I am seeking the services of an acupuncturist for chronic low back pain. But I'm finding that some people trained in acupuncture have other skills as well. Some are also naturopaths or massage therapists. Is it better to see someone who just does one thing (acupuncture)? Or is it better to see someone who could do a variety of treatments?

Many patients prefer a combined approach to the treatment of low back pain. However, with this method, they may not be able to tell what really worked: was it the massage? the acupuncture? the manipulation? or some combination of these? In such cases, the individual likes to hit it with everything at once in hopes of getting some pain relief.

Others would rather try one thing at a time. This way they know what worked best. In the future, if similar problems develop, they won't have to go chasing after all forms of treatment again. They can start with what worked last time and go from there.

Third-party payers may have something to say about this. They are very interested in only reimbursing for treatments that are known to have a positive benefit. This is called evidence-based treatment.

More and more studies are being geared toward finding evidence that one particular treatment works more effectively than others. Patients are randomly assigned to one treatment group. The results for all patients in each individual treatment group are compared with outcomes for other (different) treatment approaches.

Sometimes there's no difference from one competing therapy to another. In other cases, patients get better results with the clinician who has the most experience. It may be best if research that is done to compare different treatment approaches was only carried out by clinicians with expertise in that one area. This would be an expert-based AND evidence-based trial.

Bradley C. Johnston, ND, et al. The Use of Expertise-Based Randomized Controlled Trials to Assess Spinal Manipulation and Acupuncture for Low Back Pain. A Systematic Review. In Spine. April 15, 2008. Vol. 33. No. 8. Pp. 914-918.