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Randomized Controlled Trial
. 2009 May 11;169(9):858-66.
doi: 10.1001/archinternmed.2009.65.

A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain

Daniel C Cherkin  1 , Karen J Sherman, Andrew L Avins, Janet H Erro, Laura Ichikawa, William E Barlow, Kristin Delaney, Rene Hawkes, Luisa Hamilton, Alice Pressman, Partap S Khalsa, Richard A Deyo
Affiliations
Randomized Controlled Trial

A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain

Daniel C Cherkin et al. Arch Intern Med. .

Abstract

Background: Acupuncture is a popular complementary and alternative treatment for chronic back pain. Recent European trials suggest similar short-term benefits from real and sham acupuncture needling. This trial addresses the importance of needle placement and skin penetration in eliciting acupuncture effects for patients with chronic low back pain.

Methods: A total of 638 adults with chronic mechanical low back pain were randomized to individualized acupuncture, standardized acupuncture, simulated acupuncture, or usual care. Ten treatments were provided over 7 weeks by experienced acupuncturists. The primary outcomes were back-related dysfunction (Roland-Morris Disability Questionnaire score; range, 0-23) and symptom bothersomeness (0-10 scale). Outcomes were assessed at baseline and after 8, 26, and 52 weeks.

Results: At 8 weeks, mean dysfunction scores for the individualized, standardized, and simulated acupuncture groups improved by 4.4, 4.5, and 4.4 points, respectively, compared with 2.1 points for those receiving usual care (P < .001). Participants receiving real or simulated acupuncture were more likely than those receiving usual care to experience clinically meaningful improvements on the dysfunction scale (60% vs 39%; P < .001). Symptoms improved by 1.6 to 1.9 points in the treatment groups compared with 0.7 points in the usual care group (P < .001). After 1 year, participants in the treatment groups were more likely than those receiving usual care to experience clinically meaningful improvements in dysfunction (59% to 65% vs 50%, respectively; P = .02) but not in symptoms (P > .05).

Conclusions: Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture's purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects.

Trial registration: ClinicalTrials.gov NCT00065585.

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Conflict of interest statement

Disclosure of Potential Conflicts of Interest

None of the authors had a conflict of interest; including financial interests, relationships or affiliations relevant to the subject of this manuscript.

Figures

Figure 1
Figure 1
Study Participant Flow Diagram
Figure 2
Figure 2
Mean Roland disability scores and 95% confidence intervals by treatment group and time since randomization
Figure 3
Figure 3
Mean symptom bothersomeness score and 95% confidence intervals by treatment group and time since randomization
Figure 4
Figure 4
Percent of participants improving by at least 3 points on the Roland scale
Figure 5
Figure 5
Percent of participants improving by at least 2 points on the symptom bothersomeness scale
See this image and copyright information in PMC

Comment in

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