Acupuncture May Provide Benefit in Chronic Lower Back Pain
Acupuncture, a treatment that goes back over 2000 years, is gaining popularity as an alternative treatment in the Western world, particularly for treatment of chronic lower back pain (CLBP). There are different styles of acupuncture available: Japanese Meridian Therapy, French Energetic acupuncture, Korean Constitutional acupuncture, and Lemington Five Elements acupuncture. Other forms have also been created.
Use of acupuncture is based on the belief that the body is a balance of two opposing forces: yin and yang. When a person is sick or disabled, these become unbalanced, blocking the flow of vital energy in the body. Through applying needles to acupuncture points along certain pathways in the body, the balance is restored.
How acupuncture works is not known, however researchers do have several theories. They range from the nervous system reacting to the needles and producing biochemical and endorphins that influence pain sensation to stimulation of vascular and immunomodulatory factors, such as mediators of inflammation.
While acupuncture does not have any specific diagnostic testing to be performed before beginning treatment, there are some groups of patients who should not undergo acupuncture. They include those who have hemophilia, bleeding disorders, septicemia, cellulitis, skin infections, or loss of skin integrity from burns or ulcerations at the site where the needles will be inserted. If the acupuncturist uses electroacupuncture, this should not be performed over the brain or heart, nor in an area of an implanted electrical device. Pregnant women, those taking anticoagulants, and people with metal allergies should proceed with caution.
The authors of this article reviewed several studies that investigated the efficacy of acupuncture compared with other forms of treatment, including sham treatments. The findings are as follows:
- moderate evidence that acupuncture is more effective for short-term and immediate pain relief, and immediate functional improvement, than no treatment in treating CLBP (1 high-quality study, 2 low-quality studies)
- limited evidence that acupuncture is more effective for short-term functional and global outcomes than no treatment (2 low-quality trials)
- conflicting evidence that acupuncture was more effective than sham therapy for immediate pain relief; more effective according to 1 high-quality trial and no difference for 2 high-quality trials and 3 low-quality trials
- conflicting evidence that acupuncture was more effective than sham acupuncture for short-term pain relief; no difference in 1 high-quality study and more effective in 2 high-quality trials
- strong evidence that there is no difference in intermediate pain relief between acupuncture and sham acupuncture (2 high-quality trials and 2 low-quality trials)
- conflicting evidence that there is no difference in intermediate global improvement between acupuncture and sham acupuncture (positive in 1 high-quality trial and no difference in 1 low-quality trial)
- moderate evidence that acupuncture is more effective than sham treatment for short-term global improvement (1 high-quality trial)
- moderate evidence that acupuncture is no different from sham acupuncture in immediate, short-term, and long-term follow up (2 high-quality trials, 2 low-quality trials)
- moderate evidence that acupuncture showed no difference over sham acupuncture for return to work status at intermediate follow up (1 high quality trial, 1 low-quality trial
- moderate evidence of no difference immediately after treatment between acupuncture and massage, but significant difference in favor of massage at long-term follow up (1 high-quality trial)
- marginally significant difference between acupuncture and massage at long-term follow up for measures of function; massage more effective than acupuncture directly after sessions (1 high-quality trial)
- conflicting evidence on effectiveness of acupuncture compared with transcutaneous electrical nerve stimulation (TENS) immediately after treatment (1 high-quality trial, 1 low-quality trial)
- limited evidence of no difference in pain from acupuncture or TENS at intermediate follow up (1 low-quality trial)
- moderate evidence of no difference between acupuncture and TENS immediately after treatment an limited evidence of no difference at intermediate follow up (1 high-quality trial, 1 low-quality trial)
- moderate evidence that acupuncture provided no difference immediately after treatment and at long-term follow up compared with self-education (1 high-quality trial)
- moderate evidence that spinal manipulation is more effective for pain an functional outcome in the short-term than is acupuncture (1 high-quality study)
As with all treatments, some complications or side effects do occur, as reported in 12 trials. These side effects included local bleeding or hematoma, worsening of CLBP, tiredness, drowsiness, light-headedness, and dizziness. Serious complications, such as hepatitis, septicemia, and pneumothorax were rare.
The authors conclude that there "appears to be some evidence for the use of acupuncture for the treatment of CLBP." They do caution, however, that more studies are needed to determine positive benefits of acupuncture beyond that of comparisons with placebo.
Carlo Ammendolia, DC, PhD, et al. Evidence-informed management of chronic low back pain with needle acupuncture. In The Spine Journal. January/February 2008. Vol. 8. Issue 1. Pp. 160-172.