Fake acupuncture works nearly as well as the real thing for low back pain, and either kind performs much better than usual care, German researchers have found.
Almost half the patients treated with acupuncture needles felt relief that lasted months. In contrast, only about a quarter of the patients receiving medications and other Western medical treatments felt better.
Even fake acupuncture worked better than conventional care, leading researchers to wonder whether pain relief came from the body's reactions to any thin needle pricks or, possibly, the placebo effect.
"Acupuncture represents a highly promising and effective treatment option for chronic back pain," study co-author Dr. Heinz Endres of Ruhr University Bochum in Bochum, Germany, said in an e-mail. "Patients experienced not only reduced pain intensity, but also reported improvements in the disability that often results from back pain and, therefore, in their quality of life."
"I was pleasantly surprised because, even though I'm a spine surgeon, this gives us really the option to add a lot of things to our treatment regimen and our patients," Dr. Roger Hartl of New York Presbyterian Hospital-Weill Cornell Medical Center, who wasn't involved in the study, told co-anchor Harry Smith on The Early Show Tuesday. "We can offer them something that actually seems to work in addition to surgery, or instead of surgery, and I think that's very helpful."
"I only want to operate on patients who are actually going to do better after surgery," Hartl continued, "so, for me, the challenge is to figure out who is going to respond to surgery, and the truth is that about 80 percent of patients I see in the office will never need any type of surgery. So if I have the ability to offer them something that will work other than surgery, that's great. That helps me. That helps the patient."
Although the study wasn't designed to determine how acupuncture works, Endres said, its findings are in line with a theory that pain messages to the brain can be blocked by competing stimuli.
Positive expectations the patients held about acupuncture -- or negative expectations about conventional medicine -- also could have led to a placebo effect and explain the findings, he said.
In the largest experiment on acupuncture for back pain to date, more than 1,100 patients were randomly assigned to receive either acupuncture, sham acupuncture or conventional therapy. For the sham acupuncture, needles were inserted, but not as deeply as for the real thing. The sham acupuncture also didn't insert needles in traditional acupuncture points on the body, and the needles weren't manually moved and rotated.
After six months, patients answered questions about pain and functional ability and their scores determined how well each of the therapies worked.
In the real acupuncture group, 47 percent of patients improved. In the sham acupuncture group, 44 percent did. In the usual care group, 27 percent got relief.
"We don't understand the mechanisms of these so-called alternative treatments, but that doesn't mean they don't work," said Dr. James Young of Chicago's Rush University Medical Center, who wasn't involved in the research. Young often treats low back pain with acupuncture, combined with exercises and stretches.
Chinese medicine holds that there are hundreds of points on the body that link to invisible pathways for the body's vital energy, or qi. The theory goes that stimulating the correct points with acupuncture needles can release blocked qi.
Dr. Brian Berman, the University of Maryland's director of complementary medicine, said the real and the sham acupuncture may have worked for reasons that can be explained in Western terms: by changing the way the brain processes pain signals or by releasing natural painkillers in the body.
In the study, the conventional treatment included many methods: painkillers, injections, physical therapy, massage, heat therapy or other treatments. Like the acupuncture patients, the patients getting usual care received about 10 sessions of 30 minutes each.
The study, appearing in Monday's National Center for Complementary and Alternative Medicine. For more on acupuncture from the NCCAM, click here.
An acupuncture session can cost $45 to $100, Young said.