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Am Fam Physician. 2002;65(2):310-313

Up to one half of adults report at least one episode of neck pain during their lifetime. For many persons, such pain is chronic or recurrent, causing difficulties in work and daily activities. Although many treatments have been suggested, including medications, massage and local injections, the outcomes have frequently been unsatisfactory, and interest in alternative therapies has grown. Irnich and colleagues studied acupuncture in patients with chronic neck pain.

The authors recruited patients from three university outpatient departments in Germany for the controlled clinical trial. Patients were required to have painful restriction of the cervical spine for at least one month and not to have participated in any active treatment during the two weeks before the start of the study. Patients were excluded if they had undergone relevant surgery or had local dislocations, fractures, or other conditions underlying their neck symptoms. Patients with neurologic deficits, systemic illnesses, or contraindications to the interventions were also excluded.

The 177 patients were randomly allocated to treatment with acupuncture, massage, or sham laser acupuncture. Each treatment was provided five times during the three-week study, and analgesic use was not permitted during the study.

Patients in the acupuncture group received traditional Chinese acupuncture, including diagnostic palpation, ear acupuncture, and dry needling. The patients assigned to massage received conventional Western massage techniques but no spinal manipulation. The remaining patients were treated with a deactivated laser acupuncture pen that emitted red light and acoustic signals. The diagnostic palpation and points of treatment with the pen were identical to those used in the acupuncture group. Patients were assessed before the first treatment, immediately following the first treatment, and again three days later. They were reassessed immediately following the final treatment, one week after the final treatment, and three months after the final treatment. Change in pain was the principal outcome, but range of motion, global complaints, and quality-of-life indicators were also measured.

The average age of the patients was 52 years. About one half of the patients in each group reported pain duration of more than five years. Almost all patients had been treated previously for neck pain, and many had used chiropractic, acupuncture, and other alternative therapies.

Patients treated with acupuncture reported the greatest reduction in pain one week after the end of the study. The improvement was significantly greater than that in patients treated with massage, but the difference was not statistically significant compared with patients treated with sham laser. Patients with myofascial pain syndrome and those with pain of more than five years' duration had the greatest benefit from acupuncture. The acupuncture group also reported the best results in the secondary outcomes but, at the three-month follow-up, the differences in benefit between the groups was not significant. One third of the acupuncture patients experienced reactions sufficiently severe as to require brief cessation of therapy. Similar reactions occurred in 7 percent of massage patients and 21 percent of sham-laser patients.

The authors conclude that while all patients improved during therapy, the greatest benefit occurred following acupuncture treatment. The short courses of treatment produced improvements in pain, range of motion, and quality of life immediately following therapy, but evidence of long-term benefit is limited.

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