A Comparison of Physician and Nonphysician Acupuncture Treatment For Chronic Low Back Pain German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Acupuncture for chronic low back pain in older patients: a randomized, controlled trial. Size is everything – large amounts of information are needed to overcome random effects in estimating direction and magnitude of treatment effects Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation A Prospective Survey of Adverse Events and Treatment Reactions following 34,000 Consultations with Professional Acupuncturists Importance of modes of acupuncture in the treatment of chronic nociceptive low back pain Acupuncture in patients with chronic low back pain: a randomized controlled trial. Acupuncture treatment of chronic low-back pain – a randomized, blinded, placebo-controlled trial with 9-month follow-up Description and validation of a noninvasive placebo acupuncture procedure. Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain Trends in access to complementary or alternative medicines via primary care in England: 1995-2001 results from a follow-up national survey. Survey of Adverse Events following Acupuncture (Safa): A Prospective Study of 32,000 Consultations The acupuncture treatment of low back pain: a randomized controlled study. The clinical importance of changes in outcome scores after treatment for chronic low back pain Standards for reporting interventions in controlled trials of acupuncture: the STRICTA recommendations. Acupuncture for acute non-specific low back pain: a pilot randomised non-penetrating sham controlled trial. Superficial acupuncture in the relief of chronic low back pain. A randomized comparative trial of acupuncture versus transcutaneous electrical nerve stimulation for chronic back pain in the elderly Effects of Trigger Point Acupuncture on Chronic Low Back Pain in Elderly Patients – a Sham-Controlled Randomised Trial Acupuncture for low back pain: traditional diagnosis and treatment of 148 patients in a clinical trial. Defining the clinically important difference in pain outcome measures Relief of Low Back Pain Immediately after Acupuncture Treatment – a Randomised, Placebo Controlled Trial Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. Dry Needling of Muscle Motor Points for Chronic Low-Back Pain: A Randomized Clinical Trial With Long-Term Follow-Up Responsiveness of functional status in low back pain: a comparison of different instruments Randomised Controlled Trial Comparing the Effectiveness of Electroacupuncture and Tens for Low Back Pain: A Preliminary Study for a Pragmatic Trial Introducing a placebo needle into acupuncture research Access to complementary medicine via general practice. The use of electro-acupuncture in conjunction with exercise for the treatment of chronic low-back pain. Efficacy of electroacupuncture and tens in the rehabilitation of chronic low back pain patients Acupuncture for Chronic Low Back Pain: A Randomized Placebo-Controlled Study With Long-Term Follow-Up Acupuncture treatment of chronic back pain. A double-blind placebo-controlled trial. The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: a randomised controlled trial. Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial Outcome of low back pain in general practice: a prospective study Does acupuncture improve the orthopedic management of chronic low back pain – a randomized, blinded, controlled trial with 3 months follow up Credibility of a Newly Designed Placebo Needle for Clinical Trials in Acupuncture Research
Background : Although up to a third of the 10,000 acupuncturists in the United States are medical doctors , little is known about the acupuncture techniques they use or how their practice s compare with those of nonphysician licensed acupuncturists . This is the first study providing descriptive data on physician acupuncture and comparison to nonphysician acupuncture . Purpose : This study describes how a r and om sample of physician acupuncturists in the United States diagnose and treat chronic low back pain and contrasts their practice s with those of nonphysician licensed acupuncturists . Methods : A total of 464 question naires were mailed to physician acupuncturists r and omly sample d from 3 sources : web-based Yellow Pages , American Academy of Medical Acupuncturists ( AAMA ) membership , and Pain Clinics associated with American College of Graduate Medical Education-approved fellowship programs . Responses ( n = 137 , 30 % ) were analyzed using descriptive statistics . The results of this survey were compared with data published from a similar survey of nonphysician licensed acupuncturists in Washington State . Results : Physicians who perform acupuncture use a mixture of styles and emphasize neuroanatomic approaches to needle placement . Most physicians received training in French Energetic acupuncture .  In contrast , most nonphysician licensed acupuncturists use a traditional Chinese medicine approach to needle placement . Despite this apparent difference in their predominant styles of acupuncture  , there was a high correlation between physician and nonphysician licensed acupuncturist acupoint selection to treat low back pain . In addition to acupuncture needling , physicians use other medical treatments , whereas nonphysician licensed acupuncturists ' employ a variety of traditional Chinese medicine adjuncts to needling . Conclusion : This study provides new information about the nature of physician acupuncture practice in the United States and how it compares to acupuncture provided by nonphysician licensed acupuncturists . Further research is necessary to determine if the different types of acupuncture provided by physicians and nonphysician acupuncturists affect treatment outcomes and costs for patients with chronic low back pain BACKGROUND To our knowledge , verum acupuncture has never been directly compared with sham acupuncture and guideline -based conventional therapy in patients with chronic low back pain . METHODS A patient- and observer-blinded r and omized controlled trial conducted in Germany involving 340 outpatient practice s , including 1162 patients aged 18 to 86 years ( mean + /- SD age , 50 + /- 15 years ) with a history of chronic low back pain for a mean of 8 years . Patients underwent ten 30-minute sessions , generally 2 sessions per week , of verum acupuncture ( n = 387 ) according to principles of traditional Chinese medicine ; sham acupuncture ( n = 387 ) consisting of superficial needling at nonacupuncture points ; or conventional therapy , a combination of drugs , physical therapy , and exercise ( n = 388 ) . Five additional sessions were offered to patients who had a partial response to treatment ( 10%-50 % reduction in pain intensity ) . Primary outcome was response after 6 months , defined as 33 % improvement or better on 3 pain-related items on the Von Korff Chronic Pain Grade Scale question naire or 12 % improvement or better on the back-specific Hanover Functional Ability Question naire . Patients who were unblinded or had recourse to other than permitted concomitant therapies during follow-up were classified as nonresponders regardless of symptom improvement . RESULTS At 6 months , response rate was 47.6 % in the verum acupuncture group , 44.2 % in the sham acupuncture group , and 27.4 % in the conventional therapy group . Differences among groups were as follows : verum vs sham , 3.4 % ( 95 % confidence interval , -3.7 % to 10.3 % ; P = .39 ) ; verum vs conventional therapy , 20.2 % ( 95 % confidence interval , 13.4 % to 26.7 % ; P < .001 ) ; and sham vs conventional therapy , 16.8 % ( 95 % confidence interval , 10.1 % to 23.4 % ; P < .001 . CONCLUSIONS Low back pain improved after acupuncture treatment for at least 6 months . Effectiveness of acupuncture , either verum or sham , was almost twice that of conventional therapy OBJECTIVE To determine if acupuncture is an effective , safe adjunctive treatment to st and ard therapy for chronic low back pain ( LBP ) in older patients . METHODS 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 r and omized 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 Rol and Disability Question naire ( RDQ ) at weeks 0 , 2 , 6 and 9 . The primary outcome measure was change in RDQ score between weeks 0 and 6 . RESULTS Fifty-five patients were enrolled , with eight drop-outs . Twenty-four subjects were r and omized to the acupuncture group and 23 were r and omized 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 . CONCLUSIONS Acupuncture is an effective , safe adjunctive treatment for chronic LBP in older patients Abstract  Variability  in patients ' response to interventions in pain and other clinical setting s is large . Many explanations such as trial methods , environment or culture have been proposed , but this paper sets out to show that the main cause of the variability may be r and om chance , and that if trials are small their estimate of magnitude of effect may be incorrect , simply because of the r and om play of chance . This is highly relevant to the questions of ‘ How large do trials have to be for statistical accuracy ? ’ and ‘ How large do trials have to be for their results to be clinical ly valid ? ’ The true underlying control event rate ( CER ) and experimental event rate ( EER ) were determined from single‐dose acute pain analgesic trials in over 5000 patients . Trial group size required to obtain statistically significant and clinical ly relevant ( 0.95 probability of number‐needed‐to‐treat within ±0.5 of its true value ) results were computed using these values . Ten thous and trials using these CER and EER values were simulated using varying group sizes to investigate the variation due to r and om chance alone . Most common analgesics have EERs in the range 0.4–0.6 and CER of about 0.19 . With such efficacy , to have a 90 % chance of obtaining a statistically significant result in the correct direction requires group sizes in the range 30–60 . For clinical relevance nearly 500 patients are required in each group . Only with an extremely effective drug ( EER>0.8 ) will we be reasonably sure of obtaining a clinical ly relevant NNT with commonly used group sizes of around 40 patients per treatment arm . The simulated trials showed substantial variation in CER and EER , with the probability of obtaining the correct values improving as group size increased . We contend that much of the variability in control and experimental event rates is due to r and om chance alone . Single small trials are unlikely to be correct . If we want to be sure of getting correct ( clinical ly relevant ) results in clinical trials we must study more patients . Credible estimates of clinical efficacy are only likely to come from large trials or from pooling multiple trials of conventional ( small ) size Study Design . A r and omized controlled clinical trial was conducted . Objective . To compare medication , needle acupuncture , and spinal manipulation for managing chronic ( > 13 weeks duration ) spinal pain because the value of medicinal and popular forms of alternative care for chronic spinal pain syndromes is uncertain . Summary of Background Data . Between February 1999 and October 2001 , 115 patients without contraindication for the three treatment regimens were enrolled at the public hospital ’s multidisciplinary spinal pain unit . Methods . One of three separate intervention protocol s was used : medication , needle acupuncture , or chiropractic spinal manipulation . Patients were assessed before treatment by a sports medical physician for exclusion criteria and by a research assistant using the Oswestry Back Pain Disability Index ( Oswestry ) , the Neck Disability Index ( NDI ) , the Short-Form-36 Health Survey question naire ( SF-36 ) , visual analog scales ( VAS ) of pain intensity and ranges of movement . These instruments were administered again at 2 , 5 , and 9 weeks after the beginning of treatment . Results . R and omization proved to be successful . The highest proportion of early ( asymptomatic status ) recovery was found for manipulation ( 27.3 % ) , followed by acupuncture ( 9.4 % ) and medication ( 5 % ) . Manipulation achieved the best overall results , with improvements of 50 % ( P = 0.01 ) on the Oswestry scale , 38 % ( P = 0.08 ) on the NDI , 47 % ( P < 0.001 ) on the SF-36 , and 50 % ( P < 0.01 ) on the VAS for back pain , 38 % ( P < 0.001 ) for lumbar st and ing flexion , 20 % ( P < 0.001 ) for lumbar sitting flexion , 25 % ( P = 0.1 ) for cervical sitting flexion , and 18 % ( P = 0.02 ) for cervical sitting extension . However , on the VAS for neck pain , acupuncture showed a better result than manipulation ( 50%vs 42 % ) . Conclusions . The consistency of the results provides , despite some discussed shortcomings of this study , evidence that in patients with chronic spinal pain , manipulation , if not contraindicated , results in greater short-term improvement than acupuncture or medication . However , the data do not strongly support the use of only manipulation , only acupuncture , or only nonsteroidal antiinflammatory drugs for the treatment of chronic spinal pain . The results from this exploratory study need confirmation from future larger studies The paper describes the type and frequency of adverse events and transient reactions following consultations with  professional acupuncturists .  In a postal survey , involving 1848 professional acupuncturists , all of whom were members of the British Acupuncture Council and practising in the UK , details of adverse events and transient reactions following treatment were recorded on st and ardised self-report forms . A sample size of 30,000 treatments was sought , and piloting indicated that a four-week period was required . Practitioners also provided information on themselves , including age , sex , length of training and years of practice . A total of 574 practitioners responded , 31 % of the total population . These practitioners reported on  adverse events and transient reactions associated with 34,407 treatments . No serious adverse events were reported , where these were defined as requiring hospital admission , prolonging hospital stays , permanently disabling , or result ing in death ( 95 % CI : 0 to 1.1 per 10,000 treatments ) . A total of 43 significant minor adverse events were reported , a rate of 1.3 per 1,000 treatments ( 95 % CI : 0.9 to 1.7 ) . These included severe nausea and actual fainting ( 12 ) , unexpected , severe and prolonged aggravation of symptoms ( 7 ) , prolonged and unacceptable pain and bruising ( 5 ) and psychological and emotional reactions ( 4 ) . There were three avoidable events : two patients had needles left in by mistake , and one patient had moxa burns to the skin , also caused by practitioner error . The acupuncturists also recorded 10,920 mild transient reactions occurring in 5136 treatments , 15 % ( 95 % CI : 14.6 to 15.3 ) of the 34,407 total . In terms of local reactions , there were reports of mild bruising ( 1.7 % ) , pain ( 1.2 % ) and bleeding ( 0.4 % ) . Practitioners reported that patients experienced an aggravation of existing symptoms after 2.8 % of treatments . The most common mild transient reactions to treatment were feeling relaxed ( 11.9 % ) and feeling energised ( 6.6 % ) . In this prospect i ve survey of 34,407 treatments , practitioners reported no serious adverse events . This conclusion was based on data collected from one in three members of the British Acupuncture Council . Given that the whole membership delivers between one and a half and two million treatments a year , this is important evidence on public health and safety . When compared with medication routinely prescribed in primary care , the results suggest that acupuncture is a relatively safe treatment modality 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 r and omly 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 ) acupunture . 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 BACKGROUND Acupuncture is widely used by patients with low back pain , although its effectiveness is unclear . We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with chronic low back pain .  METHODS Patients were r and omized to treatment with acupuncture , minimal acupuncture ( superficial needling at nonacupuncture points ) , or a waiting list control . Acupuncture and minimal acupuncture were administered by specialized acupuncture physicians in 30 outpatient centers , and consisted of 12 sessions per patient over 8 weeks . Patients completed st and ardized question naires at baseline and at 8 , 26 , and 52 weeks after r and omization . The primary outcome variable was the change in low back pain intensity from baseline to the end of week 8 , as determined on a visual analog scale ( range , 0 - 100 mm ) . RESULTS A total of 298 patients ( 67.8 % female ; mean + /- SD age , 59 + /- 9 years ) were included . Between baseline and week 8 , pain intensity decreased by a mean + /- SD of 28.7 + /- 30.3 mm in the acupuncture group , 23.6 + /- 31.0 mm in the minimal acupuncture group , and 6.9 + /- 22.0 mm in the waiting list group . The difference for the acupuncture vs minimal acupuncture group was 5.1 mm ( 95 % confidence interval , -3.7 to 13.9 mm ; P = .26 ) , and the difference for the acupuncture vs waiting list group was 21.7 mm ( 95 % confidence interval , 13.9 - 30.0 mm ; P<.001 ) . Also , at 26 ( P=.96 ) and 52 ( P=.61 ) weeks , pain did not differ significantly between the acupuncture and the minimal acupuncture groups . CONCLUSION Acupuncture was more effective in improving pain than no acupuncture treatment in patients with chronic low back pain , whereas there were no significant differences between acupuncture and minimal acupuncture & NA ; 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 r and omized , 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 r and omized 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 OBJECTIVE To evaluate a simulated acupuncture technique for use in r and omized controlled trials assessing the efficacy of acupuncture for low-back pain . SETTING The clinic of an accredited acupuncture college in Seattle , Washington . SUBJECTS Acupuncture-naïve enrollees of Group Health Cooperative who had visited their primary care provider with a complaint of back pain that persisted for at least 3 months . EXPERIMENTAL DESIGN In the first experiment , subjects received six insertions of real needles and six pokes with a toothpick in a guidetube in a two-period crossover design . In the second experiment , subjects were r and omly assigned to receive either a complete treatment with real acupuncture needles or a simulated treatment using a toothpick in a guidetube . OUTCOMES In the first experiment , we compared subjects ' perceptions about which implement was used for each " insertion " while in the second , we compared the perceptions ( e.g. , acupuncturist 's warmth and caring , the reasonableness of acupuncture as a treatment ) and pain relief of those who received an acupuncture treatment using needles to those receiving simulated acupuncture . RESULTS In the first experiment , the toothpick insertions were perceived as slightly more like real needling than the real needling ( mean ratings of 2.8 and 2.1 , respectively ; p = 0.08 ) . In the second experiment , 52 % percent of those receiving the simulated needling versus 65 % of those receiving real acupuncture believed they were " definitely " or " probably " receiving real acupuncture ( p = 0.33 ) . Perceptions of acupuncture  , as measured by a credibility question naire , were similar in the two groups . Those receiving real acupuncture were more likely to report immediate pain relief , and this was the factor most predictive of the subject 's belief about which treatment they had received ( p = 0.02 ) . CONCLUSIONS The simulated acupuncture procedure evaluated in this study represents a reasonable control treatment for acupuncture-naïve individuals in r and omized controlled trials assessing the efficacy of acupuncture for low-back pain Abstract Objective To determine whether a short course of traditional acupuncture improves longer term outcomes for patients with persistent non-specific low back pain in primary care . Design Pragmatic , open , r and omised controlled trial . Setting Three private acupuncture clinics and 18 general practice s in York , Engl and . Participants 241 adults aged 18 - 65 with non-specific low back pain of 4 - 52 weeks ' duration . Interventions 10 individualised acupuncture treatments from one of six qualified acupuncturists ( 160 patients ) or usual care only ( 81 patients ) . Main outcome measures The primary outcome was SF-36 bodily pain , measured at 12 and 24 months . Other outcomes included reported use of analgesics , scores on the Oswestry pain disability index , safety , and patient satisfaction . Results 39 general practitioners referred 289 patients of whom 241 were r and omised . At 12 months average SF-36 pain scores increased by 33.2 to 64.0 in the acupuncture group and by 27.9 to 58.3 in the control group . Adjusting for baseline score and for any clustering by acupuncturist , the estimated intervention effect was 5.6 points ( 95 % confidence interval −0.2 to 11.4 ) at 12 months ( n = 213 ) and 8.0 points ( 2.8 to 13.2 ) at 24 months ( n = 182 ) . The magnitude of the difference between the groups was about 10%-15 % of the final pain score in the control group . Functional disability was not improved . No serious or life threatening events were reported . Conclusions Weak evidence was found of an effect of acupuncture on persistent non-specific low back pain at 12 months , but stronger evidence of a small benefit at 24 months . Referral to a qualified traditional acupuncturist for a short course of treatment seems safe and acceptable to patients with low back pain . Trial registration IS RCT N80764175 [ controlled-trials.com ] A prior national survey of one in eight r and omly selected general practice s in Engl and estimated that 39 % of general practice s [ 95 % confidence interval ( CI ) 35 - 43 % ] provided some access to complementary or alternative medicine ( CAM ) therapies in 1995 . A repeat survey , conducted in 2001 , estimated that one in two practice s in Engl and now offer their patients some access to CAMs ( 95 % CI 46 - 52 % ) . The change was due to increased provision in-house ; the proportion of practice s making NHS referrals remained unchanged . The proportion of services supported by patient payments rose from 26 to 42 % Acupuncture is increasingly used , so it is important to establish whether its benefits outweigh its risks . Numerous case reports of adverse events show that acupuncture is not free of risk , but accurate data from prospect i ve investigations is scarce . A prospect i ve survey was undertaken using intensive event monitoring . Forms were developed for reporting minor events each month and significant events as they occurred . The sample size was calculated to identify any adverse events that occurred more frequently than once in 10,000 consultations . Acupuncturists were recruited from two professional organisations in the UK . Seventy-eight acupuncturists , all doctors or physiotherapists , reported a total of 2178 events occurring in 31,822 consultations , an incidence of 684 per 10,000 consultations . The most common minor adverse events were bleeding , needling pain , and aggravation of symptoms ; aggravation was followed by resolution of symptoms in 70 % of cases . There were 43 significant minor adverse events reported , a rate of 14 per 10,000 , of which 13 ( 30 % ) interfered with daily activities . One patient suffered a seizure ( probably reflex anoxic ) during acupuncture , but no adverse event was classified as serious . Avoidable events included forgotten patients , needles left in patients , cellulitis and moxa burns . In conclusion , the incidence of adverse events following acupuncture performed by doctors and physiotherapists can be classified as minimal ; some avoidable events do occur . Acupuncture seems , in skilled h and s , one of the safer forms of medical intervention 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 Abstract . When measuring treatment effect in chronic low back pain with multi-item outcome instruments , it is necessary , both for clinical decision-making and research purpose s , to underst and the clinical importance of the outcome scores . The aims of the present study were three-fold . Firstly , it aim ed to estimate the minimal clinical ly important difference of three multi-item outcome instruments ( the Oswestry Disability Index , the General Function Score and the Zung Depression Scale )  and of the  visual analogue scale ( VAS ) of back pain .  Secondly , it aim ed to estimate the error of measurement of these instruments ; and its third aim was to describe the clinical meaning of score change . The study population consisted of 289 patients treated surgically or non-surgically in a r and omised controlled trial . The minimal clinical ly important difference was estimated with patient global assessment as the external criterion . It was compared with the st and ard error of measurement of the instruments . The individual items of the instruments were compared for score changes related to improvement and deterioration . The st and ard error of measurement of the Oswestry Disability Index , the General Function Score and the Zung Depression Scale was 4 , 6 and 3 units , respectively . The 95 % tolerance interval was 10 , 16 and 8 units , respectively . The minimal clinical ly important difference was 10 , 12 and 8–9 units , respectively , thus not significantly exceeding the tolerance interval . The minimal clinical ly important difference of VAS back pain was 18–19 units , well exceeding the 95 % tolerance interval , which was 15 units . Improvement after treatment for chronic low back pain tends to occur to a greater extent in sleep disturbance , ability to do usual things and psychological irritability , but to a lesser extent in the ability to sit , st and and lift . We conclude that the VAS of back pain is responsive enough to detect the minimal clinical ly important difference , whereas the smallest acceptable score changes of the Oswestry Disability Index , the General Function Score and the Zung Depression Scale may require an increase to exceed the 95 % tolerance interval when used for clinical decision making and for power calculation . Despite improvement after treatment , the ability to sit , st and and lift , remain notable problems Acupuncture treatment and control group interventions in parallel-group r and omised trials of acupuncture are not always precisely reported . In an attempt to improve st and ards , an international group of experienced acupuncturists and research ers devised a set of recommendations , design ating them STRICTA : ST and ards for Reporting Interventions in Controlled Trials of Acupuncture . In a further consensus-building round , the editors of several journals helped redraft the recommendations . These follow the Consoli date d St and ards for Reporting Trials ( CONSORT ) format , acting as an extension of the CONSORT guidelines for the specific requirements of acupuncture studies . Participating journals are publishing the STRICTA recommendations and requesting prospect i ve authors to adhere to them when preparing reports for publication . Other journals are invited to adopt these recommendations . The intended outcome is that interventions in controlled trials of acupuncture  will be more adequately reported , thereby facilitating an improvement in critical appraisal , analysis and replication of trials OBJECTIVE A pilot study to assess the feasibility of a trial to investigate the efficacy of acupuncture compared to placebo needling for the treatment of acute low back pain ( LBP ) . As part of this , the study was design ed to establish the credibility of the placebo control , and to provide data to inform a power analysis to determine numbers for a future trial . STUDY DESIGN A pilot patient and assessor blinded r and omized controlled trial . SETTING Primary care health centre facility , South and East Belfast Trust , Northern Irel and . PATIENTS Patients from the physiotherapy waiting list ( n=48 ) with LBP of less than 12 weeks duration . OUTCOME MEASURES Rol and and Morris Disability Question naire ( RMDQ ) , Visual Analogue Scale ( VAS ) , medication use and an exit question naire were completed at baseline , end of treatment , and at 3 months follow up . RESULTS Ninety-four percent ( 45/48 ) of patients completed assigned treatment , 83 % ( 40/48 ) completed 3 months follow-up . The sham needle used here proved to be credible : 91.7 % in the placebo group believed they had received acupuncture , compared to 95.8 % in the verum acupuncture group . Differences in baseline characteristics were accounted for using ANCOVA . There was no significant difference between groups on the RMDQ over time . For pain , the only statistically significant difference was at the 3 months follow up ( worst VAS , point estimate , 18.7 , 95 % CI 1.5 - 36.0 , p=0.034 ) . The majority of patients were taking some form of analgesic medication for LBP at the start of treatment ( n=44 ; 92 % ) , and at the end of treatment the verum acupuncture group were taking significantly fewer tablets of pain control medication ( mean ( S.D. ) : 1.0+/-0.3 ) than the placebo group ( mean ( S.D. ) : 4.2+/-0.6 , p<0.05 ) . Based upon these data , power analysis ( power=90 % , alpha=0.05 , minimal clinical ly important difference ( MCID ) for RMDQ=2.5 points ) indicated that 120 participants ( 60 per group ) would be needed to complete an adequately powered r and omized controlled trial . CONCLUSIONS This study has demonstrated the feasibility of a r and omized controlled trial of penetrating needle acupuncture compared to a non-penetrating sham for the treatment of acute LBP in primary care ; 120 participants would be required in a fully powered trial . The placebo needle used in this study proved to be a credible form of control A single-blind , r and omised , 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 Sixty patients aged 60 or over with back pain for at least 6 months were recruited from General Practitioner referrals and r and omized 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 r and omized 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 can not exclude the possibility that both treatments are ' placebos ' Introduction There is some evidence for the efficacy of acupuncture , but it remains unclear whether trigger point acupuncture is effective . Our objective was to evaluate the effects of trigger point acupuncture on pain and quality of life in chronic low back pain patients compared with sham acupuncture . Methods Twenty-six consecutive out- patients ( 17 women , 9 men ; age range : 65–91 years ) from the Department of Orthopaedic Surgery , Meiji University of Oriental Medicine , with non-radiating low back pain for at least six months and normal neurological examination , were r and omised to two groups . Each group received one phase of trigger point acupuncture and one of sham acupuncture with a three week washout period between them , over 12 weeks . Group A ( n=13 ) received trigger point acupuncture in the first phase and sham acupuncture in the second . Group B ( n=13 ) received the same interventions in the reverse order . Outcome measures were pain intensity ( visual analogue scale , VAS ) and Rol and Morris Question naire . Results Nineteen patients were included in the analysis . At the end of the first treatment phase , group A receiving trigger point acupuncture scored significantly lower VAS ( P<0.001 ) and Rol and Morris Question naire scores ( P<0.01 ) than the sham control group . There were significant within-group reductions in pain in both groups during the trigger point acupuncture phase but not in the sham treatment phase . However , the beneficial effects were not sustained . Conclusion These results suggest that trigger point acupuncture may have greater short term effects on low back pain in elderly patients than sham acupuncture AIMS To assess patterns of diagnosis , including concordance , and treatment within a clinical trial of traditional acupuncture for low back pain . SETTING In a pragmatic r and omised controlled clinical trial , 148 patients with low back pain , of between 4 weeks and 12 months duration , were r and omised to the offer of individualised acupuncture and received up to 10 treatments . METHODS St and ardised diagnosis and treatment records were completed by practitioners for 148 patients . The diagnosis was based on three pre-defined low back pain syndromes . For a subgroup of patients , one of the six practitioners then independently re-examined the patients , blind to the original diagnosis . The diagnostic inter-rater reliability was assessed in terms of percentage congruent classifications and Cohen 's Kappa . Structured interviews of practitioners established further details about practice styles . RESULTS The most commonly diagnosed syndrome associated with low back pain was Qi and Blood Stagnation ( 88 % of patients ) , followed by Kidney Deficiency ( 53 % ) and Bi Syndrome ( 28 % ) , with more than one syndrome being identified for 65 % of patients . For the subgroup examined twice , practitioner concordance was reasonable : between 47 and 80 % of classifications were congruent , while Kappa values lay between 0 ( " the same as chance " ) and 0.67 ( " good " ) . Practitioners provided 1269 treatments in total , using 177 different acupuncture points . Most commonly used channels were Bladder and Gall Bladder , and the commonest points were BL-23 and the two lowest Huatuojiaji points . Auxiliary treatments were utilised by all practitioners to varying degrees . CONCLUSIONS Diagnostic concordance among practitioners was reasonable , and clear themes emerged for treatment . Further research is required to develop a flexible trial protocol with scope for individualised treatment & NA ; The purpose of this study was to determine the levels of change on st and ard pain scales that represent clinical ly important differences to patients . Data from analgesic studies are often difficult to interpret because the clinical importance of the results is not obvious . Differences between groups , as summarized by a change in mean values over time , can be difficult to apply to clinical care . Baseline scores vary widely and group mean differences could reflect large changes in a few patients , small changes in many patients , or any combination of these outcomes . Determination of the proportion of patients who have a clinical ly important improvement in their pain would provide a more interpretable result with direct clinical implication s. However , determining a clinical ly important outcome requires information about the degree of change over time that is clinical ly important . Data from the titration phase of a multiple cross‐over r and omized clinical trial of oral transmucosal fentanyl citrate ( OTFC )  for the treatment of cancer‐related breakthrough pain were re‐analyzed to examine the differences in pain scores between treatment episodes that did and did not yield adequate pain relief . The scales evaluated were absolute pain intensity difference ( PID , 0–10 scale ) , percentage pain intensity difference ( PID% , 0–100 % scale ) , pain relief ( PR , 0 ( none ) , 1 ( slight ) , 2 ( moderate ) , 3 ( lots ) , 4 ( complete ) ) , sum of the pain intensity difference ( SPID over 60 min ) , percentage of maximum total pain relief ( % Max TOTPAR over 60 min ) , and global medication performance ( 0 ( poor ) , 1 ( fair ) , 2 ( good ) , 3 ( very good ) , 4 ( excellent ) ) . Adequate relief was defined by the patient 's decision not to use another dose of opioid medication as a rescue , in addition to the study medication , to treat each painful episode . One hundred thirty OTFC naive patients contributed data on 1268 episodes of breakthrough pain . The scales that were converted to a percentage change yielded the best accuracy in predicting adequate relief , with balanced sensitivity and specificity . The best cut‐off point for both the % Max TOTPAR and the PID% was 33 % . The best cut‐off points for the absolute scales were absolute pain intensity difference of 2 , pain relief of 2 ( moderate ) , and SPID of 2 . The global medication performance of 2 ( good ) had excellent values as well . This study presents data ‐derived cut‐off points for the changes in several pain scales , each reflecting the clinical ly important improvement for patients treating breakthrough cancer pain episodes with OTFC . Confirmation in other patient population s and different pain syndromes will be needed . The use of consistent clinical ly important cut‐off points as the primary outcome in future pain therapy clinical trials will enhance their validity , comparability , and clinical applicability Background The purpose of this study was to examine the immediate effect of single acupuncture stimulation to the most painful point in patients with low back pain . Method A r and omised , evaluator-blinded , sham controlled clinical trial was conducted in which 31 patients with low back pain were r and omly allocated to either an acupuncture group ( n=15 ) or a sham acupuncture group ( n=16 ) . Both acupuncture and sham acupuncture were performed at the most painful point on the lower back of the subjects . For the acupuncture group , a stainless steel needle was inserted to a depth of 20 mm and manually stimulated ( sparrow pecking method ) for 20 seconds , while for the sham treatment a guide tube without a needle was placed at the point and tapped on the skin . Changes in low back pain were evaluated with a visual analogue scale ( VAS ) and the Schober test . Participants were also asked if they felt the needling sensation or not . The therapy and the evaluation were independently performed by two different acupuncturists . Results VAS score and the Schober test score showed significant improvement after treatment as compared with the sham group ( P=0.02 , 0.001 , respectively ) . There were no significant differences in the needling sensation between the acupuncture and sham group . Conclusion These results suggest that acupuncture at the most painful point gives immediate relief of low back pain OBJECTIVE To compare needle acupuncture , medication ( tenoxicam with ranitidine ) , and spinal manipulation for managing chronic ( > 13 weeks duration ) spinal pain syndromes . DESIGN Prospect i ve , r and omized , independently assessed preintervention and postintervention clinical pilot trial . SETTING Specialized spinal pain syndrome out-patient unit at Townsville General Hospital , Queensl and , Australia . SUBJECTS Seventy-seven patients ( without contraindication to manipulation or medication ) were recruited . INTERVENTIONS One of three separate , clearly defined intervention protocol s : needle acupuncture , nonsteroidal anti-inflammatory medication , or chiropractic spinal manipulation . MAIN OUTCOME MEASURES 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 . RESULTS R and omization 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 . CONCLUSIONS 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 Fifty-six male patients who had chronic low-back pain of at least 12 weeks ' duration ( average duration , 28.6 weeks ) and who had failed to respond to traditional medical or surgical therapy were entered into a r and omized clinical trial to compare the relative efficacies of the Clinic 's st and ard therapy regimen with and without dry needling at muscle motor points . Before entering the trial , all patients had undergone without improvement eight weeks of the Clinic 's st and ard therapy regimen of physiotherapy , remedial exercises , and occupational therapy . The 29 study subjects and 27 control patients then continued with this regimen , but the study subjects also received needling at muscle motor points once or twice a week ( average number of treatments , 7.9 ) . All patients were assessed at the time of discharge , 12 weeks after discharge , and at the time of writing ( average , 27.3 weeks ) . The group that had been treated with needling was found to be clearly and significantly better than the control group ( P > 0.005 , N = 53 ) with regard to status at discharge , status at 12 weeks ' follow-up , and status at final follow-up . At final followup , 18 of the 29 study subjects had returned to their original or equivalent jobs and 10 had returned to lighter employment . In the control group , only four had returned to their original work and 14 to lighter employment ; nine were still disabled . The results seem to justify the procedure in chronic low-back patients in whom myofascial pain ( the majority ) rather than skeletal irritation is the dominant disabling feature & NA ; This study compares the responsiveness of three instruments of functional status : two disease‐specific question naires ( Oswestry and Rol and Disability Question naires ) , and a patient‐specific method ( severity of the main complaint ) . We compared changes over time of functional status instruments with pain rated on a visual analog scale . Two strategies for evaluating the responsiveness in terms of sensitivity to change and specificity to change were used : effect size statistics and receiver‐operating characteristic method . We chose global perceived effect as external criterion . A cohort of 81 patients with non‐specific low back pain for at least 6 weeks assessed these measures before and after 5 weeks of treatment . According to the external criterion 38 patients improved . The results of both strategies were the same . All instruments were able to discriminate between improvement and non‐improvement . The effect size statistics of the instruments were higher in the improved group than in the non‐improved group . For each instrument the receiver‐operating characteristic curves showed some discriminative ability . The curves for the Rol and Question naire and pain were closer to the upper left than the curves for the other instruments . The sensitivity to change of the rating of Oswestry Question naire was lower than that of the other instruments . The main complaint was not very specific to change . The two strategies for evaluating the responsiveness were very useful and appeared to complement each other 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 clinical ly realistic manner . The study was design ed as an evaluator-blinded r and omised 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 st and ard 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 st and ard practice should be employed in pragmatic RCTs BACKGROUND A problem acupuncture research has to face is the concept of a control group . If , in control groups , non-acupoint needling is done , physiological acupuncture effects are implied . Therefore the effects shown in this group are often close to those shown in the acupuncture group . In other trials , control groups have received obviously different treatments , such as transcutaneous electrical nervous stimulation or TENS-laser treatment ; it is not clear if the effects of acupuncture are due only to the psychological effects of the treatment . METHODS We developed a placebo acupuncture needle , with which it should be possible to simulate an acupuncture procedure without penetrating the skin . In a cross-over experiment with 60 volunteers we tested whether needling with the placebo needle feels any different from real acupuncture . FINDINGS Of 60 volunteers , 54 felt a penetration with acupuncture  ( mean visual analogue scale [ VAS ] 13.4 ; SD 10.58 ) and 47 felt it with placebo ( VAS 8.86 ; SD 10.55 ) , 34 felt a dull pain sensation ( DEQI ) with acupuncture and 13 with placebo . None of the volunteers suspected that the needle may not have penetrated the skin . INTERPRETATION The placebo needle is sufficiently credible to be used in investigations of the effects of acupuncture BACKGROUND The popularity of complementary medicine continues to be asserted by the professional associations and umbrella organisations of these therapies . Within conventional medicine there are also signs that attitudes towards some of the complementary therapies are changing . AIM To describe the scale and scope of access to complementary therapies ( acupuncture , chiropractic , homoeopathy , hypnotherapy , medical herbalism , and osteopathy ) via general practice in Engl and . DESIGN OF STUDY A postal question naire sent to 1226 individual general practitioners ( GPs ) in a r and om cluster sample of GP partnerships in Engl and . GPs received up to three reminders . SETTING One in eight ( 1226 ) GP partnerships in Engl and in 1995 . METHOD Postal question naire to assess estimates of the number of practice s offering ' in-house ' access to a range of complementary therapies or making National Health Service ( NHS ) referrals outside the practice ; sources of funding for provision and variations by practice characteristics . RESULTS A total of 964 GPs replied ( 78.6 % ) . Of these , 760 provided detailed information . An estimated 39.5 % ( 95 % CI = 35%-43 % ) of GP partnerships in Engl and provided access to some form of complementary therapy for their NHS patients . If all non-responding partnerships are assumed to be non-providers , the lowest possible estimate is 30.3 % . An estimated 21.4 % ( 95 % CI = 19%-24 % ) were offering access via the provision of treatment by a member of the primary health care team , 6.1 % ( 95 % CI = 2%-10 % ) employed an ' independent ' complementary therapist , and an estimated 24.6 % of partnerships ( 95 % CI = 21%-28 % ) had made NHS referrals for complementary therapies . The reported volume of provision within any individual service tended to be low . Acupuncture and homoeopathy  were the most commonly available therapies . Patients made some payment for 25 % of practice -based provision . Former fundholding practice s were significantly more likely to offer complementary therapies than non-fundholding practice s , ( 45 % versus 36 % , P = 0.02 ) . Fundholding did not affect the range of therapies offered , and patients from former fundholding practice s were no more likely to pay for treatment . CONCLUSION Access to complementary health care for NHS patients was widespread in English general practice s in 1995 . This data suggests that a limited range of complementary therapies were acceptable to a large proportion of GPs . Fundholding clearly provided a mechanism for the provision of complementary therapies in primary care . Patterns of provision are likely to alter with the demise of fundholding and existing provision may significantly reduce unless the Primary Care Groups or Primary Care Trusts are prepared to support the ' levelling up ' of some services OBJECTIVES 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 ) . DESIGN A blinded prospect i ve r and omized controlled study . SUBJECTS AND INTERVENTIONS A total of 52 patients were r and omly allocated to an exercise group ( n = 26 ) or an exercise plus EA group ( n = 26 ) and treated for 12 sessions . OUTCOME MEASURES 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 . RESULTS 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 . CONCLUSIONS 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 & NA ; Fifty‐four patients treated in a 3‐week inpatient rehabilitation program were r and omly 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 Objective The authors sought to determine whether a series of needle acupuncture treatments produced long-term relief of  chronic low back pain .  Design A blinded placebo-controlled study with an independent observer . The patients were r and omized 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 . Setting A tertiary-level pain clinic at a Swedish university hospital . Patients 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 . Interventions 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 . Outcome Measures 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 . Results 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 . Conclusions 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 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 OBJECTIVES To compare the effect of real acupuncture and sham acupuncture in the treatment of temporom and ibulat joint myofascial pain , in order to establish the true efficacy of acupuncture . METHODS A double blind r and omised controlled trial conducted in the TMD Clinic , at the School of Dentistry , The University of Manchester . Twenty-seven patients were assigned to one of two treatment groups . Group 1 received real acupuncture treatment whilst Group 2 received a sham acupuncture intervention . Both the assessor and the patient were blinded regarding the group allocation . Baseline assessment of the outcome variables was made prior to the first treatment session , and was repeated following the last treatment . RESULTS The results demonstrated that real acupuncture had a greater influence on clinical outcome measure of TMJ MP  than those of sham acupuncture , and the majority of these reached a level of statistical significance . CONCLUSION Acupuncture had a positive influence on the signs and symptoms of TMJ MP .  In addition , this study provides evidence that the Park Sham Device was a credible acupuncture control method for trials involving facial acupoints Objective To investigate the benefit of adding acupuncture to a course of advice and exercise delivered by physiotherapists for pain reduction in patients with osteoarthritis of the knee . Design Multicentre , r and omised controlled trial . Setting 37 physiotherapy centres accepting primary care patients referred from general practitioners in the Midl and s , United Kingdom . Participants 352 adults aged 50 or more with a clinical diagnosis of knee osteoarthritis . Interventions Advice and exercise ( n=116 ) , advice and exercise plus true acupuncture ( n=117 ) , and advice and exercise plus non-penetrating acupuncture ( n=119 ) . Main outcome measures The primary outcome was change in scores on the Western Ontario and McMaster Universities osteoarthritis index pain subscale at six months . Secondary outcomes included function , pain intensity , and unpleasantness of pain at two weeks , six weeks , six months , and 12 months . Results Follow-up rate at six months was 94 % . The mean ( SD ) baseline pain score was 9.2 ( 3.8 ) . At six months mean reductions in pain were 2.28 ( 3.8 ) for advice and exercise , 2.32 ( 3.6 ) for advice and exercise plus true acupuncture , and 2.53 ( 4.2 ) for advice and exercise plus non-penetrating acupuncture . Mean differences in change scores between advice and exercise alone and each acupuncture group were 0.08 ( 95 % confidence interval −1.0 to 0.9 ) for advice and exercise plus true acupuncture and 0.25 ( −0.8 to 1.3 ) for advice and exercise plus non-penetrating acupuncture . Similar non-significant differences were seen at other follow-up points . Compared with advice and exercise alone there were small , statistically significant improvements in pain intensity and unpleasantness at two and six weeks for true acupuncture and at all follow-up points for non-penetrating acupuncture . Conclusion The addition of acupuncture to a course of advice and exercise for osteoarthritis of the knee delivered by physiotherapists provided no additional improvement in pain scores . Small benefits in pain intensity and unpleasantness were observed in both acupuncture groups , making it unlikely that this was due to acupuncture needling effects . Trial registration Current Controlled Trials IS RCT N88597683 Abstract Objectives : To investigate the cl aim that 90 % of episodes of low back pain that present to general practice have resolved within one month . Design : Prospect i ve study of all adults consulting in general practice because of low back pain over 12 months with follow up at 1 week , 3 months , and 12 months after consultation . Setting : Two general practice s in south Manchester . Subjects : 490 subjects ( 203 men , 287 women ) aged 18 - 75 years . Main outcome measures : Proportion of patients who have ceased to consult with low back pain  after 3 months ; proportion of patients who are free of pain and back related disability at 3 and 12 months . Results : Annual cumulative consultation rate among adults in the practice s was 6.4 % . Of the 463 patients who consulted with a new episode of low back pain , 275 ( 59 % ) had only a single consultation , and 150 ( 32 % ) had repeat consultations confined to the 3 months after initial consultation . However , of those interviewed at 3 and 12 months follow up , only 39/188 ( 21 % ) and 42/170 ( 25 % ) respectively had completely recovered in terms of pain and disability . Conclusions : The results are consistent with the interpretation that 90 % of patients with low back pain in primary care will have stopped consulting with symptoms within three months . However most will still be experiencing low back pain and related disability one year after consultation . Key messages It is widely believed that 90 % of episodes of low back pain seen in general practice resolve within one month In a large population based study we examined the outcome of episodes of low back pain in general practice with respect to both consultation behaviour and self reported pain and disability While 90 % of subjects consulting general practice with low back pain ceased to consult about the symptoms within three months , most still had substantial low back pain and related disability Only 25 % of the patients who consulted about low back pain had fully recovered 12 months later Since most consulters continue to have long term low back pain and disability , effective early treatment could reduce the burden of these symptoms and their social , economic , and medical & NA ; This prospect i ve , r and omised controlled trial , with three parallel groups , patient and observer blinded for verum and sham acupuncture and a follow up of 3 months raises the question : “ Does a combination of acupuncture and conservative orthopedic treatment improve conservative orthopedic treatment in chronic low back pain ( LBP ) . 186 in‐ patients of a LBP rehabilitation center with a history of LBP ≥6 weeks , VAS ≥50 mm , and no pending compensation cl aims , were selected ; for the three r and om group 4 weeks of treatment was applied . 174 patients met the protocol criteria and reported after treatment , 124 reported after 3 months follow up . Patients were assorted 4 strata : chronic LBP , ≤0.5 years , 0.5–2 years , 2–5 years , ≥5 years . Analysis was by intention to treat . Group 1 ( Verum+COT ) recieved 12 treatments of verum acupuncture and conservative orthopedic treatment ( COT ) . Group 2 ( Sham+COT ) recieved 12 treatments of non‐specific needling and COT . Group 3 ( nil+COT ) recieved COT alone . Verum‐ and Sham acupuncture were blinded against patient and examiner . The primary endpoints were pain reduction ≥50 % on VAS 3 months after the end of the treatment protocol . Secondary endpoints were pain reduction ≥50 % on VAS and treatment efficacy on a four‐point box scale directly after the end of the treatment protocol and treatment efficacy after 3 months . In the whole sample a pain relief of ≥50 % on VAS was reported directly after the end of treatment protocol : Verum+COT 65 % ( 95%CI 51–77 % ) , Sham+COT 34 % ( 95%ci 22–49 % ) , nil+COT 43 % ( 95%ci 29–58 % ) – results are significant for Verum+COT over Sham+COT ( P≤0.02 ) . The results after 3 months are : Verum+COT 77 % ( 95%ci 62–88 % ) , Sham+COT 29 % ( 95%ci 16–46 % ) , nil+Cot 14 % ( 95%ci 4–30 % ) – effects are significant for Verum+COT over Sham+COT ( P≤0.001 ) and for Verum+COT over nil+COT ( P<0.001 ) . No difference was found in the mobility of the patients nor in the intake of NSAID  diclofenac . Our conclusion is that acupuncture can be an important supplement of conservative orthopedic treatment in the management of chronic LBP Objective : To test the credibility of a newly design ed placebo needle for acupuncture research . Design : Analysis of data on credibility of true and placebo interventions of a r and omised , placebo-controlled , patient- and evaluator-blind clinical trial . Patients and Setting : The study was carried out at a university department for physical medicine and rehabilitation . 68 patients ( age 48.1 ± 14.1 years , mean ± SD ) fulfilling the criteria of the International Headache Society for tension-type headache were enrolled into the study . Interventions : Group 1 ( treatment ) was assigned to traditional needle placement and manipulation , whereas in group 2 ( control ) a new placebo device was used . Outcome Parameters : After the first treatment with real or placebo acupuncture , patients were asked to fill in a question naire on credibility . In addition , after 3 or 4 treatments , patients were asked for the feeling of needle insertion and deqi . Results : No difference between real and placebo acupuncture was detected with respect to the credibility of the treatment ( p > 0.05 ) . Needle insertion was recognised in all patients in the real acupuncture group and in all but 4 patients of the placebo group ( p < 0.05 ) . deqi was reported by 84 % of patients in the real acupuncture group and by 34 % of patients in the placebo group ( p < 0.001 ) . Conclusion : Acupuncture with the placebo needle device described here is of high credibility , and does not differ from that of real acupuncture treatment . However , to achieve comparable prick sensations in both treatment conditions , careful training with the placebo needle is needed . Furthermore , from these results arise new questions with respect to the placebo response of placebo needles . Further investigations are warranted to test if placebo needles are active controls
OBJECTIVE To explore the evidence for the effectiveness of acupuncture for nonspecific low back pain ( LBP ) .
SUMMARY OF BACKGROUND DATA Since the most recent systematic review s on RCTs on acupuncture for LBP , 6 RCTs have been published , which may impact on the previous conclusions .