Australian researchers assessed the long-term benefits of medication, needle acupuncture and spinal manipulation as exclusive and standardised treatment regimens in patients with chronic (>13 weeks) spinal pain syndromes. Extended follow-up (>1 year) of an RCT was conducted at a multidisciplinary spinal pain unit. Of the 115 patients originally randomised, 69 had exclusively been treated with the randomly allocated treatment during the 9-week treatment period (results at 9 weeks were reported earlier). These patients were followed up and assessed again 1 year after inception into the study, reapplying the same instruments (i.e. Oswestry Back Pain Index, Neck Disability Index, SF-36 and VAS). Questionnaires were obtained from 62 patients, reflecting a retention proportion of 90%. The main analysis was restricted to 40 patients who had received exclusively the randomly allocated treatment for the whole observation period since randomisation. Comparisons of initial and extended follow-up questionnaires to assess absolute efficacy showed that only the application of spinal manipulation revealed broad-based long-term benefit: five of the seven main outcome measures showed significant improvements compared with only one item in each of the acupuncture and the medication groups.