A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain.
BACKGROUND
Acupuncture is a popular complementary and alternative treatment for chronic back pain. Recent European trials suggest similar short-term benefits from real and sham acupuncture needling. This trial addresses the importance of needle placement and skin penetration in eliciting acupuncture effects for patients with chronic low back pain.


METHODS
A total of 638 adults with chronic mechanical low back pain were randomized to individualized acupuncture, standardized acupuncture, simulated acupuncture, or usual care. Ten treatments were provided over 7 weeks by experienced acupuncturists. The primary outcomes were back-related dysfunction (Roland-Morris Disability Questionnaire score; range, 0-23) and symptom bothersomeness (0-10 scale). Outcomes were assessed at baseline and after 8, 26, and 52 weeks.


RESULTS
At 8 weeks, mean dysfunction scores for the individualized, standardized, and simulated acupuncture groups improved by 4.4, 4.5, and 4.4 points, respectively, compared with 2.1 points for those receiving usual care (P < .001). Participants receiving real or simulated acupuncture were more likely than those receiving usual care to experience clinically meaningful improvements on the dysfunction scale (60% vs 39%; P < .001). Symptoms improved by 1.6 to 1.9 points in the treatment groups compared with 0.7 points in the usual care group (P < .001). After 1 year, participants in the treatment groups were more likely than those receiving usual care to experience clinically meaningful improvements in dysfunction (59% to 65% vs 50%, respectively; P = .02) but not in symptoms (P > .05).


CONCLUSIONS
Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture's purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects.
Center for Health Studies, 1730 Minor Avenue, Seattle, WA 98101, USA. cherkin.d@ghc.org
Daniel C
DC
Cherkin
Karen J
KJ
Sherman
Andrew L
AL
Avins
Janet H
JH
Erro
Laura
L
Ichikawa
William E
WE
Barlow
Kristin
K
Delaney
Rene
R
Hawkes
Luisa
L
Hamilton
Alice
A
Pressman
Partap S
PS
Khalsa
Richard A
RA
Deyo
D015669:Acupuncture Points; D015670:Acupuncture Therapy; D000328:Adult; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009339:Needles; D010147:Pain Measurement; D010812:Physical Stimulation; D016896:Treatment Outcome