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Chronic Back Pain Relieved by Acupuncture
< May 13, 2009 > -- In a group of adult patients, chronic lower back pain was relieved by acupuncture, whether it pierced the skin or not.
"All [approaches used in the study] were superior to usual care," said Daniel Cherkin, PhD, a senior investigator with the Group Health Center for Health Studies in Seattle. "Acupuncture is an effective treatment for chronic back pain. People receiving acupuncture are more likely to get better."
According to Dr. Cherkin, non-penetrating acupuncture did as well as acupuncture that used standard needles. This is an uncommon finding which will raise questions about how acupuncture works.
In the US, chronic back pain is a chronic health issue. When traditional therapies are not therapeutic, it is the primary reason why patients go to acupuncturists.
Despite the fact that previous research studies were conducted to determine if acupuncture was 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," says Dr. Cherkin.
The randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain, has been the largest research study of its kind. A total of 638 patients with chronic mechanical low back pain were enrolled in this study funded by the National Center for Complementary and Alternative Medicine (NCCAM), part of the US National Institutes of Health (NIH).
Research participants were randomized to one of four treatment groups - individualized acupuncture, standardized acupuncture, simulated acupuncture (non-penetrating), or "usual care." Each participant was given a questionnaire to rate their symptoms and dysfunction, as well as ten treatments by an experienced acupuncturist for seven weeks.
At eight weeks, dysfunction and symptom scores improved equally among the three acupuncture treatment groups. Also, medication use decreased immediately and over the next year.
At the beginning of the study, almost two-thirds of study patients were taking mostly painkillers - nonsteroidal anti-inflammatory drugs (NSAIDs); after seven weeks, this number had decreased to 47 percent in the acupuncture groups, and 59 percent in the "usual care" group.
Based on study results, researchers reported that acupuncture was effective even when the treatment did not 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?" Dr. Cherkin says. "It throws open the question of how does this work."
Some theories state that it is possible for "superficial" acupuncture to stimulate a cascade of physiological processes that result in relief, or nonspecific effects such as therapist conviction [or] patient enthusiasm.
Based on research findings, some previous studies have reported 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, stated that 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," Ms. Konefal says. "'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."
According to Ms. Konefal, acupuncture of all types is well on its way to the mainstream. She adds, "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."
"Just because you don't understand how it works doesn't mean it doesn't work. It could be worthwhile to pursue it," says Dr. Cherkin.
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Acupuncture is the practice of puncturing the skin with needles at certain anatomical points in the body to relieve specific symptoms associated with many diseases. The anatomical points (acupuncture points) are thought to have certain electrical properties, which affect chemical neurotransmitters in the body.
Acupuncture is one of the oldest, most commonly used medical practices in the world. Originating in China more than 2,500 years ago, acupuncture gained attention in this country in the 1970s, when China and the US opened relations. The practice has been growing in popularity since.
According to theories of traditional Chinese medicine, the human body has more than 2,000 acupuncture points connected via pathways, or meridians. These pathways create an energy flow (Qi, pronounced "chee") through the body that is responsible for overall health. Disruption of the energy flow can cause disease. Acupuncture may correct these imbalances when applied at acupuncture points and improve the flow of Qi.
Acupuncture theories today are based on extensive laboratory research, and have become widely known and accepted. In addition, controlled studies have shown evidence of the effectiveness of acupuncture for certain conditions.
Acupuncture is generally performed with metallic, solid, and hair-thin needles. Patients report different feelings associated with acupuncture, but most feel minimal pain as the needle is inserted. Acupuncture makes some people report feeling energized by the treatment, while others say they feel relaxed.
Improper placement of the acupuncture needle can cause soreness and pain during treatment. That is why it is important to seek treatment from a qualified acupuncture practitioner.
The US Food and Drug Administration (FDA) regulates acupuncture needles just as it does other medical devices under good manufacturing practices and single-use standards of sterility.
Instead of needles, other forms of stimulation are sometimes used, including:
In general, acupuncture points are believed to stimulate the central nervous system, which, in turn, releases chemicals into the muscles, spinal cord, and brain. These chemicals either alter the experience of pain or release other chemicals that influence the body's self-regulating systems. These biochemical changes may stimulate the body's natural healing abilities and promote physical and emotional well-being.
Many studies have documented acupuncture's effects on the body, but none has fully explained how acupuncture works within the framework of Western medicine. Researchers have proposed several processes to explain acupuncture's effects, primarily on pain.
More than 8 million Americans have used acupuncture, and the numbers are growing, according to the National Center for Complementary and Alternative Medicine (NCCAM).
Because scientific studies have not fully explained how acupuncture works within the framework of Western medicine, acupuncture remains a source of controversy in the medical world.
Always consult your physician for more information.
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