A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain

Abstract

Background Acupuncture is a popular complementary and alternative treatment for chronic back pain. 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. Methods 638 adults with chronic mechanical low back pain were randomized to: individualized acupuncture, standardized acupuncture, simulated acupuncture, or usual care. Ten treatments were provided over 7 weeks by experienced acupuncturists. The primary outcomes were back-related dysfunction (Roland Disability score, range: 0 to 23) and symptom bothersomeness (0 to 10 scale). Outcomes were assessed at baseline and after 8, 26 and 52 weeks. Results At 8 weeks, mean dysfunction scores for the individualized, standardized, and simulated acupuncture groups improved by 4.4, 4.5, and 4.4 points, respectively, compared with 2.1 points for those receiving usual care (P<0.001). Participants receiving real or simulated acupuncture were more likely than those receiving usual care to experience clinically meaningful improvements on the dysfunction scale (60% vs. 39%, P<0.0001). Symptoms improved by 1.6 to 1.9 points in the treatment groups compared with 0.7 points in the usual care group (P<0.0001). After one year, participants in the treatment groups were more likely than those receiving usual care group to experience clinically meaningful improvements in dysfunction (59% to 65% versus 50%, respectively, P=0.02) but not in symptoms (P>0.05). Conclusions 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. These findings raise questions about acupuncture’s purported mechanisms of action. It remains unclear whether acupuncture, or our simulated method of acupuncture, provide physiologically important stimulation or represent placebo or non-specific effects.

The Effect of EFT (Emotional Freedom Techniques) on Athletic Performance: A Randomized Controlled Blind Trial

“…EFT is described by its founder as "acupuncture without needles" [7]. Applying pressure to acupuncture points, instead of needling them, is used in traditional therapies such as Shiatsu massage, and has been found to have efficacy similar to needling [39].…”

Acupuncture in the Treatment of Chronic Low Back Pain

“…30,32,33 These trials were intended to advise the German government in deciding whether to reimburse acupuncturists for treatment of chronic conditions such as low back pain. Additionally, high quality RCTs in the United States 35 and United Kingdom 31 further demonstrated the effectiveness of acupuncture therapy. Thomas and colleagues have been particularly helpful in demonstrating the effects of acupuncture on a longer-term basis (2 years).…”

“…It included three studies already discussed in other systematic reviews, 30,31,33 as well as one new trial. 35 Based on these trials, Trigkilida considered acupuncture to be more effective than usual care, but also noted the similar outcomes produced by sham acupuncture regimens.…”

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“…Several articles discuss the similarity of results between needling and needle insertion simulation, controls that show signs although the points are different from those indicated in the TCM. [3,4,11], and the impossibility of preventing the acupuncturist from knowing the type of application and making a double-blind study. Systematic reviews from randomized clinical trials reinforce that most studies are numerically unsatisfactory, making it impossible to definitively conclude on the efficacy of treatment compared to placebo [12][13][14].…”