Recent Research Roundup: Low Back Pain + Acupuncture
Acupuncture significantly helpful for low back and/or pelvic pain during pregnancy
This meta-analysis included 10 studies, reporting on a total of 1040 women. Overall, acupuncture significantly relieved pain during pregnancy. Acupuncture significantly improved pain, functional status and quality of life in women with LBPP during the pregnancy. Additionally, acupuncture had no observable severe adverse influences on the newborns. More large-scale and well-designed RCTs are still needed to further confirm these results.
Acupuncture provides safer benefits than drugs or surgery for back pain without nerve root pain (radiculopathy)
This was a registered systematic review of 17,362 records and meta-analysis of randomized controlled trials. The aim of this review was to compare the benefits and harms of treatments for the management of chronic low back pain without radiculopathy and to report the findings in a format that facilitates direct comparison. Interventions included non-pharmacological (acupuncture, spinal manipulation), pharmacological and invasive treatments compared to placebo.
“From the limited trials conducted, non-pharmacological interventions of acupuncture and spinal manipulation provide safer benefits than pharmacological or invasive interventions. However, more research is needed. There were high harms ratings for opioids and surgery.”
Which kind of acupuncture is most effective for chronic low back pain (cLBP)?
A Bayesian network meta-analysis investigated the available randomized control trials to try and identify which acupuncture protocol is the most effective for chronic aspecific low back pain (LBP). Efficacy was measured in terms of pain (Visual Analogic Scale, VAS) and disability (Roland Morris Disability Questionnaire, RMQ) to investigate the efficacy of acupuncture on different aspects of the patients’ overall quality of life.
Some studies looked at whether standard points used on all patients was effective, with and without TENS or electrostim, while others allowed individualized acupuncture treatments per the diagnosis of the acupuncturist using tradional methods of diagnosis and point selection. It turns out that either individualized acupuncture or the standard protocol with TENS may be the most effective acupuncture strategies for the management of aspecific cLBP. These two treatment protocols showed the highest improvements of VAS and RMQ. As verum (real) acupuncture scored better than sham (fake acupuncture) treatment, the present study points to the efficacy of acupuncture in the management of aspecific cLBP. This finding further supports current guidelines which recommend acupuncture as one of the possible first-line, non-pharmacological management modality for aspecific cLBP.
One study indicates, interestingly, that treatment duration of at least 5 weeks is required to achieve 80% of the maximum analgesic effect of acupuncture. This supports the standard recommendation of 4-6 acupuncture treatments for cLBP patients to determine if it will be effective, and the importance of continuation of regular treatment until maximum pain relief is achieved after the initial course since on average only 80% of maximum will be achieved by that time.