New Study, Same Old Back

It’s all over the news today–the results of a recent study involving more than 1100 back pain patients. As a physical therapists AND back pain sufferer and honorary Dr. Science (I have a master’s degree–IN SCIENCE! ) I have a few words of caution in interpreting these encouraging results. But first, here’s the scoop, as it’s written.

“In a random selection, a third of the group were given 10, 30-minute acupuncture sessions, at a rate of about two a week, based on traditional Chinese medicine with the needles inserted to between five to 40 millimeters under the skin.

Another third, some 387 patients, were given sham acupuncture, with the needles only implanted to between one to three millimeters, and the final group were given conventional therapy of medication, physical therapy and exercise.

After six months, 47.6 percent of those receiving Chinese acupuncture had noticed an improvement in their condition, along with 44.2 percent in the sham group.

Only 27.4 percent of the group receiving conventional therapy however, reported any improvement, noted the study in the journal which is part of the JAMA (Journal of the American Medical Association) group.

“The superiority of both forms of acupuncture suggests a common underlying mechanism that may act on pain generation, transmission of pain signals or processing of pain signals by the central nervous system and that is stronger than the action mechanism of conventional therapy,” the authors said.” Source

First, if I was a highly trained acupuncturist, I’d react to this report like the guy who just heard his mother-in-law just went over a cliff. In his new Cadillac. It seems there is little difference between correctly placed and incorrectly placed needles in the degree of pain relief. It may have more to do with the induced pain per se, and involve the very real but yet-to-be-explained placebo effect than with the exacting procedures from oriental traditional medicine.

On the other hand, the acupuncturist might be feeling rather superior now to the more western-medicine scientifically sanctioned practice of physical therapy. Lots more folks benefited at the time of evaluating results from the needles than from “conventional physical therapy“. But what exactly does that mean?

The BBC version of the report says acupuncture competed against “painkillers, injections, heat therapy and massage.”

In my mind and practice, this isn’t the best physical therapy has to offer sufferers of acute back pain.

Did the therapy include therapeutic exercise aimed at strengthening of core muscles (especially the abdominals) and improved dynamic lumbar stabilization? Did it look at weight loss and increased and regular exercise in long range plans? Did it look at overall flexibility of trunk, pelvis and hip musculature, with a regular home exercise program incorporating these new habits?

No. Here we have a passive treatment only, and this lines up perfectly with our “fix me, I’m broken” society. I’m the first to say that when my back hurts, I want the pain to go away in the short run, and might seek out our local acupuncturist for relief. But if I don’t also follow up with changes to my body mechanics and ergonomics at home and work and become involved in an active program such as I describe here, what will be the re-occurrence rates among THESE TWO populations of back patients? Let the buyer beware.

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Fred First holds masters degrees in Vertebrate Zoology and physical therapy, and has been a biology teacher and physical therapist by profession. He moved to southwest Virginia in 1975 and to Floyd County in 1997. He maintains a daily photo-blog, broadcasts essays on the Roanoke NPR station, and contributes regular columns for the Floyd Press and Roanoke's Star Sentinel. His two non-fiction books, Slow Road Home and his recent What We Hold in Our Hands, celebrate the riches that we possess in our families and communities, our natural bounty, social capital and Appalachian cultures old and new. He has served on the Jacksonville Center Board of Directors and is newly active in the Sustain Floyd organization. He lives in northeastern Floyd County on the headwaters of the Roanoke River.

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  1. Yes, this report seems so typically misleading – a quick read gives the impression that acupuncture, even badly done, is a lot more effective than “conventional therapy.” But as you say, unless we know exactly what that conventional therapy entailed, what’s the comparison worth?

    We’re so overwhelmed with reports of “studies” like this that only confuse us, unless we read them skeptically, looking between the lines, and thinking as much about what’s NOT there as what is. And everytime I read something like this, I figure it’s just a matter of time until I read about another study that contradicts it.

    Seems like we have to reserve judgment until the research pendulum has swung back and forth a lot – until eventually a preponderance of evidence gives a more reliable consensus?

  2. Well, and one badly wants to know how “sham” the sham accupuncture was. Were the points correct, and only the depth different? Who decided that 5+ mm was the correct depth? If the points were random, then what this study really demonstrates is simply that the placebo effect of accupuncture is considerably better than the real effect of whatever these Western treatments were. In fact the really interesting news is that the placebo effect of Western medicine was so much worse than that of Chinese.

    Exercise fixed what was once chronic back pain, for me, so I’m with you there. Nothing else I tried ever had much impact on it.

  3. I would think acupuncture is more like a drug that disables the body’s way of telling you something is wrong, rather than a cure. In fact, in the long run it could make the condition worse since you might continue to do the same things and even new things that cause the problem in the first place.