Effectiveness of Acupuncture, Physiotherapy, Chiropractic and Medication in Chronic Back Pain Management: A Systematic Review and Meta-Analysis

Millions of people suffer from lower back pain, which has social, economic, and health consequences. One of the most difficult areas to effectively manage is Chronic Low Back Pain. This systematic review and meta-analysis examine the effectiveness exclusive of surgery, including acupuncture, physiotherapy or medication (NSAIDs), chiropractic procedure, or mental therapy as advised by WHO guidelines. Thirteen studies were reviewed investigating the effect of these treatments on pain relief, functional improvement, and patient satisfaction. Pain scores, functional improvements, and patient satisfaction in the acupuncture group were superior to placebo. Adherence to physiotherapy and patient satisfaction was also good. Substantially less differential added benefits emerged from complementary intervention acupuncture (encircled in red), resulting in moderate to low satisfaction levels compared to medication, especially physiotherapy. Chiropractic effectively decreased LBP and improved function, and participants were generally very satisfied. Mental therapy provided psychological support that alleviated pain intensity and promoted improved physical function, significantly increasing the satisfaction level in these patients as part of their overall pain relief. Nonsurgical treatments, such as acupuncture (Acumoxa), physiotherapy medication, and chiropractic mental therapy, are result-oriented in relieving symptoms of CLBP. Patient satisfaction was highest for acupuncture and medication. Nonetheless, differences in research methodology and population characteristics are likely to make generalizations of what we can learn from the results a more challenging task. Future studies should improve on these limitations and the long-term safety/efficacy of these treatments. Only if alternative treatments like chiropractic and mental therapy, as suggested by WHO, are integrated in management, a line of approach for CLBP will be completed.