Back Pain and Acupuncture
Acupuncture therapy for chronic lower back pain: a systematic review.
Trigkilidas D.
INTRODUCTION: Chronic low back pain is a common condition affecting a significant proportion of the population and has
large economic implications on the society. Acupuncture has grown in popularity as an alternative therapy for chronic low back
pain. Recent National Institute for Health and Clinical Excellence (NICE) guidelines on low back pain offer a course of
acupunctureas a baseline treatment option according to patient preference. The aim of this systematic review was to evaluate
if this treatment option is justified in view of recent evidence available on the efficacy of acupuncture. MATERIALS AND
METHODS: Studies included were identified by a PubMed search for relevant, randomised, controlled trials on the 23 July
2009. A systematic review was performed. RESULTS: Fifteen randomised controlled trials were identified. Of these, four met
the eligibility criteria and were critically appraised. These trials suggest acupuncture can be superior to usual care in
treating chronic low back pain, especially, when patients have positive expectations about acupuncture.
CONCLUSIONS: NICE guidelines of a course of acupuncture, offered according to patient preference as a treatment option
for chronic low back pain, are justified. PMID: 20529520 [PubMed - as supplied by publisher]
Szczurko O, Cooley K, Busse JW , Seely D, Bernhardt B, Guyatt GH, Zhou Q, Mills EJ. PLoS One. 2007 Sep
19;2(9):e919. Division of Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada.
OBJECTIVE: Chronic low back pain represents a substantial cost to employers through benefits coverage and days missed
due to incapacity. We sought to explore the effectiveness of Naturopathic care on chronic low back pain. METHODS: This
Naturopathic care for chronic low back pain: a randomized trial.
study was a randomized clinical trial. We randomized 75 postal employees with low back pain of longer than six weeks
duration to receive Naturopathic care (n = 39) or standardized physiotherapy (n = 36) over a period of 12 weeks. The study
was conducted in clinics on-site in postal outlets. Participants in the Naturopathic care group received dietary counseling,
deep breathing relaxation techniques and acupuncture. The control intervention received education and instruction on
physiotherapy exercises using an approved education booklet. We measured low back pain using the Oswestry disability
questionnaire as the primary outcome measure, and quality of life using the SF-36 in addition to low back range of motion,
weight loss, and Body Mass Index as secondary outcomes. RESULTS: Sixty-nine participants (92%) completed eight weeks
or greater of the trial. Participants in the Naturopathic care group reported significantly lower back pain (-6.89, 95% CI. -9.23 to
-3.54, p = <0.0001) as measured by the Oswestry questionnaire. Quality of life was also significantly improved in the group
receiving Naturopathic care in all domains except for vitality. Differences for the aggregate physical component of the SF-36
was 8.47 (95% CI, 5.05 to 11.87, p = <0.0001) and for the aggregate mental component was 7.0 (95% CI, 2.25 to 11.75, p =
0.0045). All secondary outcomes were also significantly improved in the group receiving Naturopathic care: spinal flexion
(p<0.0001), weight-loss (p = 0.0052) and Body Mass Index (-0.52, 95% CI, -0.96 to -0.08, p = 0.01).CONCLUSIONS:
Naturopathic care provided significantly greater improvement than physiotherapy advice for patients with chronic
low back pain.
Su JT, Zhou QH, Li R, Zhang J, Li WH, Wang Q. Zhongguo Zhen Jiu.
Department of TCM, Changhai Hospital Affiliated to The Second Military Medical University, Shanghai 200433, China.
Abstract
OBJECTIVE: To assess the immediate analgesic effect of wrist-ankle acupuncture on acute lumbago and the relationship
between the analgesic effect and the expectation of patients. METHODS: A randomized, single-blind, sham-controlled trial
was designed. Sixty cases of acute lumbago were randomly divided into two groups, 30 cases in each one. In observation
group, wrist-ankle acupuncture was adopted to the Lower 5 and Lower 6 bilaterally, no requirement of Deqi (arrival of qi). In
Immediate analgesic effect of wrist-ankle acupuncture for acute lumbago: a randomized controlled
trial].
control group, sham acupuncture was adopted. The treatment was applied once in either group, with the needles retained for
30 min. The Short-form McGill Pain Questionnaire (SF-MPQ) and the Modified-Modified Schober (MMS) test were used to
assess the motion related pain and the situation of spinal flexion in 3 min before treatment and 5 min, 10 min, 15 min, during
treatment and 30 min (needle removed), respectively. The Expectation and Treatment Credibility Scale (ETCS) was applied to
analyze the relationship between the expectation of patients and the analgesic effect. The adverse reaction was recorded.
RESULTS: There were no statistically significant differences in SF-MPQ, MMS and ETCS before treatment between two
groups (all P>0.05). In 5 min after needles insertion, the scores of the items in SF-MPQ in observation group were lower than
those in control group (P<0.05, P<0.01). In 10 min after needles insertion, the scores of SF-MPQ in observation group were
lower than those in control group and the scores of MMS were higher than those in control group (P<0.05). In 15 min after
needles insertion, except the sensory pain rating index, the scores of the rest items in SF-MPQ in observation group were all
lower than those in control group (P<0.05, P<0.01). In 30 min (needles removed), the scores of affective pain rating index of
SF-MPQ and Visual Analogue Scale (VAS) in observation group were lower than those in control group (P<0.05, P<0.01). The
expectation before treatment was negatively correlated with VAS scores in 5 min, 10 min, 15 min and 30 min after needle
insertion separately in observation group (P<0.05), while the correlation was not found in control group (P>0.05). No adverse
reaction was reported. CONCLUSION: Wrist-ankle acupuncture can reduce acute lumbago immediately and
significantly. The higher the expectation on the analgesic effect of wrist-ankle acupuncture the patients have, the
better the analgesic effect will be. This therapy is highly safe in the treatment. PMID: 20942274 [PubMed - indexed for
MEDLINE]
Sherman KJ, Cherkin DC, Ichikawa L, Avins AL, Barlow WE, Khalsa PS, Deyo RA. BMC Musculoskelet Disord. 2009 Sep
21;10:114.
Group Health Research Institute, Seattle, USA. sherman.k@ghc.org
Abstract
BACKGROUND: Although many clinicians believe there are clinically important subgroups of persons with "non-specific" low
back pain, such subgroups have not yet been clearly identified. As part of a large trial evaluating acupuncture for chronic low
back pain, we sought to identify subgroups of participants that were particularly responsive to acupuncture. METHODS: We
performed a secondary analysis of data for the 638 participants in our clinical trial comparing different types of acupuncture to
usual care to identify baseline characteristics that predicted responses to individualized, standardized, or simulated
Characteristics of patients with chronic back pain who benefit from acupuncture.
acupuncture treatments. After identifying factors that predicted improvements in back-related function or symptoms, we
determined if these factors were more likely to predict improvement for those receiving the acupuncture treatments than for
those receiving usual care. This was accomplished by testing for an interaction between the prognostic factors and treatment
group in four models: functional outcomes (measured by the Roland-Morris Disability Scale) at 8 and 52 weeks postrandomization and symptom outcomes (measured with a numerical rating scale) at 8 and 52 weeks. RESULTS: Overall, the
strongest predictors of improvement in back function and symptoms were higher baseline levels of these measures, receipt of
an acupuncture treatment, and non-use of narcotic analgesics. Benefit from acupuncture compared to usual care was greater
with worse pre-treatment levels of back dysfunction (interaction p < 0.004 for the functional outcome, Roland Morris Disability
Scale at 8 weeks). No other consistent interactions were observed. CONCLUSION: This secondary analysis found little
evidence for the existence of subgroups of patients with chronic back pain that would be especially likely to benefit from
acupuncture. However, persons with chronic low back pain who had more severe baseline dysfunction had the most shortterm benefit from acupuncture.
Itoh K, Itoh S, Katsumi Y, Kitakoji H. Complement Ther Clin Pract. 2009 Feb;15(1):22-5. Epub 2008 Oct 23.
Department of
Clinical Acupuncture and Moxibustion, Meiji University of Integrative Medicine, Kyoto 629-0392, Japan. k_itoh@meiji-u.ac.jp
Abstract
OBJECTIVE: The present study tests whether a combined treatment of acupuncture and transcutaneous electrical nerve
stimulation (TENS) is more effective than acupuncture or TENS alone for treating chronic low back pain (LBP). METHODS:
Thirty-two patients with chronic LBP were randomly allocated to four groups. The acupuncture group (ACP) received only
acupuncture treatment at selected acupoints for low back pain; the TENS group (TENS) received only TENS treatment at pain
areas; the acupuncture and TENS group (A&T) received both acupuncture and TENS treatments; the control group (CT)
received topical poultice (only when necessary). Each group received specific weekly treatment five times during the study.
Outcome measures were pain intensity in terms of visual analogue scale (VAS) and QOL of low back in terms of RolandMorris Disability Questionnaire (RDQ). RESULTS: The ACP, TENS and A&T groups all reported lower VAS and RDQ scores.
Significant reduction in pain intensity (P<0.008) and significant improvement in QOL (P<0.008) were shown in the A&T group.
A pilot study on using acupuncture and transcutaneous electrical nerve stimulation to treat
chronic non-specific low back pain.
CONCLUSION: Combined acupuncture and TENS treatment is effective in pain relief and QOL of low back
improvement for the sampled patients suffering from chronic LBP. PMID: 19161950 [PubMed - indexed for MEDLINE]
Ann R Coll Surg Engl. 2010 Oct;92(7):595-8. Epub 2010 Jun 7.
Millions of people suffer with low back pain, and it is one of the top reasons people seek medical treatment. Back problems are
also, by far, the primary reason for appointments with acupuncturists. But does acupuncture really help these patients?
Researchers from the University of Maryland School of Medicine and the Peninsula Medical School, Plymouth, U.K., analyzed
dozens of studies from around the world on acupuncture for low back pain. The study results will be published in the April 19
issue of the Annals of Internal Medicine.
“For people with chronic low back pain, this analysis shows that acupuncture is clearly effective in providing considerable pain
relief,” says Eric Manheimer, study author and director of database and evaluation for the University of Maryland Center for
Integrative Medicine. “The research also showed that acupuncture provided true pain relief. The benefit was not just due to the
placebo effect.”

The reviewers scoured the medical literature for all studies involving acupuncture for treating low back pain. To
minimize bias, the American and British teams developed explicit criteria for evaluating the studies and did the
evaluations independently. Their analysis included only randomized controlled trials, the gold standard study design
for
STUDY ANALYSIS SHOWS ACUPUNCTURE EFFECTIVE FOR TREATING CHRONIC LOW BACK PAIN
Thirty-three studies covering more than 2,100 patients met the criteria for review. In the end, the researchers used 22 of these
studies for their analysis. All 22 evaluated Chinese-style acupuncture for chronic low back pain, defined as pain that has been
on-going for more than three months. The other 11 studies were excluded because they either only reported data that could
not be combined statistically, they only included patients with acute back pain or pregnancy-related back pain or they involved
forms of acupuncture other than traditional Chinese acupuncture.
Manheimer says, “We wanted the studies for the analysis to meet the highest scientific standards. As a way to account for a
possible placebo effect, we looked at many studies that used ‘sham acupuncture’ as a control group, where acupuncture
needles were inserted only superficially or in the wrong place.”
The sham acupuncture studies were double-blinded, meaning neither the researchers nor the participants knew who was
receiving the real or the sham treatment. When looking at those studies, the reviewers found the differences in pain ratings
showed a significant difference between the real acupuncture and the sham acupuncture groups, indicating that the benefit
was not just due to the placebo effect.
“From our analysis, the message for people with chronic low back pain is that acupuncture is a truly effective therapy that
provides significant pain relief,” says Manheimer. “Patients with low back pain have many options for treatment including
medication, chiropractic care, physical therapy and back exercises. However, these treatments do not always help, and
scientific evidence indicates that they have only modest effectiveness.”
The researchers evaluated the effects of acupuncture both in the short-term (defined as three weeks after the last acupuncture
treatment) as well as in the longer term. They found acupuncture provided definite pain relief in the short-term, and this relief
appeared to be sustained over the longer term. However, they say it’s too early to be certain of longer term effects, and more
studies are underway.
For patients with acute back pain (defined as lasting less than three months), the reviewers found the data to be sparse and
inconclusive. The evidence comparing acupuncture to other therapies was also inconclusive.
Previous attempts to synthesize information on acupuncture and chronic low back pain provided mixed results. But since
1999, the publication of five high quality, large-scale studies has added new evidence for the analysis. The current analysis
includes these newer studies as well as earlier research not included in previous reviews. In all, this analysis contains more
than twice as many studies as earlier reviews and includes reports in English, Chinese, Japanese, Korean as well as
Germanic and Romance languages. For this study, the reviewers received funding from the National Center for
Complementary and Alternative Medicine, a part of the National Institutes of Health.