Friday, April 5, 2013
Does Acupuncture Really Work for Low Back Pain?
Acupuncture has been widely used to treat low back pain (LBP), though Western medicine has generally viewed it with skepticism. Prior RCTs have yielded mixed results, with findings apparently related to variations in the control group (i.e. no treatment, penetrating sham acupuncture, non-penetrating sham acupuncture, etc.). In the April 1 issue, Dr. Song and colleagues from Korea reported their results of a single-blind, placebo controlled randomized trial comparing acupuncture to non-penetrating sham acupuncture. All patients had low back pain for at least 3 months, no significant sciatica, no recent acupuncture, and were not taking narcotics or muscle relaxants. They randomized 130 patients and had 6 month follow-up on 116. Their primary outcome was the LBP bothersomeness visual analog scale (VAS) measured 2 weeks after completing 12 acupuncture sessions over 6 weeks. Compared to the sham control, acupuncture patients improved about 1 point more on the 10 point VAS, a result that was statistically significant. There were no significant differences between the two groups on the Oswestry Disability Index and no major adverse events. One of the potential concerns with this study is the effectiveness of patient blinding given the nature of the sham procedure, however, the patients were not able to reliably determine what treatment they had received. While it can be debated whether 1 point greater improvement on the LBP bothersomeness VAS is clinically important, this study provides relatively convincing Level 1 evidence that acupuncture is more effective for LBP than a sham control.
The authors of this study should be congratulated for carrying out a high quality Level 1 trial with an effective sham control. “Real” acupuncture tended to lead to greater improvement on pain scores compared to the sham version, however, both groups improved significantly over baseline. The cause of most of this improvement is difficult to determine but may be related to the favorable natural history of LBP, the placebo effect of acupuncture in a population that believes in its effectiveness or the exercise instruction that both groups received. It would be interesting to see if the same results could be obtained in a Western population that is more skeptical about acupuncture, especially in a population with workers’ compensation patients or patients taking narcotics. Future studies, possibly even one based on the data from the current study, should determine which subgroups benefit most from acupuncture and which groups have minimal improvement. This is the latest addition to a growing literature that suggests acupuncture is reasonably effective for chronic LBP. Given that we do not have other reliable methods for treating LBP, it seems as though acupuncture should be an option offered to LBP patients.
Please read Dr. Song’s article on this topic. Does it change your opinion about acupuncture for LBP? Let us know by leaving a comment on The Spine Blog.
Adam Pearson, MD, MS
Associate Web Editor