title: Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain.
abstract: BACKGROUND
  Because the value of popular forms of alternative care for chronic back pain remains uncertain, we compared the effectiveness of acupuncture, therapeutic massage, and self-care education for persistent back pain.
  
  
  METHODS
  We randomized 262 patients aged 20 to 70 years who had persistent back pain to receive Traditional Chinese Medical acupuncture (n = 94), therapeutic massage (n = 78), or self-care educational materials (n = 90). Up to 10 massage or acupuncture visits were permitted over 10 weeks. Symptoms (0-10 scale) and dysfunction (0-23 scale) were assessed by telephone interviewers masked to treatment group. Follow-up was available for 95% of patients after 4, 10, and 52 weeks, and none withdrew for adverse effects.
  
  
  RESULTS
  Treatment groups were compared after adjustment for prerandomization covariates using an intent-to-treat analysis. At 10 weeks, massage was superior to self-care on the symptom scale (3.41 vs 4.71, respectively; P =.01) and the disability scale (5.88 vs 8.92, respectively; P<.001). Massage was also superior to acupuncture on the disability scale (5.89 vs 8.25, respectively; P =.01). After 1 year, massage was not better than self-care but was better than acupuncture (symptom scale: 3.08 vs 4.74, respectively; P =.002; dysfunction scale: 6.29 vs 8.21, respectively; P =.05). The massage group used the least medications (P<.05) and had the lowest costs of subsequent care.
  
  
  CONCLUSIONS
  Therapeutic massage was effective for persistent low back pain, apparently providing long-lasting benefits. Traditional Chinese Medical acupuncture was relatively ineffective. Massage might be an effective alternative to conventional medical care for persistent back pain.
authors.affiliation: Center for Health Studies, Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Cherkin
authors.forename: D
authors.initials: D
authors.lastname: Eisenberg
authors.forename: K J
authors.initials: KJ
authors.lastname: Sherman
authors.forename: W
authors.initials: W
authors.lastname: Barlow
authors.forename: T J
authors.initials: TJ
authors.lastname: Kaptchuk
authors.forename: J
authors.initials: J
authors.lastname: Street
authors.forename: R A
authors.initials: RA
authors.lastname: Deyo
mesh_terms: D015670:Acupuncture Therapy / Q000191:economics; D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000191:economics; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008405:Massage / Q000191:economics; D008875:Middle Aged; D010353:Patient Education as Topic / Q000191:economics; D012648:Self Care / Q000191:economics / Q000379:methods