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If you have persistent neck or back pain, you might be considering acupuncture, massage or chiropractic — therapies often touted to relieve such chronic discomfort.

Do they work? Are they safe? Consumer Reports spoke to experts and reviewed the research to find out.

Chiropractic care

The founder of modern chiropractic care, a 19th-century Iowan, believed that chiropractic ma­nipu­la­tion — or “realigning” the spine by pressing on its joints — could cure all manner of maladies. But most chiropractors focus on skeletal and muscular problems, especially low-back, neck and shoulder pain, and related headaches.

Chiropractors (along with some osteopathic physicians and physical therapists) perform millions of spinal manipulations (“adjustments”) each year. And some studies suggest that they can help diminish pain. A 2011 review of 26 studies found that for chronic low-back pain, manipulation reduced pain in the short term at least as much as exercise and even pain relievers.

“The bad news is that for chronic, persistent back pain, even the best therapies result in only mild to moderate relief,” says Roger Chou, a professor of medicine at Oregon Health & Science University, who studies back pain. As for neck pain, a study of 181 people published in the Annals of Internal Medicine found that getting regular chiropractic care (about once per week for 12 weeks) could lessen discomfort better than acetaminophen and nonsteroidal anti-inflammatory drugs.

“For chronic backache or neck pain that is not accompanied by symptoms requiring medical attention — such as urinary or intestinal problems or weakness, numbness or tingling in an arm or leg — considering chiropractic manipulation seems reasonable,” says Consumer Reports’ chief medical adviser, Marvin M. Lipman. But it isn’t risk-free. “It can cause temporary headaches and, rarely, serious problems such as worsening the pain of a slipped disk,” he notes.

Massage

Documented in early Egyptian tomb paintings and Chinese writings from as far back as 2700 B.C., massage involves a range of techniques for rubbing the body to relieve muscle tension and pain. For example, Swedish massage employs long strokes and kneading movements, and deep-tissue massage uses focused, intense pressure in tight or painful areas.

Limited research suggests that massage therapy might ease low-back pain. Take, for example, a 2015 review of 25 small to midsize clinical trials. Researchers with the independent Cochrane Library found that among people with low-back pain lasting more than four weeks, massage provided better relief than such treatments as lightly touching the skin.

Massage therapy also appeared to relieve discomfort better, on average, than treatments including acupuncture, traction and relaxation exercises. Most important, when compared with no treatment or a placebo treatment, massage improved functions such as walking ability, sleeping and other important components of daily life.

So, how might massage ease discomfort? Scientists haven’t pinpointed a mechanism, but they think it might stimulate nerves that mute pain signals. Another theory suggests that massage may trigger the release of pain-reducing hormones called endorphins.

“Trying massage for back pain probably won’t hurt, and might help,” Lipman says. But if you try it, tell your practitioner beforehand about medical conditions you have and medicine you take.

Acupuncture

This traditional Chinese technique uses thin needles that are inserted into the body at specific spots called acupoints. It is based on the belief that blocked chi, or energy, causes pain and that stimulating some of our more than 300 acupoints, each believed to affect a specific body part or organ, can unblock energy and relieve pain.

A number of people who use acupuncture for chronic pain report benefits. For example, an analysis of 29 studies with a total of 17,922 participants with back and neck pain, osteoarthritis, chronic headache and shoulder pain found that people with those conditions experienced significantly more relief with acupuncture than those who had no treatment. People also reported less pain after real acupuncture than they did after fake acupuncture (for example, with needles placed in spots that were not acupoints), but the differences were small.

One possible reason for the benefits of acupuncture: Studies show that it causes us to release those feel-good endorphins, which suppress pain. “Acupuncture, real and sham, also might make you feel better simply because you feel cared for or because you expect it to work — the placebo effect,” Lipman says.

For back and neck pain, acupuncture is safe as long as sterile needles, such as single-use disposables, are used by a trained practitioner. But skip it for conditions other than pain; there’s no conclusive evidence that it will help.

Copyright 2016. Consumers Union of United States Inc.

For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.