NR 

% of male: NR 

Racial 

composition: NR 

Cervical spine 

Cause of Pain: 

N-S 

IG1 (n = 15)– acu with 

conv. needles at classical 

acu points, until 

propagated sensationneedle retention for 10 

min, 2 tx/wk for 4 wks 

Drop outs: 0 

(describe 

instrument 

used): 

Pain: VAS 

average (data 

shown in graphs, 

(describe 

instrument used): 

QoL/ well being: 

NR 

Results- mean : 

N screened: 121 Work status: NR Duration of CG1 (n = 14)– acu with 

not extracted) Baseline: NA 

Quality N randomized: 113 Pain, mean placebe needles in Results: Immediate post tx: 

score: 5/13 N completed tx: 113 Other socio­ (SD/range): classical acu points: at Baseline: NA 

Initial of 

reviewer: 

N attended last fu: 113 

Inclusion: tendomyotical 

demographics: 

NR 

Co morbidities: 

Chronic, NR 

Severity of pain 

(Grading): VAS 

sites/techniques as in IG1; 

insertion at 5 mm under 

skin, 2 tx/wk for 4 wks 

Drop outs: 1 

Pain: NR 

Immediate post tx: 

Pain: NR 

Short term: NR 

Intermediate: NR 

SG cervical and lumbar 

syndrome were under 

medical and/or physical tx 

for N of mos before 

volunteered for AP study 

Exclusion: NR (anyone 

not meeting inclusion 

criteria) 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

but NR 

Current tx/ cointervention 

common in all 

groups: NR 

CG2 (n = 14)– acu with 

conv. needles at placebo 

points: as IG; 2 tx/wk for 3 

wks 

Drop outs: 1 

IG2-IG6 (n = 70)– laser 

AP at classical acu pts: 

1)laser light, 2) no 

emission of rays, 3) mixed 

light, 4) red light, 5) 

Short term: NR 

Intermediate: NR 

Long term: NR 

Long term: NR 

Harms: NR 

Summary: no 

significant 

differences 

between groups 

complaint: NR infrared light; 60 sec/each 

AP point, 2 tx/wk for 4 wks 

Drop outs: 6 

C-210
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Giles, LG 

(2003)25 

26 

Trial Design- RCT 

Tx duration: Max. of 9 

Mean age 

(SD/range): IG1 

= 23.8 (4.8), IG2 

Region of pain: 

LBP, NP, thorax 

Cause of Pain: 

Groups 

IG1 (n = 34)– Acu: near 

and far techniques as 

Outcomes: 

Pain: VAS (1-100) 

Outcomes: 

QoL/ well being: 

SF-36 (higher 

wks = 25 (8.1), CG = N-S chosen by clinician; 2 Disability: values better) 

Fu duration (last 29.5 (2.07) yrs tx/wk, max. of 9 wks Oswestry Back 

assessment): 12 mos Drop outs: B = 12 Results- mean : 

Country: % of male: IG1 = Results: Baseline: IG1 = 46 

Australia N screened: 109 55.9%, IG2 = IG2 (n = 35)– Spinal Baseline: (15.6), IG2 = 57 

N randomized: 109 51.4%, CG = Duration of manipulation: 20 min- Pain: IG1 = 6 (22.9), CG = 37 

N completed tx: 109 57.5% Pain, mean appointments. High­ (2.2), IG2 = 6 (25.2) 

Quality N attended last fu: 62 (SD/range): velocity, low-amplitude (2.9), CG = 5 (3.7) 

score: 5/13 Racial Chronic (> 13 thrust SM to a joint (as Disability: IG1 = Immediate post tx: 

Inclusion: pts at least 17 composition: NR wks), NR judged to be safe and 30 (17.03), IG2 = IG1 = 53 (22.2), 

yrs old with usual tx by the treating 22 (22.96), CG = IG2 = 70 (38.5), 

Initial of uncomplicated Work status: NR Severity of pain chiropractor for the 32 (19.3) CG = 57 (33.3) 

reviewer: mechanical spinal pain (Grading): NR spinal level of 

SG for minimum of 13 wks - Other socio­ involvement to mobilize Immediate post tx: Short term: NR 

for long-term fu (> 1 yr) demographics: the spinal joints; same Pain: IG1 = 4 

Unemployed: 29 Current tx/ co­ as IG1 (4.4), IG2 = 5 Intermediate: NR 

Exclusion: pts with nerve (25.7%) intervention Drop outs: B = 10 (3.7), CG = 6 (4.4) 

root involvement, spinal common in all Disability: IG1 = Long term: IG1 = 

anomalies (other than Co morbidities: groups: NR CG (n = 40) – 26 (20.74), IG2 = 55 (26.7), IG2 = 77 

sacralization/lumbarizatio NR Medication that have not 14 (24.4), CG = (23.7), CG = 66 

n), pathology other than been tried: 32 (23.7) (36.3) 

mild-moderate Prior episode of Celecoxib/Celebrex 

osteroarthrosis, pain if acute: NA (200 - 400 mg/d); Long term: OBD: Harms: some pts 

spondylolisthesis of L5 or Rofecoxib/Vioxx (12.5 - IG1 = 13 (22.9), had changed tx 

S1 > Grade 1, previous Prior CAM 25 mg/d); IG2 = 16 (17.8), modality between 

spinal surgery, and leg intervention: NR paracetamol/acetamino CG = 24 (25.2) the fu due to AE. 

length inequality > 9 mm phen (500 mg tablest 2­ VAS: IG1 = 3.9 no report of detail 

with postural scoliosis. Prior surgery 6/dup to 4 g/d); NR (3.2), IG2 = 3.7 of AEs 

related to current Drop outs: B = 18 (4), CG = 3.9 (3.3) 

complaint: NR 

C-211
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Giles, LGF 

 (1999)122 Trial Design 

RCT 

Mean age 

(SD/range): IG1 

Region of pain: 

NP 

Groups 

IG1 (n = 10)– Acu: using 

Outcomes: 

Pain: VAS 

Outcomes 

(describe 

= 46.5 (9.6), IG2 Cause of Pain: sterile HWATO Chinese instrument used): 

Tx duration: 3-4 wks = 42.5 (9.6), CG N-S disposable acu guide Disability: ODI QoL/ well being: 

Fu duration (last = 35 (14.1) yrs tube needles 50mm NR 

Country: assessment): immediate long with a gauge of Results: 

Australia post-tx % of male: 0.25 mm for 20 min tx, Baseline: 

35.7% total 3-4 wks Pain: IG1 = 40 

N screened: 875 Duration of Drop outs: NR (31.8), IG2 = 32 

Quality N randomized: 40 Racial Pain, mean (14.8), CG = 28 Results- mean : 

score: 1/13 N completed tx: 40 composition: NR (SD/range): IG2 (n = 20) – SM- high­ (21.9) Baseline: NA 

N attended last fu: 40 Chronic, NR velocity, low-amplitude Disability: IG1 = 

Work status: NR SM was performed as 3.5 (5.5), IG2 = 5 Immediate post tx: 

Initial of Inclusion: pts suffering Severity of pain judged to be safe; 6 tx, (3.5), CG = 2.7 NA 

reviewer: from spinal pain for at Other socio­ (Grading): NR 3-4 wks (4.8) 

SG least 13 wks; age of at demographics: Drop outs: NR Short term: NR 

least 18 yrs NR Immediate post tx: 

Current tx/ co- CG (n = 10) – Pain-mean Intermediate: NR 

Co morbidities: intervention Medication: tenoxican change: IG1 = - 6 

Exclusion: Nerve root NR common in all (20mg/d) and ranitidine (14.4), IG2 = -10 Long term: NR 

involvements; spinal groups: NR (50mg x 2/ d); 15-20 (10.4), CG = 0 

anomalities; pathology Prior episode of min/ appointment, 3-4 (10.7) Harms: NR 

other than mild to pain if acute: NR wks Disability-mean 

moderate osteoarthrosis; Drop outs: NR change: IG1 = ­

previous spinal surgery Prior CAM 0.5 (4.8), IG2 = ­

and leg length inequality intervention: NR 2.3 (4.8), CG = -1 

of > 9 mm with postural (1.3) 

scoliosis Prior surgery Short term: NR 

related to current Intermediate: NR 

complaint: NR Long term: NR 

C-212
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Itoh K Trial Design Mean age Region of pain: Groups Outcomes: Outcomes: 

(2007)199 RCT- (SD/range): IG1 = NP IG1 (n = 8) – Traditional Pain: VAS QoL/ well being: 

[crossover 62.3 (11) vs. IG2 = Cause of Pain: acu: local points in NR 

design] Tx duration: 3 wks 62.3 (10.1) yrs N-S cervical region: needles Disability: NDI 

Country: 

Fu duration (last 

assessment): 

immediately post-tx 

% of male: 27.5% 

Racial 

inserted into muscle to 

depth of 20mm-“sparrow 

pecking” techniqueResults: 

Baseline: 

Pain: IG1 = 69.5 

Japan 

N screened: NR 

composition: Asian Duration of 

Pain, mean 

needle retention for 10 

min –or until “deqi” 

(18.6), IG2 = 67 

(13.2), CG1 = 70.9 

Results- mean : 

Baseline: NA 

N randomized: 36 Work status: NR (SD/range): sensation; 3 wks (14), CG2 = 64.1 

N completed tx: 31 Chronic, IG = Drop outs: A = 2 (20.7) Immediate post tx: 

Quality 

score: 6/13 

Initial of 

N attended last fu: 31 

Inclusion: Pts with 

chronic NP (> 6 mo) age 

 45 yrs, no radiation of 

Other sociodemographics: NR 

Co morbidities: 

Spondylosis n = 5; 

Discopath n = 3; 

3.2 (3.1), CG = 

2.9 (2.7) yrs 

Severity of pain 

(Grading): NR 

IG2 (n = 8) – TP-Acu: 

applied to myofascial 

TPs located by 

palpation, local twitch 

Disability: IG1 = 

12.6 (6), IG2 = 13 

(6.3), CG1 = 15.1 

(2.7), CG2 = 12 

(3.6) 

NA 

Short term: NR 

Intermediate: NR 

reviewer: NP, well functioning Radiculopathy n=2 elicited- similar Immediate post-tx: 

SG cervical nerve, deep 

tendon reflexes, voluntary 

muscle action, sensory 

and function 

Exclusion: Major trauma 

or systemic disease, 

other ongoing tx except 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

Current tx/ cointervention 

common in all 

groups: 

Povltice: IG: n = 

7, CG: n = 6 

Analgesic: IG :n 

technique as IG1.; 3 

wks 

Drop outs: A = 2 

CG1 (n = 10) – Non-TPAcu: NR; NR 

CG2 (n = 10) – ShamPain: IG1 = 45.9 

(17.5), IG2 = 18.6 

(18.5), CG1 = 58.4 

(16.9), CG2 = 54.6 

(20) 

Disability: IG1 = 9.3 

(5.2), IG2 = 3.9 

(3.4), CG1 = 12.8 

Long term: NA 

Harms: NR 

those receiving unified 

dosage for a mo or longer 

complaint: NR = 2, CG: n = 3 

Vit D: IG: n = 1, 

Acu: NR; NR (2.1), CG2 = 11.3 

(3.3) 

CG: n = 1 

Short term: NR 

Intermediate: NR 

Long term: NA 

C-213
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Nabeta T Trial Design Mean age Region of pain: Groups Outcomes: Outcomes 

(2002)216 RCT (SD/range): IG = Neck, shoulder IG (n = 17)– Acu: Pain: VAS; PPT (describe 

Country: 

Japan 

Tx duration: 3 wks 

Fu duration (last 

assessment): 1 mo 

34.2 (10.8) vs. 

CG = 30.8 (12) 

yrs 

% of male: 

Cause of Pain: 

N-S 

Disposable stainless 

needles 0.2 x 40 mm 

inserted into the muscle to 

a depth of 20 mm and the 

'sparrow pecking' 

technique was applied; 

Results: 

Baseline: 

Pain: IG = 60.5 

(15), CG = 48.8 

instrument used): 

QoL/ well being: 

NR 

Results- mean : 

29.4% total Duration of when dull pain or acu (28); IG = 1.7 Baseline: NA 

N screened: NR Pain, mean sensation was felt, the (0.7), CG = 1.6 

Quality N randomized: 34 Racial (SD/range): manipulation was (0.9) Immediate post tx: 

score: 5/13 N completed tx: 27 composition: Chronic, NR stransverse oscillatory NA 

Initial of 

reviewer: 

N attended last fu: NR 

Inclusion: Pts with 

Asian 

Work status: NR 

Severity of pain 

(Grading): NR 

rotped and the needle was 

retained for 5 more min; 3 

tx, 3 wks 

Drop outs: 2 (A - B) 

Immediate post tx: 

Pain: IG = 43.3 

(19.7), CG = 46.8 

(25.4); IG = 2.6 

Short term: NR 

Intermediate: NR 

SG chronic pain/stiffness in Other socio- CG (n = 17) – Sham-Acu: (1.9), CG = 1.3 

neck and shoulder demographics: Current tx/ co­ similar needles used but (0.5) Long term: NR 

without arm symptoms NR intervention tips had been cut off and 

common in all smoothed to prevent Short term: NR Harms: authors 

Co morbidities: groups: NR penetration of skin; indicate that AEs 

Exclusion: NR NR acupuncturist pretended to Intermediate: NR were not the cause 

Prior episode of 

pain if acute: 

Myofascial 

insert the needle and use 

the sparrow pecking 

technique, then removed 

needles; needle extraction 

simulated after 5 min by 

Long term: NA 

of drop out 

syndrome touching the pt, noisily 

dropping needles into a 

Prior CAM metal cases; as IG 

intervention: NR Drop outs: 5 (A - B) 

Prior surgery 

related to current 

complaint: NR 

C-214
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Petrie J Trial Design Mean age Region of pain: Groups Outcomes: Outcomes 

(1986)202 RCT (SD/range): IG = NP IG (n = 13)– Acu: Five Pain: MPQ; Daily (describe 

52.9 (9.8) vs. CG Cause of Pain: 28 g standard acu pain intensity score instrument used): 

Country: 

UK 

Tx duration: 4 wks 

Fu duration (last 

assessment): 3 mos 

= 48.1 (12.8) yrs 

% of male: IG = 

31%, CG = 42% 

N-S needles inserted at 

points GB20 and GB21 

bilaterally and Du14 in 

the mid-line. The 

Results-Baseline: 

MPQ: IG = 20.38 

(10.93), CG = 14.42 

(6.13); 

QoL/ well being: 

NR 

Daily pill count, 

sensation of "The Chi" Pain intensity: IG = mean (SD) 

N screened: 27 Racial Duration of was obtained by ME on 47.08 (15.88), CG = 

Quality N randomized: 25 composition: NR Pain, mean insertion and at 5 min 31.67 (16.55) Immediate post tx: 

score: 5/13 N completed tx: 24 (SD/range): intervals for 20 min; 20 2.71 (2.56) vs. 

Initial of 

reviewer: 

SG 

N attended last fu: 24 

Inclusion: chronic NP (at 

least 6 mo) 

Work status: NR 

Other sociodemographics: 

NR 

Chronic, IG = 18 

(11.2) mo; CG = 

26.5 (26.4) mo 

Severity of pain 

min, twice/wk for 4 wks 

Drop outs: B = 0, C = 0 

CG (n = 12) – Sham 

transcutaneous nerve 

Immediate post tx: 

MPQ: IG = 15.54 

(13.68), CG = 14.58 

(9.68) 

Pain intensity: 

IG = 36.59 (22.95), 

1.24 (1.05) 

Short term: 2.41 

(2.66) vs. 0.87 

(0.55) 

(Grading): NR stimulation (TNS): CG = 32.88 (18.55)

Co morbidities: sweep function signal Intermediate: NR 

Exclusion: peripheral NR generator placed on Short term: 

synovitis or malignancy Current tx/ co­ transverse oscillatory rot MPQ:IG = 13.85 Long term: NR 

Prior episode of intervention of an oscilloscope. (11.86), CG = 11.55 

pain if acute: NR 

Prior CAM 

intervention: NR 

common in all 

groups: NR 

When the apparatus 

was switched on, the 

controls of the signal 

generator were set to 

(8.66) 

Pain intensity: IG = 

31.77 (24.1), CG = 

24.72 (20.6) 

Harms: one ptient 

in placebo group 

experiences 

negative effects 

display a pulsed high- Intermediate: NR (WDAE) 

Prior surgery frequency pattern on the 

related to current oscilloscope in front of Long term: NR Note: n=2 in IG 

complaint: NR the pt; Same as IG and n=1 in CG had 

Drop outs: B = 1 complete recovery 

(unrelated surgery), C = of pain at last fu 

0 

C-215
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Petrie JP Trial Design Mean age Region of pain: Groups Outcomes Outcomes 

(1983)203 RCT 

Tx duration: 4 wks 

Fu duration (last 

(SD/range): 65 

yrs total 

% of male: IG = 

NP 

Cause of Pain: 

N-S 

IG (n = 7) – Acu: Five 

standard points were 

chosen: Du14, GB20, 

GB 21 (bilateral points), 

(describe 

instrument 

used): 

Pain: pain relief: 

(describe 

instrument used): 

QoL/ well being: 

NR 

Country: assessment): immediate 14.3%, CG = traditional needles 28 g 5-point scale (no 

New post-tx 50% were used to achieve relevant outcome 

Zealand 

N screened: NR 

Racial 

composition: NR 

Duration of 

Pain, mean 

sensation of The Chi 

described as numbness, 

soreness, heaviness at 

reported) Results- mean : 

Baseline: NA 

Quality N randomized: 13 (SD/range): the point of insertion; Results: Immediate post tx: 

score: 6/13 N completed tx: 13 

N attended last fu: 13 

Work status: NR 

Other socioChronic ( 2 

yrs), NR 

the needles manipulated 

for 10 min after 

insertion, no electro 

Immediate post tx: 

Very good or 

NA 

Short term: NR 

Initial of demographics: Severity of pain stimulation applied; 20 good pain relief: 6 

reviewer: Inclusion: Chronic NR (Grading): min session, twice/wk, 4 pts in IG vs. 0 in Intermediate: NR 

SG cervical pain (> 2 yrs) 

defined as pain in the 

neck radiating to the 

occiput and /or shoulders 

with some limitations in 

movement 

Exclusion: active 

synovitis, neoplasia, 

steroid or local 

anesthesia injections to 

the neck in the previous 

mo 

Co morbidities: 

(n) rheumatoid 

arthritis: 6; 

osteoarthritis: 6; 

ankylosing 

spondylitis: 2 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

majority with 

moderate pain 

Current tx/ cointervention 

common in all 

groups: antiinflammatory 

and analgesics, 

PT, hot packs, 

pool therapy 

wks 

Drop outs: NR 

CG (n = 6) – TENS 

placebo: sham 

stimulation; lead 

electrode applied to 

each side of the neck 5 

cm lateral to C7; 

although the red light 

was switched on and 

the stimulator controls 

adjusted to the full view 

of the pt, no electrical 

current was passing to 

electrodes; Same as IG 

Drop outs: NR 

CG 

Short term: NR 

Intermediate: NR 

Long term: NR 

Long term: NR 

Harms: NR 

Summary: Acu 

superior to TENSplacebo after 4 

wks of Tx. 

C-216
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Salter GC 

(2006)200 Trial Design 

RCT 

Mean age 

(SD/range): IG = 

Region of pain: 

NP 

Groups 

IG (n = 10) – Acu + GP: 

Outcomes 

(describe 

Outcomes 

(describe 

50.8 (17.1) vs. Cause of Pain: Acu: 5-24 needles/tx; instrument instrument used): 

Tx duration: 3 mos CG = 45.5 (16.4) N-S 13-50 mm length with used): QoL/ well being: 

Country: Fu duration (last yrs guage between 0.18­ Pain: NPQ- lower SF-36: no 

US assessment): immediate 0.36 mm and insertion better numerical values 

post-tx % of male: IG = depth of 0.2-2.5 cm reported. 

30%, CG = 21% Duration of common points were Results: 

Quality Pain, mean GB-21, Ah Shi, GB-20, Baseline: Use of Med at 

score: 6/13 N screened: 227 Racial (SD/range): Huatuojaji at C-6, S-13, Pain: IG = 34.31 bseline: 40% vs. 

N randomized: 24 composition: NR Chronic, IG = and Huatuojaji at C-7; (11.7), CG = 38.4 42.9% 

N completed tx: 24 5.7 (6.4); CG = other techniques such (18.6) 

Initial of N attended last fu: 24 Work status: NR 5.5 (5.5) yrs as massage, relaxation, Immediate post tx: 

reviewer: diet, EX, and rest; Immediate post tx: NR 

SG Inclusion: Pts with Other socio- Severity of pain GP: Med, massage, NR 

chronic NP aged 18 yrs demographics: (Grading): NR recommended EX; 3 mo Short term: 

or older who had NR Drop outs: A = 1, B = 1 Short term: NR 3 monhts post tx: 

consulted the NP practice IG = 22.73 11.1% vs. 41.7% 

in the previous 12 mo Co morbidities: Current tx/ co- CG (n = 14) – GP: Med, (18.64), CG = 

NR intervention massage, 25.72 (16.29) Intermediate: NR 

common in all recommended EX; 3 mo Intermediate: NR 

Exclusion: Cancer, Prior episode of groups: NR Drop outs: A = 2, B = 2 Long term: NR 

rheumatoid arthritis, or pain if acute: NR Long term: NR 

ankylosing spondylisis, Harms: IG – n = 6: 

pain below the elbow, Prior CAM aggravation of 

neck surgery, hemophilia, intervention: NR symptoms; n = 6: 

acu, awaiting legal action dizziness; n = 4: 

or not consenting tiredness; CG – No 

Prior surgery SAE occured 

related to current 

complaint: None 

C-217
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Sator- Trial Design Mean age Region of pain: Groups Outcomes Outcomes 

Katzenschla RCT (SD/range): IG = NP IG1 (n = 11)– Manual (describe (describe 

g SM 

(2003)215 Tx duration: 6 wks 

52 (12) vs. CG = 

52 (9) yrs 

Cause of Pain: 

N-S 

conventional Acu: acu 

points: cervical spine 

instrument 

used): 

instrument used): 

QoL/ well being: 

Fu duration (last (37), shen men (55), Pain: VAS No numerical data 

assessment): 3 mos % of male: and cushion (29, 19) by (numerical data reported 

28.5% total determining the position NR) 

Country: of the least skin Consumption of 

Austria N screened: NR Racial Duration of resistance using electric rescue Med 

N randomized: 21 composition: NR Pain, mean conductance meters; no Results: Immediate post tx: 

N completed tx: NR (SD/range): ES was administered; all Baseline: NR 

Quality N attended last fu: NR Work status: NR Chronic, 3.3 needles removed after Pain: NR 

score: 4/13 (1.2) (total 48 h of insertion; Short term: 

Other socio­ sample) once/wk for 6 wks Immediate post tx: Tablets mean (SD) 

Inclusion: Chronic demographics: Drop outs: 1 (A-B) Pain: NR 107 (5.0) vs. 47 

Initial of cervical pain ( 6 mo), NR Severity of pain (8.0) 

reviewer: normal neurologic (Grading): NR IG2 (n = 10) – Electro- Short term: NR 

SG function, of cervical Co morbidities: Acu- auricular: same as Intermediate: NR 

nerves with no pain NR IG + the needles were Intermediate: NR 

radiation, neural or spinal Current tx/ co­ connected to P-STIM Long term: NR 

structure pathology, VAS Prior episode of intervention which is positioned Long term: NR 

 5 pain if acute: common in all behind the ear like a Harms: No AE 

muscular origin, groups: NR hearing aid; needles was observed 

spondylarthrosis, were continuously 

Exclusion: allergy to localized stimulated with 2 mA Summary: 

lornoxicam or tramadol, protrusion of a constant current at freq. Statistically 

history of drug abuse, disc of 1 Hz for 48 h; all significantly larger 

pregnancy, concomitant needles removed after reduction in VAS 

use of TENS or Prior CAM 48 h of insertion; Same pain scores and 

pacemaker, history of acu intervention: NR as IG improved wellTx Prior surgery Drop outs: 1 (A-B) being in the E-Acurelated to current Acu arm vs. 

complaint: NR Manual-Acu 

C-218
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Seidel Trial Design Mean age Region of pain: Groups Outcomes: Outcomes 

(2002)201 RCT (SD/range): CG1 Cervical spine CG1 (n = 13)– Sham Pain: VAS (describe 

Country: 

Tx duration: 4 wks 

Fu duration (last 

assessment): 3 mos 

= 47, CG2 = 47, 

CG3 = 48, IG = 

56 yrs 

Cause of Pain: 

N-S 

(low level laser therapy, 

LLLT) on AP points 0 

mW: without skin 

contact – continuing 

average intensity; 

PPT (data not 

shown) 

instrument used): 

QoL/ well being: NR 

Cervical movement – 

axial rot 

Germany % of male: 9.8% infrared laser, wave Disability: NR 

N screened: 48 total length 830 nm; 8 Immediate post tx: 

N randomized: 51 Duration of sessions, 2 sessions/wk Results- CG1 = 137 (15.14), 

Quality N completed tx: 48 Racial Pain, mean for 4 wks Immediate post tx: CG2 = 133.3 (20.79), 

score: 10/13 N attended last fu: 48 composition: NR (SD/range): Drop outs: 1 Pain: CG1 = 25.2, CG3 = 142.1 (13.34), 

Chronic (18 – CG2 = 16.8, CG3 IG = 135.3 (16.95) 

Initial of 

reviewer: 

SG 

Inclusion: at least 6 mo 

of pain as defined by 

Schoeps & Senn for 

cervical syndrome; age 

Work status: NR 

Other sociodemographics: 

480 mo), NR 

Severity of pain 

(Grading): VAS 

CG2 (n = 12) – LLLT 7 

mW: as CG1; NR 

Drop outs: 0 

= 24.9, IG = 7.0 

Short term: 4 wks 

after the last 

Short term: NR 

CG1 = 122.4 (41.1), 

CG2 = 137.8 (14.55), 

CG3 = 128.9 (22.35), 

IG = 129.2 (15.14) 

20 – 72 yrs; consent; no NR pain intensity CG3 (n = 13) – LLLT 30 intervention, VAS: CG1 = 19.6, 

AP tx for past 6 mo mW: as CG1; 1 min reduction in pain CG2 = 17.7, CG3 = 

Co morbidities: radiation/ AP point, max. IG 82.2% vs. CG2 25.2, IG = 9.4 

Exclusion: acute No Current tx/ co­ 15 points 55.4% vs. CG3 Intermediate: NR 

blockages within past 3 intervention Drop outs: 1 29.1% vs. CG1 

wks before tx; ongoing Prior episode of common in all 26.1% Long term: NR 

process regarding 

retirement money 

pain if acute: NR groups: None IG (n = 13) – Acu: 

Conventional AP but Intermediate: NR Harms: NR 

decision making; neuro, Prior CAM individualized to location Summary: AP is 

vascular dysfunction, intervention: NR of pain; 15 min/session, Long term: NR therapeutic option in 

fibromyalgia, epilepsy, max. 15 needles/ tx of common NP 

acute fever-related Prior surgery session, 0.2 – 15 mm 

diseases, alcohol, Med related to current needle depth until De-Qi and drug abuse; other complaint: NR Drop outs: 1 Med 

C-219
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Vas, J Trial Design Mean age Region of pain: Groups Outcomes: Outcomes: 

(2006)208 RCT (SD/range): IG = NP IG (n = 61) – Acu: Pain: VAS (0-100 QoL/ well being: 

Country: 

Spain 

Tx duration: 3 wks 

Fu duration (last 

assessment): 6 mos 

46 (13.7) vs. CG 

= 47.4 (12.8) yrs 

% of male: IG = 

Cause of Pain: 

N-S, 55.25% 

arthritis, 30.9% 

rectification 

bilateral points with 

25mm x 0.25 mm or 

40mm x 0.25 mm 

manually stimulated 

mm); Northwick 

park NPQ 

(Spanish) 

SF-36: physical 

score 

Results- mean : 

Baseline: IG = 36.7 

N screened: 149 24.6%, CG = % NS: 13.85 every 10 min; -“deqi” Disability: ACM; (9.7), CG = 37.6 

N randomized: 123 11.3% % S: 86.15 sensation; needle PCM (7.9) 

Quality N completed tx: 123 retention 30 min; 

score: 7/13 N attended last fu: 85 Racial Duration of Vaccaria seeds taped in Results: Immediate post-txcomposition: NR Pain, mean ear auricle after mean change: IG = 

Initial of 

reviewer: 

SG 

Inclusion: 17 yrs and over 

with uncomplicated NP over 

3 mo duration, symptomatic 

at examination, motionrelated NP intensity 30 and 

over measured on 100mm 

Work status: NR 

Other sociodemographics: 

(SD/range): 

Chronic (> 3 

mo), IG = 47.4 

(60.3) mo; CG = 

43 (40.8) mo 

sterlizing skin after 

removing needles; pts 

instructed to apply 

pressure to each ear 

point 10 repeats 3 

Immediate post tx: 

Pain-mean 

change: IG = 

44.1, CG = 12.3; 

IG = 30.2, CG = 

6.3, CG = 0.7; IG = 

5.8, CG = 6.3 

Short term: NR 

VAS, no tx during past wk 28.4% sedentary times/d; 5 sessions over 12.7 Intermediate-mean 

Severity of pain 3 wks Disability- mean change: IG = 9.3, 

Exclusion: previous acu tx; Co morbidities: (Grading):  3 Drop outs: B = 3, C = 13 change: IG = CG = 5.3 

NP intensity < 30 on 100 NR VAS 57.2, CG = 33.6;

mm VAS; dx of CG (n = 62) – Placebo IG = 17.3, CG = Long term: NR neuropathologic, infectious, 

inflammatory, neoplasic, 

endocrine, metabolic or 

visceral NP; fracture or 

traumatism; px pinal 

Prior episode of 

pain if acute: NR 

Prior CAM 

Current tx/ cointervention 

common in all 

(TENS):; electrodes at 

GB 21 bilateral point 

with pt in prone position; 

nerve stimulation unit in 

8.9 

Short term: Painmean change: IG 

Harms: mild AEs 

similar rated in IG 

and CG (Acu: 4 

surgery; N-S fever; sever intervention: NR groups: rescue front of Pt for 30 min = 41.1, CG = 26.8 AEs swelling of 

psychiatric illness; severe Med - 50mg with visible and audible hands, bruising, 

disorder of overall health diclophenac; flasing diode; Pt Intermediate: NR pain and ulcer of 

state; pregnancy Prior surgery 50mg checked every 10 min the ear vs. placebo 

related to current tetrazepam and TENS-placebo Long term: NR 2 Aes cepalea, and 

complaint: NR potentiometer adjusted aggrevation of 

Drop outs: B = 5, C = 17 symptoms) 

C-220
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

White P Trial Design Mean age Region of pain: Groups Outcomes: Outcomes: 

(2004)213 RCT (SD/range): IG = NP IG (n = 70)– Acu: Pain: VAS QoL/ well being: 214 

Tx duration: 4 wks 

Fu duration (last 

assessment): 12 mos 

53.9 (15.71) vs. 

CG = 52.8 (15.6) 

yrs 

Cause of Pain: 

N-S, Majority 

had spoldylosis 

Single-use sterile 

needles without guide 

tubes with sizes 13, 25, 

or 40 mm x 0.25 mm 

Disability: NDI 

Results: 

SF-36 (physical 

score)- no change 

at 8 wks post tx 

(data not shown) 

Country: % of male: IG = point selection based on 

UK 

N screened: 202 

N randomized: 135 

34.28%, CG = 

36.9% 

Duration of 

Pain, mean 

(SD/range): 

individualized western 

acu techniques; S points 

determined by pain 

Immediate post tx: 

Pain: IG = 24.34 

(21.63), CG = 

Results- mean : 

Immediate post tx: 

NA 

Quality N completed tx: 135 Racial Chronic, IG = distribution, palpation of 34.38 (22.33) Short term: NR 

score: 9/13 N attended last fu: 106 composition: NR 

Work status: NR 

4.81 (7.03) yrs; 

CG = 7.71 

(11.4) yrs 

the neck and thorax to 

find ah-shi points/local 

tender points. At least 

Disability: NR 

Short term: NDI: 

Intermediate: NR 

Initial of Inclusion: Pts aged 18­ one distal point was IG = 11.78 (6.59), Long term: NR 

reviewer: 80 yrs with chronic Other socio- Severity of pain used; 6 points on avg/ CG = 12.34 (7.35) 

SG mechanical NP (> 2 mo) 

and a pain score > 30 

mm on VAS (0-100 mm) 

for 5 of 7 pre-Tx ds 

Exclusion: Pregnancy, 

history of fracture, 

surgery of the neck, 

cervical congenital 

abnormality, uncontrolled 

LBP, contraindication to 

acetaminophen, systemic 

illness, recent or current 

manual neck Tx or steroid 

use 

demographics: 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: 

Mechanical 

conditions 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: None 

(Grading): NR 

Current tx/ cointervention 

common in all 

groups: 

Acetaminophen 

side if pain was bilateral 

and deqi was obtained; 

20 min, twice/wk for 4 

wks 

Drop outs: D = 16 

CG (n = 65) – TENSPlacebo: The Noma FM4 el-acu stimulator was 

used, the cables were 

severed at the output 

plug and no current was 

delivered to the pt; 

examination and point 

selection were the same 

as in IG; Same as IG 

Drop outs: D = 12 

VAS: IG = 20.39 

(20.26), CG = 

30.69 (22) 

Intermediate: NDI: 

IG = 8.89 (6.57), 

CG = 10.72 (9.11) 

VAS: IG = 20.91 

(25.7), CG = 

24.36 (26.7) 

Harms: increase in 

symptoms after tx 

(n = 1), faintness 

(n = 3), mild 

headache (n = 2), 

dizziness (n = 2), 

tiredness (n = 1), 

thumb tingling (n = 

1), cold feeling (n = 

1), nausea (n = 1), 

discomfort (n = 1), 

hand swelling (n = 

1), bruise at LI 4 (n 

= 1), euphoria and 

enhanced vision (n 

= 1) 

C-221
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Witt CM Trial Design Mean age Region of pain: Groups Outcomes: Outcomes: 

(2006)209 RCT- (SD/range): IG = NP IG (n = 1753) – Acu: Pain: NPDS QoL/ well being: SF210-212 

Tx duration: 3 mos 

Fu duration (last 

49.8 (12.8) vs. 

CG = 51.4 (13) 

yrs 

Cause of Pain: 

N-S 

only standard acu with 

disposable needles 

permitted; conventional 

Disability: SF-36: 

physical 

36 (role physical)- % 

reduction, mean 

(95% CI) 

Country: 

Germany 

assessment): immediate 

post-tx % of male: IG = Duration of 

Tx as needed;15 

sessions over 3 mo 

functioning; 

physical Immediate post tx: 

24.5 (22.6, 26.5) vs. 31%; CG = 32% Pain, mean Drop outs: B = 29 component 5.1 (3.3, 7.0); CG vs.

N screened: NR (SD/range): IG 9.4 (16.7, 22.1), p 

N randomized: 3451 Racial Chronic, IG = 6 CG (n = 1698) – Results: < 0.001 

Quality N completed tx: 3162 composition: NR (6.9); CG = 6.1 Control: conventional Tx Baseline: 

score: 7/13 

Initial of 

reviewer: 

N attended last fu: 3162 

Inclusion: chronic NP (> 

6 mo), age  18 yrs 

Work status: NR 

Other sociodemographics: 

(7.3) yrs 

Severity of pain 

(Grading): 

as needed; NA 

Drop outs: B = 22 

Pain: IG = 55 

(15.8), CG = 53.9 

(16) 

Disability: IG = 

63.6 (21.6), CG = 

Short term: NR 

23.2 (21.1, 25.2) vs. 

20.6 (18.4, 22.8), CG 

vs. IG 2.5 (-0.5, 5.6), 

p = 0.097 

Intermediate: NR 

SG NR 63.9 (22.8); IG = 

Exclusion: prolapse of at Current tx/ co­ 37.6 (8.4), CG = Long term: NR 

least one intervertebral Co morbidities: intervention 38.1 (9.1) 

discs with concurrent NR common in all Harms: any AE, 

neurological symptoms, groups: Usual Immediate post tx: 1216 (n=1002)57% 

prior vertebral surgery, 

spondylopathy, NP 

caused by inflammatory, 

cancer or autoimmune 

Prior episode of 

pain if acute: NR 

Prior CAM 

care Pain: IG = 38.3 

(16.1), CG = 50.5 

(15.7) 

Disability: NR, 

minor 

local bleeding or 

hematoma, 10% 

pain, e.g., needling 

ain, 4% vegetative disease, congenital intervention: NR only % increase symptoms and 29% 

deformation of spine reported other). No ifeexcept scoliosis lordosis, threatening side 

compression fracture Prior surgery Short term: NR effects were 

caused by osteoporosis; related to current Intermediate: NR reported. 

spinal stenosis complaint: None Long term: NR 

C-222
 
Table 2.5 Neck Pain - Acupuncture - Mixed - Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Bin, X Trial Design Mean age Region of pain: Groups Outcomes Outcomes 

(2007)217 RCT (SD/range): 35­ IG (n = 29) – Electro­ (describe (describe 

Country: 

Tx duration: 10 ds 

Fu duration (last 

assessment): NR 

68 yrs 

% of male: 73% 

total 

Cause of Pain: 

Cervical 

spondylopathy 

of the 

acu:on acu points: GB 

20; GV 20; GB 8; 

oblique insertion (75° 

angle) -gentle lifting 

instrument 

used): 

Pain: NA 

instrument used): 

QoL/ well being: 

Life and workmean (SD) 

China N screened: NR vertebroarterial thrusting and rotating Disability: NA Post tx: 

N randomized: 57 Racial type manipulation was 3.38 (2.43) vs. 

N completed tx: 54 composition: performed to induce the Results: 2.74 (2.39) 

Quality N attended last fu: NR assume Asian arrival of qi before and Baseline: NA 

score: 5/13 electric stimulator was Pain: Cure rates 

Initial of 

reviewer: 

SG 

Inclusion: age 18-70 yrs; 

diagnosed with cervical 

spondylopathy; abnormal 

findings in X-ray exam; 

excluding ocular or aural 

vertigo, cases caused by 

Work status: NR 

Other sociodemographics: 

NR 

Duration of 

Pain, mean 

(SD/range): 

Mixed (1 wk-10 

yrs), NR 

connected to the 

needles; The points 

selected wer divided 

into two groups wich 

were used alternately; 

Disability: 

Immediate post tx: 

Pain: NA 

Disability: NA 

Immediate post tx: 

pts completely 

cured (n): 10 vs. 6; 

cured & markedly 

effective rate: 

poor blood supply in basilare 20 min/session, once 82.21 vs. 53.84; 

arterial due to pressure on Co morbidities: Severity of pain daily with a 10 d course Short term: NR Effective rate: 

the verebroartery section I NR (Grading): Drop outs: 1 92.86 vs. 84.62 

and III; also cases due to excluded mild; Intermediate: NR 

neurosis and intracranial Prior episode of total: majority CG (n = 28) – simple Change of physica tumor) pain if acute: NR moderate (8 acu: same acupoints Long term: NR signs: data not 

Exclusion: conditions 

caused by such diseases as 

Meniere's cerebral 

Prior CAM 

intervention: NR 

severe, and 49 

moderate) 

and manipulation 

methods as IG; Same 

as IG 

shown 

Quality of life: 

arterisclerosis, postural Drop outs: 2 Short term: NR 

vetigo, drug intoxication of Prior surgery Current tx/ coinner ear, neurosis, and related to current intervention Intermediate: NR 

sublavian steal syndrome complaint: NR common in all 

groups: NR Long term: NR 

Harms: NR 

C-223
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Chu J 

(1997)221 Trial Design 

RCT 

Mean age 

(SD/range): NR 

Region of pain: 

Neck, shoulder 

Groups 

IG (n = 122) – Acu (dry 

Outcomes 

(describe 

Outcomes 

(describe 

Cause of Pain: needling) – tender instrument instrument used): 

Tx duration: NR % of male: IG = S, NR points: Done bilaterally used): QoL/ well being: 

Fu duration (last 41%, CG = on levator scapulae C3, Pain:  50% pain NR 

Country: assessment): immediate 28.5% trapezus C4, anteroir relief, n (%)] 

US post-tx deltoid C5, romboid 

Racial major C5, infraspinatus Results- mean : 

composition: NR Duration of C5, posterior deltoid C6, Results: Baseline: NA 

Quality N screened: 296 Pain, mean biceps brachii-short Baseline: 

score: 1/13 N randomized: 164 Work status: NR (SD/range): head C7, brachialis C6, Pain: --- Immediate post tx: 

N completed tx: NR Mixed, NR teres major C6, triceps NA 

N attended last fu: NR Other socio­ C7, extensor communis Immediate post tx: 

Initial of demographics: Severity of pain C7, and cervical Pain: IG = 38 Short term: NR 

reviewer: NR (Grading): NR muscles at C3-C7 level; (31%), CG = 7 

SG Inclusion: Neck and arm NR (16.6%) Intermediate: NR 

pain, MPS due to cervical Co morbidities: Drop outs: NR Average pain 

nerve root irritation NR Current tx/ co­ relief: 51.8% Long term: NR 

intervention CG (n = 42) – Acu (dry (21.9) vs. 39.0% 

Prior episode of common in all needling) – random (18.7%) Harms: NR 

Exclusion: Pts with pain if acute: groups: NR points: Same as IG; NR 

peripheral neuropathy Cervical nerve Drop outs: NR Short term: NR 

root irritation 

Intermediate: NR 

Prior CAM 

intervention: NR Long term: NR 

Prior surgery 

related to current 

complaint: NR 

C-224
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Huang, YF 

(2008)226 Trial Design 

RCT 

Mean age 

(SD/range): IG1 

Region of pain: 

NP 

Groups 

IG1 (n = 37)– Acu at 

Outcomes 

(describe 

Outcomes 

(describe 

= 43 (13), IG2 = Cause of Pain: Jiquan (HT1) with lifting instrument instrument used): 

Country: Tx duration: 20 ds 41.5 (10), CG = Cervical thrusting manipulation: used): QoL/ well being: 

China Fu duration (last 41.7 (11.7) yrs spondylosis of affected arm needled Pain: NA Cure rate; 

assessment): nerve root type 25-40mm deep at 5cm effective; 

immediately post-tx % of male: IG1 = below HT1 in abduction Disability: NA ineffective; total 

Quality 64.9%, IG2 = position and shoulder flx efficacy (%) 

score: 4/13 N screened: NR 61.1%, CG = in 90°, needle Results: 

N randomized: 107 70.6% Duration of stimulated by lifting- Baseline: NA Immediate post tx: 

N completed tx: 107 Pain, mean thrusting after “deqi” Pain: IG1 = 59.5, IG2 = 

Initial of N attended last fu: 107 Racial (SD/range): sensation reached; 1 Disability: 25, CG = 32.4; IG1 

reviewer: composition: NR Mixed: (up to 12 session/2 d over 20 d = IG1 = 32.4, IG2 = 

SG Inclusion: numbness, wks)/(>12 wks): Drop outs: A = 0, B = 0 Immediate post tx: 33.3, CG = 44.1; 

NP, and radiating pain Work status: NR IG1 = 4 (3.5), NA IG1 = 8.1, IG2 = 

towards upper limb; IG2 = 4 (3.5); IG2 (n = 36)– Acu at Pain: 41.7, CG = 23.5; 

brachial plexus traction Other socio- Chronic (> 12 Jiquan (HT1) with Disability: IG1 = 91.9, IG2 = 

test (+), spurling's test demographics: wks): CG = 4.6 twirling manipulation: 58.3, CG = 76.5 

(+); deformity of cervical NR (3.6) same as IG1, stimulate Short term: NR 

vertebrae in CT; cervical needle site by twirling at Short term: NR 

vertebrae affected Co morbidities: Severity of pain freq. of 2 Hz till “deqi” Intermediate: NR 

determined by clinical NR (Grading): NR sensation; as IG1 Intermediate: NR 

evaluation same as those Drop outs: A = 0, B = 0 Long term: NA 

indicated in CT Prior episode of Long term: NR 

pain if acute: NR Current tx/ co- CG (n = 34) – Routine 

Exclusion: other cervical intervention needling: needle 25-40 Harms: NR 

disc or joint disease or Prior CAM common in all mm at LI 11, HT1, LI 4, 

musculoskeletal disease intervention: NR groups: NR PC6, PC3, manually 

affect upper limb, such as stimulated till “deqi” 

spinal tuberculosis, Prior surgery sensation, retention time 

tumor, scapulohumeral related to current 30 min; as IG1 

periarthritis, etc. complaint: NR Drop outs: A = 0, B = 0 

C-225
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Ilbuldu E Trial Design Mean age Region of pain: Groups Outcomes: QoL/ well being: 

(2004)223 RCT (SD/range): IG1 NP IG1 (n = 20)– Acu dry Pain: NHP; VAS (at Nottingham Health 

Country: 

Turkey 

Tx duration: 4 wks 

Fu duration (last 

assessment): 6 mos 

= 35.3 (9.18), 

IG2 = 33.9 

(10.36), CG = 

32.35 (6.88) yrs 

Cause of Pain: 

Myofascial pain 

needling: 0.25 x 25 size 

acu needles; once/wk 

for 4 wks 

Drop outs: NR 

rest) 

Results: 

Baseline: 

Pain: IG1 = 70 

(30.71), IG2 = 59.54 

profile inventory: 

laser grp was sig 

better than IG1 and 

CG at post tx but not 

at 6 mos 

% of male: 0 (all IG2 (n = 20)– Laser (19.47), CG = 60.42 Cervical ROM: sig

N screened: NR female) Duration of therapy: He-Ne laser at (31.39); IG1 = 5.1 increase in flexio at 

Quality N randomized: 60 Pain, mean 632.8 nm wavelength (1.97), IG2 = 5.5 post tx in dry 

score: 5/13 N completed tx: 60 Racial (SD/range): applied to the three TP (1.96), CG = 5.7 needling & laser 

Initial of 

reviewer: 

N attended last fu: 60 

Inclusion: Women aged 

composition: NR 

Work status: NR 

Mixed, IG = 

38.48 (32) mo; 

IG2 = 32.95 

(28.61) mo; CG 

in the upper trapezius 

muscles on both sides; 

3 sessions/wk, 12 

sessions over 4 wks 

(1.81) 

Immediate post tx: 

Pain: NR 

grps, range of ext sig 

increased in laser 

grp vs. dry needling 

& placebo 

SG 18-50 yrs with MTP in the Other socio­ = 36.95 (33.65) Drop outs: NR Short term: IG1 = Analgesic use: upper trapezius muscle demographics: mo 33.9 (28.37), IG2 = Immediate post tx: 

NR CG (n = 20) – Laser­ 13.5 (14.07), CG = analgesic use: 3.62 

Severity of pain placebo: everything the 32.2 (28.4); IG1 = (4.41) vs. 0.85 (1.53) 

Exclusion: Tumor, Co morbidities: (Grading): NR same as in Laser group 3.71 (2.33), IG2 = vs. 2.05 (3.38) 

infectious diseases, NR but no beam was 2.05 (1.43), CG = 

osteoarthritis (stage 3-4), applied; same as IG2 3.65 (2.03) Short term: NR 

pregnancy, scoliosis, 

COLD 

Prior episode of 

pain if acute: NR 

Current tx/ cointervention 

common in all 

Drop outs: NR Intermediate: IG1 = 

32.66 (35.15), IG2 = 

19.02 (23.02), CG = 

Intermediate: NR 

Analgesic use: 2.53 

(2.74) vs. 1.41 (3.43) Prior CAM groups: 27.89 (23.65); IG1 = vs. 2.5 (3.49)

intervention: NR paracetamol for 2.59 (2.18), IG2 = 

pain 2.12 (1.9), CG = Long term: NR 

Prior surgery 2.89 (2.63) 

related to current Harms: NR 

complaint: NR 

C-226
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Jia, CS Trial Design Mean age Region of pain: Groups Outcomes: Outcomes 

(2007)225 RCT (SD/range): NR NP 

Cause of Pain: 

IG1 (n = 49) – 

Otransverse oscillatory 

Pain: SF-MPQ (15 

descriptors) 

(describe 

instrument used): 

Country: Tx duration: one tx % of male: 51% Disc/joint rotoint- penetrative QoL/ well being: 

China Fu duration (last 

assessment): immediate 

post-tx 

total 

Racial 

disease needling: needles 

inserted at unilateral 

and bilateral (AH 13) 

Disability: NA 

Results: 

NR 

Quality composition: NR otransverse oscillatory Baseline: Results- mean : 

score: 5/13 

N screened: NR 

N randomized: 98 

Work status: NR 

Duration of 

Pain, mean 

(SD/range): 

rotoints and 

subsequently crossed 

one otransverse 

Pain: IG1 = 28 

(7.4), IG2 = 27.9 

(7.3) 

Baseline: NA 

Immediate post tx: 

Initial of N completed tx: 98 Other socio- Mixed (sub­ oscillatory rotoint area to Disability: NA NA 

reviewer: N attended last fu: 98 demographics: acute/chronic) another between 

SG 

Inclusion: diagnosed as 

cervical spondylosis 

according to "The 

diagnostic criteria for 

cervical spondylosis"; NP; 

informed consent 

obtained 

Exclusion: other spinal 

disease; pregnant and 

postnatal woman; cardiocerebrovascular disease, 

hematransverse 

oscillatory rotoietic 

disease, psychosis; not 

complete tx sessions 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

Severity of pain 

(Grading): NR 

Current tx/ cointervention 

common in all 

groups: head 

movements (rot, 

flx, ext, etc.) 

epidermis and cartilage 

of muscle, stimulate with 

twirling 5-7 times, 

retention time 30 min., 

twirling 2-3 times during 

retention; one 30 min. tx 

Drop outs: A = 0 

IG2 (n = 49) – 

Otransverse oscillatory 

rotoint- straight 

needling: needles 

directly inserted at 

selected otransverse 

oscillatory rotoints, 

needle retention time 

and twirling times same 

as IG1; Same as IG1 

Drop outs: A = 0 

Immediate post tx: 

Pain: IG1 = 12.6 

(4.9), IG2 = 21.4 

(6.4) 

Disability: NA 

Short term: NR 

Intermediate: NR 

Long term: NR 

Short term: NR 

Intermediate: NR 

Long term: NR 

Harms: NR 

C-227
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Li, Xiang-hui 

(2004)219 Trial Design 

RCT 

Mean age 

(SD/range): IG = 

Region of pain: 

NP 

Groups 

IG (n = 260) – Acu 

Outcomes 

(describe 

Outcomes: 

QoL/ well being: 

49.1, CG1 = Cause of Pain: centro-square needling instrument Based on Chinese 

Tx duration: 40 ds 50.2, CG2 = 48.1 Spondylosis Danzhui: Dazui point, used): Medical Diagnostic 

Fu duration (last yrs supplement acupoints: Pain: NA n (%) 

Country: assessment): 12 mos jianyu, jianzhen, 

China % of male: IG1 = jianqian, quchi, hegu, Disability: NA Results- mean : 

47.3%, CG1 = fengchi, huantiao, 

N screened: 780 45.8%, CG2 = Duration of yanglingquan, neiguan Results: Immediate post tx: 

Quality N randomized: 780 46.2% Pain, mean and zusanli Baseline: IG = 254 (97.7), 

score: 4/13 N completed tx: 780 (SD/range): Diameter 0.30-0.35mm, Pain: NA CG1 = 247 (95), 

N attended last fu: 780 Racial Mixed (1 mo-20 25-125mm long needle; Disability: NA CG2 = 224 (86.2) 

composition: yrs, acute, sub­ 1 tx/d, 20 tx/course, 2 

Initial of Asian acute, chronic) courses Immediate post tx: Short term: NR 

reviewer: Inclusion: Pts diagnosed Drop outs: B = 0, E = 0 Pain: NA 

SG as cervical spondylosis Work status: NR Severity of pain Disability: NA Intermediate: NR 

using Chinese Medical (Grading): NR CG1 (n = 260) – Acu 

Diagnostic and Other socio­ needling cervical Jiaji Short term: NR Long term: NR 

Effectivenes Standard demographics: point: Jiaji point, 

NR Current tx/ co- Diameter 0.30-0.40mm; Intermediate: NR Harms: NR 

intervention Same as IG1 Summary: The 

Exclusion: NR Co morbidities: common in all Drop outs: B = 0, E = 0 Long term: NR therapeutic effect 

NR groups: NR in IG1 was stable 

CG2 (n = 260) – and better than 

Prior episode of Traction-massage: that in the CGs. IG 

pain if acute: NR traction 2-10kg, has the best 

retention 30min, 10-15 therapeutic effect 

Prior CAM neck massage; Same as for cervical 

intervention: NR IG1 spondylosis and 

Drop outs: B = 0, E = 0 therapeutic effect 

Prior surgery of CG1 is better 

related to current than that in CG2 

complaint: NR 

C-228
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Lin, M Trial Design Mean age Region of pain: IG (n = 50) – Acu (Needle Outcomes Outcomes: 

(2004)220 RCT (SD/range): 46 NP & Vertebrae Scalpel/ Massage Tx): no. (describe QoL/ well being: 

Country: 

China 

Tx duration: 3 mos 

Fu duration (last 

assessment): 6 mos 

(8.5) yrs total 

% of male: 65% 

total 

Cause of Pain: 

Cervical 

spondylopathy 

of nerve root 

type 

3 or no. 4 small needle 

scalpel, cut lines parallel to 

nerves, blood vessels, 

muscle fiber, inserted 

vertically, small hole made 

with Chuanketie after 

instrument 

used): 

Pain: NA 

Disability: NA 

TR 

Cure rate: 

Post tx: 

16 vs. 10 

Racial needle withdrawn, Effective rate: 

N screened: 100 composition: NR pressure applied until Results: Short term: NR 

Quality N randomized: 100 bleeding stransverse Baseline: (49/50) 98% vs. 

score: 3/13 N completed tx: NR 

N attended last fu: NR 

Work status: NR 

Duration of 

oscillatory rotped, every 7 

d Massage therapy: digital 

Pain: NA 

Disability: NA 

(41/50) 83%, p < 

0.05 

Initial of 

reviewer: 

SG 

Inclusion: Cervical 

spondylopathy of nerve 

Other sociodemographics: 

NR 

Pain, mean 

(SD/range): 

Mixed (AcuteChronic: 15 d – 

acupoint pressure, poking 

channels, on-the-point 

pressing, rolling, rotating 

manipulation used to 

massage Fengchi, Dazhui 

Immediate post tx: 

Pain: NA 

Disability: NA 

Intermediate: NR 

Long term: NR 

root type, aged 25-76 yrs 

Exclusion: NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

32 yrs), NR 

Severity of pain 

(Grading): NR 

Current tx/ cointervention 

common in all 

acupoints and soft tissue 

focus in neck area, traction 

of cervical vertebrae and 

massage of pain areas, 

plucking and pressing, twopoint and one-site 

reposition maneuver, 

once/d; 3 mo 

Drop outs: NR 

Short term: NR 

Intermediate: NR 

Long term: NR 

Harms: NR 

Summary: Dose 

and frequency of tx 

unclear 

Prior surgery groups: NR CG (n = 50) – Massage

related to current only: Same as IG; 

complaint: Drop outs: NR 

C-229
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Shang, Xiu- Trial Design Mean age Region of pain: Groups Outcomes: Outcomes: 

kui (2002)218 RCT (SD/range): NR NP IG (n = 50)– Acu, Pain: pain score QoL/ well being: 

Country: 

Tx duration: 54 ds 

Fu duration (last 

assessment): immediate 

% of male: NR 

Racial 

Cause of Pain: 

Spondylosis 

acupoint Sitianxue: 

tianyong, tianrong, 

tianchuan, tianding, and 

liequan for major 

instrument not 

mentioned (%) 

Results: 

Score based on 

Chinese Medical 

Diagnostic and 

Effective Standard 

UK post-tx composition: acupoints, all points on Baseline: Results- mean : 

Asian affected side for cold Pain: IG = 0.8 Baseline: IG = 0.62 

Duration of dampness, add dazhui (0.03), CG = 0.79 (0.04), CG = 0.65 

Quality N screened: NR Work status: NR Pain, mean and fengmen for qi (0.04) (0.03) 

score: /13 N randomized: 80 (SD/range): stagnant, add xuehai 

Initial of 

reviewer: 

SG 

N completed tx: 80 

N attended last fu: 80 

Inclusion: Diagnostic as 

Other sociodemographics: 

NR 

Co morbidities: 

Mixed (acute – 

chronic), NR 

Severity of pain 

(Grading): NR 

add touzhui and houxi 

for headache add 

jianzhongshu and 

jianwaishu add shenmai 

for neck rot limitation 

Immediate post tx: 

Pain: IG = 0.1 

(0.02); CG = 0.32 

(0.03) 

Immediate post tx: IG 

= 3.31 (0.01), CG = 

3.4 (0.05) 

N (%) improved: IG = 

46 (92), CG = 21 (70) 

Short term: NR 

nerve-toot cervical NR add kenlun for pain in Short term: NR Intermediate: NR 

spondylopathy using lumbar sacrum, Long term: NR 

Chinese Medical Prior episode of Current tx/ co­ 40-50mm, retention Intermediate: NR 

Diagnostic Standard pain if acute: NR intervention 30min; 1 tx/2 d, 9 Harms: NR 

Exclusion: NR 

Prior CAM 

intervention: NR 

Prior surgery 

common in all 

groups: NR 

tx/course, 3 courses 

Drop outs: A = NR, B =0 

CG (n = 30) – Acu 

acupoint Jiajixue; 

Long term: NR Summary: IG as 

main therapy has a 

marked effect on 

spondylopathy. 

This study found the related to current retention 30 min; Same effect of the tx is 

complaint: NR as IG better with the 

Drop outs: A = NR, B =0 younger 20 - 40 yr 

pts than the older pts 

> 40 yrs 

C-230
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Wang, Xi-Lin 

(2008)227 Trial Design 

RCT 

Mean age 

(SD/range): IG = 

Region of pain: 

NP 

Groups 

IG (n = 51)– ShuOutcomes: 

Disability: NR 

Outcomes 

(describe 

43.3 (13.3) vs. Cause of Pain: needling + elecro-acu: instrument used): 

Country: Tx duration: 30 ds CG = 45.2 (14.1) Disc/joint GV14, S13, TE5, & EX- Results: QoL/ well being: 

China Fu duration (last yrs disease, B2 were selected, Baseline: NR 

assessment): degenerative needles were deeply Disability: --- Efficacy of TCM 

immediately post-tx % of male: IG = disease inserted into the cervical diagnostic 

Quality 49%, CG = vertebrae of Immediate post tx: criteria: 

score: 4/13 N screened: NR 52.9% corresponding Jiaji (EX- Disability: NR 

N randomized: 102 B2), until "deqi" Immediate post tx: 

N completed tx: 102 Racial Duration of sensation reached, Short term: NR cure rate IG = 

Initial of N attended last fu: 102 composition: NR Pain, mean connected with G 6805 68.6, CG = 47.1 ; 

reviewer: (SD/range): electrical impulse device Intermediate: NR 

SG Inclusion: NP, neck PPT Work status: NR Unknown and stimulated at freq. effective IG = 29.4, 

and/or radiating pain (mixed), IG = of 3.3 Hz, needle Long term: NR CG =37.2; 

towards chest, shoulder, Other socio­ 2.8 (1.62) yrs; retention for 30 min.; 

back, and upper limb, demographics: CG = 3.1 (1.71) 30min/tx, 1 tx/d, 10 ineffective IG = 2, 

upper limb and figure NR yrs d/period, 30 d total CG = 15.7 

numb, neck stiff and Drop outs: A = 0, B = 0 

ROM reduced; Lasègue Co morbidities: Severity of pain total efficacy (%)IG 

sign (-); CT or MRT NR (Grading): NR CG (n = 51) – Routine = 98, CG = 84.3 

indicate deficits on needling + electro-acu: 

cervical discs Prior episode of same acupoints as IG Short term: NR 

pain if acute: NR Current tx/ co­ and routine needling 

Exclusion: NR intervention applied, tx duration, Intermediate: NR 

Prior CAM common in all needle retention and 

intervention: NR groups: NR electrical impulse and Long term: NR 

freq. same as IG; saem 

as IG Harms: NR 

Prior surgery Drop outs: A = 0, B = 0 

related to current 

complaint: NR 

C-231
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Zhang, B Trial Design Mean age Region of pain: Groups Outcomes Outcomes 

(2005)228 RCT 

Tx duration: 3 wks 

Fu duration (last 

(SD/range): NR 

% of male: IG = 

65.63%, CG = 

NP 

Cause of Pain: 

Cervical 

spondylosis 

IG (n = 64) – 

Acupuncture + Massage 

/ Manipulation:. 

Acupoint injection - 

(describe 

instrument 

used): 

Pain: NA 

(describe 

instrument used): 

QoL/ well being: 

NR 

Country: assessment): 3 mos 56.25% Fengchi (GB 20), Cure rate: 

China 

N screened: NR 

Racial 

composition: 

bilaterally, Ashi points 

(spot of tenderness or 

node), 1 to 2; Drugs: 

Disability: NA 

Results: 

Immediate post tx: 

81.25% vs. 56.25, 

Quality N randomized: 96 Asian Duration of VB12500ug ( 1 ml), Baseline: p < 0.05 

score: 0/13 N completed tx: NR 

N attended last fu: NR Work status: NR 

Pain, mean 

(SD/range): 

Mixed, NR 

Danshen injection 2 mL 

( 1 g/mg), 2 % lidocaine 

1 ml. The above drugs 

Pain: NA 

Disability: NA 

Total effective rate 

were similar in two 

grps 

Initial of Other socio­ were drawn into a one- Immediate post tx: 

reviewer: Inclusion: NR (appears demographics: Severity of pain off 5ml syringe. the Pain: NA Short term: NR 

SG to include pts with 

cervical spondylosis only) 

Exclusion: NR 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: 4 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

(Grading): NR 

Current tx/ cointervention 

common in all 

groups: NR 

doctor inserted the 

needle into the points 

and injected the same 

amount of drugs into 

each point. If there was 

no bleeding, the needle 

was withdrawn with the 

arrival of qi; 3 tx/wk for 3 

wks 

Drop outs: NR 

CG (n = 32) – Massage: 

As IG; Same as IG 

Drop outs: NR 

Disability: NA 

Short term: NR 

Intermediate: NR 

Long term: NR 

Intermediate: NR 

Long term: NR 

Harms: NR 

C-232
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Zhang, Trial Design Mean age Region of pain: Groups Outcomes: Outcomes 

Honglai RCT (SD/range): NR NP IG (n = 60)– Electro- Pain: McGill PRI (describe 

(2003)85 

Country: 

Tx duration: 45 ds 

Fu duration (last 

assessment): NR 

% of male: IG = 

53.3%, CG = 

55% 

Cause of Pain: 

Spondylosis 

acu: tianzhu, jinbailao 

and dashu (two sides) 

for major acu points 

dazhui, fengchi, 

fengmen, jianjin and 

total; difference 

between baseline 

and fu on VAS 

Results: 

instrument used): 

QoL/ well being: 

Cure, improved, 

effective, no effect n 

(%) 

Results- mean : 

China Racial Duration of waiguan for wind Baseline: Baseline: 

N screened: unknown composition: Pain, mean dampness quchi, pishu, Pain: IG = 8.57 Immediate post tx: IG 

N randomized: 120 Asian (SD/range): fenglong, geshu for (2.33), CG = 8.61 = 56 (93.3%), CG = 

Quality N completed tx: 120 Chronic, IG = tanyuzhu type ganshu, (2.42); NR 47 (78.3%) 

score: 6/13 N attended last fu: NR Work status: NR 81.9 mo, IG2 = pishu, and zusanli for qi 

92.2 mo, CG = stagnant type ganshu, Immediate post tx: Short term: NR 

Initial of Inclusion: diagnosed as 

Other sociodemographics: 91.1 mo pishu, zusanli for qi and 

blood stagnant type 

Pain: IG = 6.73 

(2.12), CG = 7.55 Intermediate: NR 

reviewer: Cervical Spondylosis NR Severity of pain yanglao, ganshu, (2.28); IG = 4.87 Long term: NR SG using ref [1] 1993­ (Grading): shenshu and taixi for (1.67), CG = 3.56 

chinese, Special attention Co morbidities: McGill, VAS liver and kidney debility. (1.26) Harms: NR 

(only those who were NR 1.5 Chinese inch, size 

compliant with the tx, only 30 needle, freq. 120­ Short term: NR Summary: IG in 

those who responded to Prior episode of Current tx/ co­ 250/min, retention therapeutic effect 

the surveys) 

Exclusion: acute 

pain if acute: NR 

Prior CAM 

intervention: NR 

intervention 

common in all 

groups: NR 

30min; 1 tx/d, 15 

tx/course, 3 courses, 2 d 

rest between courses 

Drop outs: A = NR, B= 0 

Intermediate: NR 

Long term: NR 

and improvement of 

pain for cervical 

spondylosis is better 

than the CG. This 

study found that both external injury cause, not tx have better effect 

compliant Prior surgery CG (n = 60) – Traction: with younger pts 

related to current 30 min, average traction compared with older 

complaint: NR = 7.5kg; Same as IG pts 

Drop outs: A = NR, B= 0 

C-233
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Zhu, HZ 

(2006)224 Trial Design 

RCT 

Mean age 

(SD/range): IG = 

Region of pain: 

NP 

Groups 

IG (n = 115) – NeedleOutcomes: Pain: NR 

Outcomes 

(describe 

46.04 (9.2) vs. Cause of Pain: knife: needle-knife instrument used): 

Tx duration: 18-45 ds CG = 46.5 (10.3) Cervical therapy at the apper and QoL/ well being: 

Country: Fu duration (last yrs spondylosis lower interspinal Results: Therapeutic effect 

China assessment): 6 mos ligaments of the affected Immediate post tx: 

% of male: IG = vertebaral body and Pain: NR 

48.7%, CG = bilateral pasterior joint Results- mean : 

Quality N screened: 221 52.8% Duration of capsules; 1 time/3-5 d x Short term: NR Baseline: NA 

score: 4/13 N randomized: 221 Pain, mean 3 times/3 course 

N completed tx: 221 Racial (SD/range): Drop outs: D = 0 Intermediate: NR Immediate post tx: 

N attended last fu: 221 composition: NR Mixed, IG = 4.59 NA 

Initial of (3.06) yrs; CG = CG (n = 106) – Long term: NA 

reviewer: Inclusion: cervical Work status: NR 4.82 (3.25) yrs Acupuncture: acu at Short term: IG = 

SG sponsylosis, 18-75 yrs of Luozhen, Ashi and Jiaji 91.3%, CG = 

age Other socio- Severity of pain points; 1 time/2 d x 5 59.4% 

demographics: (Grading): NR times/3 course 

NR Drop outs: Intermediate: IG = 

Exclusion: Operation; 94.7%, CG = 

pregnant and breast- Co morbidities: Current tx/ co­ 56.6% 

feeding women; Cervical NR intervention 

TB, tumor and common in all Long term: NR 

inflammation; Mental Prior episode of groups: NR 

pain if acute: NR Harms: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

C-234
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Zhuang, Li- Trial Design Mean age: IG1 = Region of pain: Groups Outcomes: Outcomes: 

Xing (2004) RCT- Double blind/cross 53.7 (11.9), IG2 = NP- specific Pain: NR 

222 over 53.3 (11.7) IG1 (n=17) – pressed acu Disability: NR Curative effect 

Country: 

China 

Tx duration: 3 wks 

Fu duration (last 

assessment): 

% of male: IG1 = 

35.3%, IG2 = 

23.5% 

Duration of 

Pain: IG1 = 2.9 

(1.12), IG2 = 

2.78 (1.09) 

at the baihui acupoint + 

local electro-acupuncture , 

retention 30 min, by trained 

professionals 1tx/day, 

7tx/course, total of 3 

Results: 

Baseline: NA 

Short Term Follow 

immediately pos- tx: 

Number of patients 

cured: 

9/17 vs. 4/17 

Number of patients Quality 

score: /13 

Initial of 

reviewer: 

NH (Chinese 

extractions) 

N screened: NR 

N randomized: 34 

N completed tx: 34 

N attended last fu: 34 

Eligibility criteria: 

- inclusion: diagnosed as 

vertebral artery type of 

Racial 

composition: Asian 

Work status: NR 

Other sociodemographics: NR 

Co morbidities: NR 

Duration of pain: 

1mos-5yrs 

Severity of pain 

(Grading): NR 

courses 

0 dropouts 

IG2 (n=17) – local electroacupuncture by trained 

professionals, 1tx/day, 

7tx/course, total of 3 

courses 

0 dropouts 

Up: NA with significant effect: 

6/17 vs. 4/17 

Number of patients 

with improvement: 

2/17 vs. 7/17 

Number of patients 

without effect: 0/17 

vs. 2/17 

cervical spondylosis by 

western medicine, age 36­

72, duration 1mos-5yrs 

also diagnosed by chinese 

medicine 

- exclusion: diagnosed as 

shi zheng 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

Other outcomes: 

chages of contents of 

plasma thromboxane 

and 6-ketoprostaglandin 1 

alpha and the ratio of 

these two 

Harms: 

NR 

C-235
 
Table 2.6 Neck Pain - Acupuncture - Mixed Duration of Disorder - Non-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Fu ZH 

(2007)229 

Trial Design 

RCT 

Mean age 

(SD/range): NR 

Region of pain: 

NP/Upper back 

Groups 

IG1 (n = 22)– acu 

Outcomes 

(describe 

Outcomes 

(describe 

Cause of Pain: insertion along the instrument instrument used): 

Country: Tx duration: 24 hours % of male: IG1 = N-S muscle fiber towards used): QoL/ well being: 

China Fu duration (last 41%, IG2 = 24% TPs needles moved Pain: MRP NR 

assessment): immediate smoothly and (MRP); PUP 

post-tx Racial rhythmically from one (PUP) Cervical ROM: 

Quality composition: NR side to another 200 Immediate post tx: 

score: 4/13 N screened: NR Duration of times in 2 min Results: 1.36 (0.90) vs. 

N randomized: 47 Work status: NR Pain, mean horizontally, needle Baseline: 1.12 (0.88), p = 

N completed tx: 47 (SD/range): remained under skin for MRP IG1 = 6.05 0.38 

Initial of N attended last fu: 47 Other socio- Mixed 8-24 hrs; one 24 hr tx (2.44), IG2 = 5.32 

reviewer: demographics: (Acute/Sub- Drop outs: NR (2.14) Short term: NR 

SG Inclusion: Presence of a NR acute) 

tender spot associated IG2 (n = 25) – acu PUP IG1 = 6.23 Intermediate: NR 

with movement of a local Co morbidities: Severity of pain insertion across the (1.69), IG2 = 6.16 

muscle, reproduction of NR (Grading): NR muscle fibers towards (1.25) Long term: NR 

clinical symptoms by TPs 

pressing the MTP, Prior episode of ; same as IG1 Immediate post tx: Harms: NR 

presence of palpable taut pain if acute: NR Current tx/ co- Drop outs: NR MRP IG1 = 3.59 

band peripheral to the intervention (1.89), IG2 = 2.76 

MTP, restricted ROM in Prior CAM common in all (1.88) 

the related joint, 18 yrs  intervention: NR groups: NR PUP IG1 = 3.82 

age  80 yrs, TP in the (1.33), IG2 = 3.28 

neck/upper back 10 d < (1.06) 

duration < 1 yr Prior surgery 

Exclusion: Pregnancy, related to current Short term: NR 

history of fractures, complaint: None 

surgery of the cervical Intermediate: NR 

spine, taking analgesic 

drug and accepting other Long term: NA 

txs within 1 wk 

C-236
 
Table 2.7 Neck Pain - Acupuncture – Unknown duration of disorder - Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Duann, J 

(2006) 231 

Trial Design 

RCT- Double blind/cross Mean age 

Region of pain: 

Superior 

Groups 

IG1 (n=36) – 

Outcomes: 

Pain: VAS (0-10), 

Outcomes: 

QoL/ well being: 

over (SD/range): NR Trapezius Miniscalpel-needle reported as mean NR 

(MSN) treatment on for 4 time points 

Country: Tx duration: 1 treatment, % of male: NR Cause of Pain: most painful trP, Other: NR 

Taiwan 30 mins provider NR, inserted for Disability: NR 

Fu duration (last Racial % NS: NR 30 sec, observed for 30 

assessment): 3 mo composition: NR % S: NR mins, 1 tx total Results: Results- mean : 

Quality Baseline: IG1 = NR 

score: /13 Work status: NR IG2 (n=36) – Lidocaine 5.5, IG2 = 5.3 Baseline: NA 

N screened: NR Duration of trP treatment, provider 

N randomized: 72 Other socio- Pain, mean NR, observed for 30 Immediate post tx: Immediate post tx: 

Initial of N completed tx: 72 demographics: (SD/range): NR mins 1 tx total IG1 = 3.5, IG2 = NA 

reviewer: 

NH 

N attended last fu: NR 

Eligibility criteria: 

NR 

Co morbidities: 

Severity of pain 

(Grading): Nr 

4.1 

Short term: IG1 = 

Short term: NA 

- inclusion: NR 2.9, IG2 = 5.0 Intermediate: NA 

Cervical myofascial pain 

syndrome Prior episode of Current Intermediate: IG1 Long term: NA 

pain if acute: NR treatment/ co­ = 2.8, IG2 = 4.97 

- exclusion: NR intervention Harms: NR 

Prior CAM common in all note**these 

intervention: NR groups: NR results were not in 

the extraction 

form, they were 

Prior surgery taken (aug.4) 

related to current directly from a 

complaint: NR graph 

C-237
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Edwards J 

(2003)235 Trial Design 

RCT 

Mean age 

(SD/range): IG = 

Region of pain: 

NP 

Groups 

IG (n = 14)– Acu + SDN 

Outcomes: 

Pain: SFMPQ; 

Outcomes 

(describe 

57 (12), CG1 = Cause of Pain: + stretching EX: Before PPT instrument used): 

Tx duration: 3 wks 55 (17), CG2 = S SDN was done, the QoL/ well being: 

Fu duration (last 57 (19) yrs MTPs were palpated Results: NR 

Country: assessment): 3 mos and marked at each Baseline: 

UK % of male: IG = session, then needled in Pain: IG = 24.3 

29%, CG1 = turn, working from (6.3), CG1 = 23.1 

N screened: 66 39%, CG2 = Duration of proximal to distal, (7), CG2 = 20.2 

Quality N randomized: 40 24% Pain, mean needles used: 25 x 0.30 (8); IG = 1.4 (0.9), Results- mean : 

score: 6/13 N completed tx: 40 (SD/range): mm with coiled copper CG1 = 1.7 (1), Baseline: NA 

N attended last fu: 40 Racial Unknown, IG1 = handles and plastic CG2 = 1.4 (1) 

composition: NR 16 (23) mo; IG2 guide tubes, needles Immediate post tx: 

Initial of = 10 (12) mo; inserted to depth of 4 Immediate post tx: NA 

reviewer: Inclusion: Pts aged  18 Work status: NR CG = 16 (19) mm, retained for avg of Pain: IG = 13 

SG yrs with active MTPs, mo 3.4 min; stretching EXs (10.2), CG1 = Short term: NR 

consent and compliance Other socio­ 3 times/d, 3 wks 17.1 (9.4), CG2 = 

In place demographics: Severity of pain Drop outs: 0 16.5 (10.2); IG = Intermediate: NR 

NR (Grading): NR 1.8 (1), CG1 = 1.8 

CG1 (n = 13)– (1), CG2 = 2 (1.4) Long term: NR 

Exclusion: acute Co morbidities: Stretching EX: pts 

condition requiring Tx NR Current tx/ co­ received instruction for Short term: IG = Harms: No AEs 

before 6 wks; skin lesion intervention stretching EXs 9.1 (11.6), CG1 = were reported by 

infection or inflammatory Prior episode of common in all recommended by 15.2 (8.8), CG2 = pts or observed by 

oedema at MTP site; pain if acute: NR groups: NR Simons et al for involved 14.9 (11); IG = 2.7 therapists in any 

needle phobia; previous muscles containing (1.4), CG1 = 1.8 grps 

adverse reaction to Acu Prior CAM MTPs; 3 times/d, 3 wks (0.9), CG2 = 2 

or anaesthetic; serious intervention: NR Drop outs: 0 (1.6) 

neurological or systemic 

disease Prior surgery CG2 (n = 13) – No tx: Intermediate: NR 

related to current NA; NA 

complaint: NR Drop outs: 0 Long term: NR 

C-238
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Fu, W 

(2005)234 Trial Design 

RCT 

Mean age 

(SD/range): IG1 

Region of pain: 

NP 

Groups 

IG1 (n = 56)– Needle 

Outcomes: 

Pain: PRI 

Outcomes 

(describe 

= 35.13 (8.88), Cause of Pain: picking acu: acupoints: instrument used): 

Tx duration:4 wks IG2 = 35.24 Spondylosis bailao( two sides), Results: QoL/ well being: 

Fu duration (last (4.67), IG3 = dazhui, jianjing (two Baseline: Well being, scoring 

Country: assessment): immediate 34.2 (6.67) yrs sides), xinshe (two Pain: IG1 = 8.91 based on Chinese 

China post-tx sides), dashu (two (4.92), IG2 = paper ref [1] n (%) 

% of male: IG1 = sides) 0.1 ml 11.85 (2.77), IG3 Other: 

53.6%, IG2 = Duration of anesthesia, pick skin = 11.64 (3.81) 

Quality N screened: 178 55.3%, IG3 = Pain, mean 0.2 cm; 2 tx/wk, 4 wks Results- mean : 

score: 3/13 N randomized: 158 56.4% (SD/range): Drop outs: B = 1, and 2 Immediate post tx: Baseline: ---

N completed tx: 158 Unknown, IG1 = changed to other tx Pain: IG1 = 0.36 Immediate post tx: 

N attended last fu: 158 Racial 5.7 (4.67), IG2 = (0.55), IG2 = 6.91 IG1 = 53 (94.6%), 

Initial of composition: 6.05 (4.35), IG3 IG2 (n = 47) – Local (3.22), IG3 = 5.71 IG2 = 47 (100%), 

reviewer: Asian = 6.15 (5.35) anesthesia: under the (2.49) IG3 = 55 (100%) 

SG Inclusion: Using both acupoint, 0.1ml 

Western Medical and Work status: NR Severity of pain anesthesia; Same as Short term: NR Short term: NR 

Chinese Medical (Grading): NR IG1 

Diagnostic Standards to Other socio- Drop outs: B = 0 Intermediate: NR Intermediate: NR 

Diagnostic demographics: 

NR Current tx/ co­ IG2 (n = 55) – Normal Long term: NR Long term: NR 

intervention acu: acupoints as IG1, 

Exclusion: Caused by Co morbidities: common in all normal puncture; Same Harms: CG: n = 1 

acute external injury; NR groups: NR as IG1 too much to 

Spinal cord cervical Prior episode of Drop outs: B = 0 continue tx; n = 2 

spondylosis ; Pregnant; pain if acute: NR scarring after tx 

Heart, liver, or kidney (switched tx 

disease Prior CAM groups-unknown 

intervention: NR which group) 

Prior surgery Summary: sign. 

related to current difference between 

complaint: NR 3 groups 

C-239
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Liang, ZH 

(2009)230 Trial Design 

RCT 

Mean age 

(SD/range): NR 

Region of pain: 

NP 

Groups 

IG (n = 53)– 

Outcomes 

(describe 

Outcomes 

(describe 

Cause of Pain: Acupuncture: acu points instrument instrument used): 

Tx duration: single 20 min % of male: NR Cervical at Daahui (GV14), used): QoL/ well being: 

session spondylosis Jingbailao (Ex HN15), Pain: NR NR 

Country: Fu duration (last Racial and Jianzhongshu, + 

China assessment): NR composition: infrared; single session, Disability: NA Effective rates: 

Asian 20 min needle retention Immediate post tx: 

Drop outs: NR Results: 75.5% vs. 52.8%, 

Quality N screened: NR Work status: NR Duration of Baseline: p < 0.05 

score: /13 N randomized: 106 Pain, mean CG (n = 53) – Sham- Pain: NA Nordic Pain 

N completed tx: NR Other socio­ (SD/range): acu: sham acu at 1 cm Disability: NA questionnaire:, 

N attended last fu: NR demographics: Unknown, NR lateral to Bailao and mean SD: 19.16 

Initial of NR Jianzhongshu points + Immediate post tx: (11.49) vs. 23.76 

reviewer: Severity of pain infrared; Same as IG Pain: NA (12.15) 

SG Inclusion: NP caused by Co morbidities: (Grading): NR Drop outs: NR Disability: NA 

cervical spondylosis NR Short term: NR 

Short term: NR 

Prior episode of Current tx/ co- Intermediate: NR 

Exclusion: NR pain if acute: NR intervention Intermediate: NR 

common in all Long term: NR 

Prior CAM groups: NR Long term: NR 

intervention: NR Harms: NR 

Prior surgery Summary: acu 

related to current had better 

complaint: NR therapeutic effects 

than sham acu in 

pts isth cervical 

spondylosis. 

C-240
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Wang, XL 

(2007)233 Trial Design 

RCT 

Mean age 

(SD/range): IG1 

Region of pain: 

NP 

Groups 

IG1 (n = 60)– Needle 

Outcomes 

(describe 

Outcomes 

(describe 

= 46.3 (NR) vs. Cause of Pain: retention at GV 20 for 8 instrument instrument used): 

Country: Tx duration: 30 ds IG2 = 49.2 (NR) Disc/joint hrs and electro-acu at used): QoL/ well being: 

China Fu duration (last yrs disease local points: GV 20 and Pain: NR 

assessment): immediate 4 other acupoints Other: Cure rate; 

post-tx % of male: IG1 = selected, needles Disability: NA sign. Effective; 

Quality 60, IG2 = 48.3% inserted until “deqi” effective; 

score: 3/13 sensation reached, Results: ineffective; total 

N screened: NR Racial Duration of needle at GV20 Baseline: efficacy (%) 

N randomized: 120 composition: NR Pain, mean remained for 8 hrs, other Pain: NR 

Initial of N completed tx: 120 (SD/range): needles connected with Disability: NA Results- mean : 

reviewer: N attended last fu: 120 Work status: NR Unknown, IG = G6805 electrical impulse Baseline: 

SG 3.9 yrs; CG = device, retention time 30 Immediate post tx: 

Other socio­ 4.2 yrs min.; 1 session/d, 30 Pain: NR Immediate post tx: 

Inclusion: diagnosed as demographics: sessions total Disability: NA IG = 70, CG = 45; 

Cervical Spondylosis NR Severity of pain Drop outs: A = 0, B = 0 IG = 18.3, CG = 

according to "Chinese (Grading): NR Short term: NR 26.7; IG = 10, CG 

medicine clinical research Co morbidities: IG2 (n = 60) – Needle = 15; IG = 1.7, CG 

guiding principles" NR retention at GV 20 for Intermediate: NR = 13.3; IG = 98.3, 

Current tx/ co­ 30 min. and electro-acu CG = 86.7 

Exclusion: NR Prior episode of intervention at local points: GV 20 Long term: NR 

pain if acute: NR common in all retention time is 30 min. Short term: NR 

groups: NR rest of tx same as IG1; 

Prior CAM same as IG1 Intermediate: NR 

intervention: NR Drop outs: A = 0, B = 0 

Long term: NR 

Prior surgery Harms: NR 

related to current 

complaint: NR 

C-241
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Zheng, Ling 

(2005)232 Trial Design 

RCT 

Mean age 

(SD/range): IG = 

Region of pain: 

NP 

Groups 

IG (n = 30)– PointOutcomes 

(describe 

Outcomes 

(describe 

52.5 (11.9) vs. Cause of Pain: through-point acu: instrument instrument used): 

Tx duration: 30 ds CG = 51.24 Spondylosis acupoints: fengchi used): QoL/ well being: 

Fu duration (last (11.5) yrs through fengfu, tianzhu Pain: N of pts who Well being: scoring 

Country: assessment): NR through jiaji, neck jiaji has pain (binary based on Ref[1] as 

China % of male: NR through transverse variable- not well: Improved = 

oscillatory rot to bottom, recorded) cure + better; Cure 

N screened: not Racial Duration of dashu through breast, n (%) 

Quality mentioned composition: Pain, mean jiaji, houxi through Other: 

score: 5/13 N randomized: 60 Asian (SD/range): laogong, xuanzhong Results: 

N completed tx: 60 Unknown, IG = through sanyinjiao Baseline: Results- mean : 

N attended last fu: NR Work status: NR 5.2 (3.65), CG = 40-100mm long needle, Pain: --- Baseline: 

Initial of 4.9 (2.34) retention 30 min; 1 tx/d, 

reviewer: Other socio­ 15 tx/course, 2 courses, Immediate post tx: Immediate post tx: 

SG Inclusion: Diagnostic as demographics: Severity of pain 3 ds rest between Pain: --- IG = 30 (100%), 

cervical spondylopathy by NR (Grading): NR courses CG 30 (100%); IG 

ref [1]-A Chinese paper; Drop outs: A = NR, B= 0 Short term: NR = 19 (63.3%, CG = 

No surgery; coronary Co morbidities: 8 (26.7%) 

heart disease, NR Current tx/ co- CG (n = 30) – General Intermediate: NR 

rheumatism etc. intervention acu: acupoints: fengchi, Short term: NR 

Prior episode of common in all fengfu, tianzhu, neck Long term: NR 

pain if acute: NR groups: NR jiaji, dashu, houxi, juegu Intermediate: NR 

Exclusion: NR and sanyinjiao 

Prior CAM 40-100mm long needle, Long term: NR 

intervention: NR retention 30 min; Same 

as IG Harms: NR 

Prior surgery Drop outs: A = NR, B= 0 

related to current Summary: The 

complaint: NR effects were 

significantly better 

in IG 

C-242
 
Table 2.8 Neck Pain - Acupuncture - Unknown - Non-Specific Pain – No studies 

Table 2.9 Neck Pain - Manipulation & Mobilization Therapies - Acute - Specific Pain – No studies 

Table 2.10 Neck Pain - Manipulation & Mobilization - Acute - Non-Specific Pain 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Buhmann, J Trial Design-RCT- Mean age (yrs) Region of pain: Groups Outcomes: Outcomes: 

(2005)236 (SD/range): IG = NP IG1 (n = 10) – SM: Disability: N of QoL/ well being: NR 

Country: 

Germany 

Tx duration: NR 

Fu duration (last 

assessment): 24 hrs post 

last tx 

N screened: 60 

44 (22), IG2 = 46 

(14), CG = 49 (7) 

% of male: IG = 

60%; IG2 = 62%; 

Cause of Pain: 

NR 

thrusting force on lateral 

aspects of occiput or C1 

exerted for < 200 msec 

before and after 

anesthesia; NR 

Drop outs: A = 0, B = 2 

found 

dysfunctions in 

motion segments 

O/C1 and C1/C2- 

no numerical data 

Results- mean : 

Immediate post tx: 

Short term: NR 

N randomized: 26 CG = 50% Duration of is reported (only p Intermediate: NR 

Quality N completed tx: 24 Pain, mean IG2 (n = 8) – Post- values) 

score: 7/13 N attended last fu: NR Racial 

composition: NR 

(SD/range): 

Acute/Sub-acute 

isometric relaxation): 

applied to hypertonic Results: 

Long term: NA 

Initial of 

reviewer: 

SG 

Inclusion: 18-80 yrs, 

manually diagnosed 

dysfunction of one or both of 

the segments 

occiput/cervical 1 and 

cervical 1/cervical 2 

Work status: NR 

Other sociodemographics: 

NR 

Severity of pain 

(Grading): NR 

muscle - isometric 

contraction by pts against 

manual resistance for 10 

sec then stransverse 

oscillatory rotped and 

repeated after at least 20 

Baseline: 

Disability: IG1 = 

21, IG2 = 15, CG 

= 13 

Harms: 2 WDAE in 

IG1- complication 

arising from a 

surgical operation 

Summary: sig effect 

Exclusion: previous surgery 

of cervical spinal column, 

arthrosis of cervical spinal 

column, spondylolisthesis, 

fracture, inflammation, 

previous disk herniations or 

cervical spinal column, any 

kind of cancer or planned 

surgery in throat, neck or 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

Current tx/ cointervention 

common in all 

groups: NR 

sec rest with increasing 

anti-flx/ retro-flx or later flx; 

before and after 

anesthesia NR 

Drop outs: See IG1 

CG (n = 8) – Placebo: 

Laying palms of clinician 

on sides of pt's neck 

without any side-different 

Immediate post tx: 

Disability: ---

Short term: NR 

Intermediate: NR 

Long term: NA 

of IG1&2 vs. 

placebo, in restoring 

function (p< 0.01) 

In anesthesia: IG1 

vs. placebo, p < 0.01. 

No sig difference 

between IG1 & 2 (P 

= 0.137). The 

tx effect 

postnarcotically was 

head region; acute painful intervention: NR pressure or without having further sign in IG1 vs. 

dysfunctions in locomotor Prior surgery pt under tension; before placebo only

system; currently related to current and after anesthesia NR (P = 0.011 

undergoing chiropractic tx complaint: NR Drop outs: See IG1 

C-243
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Gonzalez- Trial Design Mean age Region of pain: IG (n = 23) – Outcomes: Outcomes: 

Iglesias, J 

(2009)239 

RCT- (SD/range): IG = 

34 (4) vs. CG = 

NP 

Cause of Pain: 

Electro/thermal therapy 

with thoracic spine 

Pain: 100 mm 

VAS 

QoL/ well being: 

NR 

Tx duration: 3 wks 35 (6) yrs N-S thrust manipulation: 

Country: Fu duration (last superficial thermal and Disability: 

Spain assessment): 2 & 4 wks % of male: IG = electrotherapy: infrared Northwick park Results- mean : 

after last tx 52.2%; CG = lamp (250W) 50cm from questionnaire Baseline: NA 

54.5% Duration of neck applied for 15 

Pain, mean minutes; followed by Results: Immediate post tx: 

Quality N screened: 60 Racial (SD/range): trans-cutaneous Baseline: NA 

score: 9/13 N randomized: 55 composition: NR Acute, IG = 18.7 electrical nerve Pain: IG = 54.7 

N completed tx: 55 (3.9) ds, CG = stimulation at 100Hz for (8.2), CG = 52.7 Short term: NR 

N attended last fu: 55 Work status: NR 19.5 (4.5) ds 20 min using two 4x6cm (5.5) 

Initial of electrodes bilaterally on Disability: IG = Intermediate: NR 

reviewer: Other socio- Severity of pain each side of spinous 27.9 (3), CG = 27 

SG Inclusion: 18-45 yrs of demographics: (Grading): NR process of C7 vertebra (3.1) Long term: NR 

age with mechanical NP NR + seated “distraction 

less than 1 mo duration 

Co morbidities: Current tx/ comanipulation in upward motion, 2nd manipulation 

Immediate post tx: 

Pain: IG = 20.2 

Harms: NR 

Exclusion: NR intervention applied if no popping, (7.8), CG = 44.7 

contraindication to common in all Max of 2 attempts; 5 (5.5) 

manipulation; history of Prior episode of groups: NR electro/thermal sessions Disability: IG = 

whiplash or cervical pain if acute: NR over 3 wks, 3 min. 15.2 (3.9), CG = 

surgery; diagnosis of sessions 23.1 (3.2) 

cervical radiculopathy or Prior CAM Drop outs: A = 0, B = 0, 

myelopathy; fibromyalgia; intervention: NR C = 0 Short term: Pain: 

spinal manipulative IG = 26.4 (11.8), 

therapy in prior 2 mo Prior surgery CG (n = 22) – CG = 41.2 (6.1) 

related to current Electro/thermal therapy: Disability: IG = 

complaint: NR As IG; 5 sessions, 3 wks 14.7 (2.8), CG = 

Drop outs: A = 0, B = 0, 21.8 (3.3) 

C = 0 Intermediate: NR 

Long term: NR 

C-244
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Pikula, J 

(1999)237 

Trial Design-RCT Mean age 

(SD/range): IG1 

Region of pain: 

NP 

Groups 

IG1 (n = 12)– SM 

Outcomes 

(describe 

Outcomes 

(describe 

Tx duration: One session = 39.5 (5.92), Cause of Pain: applied to painful side instrument instrument used): 

Country: Fu duration (last IG2 = 42.6 N-S (ipsilateral): supine used): QoL/ well being: 

Canada assessment): Immed. 

Post-tx 

(7.78), CG = 

44.2 (6.98) yrs 

position, open hand 

contact 2nd finger placed 

Pain: VAS 100 

mm (0-100) 

NR 

CROM-cervical 

adjacent to the articular ROM 

Quality N screened: 36 % of male: IG1 = pillars of the mid cervical Disability: NR 

score: 4/13 N randomized: 36 33%, IG2 = 8%, Duration of spine. Head rotated Immediate post tx: 

N completed tx: NR CG = 25% Pain, mean contra laterally & slightly Results: flx: 58.8 (15.6) vs. 

N attended last fu: NR (SD/range): extended passively to Baseline: 49.8 (14.6) vs. 

Initial of 

reviewer: Inclusion: 1st acute (< 2 

Racial 

composition: NR 

Acute, NR max ROM. HVLA thrust 

applied and an audible 

Pain: IG1 = 42.5 

(19.8), IG2 = 44.1 

46.0 (11.4) 

Extension: 57.3 

SG wks)unilateral NP, no hx Severity of pain crack was heard; one tx (27.5), CG = 50.4 (11.3) vs. 46.0 

of trauma, neurological Work status: NR (Grading): NR Drop outs: NR (22.5) (12.0) vs. 48.2 

deficit, or previous Disability: NR (15.9) 

chiropractic tx of the Other socio- Current tx/ co­ IG2 (n = 12)– SMT Ipsilateral rot: 612 

cervical spine demographics: intervention applied to opposite of Immediate post tx: (9.7) vs. 53.8 (9.1) 

NR common in all painful side (contra Pain: IG1 = 23.6 vs. 49.8 (19.7) 

Exclusion: Radiculitis or groups: NR lateral): same as IG1; (18.6), IG2 = 41.4 

pain into the arm or hand, Co morbidities: As IG1 (28.4), CG = 46.5 Short term: NR 

neurological deficis of he NR Drop outs: NR (21.8) 

brachial plexus roots, hx Disability: NR Intermediate: NR 

of fracture/ tumour/ Prior episode of CG (n = 12) – Placebo 

infection/ pain if acute: NR ultrasound therapy: Short term: NR Long term: NR 

spondyloarthropathy, px Transducer head 

cervical SM tx pervious Prior CAM applied in gradual Intermediate: NR Harms: NR 

neck surgery, workers' intervention: NR circular movement 

compensation or disability stimulating a tx; one 8 Long term: NR 

insurance issues, Prior surgery min tx 

conditions potentially related to current Drop outs: NR 

aggravated by electrical complaint: NR 

devices (i.e. pacemaker) 

C-245
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail 

Outcome 

results: 

Pain, Disability 

Outcome results: 

Other outcomes; 

Harms 

Yurkiw, D Trial Design-RCT Mean age Region of pain: Groups Outcomes: Outcomes 

(1996)238 

Tx duration: One session 

(SD/range): NR NP 

Cause of Pain: 

IG (n = 7)– Diversified 

SM: area of tx restricted 

Pain: 10 cm VAS (describe 

instrument used): 

Country: Fu duration (last % of male: NR N-S to lower cervical spine, Disability: QoL/ well being: 

Canada assessment): Immed. 

Post-tx Racial 

composition: NR 

Sally one vertebral level 

from the 3rd-7th 

vertebrae inclusive; tx 

Results: 

Baseline: 

NR 

Other: ROM with 

Quality N screened: NR Duration of performed according to Pain: IG = 32.857 Goniometer: Right 

score: 7/13 N randomized: 14 

N completed tx: 14 

N attended last fu: 14 

Work status: NR 

Other socioPain, mean 

(SD/range): 

Acute/Subaccepted methods 

described by Haldeman 

and also Koes et al who 

(25.777), CG = 

32.857 (17.874) 

lateral flx; left 

lateral flx 

Initial of demographics: acute, NR allowed therapy to be at Immediate post tx: Immediate post tx: 

reviewer: Inclusion: Unilateral NP NR the discretion of Pain: IG = 21.857 Right lateral flx IG 

SG of at least 3 wks duration 

between ages of 18 and 

55 yrs 

Exclusion: individuals 

with any SM during 

previous 90 ds; severe 

pathology, infection or 

suspected of malingering 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

Severity of pain 

(Grading): NR 

Current tx/ cointervention 

common in all 

groups: NR 

provider, although 

choices limited to two 

types of procedure 

described by Haldeman; 

1 tx 

Drop outs: NR 

CG (n = 7) – 

Mechanically assisted 

manipulation: As IG as 

described by Petterson, 

applied in prone position 

with instrument at “2 

ring” position, one “click” 

application given; 1 tx 

Drop outs: NR 

(21.459), CG = 

20.427 (18.402) 

Disability: 

Short term: NR 

Intermediate: NR 

Long term: NR 

= 34.429 (3.599), 

CG = 44 (8.583); 

left lateral flx IG = 

5.843 (5.5), CG = 

10.25 (5.537) 

Short term: NR 

Intermediate: NR 

Long term: NR 

Harms: NR 

C-246
 
Table 2.11 Neck Pain - Manipulation & Mobilization - Chronic - Specific Pain – No studies 

Table 2.12Neck Pain - Manipulation & Mobilization - Chronic - Non-Specific Pain 

Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Bischoff, A 

(2003)243 

Trial Design-RCT Mean age 

(SD/range): NR 

Region of pain: 

NP 

Groups 

IG (n = 24)– Sham 

Outcomes 

(describe 

Outcomes: 

QoL/ well being: 

Abstract Tx duration: 10 wks Cause of Pain: ultrasound + instrument used): NR 

Fu duration (last % of male: NR N-S Osteopathic Pain: Avg pain 

Country: assessment): Immed. intervention: 12 min intensity-NRS (0­ Results- mean : 

NR Post-tx Racial session of sham 10) Immediate post 

composition: NR ultrasound every wk for tx: 

N screened: 135 Duration of 10 wks + test-dependent 

Quality N randomized: 49 Work status: NR Pain, mean osteopathic intervention Results: Short term: NR 

score: 1/13 N completed tx: 42 (SD/range): every other wk; 1 tx/wk Baseline: 

N attended last fu: 42 Other socio- Chronic, NR for 10 wks Pain: IG = 4.7, CG Intermediate: NR 

demographics: Drop outs: A = 0, B = 1 = 4.8 

Initial of Inclusion: Chronic N-S NR Severity of pain Long term: NR 

reviewer: NP (Grading): NR Immediate post tx: 

SG Co morbidities: CG (n = 25) – Sham Pain: IG = 2.2, CG Harms: NR 

ultrasound: 12 min = 4 

Exclusion: NR Prior episode of Current tx/ co­ session of sham Summary: On 

pain if acute: NR intervention ultrasound; 1 tx/wk for Short term: NR the NRS, 

common in all avg of 10 wks average pain 

Prior CAM groups: NR Drop outs: A = 0, B = 6 Intermediate: NR intensity 

intervention: NR decreased 

Long term: NR significantly in the 

Prior surgery osteopathic 

related to current group (p<0.0005) 

complaint: NR but not the sham 

group (p=0.09) 

C-247
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Chen, L 

(2007)244 

Trial Design-RCT Mean age 

(SD/range): IG = 

Region of pain: 

NP 

Groups 

IG (n = 36) – Spinal 

Outcomes: Outcomes 

(describe 

Tx duration: 20 ds 41.32 (11.27) vs. Cause of Pain: manipulation: NR; 20-30 Pain: NRS instrument 

Fu duration (last CG = 43.68 N-S min/2 ds, 10 tx, Headache used): 

Country: assessment): 3 mos (16.63) yrs Drop outs: A = 2, C = 3 frequency, and QoL/ well being: 

China lasting time- data NR 

N screened: 75 % of male: IG = not shown) 

N randomized: 70 44.4%, CG = Duration of CG (n = 34) – TENS: Response rate 

Quality N completed tx: 70 70.6% Pain, mean Pre-medic Results: (%) 

score: 7/13 N attended last fu: 70 (SD/range): electrotherapy machine Baseline: 

Racial Chronic (>6 mo) (German); 100 Hz, 20 Pain: IG = 7.45 Immediate post 

Inclusion: Cervicogenic composition: NR IG = 24.34 min/2 ds, 10 tx (1.22), CG = 7.86 tx: 94.5% vs. 

Initial of headache; Disease (6.62); CG = Drop outs: unclear (1.34) 64.5%, p < 0.05 

reviewer: course > 6 mo; without Work status: NR 18.51 (8.43) 

SG drug therapy in 3 mo; X- Immediate post tx: Short term: NR 

ray has positive discover Other socio- Severity of pain Pain: NR 

demographics: (Grading): NR Intermediate: NR 

NR Short term: IG = 

Exclusion: Other type 2.81 (1.15), CG = Long term: NA 

of headache; after neck Co morbidities: Current tx/ co­ 5.26 (1.83) 

operation; Severe NR intervention Harms: NR 

osteoporosis common in all Intermediate: NR 

Prior episode of groups: NR 

pain if acute: NR Long term: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

C-248
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Cleland, J 

(2005)242 

Trial Design-RCT Mean age 

(SD/range): IG = 

Region of pain: 

NP 

Groups 

IG (n = 19)– Thoracic 

Outcomes: 

Pain: 100 mm VAS 

Outcomes 

(describe 

Tx duration: One 36 (8.5) vs. CG = Cause of Pain: spine manipulation: to assess resting instrument 

Country: session 35 (11.3) yrs N-S, Mechanical thoracic manipulation pain used): 

US Fu duration (last directed to identified QoL/ well being: 

assessment): Immed. % of male: IG = segmental mobility Disability: NDI to NR 

Post.tx 26.3%, CG = restrictions (performed assess perceived 

Quality 23.5% in positions of thoracic disability due to NP 

score: 7/13 N screened: 68 Duration of spine flx and ext); 1 tx Results- mean : 

N randomized: 36 Racial Pain, mean Drop outs: A = 0, B = 0 Results: Baseline: NA 

N completed tx: 36 composition: NR (SD/range): Baseline: 

Initial of N attended last fu: 36 Unknown or CG (n = 17) – Placebo Pain: IG = 41.6 Immediate post 

reviewer: Work status: NR mixed, IG = 12.2 (manipulation): (17.8), CG = 47.7 tx: NA 

SG Inclusion: 18-60 yrs (3.5) wks, CG = stabilizing open hand (18.4) 

with primary complaint of Other socio­ 13.2 (4.2) wks placed over inferior Disability: IG = 28.4 Short term: NR 

mechanical NP, referred demographics: vertebrae of pre­ (11.9), CG = 33.6 

by primary care NR Severity of pain determined segmental (14.2) Intermediate: NR 

physician to outPt (Grading): NR restriction; when preorthopaedic physical Co morbidities: manipulative position Immediate post tx: Long term: NR 

therapy clinic NR achieved, pt instructed Pain: IG = 26.1 

Current tx/ co­ to take deep breath and (17.2), CG = 4.5 Harms: no 

Exclusion: red flags; Prior episode of intervention exhale, with no (19.5) reporting of any 

pregnancy; with positive pain if acute: NR common in all intervention during Disability: NR AEs by pts (pts 

neurologic signs or groups: None exhalation; As IG were instructed to 

symptoms suggestive of Prior CAM Drop outs: A = 0, B = 0 Short term: NR contact the 

nerve root involvement, intervention: NR investigators if 

history of cervical or Intermediate: NR experiencing any 

thoracic surgery; AE) 

hypermobility of thoracic Prior surgery Long term: NR 

spine; prior experience related to current 

with spinal manipulative complaint: NR 

techniques 

C-249
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Giles, LG Trial Design- RCT Mean age Region of pain: Groups Outcomes: Outcomes: 

(2003)25,26 (SD/range): IG1 = LBP, NP, thorax IG1 (n = 34)– Acu: near Pain: VAS (1-100) QoL/ well being: 

Country: 

Australia 

Tx duration: Max. of 9 wks 

Fu duration (last 

assessment): 12 mos 

N screened: 109 

N randomized: 109 

23.8 (4.8), IG2 = 25 

(8.1), CG = 29.5 

(2.07) yrs 

% of male: IG1 = 

55.9%, IG2 = 

Cause of Pain: 

N-S 

and far techniques as 

chosen by clinician; 2 

tx/wk, max. of 9 wks 

Drop outs: B = 12 

IG2 (n = 35)– Spinal 

Disability: Oswestry 

Back 

Results: 

Baseline: 

SF-36 (higher 

values better) 

Other: 

Results- mean : 

N completed tx: 109 51.4%, CG = 57.5% manipulation: 20 min- Pain: IG1 = 6 (2.2), Baseline: IG1 = 

N attended last fu: 62 Duration of appointments. High­ IG2 = 6 (2.9), CG = 5 46 (15.6), IG2 = 

Quality Racial composition: Pain, mean velocity, low-amplitude (3.7) 57 (22.9), CG = 

score: 5/13 Inclusion: pts at least 17 

yrs old with uncomplicated 

NR (SD/range): 

Chronic (> 13 

thrust SM to a joint (as 

judged to be safe and 

Disability: IG1 = 30 

(17.03), IG2 = 22 37 (25.2) 

Initial of 

reviewer: 

SG 

mechanical spinal pain for 

minimum of 13 wks - for 

long-term fu (> 1 yr) 

Exclusion: pts with nerve 

root involvement, spinal 

Work status: NR 

Other sociodemographics: 

Unemployed: 29 

wks), NR 

Severity of pain 

(Grading): NR 

usual tx by the treating 

chiropractor for the spinal 

level of involvement to 

mobilize the spinal joints; 

same as IG1 

(22.96), CG = 32 

(19.3) 

Immediate post tx: 

Pain: IG1 = 4 (4.4), 

Immediate post 

tx: 

IG1 = 53 (22.2), 

IG2 = 70 (38.5), 

anomalies (other than 

sacralization/lumbarization) 

, pathology other than mildmoderate osteroarthrosis, 

spondylolisthesis of L5 or 

S1 > Grade 1, previous 

spinal surgery, and leg 

length inequality > 9 mm 

with postural scoliosis. 

(25.7%) 

Co morbidities: NR 

Prior episode of 

pain if acute: NA 

Prior CAM 

intervention: NR 

Prior surgery 

Current tx/ cointervention 

common in all 

groups: NR 

Drop outs: B = 10 

CG (n = 40) – Medication 

that have not been tried: 

Celecoxib/Celebrex (200 - 

400 mg/d); 

Rofecoxib/Vioxx (12.5 - 25 

mg/d); 

paracetamol/acetaminophe 

n (500 mg tablest 2-6/dup 

IG2 = 5 (3.7), CG = 6 

(4.4) 

Disability: IG1 = 26 

(20.74), IG2 = 14 

(24.4), CG = 32 (23.7) 

Long term: OBD: IG1 

= 13 (22.9), IG2 = 16 

(17.8), CG = 24 (25.2) 

VAS: IG1 = 3.9 (3.2), 

CG = 57 (33.3) 

Short term: NR 

Intermediate: NR 

Long term: IG1 = 

55 (26.7), IG2 = 

77 (23.7), CG = 

related to current to 4 g/d); NR IG2 = 3.7 (4), CG = 66 (36.3) 

complaint: NR Drop outs: B = 18 3.9 (3.3) 

Harms: NR 

C-250
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Giles, LGF 

 (1999)122 

Trial Design 

RCT 

Mean age 

(SD/range): IG1 = 

Region of pain: 

NP 

Groups 

IG1 (n = 10)– Acu: using 

Outcomes: 

Pain: VAS 

Outcomes 

(describe 

46.5 (9.6), IG2 = Cause of Pain: sterile HWATO Chinese instrument 

Tx duration: 3-4 wks 42.5 (9.6), CG = N-S disposable acu guide Disability: ODI used): 

Fu duration (last 35 (14.1) yrs tube needles 50mm long QoL/ well being: 

Country: assessment): immediate with a gauge of 0.25 mm Results: NR 

Australia post-tx % of male: 35.7% for 20 ?; 6 tx, 3-4 wks Baseline: 

total Drop outs: NR Pain: IG1 = 40 

N screened: 875 Duration of (31.8), IG2 = 32 

Quality N randomized: 40 Racial Pain, mean IG2 (n = 20) – (14.8), CG = 28 

score: 1/13 N completed tx: 40 composition: NR (SD/range): Manipulation: A high­ (21.9) Results- mean : 

N attended last fu: 40 Chronic, NR velocity, low-amplitude Disability: IG1 = 3.5 Baseline: NA 

Work status: NR SM was performed as (5.5), IG2 = 5 (3.5), 

Initial of Inclusion: pts suffering Severity of pain judged to be safe; 6 tx, CG = 2.7 (4.8) Immediate post 

reviewer: from spinal pain for at Other socio­ (Grading): NR 3-4 wks tx: NA 

SG least 13 wks; age of at demographics: Drop outs: NR Immediate post tx: 

least 18 yrs NR Pain-mean change: Short term: NR 

Current tx/ co- CG (n = 10) – IG1 = - 6 (14.4), 

Co morbidities: intervention Medication: tenoxican IG2 = -10 (10.4), Intermediate: NR 

Exclusion: Nerve root NR common in all (20mg/d) and ranitidine CG = 0 (10.7) 

involvements; spinal groups: NR (50mg x 2/ d); 15-20 Disability-mean Long term: NR 

anomalities; pathology Prior episode of min/ appointment, 3-4 change: IG1 = -0.5 

other than mild to pain if acute: NR wks (4.8), IG2 = -2.3 Harms: NR 

moderate osteoarthrosis; Drop outs: NR (4.8), CG = -1 (1.3) 

previous spinal surgery Prior CAM 

and leg length inequality intervention: NR Short term: NR 

of > 9 mm with postural Intermediate: NR 

scoliosis Prior surgery Long term: NR 

related to current 

complaint: NR 

C-251
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Haas, M Trial Design-RCT- dose Mean age Region of pain: Groups Outcomes: Outcomes 

(2004)245 response study (SD/range): IG1 = NP IG1 (n = 8)– SM 3 office Pain: headache (HA); (describe 

Country: 

US 

Tx duration: 3 wks 

Fu duration (last 

assessment): 12 wks 

N screened: 86 

38.9 (11.9) vs. 

IG2 = 46.6 (6) vs. 

IG3 = 35.4 (9.9) 

yrs 

Cause of Pain: 

N-S 

Duration of 

visits + massage and 

other tx: HVLA SM; 

discretional therapy 

included administration 

of up to 2 PM from: heat 

NP (NP) 

Disability: Modified 

Von Kroff (MVK) 

Results: 

Immediate post tx: 

HA: 40.5 (15.6) vs. 

instrument 

used): 

QoL/ well being: 

NR 

N randomized: 24 % of male: 27% Pain, mean and soft tissue therapy 31.3 (15.6) vs. 18.7

Quality N completed tx: 23 (SD/range): including massage and (14.5) Immediate post 

score: 7/13 N attended last fu: 23 Racial Chronic, NR TP therapy; recommend NP: 41.9 (11.7) vs. tx: NA 

composition: modification of daily 29.6 (15.6) vs. 22.5 

Inclusion: 18 yrs of age or 82.3% White/Non- Severity of pain activity; 1 tx/wk, 3 wks (14.9) Short term: NR 

Initial of 

reviewer: 

SG 

older with English literacy 

and uncomplicated, chronic 

cervicogenic headache; 

history of at least 5 

cervicogenic headaches 

Hispanic 

Work status: NR 

(Grading): NR 

Current tx/ coDrop outs: A = 0, B = 4, 

C = 0 

IG2 (n = 8)– 

MVK- HA: 25.2 (19.7) 

vs. 18.3 (13.7) vs. 7.9 

(10.1) 

MVK-NP 31.4 (17.7) 

vs. 22.1 (24.4) vs. 9.8 

Intermediate: NR 

Long term: NR 

/mo for at least 3 mo Other socio­ intervention Manipulation 9 office (12.1) 

Exclusion: contrain­ demographics: common in all visits + massage and Short term: Pain: HA: Harms: no AEs 

dications to SM or 47.3% Married groups: Physical other tx: As IG1; 3 tx/wk, 49 (19.8) vs. 34.2 were reported by 

complicating conditions modalities; 3 wks (12.3) vs. 27.9 (30.3); pts. potentially related to clinical Co morbidities: Massage/TP Drop outs: NR NP: 14.7 (8.9) vs. 

outcomes: malignancy or 

history of cancer, spinal 

infection, vertebral tumors 

or fracture, lumbar 

instability, blood dyscrasia, 

NR 

Prior episode of 

pain if acute: NR 

therapy; hot/cold 

packs IG3 (n = 8) – 

Manipulation 12 office 

visits + massage and 

11.5 (11.9) vs. 7 (9.8) 

MVK-HA: 39 (25.8), 

vs. 17.5 (16.1) vs. 

14.6 (27.3) 

MVK- NP 33.3 (9.6) 

severe trauma within last 3 Prior CAM other tx: As IG1; 4 tx/wk, vs. 14.2 (14.1) vs. 3.7 

months. intervention: NR 3 wks (20.0) 

Drop outs: NR 

Prior surgery 

related to current 

complaint: NR 

C-252
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Jull, G Trial Design-RCT Mean age range: Cervicogenic IG (n = 51 )– manual Outcomes: Outcomes 

(2005)240 36 – 37 years headaches therapy: not defined Pain: 1- MPQ/ PRI (describe 

Tx duration: 2- Headache specific instrument used): 

Country: 

US 

Quality 

Fu duration (last 

assessment): 1 week 

immediately post tx; 3, 6, 

and 12 months post tx 

% of male: NR 

Racial 

composition: NR 

Duration of 

Pain, mean 

(SD/range): NR 

Drop outs: NR 

IG2 (52): combined 

locus of control scale 

(HSLC) 

3- pain produced by 

active cervical 

movements by VAS 

Daily medication 

intake were 

measured at 

baseline (over the 

counter: antiscore: 9/13 N screened: NR manipulative tx and Pain and disability: inflammatory 

N randomized: 200 Work status: NR Severity of pain exercise by Northwick Park medications in 

N completed tx: (Grading): NR Drop outs: NR Neck Pain short and owe 

Initial of N attended last fu: Other socio­ questionnaire doses)—analysed 

reviewer: FY 

Inclusion: adults 18 – 60 

years with unilateral or 

unilateral dominant side 

consistent cervicogenic 

headaches aggravated by 

demographics: 

NR 

Co morbidities: 

NR 

Current 

treatment/ cointervention 

common in all 

CG1 (49): exercise 

therapy 

Drop outs: NR 

Main objective: 

predictors from 

variables in pts 

demographics and 

headache hx of 

achieving 50-79% or 

as defined daily 

does (DDD): data 

NR 

Harms: NR 

neck postures or groups: NR CG2 (n = 48)– control: 80-100% reduction in 

movement (presence of Prior episode of not defined headache Summary: no 

joint tenderness as pain if acute: NR Drop outs: NR immediately post and consistent pattern 

detected by manual 12 months post-tx of prediction of 

palpation)- frequency of 

headache at least1/week 

with history of 2 months 

Prior CAM 

intervention: NR 

Results: 

Lightheadedness had 

higher odds of 

successful 

outcomes (all 

demographics 

and 10 years achieving 50-79% including age, 

Exclusion: other causes of Prior surgery 

reduction in 

headache: OR = 5.45 

gender, family 

history, pain 

headache; bilateral related to current or 80-80% OR = 5.7 intensity/ 

headaches; migraine; complaint: NA at 12 months frequency, 

contraindication for medication use, 

manipulative therapy, or associated 

current involvement in third symptoms, etc) 

party or workers 

compensation 

C-253
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome 

results: 

Other 

outcomes; 

Harms 

Nilsson, N Trial Design-RCT Mean age Region of pain: Groups Outcomes Outcomes 

(1997)246 

Tx duration: 3 wks 

Fu duration (last 

(SD/range): IG = 

42 vs. CG = 35 

yrs 

NP 

Cause of Pain: 

N-S 

IG (n = 28) – SM: 

toggle recoil for upper 

cervical region and 

(describe 

instrument used): 

Pain: 100 mm VAS­

(describe 

instrument 

used): 

Country: assessment): 3 wks diversified technique for mean intensity of QoL/ well being: 

Denmark 

N screened: 450 

N randomized: 53 

% of male: IG = 

46%, CG = 40% 

Duration of 

mid and lower cervical, 

as determined on 

palpation; in each 

daily headache 

Results: 

NR 

Quality N completed tx: 53 Racial Pain, mean technique a HVLA thrust Baseline: Number of 

score: 7/13 N attended last fu: 53 

Inclusion: 20-60 yrs 

composition: NR 

Work status: 

(SD/range): 

Chronic, NR 

in line of drive at end 

point of normal passive; 

2 wk observation period, 

Pain: IG = 44, CG = 

41 

analgesics/d 

(mean): 

Baseline: 

Initial of with headache  5 Severity of pain 6 sessions over 3 wks Immediate post tx: 1.5 vs. 1.0 

reviewer: ds/mo for at least 3 mo; Other socio­ (Grading): IG = Drop outs: A = 0, B = 0 Pain: IG = 28, CG = 

SG no prior SM in cervical 

spine; no effect of 

migraine Med if tried; 

headache in occipital 

region, with or without 

forward radiation; 

aggravated by neck 

postures 

Exclusion: NR 

demographics: 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

48, CG = 37 

Current tx/ cointervention 

common in all 

groups: NR 

CG (n = 25) – Massage: 

deep friction massage, 

including TP, of 

posterior muscles of 

shoulder girdle, the 

upper thoracic & lower 

cervical regions, plus tx 

with laser light in upper 

cervical region; laser 

light added to include an 

upper cervical 

intervention; Same as 

IG 

Drop outs: A = 0, B = 1 

36 

Short term: NR 

Intermediate: NR 

Long term: NR 

Immediate post 

tx: 0.8 vs. 0.7 

Short term: NR 

Intermediate: NR 

Long term: NR 

Harms: NR 

C-254
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Sloop, P 

(1982)241 

Trial Design-RCTcross over Mean age 

(SD/range): NR 

Region of pain: 

NP 

Groups 

IG (n = 21)– 

Outcomes 

(describe 

Outcomes 

(describe 

Cause of Pain: Manipulation: NR; one instrument used): instrument 

Country: Tx duration: One % of male: NR N-S tx session, 3 wk fu to Pain: 100 mm VAS used): 

session assess outcomes (0-100) QoL/ well being: 

Fu duration (last Racial Drop outs: NR NR 

assessment): 3 wks composition: NR Results: General effective 

Quality CG (n = 18) – Control: Baseline: rate (did the tx 

score: 5/13 Work status: NR Duration of NR; As IG Pain: NR help you?) 

N screened: NR Pain, mean Drop outs: NR 

N randomized: 39 Other socio­ (SD/range): Immediate post tx: Immediate post 

Initial of N completed tx: NR demographics: Chronic, NR Pain-mean change: tx: pre cross over 

reviewer: N attended last fu: NR NR IG = 18.0 (31), CG data 21 (57%) vs. 

SG Severity of pain = 5.0 (32), p = 0.20 18 (28%) 

Co morbidities: (Grading): NR responded yes, p 

Inclusion: 19-68 yrs NR Short term: NR = 0.13 

with cervical spondylosis 

or N-S NP of at least Prior episode of Current tx/ co- Intermediate: NR Short term: NR 

one mo duration; no pain if acute: NR intervention 

symptoms suggestive of common in all Long term: NR Intermediate: NR 

major systemic disease; Prior CAM groups: 20mg 

no progressive neurlogic intervention: NR diazepam Long term: NR 

signs and no extraneous intravenously 

local cause of symptoms Harms: NR 

Prior surgery 

Exclusion: NR related to current Summary: local 

complaint: NR tenderness at 

baseline was the 

only item 

associated with 

VAS outcome (p 

= 0.013) 

C-255
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Sterling, M Trial Design-RCT Mean age Region of pain: Groups Outcomes Outcomes 

(2001)248 (SD/range): 35.77 NP IG (n = 10)– Spinal (describe (describe 

Country: 

Canada 

Tx duration: one session 

Fu duration (last 

assessment): post tx 

(14.92) yrs (total) 

% of male: IG = 

Cause of Pain: 

N-S 

Mob: SMT tx (passive 

Mob) condition, 

researcher applied a 

instrument used): 

Pain: Pressure pain 

threshold (PPT); 

instrument 

used): 

QoL/ well being: 

N screened: NR 

N randomized: 30 

47%, CG1 = 53%, 

CG2 = NR 

grade III posteroanterior technique to the resting pain (VAS)- 

result of post hoc 

NR 

Quality N completed tx: NR articular pillar of C5/6 on analysis reported Other: EMG 

score: 7/13 N attended last fu: NR Racial Duration of the subject's as comparison if IG activity (data not 

composition: NR Pain, mean symptomatic side vs. CG1 or IG vs. shown) 

Inclusion: Pts were (SD/range): (Maitland 1986); one CG2 

Initial of included if they had a Work status: NR Chronic, NR time in a crossover 

reviewer: 

SG 

history of mid to lower 

cervical spine pain of 

insidious onset, greater 

than 3 mo duration and 

were assessed by a 

Other sociodemographics: 

NR 

Severity of pain 

(Grading): NR 

design 

Drop outs: NR 

CG1 (n = 10) – Placebo 

Disability: NR 

Results: 

Immediate post 

tx: NA 

Short term: NR 

manipulative SM: Manual contact was Immediate post tx: 

physiotherapist as having Co morbidities: Current tx/ co­ applied over the articular Pain at rest: IG vs. Intermediate: NR 

symptoms primarily NR intervention pillar of C5/6 on the CG1 0.091 ; IG vs. 

originating from the C5/6 common in all symptomatic side but CG2 0.044 Long term: NR 

segment. Prior episode of groups: NR with no movement of the Disability: NA 

Exclusion: a history of 

trauma or surgery to the 

cervical spine; evidence of 

referred arm pain or 

pain if acute: NR 

Prior CAM 

intervention: NR 

vertebral segment; as IG 

Drop outs: NR 

CG2 (n = 10) – Control: 

Short term: NR 

Intermediate: NR 

Harms: NR 

radiculopathy; headache, no physical contact (no 

dizziness or other upper tx); as IG Long term: NR 

cervical spine symptoms; Prior surgery Drop outs: NR

diabetes or peripheral related to current 

vascular disease complaint: NR 

C-256
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Whittingham Trial Design-RCT Mean age Region of pain: Groups Outcomes Outcomes 

, W (SD/range): 39.4 NP IG (n = 55)– (describe (describe 

(2001)247 

Country: 

Australia 

Tx duration: 3 wks 

Fu duration (last 

assessment): cross over 

deign- data pre- crossover 

is shown 

(12.5) yrs 

% of male: 40.8% 

Racial 

Cause of Pain: 

N-S 

Manipulation: 

manipulation to the 

cervical spine: single 

toggle-coil thrust (a 

short-lever, high-velocity 

instrument used): 

Pain: NR 

Disability: NR 

instrument 

used): 

QoL/ well being: 

Active cervical 

N screened: NR composition: NR Duration of technique) to C1 or C2 Results: ROM: 

N randomized: 105 Pain, mean as indicated; 3 tx/wk for Immediate post tx 

Quality N completed tx: 105 Work status: NR (SD/range): 3 wks Immediate post tx: (3 wks): right rot: 

score: 8/13 N attended last fu: 105 Chronic, NR Drop outs: E = 3 Pain: NR 57 (1.4) vs. 56 

Initial of 

reviewer: 

SG 

Inclusion: 16 yrs or older 

cervicogenic headache with 

4 or more ds of headache 

in 1 mo for more than 6 mo; 

headache in occipital 

Other sociodemographics: 

NR 

Co morbidities: 

Severity of pain 

(Grading): NR CG (n = 50) – Sham 

manipulation: sham 

manipulation as IG 

Disability: NR 

Short term: NR 

Intermediate: NR 

(1.6) 

Left rot: 55 (1.4) 

vs. 54 (1.6) 

Right lateral 

flextion:37 (1.2) 

region, with/without forward NR Current tx/ co­ delivered with vs. 39 (1.3) 

projection; headache intervention deactivated Pettibon Long term: NR Left lateral 

provoked by neck Prior episode of common in all instrument; 3 tx/wk for 3 flextion: 36 (1.4)

movements or positions or pain if acute: NR groups: NR wks vs. 38 (1.1) sub-occipital manual Drop outs: NR degress

pressure Prior CAM 

Exclusion: NR ­ intervention: NR Short term: NR 

Intermediate: NR 

Prior surgery Long term: NR 

related to current Harms: NR 

complaint: NR 

C-257
 
Table 2.13 Neck Pain - Manipulation & Mobilization – Mixed - Specific Pain 

Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Coppieters, Trial DesignRCT- Mean age Region of pain: Groups Outcomes: Outcomes: 

M (SD/range): IG = Brachial or IG (n = 10)– Pain: Pain intensity QoL/ well being: 

(2003)250 Tx duration: NR 49.1 (14.1) vs. Cervicobrachial Experimental Mob: NR 

Country: 

Fu duration (last 

assessment): NR CG = 46.6 (12.1) 

yrs 

neurogenic pain 

Cause of Pain: 

Cervical contralateral 

lateral glide Mob Results: Range of Motion 

Belgium N screened: 20 

N randomized: 20 % of male: IG = 

NR technique applied at 1 or 

more motion segments Immediate post tx: 

(ROM) 

Baseline: 137.3 

N completed tx: NR 20%; CG = 0.2% (C5-T1) with pt in supine Pain: 5.8 (2.1) vs. (15.4) vs. 130.2 

N attended last fu: NR position, most frequent 7.4 (1.8) (14.7) 

Quality Racial treated spinal levels 

score: 5/13 Inclusion: Sub-acute (2 composition: NR Duration of were C5, C6 and C7 at Short term: NR 

wks-6 mo) unilateral (15) or Pain, mean low frequency; NR Immediate post 

Initial of 

reviewer: 

SG 

bilateral (5) peripheral 

neurogenic cervicobrachial 

pain, presence of a cervical 

segmental motion 

restriction related to a 

Work status: NR 

Other sociodemographics: 

(SD/range): 

Mixed, IG = 2.7 

mo, CG = 3.2 

mo 

Drop outs: NR 

CG (n = 10) – ControlUltrasound: Pulsed 

Intermediate: NR 

Long term: NA 

tx: 156.7 (10.7) 

vs. 130.7 (16.0) 

Short term: NR 

neurogenic disorder, NR ultrasound applied over 

adverse response to neural Severity of pain the most painful area; Intermediate: NR 

tissue provocation testing, Co morbidities: (Grading): NR applied for 5 min, dose 

painful nerve trunk NR of 0.5 W/cm2, sonation Long term: NA palpation, or signs of a time 20%, size of tx local musculoskeletal 

dysfunction such as 

cervical segmental motion 

restriction 

Exclusion: Neurogenic 

Prior episode of 

pain if acute: NR 

Prior CAM 

Current tx/ cointervention 

common in all 

groups: NR 

head 5 cm2, freq. 1 

MHz, sonopulse 590; 

NR 

Drop outs: NR 

Harms: NR 

disorders, such as diabetic intervention: NR 

neuropathy, that are not 

amenable to manipulative 

therapy management Prior surgery 

related to current 

complaint: NR 

C-258
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome 

results: 

Other 

outcomes; 

Harms 

Fernandez- Trial Design-RCT Mean age Region of pain: Groups Outcomes Outcomes: 

de-las­ (SD/range): 31.2 Head and Neck IG (n = 44)– Dorsal (describe QoL/ well being: 

Penas, C Tx duration: 3 wks yrs total Cause of Pain: manipulation + PT: instrument used): NR 

(2004)249 Fu duration (last 

assessment): % of male: 45% 

Whiplash active EXs, electrotherapy, ultrasound and Pain: VAS (0-100) 

Immediate post 

Country: immediately post-tx total manual therapy. Dorsal Results: tx: NA 

Spain 

N screened: 88 

N randomized: 88 

Racial 

composition: NR Duration of 

manipulation was 

performed once at the 

5th and 10th sessions. 

Immediate post tx: 

Pain reduction one 

wk after 1st dorsal 

Short term: NR 

Quality N completed tx: NR Pain, mean Manual therapy was manipulation Intermediate: NR 

score: 6/13 N attended last fu: NR Work status: NR 

Other socio­

(SD/range): 

Mixed, NR 

applied as HVLA 

technique. A cracking or 

popping sound 

cervical pain: 54 vs. 

39; TP 143 vs. 32; 

head pain: NR 

Long term: NR 

Initial of Inclusion: Suffering demographics: Severity of pain accompanied the Harms: NR 

reviewer: from neck and head pain NR (Grading): NR manipulation; 5 tx/wk, After 2nd 

SG due to whiplash injury of 

less than 3 mo and 

classified in grades II 

and III 

Exclusion: Whiplash 

injury since 3 mo ago, 

previous whiplash injury 

before the study, 

articular instability, and 

degenerative cervical 

alteration 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

Current tx/ cointervention 

common in all 

groups: NR 

15 tx, 3 wks 

Drop outs: NR 

CG (n = 44) – 

Physiotherapy: active 

EXs, electro-therapy, 

ultrasound and manual 

therapy, ultrasound in 

soft tissues of neck 

region, active EXs at 

home, muscle stretching 

and multimodal therapy; 

As IG 

Drop outs: NR 

manipulation: 

cervical pain: 100 

vs. 73; TP 238 vs. 

59 head pain 

Short term: NR 

Intermediate: NR 

Long term: NR 

Summary: 

Dorsal 

manipulation 

favors the clinical 

improvement in 

whiplash pts. IG 

had more 

reduction of 

symptoms than 

the CG 

C-259
 
Table 2.14 Neck Pain - Manipulation & Mobilization - Mixed - Non-Specific Pain 

Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Brodin Trial Design Mean age Region of pain: Groups Outcomes Outcomes 

(1983)259 RCT (SD/range): NR IG (n = 23)– Medication: (describe (describe 

Country: 

Sweden 

Tx duration: 3 wks 

Fu duration (last 

% of male: NR 

Cause of Pain: 

N-S 

Premaspin 1.5 g + 0.5 g + 

0.5 g daily for 3 wks 

Drop outs: NR 

instrument used): 

Pain: VAS 

instrument 

used): 

QoL/ well being: 

assessment): NR Racial 

composition: NR CG1 (n = 17) – 

Information, Med + sham 

Disability: NR NR 

Quality N screened: NR therapy: as IG + Results: Increased 

score: 3/13 N randomized: 63 

N completed tx: 55 

N attended last fu: NR 

Work status: NR 

Other socioDuration of 

Pain, mean 

(SD/range): 

information on anatomy of 

cervical spine and pathophysiology, biomechanical 

Immediate post tx: 

Pain: NR 

mobility at the 

final tx: 

< 30 degrees: 

Initial of demographics: Mixed, NR problems and relaxation, Disability: NR 16/23 vs. 11 vs. 

reviewer: 

SG 

Inclusion: between 27­

60 yrs of age; condition 

suitable for manual 

therapy (i.e. possible by 

NR 

Co morbidities: 

NR 

Severity of pain 

(Grading): NR 

related to practical 

problems + superficial 

massage, electric 

stimulation and slight 

relaxing traction; 3 hrs 

Short term, one wk 

post tx: pts with no 

pain: j2 (22%) vs. 2 

17 vs. 8/23 

> 30 degrees 

7/23 vs. 6/17 vs. 

means of manual 

technique to observe 

restricted movement in 

pain-producing segment) 

Exclusion: pain from 

segments with normal or 

increased mobility 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

Current tx/ cointervention 

common in all 

groups: NR 

instruction, 3 tx/wk for 3 

wks 

Drop outs: A = 8 

CG2 (n = 23) – 

Information, Med + Manual 

Mob: CG1 + mobilizing 

technique comprised of 

passive movements 

directed to actual mobile 

(12%) vs. 11 (48% 

Intermediate: NR 

Long term: NA 

15/23 

Short term: NR 

Intermediate: NR 

Long term: NA 

Harms: pts with 

increased pain 5 

(22%) vs. 2 

related to current segments; as CG1 (12%) vs. 1 (4%) 

complaint: NR Drop outs: NR 

In total, 16% of 

pts had some 

discomfort 

C-260
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Cassidy, J Trial Design-RCT Mean age Region of pain: Groups Outcomes: Outcomes 

(1992)252 (SD/range): IG = NP IG (n = 52)– Manipulation: Pain: NRS (0-100) (describe 

Country: 

Canada 

Tx duration: one session 

Fu duration (last 

assessment): immed. 

Post-tx 

34.5 (13) vs. CG = 

37.7 (12.5) yrs 

% of male: NR 

Racial composition: 

Cause of Pain: 

N-S, 100% with 

radiating pain 

contacting third finger over 

articular pillar on painful 

side of neck at level of 

tenderness and passively 

rotating neck away from 

painful side as far as 

Results: 

Baseline: 

Pain: IG = 37.7 

(25.9), CG = 31 

instrument 

used): 

QoL/ well being: 

NR 

Quality N screened: NR NR possible; then applying a (19.9) Range of motion 

score: 6/13 N randomized: 100 high-velocity, low­ (ROM): 

N completed tx: 100 Work status: NR Duration of amplitude thrust in the Immediate post tx: 

N attended last fu: 100 Pain, mean same direction; one Pain: IG = 20.4 Immediate post tx 

Initial of Other socio­ (SD/range): session (21.2), CG = 20.5 flx: 61.0 (10.1) 

reviewer: demographics: NR Mixed Drop outs: A = 0, B = 0 (21) vs. 59.6 (14.0) 

SG Inclusion: outPts 

suffering from unilateral 

mechanical NP with 

Co morbidities: 

History of NP, n = 

78; Involved in car 

Severity of pain 

(Grading): NR 

CG (n = 48) – Mobilization: 

application of muscle 

energy technique 

Short term: NR 

ext: 59.9 (11.0) 

vs. 54.7 (14.6) 

gain scores for all 

radiation into the accident, n = 31; (Bourdillon Day) to Intermediate: NR ROM data was 

trapezius muscle; pain other minor trauma hypertonic muscles NSly differenet 

aggravated by to neck, n = 28 Current tx/ co­ responsible for restricting Long term: NA between groups 

movement and local intervention joint movement, pt 

cervcial paraspinal Prior episode of common in all instructed to push against Short term: NR 

tenderness pain if acute: NR groups: NR manual resistance, 

localized force to involved Intermediate: NR 

Exclusion: NR 

Prior CAM 

intervention: NR 

levels; isometric 

contraction held for 5 sec, 

repeated 4 times with 

Long term: NA 

Prior surgery increasing rot or lateral flx Harms: No 

related to current of the neck; As IG complications 

complaint: NR Drop outs: A = 0, B = 0 repported 

C-261
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome 

results: 

Other 

outcomes; 

Harms 

Cleland JA Trial Design-RCT- Mean age Region of pain: Groups Outcomes: Outcomes: 

(2007)256 

Tx duration: NR 

(SD/range): IG = 

43.8 (11.5) vs. 

NP 

Cause of Pain: 

IG (n = 30) – 

Manipulation/ 

Pain: Numeric Pain 

Rating Scale 

QoL/ well being: 

NR 

Country: Fu duration (last CG = 42.7 (13.9) N-S Mobilization with thrust: 

US assessment): 3 mos 

N screened: 104 

N randomized: 60 

yrs 

% of male: IG = 

40%; CG = 50% Duration of 

Pts received thrust M/M 

targeting the upper (T1 

and T4) and middle (T5 

and T8) thoracic spine; 

Disability: Neck 

Disability Index 

Results: 

Results- mean : 

Baseline: NA 

Immediate post 

Quality N completed tx: 60 Pain, mean advice for EX; neck and Baseline: tx: NA 

score: 7/13 N attended last fu: 60 

Inclusion: Subjects 

Racial 

composition: NR 

(SD/range): 

Mixed, IG = 55 

(46) ds; CG = 56 

head rot to both sides 

alternatively; advice for 

EX; neck and head rot 

Pain: IG = 4.5 (2.1), 

CG = 5.3 (1.4) 

Disability: IG = 29.6 

Short term: NR 

Initial of aged 18-60 yrs with Work status: NR (27.6) ds to both sides (12.6), CG = 33.5 Intermediate: NR 

reviewer: primary complaint of NP, alternatively; 3 (11.2) 

SG and baseline NDI  10% 

Exclusion: Medical 

signs suggestive of nonmusculoskeletal 

etiology, history of 

whiplash injury within 6 

wks, spinal stenosis, 

CNS involvement, nerve 

root compression, 

previous cervico-thoracic 

surgery, or pending legal 

action 

Other sociodemographics: 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

Severity of pain 

(Grading): NR 

Current tx/ cointervention 

common in all 

groups: N (%) 

NSAIDs: IG = 8 

(27), CG = 16 

(53); Pain meds 

IG = 2 (7), CG = 

9 (30), muscle 

relaxant IG = 2 

(7), CG = 3 (10) 

min/session 

Drop outs: 0 

CG (n = 30) – M/M 

without thrust: Prone 

position; 30-sec bout of 

grade 3-4 central 

posterior anterior-non 

thrust M/M at the T1 

spinous process as 

described by Maitland et 

al; same technique 

applied to T2 and up to 

T6; advice for EX; neck 

and head rot to both 

sides alternatively; As 

IG 

Drop outs: 0 

Short term: Pain: IG 

= 3.9 (2.2), CG = 

2.7 (1.4) 

Disability: IG = 24.0 

(13.4), CG = 18.0 

(10.9) 

Intermediate: NR 

Long term: NR 

Long term: NR 

Harms: 

Aggravation of 

symptoms (n = 

10); Muscle 

spasm (n = 2); 

Neck stiffness (n 

= 2); Headache 

(n = 3); Radiating 

symptoms (n = 2) 

C-262
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Haas, M Trial Design-RCT Mean age Region of pain: Groups Outcomes: Outcomes 

(2003)254 (SD/range): IG = LBP, NP, thorax IG (n = 47)– Pain: VAS for NP (describe 

(phase 4 Tx duration: One 42.2 (12.9) vs. Cause of Pain: Manipulation: supine (100 mm)- 11-pt NRS instrument 

diagnostic 

trial) 

session 

Fu duration (last 

assessment): 3 mos 

CG = 42.9 (14.4) 

yrs 

N-S high-velocity, lowamplitude manipulation 

of cervical spine 

Disability: 100 mm 

VAS-11-pt NRS 

used): 

QoL/ well being: 

NR 

Country: N screened: 108 

% of male: IG = 

41%, CG = 33% Duration of 

targeted to individual 

cervical vertebrae 

Results-Baseline: 

Pain: IG = 42.3 Immediate post 

US N randomized: 104 Pain, mean according to whether (16.5), CG = 40.4 tx: NA 

N completed tx: 99 Racial (SD/range): cervical endplay (20.9) 

N attended last fu: 99 composition: 92% Mixed, > 30: IG restriction noted by Disability: IG = 44.5 Short term: NR 

Quality White = 51%, CG = examining clinician; 1 tx (17.7), CG = 43.9 

score: 8/13 Inclusion: 18 yrs and 63% Drop outs: A = 0, B = 0 (20.4) Intermediate: NR 

Initial of 

reviewer: 

older with min. pain level 

of 10 on 100mm VAS 

who had not received 

cervical manipulation in 

Work status: NR 

Other sociodemographics: 

Severity of pain 

(Grading): NR 

CG (n = 52) – Control: 

manipulation according 

to sham endplay 

Immediate post tx: 

Pain: IG = 26.6 

(20.2), CG = 24.7 

(19.5) 

Long term: NR 

Harms: 

SG preceding 48 hrs 

Exclusion: cancer, 

blood dyscrasias, severe 

osteopenia, severe 

trauma or fracture, disc 

herniation or cervical 

radiculopathy, signs of 

NR 

Co morbidities: 

Prior episode of 

pain if acute: NA 

Prior CAM 

intervention: 

Current tx/ cointervention 

common in all 

groups: NR 

findings generated by a 

computer algorithm; 1 tx 

Drop outs: A = 0, B = 0 

Disability: IG = 26 

(20.2), CG = 24.4 

(19.4) 

Short term: Pain: IG = 

31.9 (20.3), CG = 

28.7 (19.6) 

Disability: IG = 34.6 

(18.5), CG = 30.2 

(22.3) 

immediate pain 

exacerbation for 

examinationbased SM was 

no different from 

that for computergenerated 

indication for SM 

(odds ratio, 1.05; 

vertebrobasilar 95% CI, 0.36– 

insufficiency Prior surgery Intermediate: NR 3.04; P � 0.932). 

related to current 

complaint: NR Long term: NR 

C-263
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Hurwitz, E Trial Design Mean age Region of pain: Groups Outcomes: Outcomes: 

(2002)251 RCT- (SD/range): IG = NP IG (n = 171) – Pain: NRS QoL/ well being: 

Country: 

Korea 

Tx duration: NR 

Fu duration (last 

assessment): 6 mos 

N screened: 1848 

45.7 (11.8) vs. CG = 

45.7 (12.2) yrs 

% of male: 31% 

Racial composition: 

Cause of Pain: 

NR 

Manipulation: at least one 

controlled dynamic thrust 

applied with high-velocity 

and low-amplitude force 

with minimal ext and rot 

directed at one or more 

Disability: NDI (0-50) 

Results-Baseline: 

Pain: IG = 6.4 (2.1), 

CG = 6.6 (2.1); IG = 

4.7 (1.9), CG = 4.8 

(1.9) 

SF-36 physical 

function (all 

grps); SF-36 

physical role (all 

grps) 

N randomized: 336 61.95% White Duration of restricted upper thoracic or Disability: IG = 13.1 

Quality N completed tx: NR Pain, mean cervical spine joint (6.2), CG = 13.3 (6.3) Results- mean : 

score: 7/13 N attended last fu: NR 

Inclusion: 18-70 yrs 

Work status: 7.75% 

Unemployed 

(SD/range): 

Unknown (mix) 

segments; with or without 

heat, with or without 

electrical muscle 

Immediate post tx: 

Average pain: 0.97 

Baseline: 78.5 

(20.57); 56.9 

(38.57) 

Initial of 

reviewer: 

SG 

belonging to a health 

maintenance organization, 

seeking care between Feb 

9/98- June 30/00 

Other sociodemographics: 

65.6% Married 

Severity of pain 

(Grading): NDI 

scores <5, >20 

stimulation 4 wks 

Drop outs: NR 

CG ( n = 165) – 

((95% CI: 0.77, 1.23) 

NDI: 1.05 (95% CI: 

0.82, 1.35) Immediate post 

tx: 

presenting with NP, and not 

having received tx for NP in 

past mo 

Exclusion: NP due to 

fracture, tumor, infection, 

severe 

spondyloarthropathy, or 

other nonmechanical 

cause; progressive 

neurological deficit, 

Co morbidities: 

Head-ache, arm 

pain, arm numb 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

Current tx/ cointervention 

common in all 

groups: 

Information 

about posture 

and body 

mechanics 

Mobilization: one or more 

low velocity, variable 

amplitude movements 

applied witin the passive 

ROM directed to 1 or ore 

restricted upper thoracic or 

cervical spine joint 

segments; with or without 

heat, with or without 

electrical muscle 

stimulation 

Short term: 

Average pain: 0.93 

(95% CI: 0.81, 1.17) 

NDI: 0.99 (95% CI: 

0.79, 1.24) 

Intermediate: 

Average pain: 0.92 

(95% CI: 0.74, 1.15) 

NDI: 0.85 (95% CI: 

0.66, 1.08) 

Long term: NA 

Short term: NR 

Intermediate: NR 

Long term: NA 

Harms: pts in IG 

were more likely 

to experience 

transient AEs 

druign the initial 4 

myelopathy, herniated related to current ; 4 wks wks : 16% vs. 

nucleus pulposus or severe complaint: NR Drop outs: NR 8.7%, p = 0.051 

incapacitating pain; 

C-264
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Kanlayanap Trial Design-RCT Mean age Region of pain: Groups Outcomes: QoL/ well being: 

hotporn, R (SD/range): IG = NP IG (n = 30)– Ipsi-lateral Pain: 100 mm VAS GPE-

(2009)258 

Country: 

Thailand 

Tx duration: one session 

Fu duration (last 

assessment): immed. Posttx 

39.7 (10) vs. CG 

= 44.8 (13.6) yrs 

% of male: IG = 

Cause of Pain: 

N-S 

uni-lateral posteroanterior Mob: over 

zygapophysial joint of 

cervical spine, on the 

as rest; 100 mm 

VAS at most painful 

movement 

immediately post 

tx:Completely 

recovered: 2/30 

vs. 2/30 

N screened: 84 43.3%, CG = side of the symptoms Results: 

N randomized: 60 36.7% (ipsilateral); one tx Baseline: Immediate post 

Quality N completed tx: 60 Duration of Drop outs: A = 0, B = 0 Pain: IG = 47.4 tx: 

score: 11/13 N attended last fu: 60 Racial Pain, mean (15.9), CG = 48.3 Cervical ROM, 

composition: NR (SD/range): Mix, CG (n = 30) – Random (22.2); IG = 59.5 changre from Inclusion: mechanical NP, IG = 804.3 Mob: one of the (16.6), CG = 61.6 baseline 

Initial of 

reviewer: 

SG 

unilaterally distributed for at 

least 1-wk duration; 

symptoms primarily 

confined to area between 

superior nuchal line and tip 

Work status: NR 

Other sociodemographics: 

(149.4) ds; CG = 

999.6 (182.5) ds 

Severity of pain 

following three Mob 

techniques that could be 

applied in a clinic as a 

placebo intervention: 1) 

(23) 

Immediate post tx: 

Pain-mean change: 

(degree): 

Flextion: 1.9 (4.1) 

vs. -0.7 (4.5) 

Extension: 1.8 

of first thoracic spinous NR (Grading): IG = central posteroanterior IG = 10.8 (11.4), (6.3) vs. 0.8 (4.6) 

process and provoked by 22.9 (10), CG = (PA) Mob; 2) ipsilateral CG = 12.3 (12.5); On most painful 

neck movements or by Co morbidities: 26.5 (10) unilateral PA; 3) IG = 16.7 (17.6), movement: 2.7 

sustained neck postures; NR contralateral unilateral CG = 16.9 (16) (5.5) vs. 1.4 (4.3) NP at rest > 20 on 100mm PA pressure; one tx VAS 

Exclusion: 

contraindications to Mob; 

trauma/fracture of cervical 

spine; cervical spine 

Prior episode of 

pain if acute: NR 

Prior CAM 

Current tx/ cointervention 

common in all 

groups: 

Drop outs: A = 0, B = 0 Short term: NR 

Intermediate: NR 

Short term: NR 

Intermediate: NR 

surgery; SMwithin past mo; intervention: NR Long term: NR 

positive neurological Long term: NA 

examination Prior surgery Harms: No AE 

related to current as result of Mob 

complaint: NR was reported. 

C-265
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Martinez- Trial Design-RCT Mean age Region of pain: Groups Outcomes QoL/ well being: 

Segura, R 

(2006)253 Tx duration: One 

(SD/range): IG = 

35 (10) vs. CG = 

NP 

Cause of Pain: 

IG (n = 34)– Cervical 

HVLA: directed at 

(describe 

instrument used): 

NR 

Improvement of 

session 39 (10) yrs dysfunctional level, with Pain: VAS NP at ROM (pre-post 

Country: Fu duration (last Pt supine with cervical rest (0-100 cm) IG vs. pre-post 

Spain assessment): Immed. % of male: IG = spine in neutral position, CG): 

Post-tx 38.2%, CG = HVLA thrust directed Immediate post 

35.1% Duration of upwards, S Results: tx: 

Quality N screened: NR Pain, mean cracking/popping sound Baseline: flx 7.0 (95% CI: 

score: 6/13 N randomized: 71 Racial (SD/range): accompanied all Pain: IG = 5.7 (1.5), 9.0, 5.0) vs. 1.5 

N completed tx: 71 composition: NR Mixed, IG = 4 manipulations; 1 tx CG = 5.5 (1.7) (95% CI: 2.4, 0.7) 

N attended last fu: 71 (3.4) wks, CG = Drop outs: NR 

Initial of Work status: NR 4.5 (4.6) wks Immediate post tx: Short term: NR 

reviewer: Inclusion: age >/= 18 CG (n = 37) – Control Pain: IG = 2.2 (1.5), Intermediate: NR 

SG yrs; mechanical NP >/= Other socio- Severity of pain (manual Mob): Pt supine CG = 5.1 (1.9) Long term: NR 

1 mo in duration demographics: (Grading): NR with cervical spine in Harms: NR 

referred by primary care NR neutral position, held for Improvement of 

physician 30 sec without additional pain (pre-post IG -tive association 

Exclusion: Co morbidities: Current tx/ co­ tension and HVLA vs. pre-post CG): between the 

contraindication to NR intervention thrust, side of manual 3.5 (3.9, 3.1) vs. improvement in 

manipulation; common in all contact was 0.4 (95% CI: 0.5, NP at rest & 

fibromyalgia; whiplash Prior episode of groups: NR randomized; 1 tx 0.2) improvement on 

injury history; history of pain if acute: NA Drop outs: NR each ROM: 

cervical spine surgery; Short term: NR flx (r = -0.6, P < 

diagnosis of cervical Prior CAM .001), ext (r = ­

radiculopathy or intervention: NR Intermediate: NR 0.6, P P< .001) 

myelopathy; SM tx within [less pain with 

one mo prior to study; Prior surgery Long term: NR better ROM] 

positive result in ext-rot related to current 

test complaint: None 

C-266
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Strunk, R Trial Design-RCT Mean age Region of pain: Groups Outcomes: Outcomes 

(2007)257 (SD/range): IG = NP IG (n = 3)– Cervical Median (range) (describe 

Country: 

U.S 

Tx duration: 2 wks 

Fu duration (last 

assessment): Post-tx 

42 (12) vs. CG = 

54 (10) yrs 

Cause of Pain: 

Mechanical 

spine HVLA SM: pts 

received HVLA SM to 

C0 through C7 vertebral 

Pain: VAS (0-100 

mm) 

instrument 

used): 

QoL/ well being: 

N screened: 12 

N randomized: 6 

% of male: IG = 0, 

CG = 16.7% 

levels at the discretion 

of the doctor; 4 tx 

Disability: NDI (0­

100) 

NR 

Quality N completed tx: 6 sessions over 2 wks 

score: 6/13 N attended last fu: 5 Racial Duration of Drop outs: 0 Results: Immediate post 

composition: Pain, mean Baseline: tx: NA 

Inclusion: Pts 20-65 yrs 100% White/Non­ (SD/range): CG (n = 3) – Combined Pain: IG = 35.0 (12­

Initial of with primary complaint of Hispanic Mixed, NR therapeutic approach: 34), CG = 29.0 (27­ Short term: NR 

reviewer: 

SG 

mechanical NP for at least 

4 wks. Pts who had 

secondary complaint of 

headache as long as their 

primary complaint was NP 

Work status: NR 

Other socioSeverity of pain 

(Grading): ptw 

with 

Pts received HVLA SM 

to T1 through T12 

vertebral levels and the 

sacroiliac joints at 

50) 

Disability: IG = 

34.0 (12-34), CG = 

Intermediate: NR 

Long term: NR 

Exclusion: NP resulted demographics: grade 3 or 4 on discretion of doctor. 24.0 (20-38) 

from inflammatory joint 50% Married Quebec Task Muscle energy Harms: Two 

disease, infection, tumor, Force technique administered Immediate post tx: indicated they

fracture; comorbid disease Co morbidities: classification according to Lewit Pain: outcome by experienced that would contraindicate 

HVLA SM; currently 

receiving tx of NP by other 

health care providers; 

previous history of stroke, 

diagnosis of a bleeding 

NR 

Prior episode of 

pain if acute: NR 

system were 

excluded 

Current tx/ cointervention 

procedure, 2 sets of 3 

reps; Same as IG 

Drop outs: 1 

pts- data not shown 

Disability: outcome 

by pts- data not 

shown 

discomfort or an 

unpleasant 

reaction from 

study tx in post-tx 

response 

disorder or currently Prior CAM common in all Short term: NR questionnaire 

undergoing anti- intervention: NR groups: NR 

coagulation tx Intermediate: NR 

Prior surgery Long term: NR 

related to current 

complaint: NR 

C-267
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Vernon, H 

(1990)255 

Trial DesignRCT 

Mean age 

(SD/range): 32.5 

Region of pain: 

NP 

Groups 

IG (n = 5)– Rotational 

Outcomes 

(describe 

Outcomes 

(describe 

yrs Cause of Pain: manipulation: high instrument used): instrument 

Country: Tx duration: One N-S velocity, low amplitude Pain: Pessure pain used): 

Canada session % of male: 66.7% thrust; one tx threshold by a PPT QoL/ well being: 

Fu duration (last (total sample) Drop outs: A = 0, B = 0 meter, kg/cm2 - avg NR 

assessment): imm. Post- for 4 tender pts 

Quality tx Racial CG (n = 4) – Rotational 

score: 6/13 composition: NR Duration of Mob (sham): with gentle Results- mean : 

Pain, mean oscillations into the Results: Baseline: 

N screened: NR Work status: NR (SD/range): elastic barrier; one tx Baseline: 

Initial of N randomized: 9 Mixed, 2 wks-8 Drop outs: A = 0, B = 0 Pain: IG = 3.375; Immediate post 

reviewer: N completed tx: 9 Other socio­ yrs [range] CG = 2.45 tx: 

SG N attended last fu: 9 demographics: 

NR Severity of pain Immediate post tx: Short term: NR 

(Grading): NR Pain: IG = 4.95; CG 

Inclusion: Mechanical Co morbidities: = 2.525 Intermediate: NR 

NP NR 

Current tx/ co- Short term: NR Long term: NR 

Prior episode of intervention 

Exclusion: NR pain if acute: NR common in all Intermediate: NR Harms: NR 

groups: NR 

Prior CAM Long term: NR Summary of 

intervention: NR results (if 

provided): mean 

age males: 27 

Prior surgery yrs; mean age 

related to current females 38 yrs 

complaint: NR 

C-268
 
Table 2.15 Neck Pain - Manipulation & Mobilization - Unknown - Specific Pain 

Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Cilliers, K Trial Design-RCT- Mean age Region of pain: IG (n = 15) – Transverse Outcomes: Outcomes: 

(1998)260 (SD/range): IG = NP oscillatory rot segment Pain: SF-MPQ QoL/ well being: 

Country: 

South Africa 

Tx duration: 4 wks 

Fu duration (last 

assessment): 1 mos 

N screened: NR 

33 vs. CG = 29.3 

yrs 

% of male: IG = 

53.3%; CG = 

Cause of Pain: 

Facet joint 

syndrome 

adjustment: of the fixation 

into the restriction of 

motion; fixated segment 

determined by Kemp's test, 

motion palpation findings 

and local tenderness; only 

Disability: NR 

No numeric data is 

reported-both grps 

NR 

ROM: no 

numerica data is 

reported (IG vs. 

N randomized: 30 26.6% the most restricted fixation improved sign. CG p< 0.05 for 

Quality N completed tx: 30 Duration of was adjusted; adjustment From baseline forward flx at mo 

score: 3/13 N attended last fu: 30 Racial Pain, mean used a HVLA thrust using fu) 

composition: NR (SD/range): S contacts and line of Results: 

Inclusion: 14 yrs of age Unknown, NR drive; only cervical rotary Immediate post 

Initial of 

reviewer: 

SG 

or older with diagnosis of 

cervical facet syndrome; 

physically fit individuals 

with a cause of NP 

Work status: NR 

Other sociodemographics: 

Severity of pain 

(Grading): NR 

adjustments were used; 

adjustment was preceded 

by 5 min of massage with 

oil; 8 tx over 4 wks 

Drop outs: NR 

Immediate post tx: 

Pain: NR 

Disability: NR 

tx: NA 

Short term: NR 

related to cervical facet NR Current tx/ co- Short term: NR Intermediate: NR 

syndrome intervention CG (n = 15) – Transverse 

Co morbidities: common in all oscillatory rot and bottom Intermediate: NR Long term: NR 

NR groups: Pts segment adjustment: of the 

Exclusion: organic were requested fixation into the restriction Long term: NR Harms: NR 

cause of cervical pain or 

who had surgery on 

cervical spine; positive 

Wallenberg test 

Prior episode of 

pain if acute: NR 

Prior CAM 

to not take any 

Med or other tx 

that may have 

influenced 

of motion, and the bottom 

segment in the opposite 

direction; adjustment as IG, 

also preceded by 5 min of 

massage with oil; As IG 

Summary: bothe 

approaches to 

adjusting the 

intervention: NR outcome of the Drop outs: NR cervical spine 

study were effective in 

Prior surgery treating facet 

related to current syndrome. IG2 

complaint: NR was slightly more 

effective than IG1 

C-269
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Egwu 

(2008)261 

Trial Design-RCT Mean age 

(SD/range): IG1 = 

Region of pain: 

NP 

Groups 

IG1 (n = 24) – PosteriorOutcomes: Pain: N of pts 

Outcomes 

(describe 

Tx duration: Max.4 wks 43.9 (2.2), IG2 = Cause of Pain: anterior-unilateral reporting 100% instrument 

Fu duration (last 45.8 (3.23), IG3 = Cervical pressure: NR; 3 tx/wk pain free used): 

Country: assessment): post tx 42.7 (2.9), IG4 = Spondylosis until cured – up to 4 wks immediately QoL/ well being: 

Nigeria 44.8 (3) yrs Drop outs: 0 NR 

N screened: NR 

N randomized: 96 % of male: 100% IG2 (n = 24) – Antero- Immediate post tx: 

Quality N completed tx: 96 Duration of posterior-unilateral Pain: IG1 = 11 Short term: 

score: 1/13 N attended last fu: NR Racial Pain, mean pressure: NR; Same as (46%), IG2 = 15 Number of pts 

composition: (SD/range): IG1 (63%), IG3 = 4 returning for tx 

Inclusion: Diagnosis of 100% African Unknown, NR Drop outs: 0 (17%), IG4 = 6 after 3 mos. 

Initial of cervical spondylosis (25%) IG12= 0; IG 3 3 

reviewer: referred for manipulative Work status: NR Severity of pain IG3 (n = 24) – Cervical (12%), IG4 2 

SG therapy; severe NP, (Grading): NR oscillatory rot: NR; Short term: NR (8%) 

unilaterally distributed Other socio- Same as IG1 

relative to the midline of demographics: Drop outs: 0 Intermediate: NR Intermediate: NR 

the neck; positive skin NR Current tx/ corolling test; no previous intervention IG4 (n = 24) – Long term: NR Long term: NR 

manual therapy, onset Co morbidities: common in all Transverse oscillatory 

within 6 wks of entry to NR groups: NR pressure: NR; Same as Harms: none of 

study; no history of IG1 the pts reported 

vertebro-basilar Prior episode of Drop outs: 0 worse pain 

insufficiency; 40- 50 yrs pain if acute: NA 

old 

Prior CAM 

Exclusion: NR intervention: NR 

Prior surgery 

related to current 

complaint: NR 

C-270
 
 Table 2.16 Neck Pain - Manipulation & Mobilization - Unknown - Non-Specific Pain 

Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Cleland, J 

(2004)262 

Trial Design 

RCT 

Mean age 

(SD/range): NR 

Region of pain: 

NP 

Groups 

IG (n = 34) – Thoracic 

Outcomes 

(describe 

Outcomes 

(describe 

Abstract Cause of Pain: spine manipulation: instrument used): instrument 

Tx duration: One % of male: NR N-S treating clinician Pain: VAS (0 – 100) used): 

Country: session performed a segmental QoL/ well being: 

US Fu duration (last Racial evaluation of thoracic NR 

assessment): NR composition: NR spine and then Results: 

performed a thoracic Other: 

Quality Work status: NR Duration of spine manipulation to Immediate post tx: 

score: 2/13 N screened: 68 Pain, mean identified segmental Pain-mean change 

N randomized: 68 Other socio­ (SD/range): restriction; one tx (reduction in pain): Results- mean : 

N completed tx: NR demographics: Unknown, NR Drop outs: NR IG = -15.5 (95% CI: Baseline: NA 

Initial of N attended last fu: NR NR 11.8, 19.2), CG = ­

reviewer: Severity of pain CG (n = 34) – Placebo: 4.2 (95% CI: 1.9, Immediate post 

SG Co morbidities: (Grading): NR NR; one tx 6.6), p < 0.001 tx: NA 

Inclusion: 18-60 yrs of NR Drop outs: NR 

age with complain of Short term: NR Short term: NR 

mechanical NP Prior episode of Current tx/ copain if acute: NR intervention Intermediate: NR Intermediate: NR 

common in all 

Exclusion: NR Prior CAM groups: NR Long term: NR Long term: NR 

intervention: NR 

Harms: NR 

Prior surgery 

related to current 

complaint: NR 

C-271
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome 

results: 

Other 

outcomes; 

Harms 

Krauss, J Trial Design-RCT- Mean age Region of pain: IG (n = 22) – Outcomes: Outcomes: 

(2008)264 

Tx duration: One 

(SD/range): IG = 

35 (10.51) vs. CG 

NP 

Cause of Pain: 

Translatoric SM: using 

short straight-lined high 

Pain: Faces pain 

scale to assess 

QoL/ well being: 

NR 

Country: session = 34.2 (9.56) yrs N-S and low velocity pain at end range 

US Fu duration (last 

assessment): post tx 

N screened: 32 

% of male: IG = 

14%; CG = 30% 

Duration of 

movements directed 

parallel to or at a right 

angle to spinal joint 

surfaces; Sally a 

of active cervical 

rot: right direction; 

left direction 

Results- mean : 

Baseline: NA 

Quality N randomized: 32 Racial Pain, mean bilateral translatoric Results: Immediate post 

score: 9/13 N completed tx: 32 

N attended last fu: 32 

composition: NR 

Work status: NR 

(SD/range): 

Unknown, NR 

facet joint traction 

manipulation to 

hypomobile UT 

Baseline: 

Pain: IG = 2.8 (2.7), 

CG = 2.8 (1.8); IG = 

tx: 

Short term: NR 

Initial of Inclusion: 19 to 50 yrs Severity of pain intervertebral segments, 3.7 (2.7), CG = 2.5 

reviewer: with complaints of non- Other socio­ (Grading): NR a short passive linear (2.8) Intermediate: NR 

SG traumatic posterior midcervical pain of insidious 

onset in region of fourth 

to seventh cervical 

vertebral levels and 

aggravated with active 

cervical rot 

Exclusion: symptoms 

originating from thoracic 

spine, systemic disease 

or autoimmune disease 

affecting 

musculoskeletal system, 

positive radicular signs, 

myelopathy or previous 

surgery to cervical spine 

demographics: 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

Current tx/ cointervention 

common in all 

groups: NR 

movement perforemed 

in a dorsal direction 

perpendicular to plane 

of facet joints and 

parallel to plane or UT 

intervertebral disc joints 

at each level; one tx 

Drop outs: A = 0, B = 0 

CG (n = 10) – No tx: no 

intervention to minimize 

N-S effects of sham tx 

but remained seated on 

tx table for approx. the 

same amount of time it 

would take for TSM to 

be performed; As IG 

Drop outs: A = 0, B = 0 

Immediate post tx 

change from 

baseline: 

right rot, 1.5 (2.88) 

vs. -1.0 (0.23) 

left rot: 0.69 (1.03) 

vs. 0.67 (1.2) 

Short term: NR 

Intermediate: NR 

Long term: NR 

Long term: NR 

Harms: NR 

Summary: sign. 

Between group 

differences in riht 

rot only 

C-272
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Metcalfe, S 

(2006)266 

Trial Design- RCT Mean age 

(SD/range): 37 

Region of pain: 

NP 

Groups 

IG (n = 41) – 

Outcomes 

(describe 

Outcomes 

(describe 

Tx duration: One (11) yrs (total) Cause of Pain: Manipulation: low instrument used): instrument 

Country: session N-S amplitude, high-velocity Pain: NA used): 

Canada Fu duration (last % of male: 23.9% thrusts with a primary QoL/ well being: 

assessment): NR (total) movement of side Disability: NA NR 

bending to dysfunctional 

Quality N screened: NR Racial Duration of segments in upper (c0­ Results: Mean strength 

score: 4/13 N randomized: 67 composition: NR Pain, mean c2) and lower (c2-c7) Baseline: (pounds): 

N completed tx: 67 (SD/range): cervical spine; lower Pain: NA Immediate post 

N attended last fu: 67 Work status: NR Unknown cervical dysfunctional Disability: NA tx: 

Initial of segments received predicted weak: 

reviewer: Inclusion: with NP or Other socio- Severity of pain linear thrust along tri- Immediate post tx: 19.6 (6.5) vs. 

SG headaches demographics: (Grading): NR planar motion in Pain: NA 15.5 (6.4) 

NR direction of restricted Disability: NA predicted strong: 

Exclusion: non- movement; 1 tx 18.8 (5.4) vs. 

cervicogenic NP or Co morbidities: Current tx/ co- Drop outs: A = 0, B = 0 Short term: NR 15.8 (6.3) 

headaches, over 65 yrs NR intervention 

had previous neck common in all CG (n = 26) – Intermediate: NR Short term: NR 

surgery, unable to Prior episode of groups: NR Manipulation: 

achieve adequate ROM pain if acute: NR manipulation to Long term: NR Intermediate: NR 

for strength test position dysfunctional segments 

(80° rot) or displayed Prior CAM of lower cervical spine Long term: NR 

radicular signs such as intervention: NR only; 1 tx 

loss of reflexes, Drop outs: A = 0, B = 0 Harms: NR 

decreased sensation or 

fatigable weakness, if Prior surgery 

strength testing limited related to current 

by pain or the result of complaint: NR 

strength testing was 66 

pounds 

C-273
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Parkin- Trial Design-RCT Mean age Region of pain: Groups Outcomes: Outcomes 

Smith, G (SD/range): IG = NP IG (n = 13) – Cervical SM: Pain: NPRS-101 (0­ (describe 

(1998)265 

Country: 

South Africa 

Tx duration: 3 wks 

Fu duration (last 

assessment): Immed. Posttx 

N screened: 30 

33.8 vs. CG = 37 

yrs 

% of male: IG = 

54%, CG = 71% 

Cause of Pain: 

N-S 

most fixated segment(s) 

were manipulated (no more 

than 2). Chiropractic 

adjustments were applied; 

S manipulative techniques 

were selected and given in 

100) 

Disability: CMCC 

NDI (0-100) 

instrument used): 

QoL/ well being: 

NR 

ROM, mean 

change from 

baseline: 

N randomized: 30 the form of cervical breaks, Results: 

Quality N completed tx: 30 Racial Duration of combination movements, Baseline: Immediate post tx: 

score: 6/13 N attended last fu: 30 

Inclusion: Mechanical NP 

composition: NR 

Work status: NR 

Pain, mean 

(SD/range): 

Unknown, NR 

crossed bilateral ransvers 

pisiform, and anterior 

thoracic techniques. If 

Pain: IG = 33.89 

(12.47), CG = 33 

(13.99) 

Flexion: 3.71 (3.9) 

vs. 1.4 (1.8) 

Extension: 2.7 (3.9) 

Initial of 

reviewer: 

SG 

without neurological or 

vascular deficit, unilateral 

or bilateral, possible 

discomfort with joint 

challenge/pressure, 

Other sociodemographics: 

NR 

Severity of pain 

(Grading): NR 

required, pts received brief 

(no more than 20-30 min) 

of non-therapeutic premanipulative soft-tissue 

massage of cervical spine 

Disability: IG = 

18.24 (9.66), CG = 

17.64 (8.17) 

vs. 1.7 (2.8) 

Right lateral flx: 2.0 

(3.2) vs. 2.6 (2.6) 

Right rot: 2.6 (3.2) 

vs. 3.5 (3.3) 

restriction of movement of 

at least one motion 

segment identified by 

motion palpation, between 

16-60 yrs old, exhibit a 

negative Wallenberg's test 

Exclusion: Radiculopathy, 

contraindications to SM, 

history of cardiovascular 

disease, hypertension or 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Current tx/ cointervention 

common in all 

groups: no Med 

was allowed 

during the study 

for muscle spasm; 2 tx/wk 

for 3 wks 

Drop outs: NR 

CG (n = 17) – Cervical and 

upper thoracic SM: most 

fixated cervical and 

thoracic segments were 

manipulated, not extending 

below T7; As IG 

Immediate post tx: 

Pain: IG = 17.17 

(18.41), CG = 

13.18 (10.56) 

Disability: IG = 6.89 

(8.17), CG = 4.71 

(5.74) 

Short term: NR 

Left rot: 1.8 (3.6) 

vs. 3.6 (5.2) 

Short term: NR 

Intermediate: NR 

Long term: NR 

Harms: NR 

dizziness, received manual Drop outs: NR 

therapy for at least 2 wks Intermediate: NR Summary: two tx 

prior to study Prior surgery were not different 

related to current Long term: NA 

complaint: NR 

C-274
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Van Trial Design-RCT Mean age Region of pain: Groups Outcomes: Outcomes: 

Schalkwyk, (SD/range): IG = NP IG (n = 15)– Pain: NPRS-level of QoL/ well being: 

R (2000)263 Tx duration: 4 wks 

Fu duration (last 

31.7 vs. CG = 

27.7 yrs 

Cause of Pain: 

N-S 

Manipulation on 

ipsilateral side: supine 

pain intensity; SFMcGill-quality of pain 

NA 

Cervical ROM 

Country: 

South Africa 

assessment): 3 mos 

N screened: NR 

% of male: IG = 

80%, CG = 53.3% 

cervical rotary break 

manipulation with 

contact taken on 

Disability: CMCC 

(CANadian Memorial 

Chiropractic 

Immediate post 

tx, 

N randomized: 30 Duration of ipsilateral side of lateral Colledge) NDI Flexion: 60.8 

Quality N completed tx: 30 Racial Pain, mean flx fixation; 10 tx over 4 (12.9) vs. 60.9 

score: 1/13 N attended last fu: 30 

Inclusion: over 15 yrs 

composition: NR 

Work status: NR 

(SD/range): 

Unknown, NR 

wks 

Drop outs: NR 

ResultsImmediate post tx: 

(11.67) 

Extension: 53.4 

(13.6) vs. 54.8 

Initial of 

reviewer: 

SG 

of age with mechanical 

NP with lateral flx 

fixations in cervical 

spine, literate 

Other sociodemographics: 

NR 

Severity of pain 

(Grading): NR 

CG (n = 15) – 

Manipulation on 

contralateral side: 

supine lateral break 

Pain: IG = 9.4 (5.47), 

CG = 17.54 (12.47); 

IG = 4.27 (8.17), CG 

= 7.48 (13.47) 

Disability: IG = 6 

(12.2) 

Short term: NR 

Exclusion: pathologic 

condition or disease; 

contraindications to 

manipulation, no form of 

analgesic or antiinflammatory before or 

during tx 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Current tx/ cointervention 

common in all 

groups: NR 

manipulation on 

contralateral side of 

lateral flx fixation; As IG 

Drop outs: NR 

(5.74), CG = 6.13 

(18.41) 

Short term: Pain: IG = 

11.83 (11.8), CG = 

18.52 (14); IG = 6.18 

(5.8), CG = 9.08 

(10.7) 

Disability: IG = 6 

(6.8), CG = 6.13 (8) 

Intermediate: NR 

Long term: NR 

Harms: NR 

Summary: both 

txs were effective 

but there was no 

Intermediate: NR sign. Difference 

Prior surgery between the grps 

related to current Long term: NR 

complaint: NR 

C-275
 
Table 2.17 Neck Pain- Spinal Mobilization- Acute – Specific Pain – No studies 

Table 2.18 Neck Pain- Spinal Mobilization- Acute – Non-Specific Pain 

Author ID 

Country 

Buchmann, 

J 

(2005)236 

Country: 

Germany 

Study Characteristics 

Trial Design-RCTTx duration: NR 

Fu duration (last 

assessment): 24 hrs post 

last tx 

N screened: 60 

Population 

Characteristics 

Mean age 

(SD/range): IG = 

44 (22), IG2 = 46 

(14), CG = 49 (7) 

yrs 

% of male: IG = 

Pain 

Characteristics 

Region of pain: 

NP 

Cause of Pain: 

NR 

Intervention Detail 

Groups 

IG1 (n = 10) – SM: 

thrusting force on lateral 

aspects of occiput or C1 

exerted for < 200 msec 

pre/post anesthesia; NR 

Drop outs: A = 0, B = 2 

Outcome results: 

Pain, Disability 

Outcomes: 

Disability: N of 

found dysfunctions 

in motion segments 

O/C1 and C1/C2- 

no numerical data 

is reported (only p 

Outcome 

results: 

Other 

outcomes; 

Harms 

Outcomes: 

QoL/ well being: 

NR 

Short term: NR 

Intermediate: NR 

Quality 

score: 7/13 

Initial of 

reviewer: 

SG 

N randomized: 26 

N completed tx: 24 

N attended last fu: NR 

Inclusion: 18-80 yrs, 

manually diagnosed 

dysfunction of one or both 

of the segments 

occiput/cervical 1 and 

cervical 1/cervical 2 

60%; IG2 = 62%; 

CG = 50% 

Racial 

composition: NR 

Work status: NR 

Other sociodemographics: 

Duration of 

Pain, mean 

(SD/range): 

Acute/Sub-acute 

NR 

Severity of pain 

(Grading): NR 

IG2 (n = 8) – Postisometric relaxation): 

applied to hypertonic 

muscle - isometric 

contraction by pts against 

manual resistance for 10 

sec then stransverse 

oscillatory rotped and 

repeated after at least 20 

sec rest;pre/post 

values) 

Results: 

Baseline: 

Disability: IG1 = 21, 

IG2 = 15, CG = 13 

Immediate post tx: 

Disability: ---

Long term: NA 

Harms: 2 WDAE in 

IG1- complication 

arising from a 

surgical operation 

Summary: sig 

effect of IG1&2 vs. 

placebo, in 

restoring function 

Exclusion: previous 

surgery of cervical spinal 

column, arthrosis of 

cervical spinal column, 

spondylolisthesis, fracture, 

inflammation, previous disk 

herniations or cervical 

spinal column, any kind of 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Current tx/ cointervention 

common in all 

groups: NR 

anesthesia NR 

Drop outs: See IG1 

CG (n = 8) – Placebo: 

Laying palms of clinician 

on sides of pt's neck 

without any side-different 

pressure or without having 

pt under tension; pre/post 

Short term: NR 

Intermediate: NR 

Long term: NA 

(p< 0.01) 

In anesthesia: IG1 

vs. placebo, p < 

0.01. 

No sig difference 

between IG1 & 2 (P 

= 0.137). The 

tx effect 

postnarcotically 

cancer or planned surgery anesthesia NR was further sign in 

in throat Prior surgery Drop outs: See IG1 IG1 vs. placebo

related to current only (P = 0.01) 

complaint: NR 

C-276
 
Table 2.19 Neck Pain - Massage - Acute - Specific Pain – No studies 

Table 2.20Neck Pain - Massage - Acute - Non-Specific Pain 

Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Blikstad, A 

(2007)267 

Country: 

England 

Trial Design-RCT 

Tx duration: One session 

Fu duration (last 

assessment): post tx 

N screened: 45 

N randomized: 45 

Mean age 

(SD/range): IG1 = 

23.9 (3.925), IG2 = 

22.6 (2.384), CG = 

24.9 (5.44) yrs 

% of male: IG1 = 

27, IG2 = 60, CG = 

Region of pain: 

NP and upper 

trapezius TPs 

Cause of Pain: 

N-S 

Groups 

IG1 (n = 15)– Activator TP 

tx (ATPT): An force to TP 

= 170 Newton : One 

session, 10 thrusts at 1 

thrust/sec 

Drop outs: NR 

Outcomes: 

Pain: NRS (0-10); 

PPT (kg/cm2) 

Disability: CROM 

Results: 

Harms 

Outcomes: 

QoL/ well being: 

NR 

Number of 

subjects 

improved based 

on reduced pain: 

Quality 

score: 10/13 

Initial of 

reviewer: 

SG 

N completed tx: NR 

N attended last fu: NR 

Inclusion: Between 18-55 

yrs. N-S unilateral or 

bilateral NP of at least 4 

wks, no longer than 12 wks 

and at least 4 on an 11-pt 

(NRS), an upper trapezius 

TP (TP) and decreased 

47 

Racial composition: 

NR 

\Work status: NR 

Other sociodemographics: 

NR 

Co morbidities: 

Duration of 

Pain, mean 

(SD/range): 

Sub-acute, NR 

Severity of pain 

(Grading): NR 

IG2 (n = 15) – Myofascial 

band tx (MBT): Firm thumb 

pressure in a slow stroking 

motion from the lateral 

shoulder to the mastoid 

process along the upper 

trapezius muscle and 

through the active TP; One 

1 min session 

Drop outs: NR 

Baseline: 

Pain: IG1 = 4.6 

(0.6325), IG2 = 4.6 

(0.5071), CG = 4.7 

(0.9612); IG1 = 3.4 

(1.803), IG2 = 3.2 

(0.8367), CG = 3.8 

(1.71) 

Disability: NR 

Immediate post 

tx: 

8 (53.3%) vs. 2 

(13.3%) vs. 2 

(13.3%) 

Based on right 

lateral cervical 

flx: 6 (40%) vs. 5 

cervical lateral flx to the NR Current tx/ co­ (33.3%) vs. 6 

opposite side of the active intervention CG (n = 15) – Sham Immediate post tx: (40%) 

upper trapezius TP. NP Prior episode of common in all Ultrasound (SUS): If Pain: NR 

could extend to shoulder pain if acute: NR groups: NR subject felt any sensation Disability: NR Short term: NR 

region and upper arms of heat or pain, machine 

Exclusion: Specific NP; 

Prior CAM 

intervention: NR 

was turned down- same 

area as IG; One 2 min Short term: NR Intermediate: NR 

blood coagulation 

disorders, currently taking Prior surgery 

session 

Drop outs: NR Intermediate: NR Long term: NA 

anticoagulants; long-term related to current 

steroid use complaint: NR Long term: NA Harms: NR 

C-277
 
Table 2.21 Neck Pain - Massage - Chronic- Specific Pain 

Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Cen, S Trial Design-RCT Mean age Region of pain: Groups Outcomes: Outcomes: 

(2003)271 (SD/range): IG1 = NP IG1 (n = 10)– Traditional Pain: Northwick QoL/ well being: 

Tx duration: 6 wks 47 (11), IG2 = 48 Cause of Pain: Chinese Massage Park NP NR 

Country: 

Fu duration (last 

assessment): Post-tx 

(13), CG = 51 (7) 

yrs 

Trauma (35.8%) 

Chronic 

use/stress 

(TCTM): one-finger 

meditation massage 

used to search and treat 

Results-Baseline: 

Pain: IG1 = 32.46 

Immediate post tx: 

NA 

Germany N screened: 31 % of male: IG1 = (51.2%); Post- any perceived abnormal (8.59), IG2 = 27.81 Short term: NR 

N randomized: 31 20, IG2 = 30, CG herniated soft tissue sites; 30 min/ (11.9), CG = 31.51 

N completed tx: 28 = 27.3 nucleus tx, 3 tx/wk, 6 wks (12.11) Intermediate: NR 

Quality N attended last fu: 28 pulposus (10%); Drop outs: A = 1 Long term: NR 

score: 4/13 Racial Spinal Immediate post tx: 

Inclusion: NP and loss composition: NR malformation IG2 (n = 10)– Exercise Pain: IG1 = 13.24 Harms: NR 

Initial of 

reviewer: 

SG 

in ROM, for more than 1 

yr, noticeably daily NP 

and tightness, neck 

muscle pain and 

Work status: NR 

Other sociosue to arthritis 

(3.0%); Spinal 

malformation 

due to post-polio 

program: Home-based, 

self-administrated. 2 

steps: 1) application of 

moist heat on neck area 

(11.88), IG2 = 

20.23 (12.06), CG 

= 35.64 (12.54) 

Summary: 

Exercise plus 

TCTM appeared 

equally effective as tightness associated demographics: syndrome followed by S stretching Short term: NR TCTM alone but 

with a mechanical NR (3.3%) EX. Daily EX program better than just EX 

disorder of the cervical included head tilt, Intermediate: NR only, suggesting 

spine (such as Co morbidities: Duration of trapezius stretch, neck that TCTM may 

whiplash/trauma, chronic NR Pain, mean flx, shoulder rolls, and Long term: NR provide the initial 

use, disc degeneration, 

post-herniated nucleus 

pulpous), no regular 

therapeutic tx (more 

Prior episode of 

pain if acute: NR 

(SD/range): 

Chronic, NR 

Severity of pain 

neck rolls; moist heat for 

10 min, stretching for 10 

min 

Drop outs: A = 2 

major contribution 

to the tx effect. 

Also, improvements 

in ROM for TCTM 

group seemed than once/wk) in Prior CAM (Grading): NR (personal family more consistent 

previous 3 mo for NP intervention: NR problems) than EX group 

Current tx/ coPrior surgery intervention CG (n = 11) – No tx: NA; 

Exclusion: NR related to current common in all NA 

complaint: None groups: NR Drop outs: NR 

C-278
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Irnich D 

(2001)269,270 

Country: 

Germany 

Quality 

score: 4/13 

Initial of 

reviewer: 

SG 

Trial Design 

RCT 

Tx duration: 3 wks 

Fu duration (last 

assessment): 6 mos 

N screened: 182 

N randomized: 177 

N completed tx: 177 

N attended last fu: 165 

Inclusion: Pts with 

chronic NP (>1 mo) and 

painful restriction of 

cervical spine mobility 

who had not received 

any Tx in the two wks 

before the study 

Exclusion: Pts with 

dislocation, had surgery, 

fracture, neurological 

deficits, systemic 

disorders, or Tx 

contraindications 

Mean age 

(SD/range): IG1 = 

52.3 (13.3), IG2 = 

52.7 (11.5), CG = 

52.2 (13.2) yrs 

% of male: 

33.97% total 

Racial 

composition: NR 

Work status: NR 

Other sociodemographics: 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: (n) 

whiplash = 56; 

MPS = 129 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: None 

Region of pain: 

NP 

Cause of Pain: 

Myofascial pain 

and whiplash 

Duration of 

Pain, mean 

(SD/range): 

Chronic, NR 

Severity of pain 

(Grading): NR 

Current tx/ cointervention 

common in all 

groups: None 

Groups 

IG1 (n = 56)– Acu: 

according to traditional 

Chinese medicine rules, 

local MTPs treated with 

dry needling to elicit 

local twitch, common 

points S13, UB10, 

UB60, Liv3, GB20, 

GB34, TE5, and the ear 

point cervical spine; 5 tx, 

3 wks 

Drop outs: D = 7 

IG2 (n = 60)– Massage: 

Conventional Western 

massage (effleurage, 

petrissage, friction, 

tapotement, and 

vibration), SM not 

performed; Same as IG1 

Drop outs: D = 1 

CG (n = 61) – Shamlaser: Inactivated laser 

pen, every point treated 

for 2 min at 0.5-1 cm 

distance from the skin; 

Same as IG1 

Drop outs: D = 4 

Outcomes: 

Pain: VAS; PPT 

Results-Baseline: 

Pain: IG1 = 54.15 

(21.91), IG2 = 

54.71 (23.46), CG 

= 57.15 (26.71); 

IG1 = 1.07 (0.57), 

IG2 = 1.07 (0.58), 

CG = 1.05 (0.57) 

Immediate post tx: 

Pain-mean change: 

IG1 = 25.3 (22.6), 

IG2 = 12.7 (29.5), 

CG = 19.2 (26.5); 

IG1 = 0.06 (0.58), 

IG2 = 0.04 (0.5), 

CG = -0.03 (0.51) 

Short term: ---

Intermediate: IG1 = 

17.4 (29.7), IG2 = 

14.4 (31.9), CG = 

17.4 (26.4); IG1 = 

0.19 (0.77), IG2 = 

0.50 (0.59), CG = 

0.03 (0.62) 

Long term: NR 

Outcomes: 

QoL/ well being: 

SF-36: Physical 

role; Pain Index 

Results- mean : 

Immediate post 

tx: 

Short term: (P 

values)IG1 vs. 

IG2 = 0.797, IG1 

vs. CG= 0.498; 

IG1 vs. IG2 = 

0.843, IG1 vs. 

CG = 0.989 

Intermediate: IG1 

vs. IG2 = 0.865, 

IG1 vs. CG = 

0.825; IG1 vs. 

IG2 = 0.971, IG1 

vs. CG = 0.87 

Long term: NR 

Harms: Mild 

reactions n = 17 

(33%) in IG1, vs. 

4 (7%) in IG2, 

and 12 (21%) in 

CG, no SAEs 

observed. 

C-279
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Yagci, N 

(2004)268 

Trial Design-RCT Mean age 

(SD/range): IG = 

Region of pain: 

LBP 

Groups 

IG (n = 20)– Vapo 

Outcomes: 

Pain: VAS(0-10); 

Outcomes 

QoL/ well being: 

Tx duration: 2-5 ds 30.7, CG = 31, Cause of Pain: coolant spray + stretch Pain threshold; NA 

Country: Fu duration (last SD NR NR technique: Ethylchloride Pain tolerance ROM 

Turkey assessment): post tx spray for 4-5 s to each Immediate post 

% of male: IG = muscle, from 30 cm Disability: NR tx:flx 42.2 (7.18) 

N screened: 40 35%, CG = 15% distance and 45 degree vs. 46.4 (5.7) 

Quality N randomized: 40 Duration of angle; spray stretch Results: Extension: 52.2 

score: 2/13 N completed tx: NR Racial Pain, mean technique + active EXs Immediate post tx: (8.4) vs. 50.4 

N attended last fu: NR composition: NR (SD/range): (same for both grps), 10 Pain (VAS): IG = (5.9) 

chronic, NR reps, 3 tx/d- 6 sessions 2.88 (1.5), CG = 

Initial of Inclusion: Diagnosis of Work status: NR in total 2.6 (1.73); Short term: NR 

reviewer: MPS (MPS) with Severity of pain Drop outs: NR Intermediate: NR 

SG duration of symptoms of Other socio­ (Grading): VAS PPT IG = 37.05 Long term: NR 

at least 6 mos demographics: CG (n = 20) – (4.52), CG = 21.7 

NR Current tx/ co- Connective tissue (8.42); Harms: NR 

Exclusion: NR intervention massage: starts from 

Co morbidities: common in all sacral region and Pain tolerance Summary of 

NR groups: NR terminated to shoulder IG = 94.85 (5.56), results (if 

and cervical regions; CT CG = 81.75 (5.65) provided): Spray 

Prior episode of massage + active Stretch technique 

pain if acute: NR EXs(same for both Disability: NR seemed to be 

grps), 10 reps, 3 tx/d- 6 most effective on 

Prior CAM sessions in total trigger 

intervention: NR Drop outs: NR points as they 

required less time 

Prior surgery (only 6 sessions 

related to current vs 15 for CMT) 

complaint: NR 

C-280
 
Table 2.7 Neck Pain - Massage - Chronic - Non-Specific Pain 

Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Cen, S Trial Design-RCT Mean age Region of pain: Groups Outcomes: Outcomes: 

(2009)273 (SD/range): IG = NP IG1 (n = 32)– Massage: Pain: symptom Global rating of 

Tx duration: 10 wks? 47.4 (12.3) vs. CG = Cause of Pain: median of 7 techniques bothersome: improvement (%) 

Country: 

US 

Fu duration (last 

assessment): 6 mos 

N screened: 222 

N randomized: 64 

46.4 (11.3) yrs 

% of male: 31.2 

Racial composition: 

N-S 

Duration of Pain, 

mean (SD/range): 

Chronic, (pts with 

with a range of 4 to 15 

per visit, most common 

technique: kneading, 

clinical gliding; At least 1 

numerical 0-10 scales 

Disability: NDI 

Results-Baseline: 

Better or much 

better: at 4 wks: 

58% vs. 7% 

At 10 wks: 55% vs. 

25% 

N completed tx: 59 Majority White (87.1 > 1 yr: 80.6%) tx, (1-10 tx) Pain: IG = 4.8 (2.3), At 6 mos: 43% vs. 

N attended last fu: NR vs. 81.3%) Drop outs: 1 CG = 4.9 (1.8) 25% 

Quality Severity of pain Disability: NR 

score: 8/13 Inclusion: group health Work status: (Grading): rating CG (n = 32) – Self-care Medication usage, 

enrollees between 20 - 64 Employed: 84.4% of < 3 on 0 - 10 book: NR; NA Immediate post tx: (similar 

Initial of 

reviewer: 

SG 

yrs who had received 

primary care for NP at least 

3 mo prior 

Exclusion: NP likely due to 

Other sociodemographics: 

Family income > 

$35 K: 78.7% 

point bothersome 

scale 

Current tx/ cointervention 

Drop outs: 4 Pain: improvement (% 

of pts): 55% vs. 25%, 

RR=2.2; 95% CI, 

1.04, 4.2) 

at baseline), did 

not change in the 

IG but increased by 

14% in CG at 6 

monhts 

a non-mechanical cause; common in all Disability: 

complex NP or NP Co morbidities: NR groups: all pts improvement (% of Long term: NR 

potentially inappropriate for were advised on pts): 39% vs. 14% 

massage, prior neck Prior episode of stretching and (RR=2.7, 95% CI: Harms: IG: n = 9 

surgery, MVA in past 3 mo; pain if acute: NR were allowed to 0.99, 7.5) with mild AEs; n = 

unstable serious medical or take Med for NP: 5 with discomfort or 

psychiatric conditions or Prior CAM 56.3 vs. 62.5%; Short term: NR pain during 

demetia; minimal NP or NP intervention: NR NSAIDs: 456.9 vs. massage tx; n = 3 

lasting less than 12 wks; 53.1%; narcotic Intermediate: increased soreness 

currently receiving other tx Prior surgery analgesics: 6.3% Pain: RR = 1.1 (95% after tx; n = 1 

for NP apart from Meds; related to current CI: 0.6, 2.0) migraines and 

had used massage for NP complaint: NR NDI: RR = 1.8 (95% nausea one d after 

within the last yr CI: 0.97, 3.5) tx; one pt withdrew 

Long term: NR from tx; no SAEs 

observed 

C-281
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Zaproudina, 

N (2007)272 

Trial Design 

RCT 

Mean age 

(SD/range): IG1 = 

Region of pain: 

NP 

Groups 

IG1 (n = 35)– Traditional 

Outcomes: 

Pain: VAS (100 

Outcomes: 

QoL/ well being: 

41.2 (5.7), IG2 = Cause of Pain: bone setting: 5 sessions mm) NR 

Tx duration: Not clear, 5­ 40.9 (5.9), CG = N-S (each 1.5 hrs) per pt Numer of sick10 wks? 42.4 (5.9) yrs provided with 1-2 wk Disability: NDI (0­ leave ds: 

Country: Fu duration (last intervals 100) 0.61/peroperson 

Finland assessment): 1 yr % of male: IG1 = Duration of Drop outs: D = 0 in IG1, 2.6 in IG2, 

31, IG2 = 38.2, Pain, mean Results-Baseline: and 3.9 in CG 

CG = 33.3 (SD/range): IG2 (n = 34)– Pain: IG1 = 49.5 

Quality N screened: NR Racial Chronic, IG1 = Physiotherapy: Included (21.3), IG2 = 46.8 Decrease in use 

score: /13 N randomized: 102 composition: NR 11.7 (6.2), IG2 = massage, therapeutic (19.8), CG = 46.6 of painkillers: 

N completed tx: 102 Work status: NR 10.6 (6.5), CG = stretching, and EX (22.2) 65.7% vs. 50.0% 

N attended last fu: NR 11.2 (7.3) yrs therapy; 5 sessions; Disability: IG1 = vs. 56.2% 

Initial of Other socio­ session duration: 45 min 24.11 (8.2), IG2 = 

reviewer: demographics: Severity of pain Drop outs: D = 1 27.41 (8.8), CG = Immediate post 

SG Inclusion: Pts with NR (Grading): NR 26.0 (10.9) tx: NA 

chronic N-S NP aged CG (n = 33) – Massage: 

28-50 yrs Co morbidities: 5 sessions (each 1 hr) Immediate post tx: Short term: NR 

NR Current tx/ co­ per pt Pain: IG1 = 17.9 

intervention Drop outs: D = 2 (18), IG2 = 29.6 Intermediate: NR 

Exclusion: Previous Prior episode of common in all (23), CG = 25.4 

neck surgery; current pain if acute: NR groups: None (22) Long term: NR 

nerve root entrapment; Disability: IG1 = 

spinal cord compression; Prior CAM 11.7 (9), IG2 = 18.4 Harms: None of 

severe neurologic, intervention: NR (10), CG = 15.3 the pts in IG1 

metabolic, psychiatric or (10) had any negative 

CVD diseases; any Prior surgery Short term: NR effects. 

therapy or sick leave related to current Intermediate: NR 

previous mo complaint: None Long term: NR 

C-282
 
Table 2.23 Neck Pain - Massage - Mixed - Specific Pain 

Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Fernandez- Trial Design-RCT Mean age Region of pain: Groups Outcomes: Outcomes 

de-lasPenas 

(2005)275 

Tx duration: NR 

Fu duration (last 

assessment): Post-tx 

(SD/range): IG1 = 

27.7 (5.5), IG2 = 

29.7 (6.2) yrs 

NP & Upper 

Trapezius 

Cause of Pain: 

Mechanical 

IG1 (n = 20)– Ischemic 

compression technique: 

Patient lays supine with 

cervical spine in neutral 

position. Therapist applies 

Pain: PPT; VAS 

(2.5 kg/cm2) 

Disability: NA 

(describe 

instrument 

used): 

QoL/ well being: 

Country: 

Spain 

N screened: 40 

N randomized: 40 

N completed tx: NR 

N attended last fu: NR 

% of male: IG1 = 

40, IG2 = 45 

Racial 

gradually increasing pressure 

to MTP until sensation of 

pressure becomes pressure 

and pain. Pressure maintained 

until discomfort and/or pain 

Results: 

Baseline: 

Pain: IG = 1.8 (0.5), 

NR 

Results- mean : 

Quality 

score: 7/13 

Initial of 

reviewer: 

SG 

Inclusion: At least 18 yrs 

old, with mechanical NP for 

at least 2 wks, diagnosed 

with MTPs either latent or 

active in the upper 

trapezius muscle. Mech NP 

defined as: generalized 

composition: NR 

Work status: NR 

Other sociodemographics: 

NR 

Duration of 

Pain, mean 

(SD/range): 

Mixed, NR 

Severity of pain 

(Grading): 

eased by around 50%, then 

pressure was increased until 

discomfort appeared again. 

Repeated for 90sec ; NR 

Drop outs: NR 

IG2 (n = 20) – Transverse 

friction massage: Applied with 

forefinger and reinforced with 

CG = 2 (0.4); IG = 

4.6 (1.2), CG = 4.9 

(1.5) 

Immediate post tx: 

Pain: IG = 2.2 (0.6), 

CG = 2.35 (0.4); IG 

Baseline: NA 

Immediate post 

tx: 

Short term: NR 

neck and/or shoulder paint 

with mechanical 

characteristics 

Exclusion: diagnosis of 

fibromyalgia syndrome; 

history of whiplash injury, 

cervical spine surgery; 

diagnosis of radiculopathy 

or myelopathy determined 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

NR 

Current tx/ cointervention 

common in all 

groups: 

NR 

middle finger. Executed with 

relaxed muscle applied for 3 

min. Frictions applied slowly 

with a pressure slightly painful. 

Approx at PPT level of each 

pt; NR 

Drop outs: NR 

= 3.8 (0.9), CG = 

4.2 (0.09) 

Short term: NR 

Intermediate: NR 

Long term: NR 

Intermediate: NR 

Long term: NR 

Harms: NR 

by their physician; having 

undergone myofascial pain 

therapy within the past mo 

before study 

Prior surgery 

related to current 

complaint: NR 

C-283
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Lin, M 

(2004)220 

Trial Design 

RCT 

Mean age 

(SD/range): IG = 

Region of pain: 

NP and 

Groups 

IG (n = 50)– Needle 

Outcomes 

(describe 

QoL/ well being: 

NR 

46(8.5) , CG = NR vertebrae scalpel combined with instrument used): Cure effect 

Country: Tx duration: 3 mos Cause of Pain: massage therapy; every Pain: NA measured by% of 

China Fu duration (last % of male: IG= NR 7 ds, tx course was 3 Disability: NA pts who were 

assessment): post tx 65% times, each course 7 completely cured 

CG= NR times Results: 

Quality Drop outs: NR Baseline: NA 

score: 3/13 N screened: 100 Racial Pain: Immediate post 

N randomized: 100 composition: NR Duration of CG (n = 50) – Simple Disability: tx: 16(32%) vs. 

N completed tx: NR Pain, mean massage therapy once a 10(20%) 

Initial of N attended last fu: NR Work status: NR (SD/range): d, and 7 times. Three Immediate post tx: Effective rate: 

reviewer: Acute to courses were performed NA 98% (49/50) vs. 

SG Other socio­ chronic(15 ds – continuously and Pain: 82% (41/50), p < 

Inclusion: Cervical demographics: 32 yrs) interval of each course Disability: 0.05 

spondylopathy of nerve NR was 3 ds 

root type, aged 25-76 Severity of pain Drop outs: NR Short term: NR Short term: NR 

Co morbidities: (Grading): 

Exclusion: NR NR NR Intermediate: NR Intermediate: NR 

Prior episode of Current tx/ co- Long term: NR Long term: NR 

pain if acute: NR intervention 

common in all Harms: NR 

Prior CAM groups: 

intervention: NR NR 

Prior surgery 

related to current 

complaint: NR 

C-284
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Xi-zhen Trial Design-RCT Mean age Region of pain: Groups Outcomes: Outcomes : 

(2005)274 (SD/range): NR NP IG (n = 26)– Traction and Pain: Cervical QoL/ well being: 

Country: 

China 

Tx duration: 5-10 ds 

Fu duration (last 

assessment): Post-tx 

N screened: NR 

N randomized: 52 

% of male: 55.8 

Racial 

composition: NR 

Cause of Pain: 

Cervical 

spondylopathy 

Massage: of cervical 

vertebrae: traction by 5% 

of body mass increased by 

2.5-5.0 N every 2-3 times; 

massage was given in 

prone position with 

Spondylopathy 

Treatment Effect 

Rating Scale-3 

items 

NR 

Effect rate, post 

tx (obviousely 

effective): 80.8% 

vs. 46.2% 

Quality N completed tx: 52 methods consisting of Disability: NA 

score: 1/13 N attended last fu: 52 Work status: NR grasping, pressing, Results- mean : 

Duration of pushing, kneading, rolling, Results: Baseline: NA 

Inclusion: diagnosis of Other socio- Pain, mean tapping and traction and Baseline: NA 

Initial of cervical spondylopathy demographics: (SD/range): counter traction etc; Pain: IG = 8.132 Immediate post 

reviewer: 

SG 

owing to first attack or 

repeated attacks; meeting 

criteria for non-operation 

therapy 

NR 

Co morbidities: 

NR 

Mixed, 5 ds-8 

yrs 

Severity of pain 

Traction: 30 min/tx, 

Massage: 8-10 min/tx, 5 

tx/course, 1-2 courses, 

Drop outs: A = 0, B = 0 

(2.534), CG = 

8.304 (2.71) 

Immediate post tx: 

tx: 

Short term: NR 

Exclusion: operation (Grading): CG (n = 26) – Traction Pain: IG = 16.431 Intermediate: NR 

owing for spondylopathy; Prior episode of NR only: traction of cervical (3.212), CG = 

mental disease; liver and pain if acute: NR vertebrae and massage: 13.147 (3.036) Long term: NR 

kidney disease, blood Current tx/ co­ traction was done by 

disease, carcinoma; Prior CAM intervention special band on traction Short term: NR Harms: NR 

respiratory system and 

cerebrovascular or 

cardiovascular system 

complications; autoimmune 

disease or the weakest 

intervention: NR 

Prior surgery 

related to current 

common in all 

groups: 

NR 

shelf with Pt sitting, first 

traction force was given by 

5% of body mass and then 

tractio force increased by 

2.5-5.0 N every 2-3 times; 

Intermediate: NR 

Long term: NR 

health Pts; equipped with complaint: NR As IG 

cardiac pacemaker and Drop outs: A = 0, B = 0 

prosthetic value; pregnancy 

or breast feeding 

C-285
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

Outcome 

results: 

Other 

outcomes; 

Harms 

Zhang, B Trial Design Mean age Region of pain: Groups Outcomes Outcomes 

(2005)228 RCT 

Tx duration: 3 wks 

Fu duration (last 

(SD/range): NR 

% of male: IG = 

65.63%, CG = 

NP 

Cause of Pain: 

Cervical 

spondylosis 

IG (n = 64) – 

Acupuncture + Massage 

/ Manipulation:. 

Acupoint injection - 

(describe 

instrument used): 

Pain: NA 

(describe 

instrument 

used): 

QoL/ well being: 

Country: assessment): 3 mos 56.25% Fengchi (GB 20), Disability: NA NR 

China 

N screened: NR 

Racial 

composition: 

bilaterally, Ashi points 

(spot of tenderness or 

node), 1 to 2; Drugs: 

Results: 

Baseline: 

Cure rate: 

Immediate post 

tx: 81.25% vs. 

Quality N randomized: 96 Asian Duration of VB12500ug ( 1 ml), Pain: NA 56.25, p < 0.05 

score: 0/13 N completed tx: NR 

N attended last fu: NR Work status: NR 

Pain, mean 

(SD/range): 

Mixed, NR 

Danshen injection 2 mL 

( 1 g/mg), 2 % lidocaine 

1 ml. The above drugs 

Disability: NA 

Immediate post tx: 

Total effective 

rate were similar 

in two grps 

Initial of Other socio­ were drawn into a one- Pain: NA 

reviewer: Inclusion: NR (appears demographics: Severity of pain off 5ml syringe. the Disability: NA Short term: NR 

SG to include pts with 

cervical spondylosis 

only) 

Exclusion: NR 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: 4? 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

(Grading): NR 

Current tx/ cointervention 

common in all 

groups: NR 

doctor inserted the 

needle into the points 

and injected the same 

amount of drugs into 

each point. If there was 

no bleeding, the needle 

was withdrawn with the 

arrival of qi; 3 tx/wk for 3 

wks 

Drop outs: NR 

CG (n = 32) – Massage: 

As IG; Same as IG 

Drop outs: NR 

Short term: NR 

Intermediate: NR 

Long term: NR 

Intermediate: NR 

Long term: NR 

Harms: NR 

C-286
 
Table 2.24 Neck Pain - Massage - Mixed - Non-Specific Pain 

Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Gemmell, H Trial Design Mean age Region of pain: Groups Outcomes: Outcomes 

(2007)276 RCT (SD/range): NP and Upper IG1 (n = 15)– Ischemic Pain: VAS (0-100); (describe 

Country: 

England 

Tx duration: One 

session 

Fu duration (last 

assessment): post-tx 

(median) IG1 = 

24, IG2 = 24, CG 

= 23 yrs 

% of male: NR 

Trapezius TPs 

Cause of Pain: 

N-S 

compression (IC): 

Sustained deep pressure 

with the thumb to the upper 

trapezius trigger pt (TP).; 

one tx session, sustained 

deep pressure for 30 sPPT (kg/cm2) 

Results: 

Baseline: 

Pain: IG1 = 41.3 

instrument 

used): 

QoL/ well being: 

NR 

Quality 1min (43.6), IG2 = 43.6 Results- mean : 

score: 9/13 Racial Drop outs: NR (8.8), CG = 38.1 Baseline: NA 

N screened: 55 composition: NR Duration of (8.8); IG1 = 3.39 

N randomized: 45 Pain, mean IG2 (n = 15)– Trigger (1.16), IG2 = 2.8 Immediate post 

Initial of N completed tx: 45 Work status: NR (SD/range): Point Pressure Release (1.2), CG = 2.6 tx: 

reviewer: 

SG 

N attended last fu: 45 

Inclusion: Between 

ages 18 and 55 with N-S 

Other sociodemographics: 

NR 

Mixed, NR 

Severity of pain 

(Grading): 

(TPPR): Non painful slowly 

increasing/ maintaining 

pressure with thumb over 

TP until tissue resistance 

barrier felt. Process 

(0.83) 

Immediate post tx: 

Pain: IG1 = 22.93 

Short term: NR 

Intermediate: NR 

NP of at least 30 mm on NR repeated until no TP (12.76), IG2 = 

a VAS, and upper Co morbidities: tension/tenderness of 90s 27.13 (16.4), CG = Long term: NR 

trapezius TP and NR Current tx/ co­ had elapsed; one session 22.67 (8.21); IG1 = 

decreased cervical intervention Drop outs: NR 4.45 (1.69), IG2 = Harms: NR 

lateral flx to the opposite Prior episode of common in all 3.77 (1.76), CG = 

side of the active upper 

trapezius TP 

Exclusion: Those 

pain if acute: NR 

Prior CAM 

intervention: NR 

groups: 

NR 

CG (n = 15) – Sham 

Ultrasound (SUS): 

Ultrasound lotion applied 

over TP and ultrasound 

head was moved slowly 

3.37 (1.62) 

Short term: NR 

taking anticoagulants or over the upper trapezius Intermediate: NR 

using long-term muscle; one 2 min session, 

corticosteroid therapy, Prior surgery Drop outs: NR Long term: NR 

and those with S causes related to current 

for their NP complaint: NR 

C-287
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Hemmila, H 

(2005)277 

Trial Design-RCT Mean age 

(SD/range): IG = 

Region of pain: 

NP 

Groups 

IG (n = 22)– Bone 

Outcomes: 

Pain: Million scale 

Outcomes: 

QoL/ well being: 

Tx duration: 5 wks 47.5 (8.5) vs. CG Cause of Pain: setting: pt asked to bend (0-100 mm); Pain NR 

Country: Fu duration (last = 44.9 (9.7) yrs N-S neck forward and drawings (Pain Medication use, 

Finland assessment): 1 yr backward while healer area; Numbness and sick leaves 

% of male: IG = presses thumbs on both area) . 

N screened: 59 40.1%, CG = 20% side of net distal Immediate post 

Quality N randomized: 42 Duration of vertebrae OR make Results- tx: NR 

score: 5/13 N completed tx: 38-40 Racial Pain, mean careful rotating bending Immediate post tx: 

N attended last fu: 38 composition: NR (SD/range): movements of pt’s head Pain-mean change: Short term: NR 

Unknown (mix), with one hand while pt’s IG = 18.5, CG = 4; 

Initial of Inclusion: 18-64 yrs; Work status: NR IG = 4.3 (4.7) neck is stabilized by IG = 3.5, CG = 2.1; Intermediate: NR 

reviewer: diagnosis of tension yrs, CG = 8.4 other hand, some soft IG = 0.8, CG = 1.2 

SG neck syndrome with N-S Other socio­ (6.8) yrs tissue massage; Five 30 Long term: NA 

pain between the demographics: min sessions over 5 wks Short term-mean Pain Med 

shoulders and occiput Used folk Severity of pain Drop outs: E = 4 change: IG = 21.2, The mean annual 

for at least one mo medicine: 66.5% (Grading):  25 CG = 6.2; IG = 4.9, N of doses: IG= 

mm CG (n = 20) – Control: CG = 1.5; IG = 1.3, 63 (146) vs. CG= 

Exclusion: any tx during Co morbidities: neither offered nor CG = 1.5 188 (332) 

preceding mo; any NR Current tx/ co­ denied any therapy by 

contraindication to intervention the study protocol; as Intermediate-mean Sick leaves 

manual therapy; NP < Prior episode of common in all requested by the pt change: IG = 22.9, prescribed for NP 

25/100mm on VAS pain if acute: NR groups: NR Drop outs: See IG CG = 5.4; IG = 2.9, :IG= 3 vs. CG = 5 

CG = -0.4; IG = 1.6, for mean of 4.5 

Prior CAM CG = 0.5 (20.0) and 16.9 

intervention: NR (53.0) ds 

Long term-mean 

Prior surgery change: IG = 14.2, Harms: NR 

related to current CG = 5.5; IG = 4.4, 

complaint: NR CG = -1.3; IG = 1.5, 

CG = 1.9 

C-288
 
Table 2.25 Neck Pain - Massage - Unknown - Specific Pain 

Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Fryer 

(2005)280,281 

Country: 

Australia 

Quality 

score: 5/13 

Initial of 

reviewer: 

SG 

Trial Design 

RCT 

Tx duration: One 

session 

Fu duration (last 

assessment): post tx 

N screened: NR 

N randomized: 37 

N completed tx: NR 

N attended last fu: NR 

Inclusion: Presence of 

latent MTPs in the upper 

trapezius muscle 

Exclusion: Generalized 

primary fibromyalgia 

syndrome, taken 

analgesic Med in the 

past 24 hours, had no 

identifyable myofascial 

MTPs in the upper 

trapezius muscle 

Mean age 

(SD/range): 23.1 

(3.2) yrs 

% of male: 32.4 

Racial 

composition: NR 

Work status: NR 

Other sociodemographics: 

NR 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Prior surgery 

related to current 

complaint: NR 

Region of pain: 

NP 

Cause of Pain: 

Myofascial TP 

Duration of 

Pain, mean 

(SD/range): 

Unknown, NR 

Severity of pain 

(Grading): 

NR 

Current tx/ cointervention 

common in all 

groups: 

NR 

Groups 

IG1 (n = 20)– Massage: 

Myofascial manual 

pressure release; one tx 

Drop outs: NR 

CG (n = 17) – Sham 

myofascial release: 

extremely light pressure; 

same as IG 

Drop outs: NR 

Outcomes: 

Pain: PPT 

Results: 

Immediate post tx: 

Pain-mean change: 

IG = -2.05 (1.7), 

CG = 0.083 (1.7) 

Short term: NR 

Intermediate: NR 

Long term: NR 

Outcomes 

(describe 

instrument 

used): 

QoL/ well being: 

NR 

Results- mean : 

Baseline: NA 

Immediate post 

tx: 

Short term: NR 

Intermediate: NR 

Long term: NR 

Harms: NR 

C-289
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Hanten, W 

(1997)278 

Trial Design 

RCT 

Mean age 

(SD/range): 29.9 

Region of pain: 

NP 

Groups 

IG1 (n = 20)– Occipital 

Outcomes 

(describe 

Outcomes 

(describe 

(9.2) yrs Cause of Pain: Release: traction; One instrument used): instrument 

Country: Tx duration: One Myofascial TP tx Pain: Pain used): 

US session % of male: 30 Drop outs: 0 threshold (kg/cm2) QoL/ well being: 

Fu duration (last (pressure NR 

assessment): Post-tx Racial IG2 (n = 20)– algometer) 

Quality composition: NR Retraction/Retractionscore: 5/13 Duration of Extension: head traction Results: 

N screened: NR Work status: NR Pain, mean and retraction/ext EXs; Baseline: 

N randomized: 60 (SD/range): Same as IG1 Pain: IG1 = 2.1 (1), Results- mean : 

Initial of N completed tx: 60 Other socio- Unknown, NR Drop outs: 0 IG2 = 2.2 (1), CG = Baseline: NA 

reviewer: N attended last fu: 60 demographics: 2.2 (1.2) 

SG NR Severity of pain CG (n = 20) – No Tx: 5 Immediate post 

Inclusion: Pts with one (Grading): min sitting upright; Immediate post tx: tx: 

or more active or latent Co morbidities: NR Same as IG1 Pain: IG1 = 2.5 

cervical and or scapular NR Drop outs: 0 (1.1), IG2 = 2.8 Short term: NR 

TPs Current tx/ co­ (1.3), CG = 2.6 

Prior episode of intervention (1.5) Intermediate: NR 

Exclusion: Known pain if acute: NR common in all 

orthopedic groups: Short term: NR Long term: NR 

cardiovascular or Prior CAM NR 

neurological conditions. intervention: NR Intermediate: NR Harms: NR 

Not received clinical tx 

for the TP Prior surgery Long term: NR 

related to current 

complaint: NR 

C-290
 
Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Hou CR Trial Design Mean age Region of pain: Groups Outcomes: Outcomes 

(2002)279 RCT (SD/range): 46.2 NP IG1-3 (n = 8 in each grp)– Pain: Pain QoL/ well being: 

Country: 

Taiwan 

Tx duration: One 

session 

Fu duration (last 

assessment): 

(13.4) yrs 

% of male: 8.6 

Racial 

Cause of Pain: 

Myofascial TP 

ischemic compression (IC) 

to pain threshold (P1), 30, 

60, 90 sec for grps 

respectively; single tx; no 

drop outs 

IG4- 6 (n = 8 in each grp)– 

threshold (data not 

shown); pain 

toleranc (data not 

shown) e; 10 cm 

VAS 

NR 

ROM- data not 

shown- see 

summary 

Quality composition: NR IC to Average of Pain Harms: NR 

score: 2/13 N screened: NR Duration of Threshold and Pain ResultsN randomized: 119 Work status: NR Pain, mean Tolerance (P2), 30, 60, 90 Summary: PPT, 

N completed tx: (SD/range): sec for grps respectively Immediate post tx: pain intensity, 

Initial of N attended last fu: Other socio- Unknown, NR IG7 (n = 21)– Hot Pack + Pain (VAS) and pain 

reviewer: 

SG Inclusion: Clinically 

active, palpable MTPs in 

a single side or both 

demographics: 

NR 

Co morbidities: 

Severity of pain 

(Grading): 

NR 

Active ROM 

IG8 (n = 13)– Hot Pack + 

Active ROM and IC to 

average Pain,(30, 60 or 90 

sec) 

IG1 = 4.59 (0.85), 

IG2 = 4.72 (0.96), 

IG3 = 3.44 (1.14), 

IG4 = 3.67 (1.34), 

tolearance were 

improved better 

in ICP1-90sec, 

and ICP2, 60& 90 

sides NR IG9 (n = 9)– IG7 + IG5 = 3.46 (1.03), sec vs. ICP1 30, 

Current tx/ co- TENS(30, 60 or 90 sec) IG6 = 3.57 (1.03), & 60 sec or ICP2 

Exclusion: Neck or Prior episode of intervention IG10 (n = 10)– IG7 + IG7 = 4.33 (1.82), 30 sec 

shoulder surgery within pain if acute: NR common in all stretch with spray(30, 60 or IG8 = 3.35 (1.66), Addition of PM 

past yr, radiculopthy or groups: 90 sec) IG9 = 2.46 (1.33), such as 

myelopethy, history of 

disc disease, 

degenerative joint 

disease, fracture or 

Prior CAM 

intervention: NR 

NR IG11 (n = 9)– Hot Pack + 

Active ROM and stretch 

with spray, and TENS(30, 

60 or 90 sec) 

IG10 = 3.26 (1.39), 

IG11 = 2.43 (0.65), 

IG12 = 2.34 (0.9) 

interferential 

current, 

myofascial 

release, spray & 

dislocation in the Prior surgery IG12 (n = 9)– IG7 + stretch, or 

cervical vertebrae, related to current interferrential current and Short term: NR TENSE resulted 

cognitive deficits, complaint: NR myofascial release in better 

unwillingness to technique (30, 60 or 90 Intermediate: NR improvement 

participate sec) also. 

Long term: NR 

C-291
 
Table 2.26 Neck Pain - Massage - Unknown - Non-Specific Pain 

Outcome 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics Intervention Detail Outcome results: Pain, Disability 

results: 

Other 

outcomes; 

Harms 

Meseguer, Trial Design Mean age Region of pain: Groups Outcomes: Outcomes 

A.A. RCT (SD/range): IG1 = NP IG1 (n = 18) – Manipulation Pain: VAS on (describe 

(2006)282 

Country: 

Spain 

Tx duration: one session 

Fu duration (last 

assessment): Post-tx 

N screened: NR 

38 (11) vs. IG2 = 

43 (15) vs. CG = 

39 (10) yrs 

% of male: 30 

Cause of Pain: 

N-S 

(stain/counter strain): 

gradually increasing 

pressure to the tender 

point until the sensation of 

pressure became one of 

pressure and pain, pts 

pressure point (0­

10 cm) assessed 

by application of 

4.5 kg/cm2 with 

algometer 

instrument 

used): 

QoL/ well being: 

NR 

N randomized: 54 positioned so the 

Quality N completed tx: 54 Racial Duration of palpatable tension relieved Results: Results- mean : 

score: 6/13 N attended last fu: 54 

Inclusion: 19-41 yrs old 

composition: NR 

Work status: NR 

Pain, mean 

(SD/range): 

Unknown, NR 

to pain reduction of 70%; 

one session 

Drop outs: NR 

Baseline: 

Pain: IG1 = 5.9 

(2.1), IG2 = 5.1 

Baseline: NA 

Immediate post 

Initial of 

reviewer: 

SG 

with mechanical NP, tender 

point in the upper trapezius 

muscle 

Exclusion: widespread 

pain and or other symptom 

Other sociodemographics: 

NR 

Severity of pain 

(Grading): 

NR 

IG2 (n = 18) – Modified 

manipulation (stain/ 

counter strain): modified 

version with pts arm placed 

(2.5), CG = 5.7 (2) 

Immediate post tx: 

Pain: IG1 = 3.3 

tx: 

Short term: NR 

concomitant with 

fibromyalgia syndrome; 

whiplash injury, cervical 

spine surgery, 

radiculopathy or 

myelopathy determined by 

GP, presence of refered 

pain provoked by the 

compression of the tender 

spot that is diagnosis of 

Co morbidities: 

NR 

Prior episode of 

pain if acute: NR 

Prior CAM 

intervention: NR 

Current tx/ cointervention 

common in all 

groups: 

NR 

in abduction; As IG1 

Drop outs: NR 

CG (n = 18) – No Tx: after 

pre-intervention data pts 

lay supine with the cervical 

spine in neutral position for 

5 minutes until postintervention data were 

again assessed; As IG1 

(2.4), IG2 = 2.5 

(1.2), CG = 5.7 

(2.1) 

Short term: NR 

Intermediate: NR 

Long term: NR 

Intermediate: NR 

Long term: NR 

Harms: NR 

myofascial TPs, or having Drop outs: NR 

undergone any tx in the 

cranio-cervical region. Prior surgery 

related to current 

complaint: NR 

C-292
 
Outcomes: ODQ=Oswestry disability questionnaire; RMQ=Roland Morris Questionnaire; NPQ=Northwick Neck Pain Questionnaire; MPQ=McGill Pain 

Questionnaire; ODI=Oswestry Disability Index; NDI=Neck Disability Index; NHP=Nottingham Health Profile; HFAC=Hanover Functional Ability Questionnaire 

PDI=pain disability index; GWBS=global well-being scale; SLR=straight leg raising; GPE=global perceived effect; FTF=finger-to-floor; PPI=present pain intensity; 

PRI=pain rating index; PUP=pain under pressure; MRP=motion related pain; NPAD=Neck Pain and Disability Scale; QoL=Quality of Life; MVEE=maximum 

voluntary extension effort; PQ=pain questionnaire; MPQ=Short Form McGill Pain Questionnaire; RMAS=Roland Morris Activity Scale; QBPDS=Quebec Back Pain 

Disability Scale; mRDQ=modified Roland Morris Questionnarie NRS=numeric pain rating scale; PPT= pressure pain VAS=visual analogue scale;; SF= short form 

threshold; Special terms:HVLA=high velocity low amplitude; ETOIMS=electrical twitch-obtaining intramuscular stimulation; IMS=intramuscular stimulation; FDT= 

flexion distraction technique; TrP=trigger point; GP=general practitioner; CAM=complementary and alternative medicine; NSAIDs=non-steroidal anti-inflammatory 

drugs; NP=neck pain; N-S=non-specific; S=specific; Med=medication; PT= physiotherapy; ST=standard therapy; E-acu=electro acupuncture; MR= muscle 

relaxation; EX=exercise CLBP=chronic low back pain; A=baseline evaluation; B=immediately post treatment; C= short term follow up (up to 3 months post 

treatment); D=intermediate follow up (up to 6 months post treatment); E=long term follow up (over 6 months post treatment); acu=acupuncture; SM=spinal 

manipulation; LBP= low back pain; NP=neck pain; TP=thoracic pain TENS/TNS= transcutaneous electrical nerve stimulation; ROM=range of motion; 

MPS=myofascial pain syndrome; Mob=mobilization; ext=extension; flx=flexion; rot=rotation; MS=MS; PM=physical modalities; mA=milli Amp; Statistical: 

NS=statistically non-significant; SD=standard deviation; SE=standard error; WMD=weighted mean difference ; p=p-value; 95% CI= 95% Confidence Interval; SS= 

statistically significant; General terms: NA=not available/applicable; NR=not reported; Pt(s)=patient(s); d=day(s); mo(s)=month(s); yr(s)=year(s); wk(s)=week(s); 

N=number NS= not significant; pt/s= patient/s; tx=treatment/intervention Fu=follow up; ITT=intention to treat; IG=intervention group; CG=control group; 

RCT=randomized controlled trial; AE(s)=adverse event(s); SAE= serious adverse events; WDAE= withdrawal due to adverse events 

C-293
 
Table 3-1 – CAM Back Pain II- RCTs evaluating cost effectiveness of CAM txs 

Author ID 

Country Study Characteristics 

Population 

Characteristics 

Pain Characteristics 

Intervention Detail 

(method, frequency, tx 

provider) 

Efficacy/Harms 

Outcomes 

(summary data) 

Economic Outcomes 

(summary data) 

Low Back Pain 

Hollinghurst, 

S 

ATEAM 

study 

(2008)178,283 

Country: UK 

Treatment duration: 3 

mos 

Last assessment: 1 yr 

N screened: 810 

N randomized (total): 579 

N completed tx (total): 464 

Inclusion: chronic or 

recurrent non S LBP from 

primary care 

Exclusion: previous 

experience of Alexander 

technique ; pts under 18 

and over 65; clinical 

indicators of seriuos spinal 

disease; current nerve root 

pain (below knee in 

dermatomal distribution), 

previous spinal surgery, 

pending litigation (outcome 

maybe different, group too 

small to analyze); history of 

psychosis or major alcohol 

misuse (difficulty 

completing outcome); 

perceived inability to walk 

100 m (EX difficult) 

Mean age (SD/range): 

45 yrs 

% of male: range 22% to 

37% 

Racial composition: NR 

Work status employed, n 

(%): reported for 

combined grps (no EX 

and EX) massage 76%; 

Alexander technique 6 

lessons 76%; 24 lessons 

73%; GP care 73% 

Other sociodemographics married, n 

(%): 59% vs. 63% vs. 

56% vs. 59% 

Co morbidities: NR 

Pain grading: NR 

Current tx/ co-intervention 

common in all groups: NR 

Groups 

IG (n = 75) – Massage- not 

described. 

Therapists: NR 

Drop outs: at 3 mos 10, at 

12 mos = 11 

CG1-3 (no EX) – 

CG1 (n = 72)- GP care 

CG2 (n = 73), 6 lessons 

Alexander technique (AT) 

CG3 (n=73)- 24 lessons 

Alexander technique 

CG4-7 (with EX) 

CG4 (n = 71)- 6 lessons AT 

+ EX 

CG5 (n = 71) - 24 lessons 

AT+ EX 

CG6 (n = 72) - Massage + 

EX 

CG7 (n = 72) - GP care + 

EX - prescription by GP, and 

up to 3 sessions of 

behavioral counseling with 

practice nurse 

Therapists: GP, and 

physiotherapists 

Drop outs: at 3, 12 mos CG1 

= 17, 23; CG2 = 13, 15; CG3 

= 13, 14; CG4 = 8, 11; CG5 

16, 22; CG6 19, 22; CG7 = 

19, 21 

Results: 

Pain: 

Days with back pain and 

troublesomeness was 

reported (not used for 

this report) 

Disability: 

Exercise & lessons in 

Alexander technique,but 

not massage, remained 

effective at 1 yr 

(compared with control 

Roland disability score 

8.1: massage í0.58, 

95% confidence interval 

í1.94 to 0.77, six 

lessons í1.40, í2.77 to 

í0.03, 24 lessons í3.4, 

í4.76 to í2.03, and EX 

í1.29, í2.25 to í0.34). 

Exercise after six 

lessons achieved 72% 

of the effect of 24 

lessons alone (Roland 

disability score í2.98 

and í4.14, respectively). 

Conventional care:: 

hours of informal care 

(mean) range from 4.4 in 

CG3 to 45.8 in IG; and 

from 17.8 in CG7 to 44.3 

in CG7 

Base yr: 2005 (1 £ UK = 1.78 

USD) 

Reported Results: 

Total NHS cost over 1 yr 

(intervention, GP visits, other 

primary/ secondary care, and 

Med) : 

IG (n=64) $459.7 (363.9) 

CG1 (n=60) $96.9 (178.7) 

CG2 (n=53) $387.9 (259.8) 

CG3 (n=61) $1,086.5 (467.1) 

CG4 (n=57) $427.2 (190.3) 

CG5 (n=56) $1,177.4 (584.6) 

CG6 (n=56) $475.9 (647.1) 

CG7 (n=51) $274.8 (931.7) 

Total Personal cost (35% 

imputed) also reported. 

Conclusion: study suggests 

that at £20 000/ QALY there 

is > 85% chance that a GP 

EX prescription with a nurse 

fu, or a short series of lessons 

in the AT, will be cost 

effective for pts with chronic 

or recurrent nonS back pain. 

C-294
 
Author ID 

Country Study Characteristics 

Population 

Characteristics 

Pain Characteristics 

Intervention Detail 

(method, frequency, tx 

provider) 

Efficacy/Harms 

Outcomes 

(summary data) 

Economic Outcomes 

(summary data) 

Kominski, Treatment duration: 6 wks Mean age: Mean range Groups Results: reported Base yr: 1995 - 1998 

GF (?) from 49.2 to 53.6 yrs IG (n = 162)– at 6 wks and 6 mos 

(2005)157,284­

291 

Last assessment: efficacy 

= 6 mos; cost = 18 mos % of male: range from 42 

chiropractic- SM or 

another spinal-adjusting Pain: % of pts 

Reported Results: 

Average LBP outPt costs 

to 53 technique and instruction improved from in 18 mos 

Country: N screened: 2355 on proper back care and baseline (2+ points) chiropractic: $550.0 

U.S. N randomized (total): 681 Racial composition (%): EXs- mean no of visits = on numerical rating (834.0) 

N completed tx (total): 654 White: 53 – 66; Black: 1.0 6.9 scales (0-10) to 2, chiropractic + PM: $565.0 

– 3.6; Asian/Pacific Therapists: chiropractor 6-wk, and 6-mos(IG (547.0) 

Inclusion: members of Islander: 3.1 – 6.8; vs. CG1): medical care: $463.0 

various HMOs who chose Hispanic: 25.2 – 34.1; CG1 (n = 163)- - most severe (1255.0) 

the 200-physicain medical Other: 1.2 – 3.6 chiropractic + PM- mean pain:38%, 49%, medical care + PT: $765.0 

groups as their primary no of visits = 7.5 59% vs. 39%, 64%, (1040.0) 

care provider between Work status: NR 56% 

October 1995, and Nov CG2 (n = 162) – medical - average pain: Adjusted mean outPt costs 

1998, presented with acute Other socio­ care- mean no of visits = 25%, 34%, 50% vs. per tx group: 

to chronic non S LBP (with demographics: reported 4.4 35%, 45%, 51% chiropractic: $560.0 

or without leg symptoms) education (no difference Therapists: primary care chiropractic + PM: $579.0 

between grps) physician Disability: Roland medical care: $369.0 

Exclusion: LBP of non Morris Disability medical care + PT: $760.0 

mechanical cause, sever Co morbidities: NR CG3 (n = 167)- medical scores (24 items) in 

coexisting conditions that care + PT- mean no of all pts (unadjusted): Conclusion: higher costs threatened their 18 mos 

survival; blood coagulation 

disorder; use of anti 

coagulants; signs or symptoms 

of cauda equina syndrome; 

involved with third party liability 

Pain grading: NR 

Current tx/ co-intervention 

common in all groups: NR 

visits = 6.6 

Therapist: GPs 

Dropouts for total sample: 

n=37 (4 pts in IG and 9 in 

reduction of about 

2 points at 2 wks, 3 

points at 6 wks and 

4 points at 6 mos 

for chiro care without 

producing better clinical 

outcomes, The cost of 

medical care might have 

been understated due to 

or workers' compensation as a CG1 dropped out at 6 Conventional lack of pharmaceutical 

result of their LB problem mos) care:: NR data. 

C-295
 
Author ID 

Country Study Characteristics 

Population 

Characteristics 

Pain Characteristics 

Intervention Detail 

(method, frequency, tx 

provider) 

Efficacy/Harms 

Outcomes 

(summary data) 

Economic Outcomes 

(summary data) 

Niemisto, L Treatment duration: 4 wks Mean age (SD/range): Groups Results: Base yr: 2002 

(2003)292 Last assessment: 1 yr 37 yrs IG (n = 102) – Manipulation 

+ education booklet=- Pain: VAS (mm) at 5 Reported Results: study 

Country: 

Finland 

N screened: NR 

N randomized (total): 204 

N completed tx (total): 196 

% of male: 46% 

Racial composition: NR 

muscle energy technique 

and stabilizing EXs aiming to 

correct the lumbo-pelvic 

rhythm- 60 minutes- 4 times 

mos: 

25.2 (23.3) vs. 36.1 

(23.3) 

At 1 yr: 

provided data for baseline 

cost (not shown); &1 yr: 

Total healthcare cost, mean: 

in 4 wks 25.7 (23.3) vs. 32.2 Manipulation (n=96) $470.0 Inclusion: 24-46 yr old Work status: sick leave Therapists: experienced (23.3) (cost to pt= $139.0)

employed with chronic during the period of 1 yr, manual therapist Physician consultation 

nonS LBP  3 mos ds mean (SD): 14 (28) vs. Drop outs: 6 Disability: Oswestry (n=100) $431.0 (cost to pt= 

duration and Oswestry LBP 20 (35); employed (%) Disability Index at 5 $154.0) 

Disability Index score 

16%; with or without radiating 

pain above or below knee 

(76% vs. 80% had radiating 

pain) 

99% vs. 91% 

Other sociodemographics: NR 

CG (n = 102) – Physician 

consultation + education 

booklet- education, 

instruction for postural EXsadvice on daily activities 

(static work, lifting, etc.)- 

mos 14.7 (11.6) vs. 

18.6 (11.6) 

At 1 yr: 

13.7 (11.6) vs. 16.5 

(11.6) 

Productivity loss -full d / half d 

salary: 

Manipulation $1,848.0 

(3543.0) / $924 (1772.0) 

Physician consultation 

Exclusion: malignancies, 

ankylosing spondylitis, 

Co morbidities: NR 

Pain grading: NR 

information were reinforced 

at 5 mos Fu- self selected 

frequency of EXHealth related QoL: 

5 mos: 0.88 (0.071) 

vs. 0.90 (0.074) 

$2,450.0 (5163.0) / $1,229.0 

(2582.0) 

sever osteoporosis, sever Therapists: physician 1 yr: 0.89 (0.071) vs. Total cost full d / half d salary

osteoarthritis, paralysis, Current tx/ co-intervention Drop outs: 2 0.90 (0.074) Manipulation $2,457.0 / 

progressive neurologic 

disease, hemophilia, spinal 

infection, previous spinal 

operation, vertebral fracture 

in last 6 mos, sever 

psychiatric disease or 

severe sciatic with a SLR < 

common in all groups: pts 

using analgesics for back 

pain (%): 30% vs. 35% Conventional care:: 

NR 

No AEs in any of the 

groups occurred 

$1,533.0 

Physician consultation 

$3,035.0 / $1,814.0 

Conclusion: the manipulative 

tx with stabilizing EX was 

more effective in reducing 

pain intensity and disability 35° or with  1 recent motor than the physician 

deficit consultation alone. 

C-296
 
Author ID 

Country Study Characteristics 

Population 

Characteristics 

Pain Characteristics 

Intervention Detail 

(method, frequency, tx 

provider) 

Efficacy/Harms 

Outcomes 

(summary data) 

Economic Outcomes 

(summary data) 

Seferlis, T Treatment duration: 8 wks Mean age (SD): 38 yrs Groups Results: Base yr: 1996 ($I USD = 

(2000)293,294 Last assessment: 1 yr 

% of male: 53% 

IG (n = 60)– Manual 

therapy- auto traction, Pain: NA 

6.80 SEK) 

Country: 

Sweden 

N screened: NR 

N randomized (total): 180 

N completed tx (total): 180 

Racial composition: NR 

Work status: all on sick 

manipulation, general Mob, 

auto-Mob, muscle energy 

technique, stretching and 

training co-ordination/ 

stability 

Disability: NA 

Reported Results: 

Cost per Pt: 

Direct cost per PtManual therapy: $1,054.26 

Inclusion: pts with acute leave < 2 wks at baseline Therapists: private physical GP care: $403.53 

LBP with or without sciatica therapist Conventional Intensive therapy: 

requiring sick-leave; and a Other socio- Drop outs: 20 care:: NA $1,123.24 

sick leave period for acute demographics: NR 

LBP < 2 wks before 

entering the study 

Exclusion: spine trauma or 

surgery, inflammatory 

Co morbidities: NR 

Pain grading: NR 

CG1 (n =60 ) – GP care -

rest, sick leave, drug 

prescription like analgesics, 

anti-inflammatory drugs, 

advice/information about 

posture, self curing nature of 

Indirect cost per PtManual therapy: $6,162.79 

GP care: $7,072.06 

Intensive therapy: 

$5,556.62 

disease, tumors of the the disease- -PT were often 

spine, symptoms from prescribed later. Total cost per Pt: 

cervical spine, thoracic Current tx/ co-intervention Therapists: physicians Manual therapy: $7,217.06 

spine or upper extremities, common in all groups: NR Drop outs: 19 GP care:.$7,475.59 

clinical symptoms or severe 

LB disease requiring 

surgery, severe/major 

medical disease, 

pregnancy, drug and or 

CG2 (n =60 ) –intensive 

therapy- information, muscle 

training (EX to Ļmuscle 

fatigue & Ĺ muscle strength 

& co-ordination in abdominal 

Intensive therapy: 

$6,679.85 

Total costs: 

Manual therapy 

alcohol addiction, psychiatric gluteal, para-spinal , $433,018.53 

disease/disorder and shoulder and lower extremity GP care $448,529.71 

unsatisfactory knowledge of muscles), &general intensive therapy the Swedish language. condition training- 3 x wk for $400,790.74 

8 wks 

Therapists: GPs/ PT 

Drop outs: 18 Conclusion: the direct 

costs for tx were lowest in 

the GP group 

C-297
 
Author ID 

Country Study Characteristics 

Population 

Characteristics 

Pain Characteristics 

Intervention Detail 

(method, frequency, tx 

provider) 

Efficacy/Harms 

Outcomes 

(summary data) 

Economic Outcomes 

(summary data) 

Ratcliffe, Treatment duration: 10 Mean age (SD/range): 43 Groups Results: Base yr: 2002-2003 

(2006)95,295­

303 

wks 

Last assessment: 1, and 2 

yrs 

yrs 

% of male: 40% 

IG (n = 159) – acu- 177 

different bilateral & 

unilateral acu points 

Pain: mean 

Present Pain Index 

(McGill) 

Reported Results: 

Total NHS cost, mean 

Country: UK 

N screened: 289 

N randomized (total): 239 

Racial composition: 

majority White 

(BL23, BL26, BL53, 

BL54, and GB30 as well 

as lumbar points); 25 – 

at 1 yr : 1.43 (1.1) 

vs. 1.53 (0.9) 

2 yrs: 1.42 (1.1) vs. 

(SD): 

Acupuncture $744.34 

N completed tx (total): 149 Work status: 51.6, and 40 mm long needles, 0.20 1.71 (1.1) (539.74) 

(group with complete data- 56.3% of pts were on full – 0.30 mm in diameter- Usual care 

also used for cost time work; off work due to 1285 tx were provided; Oswestry PDI (0 – 524.94(673.87) 

effectiveness analysis) BP n=11 in acu care, no the mean (range) of 8.1 100) data for usual care grp (0 – 10) tx per Pt, max 1 yr: 20.6 (19.3) vs. Conclusion: short course 

Inclusion: Patients aged 

18 – 65 yrs with N-S LBP of 

4 – 52 wk duration (sub 

Other socio-demographics: 

NR 

no. of tx was 10 for 

duration of 3 mos 

Therapists: physicians 

19.6 (15.4) 

2 yrs: 18.3 (16.5) 

vs. 21.0 (14.2) 

of traditional acu for 

persistent N-S LBP in 

primary care confers a 

acute – chronic) Co morbidities: NR with a German diploma, modest heath benefit for 

140 hrs of certified acu SF-36 Bodily Pain minor extra cost to NHS 

Exclusion: Possible spinal Pain grading: based on education score (0 – 100) compared with usual care. 

pathology, carcinoma, mean values, majority had Drop outs: 3 mo n=13; 1 1 yr: 64.0 (25.6) vs. 

motor weakness, disc mild to moderate pain at yr n=12; 2 yrs n=36 58.3 (22.2) 

prolapse, past spinal baseline 2 yrs: 67.8 (24.1) 

surgery, bleeding disorders, 

or current Acu Tx Current tx/ co-intervention 

common in all groups: 

Moxibustion (17.7%), 

massage (42.2%), 

CG (n = 80) – Usual care 

- Mix of PT, Med, and 

back EXs 

Therapists: NR 

vs. 59.5 (23.4) 

Disability: NR 

acupressure (12.8%), Drop outs: 3 mos n=9; 1 Conventional 

cupping (4.5%), Chinese yr n=12 mos; 24 mos care: use of meds. 

herbs (4.5%), diet (11.3%), n=21 In past 2 yrs: 40% 

yoga EX (3.3%), relaxation vs. 59%; other

(3.0%)- drugs for LBP prior variables also 

to tx 88% vs. 90% reported 

C-298
 
Author ID 

Country Study Characteristics 

Population 

Characteristics 

Pain Characteristics 

Intervention Detail 

(method, frequency, tx 

provider) 

Efficacy/Harms 

Outcomes 

(summary data) 

Economic Outcomes 

(summary data) 

UK BEAM Treatment duration: 12 Mean age : 43 yrs Groups Results: Base yr: 2000-2001 

trial team wks IG (n = 342)– Utility EQ-5D 

(UK beam 

study119,304,30 

5 

Country: 

Last assessment: 3 mos 

and 1 yr 

N screened: 3535 

N randomized (total): 1334 

% of male: 37 – 47% 

Racial composition: 

majority White (> 92%) 

manipulation + best careHVTT develop by multidisciplinary group- 8 tx in 

12 wks 

Therapists: chiropractors, 

(estimated by 

analysis of 

covariance with 

adjustment for 

baseline score), 

mean (SD): 

Reported Results: 

Total cost of health care 

over 12 mos (included: EX 

class within UK BEAM, 

U.K. N completed tx (total): 1287 Work status: 27 – 33% off osteopathic practitioners hospital inPt stay, outPt 

work in past 4 wks due to and physiotherapist Baseline/ 3 mo/1 yr: attendance, GP 

Inclusion: Pts aged 18-65 LBP, or leg pain; 7 – 12% Drop outs: IG: 0.59 (0.25)/ 0.68 consultation): 

yrs with LBP (RMDQ => 4) not doing work due to (0.26)/ 0.66 (0.28) Manipulation $998.69 

who had experienced the 

pain daily for the past mo 

Exclusion: Serious spinal 

disorder (malignancy, OP, 

pain in last 4 wks 

Other sociodemographics: NR 

CG1 (n= 322)- 

manipulation + EX + best 

care 

Therapists: as IG 

CG1: 0.59 (0.24)/ 

0.66 (0.24)/ 0.68 

(0.27) 

CG2: 0.59 (0.23)/ 

0.63 (0.26)/ 0.63 

(0.26) 

(1417.73) 

Manipulation + EX $869.47 

(904.54) 

Best care in GP $638.72 

(1111.29) 

AS, cauda-equina, Co morbidities: NR CG2 (n = 328) – best Best care in GP + EX 

infection, or compression), care in GP Quality adjusted life $897.16 (1674.32) 

previous spinal surgery, Pain grading: mean Therapists: 12 wks yr (QALY)s – 1 yr, 

severe mental disorder, values on VAS 0 – 100 Drop outs: mean (SD) 

CVD, hypertension (systolic 

blood pressure > 180 mm 

Hg and diastolic > 105 mm 

Hg), anticoagulant Tx, 

reported; mean < 4.0 for 

all grps CG3 (n = 297) – best 

care in GP + EX 

Therapists: 9 classes of 

IG: 0.66 (0.24) 

CG1: 0.65 (0.24) 

CG2: 0.62 (0.23) 

CG3: 0.64 (0.25) 

Conclusion: SM showed 

to be cost effective 

addition to best care by 

GP for back pain. 

steroids, RMDQ <= 3, Current tx/ co-intervention EX in 12 wks + GP Manipulation alone might 

illiterate in English common in all groups: NR Drop outs: Note: other efficacy give better value vs. 

data is presented in manipulation vs. EX 

table UK Beam Trial 

Team (2004)119 

C-299
 
Author ID 

Country Study Characteristics 

Population 

Characteristics 

Pain Characteristics 

Intervention Detail 

(method, frequency, tx 

provider) 

Efficacy/Harms 

Outcomes 

(summary data) 

Economic Outcomes 

(summary data) 

Witt, CM 

(2006)49,306,3 

07 

Treatment duration: 3 

mos 

Last assessment: 6 mos 

Mean age (SD/range): 

53.1 (13.5) vs. 52.6 (13.2) 

yrs 

Groups 

IG (n = 1451)– acu -

disposable needles- at 

Results: 

Pain: Back pain 

Base yr: 2001-2004 (1 € = 

1.45364 USD) 

Country: N screened: 11630 % of male: 43% 

acu points decided by the 

treating physician- 3 mos 

los (LBP rating 

scale) change in 3 

Reported Results: 

QALY mean (SD): 

Germany N randomized (total): 2841 

with consent form 

N completed tx/fu (total): 

2385 

Racial composition: NR 

Work status: NR 

tx phase with a maximum 

of 15 acu tx- 74% 

received 5- 10 sessions; 

21% received > 10 

sessions; 5% received < 

and 6 mos from 

baseline- mean 

(95% CI) IG vs. 

CG: 

Baseline to 3 mos: 

Baseline: 0.60 (0.11) vs. 

0.61 (0.11) 

3 mos: 0.69 (0.12) vs. 063 

(0.11) 

Over the duration of study 

Inclusion: clinical Other socio­ 5 sessions 37.0 (35.2, 38.9) (baseline – 3 mos /2) 

diagnosis of CLBP> 6 mos; 

age 18 or over, provision of 

demographics: education 

(>10 yrs schooling) 

Therapists: physicians 

with A-diploma, a 

vs. 9.8 (7.9, 11.7) 

Baseline to 6 mos: 

0.65 (0.10) vs. 0.62 (0.10) 

written informed consent 

Exclusion: protrusion or 

25.8% vs. 29.2% 

Co morbidities: NR 

German diploma 

representing 140 hrs of 

certified acu education 

33.5 (31.4, 35.7) 

vs. 30.8 (28.7, 

33.0) 

Overall cost at 3 mos post 

randomization, mean (SD): 

Acupuncture (n = 1231) 

prolapse > 1 intervertebral Drop outs: $1,544.43 (3,253.57) 

discs with concurrent 

neurologic symptoms; prior 

vertebral column surgery, 

infectious spondylopathy, 

LBP caused by 

Pain grading: NR 

Current tx/ co-intervention 

common in all groups: 

usual care 

 CG (n = 1390) – Delayed 

acu- 3 mos phase 

Therapists: as acu 

Disability- Back 

function loss 

(HFAQ), mean 

(95% CI) IG vs. 

CG: 

Conventional care (n = 

1157) $1,137.27 

(2,513.05) 

Diagnostic S cost at 3 

inflammatory, malignant or 

autoimmune disease; 

congenital deformation of 

the spine, except for slight 

lordosis or scoliosis; 

Drop outs: Baseline to 3 mos: 

33.3 (31.4, 35.3) 

vs. 11.3 (9.5, 13.1) 

Baseline to 6 mos: 

32.4 (30.3, 34.4) 

mos, mean (SD): 

Acupuncture (n = 1231) 

$809.90 (1,268.94) 

Conventional care (n = 

1157) $366.19 (1,548.72) 

compression fracture vs. 28.6 (26.5, 

caused by osteoporosis; 

spinal stenosis; and 

spondylolysis or 

spondylolisthesis. 

30.8) 

Conventional 

care:: NR 

Conclusion: acu + routine 

care was associated with 

marked clinical 

improvement and was 

relatively cost-effective. 

C-300
 
Author ID 

Country Study Characteristics 

Population 

Characteristics 

Pain Characteristics 

Intervention Detail 

(method, frequency, tx 

provider) 

Efficacy/Harms 

Outcomes 

(summary data) 

Economic Outcomes 

(summary data) 

Neck Pain 

Willich, SN Mean age (SD/range): Groups Results: Base yr: 2004 

(2006)209,210 Treatment duration: 3 49.8 (12.8) vs. 51.4 IG (n = 1753)– acu- %, mean changes 

mos (13.0) yrs standard acu with from baseline (95% Reported Results: 

Country: Last assessment: 6 mos % of male: 30.1% vs. disposable needles CI) Total cost, mean (SD): 

Germany 32.1% permitted; 15 sessions $1165.42 (1953.09) vs. 

N screened: 14161 during 3 mo Pain and $816.04 (1837.34) 

N randomized (total): 3766 Racial composition: NR Therapists: Physicians disability: bodily - Total diagnostic S cost: 

N completed tx (total): 3715 held A-diploma based on pain reduction $556.40 (688.54) vs. 

Work status: NR 140 h certified acu 3 mos: 28.9 (27.6; $145.80 (930.36) 

Inclusion: adults age  18 education 30.2) vs. 5.8 - Difference in total overall 

yrs of age with chronic N-S Other socio- Drop outs: 29 (4.5;7.1) cost in 6 mo: $471.61 

NP (> 6 mos in duration) demographics: > 10 yrs 6 mos: 28.0 (26.5; (2106.2) vs. 36.41 

of schooling 31.4% vs. 29.4) vs. 25.1 (1581.28) 

Exclusion: prolapse of at 30.1% CG (n = 1698) – GP care- (23.6; 26.5) - Difference in total 

least one intervertebral conventional Tx as diagnosis-S cost in 6 mos: 

discs with concurrent Co morbidities: NR needed QoL, SF-36 $399.17 (465.88) vs. $7.41 

neurological symptoms, Therapists: GP (increase from (525.76) 

prior vertebral surgery, Pain grading: NR Drop outs: 22 baseline): 

spondylopathy, NP caused Physical Conclusion: In the acu 

by inflammatory, cancer or functioning: 8.4 group 0.024 ± 0.004 

autoimmune disease, Current tx/ co-intervention (7.6; 9.2) vs. 0.9 additional QALYs were 

congenital deformation of common in all groups: (0.2; 1.7) gained compared to the CG 

spine except scoliosis 

lordosis, compression 

fracture caused by 

osteoporosis; spinal 

usual care Role physical: 24.5 

(22.6; 26.5) vs. 5.1 

(3.3; 7.0) 

Bodily pain: 21.0 

(associated with additional 

costs (overall: $370.03 ± 

65.20; diagnosis-S: $404.16 ± 

30.69). The (ICER) was 

$15,698.47 (overall) and 

stenosis (20.0; 22.0) vs. 5.3 $17,145.06 (diagnosis- S) per 

(4.3; 6.3) QALY gained. Therefore, for 

Physical the assumed threshold value 

component score: of $62,950 the additional acu 

5.8 (5.5; 6.2) vs. intervention was cost1.2 (0.8; 1.5) effective. 

C-301
 
Author ID 

Country Study Characteristics 

Population 

Characteristics 

Pain Characteristics 

Intervention Detail 

(method, frequency, tx 

provider) 

Efficacy/Harms 

Outcomes 

(summary data) 

Economic Outcomes 

(summary data) 

Lewis, M Treatment duration: 6 wks Mean age: 51 yrs Groups Base yr: 2003 

(2005)308,309 Last assessment: 6 mos 

% of male: 37% IG (n = 114)– manual 

therapy (MT)- hands-on, 

Pain: Northwick 

Park Scores (NPQ, 

Reported Results: 

Total healthcare resources 

Country: UK 

N screened: 735 

N randomized (total): 350 Racial composition: NR passive or active assisted 

movements, Mobs or 

0 - 100) , mean 

(SD): 

cost at 6 mos MT(n=87): 

$190.69 (1742.41) 

N completed tx (total): Work status (%): Employed 

58;Unemployed 42; Pts off 

manipulations to the 

joints and soft tissues – 

6 wks: 29.6 (15.5) 

25.6 (17.6) vs. 

A&E (n = 77): $169.10 

(1735.23) 

Inclusion: pts at least 18 work in px 3 mo due to NP max of 8, 20 min session 28.9 (15.5) PSWD (n = 94): $598.22 

yrs with clinical diagnosis of 29; Routine and manual over 6 wks 6 mos: 27.8 (19.4) (10427.93) 

nonS NP; referred to PT by occupations 49 Therapists: experienced vs. 24.2 (18.6) vs. 

a GP with a new episode of senior musculoskeletal 26.9 (18.7) Total Societal costs (total 

non- S NP; no consultations 

other than primary health 

Other socio-demographics: 

NR therapist 

Drop outs: 4 Global assessment 

costs of health-care 

resources + pts resources 

care team for NP in 

previous 6 mo Co morbidities: NR of overall change 

(%): 

+ productivity loss) 

MT(n=87): $486.81 

Pain grading: higher mean CG (n = 115) – A&E only Much better (7321.56) 

Exclusion: weight loss, NPQ scores and lower mean (control) 6 wks: 31 vs. 27 vs. A&E (n = 77): 

fever, progressive EQ-5D scores for MT group Therapists: as IG 22; 6 mos: 33 vs. $197(1714.75) 

neurologic disorder, Drop outs: 13 31 vs. 28 PSWD (n = 94): $543.13 

evidence of muscle Current tx/ co-intervention (8921.38) 

weakness or disturbance in 

normal sensation, history of 

malignancy, inflammatory 

arthritis, polymyalgia 

rheumatica, osteoporosis, 

common in all groups: nonsteroidal anti-inflammatory 

drugs continued at a stable 

dose; advise and EX (A&E) 

delivered by study therapist; 

consultation/prescription 

CG (n =121 ) –MT + 

shortwave diathermy 

(PSWD) 

Therapists: as IG 

Drop outs: 8 

Much worse: 

6 wks: 0 vs. 0 vs. 1; 

6 mos: 1 vs. 2 vs. 3 

Conventional 

Conclusion: the costeffective intervention is 

likely to be A&E or MT, 

depending on the 

or gross structural or from GP, extra PT; OTC advice and EX and care:: % taking economic perspective and 

neurologic abnormality Med, consult other health manual therapy (SM) painkillers in past preferred outcome 

affecting the neck; prof. 48 hrs 

pregnancy; participants with 6 wks: 55 vs. 31 vs. 

contraindications to the 43 

study tx 6 mos: 54 vs. 32 

vs. 52 

C-302
 
Author ID 

Country Study Characteristics 

Population 

Characteristics 

Pain Characteristics 

Intervention Detail 

(method, frequency, tx 

provider) 

Efficacy/Harms 

Outcomes 

(summary data) 

Economic Outcomes 

(summary data) 

Kothals de Treatment duration: 6 wks Mean age (SD/range): Groups Results: Base yr: 1997-1998 

Bos 

(2005)310 

Last assessment: 1 yr 45 yrs IG (n = 60)– manual 

therapy – Mob (muscular Pain: intensity (0­ Reported Results: 

% of male: 30 – 44% and spinal) , co­ 10) at 1 yr 42 (2.4) Average LBP outPt costs 

Country: the N screened: NR ordination, stabilization- vs. 3.1 (2.9) vs. 4.1 in 18 mos 

Netherlands N randomized (total): 183 Racial composition: NR 45 min per session; 1 x (2.9) IG = 402.0 

N completed tx (total): 178 wk CG = 1,166.4 

Work status: n (%) pts Therapists: 6 registered Disability: different CG2 = $ 1,240.2 

Inclusion: non S NP for at employed ranged 71- manual therapists with of mean effects 

least 14 ds,18-70 yrs old 78% min 3 yrs training within each tx 

Drop outs: 2 at 1 yr between baseline Conclusion: manual 

Exclusion: Other socio­ and 52 wks 7.2 therapy is more effective 

manual therapy or PT demographics: NR CG1 (n = 59) – PT- (7.5) vs. 6.3 (8.0) and less costly for treating 

during previous 6 mos; individual build-up EXs, vs. 8.5 (7.4) NP than PT 

operative surgeries in neck Co morbidities: NR active relaxation & 

area or S reasons for relieving EXs, stretching Conventional 

complaints (e.g. malignant Cause/duration of Pain: & functional EXs- 30 min care:: N of visits to 

disease) per tx; 2 x wk GP, manual tx 

Pain grading: NR Therapists: 5 sessions, PT 

physiotherapists sessions, medical 

Current tx/ co-intervention Drop outs: 0 at 1 yr specialist care; 

common in all groups: professional home 

home EX, Med such as CG2 (n = 64) – standard care, during one yr 

paracetamol or non­ tx- heat application, EXs, 

steroidal antiphlogistica paracetamol, non- Other: absenteeism 

as usual if these not steroidal antiphlogistica- from paid work ; or 

replaced by others during 10 min visits, 2 x wk unpaid work in one 

tx Therapists: 42 GPs yr 

Drop outs: 3 at 1 yr 

C-303
 
Author ID 

Country Study Characteristics 

Population 

Characteristics 

Pain Characteristics 

Intervention Detail 

(method, frequency, tx 

provider) 

Efficacy/Harms 

Outcomes 

(summary data) 

Economic Outcomes 

(summary data) 

ID = identification; RCT = randomized clinical trial; SD = SD; LBP = LBP; NP = NP:TP = TP; NS = non S; NR = NR; Acu = acu; AP = acu points; TENSE 

= ; fu = Fu; wk/s = wk/s; mth/s = mo/s; Tx = tx; IG = IG (only CAM interventions would use this acronym); CG = CG (used for all comparisons including 

CAM used in conjunction with another intervention) ES= ES; TP = TP; PP = pressure point; GP= GP; PT= physical therapy 

HFAQ: Hannover Functional Ability Questionnaire; HVTT= high velocity thrust technique; QALY= quality adjusted life yr 

All cost are reported as USD as reported in the study or converted using historic data (rates) for the yr/s indicated by authors. 

C-304
 
Table 4-1 – CAM Back Pain II- Observational Studies Reporting Harms 

Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics 

Group / Intervention 

Detail 

Outcome results: 

Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Cassidy, D 

(2008) 311 

Country: 

Canada 

Quality score: 

8/27 

Trial Design: Case control 

and case-crrosover 

Cases n = 818 

Matched controls n= 3164 

Inclusion: All incident 

vertebrobasilar occlusion 

and stenosis strokes 

resulting in acute care 

hospital admission from 

April 1, 1993 – March 31, 

2002. 

Exclusion: Cases that had 

an acute care hospital 

admission for any type of 

stroke, transient cerebral 

ischemia or late effects of 

cerebrovascular diseases 

before their VBA stroke 

admission or since April 1, 

1991. 

Mean age: 

Cases: 63.1 

Control: 62.6 

% of male: 

Cases: 63.3 

Control: 63.9 

Racial 

composition: 

NR 

Work status: NR 

Other sociodemographics: NR 

Co morbidities: 

NR 

Prior CAM 

intervention: NRs 

Prior surgery 

related to current 

complaint: NR 

Cause of Pain: 

Headache / Neck 

Pain 

Duration of Pain: 

NA 

Severity of pain 

(Grading): NA 

Co-interventions: 

NA 

Groups: Separated by 

age categories and 

doctor visit type 

Patients over 45 years 

old 

Patients 45 years old 

and younger 

Primary Care Physician 

Visits 

Chiropractic Visits 

Outcome 

instruments: 

Pain: NA 

Disability: NA 

Results: 

Baseline: 

Pain: NA 

Disability: NA 

Harms: 

Chiropractic visit in the 

month before the index 

date: 

Patients 45 years of age 

and under: (OR=3.13, 

95% CI: 1.48, 6.63). 

Primary care physician 

visits in the month before 

the index date: 

Patients 45 years of age 

and under (OR= 3.57, 

95% CI: 2.17, 5.86) 

Patients over 45 years of 

age (OR= 2.67, 95%CI: 

2.25, 3.17). 

C-305
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics 

Group / Intervention 

Detail 

Outcome results: 

Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Cook, C (2008) 

314 

Country: 

USA 

Quality score: 

6/27 

Trial Design: 

Retrosepctive cohort 

Group with PT: n = 75 

Group without PT: n = 75 

Inclusion: All patients with 

a primary diagnosis of 

mechanical low back pain, 

hospitalized and 

documented in NIS 

databases from 1988 to 

2005 with additional codes 

for PT MSK manipultion, 

non-operative 

manipulation of the spine, 

mobilization of the spone, 

Exclusion: Patients 

younger than 18 years 

with any form of surgical 

procedure and withany 

form of pathlogic 

fracture,tumor or other 

mechanical low back 

diagnosis. 

Mean age: 

Group with PT: 

53.62 

Group without PT: 

50.93 

% of male: 

Group with PT: 

23% 

Group without PT: 

22% 

Racial 

composition: 

Group with PT: 

White: 66.7% 

Black: 4.00% 

Hispanic: 2.67% 

Other: 3.00% 

Missing: 22.67% 

Group without PT: 

White: 69.33% 

Black: 5.33% 

Hispanic: 2.67% 

Other: 0% 

Missing: 22.67% 

Cause of Pain:NA 

Duration of Pain: 

NA 

Severity of pain 

(Grading): NA 

Co-interventions: 

NA 

Groups: 

Group with PT: 

Diagnosis of of 

mechanical LBP who 

received PT manual 

therapy 

Group without PT: 

Diagnosis of 

mechanical LBP who 

did not receive PT 

manual therapy 

Outcome 

instruments: 

Pain: NA 

Disability: NA 

Results: 

Baseline:NA 

Pain: NA 

Disability: NA 

Harms: 

Complication variables 

between two groups: No 

difference. 

No further description of 

adverse events was 

provided in this study. 

Work status: NR 

C-306
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics 

Group / Intervention 

Detail 

Outcome results: 

Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Kohlbeck, F Trial Design: Prospective Mean age: Cause of Interventions: Outcome Harms: 

(2005) 315 cohort 

N screened = 314 

41.2 Pain:Nonspecific 

Low Back Pain Spinal manipulation 

instruments: 

Pain: 0-100 point Treatment with 

Country: N included = 68 % of male: 61.8% therapy only: scale (most pain to medication-assisted 

USA 

Inclusion: Patients that 

sought care at private 

Racial 

composition: 

Duration of Pain: 

Chronic 

Patients continued to 

receive SMT similar to 

initial phase of 

least) 

Disability: 0-100 

manipulation or spinal 

manipulation alone for at 

least 4 – 6 weeks 

Quality score: chiro practices from Aug. White: 83.8 Severity of pain treatment. It involved a point scale (most resulted in no 

12/27 20, 2000 – Feb. 5, 2002; 

presented with chronic 

nonspecific LBP; reduced 

lumbopelvic flexibility; 

btwn 18-60 years. 

Exclusion: BP caused by 

fracture, tumor, infection, 

severe 

spondyloarthropathy; 

active rheumatoid disease; 

any active infectious 

disease; current history of 

smoking & drug/alcohol 

abuse; severe coexisting 

disease; blood coagulation 

disorder; any medication 

that would conflict with 

sedating meds; any 

conditions that would 

preclude the use of 

manipulation; lacked ability 

to read English; current 

LBP involving third-party 

liability or worker’s comp. 

Black: 1.5% 

Hispanic: 7.4% 

Asian: 2.9% 

Other: 4.4% 

Work status: 

Currenly working: 

92.6 

Unemployed/retire 

d: 7.4 

(Grading): 100 

point scale 0-100 

(most pain to 

least) 

Co-interventions: 

NA 

controlled dynamic 

thrust applied with high 

velocity and low 

amplitude, directed at 1 

or more joints of the 

spine using short-lever 

contacts. 

Medication-assisted 

manipulation: MAM 

incorpoates the 

intravenous 

administration of 

sedative and analgesic 

medication – reducing 

pain and muscle spasm 

that hinder the 

effectivenss of tradition 

al SMT. 

disability to least) 

Results: 

Baseline: 

Mean Pain/Disability: 

61.2 MAM vs. 71.2 

SMT 

6wk: 75.7 vs. 79.2 

3 mo: 84.8 vs. 80.4 

6 mo: 85.6 vs. 83.4 

1 year: 81.3 vs. 81.0 

complications. In this 

study spinal manipulation 

had been delivered by 

two chiropractors. In 

addition to the 

intervention treatment, 

participants received 

advice for exercise. 

C-307
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics 

Group / Intervention 

Detail 

Outcome results: 

Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Rothwell, DM 

(2001) 313 

Country: 

Canada 

Quality score: 

8/27 

Trial Design: Populationbased nested case-control 

Cases n = 582 

Matched controls n = 2328 

Inclusion: All persons 

admitted to an Ontario 

acute care facility with a 

diagnosis of 

vertrebrobasilar dissection 

or occlusion from January 

1993-December 1998. 

Exclusion: Cases who 

were not eligible for OHIP 

in the year before the 

reference date; Patients in 

chronic care facilities with 

prior stroke treated within 

the chronic care facility. 

Mean age: 

All subjects: 60 

years 

% of male: 

All subjects: 61% 

Racial 

composition: 

NR 

Work status: NR 

Other sociodemographics: NR 

Co morbidities: 

NR 

Prior CAM 

intervention: NRs 

Prior surgery 

related to current 

complaint: NR 

Cause of Pain:NA 

Duration of Pain: 

NA 

Severity of pain 

(Grading): NA 

Co-interventions: 

NA 

Groups: Cases and 

control 

Cases: Diagnosis of 

vertebrobasilar 

dissection or occlusion 

Control: matched by 

sex and age with no 

history of hospital 

admission of stroke 

The groups were also 

categorized by age into 

two groups 45 years 

and younger and over 

45 years old. 

Outcome 

instruments: 

Pain: NA 

Disability: NA 

Results: 

Baseline:NA 

Pain: NA 

Disability: NA 

Harms: 

Case group: (Patients 

aged 45 years and 

younger) 

Chiroparctic visits by a 

week before a vertebrobasilar accident: 

(OR= 5.03, 95% CI: 1.3, 

43.8) 

3 or more vists to a 

chiropractic care in the 

month before vetrebrobasilar accident 

(OR= 4.98, 95% CI: 1.3, 

18.6) 

C-308
 
Author ID 

Country Study Characteristics Population Characteristics 

Pain 

Characteristics 

Group / Intervention 

Detail 

Outcome results: 

Pain, Disability 

Outcome results: 

Other Outcomes/ 

Harms 

Smith, W.S. 

(2003) 312 

Country: 

USA 

Quality score: 

10/27 

Trial Design: Nested casecontrol 

Cases n = 51 

Matched controls n= 100 

Inclusion: All patients 

evaluated for ischemic 

stroke or TIA from 1995 – 

20000 who were aged 60 

years or less at the time of 

the event. 

Exclusion: Vascular events 

not caused by arterial 

dissection 

Mean age: 

Cases: 40.6 

Control: 44.0 

% of male: 

Cases: 41 

Control: 42 

Racial 

composition: 

NR 

Work status: NR 

Other sociodemographics: NR 

Co morbidities: 

NR 

Prior CAM 

intervention: NRs 

Prior surgery 

related to current 

complaint: NR 

Cause of Pain: 

NA 

Duration of Pain: 

NA 

Severity of pain 

(Grading): NA 

Co-interventions: 

NA 

Groups: Cases and 

control 

Cases: Had vascular 

event casued by arterial 

dissection 

Control: matched by 

sex and within 10-year 

age stata. 

Outcome 

instruments: 

Pain: NA 

Disability: NA 

Results: 

Baseline:NA 

Pain: NA 

Disability: NA 

Harms: 

% of patients with arterial 

dissection had SMT 

within 30 days = 14.0 % 

% of controls had SMT 

within 30 days = 3.0%, 

SMT within 30 days 

(Vertebral Dissection 

group) (OR = 6.6, 95% 

CI: 1.4 to 30.0). 

C-309
 
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D-31
 
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D-34
 
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D-35
 
Appendix E. Additional Acknowledgements 

The UO-EPC gratefully acknowledges the following individuals who served on our 

Technical Expert Panel (TEP). Acknowledgment does not reflect endorsement of this 

report. 

Dr. Jill Hayden, D.C, PhD 

Community Health & Epidemiology 

Dalhousie University 

Halifax, NS 

Dr. Gert Bronfort, D.C, PhD 

Vice President of Research 

Northwestern Health Sciences University 

Bloomington, MN 

Dr. Karen Sherman MPH, PhD, 

Senior Investigator 

Group Health Research Institute 

Seattle, WA 

Dr. Rick Deyo, M.D., M.P.H. 

Department of Family Medicine 

Oregon Health & Science University 

Portland, OR 

The UO-EPC gratefully acknowledges the following individuals who peer reviewed the 

initial draft of this report. Acknowledgment does not reflect endorsement of this report. 

Dr. Gert Bronfort, D.C, PhD 

Vice President of Research 

Northwestern Health Sciences University 

Bloomington, MN 

Dr. Jeanette Ezzo, MPH, PhD 

Director of Research 

JPS Enterprises 

Baltimore, MD 

Dr. Christine Goertz, DC, PhD 

Vice Chancellor for Research & Health 

Policy 

Palmer Center for Chiropractic Research 

Davenport, IA 

Dr. Roger Chou, MD 

Associate Professor of Medicine 

Oregon Health & Science University 

Portland, OR 

Dr. Andrew Vickers, PhD 

Research Methodoligist & Biostatistician 

Memorial Sloan – Kettering Cancer Center 

New York, NY 

Dr. Timothy Flynn, PhD 

Associate Professor 

Regis University 

Denver, CO 

Dr. Lixing Lao, MD, PhD 

Director, TCM Research Program 

Centre for Integrative Medicine 

University of Maryland 

Baltimore, MD 

Dr. Christopher Moyer, PhD 

Assistant Professor 

Department of Psychology 

University of Wisconsin-Stout 

Menomonee, WI 

E-1
 
Appendix F 

Quality Assessment Tools and Questionnaires 

Table 1. Updated Method Guidelines for Systematic Reviews in the Cochrane 

Collaboration Back Review Group – A 12 Item tool. 

Was the method of randomization adequate? Yes / No / Unsure
 

Was the treatment allocation concealed? Yes / No / Unsure
 

Were the groups similar at baseline regarding Yes / No / Unsure 

the most important prognostic indicators? 

Was the patient blinded to the intervention? Yes / No / Unsure
 

Was the care provider blinded to the Yes / No / Unsure 

intervention? 

Was the outcome assessor blinded to the Yes / No / Unsure 

intervention? 

Were co-interventions avoided or similar? Yes / No / Unsure
 

Was the compliance acceptable in all groups? Yes / No / Unsure
 

Was the drop-out rate described and Yes / No / Unsure 

acceptable?
 

Was the timing of the outcome assessment in Yes / No / Unsure 

all groups similar? 

Did the analysis include an intention-to-treat
 Yes / No / Unsure 

analysis? 

Are reports of the study free of suggestion of
 Yes / No / Unsure 

selective outcome reporting? 

Item Rating 

Maurits van Tulder, PhD, Andrea Furlan, MD, Claire Bombardier, MD, FRCP, Lex Bouter, PhD, and the Editorial 

Board of the Cochrane Collaboration Back Review Group 

Table 2. Acupuncture for Chronic Low-back pain a systematic review of the literature – A 

13 item tool 

Item Rating 

Adequate sequence generation? Yes / No / Unsure 

Allocation concealment? Yes / No / Unsure 

Blinding? (All outcomes - patients?) Yes / No / Unsure 

Blinding? (All outcomes - providers?) Yes / No / Unsure 

Blinding? (All outcomes - outcome assessors?) Yes / No / Unsure 

Incomplete outcome data addressed? (All 

outcomes - drop-outs?) 

Yes / No / Unsure 

F - 1 
F - 2 

Incomplete outcome data addressed? (All 

outcomes - ITT analysis?) 

Yes / No / Unsure 

Free of selective reporting? Yes / No / Unsure 

Free of other bias? Yes / No / Unsure 

Similarity of baseline characteristics? Yes / No / Unsure 

Co-interventions avoided or similar? Yes / No / Unsure 

Compliance acceptable? Yes / No / Unsure 

Timing outcome assessments similar? Yes / No / Unsure 

Table 3. CHEC List- 19 item Quality assessment tool for economic studies 

Item Rating 

Is the study population clearly described? Yes / No 

Are competing alternatives clearly described? Yes / No 

Is a well-defined research question posed in 

answerable from? 

Yes / No 

Is the economic study design appropriate? Yes / No 

Is the chosen time horizon appropriate in order 

to include? 

Yes / No 

Is the actual perspective chosen appropriate? Yes / No 

Are all important and relevant costs for each 

alternative identified? 

Yes / No 

Are all costs measured appropriately in physical 

units? 

Yes / No 

Are costs valued appropriately? Yes / No 

Are all important and relevant outcomes for 

each alternative identified? 

Yes / No 

Are all outcomes measured appropriately? Yes / No 

Are outcomes valued appropriately? Yes / No 

Is an incremental analysis of costs and 

outcomes of alternatives performed? 

Yes / No 

Are all future costs and outcomes discounted 

appropriately? 

Yes / No 

Are all important variables shoes values are 

uncertain appropriately subjected to sensitivity 

analysis? 

Yes / No 

Do the conclusions follow from the data 

reported? 

Yes / No 

Does the study discuss the generalizability of 

the results to other setting and patient groups? 

Yes / No 

Does the article indicate that there is no 

potential conflict of interest of study 

researcher(s) and funder(s)? 

Yes / No 

Are ethical and distributional issues discussed 

appropriately? 

Yes / No 
Table 4. The McGill Pain Questionnaire 

Overview: The McGill Pain Questionnaire can be used to evaluate a person experiencing 

significant pain. It can be used to monitor the pain over time and to determine the 

effectiveness of any intervention. It was developed at by Dr. Melzack at McGill 

University in Montreal Canada and has been translated into several languages. 

Sections: 

(1) What Does Your Pain Feel Like? 

(2) How Does Your Pain Change with Time? 

(3) How Strong is Your Pain? 

1- What Does Your Pain Feel Like? 

Statement: Some of the following words below describe your present pain. Circle ONLY 

those words that best describe it. Leave out any category that is not suitable. Use only a 

single word in each appropriate category - the one that applies best. 

Group Descriptor Points 

1 (temporal) Flickering 1 

 Quivering 2 

Pulsing 3 

Throbbing 4 

 Beating 5 

Pounding 6 

2 (spatial) Jumping 1 

Flashing 2 

Shooting 3 

3 (punctate pressure) Pricking 1 

Boring 2 

Drilling 3 

Stabbing 4 

 Lancinating 5 

4 (incisive pressure) Sharp 1 

 Cutting 2 

 lacerating 3 

5 (constrictive pressure) Pinching 1 

Pressing 2 

 Gnawing 3 

Cramping 4 

 Crushing 5 

6 (traction pressure) Tugging 1 

Pulling 2 

Wrenching 3 

7 (thermal) Hot 1 

F - 3 
Boring 2 

Scalding 3 

Searing 4 

8 (brightness) Tingling 1 

Itchy 2 

Smarting 3 

Stinging 4 

9 (dullness) Dull 1 

Sore 2 

Hurting 3 

Aching 4 

Heavy 5 

10 (sensory miscellaneous) Tender 1 

Taut 2 

Rasping 3 

Splitting 4 

11 (tension) Tiring 1 

Exhausting 2 

Sickening 1 

Suffocating 2 

14 (punishment) punishing 1 

gruelling 2 

cruel 3 

 vicious 4 

killing 5 

15 (affective-evaluativesensory: miscellaneous) wretched 1 

blinding 2 

16 (evaluative) annoying 1 

troublesome 2 

miserable 3 

intense 4 

F - 4 
F - 5 

pain score = SUM(points for applicable descriptors) 

 unbearable 5 

17 (sensory: miscellaneous) spreading 1 

radiating 2 

penetrating 3 

piercing 4 

18 (sensory: miscellaneous) tight 1 

numb 2 

 drawing 3 

 squeezing 4 

tearing 5 

19 (sensory) cool 1 

cold 2 

 freezing 3 

20 (affective-evaluative: 

miscellaneous) nagging 1 

 nauseating 2 

agonizing 3 

dreadful 4 

torturing 5 

2 - How Does Your Pain Change with Time? 

Question Response Points 

Which word or words would 

you use to describe the 

pattern of your pain? 

continuous steady 

constant 

1 

rhythmic periodic 

intermittent 

2 

 brief momentary 

transient 

3 
Do the following items increase or decrease your pain? 

(1) liquor 

(2) stimulants such as coffee 

(3) eating 

(4) heat 

(5) cold 

(6) damp 

(7) weather changes 

(8) massage or use of a vibrator 

(9) pressure 

(10) no movement 

(11) movement 

(12) sleep or rest 

(13) lying down 

(14) distraction (TV reading etc.) 

(15) urination or defecation 

(16) tension 

(17) bright lights 

(18) loud noises 

(19) going to work 

(20) intercourse 

(21) mild exercise 

(22) fatigue 

3 -How Strong is Your Pain? 

Statement: People agree that the following 5 words (mild discomforting distressing 

horrible excruciating) represent pain of increasing intensity. To answer each question 

below write the number of the most appropriate word in the space beside the question. 

Question Response Points 

Which word describes your 

pain right now? 

Mild 1 

 Discomforting 2 

F - 6 
 Distressing 3 

Horrible 4 

 Excruciating 5 

Which word describes it at 

its worst? 

Mild 1 

 Discomforting 2 

 Distressing 3 

Horrible 4 

 Excruciating 5 

Which word describes it 

when it is least? 

Mild 1 

 Discomforting 2 

 Distressing 3 

Horrible 4 

 Excruciating 5 

Which word describes the 

worst toothache you ever 

had? 

Mild 1 

 Discomforting 2 

 Distressing 3 

Horrible 4 

 Excruciating 5 

Which word describes the 

worst headache you ever 

had? 

Mild 1 

 Discomforting 2 

 Distressing 3 

Horrible 4 

 Excruciating 5 

F - 7 
Which word describes the 

worst stomach-ache you 

ever had? 

Mild 1 

 Discomforting 2 

 Distressing 3 

Horrible 4 

 Excruciating 5 

Interpretation: 

• Maximum pain score: 78 

• The higher the pain score the greater the pain. 

References: 

Melzack R. The McGill Pain Questionnaire: Major properties and scoring methods. Pain. 

1975; 1: 277-299. 

Stein C Mendl G. The German counterpart to McGill Pain Questionnaire. Pain. 1988; 32: 

251-255. 

• Minimum pain score: 0 (would not be seen in a person with true pain) 

Table 5. Downs and Black Quality Assessment – A 27 item tool. 

Item Rating 

Reporting 

Is the hypothesis/aim/objective of the study clearly 

described? 

Yes / No 

Are the main outcomes to be measured clearly described 

in the Introduction or Methods section? 

Yes / No 

Are the characteristics of the patients included in the 

study clearly described? 

Yes / No 

Are the interventions of interest clearly described? Yes / No 

Are the distributions of principal cofounders in each 

group of subjects to be compared clearly described? 

Yes / No 

Are the main findings of the study clearly described? Yes / No 

Does the study provide estimates of the random 

variability in the data for the main outcome? 

Yes / No 

Have all the important adverse events that may be a 

consequence of the intervention been reported? 

Yes / No 

Have the characteristics of patients lost to follow-ups 

been described? 

Yes / No 

Have actual probability values been reported (e.g. 0.035 

rather than <0.05) for the main outcomes except where 

the probability value is less than 0.001? 

Yes / No 

External validity 

F - 8 
Were the subjects asked to participate in the study 

representative of the entire population from which they 

were recruited? 

Yes / No / Unable to determine 

Were those subjects who were prepared to participate 

representative of the entire population from which they 

were recruited? 

Yes / No / Unable to determine 

Were the staff, places and facilities where the patients 

were treated, representative of the treatment the majority 

of patients receive? 

Yes / No / Unable to determine 

Internal validity - bias 

Was an attempt made to blind study subjects to the 

intervention they have received? 

Yes / No / Unable to determine 

Was an attempt made to blind those measuring the main 

outcomes of the intervention? 

Yes / No / Unable to determine 

If any of the results of the study were based on “data 

dredging”, was this made clear? 

Yes / No / Unable to determine 

In trials and cohort studies, do the analyses adjust for 

different lengths of follow-up of patients, or in casecontrol studies, is the time period between intervention 

and outcome the same for cases and control? 

Yes / No / Unable to determine 

Were the statistical tests used to assess the main 

outcomes appropriate? 

Yes / No / Unable to determine 

Was compliance with the intervention/s reliable? Yes / No / Unable to determine 

Were the main outcome measures used accurate (valid 

and reliable)? 

Yes / No / Unable to determine 

Internal validity – confounding (selection bias) 

Were the patients in different intervention groups (trials 

and cohort studies) or were the cases and controls 

(case-control studies) recruited from the same 

population? 

Yes / No / Unable to determine 

Were study subjects in different intervention groups 

(trials and cohort studies) or were the cases and controls 

(case-control studies) recruited over the same period of 

time? 

Yes / No / Unable to determine 

Were study subjects randomized to intervention groups? Yes / No / Unable to determine 

Was the randomized intervention assignment concealed 

from both patients and health care staff until recruitment 

was complete and irrevocable? 

Yes / No / Unable to determine 

Was there adequate adjustment for confounding in the 

analyses from which the main findings were drawn? 

Yes / No / Unable to determine 

Were loses of patients to follow-up taken into account? Yes / No / Unable to determine 

Power 

Did the study have sufficient power to detect a clinically 

important effect where the probability value for a 

difference being due to chance is less than 5%? 

Yes / No 

F - 9 
 Appendix G. Quality Assessment Data

 Table 1.1 Low Back Pain - Acupuncture 

Q2. Q3. Q6. Q7. Q10. Q11. 

Treatmen Groups similar at Q4. Patient Q5. Care Outcome Co- Q8. Q9. Drop Timing of the Analysis 

Q1. 

Randomizat t baseline blinded provider blinded to assessor interventi Complian out rate describe includes 

Study ID ion Allocatio to the the blinded ons ce d and outcome an 

n 

re: 

interventi interventi to the avoided acceptabl e in all assessm ent in all intention- 

Adequate? Conceale prognosti on? on? interventi or acceptabl e? to-treat 

d? c indicators on? similar? groups groups similar? analysis? 

Araki 2001 

1 Yes Yes Yes Yes No Yes Not clear Yes Yes Yes Yes 

Brinkhaus 

2006 2 Yes Yes Yes Yes No Not clear Not clear Not clear Yes Yes Yes 

Cao 2001 3 Not clear Not clear Not clear Not clear Not clear Not clear Not clear Not clear No Not clear Not clear 

Carlsson 

2001 4 Not clear Not clear Yes No No Yes No No Yes Yes Yes 

Ceccherelli 

2002 5 Yes Yes Yes Not clear Yes No Yes Not clear Yes Yes Yes 

Ceccherelli 

2003 6 Not clear Not clear Not clear No No Yes Yes Yes Yes Yes Yes 

Chen 1998 

7 Not clear Not clear Not clear Not clear Not clear Not clear Not clear Not clear Not clear Yes Not clear 

Chen 2005 

8 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Chen 2007 

9 Not clear Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Cherkin 

2001 10 Yes No Yes No No No Not clear Yes Yes Yes Yes 

Cherkin 

2009 11 Not clear Not clear Not clear No No Yes Yes Yes Yes Yes Yes 

G-1
Study ID 

Q1. 

Randomizat 

ion 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded 

to the 

Q5. Care 

provider 

blinded to 

the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. Drop 

out rate 

describe 

d and 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

n 

re: 

interventi interventi to the avoided acceptabl e in all assessm ent in all intention- 

Adequate? Conceale prognosti on? on? interventi or acceptabl e? to-treat 

d? c indicators on? similar? groups groups similar? analysis? 

Chu 2004 

12 No No Yes Yes No No Yes Not clear Yes Yes Yes 

Coan 1980 

13 Not clear Not clear No No Not clear Not clear Not clear Yes Yes Not clear Not clear 

Cui 2004 14 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Ding 1998 15 Not clear Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Ding 2002 16 Not clear Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Edelist 

1976 17 Not clear Not clear Not clear Yes No Yes Not clear Not clear Not clear Not clear Not clear 

Eisenberg 

2007 18 Yes Yes Yes No No Yes Not clear Not clear Yes Yes Yes 

Fu 2006 19 Not clear Yes Yes Not clear Not clear Not clear Yes Not clear Not clear Not clear Not clear 

Garvey 1989 20 Yes No Yes Yes Yes Yes Yes No No Yes Not clear 

Giles 1999 

21 Not clear Not clear No No No Not clear Not clear No No Not clear No 

Giles 2003 

22 Yes Yes No No No Yes No No No Yes Yes 

Grant 1999 

23 Yes Yes No No No Yes Not clear Not clear Yes Yes No 

Gunn 1980 

24 Yes Not clear Not clear Not clear Not clear Not clear Yes Not clear Yes No Not clear 

G-2
 
Study ID 

Q1. 

Randomizat 

ion 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded 

to the 

Q5. Care 

provider 

blinded to 

the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. Drop 

out rate 

describe 

d and 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

n 

re: 

interventi interventi to the avoided acceptabl e in all assessm ent in all intention- 

Adequate? Conceale prognosti on? on? interventi or acceptabl e? to-treat 

d? c indicators on? similar? groups groups similar? analysis? 

Guo 2005 

25 No Not clear Yes Not clear Not clear Not clear Not clear Not clear Yes Yes Yes 

Haake 

2007 26 Yes Yes Yes Yes No Yes Not clear Not clear Yes Yes Yes 

He 1997 27 Not clear No Not clear Yes No No Not clear Not clear No Yes Yes 

He 2007 28 No Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Hirota 2006 

29 Yes Not clear Not clear Yes No Not clear No Yes Not clear Yes Not clear 

Hodgson 

2006 

30 

Yes Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Hollisaz 

2006 31 Not clear Not clear Yes Not clear No Not clear Not clear No No Yes Not clear 

Huang 

2006 32 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear Yes Yes Yes 

Huang 

2006 33 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes No 

Inoue 2000 

34 Yes Yes Not clear Yes No Yes Yes Yes Yes Yes Yes 

Inoue 2001 

35 Yes Yes Not clear Yes No Yes Yes Yes Yes Yes Yes 

Inoue 2006 

36 Yes Yes Yes Yes No Yes Not clear Not clear Yes Yes Yes 

Itoh 2004 37 Yes Not clear Yes Yes No Yes Not clear Not clear Yes Yes No 

G-3
 
Study ID 

Q1. 

Randomizat 

ion 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded 

to the 

Q5. Care 

provider 

blinded to 

the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. Drop 

out rate 

describe 

d and 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

n 

re: 

interventi interventi to the avoided acceptabl e in all assessm ent in all intention- 

Adequate? Conceale prognosti on? on? interventi or acceptabl e? to-treat 

d? c indicators on? similar? groups groups similar? analysis? 

Itoh 2006 38 Yes Yes Yes Yes No Yes Not clear Not clear Yes Yes No 

Itoh 2009 39 Not clear Not clear Yes No No Not clear Yes Yes Yes Yes Not clear 

Jia 2004 40 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Yes 

Kawase 

2006 41 Yes Yes Yes Yes Not clear Not clear Yes Yes Yes Yes Yes 

Kennedy 

2008 42 Yes Yes No No No Yes Not clear Yes Yes Yes Yes 

Kerr 2003 

43 No No Yes Yes No Not clear Yes No No Yes Not clear 

Kittang 

2001 44 No Not clear No Not clear Not clear Yes Yes Yes Yes Yes Yes 

Kurosu 

1979 45 Not clear Not clear Not clear No No Not clear Not clear Yes Not clear Yes Not clear 

Kwon 2007 

46 Yes No Yes Yes No Not clear Not clear Yes Yes Yes Yes 

Lai 2004 47 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Lee 2007 48 Not clear Not clear Not clear Yes No No Not clear Not clear Yes Yes Not clear 

Lehmann 

1983 49 Not clear Not clear Not clear No No Not clear Not clear No No Yes Not clear 

Leibing 2002 50 Not clear Not clear Yes Not clear No Not clear No No No Yes Not clear 

G-4
 
Study ID 

Q1. 

Randomizat 

ion 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded 

to the 

Q5. Care 

provider 

blinded to 

the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. Drop 

out rate 

describe 

d and 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

n 

re: 

interventi interventi to the avoided acceptabl e in all assessm ent in all intention- 

Adequate? Conceale prognosti on? on? interventi or acceptabl e? to-treat 

d? c indicators on? similar? groups groups similar? analysis? 

Li 1997 51 Not clear Not clear Not clear Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Li 2005 52 Not clear Not clear Yes Yes No No Yes Not clear No Yes No 

Li 2006 

53 Yes Not clear Yes Not clear Not clear No Yes Not clear Yes Yes Yes 

Lian 2005 

54 Not clear Not clear Yes Not clear Not clear Not clear Not clear Not clear Yes Yes Not clear 

Liang 2008 55 Not clear Not clear Yes No Not clear Yes Not clear Not clear Yes Yes Not clear 

Long 2000 56 Not clear Not clear Not clear No No Not clear Not clear Not clear Not clear Yes Not clear 

Luo 2007 

57 Not clear Not clear Not clear Not clear Not clear Not clear Not clear Not clear Not clear Not clear Not clear 

Macdonald 

1983 58 Not clear Not clear Not clear No No Yes Not clear Not clear Not clear Not clear No 

Mencke 

1988 59 Yes Not clear Yes Yes Not clear Yes Yes Not clear Yes Yes No 

Mendelson 

1978 60 Not clear Not clear Not clear Not clear Not clear Not clear Not clear No No Yes Not clear 

Mendelson 

1983 61 Not clear Not clear Yes Yes Not clear Yes Not clear Not clear Yes Yes No 

Meng 2003 62 Yes Yes Yes No No Not clear Yes Not clear Yes Yes Yes 

Molsberger 

2002 63 Not clear No Yes No No No Not clear No No Yes Yes 

G-5
 
Study ID 

Q1. 

Randomizat 

ion 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded 

to the 

Q5. Care 

provider 

blinded to 

the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. Drop 

out rate 

describe 

d and 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

n 

re: 

interventi interventi to the avoided acceptabl e in all assessm ent in all intention- 

Adequate? Conceale prognosti on? on? interventi or acceptabl e? to-treat 

d? c indicators on? similar? groups groups similar? analysis? 

Mu 2007 64 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear Yes Yes Not clear 

Peng 2006 65 No Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes No 

Qu 2006 66 No No Yes No No No Not clear Not clear Not clear Yes No 

Sakai 1998 

67 Not clear Not clear No No No Not clear Not clear Not clear No No Not clear 

Sakai 2001 

68 Yes Yes Yes No No Yes Yes Yes Yes Yes No 

SatorKatzenschlag 

er 2004 69 Yes Yes No Yes No Yes Not clear Yes Yes Yes Yes 

She 2008 

70 No Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Takeda 

2001 71 Yes Not clear Not clear Yes No No Not clear Yes Yes Yes Not clear 

Tang 2008 72 No Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes No 

Thomas 

1994 73 Not clear Not clear Yes No No No Not clear Yes Yes Yes Not clear 

Thomas 

2005 74 Yes Yes Yes No No Yes Yes Yes Yes Yes No 

Tsui 2004 

75 Not clear Not clear Yes Yes Not clear Yes Not clear Not clear Yes Yes Not clear 

Tsukayama 

2002 76 Yes No Yes Not clear No Not clear Yes Yes Yes Yes Not clear 

G-6
 
Study ID 

Q1. 

Randomizat 

ion 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded 

to the 

Q5. Care 

provider 

blinded to 

the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. Drop 

out rate 

describe 

d and 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

n 

re: 

interventi interventi to the avoided acceptabl e in all assessm ent in all intention- 

Adequate? Conceale prognosti on? on? interventi or acceptabl e? to-treat 

d? c indicators on? similar? groups groups similar? analysis? 

Wang 2004 77 Not clear Not clear Not clear No No Not clear Not clear Not clear Not clear Yes No 

Wang 2004 78 Not clear Not clear Yes Not clear Not clear Not clear Yes Not clear No Not clear Not clear Wang 2005 79 Yes Not clear Yes Not clear Not clear Yes Yes Not clear No Yes Yes 

Wang 2007 80 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear Yes Yes Yes 

Witt 2006 

81 Yes Yes Yes No No Yes Not clear Not clear Yes Yes No 

Wu 2004 82 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Wu 2004 83 No Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Wu 2007 84 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Xia 1997 85 Not clear Not clear Not clear Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Yao 2007 

86 Not clear Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Ye 2002 87 Not clear Not clear Not clear Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Ye 2004 88 Not clear Not clear Not clear Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Yeung 

2003 89 Not clear Not clear Yes No No Not clear Yes Yes Yes Yes Yes 

G-7
 
Study ID 

Q1. 

Randomizat 

ion 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded 

to the 

Q5. Care 

provider 

blinded to 

the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. Drop 

out rate 

describe 

d and 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

n 

re: 

interventi interventi to the avoided acceptabl e in all assessm ent in all intention- 

Adequate? Conceale prognosti on? on? interventi or acceptabl e? to-treat 

d? c indicators on? similar? groups groups similar? analysis? 

Yu 1997 

90 Not clear Not clear Not clear Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Yuan 2006 

91 Not clear Not clear Not clear Not clear Not clear Not clear Not clear Not clear Not clear Not clear Not clear 

Yuan 2009 

92 Yes Yes Yes No No Yes Yes Yes Yes Yes Yes 

Zeng 2007 93 Not clear Not clear Not clear Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Zhang 

2002 

94 

Not clear Not clear Yes Not clear Not clear Not clear No Not clear No Yes Not clear 

Zhang 

2002 95 Not clear Not clear Not clear Not clear Not clear Not clear No Not clear No Yes Not clear 

Zhang 

2007 96 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Zhang 

2008 97 Not clear Not clear Yes Not clear Not clear Not clear Yes Not clear Yes Yes No 

Zhong 

2006 98 Not clear Not clear Not clear Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Zhou 1998 

99 Not clear Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Zhou 2004 

100 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Zhou 2005 

101 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Zhou 2006 

102 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear Yes Yes Not clear 

G-8
 
Study ID 

Q1. 

Randomizat 

ion 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded 

to the 

Q5. Care 

provider 

blinded to 

the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. Drop 

out rate 

describe 

d and 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

n 

re: 

interventi interventi to the avoided acceptabl e in all assessm ent in all intention- 

Adequate? Conceale prognosti on? on? interventi or acceptabl e? to-treat 

d? c indicators on? similar? groups groups similar? analysis? 

Zhu 2003 

103 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Table 1.2 Low Back Pain - Manipulation 

Q3. Q6. Q10. Q

Q1. Q2. Groups Q4. Patient Q5. Care Outcome Q7. Co- Q8. Q9. Drop Timing of the An

Randomiz Treatment similar at blinded to provider blinded to assessor interventio Complianc out rate described in

Study ID ation Allocation baseline the the blinded to e and outcome 

Adequate Conceale re: interventio interventio the ns avoided or acceptabl e in all assessme nt in all int

? d? prognostic n? n? interventio similar? acceptabl e? to

indicators n? groups groups similar? an

Alaksiev 

1996 

104 

Not 

clear 

Not 

clear Yes No No No Not clear Not clear Not clear Yes 

c

Alaksiev 

1996 104 

Not 

clear 

Not 

clear Yes No No No Not clear Not clear Not clear Yes 

c

Bronfort 

1989 

105 

Not 

clear 

Not 

clear No No No No Not clear Not clear Not clear Yes 

c

Bronfort 

1989 105 

Not 

clear 

Not 

clear No No No No Not clear Not clear Not clear Yes 

c

Buerger 

1980 106 

Not 

clear 

Not 

clear Yes Yes No Yes Not clear Not clear Not clear Not clear 

c

Buerger 

1980 106 

Not 

clear 

Not 

clear Yes Yes No Yes Not clear Not clear Not clear Not clear 

c

G-9
 
Study ID 

Q1. 

Randomiz 

ation 

Q2. 

Treatment 

Allocation 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded to 

the 

Q5. Care 

provider 

blinded to 

the 

Q6. 

Outcome 

assessor 

blinded to 

Q7. Cointerventio 

Q8. 

Complianc 

e 

Q9. Drop 

out rate 

described 

and 

Q10. 

Timing of 

the 

outcome 

Q

An

in

Adequate Conceale re: interventio interventio the ns avoided or acceptabl e in all assessme nt in all int

? d? prognostic n? n? interventio similar? acceptabl e? to

indicators n? groups groups similar? an

Cherkin 

1998 107 

Not 

clear No No Not clear Not clear Not clear Yes Yes Yes Yes Y

Childs 

2004 108 Yes Yes Yes No No Yes Yes Not clear No Yes Y

Cote 1994 

109 Yes Not clear Yes No No Not clear Not clear Not clear Not clear Yes 

c

Dai 2006 

110 No Not clear Yes Not clear Not clear Not clear Yes Not clear Not clear Yes 

Evans 

1978 111 

Not 

clear 

Not 

clear Yes No No Not clear Yes Yes Yes Yes Y

Giles 1999 

21 

Not 

clear 

Not 

clear No No No Not clear Not clear No No Not clear 

Haas 2004 

112 Yes Yes No No No Not clear No Yes Yes Yes Y

Hadler 

1987 113 

Not 

clear No Yes Yes No Yes Not clear Yes Yes Yes 

Herzog 

1991 114 

Not 

clear 

Not 

clear 

Not 

clear No No Yes Yes Yes No Yes 

Hoehler 

1981 115 

Not 

clear 

Not 

clear Yes No No Yes Not clear Not clear Not clear Not clear 

Hoehler 

1981 115 

Not 

clear 

Not 

clear Yes Not clear Not clear Not clear Not clear Not clear Not clear Yes 

c

Hoiriis 

1999 116 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

c

Hoiriis 

2004 117 No No Yes Yes Yes Yes Yes Yes No Yes Y

Hondras 

2009 

118 

Yes Yes Yes Yes No Yes Yes Yes Yes Yes Y

G-10
 
Study ID 

Q1. 

Randomiz 

ation 

Q2. 

Treatment 

Allocation 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded to 

the 

Q5. Care 

provider 

blinded to 

the 

Q6. 

Outcome 

assessor 

blinded to 

Q7. Cointerventio 

Q8. 

Complianc 

e 

Q9. Drop 

out rate 

described 

and 

Q10. 

Timing of 

the 

outcome 

Q

An

in

Adequate Conceale re: interventio interventio the ns avoided or acceptabl e in all assessme nt in all int

? d? prognostic n? n? interventio similar? acceptabl e? to

indicators n? groups groups similar? an

Hsieh 2002 

119 

Not 

clear 

Not 

clear Yes No No Not clear Not clear No Yes Yes Y

Lalanne 

2009 120 

Not 

clear 

Not 

clear Yes No Not clear Not clear Not clear Not clear Not clear Yes 

c

Mathews 

1988 121 

Not 

clear 

Not 

clear 

Not 

clear No No Yes Not clear Not clear Not clear Yes 

c

MohseniBandpei 

2006 122 

Not 

clear 

Not 

clear Yes No No Not clear Not clear Not clear No Yes 

c

Morton 

1999 123 Yes Not clear Yes No No Not clear Not clear Not clear Not clear Yes 

c

Pope 1994 124 Not clear Yes Yes No No Yes Not clear No Not clear Yes 

Postacchini 

1988 125 

Not 

clear 

Not 

clear Yes No No Not clear Yes Yes Yes Yes 

c

Rasmusse 

n 1979 126 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear Yes Yes Not clear 

c

Rasmusse 

n 2008 127 

Not 

clear 

Not 

clear 

Not 

clear No No Yes Yes Yes Yes Yes Y

Rupert 

1985 128 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear Yes Not clear Not clear Not clear Not clear 

c

Sanders 

1990 129 

Not 

clear No Yes Not clear Not clear Yes Not clear Yes Yes Yes Y

Shearar 

2004 130 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear Yes Not clear Not clear Not clear 

c

Triano 

1995 131 Yes No Yes No No Yes Yes No No Yes 

G-11
 
Study ID 

Q1. 

Randomiz 

ation 

Q2. 

Treatment 

Allocation 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded to 

the 

Q5. Care 

provider 

blinded to 

the 

Q6. 

Outcome 

assessor 

blinded to 

Q7. Cointerventio 

Q8. 

Complianc 

e 

Q9. Drop 

out rate 

described 

and 

Q10. 

Timing of 

the 

outcome 

Q

An

in

Adequate Conceale re: interventio interventio the ns avoided or acceptabl e in all assessme nt in all int

? d? prognostic n? n? interventio similar? acceptabl e? to

indicators n? groups groups similar? an

UK BEAM 

Trial Team 

2004 132 

Not 

clear 

Not 

clear Yes No No Not clear Not clear Not clear Not clear Yes Y

Waagen 

1986 133 No Not clear Not clear Yes No Yes Yes No No Yes 

c

Zhang 

2008 134 

Not 

clear 

Not 

clear Yes Not clear Not clear Not clear Yes Not clear Yes Yes 

Table 1.3 Low Back Pain - Mobilization 

Study ID 

Q1. 

Randomi 

zation 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded to 

the 

Q5. Care 

provider 

blinded 

to the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. 

Dropout 

rate 

described 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

Adequate n re: interventi interventi to the avoided acceptabl e in all and assessm ent in all intention- 

? Conceale prognosti on? on? interventi or acceptabl to-treat 

d? c indicators on? similar? groups e? groups similar? analysis? 

Aleksiev 

1995 

135 

Not 

clear 

Not 

clear Yes Not clear Not clear Not clear Not clear Not clear Not clear Yes Not clear 

Chiradejnant 

2002 136 

Not 

clear 

Not 

clear 

Not 

clear No No Yes Not clear Yes Yes Yes Yes 

Chiradejnant 

2003 137 Yes Yes Not clear No No Yes Yes Yes Yes Yes Yes 

Cote 1994 

109 Yes Not clear Yes No No Not clear Not clear Not clear Not clear Yes Not clear 

G-12
 
Study ID 

Q1. 

Randomi 

zation 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded to 

the 

Q5. Care 

provider 

blinded 

to the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. 

Dropout 

rate 

described 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

Adequate n re: interventi interventi to the avoided acceptabl e in all and assessm ent in all intention- 

? Conceale prognosti on? on? interventi or acceptabl to-treat 

d? c indicators on? similar? groups e? groups similar? analysis? 

Goodsell 

2000 138 No Not clear Not clear No No Yes Not clear Not clear Not clear Yes Not clear 

Hadler 

1987 113 

Not 

clear No Yes Yes No Yes Not clear Yes Yes Yes No 

Hanrahan 

2005 139 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear Yes Not clear 

Hemmila 

1997 140 Yes Not clear Yes No No Not clear Yes No No Yes Not clear 

Hemmila 

2002 141 Yes Yes Yes No No Yes No Yes Yes Yes Yes 

Konstantinou 

2007 142 Yes Not clear Not clear No No Yes Not clear Not clear Yes Yes Not clear 

Li 2006 143 Yes Yes Yes Yes Not clear Yes Yes Not clear Yes Yes Yes 

Lopez 

2007 

144 

Yes Not clear No No No Yes Not clear Yes Yes Yes Yes 

Mackawan 

2007 145 

Not 

clear 

Not 

clear No No No Not clear Not clear Yes Yes Yes Yes 

Powers 

2008 146 

Not 

clear No Yes No No Yes Not clear Not clear No Yes Not clear 

Ritvanen 

2007 

147 

Not 

clear 

Not 

clear Yes No No Yes Not clear Not clear Yes Yes No 

Timm 1994 

148 

Not 

clear 

Not 

clear Yes No No Yes No Not clear Yes Yes Not clear 

G-13
 
Study ID 

Q1. 

Randomi 

zation 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded to 

the 

Q5. Care 

provider 

blinded 

to the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. 

Dropout 

rate 

described 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

Adequate n re: interventi interventi to the avoided acceptabl e in all and assessm ent in all intention- 

? Conceale prognosti on? on? interventi or acceptabl to-treat 

d? c indicators on? similar? groups e? groups similar? analysis? 

Wreje 1992 149 Not clear Not clear Not clear Not clear No Not clear Yes Yes Yes Yes Not clear 

Zaproudina 

2009 150 

Not 

clear 

Not 

clear Yes No No Yes Not clear Yes Yes Yes Not clear 

 Table 1.4 Low Back Pain - Massage 

Q2. Q3. Q6. Q7. Q9. Q10. Q11. 

Q1. Treatmen Groups similar at Q4. Patient Q5. Care Outcome Co- Q8. Dropout Timing of the Analysis 

Randomi t baseline blinded to provider blinded assessor interventi Complian rate includes 

Study ID zation Allocatio the to the blinded ons ce described outcome an 

Adequate n re: interventi interventi to the avoided acceptabl e in all and assessm ent in all intention- 

? Conceale prognosti on? on? interventi or acceptabl to-treat 

d? c indicators on? similar? groups e? groups similar? analysis? 

Chatchawan 

2005 151 Yes Not clear Yes Not clear No Not clear Not clear Yes Yes Yes Yes 

Cherkin 

2001 10 Yes No Yes No No No Not clear Yes Yes Yes Yes 

Farasyn 

2006 152 

Not 

clear 

Not 

clear Yes No No Not clear Yes Yes Yes Yes Yes 

Field 2007 

153 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear Yes Not clear 

Franke 

2000 154 Yes Not clear Yes No Not clear Not clear Yes Yes Yes Yes No 

G-14
 
Study ID 

Q1. 

Randomi 

zation 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded to 

the 

Q5. Care 

provider 

blinded 

to the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. 

Dropout 

rate 

described 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

Adequate n re: interventi interventi to the avoided acceptabl e in all and assessm ent in all intention- 

? Conceale prognosti on? on? interventi or acceptabl to-treat 

d? c indicators on? similar? groups e? groups similar? analysis? 

Geisser 

2005 

155 

Don't 

know 

Don't 

know Yes Don't know No Yes Don't Know No No Don't know Don't know 

HernandezReif 2001 

156 

Not 

clear 

Not 

clear 

Not 

clear No No Not clear Not clear Not clear Not clear Yes No 

Hoehler 

1981 115 

Not 

clear 

Not 

clear Yes Not clear Not clear Not clear Not clear Not clear Not clear Yes Not clear 

Hsieh 2004 

157 Yes No Yes Not clear No Yes Yes Yes Yes Yes Yes 

Hsieh 2006 

158 Yes Yes Yes No No Yes Not clear Yes Yes Yes Yes 

Konrad 

1992 159 

Not 

clear 

Not 

clear Yes No No Yes Yes Yes Yes Yes No 

Li 2006 143 Yes Yes Yes Yes Not clear Yes Yes Not clear Yes Yes Yes 

Little 2008 

160 Yes Yes Yes Not clear Not clear Yes Not clear Yes Yes Yes Not clear 

Mackawan 

2007 145 

Not 

clear 

Not 

clear No No No Not clear Not clear Yes Yes Yes Yes 

Poole 2007 

161 

Not 

clear 

Not 

clear Yes Not clear Not clear Not clear Not clear Not clear Yes Yes Yes 

Pope 1994 124 Not clear Yes Yes No No Yes Not clear No Not clear Yes No 

Preyde 

2000 162 Yes Not clear Yes No No Yes Not clear Not clear Yes Yes No 

G-15
 
Study ID 

Q1. 

Randomi 

zation 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded to 

the 

Q5. Care 

provider 

blinded 

to the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. 

Dropout 

rate 

described 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

Adequate n re: interventi interventi to the avoided acceptabl e in all and assessm ent in all intention- 

? Conceale prognosti on? on? interventi or acceptabl to-treat 

d? c indicators on? similar? groups e? groups similar? analysis? 

Quinn 2008 

163 Yes No Yes Yes No Yes Not clear Yes Yes Yes Yes 

Yip 2004 164 No No Yes Not clear No No Yes Yes Yes Yes Not clear 

Zhang 

2004 165 Yes Not clear Yes Yes Not clear Not clear Yes Yes No Not clear Yes 

Table 1.5 

Low Back Pain - Manual Treatment 

Study ID 

Q1. 

Randomi 

zation 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded to 

the 

Q5. Care 

provider 

blinded 

to the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. 

Dropout 

rate 

described 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

Adequate n re: interventi interventi to the avoided acceptabl e in all and assessm ent in all intention- 

? Conceale prognosti on? on? interventi or acceptabl to-treat 

d? c indicators on? similar? groups e? groups similar? analysis? 

Aure 2003 

166 Yes Yes Yes No No Not clear Yes Yes Yes Yes Yes 

Farrell 

1982 

167 

Not 

clear 

Not 

clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Ferreira 

2007 168 Yes Yes Yes No No Yes Not clear Not clear Yes Yes No 

Hancock 

2007 169 Yes Yes Yes Yes No Yes Not clear Not clear Yes Yes Not clear 

G-16
 
Study ID 

Q1. 

Randomi 

zation 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded to 

the 

Q5. Care 

provider 

blinded 

to the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. 

Dropout 

rate 

described 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

Adequate n re: interventi interventi to the avoided acceptabl e in all and assessm ent in all intention- 

? Conceale prognosti on? on? interventi or acceptabl to-treat 

d? c indicators on? similar? groups e? groups similar? analysis? 

Hurley 

2004 170 Yes No Yes No No Yes Yes No No Yes Yes 

Hurwitz 

2006 171 Yes Yes Yes No No Not clear Not clear Not clear Yes Not clear Yes 

Koes 1992 

172 Yes Not clear Yes No No Yes Not clear No Yes Yes Not clear 

MacDonald 

1990 173 

Not 

clear 

Not 

clear Yes No No Not clear Yes Yes Yes Yes Not clear 

Meade 

1991 174 

Not 

clear 

Not 

clear Yes Not clear Not clear Not clear Not clear Not clear Yes Yes Yes 

Sims-Williams 

1979 175 

Not 

clear 

Not 

clear No Yes Not clear Yes Not clear Not clear Not clear Yes Not clear 

G-17
 
Table 1.6 Low Back Pain – Flexion Distraction 

Study ID 

Q1. 

Randomi 

zation 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded to 

the 

Q5. Care 

provider 

blinded 

to the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. 

Dropout 

rate 

described 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

Adequate n re: interventi interventi to the avoided acceptabl e in all and assessm ent in all intention- 

? Conceale prognosti on? on? interventi or acceptabl to-treat 

d? c indicators on? similar? groups e? groups similar? analysis? 

Beyerman 

2006 176 

Not 

clear 

Not 

clear Yes No No Not clear Not clear Not clear Yes Yes No 

Cambron 

2006 177 

Not 

clear 

Not 

clear No Not clear Not clear Not clear Not clear Not clear Yes Yes No 

Hawk 1999 

178 

Not 

clear Yes Not clear Yes Not clear Not clear Not clear Not clear Yes Yes Not clear 

Hawk 2005 

179 Yes Yes Yes Yes No Not clear Not clear Not clear Yes Yes Yes 

Table 2.1 Neck Pain - Acupuncture 

Q2. Q3. Q6. Q7. Q9. Q10. Q11. 

Q1. Treatmen Groups similar at Q4. Patient Q5. Care Outcome Co- Q8. Dropout Timing of the Analysis 

Randomi t baseline blinded provider blinded assessor interventi Complian rate includes 

Study ID zation Allocatio to the to the blinded ons ce describe outcome an 

Adequate n re: interventi interventi to the avoided acceptabl e in all d and assessm ent in all intention- 

? Conceale prognosti on? on? interventi or acceptabl to-treat 

d? c indicators on? similar? groups e? groups similar? analysis? 

Abernethy 

2008 180 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Aigner 

1999 181 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear Not clear Yes No 

Allison 

2002 182 

Not 

clear 

Not 

clear Yes No No Yes Not clear Not clear Not clear Yes Yes 

G-18
 
Study ID 

Q1. 

Randomi 

zation 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded 

to the 

Q5. Care 

provider 

blinded 

to the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. 

Dropout 

rate 

describe 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

Adequate n re: interventi interventi to the avoided acceptabl e in all d and assessm ent in all intention- 

? Conceale prognosti on? on? interventi or acceptabl to-treat 

d? c indicators on? similar? groups e? groups similar? analysis? 

Bin 2007 

183 

Not 

clear 

Not 

clear Yes Not clear Not clear Yes Yes No No Not clear Not clear 

Birch 1998 

184 

Not 

clear 

Not 

clear Yes No No Not clear Not clear No No Yes Not clear 

Ceccherelli 

2006 185 Yes Not clear Yes No No Yes Not clear Not clear Yes Yes Not clear 

Chu 1997 

186 

Not 

clear No No Not clear Not clear Not clear Not clear No No Yes Not clear 

Coan 1981 

187 Yes Yes No Not clear Not clear Not clear Not clear Yes Yes No Not clear 

David 1998 

188 

Not 

clear No Yes No No Not clear Not clear Yes Yes Yes Not clear 

Edwards 

2003 189 

Not 

clear 

Not 

clear Yes No No Yes Not clear Not clear Yes Yes Yes 

Fu 2005 190 Not clear No Yes No Not clear Not clear Yes Not clear No Yes No 

Fu 2007 

191 

Not 

clear 

Not 

clear Yes No No Yes Not clear Not clear Not clear Yes Not clear 

Ga 2007 192 Not clear Not clear Yes No Not clear Yes Not clear Not clear Yes Yes Not clear 

Gallacchi 

1983 193 

Not 

clear 

Not 

clear Yes No Not clear Not clear Not clear Not clear Yes Yes No 

Giles 1999 

21 

Not 

clear 

Not 

clear No No No Not clear Not clear No No Not clear No 

Giles 2003 

22 Yes Yes No No No Yes No No No Yes Yes 

G-19
 
Study ID 

Q1. 

Randomi 

zation 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded 

to the 

Q5. Care 

provider 

blinded 

to the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. 

Dropout 

rate 

describe 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

Adequate n re: interventi interventi to the avoided acceptabl e in all d and assessm ent in all intention- 

? Conceale prognosti on? on? interventi or acceptabl to-treat 

d? c indicators on? similar? groups e? groups similar? analysis? 

Hoehler 

1981 

115 

Not 

clear 

Not 

clear Yes Not clear Not clear Not clear Not clear Not clear Not clear Yes Not clear 

Huang 

2008 194 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Ilbuldu 

2004 195 

Not 

clear 

Not 

clear Yes No No Yes Yes Not clear Not clear Yes Not clear 

Irnich 2001 

196 

Not 

clear 

Not 

clear No No Not clear Not clear Not clear Yes Yes Yes Yes 

Itoh 2007 

197 

Not 

clear 

Not 

clear Yes Yes No Yes Not clear Not clear Yes Yes No 

Jia 2007 198 Yes Not clear Yes Yes Not clear Not clear Yes Not clear No Yes Not clear 

Li 2004 199 Not clear Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Yes 

Li 2006 200 Yes Not clear Not clear Not clear Not clear Not clear Yes Not clear Yes Yes Yes 

Liang 2009 201 Yes Yes Not clear Not clear Not clear Not clear Not clear Yes Yes Yes Not clear 

Lin 2004 202 Not clear Not clear Yes No No Not clear Not clear Not clear No Yes No 

Lu 2006 203 No Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Lundeberg 

1991 204 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear No Not clear Not clear Not clear Not clear Yes Not clear 

Nabeta 

2002 205 

Not 

clear 

Not 

clear 

Not 

clear Yes No Not clear Not clear Yes Yes Yes Yes 

G-20
 
Study ID 

Q1. 

Randomi 

zation 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded 

to the 

Q5. Care 

provider 

blinded 

to the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. 

Dropout 

rate 

describe 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

Adequate n re: interventi interventi to the avoided acceptabl e in all d and assessm ent in all intention- 

? Conceale prognosti on? on? interventi or acceptabl to-treat 

d? c indicators on? similar? groups e? groups similar? analysis? 

Petrie 1983 

206 

Not 

clear 

Not 

clear Yes No No Not clear No Yes Yes Yes Yes 

Petrie 1986 

207 

Not 

clear 

Not 

clear No Yes No Not clear Not clear Yes Yes Yes Not clear 

Salter 2006 

208 Yes Not clear Yes No No Not clear Not clear Not clear Yes Yes Yes 

SatorKatzenschl 

ager 2003 209 No Not clear Yes Not clear Not clear Not clear Yes Not clear Yes Yes Not clear 

Seidel 

2002 210 Yes Not clear Yes Yes Yes Not clear Yes Yes Yes Yes No 

Shang 

2002 211 Yes Yes Not clear Not clear Not clear Not clear Not clear Yes Yes Yes Not clear 

Vas 2006 

212 

Not 

clear Yes Yes No No Yes Not clear Not clear Yes Yes Yes 

Venancio 

2008 

213 

Not 

clear 

Not 

clear No No Not clear Not clear Not clear Not clear Yes Not clear Not clear 

Wang 2007 214 Not clear Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Wang 2007 215 Not clear Not clear Yes Not clear Not clear Not clear Not clear Not clear No Yes Not clear Wang 2008 216 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

White 2000 

217 

Not 

clear 

Not 

clear 

Not 

clear No No Yes Not clear Not clear Yes Yes Yes 

G-21
 
Study ID 

Q1. 

Randomi 

zation 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded 

to the 

Q5. Care 

provider 

blinded 

to the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. 

Dropout 

rate 

describe 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

Adequate n re: interventi interventi to the avoided acceptabl e in all d and assessm ent in all intention- 

? Conceale prognosti on? on? interventi or acceptabl to-treat 

d? c indicators on? similar? groups e? groups similar? analysis? 

White 2004 

218 Yes Yes Yes Yes No Not clear Yes Yes Yes Yes Yes 

Witt 2006 

219 Yes Yes Yes No No Not clear Not clear Not clear Yes Yes Yes 

Yang 2009 220 Yes Yes Not clear Not clear Not clear Not clear Not clear Yes Yes Yes Not clear 

Zeng 2005 221 Not clear Not clear Yes Yes Not clear Not clear Yes Not clear No Yes Yes 

Zhang 

2003 222 Yes Yes Yes Not clear Not clear Not clear Yes Yes No Yes No 

Zhang 

2005 223 

Not 

clear 

Not 

clear 

Not 

clear No No Not clear Not clear Not clear Not clear Not clear Not clear 

Zhao 2004 

224 Yes Not clear Yes No Not clear Not clear Not clear Not clear No Yes Not clear 

Zhu 2002 

225 

Not 

clear Yes Yes No No Yes Not clear Yes Yes Yes Not clear 

Zhu 2006 

226 Yes Not clear Yes Not clear Not clear Not clear Yes Not clear No Yes Not clear 

Zhuang 

2004 227 

Not 

clear 

Not 

clear Yes Not clear Not clear Not clear Yes Not clear No Yes Yes 

G-22
 
 Table 2.2 Neck Pain - Manipulation 

Q3. Q6. Q7. Q9. Q10. 

Q1. Q2. Treatmen Groups similar at Q4. Patient Q5. Care Outcome Co- Q8. Dropout Timing of the Q11. 

Randomi baseline blinded to provider blinded assessor interventi Complian rate Analysis includes an 

Study ID zation t Allocation the to the blinded ons ce described outcome intention-to- 

Adequate Conceale re: interventi interventi to the avoided acceptabl e in all and assessm ent in all 

? d? prognosti on? on? interventi or acceptabl treat 

c 

indicators on? similar? groups e? groups similar? analysis? 

Bischoff 

2003 228 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear 

Not 

clear Yes Not clear Not clear 

Buchmann 

2005 229 Yes Not clear Not clear No No Yes Yes Yes Yes Yes Not clear 

Cassidy 

1992 230 

Not 

clear 

Not 

clear Yes No No Not clear Not clear Yes Yes Yes Yes 

Chen 2007 

231 Yes Not clear Yes Not clear Not clear Not clear Yes Yes Yes Yes Not clear 

Cilliers 

1998 232 

Not 

clear 

Not 

clear Yes No No Not clear Yes Not clear Not clear Yes Not clear 

Cleland 

2004 233 

Not 

clear 

Not 

clear Yes No No Yes Not clear Not clear Not clear Not clear Not clear 

Cleland 

2005 234 Yes Yes Yes No No Not clear Not clear Not clear Yes Yes Yes 

Cleland 

2007 235 Yes Yes Yes No No Not clear Not clear Not clear Yes Yes Yes 

Egwu 2008 236 No Not clear Yes Not clear No No Yes Yes Yes Yes No 

Fernandezde-LasPenas Yes Not clear Yes Not clear No Not clear Not clear Yes Yes Yes Yes 

2004 237 

Giles 1999 

21 

Not 

clear 

Not 

clear No No No Not clear Not clear No No Not clear No 

Giles 2003 

22 Yes Yes No No No Yes No No No Yes Yes 

Giles 2003 

22 Yes Yes No No No Yes No No No Yes Yes 

G-23
Study ID 

Q1. 

Randomi 

zation 

Q2. 

Treatmen 

t 

Allocation 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded to 

the 

Q5. Care 

provider 

blinded 

to the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. 

Dropout 

rate 

described 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes an 

intention-to

Adequate Conceale re: interventi interventi to the avoided acceptabl e in all and assessm ent in all 

? d? prognosti on? on? interventi or acceptabl treat 

c 

indicators on? similar? groups e? groups similar? analysis? 

GonzalezIglesias 

2009 238 

Yes Yes Yes No No Yes Not clear Yes Yes Yes Yes 

Haas 2003 

239 No No Yes No Yes Not clear Yes Yes Yes Yes Yes 

Haas 2004 

240 

Not 

clear Yes Yes No No Not clear Not clear Yes Yes Yes Yes 

Hurwitz 

2002 241 

Not 

clear Yes Yes No No Not clear Not clear Not clear Not clear Yes No 

Krauss 

2008 242 Yes Not clear Yes No No Yes Yes Not clear Yes Yes Yes 

MartinezSegura 

2006 243 

Yes Yes Yes No No Yes Not clear Not clear No Yes Not clear 

Metcalfe 

2006 244 

Not 

clear 

Not 

clear No No No Not clear Not clear Yes Yes Yes Not clear 

Nilsson 

1997 245 Yes No Yes Yes No Yes No Yes Yes Yes Not clear 

ParkinSmith 1998 

246 

Yes Yes Yes No No No Yes Not clear Not clear Yes Not clear 

Pikula 

1999 247 Yes Not clear Not clear No No No Not clear Not clear Not clear Yes Not clear 

Sloop 1982 248 Not clear Not clear Yes Yes No Yes No Not clear Yes Yes Not clear 

Strunk 

2008 249 Yes Yes Not clear No No Not clear Yes Yes Yes Yes Not clear 

G-24
 
Study ID 

Q1. 

Randomi 

zation 

Q2. 

Treatmen 

t 

Allocation 

Q3. 

Groups 

similar at 

baseline 

Q4. 

Patient 

blinded to 

the 

Q5. Care 

provider 

blinded 

to the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complian 

ce 

Q9. 

Dropout 

rate 

described 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes an 

intention-to

Adequate Conceale re: interventi interventi to the avoided acceptabl e in all and assessm ent in all 

? d? prognosti on? on? interventi or acceptabl treat 

c 

indicators on? similar? groups e? groups similar? analysis? 

van 

Schalkwyk 

2000 250 

No No Not clear No No Not clear Not clear Not clear Not clear Not clear Not clear 

Vernon 

1990 251 

Not 

clear No No Not clear No Yes Not clear Yes Yes Yes Yes 

Whittingha 

m 2001 252 Yes Yes Yes Yes No Not clear Not clear Yes Yes Yes Not clear 

Yurkiw 

1996 253 Yes Not clear Not clear No No Yes Not clear Yes Yes Yes Yes 

Table 2.3 Neck Pain - Mobilization 

Study ID 

Q1. 

Randomi 

zation 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

re: 

Q4. 

Patient 

blinded 

to the 

Q5. Care 

provider 

blinded 

to the 

Q6. 

Outcome 

assessor 

blinded 

to the 

Q7. Cointerventi ons 

avoided 

Q8. 

Complian 

ce 

acceptabl 

Q9. 

Dropout 

rate 

described 

and 

Q10. 

Timing of 

the 

outcome 

assessm 

Q11. 

Analysis 

includes 

an 

intention

Adequate 

? 

n 

Conceale prognosti interventi interventi interventi e in all ent in all 

d? c on? on? on? or similar? groups acceptabl e? groups to-treat 

indicators similar? analysis

Brodin 1983 

254 

Not 

clear 

Not 

clear Yes No No Not clear Not clear Not clear Yes Yes Not clear 

Buchmann 

2005 229 Yes Not clear Not clear No No Yes Yes Yes Yes Yes Not clear 

Cassidy 1992 230 Not clear Not clear Yes No No Not clear Not clear Yes Yes Yes Yes 

Coppieters 

2003 255 

Not 

clear Yes Yes No No Yes Not clear Not clear Not clear Yes Not clear 

G-25
 
Study ID 

Q1. 

Randomi 

zation 

Q2. 

Treatmen 

t 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

re: 

Q4. 

Patient 

blinded 

to the 

Q5. Care 

provider 

blinded 

to the 

Q6. 

Outcome 

assessor 

blinded 

to the 

Q7. Cointerventi ons 

avoided 

Q8. 

Complian 

ce 

acceptabl 

Q9. 

Dropout 

rate 

described 

and 

Q10. 

Timing of 

the 

outcome 

assessm 

Q11. 

Analysis 

includes 

an 

intention

Adequate 

? 

n 

Conceale prognosti interventi interventi interventi e in all ent in all 

d? c on? on? on? or similar? groups acceptabl e? groups to-treat 

indicators similar? analysis

Hemmila 2005 

256 

Not 

clear 

Not 

clear No No No Yes Not clear Not clear Yes Yes Yes 

Hoving 2006 257 Yes Yes Not clear No No Yes No Not clear Yes Yes Yes 

Hurwitz 2002 

241 

Not 

clear Yes Yes No No Not clear Not clear Not clear Not clear Yes No 

Kanlayanapho 

tporn 2009 258 Yes Yes Yes Yes Yes Yes Not clear Yes Yes Yes Yes 

MartinezSegura 2006 243 Yes Yes Yes No No Yes Not clear Not clear No Yes Not clear 

MartinezSegura 2006 243 Yes Yes Yes No No Yes Not clear Not clear No Yes Not clear 

Sterling 2001 259 Yes Yes Not clear Not clear Yes Yes Not clear Yes Yes Yes Not clear 

Zaproudina 

2007 260 

Not 

clear 

Not 

clear Yes Yes No Yes Not clear Not clear Yes Yes No 

G-26
 
 Table 2.4 Neck Pain - Massage 

Q3. 

Q2. Groups Q6. Q7. Q9. Q10. Q11. 

Q1. Treatme similar at Q4. Patient Q5. Care Outcome Co- Q8. Dropout Timing of the Analysis includes 

Randomi nt baseline blinded provider blinded assessor interventi Complia rate 

Study ID zation Allocatio re: to the to the blinded ons nce describe outcome an intention- 

Adequat n prognosti interventi interventi to the avoided acceptab le in all d and assessm ent in all 

e? Conceal c on? on? interventi or acceptab to-treat 

ed? indicator on? similar? groups le? groups similar? analysis ? 

s 

Blikstad 

2008 261 Yes Yes Yes No No Yes Yes Yes Yes Yes Yes 

Cen 2003 262 Yes Not clear No No No Not clear Not clear Not clear Yes Yes No 

Fernandezde-LasPenas 2006 Not clear Not clear Yes No No Yes Not clear Yes Yes Yes Yes 

263 

Gemmell 

2008 264 Yes Yes Yes No No Yes Not clear Yes Yes Yes Yes 

Hanten 1997 

265 

Not 

clear 

Not 

clear Yes No No Not clear Not clear Yes Yes Yes Yes 

Irnich 2001 

196 

Not 

clear 

Not 

clear No No Not clear Not clear Not clear Yes Yes Yes Yes 

Lin 2004 202 Not clear Not clear Yes No No Not clear Not clear Not clear No Yes No 

Meseguer 

2006 266 Yes Not clear Yes No No Yes Not clear Not clear Yes Yes No 

Sherman 

2009 267 Yes Yes Not clear No No Yes Yes Yes Yes Yes Yes 

Yagci 2004 268 Not clear Not clear No Not clear Not clear Not clear Not clear Not clear Not clear Yes No 

Zaproudina 

2007 260 

Not 

clear 

Not 

clear Yes Yes No Yes Not clear Not clear Yes Yes No 

Zhang 2005 269 Not clear Not clear Yes No No Not clear Not clear Not clear Not clear Not clear Not clear 

G-27
Study ID 

Q1. 

Randomi 

zation 

Q2. 

Treatme 

nt 

Allocatio 

Q3. 

Groups 

similar at 

baseline 

re: 

Q4. 

Patient 

blinded 

to the 

Q5. Care 

provider 

blinded 

to the 

Q6. 

Outcome 

assessor 

blinded 

Q7. Cointerventi ons 

Q8. 

Complia 

nce 

Q9. 

Dropout 

rate 

describe 

Q10. 

Timing of 

the 

outcome 

Q11. 

Analysis 

includes 

an 

intention

Adequat n prognosti interventi interventi to the avoided acceptab le in all d and assessm ent in all 

e? Conceal c on? on? interventi or acceptab to-treat 

ed? indicator on? similar? groups le? groups similar? analysis ? 

s 

Zhang 2005 223 Not clear Not clear Not clear No No Not clear Not clear Not clear Not clear Not clear Not clear 

Table 3.1 Headache - Acupuncture 

Q2. Q3. Q6. Q7. Q9. Q10. Q11. 

Q1. Treatmen Groups similar at Q4. Patient Q5. Care Outcome Co- Q8. Dropout Timing of the Analysis 

Randomi t baseline blinded to provider blinded assessor interventi Complian rate includes 

Study ID zation Allocatio the to the blinded ons ce described outcome an 

Adequate n re: interventi interventi to the avoided acceptabl e in all and assessm ent in all intention- 

? Conceale prognosti on? on? interventi or acceptabl to-treat 

d? c indicators on? similar? groups e? groups similar? analysis? 

Carlsson 

1990 270 

Not 

clear 

Not 

clear Yes No No Yes Yes Yes Yes No Not clear 

Venancio 

2008 213 

Not 

clear 

Not 

clear No No Not clear Not clear Not clear Not clear Yes Not clear Not clear 

G-28
 
 Table 3.2 Headache - Manipulation 

Q3. Q11

Groups 

similar Q6. Q9. Q10. Analy

Q2. 

Treatmen 

Q4. 

Patient 

Q5. Care Outcome Q7. Co- Q8. Dropout Timing of the s includ

Q1. 

Randomizati 

at 

baseline blinded to 

provider 

blinded to assessor interventio Complian rate 

Study ID t Allocation the the blinded to ce described outcome s an intent

on 

Conceale 

re: 

interventio interventio the ns avoided or acceptabl e in all and assessme nt in all 

Adequate? 

d? 

prognost 

ic n? n? interventio similar? acceptabl n-to

indicator n? groups e? groups similar? trea

analy

s? 

s 

Nilsson 

1997 245 Yes No Yes Yes No Yes No Yes Yes Yes Not clea

Whittingh 

am 2001 

252 

Yes Yes Yes Yes No Not clear Not clear Yes Yes Yes Not clea

Table 4.1 Thoracic Pain 

Study ID 

Q1. 

Randomization 

Q2. 

Treatment 

Allocation 

Q3. 

Groups 

similar at 

baseline 

Q4. Patient 

blinded to 

the 

Q5. Care 

provider 

blinded to 

Q6. 

Outcome 

assessor 

blinded to 

Q7. Cointerventions 

Q8. 

Compliance 

acceptable 

Q9. 

Dropout 

rate 

described 

Q10. 

Timing of 

the 

outcome 

Adequate? Concealed? re: intervention? the the avoided or in all and assessmen

in all 

prognostic intervention? intervention? similar? groups 

indicators acceptable? groups similar? 

Schiller 

2001 

271 

Not clear Not clear Not clear Not clear No No Yes Not clear Not clear Yes 

G-29
 Table 5.1 Methodological quality of economic evaluations on back pain using the CHEC-list. 

Hollinghurst et al160,272 

Kominski et al171,273-280 

Seferlis et al 281,282 

Niemisto et al 283 

Ratcliffe et al74,284-29226 

Witt et al 200681,293,294 

Study population described Yes Yes Yes Yes Yes Yes Competing alternatives described Yes Yes Yes Yes Yes Yes Research question posed in answerable form Yes Yes Yes Yes Yes Yes Appropriate study design Yes Yes Yes Yes Yes Yes Appropriate time horizon Yes Yes Yes Yes Yes No Appropriate perspective Yes No No Yes Yes Yes All costs identified Yes No Yes Yes Yes No All costs measured appropriately Yes Yes No Yes Yes Not clear Costs valued appropriately Yes Yes No Yes Yes No All outcomes identified Yes NA NA Yes Yes Yes All outcomes measured appropriately Yes NA NA Yes Yes Yes Outcomes valued appropriately Yes NA NA Yes Yes Yes Incremental analysis of costs and outcomes performed Yes NA NA Yes Yes Yes Discounting NA No NA No Yes NA Sensitivity analysis Yes No No No Yes No Conclusions follow from the data reported Yes Yes Yes Yes Yes Yes 

G-30
Hollinghurst et 

al160,272 

Kominski et al171,273-280 

Seferlis et al 281,282 

Niemisto et al 283 

Ratcliffe et al74,284-29226 

Witt et al 200681,293,294 

Generalisability discussed No Yes No Yes Yes Yes No potential conflict of interest Yes Yes No Yes Yes Yes Ethical and distributional issues discussed appropriately Yes Yes No No Yes Yes 

 Table 5.2 Methodological quality of economic evaluations on neck pain using the CHEC-list. 

Korthals-de Bos et al297 Lewis et al298,299 Willich et al219,300 

Study population described Yes Yes No Competing alternatives described Yes Yes No Research question posed in answerable form Yes Yes Yes Appropriate study design Yes Yes Yes Appropriate time horizon Yes Yes No Appropriate perspective Yes Yes Yes All costs identified Yes Yes Yes All costs measured appropriately Yes Yes Yes Costs valued appropriately Yes Yes No All outcomes identified Yes Yes Yes All outcomes measured appropriately Yes Yes Yes Outcomes valued appropriately Yes Yes Yes Incremental analysis of costs and outcomes performed Yes Yes Yes Discounting NA NA Yes Sensitivity analysis No No Yes Conclusions follow from the data Yes Yes Yes 

G-31
 
Korthals-de Bos et al297 Lewis et al298,299 Willich et al219,300 

reported Generalisability discussed No No No No potential conflict of interest Yes Yes Yes Ethical and distributional issues discussed appropriately No No No 

Table 6.1 – Quality Assessment on Observational Studies. 

Cassidy 2008 301 Kohlbeck 2005 302 Cook 2008 303 Rothwell 2001 304 

Item 

Reporting 

Is the hypothesis/aim/objective of the study clearly described? 

Yes Yes Yes Yes 

Are the main outcomes to be measured clearly described in the Introduction or Methods section? 

Yes Yes Yes Yes 

Are the characteristics of the patients included in the study clearly described? 

Yes Yes Yes No 

Are the interventions of interest clearly described? 

Yes Yes Yes Yes 

Are the distributions of principal cofounders in each group of subjects to be compared clearly described? 

No No No Unable to 

determine 

Are the main findings of the study clearly described? 

Yes Yes Yes Yes 

Does the study provide estimates of the random variability in the data for the main outcome? 

No No Unable to 

determine 

Yes 

Have all the important adverse events that may be a consequence of the intervention been reported? 

Yes Yes Unable to 

determine 

No 

Have the characteristics of patients lost to follow-ups been described? 

No No No Unable to 

determine 

G-32
 
Have actual probability values been reported 

(e.g. 0.035 rather than <0.05) for the main outcomes except where the probability value is less than 0.001? 

No No Unable to 

determine 

Unable to determine 

External validity 

Were the subjects asked to participate in the study representative of the entire population from which they were recruited? 

Unable to determine 

Yes Unable to 

determine 

Unable to determine 

Were those subjects who were prepared to participate representative of the entire population from which they were recruited? 

Unable to determine 

Unable to determine 

Unable to determine 

Unable to determine 

Were the staff, places and facilities where the patients were treated, representative of the treatment the majority of patients receive? 

Unable to determine 

Unable to determine 

Unable to determine 

Unable to determine 

Internal validity - bias 

Was an attempt made to blind study subjects to the intervention they have received? 

Unable to determine 

No Unable to 

determine 

No 

Was an attempt made to blind those measuring the main outcomes of the intervention? 

No No Unable to 

determine 

No 

If any of the results of the study were based on “data dredging”, was this made clear? 

No Unable to 

determine 

Unable to determine 

Unable to determine 

In trials and cohort studies, do the analyses adjust for different lengths of follow-up of patients, or in case-control studies, is the time period between intervention and outcome the same for cases and control? 

Unable to determine 

Yes Unable to 

determine 

Yes 

Were the statistical tests used to assess the main outcomes appropriate? 

Unable to determine 

Unable to determine 

Yes Unable to 

determine 

Was compliance with the intervention/s reliable? Unable to 

determine 

Unable to determine 

Unable to determine 

Unable to determine 

Were the main outcome measures used accurate (valid and reliable)? 

Unable to determine 

Yes Unable to 

determine 

Unable to determine 

Internal validity – confounding (selection bias) 

Were the patients in different intervention groups (trials and cohort studies) or were the 

Yes Yes Unable to 

determine 

Yes 

G-33
 
cases and controls (case-control studies) 

recruited from the same population? Were study subjects in different intervention groups (trials and cohort studies) or were the cases and controls (case-control studies) recruited over the same period of time? 

No Yes Unable to 

determine 

Yes 

Were study subjects randomized to intervention groups? 

No No No No 

Was the randomized intervention assignment concealed from both patients and health care staff until recruitment was complete and irrevocable? 

No No No No 

Was there adequate adjustment for confounding in the analyses from which the main findings were drawn? 

Yes Unable to 

determine 

Unable to determine 

Unable to determine 

Were loses of patients to follow-up taken into account? 

No Unable to 

determine 

Unable to determine 

No 

Power 

Did the study have sufficient power to detect a clinically important effect where the probability value for a difference being due to chance is less than 5%? 

Unable to determine 

Yes Unable to 

determine 

Unable to determine 

Total Number of Yes 8 12 6 8 

Table 7.1 - Methodological quality of RCTs by CAM treatment type (LBP) 

Selected Item of the Cochrane Risk of Bias Tool 

Acupuncture (n=104) 

Spinal Manipulation (n=28) 

Spinal mobilization (n=18) 

Spinal ManipulatSpinal mobilizati(n=9) 

Appropriate method of randomization 44 (43.1) 6 (18.2) 6 (37.5) 6 (66.7) Inappropriate method of randomization 10 (9.8) 4 (12.1) 1 (6.3) 0 Appropriate concealment of treatment allocation 

20 (19.6) 3 (9.1) 3 (18.8) 4 (44.4) 

Inappropriate concealment of treatment allocation 

11 (10.8) 7 (21.2) 2 (12.5) 1 (11.1) 

Dissimilarity of baseline prognostic 8 (7.8) 3 (9.1) 1 (6.3) 1 (11.0) 

G-34
 
Selected Item of the Cochrane Risk of Bias 

Tool 

Acupuncture (n=104) 

Spinal Manipulation (n=28) 

Spinal mobilization (n=18) 

Spinal ManipulatSpinal mobilizati(n=9) 

indicators Appropriate outcome assessor blinding 29 (28.4) 15 (45.5) 10 (62.5) 5 (55.6) Inappropriate outcome assessor blinding 10 (9.8) 2 (6.1) 0 0 Imbalance in use of co-interventions between groups 

5 (4.9) 1 (3.0) 2 (12.5) 0 

Described and acceptable drop out rates 1 47 (46.1) 12 (36.4) 10 (62.5) 7 (77.8) Unacceptable drop out rates 45 (44.1) 6 (18.2) 2 (12.5) 1 (11.1) Similarity of timing in assessment of outcomes between groups 

92 (90.2) 27 (81.8) 15 (93.8) 8 (88.9) 

Reporting of intention-to-treat analysis 30 (29.4) 10 (30.3) 5 (31.3) 4 (44.4) Absence of selected outcome reporting 39 (38.2) 17 (51.5) 10 (62.5) 5 (55.6) Selected outcome reporting bias 17 (16.7) 10 (30.3) 2 (12.5) 4 (44.4) Total Score of Risk of Bias (max 13) Median (Inter Quartile Range) 

4 (1, 3) 2 (3, 6) 7 (4, 7) 8 (3, 6) 

Item number # 9 of the Cochrane risk of bias tool: the number of participants who were included in the study but did not complete the observation period or were not i

described and reasons given. If the percentage of withdrawals and drop-outs does not exceed 20% for short-term follow-up and 30% for long-term follow-up and does no

is scored. (N.B. these percentages are arbitrary, not supported by literature). 

G-35 

1 
Table 7.2- Methodological quality of RCTs by CAM treatment type (NP) 

Item Acupuncture 

(n=54) 

Spinal Manipulation (n=30) 

Spinal mobilization (n=11) 

Spinal ManipulatSpinal mobilizati(n=2) 

Appropriate method of randomization 14 (26.4) 15 (51.7) 4 (44.4) Inappropriate method of randomization 4 (7.5) 2 (6.9) 1 (11.1) Appropriate concealment of treatment allocation 

8 (15.1) 10 (34.5) 5 (55.6) 

Inappropriate concealment of treatment allocation 

2 (3.8) 4 (13.8) 1 (11.1) 

Dissimilarity of baseline prognostic indicators 

6 (11.3) 4 (13.8) 0 

Appropriate outcome assessor blinding 14 (26.4) 10 (34.5) 5 (55.6) Inappropriate outcome assessor blinding 0 2 (6.9) 5 (55.6) Imbalance in use of co-interventions between groups 

1 (1.9) 3 (10.3) 0 

Described and acceptable drop out rates 2 27 (50.9) 19 (65.5) 5 (55.6) Unacceptable drop out rates 14 (26.4) 3 (10.3) 1 (11.1) Similarity of timing in assessment of outcomes between groups 

41 (77.4) 24 (82.8) 9 (100.0) 

Reporting of intention-to-treat analysis 13 (24.5) 12 (41.4) 2 (22.2) Absence of selected outcome reporting 26 (49.1) 20 (69.0) 6 (66.7) Selected outcome reporting bias 8 (15.1) 5 (17.2) 3 (33.3) Total Score of Risk of Bias (max 13) Median (Inter Quartile Range) 

4 (3, 6) 3 (4, 7) 3 (5, 7) Only two trials (N

2 Item number # 9 of the Cochrane risk of bias tool: the number of participants who were included in the study but did not complete the observation period or were not in

described and reasons given. If the percentage of withdrawals and drop-outs does not exceed 20% for short-term follow-up and 30% for long-term follow-up and does no

is scored. (N.B. these percentages are arbitrary, not supported by literature). 

G-36 
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H-8 
Appendix I. Summary Tables 

Table 1.1 Low Back Pain - Acupuncture – Acute/Sub-acute - Specific Pain 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Huang, SR 98 % male: 49.8% L4/5 Disc 1 – local single-point 2 treatments/ 1 – Disability: 4/13 

(2006)1 herniation or electro-acupuncture, Week Oswestry disability 

Mean age: 44.5 with other disc treatment provider NR n index 

China yrs herniation; = 53 4 weeks 2 – ADVERSE 

Age<65yrs; 

Duration of 2 – routine electroEVENTS: no harms reported 

pain≤2w; Non- acupuncture, n = 45 

use of Data measured at 4 

glucocorticoid weeks 

and nonsteroidal antiinflammatory 

drugs in the 

study period 

Lai, Y 76 % male: NR Diagnostic 1 – acupuncture Xi-cleft 1 treatment 1 – Pain: VAS 4/13 

(2004)2 using Chinese and normal points, /day 2 – Quality of Life: 

Mean age: NR New Medicine treatment provider NR n Well being, Chinese 

China Clinical Trial 

Reference 

1993 ref[2] 

= 41 

2 – acupuncture normal 

points, n = 35 

20 treatments Standard 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measures at 20 

days 

Wen-Jun, L 238 % male: 84.5% Patients with 1 – acupuncture­ 5 treatments Response rate 2/13 

(2000)3 acute lumbar treatment, treatment 1 – ADVERSE 

Mean age: NR sprain provider NR n = 112 NR EVENTS: no harms 

China reported 

2 – acupuncture-control, 

n = 126 

Table 1.2 Low Back Pain - Acupuncture – Acute/Sub-acute - Non –Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sampl (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

e size duration 

Kennedy, S 48 % male: 47.95% 18-70 yrs adults 1 – Acupuncture (verum), Maximum 12 1 – Pain: VAS 8/13 

(2008)4 with non-specific by senior experienced treatment in (average and worst) 

Mean age: LBP, with/out physiotherapists, n = 24 total 2 – Disability: Roland 

Northern Ireland 45.55 yrs referred pain, up Morris Disability 

to 12 weeks 2 – Sham Acupuncture, 6 weeks Questionnaire 

duration. by same senior 

experiences 

3 – Quality of Life: 

NR 

Acute/sub-acute physiotherapists as 4 – Work: work 

intervention group n = 24 absenteeism 

5 – Utility of 

conventional care: 

medication use 

(tablets/day) 

6 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 

baseline, 6 weeks 

and 3 mo 

Eisenberg, DM 

(2007)5 

434 % male: 47.5% Patients with 

acute LBP for 21 

1 – acupuncture, by 11 

acupuncturists, n = 58 

10 sessions 

total 

1 – Pain: 

bothersomeness of 

8/13 

Mean age: d or less aged > 5 weeks worse symptom; 

US 42.95 yrs 18 yrs 2 – chiropractic, by 9 2 – Disability: Roland 

chiropractors, n = 76 Morris Disability 

Questionnaire 

3 – massage, by 12 3 – Quality of Life: 

massage therapists, n = physical and mental 

152 SF-12 

4 – ADVERSE 

4 – usual care, n = 148 EVENTS: minor 

discomfort/soreness 

Data measured at 

immediate posttreatment 

I-1
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sampl (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

e size duration 

Wenzhong, C 

(2001)6 

400 % male: 33.8% Patients with 

acute lumbago 

1 – acupuncture with 

filiform needle, n = 100 

5 or 10 times of 

separate 

1 – Quality of Life: 

curative effect at 5 

0/13 

Mean age: NR (severe and very treatment, and 10 treatments 

China severe pain) who 2 – acupuncture with once/2 days 2 – ADVERSE 

sought medical filiform needle + cupping, EVENTS: no harms 

advice from n = 100 6 hrs-9 days reported 

Department of 

Acu and Moxi 3 – acupuncture with Data measured at 5 

and the surgical filiform needle + pricking and 10 treatments 

Department of collateral + cupping, n = 

Orthopedics 100 

4 - acupuncture with 

filiform needle + pricking 

collateral + cupping + 

Moxibustion, n = 100 

Treatment provider : NR 

Araki, S 40 % male: 70% Patients with 1 – acupuncture by 2 Single 1 – Pain: VAS (mm) 10/13 

(2001)7 acute LBP (who acupuncturists with 3 and treatment of pain and LBP 

Mean age: 43.8 have gait 6 years experience, n = score by JOA 

Japan yrs disturbance; 

information from 

20 2 – Disability: JOA 

score 

author) 2 – sham acupuncture by 3 – ADVERSE 

same therapists = 20 EVENTS: no harms 

reported 

Data measured after 

single treatment 

Kittang, G (2001)8 60 Male (%): NR Patients with 

non-radiating 

1 – Acupuncture, n = 30 4 sessions 1 - Pain (VAS) 

2 - use of other pain 

7/13 

Norway Mean age: NR acute low-back 2 – Medication, n = 30 2 weeks medication 

(range 18 – 67 pain (lasting less 3 - number of back 

years) than 10 days). Co-intervention: advice 

and exercise 

pain episodes at 6, 

18 months 

4 - stiffness 

Treatment provider: NR measured at baseline 

1, and 2 weeks, and 

3 and 6 months 

5 – ROM (lateral 

flexion) 

6 - Harms at 1 and 2 

weeks 

Table 1.3 Low Back Pain - Acupuncture - Chronic - Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sampl (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

e size duration 

Itoh, K (2004)9 35 % male: 28.6% Patients with 

lumbar or 

1 – superficialacupuncture (trigger 6 weeks 1 – Pain: VAS pain 

intensity 

7/13 

Japan Mean age: 71.9 lumbosacral LBP points), by acupuncturist 2 – Disability: Roland 

yrs of ≥ 6 mo, aged ≥ with 4 yrs training and 7 Morris Questionnaire 

65 yrs, no 

radiation of LBP, 

yrs experience, n = 12 3 – ADVERSE 

EVENTS: no harms 

normal 2 – deep-acupuncture reported 

neurological (trigger points by the Data measured at 6 

examination, no same therapist = 10 weeks 

previous 

Treatment with 

Acu for LBP 

3 – STD-acupuncture 

(traditional points), by 

same therapist, n = 13 

Ceccherelli, F 42 % male: 71% Normal deep 1 – deep acupuncture, by 8 session total 1 – Pain: McGill pain 9/13 

(2001)10 tendon reflexes medical licensed questionnaireMean age: at lower limbs; acupuncturists, n = 21 6 weeks number of words; 

Italy 41.64 yrs negative Laseque 

and Wassermann 2 – superficial 

total score 

2 – ADVERSE 

test findings; acupuncture, n = 21 EVENTS: no harms 

Patients with reported 

radiographic 

evidence of 

arthritis; negative 

Data measured at 6 

weeks and 3 mo 

CT scan findings 

for disc bulging; 

normal EMG 

results 

I-2
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sampl (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

e size duration 

Gunn, CC 56 % male: 100% Male workers 1 – acupuncture + Maximum of 15 1 – Pain: pain + work 4/13 

(1980)11 disabled from standard care, by treatments status questionnaire: 

Mean age: 40.6 injury for at least acupuncturist n = 29 8 weeks full recovery; partial 

Canada yrs 12 weeks; 

disabling pain 

despite traditional 

medical or 

surgical 

2 – standard care by 

general practitioner, n = 

27 

recovery; slight 

recovery; no recovery 

2 – ADVERSE 

EVENTS: no harms 

reported 

treatment ; 

disability periods 

12-168 weeks 

Data measured at 8, 

12 and 12-6 weeks, 

mean 27.3 weeks 

Table 1.4 Low Back Pain - Acupuncture - Chronic - Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Haake, M 1162 % male: 40.43% > 18 yrs old 1 – Acupuncture (verum), Up to 7 weeks 1 – Pain: CPGS 10/13 

(2007)12 adults with by physicians of various 2 – Disability: HFAQ 

Mean age: 50.03 chronic LBP specializations with (treatment responses 

Germany yrs for ≥ 24 weeks median of 8 yrs practice n 

= 387 

2 – Sham acupuncture 

(placebo) by same 

physicians, n = 387 

3 – standard therapy, n = 

388 

12% or better) 

3 – Quality of Life: 

SF-12 (physical 

score); patient global 

assessment 

4 – ADVERSE 

EVENTS: not 

relevant for 

abstraction 

Data measured at 3 

and 6 mo 

Inoue, M (2006)13 31 % male: 67.9% Patients 1 – acupuncture by NR 1 – Pain: VAS 9/13 

consulted for acupuncturists, n = 15 2 – Disability: range 

Japan Mean age: 69 yrs LBP, newly of lumbar spinal 

referred and 2 – sham acupuncture by flexion 

those re- same therapists, n = 16 3 – ADVERSE 

attending, with EVENTS: no harms 

only LBP in a reported 

limited area, 

which was 

exacerbated in 

particular 

posture 

Witt, CM (2006)14 2841 % male: 42.7% clinical 1 – acupuncture by Maximum of 15 1 – Pain: back pain 7/13 

diagnosis of physicians with A-diploma acu treatment score; % reduction of 

Germany Mean age: 52.85% chronic LBP 

lasting more 

than 6 months; 

age 18 or over, 

provision of 

written 

informed 

consent 

of 140 hrs acu education, 

n = 1451 

2 – control: no treatment, 

n = 1390 

3 months 

pain 

2 – Disability: HFAQ 

3 – Quality of Life: 

SF-36 

4 – Cost: incremental 

cost effective per 

quality adjusted life 

year-overall 

5 – ADVERSE 

EVENTS: reported 

for Acu group but no 

details 

Data measured at 3 

and 6 mo 

Itoh, K (2006)15 26 % male: NR Patients at 1 – trigger point 36 treatments 1 – Pain: VAS 10 cm 8/13 

least 65 yrs acupuncture by total scale 

Japan Mean age: 76.15 

yrs 

with history of 

LBPlumbar/lumbos 

acral pain for 

at least 6 mo; 

leg pain; 

acupuncturist with 4 yrs 

training and 7 yrs clinical 

experience, n = 13 

2 – sham by same 

therapist, n = 13 

12 weeks 

2 – Disability: Roland 

Morris Questionnaire 

(24 questions) 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 12 

weeks 

I-3
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Brinkhaus 295 % male: 30.97% Clinical 1 – acupuncture by 12 sessions 1 – Pain: VAS score 8/13 

(2006)16 diagnosis of acupuncture physicians total (pain intensity); PDI 

Mean age: 58.73 CLBP with a with at least 3 yrs score 

Japan yrs disease of 

more than 6 

mo; 40-75 yrs; 

average pain 

intensity of 40 

or more; 

written 

consent; use of 

oral nonsteroidal antiinflammatory 

drugs in 4 

weeks before 

treatment 

experience and 140 hrs 

of acu training, n = 145 

2 – minimal acupuncture 

or sham by same 

physicians, n = 71 

3 – waiting list group, n = 

79

8 weeks 2 – Disability: FFbHR scores; SF-36: 

physical component 

4 – Quality of Life: 

SF-36 – physical 

health 

5 – Utility of 

conventional care: 

analgesics use in 

weeks 5 - 8 (diary), 

days 

6 – ADVERSE 

EVENTS: details not 

reported 

Data measured at 8 

weeks, 2 mo, 6 

months and 1 yr 

Giles, LG 115 % male: 54.93% Patients at 1 – acupuncture(LB, NP, Maximum of 9 1 – Pain: pain 6/13 

(2003)17 

Mean age: 26.1 

least 17 yrs; 

uncomplicated 

thorax), n = 36 weeks frequency; VAS 

intensity 

Australia yrs mechanical 

spinal pain for 

2 – spinal manipulation, n 

= 36 

2 – Disability: 

Oswestry Disability 

13 weeks 3 – Quality of Life: 

minimum-for 3 – medication that has SF-36 

long-term fu > not been tried by Patients 4 – ADVERSE 

1 yr; those who 

received their 

in this group, n = 43 EVENTS: hematoma 

and bleeding, n = 1 

randomly committed suicide 

allocated Data measured at 9 

treatment weeks and 1 yr 

regimen during 

treatment 

period 

Sator­ 61 % male: 0.299­ Lumbar LBP of 1 – Auricular electro­ 6 weeks 1 – Pain: VAS pain 9/13 

Katzenschlager verify at least 6 mo; acupuncture, n = 31 intensity 

SM (2004)18 

Mean age: 53.6 

normal 

neurological 2 – Auricular 

2 – Quality of Life: 

well being 

Austria yrs function of 

lumbosacral 

nerved; no 

pain radiation; 

persisting pain 

intensity VAS 

≥5 

acupuncture, n = 30 

Treatment provider : NR 

3 – Work: Patients on 

sick leave who 

returned to full-time 

work at 3 mo 

4 – Utility of 

conventional care: 

consumption of 

tramadol rescue 

medication 

5 – ADVERSE 

EVENTS: no harms 

reported 

No numerical data 

Data measured at 6 

weeks 

Chu, J (2004)19 36 % male: 50% Patients with 1 – E-MS (ETOIMS) by NR 1 – Pain: VAS pain 7/13 

US Mean age: 53.4 

chronic LBP 

(duration=> 3 

trained physician, n = 12 intensity 

2 – ADVERSE 

yrs mo) 2 – MS by trained EVENTS: no harms 

physician, n= 12 reported 

3 – SS by trained Data measured at 1 

physician, n = 12 and 2 weeks posttreatment 

Cecherelli, F 31 % male: 29% Patients with 1 – acupuncture 5x/week 1 – 5 weeks 1 – Pain: pain 7/13 

(2003)20 

Mean age: 49.36 

chronic 

"lombalgia" 2 – acupuncture 

2 – 10 weeks monitored with daily 

self-rating chart; final 

Italy yrs meaning LBP 10x/week pain change relative 

(pain greater to original pain (%) 

than 3 months) Treatment provider: Not 2 – ADVERSE 

specified, but author is 

from anesthesia 

EVENTS: no harms 

reported 

department 

No numerical data 

Meng, CF 55 % male: 39.75% chronic non 1 – acupuncture, n = 31 10 sessions 1 – Pain: VAS with 7/13 

(2003)21 specific LBP > total word anchors-ITT 

Mean age: 71 yrs 12 weeks; age 2 – usual care, NSAIDS, 2 – Disability: mRDQ 

US 60 years or 

more; 

analgesics, exercises, n = 

24 

 4 weeks - ITT 

3 – Quality of Life: 

radiography global transition scale 

within past Treatment provider: NR 

year Data measured at 4, 

6 and 9 weeks 

I-4
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Kerr, P (2003)22 46 % male: 47.3% LBP symptoms 

> 6 mo; with or 

1 – acupuncture by 

chartered physiotherapist 

6 weeks 1 – Pain: McGill Pain 

Questionnaire; VAS 

4/13 

Northern Ireland Mean age: 40.5 

yrs 

without leg 

pain; no 

neurological 

deficits; 

patients had to 

be happy to 

have 

trained in acu, n = 26 

2 – placebo-TENS by 

same therapist, n = 20 

3 – non-attendees (drop 

outs), n = 0 

(mm); 

2 – Quality of Life: 

SF-36- duration of 

pain relief 

3 - ADVERSE 

EVENTS: no harms 

reported 

acupuncture or 

another 

treatment; 

willing to 

participate in 

trial and 

undergo 

Data measured at 6 

weeks and 6 mo 

assessment 

procedures 

Yeung, KN 52 % male: 17.3% Patients with 1 – electro-acupuncture + 4 weeks 1 – Pain: NRS- 7/13 

(2003)23 chronic non- exercise by average pain; worst 

Mean age: 53 yrs specific LBP (> physiotherapist certified pain 

Hong Kong 6 mo) with or in acu, n = 26 2 – Disability: 

without Aberdeen LBP 

radiation- age 2 – exercise by same scale(0-100 points) 

between 18-75 

yrs - 3 (12%) 

therapist, n = 26 3 – ADVERSE 

EVENTS: n = 1 had a 

of group 2 had stroke before 3 

prolapsed months fu 

intervertebral Data measured at 4 

disc weeks and 3 mo 

Molsberger, AF 186 % male: 47.9% LBP (pain 1 – verum acupuncture + 6 weeks 1 – Pain: VAS mean 3/13 

(2002)24 between 12th conventional orthopaedic pain intensity (ITT) 

Mean age: 49.3 rib and gluteal therapy by experienced 2 – Quality of Life: 

Germany yrs fold); with pain medical doctor, n = 65 PBS: rated 

for at least 6 effectiveness of the 

weeks; 2 – sham acupuncture + treatment protocol 

average pain 

score of at 

conventional orthopaedic 

therapy by same doctor, Data measured at 6 

least 50 mm n = 61 weeks and 3 mo 

on 100 mm 

VAS during 3 – nil + conventional 

last week; 20­ orthopaedic therapy, n = 

60 yrs; ability 60 

to 

communicate 

in German 

Leibing, E 

(2002)25 

131 % male: NR Non-radiating 

pain for more 

1 – combined traditional 

body and ear 

20-26 sessions 

total 

1 – Pain: VAS (10 

cm) –pain intensity; 

2/13 

Mean age: 48.1 than 6 months. acupuncture + PDI (total score = 70) 

Germany yrs Age 18-65 physiotherapy by 12 weeks 2 – ADVERSE 

years experienced Taiwanese EVENTS: n = 2, 

physician, n = 40 painfulness of 

acupuncture; n = 1, 

2 – physiotherapy by problem with 

trained physiotherapist, n circulation 

= 45 

Data measured at 12 

3 – sham acupuncture + weeks and 9 mo 

physiotherapy by same 

investigators in other 

groups, n = 46 

Carlsson, CPO 50 % male: 34% Lumbar or 1 – manual acupuncture, 8 weeks 1 – Pain: VAS- pain 6/13 

(2001)26 

Mean age: 49.5 

lumbosacral 

LBP for at 

n = 18 intensity in the 

morning; in the 

Sweden yrs least 6 mo; no 2 – electro-acupuncture, evening 

radiation of n = 16 2 – Quality of Life: 

pain below Global assessments 

knee; normal 

neurological 

3 – TENS, n = 16 

Data measured at 8 

exam findings Treatment provider: NR weeks, 1 and 3 mo 

of lumbosacral 

nerve function 

Cherkin, DC 262 % male: 41% Ages 20 to 70 1 – acupuncture by Up to 10 visits 1 – Pain: symptom 6/13 

(2001)27 years who licensed acupuncturists bothersomeness 

Mean age: 44.9 visited a with at least 3 yrs 10 weeks during past week 

US yrs primary care 

physician for 

low back pain 

who had 

persistent LBP 

for 6 weeks 

experience, n = 94 

2 – massagemanipulation of softtissue by licensed 

therapists with at least 3 

yrs experience, n = 78 

3 – self care education, n 

= 90 

2 – Disability: Roland 

Disability Scale 

Score; National 

Health Interview 

survey 

3 – Quality of Life: 

SF-12 mental health 

summary scales 

4 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 10 

weeks and 1 yr 

I-5
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Grant, DJ 60 % male: 10.26% Patients at 1 – acupuncture by 8 sessions total 1 – Pain: VAS (IQR); 6/13 

(1999)28 least 60 yrs old physiotherapist, n = 32 NHP 

Mean age: 73.5 with complain 4 weeks 2 – Utility of 

UK yrs of back pain of 2 – TENS by same conventional care: 

at least 6 

months 

duration 

therapist, n = 28 tablets consumed in 

last week (IQR) 

3 - Quality of Life 

4 – ADVERSE 

EVENTS: drop outs: 

n = 2, influenza and 

immobility; n = 1, 

acute depression 

Data measured at 4 

weeks, 4 days post 

treatment and 3 mo 

Lehmann, TR 53 % male: 67% Patients with 1 – electro-acupuncture 3 weeks 1 – Pain: peak pain; 1/13 

(1983)29 chronic by certified and average level of pain 

Mean age: 39 yrs disabling LBP experienced 2 – Return to work 

US who acupuncturist, n = 17 3 – ADVERSE 

demonstrate at EVENTS: no harms 

least minimal 2 – TENSE by reported 

levels of experienced physical 

motivation and therapist, n = 18 Data measured at 3 

in whom the 

level of 3 – sham TENSE by 

weeks and 3-6 mo 

disability would same provider as in 

warrant the group 2, n= 18 

expense of 

inpatient 

treatment 

MacDonald, AJR 

(1983)30 

17 % male: 29% Patients with 

chronic LBP 

1 – elecrto-acupuncture, 

n = 8 

1 

treatment/week 

1 – Pain: %, pain 

relief; pain score 

2/13 

Mean age: NR which had reduction; activity 

UK failed to derive 2 – sham electro- NR pain score reduction; 

relief from acupuncture, n = 9 physical signs 

conventional reduction; combined 

methods; Treatment provider: NR average reduction 

referred BP for 2 – ADVERSE 

at least one EVENTS: no harms 

year. reported 

Data measured at 

before each 

treatment 

Mendelson, G 77 % male: 48.4% Chronic LBP; 1 – Acupuncture/ placebo 2 1 – Pain: VAS 100 6/13 

(1983)31 

Mean age: 54.1 

no Litigation or 

compensation 

by surgeon, n = 36 treatment/week mm; McGill Pain 

Questionnaire (PRI, 

Australia yrs claims 2 – Placebo/ Acupuncture 4 weeks PPI) 

pending; by same surgeon, n = 41 2 – ADVERSE 

no overt EVENTS: no harms 

psychiatric reported 

illness; 

ability to read Data measured at 4 

and write in weeks 

English 

Coan, R 50 % male: 46.3% LBP for 6 1 – acupuncture- NR 1 – Pain: VAS 10 cm 3/13 

(1980)32 

Mean age: 46.9 

months or 

more; No 

immediate, n = 23 

2 – ADVERSE 

US yrs previous 

acupuncture 

2 – acupuncture-delayed 

(control), n = 16 

EVENTS: no harms 

reported 

treatments; 

no history of 

diabetes, 

infection or 

3 – acupunctureinadequate, n = 11 Data measured at 3 

and 6 mo 

cancer; not 

more than 2 

back surgeries 

Treatment provider: NR 

Mendelson, G 77 % male: 48% Chronic LBP; 1 – acupuncture, n = 36 2 1 – Pain: VAS 100 1/13 

(1978)33 

Mean age: 53.5 

no Litigation or 

compensation 2 – placebo (sham 

treatment/week mm for pain 

2 – ADVERSE 

Australia yrs claims acupuncture), n = 41 4 weeks EVENTS: no harms 

pending; reported 

no overt Treatment provider: NR 

psychiatric Data measured at 4 

illness; fluent weeks 

in English; 

referred by 

their attending 

doctor 

I-6
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Fu, ZH 60 % male: 47% Adults 20-60 1 – Fu’s subcutaneous NR 1 – Pain: VAS: 3/13 

(2006)34 

Mean age: 56.1 

years old with 

chronic LBP 

needling (FSN), n = 32 motion related pain 

(MRP); pain under 

China yrs (between the 2 – minimal needling, n = pressure (PUP) 

12th rib and 28 2 – ADVERSE 

gluteal fold) EVENTS: n = 1, 

Treatment provider: NR fainted during 

intervention; n = 11, 

bleeding after 

intervention; n = 6, 

hurt feeling during 

needling 

manipulation 

Data measured at B 

Nan, L 360 % male: NR Patients age 1a – dermal needling, n = 1 - 10 1 – Pain: Patients 3/13 

(2005)35 18- 65 yrs with 88 treatment with no pain at the 

Mean age: 46 yrs lumbar strain 1b – dermal needling, n = sessions total end of two courses; 

China in reference 

with relevant 

92 

2 – 14 

Patients with grade II 

pain 

standard 2a – body acupuncture, n treatment 2 – ADVERSE 

implementation = 91 sessions total EVENTS: n = 3, pain 

in 2b – body acupuncture, n during tapping could 

Traumatology = 89 not be tolerated (did 

in Chinese 

Medicine; Treatment provider: NR 

not get treatment) 

(from Data measured at B 

Department of 

Pain) 

Li, N 60 % male: 43.5% LBP and 1 – acupuncture, n = 31 One 1 – Pain: overall 4/13 

(2005)36 

Mean age: 56.5 

duration of 

pain>1 year; 2 – physiotherapy, n = 29 

treatment/day efficiency; relapse 

rate 

China yrs age:1870 yrs; 

Oswestry LBP 

disability index 

>30; Patients 

adhere to be 

follow-up 

Treatment provider: NR 

4 weeks 2 – Disability: 

Oswestry LBP 

disability index 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 4 

weeks and 6 mo 

Wang, BX 40 % male: NR Patients with 1 – electro-acupuncture One treatment/ 1 – Pain: VAS pain 2/13 

(2004)37 

Mean age: 46 yrs 

intervertebral 

disc protrusion 

by acupuncturist, n = 23 day intensity at buttock 

2 – ADVERSE 

Pakistan aged => 18 yrs 2 – medication by same 5-7 days EVENTS: no harms 

suffering from therapist, n = 17 reported 

radiating pain 

to the lower Data measured at 

limb for > 2 yrs end of treatment 

period, 5-7 days 

Hollisaz, MT 119 % male: 45.4% Patients with 1 – electro-acupuncture, 15 sessions in Percent of patients 2/13 

(2008)38 

Mean age: NR 

LBP of sciatica 

origin (> 6 mo) 

n = 41 total with resolved 

symptoms not related 

Iran aged ≥ 20 yrs 2 – physiotherapy, n = 38 to LBP – irrelevant to 

review 

Chronic 3 – placebo, n = 40 1 – ADVERSE 

EVENTS: no harms 

Treatment provider: NR reported 

Takeda, H 20 % male: 85% Students of 1 – acupuncture-distal 6 treatment 1 – Pain: VAS; pain 5/13 

(2001)39 acupuncture point needling, n = 10 sessions in threshold at lumbar 

Mean age: 31.1 college who total area, and foot 

Japan yrs are suffering 

from lumbago 

2 – acupuncture-lumbar 

area needling, n = 10 

Treatment provider: NR 

3 weeks 

2 – Disability: ADL 

score 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 3 

weeks and 3, 5, and 

7 days after each 

session 

Sakai, T 26 % male: 27% Non-specific 1 – acupuncture, n = 14 4 sessions in 1 – Pain: subjective 0/13 

(1998)40 

Mean age: 52.3 

LBP 

2 – medication (NSAID), 

total symptoms of LBP in 

JOA score; pain relief 

Japan yrs n = 12 

Treatment provider: NR 

2 weeks score 

2 – Disability: ADL in 

JO score 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 1 

week after start of all 

treatments and 2 

weeks 

I-7
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Yu, W 200 % male: NR Pain in waist 1 – acupuncture local 1 treatment/ 1 – Quality of Life: 

(1997)41 

Mean age: NR 

and leg point, n = 103 day, 20 

treatments/ 

well being 

2 – ADVERSE 

China 2 – acupuncture local and 

Weizhong point, n = 97 

course 

1 or 2 courses 

EVENTS: no harms 

reported 

Treatment provider: NR 20 or 40 days Data measured at 20 

or 40 days 

Itoh, K 32 % male: 37.5% Outpatients 60 1 – acupuncture by 5 treatments/ 1 – Pain: pain 6/13 

(2008)42 yrs or older acupuncturist with at least week intensity VAS (10 cm) 

Mean age: NR with non­ 4 yrs experience, n = 8 2 – Disability: RDQ 

Japan specific LBP; 1 week total (0-24 points) 

lumbar or 

lumbosacral 

2 – acupuncture + TENS 

by same therapist, n = 8 

3 – ADVERSE 

EVENTS: WDAE, n = 

LBP for at 1 

least 6 mo; no 3 – TENS by same 

radiation of therapist, n = 8 Data measured 1, 2, 

LBP; normal 3, 4, 5 and 10 weeks 

neurological 

findings of 

4 – control-topical 

poultice when necessary, 

lumbosacral n = 8 

nerve; not 

receiving acu 

treatment for 

more than 6 

mo; no change 

in medicine 

and dose for 

one months or 

longer 

Yuan, J 30 % male: 60% Subjects with 1 – acupuncture by 1 – 2 1 – Pain: VAS 9/13 

(2009)43 chronic Non- acupuncturists with treatments/ average 

Mean age: 43.7 Specific LBP experience of > 5 yrs in week for 5 2 – Disability: RMDQ 

Ireland yrs clinical practice, n = 15 

2 – acupuncture by same 

therapists, n = 15 

weeks 

2 – 5 

treatments/ 

week for 2 

weeks 

4 – ADVERSE 

EVENTS: minor 

bleeding, n = 11; 

pain, n = 2; tiredness, 

n = 4; 

dizziness/headache/r 

edness/dry mouth, n 

= 1 

Data measured at 2 

or 5 weeks, 3 and 6 

mo 

Cherkin, DC 

(2009)44 

638 % male: 40.5 Patients aged 

18-70 yrs 

1 – IND-acupuncture by 6 

licensed acupuncturists 

1-2 treatments 

/week 

1 – Disability: RMDQ 

2 – ADVERSE 

6/13 

Mean age: 47.2 receiving care with 4-19 yrs experience, EVENTS: n = 11 

US yrs for chronic n = 157 4 weeks Patients had 

LBP (3-12 moderate short-term, 

months) within 2 – St-acupuncture by n = 1 pt had severe 

the past yr same therapists, n = 158 harms-no details 

3 – sham by same 

therapists, n = 162 Data measured at 4 

weeks, 3 and 6 mo 

4 – usual care, n = 161 

Not yet screened 9 % male: NR Patients with 1 – acupuncture-trigger Total of 5 1 – Pain: VAS 5/13 

(2005)45 chronic (> 6 point needling, n = 4 treatment 2 – Disability: RDQ 

Mean age: NR months) LBP sessions 3 – ADVERSE 

Japan 2 – acupuncture-tender 

point needling, n = 5 5 weeks 

EVENTS: no harms 

reported 

Treatment provider: NR Data measured at 5 

weeks 

Tsui MLK 42 % male: 31% Patients aged 1 – electro-acupuncture Total of 8 1 – Pain: pain 6/13 

(2004)46 20-55 yrs with by principal investigator , sessions intensity VAS 

Mean age: 39.9 LBP radiating n = 14 2 – Disability: Roland 

China yrs down to the 

thigh or calf for 2 – EH-acupuncture by 

4 weeks Morris Disability 

Questionnaire 

=> 3 months principal investigator, n = 3 – ADVERSE 

mechanical 14 EVENTS: no harms 

cause but not reported 

from cancer or 

TB, with 

3 – exercise, n = 14 Data measured at 4 

weeks and 3 mo 

positive SLR 

findings 

Thomas, A 43 % male: NR Patients with 1 – acupuncture (manual 3 treatments 1 - Pain: activities 4/13 

(1994)47 CLBP; sudden stimulation = MS; LF with <50% pain; word 

Mean age: NR or insidious electrical stimulation; HF 6 weeks score 

Sweden onset of LBP 

with or without 

electrical stimulation) by 2 

physiotherapists trained 

2 – Disability: 

subjective 

trauma; in acu, n = 33 assessment 

duration ≥ 6 3 – ADVERSE 

mo; 2 – waiting list, n = 10 EVENTS: no harms 

recurrences reported 

with pain of 

variable Data measured at 6 

intensity; weeks and 6 mo 

I-8
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Kwon, Y.D 50 % male: 33.5 Lumbar or 1 – acupuncture, n = 25 12 sessions 1 – Pain: VAS scores 7/13 

(2007)48 lumbosacral 2 – Disability: RDQ 

Mean age: NR pain for 2 – sham acupuncture, n 4 weeks 3 – Quality of Life: 

China duration of at = 25 PGA, patient global 

least 3 months; 4 – ADVERSE 

older than 20 Treatment provider : NR EVENTS: no harms 

years of age, 

LBP as main 

reported 

complaint; Data measured at 2 

normal and 4 weeks 

neurological 

examination; 

Inoue, M 27 % male: NR Patients with 1 – acupuncture, n = 15 Single 1 – Pain: VAS (10 10/13 

(2001)49 

Mean age: 59.9 

chronic 

lumbago who 2 – sham acupuncture, n 

treatment cm) of pain at most 

restricted action 

Japan yrs attended the = 12 2 – ADVERSE 

university EVENTS: no harms 

acupuncture Treatment provider : NR reported 

clinic as 

outpatient and Data measured after 

gave consent single treatment 

to attend to the 

trial 

Table 1.5 Low Back Pain - Acupuncture - Mixed duration- Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Chen, MZ 90 % male: 70% disc herniation, 1 – Warming needle and 3 courses of 1 – Quality of Life: 4/13 

(2005)50 bone TB, acupoint injection + oral treatment Cured rate; total 

Mean age: 34.47 tumour; pain medication, n = 30 effective rate 

China yrs threshold < 0.4 

mA 2- Oral medication, n = 

30 

NR 2 – ADVERSE 

EVENTS: no harms 

reported 

3 – Acupoint injection, n = 

30 

Treatment provider : NR 

Liang, SY 

(2008)51 

112 % male: NR Patients with 

myofascitis 

1 – tendon muscle 

picking (acupuncture), n 

Total of 14 

sessions, 5 or 

1 – Quality of Life: 

Therapeutic effect 

5/13 

Mean age: NR LBP = 56 7 days each 

China course 

2 – electro-acupuncture, 

n = 56 2 treatment 

courses 

Treatment provider : NR 

Hua-Sheng Tang 165 % male: 56.9% Between 20-69 1 – electro-acupuncture 1 session/day 1 – Quality of Life: 3/13 

(2008)52 yrs; CLBP/ along channel by Cure rate; 

Mean age: 40.2 traumatic LB neuropathy doctor, n = 85 40 sessions significantly effective; 

China yrs injury; 

2 – routine acupuncture 

by same doctor, n = 80 

(days) total effective; ineffective; 

total efficacy; 

reoccurrence 

2 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 

immediate post-NR 

and 6 mo 

Rui,ping She 279 % male: 55.9% LBP; sciatica; 1 – electro-acupuncture 1 session/day 1 – Quality of Life: 3/13 

(2008)53 lower limb (deeply needling Qiangji Cure rate; 

Mean age: NR numbness; 4 points) by neuropathy 20 sessions significantly effective; 

China limp 

intermittently; 

protective 

posture; 

deformity of 

spinal cord; 

straight leg 

raise test(+); 

Bragard’s 

test(+); dysuria 

or lower limb 

myophagism; 

dura mater and 

doctor, n = 140 

2 – electro-acupuncture 

(routine points) by same 

doctor, n = 139 

(days) in total effective; ineffective; 

total efficacy; 

2 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 

immediate posttreatment 

nerve root 

disturbed; 

MRI:interverte 

bral space 

narrow 

I-9
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Mu, JP (2007)54 120 % male: NR lumbar 1 – Jiaji electro­ 1 – 21 1 – Quality of Life: 5/13 

herniation; acupuncture by sessions total SF-MPQ score 

China Mean age: 39.27 between 20-65 neuropathy doctor, n = 40 

yrs yrs; acute LBP 2 – 3 sessions 2 – ADVERSE 

less than 2 2 – laser needle knife by total EVENTS: no harms 

weeks after same doctor, n= 40 reported 

lumber 

herniation 3 – Jiaji electro3 - 1 + 2 

diagnosed; not acupuncture + laser 1 – 3 weeks 

undergoing needle knife by same 

hormonotherap doctor, n= 40 

y or taking 

steroid 

hormones; 

signed consent 

form 

Qian-mei, Wu 

(2007)55 

116 % male: 53.75% Diagnosed as 

lumbar 

1 – needling acupoints at 

same nervous segment 

21 sessions in 

total 

1 – Quality of Life: 

Cure rate; 

4/13 

Mean age: NR herniation by neuropathy doctor, n = significantly effective; 

China according to 66 effective; ineffective; 

"traditional total efficacy 

Chinese 2 – needling acupoints 

medicine selected routinely by 2 – ADVERSE 

diagnostic same doctor, n= 50 EVENTS: no harms 

efficacy reported 

standards" 

Data measured at 

Mixed immediate posttreatment 

He, X (2007)56 78 % male: 53.85% Diagnosed as 1 – routine acupuncture + 15 sessions 1 – Quality of Life: 3/13 

China Mean age: 45.2 

lumbar 

herniation 

warming needle 

Moxibustion by 

total total effective rate; 

incidence rate 

yrs according to neuropathy doctor, n = 39 

Diagnosis 2 – ADVERSE 

verified with 2 – routine acupuncture EVENTS: no harms 

CT or MRI; by same doctor, n = 39 reported 

Age <70 

Data measured at 

immediate posttreatment 

Zhou, YL 310 % male: 47.46% Disc 1 – ankle-three-needle, n NR 1 – Pain: 5/13 

(2006)57 

Mean age: 45.41 

herniation; 

VAS>=3; Sign 

= 162 improvement of VAS; 

time of inducing 

China yrs a consent 

form; 20-65yrs 

2 – routine acupuncture, 

n = 76 

analgesia; effectlasting time 

2 – Disability: straight 

3 – medication injection, leg raising test 

n = 72 3 – ADVERSE 

Treatment provider: NR 

EVENTS: no harms 

reported 

Data measured at 

immediate posttreatment 

Zhang, BM 200 % male: 52.1% Disc 1 – electro-acupuncture, 20 treatments 1 – Pain: diagnosis 4/13 

(2008)58 

Mean age: 47.3 

herniation; 25­

60 yrs old 

n = 100 (days) and treatment of local 

standards 

China yrs 2 – oral medication, n = 

100 

Treatment provider : NR 

2 – Disability: lower 

extremity pain or 

numbness; ability of 

walking; skin sensory 

function of lower 

extremity; straight let 

raising test; muscle 

tension 

3 – ADVERSE 

EVENTS: n = 3, local 

hematoma; n = 54, 

gastrointestinal 

discomfort 

Data measured at 20 

days 

Huang, GF 68 % male: 58.8% Disc herniation 1 – special acupuncture, 20 days 1 – Pain: VAS; 6/13 

(2006)59 

Mean age: NR 

n = 36 (treatments) overall efficiency; 

level of b-endorphin, 

China 2 – routine acupuncture, 

n = 32 

Treatment provider : NR 

nitric oxide, 

superoxide 

dismutase and 

malondialdehyde in 

serum 

2 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 20 

days 

I-10
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Wang, N 90 % male: 53.4% Disc 1 – spinal manipulation, n 24 treatments 1 – Pain: VAS; 6/13 

(2007)60 

Mean age: 41.5 

herniation; 

age:18-65yrs; 

= 45 (days) overall efficiency 

2 – ADVERSE 

China yrs Diagnosed by 

CT or MRI 

2 – spinal manipulation + 

acupuncture, n = 45 

EVENTS: no harms 

reported 

Treatment provider : NR Data measured at 24 

days 

Li, D 240 % male: not sure Patients with 1 – traction rotary One treatment/ 1 – Pain: NRS; 6/13 

(2006)61 lumbar disc manipulation of lumbar week improvement of 

Mean age: NR herniation spine treatment, n = 80 clinical signs and 

China 

2 – acupuncture silver 

needle heat conductive 

treatment, n = 80 

2 weeks curative effect 

2 – ADVERSE 

EVENTS: no harms 

reported 

3 – traction + needle 

heat, n = 80 

Data measured at 3 

and 6 mo 

Treatment provider : NR 

Wang, YQ 58 % male: 74.1% Disc herniation 1 – massage + spinal One treatment/ 1 – Pain: VAS; 6/13 

(2005)62 

Mean age: 45.7 

mobilisation + 

acupuncture, n = 30 

day overall efficiency 

2 – ADVERSE 

China yrs 20 days EVENTS: no harms 

2 – massage + spinal reported 

mobilisation, n = 28 

Treatment provider : NR 

Guo, W 197 % male: 52.8% Disc 1 – electro-acupuncture + 10 days 1 – Pain: VRS 4/13 

(2005)63 

Mean age: 43.5 

yrs 

herniation; 

age: 20-70y; 

Diagnosed by 

CT or MRI; 

Clinical 

Positive Signs 

acupoint inject 

medication, n = 100 

2 – spinal manipulation or 

spinal mobilisation + oral 

medication, n = 97 

2 – Disability: angle 

for straight leg raising 

test 

3 – ADVERSE 

EVENTS: no harms 

reported 

Treatment provider : NR Data measured at 10 

days 

Xingsheng, C 198 % male: 59.1% Patients with 1 – acupuncture-point-to­ 1-2 treatments 1 – Quality of Life: 2/13 

(1998)64 sciatica aged point penetration + deep / day Cured: all signs and 

Mean age: 45.6 => 18 yrs puncture, n = 108 symptoms 

China yrs 

2 – routine acupuncture, 

n = 90 

Treatment provider : NR 

1-3 courses, 10 

sessions each 

disappeared 

2 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 6 

mo 

Jia, Chao 82 % male: NR Diagnosed as 1 – deeply-acupuncturing 1 treatment 1 – Pain: VAS; McGill 5/13 

(2004)65 Cervical Jiaji acupoint + acupoint­ /day PRI total, feeling, 

Mean age: NR Spondylosis injection by one doctor, sense 

China using ref[1] 

1993-chinese, 

only those who 

were compliant 

with the 

treatment, only 

those who 

responded to 

the surveys 

two are not mentioned, n 

= 45 

2 – acupuncturing backshu acupoint + acupointinjection by same doctor 

and two others, n = 37 

20 days 2 – Quality of Life: 

Chinese Medical 

Diagnostic and 

effectiveness 

standard (cure, 

improve, no effect) 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 20 

days 

Yuan, X 144 % male: 55.5% Patients (age ≥ 1 – acupuncture, n = 78 1 treatment/ 1 – Pain: Hu’s criteria 0/13 

(2006)66 

Mean age: NR 

18 yrs) with 

Diagnosis of 2 – conventional medical 

day of curative effect 

2 – ADVERSE 

China lumbar care, n = 66 45 days EVENTS: no harms 

intervertebral reported 

disc prolapsed Treatment provider : NR 

Data measured at 45 

days 

Ye, Z 56 % male: 76.8% Diagnostic as 1 – needle-knife + take Total of 6 1 – Quality of Life: 2/13 

(2004)67 lumbar Chinese medicine + treatments well being, Chinese 

Mean age: 44.5 intervertebral therapy by hand, n = 30 Standard 

China yrs disc protrusion 2 – ADVERSE 

using CT 

examination 

2 – electro-acupuncture + 

take Chinese medicine + 

EVENTS: no harms 

reported 

and based on therapy by hand, n = 26 

Shanghai Data measured at 

Chinese Treatment provider : NR end of treatment 

Medical 

Diagnostic and 

Treatment 

Standard 

I-11
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Ding, X 68 % male: 33.8% Diagnosed as 1 – injection + 1 treatment/ 1 – Quality of Life: 3/13 

(2002)68 intervertebral acupuncture on healthy day well being, instrument 

Mean age: NR disc protrusion; side, n = 34 was not reported 

China Only one side Total of 20 2 – ADVERSE 

is in pain; Who 2 – injection + treatments EVENTS: no harms 

has obvious 1 acupuncture on affected reported 

or 2 

symptoms: 

side, n = 34 

Data measured at 

cannot go to Treatment provider : NR end of treatment 

sleep, turn 

aside, walk, 

cough, sneeze, 

bowel 

movement, 

bend waist 

because of the 

pain; Pain in 

waist 1 Jiaji 

and waist 5 jiaji 

is in the 

healthy side; 

pain rate is ++ 

above 

Zhang, D 96 % male: NR Patients with 1 – acupuncture NR 1 – Quality of Life: 2/13 

(2002)69 LBP due to Moxibustion + massage, cure rate; effective 

Mean age: NR lumbar n = 48 rate 

China intervertebral 

disc protrusion 2 – acupuncture 

Moxibustion, n = 22 

2 – ADVERSE 

EVENTS: no harms 

reported 

3 – massage, n = 26 

Treatment provider : NR 

Zhang, Zhong-yi 61 % male: NR Diagnosed as 1 – acupuncture + 2 treatments/ 1 – Quality of Life: 1/13 

(2002)70 Lumbar massage, n = 30 week well being, Chinese 

Mean age: NR Intervertebral Medical Diagnostic 

Disc Protrusion 

using Xray, CT 

2 – massage, n = 31 10 weeks and therapeutic 

Effective Standard 

or MRI Treatment provider : NR 2 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 10 

weeks 

Ye, D 

(2002)71 

60 % male: NR Diagnosed 

using Chinese 

1 – electric-acupuncture 

+ traction + Tuina 

1 treatment/ 

day 

1 – Quality of Life: 

well being, Chinese 

2/13 

Mean age: NR Medical (massage), n = 20 Medical Diagnostic 

China Diagnostic and 30 days and therapeutic 

therapeutic 2 – electric-acupuncture Effective Standard 

Standard + traction, n = 20 2 – ADVERSE 

EVENTS: no harms 

3 – electric-acupuncture reported 

+ Tuina (massage), n = 

20 Data measured at 30 

days 

Treatment provider : NR 

Chen, Xiao-kai 160 % male: NR Diagnosed as 1 – acupuncture and 1 treatment/ None 4/13 

(2001)72 lumbar Moxibustion + three-palm day for 10 days 1 – ADVERSE 

Mean age: NR intervertebral massage by doctors and then 1 EVENTS: no harms 

China disc prolapsed assistants , n = 80 treatment/ 2 reported 

based on days for next 

ref[1]-Chinese 2 – acupuncture and 20 days 

Medical 

Diagnostic and 

Moxibustion + traction 

(full automatic computer 30 days 

therapeutic traction table), providers 

Effective not mentioned n = 80 

Standard 

1994, 

Yao, Z 116 % male: NR Diagnosed 1 – acupuncture + 18 treatments 1 – Quality of Life: 3/13 

(2007)73 

Mean age: NR 

using Chinese 

Medical 

Moxibustion, n = 62 (days) total well being, cured 

2 – ADVERSE 

China Diagnostic and 2 – electro-acupuncture, EVENTS: no harms 

therapeutic n = 54 reported 

Effective 

Standard, Treatment provider: NR Data measured at 

end of treatment, 18 

days 

Chen, X 88 % male: 54.5% Diagnosed 1 – deep acupuncture of 10 treatments/ 1 – Quality of Life: 3/13 

(2007)74 

Mean age: NR 

using Chinese 

Medical 

lumbar Jiaji points, n = 44 course well being, B, based 

on Chinese Medical 

China Diagnostic and 2 – conventional 2 courses Diagnostic and 

therapeutic 

Effective 

acupuncture of Jiaji point, 

n = 44 

therapeutic Effective 

Standard 

Standard 2 – ADVERSE 

CT Treatment provider: NR EVENTS: no harms 

examination reported 

showed lumbar 

intervertebral 

Disc Protrusion 

Data measured at 

end of treatment 

I-12
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Zeng, Y 133 % male: 46.6% Diagnosed 1 – abdomen 1 treatment/ 1 – Quality of Life: 2/13 

(2007)75 

Mean age: NR 

using Chinese 

Medical 

acupuncture, n = 67 day well being, B, based 

on Chinese Medical 

China Diagnostic and 2 – body acupuncture, n 10 treatments/ Diagnostic and 

therapeutic = 66 course therapeutic Effective 

Effective Standard 

Standard; 20­

65 yr; CT or 

Treatment provider: NR 2 – ADVERSE 

EVENTS: no harms 

MRI reported 

examination 

showed lumbar Data measured at 

intervertebral 

Disc 

end of treatment 

Protrusion; 

Signed 

consent form 

Zhong, B 60 % male: NR Had injuries, 1 – abdominal NR 1 – Quality of Life: 2/13 

(2006)76 caught cold; acupuncture + traction + efficacy rate 

Mean age: NR Waist pain body acupuncture, n = 30 2 – ADVERSE 

China complained EVENTS: no harms 

with sciatic 2 – lumbar traction + reported 

nerve pain; body acupuncture, n = 30 

Lumbar bend, 

limitation on Treatment provider: NR 

movement, 

pain around 

Jitu with 

radiating pain, 

skin nerve 

control too 

sensitive or 

obtuse, 

Qu, Y 120 % male: 56.5% Outpatients 1 – acupuncture with 7 treatments 1 – Quality of Life: 2/13 

(2006)77 

Mean age: NR 

with diagnosis 

on syndrome 

warming needles, n = 60 total therapeutic effect: 

cured 

China of L3 2 – electro-acupuncture, 7 days 2 – ADVERSE 

transverse 

process (in 

n = 60 EVENTS: no harms 

reported 

Criteria on Treatment provider: NR 

Diagnosis and Data measured at 7 

Therapeutic days and 2 weeks 

Effects on 

Syndromes of 

Chinese 

Medicine) 

Ye, L 98 % male: 51% MRI and CT 1 – hypodermic catgut 1 treatment/ 1 – Quality of Life: 

(2004)78 examination, embedding therapy on week well being 

Mean age: 38.4 using Chinese prolapse of lumbar 2 – Pain: score for 

China yrs Medical 

Diagnostic and 

intervertebral disc, n = 49 3 courses symptoms 

somatoscopy and 

Therapeutic 2 – electro-acupuncture, activity of daily life 

Standard for n = 49 3 – ADVERSE 

lumbar EVENTS: no harms 

intervertebral Treatment provider: NR reported 

disc 

Data measured at 

end of treatment 

Wang, Y 111 % male: 64.1% Diagnosed 1 – Waiguan-through­ 1 treatment/ 1 – Quality of Life: 2/13 

(2004)79 third lumbar Neiguan and Lumbus 2 day well being, 

Mean age: NR vertebra through-Lumbus 4 and 10 treatments 2 – ADVERSE 

China transverse transverse acupuncture /course EVENTS: no harms 

process 

syndrome 

methods, n = 66 reported 

2 – routine acupuncture, Data measured at 

n = 45 end of treatment 

Treatment provider: NR 

Zhou, Z 82 % male: 63.3% LBP or sciatic 1 – abdominal 1 treatment/ 1 – Quality of Life: 4/13 

(2004)80 nerve pain, acupuncture + Danshen day well being, Chinese 

Mean age: NR pain may injection + TDP 4 courses Medical Diagnostic 

China become worse illuminate, n = 42 24 days, 1 day and therapeutic 

when between Standard 

coughing, 2 – lumbar shallow courses 2 – ADVERSE 

sneezing or 

bow 

acupuncture + Danshen 

injection + TDP Injection: 1 

EVENTS: no harms 

reported 

movement; illuminate, n = 40 treatment/ day 

pain on lumbar 20 days Data measured at 20 

vertebra or Treatment provider: NR or 24 days 

sciatic nerve, 

test of raising 

straight leg; CT 

or MRI 

examination 

diagnostic 

lumbar 

intervertebral 

disc protrusion 

I-13
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Chu, J 50 % male: 58% Chinese 1 – scalp acupuncture + 1 treatment/ 1 – Quality of Life: 4/13 

(2004)81 Medical massage, n = 25 day, 10 well being, Chinese 

Mean age: 42.5 Diagnostic and treatments/ Medical Diagnostic 

China yrs Therapeutic 2 – massage, n = 25 course, 2 and therapeutic 

Standard. courses Standard 

Treatment provider: NR 2 – ADVERSE 

20 days EVENTS: no harms 

reported 

Wu, Y 114 % male: 60.3% Diagnosed 1 – abdominal 1 treatment/ 1 – Quality of Life: 3/13 

(2004)82 using Chinese acupuncture, n = 62 day, 10 well being 

Mean age: NR Medical treatments/ 2 – ADVERSE 

China Diagnostic and 2 – body acupuncture, n course, 3 EVENTS: no harms 

Therapeutic 

Standard 

= 52 courses reported 

Treatment provider: NR 30 days Data measured at 30 

days 

Zhu, Q % male: 80% Diagnosed 1 – acupuncture + 30 treatments 1 – Quality of Life: 4/13 

(2003)83 using Chinese Moxibustion + autonomic total well being 

Mean age: 33.5 Medical traction of knee-chest, n 2 – Pain: VAS 

China yrs Diagnostic and 

Therapeutic 

= 31 30 days 3 – ADVERSE 

EVENTS: no harms 

Standard 2 – acupuncture + reported 

Moxibustion, n = 29 

Data measured at 30 

Treatment provider: NR days 

Zhang, Honglai 120 % male: 54.2 diagnosed as 1 – electro-acupuncture, 45 treatments 1 – Quality of Life: 6/13 

(2003)84 

Mean age: NR 

Cervical 

Spondylosis 

n = 60 total well being 

2 – ADVERSE 

China using ref[1] 2 – traction, n = 60 45 days EVENTS: no harms 

1993-chinese; reported 

compliant with Treatment provider: NR 

treatment; 

responded to 

Data measured at 45 

days 

the surveys 

Zhou, Q 58 % male: NR CT diagnosed 1 – acupuncture on Jiaji, 30 treatments 1 – Quality of Life: 3/13 

(1998)85 

Mean age: 48 yrs 

as lumbar 

intervertebral 

n = 30 total well being 

2 – ADVERSE 

China disc protrusion 2 – acupuncture on 30 days EVENTS: no harms 

pangguangjingxue, n = 

28 

reported 

Data measured at 30 

Treatment provider: NR days 

Xia, F 82 % male: NR X-ray or CT 1 – acupuncture + 1 treatment/ 2 1 – Quality of Life: 2/13 

(1997)86 diagnosed injection + massage, n = days well being 

Mean age: NR 41 10 treatments/ 2 – ADVERSE 

China Mixed 

2 – acupuncture, n = 40 

course EVENTS: no harms 

reported 

Treatment provider: NR Data measured at 

end of treatment 

Li, Q 156 % male: 51.3 NR 1 – acupuncture + 1-2 treatment/ 1 – Quality of Life: 2/13 

(1997)87 

Mean age: NR 

cupping, n = 78 day, 10 

treatments/ 

well being 

2 – ADVERSE 

China 2 – acupuncture, n = 78 

Treatment provider: NR 

course 

Cupping-1 

treatment/ 

2days 

Until cured 

EVENTS: no harms 

reported 

Data measured at 

end of treatment 

Ding, Y 54 % male: 71.6 LBP 1 – fly-probing-acupoint 1 treatment/ 1 – Quality of Life: 3/13 

(1998)88 repeatedly manipulation, n = 35 day well being 

Mean age: 43.5 occurring; 10 treatment/ 2 – ADVERSE 

China yrs lumbar sacrum 2 – routine acupuncture, course EVENTS: no harms 

pain become n = 19 reported 

worse with 

fatigue; 

X-ray and 

Treatment provider: NR Data measured at 

end of treatment 

examination 

exclude the 

other disease; 

LBP caused by 

Qi and blood 

stagnant. 

I-14
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Luo, S 108 % male: 72.2 Varying 1 – scalp acupuncture + 30 min/session 1 – Quality of Life: 

(2007)89 degrees of traction, n = 56 clinically cured; 

Mean age: NR LBP radiating 3 sessions marked effective; 

China to the lower 

limb. With 

straight leg 

raising test: 

</= 30 degrees 

in 37 cases, 31 

- 65 in 68 

cases, sand 3 

cases with 

positive 

response in 

the intensive 

test; Patients 

diagnosed with 

CT and or MRI 

2 – traction, n = 52 

Treatment provider: NR 

improved; no change 

2 – ADVERSE 

EVENTS: no harms 

reported 

Data measured t 3 

sessions 

exam. 

Peng, Y 116 % male: 53.4 Diagnosed 1 – acupuncture: round 20 treatments 1 – Quality of Life: 3/13 

(2006)90 using Chinese sharp needle therapy total well being, Chinese 

Mean age: 47 yrs Medical combined with massage Medical Diagnostic 

China Diagnostic and by a doctor, n = 58 20 days and Therapeutic 

Therapeutic Standard 

Standard; 30­

60 yrs; CT-MRI 

2 – acupuncture : filiform 

needle plus massage by 

2 – ADVERSE 

EVENTS: no harms 

examined and a doctor, n = 58 reported 

diagnosed; 

signed on the Data measured at 20 

consent form days 

Zhou, Y 242 % male: 53.1 Diagnosed 1 – acupuncture- NR 1 – Pain: VAS 4/13 

(2005)91 

Mean age: 45.5 

using Chinese 

Medical 

Huaisanzhen, n = 96 2 – Quality of Life: 

well being, Chinese 

China yrs Diagnostic and 2 – medication-drug Medical Diagnostic 

Therapeutic control, n = 48 and Therapeutic 

Standard and Standard and 1988 

1988 Clinical 

Trial 

3 – acupuncture, n = 48 Clinical Trial 

Diagnostic Standard 

Diagnostic 4 – combination, n = 50 3 – ADVERSE 

Standard; 20­ EVENTS: no harms 

65 yrs; signed Treatment provider: NR reported 

consent form 

Data measured at 1, 

12, 24, and 48 hours 

later 

Table 1.6 Low Back Pain - Acupuncture - Mixed - Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Zhang, Y 

(2007)92 

120 % male: 54.17% Low back pain 1 – electro-acupuncture, 

n = 40 

10 days total 1 – Pain: Overall 

efficiency 

4/13 

Mean age: 39.28 

China yrs 2 – acupoint injection of 2 – ADVERSE 

Danggui, n = 40 EVENTS: no harms 

reported 

3 – acupoint injection of 

O3, n = 40 Data measured at 

immediate postTreatment provider: NR treatment 

Ratcliffe, J 241 % male: 22.5 Adults aged 1 – Acupuncture, by 10 treatments 1 – Pain: bodily pain 

(2006)93 (9010) 18-65 with N-S acupuncturists trained in dimension on SF-36 

Mean age: 43.6 

years 

LBP of 4-52 

weeks duration 

traditional Chinese 

medicine, n = 160 

2 – Usual care, n = 81 

3 months 2 – Quality of Life: 

QALYs (quality 

adjusted life years) 

3 – Cost: NHS 

Data measures at 12 

and 24 months 

Tsukayama, H 19 % male: 15.5% LBP without 1 – electro-acupuncture, 2 weeks 1 – Pain: PRS – 10 7/13 

(2002)94 sciatica, at n = 9 mm VAS 

Mean age: 45 yrs least 2 weeks 2 – Disability: JOA 

Japan history of pain 

and > 20 yrs of 

age 

2 – TENS, n = 10 

Treatment provider: NR 

3 – ADVERSE 

EVENTS: transient 

aggravation of LBP, n 

= 2; one of each: 

discomfort due to 

needles; pain on 

needle insertion; 

small subcutaneous 

bleeding; transient 

fatigue; itching with 

electrode 

Data measured at 2 

weeks 

I-15
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Sakai, T 68 % male: 55% LBP without 1 – electro-acupuncture, 4 treatment 1 – Pain: pain relief 8/13 

(2001)95 

Mean age: 36.8 

sciatica; at 

least 2-week 

n = 32 sessions total scale- VAS 1-10 cm 

2 – Disability: JOA 

Japan yrs history of LBP; 

over 20 years 

old 

2 – TENS, n = 36 

Treatment provider: NR 

2 weeks score 

3 – ADVERSE 

EVENTS: n = 2, 

itching with electrode 

and dullness after 

treatment 

Data measured at 2 

weeks 

He 100 % male: NR LBP, fixed in 1 – manual acupuncture Total of 20 1 – Quality of Life: 4/13 

(1997)96 location, + Moxibustion + Chinese treatments cured-treatment 

Mean age: 44 yrs limited range herbal medicine, n = 50 effect; marked 

China of motion, 

worse in cold 

and raining 

weather. 

2 – Chinese herbal 

medicine, n = 50 

Treatment provider: NR 

20 days effective; improved; 

no change 

2 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 20 

days and 1 year 

Thomas, KJ 241 % male: 40.5% Patients aged 1 – acupuncture by 6 10 treatments 1 – Pain: SF-36 9/13 

(2006)97 18-65 yrs with acupuncturists with 3.2 Bodily Pain score; 

Mean age: 43 yrs non-specific yrs mean duration of 3 months McGill PPI 

UK LBP of 4-52 training and mean of 12.8 2 – Disability: 

weeks yrs in practice, n = 160 Oswestry Disability 

duration, Index 

assessed as 2 – standard treatment­ 3 – Quality of Life: 

suitable by 

their general 

usual care, n = 81 SF-6D 

4 – ADVERSE 

practitioner EVENTS: no harms 

(GP) for reported 

primary care 

management Data measured at 3, 

12 and 24 mo 

Table 1.7 Low Back Pain - Acupuncture - Unknown - Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Wang, Z 139 % male: 67.5% Patients with 1 – electro-acupuncture, 2 courses 1 – Quality of Life: 

(2009)98 senile radical n = 70 (possibly 5-7 cure rate (%) 

Mean age: 58.9 sciatica days in each 2 – ADVERSE 

China yrs 2 – TENS, n = 69 

Treatment provider: NR 

course) EVENTS: no harms 

reported 

Data measured at 

end of each course 

Wu, J 300 % male: NR Diagnosed as 1 – electro-acupuncture 1 treatment/ 1 – Quality of Life: 4/13 

(2004)99 lumbar by professional doctor, n day, 10 well being, using both 

Mean age: NR intervertebral = 100 treatments/ Chinese and Western 

China disc protrusion; 

25-60 yrs; stop 

using other 

treatment or 

medicine; 

signed consent 

form 

2 – normal acupuncture 

by same doctor, n = 100 

3 – medicine by same 

doctor, n = 100 

course, 2 

courses 

20 days 

diagnostic and 

therapeutic standard 

for Lumbar 

intervertebral disc 

protrusion 

2 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 20 

days 

Lee, J 31 % male: 0 Female 1 – Kuesu-point 12-15 sessions 1 – Pain: VAS 0-10 3/13 

(2007)100 patients 20-50 acupuncture, n = 16 2 – Quality of Life: 

Mean age: NR yrs old with 3 weeks Estimation Index of 

Korea LBP and 

accompanied 

sciatic 

neuralgia 

2 – non Kuesu-point 

acupuncture, n = 15 

Treatment provider: NR 

Backache 0-100 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 3 

weeks 

I-16
 
Table 1.8 Low Back Pain - Acupuncture - Unknown - Non-Specific Pain 

Study ID 

Year Country 

Total 

sampl 

e size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Garvey, TA 

(1989)101 

63 % male: 65.1% Patients treated 

for strain LBP 

1 – Trigger point (TP) 

method I: Lidocaine 

One time 

intervention 

1 – Pain: self rating 

scale (1-10); pain 

7/13 

Mean age: 38 with non-steroidal injection- and method II: improvement 

US yrs anti-inflammatory Lidocaine and Aristospan 2 – ADVERSE 

agents; hot injection, n = 27 EVENTS: no harms 

showers; reported 

avoidance activity 2 – dry-needling 

that might injection, n = 20 Data measured at 2 

aggravate the weeks 

pain for 4 weeks 3 – ethylchoride spray, n 

= 16 

Treatment provider: NR 

Mencke 75 % male: 49.3% Patients who 1 – typical AP by same 6 treatment 1 – Pain: VAS 9/13 

(1988)102 

Mean age: 49.4 

have previously 

been treated 

therapist, n = 40 sessions average 

2 – Disability: 

Germany yrs unsuccessfully 2 – atypical AP by same 3 weeks Examination of 

(general 

practitioner, 

orthopedic, 

physiotherapist); 

no involvement in 

other therapies 

therapist, n = 35 affected arm, 

orthopaedic 

parameter, ante 

version of head 

3 – Physical 

measures: Aversion 

of the head (AOH); 

Inner rotation of 

damages arm (IRDA) 

4 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 3 

and 8 weeks 

Inoue, M 16 % male: NR Patients with 1 – acupuncture-real Single 1 – Pain: VAS (100 10/13 

(2001)103 lumbago who needling by treatment mm) of pain at most 

Mean age: 55.7 attended the acupuncturist, n = 10 restricted action 

Japan yrs university 

acupuncture 2 – placebo-sham 

2 – ADVERSE 

EVENTS: no harms 

clinic as needling by same reported 

outpatient and therapist, n = 6 

gave consent to Data measured post 

attend to the trial treatment 

Kurosu, Y 20 % male: 50% Patients with pain 1 – acupuncture, n = 10 NR 1 – Pain: pain 3/13 

(1979)104 

Mean age: NR 

in the low back or 

the low back and 2 – acupuncture-garlic 

recovery score by 

questionnaire 

A sacral region. Moxibustion, n = 10 2 – ADVERSE 

Japan 

Treatment provider: NR 

EVENTS: no harms 

reported 

Data measured at 2nd 

and 4th visit before 

treatment 

Kurosu, Y 20 % male: 55% Patients with pain 1 – acupuncture-needle NR 1 – Pain: pain 3/13 

(1979)104 in the low back or retention technique, n = recovery score by 

Mean age: NR the low back and 10 questionnaire 

B sacral region. 2 – ADVERSE 

Japan 2 – acupuncture-simple 

insertion technique, n = 

10 

Treatment provider: NR 

EVENTS: no harms 

reported 

Data measured at 

2nd and 4th visit 

before treatment 

Edelist, G 30 % male: NR Patients with disc 1 – acupuncture, n = 15 3 treatments 1 – Pain: subjective 2/13 

(1976)105 disease- not total, 2 day improvement of pain 

Mean age: NR responding to 2 – sham acupuncture, n intervals 2 – ADVERSE 

Canada conventional = 15 EVENTS: no harms 

therapy including 6 days reported 

bed rest, Treatment provider: NR 

analgesics, heat, 

and 

Data measured at 

end of treatment 

physiotherapy 

Kawase, Y 64 % male: 56% NR 1 – whole body 1 time 1 – Pain: therapeutic 10/13 

(2006)106 

Mean age: 52.8 

acupuncture pole 

treatment (Taikyo-Ryoho) 

treatment effectiveness-VAS 

2 – Disability: 

Japan yrs + low frequency 

acupuncture by 

acupuncturist with 6-53 

yrs experience, n = 12 

2 – whole body 

acupuncture pole 

treatment by same 

therapist, n = 13 

measuring patients’ 

ADL-JOA score 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 

end of single 

treatment 

3 - low frequency 

acupuncture by same 

therapist, n = 20 

4 - sham acupuncture by 

same therapist, n = 19 

I-17
 
Table 1.9 Low Back Pain - Manipulation – Acute/Sub-acute - Specific Pain – No Studies 

Table 1.10 Low Back Pain – Manipulation – Acute/Sub-acute - Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Russell I (UK 1334 % male: 43.2 Patients aged 1 – standard care by 8 sessions 1 – Pain: Serious 5/13 

BEAM Trial) 

(2004)107 Mean age: 43.1 

yrs 

18-65 yrs with 

LBP (RMDQ => 

4) who had 

general practitioner (GP), 

n = 338 

over 4-8 weeks 

Last session at 

spinal disorder 

2 – ADVERSE 

EVENTS: no harms 

UK experienced the 2 – Exercise by trained 12 weeks reported 

pain daily for Physical therapists with ≥

the past month 2 yrs experience, n = 310 Data measured at 12 

3 – Private-M by qualified 

weeks 

manipulators, n = 180 

4 – NHS-M by same 

therapists/manipulators, n 

= 173 

5 – Private-M + Exercise 

by same 

therapists/manipulators , 

n = 172 

6 – NHS-M + Exercise by 

same 

therapists/manipulators, n 

= 161 

Hoiriis K 156 % male: 56.7 21 - 59 years 1 – Chiropractic N of treatments 1 – Pain: VAS (10 8/13 

(2004)108 

Mean age: 41.9 

old with 

uncomplicated 

adjustments and medical 

placebo by a chiropractor, 

varied cm) 

2 – Disability: 

yrs LBP of 2 - 6 medical doctor, n = 50 7 weeks Oswestry LBP 

weeks duration Disability 

2 – Muscle relaxants and Questionnaire 

sham adjustments by a 3 – ADVERSE 

medical doctor, n = 53 EVENTS: no harms 

reported 

3 – Medical placebo and 

sham adjustments by a Data measured at 7 

medical doctor, n = 53 weeks and 3 mo 

Hsieh, C 

(2002)109 

200 % male: 65.4 18 years or 

older, LBP 

1 – Back school program 

by experienced licensed 

1-3 times/ 

week 

1 – Pain: VAS scale 

for pain during past 

4/13 

Mean age: 48.2 between 3 physical therapists and week 

California yrs weeks and 6 chiropractors, n = 48 3 weeks 2 – Disability: 

months for the Roland-Morris 

current episode 2 – Myofascial therapy Activity Scale 

or a pain-free program by trained (RMAS) 

period of at clinicians – Physical 3 – ADVERSE 

least 2 months therapists and EVENTS: n = 23 

in the preceding chiropractors, n = 51 reported adverse 

8 months for effects, mostly 

recurrent LBP, 3 – Joint manipulation by transient 

agreement for experienced licensed exacerbations of 

randomization, chiropractors with 5 years symptoms 

and consent for min. Clinical experience, 

treatment n = 49 N based on intent to 

treat 

4 – Combined joint Data measured at 3 

manipulation + weeks an 6 mo 

myofascial therapy, same 

providers as group 2 and 

3n = 52 

Seferlis T 180 % male: 53 18 - 16 years of 1 – General practitioner 3 times/week 1 – Cost: Direct, 5/13 

(2000)110 age; LBP with program (GPP) (Control), 8 weeks only indirect and total 

Mean age: NR or without n = 60 reported for costs 

Stockholm, sciatica ITP group 2 – ADVERSE 

Sweden requiring sickleave; and a 2 – Manual Therapy 

program (MTP), by 

EVENTS: no harms 

reported 

sick-leave physiotherapist, n = 60 

period for LBP 

less than 2 3 – Intensive Training 

weeks before 

entering the 

program (ITP), by 

physical therapist, n = 60 

study. 

Acute 

I-18
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Pope, M 240 % male: 62 Ages 18-55 1 – Manipulation by 5 9 sessions 1 – Pain: 10 cm VAS 5/13 

(1994)111 years; general licensed chiropractors, n 2 – Disability: Rage 

California, US 

Mean age: 32 yrs good health; 

LBP between 3 

weeks and 6 

months 

duration (this 

episode); free 

from LBP for 

minimum 3 

weeks for this 

episode 

= 60 

2 – Soft-tissue massage 

by 2 licensed massage 

therapist serving as a 

chiropractor, n = 30 

3 – Transcutaneous 

muscle stimulation by a 

licensed chiropractor, n = 

30 

3 weeks of motion-Schober’s 

test – Extension; 

Flexion 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 3 

weeks 

4 – Lumbosacral corset 

by a licensed 

chiropractor, n = 30 

Sanders GE 18 % male: 50 Patients with 1 – Spinal manipulation, n One treatment 1 – Pain: VAS 7/13 

(1990)112 

Mean age: NR 

acute LBP (< 2 

weeks) naïve to 

= 6 2 – ADVERSE 

EVENTS: no harms 

US chiropractic 2 – Sham-SM, n = 6 reported 

manipulation 

and had not 3 – No treatment, n = 6 Data measured at 

taken any pain end of single 

medication for 

48 hrs prior to 

Treatment provider: NR treatment 

the study 

enrolment 

Hadler NM 54 % male: 48 Patients aged 1 – Mobilization by an NR 1 – Disability: RMDQ 7/13 

(1987)113 18-40 yrs with investigator with 2 – ADVERSE 

Mean age: NR acute LBP (<= experience, n = 28 EVENTS: no harms 

US 1 mo), no other 

episode of back 

pain in previous 

6 mo, not workrelated pain, no 

previous 

2 – Manipulation by the 

same investigator, n = 26 

reported 

Data measured at 3 

mo 

surgery 

Alaksiev A 

(1996)114 

65 % male: 49.2 Outpatients 

with LBP lasting 

1 – SM, n = 22 3-4 

treatment/week 

1 – Total 

improvement 

3/13 

Mean age: 33.4 no more than 1 2 – Relaxation, n = 22 

years mo 3 weeks 2 – ADVERSE 

3 – Placebo, n = 21 EVENTS: no harms 

reported 

Treatment provider: NR 

Rasmussen, G 24 % male: 100 Male 1 – Short wave, n = 12 3 times/week-6 1 – Pain: Restoration 2/13 

(1979)115 outpatients, 20­ sessions 2 – Disability: 

Mean age: 34.9 50 years of age 2 – Manipulation in pain Schober’s test 

years with LBP free direction by a 2 weeks 3 – ADVERSE 

without signs of 

root pressure; 

physiotherapist or 

physician, n = 12 

EVENTS: no harms 

reported 

duration less 

than 3 weeks; Data measured at 2 

no treatment weeks 

except 

analgesics prior 

to the trial 

Shah, M 16 % male: NR Patients with 1 – Manipulation, n = 10 7 days 1 – Quality of Life: % 

(1989)116 

Mean age: NR 

acute back pain 

2 – Naprosyn (oral 

(assumed) improved 

2 – Pain: PRS 

UK medication), n = 6 

Treatment provider: NR 

3 – Disability 

4 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 1 

and 4 weeks 

Table 1.11 Low Back Pain- Manipulation- Chronic specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Morton, J 29 % male: 35 Aged between 1 – Manipulation + 8 treatments 1 – Pain: AVAS 4/13 

(2005)117 18 and 70 exercise, n = 15 total 2 – Disability: RMDQ 

Mean age: 44.6 years with 3 – ROM in degrees 

yrs acute 

mechanical 

2 – Exercise alone, n = 

14 

4 weeks 4 – ADVERSE 

EVENTS: no harms 

LBP of approx. reported 

4 weeks or Treatment provider: NR 

less; Pain Data measured at 4 

located weeks 

between T12 

and the gluteal 

fold (might 

radiate to one 

lower limb) 

I-19
 
Hoehler, FK 95 % male: 59.0 Patients with 1 – Manipulation by a 1 treatment 1 – Pain: VAS 3/13 

(1981) 118 

Mean age: 31 

low back pain 

candidate for 

physician, n = 56 session 2 – Range of motion 

3 – Adverse events: 

USA years manipulation 

by palpatory 

cues; no 

psychosocial 

2 – Soft tissue massage 

by the same physician, n 

= 39 

not reported 

or 

contradictions 

for 

manipulation 

Postacchini, F 398 % male: 50.5 Low back pain 1 – Manipulation by a 7 times for 1 - Combined Score 6/13 

(1988) 119 Italy patients aged trained chiropractor, n = 1stweek, then (Pain VAS, disability, 

Mean age: 36.5 – 17-58 years 87 twice for up to forward spinal flexion, 

39.5 years presenting at 2 

clinics 

6 weeks leg lowering test) on 

a 32 point scale 

2 – Drug therapy, n = 81 ranging from 5 (poor 

clinical status) to 32 

3 - Physiotherapy, n = 78 (excellent clinical 

status). 

4 – Bed rest, n = 29 

5 – Low back school, n = 

50 

6 – Placebo, n = 73 

Table 1.12 Low Back Pain – Manipulation - Chronic - Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Haas, M 

(2004)120 

191 % male: 45.8 Current 

episode of 

1 – a- 3 treatments of 

spinal manipulation (SM); 

3-12 

treatments total 

1 – Pain: Von Korff 

Pain Scale 

7/13 

Mean age: 47.8 CLBP; LB was b- a + 3 treatments of 2 – Disability: Von 

NR yrs defined as the physical modalities (PM) 3 weeks Korff Disability Scale 

area below the 

12th rib and 

by 4 chiropractors with 2­

22 yrs of practice 

3 – ADVERSE 

EVENTS: no harms 

above the experience, n = 54 reported 

gluteal fold. 

Chronic 2 – a- 6 treatments of Data measured at 3 

defined as SM; b- a + 6 treatments and 12 weeks 

episode of pain of PM by same the 

of at least 3 chiropractors, n = 46 

months 

duration; 18 3 – a- 9 treatments of 

yrs or older; SM; b- a + 9 treatments 

English literacy of PM by same the 

chiropractors, n = 44 

4 – a-12 treatments of 

SM; b- a + 12 treatments 

of PM by the same 

chiropractors , n = 47 

Niemisto 204 % male: 46 24-46 yrs, 1 – Manipulation + 4 treatments 1 – Pain: VAS (0­ 8/13 

(2003)121 employed, Stabilizing exercise, by 100); PDI (6 pts); 

Mean age: 37 yrs patients who 

had LBP (with 

or without 

sciatica) of at 

least 3 

months’; selfrated disability 

index 

(Oswestry LBP 

Disability 

Questionnaire) 

score had to 

be at least 

16% 

Chronic 

experienced manual 

therapist, n = 102 

2 – Consultation only, by 

physician, n = 102 

4 weeks RMQ adjusted for 

length of symptoms; 

VAS (100 mm) 

2 – Disability: ODI (0­

100) 

3 – Quality of Life: 

4 – Work: N days of 

work, sick leaves 

5 – Utility of 

conventional care: 

Visits to physicians; 

visits to 

physiotherapy 

6 – Cost: total 

healthcare cost 

7 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 5 

and 12 mo 

Triano JJ 209 % male: 54 Patients aged 1 – SM (HVLA), n = NR Daily sessions 1 – Pain: VAS 6/13 

(1995)122 

Mean age: 41.6 

=> 18 yrs with 

mechanic 2 – HVLF mimic, n = NR 2 weeks 

2 – Disability: 

Oswestry scale 

US yrs CLBP (pain > 3 – ADVERSE 

12 months 3 – BEP, n = NR EVENTS: no harms 

between L1 reported 

and L5 

including 

Treatment provider: NR 

Data measured at 2 

sacroiliac weeks and 3 mo 

joints) 

experiencing 

palpatory 

tenderness 

I-20
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Cote P 30 % male: 54.4 Patients with 1 – Manipulation by a One session 1 – Pain: PPT-L5 4/13 

(1994)123 mechanic clinician, n = 16 tender point; SI 

Mean age: 31 yrs CLBP > 2 mo ligament tender point; 

Canada 2 – Mobilization by a gluteus tender point 

clinician, n = 14 2 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 

end of single session 

Mohseni­ 120 % male: 41% Patients with 1 – Manipulation/ 6 sessions 1 – Pain: VAS pain 2/13 

Bandpei, M CLBP, age 18­ Exercise by one qualified intensity 

(2006)124 Mean age: 36 yrs 55 with pain in manipulative therapist, n 1-2 times/week 2 – Disability: 

LB between L1 = 60 Oswestry Disability 

UK and L5 and the Index (%) 

sacroiliac 2 – Ultrasound/ exercise 3 – ADVERSE 

joints; had LBP by a second EVENTS: no harms 

> 3 mo, signs physiotherapist, n = 60 reported 

and symptoms 

interpreted to Data measured at 

be referred end of treatment 3 or 

from the 6 weeks 

lumbar spine 

and not other 

organs; good 

self-reported 

general health 

Biedermann, F 

(1980)125 

NR % male: NR Sudden onset 

associated 

1 – Rotational 

Manipulation, n = NR 

NR 1 – Pain: duration of 

pain relief (mean in 

3/13 

Mean age: 30.5 with trauma, days) 

NR yrs recent onset 2 – Soft-tissue Massage, 2 – ADVERSE 

usually of 2 or n = NR EVENTS: no harms 

3 weeks reported 

duration, Treatment provider: NR 

abnormally low Data measured at 3 

straight leg mo 

raising tests 

presumably 

due to tight 

hamstrings 

Waagen, G 29 % male: 46.7 Chief 1 – Spinal adjusting 2-3 treatments 1 – Pain: 10 cm VAS 5/13 

(1986)126 complaint of therapy by a chiropractor, /week decrease 

Mean age: 24.8 LBP; no n = 11 2 – Disability: Straight 

Iowa, US yrs experience 

with 

chiropractic 

2 – Sham adjustment by 

a chiropractor, n = 18 

2 weeks leg raising test; 

Lumbar flexion; 

Lumbar extension; 

Global index; Lateral 

flexion 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 2 

weeks and 3 mo 

Rasmussen, J 72 % male: 18-60 yrs; LBP 1 – Extension exercises + Manipulation at 1 – Pain: VAS (1-10) 6/13 

(2008)127 more than 3 Manipulation by and baseline, 2 and 2 – ADVERSE 

Mean age: mo examiner with a diploma 4 weeks EVENTS: reported 

Denmark in manual medicine, n = but no details 

35 

Data measured at 3 

2 – Extension exercises and 6 mo 

by the same examiner, n 

= 37 

Lalanne, K 27 % male: 52.2 18-60 yrs; 1 – Lumbar Spine One 1 – Pain: VAS (1­ 1/13 

(2009)128 constant or Manipulation by an manipulation 100) 

Mean age: 39.8 recurrent LBP experienced chiropractor, 2 – ADVERSE 

Quebec yrs for more than 6 n = 13 EVENTS: no harms 

mo reported 

Chronic 

2 – Control (no 

manipulation-side lying Data measured after 

posture), n = 14 end of treatment 

Giles, LGF 69 % male: 35.67% Patients 1 – acupuncture, n = 18 6 treatments 1 – Pain: VAS 1/13 

(1999)129 suffering from 2 – Disability: 

Mean age: 41.3% spinal pain for 2 – Spinal manipulation, n 3-4 weeks Oswestry Disability 

Australia at least 13 

weeks; at least 

= 32 Index 

3 – ADVERSE 

18 years of 3 – medication, n = 19 EVENTS: no harms 

age reported 

Treatment provider: NR 

Data measured at 3-4 

weeks 

I-21
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Giles, LG 115 % male: 54.93% Patients at 1 – acupuncture (LB, NP, Maximum of 9 1 – Pain: pain 6/13 

(2003)17 

Mean age: 26.1 

least 17 yrs; 

uncomplicated 

thorax), n = 36 weeks frequency; VAS 

intensity 

Australia yrs mechanical 2 – spinal manipulation, n 2 – Disability: 

spinal pain for = 36 Oswestry Disability 

13 weeks 3 – Quality of Life: 

minimum-for 

long-term fu > 

3 – medication that has 

not been tried by Patients 

SF-36 

4 – ADVERSE 

1 yr; those who in this group, n = 43 EVENTS: hematoma 

received their and bleeding, n = 1 

randomly committed suicide 

allocated 

treatment 

Data measured at 9 

weeks and 1 yr 

regimen during 

treatment 

period 

Postacchini, F 398 % male: 50.1% Patients 18 – 1 – spinal manipulation 3 (acute), to 6 1 – pain severity, 6/13 

(1988)119 58 years by trained chiropractor, n (chronic) VAS 1 – 4 (higher 

Mean age: 36.3 – = 271 weeks better) 

Italy 40.3 Group I: LBP 2 – disability: patients 

with no 2 – drug therapy: ability to perform ten 

radiating pain, NSAIDS (Diclofenac) everyday activities as 

n = 271 assessed by a 

3 – physiotherapy: light disability 

Acute, chronic, 

or acute with 

massage, analgesic 

currents and diathermy 

questionnaire (1 -= 

extremely disabled; 4 

chronic history (infrareds in acute = unlimited) 

syndromes and short 

Group II: LBP wave diathermy in 3 – forward flexion, 

with radiating 

pain, n = 188 

chronic) (fingertips and floor 

distance: > 60 cm = 1 

4 – placebo: antioedema pint; < 20 cm = 4 

Acute and gel contained in a vessel pints) 

chronic without identification 

3- abdominal muscle 

5 – bed rest strength by leg 

lowering test 

6 – low back school (only 

in chronic syndromes) 4 – isometric 

based on Canadian endurance of back 

model of back education muscles 

Herzog, W 37 % male: 67.6% Patients age 1 – spinal manipulation, 4 weeks, 1 – pain intensity by 5/13 

(1991)130 18- 50 years, by chiropractors, n = 16 VAS (recovery = 0 on 

Mean age: 33.5 ambulatory 10 treatments scale of 0 – 10) 

Canada years with chronic 2 – back school therapy 2 – disability, by 

sacroiliac joint by physiotherapist, n = 13 Oswestry Functional 

problems Disability 

diagnosed questionnaire 

independently 

by two 

(recovery = 6% or 

less) 

chiropractors 3 – sacroiliac joint 

fixation evaluation by 

Gillett motion 

palpation test 

4 – gain analysis by 

Kistler force platform 

5 – Adverse events: 

NR 

Table 1.13 Low Back Pain – Manipulation – Mixed - Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Jull, G (2005)131 200 % male: NR Patients 1 – Manipulative therapy, 6 weeks 1 – Pain: VAS (10 

between 18-60 n = 51 cm); PRI; MPQ 

Mean age: 36.6 years with 2 – Disability – 

Australia years chronic 2 – Therapeutic exercise, Northwick Park Neck 

cervicogenic 

headaches 

n = 52 Pain Questionnaire; 

CCFT (25) 

3 – Combined exercise 

and manipulative therapy, 

n = 49 Data measured at 7 

4 – Control, n = 48 

weeks and 3, 6, and 

12 months post 

intervention 

Treatment provider NR 

Mathews W 282 % male: NR 18-60 years of 1 – Manipulation, Trial 1 – Pain: VAS (1-6) 2/13 

(1988)132 

Mean age: NR 

age; 

presenting 

B1, n = 31 3 times/week 2 – ADVERSE 

EVENTS: no harms 

episode of pain 

of less than 3 

mo 

2 – Control-Infrared lamp, 

Trial B1, n = 25 

3 – Manipulation, Trial 

B2, n = 127 

2-3 weeks reported 

Point of 

measurement not 

reported 

4 – Control-Infrared lamp, 

Trial B2, n = 99 

Treatment provider: NR 

I-22
 
Zhang, W 

(2008)133 

China 

11928 % male: NR 

Mean age: NR 

Diagnosed 

using Chinese 

Medical 

Diagnostic and 

therapeutic 

Effective 

Standard; 

diagnosed 

using CT or 

MRT; signed 

consent form 

1 – Manipulation 

reduction + lumbar 

traction + various 

physiotherapies, n = 5760 

2 – Lumbar traction + 

various physiotherapies, 

n = 5368 

Treatment provider: NR 

30 treatments 

30 days 

1 – Pain: VAS 

2 – Quality of Life: 

well being, NR 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 30 

days 

4/13 

Table 1.14 Low Back Pain - Manipulation - Mixed - Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Childs, JD 131 % male: 58 LBP Patients 1 – SM + exercise by 13 4 weeks 1 – Disability: ODQ 8/13 

(2004)134 aged 18-60 yrs licensed Physical 2 – Utility of 

Mean age: 34 yrs with ODQ therapists who received conventional care: 

US score ≥ 30% one training session, n = 

70 

2 – Exercise by same 

therapists, n = 61 

medication use; 

healthcare utilization 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 4 

weeks and 6 mo 

UK BEAM Trial 1334 % male: NR Mixed 1 – General practice, n = 2 – 9 classes 1 – Cost: healthcare; 2/13 

(2004)135 

Mean age: NR 

326 

3 – 8 sessions 

cost/QALYs 

2 – Quality of Life: 

UK 2 – Exercise program, n = QALYs 

297 4 – 6 weeks 

manipulation + 

3 – Spinal manipulation, n 6 weeks 

= 342 exercise 

4 – Combined treatment, 12 weeks 

n = 322 

Cherkin D 321 % male: 52.7 20-64 years 1 – Physical Therapy by Up to 9 visits 1 – Quality of Life: 5/13 

(2008)136 old who saw 13 therapists with a Bothersomeness of 

Ottawa, Canada 

Mean age: 40.5 

yrs 

their primary 

care physician 

median of 14 yrs 

experience, n = 133 

1 mo symptoms index 

2 – Disability: RDQ 

for LBP and 3 – ADVERSE 

who still had 2 – Chiropractic EVENTS: no harms 

pain seven Manipulation by reported 

days later. chiropractors with 6-14 

yrs experience, n = 122 Data measured at 1 

and 3 mo 

3 – Educational Booklet, 

n = 66 

Hoehler F 95 % male: 59 Presence of 1 – Rotational N of treatments 1 – Pain: 3/13 

(1981)137 palpatory cues Manipulation of varied Improvement in 

Mean age: 31.1 indicating that lumbosacral spine by a amount of pain 

California yrs manipulation 

might be 

successful 

physician, n = 56 

2 – Soft-tissue massage 

by a physician, n = 39 

2 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 

end of treatment 

Mathews W 282 % male: NR 18-60 years of 1 – Manipulation, Trial 1 – Pain: VAS (1-6) 2/13 

(1988)132 

Mean age: NR 

age; 

presenting 

B1, n = 31 3 times/week 2 – ADVERSE 

EVENTS: no harms 

episode of pain 

of less than 3 

mo 

2 – Control-Infrared lamp, 

Trial B1, n = 25 

3 – Manipulation, Trial 

B2, n = 127 

2-3 weeks reported 

Point of 

measurement not 

reported 

4 – Control-Infrared lamp, 

Trial B2, n = 99 

Treatment provider: NR 

Bronfort, G 19 % male: 49 Native to 1 – Chiropractic-no 1 month 1 – Pain: Patient rate 2/13 

(1989)138 chiropractic practical technique of improvement 

Mean age: 37.5 and between named by chiropractors, 2 – ADVERSE 

Denmark yrs 18-70 yrs of n = 10 EVENTS: no harms 

age; Primarily reported 

suffering from 

LBP of various 

2 – Medical-analgesic, 

local analgesic- Data measured at 1, 

durations with anaesthetic injections, 3, and 6 months 

or without bed rest and/or 

radiating pain physiotherapy by MDs, n 

to one or both = 9 

lower 

extremities 

I-23
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Rupert R 145 % male: NR 18-68 years 1 – SM by 2 clinically 3 1 – Pain reduction 2/13 

(1985)139 

Mean age: NR 

with LBP or leg 

pain and/or 

experienced 

chiropractors, n = 49 

treatment/week 

Egypt restriction in 

lumbar ROM 2 – Sham SM by same 

chiropractors, n = 46 

3 – Medication, Drugs 

and bed rest by a team of 

medical orthopaedic 

specialists, n = 50 

Zhang, W 11928 % male: NR Diagnosed 1 – Manipulation 30 treatments 1 – Pain: VAS 4/13 

(2008)133 using Chinese reduction + lumbar 2 – Quality of Life: 

Mean age: NR Medical traction + various 30 days well being, NR 

China Diagnostic and physiotherapies, n = 5760 3 – ADVERSE 

therapeutic EVENTS: no harms 

Effective 2 – Lumbar traction + reported 

Standard; various physiotherapies, 

diagnosed 

using CT or 

n = 5368 Data measured at 30 

days 

MRT; signed Treatment provider: NR 

consent form 

Hoiriis K 26 % male: NR LBP of greater 1 – Cervical adjustments, Up to 6 mo 1 – Pain: VAS 0/13 

(1999)140 than 2 months n = NR 2 – Disability: 

Mean age: NR Oswestry Disability 

2 – Full Spine 

Adjustments, n = NR 

Questionnaire 

3 – ADVERSE 

EVENTS: no harms 

3 – Combination of both reported 

techniques, n = NR 

Treatment provider: NR 

Data measured at 6 

mo 

Herzog, W 29 % male: 76.5 Patients with 1 – Manipulation by a 10 sessions 1 - Pain (VAS) 

(1991) 130 chronic chiropractor, n = 16 over 4 weeks 2 - Functional 

Canada Median age: 33.5 

years 

sacroiliac joint 

problem, aged 

18-50 years, 

ambulatory 

2 – Other (stretching, 

exercises) by a 

physiotherapist, n = 13 

disability (Oswestry) 

3 - Harms (not 

reported) 

Evans, D.P 32 % male: 47 Patients with 1 – Rotational 3 treatments at 1 – Anterior spinal 

(1978)141 

Mean age: NR 

chronic LBP manipulation, n = 15 

2 – Control, n = 17 

weekly 

intervals 

flexion 

measurements 

2 – Pain: daily pain 

Treatment provider NR 

scores 

3 – Patients global 

assessment 

4 – Patients 

assessment of 

efficacy 

Data measured at 21 

and 42 days 

Honduras, M 240 % male: 56 Subjects at 1 – High velocity, low 12 visits of 1 - Disability: 24-item 

(2009)142 

Mean age: 63.1 

years 

least 55 years 

old with subacute or 

chronic nonridiculer LBP 

amplitude spinal 

manipulation, by 4 

chiropractors with more 

than 6 yrs experience, n 

= 96 

2 – Low velocity, variable 

amplitude spinal 

mobilization, by same 

treatment providers as 

group 1, n = 95 

HVLA-SM, 

LVVA-SM or 3 

visits of MCMC 

6 weeks 

Roland Morris 

disability 

questionnaire 

2 – Pain: severity of 

pain-100 mm VAS 

3 – Global 

improvement 

measure 

Data measured at 3, 

6, 12, and 24 weeks 

3 – Minimal conservative 

medical care, n = 49 

Table 1.15 Low Back Pain - Manipulation - Unknown - Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Dai, DC 99 % male: 23.2 Lumbar 1 – Spinal fine adjusting 10 treatments 1 – Pain: Local 3/13 

(2006)143 stability of manipulation, n = 50 standard of 

Mean age: 58.1 degenerative 5 weeks integrated score of 

China yrs spondylolisthe 

sis 

2 – Flexing hip and knee 

manipulation, n = 49 

Treatment provider: NR 

symptoms and 

function 

2 – Disability: X-ray 

changes of lumbar 

spine 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 5 

weeks 

I-24
 
Table 1.16 Low Back Pain – Manipulation - Unknown - Non-Specific Pain 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) 

Eligibility Randomized Groups 

(no. of patients) 

Frequency 

and Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Shearar K 60 % male: 50 18 - 59 ; 1 – High velocity, Low 4 treatments 1 – Pain: NRS-101 1/13 

(2004)144 diagnosed with amplitude chiropractic 2 – Disability: 

Mean age: NR sacroiliac joint adjustments (HVLA) by a 2 weeks Revised Oswestry 

South Africa syndrome chiropractor, n = 30 

2 – Mechanical force, 

manually assisted 

chiropractic adjustments 

by the same chiropractor, 

n = 30 

LBP Disability 

Questionnaire 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 2 

weeks 

Table 1.17 Low Back Pain – Mobilization – Acute/Sub-acute-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Hadler NM 54 % male: 48 Patients aged 1 – Mobilization by an NR 1 – Disability: RMDQ 7/13 

(1987)113 18-40 yrs with investigator with 2 – ADVERSE 

Mean age: NR acute LBP (<= experience, n = 28 EVENTS: no harms 

US 1 mo), no other 

episode of 

back pain in 

previous 6 mo, 

not workrelated pain, 

no previous 

2 – Manipulation by the 

same investigator with 

experience, n = 26 

reported 

Data measured at 3 

mo 

surgery 

Hanrahan, S 

(2005)145 

19 % male: 100 Male collegiate 

athletes with 

1 – Grade 1 (small 

amplitude) or 2 (large 

Single session 1 – Pain (McGill Pain 

Questionnaire, and 

2/13 

Mean age: 20.3 acute low back amplitude) VAS) 

U.S. years pain and no posteroanterior joint 2 – Muscle strength 

neurological mobilization by a certified (by handheld 

deficits or athletic trainer, n = 9 dynamometer) 

suspected disc 

herniation 2 – Control, n = 10 Measured 

immediately post 

Co-intervention: intervention 

standardized protocol of 

cryotherapy and 

stretching 

Aleksiev A NR % male: 46.3 LBP but not a 1 – Post-isometric 20 treatment 1 – Pain: 2/13 

(1995)146 candidate for relaxation, n = NR days, 12 2 – Disability: 

Mean age: NR surgery prior or procedures 3 – ADVERSE 

Bulgaria during the trial 2 – AFSMC and sham 

mobilization, n = NR 

each group EVENTS: no harms 

reported 

3 – Perl’s traction therapy 

and sham mobilization, n 

= NR 

Data measured 

immediately post 

intervention and 6 mo 

4 – Sham mobilization, n 

= NR 

Treatment provider: NR 

Table 1.18 Low Back Pain – Mobilization – Acute/Sub-acute-Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Wreje, U 

(1992)147 

39 % male: 0 (all 

female) 

Patients with 

LBP due to 

1 – Spinal mobilization, n 

= 18 

Single session 1 – Pain (VAS) 

2 – number of 

4/13 

pelvic joint patients using 

Sweden Mean age: 32 dysfunction , 2 – Sham mobilization analgesic drugs 

years and no (manual transverse 

neurological frictions on the gluteus Measured 

disease or medius), n = 21 immediately after 

spine intervention 

pathology Standardized cointervention: paracetamol 

Treatment provider: NR 

I-25
 
Table 1.19 Low Back Pain – Mobilization – Chronic-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Timm, K. E 250 % male: 73 LBP with or 1 – Joint Manipulation by Three times 1 - Functional 4/13 

(1994) 

148 Mean age: 43 

without 

radiation, and 

a physical therapist, n= 

50 

per week for 8 

weeks 

Disability (Oswestry, 

Schober) (A, B) 

years associated 

symptoms for 2 – Physiotherapy by the 

US at least 6 same therapist, n=50 

months 

following a 3 – Low-tech McKenzie 

single-level exercises by the same 

lumbar therapist, n= 50 

laminectomy of 

the L5 4 – High-tech Cybex 

segment exercises by the same 

therapist, n= 50 

5 – No treatment, n= 50 

Table 1.20 Low Back Pain – Mobilization – Chronic-Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Ritavanen, T 61 % male: 55 Patients with 1 – Spinal mobilization by 5 treatments 1 – Pain (VAS 0 - 5/13 

(2007)149 chronic LBP experienced bone setter , with 2 weeks 100) 

Mean age: 41 aged 20-60 yrs n = 33 interval 2 – Disability 

Finland years who had (Oswestry index 0 – 

restricted 2 – Physiotherapy 2 months 100) 

functioning and including massage, 3 – ROM (finger- floor 

no therapeutic stretching, distance), lateral 

contradiction to 

mobilization 

trunk stabilization 

exercise, exercise 

bending) 

4 – Depression score 

therapy by a fitness 5 – ADVERSE 

centre specialist, n = 28 EVENTS: no 

information 

Measured at short 

term follow up (1 

month after last 

intervention) 

Hemmila H 114 % male: NR Non-retired 1 – Physiotherapy, n = 34 Maximum of 10 1 – Disability: ODQ 8/13 

(2002)150 people ; BP treatments 2 – ADVERSE 

Mean age: NR and no 2 – Bone-setting, by 4 EVENTS: no harms 

Finland contraindicatio 

ns to manual 

folk healers, n = 45 6 weeks reported 

therapies 3 – Exercise, n = 35 Data measured at 6 

weeks, 3 and 6 mo 

Sub-acute 

Cote P 30 % male: 54.4 Patients with 1 – Manipulation by a One session 1 – Pain: PPT-L5 4/13 

(1994)123 mechanic clinician, n = 16 tender point; SI 

Mean age: 31 yrs CLBP > 2 mo ligament tender point; 

Canada 2 – Mobilization by a gluteus tender point 

clinician, n = 14 2 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 

end of single session 

Mackawan S 67 % male: 39 20 - 60 years; 1 – Traditional Thai One 10 min 1 – Pain: VAS (10 5/13 

(2007)151 persistent Massage (TTM) by an session cm); Substance P 

Mean age: 38.8 chronic LBP experienced levels in saliva 

Thailand yrs (more than 12 physiotherapist, n = 35 (severity of chronic 

weeks); no pain) 

evidence of 2 – Joint Mobilization by 2 – ADVERSE 

underlying the same therapist, n = EVENTS: no harms 

diseases or 32 reported 

anatomical 

abnormalities Data measured at 

end of single session 

Lopez de, C 100 % male: NR Patients with 1 – Spinal mobilization, n Single session 1 - Pain: VAS (100 8/13 

(2007)152 

Mean age: NR 

non specific 

chronic low 

= NR mm) 

2 - Function 

Spain back pain, age 

18 – 65 and no 

lumbar 

fracture; 

2 – No treatment, n = NR 

Treatment provider: NR 

3 - range of motion 

4 – ADVERSE 

EVENTS: no 

information 

tumour, 

rheumatoid 

disease, or 

spondylolysis 

I-26
 
Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Hemmila, H. M 114 % male: 57 Back pain 1 - Bone Setting by 4 folk 1-2 times per 1 – Pain: VAS (0­ 6/13 

(1997) 

153 Mean age: 42 

between the 

shoulders and 

healers, n= 34 week for 6 

weeks 

100) Pain during past 

3 days 

years the buttocks 2 – Physiotherapy by a 

Finland physiotherapist, n = 45 2 – Pain Point 

Sensitivity 

3 – Home exercises by 

the same therapist, n = 3 – Pressure Pain 

35 Threshold 

Table 1.21 Low Back Pain – Mobilization – Mixed – Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Konstantinou K 26 % male: 57 Patients aged 1 – Flexion mobilization NR 1 – Pain: VAS 5/13 

[crossover] > 18 yrs with or with movement technique 2 – Disability: RMDQ­

(2007)154 Mean age: 38.3 without leg (MWMs), n = 15 reported for 

years pain with LBP respondents only 

UK 2 – Placebo-Flexion 

Mixed MWMs, n = 11 Crossover data 

Hoving, J 183 % male: NR Non-specific 1 – Mobilization, n = 60 1 – 6 sessions 1 – Pain: Pain 7/13 

(2006)155 NP for at least 2 – 12 intensity 11-pt scale 

Mean age: NR 2 weeks 2 – Physical Therapy sessions 2 – Disability: 

Netherlands 

Mixed 

(PT), n = 59 3 – 3 sessions Physical dysfunction 

11-pt scale; 

3 – General Care, n = 64 6 weeks for all functional neck 

3 – Quality of Life: 

Global perceived 

recovery 

Data measured at 3, 

7, 13, 26 and 52 

weeks 

Chiradejnant A 140 % male: 51 Resting pain of 1 – Correct mobilization Two 1 min 1 – Pain: VAS (10 9/13 

(2003)156 more than 2 on treatment by repetitions cm) 

Mean age: 46.4 a 0 to 10 pain physiotherapist, n = 70 2 – ADVERSE 

Sydney, Australia yrs scale and the 

treating 

physiotherapist 

had to agree 

that spinal 

mobilisation 

2 – Randomly assigned 

mobilization technique, by 

physiotherapist, n = 70 

EVENTS: no harms 

reported 

Data measured at 

end of treatment 

treatment was 

indicated. 

Mixed 

Goodsell, M 26 % male: 51.5 Current 1 – PA Manual NR 1 – Pain: McGill Pain 3/13 

(2000)157 episode of LBP mobilization, by one score-Worst pain; 

Mean age: 39.2 experienced physiotherapist with a Overall % 

Australia yrs pain in 

previous 48 

hrs; BP elicited 

by active 

lumbar flexion 

or extension 

postgraduate qualification 

in manual therapy, n = 12 

2 – Control treatment, n = 

14 

2 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 

end of treatment 

movements 

Mixed 

Chiradejnant, A 

(2002)158 

120 % male: 59 Non-specific 

LBP 

1 – Posteroanterior (PA) 

mobilization at most 

Two 1 minute 

repetition 

1 – Pain: NRS 11 pt 

scale; Global 

5/13 

Mean age: 41.2 symptomatic spinal level, Perceived Effect 11 

Australia yrs Mixed n = 60 pt scale 

2 – ADVERSE 

2 – Posteroanterior (PA) EVENTS: no harms 

mobilization at randomly reported 

selected lumbar level, n = 

60 Data measured at 

end of treatment 

Treatment provided by 

one physiotherapist 

I-27
 
Powers, CM 

(2008)159 

30 % male: 37 

Mean age: 31.2 

yrs 

18 to 45 years 

of age with 

non-specific 

LBP; recent 

onset of LBP 

(duration of < 3 

months) 

Mix (acute, 

sub-acute) 

1 – Passive segmental 

mobilization, n = 15 

2 – Press up exercise, n 

= 15 

Both treatments 

administered by a 

physical therapist 

with 18 yrs of manual 

therapy experience 

and certification as an 

Orthopaedic 

Clinical Specialist by the 

American Board of 

Physical Therapy 

Specialties 

1 intervention 

10 minutes 

1 – Pain: VAS 

2 – Disability: Lumbar 

extension 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 

end of single 

treatment 

4/13 

Table 1.21 Low Back Pain – Manipulation + Mobilization – Acute/Sub-acute- -Specific Pain- No Trials 

Table 1.22 Low Back Pain – Manipulation + Mobilization – Acute/Sub-acute-Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Hancock MJ 

(2007)160 

240 % male: 56 Patients with 

acute LBP (< 6 

1 – Diclofenac-NSAID by 

a general practitioner, n = 

Twice/day 

2-3 times/week 

1 – Pain: VAS; time 

to recovery 

9/13 

Mean age: 40.3 weeks) in the 60 2 – Disability: RMDQ; 

Australia yrs area between 4 weeks PFS 

the 12th rib 2 – Spinal manipulation 3 – ADVERSE 

and the by Physical therapists EVENTS: no harms 

buttock crease with graduate diploma in reported 

causing manipulative therapy, n = 

moderate pain 60 Data measured at 4 

and disability weeks and 3 months 

3 – Dicloflenac + SM by a 

general practitioner and 

Physical therapists, n = 

60 

4 = Placebo manipulative 

therapy + placebo 

diclofenac, n = 60 

Hurley DA 240 % male: 52 Patients aged 1 – MT by chartered 8 weeks 1 – Pain: VAS; McGill 6/13 

(2004)161 

Mean age: 40.1 

18-65 yrs with 

acute LBP 

Physical therapists , n = 

80 

pain questionnaire; 

SF-36 Bodily pain 

yrs (duration: 4-12 2 – Disability: RMDQ 

weeks) with or 2 – IFT-standard 3 – ADVERSE 

without pain stimulation by same EVENTS: no harms 

irradiation to therapists, n = 80 reported 

the buttock or 

legs 3 – MT + IFT by the same Data measured at 8 

therapists, n = 80 weeks, 3 and 6 

Acute LBP months 

Table 1.23 Low Back Pain – Manipulation + Mobilization – Chronic-Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Aure, O 49 % male: 53 Men and 1 – Manual Therapy by a 16 treatments 1 – Pain: VAS (100 8/13 

(2003)162 women age 20 specialist, n = 27 mm) 

Mean age: 40.2 to 60 years 8 weeks 2 – Disability: 

Norway yrs that had been 2 – Exercise Therapy by Oswestry LBP 

sick-listed 2 physiotherapists, n = 22 Questionnaire 

between 8 3 – Work: N of sickweeks and 6 listed patients at each 

months due to assessment session 

LBP with or (Analysis’ based on 

without leg intention to treat) 

pain. 

Data measured at 8 

weeks, 3 and 6 mo 

Ferreira ML 240 % male: 31 Patients with 1 – Spinal manipulation + 12 sessions 1 – Pain: VAS 7/13 

(2007)163 Non-specific mobilization by 2 – Disability: RMDQ; 

Mean age: 53.6 CLBP aged physiotherapists, n = 80 8 weeks PSFS 

Australia yrs 18-80 yrs; 

Patients with 2 – MC + exercise by the 

3 – ADVERSE 

EVENTS: no harms 

OA, disc same therapists, n = 80 reported 

protrusion, or 

herniation 3 – GEN exercise by the Data measures at 8 

without 

neurological 

same therapists, n = 80 weeks, 3 and 6 mo 

compromise 

were also 

included 

I-28
 
Table 1.24 Low Back Pain – Manipulation + Mobilization – Mixed- Specific Pain- No trials 

Table 1.25 Low Back Pain – Manipulation + Mobilization – Mixed-Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Hurwitz, El 

(2006)164 

681 % male: 48 Health 

maintenance 

1 – Spinal manipulation 

/mobilization by 

6 weeks 1 – Pain: VAS-most 

severe; average 

6/13 

Mean age: 51 organization chiropractors with ≥ 5 yrs 2 – Disability: RMDQ 

US years membership, experience, n = 169 3 – Utility of 

sought care in conventional care: 

one of the 2 – Spinal manipulation OTC use; prescribed 

study sites /mobilization by the same use; mean n of back 

between 1995­ chiropractors, n = 172 related visits 

1998 with LBP, 4 – ADVERSE 

had no 3 – MC,-instruction in EVENTS: no harms 

treatment proper back care, reported 

received for exercises, prescriptions 

the past by family medicine Data measured at 2 

month, age ≥ practitioners, n = 170 and 6 weeks, 6 and 

18 yrs 18 mo 

4 – MC + PT- one PM by 

licensed physiotherapists, 

n = 170 

Koes, B 

(1992)165 

136 % male: 52 Pain or selfreported 1 – Spinal manipulation 

/mobilization by a manual 

Maximum 

duration of 3 

1 – Physical 

measures: 

5/13 

Mean age: 42.8 limited range therapist, n = 36 mo Improvement in 

Netherlands yrs of motion in spinal mobility-mean 

the back or 2 – Physiotherapy by a 4 – 2 times/ change of ROM at T1 

neck for at physiotherapist, n = 31 week for 6 measured by 

least 6 weeks weeks inclinometer-spinal 

3 – Continued treatment forward flexion 

with General practitioner, 2 – ADVERSE 

n = 39 EVENTS: no harms 

reported 

4 – Physical exam and 

detuned shortwave Data measured at 6 

diathermy by a and 12 weeks 

physiotherapist, n = 30 

Macdonald, R 95 % male: 41 Patients 1 – Spinal manipulation 2 times/week 1 – Pain: Pain 5/13 

(1989)166 between 16 /mobilization by a until cured Disability Index; Pain 

Mean age: NR and 70, registered osteopath, n = Analog 

London presenting to 

their general 

49 2 – Disability: Activity 

Loss (ALA) 

practitioner 2 – Control, advice; 3 – ADVERSE 

with pain partly patients seen in clinic for EVENTS: Excess 

or wholly examination, n = 49 lumbar lordosis; pins 

between the and needles 

inferior angles 

of the scapula Data measured at 

and the end of treatment 

buttock folds 

Table 1.26 Low Back Pain – Manipulation + Mobilization – Unknown -Specific Pain- No trials 

Table 1.27 Low Back Pain – Manipulation + Mobilization – Unknown -Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Meade, TW 741 % male: 51 LBP 1 – Spinal manipulation 1 – Maximum 1 – Disability: ODQ; 5/13 

(1991)167-170 mechanical /mobilization by 10 sessions ODQ pain intensity 

Mean age: 38.6 origin, no chiropractors, n = 384 30 weeks 2 – Utility of 

UK yrs contraindicatio conventional care: % 

n to SM, no 

treatment 

within the past 

month 

2 – HM-Maitland 

mobilization/manipulation 

by hospital staff, n = 357 

2 – 12 weeks patients using 

analgesic/NSAIDs 

drugs 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 6 

mo, 1 year and 2 yrs 

post-R 

Sims-Williams H 94 % male: 58.3 Patients with 1 – Spinal manipulation Assuming 15 1 – Disability: Spinal 4/13 

(1979)171 

Mean age: 42.7 

non-specific 

LBP 

/mobilization n = 48 sessions movement- Flexion; 

Extension 

UK yrs 2 – Placebo, n = 46 4 weeks 2 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 4 

weeks and 3 mo 

I-29
 
Table 1.28 Low Back Pain – Flexion Distraction Technique – Acute/Subacute- Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Kominski, G.F 681 % male: 52 Adults with 1 – Medical care only, by NR 1 – Pain: pain scale, 3/13 

(2005)164,172 

Mean age: 51.1 

years 

complaint of 

LBP (with or 

without leg 

symptoms) 

primary care physician, n 

= NR 

2 – Medical care with 

physical therapy, by 

physical therapist, n = NR 

3 – Chiropractic care 

only, by chiropractor, n = 

NR 

4 – Chiropractic care with 

physical modalities, n = 

NR 

lower-extremity pain 

(0-10 scale) 

2 – Quality of Life: 

SF-36 emotional and 

physical function 

scores (0-100 scale) 

Table 1.29 Low Back Pain – Flexion Distraction Technique – Chronic- Specific- No studies 

Table 1.30 Low Back Pain – Flexion Distraction Technique – Chronic -Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Cambron JA 235 % male: 63 Patients aged 1 – Flexion + distraction 2-4 times/ 1 – Pain: VAS; VAS, 3/13 

(2006)173 > 18 yrs with by a chiropractor with week Patients with 

Mean age: 41.6 chronic LBP > postgraduate certification radiculopathy; VAS, 

yrs 3 months from in the technique, n = 123 4 weeks Patients without 

US L1 to S1 joint 

inclusive, 

willing to 

undergo 

narcotic/NSAI 

Ds muscle 

relaxant's use 

2 – Exercise by licensed 

physiotherapists, n = 112 

radiculopathy 

2 – Disability: RMDQ 

3 – Utility of 

conventional care: 

annual mean N of 

visits; healthcare 

utilization 

4 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 4 

weeks, 3 and 6 mo, 1 

yr 

Table 1.31 Low Back Pain – Flexion Distraction Technique – Mixed - Specific- No studies 

Table 1.32 Low Back Pain – Flexion Distraction Technique – Mixed - Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Hawk, C 111 % male: NR 18 yrs and 1 – Flexion distraction 8 treatments 1 – Pain: PDI; RMQ; 8/13 

(2005)174 over, with sub- technique by 4 VAS (100 mm) 

Mean age: 52 yrs acute (onset 4­ experienced licensed 3 weeks 2 – ADVERSE 

Midwestern US 12 weeks prior 

to contact) or 

CLBP (onset 

more than 12 

weeks prior) 

chiropractors in FDT and 

TP therapy, n = 54 

2 – Control-Manipulation, 

n = 57 

EVENTS: no harms 

reported 

Data measured at 3 

weeks 

Hawk C 13 % male: 66.6 18 years of 1 – Chiropractic 4 visits 1 – Pain: VAS (10 4/13 

(1999)175 age or older; Adjustment (active)- cm) 

Mean age: 33. 5 self-report of Flexion distraction 2 weeks 2 – Quality of Life: 

yrs LBP within the technique by a licensed Global Well-Being 

last 6 mo doctor of chiropractic 

(DC) certified in FDT, n = 

scale (GWBS) (VAS, 

10 cm) 

8 3 – ADVERSE 

EVENTS: no harms 

2 – Placebo-Sham reported 

adjustments by the same 

doctor, n = 5 Data measured at 2 

weeks 

Table 1.33 Low Back Pain – Flexion Distraction Technique – Unknown - Specific- No studies 

I-30 
Table 1.34 Low Back Pain – Flexion Distraction Technique – Unknown -Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Beyerman, KL 217 % male: NR English 1 – Flexion distraction 20 sessions 1 – Disability: ODQ 4/13 

(2006)176 speaking technique + moist hot pain intensity; ODQ 

Mean age: NR patients with pack, n = 124 5 weeks (ADL) 

US arthritis, OA, 2 – ADVERSE 

degenerative 

joint/disc 

2 – Moist heat, n = 93 EVENTS: no harms 

reported 

disease, facet Treatment provider: NR 

arthropathy, Data measured at 5 

capable of weeks 

traveling to 

the 

appointments 

Table 1.35 Low Back Pain - Massage – Acute/Sub-acute - Specific Pain – No studies 

Table 1.36 Low Back Pain - Massage – Acute/Sub-acute - Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) (no. of patients) and Treatment treatment follow-up score 

size duration 

Preyde M 98 % male: 48.2 18 - 81 years; 1 – Comprehensive 6 treatments 1 – Disability: RMDQ; 6/13 

(2000)177 existence of massage therapy by 2 Modified Schober test 

Canada 

Mean age: 46.2 

years 

sub-acute 

(between 1 

week and 8 

months LBP; 

stable health. 

massage therapists with 

more than 10 yrs 

experience, n = 25 

2 – Soft-tissue 

manipulation by the same 

therapists, n = 25 

1 month 2 – Pain: MPQ (PRI 

and PPI scores) 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 3 

3 – Remedial exercises 

by the same therapists, n 

= 22 

mo 

4 – Sham laser treatment 

by 1 massage therapists 

with more than 10 yrs 

experience and 1 certified 

personal trainer and 

certified weight-trainer 

supervisor, n = 26 

Pope, M 240 % male: 62 Ages 18-55 1 – Manipulation by 5 9 sessions 1 – Pain: 10 cm VAS 5/13 

(1994)111 years; general licensed chiropractors, n 2 – Disability: Rage 

California, US 

Mean age: 32 yrs good health; 

LBP between 3 

weeks and 6 

months 

duration (this 

episode); free 

from LBP for 

minimum 3 

weeks for this 

episode 

= 60 

2 – Soft-tissue massage 

by 2 massage therapists 

serving as chiropractic 

interns, n = 30 

3 – Transcutaneous 

muscle stimulation by 1 

licensed chiropractor, n = 

30 

3 weeks of motion-Schober’s 

test – Extension; 

Flexion 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 3 

weeks 

4 – Lumbosacral corset 

by 1 licensed 

chiropractor, n = 30 

Konrad K 

(1992)178 

158 % male: 44.7 NS LBP with or 

without 

1 – Balneotherapy, n = 35 4 weeks 1 – Pain: VAS 

2 – Utility of 

6/13 

Hungary 

Mean age: 41.5 radiation to the 

thigh, 1 

months <= 

duration <= 3 

mo, a pain free 

year before the 

present 

episode 

2 – Underwater traction 

bath, n = 44 

3 – Underwater massage, 

n = 26 

4 – Control, no treatment, 

n = 53 

conventional care: N 

of analgesics taken in 

past 24 hrs 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 6 

Treatment provider: NR 

mo 

Farasyn A 60 % male: 41.3 21 - 75 years; 1 – Placebo by 2 male One 30 min 1 – Pain: VAS (100 7/13 

(2006)179 N-S sub-acute manual therapists with session mm) 

Mean age: 41.3 LBP with or minimum 2 yrs 2 – Disability: ODI 

Belgium years without 

referred pain to 

the leg 

experience in physical 

examinations and 

pressure pain, n = 20 

3 – ADVERSE 

EVENTS: no harms 

reported 

2 – Massage by same 

manual therapists, n = 20 

3 – Control, no treatment 

by same manual 

therapists, n = 20 

Data measured 

immediately post 

intervention 

I-31
 
Yip, YB 61 % male: 15.0 Patients 18 1 – Acupoint stimulation 8 sessions of 1 – Pain (VAS) 5/13 

 (2004)180 years old or for relaxation with 35-40 min each 

Mean age: 44.0 – older with non- electrode pads followed for 3 weeks 2 – Walking time (in 

China 48.1 years specific subacute low back 

pain for most 

days in the 

past 4 weeks 

who had not 

received 

acupuncture, 

manipulation, 

by acupressure massage 

with natural aromatic 

lavender oil and 

conventional treatment, n 

= 32 

2 - Conventional 

treatment alone, n = 29 

sec) 

3 – Lateral fingertipto-floor distance (cm) 

or 

physiotherapy 

in the past 

week 

Table 1.37 Low Back Pain - Massage - Chronic- Specific Pain – No Studies 

Table 1.38 Low Back Pain - Massage - Chronic - Non-Specific Pain 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Little, P 

(2008)181-183 

UK 

579 % male: 30.5 

Mean age: 45.5 

years 

Patients with 

recurrent or 

CLBP, 

presenting to 

primary care 

with LBP > 3 

months 

(currently 

scoring ≥ 4 on 

Roland 

disability scale, 

current pain for 

≥ 3 weeks (to 

exclude 

recurrence of 

short duration) 

1a – Massage only 

1b – Massage + 

Exercise, n = 147 

2a – Six Alexander 

technique lessons 

2b – Six Alexander 

lessons + Exercise, n = 

144 

3a – 24 Alexander 

lessons 

3b – 24 Alexander 

lessons + Exercise, n = 

144 

4a – Usual care 

4b – Usual care + 

Exercise, n = 144 

1 – 6 sessions, 

6 weeks 

2 – 6 sessions, 

4 weeks 

3 – 24 lessons 

in 5 mo 

4 – 4b started 

exercise 

treatment at 6 

weeks 

1 – Pain: median 

days with no pain 

(IQR) 

2 – Disability: Roland 

disability score 

3 – Quality of Life: 

SF-36 physical score 

4 – ADVERSE 

EVENTS: no 

significant harms 

reported 

Data measured at 3 

and 12 mo 

8/13 

Zaproudina, N 122 % male: 49 Chronic LBP 1 - physical and exercise 1 – Five 1 – Pain: VAS (0­ 5/13 

(2009)184 

Mean age: 41 

with or without 

referred leg 

therapy by an 

experienced registered 

sessions 100) 

Finland years pain; minimal therapist, n = 63 2- Three - Five 

VAS of 30 sessions 

and/or 2 - Traditional bone lasting 90 

Oswestry setting by a Finnish bone- minutes per 

Disability Index 

of at least 

setter, n = 59 patient at 1 or 

2 week 

16%. intervals 

Quinn, F 15 % male: 32.2 Staff employed 1 – Massage-reflexology 1 treatment/ 1 – Pain: VAS­ 9/13 

(2008)185 at the U of by 3 experienced week primary outcome 

Mean age: 43.5 Ulster with reflexologists, n = 7 measure; MPQ 

UK years non-specific 

LBP, any 

physiotherapy, 

medication or 

other treatment 

for LBP has 

been stabilized 

for at least 3 

2 – Sham (foot massage) 

by the same therapists, n 

= 8 

6 weeks 2 – Disability: RMDQ; 

SF-36 health survey 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 3 

mo 

mo 

Poole H 290 % male: 40.8 18 - 65 yrs with 1 – Massage-reflexology 6 treatments 1 – Pain: SF-36; VAS 5/13 

(2007)186 benign CLBP by 5 experienced 2 – Disability: ODQ; 

Mean age: 46.8 reflexologists, n = 77 6-8 weeks physical functioning 

UK years 

2 – Relaxation by an 

experienced certified 

therapist, n = 82 

SF-36; BDI II 

3 – ADVERSE 

EVENTS: no harms 

reported 

3 – standard treatment by 

general practitioner -nonintervention, n = 131 

Data measured at 6 

mo 

Hsieh LLC 129 % male: 30 Patients aged 1 – Acupressure by a 6 sessions 1 – Pain: VAS; Core 9/13 

(2006)187 > 18 yrs with senior acupressure outcome measures 

Mean age: 51.4 CLBP (> 4 mo) therapist, n = 64 1 mo 2 – Disability: RMDQ 

Taiwan yrs 

2 – PT by a physical 

therapist, n = 65 

score; modified 

Oswestry score 

3 – Work: 

Satisfaction of life 

with symptoms 

4 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 1 

and 6 mo 

I-32
 
Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Geisser, M 100 % male: 34 Aged 18-65 1 – Manual therapy, 5 visits 1 – Pain: VAS; MPQ 3/13 

(2005)188 yrs; single or Specific Exercise by a 2 – Disability: 

Mean age: 40.2 primary physical therapist with 12 5 weeks Quebec Back Pain 

Michigan yrs complaint of yrs post-grad training in Disability Scale 

CLBP and manual medicine, n = 26 (QBPDS) 

were judged to 3 – ADVERSE 

have 

musculoskelet 

2 – Sham therapy, 

specific exercise by the 

EVENTS: no harms 

reported 

al pain based same therapist, n = 25 

on evaluation Data measured at 5 

by the 3 – Manual therapy, non- weeks 

physician or 

physical 

specific exercise by the 

same therapist, n = 24 

therapist 

4 – Sham therapy by the 

same therapist, N-S 

exercise, n = 25 

Hsieh, L 146 % male: 47.7 16 - 84 yrs with 1 – Massage­ 6 sessions 1 – Pain: Chinese 9/13 

(2004)189 chronic LBP Acupressure by a senior version of SF-PQ 

Mean age: 47.6 acupressure therapist, n 4 weeks 2 – ADVERSE 

Taiwan years = 69 

2 – Physical therapy by 

the same therapist, n = 

77 

EVENTS: no harms 

reported 

Data measured at 6 

mo 

Cherkin, DC 262 % male: 41% Ages 20 to 70 1 – acupuncture, n = 94 Up to 10 visits 1 – Pain: symptom 6/13 

(2001)27 years who bothersomeness 

Mean age: 44.9 visited a 2 – massage­ 10 weeks during past week 

US yrs primary care 

physician for 

low back pain 

who had 

persistent LBP 

for 6 weeks 

manipulation of softtissue, n = 78 

3 – self care education, n 

= 90 

2 – Disability: Roland 

Disability Scale 

Score; National 

Health Interview 

survey 

3 – Quality of Life: 

SF-12 mental health 

summary scales 

4 – ADVERSE 

EVENTS: no harms 

reported 

Data measured at 10 

weeks and 1 yr 

Hernandez-Reif 24 % male: 45.8 Adults with 1 – Massage therapy by 2 sessions/ 1 – Pain: SF-MPQ; 2/13 

M 

(2001)190 Mean age: 40.25 

LBP with a 

duration of at 

trained massage 

therapists, n = 12 

week VAS 

2 – Disability: Range 

years least 6 mo 5 weeks of motion (trunk 

US 2 – Relaxation-no flexion; pain flexion) 

treatment, n = 12 3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured 

immediately post 

intervention 

Field T 30 % male: 53 Adults with 1 – Massage therapy by 2 session/ 1 – Pain: VAS (10 2/13 

(2007)191 LBP of a trained massage week cm) 

Mean age: 41 duration of at therapists, n = 15 2 – Disability: 

US years least 6 mo; 

cleared by 

their primary 

physician to 

participate in 

the study 

2 – Relaxation therapy, n 

= 15 

5 weeks Range of motion 

(trunk flexion; pain 

flexion) 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured 

immediately post 

intervention 

Mackawan S 67 % male: 39 20 - 60 years; 1 – Traditional Thai One 10 min 1 – Pain: VAS (10 5/13 

(2007)151 persistent Massage (TTM) by an session cm); Substance P 

Mean age: 38.8 chronic LBP experience levels in saliva 

Thailand yrs (more than 12 physiotherapist, n = 35 (severity of chronic 

weeks); no pain) 

evidence of 2 – Joint Mobilization by 2 – ADVERSE 

underlying 

diseases or 

the same therapist, n = 

32 

EVENTS: no harms 

reported 

anatomical 

abnormalities Data measured at 

end of single session 

I-33
 
Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Hollinghurst, S 579 % male: 30.5 Chronic or 1 – Normal care (no 6- 24 sessions 1 – Cost: QALYs 

(2008)183 

Mean age: 45.5 

years 

recurrent LBP 

recruited from 

primary care 

exercise), n = 72 

2 – Therapeutic massage 

(no exercise), by 

massage therapists, n = 

75 

2 – Disability: 

Roland-Morris 

disability score 

Data measured at 3 

and 12 months 

3 – Six Alexander 

technique lessons (no 

exercise, by teachers, n = 

73 

4 – Twenty-four 

Alexander technique 

lessons (no exercise), n = 

73 

5 – Normal care + 

exercise, n = 72 

6 – Therapeutic massage 

+ exercise, n = 72 

7 - Six Alexander 

technique lessons + 

exercise, n = 71 

8 - Twenty-four Alexander 

technique lessons + 

exercise, n = 71 

Franke, A (2000) 190 % male: 61.0 Patients with 1 – acupuncture massage EG: 12-16 1 - VAS (at baseline 8/13

192 low back pain (APM) according to sessions each and after treatment) 

Mean age: 43.5 – aged 20 – 55 Penzel + individual 30 min 

45.6 years years, German 

speaking, 

chronic back 

pain > 1 year 

gymnastic exercise (EG), 

n = 46 

2 – Classical Swedish 

massage TM + individual 

gymnastic exercise (EG), 

n = 49 

3 – APM + gymnastic 

exercises in groups 

(KGG) by therapists 

trained according to 

Penzel, 

n = 46 

KKG: in gym – 

8-10 sessions 

each 30 min, in 

pool 4-6 

sessions 

APM: 4 

sessions each 

30 min 

TM: 8 sessions 

each 15 min 

2 - Flexion & 

extension (at 

baseline and after 

treatment) 

4 – KGG + TM, 

n = 49 

Table 1.39 Low Back Pain - Massage - Mixed - Specific Pain – 193
 

Table 1.40 Low Back Pain - Massage - Mixed - Non-Specific Pain 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Hoehler F 95 % male: 59 Presence of 1 – Rotational N of treatments 1 – Pain: 3/13 

(1981)137 palpatory cues Manipulation of varied Improvement in 

Mean age: 31.1 indicating that lumbosacral spine by a amount of pain 

California yrs manipulation physician, n = 56 2 – ADVERSE 

might be EVENTS: no harms 

successful 2 – Soft-tissue massage reported 

by a physician, n = 39 

Data measured at 

end of treatment 

Chatchawan U 180 % male: 36 21-50 years; 1 – Traditional Thai 6 sessions 1 – Pain: VAS (10 6/13 

(2005)194 persistent BP, Massage (TTM) by 1 of 3 cm) 

Mean Age: 36.4 either sub- massage therapists who 3-4 weeks 2 – Disability: ODQ 

years acute (lasting had 4, 8, and 20 yrs of 3 – ADVERSE 

4-12 weeks) or 

chronic (lasting 

experience, n = 90 EVENTS: no harms 

reported 

for over 12 2 – Swedish massage 

weeks) (SM) by the same Data measured at 3 

massage therapists, n = mo 

Mixed 90 

I-34
 
Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Zhang, J 165 % male: 31.5 2-60 yrs 1 – Traction by a doctor 1 or 3 1 – Pain: Shanghai 6/13 

(2004)193 Diagnosed as and a hospital staff treatment/week Chinese Medical 

Mean age: 41.4 Shanghai member, n = 55 20 treatments Diagnostic and 

China years Chinese 

Medical 

Diagnostic and 

therapeutic 

Effective 

Standard 

Mixed 

2 – Massage by the same 

treatment provider, n = 55 

3 – Massage + Exercise 

by the same treatment 

provider, n = 55 

total treatment Standard 

Procedure 

2 – Disability: 

Function of lumbar 

spine 

3 – ADVERSE 

EVENTS: no harms 

reported 

Data measured 

immediately post 

intervention 

Table 1.41 Low Back Pain - Massage - Unknown - Specific Pain 

Study ID 

Year Country 

Total 

sampl 

e size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and Treatment 

duration 

Outcomes and posttreatment follow-up 

Quality 

score 

Li ZY 

(2006)195 

60 % male: 53.6 Typical 

symptoms; 

1 – Massage-Living 

acupoint treatments, n = 

NR 1 – Pain: Score 

evaluation of pain 

10/13 

Mean age: 45.4 Clinical positive 30 treatment; VAS 

China yrs signs; Diagnosed 2 – ADVERSE 

by CT or MRI; 2 – Spinal Manipulation- EVENTS: no harms 

age: 20-55 yrs Oblique-pulling, n = 30 reported 

Treatment provider: NR Data measured at 

end of treatment 

Table 2 1 Neck Pain - Acupuncture - Acute - Specific Pain 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Aigner, N 

(1999)196 

Austria 

74 % male: NR 

Mean age: NR 

18-65 years 

with whiplash 

for no longer 

than 4 days 

1 – Cervical collar, 

Chlormezanon, Paracetamol + 

Acupuncture, n = 28 

2 – Cervical collar, 

Chlormezanon, Paracetamol + 

Laser Acupuncture, n = 23 

NR 1 – Pain: improvement in 

ROM 

2 – Work: sick leave 

3 – ADVERSE EVENTS: 

no harms reported 

6/13 

3 - Chlormezanon, Paracetamol 

and cervical collar, n = 33 

Treatment provider: NR 

Table 2.2 Neck Pain - Acupuncture - Acute - Non –Specific Pain - No Studies 

Table 2.3 Neck Pain - Acupuncture - Chronic - Specific Pain 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Venancio RA 45 % male: 11.1 Patients 18-65 1 – Acupuncture (dry needling), n NR 1 – Pain: pain intensity, 2/13 

(2008)197,198 

Mean age: NR 

years with 

chronic (≥6 mo) 

= 15 

3 weeks 

frequency, duration (SSI 

scores); VAS 

Brazil myofascial pain 2 – Lidocaine injection, n = 15 2 – ADVERSE EVENTS: 

and headache no harms reported 

3 – Lidocaine + Decadron, n = 15 

Data measured 

Treatment provider: NR immediately post 

intervention and 6 mo 

Ga, H 39 % male: 7.5 Patients aged > 1 – Acupuncture by a family 3 1 – Pain: Pain intensity: 5/13 

(2007)199 60 yrs physician who completed TP treatments/ VAS; FACES; PTS 

Mean age: 77.6 complaining of injection courses, n = 18 week 2 – ADVERSE EVENTS: 

Korea years chronic no harms reported 

shoulder/neck 

pain or 

2 – Lidocaine injection, n = 21 

Data measured 

headache for immediately post 

more than 6 mo intervention and 3 mo 

Ga, H 40 % male: 7.5 Patients aged > 1 – Acupuncture by a family Treatment 1 – Pain: pain intensity 6/13 

(2007)200 20 years physician who completed TP performed 3 scores: VAS; FACES; PTS 

Mean age: 77.8 complaining of injection courses, n = 18 times a 2 – ADVERSE EVENTS: 

Korea years chronic 

shoulder/neck 2 –Acupuncture (IMS) , n = 22 

week no harms reported 

pain or Data measured 

headache for immediately post 

more than 6 mo intervention and 3 mo 

I-35
 
Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Lv, YX 70 % male: 38.7 Cervicogenic 1 – Probing needling, n = 36 12 1 – Pain: VAS 3/13 

(2006)201 

Mean age: 41.4 

headache 

2 – Routine Acupuncture, n = 34 

treatments 2 – ADVERSE EVENTS: 

no harms reported 

China years 12 days 

Treatment provider: NR Data measured 

immediately post 

intervention 

Irnich D 102 % male: 26.4 Patients with 1 – non-local-Acupuncture by an 30 1 – Pain: VAS (0-100) 8/13 

[crossover] chronic NP (> 2 acupuncturist with 2 yrs training, min/session motion-related 

(2002)202,203 Mean age: 51.9 

years 

mo) and 

myofascial or 

n = 34 

immediate 

2 – ROM 

2 – ADVERSE EVENTS: 

Germany irritation 

syndrome 

2 – Local-Acupuncture (Dry 

Needling) by the same therapist, 

post 

treatment – 

one subject reported mild 

hypotension and sweating 

n = 34 1 session 

Data measured 

3 – Laser-Acupuncture Sham by immediately post 

the same therapist, n = 34 intervention (only 

crossover data reported) 

Zhu XM 29 % male: 52 Patients with 1 – Acupuncture, n = 14 9 sessions 1 – Pain: Pain intensity­ 7/13 

[crossover] chronic NP adapted MPQ; VAS; Daily 

(2002)204 Mean age: 49.4 aged 31-71 2 – Sham-Acupuncture, n = 15 3 weeks pain duration 

years years had neck 2 – Disability: NDI 

Australia complaints ≥ 6 

mo 

Treatment provider: NR 3 – Healthcare Utilization: 

Daily use of pain pills 

4 – ADVERSE EVENTS: 

no harms reported 

Data measured 

immediately post 

intervention 

Irnich D 177 % male: 34 Patients with 1 – Acupuncture by an 5 sessions 1 – Pain: VAS (0-100); 4/13 

(2001)205-207 chronic NP (>1 experienced and licensed PPT 

Mean age: 52.4 mo) and painful acupuncturists, n = 56 3 weeks 2 – Quality of Life: SF-36: 

Germany years restriction of Role physical, Pain Index 

cervical spine 2 – Massage by experienced 3 – ROM 

mobility, not physiotherapists, n = 60 4 – ADVERSE EVENTS: 

received 

treatment two 3 – Sham Laser acupuncture, n = 

mild reactions (slight pain, 

sweating, low blood 

weeks before 61 pressure) 

the study 

Data measured at 1 and 3 

weeks, and 3 months 

White, PF 204 % male: NR Patients with 1 – Acupuncture with electrical 9 1 – Pain: VAS (10 cm) 5/13 

(2000)208 

Mean age: 52 

history of NP 

and cervical 

stimulation at local points, n = 23 treatments crossover design 

2 –Quality of Life: SF-36 

U.S. years disk disease 2 – Acupuncture with ES at 3 weeks crossover design 

with a stable remote points (Low Back region), 3 – Healthcare utilization: 

level of pain for n = 68 Daily analgesic decrease 

a period of at 

least 3 months 3 – Acupuncture needles only at 

4 – ADVERSE EVENTS: 

needle site side effects 

before neck, n = 23 only 

enrolment 

Treatment provider: NR Data measured 

immediately post 

intervention 

Lundeburg 58 % male: NR 44-76 years; 1 – Sham-superficial needling by One 40 1 – Pain: pain intensity 1/13 

(1991)209 osteoarthritis of an acupuncturist, n = 14 minute (sensory) VAS (10 cm); 

Mean age: NR the cervical session pain unpleasantness 

and/or thoracic 2 – Manual acupuncture by the (affective) VAS (10 cm) 

spine (C1-T1), same therapist, n = 14 2 – ADVERSE EVENTS: 

with no no harms reported 

previous 3 – 2 Hz Electrical stimulation by 

experience of the same therapist, n = 15 Data measured 

acupuncture; immediately post 

pain for 6 4 – 80 Hz Electrical stimulation intervention 

months or more by the same therapist, n = 15 

Cecchereli F 62 % male: 26 Myofascial 1 – Somatic Acupuncture, n = 31 8 sessions 1 – Pain: MPQ; VAS 6/13 

(2006)210 cervical pain 2 – ADVERSE EVENTS: 

Mean age: 42.7 2 – Acupuncture + 8 weeks no harms reported 

Italy years Auriculotherapy, n = 31 

Data measured 

Treatment provider: NR immediately post 

intervention, 3 and 6 mo 

Thomas, M 

(1991)211 

44 % male: NR 42-77 years 

with 

1 – Acupuncture by an 

acupuncturist, n = NR 

3-5 days 

between 

1 – Pain: (VAS 10 cm 

sensory) pain intensity; 

5/13 

Mean age: NR osteoarthritis of different VAS (10 cm) affective 

Sweden the cervical 2 – Sham Acupuncture by an trials 2 – ADVERSE EVENTS: 

spine acupuncturist, n = NR no harms reported 

NR 

3 – Diazepam, n = NR Data measured 

immediately post treatment 

4 – Sham Diazepam, n = NR 

I-36
 
Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Zhao, Z 106 % male: 49.1 Diagnostic 1 – Moxibustion + Acupuncture, 10 1 – Quality of Life: well­ 3/13 

(2004)212 

Mean age: 46.5 

using Chinese 

Standard; X-ray 

n = 53 treatments being 

2 – ADVERSE EVENTS: 

China years show unstable 2 – Acupuncture, n = 53 20 days (2 no harms reported 

of neck spinal courses) 

and discs Treatment provider: NR Data measured 

immediately post 

intervention 

Yang, T 66 % male: 51.5 Spinal cord 1 – Acupoint sticking therapy, n = 34 days 1 – Quality of Life: number 

(2009)213 

Mean age: 45.1 

type and 

radicular type 

33 of effect 

2 – ADVERSE EVENTS: n 

China years cervical 

intervertebral 

2 – Acupuncture, n = 33 = 2 discontinued treatment 

due to allergy 

disc Treatment provider: NR 

Data measured 

immediately post 

intervention and 3 mo 

Table 2.4 Neck Pain - Acupuncture - Chronic - Non-Specific Pain 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Abernathy, AP 123 % male: NR, Patients ≥ 18 1 – Acupuncture by an 5 sessions 1 – Pain: VAS (0-100 mm) 0/13 

(2008)214 majority female years with acupuncturist, n = NR motion 

uncomplicated 3 weeks 2 – Quality of Life: SF-36 

Mean age: 46.5 NP for at least 3 2 – TENS, n = NR improvement 

years months with 3 – Medication used (no 

motion-included data provided) 

pain of at least 4 – ADVERSE EVENTS: 

30 on 100 mm mild but not described 

VAS 

Data measured at 1 week 

post treatment and 6 

months post randomization 

Itoh, K (2007215 

Japan 

40 (cross 

over 

design) 

% male: 27.5 

Mean age: 62.3 

years 

Patients age at 

least 45 years, 

no radiation of 

neck pain, and 

no major 

trauma or 

systemic 

disease 

1 – Trigger point acupuncture, n 

= 10 

2 – Acupoint acupuncture 

(standard), n = 10 

3 – Non trigger point 

acupuncture, n = 10 

A pre-cross 

over period 

followed by 

18 acu 

treatments 

3 weeks 

1 - Pain (VAS) 

2 – Disability (Neck 

Disability Index) 

3 – ADVERSE EVENTS: 

reported 

6/13 

4 – Sham acupuncture, n = 10 

All treatments by acupuncturist 

with 2 – 7 years experience and 

4 years training 

Salter GC 24 % male: 25.5 Patients with 1 – Acupuncture + standard 3 months 1 – Pain and disability: 6/13 

(2006)216 chronic neck treatment by acupuncturists and NPQ 

Mean age: 48.2 pain aged 18 general practitioner, n = 10 2 – Drug utilization 

US years yrs or older who 3 – ADVERSE EVENTS: 

had consulted 2 – general practitioner, n = 14 aggravation of symptoms, 

the neck pain dizziness, tiredness 

practice in the 

previous 12 mo Data measured 

immediately post 

intervention 

Seidel 51 % male: 9.8 Patients with 1 – Low-level laser therapy 8 1 – Pain: pain intensity 10/13 

(2002)217 218 

Mean age: 49.5 

cervical pain for 

at least 6 

(LLLT) on AP by a “therapist”, n = 

13 

treatments VAS (0-10); pain sensation 

PPT; 

Germany years months aged 

20-72 years; no 

AP treatment 

for past 6 mo; 

consent 

2 – LLLT 7 mW, n = 12 

3 – LLLT 30 mW, n = 13 

4 – Conventional Acupuncture, n 

= 13 

4 weeks 2 – Disability: Cervical 

movement function 

3 – Physical Measures: 

cervical mobility; mental 

health questionnaire 

4 – ADVERSE EVENTS: 

no harms reported 

Data measured 

immediately post 

intervention and 1 mo 

Petrie, J 25 % male: 36.5 Chronic neck 1 – Acupuncture + analgesic, n = 8 sessions 1 – Pain: MPQ-PRI based 5/13 

(1986)219 pain (at least 6 13 on word rank; Daily pain 

Mean age: 50.5 months) 4 weeks score-VAS (0-10) 

United Kingdom years 2 – Sham transcutaneous nerve 

stimulation (TNS) + analgesic, n 

= 12 

-

2 – ADVERSE EVENTS: 

no harms reported 

Treatment provider: NR (author 

administered the treatment) 

Data measured at 4 weeks 

I-37
 
Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Petrie, JP 13 % male: 32.2 Chronic cervical 1 – Acupuncture, n = 7 8 sessions 1 – Pain: pain relief: 5-pt 6/13 

(1983)220 pain (> 2 yrs) simple scale (no relevant 

Mean age: 65 defined as NP 2 – TENS-placebo 4 weeks outcome reported) 

New Zealand years radiating to the 2 – ADVERSE EVENTS: 

occipital and /or Treatment provider: NR no harms reported 

shoulders with 

some limitations Data measured 

in movement immediately post 

intervention 

Gallacchi G 

(1983)221,222 

Switzerland 

113 % male: NR 

Mean age: NR 

Tendomyotical 

cervical and 

lumbar 

syndrome were 

under medical 

and/or physical 

treatment for 

number of 

months before 

volunteered for 

acupuncture 

study 

(data reported 

for cervical 

pain) 

1 – AP conventional needle AP 

at classical acupuncture points 

by a physician, n = 15 

2 – PN conventional needle AP 

at classical acupuncture points 

with placebo needles, n = 14 

3 – PP needle acupuncture at 

placebo points, n = 14 

4 – Laser AP at classical 

acupuncture points- laser light, n 

= 15 

5 – Laser AP at classical a 

acupuncture points-no emission 

of rays, n = 14 

6 - Laser AP at classical a 

acupuncture points-mixed light, n 

= 14 

7 - Laser AP at classical a 

acupuncture points-red light, n = 

13 

8 - Laser AP at classical a 

acupuncture points-infrared light, 

n = 14 

8 

treatments 

4 weeks 

1 – Pain: VAS (Scale NR) 

2 - VAS muscle tension 

3 – ADVERSE EVENTS: 

no harms reported 

5/13 

Coan RM 30 % male: 26.7 chronic Neck 1 – Acupuncture + 3-4 1 – Pain: VAS (0-10); 4/13 

(1982)223 pain and/or electroacupuncture or times/week mean number of hrs with 

Mean age: 49.3 radicular arm Moxibustion was used on some pain/day 

US years and hand pain subjects, n = 15 8 weeks 2 – mean number of pain 

≥6 mo pills used 

2 – wait list control, n = 15 3 – ADVERSE EVENTS: 

no harms reported 

Treatment provider: NR 

Data measured at 3 mo 

Giles, LGF 40 % male: 35.7 Patients 1 – Acupuncture, n = 10 6 1 – Pain: VAS (0-10) 1/13 

(1999)129 

Mean age: 41.3 

suffering from 

NP for at least 2 – Manipulation, n = 20 

treatments 2 – Disability: NDI (0-50) 

3 – ADVERSE EVENTS: 

Australia years 13 weeks, at 3-4 weeks no side effects occurred for 

least 18 years 

of age 

3 – Medication [tenoxicam 

(NSAID) with ranitidine], n = 10 

acupuncture or 

manipulation 

Data measured 

Treatment provider: NR immediately post 

intervention 

David, J 70 % male: 28.6 Patients aged 1 – Acupuncture by general 6 sessions 1 – Pain: VAS (0-100); 4/13 

(1998)224 18-75 years practitioners registered with the NPQ 

Mean age: 46 with chronic BMAS, n = 35 6 weeks 2 – Quality of Life: GHQ 

UK years neck pain (> 6 

weeks) and 

WAD 

2 – PT (Maitland mobilization) by 

a senior physiotherapist, n = 35 

3 – ADVERSE EVENTS: 

no harms reported 

No numerical data given, 

data measured at 6 weeks 

and 6 mo 

Vas, J 123 % male: 18 17 yrs and over 1 – Acupuncture by a doctor with 5 sessions 1 – Pain: VAS(0-100 mm); 7/13 

(2006)225 with over 15 years of clinical NPQ (Spanish) 

Mean age: 46.7 uncomplicated experience, n = 61 3 weeks 2 – Disability: ACM (Active 

Spain yrs NP over 3 

months 

duration; 

symptomatic at 

examination; 

motion-related 

NP intensity 30 

and over on 

100mm VAS, 

no treatment 

during past 

week 

2 – TENS placebo, unclear who 

administered the treatment, n = 

62 

Cervical Mobility; PCM 

(Passive Cervical Mobility) 

3 – Quality of Life: SF-36 

physical score 

4 – Utility of conventional 

care: N of doctor visits in 

past 3 mo 

5 – ADVERSE EVENTS: 

swelling of the hand, 

bruising, pain, ulcer of the 

ear; cephalea, aggravation 

of symptoms 

Data measured at 3 weeks 

and 3 mo 

I-38
 
Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

White P 135 % male: 35.6 Patients aged 1 – Acupuncture by an 8 sessions 1 – Pain: VAS (0-100) 9/13 

(2004)226,227 123 of 18-80 years acupuncturist with 7 years of 2 – Disability: NDI 

235 were Mean age: 53.4 with chronic experience, n = 70 4 weeks 3 – Quality of Life: 

analyzed years mechanical PCS/SF-36 

neck pain (> 2 2 – TENS-Placebo by the same 4 – Healthcare utilization: 

months) and a 

pain score > 30 

mm on VAS (0­

100 mm) for 5 

of 7 pretreatment days 

therapist, n = 65 daily consumption of 

acetaminophen tablets 

5 – ADVERSE EVENTS: 

increase in symptoms, 

faintness, swelling of the 

hand, bruising, mild 

headache, euphoria and 

enhanced vision, dizziness 

Data measured 

immediately post 

treatment, 8 weeks and 6 

mo, 12 mo 

Sator­ 21 % male: 28.5 Chronic cervical 1 – M-Au-Acupuncture, n = 11 Once/week 1 – Pain: VAS (no 4/13 

Katzenschlager pain (≥ 6 mo), numerical data) 

SM Mean age: 52 normal 2 – EI-Au-Acupuncture, n = 10 6 weeks 2 – Quality of Life: well­

(2003)228 years neurologic 

function, of Treatment provider: NR 

being(no numerical data) 

3 – Utility of conventional 

Austria cervical nerves 

with no pain 

radiation, 

neural or spinal 

care: utilization of rescue 

medication 

4 – ADVERSE EVENTS: 

no harms reported 

structure 

pathology, 

VAS≥5 

Data measured at 3 mo 

Nabeta, T 34 % male: 29.4 Patients with 1 – Acupuncture by well- trained 3 1 – Pain: VAS (0-10); PPT 5/13 

(2002)229 chronic acu instructors, n = 17 treatments 2 – ADVERSE EVENTS: 

Mean age: 32.5 pain/stiffness in at weekly no harms reported 

Japan years neck and 2 – Sham-Acupuncture by the intervals 

shoulder same instructors, n = 17 Data measured at 3 weeks 

without arm 3 weeks and 3 mo 

symptoms 

Table 2.5 Neck Pain - Acupuncture - Mixed - Specific Pain 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Bin, X 57 % male: 26.3 35-68 years; 1 – Electro-acupuncture, n = 29 20 1 – Therapeutic effects 5/13 

(2007)230 

Mean age: NR 

diagnostic 

criteria of 2 – Control-Simple acupuncture, 

treatments 2 – ADVERSE EVENTS: 

no harms reported 

NR western n = 28 

medicine Data measured 

Treatment provider: NR immediately post 

intervention 

Shang, Xiu-kui 80 % male: NR Diagnostic as 1 – Acupuncture, acupoint 1 treatment/ 1 – Pain: Scoring based on 

(2002)231 nerve-root Sitianxue, n = 50 2 days Chinese Medical 

Mean age: NR cervical 9 Diagnostic and therapeutic 

China spondylopathy 

using Chinese 

Medical 

Diagnostic 

Standard 

2 – Acupuncture, acupoint 

Jiajixue, n = 30 

Treatment provider: NR 

treatments/ 

course, 3 

courses 

Effective Standard for 

Neck Disease 

2 – Quality of Life: Scoring 

based on Chinese Medical 

Diagnostic and therapeutic 

Effective Standard for 

Neck Disease 

3 – ADVERSE EVENTS: 

no harms reported 

Data measured 

immediately post 

intervention 

Li, Xiang-hui 780 % male: 46.4 Patients 1 – Acupuncture Centro-square 20 1 – Quality of Life: well­ 4/13 

(2004)232 

Mean age: 49 

diagnosed as 

cervical 

needling Danzhui, n = 260 treatments being based on Chinese 

Medical Diagnostic and 

China years spondylosis 2 – Acupuncture needling 20 days therapeutic Effective 

using Chinese cervical Jiaji point, n = 260 Standard 

Medical 2 – ADVERSE EVENTS: 

Diagnostic and 3 – Traction-Massage, n = 260 no harm reported 

Effectiveness 

Standard Treatment provider: NR Data measured 

immediately post 

intervention and 1 yr 

Zhang, Honglai 120 % male: 54.2 Diagnosed as 1 – Electro-acupuncture, n = 60 45 1 – Pain: McGill PRI; VAS; 6/13 

(2003)84 

Mean age: NR 

Cervical 

Spondylosis 2 – Traction, n = 60 

treatments PRI 

2 – Quality of Life: Cure, 

China using ref[1] 

1993-Chinese; Treatment provider: NR 

45 days, 2 

days rest 

improved, effective, no 

effect 

compliant to between 3 – ADVERSE EVENTS: 

treatment, courses-3 no harms reported 

responded to courses 

surveys Data measured after each 

of the 3 courses 

I-39
 
Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Zhuang, Li-Xing 34 % male: 29.4 Patients 1 – Pressed Acupuncture at the 21 1 – Quality of Life: well 4/13 

(2004)233 diagnosed as Baihui acupoint + Local Electro­ treatments being: scoring based on 

Mean age: 53.5 vertebral artery Acupuncture by trained Chinese Medical 

China years type of cervical professionals, n = 17 21 days Diagnostic and therapeutic 

spondylosis by Effective Standard 1995 

Western 

Medicine, 36-72 

2 – Local Electro-Acupuncture by 

trained professionals, n = 17 

2 – ADVERSE EVENTS: 

no harms reported 

years, duration 

1 mo-5 yr, also Data measured 

diagnosed by immediately post 

Chinese 

medicine 

intervention 

Lin, M 100 % male: 65 Cervical 1 – Needle scalpel combined 21 1 – Quality of Life: Cure 3/13 

(2004)234 

Mean age: 46 

spondylopathy 

of nerve root 

with Massage therapy, n = 50 treatments 2 – ADVERSE EVENTS: 

no harms reported 

China years type, aged 25­ 2 – Simple Massage therapy, n = 3 months 

76 years 50 Data measured 

immediately post 

Treatment provider: NR intervention 

Chu J 164 % male: 34.8 Neck and arm 1 – Acupuncture (dry needling)­ NR 1 – Pain: ≤ 50% pain relief 1/13 

(1997)235 

Mean age: NR 

pain, MPS due 

to cervical 

tender points, n = 122 2 – ADVERSE EVENTS: 

no harms reported 

US nerve root 2 – Acupuncture (dry needling)­

irritation random points, n = 42 Data measured 

immediately post 

Treatment provider: NR intervention 

Zhu, HZ 221 % male: 50.8 18-75 years 1 – Needle-knife therapy, n = 115 9 1 – Pain: Overall efficiency 4/13 

(2006)236 with cervical treatments 2 – ADVERSE EVENTS: 

Mean age: 46.3 spondylosis 2 – Acupuncture, n = 106 1 treatment/ no harms reported 

China years 

Treatment provider: NR 

3-5 days 

Data measured at 6 mo 

Cun-sheng jia, 98 % male: 51 Diagnosed as 1 – Otopoint-penetrative needling 30 minutes 1 – Pain: SF-MPQ 5/13 

Jing Shi, Xio­ cervical by a neuropathy doctor, n = 49 total 2 – ADVERSE EVENTS: 

shun Ma, Xiao- Mean age: NR spondylosis no harms reported 

feng Li, Ying according to 2 – Otopoint-straight needling by 

Wang, Jing-lan "The diagnostic the same doctor, n = 49 Data measured 

Wang criteria for immediately post 

(2007)237 cervical 

spondylosis"; 

intervention 

China NP; consent 

Yuan-fang 107 % male: 65.5 Numbness, NP 1 – Acupuncture at Jiquan (HT1) 10 sessions 1 – Physical Measures: 4/13 

Huang, Tai-fen and radiating with lifting thrusting manipulation Traditional Chinese 

Wang, Yan liu, Mean age: 42.1 pain towards by a neuropathy doctor, n = 37 20 days medicine diagnostic 

Shi-xing Zhang years upper limb efficacy standards: cure, 

(2008)238 2 - Acupuncture at Jiquan (HT1) effective, ineffective 

with twirling manipulation by the 2 – ADVERSE EVENTS: 

China same doctor, n = 36 no harms reported 

3 – Routine needling by the 

same doctor, n = 34 

Data measured 

immediately post 

intervention 

Xi lin Wang 102 % male: 51 NP, neck 1 – Shu-needling + Electro­ 30 sessions 1 – Disability: Efficacy of 4/13 

(2008)239 pressure pain Acupuncture by a neuropathy TCM diagnostic criteria 

Mean age: 44.2 and/or radiating doctor, n = 51 30 days 2 – ADVERSE EVENTS: 

China years pain no harms reported 

2 – Routine needling + ElectroAcupuncture by a neuropathy 

doctor, n = 51 

Data measured 

immediately post 

intervention 

Zhang, W 96 % male: 60.9 Patients with 1 – Acupuncture + 9 sessions 1 – Quality of Life: Cure 0/13 

(2005)240 cervical Massage/Manipulation, n = 64 rate; total effective rate 

Mean age: NR sponodylosis 3 weeks 2 – ADVERSE EVENTS: 

China 2 – Control-Massage, n = 32 

Treatment provider: NR 

no harms reported 

Table 2. 6 Neck Pain - Acupuncture - Mixed Duration of Disorder - Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups (no. of Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) patients) and treatment follow-up score 

size Treatment 

duration 

Fu ZH 

(2007)241 

47 % male: 32.5 18-80 years, 

TrP in 

1 – FSM-Along (insertion along 

the local muscle fibres pointed to 

One 

treatment 

1 – Pain: MRP scores; 

PUP scores 

4/13 

Mean age: NR neck/upper the MTrP), n = 22 (24 hrs) 2 – ADVERSE EVENTS: 

China back for 10 no harms reported 

days-1 yr 2 – FSM-Across (insertion across 

the local muscle fibres pointed to Data measured 

Acute – sub- the MTrP), n = 25 immediately post 

acute intervention 

Treatment provider: NR 

I-40
 
Table 2. 7 Neck Pain - Acupuncture – Unknown duration of disorder - Specific Pain 

Study ID Total Population Eligibility Randomized Groups (no. of Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) patients) and treatment follow-up score 

size Treatment 

duration 

Liang, Z 108 % male: 18.9 18-60 years; no 1 – Acupuncture, n = 54 3 weeks 1 – Pain: Northwick Park 

(2009)242 

Mean age: 33.9 

acupuncture 

treatment for 2 – Control-Acupuncture, n = 54 

NP Questionnaire 

2 – Disability: not 

China years NP within 6 mo; 

signed consent 

form 

Treatment provider: NR 

measured 

3 – number of all 

effect/number of total 

patients 

4 – ADVERSE EVENTS: 

no harms reported 

Data measured 

immediately post 

intervention 

Zheng, Ling 60 % male: NR No surgery; 1 – Point-through-point 30 1 – Pain: Number of 5/13 

(2005)243 

Mean age: 52 

Diagnostic as 

cervical 

Acupuncture, n = 30 treatments patients who have painChinese paper, Internal 

China years spondylopathy 

by ref[1]-A 

Chinese paper; 

coronary heart 

disease, 

rheumatism 

2 – General Acupuncture, n = 30 

Treatment provider: NR 

30 days(2 

courses), 3 

days 

between 

courses 

Medical Disease Diagnosis 

standard 

2 – Quality of Life: wellbeing, scoring based on 

Ref[1] 

3 – ADVERSE EVENTS: 

no harms reported 

Data measured 

immediately post 

intervention 

Xi-lin Wang, Hai­ 120 % male: 54.2 Diagnosed as 1 – Needle retention at GV 20 for 30 sessions 1 – Pain: NR 3/13 

yan Huang Cervical 8 hrs and Electro-Acupuncture at total 2 – Quality of Life: Cured 

(2007)244 Mean age: 47.8 Spondylosis local points by a neuropathy 3 – ADVERSE EVENTS: 

years according to doctor, n = 60 30 days no harms reported 

China "Chinese 

medicine 2 – Needle retention at GV 20 for Data measured 

clinical research 30 min and Electro-Acupuncture immediately post 

guiding 

principles" 

at local points by the same 

doctor, n = 60 

intervention 

Fu, W 158 % male: 55.1 Western 1 – Needle picking Acupuncture, 8 1 – Pain: PRI 3/13 

(2005)245 

Mean age: 34.5 

Medical and 

Chinese 

n = 56 treatments 2 – Quality of Life: Wellbeing, scoring based on 

China years Medical 

Diagnostic 

Standards to 

Diagnostic 

2 – Local anaesthesia, n = 47 

3 – Normal Acupuncture, n = 55 

Treatment provider: NR 

4 weeks Chinese paper ref[1] 

3 – ADVERSE EVENTS: 

too much pain to continue 

treatment, scars left after 

treatment 

Data measured 

immediately post 

intervention 

Edwards J 40 % male: 30.7 Patients aged ≥ 1 – SDN + Stretching exercise, n 3 weeks 1 – Pain: SFMPQ; PPT 6/13 

(2003)246 18 years with = 14 2 – ADVERSE EVENTS: 

Mean age: 56.3 active MTrPs, no harms reported 

UK years consent and 2 – Stretching exercise, n = 13 

compliance Data measured at 3 weeks 

2 – No treatment, n =13 and 3 mo 

Treatment provider: NR 

Duann, J 72 % male: NR Cervical 1 – Mini scalpel-needle (MSN) One 1 – Pain: pain intensity 2/13 

(2007)247 myofascial pain Treatment, n = 36 treatment VAS 

Mean age: NR syndrome (30 s, 30 2 – Disability: NP and 

Taiwan 2 – Lidocaine Trigger Point 

Treatment, n = 36 

Treatment provider: NR 

min 

observation) 

Disability CAS (NPDVAS) 

3 – Tripper Point 

Evaluation 

4 – ADVERSE EVENTS: 

no harms reported 

Data measured at 2 

weeks, 2 and 3 mo 

Table 2. 8 Neck Pain - Acupuncture - Unknown - Non-Specific Pain – No studies 

Table 2. 9 Neck Pain - Manipulation & Mobilization Therapies - Acute - Specific Pain – No studies 

I-41
 
Table 2. 10 Neck Pain - Manipulation & Mobilization - Acute - Non-Specific Pain 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Buchmann, J 

(2005)248 

27 % male: 57.3 18 -80 years, 

manually 

1 – Spinal Manipulation by a 

neurologist experienced in 

NR 1 – Disability: Number of 

found dysfunctions in 

7/13 

Mean age: 46.3 diagnosed manual and osteopathic motion segments 

Germany years dysfunction of medicine, n = 10 2 – ADVERSE EVENTS: 

one or both of no harms reported 

the segments 2 – Postisometric Relaxation 

occipital/cervica (mobilization) by the same Data measured 

l 1 and cervical neurologist, n = 8 immediately post 

1/cervical 2 intervention 

3 – Placebo by the same 

neurologist, n = 8 

Pikula, J 36 % male: 22 Acute unilateral 1 – Spinal Manipulative Therapy One single 1 – Pain: VAS (100 mm)(0­ 4/13 

(1999)249 NP; no prior (SMT) applied to same side as treatment 100) for pain intensity 

Mean age: 42.1 similar history; pain (ipsilateral) by a 2 – Disability: CROM for 

Brantford, ON yrs no history of chiropractor, n = 12 cervical range of motion 

trauma; no 

neurological 2 – SMT applied to opposite side 

3 – ADVERSE EVENTS: 

no harms reported 

deficit; no of pain (contralateral) by the 

previous same chiropractor, n = 12 Data measured at end of 

chiropractic treatment session 

treatment of 3 – Placebo Ultrasound Therapy, 

cervical spine n = 12 

Yurkiw, D 14 Male (%): 27.3 Unilateral neck 1 – manipulation by a Single 1 – Pain: VAS (0 – 10) 7/13 

(1996)250 

Mean age: 37.4 

pain chiropractor, n = 7 treatment 

session 

lower values better 

2 – Physical Measures: 

Canada years 2 – mechanically assisted 

manipulation by the same 

chiropractor, n = 7 

range of motion 

3 – ADVERSE EVENTS: 

no harms reported 

Data measured 

immediately post 

intervention 

Gonzalez­ 45 Male (%): 53.4 Mechanical 1 - thoracic spine thrust Once per 1 – Pain: VAS 100 mm- 9/13 

Iglesias, J neck pain manipulation + electro thermal week (5 lower values better 

(2009)251 Mean age: 34.5 

years 

therapy, n = 23 electro/ther 

mal 

2 – Disability: Northwick 

Pain Questionnaire - 

2 – electrothermal therapy, n = therapy) Spanish version (max 

22 score = 36) 

3 weeks 

Treatment provider: NR Measured at 2 and 4 week 

Table 2. 11 Neck Pain - Manipulation & Mobilization - Chronic - Specific Pain – No studies 

Table 2. 12 Neck Pain - Manipulation & Mobilization - Chronic - Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups (no. of Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) patients) and treatment follow-up score 

size Treatment 

duration 

Giles, LG 115 % male: 54.9 At least 17 1 – Acupuncture (LB, Neck, 2 1 – Pain: pain intensity and 5/13 

(2003)17 252 

Mean age: 26.1 

years with 

uncomplicated 

Thorax), n = 36 treatments/ 

week 

frequency neck VAS-lower 

values better 

Australia years mechanical 

spinal pain for 

minimum of 13 

weeks 

2 – Spinal Manipulation by a 

chiropractor, n = 36 

3 – Medication that has not been 

tried by patients randomized to 

this group by a sports physician, 

n = 43 

Up to 9 

weeks 

2 – Disability: NDI; 

Oswestry-lower values 

better 

3 – Quality of Life: SF-36­

higher values better 

4 – ADVERSE EVENTS: 

no harms reported 

Data measured 

immediately post 

intervention 

Giles, LGF 40 % male: 35.7 Patients 1 – Acupuncture, n = 10 6 1 – Pain: VAS 1/13 

(1999)129 

Mean age: 41.3 

suffering from 

NP for at least 2 – Manipulation, n = 20 

treatments 2 – Disability: ODI 

3 – ADVERSE EVENTS: 

Australia years 13 weeks, at 

least 18 years 

of age 

3 – Medication, n = 10 

Treatment provider: NR 

3-4 weeks no harms reported 

Data measured 

immediately post 

intervention 

Sloop, P 39 Male (%): 33 19-68 years 1 – manipulation by a Single 1 – Pain: VAS (0 – 8) 5/13 

(1982)253 with non- rheumatologist experienced in treatment 

Mean age: 49 specific or manipulation, n = 21 session Measured immediately 

NR years cervical post intervention and at 3, 

spondylosis NP 2 – no treatment (delayed 12 week 

manipulation) by a physician, n = 

18 

I-42
 
Study ID Total Population Eligibility Randomized Groups (no. of Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) patients) and treatment follow-up score 

size Treatment 

duration 

Cleland, J 

(2005)254 

36 % male: 24.9 18 – 60 yrs with 

primary 

1 – Thoracic Spine Manipulation 

by a licensed physical therapist, 

One 

treatment 

1 – Pain: VAS to assess 

resting pain (0-100 mm) 

7/13 

Mean age: 35.5 complaint of n = 19 2 – Disability: NDI to 

New Hampshire, yrs mechanical NP, assess perceived disability 

US referred by 2 – Placebo Manipulation by the due to NP 

primary care same therapist, n = 17 3 – ADVERSE EVENTS: 

physician to no harms reported 

outpatient 

orthopaedic Data measured at end of 

physical single treatment 

therapy clinic. 

Bischoff, A 49 Male (%): NR Non-specific 1 – osteopathic intervention + Once every 1 – Pain: pain intensity 1/13 

(2003)255 

Mean age: NR 

neck pain sham ultrasound, n = 24 2 weeks 

(ultrasound 

2 – ADVERSE EVENTS: 

no harms reported 

NR 2 – sham ultrasound, n = 25 was given 

one per Data measured 

Treatment provider: NR week) immediately post 

10 weeks 

intervention 

Chen, L 70 Male (%): 57.5% Patients with 1 - Spinal manipulation, n = 36 20 to 30 1 – Pain (numeric rating 7/13 

(2007)256 cervicogenic minutes scale, NRS) 

Mean age: 42 headache > 6 2 – TENS, n = 34 every 2 2 – ROM 

China years months without days 3 – ADVERSE EVENTS: 

drug therapy in Treatment provider: NR no information reported 

3 months 10 sessions 

in total 

Haas, M 

(2004)257 

24 Male (%): 18% Patients 18 

years and older 

1 – Spinal manipulation by 

chiropractors with 3-9 years 

3, 9, or 12 

sessions of 

1 – Pain intensity and 

number of headaches in 

7/13 

Mean age: 40 and experience, 3 sessions, n = 8 manipulatio past 4 weeks 

U.S. years uncomplicated n were 2 – Neck pain 

chronic 2 – Spinal manipulation by the compared 3 – Disability due to 

cervicogenic same chiropractors, 9 sessions, headache 

headaches for n = 8 4 – Disability due to neck 

at least 3 pain 

months 3 – Spinal manipulation by the 

same chiropractors, 12 sessions, Immediate, short term and 

n = 8 intermediate follow up 

Co-intervention for all groups: 

massage and other treatments 

Bokine, P 126 Male (%): Patients 18 1 – Spinal manipulation by 20 minutes, 1 – Pain (0 – 5) 1/13 

(1995)258 years and older general practitioner, n = 70 twice a 2 – quality of life 

and chronic week 3 – AE 

U.S. cervicogenic 2 – medication (Amitriptyline) by 

headaches for general practitioner, n = 56 6 weeks Immediate, short term and 

at least 3 intermediate follow ups 

months 

Ouseley, BR 11 Male (%): 35% Patients with 1 – Spinal manipulation by Maximum of 1 – Pain (NRS, 0 – 10) 5/13 

(2002) 259 chronic clinician with at least 3 years 8 sessions 2 – Neck disability index 

Mean age: 40 headache experience, n = 5 (NDI) 

U.K years (tension type) 4 weeks 3 – ADVERSE EVENTS: 

2 – Spinal mobilization, n = 6 no information reported 

Nilsson, N 54 Male (%): 43% Patients 20 to 1 – Spinal manipulation by 2-week 1 – Pain (VAS headache) 7/13 

(1997)260 60 years with registered chiropractor, n = 28 observation 2 – change in medication 

Mean age: NR headache >= 5 period, use 

Denmark (median 37 years) days per month 2 – massage by registered followed by 

for at least 3 chiropractor, n = 25 six sessions Immediate post treatment 

months in of SM follow up 

occipital region 

3 weeks 

Whittingham, W 105 Male (%): 41% Patients with 1 – Spinal manipulation by 2- week 1 – Pain intensity (head 8/13 

(2001)261 (cross cervicogenic experienced chiropractor observation and neck) 

over Mean age: 40 headache for period 2 – Pain frequency 

design) years longer than 6 2 – Placebo manipulation by 3 – change in medication 

Australia months, 

headache in 

occipital region 

experienced chiropractor 

3 – No treatment 

SM, 

placebo 

SM, and no 

treatment 3 

weeks each 

use 

3 – ADVERSE EVENTS: 

no information reported 

Data for 1st phase is used 

9 weeks 

trial duration 

Sterling, M 30 (cross Male (%): 50% Patients with 1 –Spinal mobilization, n = 10 Once per 1 – Pain (VAS) 7/13 

(2001)262 over 

design) Mean age: 36 

mid to lower 

cervical spine 2 – Sham mobilization, n = 10 

treatment 2 - Pressure Pain 

Threshold 

Canada years pain of 

insidious onset, 3 – no treatment, n = 10 

3 –EMG activity 

4 – ADVERSE EVENTS: 

greater than 3 no data reported 

months Treatment provider: NR 

duration 

I-43
 
Table 2. 13 Neck Pain - Manipulation & Mobilization – Mixed - Specific Pain 

Study ID Total Population Eligibility Randomized Groups (no. of Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) patients) and treatment follow-up score 

size Treatment 

duration 

Fernandez-de­ 88 % male: 45 Suffering from 1 – Dorsal Manipulation + 15 sessions 1 – Pain: VAS (0-100) 6/13 

las-Penas, C neck and head Physiotherapy, n = 44 2 – ADVERSE EVENTS: 

(2004)263 Mean age: 31.2 

yrs 

pain due to 

whiplash injury 2 – Physiotherapy, n = 44 

no harms reported 

Spain of less than 3 

months and Treatment provider: NR 

Data measured at end of 

treatment sessions 

classified in 

grades II and III 

Coppieters, M 20 Male (%): 40% Patients with 1 – cervical mobilization by Single 1 – Pain perception during 5/13 

(2003)264 cervicobrachial trained manipulative therapist, n treatment NTPT1 - neural tissue 

Mean age: 48.5 pain of 2 – 6 = 10 session of 3 provocation testing for 

Belguim years months 

duration due to 

neurogenic 

disorders 

2 – Ultrasound, n = 10 

repetitions median nerve 

Table 2. 14 Neck Pain - Manipulation & Mobilization - Mixed - Non-Specific Pain 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Hurwitz, E 

(2002)265 

336 % male: 31.2 18-70 years 

belonging to a 

1 – Manipulation by a 

chiropractor, n = NR 

4 weeks 1 – Pain: 11-pt NRS most 

severe pain in last week; 

7/13 

Mean age: 45.7 health average pain intensity 

California, US yrs maintenance 2 – Manipulation with heat, n = during past week-11-pt 

organization; NR NRS 

seeking care 2 – Disability: NDI (0-50) 

between Feb 3 – Manipulation with Electrical 3 – Quality of Life: SF-36 

9/98- June Muscle stimulation, n = NR physical function, physical 

30/00 role 

presenting with 4 – Manipulation with heat and 4 – Work: Job Demands 

NP; not having electrical muscle stimulation, n = Questionnaire 

received NR 5 – ADVERSE EVENTS: 

treatment for Transient minor discomfort 

NP in past mo 5 – Mobilization, n = NR 

Data measured at 4 

Unknown ( 6 – Mobilization with heat, n = weeks, 3 and 6 mo, and 1 

NR yr 

7 – Mobilization with electrical 

muscle stimulation, n = NR 

8 – Mobilization with heat and 

electrical stimulation, n = NR 

Cassidy, J 100 Male (%): NR Mechanical 1 – manipulation by an Single 1 – Pain: numerical rating 6/13 

(1992)266 neck pain with experienced clinician, n = 52 treatment scale (0 – 100)- lower 

Mean age: 36 radiation into session values better 

Canada years the trapezius 2 – mobilization by an 2 – Physical measures: 

muscle experienced clinician, n = 48 range of motion 

3 – ADVERSE EVENTS: 

no harms reported 

Data measured 

immediately post 

intervention 

Martinez-Segura, 71 % male: 36.7 18 yrs or older 1 – Cervical HVLA by a therapist One 1 – Pain: VAS NP at rest 6/13 

R with mechanical with more than 5 years treatment (0-100 cm) 

(2006)267 Mean age: 37 yrs NP of at least 1 

mo; referred by 

experience, n = 34 2 – Disability: Cervical 

range of motion 

Alicante, Spain primary care 2 – Control (manual mobilization) 3 – ADVERSE EVENTS: 

physician to by the same therapist, n = 37 no harms reported 

private physical 

therapy and Data measured at end of 

osteopathy treatment 

clinic 

Haas, M 104 % male: 37 18 years and 1 – Manipulation-Supine HVLA of One 1 – Pain: VAS 100 mm for 8/13 

(2003)268 older; minimum cervical spine by 2 chiropractors, treatment NP 

Mean age: 42.6 pain level of 10 one with 20 years experience 2 – Disability: VAS 100 mm 

Portland, US on 100mm VAS and the other with 2 years, n = for Neck stiffness 

who had not 52 3 – ADVERSE EVENTS: 

received no harms reported 

cervical 2 – Sham Manipulation 

manipulation in 

preceding 48 

generated by computer algorithm 

by the same chiropractors, n = 52 

Data measured at end of 

treatment and 3 mo 

hrs 

Vernon, H 9 Male % = 67 Mechanical 1 – manipulation, n = 5 Single 1 – Pain: pressure pain 6/13 

(1990)269 Mean age: 38 neck pain (not treatment threshold (kg/cm2

) a t 4 

years defined) 2 – mobilisation, n = 4 session tender points 

Canada 2 – ADVERSE EVENTS: 

Mixes 

population, 

Treatment provider: NR no harms reported 

majority acute Measured immediately 

and sub-acute post treatment 

I-44
 
Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Cleland, JA 104 % male: 45 Subjects aged 1 - TS-M/M with thrust by a Single 1 - Pain: NPR 7/13 

(2007) 270 18-60 yrs with clinician with 9.7 (1-19) years treatments 2 - Disability: NDI 

Mean age: 43.2 primary experience, n= 30 session; 3 - Well-being: GROC 

US yrs complaint of duration: 3 4 - ADVERSE EVENTS: 

neck pain, and 2 - TS-M/M without thrust by the min no harms reported 

baseline same clinician, n= 30 

NDI=>10% 

Strunk, R 6 Male (%): 83% Patients 20- 65 1 – Cervical manipulation by 4 sessions 1 – Pain (VAS 0 – 100 6/13 

(2007)271 years with experienced licensed mm) 

Mean age: 48 primary chiropractor, n = 3 2 weeks 2 – Neck Disability 

U.S. years complaint of 3 – ADVERSE EVENTS: 

mechanical 

neck pain for at 

2 - Thoracic and sacroiliac joint 

manipulation by experienced 

no information reported 

least 4 weeks licensed chiropractor, n = 3 Immediate post treatment 

follow up 

Kanlayanaphotp 60 Male (%): 40% Patients with 1 – Ipsilateral unilateral Single 1 – Pain (VAS 0 – 100) 11/13 

orn, R (2009)272 mechanical posteroanterior mobilization by treatment 2 – Neck disability 

Mean age: 43 neck pain physical therapist, n = 30 3 – ADVERSE EVENTS: 

Thailand years provoked by 

neck 

movements or 

sustained 

2 – Random mobilization by 

physical therapist, n = 30 

no AE occurred 

pressure, 

unilaterally 

distributed for 

at least 1-week 

duration; and 

VAS score of 

>20 at rest 

Brodin, H 

(1983)273 

63 Male (%): NR Patients 27 to 

60 years; 

1 – Mobilization by 

physiotherapist, n = 23 

3 times per 

week 

1 – Pain 

2 – Mobility 

3/13 

Mean age: NR condition 

Sweden suitable for 2 – Sham mobilization, n = 17 3 weeks Immediate and short term 

manual therapy follow ups 

3 – Medication and information, n 

= 23 

Cointervention in group 1 and 2: 

medication and information 

Table 2. 15 Neck Pain - Manipulation & Mobilization - Unknown - Specific Pain 

Study ID Total Population Eligibility Randomized Groups (no. of Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) patients) and treatment follow-up score 

size Treatment 

duration 

Cilliers, K 30 Male (%): 40 (53 Cervical facet 1 – manipulation (top segment 8 1 – Pain: McGill pain 3/13 

(1998)274 vs. 27) syndrome and adjustment) by a chiropractor, n treatments questionnaire 

neck pain =15 2 – Disability: neck 

South Africa Mean age: 31 4 weeks disability index 

years 2 – manipulation (bottom 

segment adjustment) by a 

3 – Physical Measures: 

range of motion 

chiropractor, n = 15 

Data measured at 4 weeks 

and 3 mo 

Egwu, MONTHS 

(2008)275 

96 Male (%): 100% Patients 40 – 

50 years old 

1 – posteroanterior unilateral 

manipulation, n = 24 

3 times per 

week until 

1 – Pain (pain free patients 

at the end of treatment) 

1/13 

Mean age: 44 with cervical cured up to 

Nigeria years spondylosis 2 – Antero-posterior unilateral 4 weeks 2 – ADVERSE EVENTS: 

and severe manipulation, n = 24 no information provided 

neck pain with 

onset of within 3 - Cervical oscillatory rotation, n 

6 weeks at time = 24 

of entry to the 4 weeks 

trial 4 - Transverse oscillatory 

pressure, n = 24 

Treatment provider : therapists 

Table 2. 16 Neck Pain - Manipulation & Mobilization - Unknown - Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups (no. of Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) patients) and treatment follow-up score 

size Treatment 

duration 

van Schalkwyk, 

R (2000)276 

30 Male (%): 67 Mechanical NP 

with lateral 

1 – manipulation on the 

ipsilateral side, n = 15 

10 sessions 1 – Pain: numerical pain 

rating 101; McGill short 

1/13 

Mean age: 30 fixation 4 weeks form pain questionnaire 

South Africa years 2 – manipulation on the 2 – Disability: Neck 

contralateral side, n = 15 disability index 

3 – Range of motion 

Treatment provider: NR 

Measured immediately 

post intervention and at 1 

month 

I-45
 
Study ID Total Population Eligibility Randomized Groups (no. of Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) patients) and treatment follow-up score 

size Treatment 

duration 

Krauss, J 32 Male (%): 22 (14 Non-specific 1 – Manipulation by an Single 1 – Pain: Faces pain scale 9/13 

(2008)277 vs. 30) neck pain (C4 – orthopaedic manual physical treatment measuring pain at end of 

C7) aggravated therapist, n 22 session active R, L, and bilateral 

Oakland, US Mean age: 35 by active rotation in R and L 

years rotation 2 – No treatment by the same component 

therapist, n = 10 

Immediately post 

intervention 

Parkin-Smith, G 30 % male: 62.5 Patients 1 – Cervical Manipulation by a 6 treatment 1 – Pain: NPRS (0-100) 6/13 

(1998)278 

Mean age: 35.4 

between 16-60 

yrs; negative 

chiropractor, n = 13 sessions 2 – Disability: CMCC NDI 

(0-100) 

South Africa yrs Wallenberg’s 2 – Cervical and Upper Thoracic 3 weeks 3 – ADVERSE EVENTS: 

test; Manipulation, n = 17 no harms reported 

mechanical NP 

without Data measured at 3 weeks 

neurological or 

vascular deficit; 

no medication 

for NP during 

study 

Metcalfe, S 67 % male: 23.9 With NP or 1 – Manipulation by a physical One 1 – Physical Measures: 4/13 

(2006)279,280 

Mean age: 37 

headaches therapist, n = 46 treatment Neck muscle strength 

2 – ADVERSE EVENTS: 

Canada years 2 – Control-Manipulation by the no harms reported 

same therapist, n = 26 

Data measured 

immediately post 

intervention 

Table 2.17- Neck Pain – Spinal Manipulation – Chronic – Non-Specific Pain 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Bischoff, A 

(2003)255 

49 Male (%): NR Non-specific 

neck pain 

1 – osteopathic intervention + 

sham ultrasound, n = 24 

Once every 

2 weeks 

1 – Pain: pain intensity 

2 – ADVERSE EVENTS: 

1/13 

Mean age: NR (ultrasound no harms reported 

NR Chronic 2 – sham ultrasound, n = 25 was given 

one per Data measured 

Treatment provider NR week) immediately post 

intervention 

10 weeks 

Table 2.18- Neck Pain – Spinal Manipulation – Mixed – Non-Specific Pain 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Korthanis-de 183 % male: 39 Physiotherapy 1 – Manual therapy, by 6 1 – 1 – Pain: Perceived 7/13 

Bos, I or manual registered manual therapists who maximum of recovery-6-pt scale; mean 

(2003)281,282 Mean age: 45.5 

yrs 

therapy for NP 

in previous 6 

had followed a 3 years 

curriculum in manual therapy 

6 sessions pain during preceding 

week-11-pt scale 

Netherlands mo, surgery of 

neck or specific 

cause of NP 

Unknown (mix) 

after training in physiotherapy, n 

= 60 

2 – Physiotherapy, by 5 

physiotherapists, n = 59 

3 – General Practitioner care, n = 

64 

2 – 

maximum of 

12 sessions 

6 weeks 

3 – one 

session 

2 – Disability: NDI 

3 – Work: Absenteeism 

from paid, unpaid work due 

to NP 

4 – Utility of conventional 

care: Euro Quality of Life; 

N of patient taking 

prescription drugs; N of 

visits to general practice; N 

of sessions of manual 

therapy, physiotherapy; 

help from others; N of 

outpatient visits to medical 

specialist care 

5 – Cost: 52-week cost 

diary-Direct, Indirect costs 

6 – ADVERSE EVENTS: 

minor benign short term, 

reaction; increase in NP 

Data measured at 3 

months and 1 year 

Table 2.19- Neck Pain – Spinal Manipulation – Unknown – Non-Specific Pain 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up 

Quality 

score 

Cleland, J 68 Male % = NR Mechanical 1 – thoracic spine manipulation, Single 1 - Pain: VAS 2/13 

(2004)283 Age range: 18 – neck pain n = NR treatment 2 – ADVERSE EVENTS: 

60 years session no harms reported 

United States NR 2 – sham, n = NR 

Measured immediately 

Treatment provider NR post intervention 

I-46
 
Table 2.20- Neck Pain- Spinal Mobilization- Acute – Specific Pain – 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Kongsted, A 458 % male: 28.3 18-65 years 1 – Mobilization program, by one 1 – 1 – Pain: neck and 5/13 

(2007)284 with acute physiotherapist, n = 149 Maximum headache VAS (0-10)­

Mean age: 33.3 whiplash twice daily lower better 

Denmark years associated 

disorder 

2 – Information and advice, by 

research nurse, n = 153 

for 6 weeks 

2 – one 

2 – Disability: Neck 

Disability Scale (0-30) 

session lower better; SF-36 

Acute 3 – Cervical collar 3 – 2 weeks Physical health summary 

(immobilization) applied by collar + 4 3 – Work: Subjects with 

project nurse at initial phase and 

active mobilization as group 1 for 

weeks twice 

daily 

affected work disability, 

ability 

rest of study period mobilization 4 – Utility of conventional 

care: analgesics used; any 

other treatments other than 

study intervention 

5 – ADVERSE EVENTS: 

no harms reported 

Data measured at 1 year 

Table 2.21- Neck Pain- Spinal Mobilization- Acute – non-Specific Pain 

Table 2. 22 Neck Pain - Massage - Acute - Specific Pain – No studies 

Table 2. 23Neck Pain - Massage - Acute - Non-Specific Pain 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up 

Quality 

score 

Blikstad, A 

(2007)285 

45 % male: 44.7 Between 18-55 

yrs; Non1 – Activator Trigger Point Therapy (AtrPT) by a clinician, n 

One 

treatment 

1 – Pain: NRS (0-10); PPT 

(kg/cm2) (pressure 

10/13 

Mean age: 23.8 specific = 15 session algometer) 

England yrs unilateral or 2 – ADVERSE EVENTS: 

bilateral NP of 2 – Myofascial band therapy no harms reported 

4-12 weeks and (MBT), n = 15 

at least 4 on an Data measured at end of 

11pt NRS 3 – Sham Ultrasound (SUS), n = treatment 

15 

Sub-acute 

Table 2.24 Neck Pain - Massage - Chronic- Specific Pain 

Study ID Total Population Eligibility Randomized Groups (no. of Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) patients) and treatment follow-up score 

size Treatment 

duration 

Yagci, N 40 % male: 25 Diagnosis of 1 – Vapo-coolant spray and 3 1 – Pain: VAS; Pain 2/13 

(2004)286 myofascial pain stretch technique, n = 20 treatments/ threshold; Pain tolerance 

Mean age: 30.9 syndrome for at day 2 – Disability: Number of 

Turkey years least 6 mo 2 – Connective tissue massage, trigger points 

n = 20 3 – ADVERSE EVENTS: 

Chronic no harms reported 

Treatment provider: NR 

Data measured 

immediately post 

intervention 

Irnich D 177 % male: 34 Patients with 1 – Acupuncture by experienced 5 sessions 1 – Pain: VAS; PPT 4/13 

(2001)205,206 chronic NP (>1 and licensed acupuncturists, n = 2 – Quality of Life: SF-36: 

Mean age: 52.4 mo) and painful 56 3 weeks Role physical, Pain Index 

Germany years restriction of 

cervical spine 2 – Massage by experienced 

3 – ADVERSE EVENTS: 

mild reactions (slight pain, 

mobility, not physiotherapists, n = 60 sweating, LBP) 

received 

treatment two 3 – Sham Laser, n = 61 Data measured at 1 and 3 

weeks before 

the study 

weeks, and 3 months 

Cen, S 31 % male: 25.8 NP and loss in 1 – Traditional Chinese 1 – 18 1 – Pain: Northwick Park 4/13 

(2003)287 ROM for more Therapeutic Massage (TCTM) by sessions Neck Pain Questionnaire 

Mean age: 48.7 than 1 year a licensed acupuncturist, n = 10 over 6 (0-100)-higher score 

California, US years weeks 2 – Neck flexibility 

2 – Exercise Program, n = 10 3 – ADVERSE EVENTS: 

3 – Control-no treatment, n = 11 

2 – 

assuming 

no harms reported 

one session Data measured 

immediately post 

intervention 

I-47
 
Table 2. 25 Neck Pain - Massage - Chronic - Non-Specific Pain 

Study ID Total Population Eligibility Randomized Groups (no. of Frequency Outcomes and post- Quality 

Year Country sample (Gender, Age) patients) and treatment follow-up score 

size Treatment 

duration 

Zaproudina, N 

(2007)288 

102 % male: 34.2 Patients with 

chronic N-S NP, 

1 – Traditional bone-setting by an 

experienced Finnish bone 

5 sessions 1 – Pain: NP VAS 

2 – Disability: NDI 

Mean age: 41.5 aged 28-50 setters, n = 35 3 – ADVERSE EVENTS: 

Finland years years no harms reported 

2 – Physiotherapy by a 

registered therapist, n = 34 Data measured at 3 

months and 1 year 

3 – Massage by a 

physiotherapist, n = 33 

Sherman, K.J 64 % male: 31.2 20-64 years 1 – Massage by massage Up to 10 1 – Disability: NDI 8/13 

(2009)289 who had therapists, n = 32 massage 2 – Pain: 11-pt(0-10) NRS; 

Mean age: 57 received treatments SF-36 physical and mental 

US years primary care for 

NP at least 3 

months prior to 

the study 

2 – Self-care-book, n = 32 

10 weeks 

health component 

3 – Quality of Life: global 

improvement 

4 – Utility of health care: 

questions regarding use of 

other treatments during 

study period; use of 

medication in last week 

5 – ADVERSE EVENTS: 

increased soreness, 

discomfort or pain during 

treatment 

Data measured at 4, 10 

and 26 weeks 

Table 2. 26 Neck Pain - Massage - Mixed - Specific Pain 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of 

patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Lin, M 100 % male: 65 Cervical 1 – Needle scalpel combined 21 1 – Quality of Life: Cure 3/13 

(2004)234 

Mean age: 46 

spondylopathy 

of nerve root 

with Massage therapy, n = 50 treatments 2 – ADVERSE EVENTS: 

no harms reported 

China years type, aged 25­ 2 – Simple Massage therapy, n = 3 months 

76 years 50 Data measured 

immediately post 

Acute-Chronic Treatment provider: NR intervention 

Yi-zhen 52 % male: 55.8 Diagnosis of 1 – Traction and Massage, n = One 1 – Pain: treatment effect 1/13 

(2005)290 cervical 26 treatment rating scale 

Mean age: NR spondylopathy /day 2 – ADVERSE EVENTS: 

China owing to first 

attack or 

repeated 

attacks 

2 – Traction only, n = 26 

Treatment provider: NR 

5 

days/course 

1-2 courses 

no harms reported 

Data measured 

immediately post 

intervention 

Fernandes-de­ 40 % male: 42.5 At least 18 1 – Ischemic compression NR 1 – Pain: PPT(pressure 7/13 

las-Penas, C years old with technique, n = 20 pain threshold); VAS(2.5 

(2005)291 Mean age: 28.7 mechanical NP kg/cm2 of pressure on 

years for at least 2 2 – Transverse friction massage, MTrP) 

Spain weeks n = 20 2 – ADVERSE EVENTS: 

no harms reported 

Treatment provider: NR – 

vaguely stated as “therapist” Data measured 

immediately post 

intervention 

Zhang, W NR % male: 65.63 Cervical 1 – Acupuncture + Massage / 3x/week, for NR 0/13 

(2005) 240 

Mean age: NR 

spondylopathy Manipulation n = 64 3 weeks 

China 2- Massage (Control) n = 32 

Treatment provider: NR 

Fernandes-de­ 40 % male: 42.5 At least 18 1 – Ischemic compression NR 1 – Pain: PPT(pressure 7/13 

las-Penas, C years old with technique by physiotherapist, n = pain threshold); VAS(2.5 

(2005)291 Mean age: 28.7 mechanical NP 20 kg/cm2 of pressure on 

years for at least 2 MTrP) 

Spain weeks 

NR 

2 – Transverse friction massage, 

n = 20 

2 – ADVERSE EVENTS: 

no harms reported 

Data measured 

immediately post 

intervention 

I-48
 
Table 2. 27 Neck Pain - Massage - Mixed - Non-Specific Pain 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Gemmell, H 45 % male: NR Between 18-55 1 – Ischemic Compression (IC) One 1 – Pain: VAS (0-100); 9/13 

(2007)292 yrs with non- by a 4th year chiropractic student treatment Pressure Pain Threshold 

Mean age: 23.5 specific NP of trained by a chiropractor with 28 session (PPT-kg/cm2) 

England yrs at least 30mm 

on a VAS, and 

years clinical practice, n = 15 2 – ADVERSE EVENTS: 

no harms reported 

upper trapezius 2 – Trigger Point Pressure 

TP and 

decreased 

Release (TrPPR), n = 15 Data measures at end of 

treatment session 

cervical lateral 3 – Sham Ultrasound (SUS), n = 

flexion to the 

opposite side of 

the active upper 

trapezius TP 

15 

Hemmila, H 42 Male (%): 30% Patients 18 - 64 1 – Massage by experienced folk 5 sessions, 1 – Pain (million scale 5/13 

(2005)293 years; healer, n = 22 30 minutes adapted for neck pain) 

Mean age: 46.5 diagnosis of each 2 – Pain drawings 

tension neck 2 – Control: neither offered nor 3 – Health care utilization 

syndrome for at 

least one month 

denied any treatments, n = 20 5 weeks 4 – Sick leaves due to 

neck pain

 – Cervical ROM 

– self rated 

improvement of neck 

pain 

measured at immediate, 

short term, intermediate 

and long term follow ups 

Table 2. 28 Neck Pain - Massage - Unknown - Specific Pain – No Studies 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Hanten, W 60 Male (%): 30% Patients with 1 – Massage: occipital release One 1 – Pain: Pressure Pain 5/13 

(1997)294 

Mean age: 30 

one or more 

active or latent 

(traction), n = 20 treatment 

session 

Threshold (PPT-kg/cm2) 

U.S. years cervical and or 2 – Massage: head 

scapular trigger retraction/retraction-extension, n 

points without = 20 

any known 

orthopaedic 3 – No treatment, n = 20 

cardiovascular 

or neurological Treatment provider: NR 

conditions (“Examiner”) 

Hou CR 40 Male (%): NR clinically active, 1 - ischemic compression to pain One 1 – Pain: VAS (0-10); 2/13 

(2002)295 

Mean age: 43 

palpable MTrPs 

in a single side 

threshold, 60 sec, n =8 treatment 

session 

Taiwan years or both sides 2 - ischemic compression to pain 

threshold, 90 Sec, n =8 

3 - ischemic compression to 

Average of Pain Threshold and 

Pain Tolerance, 30 sec, n= 8 

4 - ischemic compression to 

Average of Pain Threshold and 

Pain Tolerance, 60 sec, 

n= 8 

5 - ischemic compression to 

Average of Pain Threshold and 

Pain Tolerance, 90 sec, n=8 

All treatments provided by an 

experienced physical therapist 

Fryer (2005)296 37 Male (%): 32.4 presence of 

latent MTrPs in 

1 - myofascial release, n = 20 One 

treatment 

1 – Pain: PPT 5/13 

Australia the upper 2 - sham myofascial release, n = session 

Mean age: 23.1 trapezius 17 

years muscle 

Treatment provider: NR 

I-49
 
Table 2. 29 Neck Pain - Massage - Unknown - Non-Specific Pain – No Studies 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Meseguerm, AA 54 Male (%): 30% Patients 19-41 1 - manipulation (stain/counter One 1 – Pain: VAS (0-10); 6/13 

(2006)297 years old with strain), n = 18 treatment Pressure Pain Threshold 

Mean age: 38 mechanical session (PPT-kg/cm2) 

Spain years neck pain, 2 - modified manipulation (stain/ 

tender point in 

the upper 

counter strain), n = 18 

trapezius 3 - no treatment, n= 18 

muscle either 

on the left or Treatment provider: NR (clinician 

right side. 

(mechanical 

with experience in management 

of mechanical NP) 

pain defined as 

a generalized 

neck and or 

shoulder pain 

with mechanical 

characteristics 

including 

symptoms 

provoked by 

maintained 

neck postures 

by movement or 

by palpation of 

the postures by 

movement or by 

palpation of 

cervical 

muscles) 

Table 3.1- Thoracic Pain – Manipulation – Unknown – Non-Specific Pain 

Study ID 

Year Country 

Total 

sample 

size 

Population 

(Gender, Age) Eligibility Randomized Groups (no. of patients) 

Frequency 

and 

Treatment 

duration 

Outcomes and posttreatment follow-up Quality 

score 

Schiller, L 

(2001)298 

30 % male: 47 Subjects 16-60 

years with 

1 – Experimental group, n = 15 Maximum of 

6 

1 – Pain: McGill; NRS-101 

2 – Disability: OSW 

2/13 

Mean age: NR diagnosis of 2 – Non-functional ultrasound, n treatments 

mechanical = 15 Data measured at end of 

thoracic spine 2-3 weeks treatment and 1 month 

pain Treatment provider NR 

I-50
 
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