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Neck Pain Commentaries: Part 4

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Neck Pain Commentaries: Part 4

The Chiro.Org Blog

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).

Editorial Commentary:

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. [1]

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. [2] 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. [3] 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 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

About the Author:

I was introduced to Chiro.Org in early 1996, where my friend Joe Garolis helped me learn HTML, the "mark-up language" for websites. We have been fortunate that journals like JMPT have given us permission to reproduce some early important articles in Full-Text format. Maintaining the Org website has been, and remains, my favorite hobby.


  1. Orem Chiropractor September 3, 2010 at 11:48 am

    It’s very powerful when researchers say “only spinal manipulation had provided broad-based beneficial short-term and long-term benefits from care.”

  2. Allison Blatherton September 22, 2010 at 7:59 am

    That chiropractic treatments can cure the numerous ailments that arise from spinal symptoms is a great alternative to some of the more dangerous options, namely surgery and medication. Thanks for posting.

  3. seattle chiropractor November 8, 2010 at 6:56 pm

    When doctors recommend an operation, patients are all too quick to agree. As a society, we all want instant gratification or instant relief. Great information like this needs to be shared, so patients can make better informed choices about their short term and long term health care.

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