Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Acupuncture for chronic low back pain: a randomized placebo-controlled study with long-term follow-up. The use of electro-acupuncture in conjunction with exercise for the treatment of chronic low-back pain. Superficial acupuncture in the relief of chronic low back pain. Comparison of superficial and deep acupuncture in the treatment of lumbar myofascial pain: a double-blind randomized controlled study. [Acupuncture contra antiphlogistics in acute lumbago]. Importance of modes of acupuncture in the treatment of chronic nociceptive low back pain. Dry needling of muscle motor points for chronic low-back pain: a randomized clinical trial with long-term follow-up. A randomized comparative trial of acupuncture versus transcutaneous electrical nerve stimulation for chronic back pain in the elderly. Acupuncture in the management of chronic low back pain: a blinded randomized controlled trial. Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. A prospective, randomized, double-blind evaluation of trigger-point injection therapy for low-back pain. Acupuncture treatment of chronic low-back pain -- a randomized, blinded, placebo-controlled trial with 9-month follow-up. Randomised controlled trial comparing the effectiveness of electroacupuncture and TENS for low back pain: a preliminary study for a pragmatic trial. Efficacy of electroacupuncture and TENS in the rehabilitation of chronic low back pain patients. Acupuncture for chronic low back pain in older patients: a randomized, controlled trial. The acupuncture treatment of low back pain: a randomized controlled study. Acupuncture treatment of chronic back pain. A double-blind placebo-controlled trial. Treatment of low back pain with acupuncture.
Because the value of popular forms of alternative care for chronic back pain remains uncertain, we compared the effectiveness of acupuncture, therapeutic massage, and self-care education for persistent back pain.
                We randomized 262 patients aged 20 to 70 years who had persistent back pain to receive Traditional Chinese Medical acupuncture (n = 94), therapeutic massage (n = 78), or self-care educational materials (n = 90). Up to 10 massage or acupuncture visits were permitted over 10 weeks. Symptoms (0-10 scale) and dysfunction (0-23 scale) were assessed by telephone interviewers masked to treatment group. Follow-up was available for 95% of patients after 4, 10, and 52 weeks, and none withdrew for adverse effects.
                Treatment groups were compared after adjustment for prerandomization covariates using an intent-to-treat analysis. At 10 weeks, massage was superior to self-care on the symptom scale (3.41 vs 4.71, respectively; P =.01) and the disability scale (5.88 vs 8.92, respectively; P<.001). Massage was also superior to acupuncture on the disability scale (5.89 vs 8.25, respectively; P =.01). After 1 year, massage was not better than self-care but was better than acupuncture (symptom scale: 3.08 vs 4.74, respectively; P =.002; dysfunction scale: 6.29 vs 8.21, respectively; P =.05). The massage group used the least medications (P<.05) and had the lowest costs of subsequent care.
                Therapeutic massage was effective for persistent low back pain, apparently providing long-lasting benefits. Traditional Chinese Medical acupuncture was relatively ineffective. Massage might be an effective alternative to conventional medical care for persistent back pain. The authors sought to determine whether a series of needle acupuncture treatments produced long-term relief of chronic low back pain.
                A blinded placebo-controlled study with an independent observer. The patients were randomized to receive manual acupuncture, electroacupuncture, or active placebo (mock transcutaneous electrical nerve stimulation). Subjects were examined and monitored by an investigator who was blinded to the treatment given.
                A tertiary-level pain clinic at a Swedish university hospital.
                Fifty consecutive patients (33 women, 17 men; mean age, 49.8 years) with chronic low back pain (mean pain duration, 9.5 years) and without rhizopathy or history of acupuncture treatment were included in the study.
                Treatments were given once per week for 8 weeks. Two further treatments were given during the follow-up assessment period of 6 months or longer.
                The independent observer made a global assessment of the patients 1, 3, and 6 months after treatment. The patients kept pain diaries to score pain intensity twice daily, analgesic intake, and quality of sleep daily, and activity level weekly.
                At the 1-month independent assessment, 16 of 34 patients in the acupuncture groups and 2 of 16 patients in the placebo group showed improvement (p <0.05). At the 6-month follow-up assessment, 14 of 34 patients in the acupuncture groups and 2 of 16 patients in the placebo group showed improvement (p <0.05). A significant decrease in pain intensities occurred at 1 and 3 months in the acupuncture groups compared with the placebo group. There was a significant improvement in return to work, quality of sleep, and analgesic intake in subjects treated with acupuncture.
                The authors found a long-term pain-relieving effect of needle acupuncture compared with true placebo in some patients with chronic nociceptive low back pain. To determine the effect of a series of electro-acupuncture (EA) treatment in conjunction with exercise on the pain, disability, and functional improvement scores of patients with chronic low-back pain (LBP).
                A blinded prospective randomized controlled study. Subjects and interventions: A total of 52 patients were randomly allocated to an exercise group (n = 26) or an exercise plus EA group (n = 26) and treated for 12 sessions.
                Numerical Rating Scale (NRS), Aberdeen LBP scale, lumbar spinal active range of movement (AROM), and the isokinetic strength were assessed by a blinded observer. Repeated measures analysis of variance (R-ANOVA) with factors of group and time was used to compare the outcomes between the two groups at baseline (before treatment), immediately after treatment, 1-month follow-up, and 3-month follow-up. The level of significance was set at p = 0.05.
                Significantly better scores in the NRS and Aberdeen LBP scale were found in the exercise plus EA group immediately after treatment and at 1-month follow-up. Higher scores were also seen at 3-month follow-up. No significant differences were observed in spinal AROM and isokinetic trunk concentric strength between the two groups at any stage of follow-up.
                This study provides additional data on the potential role of EA in the treatment of LBP, and indicates that the combination of EA and back exercise might be an effective option in the treatment of pain and disability associated with chronic LBP. A single-blind, randomised, placebo-controlled trial of superficial acupuncture in the treatment of low back pain was carried out by comparing 8 patients treated by acupuncture with 9 patients treated by placebo. In all five measures of efficacy chosen for study the acupuncture group achieved better responses than the placebo group; four of the five inter-group differences were statistically significant. In addition, an overall mean for all five measures combined showed significant superiority of acupuncture over placebo. The aim of the study was to compare the therapeutic effect of the superficial and in-depth insertion of acupuncture needles in the treatment of patients with chronic lumbar myofascial pain.
                A prospective randomized double-blind study of superficial and deep acupuncture was conducted.
                The study was conducted in the Pain Service Unit of the University of Padova.
                The study comprised 42 patients with lumbar myofascial pain who were divided into two equal groups (A and B).
                In group A, the needle was introduced in the skin at a depth of 2 mm, whereas in group B the needle was placed deeply into muscular tissue. The treatment was planned for a cycle of eight sessions.
                The intensity of pain was evaluated with the McGill Pain Questionnaire before and after treatment and at the 3-month follow-up examination.
                Although at the end of the treatment there was no evidence of significant statistical differences between the two different groups, pain reduction was greater in the group treated with deep acupuncture. A statistical difference existed between the two groups at the 3-month follow up, with a better result in the deeply stimulated group.
                Clinical results show that deep stimulation has a better analgesic effect when compared with superficial stimulation. Acute low back pain is one of the most frequent complaints presented in general practice. This study compares acupuncture and antiphlogistica in the treatment of acute low back pain in general practice.
                Among 60 consecutively included patients with acute low back pain, 30 patients were randomized to standardised acupuncture treatment for two weeks, and 30 patients to entero-soluble naproxen 500 mg twice daily for ten days. Effects were observed over six months, and observed for a further 12 months with regard to relapse of low back pain and number of days on sickness leave.
                There were no differences in pain or stiffness (VAS, physical tests) at inclusion, nor in the reduction of pain or stiffness over a six month evaluation. However, patients receiving acupuncture used significantly less analgetic drugs during the first week after start of treatment than those receiving naproxen (2/28 versus 11/29, p < 0.01). Patients receiving acupuncture also reported fewer new episodes of low back pain (11/28 versus 30/29, p < 0.05) during the 6 + 12 month follow-up. Side effects were frequent in the naproxen group, especially gastro-enteric side effects (0/28 versus 15/29, p < 0.01).
                Standardised acupuncture treatment seems to be safe and effective in the treatment of acute low back pain in general practice. A controlled study of different modes of acupuncture stimulation was conducted on patients fulfilling clinical criteria for chronic low back pain of nociceptive origin. Forty patients were randomly entered into the study. Thirty had three trial treatments with manual stimulation of needles (MS), electrical low frequency stimulation at 2 Hz (LF), and high-frequency stimulation at 80 Hz (HF), and then continued treatment with the mode they felt most benefitted them. Ten patients were put on the waiting list for treatment but served as the untreated control group. The results were evaluated after 6 weeks and at 6 months for: activity related to pain; mobility; verbal descriptors of pain and the patient's subjective assessment of his condition. After 6 weeks, patients receiving treatment showed significant improvement (P < 0.05 to P < 0.001) on three of the four measures compared to the untreated controls. After 6 months a similar measure of significant improvement was seen in patients continuing with low-frequency (LF) acupuncture, but not in those groups continuing with manual stimulation (MS) or high-frequency (HF) acupuncture. The results suggest that 2 Hz electrical stimulation is the mode of choice when using acupuncture in the treatment of chronic nociceptive low back pain. nan Sixty patients aged 60 or over with back pain for at least 6 months were recruited from General Practitioner referrals and randomized to 4 weeks of treatment with acupuncture or transcutaneous electrical nerve stimulation (TENS). All treatments were administered by the same physiotherapist and both groups had the same contact with him. The following were measured at baseline, completion and at a 3-month follow-up by an independent observer blinded to treatment received: (1) pain severity on visual analogue scale (VAS); (2) pain subscale of Nottingham Health Profile (NHP); (3) number of analgesic tablets consumed in previous week; (4) spinal flexion from C7 to S1. Thirty-two patients were randomized to acupuncture and 28 to TENS; only three withdrew (two from acupuncture, one from TENS). Significant improvements were shown on VAS (P < 0.001), NHP (P < 0.001) and tablet count (P < 0.05) between baseline and completion in both groups, these improvements remaining significant comparing baseline with follow-up with a further non-significant improvement in VAS and NHP in the acupuncture group. The acupuncture but not the TENS patients showed a small but statistically significant improvement (P < 0.05) in mean spinal flexion between baseline and completion which was not maintained at follow-up. Thus in these elderly patients with chronic back pain both acupuncture and TENS had demonstrable benefits which outlasted the treatment period. Acupuncture may improve spinal flexion. This trial cannot exclude the possibility that both treatments are 'placebos'. To assess the efficacy of acupuncture in the treatment of chronic low back pain.
                Patients (n = 60) with chronic low back pain were recruited and randomly allocated to either Acupuncture therapy or Placebo transcutaneous electrical nerve stimulation (TENS) groups. Patients were treated weekly for 6 weeks, and blinded assessments were carried out pre- and post-treatment using the McGill Pain Questionnaire (MPQ) and visual analog scales (VAS) for pain, the Short-form 36 quality-of-life questionnaire, and a simple range of motion measurement. A total of 46 patients completed the trial and were followed up at 6 months.
                Analysis of results using t tests showed that in both groups there were significant pre-post improvements for all scores, except for MPQ scores in the Placebo-TENS group. There was no significant difference between the 2 groups for any of the outcome measures at the end of treatment. Results from the 6-month follow-up would suggest that the response was better in the acupuncture group.
                Further research is necessary to fully assess the efficacy of this treatment in combating chronic low back pain using larger sample sizes or alternative control groups. To compare needle acupuncture, medication (tenoxicam with ranitidine), and spinal manipulation for managing chronic (>13 weeks duration) spinal pain syndromes.
                Prospective, randomized, independently assessed preintervention and postintervention clinical pilot trial.
                Specialized spinal pain syndrome out-patient unit at Townsville General Hospital, Queensland, Australia.
                Seventy-seven patients (without contraindication to manipulation or medication) were recruited.
                One of three separate, clearly defined intervention protocols: needle acupuncture, nonsteroidal anti-inflammatory medication, or chiropractic spinal manipulation.
                Main outcome measures were changes (4 weeks vs. initial visit) in the scores of the (1) Oswestry Back Pain Disability Index, (2) Neck Disability Index, and (3) three visual analogue scales of local pain intensity.
                Randomization was successful. After a median intervention period of 30 days, spinal manipulation was the only intervention that achieved statistically significant improvements (all expressed as percentages of the original scores) with (1) a reduction of 30.7% on the Oswestry scale, (2) an improvement of 25% on the neck disability index, and (3) reductions on the visual analogue scale of 50% for low back pain, 46% for upper back pain, and 33% for neck pain (all P<.001). Neither of the other interventions showed any significant improvement on any of the outcome measures.
                The consistency of the results provides, in spite of several discussed shortcomings of this pilot study, evidence that in patients with chronic spinal pain syndromes spinal manipulation, if not contraindicated, results in greater improvement than acupuncture and medicine. The efficacy of trigger-point injection therapy in treatment of low-back strain was evaluated in a prospective, randomized, double-blind study. The patient population consisted of 63 individuals with low-back strain. Patients with this diagnosis had nonradiating low-back pain, normal neurologic examination, absence of tension signs, and lumbosacral roentgenograms interpreted as being within normal limits. They were treated conservatively for 4 weeks before entering the study. Injection therapy was of four different types: lidocaine, lidocaine combined with a steroid, acupuncture, and vapocoolant spray with acupressure. Results indicated that therapy without injected medication (63% improvement rate) was at least as effective as therapy with drug injection (42% improvement rate), at a P value of 0.09. Trigger-point therapy seems to be a useful adjunct in treatment of low-back strain. The injected substance apparently is not the critical factor, since direct mechanical stimulus to the trigger-point seems to give symptomatic relief equal to that of treatment with various types of injected medication. There is some evidence for the efficacy of acupuncture in chronic low-back pain (LBP), but it remains unclear whether acupuncture is superior to placebo. In a randomized, blinded, placebo-controlled trial, we evaluated the effect of traditional acupuncture in chronic LBP. A total of 131 consecutive out-patients of the Department of Orthopaedics, University Goettingen, Germany, (age=48.1 years, 58.5% female, duration of pain: 9.6 years) with non-radiating LBP for at least 6 months and a normal neurological examination were randomized to one of three groups over 12 weeks. Each group received active physiotherapy over 12 weeks. The control group (n=46) received no further treatment, the acupuncture group (n=40) received 20 sessions of traditional acupuncture and the sham-acupuncture group (n=45) 20 sessions of minimal acupuncture. Changes from baseline to the end of treatment and to 9-month follow-up were assessed in pain intensity and in pain disability, and secondary in psychological distress and in spine flexion, compared by intervention groups. Acupuncture was superior to the control condition (physiotherapy) regarding pain intensity (P=0.000), pain disability (P=0.000), and psychological distress (P=0.020) at the end of treatment. Compared to sham-acupuncture, acupuncture reduced psychological distress (P=0.040) only. At 9-month follow-up, the superiority of acupuncture compared to the control condition became less and acupuncture was not different to sham-acupuncture. We found a significant improvement by traditional acupuncture in chronic LBP compared to routine care (physiotherapy) but not compared to sham-acupuncture. The trial demonstrated a placebo effect of traditional acupuncture in chronic LBP. The objective of this study was to compare the effectiveness of electroacupuncture and TENS for low back pain when the electroacupuncture is applied in a clinically realistic manner. The study was designed as an evaluator-blinded randomised controlled trial (RCT). The study was performed at the Tsukuba College of Technology Clinic in Japan. Twenty subjects, who suffered from low back pain (LBP) without sciatica, were recruited, using leaflets in Tsukuba city. Subjects were allocated to either an electroacupuncture (EA) group (10 patients) or a transcutaneous electrical nerve stimulation (TENS) group (10 patients). The procedure for EA was in accordance with standard practice at our clinic. The main outcome measures were a pain relief scale (100 mm visual analogue scale: VAS) and a LBP score recommended by the Japanese Orthopaedic Association (JOA Score). Mean VAS value during the 2-weeks experimental period of the EA group was significantly smaller than that of the TENS group (65 mm vs 86 mm; 95% CI, 4.126 - 37.953). JOA Score in the EA group improved significantly while that in the TENS group showed no change. Although some placebo effect may be included, EA appeared more useful than TENS in the short-term effect on low back pain. We suggest that more realistic acupuncture interventions based on standard practice should be employed in pragmatic RCTs. Fifty-four patients treated in a 3-week inpatient rehabilitation program were randomly assigned to and accepted treatment with electroacupuncture (n = 17), TENS (low intensity transcutaneous nerve stimulation, n = 18), and TENS dead-battery (placebo, n = 18). Outcome measures included estimates of pain (on a Visual Analogue Scale) and disability by both physician and patient, physical measures of trunk strength and spine range of motion, as well as the patient's perceptions of the relative contribution of the education, exercise training, and the electrical stimulation. Analyses of variance were utilized to determine effects of treatment (electroacupuncture, TENS, placebo) across time (admission, discharge, and return) for the outcome measures. There were no significant differences between treatment groups with respect to their overall rehabilitation. All 3 treatment groups ranked the contribution of the education as being greater than the electrical stimulation. However, the electroacupuncture group consistently demonstrated greater improvement on the outcome measures than the other treatment groups. For the visual analogue scale measure of average pain, there was a statistical trend at the return visit suggesting that the acupuncture group was experiencing less pain. To determine if acupuncture is an effective, safe adjunctive treatment to standard therapy for chronic low back pain (LBP) in older patients.
                The inclusion criteria for subjects were: (i) LBP > or =12 weeks and (ii) age > or =60 yr; the exclusion criteria were (i) spinal tumour, infection or fracture and (ii) associated neurological symptoms. The subjects were randomized to two groups. The control group of subjects continued their usual care as directed by their physicians, i.e. NSAIDs, muscle relaxants, paracetamol and back exercises. Subjects in the acupuncture group in addition received biweekly acupuncture with electrical stimulation for 5 weeks. Outcome was measured by the modified Roland Disability Questionnaire (RDQ) at weeks 0, 2, 6 and 9. The primary outcome measure was change in RDQ score between weeks 0 and 6.
                Fifty-five patients were enrolled, with eight drop-outs. Twenty-four subjects were randomized to the acupuncture group and 23 were randomized to the control group. Acupuncture subjects had a significant decrease in RDQ score of 4.1 +/- 3.9 at week 6, compared with a mean decrease of 0.7 +/- 2.8 in the control group (P = 0.001). This effect was maintained for up to 4 weeks after treatment at week 9, with a decrease in RDQ of 3.5 +/- 4.4 from baseline, compared with 0.43 +/- 2.7 in the control group (P = 0.007). The mean global transition score was higher in the acupuncture group, 3.7 +/- 1.2, indicating greater improvement, compared with the score in the control group, 2.5 +/- 0.9 (P < 0.001). Fewer acupuncture subjects had medication-related side-effects compared with the control group.
                Acupuncture is an effective, safe adjunctive treatment for chronic LBP in older patients. The acupuncture treatment situation was beneficial to the majority of people with low back pain. This was shown by the use of short-term controls and long-term controls, although the latter were not intended in the study design. After acupuncture, there was a 51% pain reduction in the average pain score in the Immediate Treatment Group. The short-term controls, the Delayed Treatment Group, had no reduction whatsoever in their pain scores at the comparable followup period. Later, the Delayed Treatment Group bere also treated by acupuncturists, and reported 62% less pain. When these two treatment groups were compared at 40 weeks with long-term controls (Inadequate Treatment Group), the Inadequate Treatment Group still had the same pain scores, on the average, as when they enrolled in the study. Both treatment groups, on the average, had 30% lower pain scores. Furthermore, 58% of the treatment groups felt that they were definitely improved at 40 weeks, while only 11% of the Inadequate Treatment Group felt definitely improved at 40 weeks. Acupuncture treatment of chronic low back pain was studied in a placebo-controlled double-blind crossover trial completed by 77 patients. The patients had significantly increased depression, neuroticism, and hypochondriasis scores. Initial pain levels correlated with state-anxiety, depression, pain duration, and abnormal illness behavior measures, as well as with the intake of psychotropic but not analgesic medication. Overall reduction in pain score was 26 percent for acupuncture and 22 percent for placebo treatment; the difference was not significant (p greater than 0.6). Analgesic drug intake was reduced to a similar extent in both groups. During the first phase of treatment, patients receiving acupuncture had a greater but not significantly different reduction in pain rating scores compared with those receiving placebo (t = 0.52; p greater than 0.6). This group showed significantly lower pain scores (p less than 0.05) in the second phase of the trial while receiving placebo treatment. Overall reduction in individual patient's pain score was best predicted by initial pain severity (r = 0.43; p less than 0.001) and psychotropic drug intake (r = 0.37; p less than 0.001). None of the variables tested predicted which patients would specifically respond to acupuncture or placebo. nan