Acupuncture needles can improve back pain, and so can toothpicks

BMJ Group News

Acupuncture can lead to lasting improvements for people with long-term low back pain, according to a new study - but so can simulated acupuncture using toothpicks pressed against skin. These findings suggest that penetrating the skin with needles may not be necessary for the treatment to work.

What do we know already?

Low back pain is extremely common. Up to 85 percent of people in the UK have back pain at some point in their lives, and about 5 million people see their GP for back pain each year. Most people's back pain improves in less than two weeks, but some have pain for three months or more. Long-term back pain is harder to treat, leading many people to seek out alternative therapies, such as acupuncture.

Acupuncture uses very fine needles placed into specific points around the body (called acupuncture points). Some doctors think acupuncture helps the body to release natural chemicals that block the feeling of pain. Some studies have found that acupuncture can ease the symptoms of low back pain, and help people move more freely.

But most studies have been fairly short, so it's unclear how long the benefits of acupuncture last. Also, some research has found that shallowly inserting needles into non-acupuncture points can also improve low back pain, raising questions about how acupuncture actually works. To explore these issues further, researchers have now looked at how real acupuncture compares with simulated acupuncture that doesn't pierce the skin, in both the short and long term.

What does the new study say?

The study included 638 adults with long-term low back pain who were randomly assigned to receive one of the following four treatments over seven weeks:

• 10 acupuncture sessions that were tailored to them individually
• 10 acupuncture sessions that weren't tailored, but instead followed a standard approach for low back pain
• 10 sessions of simulated acupuncture, which involved applying a toothpick inside a needle-guide tube to acupuncture points, to mimic insertion, stimulation and removal of needles
• Usual care provided by a GP, with no real or simulated acupuncture added.

People who had real or simulated acupuncture wore eye masks to conceal which treatment they were receiving.

After eight, 26 and 52 weeks, the participants were interviewed about their symptoms and how much the pain was hampering their usual activities (their level of dysfunction). They were also asked to rate how troublesome their pain was on a scale of zero (not troublesome at all) to 10 (extremely troublesome).

Overall, people who had either real or simulated acupuncture had less pain and were less hampered in their activities than those who had only usual care. Acupuncture that was tailored to the individual didn't seem to help any more than standard or simulated acupuncture.

After eight weeks:

• 60 percent of people who had real or simulated acupuncture had improvements in how much activity they could do, compared with only 39 percent of those receiving usual care
• Pain scores improved by 1.6 to 1.9 points in people who had real or simulated acupuncture, compared with 0.7 points for those receiving usual care.

After one year:

• 59 percent to 65 percent of people who'd received real or simulated acupuncture had improvements in how much they could do, compared with 50 percent in the usual care group. There was no significant difference between the groups in pain scores.