Table 3
Evidence for low back pain
| Comparator | Quality | Population size | Complementary medicine | Safety | Cost-effectiveness |
| Active intervention | Good | Medium | Osteopathy65 | Some evidence of harm65* | NR |
| Moderate | Large | Spinal manipulation/mobilisation (chronic only)40 43 44 | Some evidence of safety44† | Mixed results—some evidence of CE47‡ | |
| Moderate | Medium | Yoga62 | Some evidence of safety51 60 62§ | No data | |
| Moderate | Small | Balneotherapy52 | Some evidence of safety52 | NR | |
| Usual care | Moderate | Large | Acupuncture40 50 (for pain, function, well-being, disability, range of movement, quality of life) | Some evidence of safety53 54¶ | Some evidence of CE40** |
| Moderate | Small | Spa therapy52 | Some evidence of safety52†† | NR | |
| Tai chi54 | NR | NR | |||
| Placebo | Moderate | Large | Acupuncture (for pain and quality of life; negative evidence for disability).40 50 | Some evidence of safety53 54¶ | Some evidence of CE40** |
*Two studies reported minor adverse events.
†One review identified serious adverse events, but this appeared unrelated to treatment. Minor adverse events included muscle soreness, stiffness and/or transient increase in pain.
‡Mixed results regarding cost-effectiveness,40 with limited evidence that manual therapy is more cost-effective than usual care.47
§No serious adverse events associated with the yoga.
¶5% minor adverse events and no serious adverse events.
**Short-term only.
††No adverse events from one study.
CE, cost effectiveness; NR, not reported (by systematic reviews).