What Does Clinical Research Say About Acupuncture for Back Pain?

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Introduction

Chronic pain is one of the most common reasons for individuals to seek medical care, and low back pain is one of the most common forms of chronic pain. Whether acute (lasting for a short duration, usually less than four weeks) or chronic, low back pain is experienced by a wide swath of the population, estimated to affect as many as 25 million people in the United States (Bevers, 2017). The effects of low back pain range from a few days of stiff, sore joints to years of negative impact on patients’ mobility, ability to work and overall quality of life.

The causes of chronic low back pain (cLBP) are as varied as the individuals who suffer from the condition. Structural abnormalities like herniated discs, fractures and spinal stenosis account for approximately 15% of all chronic back pain cases, but the vast majority - up to  85% - of cLBP is classified as “unspecified,” meaning that imaging and other diagnostic techniques were unable to determine a specific cause of pain and dysfunction (Centers for Medicare and Medicaid Services, 2020).

In these frustrating cases, the first line of treatment has traditionally been opioid medication to manage pain. Given what we now know about the dangers of opioid use and the potential for addiction and overdose, alternative treatments for chronic pain such as acupuncture, massage, yoga, and biofeedback have garnered much more attention and study. In this article, we will examine some of the scientific evidence for the use of acupuncture to manage cLBP.

Blinded Studies and “Sham” Acupuncture

The gold standard in medical research is the double-blind controlled study. In a nutshell, when discussing research about acupuncture this means that neither the patient nor the practitioner giving the treatment know what treatment they are being given, and there is at least one group receiving the treatment being tested, with an accompanying control group either receiving nothing, a placebo, or a different therapy. When research studies use “sham” acupuncture as a placebo, this could mean the study participants received acupuncture, but at points that are not known to help cLBP. This may explain why the results in studies that compare placebo acupuncture to the real thing have outcomes that are closer than one would expect - the  “sham” participants may be receiving real benefits from the fake treatment.

For example, in a German study conducted in 2007 (Haake 2007), three groups of participants who suffered from cLBP were divided into groups who received real acupuncture, a placebo, or standard treatment for cLBP, which included physical therapy with assigned exercises and pain management drugs. At the conclusion of the study, 47% of the real acupuncture group improved their pain by 33% or more. 44% of the placebo acupuncture group reported a 33% or better reduction, and just 27% or the conventional therapy group reported the same improvement. Even with a fake acupuncture treatment, patients saw better results and improvement in pain versus the standard care.

In a similar study (Brinkhaus et al, 2006) three groups of cLBP patients (real acupuncture, sham acupuncture, and a third group told they were on a waitlist to receive acupuncture) were asked to report their pain levels on a visual scale of 0 to 100 at baseline (before treatment), during treatment, and after final treatments. The acupuncture group reported an average reduction in pain of 28 to 30 points, the placebo group reported a similar but smaller average pain reduction of 23 to 31 points, and the waitlist group reported an average pain reduction of 7 to 22 points, again suggesting that real acupuncture based on a TCM (Traditional Chinese Medicine) diagnosis is an effective tool to assist in the management of cLBP.

Lasting Results

In 2001, a study looked at the effects of treatment of cLBP with acupuncture for several months after the actual course of treatment had ended. Three groups, consisting of two groups using different styles of acupuncture, and a placebo group, were all seen once per week for 8 weeks. The researchers followed up at month 1, month 3, and month 6. The participants were asked to keep pain journals monitoring the frequency and intensity of their symptoms, as well as their use of over-the-counter and prescription pain relievers. At the 1 month follow-up (after participants had received four weekly treatments) 16 of the 34 acupuncture group participants reported improvement in pain levels, as did 2 of the 16 placebo group participants. At month 6 - four months after the course of treatment had finished - 14 of the 34 acupuncture patients reported a continued reduction in pain.

A 2003 study (Kerr, 2003) compared an acupuncture group to a group using transcutaneous electrical stimulation (a TENS machine) and found that both had similar levels of pain reduction over a six-week course of treatment. However, at a 6-month follow-up, researchers found that the acupuncture group enjoyed lasting pain relief results as compared to the TENS group.

Conclusion

The evidence suggests that acupuncture is a safe, effective treatment for cLBP that can result in lasting relief far beyond the actual course of treatment. Could this therapy be helpful for you or a loved one suffering from chronic low back pain? Contact us for an initial consultation today.

References

Bevers K, Hulla R, Rice O, Verdier G, Salas E, Gatchel RJ. The Chronic Low Back Pain Epidemic in Older Adults in America. J Pain Relief. 2017; 6 (2):285. doi: 10.4172/2167-0846.1000285. 

Brinkhaus, B., Witt, C. M., Jena, S., Linde, K., Streng, A., Wagenpfeil, S., Irnich, D., Walther, H. U., Melchart, D., & Willich, S. N. (2006). Acupuncture in patients with chronic low back pain: a randomized controlled trial. Archives of internal medicine, 166(4), 450–457. https://doi.org/10.1001/archinte.166.4.450

Carlsson, C. P., & Sjölund, B. H. (2001). Acupuncture for chronic low back pain: a randomized placebo-controlled study with long-term follow-up. The Clinical journal of pain, 17(4), 296–305. https://doi.org/10.1097/00002508-200112000-00003

Centers for Medicare and Medicaid Services. Decision Memo for Acupuncture for Chronic Low Back Pain (CAG-00452N). (2020, January 21). https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=295.

Haake M, MüLler H, Schade-Brittinger C, et al. German Acupuncture Trials (Gerac) For Chronic Low Back Pain: Randomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups. Arch Intern Med.2007;167(17):1892–1898. doi:10.1001/Archinte.167.17.1892

Kerr, D. P., Walsh, D. M., & Baxter, D. (2003). Acupuncture in the management of chronic low back pain: a blinded randomized controlled trial. The Clinical journal of pain, 19(6), 364–370. https://doi.org/10.1097/00002508-200311000-00004