Dr. Johnson is a primary care provider in the spinal cord injury clinic and Ms. Cosgrove works in quality management, both at the Orlando VAMC in Florida.
Rubinstein and colleagues reported low- to very-low-quality evidence that acupuncture provided a short-term clinically relevant effect compared with waiting list control or when it was added to another intervention for chronic low back pain. 38 Standaert and colleagues concluded that there was insufficient evidence to determine the relative effectiveness of acupuncture compared with either exercise or spinal manipulative therapy (SMT) in relieving chronic low back pain. 42 Yuan and colleagues reported strong evidence that acupuncture combined with conventional therapy was more effective than conventional therapy alone. 36
Furlan and colleagues found moderate evidence for significant improvement in pain intensity compared with subjects in physical therapy or usual care groups at short-term or immediate follow-up for chronic back pain. 35 Studies that evaluated the efficacy of acupuncture for knee osteoarthritis compared acupuncture with sham acupuncture controls or no additional treatment and found that acupuncture was significantly better at relieving knee pain. 39,40,43 Cao and colleagues found it to be effective both in the short term and long term. 39 White and colleagues and Kwon and colleagues were unable to draw a conclusion concerning long-term effects due to the data point included in the study or the heterogeneity in the results. 40,43
Trinh and colleagues reported moderate evidence that acupuncture is more effective for relief of chronic neck pain compared with inactive, sham treatments at immediate posttreatment. 8 They also found moderate evidence that acupuncture was more effective than some other types of sham controls immediately posttreatment and limited evidence that it was more effective than massage at short-term follow-up. 8 Furlan and colleagues found trials that applied sham acupuncture tended to produce nonstatistically significant results. 35 Their meta-analysis of 2 studies indicated no significant difference between acupuncture and sham acupuncture for immediate posttreatment pain intensity. They also reported inconsistent results for the effects of acupuncture compared with medication or with spinal manipulation for chronic neck pain. 35
Massage
Massage promotes health and well-being through the use of mechanical manipulation of body tissues with rhythmic pressure and stroking. 47 Treatment techniques include Hoffa massage, friction massage, connective tissue massage, transverse friction massage, and trigger point massage. 48 Massage is one of the most popular CAM therapies for neck and back pain. 49 In their survey, White and colleagues reported that active-duty military personnel listed massage as the most frequently used CAM therapy in the previous 12 months. 18
Patel and colleagues reported that the overall methodology of the trials assessed in their study was either low- or very-low-GRADE level. 32 They found very-low to low-quality evidence that there is no difference in effectiveness of 3 approaches of massage therapies (ischemic compression to upper fibre of trapezius trigger point, transverse friction massage to upper fibre of trapezius, and ischemic compression to upper fibre of trapezius) for neck muscle pain. They also reported no difference between conventional Western massage and acupuncture for generalized neck muscle pain at short-term follow-up, and no difference in pain intensity compared with other therapies such as acupuncture, manual therapy, exercise, education, and multimodal interventions. The investigators concluded that the effectiveness of massage therapy for improving neck pain remains unclear, as results could not be combined due to the wide range of techniques and comparative treatments. They were unable to make any firm statement to guide clinical practice. 32
