Acupuncture for Chronic Low Back Pain

Posted by • July 30th, 2010

This week’s Clinical Therapeutics feature by Dr. Brian Berman et al., Acupuncture for Chronic Low Back Pain, discusses the problem of low back pain in the Western world and the use of acupuncture as therapeutic intervention.

Traditional Chinese medicine espouses an ancient physiological system (not based on Western scientific empiricism) in which health is seen as the result of harmony among bodily functions and between body and nature. Internal disharmony is believed to cause blockage of the body’s vital energy, known as qi, which flows along 12 primary and 8 secondary meridians.

Clinical Pearls

According to traditional Chinese medicine, how is acupuncture thought to work?

The insertion of acupuncture needles at specific points along the meridians is supposed to restore the proper flow of qi.

What pathophysiological phenomena have been identified in association with acupuncture?

Local anesthesia at needle-insertion sites completely blocks the immediate analgesic effects of acupuncture, indicating that these effects are dependent on neural innervation. Acupuncture has been shown to induce the release of endogenous opioids in brain stem, subcortical, and limbic structures. Acupuncture also causes effects on local tissues, including mechanical stimulation of connective tissue, release of adenosine at the site of needle stimulation, and increases in local blood flow.

Morning Report Questions

Q: What do the data from the most recent well-powered clinical trials of acupuncture conclude?

A: The most recent well-powered clinical trials of acupuncture for chronic low back pain showed that sham acupuncture was as effective as real acupuncture. The simplest explanation of such findings is that the specific therapeutic effects of acupuncture, if present, are small, whereas its clinically relevant benefits are mostly attributable to contextual and psychosocial factors, such as patients’ beliefs and expectations, attention from the acupuncturist, and highly focused, spatially directed attention on the part of the patient.

Q: What guidance do the American College of Physicians and the American Pain Society provide for the use of acupuncture for chronic low back pain?

A: The American College of Physicians and the American Pain Society have issued joint clinical practice guidelines recommending that clinicians consider acupuncture as one possible treatment option for patients with chronic low back pain who do not have a response to self-care. The level of supporting evidence for this recommendation was characterized as fair.

6 Responses to “Acupuncture for Chronic Low Back Pain”

  1. Michael Rolli says:

    Q: What do the data from the most recent well-powered clinical trials of acupuncture conclude?

    A. The most recent well-powered clinical trials of acupuncture for chronic low back pain showed that sham acupuncture was as effective as real acupuncture. The simplest explanation of such findings is that acupuncture is just as effective as placebo. Sham knee arthroscopy was found to be more effective than NO arthroscopy. Do you recommend we perform sham arthroscopy?

  2. Anonymous says:

    The difference is that sham acupuncture still involves insertion of a needle into the body, which will still illicit some kind of therapeutic effect. This entire process is obviously poorly understood in the western medical community.

  3. Aeyal says:

    Sham western medicine has a long way to evolve before it can truly and fully comprehend the actual mechanism behind the therapeutic success of acupuncture. For the time being, it tries to measure and assess Chinese medicine with very limited (not to say primitive) parameters.
    If you take LBP for example, the percnetage of long term relief and cure is greater with acupuncture treatments than with western drug therapy.

  4. I think westerners need to keep an open mind about any form of ancient/chinese medicine. They (I mean we, I’m English) seem to forget that we didn’t know what electricity was 200 years ago. There are more types of energy to be discovered who knows maybe in another 200 years we’ll discover something equally as exciting!

  5. Hey says:

    Hi, Listening to news about Japan and the earthquick. Wondering if this will affect all the education they were doing into acupuncture.

  6. The problem with Sham acupuncture is that (as someone already mentioned) the researchers don’t understand the fact the sham acupuncture still stimulate the body and it is actual enough stimulation according to most Japanese acupuncturist. There are a lot of things western researchers are missing when conducting experiments on acupuncture.