Acupuncture in Patients With Chronic Low Back Pain: A Randomized Controlled Trial

Abstract

Background: Acupuncture is widely used by patients with low back pain, although its effectiveness is unclear. We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with chronic low back pain.Methods: Patients were randomized to treatment with acupuncture, minimal acupuncture (superficial needling at nonacupuncture points), or a waiting list control. Acupuncture and minimal acupuncture were administered by specialized acupuncture physicians in 30 outpatient centers, and consisted of 12 sessions per patient over 8 weeks. Patients completed standardized questionnaires at baseline and at 8, 26, and 52 weeks after randomization. The primary outcome variable was the change in low back pain intensity from baseline to the end of week 8, as determined on a visual analog scale (range, 0-100 mm).Results: A total of 298 patients (67.8% female; mean±SD age, 59±9 years) were included. Between baseline and

Acupuncture in the Treatment of Chronic Low Back Pain

“…The majority of trials examined in this systematic review were already included in the 2005 Cochrane systematic review update; however, Ammendolia et al contributed three novel trials of interest. 30,31,32 26 Yuan and colleagues were in accordance with Ammendolia et al, concluding that acupuncture did not differ from sham in pain reduction or functional improvement. They also affirmed previous findings that acupuncture is more effective than no treatment at all, and that acupuncture improves outcomes as an adjunct to other therapy.…”

“…24 Rubenstein et al published a systematic review of three common CAM therapies for chronic low back pain: acupuncture, herbal medicine, and spinal manipulation. All eighteen studies included in their acupuncture analyses were previously discussed by Yuan et al 26 Based on one study alone, 30 Rubenstein and colleagues hesitantly concluded that acupuncture is more effective than no treatment at short term pain relief. Moreover, they determined that acupuncture has a statistically significant advantage over sham in terms of pain relief and functionality at short-and intermediate-term follow-up; however, these effect sizes were too small to be considered clinically significant.…”

“…25 Trigkilidas' systematic review was the most recently published, and examined studies from 2005 onward. 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.…”

Acupuncture-Related Modulation of Pain-Associated Brain Networks During Electrical Pain Stimulation: A Functional Magnetic Resonance Imaging Study

“…57 The activation pattern of ACC, anterior insula, and PFC during acupuncture, also present in this study, may reflect a close connection of these brain regions and the cognitive processing of painful sensations. 48 In clinical acupuncture trials, 40,58 as well as in imaging studies, 40 acupuncture repeatedly leads to significant pain reduction, but several studies show no difference on pain ratings between sham and real acupuncture. 59,60 In the current study, subjective pain ratings did not differ significantly between the two experimental sessions; thus, the differences in activation pattern observed may be due to placebo effects.…”

Introducing “Evidence for clinical practice”

“…For example, two large, methodologically sound randomized trials have concluded that acupuncture reduces chronic low back pain compared to no acupuncture or conventional treatment but is no more effective than minimal (sham) acupuncture [9,10]. From this evidence, one might conclude that acupuncture 'works', or that acupuncture 'does not work', and professional guidelines have both suggested a role for acupuncture and failed to recommend it [11,12].…”