Acupuncture more effective than conventional treatments for back pain: study

Last Updated: Monday, September 24, 2007 | 4:50 PM ET

CBC News

Suffering from low back pain? Acupuncture might be a better option than conventional medication, physical therapy and exercise, according to a new study.

"Our study, which directly compared the conventional, non-surgical treatments with acupuncture, showed that patients who were treated with acupuncture over a period of about six weeks experienced nearly 50 per cent decrease in pain intensity, while those treated with physical therapy and other conventional treatments over a period of six weeks had less than 25 per cent improvement," Heinz Endres, one of the authors, told CBCNews.ca.

The findings are published in the Sept. 24 issue of Archives of Internal Medicine.

German researchers conducted a randomized clinical trial involving 1,162 patients, with an average age of 50, that had suffered chronic low back pain for approximately eight years.

Study participants were broken into several groups. One group of 387 patients underwent 10, 30-minute sessions of verum acupuncture, which consisted of inserting needles into fixed points to a depth of five millimetres to 40 millimetres, based on traditional Chinese medicine.

Another group of 387 patients underwent "sham" acupuncture for the same time period, which consisted of inserting needles superficially (one millimetre to three millimetres) into the lower back avoiding all known verum points or meridians.

'Acupuncture has not yet been recommended as a routine therapy. We think this will change with our study.'— Heinz Endres

And a third group of 388 patients underwent conventional therapy, which involved a combination of medication (analgesics), physical therapy and exercise for 30 minutes a session for 10 sessions.

In the study, the response rate was defined as a 33 per cent improvement in pain or a 12 per cent improvement in functional ability.

"At six months, response rate was 47.6 per cent in the verum acupuncture group, 44.2 per cent in the sham acupuncture group and 27.4 per cent in the conventional therapy group," reads the study.

"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," the authors conclude.

Sham acupuncture raises questions

The authors also point out that the subtle difference in the response rate to both sham and verum acupuncture "forces us to question the underlying action mechanism of acupuncture and to ask whether the emphasis placed on learning the traditional Chinese acupuncture points may be superfluous."

The study's outcome could mean that there are no specific effects of acupuncture, that the effect of acupuncture is very small or the success of acupuncture is not dependent on accessing specific points nor depths in the skin, the authors theorize.

"The narrow difference between verum and sham acupuncture also leads to the consideration of whether there might be only a "super-placebo" effect in operation for both forms of acupuncture. Alternatively, however, it can be also be theorized that sham acupuncture does not present a genuine placebo effect, but that it actually triggers specific physiological effects as well, of which we are not yet aware," said Endres.

Regardless, the researchers feel that because the difference in response rates between the acupuncture therapies and conventional treatment is too dramatic to ignore and "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 that is stronger than the action mechanism of conventional therapy."

The researchers conclude that acupuncture "gives physicians a promising and effective treatment option for chronic low back pain, with few adverse effects or contraindications. "

Got back pain? See a doctor

Endres says that anyone experiencing back pain should consult their doctor as soon as possible to determine the nature of the pain.

Secondly, he says, treatment should be started as soon as possible, to prevent acute back pain from turning into chronic back pain.

"There are many widely used and recommended conservative, non-surgical forms of treatment such as physical therapy, massage, chiropractic manipulation, or short-term use of NSAIDs like diclofenac, ibuprofen or others," he says. 

"Unlike these treatments, acupuncture has not yet been recommended as a routine therapy," says Endres. "We think this will change with our study."