title: The diagnosis and treatment of chronic back pain by acupuncturists, chiropractors, and massage therapists.
abstract: OBJECTIVE
  To describe the diagnostic and therapeutic content of visits for chronic back pain to acupuncturists, chiropractors, and massage therapists.
  
  
  METHODS
  Randomly selected acupuncturists, chiropractors, and massage therapists in two states were surveyed, and then eligible providers collected data on consecutive patient visits. The authors analyzed information on diagnosis, treatment, and self-care recommendations for chronic back pain patients collected during consecutive patient visits to these complementary and alternative medicine (CAM) providers.
  
  
  RESULTS
  Back pain was the most common reason for visits to each of these providers, with chronic back pain representing about 10% of visits to acupuncturists, 20% of visits to chiropractors, and 12% of visits to massage therapists. Diagnosis by acupuncturists included traditional questioning and inspecting the patient as well as pulse and tongue assessment and palpation of the acupuncture meridians. Treatments usually included acupuncture needling, heat of some sort, and other modalities, such as East Asian massage, herbs, and/or cupping (application of suction cups to the skin). Lifestyle recommendations were common, particularly exercise and dietary counseling. Visits to chiropractors usually included spinal and muscle/soft tissue examinations and spinal manipulation. Soft tissue techniques (eg, "active release"), stretch or strength training, and home exercise recommendations were much less common. Massage therapists usually performed a tissue assessment and commonly assessed range of motion. They emphasized Swedish, deep tissue, and trigger point massage techniques and usually made self-care recommendations, particularly increased water intake, hot/cold therapy, exercise, and body awareness.
  
  
  CONCLUSIONS
  Information on the care patients routinely receive from CAM providers will help physicians better understand these increasingly popular forms of care.
authors.affiliation: Center for Health Studies, Group Health Cooperative, Seattle, Washington 98101, USA. sherman.k@ghc.org
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Sherman
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Cherkin
authors.forename: Richard A
authors.initials: RA
authors.lastname: Deyo
authors.forename: Janet H
authors.initials: JH
authors.lastname: Erro
authors.forename: Andrea
authors.initials: A
authors.lastname: Hrbek
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.forename: David M
authors.initials: DM
authors.lastname: Eisenberg
mesh_terms: D015670:Acupuncture Therapy / Q000706:statistics & numerical data*; D000328:Adult; D001416:Back Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000706:statistics & numerical data*; D008405:Massage / Q000706:statistics & numerical data*; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology