The use of electroacupuncture on patients with chronic lower back pain had no effect on pain levels compared to the use of a sham procedure, researchers found; however, the treatment did result in a greater reduction in back pain-specific disability.
Jiang-Ti Kong, MD, Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, and colleagues reported that to their knowledge, “this is the first study to demonstrate a statistically and clinically significant treatment effect of electroacupuncture on disability associated with chronic low back pain in a randomized clinical trial.” Their study was published in JAMA Network Open.
Chronic lower back pain is a leading cause of disability — In fact, according to a study by the U.S. Burden of Disease Collaborators, as of 2016 it was the fifth leading cause of disability-adjusted life-years, trailing only ischemic heart disease, lung cancer, COPD, and diabetes. It is also difficult to manage, with pharmacologic and surgical treatments associated with adverse effects such as opioid addiction or surgical complications.
Acupuncture has proven to be somewhat effective in treating chronic lower back pain, with response rates ranging from 40% to 60%. Thus, it has been suggested that electroacupuncture could lead to even better outcomes than manual acupuncture. However, the few clinical trials assessing electroacupuncture in lower back pain have had methodological limitations.
In this randomized clinical trial, Kong and colleagues assessed the effectiveness of electroacupuncture in treating chronic lower back pain while also attempting to identify factors associated with treatment response using change in pain reduction and disability as clinical outcomes.
The single-center, parallel-arm, randomized clinical trial compared real versus sham electroacupuncture in treating patients with chronic lower back pain. The 121 participants were adults ages 21-65 years who were fluent in English, had chronic lower back pain for at least 6 months, and had back pain intensity of at least 4 on a 0 to 10 numerical rating scale in the past month, and no radiculopathy. Of the 121 participants in the study, 59 were randomized to real electroacupuncture while the remaining 62 underwent the sham treatment twice a week over the course of six weeks.
The main outcome was the change in pain severity from baseline to 2 weeks after completion of treatment as measured by the National Institutes of Health PROMIS pain intensity scale, while a secondary outcome was the change in lower back pain-specific disability as measured by the Roland Morris Disability Questionnaire (RMDQ) score (ranging from 0 to 24, with 0 representing no disability).
At baseline, the mean PROMIS T-score was 50.49 in the real electroacupuncture group and 51.71 in the sham acupuncture group, while the mean RMDQ score was 10.16.
Kong and colleagues found that two weeks after treatment was completed there was no statistically significant difference between the two groups regarding the change in pain scores (real electroacupuncture: −4.33; 95% CI, −6.36 to −2.30; sham acupuncture: −2.90; 95% CI, −4.85 to −0.95; difference: −2.09; 95% CI, −4.27 to 0.09).
They did find, however, that there was a significantly greater reduction in the lower back pain-specific disability score in the real electroacupuncture group (−2.77; 95% CI, −4.11 to −1.43) compared with the sham electroacupuncture group (−0.67; 95% CI, −1.88 to 0.55; difference: −2.11; 95% CI, −3.75 to −0.47).
The researchers also assessed 14 prespecified potential factors associated with pain and disability outcomes, including demographic characteristics such as sex, age, and ethnicity, as well as factors such as efficacy in managing pain, pain threshold, and patient coping strategies. They found that there was an association between effective coping and greater RMDQ reduction, and between white race and less reduction in both pain and RMDQ.
“Our study… contributes to current knowledge on the patient factors associated with clinical response to electroacupuncture treatment,” Kong and colleagues wrote. “If validated, these findings may help match people to treatment. For example, low scores on the coping strategies questionnaire could identify individuals who may need psychological intervention alone or as an augmentation to electroacupuncture.”
Electroacupuncture had no effect on chronic lower back pain compared to the use of a placebo treatment.
Electroacupuncture did, however, result in statistically and clinically greater reduction in back pain-specific disability compared with a sham control.
Michael Bassett, Contributing Writer, BreakingMED™
Kong reported receiving grants from National Center for Complementary and Integrative Health during the conduct of the study.
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