Acupuncture In Colorado | Acupuncture Provides Long-Term Relief of Low Back Pain

Acupuncture Provides Long-Term Relief of Low Back Pain

Acupuncture Associates

By Michael Devitt

Back pain is one of the most common reasons people see a health care provider. It has been estimated that up to 80% of the world's population will suffer from back pain at some point in their lives, with the lower back as the most common location of pain.

Although most episodes of low back pain last less than two weeks, research has shown that recurrence rates for low back pain can reach as high as 50% in the first few months following an initial episode.1,2

While there is no definitive way to resolve lower back pain, the use of acupuncture to treat this condition has increased dramatically in the past few decades, based in a large extent to placebo-controlled studies that have validated it as a reliable method of pain relief. The results of a recent study published in the Clinical Journal of Pain3 provide further proof that acupuncture is a safe and effective procedure for low-back pain, and that it can maintain positive outcomes for periods of six months or longer without producing the negative side-effects that often accompany more traditional pain remedies.

Drs. Christer Carlsson and Bengt Sj˜lund of the Lund University Hospital in Sweden recruited 50 patients (33 women, 17 main) from a tertiary level pain clinic for their study. The median age of the participants was 49.8; each patient had been suffering chronic low back pain for a minimum of six months and had tried a variety of other therapies (such as corsets, nerve blocks, drugs and physiotherapy) to treat their condition, but to no avail.

Subjects were randomly assigned to a manual acupuncture group, an electroacupuncture group or a placebo group. Treatment sessions lasted a total of 20 minutes each and were delivered once per week for eight weeks, with the same amount of time and care given to all patients in each group. A followup treatment was given after two months, and a tenth and final treatment was given after an additional two months.

Figure I: Flowchart of the study design.

In the manual group, local points on the lower back and distal points on the lower limbs, forearms and hands were used. The number of needles used per patient increased from an average of eight during the first session to as many as 18 during the third or fourth session. Needles were stimulated three times during each session to attain de qi.

A slightly different protocol was used on patients receiving electroacupuncture. Patients in this group received manual stimulation only during the first few sessions, followed by electrical stimulation of four needles in the low back in subsequent sessions. A similar number of needles as used in the manual acupuncture group were inserted and activated by hand.

The placebo group was given mock stimulation using what the researchers termed an "impressive" -- but disconnected - stimulator attached to two large electrodes. The electrodes were placed on the skin over the most painful areas in the lower back. During mock stimulation, flashing lamps from the machine were displayed and made visible to the patient to give the illusion that treatment was being delivered.

Figure III: Mean weekly pain intensity scores for acupuncture and placebo groups. Measurements were taken at baseline and at one-, three- and six-month follow-up assessments.

Throughout the study, patients recorded pain levels and other measurements in small booklets called pain diaries. Among the variables measured were pain intensity (recorded twice daily on a visual analog scale from 0 to 100, 100 being severe as possible); intake of analgesics (recorded daily); sleep quality (scored on a scale of "good," "slightly disturbed by pain" or "badly disturbed by pain"); and activity level. These diaries were compiled and their results analyzed by a nurse practitioner at the end of the study.

In addition, assessments were performed by an independent observer who did not know which type of acupuncture each patient received. These assessments were taken at four intervals: baseline, one month, three months and six months after the treatment period. These assessments consisted of a clinical interview and physical examination, after which the observer classified the patient's pain as improved, unchanged, or worse.

"Significant" Changes Observed in Acupuncture Patients

Analysis of the pain diaries revealed "significant" differences between acupuncture and placebo patients at the one-, three- and six-month intervals following treatment, all of which favored acupuncture as a more effective form of pain relief. For example, in the acupuncture group, both morning and evening pain scores were lower than baseline measurements and continued to decrease for the duration of treatment. In the placebo group, however, pain scores were several points higher after one month than they were at baseline, and continued to remain higher than the baseline scores throughout the study.

Activity levels were also markedly improved in the acupuncture group. Fourteen acupuncture patients and seven placebo patients had been on sick leave (either part-time or full-time) prior to the start of the study. By the time the tenth acupuncture treatment was delivered, six of the acupuncture patients on sick leave had returned to part-time or full-time work; another six were retired but still reported improved activity levels. In comparison, only one patient in the placebo group showed an improvement in activity; another patient actually regressed to being put on full sick leave.

Figure II: Acupuncture points used in the study. Points are labeled according to World Health Organization standards.

Furthermore, acupuncture patients experienced less episodes of sleep disturbance than their placebo-treated counterparts. Before the study, 30 acupuncture patients and 12 placebo patients reported sleep disturbances due to pain. The researchers reported that the sleep pattern was "significantly less disturbed after the treatment period" in the acupuncture group, but that there was "no significant difference in sleep disturbance" in the placebo patients.

Finally, total intake of analgesics dropped dramatically in the acupuncture group, but not the placebo group. At the start of the study, patients in the acupuncture group consumed an average of 31 pills per week; those in the placebo group consumed an average of 23 pills. At the six-month follow-up, the number of pills taken by placebo patients remained almost identical (21.5 per person per week), but had dropped more than 28% to 21.4 pills per week in acupuncture patients.

Independent examination by the blinded observer appeared to corroborate the patients' pain estimates. One month after the initial treatment period, 16 acupuncture patients (but only two placebo patients) were judged to be improved. After six months, 14 acupuncture patients (and only two placebo patients) were still improved. Both types of acupuncture worked effectively; of the 14 patients who showed improvement after six months, eight received manual acupuncture and six received electrical stimulation.

One interesting result of the study was that acupuncture appeared to be most effective in women. Of the 16 acupuncture patients judged to be "improved" at the one-month follow-up, 15 were women. At the six-month follow-up, all 14 patients who were still improved were women. The researchers were at a loss to explain this phenomenon, but hypothesized that it may be linked to estrogen receptors in the central nervous system.

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June 18^th, 2008

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