Acupuncture works better than conventional treatments in reducing lower back pain, according to researchers in Germany.

But so does fake acupuncture, where the needles are inserted shallowly and in the wrong places. In a trial of more than 1,100 people, both were almost twice as effective as a combination of drugs, physiotherapy and exercise.

The results suggest that both acupuncture and sham acupuncture act as powerful versions of the placebo effect, providing relief from symptoms as a result of the convictions that they engender in patients.

A team led by Michael Haake, of the University of Regensburg, recruited 1,162 patients aged between 18 and 86 who had suffered lower back pain for an average of eight years. They were divided into three equal groups, and treated either with genuine acupuncture, with the needles inserted in precisely specified places and to a predetermined depth, with fake acupuncture, or with antiinflammatory drugs, painkillers and physiotherapy.

Success was measured as a one-third improvement in pain, or a 12 per cent improvement in mobility.

After six months, almost half of those on true acupuncture (47.6 per cent) and 44.2 per cent of those on sham acupuncture had met these criteria, while only 27.4 per cent of those treated conventionally had. This suggests, say the authors in Archives of Internal Medicine, that acupuncture, however incompetently it may be applied, is about twice as effective as conventional therapy.

“The superiority of both forms of acupuncture suggests a common underlying mechanism that may act on pain generation, transmission of pain signals or processing of pain signals by the central nervous system and that is stronger than the action mechanism of conventional therapy,” the authors say.

“Acupuncture gives physicians a promising and effective treatment option for those experiencing chronic low back pain, with few adverse effects or contraindications. The improvements in all primary and secondary outcome measures were significant and lasted long after completion of treatment.”

They say that this is the largest and most rigorous trial to investigate the benefits of acupuncture, the technique in which sharp needles are introduced to a considerable depth into the body in precisely defined places in the body.

Its results, they acknowledge, are surprising. That random pricking of the skin to a depth of one to three millimetres works almost as well as “true” acupuncture, which involves penetrations to a depth of five to forty millimetres in precise places, leads them to question the underlying mechanism.

It also suggests that lengthy training in the technique may be superfluous. All that is needed is to declare that you are a practising acupuncturist and make a few shallow insertions, the trial suggests.

The trial aimed to distinguish between the physical and the psychological effects of the technique. If true acupuncture worked better than sham, it would have shown that it has a genuine basis in physiology. But the trial failed to find any differences at all. So the authors conclude that the results send a confused message. One possibility is that there are no physical effects at all of acupuncture, or that they are are so small that they are overlaid by far stronger psychological effects.

Alternatively, acupuncture does work, but it does not matter how well or badly it is done. Symptoms improve regardless of point selection or depth of needling.

Since all the participants had long-term back pain, it is reasonable to assume that all had experienced conventional treatment, which often fails. Low back pain is notoriously hard to treat, so the use of acupuncture would have been novel, and likely to bring the placebo effect into play.

That fake acupuncture appeared to have worked almost as well as true acupuncture supports this conclusion.

Straight to the point

–– In Oriental medicine, illness is said to be due to an imbalance of “vital energy” (Ch’i) which flows through the body along 12 pathways or meridians, each corresponding to one of the vital organs

–– The acupuncturist inserts very fine stainless steel needles at specific points to stimulate energy flow; patients report a tingling sensation

–– Trials have shown benefits in treating pain, nausea and headaches

–– There appears to be no scientific basis for the medical concept or placement of needles

–– It has been used in China since 3000 BC, with stone needles found in Mongolia

–– The Cochrane Collaboration, the most authoritative review of evidence, says that it is effective for low-back pain but no better than conventional treatment

Source: Times database

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