400863 Spring 2018 - Acupuncture for Chronic Low Back Pain: An Essay

This essay assesses the effectiveness of acupuncture as a treatment for chronic low back pain (cLBP) by examining three research articles. It highlights studies by Xu et al. (2013) and Weiß et al. (2013), which suggest acupuncture's positive impact on pain relief and overall well-being compared to other treatments, noting its high acceptance and minimal adverse effects. The essay also incorporates Li et al.'s (2014) research, providing an objective measurement method via default mode network imaging to understand acupuncture's therapeutic mechanisms. Concluding that acupuncture shows promise in treating cLBP, the essay emphasizes the significance of these findings due to large sample sizes and objective measures, reinforcing acupuncture's potential as a valuable treatment option.

400863 Spring 2018, Assessment 3 Part B
Assignment — Using Evidence
Student name: Student ID:
Evidence selection
Chronic low back pain (cLBP) is a significant health problem now a days and
recently acupuncture is gaining momentum as a treatment to relief cLBP. To
investigate the effectiveness of acupuncture as a treatment to cLBP, three
research articles were selected and examined. The objectives of two of them
were to found out whether acupuncture work as pain relief in chronic low back
pain while other one were vested in acupuncture works and tried to provide a
objective method for measurement. Xu et al. (2013) used a meta analysis of
thirteen controlled trials (randomized) to investigate the effect of acupuncture in
cLBP. They identified 2678 patients for their controlled groups and I-square test,
Cohen’s test and Begg’s test were performed for meta analysis. Evaluation
parameters for their clinical outcome were disability, pain intensity, quality of life
and spinal flexion. In their study, they have shown that acupuncture achieved
better results in comparison with other treatments for cLBP. Like the previous
research study, Weiß et al. (2013) have also studied the effectiveness of the
acupuncture as a treatment of cLBP but with different design. There subject
were patient from a rehabilitation program and total 143 patients were took part
in two group. One was control and the other one was intervened with
acupuncture treatment. They also pointed out that acupuncture is an effective
method. In contrast with the previous two research program, Li et al. (2013)
have assumed that acupuncture is an effective method and tried to provide an
objective method for measurement by studying altered default mode network.
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400863 Spring 2018, Assessment 3 Part B
The objective of this evidence search was to find out whether acupuncture is an
effective treatment tool against cLBP. For this purpose, research article of Xu et
al. (2013) and Weiß et al. (2013) were selected. However, mechanism of
acupuncture is still not very much clear and pain is subjective matter. To answer
this predicament, study of Li et al. (2013) were selected.
Evidence summary
Chronic low back pain is one of most common reason for people to attain
medical treatment and it is quite a financial burden to some families. In that
context, acupuncture is increasing popularity as a treatment for chronic low back
pain. Therefore, this essay will discuss the effectiveness of acupuncture as a
treatment of chronic low back pain based on academic research.
Xu et al. (2013) have shown in their study that acupuncture is an effective tool
against acupuncture. They have also shown that it is much more effective that
other treatments for chronic low back pain. Similar like the previous author,
Weiß et al. (2013) have reported similar findings in their study. Along with that,
they have also reported that acupuncture and traditional Chinese medicine is
highly accepted among the subjects and acupuncture is a well tolerated
treatment with close to none adverse events. However, mechanism of
acupuncture is still not clear and there is no clear objective protocol for this
treatment method. Along with that, pain is a subjective matter which poses a
significant hindrance in this situation. Keeping this situation in mind, Li et al.
(2014) have sought to investigate how acupuncture influences chronic low back
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400863 Spring 2018, Assessment 3 Part B
pain by examining the default mode network connectivity. They reported that
less connectivity is present amongst the patient with chronic low back pain in
comparison with control patients. They have come to the conclusion that default
mode network modulation by acupuncture is related to its therapeutic effects.
They also presented an objective assessment method for acupuncture by
default mode network imaging. From the above discussion, it can be seen that
all the researchers have agreed that acupuncture has therapeutic effects as a
treatment for chronic low back pain. Additionally, Weiß et al. (2013) have also
shown that acupuncture is a well tolerated treatment with no adverse effects.
This suggests that acupuncture has the potential to be effective treatment for the
chronic low back pain. Furthermore, the findings of the researches performed by
Xu et al. (2013) and Weiß et al. (2013) is rather significant as sample size for
both of their studies were fairly high. For example, Xu et al. (2013) performed
their analysis with a sample pool of 2678 patients. To make further interesting, Li
et al. (2014) have provided an objective measure technique to study effect of
acupuncture, which in turn will help better understanding of the technique.
Therefore, from the above discussion, it can be concluded that acupuncture has
therapeutic effects as a treatment for the chronic low back pain. Recent studies
and researches related to this subject have only emphasises this point evidently.
References
Li, J., Zhang, J. H., Yi, T., Tang, W. J., Wang, S. W., & Dong, J. C. (2014).
Acupuncture treatment of chronic low back pain reverses an abnormal brain
default mode network in correlation with clinical pain relief. Acupuncture in
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400863 Spring 2018, Assessment 3 Part B
Medicine, 32(2), 102-108.
Weiß, J., Quante, S., Xue, F., Muche, R., & Reuss-Borst, M. (2013).
Effectiveness and acceptance of acupuncture in patients with chronic low
back pain: results of a prospective, randomized, controlled trial. The Journal
of Alternative and Complementary Medicine, 19(12), 935-941.
Xu, M., Yan, S., Yin, X., Li, X., Gao, S., Han, R., ... & Lei, G. (2013).
Acupuncture for chronic low back pain in long-term follow-up: a meta-
analysis of 13 randomized controlled trials. The American journal of Chinese
medicine, 41(01), 1-19.
Search results
Li et al. (2014)
Background Acupuncture is gaining in popularity as a treatment for chronic low
backpain (cLBP); however, its therapeutic mechanisms remain controversial, partly
because of the absence of an objective way of measuring subjective pain. Resting-state
functional MRI (rsfMRI) has demonstrated aberrant default mode network (DMN)
connectivity in patients with chronic pain, and also shown that acupuncture increases
DMN connectivity in pain-modulator and affective-emotional brain regions of healthy
subjects.
Objective This study sought to explore how cLBP influences the DMN and whether,
and how, the altered DMN connectivity is reversed after acupuncture for clinical pain.
Methods RsfMRI data from 20 patients with cLBP, before and after 4 weeks of
treatment, and 10 age- and gender-matched healthy controls (without treatment) were
analysed using independent components analyses to determine connectivity within the
DMN, and combined with correlation analyses to compute covariance between changes
in DMN connectivity and changes in clinical pain. Visual analogue scale data were
assessed to rate clinical pain levels.
Results Less connectivity within the DMN was found in patients with cLBP than in
healthy controls, mainly in the dorsolateral prefrontal cortex, medial prefrontal cortex,
anterior cingulated gyrus and precuneus. After acupuncture, patients’ connectivities
were restored almost to the levels seen in healthy controls. Furthermore, reductions in
clinical pain were correlated with increases in DMN connectivity.
Conclusions This result suggests that modulation of the DMN by acupuncture is
related to its therapeutic effects on cLBP. Imaging of the DMN provides an objective
method for assessment of the effects of acupuncture-induced analgesia.
Weiß et al. (2013)
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400863 Spring 2018, Assessment 3 Part B
Objective: To investigate the effectiveness of additional acupuncture in patients with
chronic low back pain participating in an inpatient rehabilitation program.
Design: Patients were randomly assigned to one of two groups (A and B), both
receiving a standard rehabilitation program according to German guidelines. Patients in
group A additionally underwent acupuncture twice weekly, conducted by two Chinese
physicians with education in Traditional Chinese Medicine (TCM). At the beginning and
end of the program, as well as at 3 months after, patients completed questionnaires
about health related quality of life (Short-Form 36 Health Survey [SF-36]),
sociodemographic and clinical data, attitude towards TCM, pain, and adverse events.
Setting: Inpatient rehabilitation clinic in Germany.
Patients: Patients with chronic low back pain participating in an inpatient rehabilitation
program.
Outcome measures: Acceptance of acupuncture, health-related quality of life, and
pain/symptoms.
Results: One hundred and forty-three patients were analyzed: 74 in group A
(intervention) and 69 in group B (controls); 67% were men and 33% were women, with
a mean age of 50.7 years. Acceptance of TCM was excellent: 89% of the patients
would want TCM to be integrated into standard inpatient rehabilitation, and 83% would
even have paid for TCM if necessary. Responses to SF-36 questionnaires showed that
group A reported significantly better physical functioning, general health, vitality, and
emotional role than group B. Pain outcomes in group A were superior to those in group
B. Specifically, pain with sitting/standing, pain upon carrying loads of 10 kg or more, and
prickling in hands and feet were significantly diminished.
Conclusion: Acupuncture was highly accepted and had positive effects in patients with
chronic low back pain. These results show that acupuncture can be an effective, well-
tolerated therapy with no major adverse events.
Xu et al. (2013)
Abstract: Chronic low back pain is one of the most common reasons that people seek
medical treatment, and the consequent disability creates a great financial burden on
individuals and society. The etiology of chronic low back pain is not clear, which means
it is often refractory to treatment. Acupuncture has been reported to be effective in
providing symptomatic relief of chronic low back pain. However, it is not known whether
the effects of acupuncture are due to the needling itself or nonspecific effects arising
from the manipulation. To determine the effectiveness of acupuncture therapy, a meta-
analysis was performed to compare acupuncture with sham acupuncture and other
treatments. Overall, 2678 patients were identified from thirteen randomized controlled
trials. The meta-analysis was performed by a random model (Cohen’s test), using the I-
square test for heterogeneity and Begg’s test to assess for publication bias. Clinical
outcomes were evaluated by pain intensity, disability, spinal flexion, and quality of life.
Compared with no treatment, acupuncture achieved better outcomes in terms of pain
relief, disability recovery and better quality of life, but these effects were not observed
when compared to sham acupuncture. Acupuncture achieved better outcomes when
compared with other treatments. No publication bias was detected. Acupuncture is an
effective treatment for chronic low back pain, but this effect is likely to be produced by
the nonspecific effects of manipulation.
Keywords: Meta-Analysis; Chronic Low Back Pain; Efficacy; Disability; Acupuncture.
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