The Effectiveness of Acupuncture in Reducing Chronic Back Pain

This report investigates the effectiveness of acupuncture in treating chronic back pain, comparing it to other treatments like anti-inflammatory non-steroidal drugs (NSAIDs). The student has analyzed several research papers, including systematic reviews and randomized controlled trials, to address the PICO question: 'Is acupuncture therapy more effective in mitigating lower back pain than anti-inflammatory non steroidal medicines?' The report explores the mechanisms of acupuncture, potential benefits, and limitations of the existing studies. The analysis includes studies by Weib et al. (2013), Lee et al. (2013), and Trigkilidas (2010), providing a comprehensive overview of the current evidence. The report highlights the importance of considering both the psychological and physiological aspects of acupuncture, while acknowledging the need for further research to confirm the findings. The report concludes that the NICE guidelines of a course of acupuncture, offered according to patient preference as a treatment option for chronic low back pain, are justified.

Running head: ROLE OF ACUPUNCTURE TO REDUCE CHRONIC BACK PAIN
ROLE OF ACUPUNCTURE TO REDUCE CHRONIC BACK PAIN
Name of the Student
Name of the university
Author’s note

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PART A
PICO: Is acupuncture therapy more effective in mitigating lower back pain than anti-
inflammatory non steroidal medicines?
The article by Weib et al.,2013, focuses on the effectiveness of the additional
acupuncture in patients suffering from chronic lower back pain. It consist of a randomized trial
of two groups (A and B), where both the groups were receiving rehabilitation regimen as per the
German guidelines. But group A was receiving acupuncture twice weekly, by two Chinese
physicians having knowledge about traditional Chinese medicine. This article can be positioned
on level II as per the hierarchy of evidence. The publishing year of this article is 2013, which
indicates a high currency of evidence. This article helps one to understand the advantages or the
disadvantage of using the acupuncture therapy and also helps one to compare it with other
therapies. The paper gives detailed information regarding the mechanism of acupuncture in
relieving pain. All these qualities made this article suitable for addressing my PICO.
This article by Lee et al., 2013 is a systematic review on a randomized control trial which
measured the effectiveness of acupuncture therapy over the anti-inflammatory non –steroidal
drugs in treating lumber pain, lumbago and lumber strain. This paper have been accessed from
the CINAHL database by advance searching method and this paper belongs to level II of the
hierarchy of evidences and the currency of the evidence is high as it was published in 2012. The
result of this systematic review indicates towards evidences that were inconclusive. Therefore
the current findings can only be confirmed by future researches. As this paper provides me with

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an unbiased result regarding the effectiveness of acupuncture, the paper is suitable for my
research.
The article by Trigkilidas (2010) is a systematic review where fifteen randomized trials have
been identified by searching the Pubmed database where only four articles have been critically
appraised. The randomized trials included the patients who were receiving treatments from two
centers for 5-12 months. The article supports the fact that acupuncture can be applied to treat
chronic back pain. The article lies in hierarchy II of evidence. It is a multicentre trial where
comparisons have been made between the various types of Acupuncture therapy. Thus it
provides us with a broader knowledge about the topic. Its publishing year is 2010, which makes
the article reliable for my PICO question.
PART B
Question: Is acupuncture therapy more effective in mitigating lower back pain than anti-
inflammatory non steroidal medicines?
Chronic low back pain is common after an age. There are certain reasons that can give rise to
chronic back pain, one can have herniated discs, where a part of the spinal disc is pushed in to
the nearby nerves. If the spaces between the spinal nerves become narrow, this can also lead to
spinal stenosis (Cherkin et al., 2003). Acupuncture has emerged popularly among the alternative
therapies for mitigating the back pain.
As per the article by Trigkilidas (2010) the increased popularity of the acupuncture has led to the
formation of the NCE guidelines, where a course of acupuncture is offered as per the treatment
option for the patient. This paper is a systematic review of the controlled trials which focuses on
proving the effectiveness of acupuncture for the in treating the lower back pain. The paper also

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compared between the traditional acupuncture and stimulated acupuncture. At the 8th week of the
study all most all the groups showed marked improvements. They gave 6.7 on a scale of 0-10 on
the effectiveness of acupuncture. The main strength of this study was that it was a central
randomized process. According to the author, acupuncture provides a strong psychological
element to the patient, although it is still hard to understand the elements of the psychological
effect due to lack of evidences. The negative point of this study is the process of recruiting the
participants. As most of the patients were invited via advertisements in the clinic or newsletters,
most of the participants who contacted believed in the effectiveness of acupuncture. There a
psychological thing already in action which might have caused biasness in the study.
The article by Jun hwang, strongly recommends the use of acupuncture over the anti-
inflammatory steroid medicines. This paper reviews on a randomized control trials, where it is
was found that acupuncture in combination with medications are more effective in relieving pain
than using the medications alone. It should be mentioned that the included with studies of very
small size, having poor methodological quality. This review has also admitted that evidence on
acupuncture for LBP is meager despite of the comprehensive literature search. Although the
evidence demonstrated the effectiveness of acupuncture, but it did not provide evidences whether
they have better effects than NSAIDs.
In relation to this, the paper by Weib et al., (2013), aims to focus on the positive effects of
acupuncture. For this a randomized control study was organized where some patients with
chronic back pain received the normal medications and another group receiving acupuncture
therapies from two traditional Chinese physicians. It can be understood from the study that the
mechanism of removal of pain involves the release of the opoid mediators and the endorphins
that binds to the γ, δ, and κ-receptors. Several other mediators such as serotonin, cholecytokinin

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and nitric oxide are secreted which have roles in relieving the back pains. According to (Weib et
al., 2013) signals to the ventrolateral pathway of the spinal cord, where the inhibitory parts of the
nervous system are activated which leads to analgesia. The sample size was insufficient to do the
testing. Several patients dropped out from the study and the rate of dropout was different in the
groups which might have caused selection bias.
Thus, the following research on the literatures addresses my given PICO that Acupuncture are
more effective in treating lower back pain than the NSAIDs.

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References
Cherkin, D. C., Sherman, K. J., Deyo, R. A., & Shekelle, P. G. (2003). A review of the evidence
for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal
manipulation for back pain. Annals of internal medicine, 138(11), 898-906.
Lee, J. H., Choi, T. Y., Lee, M. S., Lee, H., Shin, B. C., & Lee, H. (2013). Acupuncture for acute
low back pain: a systematic review. The Clinical journal of pain, 29(2), 172-185.
Trigkilidas, D. (2010). Acupuncture therapy for chronic lower back pain: a systematic
review. The Annals of The Royal College of Surgeons of England, 92(7), 595-598.
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.

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ABSTRACT COPIED AND PASTED AS PER THE REQUIREMENT OF THE STUDENT
PAPER 1
Effectiveness and Acceptance of Acupuncture in Patients with Chronic Low Back Pain:
Results of a Prospective, Randomized, Controlled Trial
Johannes Weiß, MD, 1 Sabine Quante, MD, 1 Fuping Xue, 1 Rainer Muche, PhD,2 and Monika
Reuss-Borst, MD1
Abstract
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 healthrelated 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

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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 10kg 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.
PAPER 2
Acupuncture for Acute Low Back Pain A Systematic Review
Jun-Hwan Lee, KMD, PhD,* Tae-Young Choi, PhD, w
Myeong Soo Lee, PhD, w
Hyejung Lee, KMD, PhD, z
Byung-Cheul Shin, KMD, PhD, y
and Hyangsook Lee, KMD, PhD z
Acute nonspecific low back pain (LBP), relevant systematic reviews indicate sparse and
inconclusive evidence. This systematic review aimed at critically evaluating the evidence
for/against acupuncture for acute LBP.
Methods: We searched Medline, Central, Embase, 2 Chinese databases, relevant journals, and
trial registries for the randomizedcontrolled trials of acupuncture that involved needling for
acute/ subacute LBP. Risk of bias was assessed using the assessment tool from the Cochrane

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Back Review Group and the adequacy of acupuncture intervention was evaluated by 2
independent reviewers. The studies according to the control types were combined using a
random-e ects model.ff
Results: A total of 11 randomized-controlled trials (n=1139) were included. Compared with
nonsteroidal anti-inflammatory drugs, acupuncture may more e ectively improve symptoms offf
acute LBP (5 studies; risk ratio, 1.11; 95% confidence interval: 1.06, 1.16). For pain, there exists
inconsistent evidence that acupuncture is more e ective than medication. Compared with shamff
acupuncture, acupuncture may more e ectively relieve pain (2 studies; mean di erence, 9.38;ff ff
95% confidence interval: 17.00, 1.76) but not function/disability. Acupuncture appears to be
associated with few side e ects but the evidence is limited.ff
Discussion: The current evidence is encouraging in that acupuncture may be more e ective thanff
medication for symptom improvement or relieve pain better than sham acupuncture in acute
LBP. The present findings should be confirmed by future studies that overcome the
methodological limitations of the studies evaluated in our review.
Key Words: acupuncture, acute low back pain, systematic review, randomized-controlled trial,
sham acupuncture
PAPER 3
(Clin J Pain 2013;29:172–185)
Acupuncture therapy for chronic lower back pain: a systematic review
Dionysios Trigkilidas
Orthopaedic Department, Milton Keynes Hospital NHS Trust, Milton Keynes, UK

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ABSTRACT
INTRODUCTION Chronic low back pain is a common condition affecting a significant
proportion of the population and has large economic implications on the society. Acupuncture
has grown in popularity as an alternative therapy for chronic low back pain. Recent National
Institute for Health and Clinical Excellence (NICE) guidelines on low back pain offer a course of
acupuncture as a baseline treatment option according to patient preference. The aim of this
systematic review was to evaluate if this treatment option is justified in view of recent evidence
available on the efficacy of acupuncture.
MATERIALS AND METHODS: Studies included were identified by a PubMed search for
relevant, randomised, controlled trials on the 23 July 2009. A systematic review was performed.
RESULTS: Fifteen randomised controlled trials were identified. Of these, four met the eligibility
criteria and were critically appraised. These trials suggest acupuncture can be superior to usual
care in treating chronic low back pain, especially, when patients have positive expectations about
acupuncture.
CONCLUSION: NICE guidelines of a course of acupuncture, offered according to patient
preference as a treatment option for chronic low back pain, are justified.