Does Acupuncture Help Low Back Pain?Acupuncture as an alternative treatment to traditional medicine has been making the news. More and more studies are showing its positive effects on chronic low back pain. But differences in how the studies are conducted have left some lingering doubts as to the true benefit of this treatment. Since patients receiving a placebo treatment seem to fare as well as those receiving the "true" acupuncture treatment, further study is needed.
That's where this study from Korea comes in. The authors (from the Department of Korean Rehabilitation Medicine) designed a study to compare the results of true acupuncture with sham acupuncture treatment. The two different types of treatment were used in the care of patients ages 18 to 65 who had nonspecific chronic low back pain (cLBP or LBP). Each patient reported pain levels as being a six or higher on a scale from zero (no pain) to 10 (severe pain). Patients were assigned to the sham treatment and the real acupuncture treatment in a random fashion.
Nonspecific cLBP is the term used to describe pain of unknown cause that lasts for more than three months. It is likely that there is no one specific cause for the pain. It is suspected that more than one factor comes into play including individual (e.g., personality, stress and response to stress, socioeconomic) factors, psychological factors, and even workplace-associated contributing factors.
In this study, 130 patients received nonpenetrating sham acupuncture or true (penetrating) acupuncture twice a week for more than six weeks. Nonpenetrating acupuncture means a blunt tipped needle was used to make contact with the skin but without piercing through the skin.
This way of providing a sham acupuncture treatment has been shown in past studies to be perceived as genuine by other patients. Points of stimulation used were NOT true acupuncture points to further differentiate the sham treatment from the real or true acupuncture treatment (which was applied to actual acupuncture points).
Results were measured based on patient report of how "bothersome" the chronic low back pain (cLBP) was, pain intensity, general health status, and level of disability and depression. Different well-known assessment tools were used before and after treatment to measure these outcomes (e.g., Visual Analogue Scale, Oswestry Disability index, Beck Depression Inventory, Short Form-36 of general health).
Patients in both groups reported significant improvement but the real acupuncture group had a much greater reduction of "bothersome" pain. Intensity of pain was also reduced more in the group receiving real acupuncture. Patients in the sham group who benefitted from this "treatment" may have been experiencing both physiologic and psychologic benefit from the expectation that acupuncture would help. The group receiving real acupuncture would have the same positive expectation but with the added benefit of a true physiologic (not just perceived) effect.
In summary, acupuncture is a safe and effective treatment for chronic low back pain (cLBP) of the nonspecific variety. Real acupuncture reduces the intensity and bothersomeness of cLBP more than sham acupuncture. Other measures (patient perceived and rated depression, disability, general health status) were not different between the two groups. There was some discussion of the difficulty Korean adults have in expressing emotions such as depression or anger leading to depression. This factor could affect outcomes in both groups and may require further investigation for this particular patient population.
Yu-Jeong Cho, KMD, PhD, et al. Acupuncture for Low Back Pain. In Spine. April 1, 2013. Vol. 38. No. 7. Pp. 549-557.
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