Giles Lynton G F, Muller Reinhold
National Unit for Multidisciplinary Studies of Spinal Pain, The University of Queensland, The Townsville Hospital, Australia.
Spine (Phila Pa 1976). 2003 Jul 15;28(14):1490-502; discussion 1502-3. doi: 10.1097/00007632-200307150-00003.
A randomized controlled clinical trial was conducted.
To compare medication, needle acupuncture, and spinal manipulation for managing chronic (>13 weeks duration) spinal pain because the value of medicinal and popular forms of alternative care for chronic spinal pain syndromes is uncertain.
Between February 1999 and October 2001, 115 patients without contraindication for the three treatment regimens were enrolled at the public hospital's multidisciplinary spinal pain unit.
One of three separate intervention protocols was used: medication, needle acupuncture, or chiropractic spinal manipulation. Patients were assessed before treatment by a sports medical physician for exclusion criteria and by a research assistant using the Oswestry Back Pain Disability Index (Oswestry), the Neck Disability Index (NDI), the Short-Form-36 Health Survey questionnaire (SF-36), visual analog scales (VAS) of pain intensity and ranges of movement. These instruments were administered again at 2, 5, and 9 weeks after the beginning of treatment.
Randomization proved to be successful. The highest proportion of early (asymptomatic status) recovery was found for manipulation (27.3%), followed by acupuncture (9.4%) and medication (5%). Manipulation achieved the best overall results, with improvements of 50% (P = 0.01) on the Oswestry scale, 38% (P = 0.08) on the NDI, 47% (P < 0.001) on the SF-36, and 50% (P < 0.01) on the VAS for back pain, 38% (P < 0.001) for lumbar standing flexion, 20% (P < 0.001) for lumbar sitting flexion, 25% (P = 0.1) for cervical sitting flexion, and 18% (P = 0.02) for cervical sitting extension. However, on the VAS for neck pain, acupuncture showed a better result than manipulation (50% vs 42%).
The consistency of the results provides, despite some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication. However, the data do not strongly support the use of only manipulation, only acupuncture, or only nonsteroidal antiinflammatory drugs for the treatment of chronic spinal pain. The results from this exploratory study need confirmation from future larger studies.
进行了一项随机对照临床试验。
比较药物治疗、针刺疗法和脊柱推拿治疗慢性（病程超过13周）脊柱疼痛的效果，因为针对慢性脊柱疼痛综合征的药物及其他常用替代疗法的价值尚不确定。
1999年2月至2001年10月期间，115例无三种治疗方案禁忌证的患者在公立医院的多学科脊柱疼痛科入组。
采用三种独立干预方案之一：药物治疗、针刺疗法或整脊脊柱推拿。治疗前由运动医学医生评估患者的排除标准，研究助理使用奥斯威斯利背痛残疾指数（Oswestry）、颈部残疾指数（NDI）、简短健康调查问卷（SF-36）、疼痛强度视觉模拟量表（VAS）及活动范围对患者进行评估。这些工具在治疗开始后的第2、5和9周再次使用。
随机分组证明是成功的。脊柱推拿组早期（无症状状态）恢复比例最高（27.3%），其次是针刺疗法组（9.4%）和药物治疗组（5%）。脊柱推拿取得了最佳总体效果，Oswestry量表改善50%（P = 0.01），NDI改善38%（P = 0.08），SF-36改善47%（P < 0.001），背痛VAS改善50%（P < 0.01），腰椎站立前屈改善38%（P < 0.001），腰椎坐位前屈改善20%（P < 0.001），颈椎坐位前屈改善25%（P = 0.1），颈椎坐位后伸改善18%（P = 0.02）。然而，在颈部疼痛VAS方面，针刺疗法的效果优于脊柱推拿（50%对42%）。
尽管本研究存在一些讨论中的不足，但结果的一致性提供了证据，表明在慢性脊柱疼痛患者中，脊柱推拿（如无禁忌）在短期内比针刺疗法或药物治疗能带来更大改善。然而，数据并不强烈支持仅使用脊柱推拿、仅使用针刺疗法或仅使用非甾体抗炎药来治疗慢性脊柱疼痛。这项探索性研究的结果需要未来更大规模研究的证实。
