Acupuncture for the Treatment of Low Back Pain

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The summary below is from the full report titled "Meta-Analysis: Acupuncture for Low Back Pain." It is in the 19 April 2005 issue of Annals of Internal Medicine (volume 142, pages 651-663). The authors are E. Manheimer, A. White, B. Berman, K. Forys, and E. Ernst.

What is the problem and what is known about it so far?

Acute low back pain goes away after several days or weeks. Chronic low back pain persists over months or years. The main goal in treating back pain is to decrease pain so that patients can resume their normal activities. Traditional treatments for low back pain include drugs (pain killers, anti-inflammatory drugs, and muscle relaxants), physical therapy, back exercises, and education about ways to prevent back injury and to deal with back pain. Unfortunately, these treatments do not always help. Many people with low back pain seek alternative treatments, such as acupuncture. Acupuncture is an ancient Chinese medical treatment that involves putting special needles into specific points of the body. Increasingly, mainstream medicine is recognizing acupuncture as an effective treatment for various disorders. It is unclear whether acupuncture is an effective treatment for low back pain.

Why did the authors do this review?

To summarize the results of published studies of acupuncture for treating low back pain.

How did the authors do this review?

They searched computerized databases to find published studies that assigned patients with low back pain to receive either acupuncture or one of the following comparison treatments: sham acupuncture, no low back pain treatment, or traditional treatments for low back pain. Sham acupuncture means "pretend" acupuncture; for example, the therapist might insert the needles in the wrong site or insert needles only very superficially. In contrast, for real acupuncture, the therapist inserts correctly placed needles. The researchers collected information about each study and its results. They used a method called meta-analysis to combine the results of studies that looked at the same comparison group and calculated the effectiveness of acupuncture compared with that group.

What did the authors find?

33 studies met their criteria. The studies provided convincing evidence that patients who received acupuncture improved more than patients who received sham acupuncture or no treatment. Published studies did not determine whether acupuncture works better than other low back pain treatments or whether acupuncture benefits patients with acute low back pain.

What are the limitations of this review?

Conclusions about the effectiveness of acupuncture compared with other treatments or for patients with acute low back pain may change as new studies are done and new drugs or new acupuncture techniques are developed.

What are the implications of the review?

For chronic low back pain, acupuncture seems to work better than no treatment. Additional studies are needed to determine whether acupuncture works better than traditional treatments or whether it helps patients with acute low back pain.