Acunpuncture needles out low back pain

Science Daily – Six months of acupuncture treatment appears to be more effective than conventional therapy in treating low back pain, according to a study in the Sept. 24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals, although the study suggests that both sham acupuncture and traditional Chinese verum acupuncture appear to be effective in treating low back pain.

“Low back pain is a common, impairing and disabling condition, often long-term, with an estimated lifetime prevalence of 70 percent to 85 percent,” the authors write as background information in the article. “It is the second most common pain for which physician treatment is sought and a major reason for absenteeism and disability.” Acupuncture is increasingly used as an alternative therapy, but its value as a treatment for low back pain is still controversial.

Michael Haake, Ph.D., M.D., of the University of Regensburg, Bad Abbach, Germany, and colleagues conducted a randomized clinical trial involving 1,162 patients (average age 50) who had experienced chronic low back pain for an average of eight years.

Patients underwent ten 30-minute sessions (approximately two sessions per week) of verum acupuncture (387 patients), sham acupuncture (387 patients) or conventional therapy (388 patients). Verum acupunture consisted of needling fixed points and additional points to a depth of 5 millimeters to 40 millimeters based on traditional Chinese medicine, while sham acupuncture consisted of inserting needles superficially (1 millimeter to 3 millimeters) into the lower back avoiding all known verum points or meridians.

Conventional therapy consisted of a combination of medication, physical therapy and exercise. Five additional sessions were offered to those who had a partial response to treatment (10% to 50% pain reduction).

“A total of 13,475 treatment sessions were conducted (verum acupuncture, 4,821; sham acupuncture, 4,590; conventional therapy, 4,064),” the authors write. Patients receiving the additional five sessions were 232 (59.9%) in the verum group, 209 (54.3%) in the sham group and 192 (52.5%) in the conventional group.

Response rate was defined as a 33% improvement in pain or a 12 percent improvement in functional ability. “At six months, response rate was 47.6% in the verum acupuncture group, 44.2% in the sham acupuncture group and 27.4% in the conventional therapy group,” the authors note. “Differences among groups were as follows: verum vs. sham, 3.4%; verum vs. conventional therapy, 20.2%; and sham vs. conventional therapy, 16.8%.”

“The superiority of both forms of acupuncture suggests a common underlying mechanism that may act on pain generation, transmission of pain signals or processing of pain signals by the central nervous system and that is stronger than the action mechanism of conventional therapy,” the authors conclude. “Acupuncture gives physicians a promising and effective treatment option for chronic low back pain, with few adverse effects or contraindications. The improvements in all primary and secondary outcome measures were significant and lasted long after completion of treatment.”

Tai chi soothes pain in arthritis sufferers

CM NEWS – The results of a new analysis have provided good evidence to suggest that Tai Chi is beneficial for arthritis. Specifically, it was shown to decrease pain with trends towards improving overall physical health, level of tension and satisfaction with health status.

Musculoskeletal pain, such as that experienced by people with arthritis, places a severe burden on the patient and community and is recognized as an international health priority. Exercise therapy including such as strengthening, stretching and aerobic programs, have been shown to be effective for arthritic pain. Tai Chi, is a form of exercise that is regularly practiced in China to improve overall health and well-being. It is usually preformed in a group but is also practiced individually at one’s leisure, which differs from traditional exercise therapy approaches used in the clinic.

Recently, a new study examined the effectiveness of Tai Chi in decreasing pain and disability and improving physical function and quality of life in people with chronic musculoskeletal pain. The study is published in the June issue of Arthritis Care & Research. Led by Amanda Hall of The George Institute in Sydney, Australia, researchers conducted a systematic review and meta-analysis. They analyzed seven eligible randomized controlled trials that used Tai Chi as the main intervention for patients with musculoskeletal pain. The results demonstrate that Tai Chi improves pain and disability in patients suffering arthritis.

The authors state, “The fact that Tai Chi is inexpensive, convenient, and enjoyable and conveys other psychological and social benefits supports the use this type of intervention for pain conditions such as arthritis.”

“It is of importance to note that the results reported in this systematic review are indicative of the effect of Tai Chi versus minimal intervention (usual health care or health education) or wait list control,” the authors note. Establishing the specific effects of Tai Chi would require a placebo-controlled trial, which has not yet been undertaken.

Acupuncture eases chronic low back pain

Acupuncture can help people with chronic low back pain feel less bothered by their symptoms and function better in their daily activities, according to the largest U.S. randomized trial of its kind, published in the May 11, 2009 Archives of Internal Medicine. But the SPINE (Stimulating Points to Investigate Needling Efficacy) trial raises questions about how the ancient practice actually works.
Compared to the group that got usual care, results were similar for all three of the SPINE trial’s acupuncture groups: individualized, standardized, and simulated (without going through skin). Of the people who got any kind of acupuncture, an extra one in five were functioning significantly better at the end of the seven-week treatment—and an extra one in eight were still functioning better at one year.

“This study suggests that acupuncture is about as effective as other treatments for chronic back pain that have been found helpful,” said SPINE trial leader Daniel C. Cherkin, PhD, a senior investigator at Group Health Center for Health Studies in Seattle. “But we found that simulated acupuncture, without penetrating the skin, produced as much benefit as needle acupuncture—and that raises questions about how acupuncture works.”

The SPINE trial included 638 adult patients at two nonprofit health plans: Group Health Cooperative in Seattle and Northern California Kaiser Permanente in Oakland. They all rated the “bothersomeness” of their chronic low back pain as at least a 3 on a 0-to-10 scale. None of them had received acupuncture before. They were randomly assigned to one of four groups:

* Individualized needle acupuncture, involving a customized prescription for acupuncture points from a diagnostician
* Standardized needle acupuncture, using a single prescription for acupuncture points on the back and backs of the legs, which experts consider generally effective for chronic low back pain
* Simulated acupuncture on those same standardized points, mimicking needle acupuncture but instead of a needle using a toothpick in a needle guide tube without penetrating the skin
* Usual care, which is the standard medical care they would have gotten anyway—and that all patients in all groups received

Everyone in the three acupuncture groups (individualized, standardized, or simulated) was treated twice a week for three weeks, and then weekly for four weeks. At eight weeks, half a year, and one year, researchers measured back-related dysfunction and how much symptoms bothered patients.

The SPINE team found that at eight weeks all three acupuncture groups were functioning substantially better, while the group getting only usual care was functioning only slightly better. Dysfunction scores improved significantly more for all three acupuncture groups than for the usual care group. These benefits lasted for a year, although they waned over time.

Notably, the outcomes for groups that received the needle and simulated forms of acupuncture did not differ significantly. So, although acupuncture effectively treated low back pain, that therapeutic benefit seemed to require neither tailoring acupuncture needle sites to an individual patient nor inserting needles into the skin.

“We don’t know precisely why people got back pain relief from the simulated acupuncture,” said Cherkin’s co-author Karen J. Sherman, PhD, MPH, a senior investigator at Group Health Center for Health Studies. “Historically, some types of acupuncture have used non-penetrating needles. Such treatments may involve physiological effects that make a clinical difference.” Or it might be all about the mind-body connection, she said: “Maybe the context in which people get treatment has effects that are more important than the mechanically induced effects.”

Western medicine does not have highly effective medical treatments for chronic back pain, Cherkin said. Back pain is the number-one reason that Americans use complementary and alternative medicine (CAM), including acupuncture.

The National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, funded the SPINE trial.

“The findings of this research show that acupuncture-like treatments, including simulated acupuncture, can elicit positive responses,” said Josephine P. Briggs, MD, director of NCCAM. “This adds to the growing body of evidence that something meaningful is taking place during acupuncture treatments outside of actual needling. Future research is needed to delve deeper into what is evoking these responses.”

Cherkin and Sherman’s SPINE trial co-authors were Richard A. Deyo, MD, MPH, of Oregon Health & Science University in Portland; Partap S. Khalsa, DC, PhD, of NCCAM’s Division of Extramural Research; Andrew L. Avins, MD, MPH, Luisa Hamilton, MD, and Alice Pressman, MS, of NorthernCalifornia Kaiser Permanente in Oakland; William E. Barlow, PhD of Cancer Research and Biostatistics and Group Health Center for Health Studies; and Laura Ichikawa, MS, Janet H. Erro, RN, MN, Kristin Delaney, MPH, and Rene Hawkes of Group Health Center for Health Studies.