Acupuncture is a popular complementary and alternative treatment for chronic back pain, write Daniel C. Cherkin, PhD, from the Center for Health Studies in Seattle, Washington, and colleagues. Recent European trials suggest similar short-term benefits from real and sham acupuncture needling. This trial addresses the importance of needle placement and skin penetration in eliciting acupuncture effects for patients with chronic low back pain.
The study treated 638 chronic mechanical low back pain adults with individualized acupuncture, standardized acupuncture, simulated acupuncture, or usual care. All acupuncture groups received 10 treatments administered by experienced acupuncturists during a 7-week period. The main endpoints of the study were back-related dysfunction measured with the Roland-Morris Disability Questionnaire (scored 0 – 23) and symptom bothersomeness (scored 0 – 10), evaluated at baseline and after 8, 26, and 52 weeks.
At 8 weeks, improvements in mean dysfunction scores were 2.1 points for those receiving usual care, 4.4 points for individualized acupuncture, 4.5 points for standardized acupuncture, and 4.4 points for simulated acupuncture (P < .001). Compared with participants receiving usual care, those receiving real or simulated acupuncture were more likely to achieve clinically meaningful improvements on the dysfunction scale (60% vs 39%; P < .001).
In the usual-care group, symptoms improved by 0.7 points vs 1.6 to 1.9 points in the treatment groups (P < .001). Clinically meaningful improvements in dysfunction persisted in the treatment groups vs the usual-care group after 1 year (59% – 65% vs 50%, respectively; P = .02), but symptom improvements were not significantly different among groups (P > .05).
Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits, the study authors write. These findings raise questions about acupuncture’s purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide [sic] physiologically important stimulation or represent [sic] placebo or nonspecific effects.
Limitations of this study include restricting treatment to only the needling component of traditional Chinese acupuncture, predetermined number and duration of treatments, limited conversation between the acupuncturists and the patients, and lack of a medical care comparison group.
The reduction in long-term exposure to the potential adverse effects of medications is an important benefit that may enhance the safety of conventional medical care, the study authors write. The number of patients who would need to be treated with insertive or superficial acupuncture stimulation to result in 1 person achieving meaningful improvement in function ranges from 5 (for short-term benefits) to 8 (for persisting benefits).
