Giles L G, Müller R
National Unit for Multidisciplinary Studies of Spinal Pain, Townsville General Hospital, Queensland, Australia.
J Manipulative Physiol Ther. 1999 Jul-Aug;22(6):376-81. doi: 10.1016/s0161-4754(99)70082-5.
To compare needle acupuncture, medication (tenoxicam with ranitidine), and spinal manipulation for managing chronic (>13 weeks duration) spinal pain syndromes.
Prospective, randomized, independently assessed preintervention and postintervention clinical pilot trial.
Specialized spinal pain syndrome out-patient unit at Townsville General Hospital, Queensland, Australia.
Seventy-seven patients (without contraindication to manipulation or medication) were recruited.
One of three separate, clearly defined intervention protocols: needle acupuncture, nonsteroidal anti-inflammatory medication, or chiropractic spinal manipulation.
Main outcome measures were changes (4 weeks vs. initial visit) in the scores of the (1) Oswestry Back Pain Disability Index, (2) Neck Disability Index, and (3) three visual analogue scales of local pain intensity.
Randomization was successful. After a median intervention period of 30 days, spinal manipulation was the only intervention that achieved statistically significant improvements (all expressed as percentages of the original scores) with (1) a reduction of 30.7% on the Oswestry scale, (2) an improvement of 25% on the neck disability index, and (3) reductions on the visual analogue scale of 50% for low back pain, 46% for upper back pain, and 33% for neck pain (all P<.001). Neither of the other interventions showed any significant improvement on any of the outcome measures.
The consistency of the results provides, in spite of several discussed shortcomings of this pilot study, evidence that in patients with chronic spinal pain syndromes spinal manipulation, if not contraindicated, results in greater improvement than acupuncture and medicine.
比较针刺、药物治疗（替诺昔康与雷尼替丁联用）和脊柱推拿治疗慢性（病程超过13周）脊柱疼痛综合征的效果。
前瞻性、随机、独立评估的干预前和干预后临床试验。
澳大利亚昆士兰州汤斯维尔综合医院的脊柱疼痛综合征专科门诊。
招募了77名患者（无推拿或药物治疗禁忌证）。
三种明确界定的独立干预方案之一：针刺、非甾体类抗炎药或脊椎按摩推拿。
主要观察指标为（1）奥斯维斯特背痛功能障碍指数、（2）颈部功能障碍指数以及（3）三个局部疼痛强度视觉模拟量表评分在（干预4周后与初次就诊时相比）的变化。
随机分组成功。在中位干预期30天后，脊柱推拿是唯一在统计学上取得显著改善的干预措施（均以原始评分的百分比表示），具体为：（1）奥斯维斯特量表评分降低30.7%，（2）颈部功能障碍指数提高25%，（3）视觉模拟量表评分中，下背痛降低50%，上背痛降低46%，颈部疼痛降低33%（均P<0.001）。其他两种干预措施在任何观察指标上均未显示出显著改善。
尽管本初步研究存在一些讨论中的不足之处，但结果的一致性表明，对于慢性脊柱疼痛综合征患者，在无禁忌证的情况下，脊柱推拿比针灸和药物治疗能带来更大改善。
