A new study published this week in “Archives of Internal Medicine”, shows that acupuncture is effective for back pain relief. The study followed a random selection of 638 men and women with chronic back pain who had never received acupuncture. They were divided into 4 groups:
- One group received customized acupuncture treatment
- One group received standard acupuncture treatment considered to be effective for low back pain
- One group received “simulated” acupuncture where a toothpick was used on standard back pain acupuncture points but the skin was not penetrated by a needle
- One group continued doing whatever they’d been doing such as taking medication or doing physical therapy
All patients in the acupuncture groups received the same number of tretments over a 7 week period, and all patients in the study were assessed at 8 weeks, 6 months and 1 year.
All three groups who received acupuncture treatment reported “meaningful” improvement (60%) in their abilities to perform activities of daily living compared to the “usual care” group (39%). One year after treatment, 65% of the acupuncture group reported continued improvement compared to 50% of the “usual care” group.
There was no measurable difference between customized, standard, or “sham” acupuncture - all were more effective than “usual care”.
In reading the comments on this study that have been posted this week, it’s curious to note that most of the focus has been on the question “what is acupuncture, and what does it do?” If using toothpicks is the same as using needles, how does acupuncture work?
In commenting on the results of the study, Arya Nick Shamie, MD, associate professor of spine surgery at the University of California David Geffen School of Medicine and a spokesman for the American Academy of Orthopaedic Surgeons, stated that “this paper has confused the issue even further as to how acupuncture works.” He also stated that perhaps “toothpick” acupuncture had a placebo effect.
Perhaps there’s a placebo effect.
Or perhaps acupuncture points can be stimulated without penetrating the skin.
The bottom line is that acupuncture is a relatively safe treatment option and seems to be effective. Rather than asking the question “what does acupuncture do?”, or “how does acupuncture work?”, we need to look further.
I’d like to ask Dr. Shamie the following question, “What can you learn from this study that will change your own treatment approach?”
Rather than shining the light on acupuncture, I think there’s a bigger question here. The real question for me is, “what is back pain?” If acupuncture, a technique that doesn’t directly treat “the pain”, is so effective, what’s really going on with back pain?
With the billions of dollars that are spent annually on treating back pain, and the additional billions that are lost due to decreased productivity and poor quality of life, it’s curious to note that little attention has been paid to simple and low cost alternatives like acupuncture. Or to exploring why acupuncture works better than standard medical treatment. Why do we continue using standard medical treatment when studies such as this show it to be less effective?
Why is standard medicine still using dangerous, costly and ineffective treatments like drugs and surgery?
Whether or not a placebo effect is at work with acupuncture, this study shows that back pain is not just about treating “the diagnosis”. Or even “the pain”. If finding a herniated disc, spinal stenosis or arthritis using our advanced imaging technology were the answer, we’d all be feeling 100% pain free.
But we’re not.
There’s something going on beyond the physical diagnosis.
Back pain is now occuring in huge numbers. This was not always the case. What’s happened in our modern society that’s exploded the back pain epidemic to the level that it is today? And why do we continue to pursue treatments that are less than 50% effective? Like surgery. Or “usual care”?
Did you know that there is now a diagnosis code for “Failed Back Surgery Syndrome”? That’s how common it is. And yet we consumers continue to accept the “standard of care”.
We’re seeing studies like the one mentioned in this post, where the best questions the experts can come up with are how and why acupuncture works. These are, of course, important questions, but…
Wouldn’t we be better served by asking “What are we missing in the usual care approach?”, or, “If acupuncture works, why are we still prescribing drugs, basic exercise, and surgery?”, or, “How can we train our physicians to be more effective in their patient interactions and quality of treatment so that they address what’s going on beyond the diagnosis?”
I’ll start having more respect for the medical business when studies like this are pursued. Medicine needs to investigate all treatment options for back pain, and not just the ones that make the drug, surgical and insurance companies wealthy.
More questions need to be asked.
Filed under: Back Pain studies by lindyroyer
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