title: Acupuncture for chronic low back pain: diagnosis and treatment patterns among acupuncturists evaluating the same patient.
abstract: BACKGROUND
  There is increasing need to examine the effectiveness of acupuncture and other alternative therapies for common conditions. However, little attention has focused on the variability in acupuncturists' assessment, diagnosis, and treatment patterns.
  
  
  METHODS
  Seven office-based acupuncturists practicing Traditional Chinese Medicine evaluated the same patient with chronic low back pain and provided data regarding principal assessment techniques, diagnoses, and therapeutic recommendations.
  
  
  RESULTS
  A high diagnostic agreement existed among 5 of 7 acupuncturists. However, recommended treatments included varying numbers and locations of acupuncture points. Recommendations varied between 5 and 14 points requiring 7 to 26 needles, since many points were intended for bilateral application. Of 28 acupuncture points selected, only 4 (14%) were prescribed by two or more acupuncturists. Most recommended various forms of adjuvant heat.
  
  
  CONCLUSIONS
  Seven acupuncturists agreed considerably in the diagnoses for the same patient with chronic low back pain, but treatment recommendations varied substantially. Clinicians and researchers must recognize treatment recommendation variations and the challenges they present for study design and interpretation.
authors.affiliation: Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: D
authors.initials: D
authors.lastname: Kalauokalani
authors.forename: K J
authors.initials: KJ
authors.lastname: Sherman
authors.forename: D C
authors.initials: DC
authors.lastname: Cherkin
mesh_terms: D015669:Acupuncture Points; D015670:Acupuncture Therapy / Q000379:methods*; D000328:Adult; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000628:therapy*; D008516:Medicine, Chinese Traditional; D010173:Palpation; D010808:Physical Examination; D011787:Quality of Health Care; D014861:Washington