Abstract
BackgroundAcupuncture has been shown to be effective for the treatment of chronic musculoskeletal back, neck, and osteoarthritis pain. However, access to acupuncture treatment has been limited in medically underserved and low-income populations.ObjectiveAcupuncture therapy delivered in groups could reduce cost and expand access. We compared the effectiveness of group versus individual acupuncture for pain and function among ethnically diverse, low-income primary care patients with chronic musculoskeletal pain.DesignThis was a randomized comparative effectiveness non-inferiority trial in 6 Bronx primary care community health centers. Participants with chronic (> 3 months) back, neck, or osteoarthritis pain were randomly assigned to individual or group acupuncture therapy for 12 weeks.ParticipantsSeven hundred seventy-nine participants were randomized. Mean age was 54.8 years. 35.3% of participants identified as black and 56.9% identified as Latino. Seventy-six percent were Medicaid insured, 60% reported poor/fair health, and 37% were unable to work due to disability.InterventionsParticipants received weekly acupuncture treatment in either group or individual setting for 12 weeks.Main MeasuresPrimary outcome was pain interference on the Brief Pain Inventory at 12 weeks; secondary outcomes were pain severity (BPI), physical and mental well-being (PROMIS-10), and opiate use. Outcome measures were collected at baseline, 12 and 24 weeks.Key Results37.5% of individual arm and 30.3% in group had > 30% improvement in pain interference (d = 7.2%, 95% CI − 0.6%, 15.1%). Non-inferiority of group acupuncture was not demonstrated for the primary outcome assuming a margin of 10%. In the responder analysis of physical well-being, 63.1% of individual participants and 59.5% of group had clinically important improvement at 12 weeks (d = 3.6%, 95% CI − 4.2%, 11.4%).ConclusionsBoth individual and group acupuncture therapy delivered in primary care settings reduced chronic pain and improved physical function at 12 weeks; non-inferiority of group was not shown.Trial RegistrationClinicaltrials.gov # NCT02456727
Highlights
The prevalence of chronic pain conditions in the adult US population ranges from 11 to 47% in large surveys[1,2,3,4,5,6,7,8]; low back and neck pain, osteoarthritis (OA), and headache are the most common.[9]
We found clinically significant improvement in pain interference in both group and individual arms for a substantial proportion of participants at 12 weeks in both our ITT and per protocol (PP) analyses
Our response rates in both arms were slightly lower than the 40–50% response seen in a large individual patient data meta-analyses,[33, 72] and we did not demonstrate noninferiority of group treatment, our results suggest that both individual and group acupuncture can be offered safely in the community health center setting, and that a substantial proportion of patients with chronic pain will have clinically significant improvement
Summary
The prevalence of chronic pain conditions in the adult US population ranges from 11 to 47% in large surveys[1,2,3,4,5,6,7,8]; low back and neck pain, osteoarthritis (OA), and headache are the most common.[9]. Acupuncture has been shown to be effective for the treatment of chronic musculoskeletal back, neck, and osteoarthritis pain. Access to acupuncture treatment has been limited in medically underserved and low-income populations. We compared the effectiveness of group versus individual acupuncture for pain and function among ethnically diverse, low-income primary care patients with chronic musculoskeletal pain. DESIGN: This was a randomized comparative effectiveness non-inferiority trial in 6 Bronx primary care community health centers. Participants with chronic (> 3 months) back, neck, or osteoarthritis pain were randomly assigned to individual or group acupuncture therapy for 12 weeks. INTERVENTIONS: Participants received weekly acupuncture treatment in either group or individual setting for 12 weeks. Non-inferiority of group acupuncture was not demonstrated for the primary outcome assuming a margin of 10%.
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