In 1999, a prospective, randomized clinical pilot trial conducted by Giles, et. al., at the specialized spinal pain syndrome outpatient unit of Townsville General Hospital, Queensland, Australia, aimed to compare the effectiveness of needle acupuncture, nonsteroidal anti-inflammatory medication, and chiropractic spinal manipulation in managing chronic spinal pain syndromes lasting over 13 weeks.

Seventy-seven eligible patients, without contraindications to manipulation or medication, were recruited for the study. The participants were randomly assigned to one of three clearly defined intervention protocols: needle acupuncture, nonsteroidal anti-inflammatory medication (tenoxicam with ranitidine), or chiropractic spinal manipulation.

The main outcome measures included changes observed over a 4-week period compared to the initial visit. Assessment tools comprised the Oswestry Back Pain Disability Index, Neck Disability Index, and three visual analogue scales measuring local pain intensity.

Successful randomization was achieved, and after a median intervention period of 30 days, spinal manipulation emerged as the sole intervention demonstrating statistically significant improvements. The results, expressed as percentages of the original scores, revealed a reduction of 30.7% on the Oswestry scale, a 25% improvement on the neck disability index, and notable reductions on the visual analogue scale – 50% for low back pain, 46% for upper back pain, and 33% for neck pain (all P<.001). In contrast, neither acupuncture nor nonsteroidal anti-inflammatory medication exhibited significant improvements on any of the outcome measures.

Despite acknowledged limitations in this pilot study, the consistent findings suggest that, for patients with chronic spinal pain syndromes, spinal manipulation, when not contraindicated, leads to greater improvements compared to acupuncture and medication. These results contribute valuable evidence to the ongoing discourse on effective interventions for chronic spinal pain, emphasizing the potential benefits of spinal manipulation in this patient population.

Reference: Giles, L. G., & Müller, R. (1999). Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. Journal of manipulative and physiological therapeutics, 22(6), 376-381.