At the start of the acupuncture study, there were participants who had an average back dysfunction score of 10.6 in which the score range zero to 23. All groups showed improvements in dysfunction at the end of the eight-week treatment period.
After eight weeks of treatment the researchers found that all forms of acupuncture individualized, standardized and simulated reduced back-related dysfunction compared with usual care (acupuncture reduced score by about 4.5 points and usual care by 2.1 points on a 23-point scale). There was no statistically significant difference between the three acupuncture groups. There was little change in scores between eight and 52 weeks, with no difference between the acupuncture groups, and the usual care group continuing to have worse dysfunction than the acupuncture groups.
The researchers conclude that although acupuncture did reduce chronic low back pain, whether or not needle sites were tailored to the individual patient or whether the needles actually pierced the skin did not appear to be important.
They say this brings into question how acupuncture is thought to have an effect, and that it is still unclear whether acupuncture actually has a biological effect or whether it acts as a placebo. They conclude that acupuncture may be a reasonable option for doctors and patients looking for a relatively safe and effective treatment, especially as conventional treatments for chronic low back pain are often ineffective.
The strengths of this study include its randomized allocation of participants into treatment groups, the inclusion of a credible ‘sham’ acupuncture treatment as well as a usual care control group and a high level of follow-up for a long period of time. Its findings suggest that although acupuncture may reduce back-related dysfunction, this may not be due to biological effects. There are some points to note:
- The study included people with uncomplicated chronic low back pain with no serious identifiable cause. As such, the results may not apply to people with acute low back pain (for less than three months) or low back pain from other identified causes, including those with nerve root pain and sciatica.
- It is possible that simulated acupuncture does have some biological effect, and this may explain why no differences between the acupuncture methods were found.
- The Bellingham acupuncture used in the study used only needles and involved minimal interaction between the acupuncturist and patient, therefore the results may not be representative of effects that would be seen with acupuncture including more interaction or other aspects of treatment, such as applying electrical currents through the needles.