Table 3

Evidence for low back pain

ComparatorQualityPopulation sizeComplementary medicineSafetyCost-effectiveness
Active interventionGoodMediumOsteopathy65 Some evidence of harm65*NR
ModerateLargeSpinal manipulation/mobilisation (chronic only)40 43 44 Some evidence of safety44Mixed results—some evidence of CE47
ModerateMediumYoga62 Some evidence of safety51 60 62§No data
ModerateSmallBalneotherapy52 Some evidence of safety52 NR
Usual careModerateLargeAcupuncture40 50 (for pain, function, well-being, disability, range of movement , quality of life)Some evidence of safety53 54Some evidence of CE40**
ModerateSmallSpa therapy52 Some evidence of safety52††NR
Tai chi54 NRNR
PlaceboModerateLargeAcupuncture (for pain and quality of life; negative evidence for disability).40 50 Some evidence of safety53 54Some 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).