In a study published in the July 15, 2003 issue of Spine, researchers conducted a randomized clinical trial to compare three common approaches for managing chronic spinal pain (lasting more than 13 weeks): medication, needle acupuncture, and chiropractic spinal manipulation.

A total of 115 patients with chronic spinal pain and no contraindications to any of the treatments were enrolled between February 1999 and October 2001. Each patient was randomly assigned to one of the three treatment groups.

Study Design and Treatment Groups

Participants received one of the following:

• Medication group: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Celebrex or Vioxx.
• Acupuncture group: Needle acupuncture sessions.
• Chiropractic group: Chiropractic spinal manipulation performed by chiropractors.

Patients were evaluated before treatment and then again at 2, 5, and 9 weeks after starting care. To measure changes in pain, function, and overall health, the following standardized tools were used:

• Oswestry Back Pain Disability Index (Oswestry)
• Neck Disability Index (NDI)
• Short-Form-36 Health Survey questionnaire (SF-36)
• Visual Analog Scales (VAS) for pain intensity
• Measurements of spinal ranges of motion

Results

Who Became Asymptomatic?

Within 9 weeks of treatment, the percentage of patients who became asymptomatic (no reported symptoms) was:

• Chiropractic group: 27.3% – importantly, these were chronic patients who had felt bad for a long time, not new acute cases.
• Acupuncture group: 9.4%
• Medication group: 5%

Overall Improvements

The chiropractic group showed the most significant improvements across multiple outcome measures:

• Oswestry (back disability): ~50% improvement
• Neck Disability Index (NDI): ~38% improvement
• SF-36 (overall health): ~47% improvement
• VAS for back pain: ~50% improvement
• Lumbar standing flexion: ~38% improvement
• Lumbar sitting flexion: ~20% improvement
• Cervical sitting flexion: ~25% improvement
• Cervical sitting extension: ~18% improvement

For neck pain VAS scores specifically, acupuncture showed a slightly better result than chiropractic manipulation (about 50% vs. 42% improvement), indicating that different approaches may have strengths for different regions or conditions.

Adverse Events and Safety

No adverse events were reported in either the chiropractic or acupuncture groups. However, approximately 6.1% of patients in the medication group experienced adverse events, highlighting an important difference in safety between drug-based and non-drug approaches.

Conclusions

The authors concluded that chiropractic spinal manipulation produced greater short-term improvement in patients with chronic spinal pain than either acupuncture or medication alone.

For individuals struggling with long-standing spinal pain who are seeking non-surgical, low-risk options, this study suggests that chiropractic care is not only a viable choice, but may provide superior improvements in pain, function, and quality of life compared to these other approaches—without the medication-related side effects seen in some patients.