Lower back pain is the leading cause of disability worldwide , yet most treatments offer limited relief. One of the most divisive is acupuncture - recommended in US guidelines for lower back pain but not in the UK . A new study has now examined whether it truly helps.
Author
- Kieran O'Sullivan
Professor, Physiotherapy, University of Limerick
The study found that acupuncture does provide some relief for people with lower back pain, though the benefit was modest. Having additional maintenance sessions did not boost the effect.
More significantly, the improvement was smaller than that seen in studies using different approaches from Australia and the US . Although acupuncture is unlikely to be the best treatment for lower back pain, the fact that it helps at all reveals something important about the condition and how people can find relief.
The study included 800 older adults who were randomly assigned to "usual care" or one of two acupuncture plans. The standard programme involved 11 sessions over 12 weeks, while the enhanced version added five more maintenance sessions over the following 12 weeks. The trial took place with 55 acupuncturists in different parts of the US and focused on older adults.
After six and 12 months, both acupuncture groups had similar results, so the extra follow-up sessions didn't help. Both acupuncture groups had less pain and disability after six months than those who received usual care - and about 40% improved by at least 30%. These improvements persisted until the 12-month evaluation, and no major safety concerns emerged.
These findings align with large reviews of lower back pain treatments focusing on acupuncture or all non-drug and non-surgical approaches . Overall, acupuncture performs somewhat better than no treatment or usual care at improving pain and disability, though this benefit is typically small.
More tellingly, reviews show that any benefit from acupuncture appears even smaller when compared with sham (pretend) or placebo treatments. This means some of the benefit may come from the experience of being treated, not the acupuncture itself.
What patients expect can affect how much they say they improve, which is important in all studies that rely on self-reported pain. This makes it crucial to consider what comparison treatment was used when any study claims acupuncture helps, as usual-care groups - who typically receive less time and attention - are easiest to outperform.
Better options exist
Some people might say that any relief from lower back pain is worth celebrating or even paying for. But it's also important to think about whether safer and cheaper options are available.
The benefits of different mind-body treatments for lower back pain studied in Australia and the US are worth considering, as they appear to offer greater reductions in pain and disability without increasing costs or risks.
The Australian study showed much greater reductions in disability and pain (using the same outcome measures) through a rehabilitation programme delivered by physiotherapists that addressed both physical and psychological aspects of back pain. Even more importantly, the economic analysis revealed significant cost savings.
The US study involved teaching people that back pain comes from their brain being overprotective, rather than actual damage to their back. It used talk therapy techniques to help the participants think about and respond to pain differently. As with the Australian study, the US study also demonstrated much larger reductions in pain and disability than those seen with acupuncture - albeit using slightly different measures.
The fact that these holistic, mind-body rehabilitation programmes outperform acupuncture - and other relatively basic interventions such as massage and medication - reflects the emerging international consensus that comprehensive approaches help people manage their lower back pain.
Effective help for people with lower back pain exists; the challenge is ensuring healthcare professionals are properly trained to deliver these treatments, and that sufferers are aware of the available approaches.
Without accessible alternatives, people with lower back pain will understandably continue seeking treatments such as acupuncture which they know about, can access and provide some modest symptom relief. It is hard to fault them when alternatives that are both accessible and affordable are not available.
Kieran O'Sullivan receives funding from the EU (Erasmus+) and the Irish Government (Research Ireland) for research on low back pain. He also receives honoraria and expenses for speaking about low back pain at conferences. He is a co-author on one of the studies cited in this article.
