Acupuncture better than standard treatments for chronic back pain
Publication Date:24/09/2007
People with back pain may get longer-lasting improvement with acupuncture than with standard treatments like physiotherapy and regular painkillers, a large new study has found.
What do we know already?
Many people suffer from long-lasting pain in the lower back. It's one of the most common reasons why people visit a GP. And there's not much agreement about how best to treat long-term back pain.
Until now, there haven't been many good quality studies into the use of acupuncture for back pain. Most studies have been quite small, had problems with the way they were carried out, or were too short, so we don't know how long the effect of treatment lasted.
Researchers also don't know whether acupuncture only has an effect when it is carried out in the traditional way. Traditional Chinese acupuncture is based on the theory that energy travels around your body along pathways called meridians. This energy flow can become blocked, causing pain. Acupuncturists insert thin, sterile needles through the skin at specific points on these meridians where the energy (known as 'chi') is thought to be blocked. These needles are then used to unblock the chi and restore balance in the body. Acupuncturists say this is why it works for pain.
What does the new study say?
The study compared three types of treatment: traditional Chinese acupuncture, 'pretend' acupuncture (avoiding specific acupuncture points and only putting needles just below the skin) and standard treatments such as physiotherapy, massage, heat therapy and taking painkillers regularly. Everyone had 10 half-hour sessions with a therapist, usually two sessions a week. Researchers interviewed the patients throughout the study and for six months afterwards, to see how much effect the treatments had on people's back pain.
Both traditional Chinese acupuncture and 'pretend' acupuncture worked well to improve back pain for almost half the people in the study. They had much less back pain, even six months later. However, there wasn't much difference between the two types of acupuncture. 'Pretend' acupuncture seemed to work as well as traditional Chinese acupuncture.
Both types of acupuncture worked for many more people than standard treatments. Only about a quarter of people having conventional therapies had a big improvement in pain that lasted six months.
The people having standard therapies had a mixture of treatments, including physiotherapy, massage and heat therapy. They also took painkiller medicines. They saw a therapist or a doctor as often, and for as long, as the people having acupuncture. Not many studies have compared acupuncture to regular conventional therapies in this way.
People having acupuncture were allowed to take painkillers when they felt they needed them. But if they needed to take them regularly (more than 2 days a week), the researchers didn't include their results as successful acupuncture treatment. That's because the painkillers, not the acupuncture, might have been having more effect.
Tell me more about the study's findings
The findings were quite surprising. Firstly, both types of acupuncture worked much better than the conventional therapies. Secondly, it's surprising that 'pretend' acupuncture worked as well as traditional Chinese acupuncture. This raises the question of what makes acupuncture work. Traditional acupuncturists think it works because putting needles into the body at specific acupuncture points releases energy. But 'pretend' acupuncture works just as well.
The researchers suggest it might work because people are very positive about the idea of acupuncture, and expect it to help them. They may be less positive about treatments like physiotherapy. On the other hand, the researchers say there may be physical reasons why 'pretend' and traditional acupuncture work, that we just don't know about yet.
Where does the study come from?
The study was carried out by researchers from several universities in Germany, including the University of Regensburg, Philipps-University Marburg and Ruhr-University Bochum. It was published in the US medical journal, Archives of Internal Medicine.
How reliable are the findings?
This was a big, good-quality study of more than 1000 people. It was designed very carefully to get the most reliable answers about treatment for back pain. There were no major problems with the way it was carried out.
The people having standard therapies had a mixture of treatments and pain relief medicine. Some of these treatments (for example physiotherapy, heat treatment) might have worked better than others, but the study doesn't tell us which ones worked better. So it's possible some of the conventional therapies might have worked as well as acupuncture, but the results from other conventional therapies that aren't as good have hidden this result.
What does this mean for me?
Lots of people have back pain. For some people, the pain can be long-lasting and cause a lot of distress and disability. If you're in that position, you might feel that this study gives you hope that acupuncture can help. But it's worth taking note of a few points.
- Acupuncture didn't help everyone in the study. Just under half the people who had either type of acupuncture had a big improvement in back pain, six months after treatment.
- The study was carried out in Germany. Conventional treatments in Germany might be different from the ones recommended in the UK. So we don't know whether conventional treatments in the UK might have worked as well, or better than, acupuncture.
- The study didn't include anyone who'd had a broken bone in their spine, who had rheumatoid arthritis, sciatica, or long-term pain from other diseases. So we don't know what the results of treatment would be for people with those conditions.
What should I do now?
If you do decide to try acupuncture for back pain, it's very important to see a qualified acupuncturist. You could ask your GP if he or she can recommend someone. Harmful effects from acupuncture are rare, but there is a risk of infection, especially if the acupuncturist doesn't use properly sterilised needles.
There are lots of treatments for low back pain. To find out more, see our information about back pain.
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