Acupuncture for chronic low back pain in older patients: a randomized, controlled trial. Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation Importance of modes of acupuncture in the treatment of chronic nociceptive low back pain Acupuncture treatment of chronic low-back pain – a randomized, blinded, placebo-controlled trial with 9-month follow-up Effect of acupuncture on pain management in patients before and after lumbar disc protrusion surgery--a randomized control study. [Acupuncture contra antiphlogistics in acute lumbago]. A Prospective, Randomized, Double-Blind Evaluation of Trigger-Point Injection Therapy for Low-Back Pain Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. A randomized comparative trial of acupuncture versus transcutaneous electrical nerve stimulation for chronic back pain in the elderly Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists Dry Needling of Muscle Motor Points for Chronic Low-Back Pain: A Randomized Clinical Trial With Long-Term Follow-Up Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists Randomised Controlled Trial Comparing the Effectiveness of Electroacupuncture and Tens for Low Back Pain: A Preliminary Study for a Pragmatic Trial Acupuncture and chronic pain mechanisms Comparison of Superficial and Deep Acupuncture in the Treatment of Lumbar Myofascial Pain: A Double-Blind Randomized Controlled Study 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 Lessons from a Trial of Acupuncture and Massage for Low Back Pain: Patient Expectations and Treatment Effects 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. A prospective randomized study comparing acupuncture with physiotherapy for low‐back and pelvic pain in pregnancy [Acupuncture and laser treatment in cervical and lumbar syndrome]. Does acupuncture improve the orthopedic management of chronic low back pain – a randomized, blinded, controlled trial with 3 months follow up
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 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 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 & 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 Management of acute and chronic low back and leg pain often includes the use of acupuncture . The effectiveness of this form of therapy is dependent upon compliance , which in turn is dependent on availability , response , treatment of proper acupoints , and the placebo effect . We hypothesized that classical acupuncture would be more effective than placebo acupuncture .  One hundred and thirty-two patients with acute and chronic low back and leg pain were examined before and after surgery for lumbar disc protrusion . Diagnosis was based on CT and MRT findings . Patients received acupuncture drug-free throughout the study period . The visual analogue scale was used to assess pain intensity before and after ( i.e. 30 min . 60 min . 2 h and 6 h ) acupuncture . Classical acupuncture result ed in a significant reduction in pain that become increasingly stronger during the 6h study period . Placebo acupuncture lead to same early pain relief that did not reach statistic significant and then declined thereafter BACKGROUND 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 . MATERIAL AND METHODS Among 60 consecutively included patients with acute low back pain , 30 patients were r and omized to st and ardised  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 . RESULTS 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 ) . INTERPRETATION St and ardised acupuncture treatment seems to be safe and effective in the treatment of acute low back pain in general practice The efficacy of trigger-point injection therapy In treatment of low-back strain was evaluated in a prospect i ve , r and omized , 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 : lldocaine , lldocaine 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 BACKGROUND 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 . METHODS We r and omized 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 material s  ( 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 . RESULTS Treatment groups were compared after adjustment for prer and omization 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 . CONCLUSIONS 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 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 ' 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 Recent reports have highlighted the importance of having good evidence on the safety of acupuncture . 1 2 Sound evidence on the risks associated with acupuncture is , however , scarce.3 Our primary aim , therefore , was to describe the type and frequency of adverse events after acupuncture . A secondary aim was to examine mild transient reactions associated with  acupuncture  , some of which may indicate a positive response to treatment . The study involved a prospect i ve postal audit of treatments undertaken during a four week period in 2000 . All 1848 professional acupuncturists who were members of the British Acupuncture Council and were practising in the United Kingdom were invited to record details of adverse events and mild transient reactions after treatment . St and ardised self report forms were used . Participating practitioners also provided information on themselves , including age , sex , length of training , and years of practice . To have a 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 Acupuncture is increasingly popular , but it is not free from risk for the patient.1 Safety is best established with prospect i ve surveys . Our aim was to ascertain the incidence of adverse events related to acupuncture treatment , as currently practised in Britain by doctors and physiotherapists . Volunteer acupuncture practitioners were recruited through journals circulated to members of the British Medical Acupuncture Society and the Acupuncture Association of Chartered Physiotherapists ( approximately 2750 members).2 A prospect i ve survey was undertaken using forms for intensive event monitoring that had been piloted previously.3 Minor adverse events were defined as “ any ill-effect , no matter how small , that is unintended and non-therapeutic , even if not unexpected . ” These events were reported every month , along with the total number of consultations . Minor or serious events that were considered to be “ significant”—“unusual , novel , dangerous , significantly inconvenient , or requiring further information”—were reported on separate forms when they occurred . Anonymous reporting was accepted . A sample size of 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 & NA ; Forty patients with chronic pain below the waist level not amenable to conventional medical and /or surgical treatment were r and omly assigned to one of two different methods of acupuncture , after study ing the underlying pain mechanisms using a Multidisciplinary Pain Clinic approach and the differential spinal block ( DSB ) . One group received acupuncture needling in the classical acupuncture points referred to as meridian loci needling ( MLN ) and the other group received tender area needling ( TAN ) with needles inserted in the dermatomal distribution of the painful areas . The responses between the two groups showed no significant difference . Results were then related to the predetermined somatopsychological basis of the individual 's pain problems as classified by the DSB . A group of patients in whom pain relief occurred upon subarachnoid injection of 0.25 % procaine followed by sympathetic blockade or 0.5 % procaine injection followed by hypalgesia without motor loss , also reported maximum subjective improvement in their pain level following acupuncture therapy performed at a later time . The other group of patients in whom pain persisted despite sensory and motor blockade ( 1 % procaine ) responded very poorly to acupuncture therapy . DSB was found to be complimentary to acupuncture therapy in that it facilitated patient selection for the therapy Objective 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 . Design A prospect i ve r and omized double-blind study of superficial and deep acupuncture was conducted . Setting The study was conducted in the Pain Service Unit of the University of Padova . Patients The study comprised 42 patients with lumbar myofascial pain who were divided into two equal groups ( A and B ) . InterventionIn 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 . Outcome Measures The intensity of pain was evaluated with the McGill Pain Question naire before and after treatment and at the 3-month follow-up examination . Results 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 . Conclusions Clinical results show that deep stimulation has a better analgesic effect when compared with superficial stimulation 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 Study Design . A sub analysis of data derived from a r and omized clinical trial was performed . Objective . To evaluate the association of a patient ’s expectation for benefit from a specific treatment with improved functional outcome . Summary of Background Data . Psychosocial factors , ambiguous diagnoses , and lack of a clearly superior treatment have complicated the management of patients with chronic low back pain . The authors hypothesized that patient expectation for benefit from a specific treatment is associated with improved functional outcomes when that treatment is administered . Methods . In a r and omized trial , 135 patients with chronic low back pain who received acupuncture or massage were studied . Before r and omization , study participants were asked to describe their expectations regarding the helpfulness of each treatment on a scale of 0 to 10 . The primary outcome was level of function at 10 weeks as measured by the modified Rol and Disability scale . Results . After adjustment for baseline characteristics , improved function was observed for 86 % of the participants with higher expectations for the treatment they received , as compared with 68 % of those with lower expectations ( P = 0.01 ) . Furthermore , patients who expected greater benefit from massage than from acupuncture were more likely to experience better outcomes with massage than with acupuncture , and vice versa ( P = 0.03 ) . Conclusions . The results of this study suggest that patient expectations may influence clinical outcome independently of the treatment itself . In contrast , general optimism about treatment , divorced from a specific treatment , is not strongly associated with outcome . These results may have important implication s for clinical trial design and recruitment , and may help to explain the apparent success of some conventional and alternative therapies in trials that do not control for patient expectations . The findings also may be important for therapy choices made in the clinical setting 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 Background . The aim of this study was to describe the effects of acupuncture in the treatment of  low‐back and pelvic pain during pregnancy and compare it with physiotherapy Eight r and om groups , each of 15 patients with tendomyotic cervical and lumbar syndrome , underwent acupuncture , one group receiving needle acupuncture at the " correct " sites according to Chinese medicine and another receiving placebo needles at the same sites . In a third group , acupuncture needles were applied at sites which were wholly inconsistent with Chinese practice . The remaining 5 groups took part in a single blind trial involving various types of radiation at the correct acupuncture sites , using an apparatus emitting either laser rays , red light , mixed light , infrared or no radiation at all , without interference from the therapist . All the groups showed improvement , but an analysis according to Kruskal and Wallis revealed no significant differences between type and site of treatment & 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
BACKGROUND Although low-back pain is usually a self-limiting and benign disease that tends to improve spontaneously over time , a large variety of therapeutic interventions are available for its treatment .
OBJECTIVES To assess the effects of acupuncture for the treatment of non-specific low-back pain and dry-needling for myofascial pain syndrome in the low-back region .