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Acupuncture, real or fake, called best for lower back pain
September 25, 2007
The Chinese practice of acupuncture is more effective at alleviating chronic lower-back pain than physical therapy, pain medications, and other treatments typically used in the United States, German researchers reported yesterday.
Our Review Summary
This article reports on the largest randomized controlled trial to date investigating the effectiveness of acupuncture for treating chronic low back pain. It explains that both acupuncture and sham needling are more effective than conventional medical therapies, but that “fake acupuncture works nearly as well as the real thing.”
In addition to describing the quality of the evidence, the story mentions several other treatment options, tells the reader the cost of acupuncture, and hints at its novelty. The story neglects to mention harms. (A recent systematic review reinforces the study’s finding that acupuncture poses few risks; see Spine 2005;30:944-63). And it also provides an incomplete picture of the treatment’s apparent benefits. Although it notes the proportion of patients who improved with each therapy, it does not define success or otherwise quantify how much people improved clinically--in either relative or absolute terms. For a treatment to be considered successful, for example, a patient could have reported as little as a 12% improvement in function during an interview conducted over the telephone 6 months after enrollment. This is important information if people are to weigh the apparent benefit of a therapy against its cost.
The article cites one of the study’s coauthors and two physicians who appear to be users and/or proponents of complementary therapies. They attempt to explain why needling seems to work. To provide some balance, the study’s coauthor suggests that the apparent benefit could merely be the result of patients’ expectations of improvement from acupuncture, on the one hand, and of poor results from conventional medicine on the other. (Unfortunately, the researchers did not measure patients’ expectations.) It would have been interesting to hear from others. Some might point out that the new study shows that acupuncture and sham needling are only more effective than treatments that are not themselves very effective. Others might make the case that acupuncture provides no specific treatment effect and is unethical to use—because it could be construed as prescribing a placebo.
People with chronic low back pain are desperate for anything that will help. When a large new study provides apparently strong evidence to buttress a therapy that previously had little high-quality evidence to support it, readers might also benefit from more context. A major systematic review that analyzed 35 randomized trials involving 2861 patients recently concluded that acupuncture appears to confer modest, short-term pain relief, but that the quality of the studies was not very good. The reviewers were careful not to overstate the benefits of acupuncture (Spine 2005;30:944-63).
Overall, this was a good article that would have been helped by some more context.
Click on Criteria for definitions.
Acupuncture is estimated to be the third most popular complementary therapy for chronic low back pain. Though the article does not say much about its availability, readers are likely to be familiar with it.
The article states that acupuncture costs $45 to $100 per session. It does not say how this compares to other treatments and whether the cost of care is the same, more or less than alternatives.
There are no obvious elements of disease mongering. The story explains that the study participants were people with chronic low back pain. These results wouldn't apply to other back pain conditions.
The article describes the largest randomized controlled trial to date investigating the effectiveness of acupuncture for treating chronic low back pain, and reports its published results. It discusses the three treatment groups studied and potential reasons for the outcomes observed.
The story did not mention harms from any of the treatments patients received. Previous research suggests that acupuncture poses few risks when performed with sterile, disposable needles.
The story notes that this is the largest study yet of acupuncture for chronic back pain, suggesting that the treatment is not new.
The story states the proportion of patients who successfully responded to each therapy, and clearly explains that “real” acupuncture was no better than sham needling. But it does not define success or otherwise quantify how much people improved clinically in either relative or absolute terms. For a treatment to be considered successful, a patient must have reported either a 33% improvement in pain or as little as a 12% improvement in function during an interview conducted over the telephone 6 months after enrollment. Nonethless we'll grade this criterion as satisfactory.
There is no obvious use of text from a press release.
The article cites one of the study’s coauthors and two physicians who appear to be users and/or proponents of complementary therapies. It would have been interesting to hear from a skeptical observer.
The story lists the therapies received by patients assigned to the conventional medicine group. The literature suggests that these treatments generally provide very modest benefits. The article does not mention other therapies that may be effective for managing chronic pain and improving flexibility and strength. These include cognitive therapy alone or in combination with intensive exercise and strengthening.
Total Score: 9 of 10 Satisfactory
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