Acupuncture for low back pain: Real no better than sham

Acupuncture-like treatments significantly improve function in persons with chronic low back pain compared with usual care. However, the beneficial and persisting effects of real acupuncture needling may be no greater than those of noninsertive stimulation.

Cherkin and associates conducted a 4-arm randomized controlled trial comparing individualized acupuncture, standardized acupuncture, simulated acupuncture, and usual care. Patients received real or simulated acupuncture for 10 treatments (twice weekly for 3 weeks, then once a week for 4 weeks). Participants receiving acupuncture also were randomized to individualized acupuncture. Outcomes were measured at baseline and after 8, 26, and 52 weeks using computer-assisted telephone interviews.

All of the 641 patients were functioning better and feeling less pain at 8 weeks. However, those treated with acupuncture improved significantly more than those receiving usual care. The data did not suggest that one form of acupuncture was more effective than another. The benefits of sham and real acupuncture remained evident at 26 and 52 weeks.

The authors noted that the similarity in degrees of effectiveness of real and simulated acupuncture raises questions about acupuncture’s purported mechanism of action and suggests a need for future research about physiological effects, patient expectations, and other nonspecific effects.