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Uncertain benefit of electroacupuncture for chronic low back pain
Clinical Question
Is electroacupuncture safe and effective in the treatment of adults with chronic low back pain?
Bottom line
This study found mixed results on the benefits of electroacupuncture in treating adults with chronic low back pain. Although no significant difference occurred between active and sham therapy for the primary outcome of reduced pain, a secondary outcome of reduced disability was significantly improved with active versus sham therapy. In addition, eliminating one single significant outlier from the overall analysis resulted in a significant benefit of active electroacupuncture versus sham therapy in both reducing pain and disability. 2b
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Government
Setting: Outpatient (any)
Synopsis
Previous clinical trials that evaluated the benefit of manual acupuncture for adults with chronic low back pain found minimal differences of effect between active and sham acupuncture. In order to evaluate a potentially stronger analgesic effect of electroacupuncture, these investigators identified 121 adults, aged 21 to 65 years, with chronic low back pain for at least 6 months. Exclusion criteria included pain intensity of less than 4 on a 0 to 10 numerical rating scale, radicular pain due to disc compression or spinal stenosis, or recent acupuncture within the last 3 years. Study participants first selected an acupuncturist based on geographic preference and then randomly received assignment (uncertain allocation concealment) to either an active or control treatment group. Active and sham control (nonpenetrating needles on off-meridian points without active stimulation) acupuncture treatments included twelve 45-minute sessions over 6 weeks. Both the patient and the individuals who assessed the outcomes (using a previously validated back pain measurement tool) remained masked to treatment group assignment. Treating acupuncturists were aware of the group assignments. Complete follow-up occurred for 87.5% of patients for 2 weeks after treatment completion. Using intention-to-treat analysis, no significant difference in pain score change occurred between the active and sham treatment groups. There was, however, a significant difference in a post hoc secondary outcome of reduced back pain–related disability favoring the active treatment group. The authors also note that one individual in the trial was identified as a significant outlier in reporting a change in pain score. After removal of this single outlier, the treatment effect of both reduced pain and disability became significant in favor of the active treatment group. Asian participants experienced statistically significant greater reductions in both pain and disability, and white race was associated with worse outcomes in pain.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
See above comments.
See above comments.
Electroaccunpuncture
In a true study, you can not eliminate one patient because they skewed the numbers and why would there be a difference between Asians and Caucasians in an accupuncture study
low back pain
Mobility exercises, weight loss, daily functional activity are the core in my mind for bak pain. The hard part is convincing patients that taking a pill while carrying on as usual won't fix things.
Cultural acceptance of a procedure and role of placebo.
Need further studies to really conclude anything from this study: the effect of placebo and cultural acceptance of a procedure may have played a role.