Tuesday, September 25, 2007

Wham: Acupuncture Treatment May Be More Effective than Conventional Therapy for Lower Back Pain

A new study in the September 24 issue of Archives of Internal Medicine (one of the JAMA/Archives journals) shows that six months of acupuncture treatment appears to be more effective than conventional therapy in treating low back pain. Oddly, however, a "sham" version of acupuncture performed well also.

Low back pain is a common, impairing and disabling condition, often long-term, with an estimated lifetime prevalence of 70 percent to 85 percent. It is the second most common pain for which physician treatment is sought and a major reason for absenteeism and disability. Acupuncture is increasingly used as an alternative therapy, but its value as a treatment for low back pain is still controversial. This trial was conducted in Germany, involving 1,162 patients (with an average age 50) who had experienced chronic low back pain for an average of eight years.

Patients underwent ten 30-minute sessions (approximately two sessions per week) of real Chinese acupuncture (387 patients), "sham" acupuncture (387 patients) or conventional therapy (388 patients). The Chinese or "verum" acupuncture consisted of needling fixed points to a depth of 5 millimeters to 40 millimeters based on traditional Chinese medicine. The sham acupuncture consisted of inserting needles superficially (1 millimeter to 3 millimeters) into the lower back avoiding all known verum points or meridians. Conventional therapy consisted of a combination of medication, physical therapy and exercise.

Response rate was defined as a 33 percent improvement in pain or a 12 percent improvement in functional ability. “At six months, response rate was 47.6 percent in the verum acupuncture group, 44.2 percent in the sham acupuncture group and 27.4 percent in the conventional therapy group,” the authors note. “Differences among groups were as follows: verum vs. sham, 3.4 percent; verum vs. conventional therapy, 20.2 percent; and sham vs. conventional therapy, 16.8 percent.”

The authors conclude that “The superiority of both forms of acupuncture suggests a common underlying mechanism that may act on pain generation, transmission of pain signals or processing of pain signals by the central nervous system and that is stronger than the action mechanism of conventional therapy. Acupuncture gives physicians a promising and effective treatment option for chronic low back pain, with few adverse effects or contraindications. The improvements in all primary and secondary outcome measures were significant and lasted long after completion of treatment.”

What was the reason the "sham" acupuncture gave a lasting and pronounced benefit--even better for the patient than conventional drugs and exercise? In this writer's opinion, the answer is still unclear. While it sounds like it could be "placebo effect," it obviously has much more to it than that.


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