Abstract
IntroductionThe National Institute for Health and Clinical Excellence guidelines recommend acupuncture as a clinically effective treatment for chronic back pain. However, there is insufficient knowledge of what factors contribute to patients’ positive and negative experiences of acupuncture, and how those factors interact in terms of the acceptability of treatment. This study used patient interviews following acupuncture treatment for back pain to identify, understand and describe the elements that contribute or detract from acceptability of treatment.MethodsThe study used semi-structured interviews. Twelve patients were interviewed using an interview schedule as a sub-study nested within a randomised controlled trial of acupuncture for chronic back pain. The interviews were analysed using thematic analysis.Results and DiscussionThree over-arching themes emerged from the analysis. The first entitled facilitators of acceptability contained five subthemes; experience of pain relief, improvements in physical activity, relaxation, psychological benefit, reduced reliance on medication. The second over-arching theme identified barriers to acceptability, which included needle-related discomfort and temporary worsening of symptoms, pressure to continue treatment and financial cost. The third over-arching theme comprised mediators of acceptability, which included pre-treatment mediators such as expectation and previous experience, and treatment-related mediators of time, therapeutic alliance, lifestyle advice and the patient’s active involvement in recovery. These themes inform our understanding of the acceptability of acupuncture to patients with low back pain.ConclusionThe acceptability of acupuncture treatment for low back pain is complex and multifaceted. The therapeutic relationship between the practitioner and patient emerged as a strong driver for acceptability, and as a useful vehicle to develop the patients’ self-efficacy in pain management in the longer term. Unpleasant treatment related effects do not necessarily detract from patients’ overall perception of acceptability.
Highlights
The National Institute for Health and Clinical Excellence guidelines recommend acupuncture as a clinically effective treatment for chronic back pain
The results of the York Acupuncture for Back Pain trial(YACBAC) [8] showed that a short course of acupuncture compared to usual care for chronic low back pain conferred a clinically significant reduction in low back pain for minor extra cost to the NHS
[9] Within the YACBAC trial, 241 participants, aged 18–65 with a history of non-specific low back pain for a period of 4 to 52 weeks were recruited by general practitioners at GP primary care practices in York
Summary
The National Institute for Health and Clinical Excellence guidelines recommend acupuncture as a clinically effective treatment for chronic back pain. Six acupuncturists with a minimum of three years’ experience and registered with the British Acupuncture Council delivered up to ten treatments, usually weekly, tailored to individual patients’ needs. Additional care such as brief massage and acupuncturespecific advice was provided if considered appropriate by the acupuncturists [10]. Based on the growing evidence of clinical effectiveness and cost effectiveness, the National Institute for Health and Clinical Excellence guidelines recommend acupuncture as a referral option for patients with low back pain [12]
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