Traditional Therapy vs. Acupuncture Treatment of Chronic Low Back Pain
A September 2007 study in Germany compared verum and sham acupuncture and conventional therapy to see which is more effective for chronic low back pain. Their conclusion was that either type, verum or sham, was almost twice as effective as conventional therapy.1
Criticisms of the 2007 study include the fact that the researchers failed to clearly define acupuncture and that there is no way to standardize or compare the training or expertise and method of practice of all acupuncturists in a meaningful way. The context of their practice, the extent of their training, and the overall level of expertise among different acupuncturists are variables that impact the validity of this study’s conclusions. Particularly, acupuncture training and practice are different for medical doctors than for those who are trained to practice acupuncture outside the traditional medical setting. The study also failed to have a clear goal, attempting to answer questions that would require more than one study to effectively answer. Further, the German study showed no difference in effectiveness of acupuncture vs. sham acupuncture, raising the question of whether acupuncture could be considered effective at all.4
The World Health Organization (WHO) reports that low back pain is not a disease but simply a collection of symptoms that occur in a given anatomical location that can be the result of any number of causes. Based on that fact, no one treatment can be considered more effective than any other treatment. WHO further states that meta-analyses have not proven acupuncture (or other manipulative treatments) to be more effective than other forms of therapy for low back pain.6
The National Center for Complementary and Alternative Medicine agrees that, through 2007, limitations in design and size of acupuncture research studies have made them difficult to clearly interpret.7
Acupuncture vs. No Acupuncture for Low Back Pain
The question of how acupuncture works for pain relief is not clear due to conflicting study results. Studies can be found to support either side of the question about whether acupuncture is more effective than sham acupuncture.
A study done in 2006 found acupuncture to be beneficial for low back pain but found only slight differences in pain relief with needling at acupuncture sites vs. needling at nonacupuncture sites.2 At least one other study has shown greater improvement with needling at acupuncture sites vs. nonacupuncture sites. 8
Other studies have shown some degree of benefit from acupuncture treatment for low back pain where sham acupuncture was not used as a control.9
Acupuncture has also been reported to have benefits when added to other routine care for low back pain.10
Risks of Acupuncture for Back Pain
The FDA has received relatively few reports of acupunture related injuries yearly in spite of the fact that millions are receiving treatments. Acupuncture needles are now regulated by the FDA. They are required to be sterile, nontoxic and their use is limited to qualified practictioners. They must not be reused.7
Though not commonly reported, very invasive deep needling, especially when improperly done, might cause brain injury, collapsed lung, kidney or heart damage and miscarriage.5,7
Safety of acupuncture is greater when administered by a qualified practitioner. A license to practice acupuncture is required in most states. It is advisable to check the credentials of an acupuncturist before receiving treatment.7
Back pain may signal underlying pathology that may progress if left untreated. Medical doctors recommend that acupuncture be considered a complementary therapy instead of an alternative to traditional therapy.5
Combined Treatments for Back Pain
Certain types of acupuncture, when added to conventional therapies, have demonstrated small improvements in pain and function.3,10 Well-designed studies that can verify the extent of the effectiveness of acupuncture are still called for. Its safest and most effective use is generally agreed to be as a complementary therapy under the supervision of a medical doctor. 5,10
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1. Haake, Michael, Hans-Helge Muller, Carmen Schade-Brittinger, Heinz D. Basler, Helmut Schafer, Chrisoph Maier, Heinz G. Endres, Hans J. Trampisch, and Albrecht Molsberger. “German acupuncture trials (GERAC) for chronic low back pain.” Archives of Internal Medicine 167.17 (24 Sep 2007): 1892-1898. 2 Nov 2008. https://archinte.ama-assn.org/cgi/content/full/167/17/1892?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=acupuncture&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT.
2. Brinkhaus, Benno, Claudia Witt, Susanne Jena, Klaus Linde, AndreaStreng, Stefan Wagenpfeil, Dominik Irnich, Heinz-Ulrich Walther, Melchart Dieter, and Stefan Willich. “Acupuncture in patients with chronic low back pain. A randomized controlled trial.” Archives of Internal Medicine 166.4 (27 Feb 2006): 450-457. 24 Oct 2008. https://archinte.ama-assn.org/cgi/content/full/166/4/450?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=low+back+pain&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT.
3. Furlan, A. D., M. W. van Tulder, D. Cherkin, H. Tsukayama, L. Lao, B. W. Koes, B. M. Berman. “Acupuncture and dry-needling for low back pain.” Cochrane Database of Systematic Reviews (2005): Issue 1. Art. No.: CD001351. DOI:10.1002/14651858.CD001351.pub2. 24 Oct 2008. https://www.cochrane.org/reviews/en/ab001351.html.
4. Birch, S. “Reflections on the German acupuncture studies.” Journal of Chinese Medicine 83 (2007): 12-17. 29 Oct 2008. https://www.paradigm-pubs.com/sites/www.paradigm-pubs.com/files/files/Birch-german-studies.pdf.
5. Rotchford, J.K. “Overview: Adverse events of acupuncture.” Medical Acupuncture, A Journal for Physicians by Physicians 11.2 (Fall 1999/Winter 2000). 24 Oct 2008. https://www.medicalacupuncture.com/aama\_marf/journal/vol11\_2/adverse.html.
6. Ehrlich, G.E. “Low back pain.” Bulletin of the World Health Organization 81.9 (2003): 671-676. 1 Nov 2008. https://whqlibdoc.who.int/bulletin/2003/Vol81-No9/bulletin\_2003\_81(9)\_671-676.pdf.
7. “An introduction to acupuncture.” National Center for Complementary and Alternative Medicine. (27 Aug 2008). National Institutes of Health. 1 Nov 2008. https://nccam.nih.gov/health/acupuncture/.
8. Inoue, Motohiro, Hiroshi Kitakoji, Naoto Ishizaki, Munenori Tawa, Tadashi Yano, Yasukazu Katsumi, Kenji Kawakita. “Relief of low back pain immediately after acupuncture treatment–a randomised, placebo controlled trial.” Acupuncture in medicine: Journal of the British Medical Acupuncture Society 24.3 (Sep 2006):103-8. 1 Nov 2008. https://www.acupunctureinmedicine.org.uk/servearticle.php?artid=577.
9. Ratcliffe, J., K.J. Thomas, H. MacPherson, J. Brazier. “A randomised controlled trial of acupuncture care for persistent low back pain: cost effectiveness analysis.” British Medical Journal 333 (23 Sep 2006):626. 1 Nov 2008. https://www.bmj.com/cgi/content/full/333/7569/626?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=A+randomised+controlled+trial+of+acupuncture+care+for+persistent+low+back+++pain%3A+cost+effectiveness+analysis&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT.
10. Witt, Claudia M., Susanne Jena, Dagmar Selim, Benno Brinkhaus, Thomas Reinhold, Katja Wruck, Bodo Liecker, Klaus Linde, Karl Wegscheider, Stefan N. Willich. “Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain.” American Journal of Epidemiology 164.5 (1 Sep 2006):487-96. 1 Nov 2008. <https://aje.oxfordjournals.org/cgi/content/full/164/5/487?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Pragmatic+++rando