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True, sham acupuncture effective for back pain.

True acupuncture and sham acupuncture both were much more effective against chronic low-back pain than was conventional treatment in a large clinical trial comparing the three approaches.

Almost half the subjects who received either real or sham acupuncture for 6 months showed clinically relevant improvement in pain intensity or back-specific disability, compared with only one-fourth of the subjects who received a variety of conventional therapies, investigators in the German Acupuncture (GER-AC) Trials reported. (See box.)

"To our knowledge, [this] study is the largest and most rigorous trial to investigate the efficacy of verum acupuncture for chronic low-back pain compared with sham acupuncture and guideline-based conventional therapy. The study yielded several surprising results," said Dr. Michael Haake of the University of Regensburg, Bad Abbach, Germany, and his associates.

The subjects were 1,162 adults with chronic low-back pain who were randomized to conventional treatment or real or sham acupuncture administered by physicians at 340 outpatient practices. The study physicians belonged to various medical specialties, had acquired at least 140 hours of acupuncture training, and had practiced acupuncture for a median of 8 years.

Both types of acupuncture involved at least 10 30-minute sessions, usually twice per week, plus additional sessions if the subjects experienced a 10%-50% reduction in pain intensity. The two treatments were identical, except that the sham procedure avoided all known acupuncture points or meridians and involved only superficial insertion of the needles, without any manual stimulation. Subjects were unable to distinguish any difference.

Conventional therapies included at least ten 30-minute sessions with a physician or physiotherapist. Treating physicians were free to administer any combination of techniques they deemed useful, including physiotherapy, massage, heat therapy, electrotherapy, injections, analgesics, anti-inflammatory agents, yoga, hydrojet treatment, exercise, and patient education about managing back pain.

True acupuncture and sham acupuncture were equally effective, as well as more effective than conventional therapies, in relieving pain, improving function, and improving quality of life. All the improvements were significant and persisted long after treatment was completed.

"While all randomized trials and meta-analyses to date have failed to show a clear advantage of acupuncture over conventional therapy for chronic low-back pain, our findings demonstrate significant superiority," the investigators said (Arch. Intern. Med. 2007;167:1892-8).

Largely on the basis of these results, the German Federal Joint Committee of Physicians and Health Insurance Plans--an agency similar to the National Institutes of Health--made acupuncture for low-back pain an insured benefit in that country.

The investigators' finding on sham acupuncture "forces us to question the underlying action mechanism of acupuncture and to ask whether the emphasis placed on learning the traditional Chinese acupuncture points may be superfluous," Dr. Haake and his associates added.

"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," they said.


Contributing Writer
Response Rates at 6 Months For Chronic Low-Back Pain

Verum acupuncture (n = 387) 47.6%
Sham acupuncture (n = 387) 44.2%
Conventional therapies (n = 387) 27.4%

Source: Archives of Internal Medicine

Note: Table made from bar graph.
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Title Annotation:Pain Medicine
Author:Moon, Mary Ann
Publication:Clinical Psychiatry News
Date:Feb 1, 2008
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