The Back Pain Blog

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As reported in the U.S.News and published in the Archives of Internal Medicine, a study has been carried out using a group of 638 back pain sufferers and four different treatments;

• The first group received individualized acupuncture treatment from a practitioner,
• The second group received a ’standardized’ acupuncture regimen,
• The third group received a sham acupuncture treatment where toothpicks housed in needle guide tubes were used (so the participants could not visually recognize the difference),
• And the fourth group received only drugs typically taken for back pain.

The volunteers in the study received 10 treatments over a seven week period. None of the volunteers had previously received acupuncture for back pain and all were allowed to continue taking their regular medication which consisted mainly of anti-inflammatory drugs and pain relievers.

The Results.

Interestingly, a week after the last treatment about three-fifths of those receiving the acupuncture, both the ’sham’ treatment and ‘real’ treatment, reported significant improvement in disabilities brought on by their back pain, compared with only two-fifths of those not receiving any real or simulated acupuncture.

This tells us that acupuncture succeeds in reducing pain levels for a good percentage of people, but what about those receiving the ’sham’ treatment? Unlike the acupuncture needles, the toothpicks did not penetrate the skin which raises the question of  “the acupuncture’s purported mechanism of action”.

The study co-author Daniel Cherkin hypothesizes that if acupuncture has a physiological effect, the stimulation of certain points on the skin may result in the same nerve-related benefits or it could be the placebo effect in which a patient’s belief in the treatment induces improvements. Pain relief may even result from a combination of the two, he says.

My Thoughts.

If you have read any of my previous posts you would know that I am a great believer in acupuncture as a pain reliever, although I have not found it to have any great lasting effects beyond a day or two of pain-free bliss. When I had my first session of acupuncture I had no preconceived notions of what it could do for me, all I knew was it involved a lot of small needles and probably some pain! I have to say that after that first visit I was impressed, the pain relief was immediate and made life all that much more bearable.

So how do we explain a number of the volunteer’s receiving the ’sham’ treatment noticing ’significant improvement in disabilities brought on by back pain’? As stated above, I think there is only two possible causes – the subject’s knew enough about the desired outcome for the brain to take control of their pain levels or surface stimulation of the skin was enough in a number of people to provoke a nerve response resulting in a pain decrease (something similar to the feelings we can get from a light massage). Either way there is no ‘hard evidence’ here that says the traditional acupuncture methods don’t work.

To my way of thinking this study proves nothing other than if your acupuncturist is out of town you may be able to get some form of relief from the humble toothpick! I mean we could go on forever doubting the technique used by acupuncturist’s but could hundreds of years of Chinese generations have got it that wrong? I don’t think so and while it keeps on providing me with pain relief when things are really bad I’ll keep going back for more. Perhaps their time would have been better spent working on a cure for cancer or A.I.D.S., you know something actually useful.

Readers Thoughts.

I think this comment posted on U.S.News sums up the ‘misguided-ness’ ( a new word for the dictionary!) of the study;

The Facts

This study is not new. I have been reading these for years. As far as RCT’s are concerned this is actually a very good one given that it included a standard treatment branch as opposed to simply control and treatment. It is nice to see researchers getting out of their box. In the end however it is not possible to study such a dynamic animal as chronic pain and a holistic treatment approach that understands that the body and the mind are intimately connected.

Anyone who reads or posts to this article should have an understanding of how incredibly complex chronic pain is. We are not just speaking about pain. We are speaking about living with pain, losing work, changing the dynamics of the household when someone cannot fully contribute, possibly loss of income, loss of sleep and stress; which all have a psychological component that triggers very real chemical responses in the body that prevent healing. Being one of my specialties I could go on but the real controversy seems to center on the placebo effect and sham acupuncture.

The answer is quite simple. The sham acupuncture was not sham at all. The toothpicks touched the skin. The skin contains 3 afferent sensory nerves that signal the CNS as well as modulate the sympathetic and parasympathetic nervous system specifically the vagus nerve.

The toothpicks stimulated the cutaneous nerves to send a signal to the spinal cord activating the spinal neurons that secrete enkephalin and dynorphin that inhibit pain messages. Then the signal continues up to the midbrain and pituitary that activates the raphe descending pain-inhibitions system which secretes monoamines, serotonin and norepinephrine that further inhibits pain through a couple different mechanisms that gets quite complicated. If you are interested see Biomedical Acupuncture for Pain Management.

Additionally, once the sensations from the toothpicks reached the spinal cord several nerve pathways are excited that reaches the cerebral cortex which releases numerous neurochemicals that not only inhibit pain but also promotes homeostasis. Homeostasis is incredibly important because as I said before we are not just talking about pain. This is a human being whose thoughts and emotions influence their body and whose body in distress can influence their mind.

There are too many valid articles and scientific research to speak any further on this. Any one who does not believe in acupuncture can look up studies done with fMRI in which sham and placebos do not exist.

Lastly the term acupuncturist is a misnomer. Acupuncturists practice traditional Chinese medicine which incorporates other modalities such as herbal formulas, massage, tui-na, diet, exercise, lifestyle counseling, tai-chi, qi-gong etc. It is a complete system of medicine that with proper communication with other alternative practitioners and open minded Md’s strives to help people find health and balance in their lives.

Christopher Salah, DAOM., L.Ac.

In closing, have you tried acupuncture for pain relief? Did you find it gave you relief or where you disapointed in the results? Please share with us any thoughts you have on this subject (yes, toothpicks included!) .

Take Care,

Craig