More Evidence of the Benefits of Acupuncture for low Back Pain

Is acupuncture beneficial for patients with chronic pain? Are some patients more responsive to it than others? Now that clinical trials are beginning to take a closer look at this ancient Chinese remedy, are we any closer to the answers?

Arch Intern Med

A 52-week, randomized, controlled, multicenter study (. 2006;166: 450-457) compared standard acupuncture with minimal acupuncture, which consisted of superficial needling at nonacupuncture points, for chronic low back pain; a waiting list group served as controls. The study included nearly 300 patients (67.8% women; mean age, 59 ±9 years).

Pain measurements were assessed with standard questionnaires.

Both treatments consisted of 12 sessions, 30 minutes each, over a period of 8 weeks.

The primary end point was the change in low back pain intensity from baseline.

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Results showed no significant differences between those who received acupuncture (n = 146) and the minimal acupuncture group (n = 73). But when compared with the nontreatment group (n = 79), acupuncture improved pain by an average of 21.7 mm (range, 0-100 mm) on the visual analog scale (VAS) ( = .001).

At 8 weeks, 86 (62.8%) of those in the acupuncture group thought they had received acupuncture, 26 (19%) thought they had received minimal acupuncture, and 25 (18.2%) said they did not know what kind of acupuncture they had received. Similar trends were seen in the minimal acupuncture group.

VAS pain intensity decreased by a mean of 27.7 mm in the acupuncture group, 23.6 mm in the minimal acupuncture group, and 6.9 mm in the waiting list group. The differences between the acupuncture and minimal acupuncture groups were insignificant, but the differences in pain intensity were significant between the treatment groups and the waiting list group (P <.001).

&#8220;Acupuncture was more effective than no acupuncture in patients with chronic low back pain. Most outcome variables tended to be slightly better in the acupuncture group compared with the minimal acupuncture group,&#8221; wrote the investigators, led by Benno Brinkhaus, MD, of the Institute of Social Medicine, Epidemiology, and Health Economics in Berlin, Germany.

They postulated that the main reason for the lack of a significant difference between the acupuncture and minimal acupuncture groups was that minimal acupuncture cannot be considered a &#8220;physiologically inert placebo&#8221; and that it may have treatment benefits of its own.

Dr Benno added, &#8220;The results suggested that the specific effect (correct location of the needles) played only a limited role and unspecific effects (ie, patients&#8217; expectations, setting, complex treatment strategy) were very important for the efficacy of acupuncture.&#8221;

When asked if he recommends acupuncture to his own patients, Dr Benno told IMWR, &#8220;Definitely yes; patients with lower back pain who receive acupuncture experience clinically relevant benefits compared with patients receiving no acupuncture treatment.&#8221;