May 13 -- TUESDAY, May 12 (HealthDay News) -- Any kind of acupuncture, whether it pierced the skin or not, eased chronic lower back pain in a group of adult patients.
"All were superior to usual care," said Daniel Cherkin, lead author of a report published in the May 11 issue of the Archives of Internal Medicine. "Acupuncture is an effective treatment for chronic back pain. People receiving acupuncture are more likely to get better."
But the unusual finding that non-penetrating acupuncture did as well as acupuncture that used standard needles will raise questions about how this works, added Cherkin, who is a senior investigator with the Group Health Center for Health Studies in Seattle.
Chronic back pain is a chronic health issue in the United States, and is the top reason why patients go to acupuncturists, often when traditional therapies disappoint.
Although there have been previous studies on whether acupuncture represents a viable treatment option, "the evidence of the value of acupuncture in general is very murky because the quality of the research is not very good," Cherkin said.
This trial, the largest randomized one of its kind, was funded by the National Center for complementary and Alternative Medicine, part of the U.S. National Institutes of Health.
More than 600 adults with chronic lower back pain were randomized to one of four study arms: individualized acupuncture, standardized acupuncture, simulated acupuncture (non-penetrating) or "usual care."
In the simulated acupuncture group, practitioners mimicked needle acupuncture by using a toothpick in a needle guide tube -- poking at traditional pressure points without breaking the skin.
Participants received 10 treatments over seven weeks, at the end of which dysfunction and symptom scores improved equally among the three treatment arms.
Also, medication use in all the acupuncture groups decreased immediately and over the next year. About two-thirds of patients were taking medication, mostly painkillers such as nonsteroidal anti-inflammatory drugs (NSAIDs). By eight weeks, that had declined to 47 percent in the acupuncture groups and 59 percent in the usual-care group.
There were no cost savings for the health plan (treatments were estimated to cost from $600 to $1,200).
But the real surprise was that acupuncture was effective even when the treatment didn't break the skin. "It's not necessary to penetrate the skin. There's no advantage to tailoring and no advantage to using a needle. Why?" Cherkin said. "It throws open the question of how does this work."
There are no answers to that question yet, but some theories persist. It's possible that the "superficial" acupuncture still kicks off a cascade of physiological processes that result in relief, the authors wrote. Or the benefit may come from "nonspecific effects such as therapist conviction [or] patient enthusiasm."
Some previous studies have found similar physiological responses from both types of acupuncture.
Janet Konefal, a licensed acupuncturist and assistant dean for complementary and integrative medicine at the University of Miami Miller School of Medicine, said she was not surprised that non-puncture stimulation had equal effects.
"You can stimulate a point with pressure, needle, electricity, even now with laser light and different frequencies of laser light," she said. "'Pecking' on a point is a Japanese technique for stimulation. You might use that with someone who is older or weak in their constitution. That could explain why two different methods of stimulation work equally well."
Acupuncture of all types is "well on its way to the mainstream," Konefal said. "When we understand that different stimulations may be effective rather than doing deep-needle stimulation which, for some people when in pain can be painful, we can now use laser or light needling or even just electric stimulation on the points; I think that part is great."
And, Cherkin pointed out, "just because you don't understand how it works doesn't mean it doesn't work. It could be worthwhile to pursue it."
The U.S. National Center for Complementary and Alternative Medicine has more on acupuncture.
SOURCES: Daniel Cherkin, Ph.D., senior investigator, Group Health Center for Health Studies, Seattle; Janet Konefal, licensed acupuncturist and assistant dean, complementary and integrative medicine, University of Miami Miller School of Medicine; May 11, 2009, Archives of Internal Medicine