title: Traditional Chinese medicine for neck pain and low back pain: a systematic review and meta-analysis.
abstract: BACKGROUND
  Neck pain (NP) and low back pain (LBP) are common symptoms bothering people in daily life. Traditional Chinese medicine (TCM) has been used to treat various symptoms and diseases in China and has been demonstrated to be effective. The objective of the present study was to review and analyze the existing data about pain and disability in TCM treatments for NP and LBP.
  
  
  METHODS
  Studies were identified by a comprehensive search of databases, such as MEDLINE, EMBASE, and Cochrane Library, up to September 1, 2013. A meta-analysis was performed to evaluate the efficacy and safety of TCM in managing NP and LBP.
  
  
  RESULTS
  Seventy five randomized controlled trials (n = 11077) were included. Almost all of the studies investigated individuals experiencing chronic NP (CNP) or chronic LBP (CLBP). We found moderate evidence that acupuncture was more effective than sham-acupuncture in reducing pain immediately post-treatment for CNP (visual analogue scale (VAS) 10 cm, mean difference (MD) = -0.58 (-0.94, -0.22), 95% confidence interval, p = 0.01), CLBP (standardized mean difference = -0.47 (-0.77, -0.17), p = 0.003), and acute LBP (VAS 10 cm, MD = -0.99 (-1.24, -0.73), p< 0.001). Cupping could be more effective than waitlist in VAS (100 mm) (MD = -19.10 (-27.61, -10.58), p < 0. 001) for CNP or medications (e.g. NSAID) for CLBP (MD = -5.4 (-8.9, -0.19), p = 0.003). No serious or life-threatening adverse effects were found.
  
  
  CONCLUSIONS
  Acupuncture, acupressure, and cupping could be efficacious in treating the pain and disability associated with CNP or CLBP in the immediate term. Gua sha, tai chi, qigong, and Chinese manipulation showed fair effects, but we were unable to draw any definite conclusions, and further research is still needed. The efficacy of tuina and moxibustion is unknown because no direct evidence was obtained. These TCM modalities are relatively safe.
authors.affiliation: Department of Orthopaedics of the First Affiliated Hospital, Medical School, Xi'an Jiaotong University, Xi'an 710061, China.
authors.forename: Qi-ling
authors.initials: QL
authors.lastname: Yuan
authors.affiliation: Second department of Orthopaedics, Xianyang Central Hospital, Xianyang, Shaanxi, P.R. 712000, China.
authors.forename: Tuan-mao
authors.initials: TM
authors.lastname: Guo
authors.affiliation: Department of Orthopaedics of the First Affiliated Hospital, Medical School, Xi'an Jiaotong University, Xi'an 710061, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics of the First Affiliated Hospital, Medical School, Xi'an Jiaotong University, Xi'an 710061, China; Department of Orthopaedics of the Affiliated Hospital of Xi'an Medical College, Xi'an 710077, China.
authors.forename: Fu
authors.initials: F
authors.lastname: Sun
authors.affiliation: Department of Orthopaedics of the First Affiliated Hospital, Medical School, Xi'an Jiaotong University, Xi'an 710061, China.
authors.forename: Yin-gang
authors.initials: YG
authors.lastname: Zhang
mesh_terms: D015670:Acupuncture Therapy; D002681:China; D016208:Databases, Factual; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008516:Medicine, Chinese Traditional; D019547:Neck Pain / Q000628:therapy*; D010147:Pain Measurement