Acupuncture for back pain is a very old tradition that involves the ancient practice of introducing needles into specific points in the body. The practice dates back thousands of years to China when they used to use needles made of bamboo. Certain groups of points seemed to be beneficial for treating certain types of diseases and over the years this knowledge grew into a map of specific acupuncture points. The lines along which these points lie are called meridians. There are 14 main meridians identified and approximately 700 points.
Over time, as our understanding of the science of pain has increased, the way in which acupuncture works has been more accepted into modern medical thinking. There are therefore two main schools of thought about acupuncture.
Acupuncture points model showing the lines of the meridians
Image Courtesy Wikimedia Commons
The TCM approach believes that the body is infused with a life force or energy called Ch’i which flows around the body. An obstruction in this energy leads to deficiencies and illness and a traditional Chinese acupuncturist would aim to locate where any excesses and deficiencies lie.
Treatment of appropriate acupuncture points would then be used to try and restore the flow of energy into the system.
The Western Approach
The western approach to acupuncture believes that inserting needles causes physiological changes in the body which alters our pain response. There are several theories on what changes exactly take place but it is clear that the bodies own pain reliving chemical, endorphins, are released during acupuncture. This approach to acupuncture does not require the needles to be placed in any specific points.
There has been conflicting evidence about whether acupuncture for back pain is effective or not. Research published in 2006 (1) suggested small improvements using acupuncture for back pain over usual care. However, a newer study (2) has recently been published looking at the effectiveness of acupuncture for back pain. This study took a large sample of 1162 patients and split them into three groups. One group had usual medical care, the second group had traditional acupuncture and the third group had acupuncture where the needles were placed at random and not in acupuncture points. Interestingly both the acupuncture groups did better that the usual treatment group but there was really no difference between the more traditional type of acupuncture and the more western style.
It looks like the answer is yes, but we are not really sure why, is it because of a placebo effect or is it caused by changes in the pain response? I'm not sure but anything that is helpful in managing chronic lower back pain is a good thing, provided it does not encourage passive dependence on treatments and as long as it is not used in place of other treatments such as exercise and advice.
The National Institute for Helath and Care Excellence (NICE) in the UK has published updated guidelines on the management of low back pain -currently in draft for discussion. The new recomendations suggest that acupuncture for low back pain is avoided. They have reached this conclusion after studying 30 good quality clinical trails and finding that the short term benefits seen were often also found with sham or mock acupuncture. They conclude that the helpful effects are more to do with a psychological or placebo effect. This guideline is still out for agreement so watch this space.
RESEARCH UPDATE 2012: A meta analysis of multiple studies finds that acupuncture is helpful for chronic pain and that 'real' acupuncture does better than 'sham' or pretend acupuncture - but the difference is small. (Vickers 2012)
RESEARCH UPDATE 2010 :Recent guidelines published in the UK recommend acupuncture for back pain treatment if you have had pain for more than 6 weeks but less than a year (3) The conclusions are that acupuncture may help but you can put the needles in anywhere and traditional Chinese treatments do not offer any more benefits
This trial took 1162 patients aged 18-86; they split them into three groups:
All of the participants had had back pain for a while, so they had chronic back pain. The average amount of time they had had it was 8 years.
The results were surprising. Both the acupuncture groups did much better than the ordinary treatment groups. But the most interesting thing is that there was no difference between the two acupuncture groups either.
Some newspapers have been writing about this trial and saying that this proves that acupuncture is better for back pain than other treatments. That may not be absolutely right as that all the participants had already tried conventional treatment which had failed. The acupuncture was a new treatment for them. This may have skewed the results as a novel treatment often does better than one that has been used before.
Also, the amount of improvement measured was very small; the authors considered 12% improvement on one scale as a success.
Another consideration is the high drop out amongst group 3, only 27% finished the trial compared to 40 odd % in the other two groups.
NICE Draft Guidelines Low Back Pain and Sciatica (2015) https://www.nice.org.uk/guidance/indevelopment/gid-cgwave0681/documents
Vickers, A.J., 2012. Acupuncture for Chronic Pain- Individual Patient Data Meta-analysis. Archives of Internal Medicine, p.1.
K J Thomas,et al Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. BMJ, Sep 2006; 333: 623 ; doi:10.1136/bmj.38878.907361.7C
Michael Haake, et al German Acupuncture Trials (GERAC) for Chronic Low Back Pain Randomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups Arch Intern Med. 2007;167:1892-1898.