Vol.3 Issue 1
Low Back Pain

Low back pain is a recurrent, often life-long problem for many persons in Western societies. A consensus conference at the National Institutes of Health (1997) concluded that there was insufficient evidence to support the use of acupuncture for the management of low back pain. A recent trial carried out by Molsberger and colleagues (2002) was designed to test the therapeutic effect of acupuncture for low back pain using a three-group design. Subjects (n=186) were stratified by pain duration and randomized into a group receiving acupuncture and conservative orthopedic treatment (COT); a group receiving sham acupuncture and COT; or to a group receiving COT alone. Subjects received three acupuncture or sham treatments weekly over a four-week period. Sham acupuncture consisted of superficial needling at non-acupuncture points. At the end of the treatment protocol, there was significantly greater pain relief in the true acupuncture vs. the sham acupuncture group. This effect was maintained out to three months post-treatment. At this time point, there was also significantly greater pain relief in the true acupuncture with COT group vs. the group receiving only COT. There was no change across groups in subject mobility or use of pain medication. The researchers attributed these positive findings with regard to self-reported pain relief, which are in apparent contradiction to earlier study findings, to a larger sample size, greater numbers of acupuncture treatments, and clearly defined treatment groups. A strength of this study is the use of the sham acupuncture group, as it has been reported that any needle insertion leads to release of endogenous opioids, which can modify pain perception.

Leibing and colleagues (2003) have criticized this study which appears to contradict one of their own (2002). They were concerned with the rather low effect of sham acupuncture, the rather high effect of COT alone, and question subject blinding to study protocol. Mau and Molsberger (2003) countered that they believed that the strong effect of COT was due to the rather intensive approach employed, and they attributed the rather low effect of sham acupuncture above COT to the fact that COT alone was an effective treatment. They also pointed out that because acupuncture employs such a wide variety of needling protocols, it would be unlikely for subjects to discriminate “true” vs. “sham” points.

All in all, the report by Molsberger will be of interest to clinicians who deal with patients experiencing chronic low back pain. It is suggested that others replicate this study and that follow-up times be expanded beyond the three-month post treatment period.

Janice M. Zeller, PhD, RN, FAAN
Professor, Adult Health Nursing
Rush University College of Nursing

References:

Leiberg E, Leonhardt U, Koster G, Goerlitz A, Rosenfeldt J, Hilgers R, Ramadori G. Acupuncture treatment of chronic low-back pain – A randomized, blinded, placebo-controlled trial with 9-month follow-up. Pain 2002;96:189-196.

Leibing E, Pfingsten M, Leichsenring F. Comment on: Molsberger AF, Mau J, Pawelec DB, Winkler J. Does acupuncture improve the orthopedic management of chronic low back pain? Pain 2002;99:579-87. In Pain 2003;104: 425-426.

Mau J, Molsberger AF. Reply to the comment of Leibing, E, Pfingsten, M, and Leichsenring, F concerning the trial reported in: Molsberger AF, Mau, J, Pawelec, DB, Winkler, J. Does acupuncture improve the orthopedic management of chronic low back pain? Pain 2002;99:579-87. In Pain 2003;104:426-427.

Molsberger AF, Mau J, Pawelec DB, Winkler J. Does acupuncture improve the orthopedic management of chronic low back pain – A randomized, blinded, controlled trial with 3 months follow up. Pain 2002;99:579-587.

NIH Consensus Conference. Acupuncture. Journal of the American Medical Association 1998;280:1518-1524.