Back problems are among the most prevalent conditions afflicting adults in general and the second most common condition reported by persons over age 65. Furthermore, back pin in general is the leading reason for the use of complimentary or alternative medicine (CAM) therapies by adults of all ages. Despite the common use of CAM therapies for back pain, little is known about how they compare with each other or with conventional medical therapies in terms of effectiveness and cost. Studies evaluating back pin treatments for older adults (greater than or equal to 65 years old) are particularly rare. This study will lay the groundwork for a full-scale trial that evaluates the relative effectiveness and costs of the three most commonly used physical CAM therapies (acupuncture, chiropractic, and massage) for both older and younger adults with chronic low back pain. During Phase I, we will develop, test and refine specific components of a randomized clinical trial evaluating acupuncture, chiropractic and massage for chronic low back pain. This will include specification of treatment and comparison groups, subject selection criteria, recruitment and retention strategies, and development of Phase I to conduct a pilot study designed to evaluate the three physical CAM treatments. Thirty persons with chronic low back pain will be randomized to each of the following groups: acupuncture, chiropractic, massage, and continued usual care. The subjects randomized to each intervention will be equally divided between persons over and under age 65. (Recruitment will include subjects in their 70s, 80s, and older.) The pilot study will permit us to identify and resolve unanticipated problems and to estimate the sample sizes required for an adequately powered full-scale trial. At the conclusion of this project, we will be prepared to write a competitive grant proposal to evaluate the most commonly used CAM therapies for treating both older and younger adults with chronic low back pain.