This commentary reviews a brilliant series of 3 consecutive studies, comparing popular forms of treatment for chronic spinal pain, including NSAIDs (Non-steroidal anti-inflammatory drugs), acupuncture, and chiropractic spinal adjusting for relief. The author reports that this is the first study of long-term efficacy of 3 distinct and standardized treatment regimens for patients with chronic spinal pain syndromes.
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 his 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 then randomized to receive either NSAIDs, acupuncture, or spinal adjusting as the active form of treatment. 
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. 
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. 
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.”
The author 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”.
The Chiropractic and Chronic Neck Pain page, and the Low Back Pain and Chiropractic page both contain numerous 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 those pages, please notify me
at Frankp@chiro.org so we can add them to the mix.
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
Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication,
Acupuncture, and Spinal Manipulation
Spine (Phila Pa 1976) 2003 (Jul 15); 28 (14): 1490–1502
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
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