Neck Pain Commentaries: Part 4
We conclude this series by reviewing a brilliant group of 3 consecutive studies comparing popular forms of treatment for chronic spinal pain (NSAID use, acupuncture, and spinal adjusting).
Lynton G.F. Giles, DC, PhD, a researcher at the National Unit for Multidisciplinary Studies of Spinal Pain at the University of Queensland, published the first of 3 studies in 1999. This pilot study involved 77 patients who reported to the Townsville General Hospital, Queensland, Australia with complaints of chronic spinal pain (either neck, mid back or low back). These patients were randomized to receive either NSAIDs, acupuncture, or spinal adjusting as the active form of treatment. 
Care was provided for 4 weeks, followed by assessment of improvement. The outcome measures included: (1) Oswestry Back Pain Disability Index, (2) Neck Disability Index, and (3) three visual analogue scales of local pain intensity. After the period of 30 days, the spinal manipulation group was the only intervention that achieved statistically significant improvements.
The second trial, published in 2003 in SPINE involved 115 patients randomized to the 3 treatment groups. Outcome assessment was gathered at baseline, and at 2, 5, and 9 weeks after the beginning of treatment.  Spinal adjusting again yielded the highest proportion of early (asymptomatic status) recovery, and the best overall improvements at 9 weeks. The results again demonstrated that patients with chronic spinal pain, manipulation, if not contraindicated, resulted in greater short-term improvement than acupuncture or medication.
The third study, published in 2005 involved follow-up of the same cohort of patients from the 2nd study, with a remarkable 90% retention rate.  Using the same outcome instruments they found that, of the 3 randomized treatments, only spinal manipulation had provided broad-based beneficial short-term and long-term benefits from care.
The article stated: “This is, to the authors’ knowledge, this is the first report on long-term efficacy of 3 distinct and standardized treatment regimens for patients with chronic spinal pain syndromes using a “fastidious” approach; that is, the only type of study from which potentially valid inferences of cause and effect can directly be drawn.”
He went on to state that: “Chronic mechanical spinal pain syndromes are prevalent conditions that tend to create a cluster of related problems reaching from withdrawal from social activity to a compromised immune function. The associated resulting direct and indirect costs in industrialized communities are vast.”
This concludes our series of Editorials about Kaisers decision to stop paying for chiropractic cervical adjusting. It should be obvious that their choice to reduce coverage was based upon financial incentives rather than any evidence that cervical spinal manipulation lacks benefit or safety.
The Chiropractic and Chronic Neck Pain page contains many other valid studies demonstrating the vast superiority of chiropractic care over standard medical approaches for managing chronic spinal pain syndromes. If you are aware of any other studies we failed to include on this page, please notify me at Frankp@chiro.org so we can correct that oversight.
1. Chronic Spinal Pain Syndromes: A Clinical Pilot Trial Comparing Acupuncture, A Nonsteroidal Anti-inflammatory Drug, and Spinal Manipulation
J Manipulative Physiol Ther 1999 (Jul); 22 (6): 376–381
2. Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation
Spine 2003 (Jul 15); 28 (14): 1490–1502
3. Long-term Follow-up of a Randomized Clinical Trial Assessing the Efficacy of Medication, Acupuncture, and Spinal Manipulation for Chronic Mechanical Spinal Pain Syndromes
J Manipulative Physiol Ther 2005 (Jan); 28 (1): 3–11