Last Updated: 2003-06-02 17:00:25 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Spinal manipulation, the back pain treatment most commonly offered by chiropractors, is no better or worse for treating low back pain than conventional treatments, such as exercise, pain killers and physical therapy, a team of doctors announced Monday.

Massage appears to be effective for persistent back pain, researchers report, but they say that more study is needed to determine what benefit, if any, acupuncture offers for treating back pain.

All of the methods seem to be relatively safe, the authors say.

"No therapy can lay claim to being 'the best,'" said lead investigator Dr. Paul G. Shekelle, of RAND in Santa Monica, California.

So what's a person suffering from back pain to do?

According to Shekelle, most back pain gets better even without treatment. "It is very rare for back pain to permanently disable you (but) recurrences are common," he said.

While there is no magic bullet to treat or prevent back pain, Shekelle advises that staying active is probably the best way to prevent the problem.

"All advocated therapies -- exercises, spinal manipulation, etcetera -- are about the same on average in terms of efficacy, although on an individual basis it is clear that some therapies work better than others," he said. "Find one that works best for you."

The findings are based on two new studies published in the journal Annals of Internal Medicine.

According to the researchers, more than 50 percent of Americans experience back pain each year, and many seek out chiropractors, massage therapists and acupuncturists to relieve this pain.

But little scientific research has been conducted to see how these methods stack up to more conventional methods, Shekelle explained in an interview with Reuters Health.

To investigate, the researchers combined previously published studies that compared alternative back pain treatments -- spinal manipulation, massage therapy and acupuncture -- to traditional remedies, such as medications, physical therapy, exercise and educational material about prevention and pain management.

The first study focused on spinal manipulation and evaluated the results of 39 previously published studies.

Spinal manipulative therapy was defined as any treatment that included the movement of the vertebrae of the spine by applying force through the hands of the practitioner in order to relieve pain and improve function. Specially trained individuals such as chiropractors, osteopathic physicians or physical therapists commonly give this treatment.

"For the purposes of our study, it included (both) spinal mobilization -- which is more gentle -- and spinal manipulation, which is more forceful and produces the audible 'popping' noise patients commonly associate with this treatment," Shekelle said.

"The reason we did not try and distinguish between the two ... in our paper is that in many of the reports we reviewed it was unclear which type of therapy was being given," he added.

Based on this analysis, "there is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain," the researchers report.

"Previous work has shown spinal manipulation to be better than a sham manipulation -- similar to a placebo -- and better than bed rest, the use of a corset ... or to a collection of these types of therapies loosely designated as 'medical therapy,'" said Shekelle.

"These findings were interpreted by advocates of manipulation as indicating that spinal manipulative therapy was 'the' choice of therapy for patients with back pain," said Shekelle.

"Our study should temper some of this enthusiasm by demonstrating that, on average, there is no difference in outcomes for patients treated with spinal manipulative therapy compared to other recommended care, like analgesics, exercises, or physical therapy," he said.

In the second study, the researchers evaluated studies that assessed the effectiveness, safety and cost effectiveness of spinal manipulation, massage therapy and acupuncture.

The team concluded that spinal manipulation was neither better nor worse than conventional treatments, and the effectiveness of acupuncture was unclear. Massage therapy seemed to be effective for persistent back pain.

Of the three alternative back pain treatments, only massage "may reduce the costs of care after an initial course of therapy," the authors conclude.