Authors of a study in Japan looking at acupuncture for spinal stenosis of the lumbar region, have concluded that it is more effective than either medication or physical exercise. A total of 109 patients with L5 root radiculopathy associated with lumbar spinal stenosis, visiting Iwai Orthopaedic Medical Hospital for surgical treatment, were assigned to receive either paracetamol (900mg three times a day), exercise therapy, or acupuncture (five sessions) over a period of four weeks. All groups were permitted to use additional non-steroidal anti-inflammatory drugs as required for pain control.
Symptom severity scores improved significantly in all three groups, but physical function scores improved only in the acupuncture group. Treatment satisfaction was significantly greater for the acupuncture group compared with the medication group.
(A comparative study of three conservative treatments in patients with lumbar spinal stenosis: lumbar spinal stenosis with acupuncture & physical therapy study (LAP study). BMC Complementary & Alternative Medicine, 19 January 2018.)
Clinicians in Berlin, Germany have shown that cupping for lower back pain, combined with analgesics, is more effective than analgesics alone. In the four week study they performed, 110 patients aged 18 to 65 were randomised to receive either eight sessions of cupping, plus paracetamol as required, or low suction cupping plus paracetamol as required, or paracetamol alone as required.
Compared with medication only, cupping plus paracetamol was a more effective treatment. At four weeks, both forms of cupping were comparable. However at twelve week follow-up, stronger cupping proved a superior option relative to controls. The researchers say that although the mechanism of cupping remains unclear, as it is a non-pharmacological and comparably safe therapy, it may be of use in clinical care independent of mechanisms.
(Pulsatile dry cupping in chronic low back pain – a randomized three-armed controlled clinical trial. BMC Complementary & Alternative Medicine, 2 April 2018.)
A small UK-New Zealand exploratory study suggests a trend of increased benefits after ten sessions of adjunctive acupuncture for lower back pain of a chronic nature. A total of 45 patients were randomly allocated to receive usual care plus either four, seven or ten acupuncture treatments. Outcome measures including back function, pain and disability, suggested that at the 12 week point, the 10 session group experienced most benefit. Over 90% of the study participants felt “very satisfied” &/or “extremely satisfied” with acupuncture treatment.
(Acupuncture for chronic low back pain: a randomized controlled feasibility trial comparing treatment session numbers. Clinical Rehabilitation, 1 April 2017.)
The American College of Physicians has developed a new guideline to present the evidence and provide clinical recommendations on non-invasive treatment of low back pain. The guideline is based on a systematic review of randomised, controlled trials and systematic reviews published up to April 2015, on non-invasive pharmacological and non-pharmacological treatments for lower back pain.
For chronic lower back pain, a strong recommendation is made to doctors and patients to initially try acupuncture among other treatments. Also recommended are exercise, tai chi and yoga.
(Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine, 4 April 2017.)
A systematic review by UK authors suggests that acupuncture represents a cost-effective and drug-free option for the treatment of lower back pain. Analysis of four studies showed that although acupuncture was associated with slightly increased costs, incremental cost-effectiveness ratios remained sufficiently low, and below the frequently used threshold value of £20 000 per quality-adjusted life year.
The National Institute for Health and Care Excellence (NICE) has selected this review for inclusion in NICE Evidence Search because it meets the definition of a reliable systematic review for this service.
(Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review. Applied Health Economics and Health Policy, 22 August 2016.)