Acupuncture Tops Conventional Therapy for Low-Back Pain

BOCHUM, Germany, Sept. 24 -- Acupuncture offers an effective alternative to conventional therapy for low-back pain, investigators here reported.

Almost twice as many patients responded to acupuncture versus conventional therapy, Heinz G. Endres, M.D., of Ruhr-University Bochum, and colleagues reported in the Sept. 24 issue of Archives of Internal Medicine.

However, sham acupuncture worked just as well as verum, or true, acupuncture, they reported.

"Acupuncture constitutes a strong alternative to multimodal conventional therapy," the authors concluded. "Acupuncture gives physicians a promising and effective treatment option for chronic low-back pain, with few adverse effects or contraindications."

As for the equally good results with fake or real acupuncture, the authors said, "The superiority of both forms of acupuncture suggests a common underlying mechanism that may act on pain generation, transmission of pain signals, or processing of pain signals by the central nervous system and that is stronger than the action mechanism of conventional therapy."

Used to treat many medical conditions, acupuncture has a controversial role in the management of low-back pain, although a recent Cochrane review concluded that it might be useful as an adjunct to other therapies (Cochrane Database Syst Rev 2005;(1):CD001351).

Dr. Endres and colleagues reported findings from what they believe to be the first randomized, controlled trial of verum versus sham acupuncture for treatment of low-back pain. The German Acupuncture Trials involved clinicians in 340 outpatient practices and included 1,162 patients who had a history of low-back pain lasting an average of eight years.

The patients were treated with either verum or sham acupuncture or conventional therapy, which consisted of a combination of drugs, physical therapy, and exercise. Verum acupuncture consisted of 10 30-minute sessions of treatment according to principles of traditional Chinese medicine. Patients assigned to sham acupuncture received superficial needling at non-acupuncture points.

The primary outcome was six-month response rate, with response defined as at least 33% improvement on three pain-related items on the Von Korff Chronic Pain Grade Scale or 12% improvement on the back-specific Hanover Functional Ability Questionnaire.

At the end of the study, 47.6% of patients in the verum acupuncture group had responded, as had 44.2% in the sham acupuncture group, and 27.4% in the group that received conventional therapy. Both acupuncture groups had significantly higher response rates compared with conventional therapy (P