title: Acupuncture applied as a sensory discrimination training tool decreases movement-related pain in patients with chronic low back pain more than acupuncture alone: a randomised cross-over experiment.
abstract: BACKGROUND
  High-quality clinical evidence suggests that although acupuncture appears superior to usual care in the management of chronic low back pain, there is little meaningful difference between true and sham acupuncture. This suggests that the benefits of acupuncture are mediated by the placebo response. An alternative explanation is that sham acupuncture is an active treatment and shares a mechanism of action with traditionally applied acupuncture. One plausible candidate for this mechanism is improvement in self-perception mediated through the sensory discrimination-like qualities of acupuncture. We aimed to compare the effects of acupuncture with a sensory discrimination training component to acupuncture without.
  
  
  METHODS
  25 people with chronic low back pain were enroled in a randomised cross-over experiment. We compared the effect of acupuncture delivered when sensory discrimination is optimised to acupuncture delivered when it is not, on movement-related back pain immediately after each intervention.
  
  
  RESULTS
  We found that the average pain intensity after participants had received acupuncture with sensory discrimination training (2.8±2.5) was less than when they received acupuncture without sensory discrimination training (3.6±2.0). This difference was statistically significant (after adjustment; mean difference=-0.8, 95% CI -1.4 to -0.3; p=0.011).
  
  
  CONCLUSIONS
  Our findings are consistent with the idea that acupuncture may offer specific benefit that is not dependent on precisely where the needles are inserted so much as that the patient attends to where they are inserted. If so, the location of the needles might be better focused on the painful area and the need for penetration of the skin may be mitigated.
authors.affiliation: School of Physiotherapy, The University of Notre Dame Australia, , Fremantle, Western Australia, Australia.
authors.forename: Benedict Martin
authors.initials: BM
authors.lastname: Wand
authors.forename: Sam
authors.initials: S
authors.lastname: Abbaszadeh
authors.forename: Anne Julia
authors.initials: AJ
authors.lastname: Smith
authors.forename: Mark Jon
authors.initials: MJ
authors.lastname: Catley
authors.forename: G Lorimer
authors.initials: GL
authors.lastname: Moseley
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods*; D000293:Adolescent; D000328:Adult; D059350:Chronic Pain / Q000628:therapy; D018592:Cross-Over Studies; D004192:Discrimination, Psychological / Q000502:physiology; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D017288:Pain Threshold / Q000502:physiology; D010465:Perception / Q000502:physiology; D016896:Treatment Outcome; D055815:Young Adult
keywords: Back injuries; Physiotherapy