A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain Export

@article{citeulike:4669933, abstract = {BACKGROUND: Acupuncture is a popular complementary and alternative treatment for chronic back pain. Recent European trials suggest similar short-term benefits from real and sham acupuncture needling. This trial addresses the importance of needle placement and skin penetration in eliciting acupuncture effects for patients with chronic low back pain. METHODS: A total of 638 adults with chronic mechanical low back pain were randomized to individualized acupuncture, standardized acupuncture, simulated acupuncture, or usual care. Ten treatments were provided over 7 weeks by experienced acupuncturists. The primary outcomes were back-related dysfunction (Roland-Morris Disability Questionnaire score; range, 0-23) and symptom bothersomeness (0-10 scale). Outcomes were assessed at baseline and after 8, 26, and 52 weeks. RESULTS: At 8 weeks, mean dysfunction scores for the individualized, standardized, and simulated acupuncture groups improved by 4.4, 4.5, and 4.4 points, respectively, compared with 2.1 points for those receiving usual care (P < .001). Participants receiving real or simulated acupuncture were more likely than those receiving usual care to experience clinically meaningful improvements on the dysfunction scale (60\% vs 39\%; P < .001). Symptoms improved by 1.6 to 1.9 points in the treatment groups compared with 0.7 points in the usual care group (P < .001). After 1 year, participants in the treatment groups were more likely than those receiving usual care to experience clinically meaningful improvements in dysfunction (59\% to 65\% vs 50\%, respectively; P = .02) but not in symptoms (P > .05). CONCLUSIONS: Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture's purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects.}, author = {Cherkin, Daniel C. and Sherman, Karen J. and Avins, Andrew L. and Erro, Janet H. and Ichikawa, Laura and Barlow, William E. and Delaney, Kristin and Hawkes, Rene and Hamilton, Luisa and Pressman, Alice and Khalsa, Partap S. and Deyo, Richard A.}, citeulike-article-id = {4669933}, citeulike-linkout-0 = {http://dx.doi.org/10.1001/archinternmed.2009.65}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/19433697}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=19433697}, day = {11}, doi = {10.1001/archinternmed.2009.65}, issn = {1538-3679}, journal = {Archives of internal medicine}, keywords = {biology, health, medicine, research, science, toread}, month = {May}, number = {9}, pages = {858--866}, posted-at = {2009-08-01 15:57:09}, priority = {2}, title = {A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain}, url = {http://dx.doi.org/10.1001/archinternmed.2009.65}, volume = {169}, year = {2009} }

TY - JOUR ID - citeulike:4669933 L3 - citeulike-article-id:4669933 N2 - BACKGROUND: Acupuncture is a popular complementary and alternative treatment for chronic back pain. Recent European trials suggest similar short-term benefits from real and sham acupuncture needling. This trial addresses the importance of needle placement and skin penetration in eliciting acupuncture effects for patients with chronic low back pain. METHODS: A total of 638 adults with chronic mechanical low back pain were randomized to individualized acupuncture, standardized acupuncture, simulated acupuncture, or usual care. Ten treatments were provided over 7 weeks by experienced acupuncturists. The primary outcomes were back-related dysfunction (Roland-Morris Disability Questionnaire score; range, 0-23) and symptom bothersomeness (0-10 scale). Outcomes were assessed at baseline and after 8, 26, and 52 weeks. RESULTS: At 8 weeks, mean dysfunction scores for the individualized, standardized, and simulated acupuncture groups improved by 4.4, 4.5, and 4.4 points, respectively, compared with 2.1 points for those receiving usual care (P < .001). Participants receiving real or simulated acupuncture were more likely than those receiving usual care to experience clinically meaningful improvements on the dysfunction scale (60% vs 39%; P < .001). Symptoms improved by 1.6 to 1.9 points in the treatment groups compared with 0.7 points in the usual care group (P < .001). After 1 year, participants in the treatment groups were more likely than those receiving usual care to experience clinically meaningful improvements in dysfunction (59% to 65% vs 50%, respectively; P = .02) but not in symptoms (P > .05). CONCLUSIONS: Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture's purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects. IS - 9 JF - Archives of internal medicine SN - 1538-3679 EP - 866 TI - A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain VL - 169 SP - 858 KW - biology KW - health KW - medicine KW - research KW - science KW - toread AU - Cherkin, Daniel AU - Sherman, Karen AU - Avins, Andrew AU - Erro, Janet AU - Ichikawa, Laura AU - Barlow, William AU - Delaney, Kristin AU - Hawkes, Rene AU - Hamilton, Luisa AU - Pressman, Alice AU - Khalsa, Partap AU - Deyo, Richard PY - 2009/05/11/ UR - http://dx.doi.org/10.1001/archinternmed.2009.65 ER -