Real or Fake, Acupuncture Helps Back Pain

Fake or Not, Acupuncture Helps Back Pain

Even Sham Version of Technique Beats Conventional Therapies

By CARLA WILLIAMS
ABC News Medical Unit

Sept. 24, 2007 —

The 31 million Americans who suffer from chronic back pain may be able to get relief from a surprising source: acupuncture.

But even more surprising may be the fact that sham acupuncture had a similar effect -- leading some to believe that relief from back pain may be more in the head.

A new study, published in the journal Archives of Internal Medicine, finds that six months of acupuncture treatment is more effective at treating lower back pain than conventional methods like medications, exercise and physical therapy.

Learn more about acupuncture treatments for back pain and other conditions here.

Chronic back pain is a long-term, disabling condition that is one of the most common reasons cited for missing work. Experts estimate that more than 80 percent of Americans will experience back pain at some point in their lives.

Patients and doctors alike have long debated the best way to treat this condition. Some argue that pain medications and anti-inflammatory drugs are the best options. Others rest in bed, do strengthening exercises or even seek surgery.

However, the new research may lead more to consider acupuncture as a possibility.

"Acupuncture has a low risk of side effects and few contraindications," said study co-author Dr. Heinz Endres, a specialist in clinical pharmacology, epidemiology and medical informatics at the Ruhr-University in Germany. "Acupuncture represents a highly promising and effective treatment option for chronic back pain, especially in patients with a long history of unsuccessful conventional treatment."

Acupuncture's Finer Points

Acupuncture is a traditional Chinese medicine that entails the insertion and manipulation of needles -- in this case to stimulate specific points in a patient's back thought to be connected to pain sensation.

Dr. Endres and other researchers in Germany compared the effectiveness of acupuncture to conventional treatments. They analyzed over 1,000 patients with chronic lower back pain who received either true acupuncture, sham acupuncture or conventional treatments.

Patients were randomly assigned to each treatment group, and those in the sham acupuncture group believed they were receiving true acupuncture. Everyone received two 30-minute treatments per week. After six months, researchers evaluated improvement in pain and functional ability.

Almost half of the patients in both acupuncture groups benefited from the study, reporting at least a 30 percent decrease in pain or 12 percent improvement in functional ability. In contrast, only one fourth of the patients in the conventional therapy group reported an improvement.

"There are many widely used and recommended conservative, nonsurgical forms of treatment such as physical therapy, massage, chiropractic manipulation, or short-term use of medications like ibuprofen," said Dr. Endres. "Unlike these treatments, acupuncture has not yet been recommended as a routine therapy. We think this will change with our study."

Poking Holes in an Ancient Technique?

But strangely, sham acupuncture -- inserting needles randomly and superficially into patients' backs while avoiding locations thought to relieve pain -- proved just as effective as the real thing.

"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.

Need a Needle for Your Knots, or Not?

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."