Does Acupuncture Really Help Back Pain?
A study says it's better than standard therapy, but critics balk
 (HealthDay News) -- Traditional Chinese acupuncture proved to be more effective in alleviating chronic, low-back pain than conventional treatment, a German study found.
But here's the rub: A sham treatment involving superficial needling at non-acupuncture points was just as effective.
Authors of the study, which appeared in the Archives of Internal Medicine , said the trial was the largest and most rigorous to date comparing the traditional Chinese or "verum" acupuncture for chronic low-back pain with sham, or fake, acupuncture and conventional therapy. In their view, the findings yielded several surprises.
"Acupuncture, regardless of the technique, was significantly more effective than conventional therapy at all follow-up points," wrote Dr. Michael Haake of the University of Regensburg , Bad Abbach, Germany , and his colleagues. "To our knowledge, this is the first time superiority of acupuncture over conventional treatment has been unequivocally demonstrated for the primary and secondary outcomes, including medication reduction, in contrast to studies with a usual-care group."
The authors also did not expect that verum and sham acupuncture would work equally well -- a finding that raises questions about the physiologic and psychologic effects of acupuncture.
"The underlying mechanism may be a kind of superplacebo effect produced by placebo and all nonspecific factors working together," they noted.
Acupuncture uses thin needles to stimulate specific anatomical points on the body. In the United States , the National Center for Complementary and Alternative Medicine has funded extensive research to advance the understanding of this ancient healing practice.
Yet the jury is out on its value for low-back pain. A 2005 analysis of the scientific evidence, which included a review of 35 randomized/controlled trials, could draw no firm conclusions from the data, saying only that acupuncture may be useful as an adjunct to other therapies.
The German team conducted a multicenter trial involving 1,162 people 18 to 86 years old who had a history of chronic, low-back pain. Participants were randomly assigned to receive verum acupuncture, sham acupuncture or conventional therapy.
A successful outcome was defined as a 33 percent improvement in pain or a 12 percent improvement in functional ability. After six months of treatment, the response rate was 48 percent in the verum acupuncture group and 44 percent in the sham acupuncture group -- nearly double the improvement (27 percent) with conventional therapy.
The study prompted several letters to the editor.
Howard H. Moffet of Kaiser Permanente's Division of Research in Oakland , Calif. , argued that the authors failed to explain how verum and sham acupuncture truly differ. "If the acupuncture exposures are indistinguishable, then the investigators have failed to control for the 'placebo effect' or extra attention patients receive in the course of a clinical trial," he wrote.
Researchers at the University of Notre Dame Australia asserted that the authors failed to substantiate their conclusion that acupuncture is effective for chronic, low-back pain. "The results clearly show no difference between true and sham acupuncture, and the reasonable interpretation of this result is that acupuncture is not effective beyond placebo," they wrote.
Brazilian researchers argued that sham acupuncture "should not be considered as a placebo, because it is neither an inert nor innocuous procedure that could be used in controlled experiments."
In reply, the German team said their study was not designed to explain how acupuncture works. In addition, the authors described several controls put into place to account for participants who, for instance, had a positive view of acupuncture or a negative view of conventional therapy.
What's more, the team noted, "even a placebo effect is associated with real biochemical processes in the brain, which blur the boundaries between a 'real' treatment with specific action mechanisms and a placebo treatment without such 'specific' mechanisms."
Almost half of the people with chronic pain benefited from acupuncture, they added. "To deny these patients a potentially helpful treatment is, in our view, not justifiable."
On the Web
To learn more about acupuncture, visit the National Center for Complementary and Alternative Medicine.
SOURCES:
HealthDay News ; JAMA/Archives journals, news release, Sept. 24, 2007; Sept, 24, 2007, March 10, 2008, and May 12, 2008, Archives of Internal Medicine ; National Center for Complementary and Alternative Medicine, Bethesda, Md.; Jan. 25, 2005, Cochrane Database of Systematic Reviews
Author:
Karen Pallarito
Publication Date:
Aug. 31, 2008
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