"It is surprising that sham acupuncture did as well as true acupuncture," said Dr. Scott Boden, director of the Spine Center and Professor of Orthopaedics at the Emory University School of Medicine. "Perhaps the real effect of acupuncture is a placebo effect or the effect for patients with chronic nonspecific low back pain is just from placing needles in the skin rather than specific Chinese acupuncture points."
The placebo effect is when a patient takes an inert medication or treatment -- such as a sugar pill, for example, or a random stick of a needle -- and is told that it will help cure his symptoms. The patient's improvement is simply due to the power of suggestion.
Alternatively, Endres said, patients might not be experiencing a placebo effect.
"It can also be theorized that sham acupuncture does not present a genuine placebo effect, but that it actually triggers specific physiological effects as well, of which we are not yet aware," Endres said.
Dr. Woodson Merrell, chairman of the Department of Integrative Medicine at the Beth Israel Medical Center in New York, agrees. "Sham acupuncture does provide a stimulus to an area of the body that tells the nervous system and brain to react. True acupuncture does the same thing, just with more consistent results."
So while the study highlights the superiority of acupuncture, it also introduces uncertainty about the traditional Chinese technique. Both the true and sham acupuncture techniques proved equally effective in reducing back pain. It may be that learning the traditional Chinese acupuncture skills is unnecessary.
But sham or not, the benefits may go beyond simple pain relief. In addition to the effective reduction of pain, researchers also observed a reduction in the use of pain medications by patients who received acupuncture treatment.
"The reduction in use of analgesics by patients who received acupuncture treatment means that patients who rely heavily on these medications to cope with chronic back pain may be able to reduce their dosage or stop taking the medications, at least for periods of time," Endres said.
Alleviating the need for pain medications, in and of itself, might actually be beneficial. "Medications, such as narcotics and or muscle relaxants, cause rapid depletion of your own bodies' pain modulators, which makes the pain worse and prolongs the agony," said Dr. Mark Brown at the Department of Orthopaedics & Rehabilitation at the University of Miami.
The study may also be the largest yet to demonstrate that acupuncture works better than standard therapies for back pain.
"This particular study is very well done," Merrell said. "It shows that acupuncture is an important treatment option for low back pain."
There are other benefits to acupuncture as well. "It is safe, easy, and available at a low cost," said Boden.
However, don't start running to your nearest acupuncturist. Conventional therapy still has its benefits.
"Acupuncture is not better than conventional therapy," said Merrell. "It is one option to consider. For example, is Tylenol better than Advil for curing headaches? It depends on the person."
"See a qualified spine specialist," recommended Boden. "Ask plenty of questions and try safe and less costly treatments like physical therapy or acupuncture before considering more aggressive interventions."
And if you're tired of seeing doctors and visiting therapists, take Brown's advice. "Stop all treatments, stop seeing doctors and walk it off," he said.