title: Intramuscular and periosteal acupuncture for anxiety and sleep quality in patients with chronic musculoskeletal pain--an evaluator blind, controlled study.
abstract: OBJECTIVE
  Periosteal acupuncture seems clinically to have a stronger effect on pain than standard intramuscular acupuncture. The aim of the present study was to compare their relative effectiveness on promoting psychological functioning and quality of sleep.
  
  
  METHODS
  Consecutive patients (n=144) referred to a physiotherapist for treatment of chronic nociceptive pain in the neck or low back for more than three months, aged 18-70, were alternately allocated to an intramuscular acupuncture group (n=59), to a periosteal acupuncture group (n=55), and, for the latter part of the study, to an information control group (n=30). Eight treatments were administered during a five week period with two optional treatments after one month. All patients were encouraged to stay active. Psychological functioning was estimated with the Hospital Anxiety and Depression Scale (HAD) and quality of sleep with a visual analogue scale. All estimations were performed prior to treatment, one week after the end of treatment, and one, three and six months after end of treatment. Non-parametric statistics were used.
  
  
  RESULTS
  There were no significant differences between the acupuncture groups, nor between the acupuncture and control groups during the treatment period. One month after treatment, the level of anxiety was lower in both acupuncture groups compared with the control group. The proportions of non-cases (HAD score 0-7) increased in the intramuscular acupuncture group from 39 to 47 (not significant), in the periosteal acupuncture group from 37 to 49 (P<0.001), and in the control group from 15 to 16.
  
  
  CONCLUSIONS
  No differences between periosteal and intramuscular acupuncture were found. One month after treatment both acupuncture interventions reduced anxiety in patients suffering from chronic nociceptive musculoskeletal pain in the neck or low back when compared with a control intervention.
authors.affiliation: Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ylva
authors.initials: Y
authors.lastname: Hansson
authors.forename: Christer
authors.initials: C
authors.lastname: Carlsson
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Olsson
mesh_terms: D015669:Acupuncture Points; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D019547:Neck Pain / Q000150:complications / Q000628:therapy*; D010147:Pain Measurement; D011788:Quality of Life; D016037:Single-Blind Method; D012890:Sleep; D012893:Sleep Wake Disorders / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome