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The German study compared outcomes among 1,162 patients with chronic low back pain treated with traditional Chinese acupuncture; sham acupuncture; or a conventional approach to treating back pain using drugs, physical therapy, and exercise.
The study is the largest investigation of acupuncture vs. conventional nonsurgical treatment for lower back pain ever reported, researchers say.
"Acupuncture represents a highly promising and effective treatment option for chronic back pain," researcher Heinz Endres, MD, tells WebMD. "Patients experienced not only reduced pain intensity, but also reported improvements in the disability that often results from back pain -- and therefore in their quality of life."
Acupuncture for Back Pain
Endres says up to 85% of people will suffer from low back pain at some point in their lives. The pain may last for a few days or continue as chronic low back pain for months and years.
While a recent review of research showed acupuncture to be useful for the treatment of low back pain when given in addition to other therapies, the latest study was designed to determine if acupuncture is an effective treatment on its own.
Acupuncture was delivered in 10, 30-minute sessions conducted over six weeks. Patients who received conventional treatments had a similar number of total treatments, which included exercise, pain medication, and nonsteroidal anti-inflammatory drugs (NSAIDs).
The acupuncture groups were allowed to use medication for acute episodes of back pain only. This consisted of NSAID use no more than two days a week during the treatment period.
Traditional acupuncture involved inserting needles at fixed points and depths on the body and manipulating the needles in accordance with ancient Chinese practice.
With the sham treatment, needles were inserted in the lower back at shallower depths at non-acupuncture points and the needles were not manipulated.
Patients who got the traditional and sham acupuncture treatments were almost twice as likely to report treatment-related responses six months later as patients who did not have acupuncture.
Responses were defined as a 33% improvement in pain or a 12% improvement in functional ability.
"Because acupuncture has a low risk of side effects and few contraindications, it should be added to the catalogue of treatments recommended for acute and chronic back pain, even though -- just as for any other form of treatment -- there will always be some patients who do not respond," Endres says.
Sham Acupuncture Works
Several earlier studies involving patients with chronic pain have shown similar benefits for traditional and sham acupuncture.
A 2005 analysis of 33 back pain studies did show a treatment advantage for traditional acupuncture, but a researcher involved in the analysis says more recent studies challenge this finding.
"The evidence as a whole suggests that the benefits of true acupuncture over sham acupuncture are almost clinically irrelevant," Eric Manheimer, MS, of the University of Maryland Center for Integrative Medicine tells WebMD. "The reasons for this are not really clear. It may be that putting the needles anywhere stimulates some sort of analgesic effect."
Acupuncture is still considered an alternative treatment for low back pain in the U.S., but this is no longer the case in Germany. Based on findings from the newly reported study, it is now covered by state health insurance.
Endres says acupuncture is a clearly useful treatment for low back pain, even if we don't understand why.
"Just because we cannot explain exactly the mechanism by which a treatment works, doesn't mean that it doesn't work," he says.
SOURCES: Haake, M. Archives of Internal Medicine, Sept. 24, 2007; vol 167: pp 1892-1899. Heinz G. Endres, MD, Eric Manheimer, MS, research associate, Center for Integrative Medicine, University of Maryland School of Medicine, College Park.
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