May 18, 2009

Acupuncture-Like Treatments Improve Low Back Pain

Photo of a man clutching his lower back

Acupuncture and simulated acupuncture both improved chronic low back pain more than conventional care in a new study. The result highlights central questions about how acupuncture helps people with chronic pain.

Acupuncture is a family of procedures that originated in traditional Chinese medicine. It involves stimulating specific points on the body by a variety of techniques, including the insertion of thin metal needles though the skin. In the United States, acupuncture is considered part of complementary and alternative medicine.

Many patients with back pain who are dissatisfied with their medical care seek treatment from acupuncturists. In fact, back pain is the leading reason for visits to licensed acupuncturists.

Several recent studies have suggested that both real acupuncture and "sham" acupuncture (the shallow needling of points) are equally effective for treating chronic low back pain, and that both are superior to best-practice medical care. A team of researchers led by Dr. Daniel Cherkin of the Group Health Center for Health Studies in Seattle set out to further investigate. Their work was funded by NIH's National Center for Complementary and Alternative Medicine (NCCAM).

The team enrolled 638 adults with chronic low back pain who never had acupuncture. The participants were randomly assigned to 4 groups. The first received individualized acupuncture, a customized prescription for acupuncture points from a diagnostician. The second received standardized acupuncture, targeting points that acupuncture experts consider generally effective for chronic low back pain. The third group received simulated acupuncture, which mimics needle acupuncture but doesn't involve actual penetration of the skin. The fourth group received standard medical care.

The patients in the 3 acupuncture groups were treated twice weekly for 3 weeks, and then weekly for an additional 4 weeks. At 8, 26 and 52 weeks, the researchers measured back-related dysfunction and asked the participants about their symptoms.

The researchers reported in the Archives of Internal Medicine on May 11, 2009, that dysfunction scores at 8 weeks had improved significantly more for all 3 acupuncture groups than for the standard care group. The benefits persisted for a year, though they diminished over time. There was no significant difference between the groups receiving the needle and simulated forms of acupuncture. Neither tailoring acupuncture needle sites to an individual patient nor actually penetrating the skin appeared to be necessary to get the benefits of acupuncture.

"Because of the lack of highly effective medical treatments for chronic low back pain, we were pleased to find that acupuncture-like treatments were helpful for persons suffering from chronic back pain," Cherkin says. "However, the finding that real acupuncture produced no greater benefit than simulated acupuncture raises important questions about acupuncture's mechanisms of action."

"This adds to the growing body of evidence that there is something meaningful taking place during acupuncture treatments outside of actual needling. Future research is needed to delve deeper into what is evoking these responses," says Dr. Josephine P. Briggs, director of NCCAM.

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