The results of the largest randomized back pain trial of its kind shows acupuncture clearly helps people with chronic low back pain more than standard medical care. But the results of the SPINE (Stimulating Points to Investigate Needling Efficacy) study, just published in the May 11, 2009 Archives of Internal Medicine, has some researchers scratching their heads over the remarkable findings. The reason the study's results are so intriguing? Not just one but three different forms of acupuncture beat out western medicine in helping relieve low back pain.
The SPINE trial included 638 adults with chronic low back pain who were patients at two nonprofit health plans, Group Health Cooperative in Seattle, Washington, and Northern California Kaiser Permanente in Oakland. All the research subjects ranked their pain as a minimum of three on a scale of zero to 10 of "bothersome" discomfort. None of the participants had ever experienced acupuncture before participating in the study. They were randomly put into one of four groups for different kinds of treatment. All received standard medical care but three groups of patients also were treated with varying forms of acupuncture -- needle puncture at points individualized for each case, standardized acupuncture that used a single prescription of needle punctures at points on the back and back of the legs and what the researchers called "simulated acupuncture" that involved pressing on points with a toothpick without penetrating the skin. All the research subjects in the three acupuncture groups were treated twice a week for three weeks and then had weekly treatments for another month. At eight weeks, six months and 12 months, the researchers retested back-related dysfunction and measured improvements in the patients' symptoms. The SPINE investigators found that at eight weeks all three acupuncture groups were functioning far better with less pain than the group getting only standard medical care. What's more, additional follow-ups found the benefits of acupuncture lasted for a year for many of these people. "We found that simulated acupuncture, without penetrating the skin, produced as much benefit as needle acupuncture -- and that raises questions about how acupuncture works," SPINE trial leader Daniel C. Cherkin, PhD, a senior investigator at Group Health Center for Health Studies in Seattle, said in a statement to the media. However, the idea the non-skin penetrating acupuncture was not the real deal, and was, instead, "simulated acupuncture" is disingenuous. Here's why: while most forms of acupuncture studied by Western researchers do involve piercing the skin, the ancient healing therapy also includes non-piercing types of acupuncture. In fact, the web site for the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, which funded the SPINE trial, notes that acupuncture "describes a family of procedures involving the stimulation of anatomical points on the body using a variety of techniques." And "stimulation" does not necessarily equal "skin piercing." Cherkin's co-author, Karen J. Sherman, PhD, MPH, a senior investigator at Group Health Center for Health Studies, specifically pointed this out in the media statement: "Historically, some types of acupuncture have used non-penetrating needles. Such treatments may involve physiological effects that make a clinical difference." Josephine P. Briggs, MD, director of NCCAM, noted that SPINE "..adds to the growing body of evidence that something meaningful is taking place during acupuncture treatments outside of actual needling. Future research is needed to delve deeper into what is evoking these responses."
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