SEATTLE, Washington—Individually tailored acupuncture, standard acupuncture, and a sham procedure involving toothpicks at key points work better than usual care at relieving chronic low back pain, according to a report in the May 11th issue of Archives of Internal Medicine.¹

“For clinicians and patients seeking a relatively safe and effective treatment for a condition for which conventional treatments are often ineffective, various methods of acupuncture point stimulation appear to be reasonable options, even though the mechanism of action remains unclear,” conclude the researchers who were led by Daniel C. Cherkin, PhD, of Group Health Center for Health Studies in Seattle.

To arrive at their findings, the researchers compared 4 different types of treatment in a 7-week randomized clinical trial of 638 adults who presented with chronic low back pain.

During the treatment period, 157 participants received 10 individually designed treatments prescribed by a diagnostic acupuncturist; 158 underwent standardized course acupuncture for low back pain; 162 received 10 sessions of simulated acupuncture, in which practitioners used a toothpick inside of an acupuncture needle; and 161 received usual care for low back pain. Usual care was comprised of medications, primary care, and physical therapy. Study participants reported changes in their symptoms and in the amount of back-related dysfunction after 8, 26, and 52 weeks.

Function, medication use decreased with needling—or toothpicking

At 8 weeks, 60% of the participants receiving any type of acupuncture showed improvements in functioning, compared with 39% of those receiving usual care. At the 1-year follow-up, 59% to 65% of those in the acupuncture groups experienced an improvement in function compared with 50% of participants randomized to usual care.

Self-reported medication use decreased among participants in the real and simulated acupuncture groups, when compared to their counterparts who received usual care for back pain. What’s more, self-reported medication use remained lower in the acupuncture groups by 1 year out, the study showed.

“The reduction in long-term exposure to the potential adverse effects of medications is an important benefit that may enhance the safety of conventional, medical care,” the authors wrote.

Is acupuncture a placebo effect?

Sham acupuncture seems to work, but researchers are not 100% sure why. They do have some theories.

“Superficial acupuncture point stimulation directly stimulates physiological processes that ultimately lead to improved pain and function, or participants’ improved functioning resulted from nonspecific effects such as therapist conviction, patient enthusiasm, or receiving a treatment believed to be helpful,” they speculated.

“Future research is needed to determine relative contributions of the physiologic effects of noninsertive stimulation, patient expectations, and other nonspecific effects.”

Translating research into practice: practice makes perfect

The new findings come as no surprise to Tim Rhudy, an acupuncturist at the Cleveland Clinic in Ohio. “There have been a number of studies where people have done real acupuncture and sham acupuncture and seen similar results,” he said.

“Acupuncture, in general, will be beneficial for back pain and people who have more experience in these techniques should be able to get better or more specific results,” he told MSKreport.com. “There is a knack to needling locally for low back pain in the glutes, butt, and low back to make actual changes in the musculature, whereas just doing it at distal points can benefit the whole system, but not isolate the source of the pain.”

The skill is knowing how to treat spinal stenosis, a sprained back or whatever is causing the back pain, he said.

References

1. Cherkin DC, Sherman KJ,  Avins AL, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009;169:858-866.