Can acupuncture cure back pain?

Surprising results from an acupuncture study reveals how effective it can be for back pain, reports Emma Baines.

What is the story?
Acupuncture is better than any modern medical treatment for relieving lower back pain, according to media reports.

They claimed that the Chinese needle treatment had been shown to reduce back pain more than physiotherapy, medication or advice on exercise.

Almost half of those given acupuncture felt pain relief, compared with only about a quarter who received drugs and other Western therapies.

However, the papers also reported that 'sham acupuncture' was almost as effective as real acupuncture at relieving pain. They said that acupuncture probably worked through a powerful version of the placebo effect.

What is the research?
The media reports are based on a German study designed to test whether acupuncture was more effective than conventional therapy or sham acupuncture at reducing chronic lower back pain.

The study included 1,162 patients aged 18-86 years who had suffered chronic lower back pain for an average of eight years. Patients with previous spinal surgery, fractures, infectious or tumorous spondylopathy were excluded, as well as those who had previously tried acupuncture.

The patients were allocated to treatment with conventional therapy, traditional acupuncture or sham acupuncture. Each received 10 therapy sessions, which lasted 30 minutes each.

Patients in the conventional therapy group were treated according to a multimodal programme recommended by German guidelines. This included physiotherapy, massage, heat therapy and electrotherapy as well as education and guidance. In addition, 95 per cent were treated with analgesics.

The traditional acupuncture group was treated with 14-20 needles inserted to a depth of 5-40mm depending on location at fixed points. These were chosen on the basis of traditional Chinese medicine diagnosis. The needles were manipulated by hand to stimulate the acupuncture points.

The sham acupuncture group were also treated with 14-20 needles, but these were inserted superficially at a depth of only 1-3mm. They were also inserted at locations on the back that avoided all acupuncture points and meridians. The needles were not stimulated.

In addition, patients in both acupuncture groups were permitted NSAID treatment as rescue medication for acute episodes of pain.

After six months, the patients' response to treatment was measured using a pain questionnaire. Successful treatment was defined as a 33 per cent or greater improvement on pain scores.

The researchers found that the response rate of patients in either acupuncture group was roughly double that of those in the conventional treatment group. Traditional acupuncture was effective in 47 per cent, sham acupuncture in 44 per cent, and conventional treatment in just 27 per cent of patients.

What researchers say?
Dr Heinz Endres, from the Ruhr-University Bochum, in Bochum, Germany, who was involved in the study, said: 'When we were planning the study, we assumed that the standard therapy in accordance with the guidelines would be superior to acupuncture. None of us expected the difference in success between acupuncture and the standard therapy would be so clear-cut.'

He said that there were several theories for how acupuncture might have this effect.

'Since back pain is a peripheral pain, one conceivable mechanism would be the blocking of pain transmission in the area of the spinal cord.'

Or it could work through targeting the processing of pain in the brain, or through a placebo effect, he added.

Dr Endres concluded that, regardless of the mechanism of action, acupuncture should be adopted as one of the first-line treatments for chronic lower back pain.

'Acupuncture represents a highly promising and effective treatment option for chronic back pain. Patients experienced not only reduced pain intensity, but also reported improvements in the disability that often results from back pain and therefore in their quality of life,' he said.

What do other experts say?
Dr William Campbell, consultant in anaesthesia and pain management at the Ulster Hospital, Belfast, and secretary of the British Pain Society, said: 'We currently know acupuncture works through a couple of mechanisms within the central nervous system.'

A two-year follow-up of all groups in the study would be needed, as well as similar trials to substantiate findings, he said.

Nia Taylor, chief executive of the back pain charity BackCare said: 'There is unlikely ever to be one solution to everyone's back pain.'

She recommended that patients wanting to try acupuncture should first check whether acupuncture is recommended for their type of back problem and then tell their GP that they are planning to try it.

They should also check that the acupuncturist is registered with the British Medical Acupuncture Society or British Acupuncture Council.

'If possible, ask others who have tried acupuncture what their experience was like. You should get an idea of whether it is helping within five or six sessions,' she advised.

- GPletters@haymarket.com

- Arch Intern Med 2007; 167: 1,892-8

Informing patients

  • Twice as many patients experience relief from chronic back pain with acupuncture treatment as with conventional therapy.
  • Sham acupuncture is almost as effective as real acupuncture.
  • It could work through blocking pain signals sent to the brain through the spine, or through a placebo effect.
  • Check acupuncture is suitable for you and inform your GP before treatment.

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