Given the relatively poor results of traditional medical treatment for chronic low back pain (CLBP), interest in alternative treatments, including acupuncture, has developed. While there were once very few scientific studies of acupuncture, higher quality studies including RCTs have been performed recently. None of these studies have been very large, so Ms. Lam and her colleagues from Ireland elected to perform a meta-analysis of the RCTs evaluating acupuncture in order to summarize the evidence that is currently available in the literature. They included RCTs comparing acupuncture to no treatment, medication, sham acupuncture, TENS, and “usual care”, defined as physical therapy, massage and exercise. They included 25 such RCTs that reported data on pain and function and found that acupuncture tended to improve pain and function compared to the other treatment modalities, though the effect size tended to be relatively low and in the vicinity of previously defined minimal clinically important differences (MCIDs). The exception was the analysis comparing acupuncture to TENS, which showed no difference in outcomes for the two modalities. Not surprisingly, the greatest treatment effects were observed in the comparisons to no treatment and sham treatment, though these were just above the MCID thresholds.
This study is a nice addition to the acupuncture literature and demonstrates that acupuncture can be helpful for CLBP, though the average magnitude of benefit tends to be modest. Like most of the spine literature, the acupuncture literature is limited by heterogeneity of treatment regimen, patient population, control groups, and outcome measures. As such, meta-analysis of this literature is limited by the heterogeneity of the input, and it is difficult to determine how much an individual patient is likely to benefit from a specific acupuncture regimen. Even the gold-standard study design, a double-blind, placebo-controlled randomized trial, is difficult to interpret given that “sham acupuncture” is hard to define. Despite the challenges in performing a sham controlled trial, four such trials have been performed, and “real” acupuncture did seem to have a clinically and statistically significant benefit compared to sham. These data confirm most providers’ anecdotal experience that acupuncture can help some patients to some degree, but that results are variable and, like most treatments for CLBP, are unlikely to completely eliminate pain or restore normal function. Given that acupuncture is relatively low cost and low risk, it seems like a reasonable treatment option to offer CLBP patients. Hopefully further studies with well-defined patient populations, interventions, and outcomes will continue to emerge.
Please read Ms. Lam’s paper on this topic in the November 15 issue. Does this study change how you view acupuncture for the treatment of CLBP? Let us know by leaving a comment on The Spine Blog.
Adam Pearson, MD, MS
Associate Web Editor