Acupuncture offers relief from chronic neck pain, while there is little reliable evidence on the effectiveness of massage, according to two new systematic reviews.
Acupuncture does not “cure” neck pain, and relief appears to last only a few weeks or months. Patients may thus need periodic booster treatments, says lead study author Kien Trinh, M.D., of McMaster University in Canada.
The massage review concludes, “Due to the limitations of existing studies, we are unable to make any firm statement to guide clinical practice.” Bodhi Haraldsson, a registered massage therapist in British Columbia, Canada, led the study team.
The two studies are part of a series designed to summarize the most current scientific evidence on treatments for neck pain due to “mechanical” problems such as whiplash and muscle strains. Such injuries are common, disabling and costly.
Ten percent of males and 17 percent of females report neck pain that lasts longer than six months, according to a study cited in the massage review. Both new reviews excluded patients with neck pain caused by major illnesses or injuries such as viral infections or fractures.
The reviews appear in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
The acupuncture study comprised 10 trials with a total of 661 adult participants. The studies compared a number of acupuncture approaches to no treatment, sham treatments or other “manual therapies” such as mobilization, massage or traction. Most of the studies included at least five treatment sessions.
“The specific effects of acupuncture are short-term, but have important clinical treatment benefits,” conclude the review authors.
These findings are based on a wide range of patients, treatment techniques and outcomes, said Dr. Partap Khalsa at the National Center for Complementary and Alternative Medicine. The next step is to conduct more well-defined studies to “optimize” the findings, said Khalsa, who was not involved with either review.
For some subgroups of patients with mechanical neck disorders, he said, acupuncture may be the best treatment while different options may provide greater relief for others. “We just don’t know that right now.”
Trinh calls for larger and longer trials — preferably at least 500 patients and follow-up after a year or more — to further expand understanding of acupuncture treatment.
The review of massage techniques comprised 19 trials involving nearly 1,400 adults. The trials compared massage alone or in combination with other treatments to no treatment, sham treatments, mobilization, traction, acupuncture, exercise, education and pain medication.
The authors report that the overall quality of these trials was poor. “In some cases, it was questionable whether the massage in the study would be considered effective massage under any circumstance.” No firm conclusions can be drawn at this time, they conclude.
“One of the most important functions of the Cochrane Library is to demonstrate what we do not know,” according to Bandolier, an independent British journal focusing on evidence-based healthcare. “Good quality reviews that find no trials, no good trials or good trials with no effect are really important in delimiting the extent of our knowledge (or ignorance).”
The authors of the massage review call for pilot studies to define an optimal massage intervention — including techniques along with number, duration and frequency of treatment sessions — which can then be evaluated in subsequent larger trials. In short, said Khalsa, researchers must “go back to ground zero,” in studying massage treatments for chronic neck pain.
Khalsa said that many Americans — from the lay public to physicians and scientists — have preconceived beliefs about alternative treatments. Many are inclined to believe that acupuncture is ineffective while massage is helpful, and they may dismiss the recent findings.
The new information will be most useful for people “who are neutral, who are saying show me what the evidence actually is, and I will use that to inform my own decisions,” he said.
Khalsa advises patients to consider using such therapies to complement conventional medicine, rather than just as an alternative. “That’s something patients need to discuss with their physicians” who could include doctors of medicine, osteopathy, chiropractic and/or physical therapy.
Trinh KV, et al. Acupuncture for neck disorders (Review). The Cochrane Database of Systematic Reviews 2006, Issue 3.
Haraldsson BG, et al. Massage for mechanical neck disorders (Review). The Cochrane Database of Systematic Reviews 2006, Issue 3.
The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.
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