Does acupuncture improve the orthopedic management of chronic low back pain – a randomized, blinded, controlled trial with 3 months follow up

Abstract

This prospective, randomised controlled trial, with three parallel groups, patient and observer blinded for verum and sham acupuncture and a follow up of 3 months raises the question: "Does a combination of acupuncture and conservative orthopedic treatment improve conservative orthopedic treatment in chronic low back pain (LBP). 186 in-patients of a LBP rehabilitation center with a history of LBP >or=6 weeks, VAS >or=50mm, and no pending compensation claims, were selected; for the three random group 4 weeks of treatment was applied. 174 patients met the protocol criteria and reported after treatment, 124 reported after 3 months follow up. Patients were assorted 4 strata: chronic LBP, <or=0.5 years, 0.5-2 years, 2-5 years, >or=5 years. Analysis was by intention to treat. Group 1 (Verum+COT) received 12 treatments of verum acupuncture and conservative orthopedic treatment (COT). Group 2 (Sham+COT) received 12 treatments of non-specific needling and COT. Group 3 (nil+COT) received COT alone. Verum- and Sham acupuncture were blinded against patient and examiner. The primary endpoints were pain reduction >or=50% on VAS 3 months after the end of the treatment protocol. Secondary endpoints were pain reduction >or=50% on VAS and treatment efficacy on a four-point box scale directly after the end of the treatment protocol and treatment efficacy after 3 months. In the whole sample a pain relief of >or=50% on VAS was reported directly after the end of treatment protocol: Verum+COT 65% (95%CI 51-77%), Sham+COT 34% (95%ci 22-49%), nil+COT 43% (95%ci 29-58%) - results are significant for Verum+COT over Sham+COT (P<or=0.02). The results after 3 months are: Verum+COT 77% (95%ci 62-88%), Sham+COT 29% (95%ci 16-46%), nil+Cot 14% (95%ci 4-30%) - effects are significant for Verum+COT over Sham+COT (P<or=0.001) and for Verum+COT over nil+COT (P<0.001). No difference was found in the mobility of the patients nor in the intake of NSAID diclofenac. Our conclusion is that acupuncture can be an important supplement of conservative orthopedic treatment in the management of chronic LBP.

Chapter 4 European guidelines for the management of chronic nonspecific low back pain

“…The percentage of patients showing a ≥50% reduction of pain was significantly greater in group b) than both in groups a) and c), although there were no differences in mobility (Schober's sign and finger to ground distance) nor in the intake of diclofenac (Molsberger et al 2002).…”

Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain

“…[73][74][75][76] The design and patient populations in these trials make direct comparison with the present results difficult: two trials did not assess traditional acupuncture 73,74 and a third excluded patients with a history of less than 6 months of back pain. 76 The fourth trial, a three-arm open trial of traditional acupuncture, massage and self-care, by Cherkin and colleagues, was closest to the present study in design.…”

Imperfect placebos are common in low back pain trials: a systematic review of the literature

“…For simplicity, each comparison was treated as an individual trial. Trials reported on the following categories of interventions: acupuncture (10 trials) [25,42,73,74,85,95,99,104,106,128], back school (2 trials) [11,28], behavioural (7 trials) [10,21,62,111,130,132,133], electrotherapy (20 trials) [8, 15, 25, 27, 37, 49-51, 54, 57, 63, 69, 76, 77, 89, 94, 107, 122, 137, 143], exercise (10 trials) [29,37,43,48,50,59,67,116,131,136], heatwrap therapy (2 trials) [109,110], insoles (1 trial) [127], magnets (1 trial) [33], massage (1 trial) [116], neuroreflexotherapy (1 trial) [93] [16,117,129]. Trial characteristics are presented in Table 1.…”