Acupuncture For Chronic Back Pain Research Articles

Auricular acupuncture for chronic back pain in adults: a systematic review and metanalysis.

To investigate randomized clinical trials on the action of auricular acupuncture for chronic back pain in adults, and to identify the most commonly used outcomes for assessing this condition, the protocol used for applying the intervention, and the efficacy of the therapy on pain intensity. A systematic review and a metanalysis were carried out between June 2017 and May 2018, based on the PubMed, CINAHL, PEDro, Embase, Scopus, and the Virtual Health Library databases. Reference lists of systematic reviews were also explored. 427 studies were located, 15 included in the qualitative analysis, and seven in the quantitative analysis. Auricular acupuncture led to positive results in 80% of the studies. The most commonly used outcomes were pain intensity and quality, medication consumption, physical disability, and quality of life. There is a lack of protocol standardization for auricular acupuncture for chronic back pain. The metanalysis results showed that auricular acupuncture was effective in reducing pain intensity scores (p=0.038). Auricular acupuncture is a promising practice for the treatment of chronic back pain in adults.

The Benefits of Acupuncture: What you think is what you Get, or is It?

As a complex treatment, with many contextual aspects of the visit being potentially therapeutic, acupuncture has long been assumed to be more effective among those patients who believe that it will help them. A number of studies have indeed shown that acupuncture is more effective among such patients.1–3 However, not all rigorously conducted studies have found this to be true. For example, in a large 638 person trial we conducted of acupuncture for chronic back pain with acupuncture-naive participants, we found that those with high pretreatment expectations for acupuncture showed greater expectations of improvement in general and showed greater preference for acupuncture.4 They were more likely to have heard that acupuncture was a very effective treatment and to have a very or moderately positive impression of acupuncture. However, such favourable beliefs towards acupuncture did not predict improvement in back-related function or pain at the end of 7 weeks of treatment or at the end of a year of follow-up. …

Authors' Response to "Acupuncture for Chronic Back Pain: The Mysterious Case of the Excluded Data"

Authors' Response to "Acupuncture for Chronic Back Pain: The Mysterious Case of the Excluded Data"

The Acceptability of Acupuncture for Low Back Pain: A Qualitative Study of Patient’s Experiences Nested within a Randomised Controlled Trial

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.

Willingness to Try Acupuncture Again: Reports from Patients on Their Treatment Reactions in a Low Back Pain Trial

Reactions to treatment are common following acupuncture. Understanding how these reactions are interpreted by patients is largely unexplored. To examine patients ratings of the severity and bothersomeness of a range of common treatment reactions, and to assess their impact on willingness to try acupuncture again. Self-reported ratings of the frequency, severity and bothersomeness of treatment reactions from 133 patients in the acupuncture arm of a pragmatic randomised controlled trial of acupuncture for chronic back pain are described and analysed. A total of 133 acupuncture patients reported at3 months reactions that they had experienced at anytime during a course of up to 10 acupuncture treatment sessions. They received a total of 1150 treatments, an average of 8.6 sessions per patient. All patients reported treatment reactions, most commonly relaxation (84%,n = 112), which was significantly associated with willingness to try acupuncture again, (χ2 = 7.860,df = 1, p = 0.005). Only 16% (n=21) were unwilling to experience a specific treatment reaction again, and 9%(n = 12) were unwilling to try acupuncture again. The most bothersome reaction was a temporary worsening of symptoms (29%, n=38), though this was not associated with an unwillingness to try acupuncture again (χ2 = 0.382, df = 1, p>0.536). Those unwilling to try acupuncture again reported significantly less reduction in their pain at 3 months (mean (SE) SF-36 bodily pain score at 3 months 30.453 (3.598) vs 19.30(1.128); p=0.003). Among this group of patients seeking help for low back pain, the experience of treatment reactions was universal. There was no evidence that the bothersomeness of treatment reactions was associated with patient's willingness to try acupuncture again. The benefit of pain reduction over the course of treatment appeared to outweigh self-rated bothersome reactions to treatment.

Treatment Expectations and Preferences as Predictors of Outcome of Acupuncture for Chronic Back Pain

Preplanned secondary analysis of data from participants receiving acupuncture in a randomized clinical trial. To determine whether patients' expectations of and preferences for acupuncture predict short and long-term treatment outcomes for persons with chronic back pain. Although accumulating evidence suggests that patient expectations and treatment preferences may predict treatment outcomes, few studies have examined this relationship for acupuncture. Four hundred seventy-seven acupuncture-naïve participants with chronic low back pain who were randomized to 1 of 3 acupuncture or simulated acupuncture treatments were the focus of this analysis. Ten treatments were provided during a 7-week period, and participants were masked to treatment assignment. Before randomization, participants provided expectations regarding treatment success, impressions, and knowledge about acupuncture and treatment preferences. Outcomes of interest were functional status (Roland score) and symptom bothersomeness at 8 and 52 weeks postrandomization, obtained by telephone interviewers masked to treatment assignment. Persons with high pretreatment expectations for the success of acupuncture were more likely to report greater general expectations for improvement, a preference for acupuncture, having heard acupuncture was a very effective treatment and having a very or moderately positive impression of acupuncture. However, none of these variables was a significant predictor of improvement in back-related symptoms or function at 8 or 52 weeks. After 1 treatment, participants' revised expectations of treatment success were only associated with back-symptoms at the end of treatment. After 5 treatments, revised expectation of success was predictive of both symptoms and function at 8 and 52 weeks. Pretreatment expectations and preferences for acupuncture were not found predictive of treatment outcomes for patients with chronic back pain. These results differ from previous studies evaluating acupuncture for chronic back pain. These inconsistent results suggest that the relationship between expectations and outcomes may be more complex than previously believed.

Comparing recruitment strategies in a study of acupuncture for chronic back pain

BackgroundMeeting recruitment goals is challenging for many clinical trials conducted in primary care populations. Little is known about how the use of different recruitment strategies affects the types of individuals choosing to participate or the conclusions of the study.MethodsA secondary analysis was performed using data from participants recruited to a clinical trial evaluating acupuncture for chronic back pain among primary care patients in a large integrated health care organization. We used two recruitment methods: mailed letters of invitation and an advertisement in the health plan's magazine. For these two recruitment methods, we compared recruitment success (% randomized, treatment completers, drop outs and losses to follow-up), participant characteristics, and primary clinical outcomes. A linear regression model was used to test for interaction between treatment group and recruitment method.ResultsParticipants recruited via mailed letters closely resembled those responding to the advertisement in terms of demographic characteristics, most aspects of their back pain history and current episode and beliefs and expectations about acupuncture. No interaction between method of recruitment and treatment group was seen, suggesting that study outcomes were not affected by recruitment strategy.ConclusionIn this trial, the two recruitment strategies yielded similar estimates of treatment effectiveness. However, because this finding may not apply to other recruitment strategies or trial circumstances, trials employing multiple recruitment strategies should evaluate the effect of recruitment strategy on outcome.Trial registrationClinical Trials.gov NCT00065585.

Anwendungsbeobachtung der seriellen Akupunkturbehandlung von Lumbago und Kopfschmerz in der Allgemeinpraxis

Background The German Acupuncture Trials (GERAC) have brought good results regarding the acupuncture treatment of lumbago and headache. However, for reasons of scientific practicability, patients included in these trials were restricted by certain criteria (among others, excluding patients after spinal surgery, past experiences with acupuncture, patients with ischialgia). Also, microsystems and other acupuncture-related techniques, such as moxibustion or cupping, were not included. Objective The objective of this treatment observation was the assessment of early as well as late results of acupuncture treatment series for lumbago and headache performed on the mixed patient collective of a general practitioner's practice. Methods The observation included all patients who received acupuncture for chronic back pain or headache. The treatment observation consists of data collected from 192 treatment series (10 acupuncture sessions each) for lumbago, and 86 treatment series (10 acupuncture sessions each) for headache. There were no restrictions regarding microsystems or acupuncture-related techniques. Acupuncture was administered according to the criteria of Traditional Chinese Medicine; there were no restrictions regarding the selection of the acupuncture points. Results The benefit of the treatment in the lumbago group was rated none or poor in 18 cases (9.4 %), moderate in 35 (18.2 %), and very good in 139 (72.4 %) cases. In the headache-group the benefit was rated none or poor in 2 cases (2.3 %), moderate in 28 (32.6 %), and very good in 56 (65.1 %) patients. Conclusion The results were encouraging: not only in the restricted setting of a large scientific study, but also within the mixed patient collective of a general practitioner's practice, acupuncture can lead to good results in the therapy of chronic back pain and headache.

A Review of Acupuncture Clinical Trials Indexed during 2005

Background Clinical trials in acupuncture are published in a variety of journals, and it is useful to summarise them in one place. Methods We conducted a search of PubMed and Embase for clinical trials of acupuncture with date of entry 2005, and selected randomised controlled trials with clinical outcomes for review. Where possible, the original report was read for full details. Results Thirty-eight RCTs were found from databases, and one more during the process of the study. Ten of the trials included about 100 patients or more. Five showed acupuncture to be superior to usual care in back pain, knee pain and headache. Acupuncture was superior to placebo for chronic knee pain, but not for fibromyalgia, or post-stroke rehabilitation. Acupuncture was not as good as conventional analgesia for oocyte collection. Conclusion The role of acupuncture is becoming more precisely established in treatment of chronic knee pain, back pain and headache. Acupuncture for chronic back pain is more cost-effective than many other medical interventions.

Cost‐Effectiveness of Complementary Therapies in the United Kingdom—A Systematic Review†

Objectives: The aim of this review is to systematically summarize and assess all prospective, controlled, cost-effectiveness studies of complementary therapies carried out in the UK. Data sources: Medline (via PubMed), Embase, CINAHL, Amed (Alternative and Allied Medicine Database, British Library Medical Information Centre), The Cochrane Library, National Health Service Economic Evaluation Database (via Cochrane) and Health Technology Assessments up to October 2005. Review methods: Articles describing prospective, controlled, cost-effectiveness studies of any type of complementary therapy for any medical condition carried out in the UK were included. Data extracted included the main outcomes for health benefit and cost. These data were extracted independently by two authors, described narratively and also presented as a table. Results: Six cost-effectiveness studies of complementary medicine in the UK were identified: four different types of spinal manipulation for back pain, one type of acupuncture for chronic headache and one type of acupuncture for chronic back pain. Four of the six studies compared the complementary therapy with usual conventional treatment in pragmatic, randomized clinical trials without sham or placebo arms. Main outcome measures of effectiveness favored the complementary therapies but in the case of spinal manipulation (four studies) and acupuncture (one study) for back pain, effect sizes were small and of uncertain clinical relevance. The same four studies included a cost-utility analyses in which the incremental cost per quality adjusted life year (QALY) was less than £10 000. The complementary therapy represented an additional health care cost in five of the six studies. Conclusions: Prospective, controlled, cost-effectiveness studies of complementary therapies have been carried out in the UK only for spinal manipulation (four studies) and acupuncture (two studies). The limited data available indicate that the use of these therapies usually represents an additional cost to conventional treatment. Estimates of the incremental cost of achieving improvements in quality of life compare favorably with other treatments approved for use in the National Health Service. Because the specific efficacy of the complementary therapies for these indications remains uncertain, and the studies did not include sham controls, the estimates obtained may represent the cost-effectiveness non-specific effects associated with the complementary therapies.

Acupuncture for chronic back pain. Alternative to conventional therapy?

Introduction: Acupuncture involves treatment of specific anatomic locations on the skin, called acupuncture points, by thin, solid, generally metallic needles. Acupuncture is one of the oldest and most commonly used forms of traditional medicine in the world—dating back approximately 2500 years. The general theory of acupuncture is based on the premise that patterns of energy called Qi (pronounced "chee") that flow throughout the body are essential for optimal health. In 1997 a National Institutes of Health (NIH) Consensus Panel discussed the role of acupuncture as a therapeutic intervention in the United States [1]. The panel experts concluded that many acupuncture studies provided equivocal results because of design, sample size, and other factors. The issue was further complicated by inherent difficulties in the use of appropriate controls, such as placebos and sham acupuncture groups. However, some results showed efficacy of acupuncture in adult post-operative and chemotherapy nausea and vomiting and in post-operative dental pain. There are other conditions, such as addiction, stroke rehabilitation, and chronic pain, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Acute low back pain is a painful condition that is usually self-limiting and tends to improve spontaneously over time. However, for many patients, back pain becomes a chronic or recurrent problem for which a large variety of therapeutic interventions are employed. Low back pain limits activity and is the second most frequent reason for physician visits. Previous research shows widespread use of acupuncture for low back pain. The main goal in treating back pain is to decrease pain so that patients can resume their normal activities. Traditional treatments for low back pain include drugs (analgesics, anti-inflammatory drugs, and muscle relaxants), physical therapy, back exercises, and education about ways to prevent back injury and to cope with back pain. Unfortunately, these treatments do not always help. Many patients with low back pain seek alternative treatments, such as acupuncture. Increasingly, mainstream medicine is recognizing acupuncture as an effective treatment for this disorder. It is, however, unclear whether acupuncture is an effective treatment for low back pain. Aims: To assess the effectiveness of acupuncture for treating low back pain.