Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain

Abstract

Objective To determine whether a short course of traditional acupuncture improves longer term outcomes for patients with persistent non-specific low back pain in primary care.Design Pragmatic, open, randomised controlled trial. Setting Three private acupuncture clinics and 18 general practices in York, England. Participants 241 adults aged 18-65 with non-specific low back pain of 4-52 weeks' duration. Interventions 10 individualised acupuncture treatments from one of six qualified acupuncturists (160 patients) or usual care only (81 patients). Main outcome measures The primary outcome was SF-36 bodily pain, measured at 12 and 24 months. Other outcomes included reported use of analgesics, scores on the Oswestry pain disability index, safety, and patient satisfaction. Results 39 general practitioners referred 289 patients of whom 241 were randomised. At 12 months average SF-36 pain scores increased by 33.2 to 64.0 in the acupuncture group and by 27.9 to 58.3 in the control group. Adjusting for baseline score and for any clustering by acupuncturist, the estimated intervention effect was 5.6 points (95% confidence interval − 0.2 to 11.4) at 12 months (n = 213) and 8.0 points (2.8 to 13.2) at 24 months (n = 182). The magnitude of the difference between the groups was about 10%-15% of the final pain score in the control group. Functional disability was not improved. No serious or life threatening events were reported. Conclusions Weak evidence was found of an effect of acupuncture on persistent non-specific low back pain at 12 months, but stronger evidence of a small benefit at 24 months. Referral to a qualified traditional acupuncturist for a short course of treatment seems safe and acceptable to patients with low back pain. Trial registration ISRCTN80764175.

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.…”

“…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.…”

“…Thomas and colleagues have been particularly helpful in demonstrating the effects of acupuncture on a longer-term basis (2 years). 31 Sham Acupuncture Puzzlingly, it is a recurrent observation in acupuncture trials that sham acupuncture treatments produce comparable health benefits to traditional acupuncture. Further complicating matters, it is unclear what type of methodology should constitute sham acupuncture.…”

Chinese medicine treatment for menopausal symptoms in the UK health service: Is a clinical trial warranted?

“…Hence the effects of the intervention may be inflated by factors such as expectancy (placebo), natural healing and regression to the mean. RCTs with no treatment, usual orthodox care or alternative treatment groups would control for some of these factors and they are well established for acupuncture effectiveness evaluation [32,33]. They can achieve a high level of external validity and provide the most suitable vehicle for economic evaluation and clinical decisionmaking [9,34].…”

The Effect of an Enhanced Rehabilitation Exercise Treatment of Non-Specific Low Back Pain- A suggestion for Rehabilitation Specialists

“…Sixty to eighty percent of grown ups will sooner or later face health predicaments with low back pain (LBP) [6,7,8], and 16% of grown ups in the United Kingdom (UK) counsel their general specialist consistently [9]. Back pain costs the National Wellbeing Administration (NHS) £1.3 million consistently [10] which causes about 12.5% of all work nonattendance in the UK [11].…”