Acupuncture for Bad Backs: Even Sham Therapy Works

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Anyone who has suffered from back pain knows that when the throbbing gets bad enough, you'll try anything to find relief — heating pads, acupuncture, pain relievers, physical therapy, even poking yourself with toothpicks.


Yes, toothpicks. Researchers at the Group Health Center for Health Studies in Seattle found that "fake" acupuncture using toothpicks instead of needles was as effective as the traditional Chinese healing method for relieving back pain. (See pictures of spiritual healing around the world.)

Daniel Cherkin, a senior investigator at the center, gathered 638 patients with chronic low back pain, none of whom had ever had acupuncture, and gave them one of three different acupuncture treatments. One group received individual care in the classic model of the ancient Chinese practice in which the acupuncturist analyzes the patient's overall health by studying his body and lifestyle, taking his pulse and looking at his tongue (practitioners believe that the condition of a person's tongue is indicative of his total health state) and designs a customized set of acupuncture points that are most likely to relieve pain.

Another group received acupuncture at standardized points, which experienced practitioners agree can help the majority of back-pain sufferers. A final group received the toothpick treatment. These patients were poked with toothpicks inserted through the acupuncture needle tube at the standard points — but unlike with traditional acupuncture, practitioners did not penetrate the patient's skin. Instead, they pricked and then twirled the toothpick to simulate a needle going in.

None of the patients in any of the groups knew which treatment they were receiving; all were blindfolded and lay face down with their head in a face cradle when the treatments were given. Each patient received 10 treatments over seven weeks. A control group of similar back-pain patients were told to continue doing whatever it was they did to relieve their pain, whether it was taking over-the-counter pain relievers or using massage or chiropractic services. The acupuncture patients were also allowed to continue using pain relievers if they were already taking them. (Read about the top 10 medical breakthroughs of 2008.)

Cherkin and his team followed up with the patients at eight weeks, 26 weeks and a year after their sessions to find out how much pain they were experiencing. After eight weeks, twice the number of patients getting any type of acupuncture — whether it was customized, standard or sham — reported improvements in their ability to function, such as walking or going up and down steps without pain, compared with those sticking with traditional care. That improvement was expected, to a certain extent, since physicians are increasingly aware that acupuncture does have physiological effects on the body. "There is a lot of data now that acupuncture can have an effect on the nervous system, and that the nervous system then has effects on other systems in the body," says Dr. Richard Nahin, acting director of the division of extramural research at the National Institutes of Health's National Center for Complementary and Alternative Medicine.

More surprising was the fact that all three acupuncture services, including the sham version with toothpicks, had about the same effect on pain reduction. It's worth remembering that the toothpicks were used at the same points involved in the standard acupuncture treatment — that is, practitioners were not pricking their patients at random. A year after the treatments, all of the acupuncture patients reported an average 63% improvement in pain relief, while half of the untreated patients reported feeling better. "Everyone agrees that acupuncture is having some physiological effect. But we still don't understand how it might be working," says Nahin.

Cherkin's findings raise at least two possible explanations. Since the sham procedure used the same acupuncture points as the legitimate therapy, there may be something about the stimulation of those points, even without skin penetration, that triggers a beneficial physiological reaction in the body and the nervous system, leading to pain relief. (This may be the mechanism behind acupressure, which involves pressing certain points on the body to alter physiological processes occurring deep inside organs.) Or the patients' improvement may be due simply to a powerful placebo effect, in which the mere belief that you are receiving a new pain-relieving treatment leads to actual reduction of symptoms. "What is it about the therapeutic experience that really helps people? This study raises the question that if there are pathways to relief that work more through mind than through the body, why should it matter from the perspective of patients?" says Cherkin.

That's especially salient considering that the acupuncture groups in Cherkin's study experienced relief much faster than the non-acupuncture group. At eight weeks, 60% of the acupuncture patients reported improved symptoms, compared with 40% of the untreated group. At the end of a year, the same percentage of treated patients still experienced relief, while 50% of the untreated group experienced improved symptoms. (See pictures of holistic healing.)

Since most back patients seek help when they're experiencing extreme pain, fast-acting acupuncture may be a reasonable option for them. A year ago, experts at the American College of Physicians and the American Pain Society sanctioned it when they included acupuncture in their recommended treatments for back-pain sufferers. "This study is consistent with those recommendations that if pain relievers aren't helping you, then acupuncture is a reasonable choice," says Nahin.

And while these results suggest that you might not even need the full-fledged needle-penetrating version to find relief, no physician is quite ready to recommend pricking yourself with toothpicks. "Further studies are going to have to tease out the relative magnitude of the placebo effect from the physiological effects of acupuncture," says Nahin. "But for patients, what the study tells you is that if you are having pain that is not being well managed by standard care, then acupuncture is a viable option for you."

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