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Author (up) Cameron, I. D.; Wang, E.; Sindhusake, D. url  openurl
  Title A randomized trial comparing acupuncture and simulated acupuncture for subacute and chronic whiplash Type of Study RCT
  Year 2011 Publication Spine Abbreviated Journal Spine (Phila Pa 1976)  
  Volume 36 Issue 26 Pages E1659-65  
  Keywords AcuTrials; RCT; Wounds and Injuries; Whiplash Injuries; Acu Versus Sham; Electroacupuncture; Fixed Acupuncture Protocol; Restricted Modalities, Acupuncture Only; Sham Control; Penetrating Sham; Standard Needling Depth; Near Verum Acupoint Control; Sham Electroacupuncture  
  Abstract STUDY DESIGN: A randomized controlled trial with 3 and 6 months follow-up. OBJECTIVE: To compare the effectiveness of acupuncture with simulated acupuncture in patients with subacute and chronic whiplash-associated disorders. SUMMARY OF BACKGROUND DATA: Acupuncture is widely used for the treatment of neck and other musculoskeletal pain, and there is some evidence supporting its effectiveness for short-term pain relief. The effectiveness of acupuncture in the treatment of whiplash-associated disorders is not clear. METHODS: A total of 124 patients between 18 and 65 years with chronic (85%) or subacute whiplash-associated disorders (Grade I or II) were randomly allocated to real or simulated electroacupuncture treatment for 12 sessions during a 6-week period. Both treatments involved skin penetration with acupuncture needles and were provided by a single university-trained acupuncturist in a University Clinic in Sydney, Australia. Primary outcome measures were pain intensity (10-cm visual analog scale), disability (Neck Disability Index), and health-related quality of life (SF-36). Secondary outcomes were patient-specific activity scales, and the McGill Pain Rating Index. RESULTS: Mean initial pain intensity for all participants was 5.6 cm. Participants receiving the real electroacupuncture treatment had significantly greater reduction in pain intensity at 3 and 6 months, 0.9 cm (P = 0.05) and 1.3 cm (P = 0.007), respectively, in comparison to the sham electro-acupuncture group. After adjustment for baseline status, there was no significant reduction in disability, or improvement in health-related quality of life. There was an improvement in the activity scales of a similar size to the reduction in pain, but no difference in the McGill Index. CONCLUSION: Real electroacupuncture was associated with a significant reduction in pain intensity over at least 6 months. This reduction was probably not clinically significant. There was no improvement in disability or quality of life.  
  Address Rehabilitation Studies Unit, Sydney Medical School, University of Sydney, New South Wales, Australia. ian.cameron@sydney.edu.au  
  Publisher
  Language Number of Treatments 12  
  Treatment Follow-up N/A Frequency >1/WK Number of Participants 124  
  Time in Treatment 6 Weeks Condition Whiplash Injuries
  Disease Category Wounds and Injuries OCSI Score  
  Notes Approved no  
  Call Number Serial 105  
Permanent link to this record
 

 
Author (up) Cho, Y. J.; Song, Y. K.; Cha, Y. Y.; Shin, B. C.; Shin, I. H.; Park, H. J.; Lee, H. S.; Kim, K. W.; Cho, J. H.; Chung, W. S.; Lee, J. H.; Song, M. Y. url  doi
openurl 
  Title Acupuncture for Chronic Low Back Pain: A Multicenter, Randomized, Patient-Assessor Blind, Sham-Controlled Clinical Trial Type of Study RCT
  Year 2013 Publication Spine Abbreviated Journal Spine  
  Volume 38 Issue 7 Pages 549-557  
  Keywords AcuTrials; RCT; Pain; Back Pain; Low Back Pain; Low Back Pain, Chronic; Acu + Usual Care Versus Sham + Usual Care; Acupuncture; TCM Acupuncture Style; Semi-Individualized Acupuncture Protocol; Traditional Diagnosis Based Point Selection; Sham Control; Non Penetrating Sham, Mechanical; Sham Acupoint Control; Restricted Modalities, Acupuncture Only  
  Abstract ABSTRACT: Study Design. Multicenter, Randomized, Patient-Assessor Blind, Sham-Controlled Clinical Trial.Objective. To investigate the efficacy of acupuncture treatment with individualized setting for reduction of bothersomeness in participants with chronic low back pain (cLBP).Summary of Background Data. Low back pain is one of the main reasons of disability among adults of working age. Acupuncture is known as an effective treatment for chronic low back pain, but it remains still unclear whether acupuncture is superior to placebo.Methods. One hundred thirty adults aged 18-65 with non-specific LBP of lasting for at least the last 3 months was participated in the three Korean medical hospitals in Korea. Participants got individualized real acupuncture treatments or sham acupuncture treatments over 6 weeks (twice a week) from Korean medicine doctors. Primary outcome was change of Visual Analogue Scale (VAS) score for bothersomeness of cLBP. Secondary outcomes included VAS for pain intensity and questionnaires including Oswestry disability index (ODI), General health status (SF-36), and Beck's depression inventory (BDI).Results. There were no baseline differences observed between two groups except ODI. One hundred sixteen participants finished the treatments and 3-, 6-month follow ups with fourteen subjects' drop-out. Significant difference of VAS for bothersomeness and pain intensity of cLBP have been found between two groups (p<0.05) at the primary end point (8 week). In addition, those two scores have been improved continuously until 3-month follow up (p = 0.011, p = 0.005, respectively). ODI, BDI and SF-36 scores were also improved in both groups without group difference.Conclusion. This randomized sham-controlled trial suggests that acupuncture treatment show the better effects on the reduction of the bothersomeness and pain intensity than sham-control in participants with cLBP.  
  Address 1Department of Oriental Rehabilitation Medicine, Kyung Hee University, Seoul, Korea 2Department of Oriental Rehabilitation Medicine, Kyung Won University, Sungnam, Korea 3Department of Oriental Rehabilitation Medicine, Sang Ji University, Wonju, Kore  
  Publisher
  Language Number of Treatments 12  
  Treatment Follow-up 24 Weeks Frequency >1/WK Number of Participants 130  
  Time in Treatment 6 Weeks Condition Low Back Pain, Chronic
  Disease Category Back Pain OCSI Score  
  Notes Approved no  
  Call Number Serial 180  
Permanent link to this record
 

 
Author (up) Eisenberg, D. M.; Post, D. E.; Davis, R. B.; Connelly, M. T.; Legedza, A. T.; Hrbek, A. L.; Prosser, L. A.; Buring, J. E.; Inui, T. S.; Cherkin, D. C. url  openurl
  Title Addition of choice of complementary therapies to usual care for acute low back pain: a randomized controlled trial Type of Study RCT
  Year 2007 Publication Spine Abbreviated Journal Spine  
  Volume 32 Issue 2 Pages 151-158  
  Keywords CAM Control; Acu Versus > 1 Control; Acupuncture; Low Back Pain, Acute; AcuTrials; Chiropractic; Cost Effectiveness; Low Back Pain; Massage; Pain; RCT; Usual Care Control, Unspecified  
  Abstract STUDY DESIGN: A randomized controlled trial. OBJECTIVE: To investigate the effectiveness and cost of usual care plus patient choice of acupuncture, chiropractic, or massage therapy (choice) compared with usual care alone in patients with acute low back pain (LBP). SUMMARY OF BACKGROUND DATA: Few studies have evaluated care models with facilitated access to and financial coverage for adjunctive complementary and alternative medicine therapies. METHODS: A total of 444 patients with acute LBP (<21 days) were recruited from 4 clinical sites and randomized into 2 groups: usual care or choice. Outcomes included symptoms (bothersomeness), functional status (Roland), and satisfaction between baseline and 5 weeks, and cost of medical care in the 12 weeks after randomization. RESULTS: After 5 weeks, providing patients with a choice did not yield clinically important reductions in symptoms (median -4, [interquartile range -7, -2] for usual care, and -5 [-7, -3] for choice; P = 0.002) or improvements in functional status (-8 [-13, -2] for usual care, and -9 [-15, -4] for choice; P = 0.15). Although there was a significantly greater satisfaction with care in the choice group, this came at a net increase in costs of 244 dollars per patient. This consisted of a 99 dollars reduction in the average cost to the insurer for medical care but an additional cost of 343 dollars, for an average of 6.0 complementary and alternative medicine treatments per patient. CONCLUSIONS: A model of care that offered access to a choice of complementary and alternative medicine therapies for acute LBP did not result in clinically significant improvements in symptom relief or functional restoration. This model was associated with greater patient satisfaction but increased total costs. Future evaluations of this choice model should focus on patients with chronic conditions (including chronic back pain) for which conventional medical care is often costly and of limited benefit  
  Address Division for Research and Education in Complementary and Integrative Medical Therapies, Osher Institute, Harvard Medical School, Boston, MA 02215, USA. david_eisenberg@hms.harvard.edu  
  Publisher
  Language Number of Treatments  
  Treatment Follow-up 5 Weeks Frequency N/A Number of Participants 444  
  Time in Treatment 5 Weeks Condition Low Back Pain, Acute
  Disease Category Back Pain OCSI Score  
  Notes Approved no  
  Call Number Serial 280  
Permanent link to this record
 

 
Author (up) Furlan, A. D.; van Tulder, M.; Cherkin, D.; Tsukayama, H.; Lao, L.; Koes, B.; Berman, B. url  openurl
  Title Acupuncture and dry-needling for low back pain: an updated systematic review within the framework of the cochrane collaboration Type of Study Systematic Review
  Year 2005 Publication Spine Abbreviated Journal Spine  
  Volume 30 Issue 8 Pages 944-963  
  Keywords Acupuncture; AcuTrials; Back Pain; Low Back Pain; Meta-Analysis; Pain; Systematic Review; Dry Needling  
  Abstract OBJECTIVES: To assess the effects of acupuncture and dry-needling for the treatment of nonspecific low back pain. BACKGROUND: Low back pain is usually a self-limiting condition that tends to improve spontaneously over time. However, for many people, back pain becomes a chronic or recurrent problem for which a large variety of therapeutic interventions are employed. SEARCH STRATEGY: We updated the searches from 1996 to February 2003 in CENTRAL, MEDLINE, and EMBASE. We also searched the Chinese Cochrane Centre database of clinical trials and Japanese databases to February 2003. SELECTION CRITERIA: Randomized controlled trials of acupuncture (that involved needling) or dry-needling for adults with nonspecific acute/subacute or chronic low back pain. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed methodologic quality (using the criteria recommended by the Cochrane Back Review Group) and extracted data. The trials were combined using meta-analysis methods or levels of evidence when the data reported did not allow statistical pooling. RESULTS: Thirty-five randomized clinical trials were included: 20 were published in English, 7 in Japanese, 5 in Chinese, and 1 each in Norwegian, Polish, and German. There were only 3 trials of acupuncture for acute low back pain. These studies did not justify firm conclusions because of their small sample sizes and low methodologic quality. For chronic low back pain, there is evidence of pain relief and functional improvement for acupuncture compared to no treatment or sham therapy. These effects were only observed immediately after the end of the sessions and in short-term follow-up. There is also evidence that acupuncture, added to other conventional therapies, relieves pain and improves function better than the conventional therapies alone. However, the effects are only small. Dry-needling appears to be a useful adjunct to other therapies for chronic low back pain. No clear recommendations could be made about the most effective acupuncture technique. CONCLUSIONS: The data do not allow firm conclusions regarding the effectiveness of acupuncture for acute low back pain. For chronic low back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and “alternative” treatments. The data suggest that acupuncture and dry-needling may be useful adjuncts to other therapies for chronic low back pain. Because most of the studies were of lower methodologic quality, there is a clear need for higher quality trials in this area  
  Address Institute for Work & Health, Toronto, Ontario, Canada. afurlan@iwh.on.ca  
  Publisher
  Language Number of Treatments  
  Treatment Follow-up N/A Frequency N/A Number of Participants  
  Time in Treatment N/A Condition Low Back Pain
  Disease Category Back Pain OCSI Score  
  Notes Approved no  
  Call Number Serial 351  
Permanent link to this record
 

 
Author (up) Garvey, T. A.; Marks, M. R.; Wiesel, S. W. url  openurl
  Title A prospective, randomized, double-blind evaluation of trigger-point injection therapy for low-back pain Type of Study RCT
  Year 1989 Publication Spine Abbreviated Journal Spine (Phila Pa 1976)  
  Volume 14 Issue 9 Pages 962-964  
  Keywords RCT; AcuTrials; Back Pain; Low Back Pain, Acute; Acu Versus > 1 Control; Acupuncture; Acupressure; Trigger Point Acupuncture Style; Symptom Based Point Selection; Restricted Modalities, Acupuncture Only; Usual Care Control, Pharmaceutical; Pain; CAM Control; Individualized Acupuncture Protocol  
  Abstract The efficacy of trigger-point injection therapy in treatment of low-back strain was evaluated in a prospective, randomized, double-blind study. The patient population consisted of 63 individuals with low-back strain. Patients with this diagnosis had nonradiating low-back pain, normal neurologic examination, absence of tension signs, and lumbosacral roentgenograms interpreted as being within normal limits. They were treated conservatively for 4 weeks before entering the study. Injection therapy was of four different types: lidocaine, lidocaine combined with a steroid, acupuncture, and vapocoolant spray with acupressure. Results indicated that therapy without injected medication (63% improvement rate) was at least as effective as therapy with drug injection (42% improvement rate), at a P value of 0.09. Trigger-point therapy seems to be a useful adjunct in treatment of low-back strain. The injected substance apparently is not the critical factor, since direct mechanical stimulus to the trigger-point seems to give symptomatic relief equal to that of treatment with various types of injected medication.  
  Address Department of Orthopaedic Surgery, George Washington University Medical Center, Washington, D.C.  
  Publisher
  Language Number of Treatments 1  
  Treatment Follow-up 2 Weeks Frequency N/A Number of Participants 63  
  Time in Treatment 1 Day Condition Low Back Pain, Acute
  Disease Category Back Pain OCSI Score  
  Notes Approved no  
  Call Number Serial 365  
Permanent link to this record
 

 
Author (up) Giles, L. G.; Muller, R. url  openurl
  Title Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation Type of Study RCT
  Year 2003 Publication Spine Abbreviated Journal Spine  
  Volume 28 Issue 14 Pages 1490-1502  
  Keywords CAM Control; Acu Versus > 1 Control; Acupuncture; AcuTrials; Ashi Acupuncture Style; Back Pain; Chiropractic; Individualized Acupuncture Protocol; Neck Pain; RCT; Restricted Modalities, Acupuncture Only; Spinal Manipulation; Usual Care Control, Pharmaceutical; Symptom Based Point Selection; TCM Acupuncture Style; Back Pain, Chronic; Pain  
  Abstract STUDY DESIGN A randomized controlled clinical trial was conducted.OBJECTIVE To compare medication, needle acupuncture, and spinal manipulation for managing chronic (>13 weeks duration) spinal pain because the value of medicinal and popular forms of alternative care for chronic spinal pain syndromes is uncertain.SUMMARY OF BACKGROUND DATA Between February 1999 and October 2001, 115 patients without contraindication for the three treatment regimens were enrolled at the public hospital's multidisciplinary spinal pain unit.METHODS One of three separate intervention protocols was used: medication, needle acupuncture, or chiropractic spinal manipulation. Patients were assessed before treatment by a sports medical physician for exclusion criteria and by a research assistant using the Oswestry Back Pain Disability Index (Oswestry), the Neck Disability Index (NDI), the Short-Form-36 Health Survey questionnaire (SF-36), visual analog scales (VAS) of pain intensity and ranges of movement. These instruments were administered again at 2, 5, and 9 weeks after the beginning of treatment.RESULTS Randomization proved to be successful. The highest proportion of early (asymptomatic status) recovery was found for manipulation (27.3%), followed by acupuncture (9.4%) and medication (5%). Manipulation achieved the best overall results, with improvements of 50% (P = 0.01) on the Oswestry scale, 38% (P = 0.08) on the NDI, 47% (P < 0.001) on the SF-36, and 50% (P < 0.01) on the VAS for back pain, 38% (P < 0.001) for lumbar standing flexion, 20% (P < 0.001) for lumbar sitting flexion, 25% (P = 0.1) for cervical sitting flexion, and 18% (P = 0.02) for cervical sitting extension. However, on the VAS for neck pain, acupuncture showed a better result than manipulation (50% vs 42%).CONCLUSIONS The consistency of the results provides, despite some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication. However, the data do not strongly support the use of only manipulation, only acupuncture, or only nonsteroidal antiinflammatory drugs for the treatment of chronic spinal pain. The results from this exploratory study need confirmation from future larger studies  
  Address *National Unit for Multidisciplinary Studies of Spinal Pain, The University of Queensland, The Townsville Hospital, Townsville, Queensland, and the dagger School of Public Health and Tropical Medicine, James Cook University, Townsville, Queensland, A  
  Publisher
  Language Number of Treatments 18  
  Treatment Follow-up N/A Frequency >1/WK Number of Participants 115  
  Time in Treatment 9 Weeks Condition Back Pain, Chronic
  Disease Category Back Pain OCSI Score 84  
  Notes Approved no  
  Call Number Serial 382  
Permanent link to this record
 

 
Author (up) Gunn, C. C.; Milbrandt, W. E.; Little, A. S.; Mason, K. E. url  openurl
  Title Dry needling of muscle motor points for chronic low-back pain: a randomized clinical trial with long-term follow-up Type of Study RCT
  Year 1980 Publication Spine Abbreviated Journal Spine  
  Volume 5 Issue 3 Pages 279-291  
  Keywords Acu + Usual Care Versus Usual Care; Acupuncture; AcuTrials; Back Pain; Low Back Pain, Chronic; Dry Needling, With Acupuncture Needle; Electroacupuncture; Low Back Pain; Pain; RCT; Restricted Modalities, Acupuncture + Other; Usual Care Control, Multimodality; Trigger Point Acupuncture Style; Individualized Acupuncture Protocol; Symptom Based Point Selection  
  Abstract  
  Address  
  Publisher
  Language Number of Treatments 8  
  Treatment Follow-up 27 Weeks Frequency >1/WK Number of Participants 56  
  Time in Treatment 12 Weeks Condition Low Back Pain, Chronic
  Disease Category Back Pain OCSI Score  
  Notes Approved no  
  Call Number Serial 401  
Permanent link to this record
 

 
Author (up) Johnston, B. C.; da Costa, B. R.; Devereaux, P. J.; Akl, E. A.; Busse, J. W. url  openurl
  Title The use of expertise-based randomized controlled trials to assess spinal manipulation and acupuncture for low back pain: a systematic review Type of Study Systematic Review
  Year 2008 Publication Spine Abbreviated Journal Spine  
  Volume 33 Issue 8 Pages 914-918  
  Keywords Acupuncture; AcuTrials; Chiropractic; Low Back Pain; Pain; Spinal Manipulation; Systematic Review; Back Pain; RCT  
  Abstract STUDY DESIGN: Systematic review. OBJECTIVE: To assess current use of expertise-based randomization in trials of acupuncture or spinal manipulation for low back pain. SUMMARY OF BACKGROUND DATA: The randomized clinical trial is often referred to as the gold standard for providing evidence to guide therapeutic decisions. Random allocation of participants to intervention and control groups theoretically should balance these groups for both known and unknown prognostic factors; however, when randomizing patients to competing interventions in which the clinician's skill is a central aspect of the intervention, (e.g., surgery, chiropractic, rehabilitation) a differential expertise bias may exist if a majority of clinicians participating have greater expertise in 1 of the 2 interventions under evaluation. Randomizing patients to therapists experienced in the interventions under investigation can overcome this bias. METHODS: We systematically identified relevant randomized controlled trials published up to December 2005. Two independent reviewers extracted data in duplicate using a standardized form. RESULTS: Of 12 eligible trials, none made use of an expertise-based randomized trial design. CONCLUSION: Investigators designing acupuncture or spinal manipulation trials in which 2 or more active therapies are compared should consider expertise-based randomization to increase the validity and feasibility of their efforts  
  Address Department of Medicine, University of Alberta, Edmonton, Alberta, Canada  
  Publisher
  Language Number of Treatments  
  Treatment Follow-up N/A Frequency N/A Number of Participants  
  Time in Treatment N/A Condition Low Back Pain
  Disease Category Back Pain OCSI Score  
  Notes Approved no  
  Call Number Serial 536  
Permanent link to this record
 

 
Author (up) Keller, A.; Hayden, J.; Bombardier, C.; van, Tulder M. url  openurl
  Title Effect sizes of non-surgical treatments of non-specific low-back pain Type of Study Systematic Review
  Year 2007 Publication European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society Abbreviated Journal Eur Spine J  
  Volume Issue Pages -  
  Keywords Acupuncture; Low Back Pain, Acute; AcuTrials; Low Back Pain, Chronic; Exercise; Exercise Therapy; Low Back Pain; Pain; Systematic Review; TENS; Transcutaneous Electric Nerve Stimulation; Back Pain  
  Abstract Numerous randomized trials have been published investigating the effectiveness of treatments for non-specific low-back pain (LBP) either by trials comparing interventions with a no-treatment group or comparing different interventions. In trials comparing two interventions, often no differences are found and it raises questions about the basic benefit of each treatment. To estimate the effect sizes of treatments for non-specific LBP compared to no-treatment comparison groups, we searched for randomized controlled trials from systematic reviews of treatment of non-specific LBP in the latest issue of the Cochrane Library, issue 2, 2005 and available databases until December 2005. Extracted data were effect sizes estimated as Standardized Mean Differences (SMD) and Relative Risk (RR) or data enabling calculation of effect sizes. For acute LBP, the effect size of non-steroidal anti-inflammatory drugs (NSAIDs) and manipulation were only modest (ES: 0.51 and 0.40, respectively) and there was no effect of exercise (ES: 0.07). For chronic LBP, acupuncture, behavioral therapy, exercise therapy, and NSAIDs had the largest effect sizes (SMD: 0.61, 0.57, and 0.52, and RR: 0.61, respectively), all with only a modest effect. Transcutaneous electric nerve stimulation and manipulation had small effect sizes (SMD: 0.22 and 0.35, respectively). As a conclusion, the effect of treatments for LBP is only small to moderate. Therefore, there is a dire need for developing more effective interventions  
  Address Department of Physical Medicine and Rehabilitation, Ulleval University Hospital, Kirkeveien 166, 0407, Oslo, Norway  
  Publisher
  Language Number of Treatments  
  Treatment Follow-up Frequency Number of Participants  
  Time in Treatment Condition Low Back Pain
  Disease Category Back Pain OCSI Score  
  Notes Approved no  
  Call Number Serial 560  
Permanent link to this record
 

 
Author (up) Lam, M.; Galvin, R.; Curry, P. url  doi
openurl 
  Title Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis Type of Study Systematic Review
  Year 2013 Publication Spine Abbreviated Journal Spine (Phila Pa 1976)  
  Volume 38 Issue 24 Pages 2124-2138  
  Keywords AcuTrials; Systematic Review; Back Pain; Low Back Pain, Chronic; Musculoskeletal Diseases; Acupuncture  
  Abstract STUDY DESIGN: A systematic review and meta-analysis of randomized controlled trials (RCTs). OBJECTIVE: To evaluate the totality of evidence in relation to the effectiveness of acupuncture for nonspecific chronic low back pain (NSCLBP). SUMMARY OF BACKGROUND DATA: Acupuncture has become a popular alternative for treating clinical symptoms of NSCLBP. A number of RCTs have examined the effectiveness of acupuncture in the treatment of NSCLBP. METHODS: A systematic literature search was completed without date or language restrictions up to May 2012. Studies included in the review were RCTs that examined all forms of acupuncture that adhered to the Traditional Acupuncture Theory for treating NSCLBP. Outcome measures included impairment, activity limitation, and participation restriction. The methodological quality of the studies was examined using the Cochrane risk of bias tool. RESULTS: Thirty-two studies were included in the systematic review, of which 25 studies presented relevant data for the meta-analysis. Acupuncture had a clinically meaningful reduction in levels of self-reported pain (mean difference =-16.76 [95% confidence interval, -33.33 to -0.19], P = 0.05, I squared = 90%) when compared with sham, and improved function (standard mean difference =-0.94 [95% confidence interval, -1.41 to -0.47], P < 0.00, I squared = 78%) when compared with no treatment immediately postintervention. Levels of function also clinically improved when acupuncture in addition to usual care, or electroacupuncture was compared with usual care alone. When acupuncture was compared with medications (NSAIDs, muscle relaxants, and analgesics) and usual care, there were statistically significant differences between the control and the intervention groups but these differences were too small to be of any clinical significance. There was no evidence in support of acupuncture over transcutaneous electrical nerve stimulation. CONCLUSION: This systematic review demonstrates that acupuncture may have a favorable effect on self-reported pain and functional limitations on NSCLBP. However, the results should be interpreted in the context of the limitations identified, particularly in relation to the heterogeneity in the study characteristics and the low methodological quality in many of the included studies. Level of Evidence: 1.  
  Address Department of School of Social Work & Social Policy, Trinity College Dublin, Dublin, Republic of Ireland; and School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland.  
  Publisher
  Language Number of Treatments  
  Treatment Follow-up Frequency Number of Participants  
  Time in Treatment Condition Low Back Pain, Chronic
  Disease Category Back Pain OCSI Score  
  Notes Approved no  
  Call Number Serial 619  
Permanent link to this record
 

 
Author (up) Rubinstein, S. M.; van Middelkoop, M.; Kuijpers, T.; Ostelo, R.; Verhagen, A. P.; de Boer, M. R.; Koes, B. W.; van Tulder, M. W. url  openurl
  Title A systematic review on the effectiveness of complementary and alternative medicine for chronic non-specific low-back pain Type of Study Systematic Review
  Year 2010 Publication European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society Abbreviated Journal Eur Spine J  
  Volume 19 Issue 8 Pages 1213-1228  
  Keywords AcuTrials; Systematic Review; Back Pain; Low Back Pain, Chronic;  
  Abstract The purpose of this systematic review was to assess the effects of spinal manipulative therapy (SMT), acupuncture and herbal medicine for chronic non-specific LBP. A comprehensive search was conducted by an experienced librarian from the Cochrane Back Review Group (CBRG) in multiple databases up to December 22, 2008. Randomised controlled trials (RCTs) of adults with chronic non-specific LBP, which evaluated at least one clinically relevant, patient-centred outcome measure were included. Two authors working independently from one another assessed the risk of bias using the criteria recommended by the CBRG and extracted the data. The data were pooled when clinically homogeneous and statistically possible or were otherwise qualitatively described. GRADE was used to determine the quality of the evidence. In total, 35 RCTs (8 SMT, 20 acupuncture, 7 herbal medicine), which examined 8,298 patients, fulfilled the inclusion criteria. Approximately half of these (2 SMT, 8 acupuncture, 7 herbal medicine) were thought to have a low risk of bias. In general, the pooled effects for the studied interventions demonstrated short-term relief or improvement only. The lack of studies with a low-risk of bias, especially in regard to SMT precludes any strong conclusions; however, the principal findings, which are based upon low- to very-low-quality evidence, suggest that SMT does not provide a more clinically beneficial effect compared with sham, passive modalities or any other intervention for treatment of chronic low-back pain. There is evidence, however, that acupuncture provides a short-term clinically relevant effect when compared with a waiting list control or when acupuncture is added to another intervention. Although there are some good results for individual herbal medicines in short-term individual trials, the lack of homogeneity across studies did not allow for a pooled estimate of the effect. In general, these results are in agreement with other recent systematic reviews on SMT, but in contrast with others. These results are also in agreement with recent reviews on acupuncture and herbal medicine. Randomized trials with a low risk of bias and adequate sample sizes are directly needed.  
  Address Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. SM.Rubinstein@vumc.nl  
  Publisher
  Language Number of Treatments  
  Treatment Follow-up N/A Frequency N/A Number of Participants  
  Time in Treatment N/A Condition Low Back Pain, Chronic
  Disease Category Back Pain OCSI Score  
  Notes Approved no  
  Call Number Serial 1004  
Permanent link to this record
 

 
Author (up) Sherman, K. J.; Cherkin, D. C.; Ichikawa, L.; Avins, A. L.; Delaney, K.; Barlow, W. E.; Khalsa, P. S.; Deyo, R. A. url  openurl
  Title Treatment expectations and preferences as predictors of outcome of acupuncture for chronic back pain Type of Study RCT
  Year 2010 Publication Spine Abbreviated Journal Spine (Phila Pa 1976)  
  Volume 35 Issue 15 Pages 1471-1477  
  Keywords AcuTrials; RCT; Back Pain; Low Back Pain, Chronic; Pain; Acu Versus > 1 Control; Acu Versus CAM Control; Acu Versus Acu; Acupuncture; TCM Acupuncture Style; Individualized Acupuncture Protocol; Traditional Diagnosis Based Point Selection; Fixed Acupuncture Protocol; Restricted Modalities, Acupuncture Only; Sham Control; Non Penetrating Sham, Mechanical; Verum Acupoint Control; CAM Control; Usual Care Control, Unspecified; Treatment Expectations;  
  Abstract STUDY DESIGN: Preplanned secondary analysis of data from participants receiving acupuncture in a randomized clinical trial. OBJECTIVE: To determine whether patients' expectations of and preferences for acupuncture predict short and long-term treatment outcomes for persons with chronic back pain. SUMMARY OF BACKGROUND DATA: Although accumulating evidence suggests that patient expectations and treatment preferences may predict treatment outcomes, few studies have examined this relationship for acupuncture. METHODS: Four hundred seventy-seven acupuncture-naive participants with chronic low back pain who were randomized to 1 of 3 acupuncture or simulated acupuncture treatments were the focus of this analysis. Ten treatments were provided during a 7-week period, and participants were masked to treatment assignment. Before randomization, participants provided expectations regarding treatment success, impressions, and knowledge about acupuncture and treatment preferences. Outcomes of interest were functional status (Roland score) and symptom bothersomeness at 8 and 52 weeks postrandomization, obtained by telephone interviewers masked to treatment assignment. RESULTS: Persons with high pretreatment expectations for the success of acupuncture were more likely to report greater general expectations for improvement, a preference for acupuncture, having heard acupuncture was a very effective treatment and having a very or moderately positive impression of acupuncture. However, none of these variables was a significant predictor of improvement in back-related symptoms or function at 8 or 52 weeks. After 1 treatment, participants' revised expectations of treatment success were only associated with back-symptoms at the end of treatment. After 5 treatments, revised expectation of success was predictive of both symptoms and function at 8 and 52 weeks. CONCLUSION: Pretreatment expectations and preferences for acupuncture were not found predictive of treatment outcomes for patients with chronic back pain. These results differ from previous studies evaluating acupuncture for chronic back pain. These inconsistent results suggest that the relationship between expectations and outcomes may be more complex than previously believed.  
  Address Group Health Research Institute, Group Health Cooperative, Seattle, WA 98101, USA. sherman.k@ghc.org  
  Publisher
  Language Number of Treatments 10  
  Treatment Follow-up 52 Weeks Frequency >1/WK Number of Participants 477  
  Time in Treatment 7 Weeks Condition Low Back Pain, Chronic
  Disease Category Back Pain OCSI Score  
  Notes Approved no  
  Call Number Serial 1043  
Permanent link to this record
 

 
Author (up) Standaert, C. J.; Friedly, J.; Erwin, M. W.; Lee, M. J.; Rechtine, G.; Henrikson, N. B.; Norvell, D. C. url  openurl
  Title Comparative effectiveness of exercise, acupuncture, and spinal manipulation for low back pain Type of Study Systematic Review
  Year 2011 Publication Spine Abbreviated Journal Spine (Phila Pa 1976)  
  Volume 36 Issue 21 Suppl Pages S120-30  
  Keywords AcuTrials; Systematic Review; Low Back Pain, Chronic; Back Pain; Pain; Acupuncture; Exercise; Spinal Manipulation  
  Abstract STUDY DESIGN: Systematic review. OBJECTIVE: We sought to answer the following clinical questions: (1) Is structured exercise more effective in the treatment of chronic low back pain (LBP) than spinal manipulative therapy (SMT)? (2) Is structured exercise more effective in the treatment of chronic LBP than acupuncture? (3) Is SMT more effective in the treatment of chronic LBP than acupuncture? (4) Do certain subgroups respond more favorably to specific treatments? (5) Are any of these treatments more cost-effective than the others? SUMMARY OF BACKGROUND DATA: Exercise, SMT, and acupuncture are widely used interventions in the treatment of chronic LBP. There is evidence that all of these approaches may offer some benefit for patients with chronic LBP when compared with usual care or no treatment. The relative benefits or cost-effectiveness of any one of these treatments when compared with the others are less well-defined, and it is difficult to identify specific subgroups of those with chronic LBP who may preferentially respond to a particular treatment modality. METHODS: A systematic review of the literature was performed to identify randomized controlled trials comparing a structured exercise program, SMT, or acupuncture with one another in patients with chronic LBP. RESULTS: Two studies were identified comparing the use of structured exercise with SMT that met our inclusion criteria. Although these studies utilized different approaches for the exercise and SMT treatment groups, patients in both groups improved in terms of pain and function in both studies. Using random-effects modeling, there was no difference between the exercise and SMT groups when the data from these studies were pooled. We identified no studies meeting our inclusion criteria that compared acupuncture with either structured exercise or SMT or that addressed the relative cost-effectiveness of these approaches in the treatment of patients with chronic LBP. CONCLUSION: The studies identified indicate that structured exercise and SMT appear to offer equivalent benefits in terms of pain and functional improvement for those with chronic LBP with clinical benefits evident within 8 weeks of care. However, the level of evidence is low. There is insufficient evidence to comment on the relative benefit of acupuncture compared with either structured exercise or SMT or to address the differential effects of structured exercise, SMT, or acupuncture for specific subgroups of individuals with chronic LBP. There is also insufficient evidence regarding the relative cost-effectiveness of structured exercise, SMT, or acupuncture in the treatment of chronic LBP. CLINICAL RECOMMENDATIONS: Structured exercise and SMT appear to offer equivalent benefits in the management of pain and function for patients with nonspecific chronic LBP. If no clinical benefit is appreciated after using one of these approaches for 8 weeks, then the treatment plan should be reevaluated and consideration should be given to modifying the treatment approach or using alternate forms of care. Strength of recommendation: Weak.There is insufficient evidence regarding the relative benefits of the acupuncture compared with either structured exercise or SMT in the treatment of chronic LBP.There is insufficient evidence to address differential effects of structured exercise, SMT, or acupuncture for specific subgroups of individuals with chronic LBP. There is insufficient evidence regarding the relative cost-effectiveness of structured exercise, SMT, or acupuncture in the treatment of chronic LBP.  
  Address Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98104, USA. cjs1@uw.edu  
  Publisher
  Language Number of Treatments  
  Treatment Follow-up Frequency Number of Participants  
  Time in Treatment Condition Low Back Pain, Chronic
  Disease Category Back Pain OCSI Score  
  Notes Approved no  
  Call Number Serial 1097  
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Author (up) Trinh, K.; Graham, N.; Gross, A.; Goldsmith, C.; Wang, E.; Cameron, I.; Kay, T. url  openurl
  Title Acupuncture for neck disorders Type of Study Systematic Review
  Year 2007 Publication Spine Abbreviated Journal Spine (Phila Pa 1976)  
  Volume 32 Issue 2 Pages 236-243  
  Keywords AcuTrials; Systematic Review; Neck Pain; Acupuncture; Pain  
  Abstract STUDY DESIGN: Systematic review. OBJECTIVE: To determine the effects of acupuncture for individuals with neck pain. SUMMARY OF BACKGROUND DATA: Neck pain is one of the 3 most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are the perceptions of benefits. METHODS.: We searched CENTRAL (2006, issue 1) and MEDLINE, EMBASE, MANTIS, Cumulative Index to Nursing and Allied Health Literature from their beginning to February 2006. We searched reference lists and the acupuncture database TCMLARS in China. Any published trials using randomized (RCT) or quasi-randomized (quasi-RCT) assignment to the intervention groups, either in full text or abstract form, were included. RESULTS: We found 10 trials that examined acupuncture treatments for chronic neck pain. Overall, methodologic quality had a mean of 2.3 of 5 on the Jadad scale. For chronic mechanical neck disorders, there was moderate evidence that acupuncture was more effective for pain relief than some types of sham controls, measured immediately posttreatment. There was moderate evidence that acupuncture was more effective than inactive, sham treatments measured immediately posttreatment, and at short-term follow-up (pooled standardized mean difference, -0.37; 95% confidence interval, -0.61 to -0.12). There was limited evidence that acupuncture was more effective than massage at short-term follow-up. For chronic neck disorders with radicular symptoms, there was moderate evidence that acupuncture was more effective than a wait-list control at short-term follow-up. CONCLUSIONS: There is moderate evidence that acupuncture relieves pain better than some sham treatments, measured at the end of the treatment. There is moderate evidence that those who received acupuncture reported less pain at short-term follow-up than those on a waiting list. There is also moderate evidence that acupuncture is more effective than inactive treatments for relieving pain posttreatment, and this is maintained at short-term follow-up.  
  Address DeGroote School of Medicine, Office of MD Admissions, McMaster University, Hamilton, Ontario, Canada. trinhk@mcmaster.ca  
  Publisher
  Language Number of Treatments  
  Treatment Follow-up Frequency Number of Participants  
  Time in Treatment Condition Neck Pain
  Disease Category Neck Pain OCSI Score  
  Notes Approved yes  
  Call Number Serial 1180  
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