Does acupuncture reduce pain in adults with acute or chronic low back pain?

Date Last Updated: 03/08/06
Back to Acupuncture page

Treatment in brief
Acupuncture using needles, laser or electrical stimulation of traditional points, pain points or trigger points

Low back pain
Low back pain is very common and generally gets better without treatment. Most people recover from their back pain within 2 months (acute low back pain), but about 10 to 20% will have persistent pain (chronic low back pain). In a New Zealand survey, 67% of people aged 45 to 64 years have had low back pain at some time in their lives (McBride, 2004). People with low back pain use more than 80% of all health care resources (Waddell, 1998).

The main goal in treating low back pain is to decrease pain so that people can resume their normal activities.Traditional treatments, such as drugs, physical treatments, back exercises and education do not always help. Many people seek alternatives, such as acupuncture.

Background
Acupuncture is part of the system of Traditional Chinese Medicine (TCM). In the TCM system, health is seen as a balance between two opposing forces called yin and yang within the body. An imbalance of these is considered to result in ill-health. This imbalance also causes disruption in the flow of ‘chi’ or ‘vital energy’ along pathways in the body known as ‘meridians’. Acupuncture involves stimulation of points along these meridians. This is done commonly by the insertion of needles into these points which are then manipulated manually or by electrical stimulation. They can also be stimulated by moxibustion, pressure, heat and laser light. This restores the balance between yin and yang, corrects the flow of ‘chi’ along the meridians and restores health to the body and mind.

Some low back pain is caused by a condition called myofascial pain syndrome. In this syndrome, there are painful points in the muscle of the lower back (different from the points identified through TCM), called ‘trigger points’. Usually, when you press on a trigger point, pain can be felt elsewhere in the body. Dry needling is the insertion of a needle into the trigger points with the purpose of inactivating these points to reduce pain. This is also referred to as an acupuncture treatment.

The evidence
There is level 2 evidence that acupuncture is effective at reducing chronic low back pain (lasting more than 3 months) in the short term (up to 3 months after treatment) but the benefit may be small.

There is level 3 evidence that the benefit of acupuncture for chronic low back pain is maintained up to 2 years after treatment.

There is level 3 evidence that acupuncture is more effective than usual care (a combination of physiotherapy, medication and back exercises) for chronic low back pain.

There is level 3 evidence that spinal manipulation is more effective than acupuncture for chronic low back pain.

There is insufficient evidence to determine whether acupuncture is more or less effective than any other treatments for chronic low back pain.

There is some evidence that acupuncture may reduce pain in people with acute low back pain.

There is no evidence that acupuncture is harmful. The rate of minor side effects in one of the systematic reviews was 5%.

Other important issues
The quality of the studies in the systematic reviews was poor. There was a lot of variation in terms of the participants in the studies, type of acupuncture given, control groups, outcomes, length of follow-up and of the way the data was presented. Also, the experience and training of the acupuncturists varied. Acupuncture practitioners often individualise treatments for patients and there is likely to be a lot of variability in delivery. Four of the additional studies were of fair or good quality and mostly confirmed the results of the systematic reviews finding a benefit for acupuncture. Some of the studies provided additional evidence that the effects of acupuncture are likely to last up to 2 years after treatment but this requires confirmation from more research.

There was no evidence from any of the studies that acupuncture improved function or lessened the disability of people with chronic low back pain.

It is not clear whether acupuncture is cost effective.

Relatively few harms from the use of acupuncture have been reported considering the number of people treated each year and the number of acupuncture needles used. However, harm can result from inadequate sterilization of needles and incorrect placement of needles. Acupuncturists should use a new set of disposable needles taken from a sealed package for each person.

When not inserted properly, acupuncture needles can cause serious harm, including infections and punctured organs.

For more information: http://nccam.nih.gov/health/acupuncture/#safe
http://www.jr2.ox.ac.uk/bandolier/band68/b68-4.html

Key Messages

There is evidence that acupuncture may reduce pain in people with chronic low back pain in the short term (within 3 months), but the benefit is small	2
There is evidence that acupuncture may reduce pain in people with chronic low back pain in the long term (up to 2 years)	3
There is evidence that acupuncture is more effective than usual care (a combination of physiotherapy, medication and back exercises) at reducing pain	3
There is evidence that acupuncture is less effective than spinal manipulation	3
There is tentative evidence that acupuncture may reduce pain in people with acute low back pain.	4

Key: Levels of evidence

Source
The information in this summary was developed by assessing

Cochrane review: Acupuncture and dry needling for low back pain, 2004
http://127.0.0.1:1024/media_2006-2/search/fs_search.tes

Brinkhaus B, Witt CM, Jena S, Linde K, Streng A, Wagenpfeil S et al. Acupuncture in patients with chronic low back pain. Arch Intern Med 2006; 166: 450-7.

Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. A review of the evidence for the effectiveness, safety and cost of acupuncture, massage therapy and spinal manipulation for back pain. Ann Intern Med 2003; 138: 898-906.

Furlan AD, van Tulder MW, Cherkin DC, Tsukayama H, Lao L, Koes BW et al. Acupuncture and dry needling for low back pain. The Cochrane Database of Systematic Reviews 2005, Issue 1.

Itoh K, Katsumi Y, Hirota S, Kitakoji H. Effects of trigger point acupuncture on chronic low back pain in elderly patients – a sham-controlled randomized trial. Acupuncture in Medicine 2006; 24(1): 5-12.

Li N, Wu B, Wang CW. Comparison of acupuncture-moxibustion and physiotherapy in treating chronic non-specific low back pain. Zhongguo Linchuang Kangfu 2005; 9(2): 186-7.

Manheimer E, White A, Berman B, Forys K, Ernst E. Meta-analysis: acupuncture for low back pain. Ann Intern Med 2005; 142: 651-63.

Muller R, Giles LGF. Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes. J Manipulative Physiol Ther 2005; 28: 3-11.

Thomas KJ, MacPherson H, Ratcliffe J, Thorpe L, Brazier J, Campbell M et al. Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain. Health Technology Assessment 2005; 9(32).

Additional references

McBride D, Begg D, Herbison P, Buckingham K. Low back pain in young New Zealanders. NZ Med J 2004; 117(1203).

Waddell G. The clinical course of low back pain. In: Waddell G, editor. The back pain revolution. 1st edition, Edinburgh: Churchill Livingstone; 1998, pp 103-17.

Date prepared 9 June 2006

DISCLAIMER: This website does not provide specific medical advice and the information provided should not be used as a substitute for seeking medical advice from a registered health practitioner. Full disclaimer . . .